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In cases when there is a need to visualize the posterior part of the tibia and talus, the subtalar joint and the possibility of performing osteosynthesis or arthrodesis, the most optimal is the posterior surgical approach. The article presents a demonstration of successful arthrodesis of the ankle joint using an LCP plate with angular stability of screws from the posterior surgical approach in a patient with renal osteodystrophy receiving renal replacement therapy. The result of treatment according to the AOFAS scale 4 months after the operation was 70 points, the severity of pain according to the VAS was 1/2 point. Clinical and radiological characteristics were assessed as satisfactory, taking into account the severity of the deformity and the severity of osteoporosis against the background of concomitant pathology.

Aim. Analysis of quantitative and qualitative parameters of dyspnea in patients with the fibrotic phenotype of interstitial lung disease associated with coronary artery disease. Material and methods. We examined 49 patients. Among those were 9 patients with idiopathic pulmonary fibrosis, 25 patients with chronic variant of hypersensitive pneumonitis, and 14 patients with nonspecific interstitial pneumonia. The main group consisted of 25 patients with interstitial lung diseases and coronary heart disease; comparison group consisted of 24 patients without ischemic heart disease. Clinical symptoms, questionnaire results, and instrumental study data were analyzed. Results and discussion. Patients with coronary heart disease experienced increased dyspnea earlier (after 3,21 days) than patients without it (after 7,18 days; p

Aim. Evaluation of nanostructural and micromechanical characteristics of erythrocytes and their relationship with the parameters of oxygen transport in patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) under artificial circulation (AC).Materials and methods. The study involved 30 men with IHD aged 53 to 67 years with a median of 63 years, who underwent planned CABG with AC at the clinic of the Far Eastern Federal University. Blood sampling from patients was carried out before the AC and one day after it from a venous catheter located in the right atrium. Erythrocytes were scanned using a Bioscope Catalyst atomic force microscope (AFM) (Bruker, USA) in combination with an Axiovert 200 inverted microscope (Zeiss, Germany). The micromechanical properties of cell membranes were investigated with the PFQNM-LC-A-CAL cantilevers. The following were recorded: the diameter of erythrocytes, the height of their side, area, volume, membrane rigidity, strength of its adhesion, Young's modulus, elastic deformation. To assess oxygen transport, the oxygen delivery index (DO2I), consumption (VO2I), and extraction ratio (O2ER) were calculated.Results. In one day after CABG, a decrease in DO2I, VO2I, and O2ER was recorded by 14%, 33%, and 16%, respectively, which indicated a limitation in the gas transport function of the blood. Analysis of the AFM characteristics of erythrocytes showed an increase in their area by 35%, in diameter by 6%, in volume by 19%, and the height of the side by 5 times. At the same time, multidirectional changes in the micromechanical properties of erythrocyte membranes were noted: Young's modulus and stiffness decreased by 3.2 and 2 times, respectively; the adhesion force increased by 2.7 times, and the elastic deformation – by 2.2 times. Correlation analysis showed the presence of reliable relationships between indicators of oxygen transport and biomechanical parameters of erythrocyte membranes.Conclusion. A comprehensive analysis of the nanostructural parameters of erythrocytes and oxygen transport expands the understanding of the pathophysiological mechanisms of postperfusion disorders in patients with coronary artery disease after CABG under conditions of cardiopulmonary bypass.

The article examines the historical prerequisites for the formation of the ideology of Ukrainian nationalism, analyzes its main provisions, and its impact on the foreign and domestic policy of the independent Ukrainian state. The Ukrainian national idea was formed in the late 19th first half of the 20th century. It was based on three fundamental provisions: the Russian state is the enemy of Ukrainian independence and therefore in the interests of Ukraine its weakening, and even better disintegration; the Russian population in Ukraine is a very serious obstacle to the formation of an independent Ukrainian state, and therefore it should be assimilated; the independence of the Ukrainian state can be guaranteed only by close cooperation with European countries, which will help it in defending its independence in the confrontation with “Asian” Russia, as Ukraine is a European country, part of Europe. On the basis of these ideological provisions it was supposed to form a Ukrainian identity. As the article emphasizes, the national Ukrainian idea in this form contains a very large charge of conflict with Russia, inevitably leads to a clash of their geopolitical interests. The proclamation of Ukraine’s independence in 1991 meant the emergence of a second Russian state, whose population had to be transformed into a Ukrainian nation. The ruling political elite of the country with the support of the Ukrainian intelligentsia as the ideological basis for the construction of the Ukrainian nation state and the Ukrainian nation adopted the basic tenets of the Ukrainian national idea, which was formed in the first half of the 20th century and put them at the basis of its foreign and domestic policy. All Ukrainian Presidents, though with varying degrees of determination and consistency, implemented them. Kiev’s policy of strengthening the country’s independence implied independence from Russia, which is seen as the main threat to the national security of the young Ukrainian state. The article states that the presidential elections of 2019 and the defeat of P. Poroshenko showed that the majority of Ukrainian society does not accept such an identity. They need an identity on other principles, which in Ukraine have not yet developed and are not visible. So far, there are no political forces, political party, that could formulate them and put them in the basis of statehood and nation-building. The current President V. Zelensky in his policy is guided by old ideas and visions. After the collapse of the Soviet Union and the formation of the New Independent States, Russia did not immediately realize the scale of the challenges and threats to the country’s security from Ukraine. Sobering occurred under the influence of the “Orange Revolution”, when Kiev abandoned the policy of multivectors and began to pursue a pronounced pro-Western policy. At the same time, Moscow begins to realize that it will not be able to enter the community of democratic states on its own terms, and begins to position itself as an independent center of power, opposing the West. Strengthening its positions in this confrontation, it connects with the consolidation of the post-Soviet states around itself within the framework of integration projects, first EvrAzES, and then the EAEU. Moscow linked their successful implementation with Ukraine’s participation in their implementation, because it believed that without it these projects would not be effective. However, Kiev did not want to support these plans, focusing “on entering Europe”. According to the author, from that moment the foreign policy strategies of both countries began to differ in principle and the two countries from strategic partners turned into geopolitical rivals. The West supported Kiev in its pro-Western foreign policy, considering it as an element of deterrence of Russia’s great-power ambitions. Both Moscow and the West tried to drag Kiev to their side. The coup d’etat carried out by nationalist forces in Kiev in February 2014 seemed to mean the West’s victory in this peculiar tug-of-war. In response, Moscow annexed Crimea and supported the struggle of the self-proclaimed DPR and LPR against the Kiev government. As a result, Ukraine has embarked on a tough confrontation with Russia, seeing it as an aggressor and an enemy. The author of the article comes to the conclusion, that overcoming the confrontation between them will take a lot of time and effort and for the foreseeable historical perspective the relations between them will be based on the principles of the zero-sum game. In these circumstances, there is no need to talk about partnership and cooperation, as it is a question of relations between two hostile States. The most that can be expected is to maintain a “cold peace” between them. But such a state can be achieved only if relations between Russia and the West are normalized, and a new Cold War is eliminated.

Chronic venous insufficiency is a common and treatable medical condition which has a high morbidity if left untreated, progressing to lower extremity edema, skin changes of lipodermatosclerosis, and venous ulceration. Treatment options have significantly expanded over the last several decades, shifting away from the traditional surgical approach to more minimally invasive procedures such as endoluminal venous laser ablation or radiofrequency ablation. Even more recently, several techniques using nonthermal methods to ablate varicose veins have been developed, which offer the advantage of not requiring labor-intensive and painful tumescent anesthesia to protect the surrounding tissues. These techniques include mechanochemical ablation, cyanoacrylate closure, or polidocanol microfoam injection and can be offered to a wider range of patients without the need for sedation while offering similar closure rates and improved postprocedure symptom profile. Furthermore, certain patient characteristics which might preclude or complicate the use of thermal ablation methods might not pose a problem with nonthermal nontumescent methods.

The article notes the development trend of optical sights made with a discrete change in magnification. Using two optical schemes in ideal components as an example, we consider the possibility of deviating from the classical approaches to the implementation of a discrete change in magnification to improve the performance of devices relative to existing analogs.

Coaching methods are aimed at motivating people to achieve career or social skills. Therewith, coaching acts only as an additional form of career development for persons engaged in certain professions. The novelty of the study lies in the need to apply coaching methods not only during the period of active career implementation, but also during its interruption. This study is aimed at implementing the program for the development of career competence, the main tasks of which are to independently regulate professional life in a wide range of development vectors. The leading methods are the theoretical method of analysis and empirical methods of questioning and observation, which allow to study the impact of coaching on a person's professional development. The study shows that career development opportunities should be based on the psychological readiness of a person and, if necessary, on the correction of such readiness by means of psychological methods.

The spectral characteristics of electromagnetic radiation from cloud discharges triggered by groups of model hydrometeors in an artificial thunderstorm cloud are presented on the basis of wavelet analysis. It is found that these characteristics depend on the locations of cells of different polarity relative to the ground, on the location of groups of large hydrometeors in the cloud, and the way they are combined into a common array. The characteristic frequency ranges in the spectrum of electromagnetic radiation of cloud discharges recorded on the Earth’s surface and at the height of an artificial thunderstorm cloud are determined. It is assumed that the bulk of large hailstones will modify the characteristics of the spectrum of electromagnetic radiation of cloud discharges in a thunderstorm cloud in different ways, depending on the movement of these hailstones near the areas of positive and negative charge of the thunderstorm cloud. It is found that the boundary frequencies in the spectrum of signals recorded on the Earth’s surface can reach 400 MHz, while they may achieve 1200 MHz at the height of the cloud. The risk of the impact of pulses of electromagnetic radiation from cloud discharges with the revealed spectral characteristics on digital elements of ground cyberphysical systems and aircraft in frequency ranges of mega- to gigahertz is analyzed.

Background The incidence of acute pancreatitis (AP) is characterized by circannual and geographical variation. The aim of this study was to describe seasonal variation and trends in hospitalizations for AP in the USA with respect to AP etiology. Methods The Nationwide Inpatient Sample data (2000–2016) from the Healthcare Cost and Utilization Project were used. The study population included all primary hospitalizations for AP. Biliary AP (BAP) and alcohol-induced AP (AAP) were distinguished by diagnostic and procedural ICD codes. Seasonal trend decomposition was performed. Results There was a linear increase in annual incidence (per 100 000 population) of AAP in the USA (from 17.0 in 2000 to 22.9 in 2016), while incidence of BAP, equaled 19.9 in 2000, peaked at 22.1 in 2006 and decreased to 17.4 in 2016. AP incidence demonstrated 18% annual incidence amplitude with summer peak and winter trough, more prominent in AAP. In 2016, within AAP, the highest incidence (per 100 000 population) was noted among African-Americans (up to 50.4), followed by males aged 56–70 years (26.5) and Asians of low income (25.5); within BAP, above the average incidence was observed in Hispanic (up to 25.8) and Asian (up to 25.0) population. The most consistent and rapid increase in AP incidence was noted in males aged 56–70 years with an alcoholic etiology (average 6% annual incidence growth). Conclusions The incidence and annual trends of AP vary significantly among demographic and socioeconomic groups and this knowledge may be useful for the planning of healthcare resources and identification of at-risk populations.

The development of the world economy has led not only to the acceleration of urbanization and globalization, but also to the need to improve pr oduction to meet environmental standards. The main task assigned to companies is to reduce the pollution on the environment while increasing capacity and developing production. Companies must find positive solutions to urban and social problems, control the environmental impact and prevent damage. World ports are also dependent on these trends. When handling coal, the environm ent becomes polluted with coal dust, which ad versely affects health of people in seaport towns and conditions higher social tension. The best solution in this regard is coal handling in enclosed spaces, which is hazardous with spontaneous ignition of coal. On the g round of the advanced international experience reviewed, the coal stevedore companies are to use the best available technologies and modernized engineering solutions. Adherence to this trend enabl es stevedores to comply with the environmental regulations, as well as to enhance their technical and economic potential.

Study Objective: To compare the quantitative aspects of shortness of breath in patients with fibrous interstitial lung disease (ILD) associated with cardio ischemia; to compare analysis results of the data obtained during functional and instrumental examinations. Study Design: Open comparative study in parallel groups. Materials and Methods. The study included 47 patients with fibrous ILD: 8 patients had idiopathic pulmonary fibrosis; 25 patients had chronic hypersensitive pneumonitis, and 14 patients had fibrous non-specific interstitial pneumonia. The patients were divided into two groups: study group of 24 patients with fibrous ILD associated with cardio ischemia, and 23 controls with fibrous ILD without cardio ischemia. We analysed clinical symptoms, instrumental examination results, changes in patients’ functional status with and without cardiac pathology. Study Results. In patients with fibrous ILD and cardio ischemia, respiratory symptoms were more intensive than in patients without cardio ischemia. Patients with fibrous ILD and cardio ischemia experienced worsening of their shortness of breath statistically earlier (in 3.15 days) vs patients with isolated fibrous ILD, who had shortness of breath in 7.29 days (p < 0.05). Patients with fibrous ILD and cardio ischemia demonstrated mixed functional changes: restrictive (reduced lung capacity and FVRC) and obstructive disorders (reduced FEV1 and instantaneous exhalation rate, МСВ25); statistically significant reduction in diffusing lung capacity, p < 0.05. A shorter 6-minute walking distance, more marked desaturation (SрO2 reduction by 8.31% in the study group and by 2.12% in controls, p < 0.05), higher scores of Borg Dyspnoea Scale and CRP scale (Clinical, Radiographic, and Physiologic scoring system) demonstrated statistically reduced tolerance to physical exercises in patients with cardio ischemia. CT scans did not reveal any differences in the intensity of interstitial changes in patients of both groups; “ground glass” areas were significantly more intense in patients with cardio ischemia, p < 0.05. Pulmonary hypertension and structural changes in right compartments of heart were recorded in patients in both groups; however, left ventricular hypertrophy and dysfunction were noted only in patients with cardio ischemia. Conclusion. In patients with fibrous ILD associated with cardio ischemia, intensification of shortness of breath can be a sign of a progressive respiratory disease or a new event: coronary event, atrial fibrillation attack, cardiac failure, chronic cor pulmonale. Assessment of the functional status using Borg Dyspnoea Scale, CRP, Medical Research Council Scale is a tool to identify the reasons of dyspnoea in primary care settings, to develop an algorithm for instrumental differential diagnosis of shortness of breath. Keywords: progressive fibrous interstitial lung diseases, quantification of shortness of breath, cardio ischemia.

Pharmacotherapy for patients with chronic obstructive pulmonary disease is administered through various inhalation devices. The inhalers have different designs, principles of operation and activation methods, the number of steps necessary to prepare the device for use, the resistance that the patient has to overcome with inhalation, and many other characteristics. The suboptimal choice of an inhalation device may affect the clinical outcomes of the disease. Therefore, the guidelines consider replacement of the inhaler to be an alternative to escalation of therapy with treatment failure. When choosing an inhalation device, a number of the patient’s clinical features should be considered, including the patient's ability to induce an inspiration effort. Since devices that estimate the force of inspiratory effort at different resistances are not available in Russian Federation for routine clinical practice, the expert group described some clinical features that may be observed in patients with suboptimal inspiratory flow based on the existing data. Their final choice was made by voting according to the Delphi panel method that accounts for the opinion of each expert.

Background Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system. Materials and Methods All primary admissions for acute appendicitis (AA) from the 2010 Nationwide Inpatient Sample were linked to 2010 state-level physician density data. CAA was distinguished by codes for perforation, generalized peritonitis, or intra-abdominal abscess. A multivariable logistic regression model for CAA prediction was built. Results A total of 288 556 patients were admitted with AA and 86 272 (29.9%) had CAA. Independent factors, linked to CAA, included age outside the 10-39 range (odds ratio (OR) = 2.1-2.4 and all P < .001), male gender (OR = 1.2), malnutrition (OR = 6.2), diabetes mellitus (OR = 2.1), chronic anemias (OR = 1.9), nonprivate insurances (OR 1.2-1.5), nonmetropolitan patient’s residence (OR = 1.15), and Midwest region (OR = 1.2). Patient income and physician coverage were not significant factors after adjustment for all other covariates. Highest CAA fraction of 39.6% was noted in rural patients admitted to urban teaching facilities. Discussion Although provider coverage at the state level may seem adequate and not related to increased CAA rates, the distance patients traveled for their definitive surgical care correlated with higher rates of CAA. Adjusting physician distribution into nonurban settings closer to patients could decrease rates of CAA by diminishing time to definitive care.

We study the possibility of using the technology of 3D photopolymer printing with subsequent metallization of working surfaces for developing electrodynamic components of microwave devices. The technology applicability is considered by examples of mockups of a profiled helical waveguide for a microwave undulator of a Compton free-electron laser and a periodic slow-wave system of a backward-wave oscillator with a ribbon electron beam. The results of “cold” measurements of the parameters of these electrodynamic systems are presented and good agreement with the simulation results is obtained, which confirms the prospects of using additive technologies for developing components of the vacuum microwave electronic devices.

Clinical observation of multi-cavity lung cancer in a patient with chronic recurrent laryngeal papillomatosis in a 23-year-old patient who underwent annual surgical treatment (papillomatous laser removal) is presented. Pulmonary cavities have been detected and differential diagnosis has been carried out at the annual fluorographic examination. The tactics of surgical intervention is due to the rare occurrence of this pathology, the lack of clinical manifestations and the peculiarities of the radiological picture.

The main objectives of chronic obstructive pulmonary disease (COPD) therapy are to reduce the severity of symptoms and the risk of exacerbations. The article discusses the role of local and systemic inflammation in the pathogenesis of COPD as well as various mechanisms of pharmacological influence on it. Approaches to prescribing basic therapy for patients with COPD, recommended by various national and global guidelines (clinical recommendations of the Russian respiratory society, criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), guidelines of the National Institute for Health and Clinical Excellence (NICE)), as well as recommendations on the therapy frequency review are considered. Currently, so-called triple combinations – fixed combinations of double bronchodilators with inhaled glucocorticosteroids – are being developed and registered in the world, and their place and significance in the treatment of COPD raise many discussions. The paper discusses the role of fixed triple combinations in reducing the incidence of COPD exacerbations, the impact on functional and patient-reported outcomes, and provides recommendations for the use of triple combinations in patients with COPD, taking into account the benefit/risk ratio.

It has been suggested to assess non-uniformity of illuminance by the coordinate distribution of its gradient. By the example of mathematical model, the possibility to form a desired illuminance gradient profile from a multicomponent module by means of electronic control of the LED lighting parameters.

The preparation of 2D stacked layers combining flakes of different nature gives rise to countless numbers of heterostructures where new band alignments, defined at the interfaces, control the electronic properties of the system. Among the large family of 2D/2D heterostructures, the one formed by the combination of the most common semiconducting transition metal dichalcogenides, WS2 /MoS2 , has awakened great interest owing to its photovoltaic and photoelectrochemical properties. Solution as well as dry physical methods have been developed to optimize the synthesis of these heterostructures. Here, a suspension of negatively charged MoS2 flakes is mixed with a methanolic solution of a cationic W3 S4 -core cluster, giving rise to a homogeneous distribution of the clusters over the layers. In a second step, a calcination of this molecular/2D heterostructure under N2 leads to the formation of clean WS2 /MoS2 heterostructures, where the photoluminescence of both counterparts is quenched, proving an efficient interlayer coupling. Thus, this chemical method combines the advantages of a solution approach (simple, scalable, and low-cost) with the good quality interfaces reached by using more complicated traditional physical methods.

Some informal youth associations ceased to exist with the collapse of the USSR, but others continue to operate to this day, although the moral convictions of members have changed and modernized. Th...

The review is devoted to the urgent problem of modern pulmonology: the differential diagnosis of idiopathic pulmonary fibrosis (ILF). ILF occupies a special place among many interstitial lung diseases for a number of reasons: 1) it is a deadly disease; 2) early diagnosis and adequate antifibrotic therapy significantly extend the life expectancy of patients; 3) anti-inflammatory drugs (corticosteroids) and cytostatics with ILF that are widely used in other forms of interstitial lung diseases are ineffective and accelerate the progression of the process; 4) the commonality of the main clinical signs (increasing respiratory failure) of various interstitial lung diseases. The list of respiratory diseases with which ILF should be differentiated is huge, and if with diffuse lung lesions of a known nature (disseminated pulmonary tuberculosis, pneumoconiosis, etc.) with a certain experience/qualification, the diagnosis is relatively simple, then the isolation of ILF from the group of idiopathic interstitial pneumonias always represents certain difficulties. The main methods used in the diagnosis of ILF are summarized taking into account current international and national recommendations.Обзор посвящен актуальной проблеме современной пульмонологии: дифференциальной диагностике идиопатического легочного фиброза (ИЛФ). ИЛФ занимает особое место среди множества интерстициальных болезней легких по ряду причин: 1) это смертельная болезнь; 2) ранняя диагностика и адекватная антифибротическая терапия существенно удлиняют продолжительность жизни больных; 3) широко применяемые при других формах интерстициальных болезней легких противовоспалительные препараты (кортикостероиды) и цитостатики при ИЛФ неэффективны и ускоряют прогрессирование процесса; 4) общность основных клинических признаков (нарастающая дыхательная недостаточность) различных интерстициальных болезней легких. Перечень заболеваний органов дыхания, с которыми следует дифференцировать ИЛФ, огромен, и если с диффузными поражениями легких известной природы (диссеминированный туберкулез легких, пневмокониозы и др.) при определенном опыте/квалификации диагностика относительно проста, то выделение ИЛФ из группы идиопатических интерстициальных пневмоний всегда представляет определенные трудности. Суммируются основные методы, используемые в диагностике ИЛФ, с учетом современных международных и национальных рекомендаций.

The article describes the observation of successful total hip arthroplasty in the patient with atrophic bilateral nonunion of femoral neck with end stage renal disease.Authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

The purposeof this study was to determine detection rate and clinical and morphological characteristics of mediastinal lymphadenopathy (ML) in patients with respiratory system sarcoidosis (RSS), disseminated pulmonary tuberculosis (DPT) and exogenic allergic alveolitis (EAA).Materials and Methods.Patients (n= 278) with established diagnosis RSS, DPT, EAA were investigated. The cumulative index parameters were determined, hematology test, assessments of pulmonary function, diffuse lung capacity, diffusion coefficient were performed in all patients. Computed tomography of chest organs and morphologic examination of mediastinal lymph node (LN) biopsy were performed.Results.Subjects with newly diagnosed (n= 72) and recurrent (n= 104) disease were observed among patients with RSS (n= 176). ML was observed in 95% of cases, involved bronchopulmonary, bifurcation, paratracheal and paraaortal groups; dimensions of intrathoracic LN (ITLN) were 20.0 ± 1.9 mm. Epitheliocellular granulomas (EG) without necrosis, not fusing with each other, were established morphologically; they were determined in recurrent disease course in association with background fibrosis. In patients with DPT (n= 41), subacute (n= 28) and chronic (n= 13) disease course was noted. With subacute course of DPT in 28.6% of cases, ML of paratracheal and bifurcation groups (dimensions of ITLN – 13.1 ± 0.3 mm) was observed, with chronic course – the enlargement of paratracheal and bronchopulmonary LN (7.7% of cases). EG with necrosis and tendency to fusion was verified histologically; inflammatory process involved LN capsule and could be spread to fatty tissue. In patients with EAA (n= 76), acute (n= 10), subacute (n= 38) and chronic (n= 28) disease courses were observed. With acute EAA course, hyperplasia of ITLN of bifurcation and tracheo-bronchial groups up to 13.5 ± 0.6 mm was observed in 20% of cases. Follicular hyperplasia with widening and edema of hermintative centers was observed at morphological investigation. With subacute EAA course, increased ITLN in bifurcation and broncho-pulmonary groups up to 13.6 ± 0.6 mm were observed in 46% of cases. Formation of histiocytic-macrophagal granulomas without epithelioid cells and deposit precipitation in the plasma cell aggregation areas was found at morphological evaluation. With chronic EAA, ML in broncho-pulmonary and paratracheal groups was detected in 17.8% of cases (enlargement of LN up to 11 ± 0.9 mm). The formation of diffuse and focal fibrosis and hyalinosis was noted morphologically.Conclusion.ML is observed in all granulomatous pulmonary diseases studied, however its rate and severity, composition of involved ITLN groups and character of morphological changes is different which is possible to use in diagnostics.

The objective was to determine the possibilities of using desmopressin and conjugated estrogens during primary hip joint arthroplasty in patients receiving renal replacement therapy.Methods and materials. The material for the study was data on 53 patients with pathology of the hip joint, who underwent primary arthroplasty from 2016 to 2018. All patients were divided into 2 groups. Group 1 (n=23) – patients not suffering from kidney diseases. Group 2 (n=30) – patients receiving renal replacement therapy. Each group was divided into 2 subgroups: 1 subgroup – comparisons, where the combination of desmopressin/conjugated estrogens was not used. 2 subgroup – control, where desmopressin was used at a dosage of 0.4 mg/kg 2 hours before the incision, conjugated estrogens was used at a dosage of 0.6 mg / kg of body weight within 5 days before the operation.Results. In group 1 (patients not suffering from kidney disease), there was no statistically significant difference between the subgroups. In group 2 (patients receiving hemodialysis), there was a statistically significant difference in the volume of blood loss. Thus, in the subgroup without using additional techniques, the volume of intraoperative blood loss was 769.5±389.3 ml; in the second subgroup (using desmopressin and estrogens) – 479.1±245.2 ml. The difference was statistically significant, pConclusion. The additional use of conjugated estrogens at a dose of 0.6 mg/kg of body weight within 5 days before the operation, desmopressin at a dose of 0.4 mg/kg of body weight 2 hours before the incision reduced blood loss by 27.9 %. The use of combination of conjugated estrogens and desmopressin in patients not suffering from kidney disease did not affect the amount of blood loss.

The main goals of COPD therapy are to achieve clinical stability with minimal clinical manifestations and low risk of relapse. The proposed COPD control concept by analogy with asthma has not been quite well characterized yet. COPD control is defined as "the long - term maintenance of a clinical situation with a low impact of symptoms on the patient's life and absence of exacerbations." The situation of clinical control in COPD is considered desirable and potentially achievable for most patients with COPD. Pharmacotherapeutic options for COPD are constantly expanding. The control concept may be useful when the decision on treatment of COPD is made for dynamic adjustment of the therapy volume.Основными целями терапии хронической обструктивной болезни легких (ХОБЛ) является достижение клинической стабильности с наименьшим количеством симптомов и низким риском обострений. Предложенная концепция контроля ХОБЛ по аналогии с бронхиальной астмой пока недостаточно хорошо охарактеризована. Контроль ХОБЛ определяется как «долгосрочное поддержание клинической ситуации с низким воздействием симптомов на жизнь пациента и отсутствием обострений». Ситуация клинического контроля при ХОБЛ рассматривается как желательная и потенциально достижимая для большинства пациентов с ХОБЛ. Возможности фармакологической терапии ХОБЛ постоянно расширяются. Концепция контроля может быть полезна для принятия решения о лечении ХОБЛ для динамической корректировки объема терапии.

This article presents the issue of diagnosis of two coexisting lung diseases (pulmonary tuberculosis and interstitial lung disease) in a 53-year-old muscovite without chronic diseases. The hard way of diagnostic procedures, which had to go through, is shown: repeated bronchological examination, two videothoracoscopic lung biopsies.

Objective: To describe the use of bronchial thermoplastics (BT) in a female patient with severe hormone-dependent bronchial asthma (BA). Key Points. Because of the history of unsuccessful use of the basic BA therapy and continuous inefficient use of the systemic glucocorticosteroids, the patient underwent a three-session BT. Her condition stabilised on day 5–6 following each BT session: shortness of breath retracted, stridor and sputum discharge disappeared. During a follow-up visit in 6 months, the patient had basic therapy (budesonide with formoterol (Symbicort) 160/4.5μg, 2 doses bid, methylprednisolone 4mg, once daily); she had no complains. The patient had vesicular respiration without stridor; forced expiratoty volume1 was 95%, lung capacity was 113%. Conclusion. Three BT sessions allowed minimising glucocorticosteroids dose, adjusting basic therapy and achieving long-term BA remission. Keywords: bronchial asthma, bronchial thermoplastics, glucocorticosteroids.

The aim of this study was to investigate arterial wall stiffness and its relationship with right ventricle systolic function (RVSF) in patients with interstitial lung disease. Methods . Fifty patients with chronic hypersensitivity pneumonitis (HP) and 26 patients with idiopathic pulmonary fibrosis (IPF) were included. Spirometry, body plethysmography were performed, lung diffusion capacity for carbon monoxide (DLCO), blood gases and arterial wall stiffness were measured. High resolution computed tomography (HRCT) of the chest was assessed using Kazerooni scale. Results . The aortic pulse wave velocity (PWV, m/s) was increased in 26 (52%) patients with HP and in 14 patients with IPF. Correlation analysis showed statistically significant association between PWV А o and DLCO (p < 0.05), partial oxygen pressure in the arterial blood (PaO2) (p < 0.05), pulmonary fibrosis (p = 0.001), and the extension of ground glass opacities (p < 0.05). Tricuspid annual plane systolic excursion (TAPSE), right ventricular myocardial performance index (MPI) and tricuspid annular systolic velocity (S’) were significantly related to PWV А o, ambulatory arterial stiffness index (AASI) and augmentation index (AIx) (p < 0.05). Conclusion . Increased arterial stiffness was often found in patients with HP and IPF. The increased arterial stiffness is associated with hypoxemia, pulmonary fibrosis and decreased lung diffusion capacity. The arterial stiffness is also related to the right ventricular systolic dysfunction.

Using amplified femtosecond pulses at a wavelength of 1028 nm, the second harmonic is generated at a wavelength of 514 nm by composite polymer films containing D-π-A (push–pull) chromophores with quadratic optical nonlinearity. It is shown that these films are photostable with respect to laser pulses having peak intensities of up to 11.6 GW/cm2. The effective generation of the second harmonic is observed in a wide range of pump beam incidence angles (20°–80°) with a maximum in the vicinity of 60°.

Purpose: Duplex scanning is a useful noninvasive screening tool for the detection of carotid bifurcation disease. Internal carotid artery (ICA) peak systolic velocity (PSV) and ICA/common carotid artery (CCA) PSV ratios are proven metrics determining 70%-99% ICA stenosis. A potential disadvantage of using dramatically increasing systolic velocity measurements in areas of critical arterial stenosis is flow aliasing. Diastolic velocity should be less influenced by this flow artifact. We evaluate ICA and CCA end diastolic velocity (EDV) metrics in predicting severe ICA stenosis and document the prevalence of an aliasing artifact in a population of patients with critical ICA stenosis. Methods: Consecutive patients undergoing carotid duplex assessments and contrast angiography were compared (n = 140). ICA and CCA PSV and EDV were recorded as was evidence of the flow aliasing of ICA waveforms. ICA/CCA PSV and EDV ratios were calculated. Duplex parameters were compared with angiographic ICA measurements. Receiver-operator characteristic curve (ROC) analysis was used to determine optimal criteria to identify ICA stenosis of 70% to 99%. Results: Of 256 carotid bifurcation duplex studies, critical angiographic stenosis was present in 105 arteries. Only four completed arterial duplex scans demonstrated flow aliasing. In three of these patients, systolic metrics were non-diagnostic versus ICA/CCA EDV ratios. An ICA/CCA EDV ratio of 2.3 provided the best combination of sensitivity 73.8% and specificity 75.18%. Conclusion: ICA/CCA diastolic ratios reliably determine 70% or greater ICA stenosis. Flow aliasing infrequently complicates ICA PSV.

Hepatocellular carcinoma (HCC) is the most common primary liver tumor and is currently the leading indication for liver transplantation in the United States. Liver transplantation may provide a curative option for patients with HCC, but some present outside of the transplant criteria. Additionally, as the criteria for liver transplant eligibility in HCC are expanded and the incidence of disease increases, waitlist times are becoming progressively longer, which increases the chance of a patient suffering from disease progression while awaiting an organ becoming ineligible for transplant. Multiple studies have demonstrated the successful use of locoregional therapies, including trans-arterial chemoembolization and trans-arterial radioembolization, in downstaging HCC to within transplant criteria, as well as in preventing progression of disease in patients already listed for transplant. Cirrhotic patients also commonly develop portal vein thrombosis (PVT), which is a contraindication to transplantation at many centers. PVT can lead to worsened outcomes after transplant depending on the type of portal venous reconstruction that is performed. The purpose of this article is to discuss the integral role of interventional radiology in the care of these patients, including the role of transarterial therapies in the pretransplant treatment of HCC and the use of endovascular techniques to recanalize thrombosed portal veins in order to establish or maintain transplant eligibility.

Aim Analysis of all healthcare encounters (readmissions and emergency department visits, EDV) following both inpatient and outpatient abdominal hernia repairs (AHR), with respect to the timeline of such encounters. Material and Methods Patients undergoing AHR were identified in Maryland State Inpatient and State Ambulatory Surgery and Services Databases, 2016-2017, and all their hospital and ED encounters were assembled into a comprehensive database, covering almost 95% of all AHR performed in Maryland. Results Of the total 26,215 patients who underwent AHR (3,333 inpatient and 22,950 outpatient; 48.7% inguinal and 53.0% ventral/umbilical), 5,802 (22.1%) had at least one postoperative encounter (4,186 EDV, 1,415 readmissions, and 248 encounters for mostly outpatient another AHR). 419 (80.4%) post-operative encounters within the first 48 hours were EDV and 98 (18.8%) were readmissions. Fraction of EDV within later encounters was in 69.6–71.1% range. Most frequent reasons for EDV were urinary complaints (24.1%, 10.6% and 4.0% on POD 0–2, 3–7, and 8–30, respectively), followed by pain control issues (18.1%, 24.9%, 14.4%) and delayed return of bowel function or constipation (10.5%, 9.9%, 3.4%). Readmissions mainly occurred for aforementioned GI complaints (15.3%, 19.9%, 6.9% on POD 0–2, 3–7, and 8–30, respectively), local surgical site infections (5.1%, 15.5%, 26.8%), and respiratory complications (8.2%, 6.6%, 4.1%). Conclusions 2.3% of all patients had at least one readmission while 6.4% patients had at least one EDV within 30 days following herniorrhaphy. Early postoperative EDV were mainly caused by urinary complaints, inadequately controlled pain, or delayed bowel function. Factors associated with these largely preventable complications require dedicated analysis.

When formulating economic development strategies, the environment and society must be considered to preserve well-being. This paper proposes a comparative sustainability assessment method using environmentally extended input-output analysis and multi-criteria decision aid. Using symmetric input-output tables and sectoral CO2 emissions and employment data for six countries, linkage coefficients are calculated for 163 sectors in each country. Multi-criteria decision aid tool, ELECTRE III, is used to derive outranking relationships among each country’s sectors using these coefficients as criteria, resulting in a hierarchy of sectors ordered by sustainability. Sectors that frequently appear at the top of the six hierarchies included education, health care, construction, and financial intermediation. China’s results differ significantly because of its concentration of economic activity on the primary/secondary sectors. The results can enable identification of key intervention pathways along which sustainable development could be stimulated. Country-specific recommendations and reflections on economic and sustainability policy initiatives are discussed.

For electrodes exposed to radio frequency electromagnetic fields, it is shown that an increase in electrode temperature on the nanosecond time scale increases the time required for an electrode surface microprotrusion to be heated to the critical temperature nearly by half. This may reduce the dielectric strength of the accelerating structure of a linear electron-positron collider when it is heated by accelerating electromagnetic pulses increasing in number.

Purpose Imposter phenomenon refers to feelings of inadequacy due to inability to internalize evident success. While high achievers such as physicians have been known to exhibit imposter phenomenon, there is limited literature specific to radiologists. Our purpose was to (1) investigate imposter phenomenon in radiologists and assess correlation with burnout, and (2) pilot an intervention aimed at addressing imposter phenomenon through improvisational theater techniques. Methods Part 1 - Clinical radiology faculty at a single large academic medical center completed an anonymous survey with questions related to demographics, burnout (derived from the validated Mini-Z assessment tool), and imposter phenomenon. Part 2 - A one-hour interactive workshop on imposter phenomenon was organized for the radiology department at the same institution. The workshop included the Clance Imposter Phenomenon Scale (CIPS). A post-workshop survey rating was also performed. Results Part 1 - Of 30 clinical radiology faculty who participated in the survey, 83% reported feelings of imposter phenomenon during their career. There was significant (p = 0.024) correlation between imposter phenomenon and burnout. Part 2 - Of 21 members of the Department of Radiology who completed the CIPS in the interactive workshop, 71% exhibited frequent or intense symptoms of imposter phenomenon. On the post-workshop survey asking participants to rate the workshop, the mean score was 4.4 and the mode score was 5 on a scale of 1 (poor) to 5 (excellent). Conclusion Imposter phenomenon affects radiologists and is correlated with burnout. Innovative interventions to address imposter phenomenon such as workshops utilizing medical improvisational techniques are well-received.

Spectroscopic data are presented for the motion of molecules in a liquid during double-pulse excitation and registration of the ultrafast optical Kerr effect (OKE). It is shown that selective spectroscopy of individual molecular motions can be achieved by choosing certain parameters of the double-pulse sequence.

The OBJECTIVE was to determine the effect of anemia on the volume of blood loss during total hip arthroplasty in patients with end-stage renal disease. MATERIAL AND METHODS. The study was based on the data of 41 patients with pathology of hip joint who underwent primary hip replacement. In the group 1 – the group of comparison (n=20), there was no correction of anemia. In the group 2 – the main group (n=21), erythropoietin was applied 2 months before the operation, until the blood hemoglobin level exceeded 100 g/l, hematocrit – more than 30 %. RESULTS. In the first group of patients, there was the severe anemia: hemoglobin – (88.6±4.6) g/l, the number of red blood cells – (2.7±0.3·1012)/l, hematocrit – (27±2) %. In the second group, 2 months after using erythropoietin, hemoglobin level was (114.9±7.1) g/l, red blood cell count was (3.6±0.4·1012)/l, hematocrit was (33±2) %. Blood coagulation time before operation was (15.1±2.4) min in the first group, (8.7±1.8) min in the second group. Statistically significant difference was noted in blood loss: 59.2 %. In the first group, red blood cell mass transfusion was required in the volume of (554±205) ml for 18 patients (26 doses), plasma – in the volume of (641±67) ml for 20 patients (40 doses). In the second group, blood transfusion was performed for 3 patients in the volume of (321±116) ml. An inverse correlation between blood hematocrit, blood clotting time and blood loss was noted. The correlation coefficient was 0.9. CONCLUSION. The inverse correlation was indicated between the level of hematocrit, blood clotting time and blood loss. The use of erythropoietin in advance of reaching a blood hematocrit of >30 % could significantly reduce the risk of bleeding, reduce the amount of operating blood loss and reduce complications in the postoperative period.

Purpose — to evaluate mid-term outcomes of primary hip replacement in patients with end-stage chronic renal disease and to develop an algorithm for selection of surgical tactics and perioperative treatment.Materials and Methods. The authors evaluated outcomes of primary hip replacement in 45 patients receiving renal substitution therapy and 47 patients without chronic renal disease. Patients with end-stage chronic renal disease (CRD) were divided into two groups: group I included 30 (66.6%) patients receiving chronic hemodialysis (CH) and group II included 15 (33.4%) patients after renal transplantation (RT). Group III of 47 (51.1%) patients without any signs of CRD who underwent hip arthroplasty within relevant period of time was established to evaluate the effectiveness of primary hip replacement. Blood serum Ca2+ and P5+ levels as well as levels of parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D were measured to determine the rate of calcium- phosphoric metabolism disturbance. Multi-spiral CT scans of hip joint were performed to identify bone mineral density and the mean Hounsfield (Hu) value was calculated for which the data was obtained from five various points on the proximal femur and acetabulum. Beta-2 microglobulin (B2M) blood test was performed to confirm amyloid bone disease.Results. The authors did not observe statistically significant differences for arthroplasty outcomes in patients of group II and III. Patients receiving long-term hemodialysis demonstrated significantly lower parameters of Harris score and Barthel’s index of social adaptation after hip replacement as compared to groups II and III: patients of group I demonstrated outcomes improvement at 19.55%, in group II — at 13.03%, in group III — at 10.15% as compared to preoperative status. Decrease of 1.25-dihydroxyvitamin D below 20,0 mcg results in resorption of cancellous bone in proximal femur and acetabulum along with myopathy of gluteus muscles. Sharp increase of parathyroid hormone level (over 600 pcg/ml) was accompanied by inhibition of osteoblasts proliferation and differentiation resulting in substantial impairment of mineralization.Conclusion. According to the algorithm suggested by the authors the key parameters that need to be evaluated in preoperative period are parathyroid hormone (PTH) and 1.25-dihydroxyvitamin D. Five-fold increase of PTH (600 pcg/ml) demands parathyroidectomy as the first stage of treatment to decrease risk of early aseptic loosening of hip prosthesis and development of periprosthetic fracture.

The combustion regimes were studied and the oxygen index for the bulk-density magnesium powder with a particle size of ~80 μm placed in a paper cup was determined in nitrogen–oxygen and argon–oxygen mixtures at pressures from 0.3 to 1 atm. It was shown that at a constant pressure of the mixture, there was a minimum concentration of oxygen at which sustained propagation of the combustion front was possible. The boundaries of the region of stable combustion of such a system in the pressure–oxygen concentration coordinates were determined. It was shown that, depending on the oxygen concentration, two combustion modes were possible: one-step mode far from the combustion limit and spin mode at the combustion limit. As the pressure or oxygen concentration in the mixture increased, the characteristic spin rotation time decreased and the propagation of the combustion front over the sample passed into a layer-by-layer mode. The dependence of the combustion front propagation velocity on the sample near the combustion limit on the mixture pressure and the oxygen concentration in its composition was determined.

Observational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia.

Objective . To optimize diagnosis of various variants of morphologically verified extrinsic allergic alveolitis (EAA), by determining the most significant clinical and radiological indicators of its development. Material and methods . Examinations were made in 82 patients with morphologically confirmed EAA, including 10 people with acute EAA, 38 with subacute EAA, 26 with chronic EAA, and 8 with recurrent EAA. Their medical history data were studied; physical examination, clinical blood, pulmonary function (PF), and lung diffusing capacity tests, and high-resolution computed tomography (HRCT) of the chest were performed. Transbronchial and/or video-assisted thoracoscopic lung biopsies were used for morphological studies. Results . Four disease course variants were identified. Disease duration, adherence to a specific antigenic effect, and the clinical, radiological, and morphological patterns of the disease were determined for its each variant. Conclusions . 1. Acute EAA is characterized by an abrupt onset and rapid (no more than 3 months) development with a preponderance of intoxication syndrome (Cumulative Index (CI), 2.1 ± 0.2 scores); subacute EAA is characterized by a slower (8.5–10 months) development with a predominance of respiratory symptoms (CI, 2.5 ± 0.1 scores), the steady progression of which is observed in chronic EAA (CI, 2.9 ± 0.2 scores). Recurrent EAA in previously cured patients is accompanied by both syndromes simultaneously (CI, 2.7 ± 0.3). 2. The characteristic feature of acute EAA on HRCT of the chest is the extent of ground-glass opacity in both lungs (more than 3 segments) and perivascular infiltrates; that of subacute EAA is microfocal dissemination; that of chronic EAA is macrofocal changes in the presence of interlobular septal thickening, as well all the development of cystic changes in the subpleural zones. In recurrent EAA, all the listed symptoms may appear. 3. Enlarged intrathoracic lymph nodes are most common in subacute EAA in 45.9% of cases and less common in acute and chronic EAA in 20 and 23.8% of cases, respectively. In all disease variants, lymph node hypertrophy affects the bifurcation and paratracheal groups and less often the bronchopulmonary and tracheobronchial groups; the sizes vary from 11 to 20 mm with means of 13.0 ± 1.2 mm.