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BACKGROUND. Absolute numbers of platelets are of key importance for determining the severity of multiple organ failure in sepsis, while their fluctuations within normal values are not taken into account. At the same time, early detection of a downward trend in this parameter may have greater predictive value in predicting disease outcomes. AIM OF STUDY. To identify trends in changes in platelet levels in patients with widespread peritonitis and determine the possible relationship of these changes with the outcome of the disease. MATERIAL AND METHODS. The basis of the work was an analysis of the results of treatment of 220 patients with diffuse secondary peritonitis who were treated at the Elizavetinskaya Hospital in 2013–2019. A correlation analysis was conducted to identify relationships between disease outcomes, assessed according to the severity of postoperative complications, and the degree of platelet reduction, expressed in platelet ratio. The further ROC analysis allowed us to identify a threshold value of the platelet ratio, which excess indicated a high risk of an unfavorable outcome. RESULTS. Based on the data obtained, the threshold value of the platelet ratio in the first two days has no clinical significance. At the same time, starting from the third 3rd day of the postoperative period, the quality of the resulting classifier increased, which confirms the prognostic significance of the threshold value of the platelet ratio, which was 1.72 on the third 3rd day after surgery. In other words, a decrease in platelet levels more than 1.72-fold on the 3rd day indicates a high risk of an unfavorable outcome, which may be associated primarily with intra-abdominal complications. This provision also indirectly confirms the fact that among patients with platelet ratio (PR) values exceeding 1.72 on the 3rd day, 68.7 % ultimately underwent repeated surgical interventions (33 patients out of 48 with high PR values, and the overall mortality rate was 72.1 %.Similar indicators in the subgroup with low PR values were 27.6 % of reoperated patients (29 of 105) and 26.7 % of unfavorable outcomes. CONCLUSION. The results obtained indicate that the degree of platelet reduction, rather than their absolute levels, has greater predictive value in patients operated on for diffuse peritonitis.

BACKGROUND The question of the duration and volume of conservative measures in patients with acute adhesive intestinal obstruction (AAIO) remains the subject of numerous discussions. Aim of study To evaluate the efficacy and safety of various periods of conservative therapy in patients with AAIO using a systematic review. MATERIAL AND METHODS Criteria for inclusion in the systematic review were cohort studies investigating various regimens and duration of conservative therapy in adult patients with AAIO. The search for primary sources was carried out in the CENTRAL, PubMed and eLibrary databases. The assessment of the safety of various terms of AAIO was carried out by comparing the immediate results of treatment. RESULTS The review included 19 papers with a total of 2,570 observations. At the first stage, the effectiveness of various conservative therapy regimens was evaluated by calculating the risk ratio for the success of non-surgical treatment. Taking into account the significant statistical heterogeneity of the participants, the calculation of the final risk ratio was carried out using a random effects model. The hazard ratio for nonoperative success was 1.91 (95% CI 1.2–3.1) in favor of gastrografin and 3.71 (95% CI 1.3–10.6) in favor of preoperative intestinal intubation. Taking into account the multidirectional pathogenetic action of the studied methods of conservative therapy, the obtained results suggested that the probability of success of non-surgical treatment correlates to a greater extent with the total duration of the AAIO episode than with the duration of conservative therapy, which was indirectly confirmed by constructing scattering graphs with approximation lines and calculating the coefficients determination, which amounted to 0.69 and 0.77 for the subgroups of standard therapy and undiluted gastrografin, respectively. Subsequently, the impact of different duration of an episode of AAIO on the immediate outcomes was assessed: mortality, frequency of resection interventions, complications, and total bed-day. There were no statistically significant differences in favor of early interventions (up to 48 hours) for all compared parameters; an increase in the total duration of AAIO up to 89 hours was not associated with worse results. CONCLUSION The total duration of the episode of acute adhesive intestinal obstruction, including both the pre-hospital duration and the duration of non-surgical treatment is prognostically significant. In other words, when calculating the allowable duration of conservative measures, one should proceed from the total duration of intestinal passage disturbance, which should not exceed 89 hours.

INTRODUCTION. The main component of the treatment of patients with secondary diffuse peritonitis is surgical intervention aimed at controlling the source of infection. In some cases, a single intervention is not enough for effective sanation of the abdominal cavity, which requires relaparotomy. There is currently no generally accepted approach to the timing and order for such interventions. The OBJECTIVE was to carry out a comparative analysis of the immediate results of patients with secondary diffuse peritonitis treatment using strategies of planned and «on-demand» relaparotomies.METHODS AND MATERIALS. The inclusion criteria for the review were randomized and cohort controlled trials comparing the efficacy of planned and «on-demand» relaparotomies in the treatment of secondary diffuse peritonitis. Primary sources comparing the results of these surgical strategies in adult patients were searched using the CENTRAL, MEDLINE, Scopus and eLibrary databases. The studies were independently assessed for inclusion by two review authors according to the stated eligibility criteria followed by data extraction. The methodological quality of randomized trials was assessed using the Cochrane tool for assessing the risk of bias, nonrandomized ones – using the Russian version of the Newcastle-Ottawa scale. Arising disagreements were resolved through discussions.RESULTS. The review included one randomized controlled trial according to the inclusion criteria and 16 nonrandomized cohort studies with a total of 3672 participants (1835 and 1837 patients undergoing planned and «on-demand» relaparotomies, respectively). Given the significant statistical heterogeneity of the included studies (χ2=119.2, df=16, p

Relevance. The most practiced method of treating patients with acute intestinal obstruction - urgent surgical intervention - does not guarantee remission, contributing to the progression of morphological changes in the abdominal cavity. From this perspective, a shift in emphasis towards the planned surgical treatment of patients with adhesive disease with the use of the existing anti-adhesive methods after conservative resolution of the intestinal passage disorders looks like a promising direction.Aim of the study. Improving the results of patients with acute adhesive intestinal obstruction treatment by developing a point-rating scale that allows to highlight groups of patients who are prone to conservative resolution of intestinal passage disorders episode, and, thereby, reduces the proportion of urgent interventions.Material and methods. The analysis of the 125 patients treatment results (retrospective group) admitted with symptoms of acute adhesive intestinal obstruction was carried out. On this basis, the point-rating scale was developed including a number of factors that have certain value in terms of predicting the probability of conservative therapy success. Subsequently the developed scale was applied in 170 patients (prospective group) as part of treatment tactics implementation aimed at maximally conservative resolution of adhesive intestinal obstruction without negative effect on the immediate results of patients operated in later periods.Results. The developed point-rating scale made it possible to reduce the frequency of urgent interventions among patients with signs of acute adhesive intestinal obstruction (from 79.2% to 57.6%) due to longer conservative measures — 18.1±17.2 and 11,2±8.7 hours in prospective and retrospective groups, respectively). There was no negative impact on the frequency of resection interventions (12.2 and 16.1% in the prospective and retrospective groups) as well as postoperative complications and overall mortality.Conclusions. The developed point-assessment scale made it possible to stratify patients in accordance with the probability of conservative therapy success and to justify its continuation for more than 12 hours in low-risk patients. The obtained results allow us to recommend the proposed scale for use in clinical practice.

INTRODUCTION. The problem of treating patients with peritonitis has always been and still remains relevant in surgery. Moreover, aspects of treating patients with tertiary peritonitis requiring repeated interventions are of particular importance. The OBJECTIVE of this work was to develop and evaluate the clinical effectiveness of a score-prognostic scale that allows to identify groups of patients with a high risk of persistent surgical infection in the abdominal cavity, in which a single intervention cannot be considered effective even despite the elimination of the primary surgical infection focus.METHODS AND MATERIALS. To achieve the goal, a correlation was evaluated between a number of factors and the likelihood of relaparotomy in a retrospective group consisting of 111 patients with secondary peritonitis. Based on the achieved data, score-prognostic scale for assessing the severity of peritonitis was developed, which allowed to formulate an algorithm of surgical tactics, which was used in the treatment of 109 patients. A group of 34 people with a high risk of tertiary peritonitis development was allocated from the number of patients – of which 20 patients had a total number of 39 planned surgical interventions.RESULTS. The use of the developed scale led to an increase in the total number of surgical interventions, however, reducing postoperative mortality by 1.7 times (p = 0.001) mainly due to improved survival rates in the group of patients with severe forms of peritonitis.CONCLUSION. The obtained results allowed to recommend the developed integral prognostic scale for assessing the severity of peritonitis for use in clinical practice.

BACKGROUND Much attention is currently given to the issues of surgical treatment of common forms of secondary peritonitis, which is associated with unsuccessful results of treatment of this group of patients and the lack of a unified approach to surgical tactics among patients requiring repeated surgical interventions for adequate sanitation of the abdominal cavity.AIM OF STUDY Improvement of the immediate results of treatment of patients with generalized secondary peritonitis by determining the approaches to choosing the optimal surgical tactics.MATERIAl AND METHODS We analyzed the results of treatment of 220 patients with common forms of secondary peritonitis who were treated at the Elizavetinskaya hospital of St. Petersburg in the period from 2013 to 2019. The indicated patients were divided into two groups, comparable in terms of the main features, including the depth pathomorphological changes in the abdominal cavity, assessed by calculating abdominal cavity index (ACI) and the Mannheim peritonitis Index (MPI). The main group consisted of 109 patients, where developed algorithm was used, which supposed planned sanitation relaparotomies within up to 2 days in patients with high values of ACI and MPI. The comparison group included 111 patients who underwent sanitation interventions “on demand”, that is, in the presence of signs of persistence of the infectious process in the abdominal cavity. The results of treatment were compared by assessing the level and structure of postoperative mortality, the frequency of complications, and the length of stay in intensive care units and hospital. Mathematical-statistical dataprocessing, calculations of intensive and extensive coefficients of features, assessment of the statistical significance of differences in features for the studied groups were carried out.RESUlTS The use of a differentiated approach to performing planned relaparotomy in patients with generalized peritonitis made it possible to reduce the overall mortality 1.7-fold (from 51.3 to 30.2%) (p=0.001) due to a decrease in the proportion of abdominal sepsis as a cause of unfavorable the outcome. No significant effect of the use of this algorithm on the frequency and structure of complications, as well as the duration of multiple organ failure, was found.FINDINGS The use of planned relaparotomy among the selected patients helps to reduce postoperative mortality without significantly negatively affecting other treatment results.

Various modifiers are used for non-furnace processing of cast iron. Some of them are designed for inoculating modification, which improves mechanical properties and eliminates the appearance of whiteness in castings, while others are designed for spheroidizing processing, in particular for producing cast iron with spherical and vermicular graphite. Some have both spheroidizing and inoculating properties. The main part of inoculating and spheroidizing modifiers is made on iron-silicon, Nickel and copper bases.In addition to the chemical composition, the size of the modifier particles, as well as their shape, are of great importance for modification. The optimal size of the fraction depends significantly on the non-furnace processing technology. Thus, for the larger the bucket and the longer the casting the longer the modification effect is required. One of the methods to achieve this is to increase the particle size of the modifier to 50 mm. When intraform processing of cast iron with spherical and vermicular graphite, magnesium-containing modifiers have strict limits on the upper size (4...5 mm), and in addition, the content of small fractions (less than 0.6...1 mm) is not allowed.The use of «heavy» magnesium-containing ligatures for spheroidizing modification of cast iron in order to obtain higher physical and mechanical properties has scientific and practical interest. Numerous studies show that for maximum effect the formation of the structure of the spheroidal graphite, dispersed pearlite metallic base of SGI (spheroidal graphite iron) relevant question is not only selection of the chemical composition of magnesium alloys, but also of the fractional composition, as well as effective method of input into the liquid melt.The purpose of this work was to study the technological features of obtaining cast iron with spherical graphite by bucket modification of copper-magnesium ligature.The researchers used a Leo–1420 scanning microscope, a Polam l-213 optical microscope, and a VEGA II LMU electron microscope with an INCA ENERGY 350 microanalyzer. High-speed induction melting plant, a set of equipment for analyzing the technological and mechanical properties of high-strength cast iron were used.Earlier experimental studies have shown the real possibility of obtaining in the laboratory a «heavy» copper-magnesium alloys as the alloying of magnesium metal with copper, followed by rapid cooling with use of rolling and plastic deformation of powder alloys. Analysis of test results of samples of such alloys showed that it depends on the value of its additives into liquid iron in the structure of formed graphite phase in compacted and globular form. At the same time, the metal base of cast iron is additionally alloyed with copper, which has a favorable effect on the strength characteristics of SGI.However, an urgent problem is the possibility of the appearance of a cementite phase in the structure of high-strength cast iron as a result of its increased supercooling due to the process of spheroidization of the graphite phase. This phenomenon is compounded by the fact that the copper-magnesium ligature, in contrast to the «light» ligature, does not contain silicon active graphitizer. This feature must be taken into account when obtaining high-strength cast iron of high grades.

It was established that the rosynchronization of the collective movement of vehicles as part of traffic flows in areas with special traffic conditions leads to a violation of the coherence of these flows, which leads not only to a decrease in the safety levels of the transport process, but also to the intensification of aerosol emissions of gas-dust emissions traffic flows. According to the results of studies that were carried out on the basis of analytical geometry methods on the plane and taking into account the topological features of algebraic functions, which describe the trajectories of the gradients of the traffic flow of vehicles, topological parameters and two-dimensional graphical models of possible options for transport and technological optimization of the road network were developed. The dimensions of the minimum allowable width of the carriageway in the nodes of the road network for motor traffic flows are determined depending on the intensity of traffic on roads of various categories. Accordingly, the proposed optimization of the design parameters of the road network at the intersection of motor traffic flows provides for the possibility of synchronizing the collective movement of motor vehicles as part of traffic flows, which stabilizes the performance of transport and technological operations and, consequently, increases the overall safety level of the motor complex.

Наведено екологічну оцінку сучасного стану кормової бази та перспективи її покращення для таких мисливських тварин як кабан та заєць-русак. Основну увагу акцентовано на особливості застосування біотехнічних заходів, зокрема створення ремізів, заготівлю кормів для зимового періоду, посів сільськогосподарських культур, створення підгодівельних майданчиків з метою концентрації тварин у певних місцях влітку та вплив цих заходів на збереження та примноження мисливської фауни в умовах ДП "Баранівське ЛМГ".

Usage of an upgraded device for assessing technical condition of plunger pairs makes it possible to increase assessment accuracy and reduce the number of erroneously rejected plunger pairs. The action of this device is based on introduction of automatic hydraulic pressure test time record into the evaluation process.