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Objective: to develop a personalized algorithm for extended-release tacrolimus in kidney recipients and to analyze its early outcomes in comparison with a retrospective control group.Materials and methods. The first (I) control group «Standard Protocol» included 228 patients operated on at Botkin City Clinical Hospital from June 2018 to November 2021; tacrolimus was administered postoperatively in a starting standard dosage of 0.2 mg/kg. The second group (II) consisted of 75 patients operated from December 2021 to November 2022, whose postoperative treatment involved a personalized extended-release tacrolimus dosing protocol. Induction immunosuppression was similar in both groups. The target tacrolimus level in the early postoperative period was considered to be 10-12 ng/ml for all patients. The comparison criteria included incidence of Over-immunosuppression (tacrolimus C0 >15 ng/ml), incidence of acute rejection and infectious complications in the first month after surgery, incidence and duration of delayed graft function (DGF), and length of stay at the hospital.Results. Over-immunosuppression was statistically significantly lower in the personalized protocol group, with 36.7% in group I and 87.5% in group II (p < 0.001). There was also a lower incidence of early infectious complications in group II: 5.4% vs. 13.2%, however, without reaching a level of statistical significance (p = 0.088). DGF incidence in group I and group II were 25.4% (58/228) and 22.7% (17/75), respectively. The length of stay at the hospital in group II was also statistically significantly lower: 13 versus 19 bed days (p = 0.033). In both subgroups, no patient developed acute rejection in the first month after surgery (p = 1).Conclusion. The personalized dosing protocol that was developed for extended-release tacrolimus in kidney recipients achieves the target levels of the drug recommended for the early postoperative period with low risk of under-immunosuppression and associated acute graft rejection, with a significantly lower incidence of over-immunosuppression.

Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.

The article is aimed at substantiating organizational provisions and developing recommendations for improving the conceptual principles of projecting a computer-based audit system for the activities of performers of entrepreneurial activities. The article proposes the principles of modeling the audit system in the structure of the information service of entrepreneurs, provides proposals for assessing audit risks at different stages of entrepreneurial activity, substantiates methodological approaches to conducting an audit using modern information and communication technologies. It is proved that computer-based audit is an effective instrument for controlling and managing economic security of business entities. When designing the organizational-methodological structure of the audit, it is proposed to use the stages of audit development: confirming, system-oriented, and risk-based audit. When deciding on the creation and operational function of the computer-based audit of the activities of business entities, it is recommended to take into account their size, category, organizational and legal form of management, organizational structure, level of automation of accounting and control procedures. Scientific approaches using the proposed indicator of information security to assessing the state of information security of business entity are defined, their components are: degree of use of information and communication technologies in business processes, status of information threats, and degree of security of information resources. Methodical principles of auditing using modern information and communication technologies are proposed to strengthen control and analytical functions of management with the use of the latest audit systems. It is proved that computer-based audit covers the use of information technologies and software as a method and tools of the auditor in the process of performing the task on the basis of reliability assessment and identification of significant risks of the information system of a business entity.

Aim to study the possibility and safety of performing simultaneous bilateral laparoscopic nephrectomy in symptomatic patients with autosomal dominant polycystic kidney disease (ADPKD) as a preparation for kidney transplantation. Materials and methods From May 2018 to September 2019, six symptomatic patients with end-stage renal disease caused by ADPKD, who had hemodialysis, underwent simultaneous bilateral laparoscopic nephrectomy. The mean vertical kidney size according to CT data was 211.67+/-37.15 mm, the mean horizontal size was 145.36+/-19.53 mm. In 5 cases, the hand-assisted procedure was performed. Results The average duration of the procedure was 225.1+/-40.37 minutes. Postoperative complications were recorded in 2 (33.2%) patients. The average length of stay was 8.83+/-2.13 days. There were no clinical manifestations of adrenal insufficiency. All patients are alive. In two patients, cadaveric kidney transplantation was performed after laparoscopic bilateral nephrectomy. Conclusion Laparoscopic bilateral nephrectomy in patients with chronic renal failure associated with ADPKD is feasible, safe and is associated with a short length of stay. This procedure improves the quality of life of patients and facilitates subsequent kidney transplantation.

A defibrillator pulse generator designed by E. E. Gorokhov-Miroshnikov for generation of biphasic defibrillation pulses with stepwise regulation of shape and optimum fixed duration (~10 ms) in the range of load impedance 25-175 Ω is presented. The generator, built using relatively low-cost electronic components, provides a high stored energy utilization coefficient. The main characteristics of the biphasic pulse generated by the prototype of generator are given. The design features of the generator are described.

The article is aimed at substantiating the organizational and methodical provisions, elaborating practical recommendations to improve the accounting policy of the hospitality industry enterprises. An optimization model of the accounting policy of hotel enterprises is proposed, allowing to identify the accounting-analytical resources of management in terms of the allocated reporting economic segments and on their basis to form reporting by the hotel segments. Developing the theory of costs classification, it is determined that the grouping of costs be appropriate to carry out by the most significant hotel segments, which meets the tasks of costs management, based on the characteristics of the hotel activity, creates conditions for economic substantiation of the goals of the structural units. Expediency of the maximum integration of the hotel’s accounting policy in accordance with international standards and national regulations that define the specifics of its formation is proved. In order to improve the costs management process of the hotel industry enterprises by segment, a sub-accounts system to the account 23 «Production» is recommended, wherein the second-order sub-accounts match the basic, supportive and additional level of services, and the third-order accounts match the enterprise’s production services. The proposed accounting policy model allows for rationalizing the process of formation of information resources at different levels of the hotel enterprise management and developing methodical principles for reflecting hotel services in accounting in accordance with the requirements of both international and national financial reporting standards.

A model of a defibrillator power module generating pulses of arbitrary shape with load impedance of 25-250 Ω was used to obtain the characteristics of biphasic pulses: quasi-sinusoidal pulses (Gurvich–Venin pulses) and trapezoidal pulses with sloping rise and fall. At high load impedances (100-250 Ω), production of trapezoidal pulses, as compared with quasi-sinusoidal, produced larger mean first-phase currents (by 11-20%) and greater pulse energy (by 25-35%).

Recently, an electrical stimulation of the paralyzed muscle, as a potential therapy for restoring function of a denervated muscle system, has been debated as an innovative treatment in the management of patients with laryngeal paralysis. Numerous studies in acute and chronic animal models have demonstrated that electrical stimulation of the paralyzed posterior cricoarytenoideus muscle (PCA) offers an approach to induce vocal fold abduction and restore ventilation through the glottis. The study aims to test applicability of the controlled opening of the rima glottides via direct electrical stimulation of the posterior cricoarytenoideus muscle. We developed for this purpose a novel instrument system for the controlled larynx nerve stimulation. An acute experiment on the 4 years old pig showed effectiveness of the engineered stimulator. The controlled opening of rima glottidis of both posterior cricoarytenoid muscles and afterwards of both PCA muscle contraction were observed as a result of the electrical stimulation with the applied current in the range of 0.1–3 mA and pulse width of 1 ms and 10 ms. Performed research indicates a large potential of the novel nerve stimulator for the human larynx stimulation.

First quantitative studies of the effect of electricity on excitable biological tissues forming the basis of the Hoorweg–Weiss–Lapicque law are described. The contribution of each researcher to the discovery is delineated and the practical significance of the Hoorweg–Weiss–Lapicque law is explained.

On the model of cardiomyocyte under the influence of simulated fibrillation, the dependences of the threshold energy of guaranteed defibrillation on the duration of the defibrillation pulse of a half-sine and rectangular waveform are studied. Guaranteed defibrillation is achieved when a defibrillation pulse causes an extension of the current refractory period of cardiomyocytes to a pulse repetition period of fibrillation or more. In this case, the propagation of the fibrillation wave through the myocardium becomes impossible. The obtained dependences of the threshold energy of guaranteed defibrillation on the duration of the defibrillation pulse correspond to the Hoorweg-WeissLapicque law on a limited range of relative values of the pulse duration. For a rectangular pulse, this range is much wider than for a half-sine pulse. The obtained dependence of the threshold energy of guaranteed defibrillation on the duration of a half-sine defibrillation pulse is close to the results of animal experiments. Therefore, the guaranteed defibrillation mechanism can be used to compare the energy efficiency of external defibrillation pulses.

Calculation of the parameters of studied systems heat treatment (the process duration, temperature distribution inside the product and in its mass change) is complicated both by external and internal moisture transfer. In this regard, a strict mathematical description of moisture and heat transfer between the surface of the semi-finished product, which must be considered as a capillary-porous body, and the surrounding medium should be based on a joint solution of hydrodynamics equations and convective heat- and mass transfer, taking into account the normal component of the mass flow on the body surface, which complicates the task. Consideration of such a task with regard to moisture transfer under the action of water content gradients, temperature and pressure is possible if the driving forces of transfer processes do not consider these potential gradients on the surface of a capillary-porous body, but the differences between potentials averaged over the surface and volume of the body. This theory successful application for widespread use in practical problems solving is complicated by the absence of a systematized database on the hygro- and hydro-mechanical equilibrium of treated semi-finished products with technological media. On the other hand, even in the presence of experimental data on hydro- and hygroscopic equilibrium, in this case there are not fields of transfer potentials, but only their average volume and mean surface values, which in principle does not allow calculating of heat treatment duration as the time to reach the required temperature in the middle of the product. Meat and fish products are treated at not too high temperatures and as a result gradients of transfer potentials inside capillary-porous bodies are not too great, therefore it can be considered that the internal moisture transfer does not change the temperature field inside meat and fish products significantly. Resource-saving modes of thermo-moisture treatment of combined products were justified: frying at t = 200 ° C, without humidification, duration - 5 min; baking at 180 ° C, water consumption for humidification (4.0-4.3)10-6 m3 / s with 10-15 minutes duration, providing a reduction in process losses of the finished product weight from 18% to 5-7%

In this work, the study results of an implantable pediatric rotary blood pump (PRBP) are presented. They show the results of the numerical simulation of fluid flow rates in the pump. The determination method of the backflows and stagnation regions is represented. The operating points corresponding to fluid flow rates of 1, 3, and 5 L/min for 75-80 mm Hg pressure head are investigated. The study results have shown that use of the pump in the 1 L/min operating point can potentially lead to the appearance of backflows and stagnation regions. In the case of using pumps in fluid flow rates ranging from 3 to 5 L/min, the number of stagnation regions decreases and the fluid flow rate changes marginally. Using the pump in this flow rate range is considered judicious. The study shows an increase in shear stress with an increase in fluid flow rates, while there is no increase in shear stress above the critical condition of 150 Pa (which does not allow us to reliably speak about the increased risk of blood cell damage). The aim of this work was to design, prototype, and study interaction of the Sputnik PRBP with the cardiovascular system. A three-dimensional model of Sputnik PRBP was designed with the following geometrical specifications: flow unit length of 51.5 mm, flow unit diameter of 10 mm, and spacing between the rotor and housing of 0.1 mm. Computational fluid dynamics studies were used to calculate head pressure-flow rate (H-Q) curves at rotor speeds ranging from 10 000 to 14 000 rpm (R2 = 0.866 between numerical simulation and experiment) and comparing flow patterns at various points of the flow rate operating range (1, 3, and 5 L/min) for operating pressures ranging from 75 to 80 mm Hg. It is noted that when fluid flow rate changes from 1 L/min to 3 L/min, significant changes are observed in the distribution of zero flow zones. At the inlet and outlet of the pump, when going to the operating point of 3 L/min, zones of stagnation become minuscule. The shear stress distribution was calculated along the pump volume. The volume in which shear stress exceed 150 Pa is less than 0.38% of the total pump volume at flow rates of 1, 3, and 5 L/min. In this study, a mock circulatory system (MCS) allowing simulation of physiological cardiovascular characteristics was used to investigate the interaction of the Sputnik PRBP with the cardiovascular system. MCS allows reproducing the Frank-Starling autoregulation mechanism of the heart. PRBP behavior was tested in the speed range of 6 000 to 15 000 rpm. Decreased contractility can be expressed in a stroke volume decrease approximately from 18 to 4 mL and ventricle systolic pressure decrease approximately from 92 to 20 mm Hg. The left ventricle becomes fully supported at a pump speed of 10 000 rpm. At a pump speed of 14 000 rpm, the left ventricle goes into a suction state in which fluid almost does not accumulate in the ventricle and only passes through it to the pump. The proposed PRBP showed potential for improved clinical outcomes in pediatric patients with a body surface area greater than 0.6 m2 and weight greater than 12 kg.

The device for continuous diagnosis of ECG is a complex medical system, which provides integrated software. In order to identify errors made while writing software, as well as timely detect deviations in the operation of the device, it is necessary to constantly carry out testing of all elements of the system. The report describes the methods that were used at different stages of development. Starting from tests run by scripts during debugging through a connected JTAG, and ending with automated tests that operate independently within the system. The result is a comparative description of these tests, their pros and cons. Water is made about the case in which one or another version of testing should be applied, as well as recommendations for combining them.

An implantable cardiac monitor helps in the detection of rare problems associated with a heart rhythm. They are convenient to use for continuous monitoring of the heart rhythm for the purpose of diagnostics the unconscious of states or atrial fibrillation. The most convenient and informative method of information obtaining from cardiac monitor is using graphic display. And transfer of information from the device to the display should be as effective as possible, that is, to use for this purpose an optimal data transfer interface.

Ischemic and reperfusion injury is a complex, multifactorial process that damage kidney transplant. Knowledge and understanding of pathogenic mechanisms of damage processes allows the use of various biological agents to reduce this damage. However, the application of most of biological agents is still only in the experiment. The purpose of this survey show participants of pathogenetic mechanisms, mainly inflammatory mediators (cytokines, chemokines), their interactions, and the consequences of their damaging effects on the fabric kidney transplant.

This article discusses the problem of reducing pauses during cardiopulmonary resuscitation. The probability of successful defibrillation depending on the duration of predefibrillation pause is evaluated. Basic problems of compensation for chest compression artifacts are described to reduce pauses during cardiopulmonary resuscitation. Also, methods for analysis of heart rate and approaches for improving algorithms of artifact removal during chest compressions are presented.

The software package capable to provide support of various medical devices has been developed. Architecture of the program is based on the “Mode-View-Controller” pattern, with a passive model. Each module implements the structural pattern “Bridge”. At the expense of it the system of plug-ins is provided. Plug-ins for the “Model” form the data from various devices. Plugin “View_Qt” implements a graphical user interface and provides centralized access to data. Data filtering happens at the level of model, but their check is carried out in the controller.

The dynamics of variation in the resistance of the chest (RC) exposed to a Gurvich–Venin bipolar defibrillation pulse was studied in five anesthetized pigs (body weight, 33�50 kg). During the first ~2 msec of the first pulse phase, an increase in the current amplitude up to the amplitude value induced an approximately 16% (in the 10� 22% range) decrease in the RC level. Any further effect of the pulse on RC was insignificant. The dynamics of variation in RC was mainly determined by processes in tissues exposed to the electrodes (skin, subcutaneous fat, skeletal muscles). A decrease in RC induces a proportional decrease in the effective discharge energy and dam� age to tissues located under the electrode.

Compression frequency and amplitude are the main parameters that should be monitored during human cardiopulmonary resuscitation (CPR). These parameters can be checked by monitoring the movements of the resuscitator’s hands relative to their initial position on the patient’s chest. Integral sensors of acceleration (accelerometers) can provide such monitoring. The goal of this work was to describe a technique for automatic monitoring of chest compression parameters during human cardiopulmonary resuscitation. The technique is based on data obtained using an accelerometer.

Defibrillation and cardioversion are therapeutic pro cedures used for patients with cardiac rhythm disorders [1, 2]. During cardioversion, an electrical defibrillation pulse is synchronized with the ECG QRS complex [3 5]. There are many algorithms of identification of ECG QRS complexes. Most algorithms are based on ECG sig nal amplitude parameters [6]. Maximal amplitude of ECG signal in healthy subjects is inherent in R wave of the QRS complex [7]. Patients with various cardiac pathologies demonstrate variable ECG signals. The goal of this work was to suggest resolution of QRS complexes in ECG sig nals for defibrillation and cardioversion procedures. The QRS identification algorithm is based on additive thresh old amplitude values and ECG signal increase rate.

The efficiencies of four bipolar pulses with different times and shapes were tested. The criterion of threshold energy eliminating 20-sec fibrillation in domestic pigs was used for this purpose. The efficiencies of trapeziform, rectilinear, and quasi-sinusoidal Gurvich–Venin bipolar defibrillation pulses were compared. The shape and time of the pulses corresponded to 100-Ω load regardless of the pig’s chest resistance (high-resistance model). The Gurvich–Venin model was statistically more effective than the trapeziform model and the rectilinear pulse model. The Gurvich–Venin pulse was generated using a digital defibrillator with signal processor. This technology is implemented in imPulse and imPulse PRO defibrillators.

The results of kidney transplantation from marginal donors were compared in two groups of patients who had received high-dose dopamine (10-35 mcg/kg/min). Group 1 consisted of 652 patients with grafts from stable donors given dopamine in doses from 0 to 10 mcg/kg/min, group 2--of 112 patients with grafts from donors given high-dose dopamine (10-35 mcg/kg/min). Mean follow-up was 52 +/- 19 months. The following parameters were compared: percent of delayed graft function, primary nonfunction transplants, acute graft rejection, graft survival, biopsy-proven ischemic-reperfusion graft injury. The rate of delayed graft function, primary non function transplants was higher in group 2 (59 and 51%, 7 and 4%, respectively). Five-year survival of the transplants and recipients was less in group 2 (68 vs. 73% and 78 vs. 71%, respectively, p0.05). At the end of the follow-up the level of serum creatinine was 151 +/- 50 in group 1 and 165 +/- 80 mcmol/l in group 2 (p0.05). Thus, despite worse results in group 2, kidney transplantation from such marginal donors can be used.

For many years the treatment of steroid-resistant rejection (SSR) remains a common problem od renal transplantation. We used plasmapheresis (PPH) in the treatment of SRR in 29 renal transplant recipients. All patients had progressive deterioration of renal function and compatible biopsy histology. The first group (15 patients) was administered PPH with methylprednisolone (MP). The second group (14 patients) was treated by intravenous MP. There was no significant difference in the time of beginning and severity of rejection. In the PPH group the results were better: a significant increase in SSR reversion was attained (73.3%) in comparison with the control (42.8%), the number of grafts lost during the first year was less (26.7 versus 57.2%). Better results were observed in patients with high levels of serum anti-HLA antibodies. Their transplants functioned well during 12 months after SSR. Hence, PPH can be used in patients with SSR with high levels of anti-HLA antibodies.

Introduction: Impedance compensation methods and waveforms differ among manufacturers and can play an important role in defibrillation success. Aim of study is to compare efficacy of biphasic quasi-sinusoidal pulse (BQSP) with two truncated exponential pulses (BTEP) on high impedance porcine model. Methods: We evaluated the threshold of defibrillation energy (TDE) in 7 anesthetized pigs (35–62 kg). TDE was defined as the lowest delivered energy that would terminate electrically induced 20 sec VF. MSIEE experimental defibrillator delivered BQSP, BTEP-1 – defibrillator Philips HeartStart MRx and BTEP-2 – Lifepak-12. MSIEE defibrillator compensates high impedance by controlling current with fixed pulse duration (10 ms), while the 2 defibrillators from the USA by prolonging the pulse duration (from 9 to ≥18 ms). The pulses shape and duration corresponded to load resistance 100 ohms regardless of pig chest impedance (41–52 ohms). Results: TDE of BQSP (77.6±15.1 J) was significantly lower, than in BTP-1 by 25% (104.1±14.5 J) and in BTP-2 – by 29% (109.7±12.1 J), p