Search

BACKGROUND:One of the most frequently recorded failures of structural elements of the header auger of a combine harvester is the failure of the fingers of the finger mechanism. Many manufacturers of grain harvesting equipment introduce a safety element into the design of the finger mechanism which is a groove on the finger. The optimal location of this groove with relation to the axis of rotation of the pin allows to ensure the breakage of the auger finger not along the main diameter but along the groove at a certain section of the working stroke of the mechanism. AIMS:In the specific technical literature, no special attention is paid to the analytical calculations of the structural elements of the finger mechanism of the header auger that requires the development of appropriate mathematical models depending on the targets. METHODS:This paper presents a mathematical model of the finger mechanism of the header auger of a combine harvester, based on the use of vector analysis, which has been successfully used by the author for a long time in the development of various lever mechanisms. The proposed vector analysis method is based on the coordinate transformation method. RESULTS:The mathematical model of the finger mechanism of the auger presented in the article made it possible to describe the kinematics of all of its hardpoints, to determine the vectors of angular velocities and accelerations of the links, to carry out a force analysis with optimization of the position of the safety element on the finger as well as to obtain and to study various graphical dependencies. The developed mathematical model provides a comprehensive description of the kinematic and force parameters of the considered mechanism for all of its positions. CONCLUSIONS:The presented mathematical model of the finger mechanism made it possible to successfully optimize the parameters of the location of the safety element on the finger - the groove, thereby ensuring the maximum angle of coverage of the zone of possible breakage of the finger along the groove.

Improvement of therapy of patients with ischemic stroke (IS) remains a relevant problem, despite the widespread use of drug and mechanical revascularization methods during recent years. One of the pathogenetic mechanisms of IS is oxidative stress as one of the components of brain tissue damage in the acute period and a factor that prevents the processes of repair and neuroplasticity in the recovery period. This is the rationale for the use of antioxidant drugs in the acute and recovery periods of stroke. Data from clinical studies on the use of antioxidants in the treatment of patients with IS are presented. We describe the use of the domestic drug dimephosphone (dimethyloxobutylphosphonyl dimethylate), a synthetic non-anticholinesterase organophosphorus compound, which has a wide range of effects: antioxidant, antacidotic, vasodilating, membrane stabilizing, anti-inflammatory, etc. Data are given on the use of dimephosphone in the acute period of IS in patients with no indications for thrombolytic therapy, there was a decrease in neurological deficit and a decrease in disability. The positive results of the use of dimephosphone in the recovery period of IS and in chronic cerebrovascular insufficiency are described. The data of our own study on the use of dimephosphone in the complex therapy of cognitive rehabilitation of patients in the recovery period of IS are presented. A statistically significant recovery of cognitive functions was registered according to the Montreal Cognitive Scale (MoCA), and an increase in the MoCA score by 2 points or more in 59.6% of patients. An improvement in executive functions, an increase in the flexibility of cognitive control of cognitive processes, and the predominance of verbal thinking over sensory-perceptual were noted.

Background. Bladder cancer is in the top ten most common onco-urological diseases. Its most common form – non-muscle invasive bladder cancer – is one of the most expensive for healthcare and requires many resources for diagnosis and treatment.Aim. To evaluate safety and effectiveness of en bloc transurethral resection (eTUBRT) of bladder wall with tumor compared to conventional transurethral resection (cTUBRT) in context of recurrence-free survival and perspectives of widespread implementation in onco-urological practice.Materials and methods. We have performed a search and analysis of Russian and international literature in the PubMed database on “en-bloc resection of bladder cancer” regarding information about recurrence-free survival in patients after eTURBT and cTURBT, intraand perioperative complications, overall survival, disease progression, and different surgical techniques. References in the sources were also analyzed to identify additional potentially relevant studies.Results. The analysis of the data showed that eTURBT is safer in regards to intraand postoperative complications, and it has better long-term oncological outcomes and quality of extracted histological material. Additionally, no significant differences in treatment outcomes with different instruments (monopolar, bipolar electric current, different laser equipment) were discovered.Conclusion. eTURBT has several advantages compared to cTURBT in treatment of non-muscle invasive bladder cancer and is a potential alternative to cTURBT. However, further research is required to evaluate the place and capabilities of eTURBT in the arsenal of an onco-urologist.

Background: Systemic thrombolytic therapy (STLT) with alteplase is the method of choice in all patients with acute ischemic stroke (IS) within the first 4.5 hours after the symptom onset. There is a noticeable difference between men and women in the clinical characteristics and results of stroke treatment; however, results of studies have been contradictory. Aim: To evaluate the efficacy of STLT with alteplase in women compared to men, depending on the presence of some risk factors for stroke. Materials and methods: This open-label prospective observational non-interventional cohort study of STLT in IS included 209 patients (102 women, the main group, and 107 men, or the comparison group) aged 32 to 86 years. All patients received STLT with alteplase within 4.5 hours from the onset of IS symptoms. The primary endpoint of the study was 28-day survival, and the secondary endpoint was the achievement of mobility independence (0 to 2 points by the modified Rankin Scale (mRS)). Results: The demographic and clinical patient characteristics of both groups were comparable, but women were on average 5 years older than men (p = 0.003). The index IS was not the first one in 31.4% of women and 23.4% of men (p 0.05). There were no significant differences in the severity of stroke and the timing of STLT. Men had a high mortality rate in the acute period of IS, but the difference was non-significant. PST-STLT hemorrhagic transformation was more common in men, with the difference being non-significant (2 0.743, p = 0.389). Women were more likely to have type 2 diabetes mellitus (DM2) (37.3% and 20.6%, respectively, 2 7.111, p = 0.008). In women, there was a trend towards better symptom regression by about 1 point (p = 0.129). The women with DM2 had a 13% higher survival than men (p = 0.038). The numbers of patients achieving independence (02 points on the mRS scale) by Day 28 was not different (56 women and 52 men). No between-groups differences were found in the numbers of patients with arterial hypertension and atrial fibrillation. Only 13 women (12.75%) and 21 men (20%) had a normal body mass index, while 56.3% of women and 46.7% of men had obesity 2 or 3 grades, with the gender differences being non-significant. Conclusion: In women, who have received STLT in the acute period of IS, the death rates and the functional outcomes were non-inferior to those in men, despite their older age, hyperglycemia in the acute period and past history of DM2. The risk factors for stroke in women, compared to men, could be the potential cause of more frequent IS recurrence (every third case in women and every fourth in men was recurrent). Despite a number of negative factors (age, obesity, metabolic syndrome, hyperglycemia, DM2, atrial fibrillation), there was a trend towards better outcomes of STLT in women.

Introduction. Reinfection after drainage of obstructive pyelonephritis exacerbates the postoperative course of the disease and delays the possible surgical intervention aimed at eliminating the cause of obstruction.Objectives. To determine the percentage of re-infection in patients drained with double-J stent or nephrostomy catheter for obstructive pyelonephritis. To assess the relationship between the timing of drainage removal and development of re-infection. To establish risk factors for the development of re-infection.Materials and methods. Medical records from 1022 patients who were treated from January 2019 to December 2021 and underwent drainage for obstructive pyelonephritis. The data in patients after nephrostomy and stenting were evaluated separately. A retrospective analysis of the time and frequency of the development of re-infection, as well as the effect of diabetes mellitus on pyelonephritis relapse, was carried out.Results. Re-infection during drainage developed in 16 (4.8%) patients with a nephrostomy and 45 (6.5%) patients with a stent. Among those who had re-infection in the nephrostomy-group, 4 (25.0%) patients noted it within two weeks from the moment of drainage, and 11 (69.0%) at three-four weeks. In the stent-group, the number of patients who had a complication during the first two weeks was 15 (33.0%), and it was 22 (49.0%) during the next two weeks, The proportion of patients with diabetes mellitus was higher among those who developed pyelonephritis again.Conclusion. The percentage of patients hospitalized with clinical re-infection after drainage of the upper urinary tract was 6.0%. There was an increase in the number of hospitalizations with recurrent pyelonephritis in cases where the drainage period lasted more than two weeks (p < 0.05).

Introduction. The authors present the findings of the physical modeling of the wave impact on the hydraulic structures of the construction facility known as “An offshore coal terminal at Syradasay coal deposit”. The authors have analyzed the experimental studies to provide recommendations on the most effective structural design of the connecting dam. Materials and methods. The method of physical modeling was employed to conduct the experimental studies Most of construction sciences are based on experimental research and, if the scientific support of structures, including those dealing with hydraulic engineering, is available, physical modeling is the top-priority research method in the international engineering practice. The experiments were conducted in a wave flume, which is a research and experimental facility at the Centre for Hydraulic Engineering Research and Education, NRU MGSU. The most advanced measurement equipment, produced by Wallingford (UK), was employed. The research methodology, used to verify the effectiveness of hydraulic structures, was tested on a large number of design structures that had been examined, built and are being successfully operated. Results. Given the data of experimental studies, the most effective design of a connecting dam was recommended as part of the design of an offshore coal terminal. Conclusions. The findings of this research will ensure the construction of an offshore coal terminal, which is built in difficult natural conditions typical for harsh Arctic latitudes, in the area characterized by intensive coal mining (Syradasay coal deposit), which is most relevant for the task of developing cargo port facilities along the Northern Sea Route.

Abstract The reaction of leading German companies in the Russian market after the start of the special military operation on the territory of Ukraine is considered. Companies interested in resolving the situation as soon as possible decided whether to leave the Russian market or not. The author analyzed the decisions of firms in the general context of winding down German business activities after 2014. After the acute phase of the pandemic ended, trade and economic cooperation between Russia and Germany showed a tendency to recover. However, since February 24, 2022, German companies with a small number of exceptions have generally supported anti-Russian sanctions. The conceptual typology of firms’ decisions, i.e., exit, activity compression, stabilization, and continuation of work in a difficult environment, is explored. It is concluded that the long-term trajectory of the real actions of German companies has fundamentally changed. The analysis made it possible to establish that the foundation of pragmatic market relations towards Russia is being eroded in the German foreign economic policy. This explains why German companies declare their willingness to pay. If during the annexation of Crimea to Russia groups of lobbyists for the interests of the German economy fought to maintain contacts, now such efforts are coming to naught.

Aim. To assess the frequency and timing of drainage associated complications in patients after palliative nephrostomy with nephrostomy tubes of various diameter and design. To establish a relationship between the presence of diabetes mellitus and the risk of acute pyelonephritis.Materials and methods. The records of 73 patients who received care between January 2018 and May 2021 were retrospectively reviewed for complications, related to nephrostomy tube. 201 cases of patient attendance due to nephrostomy tube dis-lodgement, nephrostomy tube obstruction and pyelonephritis were analyzed. The frequency and timing of the onset of complications in groups of patients with J-type (Results. In total, there were 100 visits of patients with J-type catheters and 101 visits with balloon nephrostomy catheters. The reasons for attendance among patients with J-type nephrostomy tube were: impaired drainage function (46 %), pyelonephritis (35 %) and dislocation of the catheter (19 %); and for patients with balloon catheters: pyelonephritis (39 %), impaired drainage function (34 %), dislocation (27 %). Patients with diabetes mellitus were significantly more likely (p Conclusion. The most common reasons for the urgent hospital attendance of patients with nephrostomy drainage are pyelonephritis and inadequate function. Diabetes mellitus is a risk factor for the development of pyelonephritis in this group of patients.

Introduction. The learning curve (LC) of radical prostatectomy (RP) is an actual problem in contemporary urology.Objective. To assess the LC of retropubic (rpRP), perineal (plRP), laparoscopic (LRP), and robot-assisted radical prostatectomy (RARP).Materials and methods. The study included 400 patients with localized or locally advanced prostate cancer (T1cT3bN0M0) who underwent rpRP, plRP, LRP or RARP performed by a single surgeon. Exclusion criteria: refusal of surgical treatment, metastatic prostate cancer, primary multiple cancer, neoadjuvant hormonal, radiation or chemotherapy.Results. Progressive improvement of metric indicators was noted in all groups as the surgical technique was mastered. Maximum rates of reaching the plateau of satisfactory functional and early oncological results were demonstrated in the RARP group after 25 – 50 procedures. In terms of the duration of the surgery, the LRP group showed the longest mastering period of 75 – 100 cases. Regression of blood loss volume requires 50 – 75 procedures in the rpRP and LRP groups, and 25 – 50 approaches in the rpRP and RARP groups. RARP demonstrates advantages in the context of minimization of catheterization time and inpatient period (25 – 50 cases). rpRP is not only associated with a maximum amount (n = 30) and frequency (21,0%) of complications, but also with a relatively long period of reaching a plateau of 50 – 75 cases. The stabilization of functional results is proceeding at the maximum pace in the RARP group at 25 – 50 procedures, in the other groups at 50 – 75 cases. Oncological safety (positive surgical margin) in the LRP, rpRP and RARP groups is achievable after 25 – 50 cases, in the rpRP group at 50 – 75 cases.Conclusion. The period of RP mastering depends on surgical approaches. RARP demonstrates the shortest LC duration.

Introduction. The majority of patients who undergo radical prostatectomy, apart from loss of sexual function, note a decrease in penis size which negatively affects their self-esteem. Penile rehabilitation is a set of measures aimed at recovery of sexual function to improve the quality of life.Objective. To analyze various options for penile rehabilitation in order to choose a method for preventing penis size reduction in patients undergoing nerve-sparing radical prostatectomy.Materials and methods. Patients who undergo radical prostatectomy (n = 83) at status flaccid and status erect were measured: length, circumference of the base, body and glans penis (mm) at different periods of penile rehabilitation. As a control, the tumescence coefficient was determined using pharmacodopplerography. All results were evaluated before, at the 6th and 12th months after radical prostatectomy.Results. Depending on the type of restoration of erectile function, the patients were divided into several groups: group 1 – men without penile rehabilitation; group 2 – patients treated with phosphodiesterase inhibitors of type 5; group 3 – using vacuum erection device (VED) and group 4 – taking combined penile rehabilitation. Medians of tumescence coefficient in group 1 on the 6th and 12th months was 2.7 (2.4; 3.1) and 2.6 (1.9; 2.9), in group 2 – 2.8 (2.2; 3.5) and 2.9 (2.2; 3.5), in group 3 – 2.7 (2.3; 3.3) and 2.8 (2.3; 3.3), in group 4 – 3.0 (2.2; 3.2) and 3.1 (2.1; 3.2), respectively (p Conclusion. The determination of the tumescence coefficient in dynamics showed more significant results throughout the entire observation period. Combined penile rehabilitation is an effective method of restoring erectile function and also allows to maintain the size of the penis at all follow-up periods.

Background. Currently, there is no single point of view on the timing of safe removal of the urethral catheter in patients who have undergone laparoscopic radical prostatectomy.Objective of the study: to evaluate the safety and functional results of early removal of the urethral catheter after laparoscopic radical prostatectomy.Materials and methods. In the period from January 2020 until April 2021, the study included 100 patients with a diagnosis of prostate cancer who underwent laparoscopic radical prostatectomy by one surgeon. Patients were divided into 2 groups. Group A (n = 50) included patients with the urethral catheter removed on the second day after surgery. Group B (n = 50) – the control group – included patients with standard catheter removal (14 days).Results. According to the results of cystography, in group A extravasation of a contrast agent from the zone of urethrovesical anastomosis was determined in 3 (6 %) cases. Seven (14 %) patients developed acute urinary retention after the removal of the urethral catheter. Among 2 patients acute urinary retention occurred immediately after catheter removal. In 5 cases acute urinary retention developed 2–7 days after catheter removal. These patients underwent repeated catheterization for a period of 2–3 days. In our study, removal of the urethral catheter on the second day increased the dynamic of restoring urinary continence in the postoperative period. The frequency of complete recovery of urinary continence (0–1 pad per day) in the groups A and B, respectively, was: after 1 month – 22 and 16 %, after 6 months – 64 and 54 %, after 12 months – 78 and 78 %. Urinary incontinence in the groups A and B was as follows: mild (2–3 pads per day): after 1 month – 40 and 34 %, after 6 months – 30 and 32 %, after 12 months – 20 and 18 %; moderate (4–5 pads per day): after 1 month – 20 and 26 %, after 6 months – 6 and 10 %, after 12 months – 2 and 2 %; severe (6 pads or more): after 1 month – 18 and 24 %, after 6 months – 0 and 4 %, after 12 months – 0 and 2 %.Conclusion. Early removal of the urethral catheter (2 days) in patients who underwent laparoscopic radical prostatectomy is a relatively safe method that improves the restoration of urinary continence.

Introduction. The heat emission of concrete during its hardening in adiabatic conditions is typically determined according to the GOST 24316 State Satndard. This method is quite limited in research possibilities, since under the conditions of constantly increasing temperature, it appears impossible to adequately assess the influence of various components or hardening conditions on the processes occurring during the concrete hardening. The assessment of the heat emission during the isothermal hardening allows much more information about the hardening process of the studied material to be obtained. The direct determination of the concrete heat emission during hardening in isothermal conditions appears to be extremely difficult in technical aspect.Aim. The study is aimed at developing a method for determining the heat emission of the concrete in isothermal conditions.Materials and methods. The GOST 31108-2016 TsEM I 52.5N portland cement, quartz sand, crushed gabbrodiabase, and the GOST 23732-2011 mixing water were used in the study. The strength of concrete samples was determined in accordance with the GOST 10180-2012 State Standard. The TAM Air (TA Instruments) isothermal calorimeter was used for calorimetric studies.Results. As a result of the performed studies, a method for determining the concrete heat emission in isothermal conditions was developed on the basis of assessment of the heat emission during the hardening of model mixtures reflecting the composition of the studied concrete. The optimal particle size of the sand and crushed stone fractions for model mixtures comprises 0.16–0.315 mm. The heat emission during the isothermal hardening of 10 model mixtures reflecting the composition of the studied concrete grades was determined. The strength class of 10 concrete compositions differing in cement content was established. The dependence of the heat emitted by model mixtures on the strength classes of the studied concrete compositions was determined. The heat emission of model mixtures during the isothermal hardening was established to be directly dependent on the strength of the studied concrete compositions.Conclusions. The determination of the amount of heat emitted by model mixtures reflecting the composition of concrete mixtures during the isothermal hardening represents a useful cost-effective test significantly accelerating and facilitating the process of control and design of concrete compositions.

Three case studies of adults with Leber hereditary optic neuropathy with and without neurological symptoms are presented. An elevated blood lactate level and changes in the activity of the mitochondrial enzymes in peripheral blood lymphocytes were noted. Mutations in the mitochondrial DNA (G3460A in one patient and G11778A in two patients) were found. The patient with a G3460A mutation, in addition to reduced visual acuity, was diagnosed with a cerebellar disorder due to cerebellar vermis hypoplasia. These changes are indications for prescribing energotropic drugs (idebenone, carnitine); carnosine can also be prescribed. These case studies show that patients with optic nerve atrophy should be assessed for Leber hereditary optic neuropathy. Differential diagnosis with multiple sclerosis should be performed, since this condition often presents as optic neuropathy.

The author uses the case of the Sokol (Czech for a “falcon”) movement in the 1860s - early 1870s to examine the ideas of the Slavic origin of the Czech nation and its kind of “kinship” with the other Slavs as an important component of Czech nationalist thinking. The first Sokol was founded at the turn of 1862 in Prague and followed the model of the German “Turnvereins”, combining nationalism with physical exercises. Analysing the print media that played a vital role in Czech nationalist culture, the author shows that Czech nationalists constantly sought to emphasize their belonging to the Slavs through verbal, visual, and musical representaions. Among the main principles of Czech nationalist thinking was totalism, which meant conceiving the nation as the highest value. Putting Czech national interests over everything else led Czech nationalists to take the idea of Slavic reciprocity as their subsidiary identity used as an instrument to define and achieve their goals. One of the manifestations of this approach was the Czech commitment to the concept of Austro-Slavism - the cooperation of Slavic nations to make the policy of the Habsburg monarchy serve their joint interests. This concept can be associated with the stable interest in the issues of Galician Poles, Slovenes, and Croats. The attention of Czech nationalists to the rest of the Slavs had a wave-like character. During the period under study, such waves were caused by one of the regular Montenegrin-Turkish military conflicts in 1862 (the popularity of the so-called Junak or heroic discourse), the January Uprising in 1863 (PoLonophiLia and Russophobia) and the Austro-Hungarian Compromise of 1867, which made Czech nationalists seek the external support (Russophilia). These trends have influenced the formation of the Sokol culture and the activities of the Sokol societies.

Introduction. In healthy men, a significant increase in pO2 in the cavernous tissue occurs during episodes of nocturnal erections. This process ensures sufficient oxygenation and high-pressure substances such as prostaglandin-E1 and nitric oxide. These substances suppress the expression of transforming growth factor β1, thereby preventing collagen synthesis and the development of cavernous fibrosis. In patients undergoing nerve-sparing radical prostatectomy, nocturnal erections are absent, hypoxia inhibits the production of PGE-i, and neuropraxia inhibits NO. Thus, cavernous fibrosis develops through the production of pro-apoptotic and profibrotic factors, resulting in persistent erectile dysfunction. The importance of a vacuum in penile rehabilitation for the prevention of penile cavernous hypoxia is not fully understood. This is due to the deficiency of data on the gas composition of cavernous blood when a vacuum-induced erection is achieved.Purpose of the study. To investigate the cavernous blood at the time of vacuum-induced erection, to analyze the obtained results with the International Index of Erectile Function score and with the values of penile hemodynamics.Materials and methods. The study included i5 patients with prostate cancer and preserved sexual function. The average age of all men was 57.87 ±4.36 years. All patients underwent a preoperative comprehensive assessment of erectile function: International Index of Erectile Function questionnaire, dynamic duplex penile ultrasound. Immediately prior to the surgery, penile blood was collected at the time of achieving a vacuum-induced erection. The gas composition and oxygenation were assessed using the values of the partial oxygen pressure, carbon dioxide and saturation in accordance with the approved standards to differentiate arterial and venous blood. Statistical data processing was carried out using the PASW Statistics 22 software (IBM SPSS, IBM Corp., Chicago, IL, USA)Results. All patients were divided into 3 groups depending on the gas composition and oxygen level of the cavernous blood. Group I included 4 (26.6%) patients with a predominance of arterial blood, group II — 4 patients (26.6%) with venous blood and group III — 7 patients (46.6%) with a mixed composition of cavernous blood. The average International Index of Erectile Function score in group I was 23.5 [2i.0; 25.0], in group II — 22.0 [2i.0; 24.0] and in group III — 24.0 [i9.0; 25.0]. Peak systolic velocity (cm/s) in group I was 40.i [35.i; 45.2], in group II — 35.9 [29.5; 50.2], in group III — 32.5 [32.5; 34.4]. End-diastolic velocity (cm/s) in group I was 2.52 [0.55; i0.5], in group II — 8.3 [2.9; i0.8], in group III — 7.5 [7.5; 9.0]. Resistive index in group I was 0.87 [0.77; 0.98], in group II — 0.75 [0.63; 0.94], in group III — 0.75 [0.73; 0.75].Conclusions. Vacuum prophylaxis may be the method of choice for penile rehabilitation in patients after nerve-sparing radical prostateectomy, especially in the early postoperative period during neuropraxia. The use of vacuum devices should be prescribed to patients with preserved veno-occlusive mechanism, which should be confirmed by dynamic duplex penile ultrasound.

This study determines the peculiarities of perception of aerobatic information in shaping the horizontal flight concept for operators who do not have experience in simulator training. The skill formation assessment in 10 flights was conducted using time indicators and generalized piloting error calculation based on the task. The program of activity concept shaping is developed using complex sensorimotor reactions at the 3rd stage of flight to increase the attention reserves of operators. The distribution of attention was analyzed when recording the coordinates of eye fixation in the designated visual zones using the mobile oculography system SMI ETG 2 WirelessAnalysPro. The number of eye fixations is established to increase with increased flight experience. Over each flight, the operator spends less time on the perception and evaluation of flight information from a particular device, thus the speed of changing saccadic eye movements increases, and the duration of the fixations themselves decreases. The proposed method of step-by-step flight concept shaping during the performance of the task of the horizontal flight showed high efficiency of developing motor and sensory skills. The development of such modular programs for training take-off and landing may significantly improve the principles of simulator training. The obtained data reveal the peculiarities of aerobatic information perception by operators of complex ergatic systems, with the prospect of increasing the reliability of professional activity of young pilots in the transition to real practical flights.

Ischemic stroke (IS) is the leading cause of neurological inpatient care, readmission, and long-term disability. Until now, there is no single point of view on when the second stage of medical rehabilitation after an IS should be started and the amount of the rehabilitation activities.Objective: to compare the effectiveness of the course of motor rehabilitation during the first 30–90 days and 91–180 days after IS.Patients and methods. The patients were divided into two groups: group 1 included 44 patients in whom ≤3 months passed from IS onset, and group 2–39 patients in whom >3 but Results and discussion. In both groups patients got a positive treatment result: a significant increase in muscle strength, gait stability, quality, and speed. The number of patients who achieved independence (≤2 points on the Rankin scale) before the start of the rehabilitation course among patients of group 1 was 9.4%, after the end of the course – 40.6%. More initially independent patients were included in the group 2 – 28.6%; after a course of rehabilitation, the proportion of independent patients increased to 35.7%.Conclusion. Rehabilitation courses are effective in patients who have had IS, both in the first three months and in the period from the 4th to the 6th month. It is advisable to conduct the second stage of medical rehabilitation earlier after a stroke.

The indicators of the activity of business structures in Ukraine for 2010-2020 were studied, namely: the dynamics of the number of active economic entities, the volume of products sold and the number of employed workers; the dynamics of the number of operating business structures by size and types of economic activity; the dynamics of the number of employed employees of entrepreneurial structures by size and types of economic activity; dynamics of the volume of products (goods, services) sold by business entities by type of economic activity. The main trends in the development of business structures are formulated: increasing the role of small and medium-sized business entities in the formation of the economy of Ukraine; provision of the majority of jobs by small and medium-sized enterprises; growth in the number of business entities operating in the field of information and telecommunications. The activity of small and medium-sized enterprises during the martial law was studied. The main problems of the development of business structures because of the full-scale war in Ukraine have been identified.

We consider the possibility of improving the superhigh-power laser pulse to superponderomotive electrons energy conversion efficiency by using porous targets of near-critical density. We report the results of numerical simulations based on the typical parameters of laser pulses of the PEARL laser facility built on the principles of parametric chirped pulse amplification (OPCPA). An original scheme for producing a controllable prepulse based on the use of a pump laser switched to a two-pulse regime is discussed. The prepulse is required to homogenise the submicron inhomogeneities of a porous target. Simulations show a significant increase in the laser-to-electron energy conversion efficiency in comparison with solid-state and gas targets. This interaction regime can be used to improve the efficiency of a broad class of laser-driven secondary radiation sources, such as a betatron source, bremsstrahlung, neutron source, etc.

Structural analysis of regional economies plays a significant role in political decision-making. In the context of Russian regional development, a new research topic emerges at the level of economic macroregions as defined in the current Spatial Development Strategy of the Russian Federation. The present work aims to empirically evaluate the use of shift-share analysis to clarify the contribution of the neighbourhood effect in addition to national and regional growth factors. The proposed approach incorporates structural shifts of spatial interactions into the classical method using various matrices (adjacency, neighbourhood). Macroregional economic growth was decomposed on the basis of consolidated sectoral structural dynamics and national development stages from 2004–2018 to reveal specific features of structural growth. It was determined that the most significant effects at all stages are those generated by national economic policy. Regional effects are especially important for macroregions whose development is characterised by substantial state support combined with an adequate resource base. Negative values of the spatial sectoral shift persisting across all macroregions testify to the positive mutual influence of macroregional specialisation and intensified interregional cooperation. Sectoral effects were observed only for particular economic sectors or at certain macroregional development stages. Recommendations for strengthening interregional interactions are proposed on the basis of the enlarged typology of structural effects in macroregions. Comparative analysis confirmed the consistency of estimates obtained using standard and spatial shift-share methods. Future research will focus on clarifying the structure of spatial relationships and detailing actual interregional economic interactions in the form of products and goods exchanged between macroregions.

Introduction. The existing methodology of personnel training determines the requirements for the competencies of future specialists, but the methods for determining the number of trained specialists are based either on the readiness of educational institutions for the quality management of the educational process, or are limited to the level of a motor transport enterprise, and do not take into account the regional needs of the labor market. The system of personnel training for the regional road transport complex is unbalanced in relation to the needs of this complex. This is due to the urgency of developing an enlarged methodology for determining the needs of the region’s motor transport complex (ATCR) in specialists with specialized education.Materials and methods. The paper uses the method of questioning economic entities engaged in road transport activities not only as the main focus, but also as an auxiliary one. The survey is aimed at determining the share of employees of motor transport enterprises and departments of various industries, taking into account the level of specialized education. The provisions of the theory of technical operation of cars and methods of mathematical statistics are used in the work.Results. The main result of the work is an enlarged methodology for determining the needs of the motor transport complex for specialists with specialized education, which differs from the known ones in that it takes into account the quantitative characteristics of personnel, taking into account the level of education in the economic entities of the region of various organizational and legal forms. These results represent the scientific novelty of the study. The structural characteristics of the personnel are determined, the corresponding algorithm is developed. The comparative values of labor productivity of specialists with specialized motor transport education are given.Discussion and conclusions. The methodological tools for determining the needs of the regional motor transport complex in specialists with specialized education have been developed, which allows overcoming the existing imbalance between the system of personnel training for the regional motor transport complex and the needs of this complex. The application of the results of the work will increase the validity of the state task for the training of specialists in the motor transport profile in the regions, increase the efficiency of using budget funds and public funds for educational activities.

The relevance of the research undertaken at RANEPA in 2021 is due to the fact that it is devoted to identifying perspective specializations of Russian regions, the targeted federal support of which will ensure the maximum effect in the growth of GRP, labor productivity, innovation activity and export volumes in the regions. The specialized types of economic activity of the regions are the subject of the study. To achieve the goal of determining the existing and perspective development of regional specializations, the following tasks were solved: a review of foreign and domestic experience in development of regional specializations was conducted, the author's methodological approach was developed, a comprehensive assessment of the specializations of the regions of Russia was carried out, and measures of their targeted federal support were proposed. The scientific novelty of the research lies in the fact that three localization indicators (products shipped, number of employees and investments in fixed assets in 173 economic activity types) were used together for the first time to identify the specializations of the regions (based on Rosstat data for 2017-2019). A comprehensive assessment of the prospects for the development of regional specializations includes defining their national and regional significance, labor productivity, innovation, and export activity, and considers their impact on the region’s development based on sectoral multipliers in terms of gross value added and the number of employees. Research methods include systemic analysis, factor analysis, statistical analysis of regional features of sectoral development, index method, etc. Using the proposed approach, the results of the evaluation of perspective specializations for 35 regions (for priority geostrategic regions and regions with individual development programs) were obtained, for which a set of sector-wide and specific measures of federal support was proposed. The application of the author’s approach is recommended for informational and methodological support and increasing the effectiveness of the state regional policy of Russia.&nbsp

The key point of successful PCNL is getting access to the renal collecting system. Ureteral catheterization and injection of contrast material provide an important advantage of visualizing and dilating the collecting system. However, catheterization increases the operation time, exposure to anesthesia, and requires additional reusable and disposable medical supplies. The purpose of the study was to develop a surgical algorithm for accessing the renal collecting system for mini-PCNL without catheterization.We analyzed the treatment results of 82 patients with a single kidney stone, who underwent mini-PCNL without prior catheterization of the ureter. The percutaneous access was obtained according to the roadmap we had developed. The puncture was performed under X-ray control and US guidance. For a calyx stone, the puncture was performed "to the stone". For a pelvis stone, the targeted calyx was accessed using the following algorithm where each next step was performed if the puncture had been impossible at the previous one: 1. 30 min before the operation: infusion load of normal saline, 1000 ml. 2. Intraoperatively: intravenous furosemide, 60 mg. 3. Puncture "to the pelvic stone", injecting contrast material into the collecting system and correcting the access puncture through the required calyx.In all 82 cases, puncture access was performed without ureteral catheterization. In 20 patients with calyceal stones, puncture onto a stone was successfully performed in 100% of the cases. Of 62 patients with pelvic stones, preliminary infusion was enough to allow a successful puncture in 49 (79%), access after intravenous administration of furosemide was obtained in 13 (21%), and a primary puncture onto a pelvic stone had to be done in 6 (10%) patients.Our proposed algorithm for accessing the PCS of the kidney was successfully used in 100% of the cases. It makes possible to avoid routine ureteral catheterization and thus reduce the overall operation time and the risk of complications, as well as save medical supplies. Clearly, such results require that the surgeon should have significant experience with puncture interventions under ultrasound control.

currently, endoscopic methods are the main option for surgical treatment of patients with urolithiasis (ICD). The widespread use of these operations has led to the development of a number of specific complications associated with the technology of their implementation. One of the frequent complications is the development of postoperative acute pyelonephritis against the background of intraoperative pyelovenous reflux.to study under experimental conditions the severity of pathomorphological changes in the ureter and kidney tissue against the background of pyelovenous reflux in the presence and absence of bacterial flora.32 mature female rabbits of the "White Giant" breed were selected as an experimental model. Experimental strain of the E. Coli microorganism 105 KOE/ml. Laboratory animals were divided into 4 groups, 1-3 experimental groups, 4 control group of observation without surgical intervention. In experimental groups, NaCl 0.9% 2.0 ml was injected into the ureteral lumen in group 1, E. Coli 1x105 CFU/ml 1.0 ml in group 2, NaCl 0.9% 1.0 ml + E. Coli 1x105 CFU/ml 1.0 ml in group 3.Results: according to the results of the study, the pathomorphological evaluation of kidney and ureter preparations revealed pronounced inflammatory changes in group 3.pyelovenous reflux does not independently lead to the development of acute pyelonephritis. The combination of reflux and microbial flora leads to inflammatory changes in the wall of the calyx-pelvic system with the development of acute pyelonephritis, which is confirmed by the results of pathomorphological examination of kidney and ureter tissue.

Bladder neck contracture after prostate surgery is a rare but feared complication. The treatment of choice is endoscopic incision or resection of fibrotic tissue. In case of ineffective transurethral correction, bladder neck reconstruction has to be done. In this report, we present a complicated case treated with combined transurethral and laparoscopic bladder neck reconstruction with buccal mucosal graft inlay. Using retrograde endoscopy fibrotic tissue in the bladder neck was resected to achieve a smooth and wide prostate cavity. After that the laparoscopy performed. The retropubic space is created and prostatic urethra opened via longitudinal prostatic-vesical incision. Buccal mucosal graft was fixed in place. Bladder and prostatic urethra were closed with resorbable suture. Two weeks after surgery the urethral catheter was removed and adequate voiding reestablished. After eleven months patient had no urination complaints and any sings of recurrence. Thus, the combined surgical approach for bladder neck reconstruction using buccal mucosa inlay may be a durable option for treatment of recalcitrant bladder neck contracture.

Based on the analysis of literature sources, modern data are presented on the nosological structure of urachus diseases in adults and children, diagnostic methods, as well as treatment tactics for various anatomical variants of anomalies in the development of the urinary duct. A modern classification of urachal malformations caused by disorders of its obliteration is presented. Various modifications of the laparoscopic approach are considered for the most common types of this pathology. The reasons for the development of malignant neoplasms from the urachus tissue, including in the gender aspect, are described, and a comparative assessment of the methods of surgical treatment of urachus tumors is given.

Neuromyelitis optica spectrum disorders (NMOSDs) are a group of central nervous system autoimmune diseases characterized by similar clinical manifestations, optic neuritis, and transverse myelitis being the most frequent among them. In most cases, the pathogenesis of NMOSDs is associated with autoantibodies to aquaporin-4 (AQP4-IgG). However, AQP4-IgG is not detected in at least 10-20% of patients with NMOSDs. In this subgroup and in patients with isolated transverse myelitis or optic neuritis, IgG antibodies to myelin oligodendrocyte glycoprotein (MOG-IgG) were detected. Patients seronegative for both AQP4-IgG and MOG-IgG have also been described.Objective: to evaluate rituximab (RTX) effectiveness in preventing relapses and disability in patients with NMOSDs.Patients and methods. The study included 27 patients with NMOSDs (9 men and 18 women) aged 20-51 years who received RTX in 2019-2021. The treatment protocol included intravenous infusions of 1000 mg of RTX on the 1st and 15th days, the second and subsequent courses (maintenance therapy) - intravenous infusions of 1000 mg of RTX once every six months. Treatment effectiveness was assessed by the average annualized relapse rate, the median changes of the Expanded Disability Status Scale (EDSS), and based on the magnetic resonance imaging (MRI) changes.Results and discussion. The annualized relapse rate at baseline and 18 months after the start of treatment was: all patients (n=27) — 0.6±0.3 and 0.07±0.27(pConclusion. RTX treatment in NMOSDs is reasonably efficient and safe, but with the obligatory prior patient evaluation and monitoring of treatment results.

Background. Bladder cancer is very common and real problem in oncourology. The main treatment for muscle invasive bladder cancer is radical cystectomy (RC). RC with pelvic lymph node dissection (PLND) may be associated with an increased risk of developing lymphatic complications such as lymphedema, prolonged lymphorrhea, and the formation of lymphocele.Objective: to compare the efficiency of clips and surgical instruments for preventing the development of lymphatic complications during PLND at the time of RC.Materials and methods. From January 2016 to October 2020 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 were performed 60 RC with PLND. All patients were divided into two groups. The 1st group included patients who underwent the sealing of lymphatic vessels using titanium/polymer clips (n = 30). In the 2nd group the sealing was performed using ultrasonic/bipolar instruments (n = 30). All operations were performed by one surgeon. The study used univariate and multivariate logistic regression analysis.Results. The overall percentage of lymphatic complications was 29 (48.3 %) out of 60 patients. Out of them 7 (11.7 %) patients developed symptomatic lymphocele, and 3 (5.0 %) developed asymptomatic lymphocele, prolonged lymphorrhea was observed in 17 (28.3 %) patients, lymphedema of the lower extremities or genitals in 2 (3.3 %). The percentage of lymphatic complications in the 1st group was 66.7 % (n = 20), and in the 2nd group - 30.0 % (n = 9) (p = 0.004). In multivariate analysis the statistical significance was (p = 0.014), a high odds ratio (6.83; 95 % confidence interval 1.48-31.49) was observed with sealing of lymphatic vessels with clips, while a low odds ratio (0.14; 95 % confidence interval 0.03-0.67) was found with electrosurgical instruments.Conclusion. The use of ultrasonic or bipolar electrosurgical instruments can be an effective method for preventing the development of lymphatic complications during PLND at the time of RC.

Varicocele is one of the most common problems in modern reproductive medicine. The incidence of varicocele in the structure of the general male population is 15%, 40% of which have problems with fertility. Among the causes of male infertility, varicocele ranks second after idiopathic, thus being the most common curable cause of male infertility. While researching the pathophysiological mechanisms of infertility in varicocele, the question of the reasons for the varicocele relapses, both after surgical and endovascular methods of treatment remains open, as well as the tactics of managing such patients. The review aimed to systematize knowledge about the problem of recurrent varicocele, to analyze the frequency and etiology of relapses after various methods of primary treatment, as well as to select the optimal diagnostic and treatment option for varicocele recurrence.

We present the results of the aberration correction of laser radiation wavefront using a dynamic method for determining the reference wavefront. The method, which is based on the processing of synchronously obtained data on the near- and far-field zones, significantly improves the focusing quality with active wavefront correction, especially under conditions of dynamic aberrations. An increase in the Strehl number S from 0.7 to 0.86 is demonstrated when a beam 18 cm in diameter is focused by an F/2.5 parabolic mirror.

The relevance of applied engineering of new development mechanisms for Russian regions is due to the ineffectiveness of innovative strategies currently in force and isolation of scientific and technological development from the sectoral potential of the territories. Russia’s Spatial Development Strategy until 2025, approved in 2019, led to a conflict between promising sectoral economic specializations and the real problems of different types of territories. The “smart specialization” approach may take the lead in aligning the sectoral and territorial approaches. The article describes the differences between traditional and smart specializations. It is shown that in the case of smart specialization, it is not the selection of individual sectors as “points” that takes place, but determination of the set of types of economic activity in conjunction with regional competencies as a fuzzy core with blurred boundaries. The characteristics of the sectoral, patent, innovation, and publishing components as integral parts of the developed methodological approach, are given. All components are linked through the priorities of the Science and Technology Development Strategy, which plays the role of a national research platform (program) reflecting the long-term priorities of the economy and society. The coordinated choice of regional development prospects solves the problem of isolated technological forecasts for territories. Coordination of sectoral and scientific and technological priorities for a territory can be considered the basis for selecting regional investment projects. This will allow the federal executive authorities to set a general framework for the most desirable goals of scientific and technological development in a spatial context, and to take on venture risks with the support of technology start-ups and emerging sectors.

Introduction Transurethral resection of the prostate (TURP) is the gold standard of BPH surgical treatment. It is of current interest to search for medications that can reduce the incidence of complications after TURP. Aim To evaluate the efficiency of Longidaza (rectal suppositories of 3000 IU) as part of combined therapy in order to prevent complications after TURP. Materials and methods The study included 202 patients who underwent TURP in 3 hospitals. The patients were divided into 2 groups: main group - 96 men taking standard postoperative therapy with Longidaza rectal suppositories N 20; control group - 106 men - taking standard postoperative therapy (tamsulosin 30 days; fluoroquinolone 5 days). Follow-up included IPSS, urinalysis, urine culture, ultrasound examination of the prostate volume (PV), post void residual urine, uroflowmetry at 1,2,3,6 months after surgery. Average preoperative indices: IPSS 27 [23; 30], Qol 5 [4; 6], prostate volume (PV) 71+/-19cc (30-272 c), Qmax 7.5+/-2.5ml/s (1,3-18,7 ml/s). Results There was a significant improvement in IPSS, QoL, Qmax, PV, post void residual urine (PVR) compared to preoperative values during the entire observation period. There was no statistical difference between the main and control groups for these indexes in 6 months. In the main group had statistically lower incidence of bacteriuria at 3 (11% vs 17%) and 6 months (7% vs 17%), and leukocyturia at 3 (31% vs 46%) and 6 months of follow-up (20% vs 44%). Overall incidence of infectious complications and additional antibacterial drugs prescription was lower in the Longidaza group compared to the control group (17,7% vs 20,7%). Urethral strictures developed in 7 men in the main group, and 8 in the control group. Conclusion Our results show that prescription of Longidaza significantly reduces the incidence of leukocyturia and bacteriuria postoperatively, decreasing the rate of infectious complications in men after TURP.

Summary. Purpose of the reserche. To study changes in microflora and sensitivity of isolated strains to antibiotics using bacteriological research methods for intra-abdominal infections and peritonitis to determine their resistance when planning antibiotic therapy. Results and discussion. The paper presents data from a retrospective analysis of the results of studies of microflora and its resistance in intra-abdominal infections (IAI) and peritonitis for 2 periods: I period — from january 2007 to december 2008, II period — from january 2018 to december 2019. The difference between period II and I was in the increase in the number of individual pathogenic strains of microorganisms. Thus, the number of Klebsiella spp. increased from 13.8 % to 23.8 %, which in absolute number of their total number amounted to a 73.5 %, ranking second in the overall structure among pathogens sown in IAI and peritonitis. The number of strains of Staphylococcus spp., Enterobacter spp., Acinetobacter spp. has also increased by 2.4–5.8 % respectively. Among the strains Klebsiella spp., E. coli and Staphylococcus spp. the number of poly- and multi-polyresistant forms has increased. Thus, the number of such forms among Klebsiella spp. increased from 19.2 to 44.5 %, Staphylococcus spp. — from 43.8 to 67.1 % and E. coli from 18.2 to 23.5 %, respectively. Conclusions. Over the past 10 years, with IAI and peritonitis, the most significant changes were revealed on the part of pathogenic strains of Klebsiella spp., Staphylococcus spp. and Acinetobacter spp. Multidrug resistant strains were predominantly susceptible to carbapenems, semisynthetic ureidopenicillins, aminoglycosides, glycopeptides, oxazalidinones, phosphonoic acid derivatives. In the context of changes in the microbial landscape observed over the past decade, an increase in the number of poly- and multi-resistant forms of pathogenic microorganisms in IAI and peritonitis, the choice of antibiotics for rational therapy should be based solely on bacterioscopy and antibiograms.