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Hypertonic saline has been used for the treatment of hyponatremia for nearly a century. There is now general consensus that hypertonic saline should be used in patients with hyponatremia associated with moderate or severe symptoms to prevent neurological complications. However, much less agreement exists among experts regarding other aspects of its use. Should hypertonic saline be administered as a bolus injection or continuous infusion? What is the appropriate dose? Is a central venous line necessary? Should desmopressin be used concomitantly and for how long? This article considers these important questions, briefly explores the historical origins of hypertonic saline use for hyponatremia, and reviews recent evidence behind its indications, dosing, administration modality and route, combined use with desmopressin to prevent rapid correction of serum sodium, and other considerations such as the need and degree for fluid restriction. The authors conclude by offering some practical recommendations for the use of hypertonic saline.

The combined use of coal bottom ash (CBA) and ground CBA (GCBA) as partial replacement of fine natural aggregate (FNA) and Portland cement, respectively, was investigated for the production of concrete mixtures. Five concrete mixtures incorporating GCBA at 20 wt% replacement of binder and CBA at 0, 25, 50, 75 and 100 wt% replacement of FNA were produced and tested for strength, microstructural characteristics and carbonation resistance. A base concrete mixture made of conventional concrete was also produced as a reference concrete mixture. Test results showed that the combined use of GCBA and CBA in concrete mixtures results in enhancement of the microstructure, carbonation resistance and compressive strength of the resulting concrete mixtures. Scanning electron microscopy and X-ray diffraction analyses pointed at the occurrence of pozzolanic reaction and pore-filling effect of GCBA and CBA in the resulting concrete mixtures. It was observed that 25 wt% replacement of FNA with CBA is an optimum dosage considering its effects on the later age strength and durability characteristics of the resulting concrete mixtures.

Background: Sepsis is considered to be a systemic inflammatory response due to infection, resulting in organ dysfunction. Timely targeted interventions can reduce mortality and improve prognosis. Therefore, it is important to identify potential sepsis in time. Inflammation plays a crucial role in the process of sepsis. We combined inflammatory markers to develop and validate a nomogram model and a simple risk scoring model for predicting sepsis in critically ill patients. Furthermore, comparing the prediction performance of the two models.Methods: The medical records of adult patients admitted to our intensive care unit (ICU) from August 2017 to December 2020 were analyzed. The finally included patients were randomly divided into training cohort (70%) and validation cohort (30%). A nomogram model for sepsis was developed through multivariate logistic regression analysis in the training cohort. The continuous variables included in nomogram model were transformed into dichotomous variables. Then a multivariable logistic regression analysis was performed based on these dichotomous variables and the odds ratio (OR) for each variable was used to construct a simple risk scoring model for predicting sepsis. The receiver operating characteristic curves (ROC) were constructed and the area under the curve (AUC) was calculated to evaluate the discrimination performance of the two models. Results: According to our inclusion and exclusion criteria, 2074 patients were included in study. Finally, white blood cell (WBC), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) were included in our models. The AUC of the nomogram model was 0.854 (95%CI: 0.835-0.872). The AUC of the simple risk scoring model was 0.842 (95%CI: 0.822-0.861). When the cut-off value was 7.5 points, the sensitivity was 77.03% and the specificity was 75.75%. The prediction performance of the two models on sepsis is comparable (p=0.1298) and better than that of Sequential Organ Failure Assessment (SOFA) scores (AUC=0.759).Conclusions: This study combining five commonly available inflammatory markers (WBC, CRP, IL-6, PCT and NLR) developed a nomogram model and a simple risk scoring model to predict sepsis in critically ill patients. Although the prediction performance of the two models is comparable, the simple risk scoring model may be simpler and more practical for clinicians to identify potential sepsis in critically ill patients at an early stage and make treatment strategies.

У статті наведено результати експериментального дослідження взаємного потенціювання протимікробної активності антисептика декаметоксин і антибіотиків при поєднаному застосуванні. Встановлено посилення протимікробної ефективності антибіотиків цефалоспоринової, карбапенемової, аміноглікозидної, фторхінолонової, поліміксинової груп у присутності декаметоксину щодо неферментуючих грамнегативних бактерій та інших мікроорганізмів. Показано можливість досягнення бактерицидного ефекту щодо плівкових форм бактерій при поєднаному впливі антибіотиків і антисептиків.

Purpose We evaluated the diagnostic performance of the texture features of dynamic contrast-enhanced (DCE) MRI for breast cancer diagnosis in which the discriminator was optimized, so that the specificity was maximized via the restriction of the negative predictive value (NPV) to greater than 98%. Methods Histologically proven benign and malignant mass lesions of DCE MRI were enrolled retrospectively. Training and testing sets consist of 166 masses (49 benign, 117 malignant) and 50 masses (15 benign, 35 malignant), respectively. Lesions were classified via MRI review by a radiologist into 4 shape types: smooth (S-type, 34 masses in training set and 8 masses in testing set), irregular without rim-enhancement (I-type, 60 in training and 14 in testing), irregular with rim-enhancement (R-type, 56 in training and 22 in testing), and spicula (16 in training and 6 in testing). Spicula were immediately classified as malignant. For the remaining masses, 298 texture features were calculated using a parametric map of DCE MRI in 3D mass regions. Masses were classified into malignant or benign using two thresholds on a feature pair. On the training set, several feature pairs and their thresholds were selected and optimized for each mass shape type to maximize specificity with the restriction of NPV > 98%. NPV and specificity were computed using the testing set by comparison with histopathologic results and averaged on the selected feature pairs. Results In the training set, 27, 12, and 15 texture feature pairs are selected for S-type, I-type, and R-type masses, respectively, and thresholds are determined. In the testing set, average NPV and specificity using the selected texture features were 99.0% and 45.2%, respectively, compared to the NPV (85.7%) and specificity (40.0%) in visually assessed MRI category-based diagnosis. Conclusion We, therefore, suggest that the NPV of our texture-based features method described performs similarly to or greater than the NPV of the MRI category-based diagnosis.

Objective The diagnosis of any dental pathology can vary from being simple to challenging. While the use of cone beam computed tomography (CBCT) is well established, magnetic resonance imaging (MRI) remains a proof of concept. This systematic review aims to compare the diagnostic ability of MRI with CBCT in diagnosing periapical pathosis. Materials and Methods This systematic search was performed using the electronic databases of MEDLINE, Cochrane Library, Google Scholar, and Science Direct to identify relevant articles from 2010 to 2020. The search terms used were magnetic resonance imaging, cone beam computed tomography, diagnosis, and periapical diseases. Result In total, 3218 potentially relevant abstracts and titles were identified. After removing duplicates, 1288 articles were reviewed for titles and abstracts, and 29 articles were selected for full-text reading. From those, 19 articles were finally selected that included original research studies, case reports, and case series and were included for systematic review. Most of the studies included in this review suggested that the combined use of CBCT and MRI is needed for a better and more precise diagnosis of complex periapical pathoses. The main advantage of MRI is its ability to image soft tissues usingnonionizing radiation, and the main disadvantage in the case of CBCT is overdiagnosis of the lesion. Conclusion MRI has various advantages over CBCT with similar diagnostic utility. When diagnosing periapical pathogens, both MRI and CBCT are needed for an accurate diagnosis.

Relevance. The consumption of caffeine-containing food in the modern world must necessarily be safe for humans, including should not affect the hereditary material of the body. Objective: to determine the possible effect of caffeine at the cytogenetic level by the micronucleus method on erythrocytes. Materials and Methods. The objects for the study were non-linear mice, which were divided into 6 groups - one control group and 5 experimental groups. The first experimental group and the second in the experiment received caffeine in doses of 40 mg/kg and 100 mg/kg.The control group received saline. Caffeine was administered orally. The mutagen (dioxidine) was injected intraperitoneally. On the 5th day of the experimental study, we performed blood sampling for cytogenetic analysis. Results and Discussion. Our study of the caffeine preparation made it possible to determine the following patterns. Firstly, when administered within 5 days, caffeine at a dose of 40 and 100 mg/kg did not cause an increase in the number of micronuclei in erythrocytes in mice. Secondly, the combined use of caffeine (both at a dose of 40mg/kgand at a dose of 100 mg / kg) and dioxidine significantly increased the level of micronuclei in comparison with the control group. Thirdly, caffeine at a dose of 40mg/kgdid not increase the mutagenic activity of dioxidine, but a dose of caffeine of 100mg/kgwhen combined with a mutagen led to a significant increase in the level of cytogenetic damage. Conclusion. According to our data, caffeine in the experimental study was not a mutagen, but at a dose of 100 mg/kg it represented a comutagenic effect.

Background. The article is devoted to the problem of causal relationships between the effects of social risk factors in the form of excessive consumption of psychoactive substances on medical risk factors, the consequences of which are the formation and spread of addictive health disorders. The purpose of the study: Observation and processing of causal relationships between social and medical risk factors in the formation of addictive health disorders using the example of the Dniepropetrivsk region through a correlation analysis from the perspective of forensic pharmacy. Materials and methods. When conducting the study, we used the current legislative, regulatory and instructive documents, Internet resources. We applied documentary, forensic, statistical, correlation, comparative and graphical methods of analysis. Results. The article presents the results of forensic and pharmaceutical research, substantiates their relevance, formulates a goal, develops a design, and describes materials and research methods. The establishment of causal relationships between social and medical risk factors in the formation of addictive disorders was carried out on the example of the Dniepropetrivsk region, which is most typical for the Dnieper region of Ukraine, through a correlation analysis during 2014-2018. The collection, analysis and processing of peremptory data was carried out taking into account five indicators of social risk factors: circulation of a psychoactive substances of the 1st level of ethanol strength (beer); circulation of a psychoactive substances of the 2nd level of ethanol strength (liquors); circulation of a psychoactive substance of the 3rd level of ethanol strength (vodka); consumer price index; circulation of the joint use of psychoactive substances (in particular, alcoholic beverages + tobacco). The collection, analysis and processing of data on indicators of medical risk factors was carried out taking into account of four factors: the number of newly reported cases of addictive health disorders; the number of cases of diseases of the nervous system; the number of cases of addictive health disorders due to the use of a psychoactive substance of alcohol; the number of cases of addictive health disorders due to the combined use of psychoactive substances. According to the results of the study, found that indicators of social risk factors for the circulation of psychoactive substances of the 3rd level of ethanol strength (vodka) causally affect the indicators of medical risk factors, resulting in an increase in the number of cases of diseases of the nervous system. The structure of the normalized t-criterion of social and medical risk factors in the formation of addictive health disorders is determined. Conclusions. Established that the formation of addictive health disorders is caused by social risk factors (excessive and uncontrolled use of psychoactive substances in the form of alcoholic beverages of various strength levels or the combined use of psychoactive substances of various classification and legal groups, for example, alcoholic beverages + tobacco). Social risk factors affect medical risk factors, resulting in an increase in the number of newly reported cases of addictive health disorders and the number of cases of diseases of the nervous system. The data obtained are the basis for planning further forensic pharmaceutical research in this direction and focus the attention of state authorities on the need to develop socially-oriented preventive measures aimed at improving the circulation of alcoholic beverages of the 1st, 2nd and 3rd strength levels (beer, liquors, vodka), immoderate consumption of which leads to the formation of addictive health disorders.

Background and study aims This study evaluated the technical aspects of colorectal endoscopic submucosal dissection (ESD) with the Clutch Cutter (CC) (Fujifilm Co., Tokyo, Japan), a scissor-type knife, and the S-O clip (SO) as a traction clip, and compared the safety and efficacy to ESD using a needle-type knife. Patients and methods This was a single-center retrospective study. In Study 1, we evaluated 125 ESD patients: 60 using the SO and CC (SO group) and 65 using the CC (CC group). In Study 2, we evaluated 185 ESD patients: the CC group (N = 65) and 120 using the Flush knife BT-S (Flush group) (Fujifilm Co., Tokyo, Japan). In both studies, the clinicopathological features and therapeutic outcomes were compared using a propensity score-matched analysis. Results In 36 pairs of matched patients in Study 1, the rates of en bloc resection, R0 resection, perforation, and postoperative bleeding (POB) were 97.2 %, 88.9 %, 2.8 %, and 0 %, respectively, for the SO group and 100 %, 91.7 %, 0 %, and 0 % for the CC group (not significant). The mean procedure time for the SO group among less-experienced endoscopists was significantly shorter than in the CC group (42 vs. 65 minutes, P = 0.036). In 49 pairs of matched patients in Study 2, the rates of en bloc resection, R0 resection, perforation, and POB were 100 %, 95.8 %, 0 %, and 0 %, respectively, for the CC group and 98.0 %, 95.8 %, 0 %, and 2.0 % for the Flush group (not significant). The mean procedure time in the CC group among less-experienced endoscopists was significantly shorter than in the Flush group (52 vs. 67 minutes, P = 0.038). Conclusions CC and the combined use of CC and SO reduced colorectal ESD procedure time among less-experienced endoscopists.

Objetivo. Avaliar o uso combinado de marcadores sorológicos e análise espacial para ampliar a sensibilidade da vigilância epidemiológica da hanseníase. Método. Este estudo transversal foi realizado com vizinhos de casos de hanseníase e familiares e vizinhos de escolares com sorologia positiva anti-glicolipídeo fenólico I (PGL-I) em Diamantina, Minas Gerais, Brasil. Definiram-se como vizinhos as pessoas que residiam em um raio de até 100 metros de escolares e de casos de hanseníase. Para a coleta de dados, foram realizados entrevista semiestruturada, exame dermatoneurológico e teste sorológico rápido ML Flow. Todos os endereços foram georreferenciados. Foram realizadas regressão multivariada e análise espacial, tendo a sororreatividade anti-PGL-I como variável dependente. Resultados. Foram estudadas 1 491 pessoas: 1 009 (67,7%) familiares e vizinhos dos escolares com sorologia positiva e 482 (32,3%) vizinhos dos casos de hanseníase. Do total, 421 (28,2%) apresentaram soropositividade anti-PGL-I. A chance de soropositividade foi maior entre familiares e vizinhos dos escolares soropositivos (P < 0,001), entre pessoas com renda familiar de 1 salário-mínimo (P < 0,001), entre os mais jovens (P < 0,001) e entre os que residiam em domicílios com um a cinco cômodos (P = 0,007). A taxa de soropositividade foi maior em área geográfica correspondente aos escolares soropositivos (P < 0,001), ou seja, houve divergência entre o foco de maior concentração de casos e o de maior soropositividade. Conclusões. O uso combinado de marcadores sorológicos e análise espacial possibilitou identificar fragilidades operacionais dos serviços e uma possível endemia oculta de hanseníase nos setores censitários urbanos do município. Atividades de rastreamento de contatos sociais e vizinhos, busca ativa, campanhas educativas, inquéritos escolares e análise do território facilitam o diagnóstico precoce da hanseníase.

Most patients with undifferentiated thyroid cancer have unresectable disease with a very high rate of airway compromise. Tracheostomy typically entails technical issues in these cases. In fact, it can be very difficult to expose or simply locate the trachea beneath the mass, and the extensive soft tissue involvement can force the surgeon to cut the tumor to place the tracheostomy tube. The combined use of rigid bronchoscopy and percutaneous tracheostomy techniques, applied in an open surgical procedure, can greatly simplify the procedure. Furthermore, by this method, the airways are quickly secured and the risk of intraoperative bleeding is reduced.

Background/aim While controversial, cytoreductive surgery (CRS) with heated intra-peritoneal chemotherapy (HIPEC) and early postoperative intra-peritoneal chemotherapy (EPIC) remains the mainstay of treatment for low grade appendiceal neoplasm with pseudomyxoma peritonei (PMP). Our study aimed to investigate the difference in survival when administering HIPEC alone vs. HIPEC + EPIC. Additionally, we examined whether the duration of EPIC affects survival. Patients and methods We compared the difference in survival in 238 patients who underwent CRS + HIPEC alone vs. CRS + HIPEC/EPIC combination for low grade appendiceal cancer. We also compared short course (1-2 days) vs. long course (3-5 days) of EPIC. Results HIPEC/EPIC combination group (n=179) showed a significantly better 5-year survival of 95% compared to 71% in HIPEC alone (n=59). There was no statistically significant difference in 5-year survival between short course (n=22) and long course of EPIC (n=157). Conclusion Combined use of HIPEC and EPIC improves 5-year survival in low-grade appendiceal neoplasm. Two days of EPIC are sufficient.

Smooth milk production is very important to meet the baby's nutritional and nutritional needs. One of the most effective methods to increase milk production and reduce mother's stress while breastfeeding is to combine the BASOKU method (breastcare, oxytocin massage and husband's support) and regulate diet. This method is by doing breast massage, oxytocin massage on the spine as an effort to release the hormone oxytocin which can stimulate more milk production, coupled with the husband's support in exclusive breastfeeding for his baby. Mother's diet regulation that can increase milk production.The aim of the study was to determine the effectiveness of the combination of the BASOKU method and diet on increasing breast milk production at PMB Santi Yosina, Syamtalira Bayu District, North Aceh Regency.This type of research is a quasi-experimental research with a two-group posttest only design. The stages of the research are: The first stage of this research is to explain to postpartum mothers and their families about the BASOKU method and the diet that will be applied to mothers. The second stage is monitoring the increase in infant weight gain in those who receive treatment and those who do not receive the BASOKU method and diet. The population of this study were all postpartum mothers who gave birth at PMB Santi Yosina. The sample in this study used purposive sampling as many as 17 people in the control group and 17 people in the treatment group. Data were analyzed using paired t-test.The study was conducted from April to September 2021. The results of the univariate analysis showed that most of the increase in breast milk production in postpartum mothers in the intervention group in the 140-200 gram category was 15 people (88.2%) while in the control group in the

Tracheal disruption is a previously unreported complication of nonhuman primate social trauma. Two cases were identified in rhesus macaques with subcutaneous emphysema. These cases resolved with medical management and demonstrate that the combined use of radiography and tracheoscopy allows rapid assessment and diagnosis of tracheal trauma in nonhuman primates.

Objective To assess the usefulness of combined diffusion kurtosis imaging (DKI) and dynamic contrast-enhanced MRI (DCE-MRI) in the differentiation of parotid gland tumors. Methods Seventy patients with 80 parotid gland tumors who underwent DKI and DCE-MRI were retrospectively enrolled and divided into four groups: pleomorphic adenomas (PAs), Warthin tumors (WTs), other benign tumors (OBTs), and malignant tumors (MTs). DCE-MRI and DKI quantitative parameters were measured. The Kruskal–Wallis H test and post hoc test with Bonferroni correction and ROC curve were used for statistical analysis. Results WTs demonstrated the highest Kep value (median 1.89, interquartile range [1.46–2.31] min−1) but lowest Ve value (0.20, [0.15–0.25]) compared with PAs (Kep, 0.34 [0.21–0.55] min−1; Ve, 0.36 [0.24–0.43]), OBTs (Kep, 1.22 [0.27–1.67] min−1; Ve, 0.28 [0.25–0.41]), and MTs (Kep, 0.71 [0.50–1.23] min−1; Ve, 0.35 [0.26–0.45]) (all p D value (1.10, [0.88–1.29] × 10−3 mm2/s) compared with PAs (1.81, [1.60–2.20] × 10−3 mm2/s) and OBTs (1.57, [1.32–1.89] × 10−3 mm2/s) (both p trans value (0.12, [0.07–0.18] min−1) compared with OBTs (0.28, [0.11–0.50] min−1) (p Kep and Ve, D, and Ktrans to distinguish WTs, MTs, and PAs sequentially were 1.06 min−1, 0.28, 1.46 × 10−3 mm2/s, and 0.21 min−1, respectively (accuracy, 89% [71/80], 91% [73/80], 78% [62/80], respectively). Conclusion The combined use of DKI and DCE-MRI may help differentiate parotid gland tumors. Key Points • The combined use of DKI and DCE-MRI could facilitate the understanding of the pathophysiological characteristics of parotid gland tumors. • A stepwise diagnostic diagram based on the combined use of DCE-MRI parameters and the diffusion coefficient is helpful for accurate preoperative diagnosis in parotid gland tumors and may further facilitate the clinical management of patients.

This study aimed to evaluate the impact of the risk minimisation measures issued by the European Medicines Agency in 2014 to restrict the combined use of renin-angiotensin system (RAS) agents in Denmark. Data from the Danish National Prescription Registry covering all medications dispensed during January 2008-December 2018 was used. The outcome was monthly prevalence of patients co-dispensed RAS-acting agents. Autoregressive integrated moving average interrupted time series regression was used to evaluate dispensing trends. The prevalence of patients co-dispensed RAS-acting agents decreased from 0.01.0003intervention trend was declining and further decreased with an additional -0.45 (950.66, -0.25) co-dispensing per million population after the intervention. Overall, the intervention had minimal impact on the combined use of RAS-acting agents. However, as the combined use of RAS-acting agents is low, further interventions to restrict the combined use of RAS-acting agents may not be required in Denmark at this point. This study aimed to evaluate the impact of the risk minimisation measures issued by the European Medicines Agency in 2014 to restrict the combined use of renin-angiotensin system (RAS) agents in Denmark. Data from the Danish National Prescription Registry covering all medications dispensed during January 2008-December 2018 was used. The outcome was monthly prevalence of patients co-dispensed RAS-acting agents. Autoregressive integrated moving average interrupted time series regression was used to evaluate dispensing trends. The prevalence of patients co-dispensed RAS-acting agents decreased from 0.01% to 0.0003%. Pre-intervention trend was declining and further decreased with an additional -0.45 (95% confidence interval -0.66, -0.25) co-dispensing per million population after the intervention. Overall, the intervention had minimal impact on the combined use of RAS-acting agents. However, as the combined use of RAS-acting agents is low, further interventions to restrict the combined use of RAS-acting agents may not be required in Denmark at this point.

BACKGROUND: Myelomeningocele is one of the most complex congenital malformations of the central nervous system. It is one of the most common types of spina bifida which involves a failure of neural tube closure. Reconstruction surgery for myelomeningocele had always been challenging for plastic and neurosurgeons. CLINICAL CASE: We report a case of a new-born with lumbosacral myelomeningocele who received treatment in the Hospital Universiti Sains Malaysia. The myelomeningocele was repaired by the neurosurgery team and subsequently, the child was left with huge lumbosacral skin defect. The large defect was successfully covered by using a combined method of bilateral bipedicle flap with lateral releasing incision and remaining lumbosacral and secondary defect resurfaced using Integra dermal regeneration template (DRT). We used ACTICOAT interfaced negative pressure wound therapy (NPWT) as our main dressing in preparing the wound bed for autologous epidermal graft. The result of our closure technique provides tension free closure. DISCUSSION: We incorporated bilateral bipedicle fasciocutaneous flap technique together with DRT for closure of the lumbosacral defect. The bilateral bipedicle flap with lateral releasing incision served to reduce tension on the skin at bilateral lumbar region. The DRT downsized the lumbosacral defect and NPWT dressing provided an optimal sterile environment in giving time for neodermis generation. The remaining secondary defect were also resurfaced utilizing DRT and autologous skin grafting. CONCLUSIONS: The outcome of surgery demonstrated that the combined use of bilateral bipedicle fasciocutaneous flap with lateral releasing incision and DRT with delayed skin grafting is safe, effective and provide long term stable and supple scar for large, exposed dura defect.

A number of interventional procedures based on the transseptal puncture (TSP) have been developed in recent years. The increasing number of interventional procedures, as well as the use of large-bore sheaths and complex devices, has led to improvements in technique and equipment. The combined use of fluoro-scopy and of transoesophageal echocardiography (TEE) has increased safety and precision. However, TSP still represents a tricky procedure, which may become even more difficult in cases of challenging interatrial septa, and life-threatening complications may occur. Consequently, an in-depth knowledge of procedural steps, equipment, echocardiographic views, fossa ovalis anatomy and how to manage the most frequent complications is critical to performing a successful TSP.

Актуальность. Течение всех заболеваний, имеющих системный характер повреждений среднетяжелой степени, сопровождается синдромом эндогенной интоксикации (СЭИ). В статье приведены результаты динамического наблюдения за показателями СЭИ гнойно-септического генеза. Цель работы — изучить влияние сочетанного применения сорбилакта и L-аргинина при стандартной терапии в динамике (первый — седьмой дни наблюдения) на детоксикационную функцию почек и уровень показателей СЭИ. Материалы и методы. В исследование включены рандомизированные группы: I группа (контрольная) — больные с синдромом системного воспалительного ответа; II группа — больные с СЭИ, которым проводилась стандартная терапия; III группы — больные с СЭИ, которым на базе стандартной терапии назначали сорбилакт; IV группа — больные с СЭИ, стандартное лечение которых дополнялось совмещенным применением сорбилакта и L-аргинина. Результаты. Установлено, что в среде фармакотерапевтических средств применение сорбилакт-L-аргининового комплекса активирует детоксикационную функцию почек (по клиренсовым характеристикам токсичных веществ — на 216 %; молекул средней массы — на 244 %) и существенно уменьшает эндогенную интоксикацию (по клеточно-гуморальному индексу интоксикации — на 204 %). Выводы. Использование сорбилакт-L-аргининового комплекса — эффективное средство воздействия на течение синдрома эндогенной интоксикации и активность детоксикационной функции почек путем роста активности механизмов элиминации токсинов, сопровождаемое снижением токсемии.

The article considers in detail the mechanisms of therapeutic action of various mucoactive agents. Modern approaches to mucoactive therapy of respiratory diseases in children are presented, they are accompanied by the formation of a viscous secretion. At the same time, the expediency of combined use of drugs having different mechanism of mucoactive action — ambroxol and carbocysteine is justified. In addition, it helps to increase the effectiveness of antibiotic therapy for respiratory diseases.

The purpose of the work was to determine the possibilities of gut microbiota correction in the treatment of children with irritable bowel syndrome according to the analysis of scientific publications 2016–2018 in journals indexed by Scopus, WоS, MedLine and PubMed. The analysis showed that disturbances of gut microbiota play a major role in the pathogenesis of irritable bowel syndrome in children. The most effective method for the correction of intestinal dysbiosis is the combined use of probiotics and diet with fermentable carbohydrate restriction. The most effective schemes for the use of probiotics have not yet been determined, this question is the subject of further research. The positive effect of dietary fiber (including Psyllium) at this time has not been proven. The popularization of the accumula­ted experience of intestinal microbiota correction in children with irritable bowel syndrome is a necessary condition to increase the effectiveness of treatment for this disease in public health-care.

Butorphanol and buprenorphine are mixed opioid receptor agonist‐antagonist drugs widely used as analgesics in people and animals. There are few reports concerning the interaction of multiple opioids, and their antinociceptive effects, when combined with other opioids, remain unclear. Therefore, we report the preliminary findings of the antinociceptive effects of the combined use of butorphanol and buprenorphine in C57BL/6JJcl mice. Both drugs were administered either simultaneously or in different orders. Compared with the baseline values, the tail‐flick and hot‐plate test latencies increased regardless of the order of administration. Furthermore, enhanced latencies were observed on administration of butorphanol followed by buprenorphine. Combined use of these drugs may not attenuate analgesic efficacy. Besides, enhancement of these effects can be obtained by changing the order of the administration of these drugs. It is necessary to further investigate the molecular basis of the underlying mechanism in future definitive studies.

У 16 пацієнтів із хронічним обструктивним захворюванням легень з метаболічним синдромом і синдромом хронічної втоми вивчено вплив комплексного застосування препаратів ноофен та бронхо-мунал на підставі оцінки клініко-імунологічних особливостей перебігу зазначеної поєднаної патології. Використання ноофену та бронхо-муналу на додаток до традиційного лікування продемонструвало позитивну динаміку перебігу захворювання, їх призначення є доцільним для корекції вегетативних, метаболічних і імунних порушень у досліджуваної категорії хворих.

The choice of which surgical dressing to use is an important step in the postoperative care of orthopaedic patients. This decision is influenced in part by the patient's level of activity prior to surgery, medical history, wound classification, and cost. As orthopaedic wounds are inherently complex, often overlying bony prominences, it is imperative that orthopaedic providers are aware of the dressings available and how best to deploy them. Classified into three categories (passive, active, and interactive), orthopaedic surgical dressings can vary based upon their mechanism of action, absorptive capacity, and ability to provide wound protection. Through the activation or promotion of one of the four stages of wound healing, orthopaedic surgical dressings act to optimize postoperative wound care, leading to improved patient outcomes and a decrease in associated complications. The combined use of multiple dressings, with varying attributes, provides the ultimate method for obtaining the ideal orthopaedic surgical dressing. Choosing the appropriate dressing and subsequent care regimen can prevent unnecessary hospitalizations and additional costs associated with complex wound care. Future prospective trials aimed at evaluating specific dressings and their utility in orthopaedics is warranted.

SUMMARY OBJECTIVE: The aim of this study was to investigate the efficacy and safety of combined doxofylline and salbutamol in the treatment of acute exacerbation of chronic obstructive pulmonary disease. METHODS: A total of 68 acute exacerbation of chronic obstructive pulmonary disease patients were randomly divided into control group (34 cases) and experimental group (34 cases), who received the doxofylline treatment and combined doxofylline and salbutamol treatment for 1 week, respectively. During the treatment, the remission time of typical respiratory manifestations was recorded, and the adverse reactions were observed. At the end of treatment, the treatment efficacy was evaluated. Before and after treatment, the pulmonary function indexes and serological indicators were detected. RESULTS: After treatment, compared with control group, in experimental group, the effective rate of treatment was significantly increased (p0.05). CONCLUSIONS: In the treatment of acute exacerbation of chronic obstructive pulmonary disease, the combined use of doxofylline and salbutamol can quickly relieve the respiratory symptoms, mitigate the pulmonary dysfunction, and reduce the inflammatory response, thus promoting the outcome of patients.

The Costa Azul wastewater treatment plant is situated in Carlos Paz city (Córdoba, Argentina). The treated water is discharged to the San Roque reservoir, which is the source of water for the city of Córdoba and surrounding towns. Consequently, it is of great importance to evaluate the potential impact on the water quality reservoir for the preservation of public health. Currently, the WWTP lacks an accurate flow monitoring system at the last treatment: disinfection. This problem led to the development of a methodology in which experimental in-situ work and computational fluid dynamics (CFD) were applied, in a combined way, to calibrate the flow measurement system. First, large-scale particle image velocimetry (LS-PIV) was applied. The results made it possible to obtain characteristic parameters of the average flow: cross-sectional velocity profiles, recirculation and flow stagnation zones, flow discharge and characteristic parameters of the contact chamber. Second, numerical models, based on the Reynolds-average Navier–Stokes equations with the k–ε turbulent closure model were used. Based on the simulation results, it was possible to calibrate the discharge equation for a rectangular weir, and elaborate recommendations to improve the discharge measurement system and hydraulics in the area of the contact chamber curves. HIGHLIGHTS CFD simulation was used to build a head-flow curve and obtain a detail characterization of flow hydrodynamics.; Five design alternatives were modeled to improve the flow hydraulics in order to achieve the most uniform possible distribution of residence time.; Large-scale particle image velocimetry (LS-PIV) was applied to characterize of turbulent flow in prototype scale contact chamber.

BACKGROUND The study aimed to quantify the characteristics of trapezius myofascial trigger points (MTrPs) using shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) and explore the application value of the new ultrasound techniques in identifying MTrPs. METHODS Forty patients participated in this study. MTrPs in the trapezius muscle were determined by palpation, and SWE and CEUS were used to quantify the focal and adjacent areas. The elastic modulus values and CEUS parameters between the focal area of MTrPs and adjacent areas were evaluated and compared. Pathological biopsy was performed according to the above two methods, and the pathological tissues were observed by Masson staining, immunohistochemistry and electron microscope. RESULTS The elastic modulus values were significantly higher for the focal area of MTrPs compared to those for adjacent areas (P

OBJECTIVE To determine the equivalence of tranexamic acid (TXA) administration topically, intravenously or the combination of both routes are equivalent in reducing blood loss after primary total hip arthroplasty. MATERIAL AND METHODS In this prospective study, we divided 285 total hip arthroplasty into 4 groups. Group A received 2,5g of intraarticular topical TXA, Group B did not receive TXA, Group C received 1g intravenous TXA and group D a combination of topical and intravenous TXA. The main outcome was blood loss according to Nadler's formula and total hemoglobin. RESULTS Blood loss was significantly greater in Group B (Group A. 797.13ml; Group B: 1,308.24; Group C: 986.30 and Group D: 859.09ml; P

Purpose of the work: to present a method for diagnosing the activity of inflammatory bowel diseases based on a combination of electrical and viscoelastic parameters of erythrocytes and the level of fecal calprotectin.Materials and methods. We examined 109 patients (37.7±11.7 years) with IBD (50 with ulcerative colitis, 41 with Crohn’s disease, 18 patients with unclassified colitis), of which 36 patients were examined in dynamics for 0.5–1 years, and 53 surveyed comparison groups. Taking into account the observation in dynamics in 109 cases, the presence of exacerbation of IBD was established and in 36 cases — remission of the diseases. The electrical and viscoelastic parameters of erythrocytes were studied by dielectrophoresis. The level of fecal calprotectin was determined by ELISA (R-Biopharm, Germany).Results. Differentiating values have been established for a number of erythrocyte parameters: average cell diameter, polarizability at a frequency of 106 Hz, the velocity of movement of cells towards electrodes, amplitude of erythrocyte deformation at a frequency of 106 Hz, the summarized indicators of rigidity, viscosity, electrical conductivity, position of the crossover frequency and the level of fecal calprotectin to distinguish patients with IBD in stages of exacerbation and remission. The proposed method for the combined use of erythrocyte parameters and the level of fecal calprotectin provided sufficient diagnostic accuracy: sensitivity 91.9%, specificity 93.1%, accuracy index 92.3%. The advantages of this approach are minimally invasiveness, high productivity, independence of the definition from the qualifications and experience of a specialist, low cost and labor intensity, and acceptability for the patient. This approach allows to establish the presence of exacerbation or remission, regardless of the nosological form of IBD.Conclusion. The combined use of electrical and viscoelastic parameters of erythrocytes and the level of fecal calprotectin is promising for determining the activity of the disease in patients with IBD.

Objective CT enterography/enteroclysis (CTE) is listed in the clinical practice guidelines as a method for diagnosing small bowel bleeding, as is capsule endoscopy (CE), but there are no real-world data yet available on CTE in Japan. This study aimed to investigate the diagnostic ability of CTE and long-term prognosis after CTE in Japan. Patients We conducted a retrospective cohort study of patients suspected of having small bowel bleeding who underwent both CTE and CE within 30 days between April 2008 and March 2019. The number of patients free from rebleeding for up to 24 months was thus determined. Results Seventy-one patients were extracted from the database. The 43 patients (60.6%) with a definite and suspicious source of bleeding in the small bowel were detected by CTE. When the 31 patients with a definite source of bleeding in the small bowel were analyzed, the sensitivity of CTE was 19/31 (61.3%) and that of CE was 24/31 (77.4%), thus indicating no significant difference (p=0.332). However, the sensitivity when CTE and CE were used in combination was 30/31 (96.8%), which was significantly higher than that of CE alone (p=0.0412). No rebleeding was observed in the CTE and CE negative group (p=0.0965). Conclusion The combined use of CTE and CE increased the detection rate of small bowel bleeding. Therefore, in patients with suspected tumor/polyp lesions, not only CE, but also CTE should be performed. This study provides the first real-world data on the diagnostic accuracy of CTE for small bowel bleeding in Japan.

Purpose The present study evaluated the potential bone regeneration capacity of combining melatonin and simvastatin, with a goal of producing more osteogenic bone substitutes. Materials and Methods A total of 48 male Wistar rats were randomly divided into 4 groups. The following were administered into critical-sized calvarial defects of the rats: Group I–human allograft; Group II–human allograft + 10 mg melatonin; Group III–human allograft + 0.1 mg simvastatin; and Group IV–human allograft + 10 mg melatonin + 0.1 mg simvastatin. Histopathologic, histomorphometric, and microcomputed tomographic evaluations were performed postprocedurally at 4 and 8 weeks. A P value Results Groups II and III had significantly superior regeneration compared to Group I at weeks 4 and 8. Group III had significantly superior regeneration compared to Group II, particularly in week 4. Group IV had significantly superior regeneration compared to all groups at week 8. Conclusions The local administration of melatonin and simvastatin resulted in increased new bone mass and quality of bone microstructure than was seen in the control group. Simvastatin shortened the defect regeneration time more effectively than melatonin did. The combined use of melatonin and simvastatin provided a synergic effect on bone regeneration, particularly in the late phase of healing.

Resumo Fundamentos: Os escores GRACE, TIMI e HEART foram validados para avaliar desfechos clínicos desfavoráveis no contexto da suspeita de síndrome coronária aguda sem elevação do segmento ST (SCASSST). No entanto, a associação entre os escores clínicos e a complexidade angiográfica ainda não está bem estabelecida. Objetivos: Descrever as características clínicas de pacientes com SCASSST admitidos em internação hospitalar para estratificação invasiva, a fim de avaliar a associação entre os escores clínicos (TIMI, GRACE e HEART) e a complexidade angiográfica, através do escore SYNTAX. Métodos: Estudo observacional incluindo pacientes com diagnóstico de SCA e admitidos no Instituto Dante Pazzanese de Cardiologia entre os meses de julho de 2018 e fevereiro de 2019. A associação entre os escores foi avaliada por correlações bivariadas e a sua acurácia pela área sob a curva (ASC) ROC. A significância estatística foi estabelecida em 5% (p < 0,05). Resultados: Um total de 138 pacientes foram diagnosticados com SCASSST. As medianas do GRACE, TIMI e HEART foram de 97, 3 e 5, respectivamente. A mediana do SYNTAX foi de 8. Foram observadas correlações positivas do SYNTAX com o HEART (ρ = 0,29; p < 0,01) e o GRACE (ρ = 0,18; p < 0,03). Em contrapartida, a correlação com o TIMI não atingiu significância estatística (ρ = 0,15; p = 0,08). O HEART foi o escore com a maior ASC para predizer SYNTAX > 32 [HEART = 0,81] (IC 95% 0,7-0,91). HEART > 4 apresentou sensibilidade de 100%, com especificidade de 50%, e GRACE > 139 sensibilidade de 55% e especificidade de 97% para SYNTAX alto. Conclusão: Os escores clínicos de risco apresentam associação modesta ao escore SYNTAX. O uso combinado do HEART e do GRACE, entretanto, oferece acurácia favorável para a detecção de complexidade angiográfica. Abstract Background: GRACE, TIMI and HEART scores have been previously validated to predict serious untoward events among patients with non-ST elevation acute coronary syndrome (Non-ST ACS). However, the ability of these scores to discriminate the angiographic complexity of coronary artery disease has not been clearly established. Objectives: We sought to evaluate the correlation between clinical scores (TIMI, GRACE and HEART) and the anatomical complexity assessed by SYNTAX score, among non-ST ACS patients undergoing cinecoronariography. Methods: Transversal cohort encompassing patients with diagnosis of Non-ST ACS referred to invasive stratification in our single center, between July 2018 and February 2019. Association between the scores was established by the Pearson's linear correlation test while the accuracy of the clinical scores versus SYNTAX score was determined with the ROC curve. Results: A total of 138 patients were enrolled. Median GRACE, TIMI and HEART scores were 97, 3 and 5, respectively, whereas the median SYNTAX was 8. There was a positive correlation between the SYNTAX and the HEART (ρ =0.29; p 4 presented 100% sensitivity, with 50% specificity; and GRACE> 139 showed 55% sensitivity and 97% specificity for high SYNTAX. Conclusion: The clinical scores presented a positive, although modest, association with the SYNTAX score. The combined use of HEART and GRACE offers good accuracy for detecting angiographic complexity.

Design has the potential to include or exclude people, depending on how user needs are translated into products. Design exclusion has been vast in design for health care. Medication packaging design is a common example. It does a good job of protecting the product but can result in creating difficulties when used, especially for those who are older. Research in this area lacks an inclusive and user-centered approach because potential users have been studied outside of their context of living and with methods that limit participation. The aim of this study was to explore the combined use of solicited diaries and photography to engage and include older users in gathering data and reflecting on their day-to-day experiences of using multiple medications and the medication packaging. Our findings show key learnings of using this combined method, as well as related methodological challenges, and provide recommendations to tackle these challenges. The use of solicited diaries with photographs taken by participants is deemed to be relevant in interdisciplinary fields of research and practice, where designers and other professionals aim to better understand the reality of older people and create meaning in their experiences of self-care.

In the presented clinical case, we consider the surgical treatment of a 9-year-old girl with an extensive post-traumatic scalp wound in the parieto-occipital region resulting from hair getting into the moving mechanism of a go-kart car and incomplete separation of the scalp in the parieto-occipital region of the head. The early postoperative period (surgical treatment with primary wound closure) was complicated by the development of skin necrosis. An extensive wound defect in the soft tissues of the scalp (up to 150 cm2) was replaced with local related tissues. For this, various methods of plastic surgery were used in different areas of the wound defect: plastic surgery with local tissues, replacement of the defect with a rotated fascio-cutaneous flap and plastic surgery with local tissues using the dosed stretching method. The combined use of these methods made it possible to completely restore full-fledged soft tissues and hair of the injured parieto-occipital region.

Background: Responses to problem substance use have largely focused on illicit drugs, but reports on rising prescription drug misuse worldwide raise questions about their combined use with alcohol ...

Obstructive sialadenitis of the submandibular gland is most often caused by sialolithiasis and rarely by a foreign body. Here, we describe a patient with acute submandibular inflammation caused by a bamboo splinter. Transcutaneous and transoral ultrasound precisely located the splinter within Wharton's duct. Shortly thereafter, the bamboo splinter was spontaneously discharged while eating, which allowed complete remission of pain and swelling. Ultrasound confirmed the absence of the foreign body within Wharton's duct and relief of sialadenitis. Combined use of transcutaneous and transoral ultrasound can provide detailed information regarding the submandibular gland and foreign bodies, which enables proper treatment planning and adequate follow-up.

Background Diffusion‐weighted whole‐body MRI (DW‐MRI) is increasingly used in the management of multiple myeloma (MM) patients, but data regarding the prognostic role of DW‐MRI imaging response after treatment are lacking. The Myeloma Response Assessment and Diagnosis System (MY‐RADS) imaging recommendations recently proposed the criteria for response assessment category (RAC) with a 5‐point scale in order to standardize response assessment after therapy, but this score still needs to be validated. Methods We investigated the prognostic role of RAC criteria in 64 newly diagnosed MM patients after autologous stem cell transplantation (ASCT), and we combined the results of MY‐RADS with those of minimal residual disease (MRD) assessment by multiparametric flow cytometry (MFC). Results Superior post‐ASCT PFS and OS were observed in patients with complete imaging response (RAC1), with respect to patients with imaging residual disease (RAC≥2): median PFS not reached (NR) versus 26.5 months, p = 0.0047, HR 0.28 (95% CI: 0.12–0.68); 3‐year post‐ASCT OS 92% versus 69% for RAC1 versus RAC ≥2, respectively, p = 0.047, HR 0.24 (95% CI: 0.06–0.99). Combining MRD and imaging improved prediction of outcome, with double‐negative and double‐positive features defining groups with excellent and dismal PFS, respectively (PFS NR vs. 10.6 months); p = 0.001, HR 0.07 (95%CI: 0.01–0.36). Conclusion The present study supports the applicability of MY‐RADS recommendations after ASCT; RAC criteria were able to independently stratify patients and to better predict their prognosis and the combined use of DW‐MRI with MFC allowed a more precise evaluation of MRD., The present study supports both the applicability and the clinical usefulness of the proposed Myeloma Response Assessment and Diagnosis System (MY‐RADS) recommendations applied to DW‐MRI imaging obtained after first‐line treatment of MM including ASCT. MY‐RADS RAC criteria were able to independently stratify patients and to better predict their outcome and their prognosis. DW‐MRI proved to be a powerful tool for the assessment of residual bone disease by functional imaging: it complemented bone marrow flow cytometry and may, therefore, represent a step forward in the clinical management of the increasing number of MM patients achieving CR with the novel treatment approaches.

La aspiración con aguja fina (ACAF) es una técnica ampliamente utilizada por su alta seguridad y fácil uso. Sin embargo, al usarse en conjunto con la evaluación rápida de la muestra en el sitio de la toma (ROSE, del inglés, Rapid On-Site Evaluation), disminuyen los tiempos necesarios para la evaluación y el diagnóstico, mejora la calidad de la muestra, disminuye el número de punciones por procedimiento y limita la necesidad de repetir la prueba, lo que hace que el uso combinado de ambas técnicas sea de gran utilidad y cada vez más solicitado en los servicios de imágenes diagnósticas y patología. ROSE, además, permite una clasificación adecuada del material recolectado para cultivos, estudios de citometría de flujo y pruebas moleculares. Particularmente, en los pacientes con nódulos tiroideos, la realización de ROSE durante el procedimiento de evaluación ecográfica y punción, puede garantizar que la muestra extraída sea suficiente y adecuada para el diagnóstico, y, así mismo, permite evaluar la necesidad de estudios complementariosde manera inmediata, brindando un diagnóstico rápido y preciso, disminuyendo los costos relacionados con la repetición del procedimiento y la morbilidad asociada a complicaciones por punciones múltiples.

Background.Osteoporosis is the fourth most common disease after cardiovascular diseases, cancer, and diabetes. All these diseases have common pathogenetic mechanisms associated with impaired cholesterol metabolism. In recent decades, the use of the key enzyme of cholesterol synthesis inhibitors — statins, which can stimulate osteogenesis, has become widespread. However, statins affect the production of the vitamin D active form by reducing the production of testosterone and thus reducing the activity of 1α-hydroxylase. The combined use of statins and α-calcidol (α-C) for the osteoporosis prevention seems promising. The aim of the study was to evaluate the effect of long-term atorvastatin (ATV) and α-C administration on morphometric growth parameters and bone vascularization in the experiment.Materials and Methods. The experiment was conducted for three months on 120 laboratory male rats, which were injected daily intragastrically with ATV and α-C. After 90 days of the experiment, the animals were decapitated under ether anesthesia. For the study, the right femur and jawbone were taken from the animals. The rat bone sections were impregnated with silver, decalcified, and the histosections were stained according to van Gieson. The distribution of the studied features was evaluated according to the Shapiro-Wilk test. The differences were considered statistically significant at p0.05.Results.It was found that ATV, both separately and together with α-C, increased the size of the newly formed bone in the endoostal and periosteal zones of the femur by 64.8; 40.4 and 15.8; 29.1%, respectively. The combined use of ATV and α-C had a positive effect on the growth of blood vessels in the femur (+23.4%). ATV increased the size of the newly formed bone from the periodontal and vestibular surfaces of the lower jaw by 18.3 and 29.5%, respectively. α-C potentiated the effect of ATV on the size of the newly formed bone tissue in the periodontal and vestibular growth zones of the mandibular bone by 10.1 and 15.0%, respectively. As for the number of vessels in the jawbone tissue, thanks to ATV, it increased by 17.2%, α-C had no effect.Conclusion. ATV increases the thickness of the newly formed bone layer in the growth areas of the femur and jawbone and increases the number of vessels in the jawbone. α-calcidol increases the number of vessels in the bone tissue of the femur and potentiates the effect of ATV on the jawbone growth zones. The combined use of ATV and α-C shows that they positively complement each other.

Purpose This study aimed to evaluate the reproducibility and diagnostic performance of a quantitative parameter of superb microvascular imaging (SMI) in real-time breast ultrasonography (US) for differentiating benign from malignant breast masses. Methods Eighty-seven breast masses in 75 patients who underwent both B-mode US and SMI before US-guided core needle biopsy were included in this study. Two radiologists performed B-mode US and measured the vascular index (VI) of SMI respectively for each lesion in real time. Intraobserver and interobserver agreements were analyzed for the VI of SMI. The diagnostic performance of B-mode US using the Breast Imaging Reporting and Database System lexicon and combined use with the VI of SMI was evaluated compared to pathology. Results The median VI of malignant masses (n=32) was significantly higher than that of benign masses (n=55) (7.6% and 2.6%, respectively; P

Objective This study aimed to investigate interferon-gamma-inducible protein-10 (IP-10) values in serum and urine in pediatric patients in the diagnosis of active tuberculosis (TB) or latent TB infection (LTBI). It also aimed to investigate whether it can be used as a biomarker to distinguish between active TB and LTBI. Methods Our study comprised active TB (25 patients), LTBI (25 patients), and the “infected” group (50 patients) formed by combining the two groups. As the control group, 37 healthy children were included in the study. TB skin test, plasma IP-10, and urine IP-10 measurements were performed in all patients included in the study. An additional QuantiFERON-TB Gold In-Tube (QFT-GIT) test was performed on patients evaluated as active TB or LTBI. Results Plasma IP-10 levels of the patients in the active TB, LTBI, and the “infected” groups were significantly higher than the control group (p = 0.022, p = 0.028, and p = 0.007, respectively). Urine IP-10 was successful in distinguishing the active TB and “infected” groups from the control group (p = 0.007 and p = 0.047, respectively). Also, in the combined use of the tests, when QFT-GIT and urine IP-10 were positive together, active TB and LTBI could be distinguished (p = 0.044). Urine IP-10 levels were found to be significantly higher in those with pulmonary TB than those with extrapulmonary TB (p = 0.012). Conclusion Our findings suggest that IP-10 can be used as a useful biomarker in the diagnosis of active TB in children.

The paper considers the possibilities of using in medical practice various cryomethods and techniques of cryopreservation of biological objects to treat the patients with purulent chronic wounds (PCW). The variety of methods and approaches to apply cold in medical practice: general and local cryotherapy, cryosurgery etc. has been emphasized. As a result of using each of these methods, regenerative processes begin, which promote the healing of PCW. Particular attention is paid to cryotechniques, ensuring the preservation of cord blood at low temperatures. Cord blood cells and serum have been shown to have immune modulatory and trophic-stimulating therapeutic effects, that is extremely important when treating the patients with PCW. The issue of combined use of cord blood serum and innovative vacuum therapy for the patients with PCW has been considered. Probl Cryobiol Cryomed 2021; 31(2): 109–115

Background. The introduction of the combined and sequential application of transosseous and intramedullary blocked osteosynthesis in limb lengthening requires an experimental study of the features of distraction regenerate. For small animals (in particular rabbits), special models are required.Aims. To develop experimental models of sequential and combined use of transosseous and intramedullary osteosynthesis in limb lengthening and substantiate their effectiveness.Materials and methods. A comparative study was carried out on 30 rabbits of the Soviet Chinchilla breed. Experimental models of sequential (EM-1) and combined (EM-2) application of transosseous and intramedullary osteosynthesis with preservation of the apparatus during the fixation period to simulate blockage were studied in the main groups. For comparison, sequential (comparison model 1 – CM-1) and combined (comparison model 2 – CM-2) use of transosseous and intramedullary osteosynthesis with dismantling of the apparatus at the end of distraction were modeled. The control was a regenerate formed according to the classical Ilizarov method. Radiographs were performed in dynamics, CT and morphological studies – at the end of the fixation period.Results. It was noted that regenerates of the same type in structure were formed in the EM-1 and CM-1 groups, as in the EM-2 and CM-2 groups. With successive methods, the spindle-shaped form of the regenerate prevailed, the formation of a pronounced periosteal component was noted. Powerful cortical plates, according to morphological studies, are formed from the periosteal and intermediate zones. With combined techniques, the cortical plates are formed thinner and predominantly from the periosteal component, the shape of the regenerate is closer to fusiform. In the comparison groups, the total time of surgical interventions was 25–50 % longer, in 50 % of cases there was a loss of length or deformation of the regenerate.Conclusions. The developed models of sequential and combined use of transosseous and intramedullary osteosynthesis for limb lengthening with preservation of fixation with an apparatus to simulate blocking have proven to be reliable in terms of fixation and easy to use on small laboratory animals..

Summary. Purpose. The improvement of the treatment effect of patients with a decompensated form of the chronic venous insufficiency. Reduction of the reatment period in a hospital by application of the complex treatment. Materials and methods. The work was based on the studies of 24 patients who had trophic ulcers on the lower leg. All patients have undergone combined treatment, including scleroobliteration of perforating veins, phototherapy, platelet-derived growth factor, the use of wound closure with a heterograft. Results and discussion. The combined use of phototherapy and platelet-derived growth factor has significantly reduced the duration of all phases of the wound process. The ultrasound-controlled scleroobliteration has helped to remove a pathological reflux in the insolvent tibial perforators. The studies have shown that the use of phototherapy in the treatment of trophic ulcers with the application of the heterograft has contributed to the rapid cleansing of wounds, accelerating the appearance of granulations and epithelialization, has reduced the need for antibacterial therapy and is an alternative to autodermoplasty. Conclusions. The use of the offered technique allows to reach optimum restoration conditions of the affected fabrics trophism, leads to the decrease in the number of complications and reduces the hospitalization period.

Aim: to improve the results of fistula treatment, to evaluate the effectiveness of the combined use of LIFT and FiLaC techniques.Patients and methods: the study included 35 patients with transsphincter fistulas of cryptopglandular etiology involved more than 1/3 of the sphincter. All patients underwent surgery with laser energy (the laser conductor speed is 1 mm per second, the wavelength is 1470 nm, the radiation output is 13 W) after the LIFT procedure.Results: the primary healing rate was 28/35 (80,0%). The patients who failed the combined procedure (cases of prolonged healing more than 3 months) underwent a second procedure ReFiLaC, which led to the closure of fistula in 2 of 3 patients. A median follow-up period was 10,2 months. No incontinence to solid and liquid stools was detected.Conclusion: preliminary results of the study permits to assess the potential of the combined low-invasive approach for anal fistulas as positive.

Regional anesthesia has been widely used in clinical practice. Over the past 30 years, various guidance techniques have been developed for regional anesthesia ranging from paresthesia progressing to neurostimulation and currently ultrasound guidance. Especially, the use of point-of-care ultrasound greatly enhances the success rate of regional anesthesia. However, the poor imaging quality of ultrasound in patients with obesity, fat infiltration, etc., limits the use of ultrasound. The combined use of ultrasound with neurostimulator, electromyography, pressure monitoring, etc. is advocated in order to facilitate regional anesthesia in this cohort of patients. The accumulated evidence has shown that the ultrasound combined with other techniques (UCOT) can help to solve the difficulties of puncture location caused by obesity, anatomical variation, and other factors when using ultrasound guidance alone. In recent years, with the development of medical image fusion and medical image artificial intelligence identification technology, guidance techniques for regional anesthesia have advanced considerably. To understand the advantages and disadvantages of the various guidance techniques for regional anesthesia developed in recent years and to guide their rational clinical application, this paper reviews these techniques, describing the progression from the early use of paresthesia to the latest UCOT, as well as the latest research on UCOT, and the prospects for the development of new guidance techniques for regional anesthesia.

Background We compared cardiovascular magnetic resonance segmental native T1 against T2* values for the detection of myocardial iron overload (MIO) in thalassaemia major and we evaluated the clinical correlates of native T1 measurements. Methods We considered 146 patients (87 females, 38.7 ± 11.1 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassaemia Network. T1 and T2* values were obtained in the 16 left ventricular (LV) segments. LV function parameters were quantified by cine images. Post-contrast late gadolinium enhancement (LGE) and T1 images were acquired. Results 64.1% of segments had normal T2* and T1 values while 10.1% had pathologic T2* and T1 values. In 526 (23.0%) segments, there was a pathologic T1 and a normal T2* value while 65 (2.8%) segments had a pathologic T2* value but a normal T1 and an extracellular volume (ECV) ≥ 25% was detected in 16 of 19 segments where ECV was quantified. Global native T1 was independent from gender or LV function but decreased with increasing age. Patients with replacement myocardial fibrosis had significantly lower native global T1. Patients with cardiac complications had significantly lower native global T1. Conclusions The combined use of both segmental native T1 and T2* values could improve the sensitivity for detecting MIO. Native T1 is associated with cardiac complications in thalassaemia major.

Aim:Traumatic rib fractures are a common injury in the trauma population and may cause severe pain in cases of both isolated rib fractures and chest injuries. The aim of our study was to compare the early pain control of intercostal block with that of intravenous analgesia + intercostal nerve block in patients with rib fractures admitted to the emergency department due to blunt thoracic trauma.Materials and Methods:Patients admitted to the emergency department due to blunt thoracic trauma in a tertiary medical facility were evaluated retrospectively. Forty-eight patients were included in the study. The patients were divided into two groups: on in which only intercostal nerve block was performed and another in which intravenous analgesia + intercostal block were performed concurrently.Results:Nine patients (18.7%) were given only intercostal block, while 39 patients (81.3%) were given intravenous analgesia + intercostal nerve block. Considering the early pain results of group A (intercostal nerve block) and group B (intravenous analgesia + intercostal nerve block), significant improvement was observed in group B in terms of pain results after the first 15 minutes.Conclusion:We conclude that the combination of intravenous nonsteroidal anti-inflammatory drugs or opioid derivatives and intercostal nerve block would be an effective combination in pain control in patients with rib fractures. In addition, intercostal nerve block would be beneficial in pain control and increase respiratory efficiency in patients with rib fractures, since it is both easy to apply and accelerates healing by providing effective analgesia. Due to these positive effects, we believe that it reduces the duration of hospital stay and would offer great advantages in terms of efficiency and cost.

This article studies information freshness in information update systems with nonorthogonal multiple access (NOMA). Information freshness is characterized by age of information (AoI), defined as the time elapsed since the generation of the last successfully received update. Conventional orthogonal multiple access (OMA) systems, say time-division multiple access (TDMA) systems, lead to high average AoI when a large number of users take turns to transmit their latest samples to a common receiver over a wireless medium. In contrast to OMA, NOMA allows multiple users to transmit simultaneously. Although NOMA could lead to higher packet error rates (PER) due to the wireless interference among users, we show that higher PERs do not always lead to a higher average AoI. Specifically, our experiments on software-defined radio indicate that NOMA with conventional multiuser decoding (MUD) techniques leads to higher PERs but lower average AoI than OMA does in the high SNR regime. Furthermore, to improve the AoI performance in the medium SNR regime, we combine MUD with physical-layer network coding (PNC), a technique that turns wireless interference into useful network-coding information. PNC works well even when the SNRs of different NOMA users do not differ much. This article is the first attempt to apply PNC to information update systems. Experiments show that the combined use of PNC and MUD reduces the average AoI significantly in a practical network setting. Overall, PNC-enabled NOMA is a promising solution to information update systems.