3rd Degree Research Articles

Uticaj starenja na demografiju, povrede i obrasce lečenja bolesnika sa opekotinama

Introduction: This study aims to investigate the effect of increasing age on the demographic, injury, and healing patterns of burn patients. Material and Methods: Patients who were followed up for burns in the Diyarbakır Gazi Yaşargil Training and Research Hospital Burn Centre were examined. Results: In this study, the data of the age groups of 1415 patients with burn injuries were examined. In all groups, the most frequent cause of burns was scalding. The right and left lower extremities were the areas most affected by burns in all age groups. When we examined the patients, 74.1% of them had 2nd-degree burns. After the age of 25, the rate of 3rd degree burns increased in parallel with age. The rate of patients with (+) wound culture results in all age groups was highest in the 1-month to 4-years-old groups and after 45 years of age. APACHE scores of our patients were significantly higher for patients especially for those over the age of 65. The rate increased in patients over 65 years of age. Conclusion: We observed that the treatment of burns became more severe with increases in age, and mortality and morbidity rates increased.

SENSITIVITY RESEARCH ON MODELS OF EARTH ENTRY AND IMPACT EFFECTS BY ASTEROIDS

Asteroid impact on Earth is one of the potential threats to human beings. Engineering models of Earth entry and impact effects by asteroids have been developed in order to estimate ground hazard by planetary defense communities nowadays. However, there are large uncertainties in input parameters of these models, which not only brings trouble to use of the model, but also greatly affects results of hazard estimate. Ranges of input parameters are analyzed, of Which baseline values are taken as maximum probability values or recommended values in literatures. Furthermore, by changing one or more input parameters based on ranges and baseline values, AICA (Asteroid Impact Consequence Analysis) code developed by authors of this paper, are used to study sensitivity of output parameters, such as energy deposition, airburst altitude, radius of 4psi overpressure and 3rd degree burn, to input parameters. The results are given for stony asteroids with diameter of 60~300~m and entry velocity of 12~40~km/s. It is indicated by results that airburst altitude of asteroid trends to decrease, with increase of size, strength at 1st breakup and mass fraction of debris cloud, and with decrease of entry velocity and ablation coefficient. Drag coefficient of asteroid and fragment, as well as strength scaling exponent, has little effect on airburst altitude and ground damage range. Radius of overpressure and thermal radiation damage generally increases with increase of size and entry velocity. If mass fraction of debris cloud is less than 50%, airburst altitude and ground damage range will fluctuate. But a large value for mass fraction of debris cloud, such as 80%, is reasonable according to analysis of many meteor events at present. Luminous efficiency only affects damage range of thermal radiation. Under the computational condition in this paper, radius of 3rd degree burn is less than that of 4-psi overpressure, indicating that the main type of ground hazard is overpressure caused by airburst.

Software to Predict the Process Parameters of Electron Beam Welding

This paper discusses the problem of choosing the effective process parameters of electron beam welding (EBW). To that end, the research team has developed a mathematical model that applies machine learning to predict the effective process parameters. Since predicting process parameters requires a regression model, this research uses regression analysis algorithms such as the ridge regression and the random forest regressor. The paper analyzes whether these algorithms are applicable to the problem and tests the accuracy of their predictions. To generalize the approach and strengthen the justification of choosing the hyperparameters of the regression algorithms studied herein and considering the high variability of these hyperparameters, the multiobjective optimization technique applicable for this combinatorial problem - an (evolutionary) genetic algorithm - is proposed to determine effective sets of hyperparameters. All the models successfully addressed the task, achieving a forecasting accuracy of at least 89%. The article presents the final form of the ridge regression model describing the dependence of the weld’s depth and width: for the weld depth, there is a 2nd degree polynomial dependence with a regularization of 10 <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">−5</sup> , and for the weld width, there is a 3rd degree polynomial dependence with a regularization of 10 <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">−4</sup> . An automated system based on this approach that accurately predicts the process parameters is proposed herein. In addition to performing basic modeling functions, the proposed system allows the visualization of the model-predicted data in the form of an interactive plot. This function could be useful for technologists by allowing them to determine the process parameters that ensure the required weld dimensions. Adopting the proposed EBW parameter prediction method in practice will provide decision support for cases when engineers need to test the EBW process or to start making new products.

Ethical dilemmas in managing severe burns:Is there a place for palliative care?

Introduction: Despite advances in treatment strategies, patients with severe burns rapidly develop complex metabolic changes and multiorgan failure, compromising survival. Severe burns are the ones complicated by major trauma or inspiratory injury, chemical or electrical ones and generally any burns in adults occupying >20% of body surface area, except for superficial burns. Methods: The presentation of ethical dilemmas in the management of a critically ill burn patient in the emergency department (ED). Results: A 31-year-old patient was admitted to the ED with 2nd and 3rd degree burns >80% of the total body surface after a tank explosion with hot water and chemicals. Initially presented in full awareness, without wheeze, in hypoxia, hemodynamically unstable with constant unbearable, agonizing pain. A multidisciplinary team consisting of anesthetists, emergency physicians, ENT, intensivist and plastic surgeon was immediately gathered. Some members of the team raised the issue of delayed anesthesia and endotracheal intubation so that the patient could speak to his family who were on the way, as his imminent death was considered almost certain. However, immediate intubation was performed. The patient eventually died 4 hours later in ICU after marked hemodynamic instability and multiorgan failure. Conclusion: During management of patients with predicted high mortality, immediate decisions are often required to enhance even minimum chances of survival. These decisions often do not consider the real benefit and wishes of the patient at that moment, which raises some ethical dilemmas. Triage of patients for palliative care without transfer to a specialised burn centre is a difficult decision, especially in the absence of both legal framework and a pre-recorded “medical will” of patients, where the goals of care based on their values and wishes are clear.

Analytical method for determining the fault location in 10 kV electric networks by the equations of the 3rd degree relative to voltages

Analytical method for determining the fault location in 10 kV electric networks by the equations of the 3rd degree relative to voltages

Optimization of the process of electrochemical wastewater treatment of yeast production

The process of purification and disinfection of yeast production sewage under the action of electrodialysis has been studied. As a result of research to determine the physicochemical and microbiological sewage composition, it was found that in sewage of the 1st degree of yeast separation has the highest excess content of organic and mineral substances in terms of: Chemical oxygen consumption (COC) - 31096/500 mg О2 / dm3, suspended solids - 6800 / 300 mg / dm3, chlorides - 2147/350 mg / dm3and sulfates - 6089/400 mg / dm3. The content of organic substances, which is characterized by the Chemical oxygen consumption (COC) indicator, in sewage of general discharge, 2nd and 3rd degree of yeast separation is 41%, 50% and 74% and that is lower than in sewage of the 1st degree of yeast separation. The number of microorganisms in terms of Total microbial count (TMC) in sewage of the 1st stage of yeast separation is the largest and is 12·107 colony-forming units CFU / cm3. It is determined that the process of sewage treatment and disinfection from minerals occurs more efficiently in the cathode zone, and from organic substances and microorganisms - in the anode zone of the electrodializer at a water temperature of 293 K, current of 0.1 A and duration of exposure 20 min.

Grain size radioactivity of surficial quaternary deposits of Wadi Arar, Saudi Arabia

The present study aims to distribute radioactive elements (radium 226Ra, thorium 232Th, and potassium 40K) within different grain sizes (gravel, coarse sand, medium sand, fine sand, and silt and clay) of quaternary alluvial deposits of Wadi Arar, north of Saudi Arabia. According to correlation analysis, r, radioactive elements have different correlations with different grain sizes and distance of Wadi Arar. Depending on hypothesis testing, Ra is the only element that has a significant correlation, with coarse sand and distance (− 0.82 and − 0.78, respectively), which is a strong and negative correlation. Upon the coefficient of determination, R2 (0.9), the reaction between Ra and both coarse sand content and distance are controlled by 3rd degree polynomial function. Conversion and diversion patterns through the distance between Ra and coarse sand content indicate the availability of three different lithofacies longitudinally, from upstream to downstream, (i) low content of coarse sand with high Ra concentration in the southwestern, (ii) medium content of coarse sand with medium Ra concentration in the central, and (iii) high content of coarse sand with low Ra concentration in the northeastern of Wadi Arar. With the increasing coarse sand content from upstream (SW) to downstream (NE), these three zones include a general decrease of Ra. Although there is a negative relationship between Ra and coarse sand content in the meander’s southern part, there is a positive relationship in the northern region, which increases the zonation to six by dividing the longitudinal zones by two for each.

VEGETABLE CELLULOSE NANOFIBER DRESSING AIDS IN THE HEALING PROCESS OF THIRD-DEGREE BURNS? STUDY ON RATS.

ABSTRACT Background:The treatment of 3rd degree burns represents a major medical challenge. Pinus vegetable cellulose is a biomaterial with characteristic similar to bacterial cellulose. Aim:To evaluate the safety of cellulose membrane (Pinus sp) in the treatment of 3rd burns in rats and to compare its effectiveness with the bacterial membrane already on the market. Method:Thirty-three Wistar rats were beaten with a 3rd degree burn on back skin by applying water at 98º C for 30 s. Then, they were divided into three groups (n=11): group 1 - simple dressing with gauze; group 2 - dressing with bacterial cellulose membrane; and group 3 - dressing with vegetable cellulose membrane. The animals were maintained for 15 days to check the general clinical status, macroscopic aspect, contraction of the wounds and microscopic analysis for the degree of healing and collagenization. Results:They were clinically well during the experiment. During the removal of the dressing, there was bleeding in the wound of the control group, unlike the groups treated with cellulose membranes, which protected the bed from injury. The macroscopic evaluation showed a greater contraction of the wounds treated with the membranes in relation to the control. A microscopic analysis revealed that most of the wounds were in advanced healing degree with predominance of mature collagen in all groups. Conclusion: Pinus sp cellulose membrane showed efficacy similar to that of the bacterial membrane in the treatment of 3rd degree burns.

MORPHOLOGICAL FEATURES OF CELLULAR INFILTRATION IN THE MUCOSA OF LARGE INTESTINE IN ULCERATIVE COLITIS AND IRRITABLE BOWEL SYNDROME

The aim is to improve morphological diagnostics, including differential, of UC and IBS, identifying morphological features of cellular infiltration in the mucous membrane ofthe large intestine. Material and methods: Autopsy and biopsy material - fragments of the mucous membrane of the large intestine was used in this study. All the material was divided into 5 groups. Group 1 included autopsy material from 6 cases, in which no general pathological processes in the gastrointestinal tract were detected during autopsy and microscopic examination. Group 2 included biopsy material from 34 patients with diagnosed UC of the 1st activity degree. Group 3 included the biopsy material of 27 patients with UC of the 2nd degree of activity. Group 4 included biopsy material from 19 patients, diagnosed with UC of the 3rd degree of activity. Group 5 included biopsy material from 82 patients with clinically diagnosed IBS. Histological, morphometrical, immunohistochemical and statistical methods of investigation were used. Results: The mucous membrane of the large intestine in patients with ulcerative colitis of varying degrees of activity, compared with the physiological norm, has pronounced infiltration by plasma cells, T-lymphocytes, B-lymphocytes, macrophages, mast cells, eosinophilic and neutrophilic leukocytes in the superficial parts of the epithelium, crypts,lamina propria. There is also an increase in the number and size of lymphoid follicles in the lamina propria. Predominant cellular elements in the infiltrate are plasma cells, T-lymphocytes, eosinophilic and neutrophilic leukocytes. The growth of ulcerative colitis activity leads to an increase the inflammatory cell infiltration in the mucous membrane of the colon, as evidenced an increase the density of cellular infiltrate; the severity of inflammatory changes in crypts and an increase in the number of crypt abscesses; a decrease the number of cases with focal infiltration in the lamina propria and an increase the number of cases with diffuse infiltration; the spread of inflammatory cell infiltration from the superficial parts of the lamina propria to its deep parts with the subsequent involvement of its entire thickness; an increase the central trends of the indexes of the severity of all cellular infiltration, infiltration by plasma cells, T-lymphocytes, macrophages, neutrophilic leukocytes. The mucous membrane of the large intestine in patients with irritable bowel syndrome has moderately pronounced cellular infiltration in the superficial epithelium andlamina propria, in comparison with the physiological norm. The number and size of lymphoid follicles increase. Inflammatory cell infiltration often spreads to the upper onethird or two thirds of the thickness of the lamina propria, characterized by the presence of plasma cells, T-lymphocytes, B-lymphocytes, macrophages, mast cells, eosinophilic and neutrophilic leukocytes. In this case, plasma cells, T-lymphocytes, mast cells and macrophages dominate. The indexes of the severity of all cellular infiltration, as well as infiltration by plasma cells, T-lymphocytes, B-lymphocytes, macrophages, mast cells, eosinophilic and neutrophilic leukocytes, increases in the mucous membrane of the large intestine in irritable bowel syndrome in comparison with the norm. In the mucous membrane of the large intestine in irritable bowel syndrome compared with ulcerative colitis of varying degrees of activity inflammatory cell infiltration is less pronounced. It often extends to one third or two thirds of the thickness of the lamina propria. There are fewer lymphoid follicles, cryptitis and crypt abscesses are not determined. The indexes of the severity of all cellular infiltration, as well as infiltration by plasma cells, T-lymphocytes, eosinophilic and neutrophilic leukocytes are lower. Conclusions: The revealed features of cellular infiltration in the mucous membrane of the large intestine make it possible to improve morphological diagnostics, including differential, of ulcerative colitis of varying degrees of activity and irritable bowel syndrome.

Analysis of Disability due to Diabetes Mellitus in a Large City

Significance. A majority of people with diabetes are unaware of having diabetes complications. When not well managed, all types of diabetes can lead to complications in many parts of the body, resulting in disabilities and early death. Purpose. To study the dynamics of the disability of the population of Almaty (Republic of Kazakhstan) due to diabetes Material and methods. Data was collected from the registries of medical records in the Republic Center of Electronic Healthcare, Ministry of Health of the Republic of Kazakhstan and Department of Labor, social protection and migration in Almaty for the period from 2013 to 2017. The object of the study was 651 patients – residents of Almaty, suffering from diabetes mellitus, who were identified as a «disabled child», I, II and III disability groups during the initial examination in 2013-2017 by the territorial departments of medical and social expertise. There were 298 disabled people due to type 1 diabetes, and 353 disabled people due to type 2 diabetes. The study group consisted of 309 women and 342 men. The paper uses data from medical and social examination records, extracts from the medical history and outpatient cards of disabled people suffering from diabetes. Statistical methods the analysis in the research was carried out on the basis of descriptive statistics: average values and standard deviations. Results. Majority of disabled people had decompensated disease. Diabetic retinopathy observed in 29.63 ± 0.06%, including among disabled people of 1st degree is 12.0%, among disabled people of 2nd degree is 42.0%, among disabled people of 3rd degree - 46.0%. Diabetic nephropathy (stage 3 or more) was detected in 22.92% ± 0.03%, including chronic renal failure. Diabetic foot syndrome over five years averaged 19.69 ± 0.04%. Of these: 1st degree disabled people - 15.3%, 2nd degree - 76.3%, 3rd degree - 8.4%. In last 5 years amputations between people with disabilities due to diabetes averaged 12.63 ± 0.02%. Amputation of one or both lower limbs is an irreversible process; it is also the most serious complication of diabetes. Discussion. The results are stated that the indicator of disability due to diabetes among the population of the city of Almaty is affected by type II diabetes adult contingents of the population and type I diabetes more often by children and adolescents. Severe complications (diabetic retinopathy, diabetic nephropathy, diabetic foot syndrome and limb amputation), early disability, premature death put this disease on a par with global health problems.

A study of the degree of inflammatory response of atherosclerotic plaque in the coronary artery in patients with impaired metabolism of homocysteine and vitamin D

Increased homocysteine (HC) levels and vitamin D deficiency play an important role in the progression of cardiovascular disease (CVD). However, to date, in medical publications, the issues of the influence of hyperhomocysteinemia (HHC) and vitamin D deficiency on the degree of the inflammatory response of atherosclerotic plaque (AsP) are insufficiently covered, which requires a detailed study of this problem. There is an opinion that inflammation contributes to the pathogenesis of CVD, therefore the identification of inflammation markers can improve the assessment of the risk of cardiovascular diseases.The aim of the study was to assess the morphological picture of inflammatory lesions of the atherosclerotic plaque depending on the degree of hyperhomocysteinemia and levels of vitamin D deficiency in patients with coronary artery disease.Materials and methods. The study analyzed data from 26 patients who, in addition to determining the level of homocysteine and vitamin D, underwent morphological studies of atherosclerotic plaque from the lumen of the coronary arteries. Samples were obtained during coronary artery bypass grafting. Depending on the level of HC and vitamin D, the patients were divided into 3 groups: the first group – patients with normal levels of homocysteine (up to 10 µmol/L) and vitamin D (more than 30 µmol/L); the second group – patients with hyperhomocysteinemia (10.38–40.08 μmol/l) and a sufficient level of vitamin D (more than 30 ng/ml); The third group – patients with hyperhomocysteinemia (more than 10.38 μmol/l) and vitamin D deficiency (less than 30 ng/ml).Results. Evaluating the morphology of AsP, we were interested in the presence of lymphocytes and segmented neutrophils, indicating an inflammatory process in the atherosclerotic plaque. In our work, a positive correlation was established between the concentration of HC (γ = 0.92) and the degree of the inflammatory response of ASB. A negative correlation was also found between the level of vitamin D (γ = -0.81) and the degree of ASP inflammation. The overwhelming number of patients, both 2 and 3 groups of the study, had exacerbations of the inflammatory process of ASB, which was confirmed by the presence of segmented neutrophils (7–10 segments in 2 mm2 plaques), corresponding to the 3rd degree of the inflammatory reaction.Conclusions. Most CHD patients have high homocysteine levels and vitamin D deficiency. Hyperhomocysteinemia and hypovitaminosis D affect the quantitative and qualitative complications of atherosclerotic plaque. Patients with severe hyperhomocysteinemia and vitamin D deficiency had a more pronounced inflammatory response of atherosclerotic plaque.

Анализ кривой обучения хирургов в зависимости от сложности нефрометрической оценки при выполнении лапароскопической резекции почки у пациентов с локализованными образованиями паренхимы почки

Aim to analyze the learning curve of surgeons while performing laparoscopic partial nephrectomy in patients with localized renal parenchymal lesions by calculating the MIC (negative surgical margin, ischemia, and complications) index depending on tumor complexity according to the R.E.N.A.L. and PADUA nephrometric scores. Materials and methods the retrospective study included the results of laparoscopic partial nephrectomies in 320 patients with localized renal parenchymal lesions. The procedures were carried out by four surgeons from the Institute of Urology and Human Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia (EC-1; ESH-4; EB-7; ME-13) from January 2014 to June 2019. At baseline, all operators had experience of performing at least 30 laparoscopic interventions. In addition to the standard preoperative examination, a 3D virtual planning was carried out using the Amira 3D modeling program. In all cases, the nephrometric assessment of complexity was performed according to the R.E.N.A.L. and PADUA scores. The learning curve was assessed based on the results of operations based on the MIC index. All surgical interventions were divided into eras. In the era, 40 consecutive procedures for each operator were evaluated. Acquired skills were assessed over two eras. Results The average age of patients, of which 191 (59.7%) were men, was 54.4+/-11.37 years. The average body mass index was 28.55+/-3.85 kg/m2, the absolute volume of kidney lesions was 26.72+/-43.72 cm3, the average Charlson comorbidity index was 1.46+/-1.29, the average R.E.N.A.L. and PADUA scores were 6.38+/-1.75 and 7.92+/-1.51, respectively, the average duration of procedure was 150.36+/-50.18 min, the average blood loss was 227.94+/-280.22 ml, the average time thermal ischemia was 13.28+/-7.82 min. Postoperative complications were seen in 36 (11.2%) cases, of which grade III and more according to Clavien-Dindo developed in 8 patients (2.5%). A positive surgical margin was found in 4 (1.2%) patients. The overall MIC index was achieved in 243 (75.9%) cases; in era 1 it was seen in 71.9% cases in comparison with 80% in era 2. With the 1st degree of complexity (152 (47.5%) patients), MIC was achieved in 80.9% of cases, compared to 76.6% and 56.8% in patients with 2nd degree of complexity (n=124, 38.8%) and 3rd degree of complexity (n=44, 13.8%), respectively. Rate of MIC achievement in eras 1 and 2 for different surgeons were as following: 65% and 72.5%, 75 and 80%, 87.5 and 85% and 60 and 82.5%, for operator 1, 4, 7 and 13, respectively. Age, tumor complexity, R.E.N.A.L. score and PADUA score were the most significant parameters for determining MIC, identified on the basis of the criterion of equality of group means of discrete analysis. Conclusion In all surgeons, the MIC index increased with the accumulation of experience in performing laparoscopic partial nephrectomy, but was lower with an increased degree of complexity of procedures. The minimum number of laparoscopic partial nephrectomies required to achieve an MIC more or equal 70% should be at least 40.

Renal function and nutritional status in patients with arterial hypertension

Arterial hypertension is the main preventable cause of cardiovascular disease and all causes of death worldwide, and also ranks second among the most important causes of chronic kidney disease after diabetes. An important factor contributing to the increase in blood pressure is obesity. Being overweight raises blood pressure and accounts for 65-75% of the initial hypertension, which is the main cause of cardiovascular disease and kidney disease. The aim of the work was to study renal function in patients with arterial hypertension, depending on the nutritional status of patients. Materials and methods. A prospective study included 47 stable outpatients with stage II arterial hypertension (left ventricular hypertrophy) of the 1st to 3rd degree, (24 women and 23 men), the average age was 55.7 (8.9) years. The mean disease duration was 14 (3.2) years. The control group included 28 relatively healthy people without arterial hypertension (15 women and 9 men), the average age was 56.0 (6.6) years. All patients were evaluated for complaints, medical history, smoking status, physical examination with anthropometric indicators (height, weight, body mass index, waist circumference), heart rate and blood pressure. The risk of cardiovascular events was also determined in accordance with the SCORE scale. The nutritional status was evaluated based on bioimpedancemetry data (Omron analyzer) with determination of the percentage of total fat, muscle mass and visceral fat. To determine the functional state of the kidneys, the level of total protein in blood serum, creatinine and albumin in the urine was determined, with the determination of the albumin creatinine ratio in a single portion of urine, the glomerular filtration rate were calculated. Results and conclusions. In patients with arterial hypertension, a change in nutritional status was detected in the form of an increase in the amount of total adipose tissue against a background of a decrease in muscle tissue pool, with the development of sarcopenia in combination with obesity. Also, patients developed hypertensive nephropathy. It was found that the BMI is not informative enough to determine nutritional status, but requires the use of bioimpedancemetry to determine the percentage of total fat, visceral fat and muscle mass.

ПРОГРЕССИВНАЯ СИСТЕМА ИСПОЛНЕНИЯ ЛИШЕНИЯ СВОБОДЫ И ПЕРСПЕКТИВЫ ЕЁ ПРИМЕНЕНИЯ В КАЗАХСТАНЕ

The article formulates the author`s definition of the progressive system: “The progressive system is a complex intersectoral institution of criminal and criminal and executive law, including several independent institutions, in the process of applying which the legal status of the convict changes depending on the degree of its correction in the direction of either expansion or restriction of the volume of his rights”. It is noted that in the current legislation, with the establishment of a general rule on various conditions for serving a sentence within one correctional institution, the progressive system has acquired a completely finished form and can be considered the basis of all punitive and educational impact on convicts. The need for a more detailed classification of positively characterized convicts has been also actualized. In this case, each positive degree of behavior of convicts must correspond to certain conditions of detention and institutions of the progressive system, namely: upon reaching the 1st positive degree, the convict is kept in the usual conditions of a correctional institution (the institution of changing conditions of detention within one correctional institution); at the 2nd positive degree – transferred to lighter conditions of detention; at the 3rd positive degree – transferred to preferential conditions of detention; upon reaching the 4th positive degree – transferred to an institution of another type; at the 5th positive degree – the institution of replacement of punishment is applied; at the 6th positive degree – parole of the convicted person is possible. A proposal regarding the release of the court from the function of changing the process of executing the sentence has been formulated, in order to entrust it to the supervisory commissions created at the correctional institution. The court will only appoint the type of punishment, and the execution of the court`s decision should be entrusted to the Committee of the Penitentiary System and the Supervisory Commission. In this case, the commission collectively decides on the application of all the institutions of the progressive system, up to the institution of parole. The necessity of further improvement of legal regulation of the process of execution of punishments, alternative to imprisonment, according to the progressive system is substantiated. Key words: criminal policy, humanization, deprivation of liberty, punishments alternative to imprisonment, progressive system of execution of imprisonment, conditions of detention, behavior of convicts.

Сonfirmatory study of the efficacy and tolerability of trifluridine/tipiracil (TAS-102) therapy in the Russian population with chemorefractory metastatic colorectal cancer

Introduction. Trifluridine/Tipiracil (FTD/TPI) is a new chemotherapeutic drug approved in more than 60 countries for use in patients with metastatic colorectal cancer who have registered progression or intolerance to treatment with fluoropyrimidines, oxaliplatin and irinotecan, anti-VEGRand anti-EGFR-targeted agents. This study evaluated for the first time the effectiveness and tolerability of FTD/TPI therapy in the Russian patient population.Materials and methods. A confirmatory open-label single-arm non-randomized trial was conducted in 2 clinical centres in Russia. The main criteria for inclusion were: conduction of at least the 2nd line of standard systemic therapy for metastatic colon adenocarcinoma. The primary efficacy criteria were: 2-month progression-free survival; secondary – median progressionfree survival, disease control frequency, safety assessment, overall survival. Research number: NCT03274882.Results. A total of 26 patients were included in the study; the median age was 60.5 years (30 to 78); 19 (73%) women; and 4 patients with ECOG 0 and 22 – with ECOG 1. All patients were previously treated with the inclusion of oxaliplatin, irinotecan, fluoropyrimidines, 21 (81%) – bevacizumab, 6 (23%) – anti-EGFR antibodies, and 2 (7.7%) – regorafenib. The median for treatment courses was 4 (1–21), 11 (42.3%) patients were treated for 6 months or more. The two-month progression-free survival rate was 52% with a median progreesion-free survival rate of 4 months (95% CI 1.8–7.4 months). The median of total survival rate was 11 months (95% CI 5,2–16,8 months). Disease control was achieved in 60%. Neutropenia, nausea, vomiting, anemia, weakness prevailed among undesirable events associated with treatment (≥5 patients). The majority of complications were of the 1st–2nd degree. Among the undesirable events of the 3rd–4th degree, neutropenia was more common, while in 3 patients febrile neutropenia of the 3rd degree was registered.Conclusions. In the Russian population of patients with colorectal chemorefractory cancer, the drug FTD/TPI (TAS-102) shows efficacy and tolerability comparable to the RECOURSE registration study.

Особливості перебігу вагітності та характеристика акушерської патології у жінок з ожирінням різного ступеня та фізіологічною масою тіла

The medical and social significance of obesity in pregnant women lies in the high frequency of obstetric complications: miscarriage, preeclampsia, placental dysfunction, abnormal labor, obstetric hemorrhages, infectious and extragenital diseases in offspring that are programmed in utero. The purpose of the research was to analyze the course of pregnancy and to characterize obstetric pathology in women with obesity of various degrees and physiological body weight. Material and methods. To achieve this goal, we surveyed 369 pregnant women. Pregnant women with obesity were divided into three experimental groups: the first one consisted of 149 women with obesity of the 1st degree; the second group included 73 women with the 2nd degree obesity; the third group had 46 women with the 3rd degree obesity. The control group consisted of 101 women with physiological body weight (BMI = 18.5-25 kg/m2). Results and discussion. In the early term of pregnancy, the risk of miscarriage in women with obesity of different degrees was reliably higher by 2.1-2.9 times compared to the control group (p˂0.05). The risk of late miscarriage in groups of women with obesity of different degrees was 1.7-2.4 times higher than in the control group, although these differences were unreliable. There was also a clear tendency for the risk of preterm labor to increase by 1.4-1.7 times (p˃0.05) in obese women. There was a significant increase in the frequency of placental dysfunction in pregnant women with obesity of varying degrees, which was 1.3-1.8 times higher than the control values. An increase in the incidence of placental dysfunction in obese pregnant women manifested as an increase in the number of cases of fetal distress during pregnancy, the frequency of which increased in accordance with the severity of obesity. There was an increase in the incidence of early preeclampsia without statistical significance in women with the 2nd and 3rd degree obesity. Regarding preeclampsia, a significant increase in its frequency should be noted in obese pregnant women depending on the severity. Only women with 2nd and 3rd degree obesity had obstetric hemorrhage caused by premature detachment of the normally situated placenta. This complication was not observed in pregnant women of the control group and with the I degree obesity. Anemia of pregnancy was 1.5 times more common in women with I degree obesity and 1.4 times in women with the 2nd degree obesity, compared to the control group. In obese pregnant women, the frequency of asymptomatic bacteriuria increased in the 1st degree obesity by 1.6 times, in the 2nd and 3rd degrees by 1.2 and 1.4 times respectively compared to the control group. Conclusion. Thus, obesity is an aggravating factor of pregnancy, as evidenced by the increasing frequency of the most threatening complications for the mother and fetus such as miscarriage, placental dysfunction, preeclampsia, and obstetric hemorrhage compared to pregnant women with physiological body weight

Maternal Exposure to Disinfection By-Products and Risk of Hypospadias in the National Birth Defects Prevention Study (2000-2005).

The purpose of this study was to estimate the association between 2nd and 3rd degree hypospadias and maternal exposure to disinfection by-products (DBPs) using data from a large case-control study in the United States. Concentration estimates for total trihalomethanes (TTHMs), the sum of the five most prevalent haloacetic acids (HAA5), and individual species of each were integrated with data on maternal behaviors related to water-use from the National Birth Defects Prevention Study (NBDPS) to create three different exposure metrics: (1) household DBP concentrations; (2) estimates of DBP ingestion; (3) predicted uptake (i.e., internal dose) of trihalomethanes (THMs) via ingestion, showering, and bathing. The distribution of DBP exposure was categorized as follows: (Q1/referent) < 50%; (Q2) ≥ 50% to < 75%; and (Q3) ≥ 75%. Logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Generally, null associations were observed with increasing TTHM or HAA5 exposure. An increased risk was observed among women with household bromodichloromethane levels in the second quantile (aOR: 1.8; 95% CI: 1.2, 2.7); however, this association did not persist after the inclusion of individual-level water-use data. Findings from the present study do not support the hypothesis that maternal DBP exposures are related to the occurrence of hypospadias.

Post-Burn Microstomia Prevention: Application of a New Therapeutic Device

Introduction: Our goal is to demonstrate an appliance that can prevent post-burn microstomia. Perioral burns result in contracture of facial tissue during healing. It may cause limited oral access due to the sphincteral nature of orbicularis oris muscle. The literature has demonstrated that burn contractures and scar formation can be modified with pressure and splinting. Technique: The patient was a 50-year-old woman who had a 3rd degree burn. She had been treated with medicinal and palliative treatments, but due to burn scar that involved all her peri-oral tissues she had progressive microstomia. We fabricated microstomia prevention device for her in order to prevent further progression of microstomia. As the patient was completely edentulous, we decided to fabricate a tissue-supported appliance. Conclusion: This appliance is made with very simple equipment and is easy to fabricate.

Оригінальний метод лікування аневризми висхідного відділу аорти

The need for surgical treatment of ascending aortic aneurysms is due to a number of severe complications that occur during the natural course of the disease, such as aortic dissection and rupture. Such interventions show good immediate and long-term treatment outcomes, but they are often accompanied by high blood loss and surgical trauma, which in elderly patients with concomitant pathology can lead to serious cardiac and extracardiac complications and prolongation of treatment in general. We present a technology of external wrapping of the aorta that reduces surgical trauma while maintaining effect of operation. A clinical case of application of this technology in a 63-year-old patient hospitalized to the clinic of the Heart Institute, Ministry of Health of Ukraine, with a diagnosis of aortic insufficiency of the 3rd degree (tricuspid aortic valve), dilatation of the root and ascending aorta, tricuspid insufficiency of the 2nd degree, high pulmonary hypertension, heart failure with reduced left ventricular systolic function. The use of the proposed method has following advantages compared to the established method of fixation of the vascular prosthesis: fixation of the proximal part of the vascular prosthesis is performed using vascular suture material; elimination of the risk of damage to the aortic wall; elimination of the risk of massive bleeding from the aorta at the site of the prosthesis fixation; decreased duration of surgery. Key words: aortic aneurysm, surgical treatment, wrapping of the ascending aorta.

Comparison between Augmentation Mastopexy in One Session and Two Separate Sessions

Abstract Background: Breast ptosis is a growing disfiguring and psychosocial problem which has gained greater attention recently. Moderate and sever degrees of breast ptosis is corrected surgically through augmentation-mastopexy opera-tion using breast implant to enhance the breast tissue and resection of excess skin. It is whiter done in one session or in two separate sessions; mastopexy followed by breast augmentation in second stage. The choice between the two technique has been a controversy since each has special challenges. Aim of Study: To draw a comparison between the two techniques in the treatment of 2nd and 3rd degree of breast ptosis, augmentation-mastopexy using silicone implants in one session versus in two separate sessions (mastopexy followed by breast augmentation in 2nd stage), regarding patient satisfaction, clinical outcome and complications in a period of 6 months post-operatively. Patients and Methods: This is a retrospective cohort study comparing the two techniques of augmentation-mastopexy regarding patient satisfaction and quality of life along with clinical outcome and complications. Two groups of 15 patients each; G1 having one stage and G2 having two stages augmen-tation-mastopexy. All cases were operated on in time period from 2015 to mid-2019 with mean follow-up time of 2.5 years in both groups and minimum of 6 months for each case. Results: G1 and G2 reached satisfaction about the breast after operation by 75% and 72% respectively with increase in satisfaction than before surgery by 55.47% and 56.27%, G1 was satisfied with outcome of operation by 82.47% vs. 78.47% in G2, psychosocial wellbeing increased by 66.07% in G1 vs. 54.54% in G2, physical wellbeing regarding breast area showed 0.07% decrease in G1 vs. decrease by 10.87% in G2 in form of pain and discomfort in chest and breast during exercise, sexual wellbeing and confidence in breast area and in front of partner were increased by 60.74% in G1 vs. 56.14% in G2, regarding clinical observation all cases of G1 was suffering from grade 2 ptosis, 2 cases of G2 were of grade 3 ptosis and the rest were of grade 2, all degrees of ptosis were corrected post operatively, no recurrence of ptosis in period extended to 6 months after operation, 13.3% of cases in G1 had wound infection vs. 6.67% in G2, 20% of cases in G1 had wound disruption vs. no disruption noticed in G2, scar widening reached up to 46.67% of cases in G2 (after 2nd stage) vs. 33.3% in G1, also capsular contracture happened in one case only of G2 by incidence of 6.66% vs. no incidence in cases of G1, no extrusion of implant in both groups. Conclusion: The study reveals that both techniques are effective in treatment of breast ptosis with no significant difference in patient satisfaction and clinical complications. And there is no added risk for combining the procedure; moreover, one stage technique excludes a 2nd operation. A more obvious comparative values between the two techniques and late post-operative complications and long-term results need to be determined by further studies on a larger scale of patients and longer duration of follow-up.