Complicated Form Research Articles

Rationale and study design of the international randomized control trial MYocarditis THerapy with Steroids: the MYTHS trial

Abstract Background Immunosuppression is generally suggested in patients with specific subtypes of acute myocarditis, such as eosinophilic myocarditis or giant cell myocarditis or associated with systemic autoimmune disorders. In contrast, no specific treatment for most acute myocarditis complicated by acute heart failure (HF) or cardiogenic shock is recommended beyond the management of acute HF and supportive therapy. Nevertheless, large registries commonly reported using corticosteroids in severe forms without data supporting this strategy. Purpose To assess the safety and efficacy of high-dose pulse intravenous (IV) corticosteroid therapy to treat patients with complicated/fulminant acute myocarditis based on clinical suspicion. Methods An international pragmatic investigator-initiated single-blinded randomized controlled trial that screens patients between 18 and 70 years admitted to the hospital for suspected acute myocarditis (cardiac symptoms onset within three weeks) complicated by acute HF/cardiogenic shock and left ventricular (LV) ejection fraction<41% without significant LV dilation is ongoing. Patients are randomized in a 1:1 ratio to pulsed IV methylprednisolone (1 g) in saline solution (250 mL) daily for three days or placebo (saline without methylprednisolone) on top of standard therapy and maximal supportive care. A final diagnosis of myocarditis is confirmed by histology or cardiac magnetic resonance imaging. A population of 288 patients has been planned to assess a reduction in the probability of reaching the primary endpoint from 25% in the placebo arm to 12% in the methylprednisolone arm with a power of 0.80 (Figure). The main analysis will be conducted on an intention-to-treat basis. Results The primary efficacy endpoint of the trial is defined as the time from randomization to the first event occurring within 6 months, including all-cause death, heart transplantation, or long-term LV assist device implant, or need for an upgrading of the temporary mechanical circulatory support (t-MCS), or ventricular tachycardia (VT)/fibrillation (VF) treated with direct current (DC) shock, or first rehospitalization due to HF or VT/VF, or advanced atrioventricular block. The safety endpoints include a composite of potential complications that can occur, including serious infections, acute gastrointestinal bleeding, and other complications that can be related to corticosteroid therapy or prolonged stay on t-MCS. There are 32 active centers, and 48 patients have been randomized since December 2021. The trial is expected to be completed by the end of 2028. Conclusion The results of the MYTHS trial can define the role of IV methylprednisolone in the initial treatment of patients with complicated forms of acute myocarditis that currently have an unacceptably high mortality rate.

«Simple» Criminal Law Measures to Combat Organized Crime and Consequences of their Application

Effective criminal law measures to counter organized crime should be based on an adequate understanding of this phenomenon and should comply With the principles, approaches and traditions of the national legal system. The disposition of the article 210.1 «Occupying the highest position in the criminal hierarchy» introduced in the Special Part of the Criminal Code of the Russian Federation is excessively concise and does not correspond to the fundamental principle of legal certainty of criminal law norms. Despite the declared successes in its application, the practice of judicial review of criminal cases of crimes is ambiguous. In addition, the conviction of a «thief-in-law» («criminal lord») and his incarceration does not deprive him of either a criminal «title» or real power in the criminal world. The low effectiveness of criminal law measures is explained by the fact that the «thieves’ world» and its criminal hierarchy headed by «thieves-in-law» are neither a criminal community (criminal organization), nor an organized group or any other form of complicity listed in Article 35 of the Criminal Code of the Russian Federation. It is proposed, having eliminated terminological redundancy, to call it a criminal community, in contrast to the forms of complicity provided for in Part 4 of Article 35 and Article 210 of the Criminal Code of the Russian Federation that are more correctly called criminal organizations. The paper defines a criminal community in its new understanding, and proposes a set of criminalized acts to effectively counter this phenomenon.

Immunity and Coagulation in COVID-19.

Discovered in late 2019, the SARS-CoV-2 coronavirus has caused the largest pandemic of the 21st century, claiming more than seven million lives. In most cases, the COVID-19 disease caused by the SARS-CoV-2 virus is relatively mild and affects only the upper respiratory tract; it most often manifests itself with fever, chills, cough, and sore throat, but also has less-common mild symptoms. In most cases, patients do not require hospitalization, and fully recover. However, in some cases, infection with the SARS-CoV-2 virus leads to the development of a severe form of COVID-19, which is characterized by the development of life-threatening complications affecting not only the lungs, but also other organs and systems. In particular, various forms of thrombotic complications are common among patients with a severe form of COVID-19. The mechanisms for the development of thrombotic complications in COVID-19 remain unclear. Accumulated data indicate that the pathogenesis of severe COVID-19 is based on disruptions in the functioning of various innate immune systems. The key role in the primary response to a viral infection is assigned to two systems. These are the pattern recognition receptors, primarily members of the toll-like receptor (TLR) family, and the complement system. Both systems are the first to engage in the fight against the virus and launch a whole range of mechanisms aimed at its rapid elimination. Normally, their joint activity leads to the destruction of the pathogen and recovery. However, disruptions in the functioning of these innate immune systems in COVID-19 can cause the development of an excessive inflammatory response that is dangerous for the body. In turn, excessive inflammation entails activation of and damage to the vascular endothelium, as well as the development of the hypercoagulable state observed in patients seriously ill with COVID-19. Activation of the endothelium and hypercoagulation lead to the development of thrombosis and, as a result, damage to organs and tissues. Immune-mediated thrombotic complications are termed "immunothrombosis". In this review, we discuss in detail the features of immunothrombosis associated with SARS-CoV-2 infection and its potential underlying mechanisms.

Algorithm for Managing Patients Hospitalized in the Surgical Wards Due to COVID-19-Related Acute Abdominal Pathology

AIM OF THE STUDY. Was to improve the outcomes of treatment of patients with COVID-19-related acute abdominal pathology by developing and implementing an algorithm for the diagnosis and treatment of those patients.MATERIAL AND METHODS. The study involved 200 patients who were randomized into two groups. This research was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology that developed against the background of COVID-19. All medical histories in emergency departments and centers of the Republic of Uzbekistan were analyzed in the period from the beginning of the declaration of the pandemic (March 2020) to July 2022 inclusive.RESULTS. In the context of an infectious disease pandemic (COVID–19 as an example), it is very important to develop an algorithm for managing patients with acute surgical pathology. This algorithm should include a diagnostic component with the purpose of timely diagnosis of acute surgical pathology and hospitalization in the surgical department. The next step is to identify patients with a high risk of perioperative complications and adverse outcomes. The final component of the algorithm is the correction of possible risk factors for adverse outcomes.CONCLUSION. The duration of hospitalization of patients who underwent surgery for acute abdominal pathology was significantly longer during the pandemic compared to that of in the post-pandemic period (10.35±7.01 vs. 5.83±3.85 days, p<0.001), which may be due to both changes in the structure of the pathology and a larger number of complicated forms. The application of the developed algorithm will optimize the management of patients with COVID-19-related acute surgical pathology, guarantee rapid decision-making while minimizing the risk of infection, reduce the risk of complications and adverse outcomes.

State of art on evaluation of three- to six-dimensional novel additive manufacturing technology for biomedical applications

Additive manufacturing has evolved over the last few decades. Three-dimensional printing is a digital manufacturing technology that provides nearly endless options for the creation of an accessible instrument for all parts of various medical practices, including tissue engineering, through meticulous optimization of material, processing, and geometry for every point in an object. Three-dimensional printing has opened up a new, faster, and safer manufacturing process, despite its incapability to fabricate complex structures and objects. Recently, novel four-dimensional printing techniques have been developed for the transformation of typical stable three-dimensional printed parts into smart objects. The limitations of three-dimensional printing could be remedied with four-dimensional printing, by applying time as the fourth dimension. Self-repairing and speedy printing are two additional benefits of this technology's by using smart materials. By adapting this technology, numerous medical domains could be profited. Four-dimensional printing does not have the ability to produce curved complicated forms. However, five-dimensional printing overcomes the flaws seems in four-dimensional printing. Five-dimensional additive manufacturing relies on the rotation of both the print bed and the extruder head. Five-dimensional printing outlasts in terms of durability than three- and four-dimensional printing. Currently, a combination of the principles of four- and five-dimensional printing into a single process is called six-dimensional printing. In six-dimensional printing, the form changes over time due to the reaction of environmental factors, which is primarily used in biomedical applications. This paper summarizes extensive research on biomaterials in the field of biomedical science and discusses the present implications of three-, four-, five-, and six-dimensional printing techniques.

Results of surgical treatment of chronic pancreatitis with a high risk of developing pancreatic cancer

Objective. To analyze the results of surgical treatment of patients with pancreatic insufficiency and a high risk of developing pancreatic cancer. Materials and methods. The study included 39 patients treated in 2019–2023. In 20 (51%) patients, it was difficult to clearly differentiate between chronic pancreatitis and pancreatic cancer. In 19 (49%) patients, the diagnosis of chronic pancreatitis was not in doubt. All patients with complicated forms of chronic pancreatitis and suspected pancreatic tumor underwent a set of laboratory tests, and routine screening methods of instrumental diagnostics were used. In addition to standard methods of examination, the levels of matrix metalloproteinases and tissue inhibitor of metalloproteinases in the blood plasma were studied. Results. The method of intraoperative multiple biopsy, improved by us, was an obligatory component of surgical care for a clear differential diagnosis of chronic pancreatitis and pancreatic cancer. In the presence of complicated chronic pancreatitis, during surgery, the biopsy was taken using a special punch instrument that resembles a pen, along the entire length of the main pancreatic duct along the upper and lower edges of the dissection in a checkerboard pattern. There were no complications of punch biopsy. Of the 20 patients in whom it was not possible to clearly differentiate between chronic pancreatitis and pancreatic cancer, 12 (60%) were diagnosed with diabetes mellitus. The characteristic changes in the pancreatic tissue gave grounds for performing extended resection interventions in these patients. In the remaining 8 (40%) patients without morphological changes inherent in malignancy, Whipple operation (2), longitudinal pancreaticoduodenectomy (2), Frey operation (2), and our proposed central pancreatic resection with preservation of the left anatomical segment (2) were performed. Drainage and resectional surgical interventions were performed in 19 (49%) patients with complicated forms of chronic pancreatitis. After radical surgical interventions for pancreatic cancer, 1 patient developed gastrostasis, and on the 11th day he underwent a relaparotomy with reconstruction of the gastroenteroanastomosis, and on the 30th day a subhepatic abscess was diagnosed in 1 patient, who underwent drainage with a subcostal mini–access with a positive effect. In 2 patients, after left–sided pancreatic resection, subdiaphragmatic abscesses were diagnosed on the left, they were treated minimally invasively with punctures and drainage under ultrasound control. Multiple organ failure occurred in 1 patient after surgery for internal pancreatic fistula, infected ascites as a complication of neglected chronic pancreatitis. The patient died. Infection of the median laparotomy wound occurred in 4 patients, and healing was achieved by controlled primary tension. Class B pancreatic fistulas occurred in 3 patients: 2 – after left–sided pancreatic resection, 1 – after longitudinal pancreaticoduodenostomy. In 1 patient, a class C permanent pancreatic fistula was formed after a combined (resection and drainage) intervention. Relaparotomy, subtotal resection with Roux–en–Y loop closure was performed. Conclusions. Morphological changes in the pancreatic tissue in chronic pancreatitis in combination with diabetes mellitus, corresponding to the development of PanIN, are direct predictors of adenocarcinoma. Multiple intraoperative pancreatic biopsies are effective in verifying pancreatic malignancy. Pre– and intraoperative diagnostics make it possible to optimize the surgical treatment of complicated forms of chronic pancreatitis and prevent the development of postoperative pancreatic fistula.

Legal remedies against amber abuse: problems of implementation and optimization

The article is devoted to the coverage of certain problems related to the use of criminal legal means against persons who commit the crimes provided for in Art. 2401 of the Criminal Code of Ukraine illegal extraction, sale, acquisition, transfer, forwarding, transportation, processing of amber, and with the improvement of such means. Emphasis is placed on the study of relevant judicial practice. The provision on the need to differentiate criminal responsibility for illegal actions with amber depending on group forms of complicity is argued. It is proved that the proposed improvement of Art. 2401 of the Criminal Code of Ukraine will be consistent with the requirements established in jurisprudence for the construction of qualified compositions of criminal offenses. The theoretical position is supported, according to which, if the relevant composition of the criminal offense does not include such features as its commission by a group of persons and an organized group, then the qualification of the offense committed by the organizer and members of the group should be carried out with a reference in the qualification formula to part 2 or part 3 st. 28 of the Criminal Code of Ukraine with the inclusion in the legal wording of the indictment of the characteristics «committed by a prior conspiracy by a group» or «committed by an organized group.» Based on the study of judicial practice materials, it has been established that the exemption of persons who commit the analyzed crime from serving a sentence is widespread (Article 75 of the Criminal Code of Ukraine), and the imperfection of the sanctions of Article 2401 of the Criminal Code of Ukraine, considerations were expressed regarding their optimization, namely the consolidation in Part 1 of Art. 2401 of the Criminal Code of Ukraine provides for a fine as the non-alternative main punishment, and in Part 2 and Part 3 of this article - alternative punishments in the form of a fine and imprisonment for a certain period. The imperfection of judicial practice related to ensuring the individualization of criminal responsibility for «amber» torts has been demonstrated - the imposition of a fine as the main type of punishment in the minimum amount and failure to take into account the role, nature and degree of participation of each of the accomplices in the commission of a criminal offense.

Second-Generation Supraglottic Airway Devices Versus Endotracheal Intubation in Adults Undergoing Abdominopelvic Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: Second-generation supraglottic airway (SGA) devices are widely used, but thought to have inferior safety performance to endotracheal tubes (ETTs), but might be equally efficacious while improving patient-centered outcomes. We compared second-generation SGAs with ETTs for perioperative safety, efficacy, and quality of recovery in adults undergoing abdominopelvic surgery under general anesthesia. Our primary objective was to assess safety in the form of major airway complications. Secondary objectives were other safety, efficacy, and quality of recovery outcomes. METHODS: We searched 4 databases for randomized controlled trials of adult patients having abdominopelvic surgery comparing second-generation SGAs and ETTs. After 2-person screening and data extraction, pairwise meta-analysis was conducted and the grading of recommendations, assessment, development, and evaluation (GRADE) approach was applied to assess the certainty of evidence. RESULTS: A total of 51 studies, randomizing 5110 patients, were included. Second-generation SGAs significantly reduced the risk of major perioperative airway complications (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.23–0.71; P = .007; low certainty), with no clear clinically relevant difference in regurgitation or pulmonary aspiration (low certainty). SGAs significantly increased the risk of inadequate ventilation (RR, 3.36; 95% CI, 1.43–7.89; P = .011; very low certainty); however, postoperative sore throat (RR, 0.52; 95% CI, 0.38–0.70; P < .001; moderate certainty), hoarseness (RR, 0.32; 95% CI, 0.231–0.48; P < .001; low certainty), coughing at the emergence of anesthesia (RR, 0.17; 95% CI, 0.08–0.36; P < .001; low certainty), and postoperative nausea and vomiting (RR, 0.64; 95% CI, 0.42–0.98; P = .042; very low certainty) were all less frequent with SGAs. No other clinically relevant differences were observed for other remaining outcomes. CONCLUSIONS: Second-generation SGAs reduce the risk of major airway complications compared with ETTs in adults undergoing abdominopelvic procedures under general anesthesia, with no reported clinically relevant differences in the risk of regurgitation or pulmonary aspiration. Additionally, they improve the quality of postoperative recovery with lower risk of sore throat, hoarseness, and postoperative nausea and vomiting. These data provide an opportunity for clinicians to reassess the implications of conservative airway management, and potentially expand the role of second-generation SGAs in routine clinical practice.

Oscillatory and Asymptotic Criteria for a Fifth-Order Fractional Difference Equation

In this paper, using the properties of the conformable fractional difference and fractional sum, we initially establish some oscillatory and asymptotic criteria for a fifth-order fractional difference equation. Several critical inequalities, the Riccati transformation technique, and the integral technique are used in the deduction process. We provide some example to test the results. The established criteria are new results in the study of oscillation, and can be extended to other types of high-order fractional difference equations as well as fractional differential equations with more complicated forms.

Comparative analysis of the structure of the heart and blood vessels surgeries, taking into account the clinical and functional status of patients with coronary heart disease in 2015 and 2020

Relevance. In a very short period of time, surgical treatment methods have become widespread due to the expansion of indicators for performing heart surgery in patients with severe complicated forms of coronary heart disease and the use of combined surgical operations.Aim: To study changes in the clinical and functional status of patients depending on the type of surgical intervention for coronary artery disease in different time periods in the gender aspect.Material and Methods. The study was conducted retrospectively. For comparative analysis, patients with an established diagnosis of coronary heart disease who underwent surgical treatment at the Federal Center for Cardiovascular Surgery of the of the Ministry of Healthcare of the Russian Federation (Chelyabinsk) in 2015 (n = 1017) and 2020 (n = 967) were included. Of the total number of patients in 2015, there were 771 (75.8%) men and 246 (24.2%) women, in 2020 718 (74.3%) and 249(25.7%), respectively.Results. In the structure of interventions performed, there is a decrease in the number of almost all types of surgical interventions for complications of myocardial infarction, most pronounced in relation to resection of the left ventricular aneurysm, reconstruction of the left ventricle and operations in combination with mitral valve replacement. In a large percentage of cases, patients with a history of risk factors for cardiovascular diseases are referred for coronary artery bypass surgery, regardless of gender. The majority of patients had angina pectoris of the 3rd–4th functional class. However, there is a trend towards a decrease in the proportion of people with post-infarction cardiosclerosis when referred for surgery.Conclusion. Despite the significant volume and availability of practical information, the number of patients with major cardiovascular risk factors is not decreasing.

A non-localized spatial–temporal constitutive relation in rarefied gas dynamics

Although the Boltzmann equation is instrumental in capturing the dynamics of rarefied gases, finding its solutions in engineering problems is challenging. Therefore, over the past century and a half, numerous partial differential equations based on a few macroscopic variables have been introduced. However, they not only have complicated forms but also cannot make satisfactory prediction when the Knudsen number is large. Here, we propose a non-localized spatial–temporal (NiST) constitutive relation for rarefied gas dynamics, where the stress/heat flux at time t and position x is determined by the velocity/temperature gradient in the nearby spatial–temporal coordinates, via convolution operators. Utilizing solutions of the Boltzmann equation for the Couette/Fourier/Poiseuille flow and the spontaneous Rayleigh–Brillouin scattering, we extract the universal parameters of non-locality as functions of the spatial and temporal Knudsen numbers. Subsequent validation through sound propagation and backward-facing step flow demonstrates that the NiST constitutive relation is capable of accurately forecasting rarefied gas flows across a broad spectrum of Knudsen numbers.

Agency at a distance: learning causal connections

AbstractIn a series of papers, we have argued that causal cognition has coevolved with the use of various tools. Animals use tools, but only as extensions of their own bodies, while humans use tools that act at a distance in space and time. This means that we must learn new types of causal mappings between causes and effects. The aim of this article is to account for what is required for such learning of causal relations. Following a proposal by Grush and Springle, we argue that learning of inverse mappings from effects to causes is central. Learning such mappings also involves constraints based on monotonicity, continuity and convexity. In order for causal thinking to extend beyond space and time, mental simulations are required that predict the effects of actions. More advanced forms of causal reasoning involve more complicated forms of simulations.

Взаимосвязь зубочелюстных аномалий с сердечно-сосудистыми заболеваниями

Introduction: A significant body of evidence has been accumulated on the associations between periodontitis (PD) and coronary heart disease (CHD), cerebrovascular diseases (CD), coronary atherosclerosis and angiopathy. Associations between arterial hypertension (AH) and diseases of the oral mucosa and PD have also been studied. However, the associations between dental anomalies (DA) and cardiovascular diseases (CVD) have not been analyzed, especially in Russian scientific papers. Aim: To perform a systematic search and qualitative synthesis of the results of original studies aimed at studying the relationship between PCA and coronary artery disease, hypertensions and atrial fibrillation (AF). Materials and Methods: A systematic search for scientific publications in Russian and English was carried out using PubMed (Medline) and E-library for the period 20002023 in accordance with the PRISMA guidelines. Results: In total, 245 publications were identified, of which only 5 met the inclusion criteria. Patients with a complicated form of CHD – acute myocardial infarction (AMI) were significantly more likely to have DA compared to patients without AMI. There is also evidence suggesting an association between DA and atrial fibrillation (AF). No associations between DA and AH were identified. Conclusions: There is a limited number of research on the associations between DA and CVD in either Russian or English literature. It is suggested that DA may be associated with AF, AMI and, probably, other forms of CHD, but there is a need in replicated of the initial findings in other studies.

A clinical case of a complicated form of pneumonia in a child after COVID-19

A clinical case of a complicated form of pneumonia in a child after COVID-19

Heart Rhythm Disturbances in Cardiac Surgery Patients with Coronary Artery Disease

The aim. To analyze arrhythmological complications in cardiac surgery patients with coronary artery disease (CAD). Materials and methods. This was a retrospective data analysis of 354 cardiac surgery patients with various forms of CAD who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The mean age of the patients was 61.9 ± 9.6 years. All the patients underwent laboratory examinations, electrocardiography, echocardiography, coronary angiography and cardiac surgery. The patients with uncomplicated forms of CAD (n = 194) underwent isolated surgical revascularization of the myocardium, in the case of complicated forms of CAD (n = 160), coronary bypass surgery was supplemented with valvular or ventricular correction. Results. Postoperative atrial fibrillation (AF) occurred in 40 (20.6%) patients with uncomplicated CAD and 43 patients with complicated CAD (26.8%), p = 0.1667. Among patients with complicated forms of CAD, 2 (1.25%) had paroxysms of ventricular tachycardia, which required the implantation of a cardioverter-defibrillator, also in this group of patients complete left bundle branch block occurred more often (p = 0.0020). The postoperative period in patients with impaired glucose metabolism was characterized by more frequent development of AF in patients with type 2 diabetes mellitus (33.3%, p = 0.0006), with impaired glucose tolerance (24.8%, p = 0.0156) compared to patients with normoglycemia (12.6%). Conclusions. There was no statistically significant difference in the frequency of postoperative AF in patients with various forms of CAD (p = 0.1667). In the occurrence of postoperative AF paroxysms, the negative influence of type 2 diabetes mellitus (p = 0.0006), impaired glucose tolerance (p = 0.0156), stage III-IV chronic kidney disease (p = 0.0015) and gouty arthritis (p = 0.0072) has been proven. The presence of postoperative AF was associated with acute encephalopathy (p = 0.0291) and panic attacks (p = 0.0043). The occurrence of postoperative AF increased the length of stay of cardiac surgery patients with CAD in the hospital from 8.2 ± 2.9 to 11.06 ± 6.8 days (p < 0.0001).

Optimizing personalized treatments for targeted patient populations across multiple domains.

Learning individualized treatment rules (ITRs) for a target patient population with mental disorders is confronted with many challenges. First, the target population may be different from the training population that provided data for learning ITRs. Ignoring differences between the training patient data and the target population can result in sub-optimal treatment strategies for the target population. Second, for mental disorders, a patient's underlying mental state is not observed but can be inferred from measures of high-dimensional combinations of symptomatology. Treatment mechanisms are unknown and can be complex, and thus treatment effect moderation can take complicated forms. To address these challenges, we propose a novel method that connects measurement models, efficient weighting schemes, and flexible neural network architecture through latent variables to tailor treatments for a target population. Patients' underlying mental states are represented by a compact set of latent state variables while preserving interpretability. Weighting schemes are designed based on lower-dimensional latent variables to efficiently balance population differences so that biases in learning the latent structure and treatment effects are mitigated. Extensive simulation studies demonstrated consistent superiority of the proposed method and the weighting approach. Applications to two real-world studies of patients with major depressive disorder have shown a broad utility of the proposed method in improving treatment outcomes in the target population.

A complicated form of spontaneous aortic atherosclerosis in an African green monkeys (Chlorocebus aethiops sabaeus) male. Clinical case

A complicated form of spontaneous aortic atherosclerosis in an African green monkeys (Chlorocebus aethiops sabaeus) male. Clinical case

Mathematical Methods for Control Systems in Electrical Engineering

Control frameworks are exceptionally imperative in electrical building since they make it conceivable to absolutely control and move forward complicated gadgets and forms. This unique talks almost essential scientific procedures that are required to get it and construct control frameworks within the field of electrical designing. Through science structures, it appears vital thoughts like criticism control, soundness examination, and framework optimization. Differential conditions, which depict how energetic frameworks carry on, are the building squares of control frameworks. These conditions appear how framework variables are associated to each other and how quick they alter over time. They are utilized to ponder how frameworks move and remain steady. These forms decide how electric circuits, engines, generators, and other critical parts of advanced innovation foundation work in electrical building employments. The thought of control gives us ways to form these frameworks more steady, controlled, and successful. Differential conditions can be effectively interpreted into the recurrence space utilizing strategies like Laplace changes. This makes it simpler to think about how frameworks react to distinctive inputs and changes. This alter makes it less demanding to figure out framework exchange capacities, which makes a difference when making controls that alter how frameworks carry on to meet execution objectives. Steadiness investigation too makes beyond any doubt that controlled frameworks work reliably and typically indeed when conditions alter. Strategies like root locus, Nyquist measure, and Bode plots offer assistance us get it the limits of a system's steadiness and how it reacts, which is vital for making beyond any doubt it works well and anticipating undesirable variances or insecurity.

Evaluation of the clinical effectiveness of osteopathic gallbladder drainage techniques

Introduction. In recent decades, a lot of new materials about etiology and pathogenesis of biliary system diseases have been obtained and new effective drugs have been introduced. But, despite this, there remains much unrecognized and controversial in etiopathogenesis and principles of treatment of the disease. Moreover, the frequency of complicated forms of the disease and the overall incidence of biliary pathology continues to grow, which clearly shows the need to search for new approaches to diagnosis and treatment of these conditions. The leading causes of biliary tract pathology formation, actual problems of pharmacotherapy (allergic reactions, side effects, polypragmasy), certain aspects of comorbid pathology make clinicians pay closer attention to non-medicament treatment methods, including osteopathic correction. Previous studies have already demonstrated a good clinical effect of osteopathic correction in the treatment of patients with biliary disorders. At the same time, most studies in osteopathy present an assessment of the possibility of using osteopathic correction in the treatment of certain nosological forms. But no less important, in our opinion, is to conduct studies aimed at evaluating the clinical effectiveness (efficiency) of individual osteopathic approaches and techniques.The aim of the study: to investigate the clinical effectiveness of osteopathic techniques of gallbladder drainage.Materials and methods. The study was conducted in 2022–2023 on the basis of Polyclinic of the Federation of Independent Trade Unions of Russia (Moscow) and City Mariinsky Hospital (St. Petersburg). There were 30 people (9 men and 21 women) aged 18 to 59 years (mean age was 40,4±2,3 years) without pathology of the gastrointestinal tract and gallbladder (biliary tract) who agreed to participate in the study. All participants underwent a fasting gallbladder volume study, followed by a gallbladder volume study one hour after eating a trial breakfast (TB). One week after the first study, the same patients underwent another fasting gallbladder volume study, then a gallbladder volume study after osteopathic correction (OC) techniques. Thus two observation groups were formed: observation 1 (TB) — study of gallbladder function before and after taking a trial breakfast; observation 2 (OC) — study of gallbladder function before and after gallbladder drainage techniques. Participants did not receive other treatments during the study. All respondents underwent clinical osteopathic examination and biliary ultrasound with motor function score (MFS) was performed. Outcomes in this study were defined as changes in gallbladder size and motility.Results. No global level somatic dysfunction was identified in the study participants. Regional biomechanical disorders and separate local somatic dysfunctions were more typical for them. However, it was not possible to identify any predominant dysfunctions, as all of them were detected in single cases. After the exposure was completed, the osteopathic status was re-evaluated. The analysis showed that there were no statistically significant changes in the frequency of detection of the main somatic dysfunctions in both observations (p>0,05). In the observed respondents, no abnormalities in the basic size and volume of the gallbladder at the beginning of the study were revealed. After the conducted stimulation no statistically significant differences in gallbladder size (length and width) both within and between the observation groups were registered (p>0,05), but statistically significant dynamics was obtained in the form of gallbladder volume decrease in response to the effect (p<0,05) both when using TB and after OC. All participants were assessed with a measure of gallbladder motor function (MFS). In case of observation 1 (TB), the MFS value was 0,66±0,09 and observation 2 (OC) was 0,58±0,07, which corresponds to normal gallbladder functional activity. Compared to the use of a trial breakfast, osteopathic correction demonstrated a slightly less pronounced effect on gallbladder motor function, but these differences between the groups were not statistically significant (p>0,05).Conclusion. Osteopathic manipulations on the gallbladder and biliary tract have an effect on the gallbladder volume and motor activity comparable to the effect of the trial breakfast.

Efficient high-order operator-splitting schemes for solving the time-dependent Schrödinger equation

Several fourth-order symmetric operator-splitting schemes with four and five stages for solving the time-dependent Schrödinger equation have been proposed. These schemes have been studied and compared with some optimal fourth- and sixth-order operator split schemes reported in the literature using a one-dimensional model and several realistic three-dimensional triatomic reactive scattering problems in Jacobi coordinates. Two new fourth-order operator-splitting schemes with four and five stages, which are more efficient than previously reported schemes, are recommended for the realistic numerical solution of the time-dependent Schrödinger equation in the field of molecular dynamics. It was found that the order-preserving method proposed by McLachlan works well for three-dimensional triatomic reactive scattering problems in Jacobi coordinates, despite the complicated form of the Hamiltonian.