Stage D2 Research Articles

The Khangalas orogenic Au deposit, Yana-Kolyma metallogenic belt (Northeast Russia): structure, ore mineral and isotopic (O, S, Re, Os, Pb, Ar, He) composition, fluid regime and formation conditions

The Khangalas orogenic gold deposit is located in the central part of the Yana-Kolyma metallogenic belt. The structure of the deposit is determined by several mineralized crush zones with a thickness of up to 70 m and a length of up to 1400 m in the arch and on the southwest wing of the anticline of the northwest strike. Host rocks – Upper Permian terrigenous deposits. Ore bodies are characterized by massive, banded, veined, disseminated and breccia structures. The main vein minerals are quartz, carbonates, sericite is less common. The main ore minerals are pyrite, arsenopyrite; minor – galena, sphalerite, chalcopyrite, native Au; rare – Fe-gersdorffite, tetrahedrite, argentotennantite. Hypergenic minerals – sulfates, phosphates, arsenates and hydroxides – are widely manifested in the linear oxidation zone. Mineral formation occurred in two stages – gold-sulfide-quartz and silver-quartz ones. Quartz veins with visible Au were formed with the involvement of low-concentrated (about 5.0 wt.% eq. NaCl) of hydrocarbonate hydrotherms with CO2 in the gas component, at a temperature of 330–280 °C and a pressure of about 0.8 kbar. Disseminated gold-bearing pyrite-3 (up to 39.3 g/t Au) and arsenopyrite-1 (up to 23.8 g/t Au) from sericite-carbonate-quartz metasomatites have a non-stoichiometric composition, Fe excess and S lack (and As in Ару), Fe/(S+As)=0.47–0.52 (Py3) and 0.47–0.50 (Ару1). The predominant form of “invisible” gold in Py3 and Apy1 is structurally related Au+. Isotopic composition of oxygen δ18O quartz (from +15.2 to +16.1‰), oxygen in the fluid δ18OH2O (from +8.4 tо +9.2‰)‰), sulfur δ34S in sulfides (from –2.1 to –0.6‰); isotopic ratio 187Os/188Os (from 0.2212 to 0.2338) in native gold and Pb in galena (206Pb/204Pb=18.0214, 207Pb/204Pb=15.5356, 208Pb/204Pb=38.2216), as well as the geochemical features of Py3 and Apy1 suggest the participation in ore formation mainly of sources from the subcontinental lithospheric mantle and, to a lesser extent, crustal reservoirs. The formation of the gold ore bodies of the deposit is related to the completion of reverse and thrust fault progressive deformation of the stage D1, which occurred in the Valanginian of the Early Cretaceous (about 137 million years ago) during late-orogenic processes in the Yana-Kolyma belt with regional south-western transport of rocks. The results obtained are important for predictive metallogenic and prospecting work aimed at identifying large-volume gold mineralization of orogenic belts.

Influence of Kappa Number on Enhancing Pulp Brightness through Stage D0 with ClO2 Bleaching Process: Environmental Implications and Considerations

<p>Stage D0 in the pulp bleaching process, utilizing Chlorine Dioxide (ClO2), represents a critical phase aimed at improving pulp brightness while simultaneously addressing environmental concerns. This stage enhancement of pulp brightness can made an environmental impact, as excessive usage can lead to harmful emissions and environmental degradation. The amount of ClO<sub>2</sub> used at stage D0 is influenced by the kappa number, the greater the kappa number, the greater the ClO<sub>2</sub> use will be to produce brightness that corresponds to standar. The calculation of ClO<sub>2</sub> usage at stage D0 is carried out after obtaining data related to ClO<sub>2</sub> and the amount of pulp production from DCS (Distribute Control System). Based on the results of calculations and analysis, it can be concluded that the kappa number influences the total use of ClO<sub>2</sub> in stage D0. The more ClO<sub>2</sub> used in the D0 tower will produce pulp with a higher level of brightness.</p>

Zespół Sticklera – opis przypadku i analiza literatury

PurposeTo present a case of patient with Stickler syndrome and retinal detachment with crystalline lens subluxation.Material and MethodsRetrospective case report.ResultsA 9-years-old patient approached Ophthalmology Department with retinal detachment in her right eye and proliferative vitreoretinopathy stage D2. Her medical history revealed previous cryotherapy of her right eye, high myopia (-14.5 D), bilateral glaucoma, bilateral posterior subcapsular cataracts and subluxated crystalline lens in her righteye. Further clinical examination of her right eye revealed best corrected visual acuity of light perception without localization, intraocular pressure 45 mmHg. Patient underwent pars plana vitrectomy with subluxated crystalline lens facoaspiration and silicone oil injection of her righteye. After 2 months pars plana vitrectomy was repeated with removal of silicon oil and further SF6 endotamponade. During control examination 6 months later right’s eye best corrected visual acuity was 5/16, intraocular pressure 23 mmHg. In USG of her right eye remains of silicon oil were noticed with retina attached.ConclusionsPars plana vitrectomy with silicon oil injection is effective method of treatment of retinal detachement in patients with Stickler syndrome. Those operations might be followed by many complications. Early diagnosis is essential in prevention of ocular complications in patient with Stickler syndrome.

Tracking the Variations in Trace Elements, Some Nutrients, Phenolics, and Anthocyanins in Grewia asiatica L. (Phalsa) at Different Fruit Development Stages.

Grewia asiatica L. (phalsa) is a very prevalent berry in Pakistan and is consumed extensively asraw or in the form of juice. Here, for the first time, we assessedphalsa from Pakistan in terms of variations in macro and micro minerals, nutrients,and bio-active phyto-constituents including total phenolic and anthocyanin contentsat different fruit developmental stages. It was found that the sugars in phalsa increased from D1 (small at the initial fruit setting stage) to D6 developmentstage (fully ripened fruit) where sugars at D5 (near to fully ripe) and D6 stages were many times greater than at D1, D2 (unripe close to full-size completion), D3 (close to semi ripe), and D4 stage (semi ripened and full-size attainment). Total acidity of was declined in all developmental stages, where the D1 stage displayed maximum and D6 with the lowest acidity. Ascorbic acid was decreased from D1 to D2 and then increased graduallyfrom D3 to D5 stages. At the D6 stage, againa steep decline in ascorbic acid was observed. The total phenolics (mg gallic acid equivalents/100g) at stage D6 were higher (136.02 ± 1.17), whereas D1 being the lowermost in totalphenolic content (79.89 ± 1.72). For anthocyanins (mg/100g), an increasing pattern of changes was observed in all stages of phalsa fruit where the D1 stage showed lower (13.97 ± 4.84) anthocyanin contents which then increased gradually at stage D2 (67.79 ± 6.73), but increased sharply at D3 (199.66 ± 4.90), D4 (211.02 ± 18.85), D5 (328.41 ±14.96) and D6 (532.30 ± 8.51) stages. A total of four anthocyanins such as cyanidin, delphidine-3-glucoside, pelargonidin, and malvidin in phalsa were identified using HPLC procedures, and a significant > 90 % DPPH inhibition in phalsa was observed at the D5 and D6 developmentstages. The macro and micro minerals includingNi, Zn, Fe, Ca, Cu, Mg, Na, P, and K contents were decreased from initial (D1) stage tothe final (D6)development stage, while only Fe displayed an increasing trend from the initial to final fruit development stages (D1-D6). Conclusively, these findings could be of greatinterest for patients who are intended to consume phalsa as adjuvant therapy against diabetes and metabolic syndromes and other diseases involving reactive oxygen species with minimum metal toxicity.

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

Automation and control of the thermal mixing process

In this research, the automation and control of an industrial mixing process were developed. Process safety was established through pipeline maintenance, plant instrumentation repair, and the addition of required instrumentation to ensure process safety. The process operation was divided into the industrial operation stages A1,F1, F2, F3, F5, and D1 of the GEMMA guide, designed in the GRAFCET methodology. The design of the temperature and level controllers was carried out using the approximation technique of each closed-loop system to a second order system with zero, based on the pole approximation technique. The industrial process was carried out with the DCS Honeywell HC900, integrating the automation of the system and the temperature and level controllers designed. A real-time SCADA supervision system was implemented to visualize the process and report alarms caused by failures in sensors or actuators. The mixing process was carried out in real-time, evidencing the settling times and overshoot values under the desired conditions.

Nutrient Changes in Berries of “Anab-e-Shahi” and “Perllete” Varieties of Grapes with Advancing Phenology in the Growing Season

Understanding how nutrients accumulate and change throughout the developmental stages according to the BBCH scale can be a very effective technique for developing fertilization programmes for high-quality, marketable grape production. Accordingly, the macro- and micronutrient concentrations at different growth stages were analyzed for two commercial grape cultivars, viz., “Anab-e-Shahi” and “Perlette”, by using an extended BBCH scale. The results show nitrogen content was reduced during the sampling period (D1 to D6) from 1.76 percent to 1.09 percent. Potassium concentration in developing berries kept on increasing from 0.15%, at principal growth stage 7 with BBCH code 73 (D1), to 0.26% at principal growth stage 8 code 89 (D6). The lowest phosphorus content of 253.88 ppm and the highest of 338.43 ppm were found in growth stages D1 and D6, respectively. The berry Ca however showed an increase first and thereafter decreased to 225.18 ppm at harvest. Mg content also recorded a similar trend from stages D1 to D6 of the BBCH scale and decreased to 116.08 ppm at D6. B and Cu concentrations increased from D1 to D6, and Mn and Zn increased first and decreased thereafter until harvest. No specific trend was recorded in Fe concentration. The concentration of nutrients in berries at different developmental stages can be used as the standard reference for growing berries using proper fertilization.

Cell cycle regulatory markers as potential prognostic biomarkers in uterine carcinosarcoma

The relevance of cell cycle regulatory markers with uterine carcinosarcoma was investigated. The immunohistochemical expression of p16, p53, and cyclin D1 were assessed using tissue microarray of 55 eligible patients. p16 and p53 showed a high rate of strong (+3) immune reaction in carcinomatous/sarcomatous components (61.8%/70.9% and 52.7%/56.4%, respectively). Cyclin D1 showed a 14.5%/7.3%of strong immune reaction in the carcinomatous/sarcomatous components. Strong expression of p16 was related to a higher rate of recurrence, lymph node metastasis, and bigger tumor size. Strong expression of cyclin D1 was related to the lower International Federation of Gynecology and Obstetrics (FIGO) stage and recurrence rate. In univariate regression analysis, FIGO stage, lymph node metastasis, p16, and cyclin D1 were prognostic factors for disease-free survival. FIGO stage, p16, p53, and cyclin D1 were prognostic factors for disease specific survival. In a multivariate regression analysis, FIGO stage and p16 in carcinomatous component were independent factors for disease-free survival (odds ratio (OR), 95% confidence interval (CI); 3.2 (1.1–9.6) and 3.5 (1.3–9.7); p = 0.035 and 0.017). p16 was a predictor of lymph node metastasis, tumor size, and prognostic outcome in uterine carcinosarcoma.

Abstract 12772: Transcatheter Aortic Valve Replacement Improves Functional and Quality Of Life Outcomes in Patients With Low Gradient Aortic Stenosis

Introduction: Aortic stenosis (AS) is the most common valvular disease, and severe disease can significantly impact morbidity. Less data exists examining the functional and quality of life (QOL) effects of transcatheter aortic valve replacement (TAVR) in patients with severe low-gradient AS in both low-flow and normal-flow states. Hypothesis: Patients with symptomatic, severe, low-gradient AS would have improvements in functional and QOL outcomes at 30-days and 1-year following TAVR procedures. Methods: A single center, retrospective study examined symptomatic, severe, low-gradient AS variants. These had an aortic valve area of ≤1.0 cm 2 , mean transvalvular gradient <40 mmHg, and peak aortic valve velocity of <4 m/s. Classical low-flow low-gradient (CLFLG) AS was defined as a left ventricular ejection fraction (LVEF) <50%. CLFLG group underwent dobutamine stress echo to assess AS severity (Stage D2). Paradoxical low-flow low-gradient (PLFLG) AS was defined as LVEF ≥50% and a stroke volume index (SVi) ≤35mL/m 2 (Stage D3). Normal-flow low-gradient (NFLG) AS was defined as LVEF ≥50% and SVi >35mL/m 2 (Stage D4). The primary outcome was change in New York Heart Association (NYHA) classification and a 12-item Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS) at 30-days and 1-year following TAVR. Results: A total of 191 patients were included for analysis: 46 CLFLG, 83 PLFLG, and 62 NFLG AS. At baseline, 130 (68%) had NYHA class III or IV symptoms. Mean baseline KCCQ-OS for all groups was 38±23 (Figure 1). The mean KCCQ-OS at 30-days and 1 year were 62±22 and 68±20. There were no significant differences in KCCQ-OS between the groups at 30-days and 1-year. Following TAVR, 92% and 88% of the cohort had NYHA class I or II symptoms at 30-days and 1 year. Conclusions: Patients with symptomatic, severe low-gradient AS had significant and sustained improvements in their functional and QOL metrics at 30-days and 1-year following TAVR procedures regardless of flow-state.

Abstract 14229: Utilization of Calcium Scores to Predict TAVR Outcomes in Paradoxical Severe Aortic Stenosis

Introduction: In patients with severe symptomatic (Stage D) aortic stenosis (AS), the disease is subcategorized based on the gradient, flow and left ventricular ejection fraction (LVEF). Stage D3 reflects low-flow, low-gradient severe AS with normal LVEF (paradoxical low-flow severe AS [PLFLG AS]. Current guidelines suggest measurement of a Computed Tomography (CT) derived calcium score of the native valve is helpful for management. Furthermore, calcium score can provide prognostic information for transcatheter aortic valve replacement (TAVR) in the general AS population. However, whether CT-derived calcium scores can predict major adverse cardiovascular events (MACE) in PLFLG AS patients undergoing TAVR has not been examined. Methods: We retrospectively investigated post-TAVR outcomes at 1 year, in patients echocardiographically characterized as PLFLG AS at our center between Jan. 2017 and Dec. 2020. Continuous variables were assessed for normality using the Kolmogorov-Smirnov test, histogram, and Q-Q plot. Logistic regression models were used to assess if calcium scores were associated with outcomes, and statistical significance was assumed if p<0.05. Results: : A total of 85 patients were included in the analysis. The baseline pre- and immediately post TAVR data are described in Table 1. In our cohort, 16 had MACE (18.8%) at 1 year. Calcium score as a predictor of MACE (odds ratio (OR): 0.99; p=0.93), death (OR: 0.99; p=0.79), stroke (OR 1.01; p=0.90), myocardial infarction (OR 0.97; p=0.63), and post-TAVR paravalvular aortic regurgitation (OR 1.02; p=0.47) did not reach statistical significance. Conclusions: In our cohort, CT-derived calcium scores did not predict MACE events or post-TAVR paravalvular aortic regurgitation in PLFLG AS. The study had several limitations: it is a single center retrospective study with a small sample size, potentially leading to recording bias.

Assessment of xenon-induced depth of hypnosis according to Kugler’s scale in elderly and senile patients undergoing knee replacement surgery: a prospective open-label cohort study

INTRODUCTION. Anesthesia with xenon is characterized by stable hemodynamic parameters, cardio- and neuroprotection preferable in elderly. Assessment of the depth of hypnosis remains challenging. The Kugler classification based on electroencephalogram has been suggested for such assessment. OBJECTIVES. To assess the feasibility of Kugler scale for objective assessment of the depth of hypnosis induced by xenon alone or in combination with narcotics and regional anesthesia during knee arthroplasty in elderly. MATERIALS AND METHODS. The study included 57 patients divided into 2 groups. In group 1, general anesthesia with xenon was performed, fentanyl and femoral nerve block were used for pain control. In group 2, xenon anesthesia was performed in combination with femoral and sciatic nerve block. The depth of hypnosis was monitored using EEG and matched with the Kugler scale. Also, the bispectral index (BIS) was recorded. RESULTS. At xenon concentration of 40 %, the depth of hypnosis reached D2 stage in group 1 and D1 in group 2 patients, while at 55 % and above it was D2 in both groups. Fentanyl increased the δ-rhythm by 19.08 %, which corresponded to reduction in the effective xenon concentration by 20 %. A correlation between δ-rhythm decrease and BIS was seen in groups 1 (r = –0.78; R2 = 60 %) and 2 (r = –0.61; R2 = 37 %). The differences could be related to the use of fentanyl in group 1. The intergroup difference between the reduction of BIS was not significant. CONCLUSIONS. In elderly patients undergoing knee arthroplasty under combined anesthesia, stage D2 according to Kugler scale (proportion of δ-rhythm more than 50 %) is achieved at xenon concentration of 55 % without narcotics and at concentration of 40 % with fentanyl. The diminished correlation between δ-rhythm and BIS in group 2 and no difference in decrease of BIS suggests that BIS is less accurate for determining the depth of hypnosis during xenon monoanesthesia.

Гемостаз та запалення у пацієнтів із політравмою

Актуальність. Причинами смерті при тяжких травмах є як ушкодження, несумісні з життям, так і тяжкі кровотечі. Коагулопатію, асоційовану з травмою, виявляють у 46 % пацієнтів уже на місці події та у 60 % пацієнтів — при надходженні на лікування. Мета: встановити наявність зв’язку між показниками загальної відповіді організму на запалення та показниками судинно-тромбоцитарного і коагуляційного гемостазу у пацієнтів з політравмою. Матеріали та методи. Проведено проспективне обсерваційне дослідження 20 пацієнтів віком від 19 до 55 років з політравмою, які перебували на лікуванні у відділенні анестезіології з ліжками інтенсивної терапії в Комунальному некомерційному підприємстві «8-ма міська клінічна лікарня м. Львова». Пацієнтів оцінювали за Injury Severity Score (ISS) та шкалою APACHE II (Acute Physiology And Chronic Health Evaluation II) з урахуванням тривалості синдрому загальної відповіді організму на запалення і лікування у відділенні інтенсивної терапії (ВІТ) та госпіталізації. Етапи дослідження: надходження на лікування у ВІТ (d1), третя доба (d3), п’ята доба (d5). Основними оцінюваними клінічними маркерами були показники: загальної відповіді організму на запалення, судинно-тромбоцитарного гемостазу (внутрішньосудинна активація тромбоцитів, агрегація тромбоцитів, індукована адреналіном і аденозиндифосфатом), коагуляційного гемостазу (міжнародне нормалізоване відношення, активований частковий тромбопластиновий час, рівень загального фібриногену та D-димерів). Результати. Встановлено наявність вірогідного (p < 0,05) позитивного кореляційного зв’язку між співвідношенням рівнів дискоехіноцитів до сфероехіноцитів та рівнем загального фібриногену на етапі d1, а також тенденцію (p = 0,09) до наявності позитивного кореляційного зв’язку між цим співвідношенням та температурою тіла пацієнта. Виявлено вірогідний (p < 0,05) зворотний кореляційний зв’язок між цим співвідношенням і рівнем тяжкості стану пацієнтів за шкалою APACHE II та прямий вірогідний (p < 0,05) кореляційний зв’язок із тривалістю госпіталізації у ВІТ, а також тенденції до зворотного кореляційного зв’язку з тяжкістю ушкоджень за шкалою ISS (p = 0,07) та до прямого кореляційного внаслідок Systemic Inflammatory Response Syndrome (SIRS) (p = 0,12). Висновки. У пацієнтів із політравмою встановлено: наявність вірогідного (p < 0,05) позитивного кореляційного зв’язку між співвідношенням дискоехіноцити/сфероехіноцити та рівнем загального фібриногену; тенденцію (p = 0,09) до позитивного кореляційного зв’язку між цим співвідношенням та температурою тіла пацієнта; вірогідний (p < 0,05) зворотний кореляційний зв’язок з рівнем тяжкості стану пацієнтів за шкалою APACHE II; прямий вірогідний (p < 0,05) кореляційний зв’язок з тривалістю госпіталізації у ВІТ; тенденцію (p = 0,07) до зворотного кореляційного зв’язку з тяжкістю ушкоджень за шкалою ISS та тенденцію (p = 0,12) до прямого кореляційного зв’язку з тривалістю SIRS.

Structural Evolution of Ore-Controlling Trans-Crustal Faults of the Olchan-Nera Zone: Constraints from the Khangalas Ore Cluster, Yana-Kolyma Metallogenic Belt, NE Russia

The article studies the structural evolution of ore-controlling trans-crustal faults of orogenic deposits and occurrences of the Khangalas ore cluster located in the southeastern part of the Olchan–Nera metallogenic zone, in the Upper Indigirka sector of the Yana–Kolyma metallogenic belt, North–East of Russia. Studies have shown that the formation of tectonic structures occurred during four Mesozoic deformation stages. Accretionary thrust stage D1 resulted in formation of the main pattern of the Mesozoic tectonic structures of the region. Further tectonic evolution occurred in a strike–slip setting of the accretionary D2 and post-accretionary D3–D4 stages. Post-ore strike-slip faults activate and complicate the earlier formed structures of the reverse and thrust paragenesis. Mineralization associated with the strike-slip faults has not been established, whereas formation of the gold-antimony mineralization is associated with sinistral strike–slip faults in the Adycha–Taryn metallogenic zone located to the southwest. The new data obtained are consistent with the previously proposed model of the evolution of the deformation structures of the Khangalas deposit.

Amalgamation of the Ryoke and Sanbagawa metamorphic belts at the subduction interface: New insights from the Kashio mylonite along the Median Tectonic Line, Nagano, Japan

AbstractWe present a detailed petrological, structural and geochronological study of the mylonitic Ryoke metamorphic rocks within the granitic mylonite (Kashio mylonite) and Sanbagawa metamorphic rocks along the Median Tectonic Line (MTL), Japan. Located in the Oshika area of the Chubu District, the Kashio mylonite is one of the few geologic units that can be used to determine detailed pressure–temperature–time–deformation (P–T–t–D) paths during mylonitization because it occurs as many small tectonic blocks of mylonitic metasediment. Detailed petrological analysis coupled with conventional thermobarometry and P–T pseudosection modelling give estimated peak P–T conditions (M1a) of 650–790°C at 4.6–5.6 kbar for the Ryoke metamorphic rocks. The gneissose Ryoke granitoids were emplaced subhorizontally at around 685–710°C and 4.6–5.8 kbar, after peak metamorphism. The Kashio shear zone developed immediately after the last igneous activity at ca. 71 Ma, and two stages of mylonitization (stages D1 and D2) can be identified from microstructural observations. The retrograde P–T conditions (M1b) recorded in the Kashio mylonite exhibit a systematic change in temperature from 710°C to 450°C at 5.2–2.6 kbar with decreasing distance from the MTL. By contrast, highly deformed mylonites with zoned garnets demonstrate a striking increase in pressure from 4.0 to 8.3 kbar with decreasing temperature from 590°C to 450°C after low‐P/T‐type metamorphism. Such a temperature range indicating isothermal compression is consistent with deformation temperatures of stage D1 determined from quartz microstructures and quartz c‐axis fabric opening‐angle deformation thermometer. Moreover, the timing of the two mylonitization episodes during retrograde metamorphism are estimated to be 69–67 and 66–64 Ma, respectively, with a high cooling rate of ~34°C/Ma using the revised time–temperature relationship of the host Ryoke granitoids. The rapid change in tectonic setting with strain localization occurred during the brief period between 69 and 64 Ma. Our field and petrological observations imply that a thick D1 mylonite zone was formed by rapid subsidence (≥10 km) with cooling of the hangingwall rocks from the middle crust to the subduction interface. It is considered that the underplating of exhumed high‐P/T‐type metamorphic rocks led to further cooling between hangingwall and footwall rocks and the formation of a narrow D2 mylonite zone, which served as an old plate boundary. Thus, low and high‐P/T‐type metamorphic belts had already been amalgamated as paired metamorphic belts beneath the brittle–ductile transition of the subduction zone before exhumation. The rapid cooling of hangingwall rocks at the subduction interface is proposed to play an essential role in the thermal overprinting of exhumed high‐P/T‐type metamorphic rocks.

Диафрагмальная дисфункция среди детей на искусственной вентиляции легких: проспективное обсервационное когортное исследование

Актуальность. Искусственная вентиляция легких (ИВЛ) может приводить к повреждению диафрагмы, которое называют вентилятор-индуцированной диафрагмальной дисфункцией и связывают с неблагоприятными результатами лечения, длительным отлучением от респираторной терапии и длительным пребыванием в отделении интенсивной терапии. Целью нашего исследования было установить распространенность диафрагмальной дисфункции среди детей в зависимости от стратегии ИВЛ. Рабочей была гипотеза, что возникновение диафрагмальной дисфункции не зависит от стратегии проведения ИВЛ. Материалы и методы. Нами проведено проспективное когортное одноцентровое исследование в отделении анестезиологии с койками интенсивной терапии КНП «Львовская областная детская клиническая больница «ОХМАТДЕТ». В исследование включали пациентов с острой дыхательной недостаточностью, требующих ИВЛ более 3 суток. Критериями исключения из исследования были: отказ законных представителей пациента от участия в исследовании на любом из его этапов, агональное состояние пациента при поступлении на лечение. В исследование были включены 89 пациентов в возрасте от 1 мес. до 18 лет. Все пациенты были разделены случайным образом на 2 группы (с помощью сервиса random.org). В I группу вошли пациенты, у которых применяли легочно-протективную стратегию ИВЛ, во II группу — пациенты, у которых применяли легочно-протективную и диафрагм-протективную стратегии ИВЛ. В анализ данных включены 82 пациента. Для оценки показателей, зависящих от возраста, пациенты были разделены на возрастные подгруппы: 1-я подгруппа — дети в возрасте 1 мес. — 1 год; 2-я подгруппа — дети 1–3 лет; 3-я подгруппа — дети 3–6 лет; 4-я подгруппа — дети 6–13 лет; 5-я подгруппа — дети 13–18 лет. Этапы исследования: 1-е сутки (d1), 3-и сутки (d3), 5-е сутки (d5), 7-е сутки (d7), 9-е сутки (d9), 14-е сутки (d14), 28-е сутки (d28). В обеих группах пациентов изучали: изменения амплитуды движений диафрагмы в ходе исследования; контрактильные свойства диафрагмы с помощью определения фракции ее истончения и динамику в ходе исследования; рассматривали снижение данного показателя менее 15 % как маркер диафрагмальной слабости; повышение его более 35 % как маркер высокой работы дыхания и потенциально повреждающий фактор для диафрагмы; время вдоха по ультразвуковым данным; мониторировали показатели кислотно-щелочного равновесия крови и параметры искусственной вентиляции легких. Результаты. Нами выявлены специфические возрастные особенности: среди пациентов 1-й возрастной подгруппы в І группе мы регистрировали слабость правого купола диафрагмы с компенсаторным чрезмерным сокращением левого купола в начале отлучения и на этапе d9, тогда как во II группе эпизод чрезмерной работы диафрагмы был зарегистрирован только на этапе d5. Среди пациентов 2-й возрастной подгруппы I группы изменения были диаметрально противоположными по сравнению с 1-й возрастной подгруппой — преобладала чрезмерная работа правого купола с низкими показателями сокращения левого купола на всех этапах исследования, тогда как во II группе был зарегистрирован эпизод диафрагмальной слабости на этапе d3. В 3-й возрастной подгруппе достоверно позже восстанавливалась надлежащая диафрагмальная активность в І группе пациентов по сравнению со II группой. В 4-й возрастной подгруппе среди пациентов I группы отмечен эпизод высокой работы диафрагмы на этапе d5, тогда как во II группе все показатели были в пределах, рекомендованных диафрагм-протективной стратегией. В 5-й возрастной подгруппе в І группе достоверно чаще регистрировали чрезмерную работу как правого, так и левого куполов диафрагмы, во II группе были эпизоды как диафрагмальной слабости, так и чрезмерной ее работы. Использование в комплексе интенсивной терапии диафрагм-протективной стратегии при проведении отлучения от ИВЛ позволило снизить продолжительность ИВЛ: у пациентов 1-й возрастной подгруппы — в 1,5 раза (p = 0,08); у пациентов 2-й возрастной подгруппы — в 2,4 раза (p = 0,18); в 4-й возрастной подгруппе — в 1,75 раза (p = 0,1); в 5-й возрастной подгруппе — в 4,25 раза (p = 0,009). У пациентов 3-й возрастной подгруппы продолжительность ИВЛ возросла в 1,1 раза (p = 0,68). Выводы. Распространенность и разнообразие проявлений диафрагмальной дисфункции зависят от стратегии проведения механической вентиляции легких. Комплексный подход на этапе отлучения от респираторной терапии, включающей проведение диафрагм-протективной стратегии ИВЛ, позволяет уменьшить инцидентность возникновения дисфункции диафрагмы и снизить продолжительность отлучения от ИВЛ.

Effects of Lipopolysaccharide on Oligodendrocyte Differentiation at Different Developmental Stages: an In Vitro Study.

BackgroundLipopolysaccharide (LPS) exerts cytotoxic effects on brain cells, especially on those belonging to the oligodendrocyte lineage, in preterm infants. The susceptibility of oligodendrocyte lineage cells to LPS-induced inflammation is dependent on the developmental stage. This study aimed to investigate the effect of LPS on oligodendrocyte lineage cells at different developmental stages in a microglial cell and oligodendrocyte co-culture model.MethodsThe primary cultures of oligodendrocytes and microglia cells were prepared from the forebrains of 2-day-old Sprague–Dawley rats. The oligodendrocyte progenitor cells (OPCs) co-cultured with microglial cells were treated with 0 (control), 0.01, 0.1, and 1 µg/mL LPS at the D3 stage to determine the dose of LPS that impairs oligodendrocyte differentiation. The co-culture was treated with 0.01 µg/mL LPS, which was the lowest dose that did not impair oligodendrocyte differentiation, at the developmental stages D1 (early LPS group), D3 (late LPS group), or D1 and D3 (double LPS group). On day 7 of differentiation, oligodendrocytes were subjected to neural glial antigen 2 (NG2) and myelin basic protein (MBP) immunostaining to examine the number of OPCs and mature oligodendrocytes, respectively.ResultsLPS dose-dependently decreased the proportion of mature oligodendrocytes (MBP+ cells) relative to the total number of cells. The number of MBP+ cells in the early LPS group was significantly lower than that in the late LPS group. Compared with those in the control group, the MBP+ cell numbers were significantly lower and the NG2+ cell numbers were significantly higher in the double LPS group, which exhibited impaired oligodendrocyte lineage cell development, on day 7 of differentiation.ConclusionRepetitive LPS stimulation during development significantly inhibited brain cell development by impairing oligodendrocyte differentiation. In contrast, brain cell development was not affected in the late LPS group. These findings suggest that inflammation at the early developmental stage of oligodendrocytes increases the susceptibility of the preterm brain to inflammation-induced injury.

SOSIALISASI PENGISIAN SISTER BAGI DOSEN PESERTA SERTFIKASI DOSEN TAHUN 2020

This activity is to provide assistance to the group of Lancang Kuning University lecturers, especially to the lecturers participating in the Phase I lecturer certification in 2020. The service team will explain the techniques and methods of collection starting with explaining the functions of the Sister application (www.sister.unilak.ac.id ) for lecturers both lecturer certification participants and certified lecturers. Certification participants must enter their personal data, educational history, functional position history, education implementation history, research history, service history and other supporting data. All participants explained the rules in the process of inputting data, especially the maximum size of data that can be input up to a quick trick in order to be able to input data themselves on the application. Of the 10 faculties at Lancang Kuning University, 72 lecturers can continue at stage D3 to stage D4. Whereas at stage D5 only 51 lecturers were able to proceed because of the selection process for the assessment of the system. The dedication team made WAG in guiding the data system input process in the framework of the certification process. This is done so that they can monitor and assist if there are obstacles in the certification process.

HEMODYNAMIC CHANGES IN CHILDREN WITH ACUTE RESPIRATORY FAILURE DURING WEANING FROM MECHANICAL VENTILATION

Background. Acute respiratory failure is accompanied by increasing load on cardiovascular system. The aim of the study was to investigate functional parameters of cardiovascular system and oxygen delivery in children with acute respiratory failure at different strategies of mechanical ventilation.Materials and methods. We conduct prospective, randomized, non-interventional, single-center controlled trial among patients 1 month – 18 years old. All patients were divided into a control group, which included 75 patients who underwent short-term ventilation during elective surgery and who were weaned immediately after surgery and restoration of physiological functions after anesthesia, and patients of the study group with acute respiratory failure (n = 162), who required invasive mechanical ventilation via endotracheal tube. Patients in the study group were randomized into study group I (83 patients) and received traditional ICU monitoring and treatment and study group II (79 patients), in which we used in addition to traditional monitoring and treatment, proposed by us methods of monitoring and treatment strategy. To assess age-dependent data, patients were divided into age subgroups: 1 subgroup – children 1 month – 1 year; 2nd subgroup – children 1 – 3 years; 3 subgroup – children 3 – 6 years; 4 subgroup – children 6 – 13 years; 5 subgroup – children 13 – 18 years. Stages of the study: 1st day (d1), 3rd day (d3), 5th day (d5), 7th day (d7), 9th day (d9), 14th day (d14), 28th day (d28). The evaluation criteria were heart rate, non-invasive blood pressure (systolic, diastolic and mean), stroke volume, stroke volume index, cardiac output, cardiac index, oxygen delivery.Results. The features of hemodynamics in patients of II study group at weaning from mechanical ventilation, depending on age, were: in the 2nd and 3rd age subgroups in hypoxemic and hypercapnic-hypoxemic forms of respiratory failure – decrease in heart rate at stage d3 by 33% and 40 %, compared with I group patients (p = 0.05 and p = 0.04); reduction of cardiac index by 25% (p = 0.001) in 2nd age subgroup at stage d3 and by 31% (p = 0.02) in the 3rd age subgroup at stage d5. In the 1st and 4th age subgroups of the II study group in hypoxemic and hypercapnic-hypoxemic respiratory failure were stroke volume index decreasing from stage d3, up to 21% (p = 0.04) and up to 37% (p = 0.05 ) for the 1st and 4th subgroups, respectively, together with significant decrease in cardiac output at stage d5, in comparison with I study group. For patients of 5th age subgroup with hypoxemic and hypercapnic-hypoxemic respiratory failure typically were significant decreasing of systolic and mean blood pressure at stage d1 by 17% (p = 0.04) and 24%, respectively (p = 0.001), in comparison with I study group; growth of cardiac output and cardiac index at stage d3 by 13% and 14% (p = 0.05 and p = 0.04). Oxygen delivery rates in patients of the 1st and 3rd age subgroups were significantly decreased from stage d5 by 22% (p = 0.05) and by 31% (p = 0.02), in 2nd and 4th age subgroups – from stage d3 by 25% (p = 0.05) and 29% (p = 0.01), no significant differences were found in patients of the 5th age group.Conclusion. Based on the analysis of hemodynamic parameters, it was found that for all age subgroups of patients with acute respiratory failure, regardless of its form, weaning from mechanical ventilation was characterized by hyperdynamic type of hemodynamic with increasing cardiac index level (5.8 ± 1.1 l/min/m2 vs 2.9 ± 0.4 l/min/m2 (p = 0.001) in control group) and significantly higher (p <0.05) oxygen delivery rates. Hemodynamic parameters were normalized significantly faster in patients of II study group in comparison with I study group with start from stage d3 for the 1st, 2nd, 3rd and 4th age subgroups and from stage d1 for the 5th age subgroup (p <0,05) in II study group.

Controversy and consideration of high and low ligation of inferior mesenteric artery in radical resection of rectal cancer

Radical resection is one of the most important treatment for rectal cancer, which requires not only removal of adequate bowel and mesorectum around the tumor, but also thorough lymphadenectomy. Besides, postoperative complications are surgeons' concerns as well. According to different ways to manage inferior mesenteric artery, procedures could be divided into two groups: inferior mesenteric artery (IMA) high ligation and low ligation, which lead to various outcomes of the extent of lymph nodes dissection, survival, preservation of intestinal blood supply, incidence of anastomotic leakage, and postoperative functions including defecation function, urinary function and sexual function. Author believes that for those patients with clinical stage T1, low ligation and D2 lymph nodes dissection could be considered. However, for patients with locally advanced carcinomas (clinical stage T2+or N+), especially suspicious metastasis of lymph nodes around IMA root, high ligation and D3 lymph node dissection is suggested to ensure en bloc resection. As for those patients with high risks for compromised intestinal blood supply, preservation of left colic artery plus D3 lymph nodes dissection might be a feasible way. Intraoperative indocyanine green fluorescent imaging might play a role in quality control of lymphadenectomy.

DIAPHRAGM-PROTECTIVE MECHANICAL VENTILATION IN CHILDREN

Background. Mechanical ventilation can lead to diaphragm injury.The aim of the study was to investigate thickness of diaphragm, it thicknening fraction and to compare the results of treatment in group of patients with lung-protective mechanical ventilation and in group where we used the combination of lung-protective and diaphragm-protective mechanical ventilation.Materials and methods. We conduct prospective, randomized, non-interventional, single-center controlled trial among patients 1 month to 18 years old. In the data analysis 31 patients of control group (lung-protective mechanical ventilation) and 27 patients of study group (lung-protective and diaphragm-protective mechanical ventilation) were included in data analysis. The primary outcome was the 28-day mortality rate. Secondary outcomes were duration of weaning from mechanical ventilation, frequency of complications (reintubation, tracheostomy), dynamics of thicknening fraction of diaphragm. Results. It was tendency to decreasing the fraction of thickening of right hemidiaphragm from 31.1% to 28.6% during the d1 - d3 stages of study in control group, while in study group this fraction increased from 25% to 32.65%. Fraction of thickening of left hemidiaphragm in control group at stage d1 was 22.5 [16.7; 35]; at stage d3 increased up to 24.55 [10.8; 53.33], and at stage d5 - up to 39.3 [24.73; 52,98]. In study group of patients it was 19 [11; 41,45] at stage d1 (p = 0,311 for control and study groups); increased up to 27.3 [14.3; 38.7] (p = 0.329) at stage d3; and exceeded the recommended by diaphragm-protective strategy of mechanical ventilation values at stage d5 and was 64 [36; 78,9] (p = 0.049), what we can be interpreted as a marker of diaphragm overload. The duration of weaning from mechanical ventilation in control group was 8 days [4 days; 19.5 days], in study group - 9 days [5.5 days; 19.75 days], (p = 0.77).Conclusion. The 28-day mortality rate was higher in control group in comparison with study group (9.7% and 3.7%, respectively, p = 0.29). The incidence of complications in control group of patients was lower in comparison with study group (7.1% and 26.9%, respectively, p = 0.06). There were no significant differences in the duration of mechanical ventilation in both groups.Trial registration: ISRCTN registry. Identifier: ISRCTN84734652.