[Organizing the medical care for the COVID-19 patients in non-infectious Moscow hospital: reassignment experience].

AIM: To present the results of work of National Medical Research Center of Treatment and Rehabilitation, reassigned for COVID-19 patients treatment during pandemic. Run-up methodology, procedures and working process organization are detailed. MATERIALS AND METHODS: 354 COVID-19 patients were treated from 13.04.2020 to 10.06.2020 [age 59 (470) years, 56% women, body mass index 28.5 (24.932.2) kg/m2]. Patients were admitted at 8 (611) day of sickness. In-hospital stay was 16 (1420) days. RESULTS: NEWS scale at the day of admittance was 2 (14); 2 (13) in patients discharged alive and 6 (47) in died patients, p=0.0001. So prognostic accuracy of NEWS scale was confirmed as very well (area under ROC-curve = 0.819). 69 patients (19.5%) were treated at intensive care department for 7 (413) days. 13 patients died, 11 of them had COVID-19 as direct or indirect cause of death. Total in-hospital mortality was 3.67%, in-hospital mortality of COVID-19 patients 3.1%. 17 healthcare workers (HCW), contacted with COVID-19 patients were infected (2.67%). 4 HCW, who had no direct contact with patients were also infected and 7 HCW were infected before the first patient was admitted. No one of them died. CONCLUSION: Complex tasks of healthcare organization during COVID-19 pandemic can be solved quickly with acceptable quality, characterized by low levels of patients; mortality and HCW infection.

On the forward modeling of radar Doppler spectrum width from LES: Implications for model evaluation.

Large-eddy simulations of an observed single-layer Arctic mixed-phase cloud are analyzed to study the value of forward modeling of profiling millimeter-wave cloud radar Doppler spectral width for model evaluation. Individual broadening terms and their uncertainties are quantified for the observed spectral width and compared to modeled broadening terms. Modeled turbulent broadening is narrower than the observed values when the turbulent kinetic energy dissipation rate from the subgrid-scale model is used in the forward model. The total dissipation rates, estimated with the subgrid-scale dissipation rates and the numerical dissipation rates, agree much better with both the retrieved dissipation rates and those inferred from the power spectra of the simulated vertical air velocity. The comparison of the microphysical broadening provides another evaluative measure of the ice properties in the simulation. To accurately retrieve dissipation rates as well as each broadening term from the observations, we suggest a few modifications to previously presented techniques. First, we show that the inertial subrange spectra filtered with the radar sampling volume is a better underlying model than the unfiltered -5/3 law for the retrieval of the dissipation rate from the power spectra of the mean Doppler velocity. Second, we demonstrate that it is important to filter out turbulence and remove the layer-mean reflectivity-weighted mean fall speed from the observed mean Doppler velocity to avoid overestimation of shear broadening. Finally, we provide a method to quantify the uncertainty in the retrieved dissipation rates, which eventually propagates to the uncertainty in the microphysical broadening.

Preliminary background ozone concentrations in the mountain and coastal areas of Bulgaria.

Urban and non-urban rural ozone (O3) concentrations are high in Bulgaria and often exceed the European AOT40 ecosystem as well as the AOT60 human health standards. This paper presents preliminary estimates to establish background, non-urban O3 concentrations for the southern region of Bulgaria. Ozone concentrations from three distinctly different sites are presented: a mountain site influenced by mountain-valley wind flow; a coastal site influenced by sea-breeze wind flow; and a 1700-m mountain peak site without 'local' wind flow characteristics. The latter offers the best estimate of 46-50 ppb for a background O3 level. The highest non-urban hourly value, 118 ppb, was measured at the mountain-valley site.

Remifentanil-based anesthesia versus a propofol technique for otologic surgical procedures.

Otologic procedures require a still surgical field and are associated with a 50% incidence of emetic symptoms. Propofol reduces nausea and vomiting but not intraoperative movement. This study compares a remifentanil/propofol anesthetic to a propofol/fentanyl combination to determine which provides the best perioperative conditions for otologic microsurgery. Eighty healthy patients were randomly assigned to receive one of the anesthetic combinations. Demographic data, hemodynamic variables, movement, and bispectral index monitoring values in addition to anesthetic emergence, nausea, vomiting, pain, and other recovery variables were compared between groups with appropriate statistical methods. Both groups were similar. Times to eye opening (7.7 +/- 0.7 vs 12.4 +/- 1.2 minutes) and extubation (9.8 +/- 0.9 vs 12.4 +/- 1.0 minutes) were shorter with remifentanil. This group also had lower hemodynamic variables and movement (23% vs 65%) under anesthesia. Postoperative pain was mild in both groups, but remifentanil patients had more than the propofol group. All other postoperative parameters were similar. Remifentanil-based anesthesia produces better hemodynamic stability, less movement, and faster emergence after otologic surgery, with propofol's antiemetic effect, for the same cost.

Mechanisms of low back pain: a neurophysiologic and neuroanatomic study.

Idiopathic low back pain has confounded health care practitioners for decades. The cellular and neural mechanisms that lead to facet pain, discogenic pain, and sciatica are not well understood. To help elucidate these mechanisms, anesthetized New Zealand white rabbits were used in a series of neurophysiologic and neuroanatomic studies. These studies showed the following evidence in support of facet pain: an extensive distribution of small nerve fibers and endings in the lumbar facet joint, nerves containing substance P, high threshold mechanoreceptors in the facet joint capsule, and sensitization and excitation of nerves in facet joint and surrounding muscle when the nerves were exposed to inflammatory or algesic chemicals. Evidence for pain of disc origin included an extensive distribution of small nerve fibers and free nerve endings in the superficial annulus of the disc and small fibers and free nerve endings in adjacent longitudinal ligaments. Possible mechanisms of sciatica included vigorous and long lasting excitatory discharges when dorsal root ganglia were subjected to moderate pressure, excitation of dorsal root fibers when the ganglia were exposed to autologous nucleus pulposus, and excitation and loss of nerve function in nerve roots exposed to phospholipase A2.

Effect of substance P on mechanosensitive units of tissues around and in the lumbar facet joint.

The purpose of this study was to examine how substance P affects the mechanosensitive afferent units identified in the tissues around and in the lumbar facet joint of the rabbit. Substance P was applied to the receptive fields of the units by microinjection, and the afferent activity of the units was recorded from dorsal root filaments. Changes in afferent discharge rates and von Frey thresholds were measured sequentially after the application of substance P. Most of the units (83.3%) had an increase in the ongoing discharge rates after the application of substance P: 54.2% of the units had immediate excitation and 29.2% had delayed excitation. One-third of the units had a decreased von Frey threshold after the application of substance P. Substance P had an excitatory effect on 81.8% of the units with a threshold of > 5.0 g and a conduction velocity of < 30 m/s, which may serve as nociceptors, and on 84.6% of the units with a threshold of < 2.0 g, which may serve as proprioceptors. These results suggest that substance P has an excitatory effect on both nociceptive and proprioceptive units in the tissues around and in the lumbar facet joint.

The effects of controlled mechanical loading on group-II, III, and IV afferent units from the lumbar facet joint and surrounding tissue. An in vitro study.

An in vitro model was developed to investigate the responses of afferent units in the lumbar spine to controlled loading as measured by a load-cell. The neuronal discharge was recorded simultaneously with loading. Three types of neuronal responses were observed. The first type of response involved phasic-type mechanoreceptors, which responded to movement, regardless of direction or initial position. The response did not outlast the movement phase of loading. These units may serve as velocity detectors. The second type of response was seen in slowly adapting low-threshold mechanoreceptors, which tended to respond to loading in the 0.3 to 0.5-kilogram range with an immediate and sustained increase in the rate of firing. This type of response appears to be associated with the activation of low-threshold group-II and group-III fibers, which were located in muscles and tendons inserting into the facet joint. The third type of response involved slowly adapting high-threshold mechanoreceptors, which could not be activated until a threshold of three to five kilograms had been exceeded. It appears that this type of response is at least partially due to the activation of high-threshold group-III and group-IV capsular afferent units, which may signal noxious mechanical stimulation.