Growth, structure, and temperature dependent emission processes in emerging metal hexachloride scintillators Cs2HfCl6 and Cs2ZrCl6.

Crystals of metal hexachlorides Cs2MCl6 (M = Hf or Zr) have recently emerged as promising materials for scintillation applications due to their excellent energy resolution. In this work, we investigated the crystal structure and scintillation properties of Cs2HfCl6 and Cs2ZrCl6 crystals in the broad temperature range from 9 to 300 K. X-ray diffraction data confirmed the same cubic structure (space group Fm3m) for Cs2HfCl6 and Cs2ZrCl6 over the entire examined temperature range. The room temperature scintillation light yield of Cs2HfCl6 excited with a 137Cs γ-source is measured to be 24 800 photons per MeV, while Cs2ZrCl6 exhibits 33 900 photons per MeV resulting in energy resolutions of 5.3% and 4.5%, respectively. The alpha-to-beta ratio determined at room temperature for 5.5 MeV α-particles from an 241Am source is equal to 0.39 for Cs2HfCl6 and 0.35 for Cs2ZrCl6. The measurements of scintillation decay curves revealed complex kinetics due to delayed recombination processes. A tangible enhancement of the scintillation yield with heating is observed in the 125-150 K range. This effect is a manifestation of negative thermal quenching explained by thermal activation of trapped carriers. A model of the emission centre is proposed that consistently explains the observed changes of emission intensity with temperature in the crystals under study.

Psychological Continuum of Elderly Patients Suffering from Arterial Hypertension with Metabolic Syndrome, Against the Background of Chronotherapy with a Fixed Combination of Amlodipine, Lisinopril and Rosuvastatin.

Aim        To study the psychological continuum in elderly patients with arterial hypertension associated with metabolic syndrome during the chronotherapy with a fixed combination (FC) of amlodipine, lisinopril, and rosuvastatin.Material and methods        In the inpatient conditions, 63 patients aged 60-74 years with arterial hypertension associated with metabolic syndrome were treated with chronotherapy with a FC of amlodipine, lisinopril, and rosuvastatin (5 / 10 / 10 mg/day in the evening). These patients composed the main group. The control group (58 patients aged 60-74 years with arterial hypertension associated with metabolic syndrome) was treated with the FC of amlodipine, lisinopril, and rosuvastatin at the same dose of 5 / 10 / 10 mg/day in the morning.Results   At one year, the disorders of psychological continuum were significantly decreased with the chronotherapy (evening dosing) with the antihypertensive FC of amlodipine, lisinopril, and rosuvastatin compared to the traditional treatment (morning dosing) at the same dose of 5 / 10 / 10 mg/day in both groups. With the chronotherapeutic approach, the dynamic of cognitive disorders in patients aged 60-74 years with arterial hypertension associated with metabolic syndrome was characterized by a significant increase in the Mini-Mental-State-Examination scale score from 17.8±0.3 at baseline to 23.5±0.4 with the evening dosing (р<0.001) vs. the increase from 16.9±0.3 to 20.4±0.4 (р<0.001) with the morning dosing. The situational anxiety score decreased from 40.0±2.2 to 30.6±1.8 (р<0.05) and from 40.8±2.5 to 33.5±1.9  (р<0.05), and the trait anxiety score decreased from 48.8±2.0 to 26.4±1.9 (р<0.001) and from 44.9±1.9 to 30.7±1.7  (р<0.01) with the evening and morning dosing, respectively. Depressive disorders slightly decreased with the chronotherapy by 14.1 % vs. 7.7 % with the traditional regimen; nevertheless, they were consistent with depressive spectrum disorders in both groups.Conclusion            The study results showed a higher effectiveness of the chronotherapeutic treatment compared to the traditional treatment with FC of amlodipine, lisinopril, and rosuvastatin in arterial hypertension with metabolic syndrome.

[The effect of antihypertensive chronotherapy on indicators of the daily blood pressure profile in elderly patients with arterial hypertension with a history of myocardial infarction.]

Traditional treatment regimens for patients with hypertension are not always effective and need to be improved based on the principles of chronobiology. The purpose of this work is to analyze the effect of preventive chronotherapy with amlodipine, lisinopril, and rosuvastatin on daily blood pressure monitoring. In 62 patients with a history of myocardial infarction and hypertension at the age of 60-74, a fixed combination of amlodipine, lisinopril and rosuvastatin at a dose of 5/10/10 mg 2 hours before reaching maximum systolic blood pressure (preventive chronotherapy), in 63 patients with similar diseases and age, this drug is taken at a dose of 5/10/10mg in the evening, and in 58 people - in the morning (traditional treatment). Daily monitoring of blood pressure before and 6 months after treatment was performed by the «SpacelabsMedical¼ device (USA) with the calculation of generally accepted indicators. The greatest effectiveness of preventive chronotherapy in comparison with other treatment options for achieving the target blood pressure level, reducing the time indices and the variability of systolic blood pressure has been established, which allows us to recommend this fixed combination in geriatric practice.

[Therapy and Rehabilitation of Patients with Pulmonary Tuberculosis and Different Treatment Adherence].

The pulmonary tuberculosis process as dependent on the disease form and the therapy efficacy with the use of Cycloferon in the treatment scheme were investigated. The study had two stages. At the first stage the data concerning 358 patients with primary pulmonary tuberculosis and infiltration (93 patients) or degradation (89 patients) and 176 patients with pulmonary fibrocavernous tuberculosis were analysed. At the second stage the efficacy of the treatment schemes applied to the patients with pulmonary fibrocavernous tuberculosis was compared. The etiotropic therapy intensive phase was applied to all the patients. Moreover, 56 patients (group 1) under the therapy and rehabilitatinon were treated with Cycloferon in a dose of 0.25 administered intramuscularly twice a week (not less than 16 injections for the course), 60 patients (group 2) were treated with Omega 3, 30 patients (group 3) were given the standard complex (vitamins and tonics), 30 patients (group 4) were under the etiotropic therapy alone. The following additional factors promoting progression and aggravation of the tuberculosis process were confirmed: degradation at the time of the disease diagnosis, high resistance of the pathogen to antituberculosis drugs, low adherence to the treatment, social desadaptation and especially psychofunctional state of the patients. The use of Cycloferon in the schemes of the intensive phase treatment of the primary fibrocavernous tuberculosis resulted in reduction of the intoxication signs, bacteria isolation, positive dynamics of the cavity healing, lower lung infiltration and consequently high frequency of the treatment positive outcomes (94.1 ± 3.33%).

[Immunomodulator Intensification of Etioropic Therapy in Patients with Advanced Pulmonary Tuberculosis].

The study was aimed at possible increase of the therapy efficacy in patients with advanced tuberculosis by including immunomodulators to the treatment schemes. The data concerning 6034 patients with advanced tuberculosis, mainly fibrocavernous tuberculosis of the lungs, were analysed. Four groups of the patients were randomized. In group 1 the management of the patients included etiotropic therapy and some treatment and rehabilitation measures with the use of Cycloferon. The group 2 patients in addition to the etiotropic therapy and some treatment and rehabilitation measures were given Omega-3. In group 3 the management included the etiotropic therapy and some treatment and rehabilitation measures. In group 4 the etioropic therapy was used alone. The analysis showed that 3419 patients had primary pulmonary tuberculosis, 340 patients had relapsing tuberculosis and 2275 patients had long-term process. The etiotropic therapy efficacy was estimated after an intensive phase of not more than 3 months. In the cases with Mycobacterium tuberculosis drug resistance and some other unfavourable factors it was estimated after a 5-month intensive phase. The results confirmed that inclusion of immunomodulators to the treatment schemes allowed to increase the therapy efficacy and the patients' adherence to the treatment, as well as to shorten the period of the bacteria carriage. Thus, the use of Cycloferon in the schemes of the treatment of the patients with fibrocavernous pulmonary tuberculosis allowed to shorten the period of the pathogen carriage (as well as the drug resistant forms) in 94.1 ± 3.33% of the patients in spite of concomitant diseases. The effect of Cycloferon in such cases was likely due to both its direct immunoprotective action and the improvement of the general state of the patients and their higher adherence to the treatment.

[Effectiveness of immunomodulating therapy of pulmonary tuberculosis with cycloferon].

Cycloferon was used to treat newly diagnosed, recurrent and long-standing pulmonary TB. The dose of 7,5 g combined with antibacterial therapy caused no complications. The effectiveness of this therapy based on the generally-accepted criteria was significantly higher than standard treatment but varied depending on the character of pathological process. It is recommended to use cycloferon in the intense phase of the basal treatment.

[Topical aspects of organization of tuberculosis monitoring at the level of a subject of the Russian Federation (in case of the Belgorod Region)].

The paper shows how a tuberculosis monitoring system is under development at the level of the Russian Federation subject--the Belgorod Region. The tuberculosis monitoring system allows an effective control of both tuberculosis-controlling measures determined by the existing normative documents and orders and supplementary measures to enhance the effectiveness of tuberculosis control in the region. Tuberculosis monitoring should be further improved at the regional region by the sections: outpatient visit, antiepidemic measures in the foci; children's sanatorium work, cohorts to be examined by a physio pediatrician.

[Immunological correction in progressive pulmonary tuberculosis].

The authors used their immunological correction method to treat 154 patients with progressive pulmonary tuberculosis. Of them, 38 patients received standard antituberculosis therapy (Group 1), 39 had additionally paravasal lymphotrophic immunological correction (Group 2), and 38 took antituberculous drugs in accordance with individual regimens (Group 3), and 39 patients were treated by individual regimens during immunological correction (Group 4). After termination of the basic course of chemotherapy, clinical cure was achieved in 61.1, 76.3, 72.2, and 94.7%, respectively (p < 0.05). During the basic course, mortality was 11.1, 5.3, and 5.5% in the first three groups. By taking into account the immunological status of patients with caseous pneumonia, disseminated, and multicavernous pulmonary tuberculous lesion, immunological correction is indicated early in the basic course of therapy.

[Penitentiary tuberculosis as an object of simulative manifestations].

The paper presents the results of a 5-year follow-up of simulative manifestations of tuberculosis at penitentiaries. The high rate of use of penitentiaries as an object of these manifestations has been established, predominantly relapse aggravation of process activity being observed when treatment is continued. The causes of simulative manifestations are diverse; along with a qualitative physical examination, they should be borne in mind by a phthisiatrician in order to make a timely diagnosis.

[Limited epidemic of tuberculosis among young socially dysadapted individuals].

Two epidemic outbreaks of tuberculosis were observed among young socially dysadapted individuals at a juvie. They were liquidated, by chiefly implementing social preventive measures and by introducing new chemotherapy regimens.

[The scope and efficiency of inpatient tuberculosis treatment].

There is evidence for the necessity of reorganizing the indications and volumes of antituberculosis care in the tuberculosis hospitals, as shown by the example of one of the subjects of the Russian Federation. The optimum variant of this reorganization lies in the formula of reduction-consolidation-profiling-efficiency by the quality criteria and, when the regional features are kept in mind, is attainable and its alternative is currently absent.

[Using non-invasive mask lung ventilation in cardiosurgical patients with acute respiratory distress syndrome]. / Primenenie neinvazivnoi masochnoi vspomogatel'noi ventiliatsii legkikh pri ostrom respiratornom distress-sindrome u kardiokhirurgicheskikh bol'nykh.

Twenty patients aged 33 to 71 (54 +/- 6) years (male - 13, female - 7) operated on the heart and main vessels were included in the case study. I.e. those patient were investigated, whose immediate postoperative results were complicated by the syndrome of multiple organ failure (SMOF) that developed due to different-etiology shock, huge blood loss and hemotransfusion or to the syndrome of acute postperfusion lung damage. NIMLV was made at the resolution stage of SMOF and ARDS after artificial pulmonary ventilation (APL) for as long as 5-7 days. The indications for extubation of patients were as follows: PaO2/FiO2 of 200 and more mm Hg, respiratory rate (RR) of less than 30 per min, respiratory volume of more than 6 ml/kg with pressure support at inspiration of less than 5 cm H2O and with the total pressure at the exhalation end of no more than 3 cm H2O. Mask ventilation sessions were started in a growing dyspnea of more than 26 per min, a decreased content of oxyhemoglobin in arterial blood (below 95% at oxygen inhalation of 10-15 l/min), involvement of auxiliary muscles in breathing and at subjective complaints of patients related with complicated breathing and with being short of air. The mask SIMV ventilation with a preset apparatus-aided rate of inhales of 2-6/min, with Bi-PAP and PSV inhale pressure of 15 cm/ H2O and with PEEP of 3-5 cm/ H2O was made by 40-120 min sessions; the number of IFMLV sessions ranged from 6 to 22/patient, mean - 11 +/- 1.1 h. The total IFMLV duration was 10.7 +/- 1.1 h. The need for respiratory support persisted for 4-6 days after extubation. In 18 (90%) of 20 patients, the mask pulmonary ventilation resolved the respiratory insufficiency. Two (10%) patients were reintubated because of progressing multiorgan failure and because of obturation of the left main bronchus. A questioning of patients on the comfort degree of mask ventilation denoted the Flow-by triggering to be by far better tolerated by patients versus the pressure triggering.

[Need for correction of the normative-legal base for implementation of a federal program and programs of the subjects of the Russian Federation for Tuberculosis Prevention under the conditions of expected stabilization of the epidemic situation]. / O neobkhodimosti korrektsii normativno-pravovoi bazy ispolneniia natsional'noi programmy i programm sub"ektov Rossiiskoi Federatsii po preduprezhdeniiu tuberkuleza v usloviiakh ozhidaemoi stabilizatsii épidemiologicheskoi situatsii.

Evidence is provided for that there is a need for making additions and amendments in Federal Law No. 77 "On Prevention of the Prevalence of Tuberculosis in the Russian Federation". Amendments are aimed at improving the legal base to increase the financing of governmental programs, at organizing the prevention and treatment of tuberculosis, at optimizing labor in specialized health care services. The authors propose to support the initiative of the Kursk Branch of the Russian Society of Phthisiologists for appealing to the State Duma of the Russian Federation to submit a legislative initiative in amending the law.

[Prospects in the search for new biological agents to prevent tuberculosis]. / Perspektivnost' poiska novykh biopreparatov dlia profilaktiki tuberkuleza.

Six biological specimens, including BCG obtained from Mycobacterium tuberculosis or animal tissues in accordance with an original procedure were studied. Their protective efficiency in tuberculosis infection was evaluated by the magnitude of allergic reactions and by pathological tissue changes 5 months after animal immunization and infection. The drug PKP-3 was found to be most effective and its further study is promising.

[Postoperative period in early activated patients after myocardial revascularization]. / Osobennosti posleoperatsionnogo perioda pri rannei aktivatsii bol'nykh posle operatsii revaskuliarizatsii miokarda.

The specific features of an early postoperative period were studied in 115 patients undergone myocardial revascularization who were divided into 3 groups according to the time of postoperative activation. Group 1 comprised 35 patients in whom tracheal extubation was made in the operating room 30-60 min after the end of the operation. Group 2 included 32 patients extubated 2-8 hours after admission to the resuscitation and intensive care unit (RICU); Group 3 consisted of 48 patients undergone tracheal intubation for more than 8 hours. The patients of this group received traditional anesthesia using ketamine, benzodiazepines, and large-dose fentanyl. The developed combined anesthesia with inhalational and intravenous anesthetics having their better pharmacodynamics, such as isoflurane, diprivan, tracrium, was used in 60.3% of the patients in Groups 1 and 2. The developed type of anesthesia using a high thoracic (T2-T4) epidural blockade as a basic component of anesthesiological maintenance was studied. In Group 2, the preextubation time was twice less than that in a control group (5.2 +/- 0.3 and 10.8 +/- 0.4 hours, respectively, p < 0.05). In groups with early extubation, the incidence of clinically significant cardiovascular disorders was less than that in the controls, which is indicative of better performance of the cardiovascular system. In Group 1, the frequency of reintubations for arterial hypoxemias was 2.8% and that of pneumonias and pulmonary microatelectasis was 2.5 times less as that in Group 3 (9%, p < 0.05). Chills occurred in 6, 4, and 15% of cases in Groups 1, 2, and 3, respectively (p < 0.05). A programme on early activation after aortocoronary bypass surgery could reduce the patients' stay at the RICU on an average by 24 hours without increasing the risk for postoperative complications.

[Urinary potassium excretion in chronic heart failure]. / Kaliiurez pri khronicheskoi serdechnoi nedostatochnosti.

Mechanisms were studied of urinary potassium excertion in patients with chronic heart failure (CHF). A total of 78 patients were examined presenting with functional class I-IV CHF.

[Treatment of mild and moderate hypertension with enalapril (multicenter study of enap and enap N in Ukraine)]. / Lechenie miagkoi i umerennoi arterial'noi gipertonii énalaprilom (mnogotsentrovoe issledovanie énapa i énapa-N na Ukraine).

AIM: Assessment of efficiency and safety of enalapril (enap) and its combination with hydrochlorotiaside (enap-N). MATERIALS AND METHODS: 127 patients with mild and moderate blood hypertension entered an open non-comparative multicenter trial. 60 of them received enap (group 1), 67--enap N (group 2). Group 1 patients were given enap for 2 weeks in a dose 10 mg/day. If this dose was not adequate to normalize blood pressure, it was raised to 20-40 mg/day. Patients of group 2 received enap-N one tablet a day for 3 weeks. If the pressure persisted higher than 140/90 mm Hg, the treatment was continued for 3 weeks more in a dose of 2 tablets a day. RESULTS: Blood pressure lowered under 140/90 mm Hg in 40 patients of group 1 (66.7%). Systolic pressure dropped by 10 mm Hg minimum and diastolic by 5 mm minimum in 18 group 1 patients (30%). Enap-N reduced blood pressure under 140-90 mm Hg in 44 of 67 patients (65.7%). Systolic and diastolic pressure dropped, respectively, in 23(34.3%) patients. CONCLUSION: Enap and enap-N tablets were found highly effective and well tolerated. Side effects were caused by lowering of blood pressure.