[Awake percutaneous tracheostomy in neurosurgical patients: clinical cases and literature review]. / Punktsionno-dilatatsionnaya trakheostomiya u patsientov s neirokhirurgicheskoi patologiei, vypolnennaya na fone samostoyatel'nogo dykhaniya cherez estestvennye dykhatel'nye puti: klinicheskie nablyudeniya i obzor literatury.

Transoral or combined transnasal-transoral approach is sometimes used for tumor resection in patients with skull base and vertebral neoplasms. In such cases, percutaneous tracheostomy before surgical intervention is advisable. Tracheostomy facilitates surgical access, eliminates intraoperative risk of endotracheal tube kinking and provides airway protection from aspiration in early postoperative period in case of bulbar disorders, hypopharynx and tongue edema. The authors present two patients with massive proliferation of pathological tissue in nasopharynx and oropharynx that excluded tracheal intubation before tracheostomy. These patients underwent awake percutaneous tracheostomy.

[Use of the IntelliVent-ASV mode for maintaining the target EtCO2 range in patients with severe TBI]. / Ispol'zovanie rezhima IntelliVent-ASV dlia podderzhaniia tselevogo diapazona EtCO2 u patsientov s tiazheloi ChMT.

PURPOSE: the study purpose was to evaluate the efficacy of the IntelliVent-ASV mode in maintaining the target range of PaCO2 in patients with severe TBI. MATERIAL AND METHODS: The study included 12 severe TBI patients with the wakefulness level scored 4-9 (GCS). This was a crossover design study. Two ventilation modes were consecutively used: IntelliVent-ASV and P-CMV, for 12 h each. When using the P-CMV mode, the ventilation parameters were set to maintain PaCO2 in a range of 35-38 mm Hg. The IntelliVent-ASV mode involved the Brain Injury ventilation algorithm. The target range of EtCO2 was set in accordance with the delta PaCO2-EtCO2 to maintain PaCO2 in a range of 35-38. At the beginning of each ventilation period and every 3 hours, the arterial blood gas composition was analyzed. When PaCO2 occurred out of the 35-38 range, appropriate adjustments were made to the ventilation parameters. In the P-CMV mode, the Pinsp and RR parameters were adjusted to achieve the target PaCO2 range. In IntelliVent mode, a shift of the target EtCO2 range was adjusted in accordance with a changed PaCO2-EtCO2 difference. In all patients, ICP, blood pressure, and EtCO2 were monitored; the arterial blood gas composition was analyzed every 3 h; the frequency of manual settings of ventilation parameters was recorded. RESULTS: The EtCO2 and PaCO2 parameters were found not to be significantly different in the P-CMV and IntelliVent modes, but the spread in these parameters was significantly lower in the IntelliVent ventilation mode. The PaCO2 parameter occurred out of the target range significantly less often in the IntelliVent mode than in the P-CMV mode. The mean frequency of manual respirator settings needed to maintain the target EtCO2 range was significantly lower in the IntelliVent-ASV mode than in the P-CMV mode. CONCLUSION: The IntelliVent-ASV mode provides more efficient maintenance of PaCO2 in the target range compared to traditional artificial ventilation using fewer manual settings of the ventilation parameters.

[Improvement of medical equipment setting for the hospital link of the medical service during wartime].

One of the priorities of the military health care is to improve the system of rationing medical equipment for the hospital unit of the medical service of the Armed Forces in wartime. This is determined the fact that the effectiveness of measures to provide military field hospitals with medical supplies depends on the quality of medical care for the wounded and sick, as well as the level of their return to duty. The article presents the characteristics of modern standards medical supplies procurement of military field hospitals included in the new regulatory legal act of the Russian Federation Ministry of Defence--"Standards of supplies medical supplies medical and pharmaceutical organizations (units) of the Russian Federation on the wartime armed forces", approved and put into effect in 2015 by order of the Minister of Defence of the Russian Federation.

[INHOSPITAL TRANSPORT OF PATIENTS IN ACUTE PERIOD OF SEVERE ISOLATED TRAUMATIC BRAIN INJURY WITH MULTIMODAL MONITORING].

UNLABELLED: Transporting patients out of intensive care unit (ICU) in the acute period of TBI to perform diagnostic tests is an integral part of the treatment process and may be associated with the risk of secondary brain injury. Despite the large number of studies related to in-hospital transport ofpatients with TBI there are no clear recommendations on the required monitoring. OBJECTIVE: To provide safe transportation of the patient by multimodal monitoring in acute period of brain injury. MATERIALS AND METHODS: The study included 9 patients with severe TBI and loss of consciousness (Glasgow coma scale (GCS) 8 or less). The average GCS score was 5.5. The median age was 31 +/- 12 (21 to 54 years). There were 2 women and 7 men. Duration of the transportation was 52 +/- 7,4 min. Data collection was carried out every minute. All patients during transportation were monitoredfor the following parameters: HR, invasive ABP, ICE CPP EtCO2, SpO2. Before and immediately after the transportation sampling of arterial blood was performed for blood gas analysis. RESULTS: Statistically significant differences in ICP was noted in 5 main items (*p < 0.05). Mean ICP was mentioned in bed (12.5 +/- 5.3), on wheelchair (18.2 +/- 6.8*), in CT-scan (16.6 +/- 3.2**), on wheelchair after scan (18.4 +/- 4.1***), in bed again (15.8 +/- 2.9). Other parameters didn't differ significantly. CONCLUSIONS: Multimodal monitoring enables safe transportation ofpatients in acute period of TBI. There are 5 critical items associated with major complication during transportation (original ICE shifting patient from bed to transport wheelchair from wheelchair to CT-scanner table, from CT-scanner table to transport wheelchair from wheelchair to bed). The most unstable parameter is ICP

[Paradoxical air embolism resulted in acute myocardial infarction and massive ischemic brain injury in a patient operated on in a sitting position].

Paradoxical air embolism (PAE) is a rare life-threatening complication when air emboli enter arteries of the systemic circulation and cause their occlusion. Here, we describe a clinical case of PAE developed during neurosurgery in a patient in the sitting position. PAE led to injuries to the cerebral blood vessels, coronary arteries, and lungs, which caused death of the patient. An effective measure for preventing PAE is abandoning surgery in the sitting position in favor of surgery in the prone position.

[Modern order of rationing of medical property for military medical and pharmaceutical organizations in peacetime].

Modern order of rationing of medical property for military medical and pharmaceutical organizations in peacetime. The characteristic of the new rules of medical supply for medical and pharmaceutical institutions of the Armed Forces in peacetime are presented, approved and put into effect by the order of the Minister of Defence of the Russian Federation. New standards of medical supply logistics adapted to the current organizational structure of the military healthcare and pharmaceutical organizations. Their use in practice will improve the quality of primary specialized healthcare, as well as specialized and high-tech medical care to military personnel and other categories of citizens who are entitled to health care through the Ministry of Defence.

[Implementation of modern approaches to medical equipment of medical service's troops].

Implementation of modern approaches to medical equipment of medical service's troops. The authors give essential characteristics of modern approaches to equipment of medical small and large units and troops. It is shown that for medical evacuation under field conditions it is neccessary to use modern complete-basic equipment that allows effectively providing medical assistance to the wounded and sick, maintaining the established level of readiness of medical troops, unifying norms of medical equipping, operatively deploying organisational stages of medical evacuation, optimizing planning of medical equipment. Medical equipment in peacetime should be carried out on the basis of standards and orders of medical care delivery that ensures harmonization with requirements of public health.

Modelling the effect of myosin X motors on filopodia growth.

We present a numerical simulation study of the dynamics of filopodial growth in the presence of active transport by myosin X motors. We employ both a microscopic agent-based model, which captures the stochasticity of the growth process, and a continuum mean-field theory which neglects fluctuations. We show that in the absence of motors, filopodia growth is overestimated by the continuum mean-field theory. Thus fluctuations slow down the growth, especially when the protrusions are driven by a small number (10 or less) of F-actin fibres, and when the force opposing growth (coming from membrane elasticity) is large enough. We also show that, with typical parameter values for eukaryotic cells, motors are unlikely to provide an actin transport mechanism which enhances filopodial size significantly, unless the G-actin concentration within the filopodium greatly exceeds that of the cytosol bulk. We explain these observations in terms of order-of-magnitude estimates of diffusion-induced and advection-induced growth of a bundle of Brownian ratchets.

Thyroid modulation of TNF-dependent apoptosis and formation of chronic liver disease in endogenous intoxication in rats.

Dynamic studies on rats with chronic endogenous intoxication showed involvement of the thyroid hormones in modulation of liver injury. Thyroid modulation is realized as more intense induction of TNF apoptosis in the cells and stimulation of microcirculatory disorders at the expense of nitroxide synthase expression. The modulation is quantitative, augmenting liver damage.

Systems analysis of a quorum sensing network: design constraints imposed by the functional requirements, network topology and kinetic constants.

Understanding the relationship between the structural organization of intracellular decision networks and the observable phenotypes they control is one of the exigent problems of modern systems biology. Here we perform a systems analysis of a prototypic quorum sensing network whose operation allows bacterial populations to activate certain patterns of gene expression cooperatively. We apply structural perturbations to the model and analyze the resulting changes in the network behavior with the aim to identify the contribution of individual network elements to the functional fitness of the whole network. Specifically, we demonstrate the importance of the dimerization of the transcription factor and the presence of the auxiliary positive feedback loop on the switch-like behavior of the network and the stability of its "on" and "off" states under the influence of molecular noise.

Unfolding of microarray data.

The use of DNA microarrays for the analysis of complex biological samples is becoming a mainstream part of biomedical research. One of the most commonly used methods compares the relative abundance of mRNA in two different samples by probing a single DNA microarray simultaneously. The simplicity of this concept sometimes masks the complexity of capturing and processing microarray data. On the basis of the analysis of many of our microarray experiments, we identified the major causes of distortion of the microarray data and the sources of noise. In this study, we provide a systematic statistical approach for extraction of true expression ratios from raw microarray data, which we describe as an unfolding process. The results of this analysis are presented in the form of a model describing the relationship between the measured fluorescent intensities and the concentrations of mRNA transcripts. We developed and tested several algorithms for inference of the model parameters for the microarray data. Special emphasis is given to the statistical robustness of these algorithms, in particular resistance to outliers. We also provide methods for measurement of noise and reproducibility of the microarray experiments.

Herpes simplex virus triggers and then disarms a host antiviral response.

Virus infection induces an antiviral response that is predominantly associated with the synthesis and secretion of soluble interferon. Here, we report that herpes simplex virus type 1 virions induce an interferon-independent antiviral state in human embryonic lung cells that prevents plaquing of a variety of viruses. Microarray analysis of 19,000 human expressed sequence tags revealed induction of a limited set of host genes, the majority of which are also induced by interferon. Genes implicated in controlling the intracellular spread of virus and eliminating virally infected cells were among those induced. Induction of the cellular response occurred in the absence of de novo cellular protein synthesis and required viral penetration. In addition, this response was only seen when viral gene expression was inhibited, suggesting that a newly synthesized viral protein(s) may function as an inhibitor of this response.

RNA polymerase II subunit Rpb9 regulates transcription elongation in vivo.

RNA polymerase II lacking the Rpb9 subunit uses alternate transcription initiation sites in vitro and in vivo and is unable to respond to the transcription elongation factor TFIIS in vitro. Here, we show that RPB9 has a synthetic phenotype with the TFIIS gene. Disruption of RPB9 in yeast also resulted in sensitivity to 6-azauracil, which is a phenotype linked to defects in transcription elongation. Expression of the TFIIS gene on a high-copy plasmid partially suppressed the 6-azauracil sensitivity of Deltarpb9 cells. We set out to determine the relevant cellular role of yeast Rpb9 by assessing the ability of 20 different site-directed and deletion mutants of RPB9 to complement the initiation and elongation defects of Deltarpb9 cells in vivo. Rpb9 is composed of two zinc ribbons. The N-terminal zinc ribbon restored the wild-type pattern of initiation start sites, but was unable to complement the growth defects associated with defects in elongation. Most of the site-directed mutants complemented the elongation-specific growth phenotypes and reconstituted the normal pattern of transcription initiation sites. The anti-correlation between the growth defects of cells disrupted for RPB9 and the selection of transcription start sites suggests that this is not the primary cellular role for Rpb9. Genome-wide transcription profiling of Deltarpb9 cells revealed only a few changes, predominantly in genes related to metabolism.

Catastrophic extinction, noise-stabilized turbulence and unpredictability of competition in a modified Volterra-Lotka model.

Spatial coexistence and competition among species is investigated through a modified Volterra-Lotka model which takes into account sexual breeding. This allows the population specific growth rate to depend on the population density. As a result of this modification the degeneracy inherent in the classical model is eliminated and qualitatively novel regimes are observed, as demonstrated by parametric analysis of the model. In the case where the corresponding parameters of competing species do not differ significantly the model can be reduced to a single Ginzburg-Landau type equation. The spatially distributed model is analyzed both in the absence and in the presence of noise mimicking inherent fluctuations in birth and death rates. It is shown that noise can qualitatively change the behavior of the system. Not only does it induce the formation of spatial patterns, but also switches on endless turbulent-like rearrangement of the system. When initially unpopulated habitat is occupied by competing species even a very low-intensity noise makes the final state of the system totally unpredictable and sensitive to any fluctuations. (c) 1996 American Institute of Physics.