[Incidence of postoperative cognitive dysfunction after simultaneous carotid surgery and coronary artery bypass grafting in patients with asymptomatic cerebral atherosclerosis]. / Chastota razvitiia posleoperatsionnoi kognitivnoi disfunktsii posle simul'tannoi operatsii na koronarnykh i vnutrennikh sonnykh arteriiakh pri asimptomnom techenii tserebral'nogo ateroskleroza.

AIM: To evaluate the incidence of early postoperative cognitive dysfunction (POCD) after simultaneous carotid surgery and coronary artery bypass grafting (CABG) in patients with asymptomatic cerebral atherosclerosis. MATERIAL AND METHODS: Fifty-three patients with polyvascular disease and asymptomatic cerebral atherosclerosis undergoing simultaneous unilateral carotid endarterectomy (CEE) and CABG were recruited in the study. Core cognitive functions were assessed with the Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) at days 2-3 before the indexed surgery and at days 7-10 after it. All the patients were assigned to two groups based on the baseline MMSE score: one group with mild cognitive impairment (MCI) and another one without MCI. Neurodynamic measurements were performed using the Status-PF hardware-software complex (certificate #2001610233 of the Russian Agency for Patents and Trademarks), followed by the calculation of the integral indicator of the main cognitive domains according to the corresponding algorithms. Attention, memory and neurodynamics were evaluated in all participants. POCD was diagnosed with a decrease from the initial indicators of memory, attention and neurodynamics by 20% in 20% of the tests. RESULTS: Patients had complications in the early postoperative period, regardless of the presence of MCI. A decline among the core cognitive functions was observed in both groups of patients at days 7-10 after the surgery. Patients demonstrated an increase in the reaction time while performing neurodynamic test battery compared with the baseline values. Alterations in memory and attention were not significant. Significant changes in the integral indicator of cognitive status were determined in both groups of patients. It increased by 14% in patients without MCI (0.34±0.2 in the preoperative period vs. 0.39±0.3 in the postoperative period, p=0.04), and by 36% in patients with MCI (0.25±0.19 vs. 0.39±0.3, p=0.003). Regardless of the presence or absence of MCI, all patients had low cognitive status or even that below the average in the perioperative period. Despite the increase in the average values of cognitive status indicators in the postoperative period, 56% of patients (n=14) without MCI and 71% of patients with MCI (n=20) had early POCD. CONCLUSION: Patients with polyvascular disease, regardless of the presence of MCI, had low cognitive status or even that below the average, probably contributing to the elimination of the expected positive effects of CEE. The absence of MCI at baseline does not guarantee the preservation of cognitive status after surgery. Patients with polyvascular disease after myocardial and cerebral revascularization remain at high risk of exacerbating cognitive impairment, and, therefore, require an individual approach and a reasonable choice of the optimal surgical strategy.

ANESTHETIC MANAGEMENT OF DELIVERY IN PATIENTS WITH COMPLEMENT-ASSOCIATED DISORDERS. CLINICAL OBSERVATION OF A PREGNANT WOMAN WITH PAROXYSMAL NOCTURNAL HEMOGLOBINURIA.

There was a case in MRRIOG (Moscow Regional Research Institute of Obstetrics and Gynecology) in 2015 when pregnant patient with paroxysmal nocturnal hemoglobinuria(PNH) has successfully passed through a delivery process. This paper analyzes the medical history, clinical, laboratory and instrumental examination, particularly anesthesia tactics for the patients with complement-associated diseases during delivery. The presented clinical case demonstrates the need for and the importance of early diagnosis of PNH in pregnant women. Of course, women with PNH are one of the most complex contingent ofpregnant women, threatened by the development of obstetric and anesthetic complications, and it requires constant monitoring of clinical and laboratory parameters of their condition, the joint hematologist, obstetri- cian and anesthesiologist observationand delivery in hospitals of III and IV levels.

[Surgical treatment of pregnant women with benign ovarian tumors].

The article describes the features of surgery in tumors and tumor-like formations of the ovaries in pregnant women. The influence of surgery on the course and outcome of pregnancy and childbirth is presented. It is showed high efficiency of laparoscopic surgery during I and II trimesters of pregnancy.

[Endovascular closure of iatrogenic arteriovenous anastomosis of the iliac artery and vein].

The presented herein clinical case report concerns successful endovascular closure of a iatrogenic lesion of the iliac artery and inferior vena cava with formation of a pathological arteriovenous anastomosis manifesting itself by venous thromboembolic syndrome and severe right-ventricular insufficiency.

Feedback control of subcritical Turing instability with zero mode.

A global feedback control of a system that exhibits a subcritical monotonic instability at a nonzero wave number (short-wave or Turing instability) in the presence of a zero mode is investigated using a Ginzburg-Landau equation coupled to an equation for the zero mode. This system is studied analytically and numerically. It is shown that feedback control, based on measuring the maximum of the pattern amplitude over the domain, can stabilize the system and lead to the formation of localized unipulse stationary states or traveling solitary waves. It is found that the unipulse traveling structures result from an instability of the stationary unipulse structures when one of the parameters characterizing the coupling between the periodic pattern and the zero mode exceeds a critical value that is determined by the zero mode damping coefficient.

Nonlinear dynamics of a double bilipid membrane.

The nonlinear dynamics of a biological double membrane that consists of two coupled lipid bilayers, typical of some intracellular organelles such as mitochondria or nuclei, is studied. A phenomenological free-energy functional is formulated in which the curvatures of the two parts of the double membrane and the distance between them are coupled to the lipid chemical composition. The derived nonlinear evolution equations for the double-membrane dynamics are studied analytically and numerically. A linear stability analysis is performed, and the domains of parameters are found in which the double membrane is stable. For the parameter values corresponding to an unstable membrane, numerical simulations are performed that reveal various types of complex dynamics, including the formation of stationary, spatially periodic patterns.

Global feedback control for pattern-forming systems.

Global feedback control of pattern formation in a wide class of systems described by the Swift-Hohenberg (SH) equation is investigated theoretically, by means of stability analysis and numerical simulations. Two cases are considered: (i) feedback control of the competition between hexagon and roll patterns described by a supercritical SH equation, and (ii) the use of feedback control to suppress the blowup in a system described by a subcritical SH equation. In case (i), it is shown that feedback control can change the hexagon and roll stability regions in the parameter space as well as cause a transition from up to down hexagons and stabilize a skewed (mixed-mode) hexagonal pattern. In case (ii), it is demonstrated that feedback control can suppress blowup and lead to the formation of spatially localized patterns in the weakly nonlinear regime. The effects of a delayed feedback are also investigated for both cases, and it is shown that delay can induce temporal oscillations as well as blowup.

Stability of localized solutions in a subcritically unstable pattern-forming system under a global delayed control.

The formation of spatially localized patterns in a system with subcritical instability under feedback control with delay is investigated within the framework of globally controlled Ginzburg-Landau equation. It is shown that feedback control can stabilize spatially localized solutions. With the increase of delay, these solutions undergo oscillatory instability that, for large enough control strength, results in the formation of localized oscillating pulses. With further increase of the delay the solution blows up.

Instability of a two-layer thin liquid film with surfactants: Dewetting waves.

Dewetting dynamics of a liquid film composed of two superposed ultra-thin layers of immiscible liquids resting on a solid substrate is investigated in the case when surfactants are present at the liquid-liquid interface. Two cases are considered: insoluble surfactant and surfactant soluble in the lower liquid. The dependence of Hamaker constants on the surfactant concentration is taken into account. A system of three strongly nonlinear evolution equations describing large (comparable to the layer thicknesses), long-wave perturbations of the liquid-liquid and liquid-gas interfaces, as well as the surfactant concentration, is derived for each case in the lubrication approximation. The linear stability analysis shows that in the presence of surfactants, oscillatory dewetting instability can occur. Numerical simulations of this system of nonlinear evolution equations are performed. It is found that in the case of oscillatory instabilities, the system exhibits either standing or traveling "dewetting waves." The weakly nonlinear analysis explains this phenomenon.

Formation of porous metal oxides in the anodization process.

A theory of the formation of nanoscale porous structures in oxides of metals grown by anodization is developed. It is shown that a growing oxide layer can become unstable which yields the formation of a spatially irregular array of pores. The instability is shown to result from a nonlinear dependence of electrochemical kinetics at the metal-oxide and oxide-electrolyte interfaces on the overpotential which is governed by the Butler-Volmer relation. The conditions for the instability of the oxide layer are found. The dependence of the oxide conductivity on the electric field is taken into account and is shown to have a destabilizing effect. A weakly nonlinear analysis is performed and it shows that the system evolution near the instability threshold is described by the Kuramoto-Sivashinsky equation. Farther from threshold, in the long-wave approximation, a system of strongly nonlinear equations is derived and solved numerically; this system describes the formation of deep irregular pores. In a particular case, a self-similar solution describing the propagation of a pore with a paraboloidal shape is found.

Nucleation and growth of droplets at a liquid-gas interface.

The nucleation of liquid droplets at a liquid-gas interface from a saturated vapor in the gas phase, as well as the droplet growth after the nucleation are studied. These two processes determine the formation of a regular hexagonal array of drops on the surface of an evaporating film of polymer solution that is used for the fabrication of polymer membranes with a regular microporous structure. The free-energy barrier for the nucleation of a droplet at a liquid-gas interface is found as a function of the droplet radius and the contact angles, and the critical nucleation radius is computed. It is shown that the heterogeneous nucleation is thermodynamically more preferable than the homogeneous one. The role of the line tension between the phases is also estimated. Further growth of a droplet nucleated at the liquid-gas interface is studied. Two growth mechanisms are considered: by the vapor diffusion flux from the gas phase and by the surface diffusion of the vapor molecules adsorbed at the liquid-gas interface outside the droplet. Two cases, corresponding to unsaturated and saturated condensation, are considered. The droplet growth is described by a free-boundary problem which is solved analytically and numerically. The droplet growth exponents at different stages of growth are found.

Feedback control of subcritical oscillatory instabilities.

Feedback control of a subcritical oscillatory instability is investigated in the framework of a globally-controlled complex Ginzburg-Landau equation that describes the nonlinear dynamics near the instability threshold. The control is based on a feedback loop between the system linear growth rate and the maximum of the amplitude of the emerging pattern. It is shown that such control can suppress the blow up and result in the formation of spatially localized pulses similar to oscillons. In the one-dimensional case, depending on the values of the linear and nonlinear dispersion coefficients, several types of the pulse dynamics are possible in which the computational domain contains: (i) a single stationary pulse; (ii) several coexisting stationary pulses; (iii) competing pulses that appear one after another at random locations so that at each moment of time there is only one pulse in the domain; (iv) spatiotemporally chaotic system of short pulses; (v) spatially-synchronized pulses. Similar dynamic behavior is found also in the two-dimensional case. The effect of the feedback delay is also studied. It is shown that the increase of the delay leads to an oscillatory instability of the pulses and the formation of pulses with oscillating amplitude.

Nonlinear stability analysis of a two-layer thin liquid film: dewetting and autophobic behavior.

The nonlinear stability analysis of a liquid film composed of two superposed thin layers of immiscible liquids resting on a solid substrate is performed. It is shown that the coupling of van der Waals interactions in the two layers can lead to an autophobic behavior in the form of spinodal decomposition of two planar liquid layers into a system of localized drops divided by almost planar wetting layers. The results of the weakly nonlinear analysis near the instability threshold are confirmed by the numerical solution of a system of two strongly nonlinear evolution equations for the liquid-liquid and liquid-gas interfaces. The kinetics of the drop coarsening at late stages is studied and is found to be close to that reported for a one-layer film. It is also shown that gravity effects can become significant even for very thin two-layer films.

Dynamic phase separation: from coarsening to turbulence via structure formation.

We investigate some new two-dimensional evolution models belonging to the class of convective Cahn-Hilliard models: (i) a local model with a scalar order parameter, (ii) a nonlocal model with a scalar order parameter, and (iii) a model with a vector order parameter. These models are applicable to phase-separating system where concentration gradients cause hydrodynamic motion due to buoyancy or Marangoni effect. The numerical study of the models shows transition from coarsening, typical of Cahn-Hilliard systems, to spatiotemporally irregular behavior (turbulence), typical of the Kuramoto-Sivashinsky equation, which is obtained in the limit of very strong driving. The transition occurs not in a straightforward way, but through the formation of spatial patterns that emerge for intermediate values of the driving intensity. As in driven one-dimensional models studied before, the mere presence of the driving force, however small, breaks the symmetry between the two separating phases, as well as increases the coarsening rate. With increasing driving, coarsening stops. The dynamics is generally irregular at strong driving, but exhibits specific structural features.

Self-organization of quantum dots in epitaxially strained solid films.

A nonlinear evolution equation for surface-diffusion-driven Asaro-Tiller-Grinfeld instability of an epitaxially strained thin solid film on a solid substrate is derived in the case where the film wets the substrate. It is found that the presence of a weak wetting interaction between the film and the substrate can substantially retard the instability and modify its spectrum in such a way that the formation of spatially regular arrays of islands or pits on the film surface becomes possible. It is shown that the self-organization dynamics is significantly affected by the presence of the Goldstone mode associated with the conservation of mass.

Disclinations in square and hexagonal patterns.

We report the observation of defects with fractional topological charges (disclinations) in square and hexagonal patterns as numerical solutions of several generic equations describing many pattern-forming systems: Swift-Hohenberg equation, damped Kuramoto-Sivashinsky equation, as well as nonlinear evolution equations describing large-scale Rayleigh-Benard and Marangoni convection in systems with thermally nearly insulated boundaries. It is found that disclinations in square and hexagonal patterns can be stable when nucleated from special initial conditions. The structure of the disclinations is analyzed by means of generalized Cross-Newell equations.

Faceting of a growing crystal surface by surface diffusion.

Consider faceting of a crystal surface caused by strongly anisotropic surface tension, driven by surface diffusion and accompanied by deposition (etching) due to fluxes normal to the surface. Nonlinear evolution equations describing the faceting of 1+1 and 2+1 crystal surfaces are studied analytically, by means of matched asymptotic expansions for small growth rates, and numerically otherwise. Stationary shapes and dynamics of faceted pyramidal structures are found as functions of the growth rate. In the 1+1 case it is shown that a solitary hill as well as periodic hill-and-valley solutions are unique, while solutions in the form of a solitary valley form a one-parameter family. It is found that with the increase of the growth rate, the faceting dynamics exhibits transitions from the power-law coarsening to the formation of pyramidal structures with a fixed average size and finally to spatiotemporally chaotic surfaces resembling the kinetic roughening.

Fingering instability of thin evaporating liquid films.

The fingering instability of growing dry patches in an evaporating film of a polar liquid placed on a solid substrate is investigated. The instability manifests itself as fingering of mobile fronts between growing "dry" (thin) and shrinking "wet" (thick) regions of the film corresponding to two stable states of the evaporating film in contact with its vapor. The boundaries of the fingering instability are found through linear stability analysis of numerical solutions of the nonlinear evolution equation defining the film profile, and the influence of the evaporation rate, polar intermolecular forces, and chemical heterogeneity of the substrate is investigated.

Convective Cahn-Hilliard models: from coarsening to roughening.

In this paper we demonstrate that convective Cahn-Hilliard models, describing phase separation of driven systems (e.g., faceting of growing thermodynamically unstable crystal surfaces), exhibit, with the increase of the driving force, a transition from the usual coarsening regime to a chaotic behavior without coarsening via a pattern-forming state characterized by the formation of various stationary and traveling periodic structures as well as structures with localized oscillations. Relation of this phenomenon to a kinetic roughening of thermodynamically unstable surfaces is discussed.

[The involvement of the components of the immune system in iron deficiency]. / Sopriazhennost' komponentov sistemy immuniteta pr defitsite zheleza.

As exemplified by iron deficiency anemia, the study was made of effect of iron deficiency on interdependence of immunity parameters. It is noted that patients with definite forms of the anemia showed less numerous correlations than in controls. The emergence of complications increased the number of persistent correlation pleiad compared to controls. Moreover, correlation and variance analyses suggested a correlation between immunity and iron deficiency parameters.