[A new paradigm for the treatment of sternomediastinitis]. / Novaya paradigma lecheniya sternomediastinita.

OBJECTIVE: To analyze the results of simultaneous surgical treatment of sternomediastinitis compared to stage-by-stage approach. MATERIAL AND METHODS: The study included 27 patients between October 2022 and March 2023. All patients underwent heart surgery through median sternotomy. There were 11 (40.7%) women and 16 (59.3%) men. Mean age of patients was 68.4±9.8 years. All patients were divided into 2 groups: 12 patients underwent partial necrectomy and vacuum wound therapy (or long-term dressings) before surgery (group 1), 15 patients underwent surgery without prior conservative treatment (group 2). RESULTS: The most common causative agent of infection was staphylococcus (48.1%). In all patients, we found histological signs of osteomyelitis. Preoperative clinical status was similar in both groups. There were differences in the following indicators: C-reactive protein upon admission - 74.9±18.6 versus 94.8±23.8 mg/l, procalcitonin - 0.13 [0.02; 1.43] versus 0.21 [0.02; 0.94] ng/ml. Postoperative outcomes were similar in both groups. Mortality was 8.3% (n=1) and 13.3% (n=2), respectively. CONCLUSION: Simultaneous combined surgical treatment (sequestrectomy + muscle flap grafting) demonstrates optimal results in the treatment of sternomediastinitis.

Experimental quantum key distribution certified by Bell's theorem.

Cryptographic key exchange protocols traditionally rely on computational conjectures such as the hardness of prime factorization1 to provide security against eavesdropping attacks. Remarkably, quantum key distribution protocols such as the Bennett-Brassard scheme2 provide information-theoretic security against such attacks, a much stronger form of security unreachable by classical means. However, quantum protocols realized so far are subject to a new class of attacks exploiting a mismatch between the quantum states or measurements implemented and their theoretical modelling, as demonstrated in numerous experiments3-6. Here we present the experimental realization of a complete quantum key distribution protocol immune to these vulnerabilities, following Ekert's pioneering proposal7 to use entanglement to bound an adversary's information from Bell's theorem8. By combining theoretical developments with an improved optical fibre link generating entanglement between two trapped-ion qubits, we obtain 95,628 key bits with device-independent security9-12 from 1.5 million Bell pairs created during eight hours of run time. We take steps to ensure that information on the measurement results is inaccessible to an eavesdropper. These measurements are performed without space-like separation. Our result shows that provably secure cryptography under general assumptions is possible with real-world devices, and paves the way for further quantum information applications based on the device-independence principle.

Registry of Acute Myocardial Infarction. REGION-MI - Russian Registry of Acute Myocardial Infarction.

Aim      To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods  The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion      REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.

[Piezopulsometric analysis of autonomic regulation of the cardiovascular system in an elderly person under stress.]

The article describes the results of using the method of arterial piezopulsometry for non-invasive assessment of the functional state and physiological mechanisms of autonomous regulation of the cardiovascular system (CVS) in an elderly person with acute pain associated with unexpected physical trauma. On the first day, such an effect caused a negative stress reaction in the muscle effectors (ME) of the CVS, provoking an abnormal increase and acceleration of the contractility of the left ventricular myocardium. Analysis of the arterial blood pressure (PP) pulse wave graphs showed that the maximum rate of PP growth - VmaxPP, which reflects myocardial contractility, increased from 625±74 before injury to 2 117±173 mm Hg/s after injury, distorting the contour of the normal PP waveform. The reason for this growth could be the rapid cumulative effect of transmitters of the neuroendocrine sympathoadrenal system on adrenergic receptors (AR) of cardiomyocytes (CM). The results of the spectral analysis of the variability of the parameters of the PP waves confirmed this possibility. It was shown that under stress, norepinephrine from activated sympathetic efferents is added to the already increased content of humoral catecholamines in the extracellular environment of the myocardium near the AR of the CM, which is characteristic of the elderly. At the same time, the activity of parasympathetic efferents, releasing acetylcholine, which inhibits the contractile reaction of the myocardium and, thereby, performs a restraining cardioprotective function, significantly increases. A personalized approach was used for piezopulsometric study of the mechanisms of autonomous regulation of ME CVS under specific conditions of stress.

Singlet-Contrast Magnetic Resonance Imaging: Unlocking Hyperpolarization with Metabolism*.

Hyperpolarization-enhanced magnetic resonance imaging can be used to study biomolecular processes in the body, but typically requires nuclei such as 13 C, 15 N, or 129 Xe due to their long spin-polarization lifetimes and the absence of a proton-background signal from water and fat in the images. Here we present a novel type of 1 H imaging, in which hyperpolarized spin order is locked in a nonmagnetic long-lived correlated (singlet) state, and is only liberated for imaging by a specific biochemical reaction. In this work we produce hyperpolarized fumarate via chemical reaction of a precursor molecule with para-enriched hydrogen gas, and the proton singlet order in fumarate is released as antiphase NMR signals by enzymatic conversion to malate in D2 O. Using this model system we show two pulse sequences to rephase the NMR signals for imaging and suppress the background signals from water. The hyperpolarization-enhanced 1 H-imaging modality presented here can allow for hyperpolarized imaging without the need for low-abundance, low-sensitivity heteronuclei.

[Features of autonomic regulation of the cardiovascular system in human late ontogenesis.]

Using the method of arterial piezopulsometry, statistical and spectral analyzes of variable parameters (VmaxPP and TNN) of pulse waves of blood pressure in patients aged 18 to 85 years were performed. The individual characteristics of the autonomous (vegetative and neuroendocrine) regulation of the muscular effectors (ME) of the cardiovascular system (CVS) in an elderly man (75 years old) and a young woman (20 years old) were estimated with high accuracy. These data, as well as the results of a comparative study of patients of different ages, made it possible to identify a certain pattern of directed change in the sympathoadrenal regulation of ME CVS in human ontogenesis. It is concluded that in the course of their lives, people undergo a restructuring of the physiological mechanism of the autonomous regulation of their ME CVS, aimed at replacing short-term sympathetic regulation in young people with more effective and more stable regulation by humoral catecholamines in elderly.

A method for simulating level anti-crossing spectra of diamond crystals containing NV- color centers.

We propose an efficient method for calculating level anti-crossing spectra (LAC spectra) of interacting paramagnetic defect centers in crystals. By LAC spectra we mean the magnetic field dependence of the photoluminescence intensity of paramagnetic color centers: such field dependences often exhibit sharp features, such as peaks or dips, originating from LACs in the spin system. Our approach takes into account the electronic Zeeman interaction with the external magnetic field, dipole-dipole interaction of paramagnetic centers, hyperfine coupling of paramagnetic defects to magnetic nuclei and zero-field splitting. By using this method, not only can we obtain the positions of lines in LAC spectra, but also reproduce their shapes as well as the relative amplitudes of different lines. As a striking example, we present a calculation of LAC spectra in diamond crystals containing negatively charged NV centers.

Different regimes of the Purcell effect in disordered photonic crystals.

We demonstrate that disorder in photonic crystals could lead to pronounced modification of spontaneous emission rate in the frequency region corresponding to the photonic band gap (PBG). Depending on the amount of disorder, two different regimes of the Purcell effect occurs. We provide statistical analysis of Purcell coefficient on the frequency of the emitter and its position within the sample. For the moderate disorder, an enhancement of spontaneous emission occurs at the edge of PBG due to the modification of properties of the edge state. This effect is responsible for recently observed mirrorless lasing in photonic crystals at the edge of PBG. When the level of disorder increases, the spontaneous emission rate enhances within the PBG due to the appearance of the high quality factor states. This effect is likely responsible for a superlinear dependence of emissions on pumping observed in synthetic opals.

Enhancement of spontaneous emission in Tamm plasmon structures.

It was theoretically and experimentally demonstrated that in metal/semiconductor Tamm plasmon structures the probability of spontaneous emission can be increased despite losses in metal, and theoretical analysis of experimental results suggested that the enhancement could be as high as one order of magnitude. Tamm plasmon structure with quantum dots has been fabricated and the emission pattern has been measured. Electromagnetic modes of the structure have been analyzed and modification of spontaneous emission rates has been calculated showing a good agreement with experimentally observed emission pattern.

A tailored multi-frequency EPR approach to accurately determine the magnetic resonance parameters of dynamic nuclear polarization agents: application to AMUPol.

To understand the dynamic nuclear polarization (DNP) enhancements of biradical polarizing agents, the magnetic resonance parameters need to be known. We describe a tailored EPR approach to accurately determine electron spin-spin coupling parameters using a combination of standard (9 GHz), high (95 GHz) and ultra-high (275 GHz) frequency EPR. Comparing liquid- and frozen-solution continuous-wave EPR spectra provides accurate anisotropic dipolar interaction D and isotropic exchange interaction J parameters of the DNP biradical AMUPol. We found that D was larger by as much as 30% compared to earlier estimates, and that J is 43 MHz, whereas before it was considered to be negligible. With the refined data, quantum mechanical calculations confirm that an increase in dipolar electron-electron couplings leads to higher cross-effect DNP efficiencies. Moreover, the DNP calculations qualitatively reproduce the difference of TOTAPOL and AMUPol DNP efficiencies found experimentally and suggest that AMUPol is particularly effective in improving the DNP efficiency at magnetic fields higher than 500 MHz. The multi-frequency EPR approach will aid in predicting the optimal structures for future DNP agents.

Maintenance of the Cardiovascular Function in a Deeply Cooled Homeothermic Organism by Physiological Methods without External Rewarming.

Gradual cooling of homeothermic organisms is followed by slowing and arrest of breathing and heart contractions. During deep cooling, even relatively slight artificial ventilation decreases the lower temperature limit of life (by 4.5-5°C) and provides minimum oxygen supply to the heart and whole body. This allows us to restore cardiovascular function and prevent animal death after lethal cooling without eternal warming.

[Organisation of medical care to military personnel with viral hepatitis. A during the local armed conflicts].

Organisation of medical care to military personnel with viral hepatitis A during the local armed conflicts. The article provides an analysis of medical care organisation system to patients with viral hepatitis A during conducting counterterror operations on the North Caucasus (1994-1996 and 1999-2002). The authors provided information on the main problems of medical support in modern local armed conflicts and shortcomings of organization of medical care to patients with viral hepatitis A in the following conditions: multistage, discrepancy between calculation of forces and facilities and character of military conditions, shortcoming of staff structure of medicalfacilities, inappropriate level ofproficiency ofphysicians of infectious profile and absence of regulations, concerning the use for equipment of infectious hospitals. 'Possible -ways for resolving these problems are showed.

Super-radiant mode in InAs-monolayer-based Bragg structures.

We report direct experimental evidence of the collective super-radiant mode in Bragg structure containing 60 InAs monolayer-based quantum wells (QWs) periodically arranged in GaAs matrix. Time-resolved photoluminescence measurements reveal an appearance of the additional super-radiant mode, originated from coherent collective interaction of QWs. This mode demonstrates a super-linear dependence of the intensity and radiative decay rate on the excitation power. The super-radiant mode is not manifested in the case if only a small number of QWs is excited.

[Meningococcal disease: early clinical diagnosis and emergency care].

Late diagnosis of meningococcal disease leads to high mortality. Early diagnosis of its generalized forms plays a crucial role in the pre-hospital phase and mainly based on the clinical picture of the disease. In most cases, pre-hospital typical mistake is late diagnosis of meningococcal disease: We propose an algorithm of early diagnosis of generalized forms of the disease in order to reduce the number of diagnostic errors. Proper and timely diagnosis will enable the physician pre-hospital fully implement measures to provide emergency and urgent care in generalized meningococcal infection, leading to. a more.favourable course and a significant improvement in the outcomes of the disease in the course of further hospital treatment.

[Restoration of respiratory function of an organism after cold oppressions without warming].

In experiments on rats studied influence of intravenous introduction NazdTA on respiratory function of rats after the full termination of breath at deep hypothermia. It is shown that such method without warming application it is possible to lower on 1.5-2.0 degrees C a temperature threshold of approach full a cold paralysis of respiratory function of an organism. It confirms the hypothesis put forward earlier about an important role of infringement of balance of ions of calcium in cytoplasm of cells in development of a pathology of an organism at deep hypothermia. The received results can be used at resuscitation of victims accidental hypothermia.

[An increase in efficiency of adaptations and a weakening of organism protective reactions in the process of biological evolution].

The main direction of evolution of living organisms is development of the central nervous system and sense organ, an increase of energy exchange development of homoiothermia, development of the more and more complex forms of behavior, an increase in energy expenditure in connection with an increase of the organism activity, and development of adaptation to the habitat. Such fundamental processes were subjected and have been subjected to numerous studies and discussions. However, in different animals there exist different species peculiarities of evolution of physiological functions, from which finally formed are fundamental evolutionary processes. We studied some of these specific processes by dividing them into two categories. The first category is "Increase of efficiency of adaptation" in development of biological evolution. By this term we mean development of amazing by perfection specific physiological mechanisms of adaptive character. The second category is "Weakening of protective organism reactions". By this we understand disturbance of protective mechanisms of the organism immune system, discoordination of movement of leukocytes along microvessels, the absence of efficient collateral circulation in brain and in heart, etc.

[Modern medical problems of microcirculation and hypoxic syndrome].

In this paper long known problems of microcirculation are shown, which were solved only during the last 40 years. They are concerned with the velocity and character of the capillary blood flow, the regulation of the capillary blood flow, the role of various vessels in the oxygen transport, the role of leukocytes in physiology and pathology of the capillary blood flow, with the special features of the function of lungs in supplying the whole organism with oxygen and with bioenergetic laws in the development of an organism adaptation to hypoxia. Here we considered a number of the most important medical problems of microcirculation and hypoxic syndrome. A relatively new factor in the capillary circulation is the fact that in the brain and heart capillaries there are sites with pO2 close to zero. They show that the capillary circulation has no central nervous regulation of the blood flow. The blood flow in these organs obeys only occasional oscillations. The new fact is that Krogh's rule about metabolism and oxygen exchange occurring only in the capillaries is abandoned. It is shown that almost 30% of consumed oxygen is delivered to the brain via arterioles, which changes our relation to the capillary circulation as a unique mechanism of the tissue supply with oxygen. The new fact is also the mass adhesion of leukocytes to the walls of microvessels, which results in the occlusion of the vessels followed by the development of the heart and brain ischemia. It was shown for the first time that contrary to previous ideas the alveoli in the lungs are supplied with blood from a powerful network of large microvessels from 20 to 50 microm in diameter rather than from thin arterioles. They make possible the passage of 6-121 of the blood in the norm and during stressed muscle activity--up to 18-231 of blood per minute. The principle is substantiated that during hypoxia only normal supply of an organism with oxygen may result in a complete adaptation of an organism to the deficit of oxygen.

Single and double bosonic stimulation of THz emission in polaritonic systems.

The influence of the surrounding cavity on the efficiency of different types of polaritonic emitters of THz radiation has been analysed. It is demonstrated that THz lasing threshold in realistic structures cannot be achieved without a THz cavity, due to destruction of polaritons via excitonic Mott transition. Even modest values of cavity quality factor (not exceeding 50) provide significant quantum efficiency.