The aim: To study possibilities of using perioperative energy monitoring in intensive care in patients with acute calculous cholecystitis (ACC).
Materials and methods: 131 patients with ACC, who ...underwent laparoscopic cholecystectomy (LC) under general anesthesia were studied. Risk of ASA II-IV. Group I (n = 63) - intensive care aimed at maintaining vital functions. Group II (n = 68) - additional use of indirect calorimetry data.
Results: At the stages of the reverse position of Trendelenburg, pneumoperitoneum and the beginning of the operation, a decrease in hemodynamic, a violation of the oxygen status and metabolism were observed with more pronounced manifestations in the I group, where there was a longer recovery. In patients of group II, on the background of enhanced infusion therapy and administration of glucocorticoids, their recovery was more intense, they woke up faster and were transferred to the ward. These patients had 2,4 times less nausea and vomiting, and less postoperative pain upon awakening (p<0,05).
Conclusions: In patients with ACC, correction of hemodynamic, oxygen status and metabolism, makes LC safer.
Background. The study of perioperative changes in metabolism in patients undergoing laparoscopic surgeries for hiatal hernia is relevant. The purpose was to study the use of personalized energy ...monitoring of patients with hiatal hernia and to evaluate its possibilities in perioperative management. Materials and methods. The study was prospective, non-randomized and included 132 patients aged 32–77 years (64 men and 68 women), who underwent laparoscopic surgeries for hiatal hernia. Preoperative risk was ASA II–III. General anesthesia was performed using the inhaled anesthetic sevoflurane and the narcotic analgesic fentanyl in conditions of low-flow artificial lung ventilation. Operational monitoring was supplemented by indirect calorimetry. In group I (n = 66), the metabolic rate (MR) and basal metabolic rate (BMR) were determined against the background of standard intensive care. In group II (n = 66), target metabolic rate (TMR) and the metabolic disorders (MD = × 100 %) were evaluated additionally, and intensive care was supplemented by additional infusion therapy and glucocorticoids, taking into account MR, TMR and MD. Results. Baseline MR indicators were without violations and significantly exceeded BMR (in group I — by 30 %, in group II — by 29 %). At the stage of reverse Trendelenburg position, pneumoperitoneum and the beginning of the operation, the patients had significant violations of MR with a decrease to BMR. In group I, there was a slow restoration of MR, which at the time of awakening was 8.2 % lower than the baseline (p < 0.05). In patients of group II, against the background of intensified infusion therapy and administration of glucocorticoids, MR restoration was more intense, with a decrease in MD to a safe level (5.4 ± 2.7 %), and in MR to the baseline (p < 0.05). Patients of group II woke up faster and were transferred to the ward, and nausea and vomiting were 2.2 times less frequent in them than in group I (p < 0.05). According to the visual analogue scale, postoperative pain 6 and 12 hours after waking up in group II was lower than in group I by 29 and 35.5 % (p < 0.05), respectively. Conclusions. Personalized perioperative energy monitoring makes it safer to perform surgical interventions in patients with hiatal hernia. Additional evaluation of the target metabolic rate and the metabolic disorders allows more effective perform perioperative intensive care.
Актуальність. Анестезіологічне забезпечення трансабдомінальної та екстраабдомінальної ендовідеохірургічної герніопластики має враховувати особливості технологій ендовідеохірургічного втручання ...(ЕВХВ): використання карбоксиперитонеуму, специфічні «круті» положення тіла на операційному столі, нерідко більша тривалість операції. Будучи розчинною кислотою, СО2 викликає гіперкапнію, гіперкарбію та ацидоз, які анестезіолог повинен компенсувати гіпервентиляцією. Отже, розробка стратегії зниження гіперкапнії при трансабдомінальній і екстраабдомінальній ендовідеохірургічній герніопластиці є актуальною. Мета: вивчити можливість корекції гіперкапнії при трансабдомінальних і екстраабдомінальних ендовідеохірургічних герніопластиках. Матеріали та методи. Досліджено 139 чоловіків, яким проводилися ЕВХВ у зв’язку з грижами передньої черевної стінки й паховими грижами. Вік хворих становив 34–76 років, функціональний клас тяжкості стану за ASA — II–IV. У групу І (n = 72) увійшли пацієнти, яким проводилася трансабдомінальна преперитонеальна герніопластика. У групу ІІ (n = 67) — пацієнти, яким було проведено тотальну екстраперитонеальну герніопластику. Тривалість операції становила 2–2,5 год. Загальне знеболювання з використанням інгаляційного анестетика севофлюрану й наркотичного анальгетика фентанілу в умовах низькопотокової штучної вентиляції легень. Здійснювали моніторинг інтраперитонеального й екстраперитонеального тиску, CI, DO2, VO2, O2ER, TV, PaCO2, PetCO2, рН. Результати. Встановлено, що при підвищенні інтраабдомінального й екстраперитонеального тиску під час оперативного втручання зростала концентрація СО2 як в артеріальній крові, так і в суміші, що видихається. З негативних ефектів гіперкапнії на особливу увагу заслуговує респіраторний, а надалі — змішаний ацидоз. Розроблена програма періопераційного менеджменту усунення гіперкапнії та її наслідків. Для цього застосовувалися безпечне збільшення дихального об’єму й частоти дихання, підвищення позитивного тиску наприкінці видиху, зміни співвідношення вдиху/видиху з 2 : 1 на 1 : 1. Незважаючи на всі заходи, повної компенсації процесів, що відбуваються, досягти не вдалося. Висновки. В обох групах під час операції підвищувалися TV, PaCO2, etCO2. Однак підвищення PetСО2, PaCO2 у групі I розвивалося лише через 1,5 год після початку операції, не було критичним і легко коригувалося протягом операції. У групі II підвищення PetСО2, PaCO2, що вимагають ретельної корекції, наставало вже через 30 хв після створення екстраперитонеального тиску. Розроблена програма періопераційного менеджменту усунення гіперкапнії та її наслідків.
The article analyzes forms of supervision and control over the compliance with labor legislation and labor standards in Ukraine in relation to the concept of inspection. The procedure for exercising ...control and supervisory functions is investigated and the powers of the entities exercising them are determined. The article analyzes theoretical and legal nature of the state and public supervision and control over the compliance with the labor legislation of Ukraine. The study reviews foreign legislation in the sphere of supervision and control over the compliance with labor legislation and legislation on labor protection. The study also correlates the latter with Ukrainian labor legislation. In the course of the research, the modern tendencies and problems arising in the process of improving Ukrainian legislation are identified, along with ways of overcoming them. Namely, the temporal legal conflict is identified, characterized by the simultaneous effect of two acts of equal legal force.
The article explores the dynamic development of atypical forms
of employment in the country and its impact on the Ukrainian labor
market. The study highlights the need to create institutional and ...legal
regulation of the latest forms of employment. This approach will
facilitate the use of the positive aspects of atypical employment
(adaptability, flexibility, the possibility of combining work and
personal life, and others). The result of the reform of labor legislation
in Ukraine should be the introduction of the latest forms of
employment, establishing social dialogue, as well as increasing social
guarantees for workers of atypical forms of employment to European
labor standards.
El artículo explora el desarrollo dinámico de formas atípicas de
empleo en el país y su impacto en el mercado laboral ucraniano. El
estudio destaca la necesidad de crear una regulación institucional y
legal de las últimas formas de empleo. Este enfoque facilitará el uso de
los aspectos positivos del empleo atípico (adaptabilidad, flexibilidad,
la posibilidad de combinar la vida laboral y personal, y otros). El
resultado de la reforma de la legislación laboral en Ucrania debería ser
la introducción de las últimas formas de empleo, el establecimiento de
un diálogo social y el aumento de las garantías sociales para los
trabajadores de formas atípicas de empleo según las normas laborales
europeas.
The article, based on the work “Protestant Ethics and the Spirit of Capitalism” explores the concept of «capitalism» by Max Weber, as well as a critique of capitalism itself based on the texts of ...Walter Benjamin and Giorgio Agamben. All three authors have different views on the nature of capitalism. If Weber is positive about capitalism, Benjamin and Weber see it as a danger. Weber approaches the issue from the point of view of Protestant practice, Benjamin and Agamben see capitalism as a parasite that uses Christian theology for its own useful purposes. Weber writes about the “spirit” of capitalism, Benjamin and Agamben write about capitalism as a form of religion. Weber wrote that «unbridled lust» is by no means identical with capitalism, much less its «spirit». Weber characterizes capitalism through such virtues as honesty, punctuality, diligence, moderation. Benjamin suggested that «Christianity during the Reformation did not contribute to the advent of capitalism, but was transformed into capitalism». He writes that capitalism is perhaps the most extreme of all religious cults, because it is based on a purely psychological connection to the object being fetishized. This cult, devoid of ideology or theology, exists solely through the continuous performance of its rituals — the purchase of goods and their consumption. Agamben asks very important question: “if capitalism is a religion, how do we interpret it in terms of faith? What does capitalism believe in?” He writes that capitalism is a religion based on faith. Capitalism is not simply the secularization of the Protestant faith. Agamben writes that capitalism is a religion where faith and credit replace God. Ever since money became a pure form of trust, capitalism has become a religion in which money is the God.
The purpose of this study, which is based on the method of political and legal analysis, is to identify and assess the modern challenges faced by legal systems of different states in the field of ...adaptation of labor legislation to new types of social and legal relations arising under the influence of the digital economy. This study allows asserting that today’s adaptation of labor legislation of different countries in the conditions of the digital economy is at the initial stages and the existing legal mechanisms are not entirely adapted to many new types of legal relations. The evolution of this legislation today is slowed down by the lack of a sufficient conceptual apparatus, a clearly defined sphere of legislative regulation, which in turn is also due to dynamic changes in the field of digital technologies. This study can be used to improve legal regulation in the field of labor law.
Background. Prostate cancer is one of the most common male malignancies worldwide that ranks second in cancer-related mortality. Artificial intelligence can reduce subjectivity and improve the ...efficiency of prostate cancer diagnosis using fewer resources as compared to standard diagnostic scheme.
This review aims to highlight the main concepts of prostate cancer diagnosis and artificial intelligence application and to determine achievements, current trends, and potential research directions in this field, using bibliometric analysis.
Materials and Methods.The studies on the application of artificial intelligence in the morphological diagnosis of prostate cancer for the past 35 years were searched for in the Scopus database using “artificial intelligence” and “prostate cancer” keywords. The selected studies were systematized using Scopus bibliometric tools and the VOSviewer software.
Results. The number of publications in this research field has drastically increased since 2016, with most research carried out in the United States, Canada, and the United Kingdom. They can be divided into three thematic clusters and three qualitative stages in the development of this research field in timeline aspect.
Conclusions. Artificial intelligence algorithms are now being actively developed, playing a huge role in the diagnosis of prostate cancer. Further development and improvement of artificial intelligence algorithms have the potential to automate and standardize the diagnosis of prostate cancer.
Aim. Post-communist planning in Ukraine was essentially transformed over the last years with new approaches, instruments and practices changing the very idea of planning at the local level. As a ...result, local planning is becoming a mix of multiple usual planning instruments, new optional tools, which have appeared with imported conceptions and widespread participatory practices. This article uses the context of Luhansk region to address the question how this variety of instruments transform the planning processes at the local level in post-transitional perspective. We examine how planning and participatory instruments are developed and combined in the territorial communities of Luhansk region, what are the outcomes and how the main actors evaluate the planning process.
Methodology. In this article, we consider how territorial communities use the planning and participation instruments from the standpoints of spatial transformations and place-making, using the experience of the region with a severe planning crisis in recent decades. In order to analyze the state of use of planning and participation instruments at the local level, we focus on planning documents and participatory tools in 26 territorial communities of the government controlled areas in Luhansk region (as of the end of 2021). Additional data for contextualizing empirical information on the planning process, its outcomes and particular instruments were obtained from two focus groups, which involved 35 persons, including local officials, local activists and residents from different territorial communities of Luhansk region.
Results. We argue that territorial communities rely on quite diverse planning documents and participatory practices with insufficient focus on planning instruments for balancing the spatial development. Active introduction of the new public participation tools that have become available in recent years had a paradoxical effect in the region, when implementing without reliance on planning instruments. At the same time, many territorial communities are adapting various instruments to specific local context, thus contributing significantly to developing the local institutional environment, creating local success stories and strengthening democratic decision-making. We show that planning instruments, their implementations and outcomes of planning activity in most cases are perceived and evaluated differently by the main actors, however many of them are becoming increasingly aware about planning process and interested in developing the planning culture.
Novelty and practical significance. This paper contributes to the discussion on the evolution of local planning instruments, the role and effectiveness of certain instruments in the post-transitional perspective. Understanding the state of affairs with local planning and participatory instruments, their interplay and ability to provide expected outcomes contributes to strengthening of the local planning policy and making it more effective.
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