No abstract

The article analyzes the results of treatment of patients with acute necrotic pancreatitis and DIC who underwent extracorporeal detoxification (ECD) with heparin anticoagulation. We performed a retrospective analysis of the medical records of such patients who were treated in Moscow Clinical Hospital No. 24 in 2016–2017. Disorders indicating the development of DIC were detected in 38 patients with acute necrotic pancreatitis, 13 of them underwent extracorporeal detoxification methods, in 25 patients ECD was not used. The effect of ECD on hemostasis and clinical outcomes was studied. A tendency towards the progression of coagulopathy and an increase in the risks of developing hemorrhagic syndrome, multiple organ failure and death during extracorporeal detoxification with heparin anticoagulation was revealed. The insufficiently large number of patients included in the study does not allow us to draw a final conclusion about the use of heparin anticoagulation ECD in patients with acute destructive pancreatitis who were initially showing the signs of consumption coagulopathy, but the data obtained cast a doubt on its feasibility. Further research is needed to make recommendations for the use of ECD in this category of patients.

A development of work to combat the asteroid hazard requires construction and study of areas of outer space in which moving spacecraft-interceptors can affect asteroids. In this paper, such areas are called attack lines, the spatio-temporal characteristics of which depend on the parameters of the asteroid’s orbits and the phase coordinates of the nodal points. At these points the trajectory intersects the asteroids and the orbital planes of the spacecraft-interceptors. In the case of the impact of spacecraft-interceptors on asteroids at nodal points, the study of the spatio-temporal characteristics of the lines of attack, taking into account restrictions on the relative speeds between asteroids and spacecraft-interceptors, is of particular importance. Building and analyzing the corresponding zones of reverse reach are suggested. In the article, the developed models include a simulation model, using which random angles between the projections of the velocity vectors of asteroids on a plane of the orbits of spacecraft-interceptors and the current directions on the hodographs of their velocity vectors at nodal points, as well as an analytical model for estimating the spatio-temporal characteristics of boundaries are simulated attacks of asteroids, including: the radii of their external and internal boundaries for certain values of the latitude arguments and arrival time of spacecraft-interceptors at modal points. Testing these models and the corresponding characteristics of the attack lines were carries out during computational experiments on two cyclic modeling of the angles between the projections of the velocity vectors of asteroids on the plane of the orbits of interceptor spacecraft and the current directions on the hodographs of their velocity vectors at nodal points. The results obtained made it possible to verify and validate the developed models, on the basis of which a conclusion was drawn about the required degree of their applicability. In the paper also a procedure for estimating the parameters of attack lines, depending on the values of the arguments of the latitudes of interceptor spacecraft and their altitudes above the Earth's surface is proposed. At the same time, an approach is substantiated for estimating the spatio-temporal characteristics of the boundaries of attack of asteroids by spacecraft-interceptors for any inside the planar parameters of their orbits.

The article describes case of successful treatment of severe coagulopathy, which developed as a result of total premature detachment of a normally located placenta. Medications and technologies used in the diagnosis and treatment of the patient are indicated. Reasonability of participating of an interdisciplinary team including obstetrician-gynecologists, resuscitation anesthetists, hematologists and vascular surgeons in the treatment of patients with massive blood loss has been confirmed.

The COVID-19 pandemic was announced in 2020, and many professional medical societies had to review their algorithms for the management of high-risk patients. In addition to risk factors such as overweight, age over 65 years, cardiovascular disease, diabetes mellitus, and bronchial asthma, other chronic diseases should also be emphasized, taking into account possible immunosuppressive therapy. This publication presents two clinical cases of COVID-19 infection in patients with multiple sclerosis treated with ocrelizumab. During the course of the disease, both patients developed a cytokine storm and were treated with IL-6 blockers. Both cases ended with recovery and a subsequent return to anti-B-cell therapy. Given the mechanism of action of ocrelizumab, there are higher risks of infectious complications, including with COVID-19, but mortality is not higher than the population average. The information published to date may serve as a reason to consider the use of extended dosing intervals to minimize the possible risks of COVID-19 infection, which are probably highest in the first months after infusion.