The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

5-7

Authors: T.G. Avakyan

In case of the experimental compression syndrome (crush-syndrome), on the second day after decompression in the hypothalamic area of pregnant rats' brain we discovered the severe discirculatory disorders, resulting in dystrophy and necrosis of neurosecretory cells.

11-15

Authors: E.V. Port

Adhesive properties strains Pseudomonas aeruginosa allocated in 2003-2004 from clinical sicks, and also museum strains and strains allocated from agricultural animals and birds were studied. The interrelation with resistance to antibiotics these strains were found. The tendency of growth adhesion properties is marked at increased resistance to antibiotics strains Pseudomonas aeruginosa.

19-24

Authors: N.I. Sklyar

The effect of microaerophilic conditions of cultivation on sensitivity of microorganisms to etiotropic med-icines has been studied. It was shown that antibiotic resistance of bacteria and yeast-like fungi of Candida genus increased after effect of above-mentioned factor. It was found that yield sensitivity changed to moderate one for (40,0±20,0) % of Staphylococci in relation to erytromycinе, laevomycetinе, lincomycinе, furazolidonе; for (20,0±10,0) % of Escherichia coli in relation to tetracyclinе; for 100 % of yield-like fungi of Candida genus in relation to itraconazole, fluconazole, ketоconazole. Appearance of resistance has been defined for (15,0±5,0) % of Staphylococcus spp. strains in relation to furazolidonе and laevomycetinе; for (30,0±10,0) % of Candida strains in relation to amphotericin. Antibiotic sensitivity of selected objects to cefalosporins of different generations was shown to be unchanged. It was found that lysis activity of specific bacteriophages in relation to staphylococci and escherichia coli was 4-32-fold increased.

29-34

Authors: L.V. Anufrieva

Forty six patients with arterial hypertension (AH) I-III stages were investigated in out-patient department. Estimated parameters were levels of systolic and diastolic blood pressures (SBP, DBP), heart rate, general index of quality of life (GIQL) and parameters of heart rate variability (total power (TP) and low- and high-frequency ratio (LF/HF)). Patients were evaluated before treatment, during the therapy and in acute pharmacological test with amlodipin. It was shown that all patients had signifficant increase of GIQL and decrease of TP. Effective decrease of SBP and DBP was found in patients with mild and moderate AH. Pa-tients with severe AH had only depressed DBP. During the dynamic observation it was defined the decrease of total power in all patients’ groups and various LF/HF fluctuations.

37-41

Authors: L.F. Bogmat, I.M. Yakovleva, I.N. Nelina

Dependence of immunologic homeostasis on Helicobacter pylori infection was studied in 73 adolescents, aged 11 to 18, with gastroduodenal pathology against the background of systemic connective tissue dysplasia. It was established that certain changes of immunologic system in gastroduodenal pathology in this group of patients did not depend upon H. pylori presence. The main aggressive factors of gastroduodenal pathology development in adolescents with systemic connective tissue dysplasia were changes in biochemical characteristics of internal medium of the upper sections of digestive system owing to refluxes against the background of immunologic homeostasis disorders.

46-52

Authors: O.A. Vlasenko

One hundred and seventeen patients with postinfarct cardiosclerosis were examined. Left ventricular remodeling was established in 80,3 % patients. It was found to have developed concentric hypertrophy of left ventricle (LV) and moderate LV diastolic dysfunction mainly with impaired relaxation in 55,5 % patients. About 24,8% patients had more significant LV structural and geometric derangement with a tendency for the development of eccentric hypertrophy of the LV, as well as more marked systolic and diastolic dysfunction.

56-60

Authors: A.L. Kulik, O.I. Serikova, N.I. Yabluchanskiy

Based on results of 62 patients’ checkup with the pain form of ischemic heart disease and arterial hypertension the correlation analysis between the indexes of psychical and clinical status was taken. Maximum correlation level with basic clinical parameters was determined by using the Hamilton depression scale and Hospital anxiety and depression scale that allows to recommend exactly these scales for patients’ psychoemotional status estimation.

63-66

Authors: N.V. Makienko

The comparison of efficiency of amiodarone and its combinations with metoprolol and carvedilol at 102 observed in in-patient department middle age of which was 64±9 years (Msd) with permanent atrial fibrillation (AF), which complicated the IHD and AH flow according to initial FC ChHF. The patients were divided into the following groups: the first group - with II FC ChHF (40 patients) and the second group – with III FC ChHF (62 patients) with subdivision to sub-groups: sub-group A – patients taken amiodarone, A+M - amiodarone with metoprolol and A+C - amiodarone with carvedilol. By results of the AF research at patients with II FC ChHF more frequently flows on the background of soft moderate the AH or IHD degrees not higher than stable angina with II-III FC and is characterized by less duration, more higher general index quality of life (GIQL), and TP spectrum HRV at less HR. AF at patients with III FC ChHF flows more frequently on the background of moderate and heavy AH degrees and painless form IHD and is characterized by greater duration with less GIQL and TP spectrum HRV and greater HR. At AF patients with II FC ChHF initial monotherapy of amiodarone with joining of beta-adrenoblockers (BAB) according to clinical indications is possible more frequently, while at patients with III FC ChHF it is expedient to begin the therapy by combination of amiodarone with BAB, hence for patients with AF combination of amiodarone with carvedilol is more preferable than combinations with metoprolol.

74-76

Authors: V.V. Pilipchuck

The experimental work shows the results of the limb reovasography investigation in sportsmen and non-sportsmen.It has been shown that regular physical activity can increase elasticy and blood-fill of vessels.

78-82

Authors: O.О. Khyzhnyak, D.А. Kashkalda

There were observed 79 boys of 10-17 years old with arterial hypertension (AH) and hypothalamic syndrome of puberty (HSP). Activeness of collagenase, elastase and elastase inhibitors in blood serum or plasma were studied, there were revealed distinguishing characteristics in the changes of proteolytic ferments and their inhibitors activeness which, along with the estimation of clinical status and central hemodynamics, can be used as a sufficiently diagnosis of AH in these patients.

90-95

Authors: W.H. Arnold, E.A. Naumova, V.V. Koloda, M.V. Ljubichev

Dental wear is a common phenomenon in archaeological material. It has been related to the diet of the individuals. Numerous investigations have been carried out in north and middle American samples as well as African anthropological material. Not much is known about dental wear in European cultures. 11 skulls of Chervona Gusarovka, and 14 skulls of the Verchniy Saltov sites from the Kharkov area in eastern Ukraine with different foot consumption with a total number of 208 teeth were studied according to dental wear and periodontal status. Abrasion grade was determined according to international classification and statistically evaluated. Periodontal status was measured using the distance between enamel-cement boarder and alveolar crest and gingival attachment. Dental wear was significantly different (p<0.01) between both populations No significant differences were found regarding to the periodontal status. It is concluded that foot consumption had influence on dental wear, whereas it did not alter the periodontal status.

4-8

Authors: V. Hakobyan, L. Balyan, N. Avetisyan, K. Ashrafyan

Inactive style of life leads to many pathologic changes in an organism as well as cerebral blood flow disturbances. The depth of pathologic shifts depends on terms of hypokinesia (HK) and these shifts involve bothcellular and subcellular levels. As GABA-ergic system relates to stress-limiting system, the objective of ourinvestigation is to study the changes in GABA-ergic macromolecular combination under the conditions of HKin experimental animals with simultaneous exploration of pathologic anxiety development and its correctionby well-known nootrops – Pyracetam. It was established, that in 15-day HK the amount of GABA-receptor macromolecular combination decrease is observed, and it continues to decrease up to 45-days of HK. Study ofanimal behavioral reaction in plus-maze test has shown that in animals under the conditions of HK anxietydevelops. Pyracetam administration during the last three days results to GABA-receptor macromolecularcombination amount increase and anxiety elimination both in 15-day and 45-day HK.

15-18

Authors: G.A. Kovalyov, A.Yu. Petrenko

In the work of original model of alcohol induced hepatic injury at female rats including three stages issubmitted: the first stage is selection of animals inclined to alcoholization; the second stage is accustoming ofanimals to alcohol; the third stage is intensive alcoholization, at this stage the consumed doze of alcohol made14-18 g/kg of weight of a body in days. Use of the given model on female rats results in almost triple increaseof activity ALT and AST in plasma of blood, more than to triple increase of duration hexane sleep, more thanto double increase prothrombin time, almost triple decrease of the contents albumin in plasma of blood, that istypical of alcohol induced hepatic injury. The offered model does not contradict to the principles of bioethicsas excludes the violent introduction of alcohol accompanied with stress.

23-30

Authors: O.O. Gunaeva, I.G. Krajz, N.I. Yabluchansky

During the investigation 10 out-patients with chronic ischemic heart disease (CIHD) after aortic-coronarybypass were observed. The average period of time after operation before initial investigation comprised(1±3,5)years. Before the operation the patients were administered simvastatin as lipid lowering therapy,6 patients were treated with atorvastatin. After the operation all patients received atorvastatin 10 mg. PO at night(trade name liprimar). Patients were divided into 3 groups according to the types of dislipoproteidemia. Totalcholesterol, LDL, VLDL, HDL, triglycerides, index of atherogenity. During the therapy the optimization oflipid spectrum of blood indices was noted in all patients, without regarding initial type and grade ofdislipoproteidemia. Moreover, in half of patients lipid lowering effect started on first days of therapy, in otherhalf - after a month from the treatment beginning. The decrease of lipid level was more essential in patientswith 2a and 4 types of dislipoproteidemia according to Fredrickson.

35-40

Authors: V.N. Olkhovskaya

By the data of the Kharkov Central Dissecting Room, the article analyses 80 cases of lethal outcomes inpuerperal who died from eclampsia in Kharkov within the past 20 years (1983-2003) with a morphologicalstudy of liver preparations from the dead women. In the course of the work done it has been revealed that themorphological equivalent of hepatic insufficiency was expressed in all the cases of eclampsia which causedthe death of the puerperae. It is manifested in the form of necrosis and dystrophy of hepatocytes with a resultant collapse of the stroma, as well as in disturbances of protein metabolism mostly localized in thecentral lobular portions of the lobes, fatty degeneration of hepatocytes, a diffuse lymphohistiocytic infiltrationagainst a background of exhaustion of compensatory-adaptive mechanisms. Prophylactic and remedial measures in gestosis must be directed at protection of the liver.

46-50

Authors: M.V. Smelyanskaya, P.I. Poteyko, S.D. Peremot

In the article essential influence cytomegalovirus infections on formation immunodeficiency conditions, current and an outcome of tubercular process is proved. Rate of infectivity in CMV patients with a tuberculosis easy has made 83,9%, and at patients with the heaviest and tuberculosis dangerous forms has made100%. Presence of a syndrome the KIND on laboratory parameters diagnosed for 100% of patients with a tuberculosis and HCMV. Authors offer a way of complex treatment of a tuberculosis in view of viral persistence.

60-63

Authors: A.I. Tereshenko, D.A. Kashkalda

The status of lipide peroxidation processes and antioxydant system was studied in adolescents girls, born from the fathers-liquidators of Chernobyl nuclear accident consequences. There was revealed certain inhibition of an enzymatic link of the antioxydant system in the form of a decrease in glutathion peroxydase activity at different stages of puberty, especially in the period of menstrual function formation.

5-9

Authors: O.N. Pobelensky

Experimental investigations of transplantation effect under the capsule of kidney of the newborn piglet’s pancreas cryopreserved microfragments on glycemia level and the indices of lipid peroxidation in rats with alloxan diabetes were carried-out in the work.

13-17

Authors: O.H. Bazarynsky

The quantitative and qualitative evaluation of uroflowmetrograms in 38 patients aged 23-48 years suffering from chronic abacterial prostatitis with dysuric syndrome had been carried out. Five basic and two complementary abnormal schematic types of dysuria were established by descriptive statistics. The results of study demonstrated that uroflowmetry is one of the most demonstrative methods of diagnostics in mentioned patients and has to become an integral part of chronic abacterial prostatitis with dysuric syndrome patients’ examination algorithm, as it is capable to determine the pathophysiologic foundation of symptoms and to clarify the essence of detrusive sphincteral dyssynergy and contributing in the choice of adequate management.

22-25

Authors: V.V. Boyko, E.D. Khvorosto, S.V. Sushkov

The experience of 89 laparoscopic vagotomies performed during 7 years is presented by avthor. Original method of laparoscopic vagotomy (declarative patent N 33508A) was used in 26 patients. The following conclusions were made: laparoscopic vagotomy is the treatment of choice in Helicobacter pylori – negative complicated duodenal ulcers that do not resolve under medical treatment during 10 weeks. Laparoscopic cryovagotomy is optimal measure for the decrease of acid production withour disturbances of gastric motor function. Laparoscopic cryovagotomy is recommended in patients with Helicobacter pylori – negative recurrent and complicated duodenal peptic ulcer due to its simple technique and efficiacy during follow – up.

30-33

Authors: B.P. Vvedensky

Resulted etiopathogenetical data of clinic, clinic, diagnostics, conservative medical treatment in arthroscopic and restoration interferences at deforming artroze of knee-joint.

37-41

Authors: R.N. Grynyov

Author presents an experience of the surgical treatment of 82 patients with different types of the Mirizzi syndrome. Most informative in diagnostics of the Mirizzi syndrome were sonography – 67,1% and endoscop-ic retrograde cholangiopancreatography – 58,5%.At a suspicion on Mirizzi syndrome all patients were performed laparoscopic intraoperative cholangiography, herewith diagnostic value of this method approached to 100%. The оperation of the choice in patients with syndrome Mirizzi type І was laparoscopic cholecystectomy, by impossibility of laparoscopic operations and at syndrome Mirizzi type ІІ preference was given to traditional cholecystectomy with drainaging of choledoch, or to Roux's hepaticojejunostomy.

44-48

Authors: Yu.B. Zakharchenko

The results of treatment the 34 patients with the acute purulent cholangitis was analysed. There were 9 men (26,4%) and 25 women (73,6%) in the age for 43 to 87. On the entrance those patients to the clinic their general condition were heavy, but some of them had middle weight condition. The possibility violation of the gall-ducts on the level of common bile duct were conditioned with: the big stones have 18 patients (52,9%), which defied to endoscopic choledocholithotraction; strictures of the ducts have 8 patients (24,7%); combination of choledocholithiasis with the strictures have 5 patients (14,7%); combination of the chole¬do-cholithiasis with parapapillar diverticulum have 3 patients (8,8%). The diagnostic program conclude of the clinical and laboratories methods investigations, ultrasound scanning, endofibroscopic investigation the top past of the gastro-intestinal tract, endoscopic retrograde cholangiopancreatography, cholangiomanometry, bacteriological cheek up of the bile. The treatment program included: the standard infussional therapy of acute cholangitis and the obstructive jaundice; the endoscopic sphincterotomy with following nasobiliar drainage; the landmark endocholangial leading physiological solution. As the results of the treatment all pa-tients with acute obstructive purulent cholangitis in all cases were mixed in the period of 4-9 days after the treatment starting, with were definite by the clinical flowing and verified by the dates of laboratorical cheek up methods. All of these allowed to fulfil the radical surgical intervention on the common bile duct with the least risk for the patient. There was no lethal outcome.

51-56

Authors: S.A. Morozov, A.V. Tsaryov

Аn experience of treatment of 160 patients with a syndrome of diabetic foot is submitted; results of inspection, tactics of treatment and volume of operative interventions are considered.

59-62

Authors: V.І. Rusin, Yu.А. Levchak, V.V. Rusin, F.V. Gorlenko

In present study the results of surgical treatment of 60 patients with chronic venous insufficiency of the lower limbs are submitted. Alongside with conventional interference – simple venectomy by Babcock, authors also used subfascial endoscopic perforance ligation and cathether sclerotherapy of the main shaft of the saphenic vein. In the group of patients, in treatment of which one miniinvasive methods were used, there were no purulent complications. Also the introduction in clinical practice of the SEPS method in combination with a distal saphen trunks scleroobliteration shortens the stay of patients in hospital and substantially decreases economic expenses on their treatment. The further study of subfascial endoscopic perforance ligation and cathether sclerotherapy of the main shaft of the saphenic vein capabilities in treatment of other stages of chronic venous insufficiency is necessary.

69-71

Authors: V.O. Siplivy, G.D. Petrenko, S.M. Teslenko, A.G. Gus, O.G. Petunin, S.V. Grinchenko

Are shown the results of laparoscopic cholecystectomy in 145 patients with acute destructive cholecystitis. Is offered the dissection of gallbladder wall for better identification of triangle Callot structures in oedematic hepatoduodenal ligament. For simplification of operative measure are constructed raspatories and conductors of tubular drainages. Are designed the rational schemes of a drainage of abdominal cavity. All this has allowed to decrease bed-day up to 7,2, and quantity of complications up to 1,3%.

75-78

Authors: A.I. Tsivenco, M.S. Тоmіn

In work gives the analysis of disease, efficiency of methods of diagnostics and modern treatment colorectal cancer is. The first experience of application of a ultrasonic (harmonic) scalpel is submitted at traditional and laparoscopic interventions concerning a colon cancer and rectum. Results of application autovaccine in complex treatment of patients with colorectal cancer.

83-86

Authors: E.P. Yakovtzov, A.E. Gavrikov, A.V.Babalyan

In article results of research of hormones at patients with cholelithiasis of various age are submitted. At elderly and senile age persons it is revealed hormonal dysbalance with decrease in melatonin concentration. The conclusion about expediency of use of synthetic analogue of melatonin – vita-melatonin in a complex of preoperative preparation and postoperative treatment at laparoscopic cholecystectomy is made.

90-94

Authors: V.G. Psarheva

We examined 69 patients with chronic heart failure (HF) caused by ischemic heart disease. It was examined endothelial function such as endothelin-1, cAMP, cGMP and 6-keto-PGF1α contens. It was determined that HF has high endothelin-1 level, wich is most in HF IV functional classes, and has low cGMP level. Enalapril and losartan inhibit the activity of RAAS function.

101-107

Authors: N.I. Yabluchansky, H.G.Datsenko

In the grounds of complex examination of 300 patients with essential arterial hypertension the mathematical pattern of prognosis the results of double-component antihypertention therapy by enalaprili maleatum (10 mg per day) and hydrochlortiasidum (25 mg per day) was worked out. Accounted the initial meanings of middle daily heart rate (HR) non-modified risk factors (the blood pressure (BP) level, the type of somato-vagal balance and the type of left ventricular geometry). It was started, that good results of lowering BP in the double-component antihypertentional therapy by enalaprili maleatum (10 mg per day) and hydrochlortiasidum (25 mg per day) correspond the probabily of 70%, setisfed results of normalisation - the probabily of 50-70%, dissetistole results - the probabily of less then 50%. The double-component antihypertentional therapy by enalaprili maleatum (10 mg per day) and hydrochlortiasidum (25 mg per day) is shown to the patients with the probability of BP normalization more than 70%.

5-14

Authors: V.N. Коvalenko, M.I. Yabluchansky

There is systematically described left ventricle is (LV) diastole in physiological and pathological condi-tions. Diastole is considered as a key process in heart biomechanics, which forms a systole and whole cyclic activity of blood circulation. Concentration on diastolic function, early and proved interventions during dias-tolic dysfunction are important components of cardiac insufficiency secondary prophylaxis and its effective treatment.

20-27

Authors: L.S. Godlevsky, K.I. Stepanenko

The effects of paleocerebellar cortex (nodulus, uvula) electrical stimulation (ES) (100-300 Hz, 0,25 ms, 150-250.A, duration of trial- 3-7 s, interstimuli intervals- 3,0-4,0 min) in artificially ventilated cats uponbenzilpenicillin- induced epileptic foci in sensorimotor cortex were investigated. ES caused a suppression of power of epileptic foci and this effect was not reproduced after electrocoagulation of cerebellar tissue neighboring the stimulative electrodes. Along with the suppressive effects upon the activity of the epilepticfoci, ES induced the formation of pronounced primarily positive component (PPC) of a spike discharge alongwith the induction of spike-wave discharges (SWD) (3/sec). Both phenomena were restricted to the zone ofpenicillin application. SWD activity substituted spikes and disappeared after renewal of epileptogen application. It was concluded that PPC and SWD are characteristic for the antiseizure effects of cerebellum on penicillin- induced foci in cats.

32-36

Authors: E.A. Romanova

The influence of serum factors on bone marrow cells and haemopoesis restitution during 10-90 days after lethal irradiation of mice and myelocariocytes grafting per se and enriched by thymocytes bone marrow cells was studied. The prevalence of stimulating serum factors during the stage of cellular compound restitution and after termination this period the moving positive balance to the side of suppressing factors was determined. It was established, that not only immunoglobulins has the stimulating effect on haemopoietic cells proliferation, but also factors of non-immunoglobuline nature.

41-44

Authors: N.A. Vodyanytskaya, M.I. Yabluchansky, N.V. Makienko

The data are presented on the potentialities of the surface electrical cardiac version in the patients with atrium fibrillation. The rate of sinus rhythm restoration in this group was 82,3%. There aren’t reliable predictors of restoration sinus rhythm in routing clinical practice. Electrical cardiac version should be used for patients with ineffective pharmacological therapy.

49-52

Authors: R.V. Кapustin

During research it was established, that the enelbin (naftidrofuril) normalized parameters neurohymoral homeostasis at patients with chronic infringements of brain blood circulation. The preparation the enelbin is a medical product of a choice in treatment dyscirculation encephalopathy.

56-60

Authors: I.V. Lakhno, E.S. Protsenko, V.A. Fedorishcheva, A.E. Tkachov

Chronic pelvic pain caused hormonal disorders due to local endometrial progesterone insufficiency and significant prostiglandins level. We had investigated 66 patients with chronic pelvic pain whom was perfor-med hystological investigation of endometrium with estrogenes and progesterone receptor level evaluation. Also therapeutical effects of Logest comparatively with traditional treatment of pelvic pain were evaluated It was determined that the majority of patients had endometrial hyperplasia with low progesterone receptors level. It was concluded that Logest application contributed enormously to the endometrial structure normalization and reduced pain symptoms in higher degree than natural progesterone drugs.

64-68

Authors: N.N. Popov, A.S. Ovcharenko

The work shows, that lymphocytes of the patients with the combined forms of genital endometriosis are characterized by low affinity of receptors, small density expression of CD3 and Ig molecules on a cell membrane, infringement of proteine-lipid interactions and microviscosity of a membrane. In serums of patients the increased quantity of р-proteins was observed. The correlation analysis of the received data with parameters of functional activity lymphocytes has allowed to make a conclusion about the change of structurally-functional properties of a membrane and receptors of them. The last and also raised shedding of receptors are some of the reasons of reduction of immunoreactivity.

75-79

Authors: Т.N. Sulima, N.V. Bagatskaya

Dermatoglyphic markers, which permit to predict illness development at pre-clinical stage, have been revealed on the basis of medicogenetic examination of 260 adolescent boys with sexual development delay (SDD) and 90 healthy boys. The algorithm for detection of persons with high risk of sexual development delay occurrence has been given.

83-87

Authors: A.Yu. Filippova

Different methods of diagnostics of non-alcogolic steatohepatitis were analyzed. Clinical and biochemical examinations in diagnostics of steatosis must have supplementary role in addition to ultrasound examinations, echocontrol punctional biopsy of liver, morphological investigations of hepar tissue. Ultrasound examination of abdominal cavity organs in case of impossibility of morphological investigation of hepar can be the single method for diagnostics of steatosis. Prediction of non-alcogolic steatogepatitis depends on expressiveness of histological changes. Diagnostics of non-alcogolic steatohepatitis must be based on combination of several features: histological characteristic, ultrasound examination, absence of alcohol abuse and data of examinations, which let us exclude other chronic hepar diseases.

93-97

Authors: E.D. Khvorostov, S.A. Bychkov, R.N. Grynyov, N.V. Tcherkova

Authors describe own experience of 2434 laparoscopic cholecystectomies. Conversion to traditional operation was fulfilled in 29 patients caused by intraoperative complications and in 43 patients were revealed different postoperative complications. The causes of conversion, intraoperative and postoperative complications were analyzed, worked out the methods of prophylaxys and correction these complications.

100-105

Authors: Т.P. Yabluchanskaya, I.P. Vakulenko

Conducted ultrasound researches of 2 representative groups of patients with continuous atrium fibrillation (AF – research group) and sinus rhythm (SR – comparing group) has shown that there was not only an increased left heart size, but also a violation in structural relations between its chambers, mostly of left ventricle. In ultrasound research of patients with AF it is possible to calculate left atrium and aorta sizes according the protocols recommended for SR, unlike left ventricle size calculation which demands more number of beat-to-beat measurings.

1-96

Authors: HEART RATE VARIABILITY: FROM THE MOST DARING IDEAS TO THE MOST PRACTICAL IMPLEMENTATION

HEART RATE VARIABILITY: FROM THE MOST DARING IDEAS TO THE MOST PRACTICAL IMPLEMENTATION