[Laparoscopic phelps approach in children with inguinal hernia: a retrospective comparative study]. / Primenenie laparoskopicheskogo metoda phelps u detei s pakhovoi gryzhei.

OBJECTIVE: To evaluate the effectiveness of a new method of inguinal hernia repair in children (PHELPS) first proposed by the authors compared to another laparoscopic method (SEAL). MATERIAL AND METHODS: The study demonstrated the results of laparoscopic treatment of 729 patients with inguinal hernias. Of these, 255 patients underwent PHELPS procedure. Other 474 patients underwent SEAL procedure. The difference between both methods is that hernial ligature is passed around the hernial sac in case of PHELPS. SEAL procedure implies capture of tissues of anterior abdominal wall (muscles and aponeurosis) into this knot. We analyzed whether this factor can lead to less incidence of recurrence and hydrocele. RESULTS: Both groups were comparable by age, body weight and gender. Median of surgery time including correction of unilateral and bilateral hernia was similar (20.0 [10.0; 20.0] min versus 15.0 [15.0; 20.0] min; p=0.666). We found faster patient recovery after PHELPS procedure for inguinal hernia including much less doses of postoperative analgesia (1.0 [1.0; 1.0] versus 1.0 [1.0; 2.0]; p<0.001) and shorter hospital-stay (8.0 [8.0; 8.0] hours versus 8.0 [8.0; 9.0] hours; p=0.010). There were no significant differences in the incidence of postoperative hydrocele (0 versus 6; p=0.097). Nevertheless, recurrence rate differed significantly (0 versus 17; p=0.001). CONCLUSION: PHELPS procedure is characterized by lower incidence of recurrence and accelerated postoperative recovery compared to SEAL technique.

[Analysis of the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of treatment of chronic pancreatitis]. / Analiz blizhaishikh i otdalennykh rezul'tatov traditsionnykh duodenumsokhranyayushchikh rezektsii golovki podzheludochnoi zhelezy i original'noi rezektsionno-dreniruyushchei metodiki pri khronicheskom pankreatite.

AIM: Compare the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of the surgery of chronic pancreatitis. MATERIALS AND METHODS: There has been the analysis of the immediate and long-term results of various types of duodenum-saving operations in 48 patients with chronic pancreatitis since 2011 to 2020. The patients were divided into two groups: the control group (n=26) where typical duodenum-saving operations were performed, and the study group (n=22) - the original resection-draining method of surgery. RESULTS: The groups had no difference in gender, age, clinical manifestations. After typical duodenum-saving operations, the number of postoperative complications was higher than after original resection-draining method (31 [14; 52]% and 23 [8; 45]% respectively). In the control group the incidence of pancreatic fistula 19% [7; 39], hemorrhagic complications 12% [2; 30] was higher. In both groups, one patient died in the early postoperative period. However, these differences were statistically insignificant. 12 (52% [31; 73]; p<0.001) patients have died in the control group for the 9-year observation period, mainly (7 cases) as a result of the progression of chronic pancreatitis against the background of alcoholism. The groups had no difference in the level of pain reduction, development of dyspeptic syndrome and diabetes mellitus. CONCLUSIONS: The proposed original technique of subtotal resection of the head, ventral part of the body and tail of the pancreas with longitudinal pancreatojejunoanastomosis made it possible to improve the short-term results and reduce the incidence of pancreatic fistula formation. Taking into account the level of compliance the selection of patients permitted to achieve a better quality of life according to the results of the SF - 36 questionnaire and to reduce the lethality to 5 [0; 25]% (p<0.001) in the long-term period. Statistically significant difference was obtained for three of the five criteria, the total value of the physical (PCS, p=0.033) and mental (MCS, p=0.032) health components.

[Dynamics of neurologic disturbances on the background of combined therapy in patients with type 2 diabetes]. / Dinamika nevrologicheskikh narushenii na fone kombinirovannoi terapii u bol'nykh sakharnym diabetom 2-go tipa.

AIM: The aim of the research was to study the dynamics of neurologic disorders in the context of combined therapy in patients with type 2 diabetes mellitus. MATERIAL AND METHODS: We examined 50 patients with diabetic polyneuropathy aged 50-70 years, with more than 12 months disease duration. The main group (n=30) included the patients who received 18 injections of Cocarnit against the background of hypoglycemic therapy. The control group patients (n=20) received only hypoglycemic therapy. The intensity and character of the pain on the background of the therapy was assessed on the TSS and NSS scales. An objective evaluation of the neurological status was performed using NDS. The state of the neuromotor apparatus was studied using stimulation electroneuromyography (ENMG) on motor fibers. RESULTS: As a result of the study, patients in the main group experienced a significant improvement in the NSS, TSS, NDS scales, as well as a decrease in the latent period, an increase in the M-response amplitude and n. peroneus impulse conduction rate. CONCLUSION: The obtained data confirm the efficacy and high safety profile of Cocarnit in the treatment of diabetic polyneuropathy in patients with type 2 diabetes.

[Prognostic methods of postoperative cognitive dysfunction in patients with ischemic heart disease after coronary bypass surgery under extracorporeal circulation]. / Prognozirovanie posleoperatsionnoi kognitivnoi disfunktsii u bol'nykh ishemicheskoi bolezn'iu serdtsa, perenesshikh operatsiiu koronarnogo shuntirovaniia v usloviiakh iskusstvennogo krovoobrashcheniia.

AIM: To work out the techniques of forecasting the development of postoperative cognitive dysfunction in early and late periods after coronary bypass surgery using fully connected multilayer neural networks. MATERIAL AND METHODS: Based on the study of 264 patients with stroke, 9 neural network models for prognosis of cognitive dysfunction after coronary bypass surgery and 7 models for prognosis of cognitive dysfunction 12 months after surgery were built. Fully connected multilayer neural networks of direct propagation were used for working-out the prognostic techniques. RESULTS AND CONCLUSION: The high prognostic significance of neural networks in relation to cognitive disorders in early and late periods after coronary bypass surgery under extracorporeal circulation was demonstrated. Possibilities of creating neural networks make their application in cardiac surgery clinics available and promising.

[The Evaluation of Medical Demographic and Economic Losses of the Region Conditioned by Mortality of Lung Cancer].

The article presents evaluation of medical demographic and economic losses of population of the Krasnoyarskii kraii conditioned by mortality of lung cancer in 2010-2014 using DALY technology. In the Krasnoyarskii kraii, during 2010-2014 64,712 individuals died because of lung cancer. The mortality of male population surpasses corresponding indices of mortality of females up to 3.9 times. In the region, the standardized indicator mortality of lung cancer among males annually surpasses the same indicator among females at maximum up to 8.1 times. The DALY maximal absolute losses of among males were registered in 2010 and 2013 and fell on age group of 55-59 years and among females on the age group of 60-64 years in 2014. The maximal (up to 5.2 times) difference in values of DALY indicator was established in 2010 between male and female population. the maximal gap in in DALY indices between male and female population was established in the age of 55-59 years. Almost half of DALY losses among males was established in 2013 and among females in 2014. The total losses of gross regional product in the region because of mortality conditioned by lung cancer made up to 29.8 billions of rubles in 2010-2014.

Dynamics of cognitive disorders in patients with type 2 diabetes mellitus under effect of metabolic therapy.

The aim of this study was to investigate the efficiency of metabolic therapy in correction of cognitive impairment in patients with type 2 diabetes. We undertook the analysis of results of the treatment of cognitive dysfunction in 80 patients with a diagnosis of type 2 diabetes. All patients received basic hypoglycemic therapy. 32 patients (study group) received in addition to the basal glucose lowering therapy daily intravenous infusion of 10 mlcytoflavindiluted in 200 ml of a 0.9% sodium chloride solution for 10 days, followed by 2 tablets b.i.d. for 25 days.The group of comparison consisted of 29 patients given in addition to the basal glucose-lowering therapy daily intravenous infusion of 24 ml (600 mg) thioctacid diluted in 200 mL of a 0.9% sodium chloride solution for 10 days. Thereafter, they received 1 tablet of thioctacid BV once daily for 30 days. The control group consisted of 19 patients who received basic hypoglycemic therapy without additional metabolic therapy.Inclusion of cytoflavin in the combined treatment of patients with type 2 diabetes ensured a more effective correction of cognitive impairment. There was a statistically significant improvement in optical-spatial activities (p = 0.001), attention (p = 0.001), abstract thinking (p = 0.046), and memory (p<0.001) compared to those in other groups, according to the MOS test. Positive dynamics was expressed as the improvement of the optical-spatial activities by 9,8 ± 10,3%, attention by 13,5 ± 11,8%, abstract thinking by 7,0 ± 8,9%, and memory by 23.0 ± 14 6%. The study of variations of the serum level of brain neurotrophic factor (BDNF) over time during the treatment with metabolic preparations reveal edits statistically significant increase (p = 0.002) in the patients treated with cytoflavin compared with comparison (p = 0.139) and control (p = 0.078) groups. These results suggest the influence of cytoflavin on the processes of neuroplasticity under conditions of hyperglycemia, improvement of cerebral microcirculation and cerebroprotective action of this medication.

Biological characteristics of the agent in patients with pulmonary tuberculosis detected by different methods.

Drug resistance and viability of Mycobacterium tuberculosis were studied in 637 patients with pulmonary tuberculosis, detected by screening fluorography (group 1) and in 909 patients in whom the specific process was detected when they applied for medical care (group 2). The mycobacteria in the two groups did not differ by the incidence, type, and spectra of drug resistance. The percentage of mycobacteria with high viability was 2-fold higher in group 2, which explains the more severe clinical structure and characteristics of the specific process in these patients.

[The development of polymer immunoglobulin preparations to identify different serovars legionella pneumophilia in reaction of slide-agglutination].

The article deals with the results of study targeted to develop polymer diagnostic preparation to identify epidemically significant serogroups Legionella pneumophilia. The preparation combines rate of record (1-5 min) of reaction of paragglutinining preparations with color visualization and demonstrative of reaction of volume agglomeration with polymer diagnosticums. The specially synthesized polymer microspheres were sensibilized with serums enriched with antibodies to lipopolysaccharide of corresponding serovar L. pneumophilia. The derived immunoglobulin diagnostic preparations detect agent of legionellesis in the reaction of slide-agglutination on glass during 1-5 min. The polymer diagnostic preparations provide positive reaction with culture of corresponding serovar and no reaction with other gomologic and geterologic agents of infectious diseases.

[Design of a polymer drug for serological diagnosis of hepatitis C].

A new immunobiological polymer drug has been designed for the serological identification of hepatitis C. The drug is able to reveal specific antibodies in the sera of patients with hepatitis C, meets the current requirements of diagnostic test systems, and shows a high sensitivity and specificity. It is based on polyacroleinic microspheres; the concentrated cell culture biomass of hepatitis C virus (HCV), which contains an adequate set of viral antigens, is used as sensitin. A new diagnosticum is proposed to be used during primary (screening) laboratory studies based on the serological detection of total antibodies to HCV antigens in the volume agglomeration test. The latter is both one of the alternative methods during serological studies and an additional procedure when a set of diagnostic techniques is used.

[Pulmonary tuberculosis and problems of its revealing in elderly and senile patients].

Analysis of the revealed for the first time pulmonary tuberculosis in persons of the elderly and senile age has shown that this age category composes 5% among all the patients over 18 years old and it makes up 19,2% of the cases with fibro-cavernous tuberculosis and 25,6% of postmortem diagnosis. A severe structure of clinical forms and features of TB process in 114 hospitalized patients over 65 was determined; this results from the violation of required terms of preventive X-ray examination. These patients appear to be highly dangerous epidemiologically. Advantages of active TB identification in persons of the elderly and senile age were proved. We've come to the conclusion that elaboration of effective measures to improve active identification of this disease is extremely necessary; we've proposed some specific steps aimed at increasing of timely identification of TB in this age group.

[Novel diagnostic kit on the basis of stained polymeric carriers for epidemiologic surveillance in natural foci of Crimean-Congo hemorrhagic fever].

AIM: To study diagnostic value of developed antigenic polymeric diagnostic kit for epidemiologic surveillance in natural foci of Crimean-Congo hemorrhagic fever (CCHF) in South federal district. MATERIALS AND METHODS: Novel antigenic diagnostic kit on the basis of polymeric microspheres for reaction of volume agglomeration was developed. The kit is designed for detection of virus-specific antibodies in human serum and in serum of agricultural animals. RESULTS: Laboratory and field trials of the kit showed its high diagnostic potency, it was included in methodical recommendations "Organization and accomplishment of measures against Crimean-Congo hemorrhagic fever on the territory of its natural foci in Russia". Use of antigenic polymeric kit for epidemiological surveillance allows for more complete and systemic understanding of CCHF epidemic process. CONCLUSION: At present, the diagnostic kit is successfully used, alongside with ELISA and PCR, on different levels of epidemiologic surveillance for CCHF in Rostov region.

[Serologic diagnostics of Legionella infection].

Technical approaches to construction of preparations for serologic diagnostics of Legionella infection were presented in the article; antigenic- and immunoglobulin-based diagnostic kits with known characteristics were developed. Immunogenic properties of protein and lypopolysaccharide antigens, which have diagnostic value, were studied; similarity of protein antigens from 7 serogroups of L. pneumophila was demonstrated. Soluble antigen with known composition was obtained and used for the development of antigen-based polymeric kit for diagnostics of Legionella infection. On the basis of hyperimmune sera, immunoglobulin-based polymeric diagnostic kit and array of coagglutinating diagnostic kits for the mentioned 7 serogroups were developed. Antigen-based polymeric diagnostic kit was recommended for licensure.