[Pulmonary alveolar proteinosis associated with persistence of SARS-CoV2 virus]. / Legochnyi al'veolyarnyi proteinoz, assotsiirovannyi s persistentsiei virusa SARS-CoV2.

Alveolar proteinosis is a rare lung disease characterized by the accumulation of protein-lipid complexes in the alveoli due to impaired surfactant utilization by alveolar macrophages. The frequency is from 2 to 4 cases per 1 million adult population. We present an observation of pulmonary alveolar proteinosis in a patient with a history of coronavirus pneumonia.

[Eduard Nikitich Vantsian: to the 100th anniversary of the birth]. / Eduard Nikitich Vantsyan: 101 god so dnya rozhdeniya.

One hundred and one years ago Eduard Nikitich Vantsyan (1921-1989), an outstanding Soviet surgeon, B.V. Petrovsky's pupil, Doctor of Medicine, Professor, Corresponding Member of the USSR Academy of Medical Sciences, was born (Fig. 1). He was the author of more than 120 scientific works and 6 monographs devoted to the study of motor function and surgery of the esophagus, conservative treatment of its constrictions and cardiospasm, diseases of the operated esophagus. He had developed methods of total and segmental plasty of the esophagus, treatment of hernias of the esophageal aperture of the diaphragm and diverticula of the esophagus. He supervised 26 dissertations, including 12 doctoral theses. Eduard Nikitich is considered one of the founders of esophageal and diaphragm surgery.

[Enteral nutrition in postoperative rehabilitation after reconstructive esophageal and gastric surgery]. / Rol' enteral'nogo pitaniya v reabilitatsii patsientov posle rekonstruktivnykh vmeshatel'stv na pishchevode i zheludke.

OBJECTIVE: To investigate enteral nutrition as a component of postoperative rehabilitation after reconstructive esophageal and gastric surgeries. MATERIAL AND METHODS: The study included 217 patients who underwent reconstructive esophageal and gastric surgeries between 2010 and 2020. In the main group (n=121), patients underwent postoperative enhanced recovery program (ERAS). Early enteral feeding including micro-jejunostomy and early oral feeding was essential for postoperative management. The control group included 96 patients who were treated in traditional fashion. The primary endpoint was length of hospital-stay (LOS) and ICU-stay. Restoration of gastrointestinal function (peristalsis, stool, oral nutrition), anastomotic leakage rate and other complications comprised secondary endpoints. RESULTS: Both groups did not differ by sex, age, body mass index, diagnosis and comorbidities. There was significant reduction in postoperative LOS in the ERAS group (14 (12; 15.8) and 9 (6.3; 12) days, p<0.0001). In the same group, we observed less in ICU-stay (4.7 (3.6; 5.6) and to 3.5 (2; 4) days, p<0.001), earlier recovery of peristalsis and X-ray control of anastomosis in patients with and without anastomotic leakage. Incidence of respiratory complications was lower in the ERAS group (p=0.034). Overall postoperative morbidity and mortality were similar. CONCLUSION: Early enteral and oral feeding after esophageal and gastric reconstructive surgery reduces hospital-stay and accelerates postoperative rehabilitation.

[Minimally invasive esophagectomy for benign esophageal diseases: results of a two-center study]. / Minimal'no invazivnaya ezofagektomiya pri dobrokachestvennykh zabolevaniyakh pishchevoda: rezul'taty dvukhtsentrovogo issledovaniya.

OBJECTIVE: To analyze the results of thoracoscopic esophagectomy for benign esophageal diseases. MATERIAL AND METHODS: The study included 78 patients who underwent thoracoscopic esophagectomy between 2011 and 2019. Peptic and burn strictures of the esophagus were diagnosed in 53 patients, achalasia - in 24 patients. Minimally invasive esophagectomy and esophagoplasty with isoperistaltic gastric tube and esophagogastrostomy on the neck was performed in 68 patients, Ivor Lewis esophagectomy - in 1 patient, coloesophagoplasty - in 9 patients. We used manual technique of anastomosis in 58 patients, stapling device - in 19 patients. In 1 case, surgery was finished with esophagostomy and gastrostomy. RESULTS: Mean blood loss was 200 ml (10-1200), surgery time - 450 min (265-765 min). Early postoperative complications occurred in 37 patients including anastomotic leakage in 24 cases. In long-term period, anastomotic strictures developed in 9 patients. No mortality was observed. CONCLUSION: Minimally invasive esophagectomy for benign esophageal diseases ensures favorable clinical outcomes. However, no consensus in the choice of surgical approach and indications, as well as small number of these patients cause challenges in implementation of this technique. There are different opinions regarding technique of anastomosis on the neck and surgical access in thoracoscopic esophagectomy.

[Enhanced recovery program in thoracoabdominal surgery]. / Programma uskorennogo vosstanovleniya v torakoabdominal'noi khirurgii.

Significant improvement of treatment outcomes and reduction of postoperative hospital stay can be achieved, provided a multifaceted approach used in the management of patients. The introduction of the enhanced recovery program addressing all possible factors of the perioperative period will contribute to the treatment protocol development for patients after extensive surgery on the esophagus. OBJECTIVE: To improve medical rehabilitation outcomes in patients after extensive surgery for benign and malignant diseases of the esophagus by implementing an enhanced recovery program. MATERIALS AND METHODS: Patients with benign and malignant esophageal diseases underwent radical surgical repair under general balanced anesthesia with mechanical ventilation. With the collaboration of surgery, anesthesiology, and intensive care staff, a proprietary day-by-day enhanced recovery program was developed based on existing guidelines for patient management and systematic reviews on the enhanced recovery protocol after surgical esophageal repair. RESULTS: The developed patient management program was effective due to the reduction of intensive care unit stay and the total postoperative stay in all main group patients. The use of minimally invasive video-endoscopic techniques contributed to the reduction of intensive care unit stay. A less severe surgical stress response was observed in patients in the group of thoracoscopic subtotal esophageal resections. CONCLUSION: The introduction of the enhanced recovery program promotes the reduction of hospital stay and ICU stay in surgical esophageal repair patients. Also, it allows optimizing the postoperative management of patients with complicated and uncomplicated postoperative periods.

[Reconstructive esophageal surgery in fast track epoch]. / Rekonstruktivnaya khirurgiya pishchevoda v epokhu fast track.

OBJECTIVE: To evaluate an efficiency and safety of perioperative fast track management in reconstructive esophageal surgery. MATERIAL AND METHODS: Perioperative fast track management protocol in reconstructive esophageal surgery has been applied since 2014 at the Department of Thoracoabdominal Surgery and Oncology of the Petrovsky Russian Scientific Center of Surgery. These patients (2017-2020) were included in the main group (n=75). Patients who underwent traditional perioperative care (2010-2013) were enrolled in the control group (n=63). The primary outcome was postoperative hospital-stay. We also evaluated ICU stay, incidence of complications according to Clavien-Dindo grading system with particular registration of respiratory complications, mortality, enteral and oral feeding onset. RESULTS: There were no significant between-group differences in sex, age, ASA grade, body mass index. Fast track management reduced hospital-stay from 14 (12; 17) days in the control group to 11 (8; 22) days in the main group (p=0.008). Mean ICU-stay decreased up to 1 (0.8; 2) day in the main group compared to the control group (4.1 (3.5; 5.6) days, p<0.0001). Pneumonia was noted in 5 patients after fast track recovery and 15 patients in the control group (p=0.004). No patients died in the main group, 3 (4.8%) patients - in the control group (p=1). CONCLUSION: Modern perioperative fast track management protocol is safe and effective for extensive reconstructive esophageal interventions. This approach reduces hospital-stay and ICU stay, as well as the incidence of respiratory complications.

[Thoracoscopic subtotal esophageal resection for benign esophageal diseases]. / Torakoskopicheskaia subtotal'naia rezektsiia pishchevoda pri ego dobrokachestvennykh zabolevaniiakh.

AIM: To investigate the role of video-assisted subtotal esophageal resection in treatment of patients with benign esophageal diseases. MATERIAL AND METHODS: Fifty-one patients with benign esophageal diseases have undergone subtotal esophageal resection in our department for the period 2010-2017. Thoracoscopic technique was applied in 25 cases, open approach - in 26 patients. Total surgery time, thoracoscopic stage duration, length of hospital-stay (LOS), ICU-stay, Clavien-Dindo morbidity rates with separate registration of respiratory complications, mortality have been considered. RESULTS: Groups were similar in terms of age, gender, ASA status. Thoracoscopic stage duration gradually decreased from 175 to 65 min with average time of 102 (75; 123) min. Total surgery time was 390 (270; 495) min in group 1 and 465 (341; 561) min in the control group (р=0.035). Mean ICU-stay decreased up to 2 (1.25; 3.75) days compared with the control group (5 (3.92; 5.85) days, р<0.0001). Conversion rate was 8%. In the main group complications Clavien-Dindo grade 2 were detected in 10 (40%) patients compared with 20 (69%) cases in the control group (р=0.009). Respiratory complications occurred in 5 patients in group 1 and in 13 cases of the control group (р=0.039). Mortality was absent. CONCLUSION: Thoracoscopic subtotal esophageal resection may be advisable alternative to open surgery for patients with benign esophageal diseases due to lower postoperative morbidity and earlier rehabilitation followed by improved outcomes.

CLINICAL ASPECTS OF GLYCEMIC MONITORING AND CONTOL IN PATIENTS IN THE EARLY POSTOPERATIVE PERIOD.

INTRODUCTION: At present, no doubt enhanced by the attention of clinicians to monitor blood glucose and methods of its correction in ICU patients. Evidence of the effect of the expressed glycemic balance disorders on the results of treatment of such patients determine of the problem. Attempts to create a computer algorithm to determine the rate of insulin. The aim of the study was to investigate the efficacy and safety of the module Space glycemic control (SGC, "BBraun Germany) with intravenous insulin therapy in patients with thoracoabdominal surgery. MATERIAL AND METHODS: Single-center prospective observational study was conducted in the ICU in 50 patients in the early period after operations on the abdominal and thoracic cavity, mediastinum. RESULTS: The average duration of the monitoring group with SGC was 57 hours (17 to 280 hours). The average length of the period during which the patients were recorded in the target range glycemia was 80.4% of the total time of SGC monitoring. The average value of glucose in capillary blood proved to 7,6?1,58 mmol/l. The incidence of severe hypoglycemia was 2% (1 patient). CONCLUSION: Application module SGC should expedient be used in patients after extensive thoracoabdiminal surgical procedures in which recorded postoperative hyperglycemia.

Probing the mechanisms of ambient ionization by laser-induced fluorescence spectroscopy.

The ionization mechanisms of several atmospheric pressure ion sources based on desorption and ionization of samples deposited on a surface were studied. Home-built desorption electrospray ionization (DESI), laserspray ionization (LSI), and atmospheric pressure matrix-assisted laser desorption/ionization (AP-MALDI) sources were characterized using low-molecular-weight compounds, in particular fluorescent dyes. Detection of the desorbed and ionized species was performed by laser-induced fluorescence and ion cyclotron resonance mass spectrometry. The dependences of the signal intensities on various experimental parameters were studied. The data obtained reveals common features, such as formation of solvated species and clusters in the ionization processes, in all of the techniques considered.

Use of models of biomacromolecule separation in AMT database generation for shotgun proteomics.

Generation of a complex proteome database requires use of powerful analytical methods capable of following rapid changes in the proteome due to changing physiological and pathological states of the organism under study. One of the promising technologies with this regard is the use of so-called Accurate Mass and Time (AMT) tag peptide databases. Generation of an AMT database for a complex proteome requires combined efforts by many research groups and laboratories, but the chromatography data resulting from these efforts are tied to the particular experimental conditions and, in general, are not transferable from one platform to another. In this work, we consider an approach to solve this problem that is based on the generation of a universal scale for the chromatography data using a multiple-point normalization method. The method follows from the concept of linear correlation between chromatography data obtained over a wide range of separation parameters. The method is further tested for tryptic peptide mixtures with experimental data collected from mutual studies by different independent research groups using different separation protocols and mass spectrometry data processing tools.

Standardization of retention time data for AMT tag proteomics database generation.

The combination of liquid chromatography (LC) with mass spectrometry (MS) has become a mainstream proteome analysis strategy. In LC-MS, measured masses possess their "universal" scale derived from atomic mass tables. In contrast, the observed LC retention times (RT) are not tied to a conventional time scale, and depend on experimental conditions. However, RT data, being explicitly orthogonal to MS, offer relevant information for proteome characterization. We present here a strategy for peptides RT data standardization, based on the generation of a standard scale using retention prediction models, which enables sharing of identification databases in the context of multi-laboratory research.

[Significance of damage index in predicting systemic lupus erythematosus outcome]. / Znachenie indeksa povrezhdeniia v prognozirovanii iskhoda sistemnoi krasnoi volchanki.

AIM: To determine the significance of the damage index (SLICC/ACR DI) in the prognosis of the outcome of systemic lupus erythematosus (SLE). MATERIALS AND METHODS: Correlations between the disease activity, cumulative damage and outcome were studied in 103 patients with SLE divided into two groups by the disease duration (21 to 60 months--group 1, 62 to 488 months--group 2). SLE activity was determined by Nasonova's classification, SLEDAI-1 and ECLAM. Cumulative damage was assessed by the damage index (systemic lupus international collaborating clinics/ACR damage index). RESULTS: We found the direct correlation between the age of the disease onset, SLE duration, degree of SLE activity and the damage index and between the maximal dose of glucocorticosteroids and the damage index. CONCLUSION: The results indicate that SLICC/ACR DI may be useful for outcome prediction in SLE.