Case report: "Proust phenomenon" after right posterior cerebral artery occlusion.

Odors evoking vivid and intensely felt autobiographical memories are known as the "Proust phenomenon," delineating the particularity of olfaction in being more effective with eliciting emotional memories than other sensory modalities. The phenomenon has been described extensively in healthy participants as well as in patients during pre-epilepsy surgery evaluation after focal stimulation of the amygdalae and post-traumatic stress disorder (PTSD). In this study, we provide the inaugural description of aversive odor-evoked autobiographical memories after stroke in the right hippocampal, parahippocampal, and thalamic nuclei. As potential underlying neural signatures of the phenomenon, we discuss the disinhibition of limbic circuits and impaired communication between the major networks, such as saliency, central executive, and default mode network.

[The specialized medical care of children with rare diseases].

The article presents the results of analysis of specialized medical care of children with life threatening and chronic progressive rare (orphan) diseases resulting in life span shortening or disability. The possibility of medication support of children with rare diseases. The development of patient routing system considering characteristics of particular disease and possibilities of the subjects of the Russian Federation is one of most important directions of enhancement of needed medical care support.

Geometrically nonlinear dynamic model for a hexagonal lattice.

It is shown that angular stiffness in the hexagonal lattice model plays a significant role in the geometrical nonlinear terms in the equations of the continuum limit. A geometrically nonlinear discrete model is formulated for the hexagonal lattice by considering the interaction of two sublattices. An asymptotic procedure is developed in order to obtain the nonlinear coupled equations of motion in the continuum limit of the discrete model. An interaction of longitudinal and shear plane strain waves is studied by using the solutions of the obtained equations.

[Successful experience in the correction of post-infarction ventricular septal defect].

Rupture of the interventricular septum (MVP) as a complication of acute myocardial infarction is a rare event and associated with high mortality without timely surgical treatment. We present a case of a 68-year-old patient who had an acute myocardial infarc­ tion with ST-segment elevation complicated by a rupture of MVP. In this article we discusse the difficulties of patient management with this pathology and the problem of choice of treatment tactics.

[Heart Failure in Patients With Preserved Ejection Fraction - Pumping Heart Failure?]

The review analyzes literature data on the phenomenon of chronic heart failure as a clinical syndrome of hypoperfusion of organs and systems of the body due to multiple causes of pumping inadequacy of the circulatory system. Special attention is paid to diastolic heart failure of different origin. Attention is drawn to the fact that integrated quantitative characteristic of CHF of any origin is indexed cardiac output (CO) rather than ejection fraction, and that allocation of systolic and diastolic CHF is a relatively conventional division concept. It has been shown that in heart failure of any origin, cardiac output is reduced, resulting in diminished supply of oxygen and substrates to tissues of the body. The variety of causes of heart failure with preserved ejection fraction makes it impossible to correct hemodynamic disturbances by "standard set" of drugs. Normalization of the balance between delivery of oxygen / substrates and metabolic demands of tissues may be a key approach to the treatment of diastolic heart failure of different origin.

Re-distribution of oxygen at the interface between γ-Al2O3 and TiN.

Interface of TiN electrode with γ-Al2O3 layers was studied using near edge X-ray absorption fine structure, conventional X-ray photoelectron spectroscopy and photoelectron spectroscopy with high energies. Despite the atomic-layer deposited Al2O3 being converted into thermodynamically-stable polycrystalline cubic γ-phase by high-temperature (1000 or 1100 °C) anneal, our results reveal formation of a thin TiNxOy (≈1-nm thick) interlayer at the interface between γ-Al2O3 film and TiN electrode due to oxygen scavenging from γ-Al2O3 film. Formation of the TiO2 was not observed at this interface. As environmental effect, a strong oxidation resulting in formation of a TiO2(1.4 nm)/TiNxOy(0.9 nm) overlayers on the top of the TiN electrode is traced. Development of O-deficiency of γ-Al2O3 is observed and related to the polarization anisotropy due to the preferential orientation of spin states involved in the X-ray absorption in the plane parallel to the surface. Investigation of the TiN electrode reveals the predominantly "stretched" octahedra in its structure with the preferential orientation relative the interface with γ-Al2O3. This anisotropy can be correlated with ≈200 meV electron barrier height increase at the O-deficient TiN/γ-Al2O3 interface as compared to the TiN/γ-Al2O3 barrier formed under abundant oxidant supply condition as revealed by internal photoemission of electrons from TiN into the oxide.

[Laparoscopic living donor nephrectomy for kidney transplantation].

Globally, the number of patients with end-stage renal disease (ESRD) has been steadily increasing every year. These patients need renal replacement therapy which includes peritoneal dialysis, programmed hemodialysis and kidney transplantation, which is the ultimate form of replacement. Living donor kidney transplantation has significant advantages over cadaveric kidney transplantation regarding the long-term functional results of renal transplant and the survival of recipients. Open nephrectomy, previously used to retrieve a healthy kidney from a donor is associated with traumatic access and a long recovery period of the donor. With the development of minimally invasive technologies, laparoscopic living donor nephrectomy has been developed, which currently is the best method for retrieving transplant kidney. The review outlines the characteristics and outcomes of laparoscopic living donor nephrectomy for kidney transplantation.

[Bilateral nephrectomy in patients with end-stage renal failure and chronic active pyelonephritis].

This study analyzed the results of bilateral nephrectomy in 14 patients with end-stage renal disease (ESRD) and chronic active pyelonephritis. Seven patients had urosepsis, and 10 patients had a purulent form of pyelonephritis, which was one-sided in 7 of them. In the early postoperative period, on average, after 9.3 days, 9 patients died. Statistically significant risk factors for death were: chronic hemodialysis, long-term antibiotic therapy, and existing sepsis. Intraoperative complications and postoperative morbidity were not significantly associated with death. The study results imply the need of differentiated approach to bilateral nephrectomy in patients with ESRD and risk factors for fatal outcome. It must be performed on the strong indications since the intervention does not lead to eradication of sepsis. It is advisable to perform "preventive, sanation" bilateral nephrectomy in the "cold period" in patients at risk for developing urosepsis.

[Cardiac Resynchronization Therapy in the Treatment of Heart Failure in Children].

Cardiac resynchronizing therapy (CRT) is currently a leading approach to the treatment of heart failure in adults. However, data regarding application of CRT in children remain limited and indications for CRT are unclear. There is evidence that the best treatment outcomes result from the administration of CRT to the group of children whose heart failure is caused by dyssynchrony mediated by traditional stimulation of the right ventricle in patient with complete atrioventricular block. On the contrary, the presence of dilated cardiomyopathy and functional class III-IV heart failure are the predictors of ineffective CRT. Implantation of CRT devices in children has many peculiarities and challenges associated with anatomic and physiological characteristics of childhood age. Taking into consideration the expected length of treatment, one should admit that epicardial biventricular stimulation should be preferred. In the present paper the authors discuss pathophysiology of the electromechanical dyssynchrony, analyze their own experience with CRT, and suggest indications for this kind of treatment.

Comparative study of the X-ray reflectivity and in-depth profile of a-C, B4C and Ni coatings at 0.1-2 keV.

The use of soft X-rays near the carbon edge of absorption (270-300 eV) greatly enhances studies in various branches of science. However, the choice of reflecting coatings for mirrors operating in free-electron and X-ray free-electron laser (FEL and XFEL) beamlines in this spectral range is not so evident and experimental justifications of the mirror efficiency are rather limited. In the present paper it is demonstrated experimentally that the reflectivity of B4C- and Ni-coated grazing-incidence mirrors is high enough for their operation in FEL or XFEL beamlines near the carbon K-edge of absorption. The minimal reflectivity of both mirrors proves to exceed 80% near the carbon absorption edge at a grazing angle of 0.6°. An in-depth profile of the chemical elements composing the reflecting coatings is reconstructed based on analysis of a set of reflectivity curves measured versus the grazing angle at different photon energies in the soft X-ray spectral region. This allows us to predict correctly the mirror reflectivity at any X-ray energy and any grazing angle.

[DELAYED PORT DEPLOYMENT FOR HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY. CASE REPORT AND LITERATURE REVIEW].

The standard method of surgical treatment of end-stage renal failure is kidney transplantation. A laparoscopic method of organ retrieval from a living donor is currently preferred. The techniques of laparoscopic surgery include hand-assisted nephrectomy and "pure" laparoscopic nephrectomy. We present analysis of the literature data and our own data on the use of the advantages of each of the techniques. A case of complication associated with the use of hand-port from our own practice is described.

[Cardiac Resynchronization Therapy in the Treatment of Heart Failure in Children].

Cardiac resynchronizing therapy (CRT) is currently a leading approach to the treatment of heart failure in adults. However, data regarding application of CRT in children remain limited and indications for CRT are unclear. There is evidence that the best treatment outcomes result from the administration of CRT to the group of children whose heart failure is caused by dyssynchrony mediated by traditional stimulation of the right ventricle in patient with complete atrioventricular block. On the contrary, the presence of dilated cardiomyopathy and functional class III-IV heart failure are the predictors of ineffective CRT. Implantation of CRT devices in children has many peculiarities and challenges associated with anatomic and physiological characteristics of childhood age. Taking into consideration the expected length of treatment, one should admit that epicardial biventricular stimulation should be preferred. In the present paper the authors discuss pathophysiology of the electromechanical dyssynchrony, analyze their own experience with CRT, and suggest indications for this kind of treatment.

[Endoscopic retrograde cholangiopancreaticography for the treatment of necrotic pancreatitis].

40 patients with the acute necrotic pancreatitis and verified biliary hypertension were included in the study. During the endoscopic retrograde cholangiopancreaticography we avoided the main pancreatic duct contrast enhancement. The canulation during papillosphincterotomy (PST) was not used if the concrement was infringed in the ampulla. The use of these methods led to fast relief of the biliary hypertension and truthworthy positive dynamics of the disease course. The negative consequences were usually limited to transitory amilasemia and the pancreonecrosis progression was registered in only 4±4% cases. In comparison with cholecystostomy, the ERCP with PST showed better prognosis considering the frequency of septic complications and terms of hospital stay. The statistical analysis proved the the ERCP with PST are preferable to cholecystostomy in cases of pancreonecrosis with choledochlithiasis and biliary hypertension and the overall severity of pancreonecrosis is not higher than 11 by the physiological condition scale.

[Effect of therapeutic apheresis on the lymphocyte sensitivity to corticosteroids in patients with secondary progressive multiple sclerosis].

Therapeutic apheresis combined with pulse therapy with small doses of corticosteroids was used in 7 patients with secondary progressing multiple sclerosis (MS) during 4 years. Before perfusions, we investigated the lymphocyte sensitivity to methylprednisolone in vitro in the reaction of leukocyte migration with myelin basic protein in each patient. The introduction of test doses of corticosteroids in each patient's blood sample before perfusion procedures showed the different rate of leukocyte migration with the myelin basic protein. On this basis, we selected an individual optimal methylprednisolone dose that was infused intravenously just after each perfusion procedure. The number of patients sensitive to low doses of methylprednisolone increased after therapeutic apheresis. These findings allow to consider the reaction of leukocyte migration with the presence of myelin basic protein as a new method of individual selection of corticosteroid doses for increase of treatment efficacy of secondary progressing multiple sclerosis.

[Remodeling of left ventricular myocardium at early stages of essential arterial hypertension in adolescents].

We studied geometric changes of the left heart in 299 teenagers aged 12-18 years with essential arterial hypertension (EAH). According to 24-hour blood pressure monitoring all patients were divided into three groups: patients with phenomenon of "white coat hypertension" (WCH, n=98); patients with labile arterial hypertension (LAH, n=108); patients with stable atrial hypertension (SAH, n=93). Control group comprised 27 healthy adolescents. Parameters of central hemodynamics were assessed by echocardiography. Geometric left ventricular (LV) changes were found in 69 (23.1%) teenagers with EAH. Risk of formation of eccentric LV hypertrophy in teenagers with SAH was significantly higher than in subjects with WCH and LAH. Pulse pressure made significant contribution to formation of LV hypertrophy. Excess weight contributed significantly to formation of structural and geometric changes of LV and left atrium.

[Perspectives of tigecycline treatment of surgical site infections in oncologic patients].

Criteria of tigecycline (Tygacil) use for the treatment of surgical site infections in oncologic inpatients were developed. High efficacy of tigecycline in vitro and in vivo against multiresistant hospital strains persistent in the surgical department of the gastrointestinal oncologic division was shown.

[Adequate empiric therapy of nosocomial fungal infections in oncologic patients of intensive care units].

The results of a 3-year experience with voriconasole in oncologic practice are presented. Rational schemes for the use of caspofungin and mycofungin in the treatment of oncologic inpatients and the criteria of their use in the therapy of fungal nosocomial infections were developmed. Good clinical and microbiological efficacy of caspofungin and mycofungin against Candida non-albicans was shown.

[Modern antifungals in therapy of nosocomial mycosis in oncologic patients].

Rational position of voriconazole in the treatment of oncologic inpatients was shown and the criteria of its use in the algorithms of the therapy and prophylaxis of nosocomial fungal infections were developed. The clinical trial enrolled 50 patients with oncologic pathologies. The patients were divided into two groups of possible invasive candidiasis risk. The patients of one group were treated with fluconazole (Diflucan) and those of the other group were treated with voriconazole (Vifend). The spectrum of the hospital fungal flora was determined and susceptibility of 310 clinically important opportunistic fungi was investigated. All the isolates of Candida albicans and C.tropicalis were susceptible to amphotericin B, fluconazole and voriconazole and 79 and 50% of the isolates were susceptible to intraconazole respectively. As for the C.krusei isolates, 67% was susceptible to amphotericin B, 50% was susceptible to fluconazole, 100% was susceptible to voriconazole and none of the strains was susceptible to intraconazole. By the clinical efficacy voriconazole was superior to fluconazole and comparable with amphotericin B, while superior to it by the number of the side effects and by the cost of the treatment course. It was concluded that voriconazole should be considered as the main agent in the antifungal therapy of oncologic patients.

[Diagnostics and treatment of postcholecystectomy biliary complications].

The study concerns early postoperative bile leak and obstructive jaundice syndrome after cholecystectomy. 4865 patients were included in the study. The initial cholecystectomy was performed through the traditional laparotomy (n=2122), minilaparotomic access (n=1024) and laparoscopic access (n=1710). Early biliary complications were registered in 135 (2,8%) patients, of whom 47 had bile leak and 88 develop obstructive jaundice. The external drainage bile leak was registered in 0,68%; bile leak trough the trained common bile duct had 0,17% and bile leak into the abdominal cavity had 0,12% of these patients. In 17 cases the bile leak was caused by the cystic duct stump insufficiency, 12 cases were caused by bile leak from the gall bladder bed. 73,5% of bile leak were caused by misdiagnosed choledocholithiasis and papilla Vateri stenosis. Obstructive jaundice in early postoperative period was determined by underdiagnosed bile ductal pathology in the majority of patients (84 patients of 88). The main diagnostic method of biliary complications was the retrograde cholangiopancreaticography with the efficacy of 99,2%. Endoscopic transpapillary operations were curative in 97% of cases. Complications after endoscopic manipulations developed in 3,3%, all of them were successfully conservatively treated.

[Challenges and opportunities for endoscopic ultrasound in the preoperative diagnosis of topical insulin the pancreas].

Insulinoma in most cases is monohormonal orthoendocrine tumor. This fact limits its searching area by a pancreas. However the insulinoma's clinical picture can be caused by other pathology. Therefore the main task of visual the tumor but also to use all the possibilities of each method for defining type of surgery and avoiding such errors and complications, as pancreatorrhage, damage of bile or pancreatic duct, necrosis of duodenal wall, etc. On the basis of our own experience of endoscopic ultrasound for 61 patients with 66 insulinomas, we have allocated the basic variants of insulinoma ultrasound pictures: hypoechoic, heteroechoic, isoechoic tumor, and also foci without a trustworthy contour. On the basis of the analysis of our own errors we have essentially added the technique, having used multiplane pancreas scanning and biplane tumor scanning. Important points in EUS algorithm are also the following items: detecting tumor relationship to pancreatic surface, distance from the tumor to the ducts, gastrointestinal wall and vessels--for definition of possibility of the tumor enucleation; careful scanning of pancreas even after detecting one tumor--for an exception of multiple tumors, especially at MEN-I; careful scanning of a contour of the gland for an exception of parapancreatic insulinomas; estimation of vascularization not only of the detected tumor and suspicious foci, but also of all the gland--for detection of hypervascularized isoechoic tumors; revealing and the description of focal changes, especially more homoechogeneous in comparison with surrounding parenchyma-- for selection patients for examination by other methods; scanning of zones of possible metastasis. Examination of patients with organic hyperinsulinism demands combined application of two or more techniques. Use of all modern possibilities of endosonography can put this technique on one of the first places in the diagnosis of insulinomas.