[LASER TECHNOLOGIES IN LAPAROSCOPIC HERNIOLOGY].

Objective - to analyze the expediency of using a universal laser coagulator "Lika-surgeon" with a wavelength of 1470 nm as an alternative to an electrocoagulation while performing dissection for TAPP. The work is based on the analysis of 88 TAPP patients, using a universal laser "Lika-surgeon" with a wavelength of 1470 nm at a radiation power of 10-12.5 W and 102 patients operated according to the trivial standard TAPP procedure, where an electrocoagulation hook with a coagulation and cutting power of 35 W is used as a dissection instrument. Evaluation considered the criteria of operating time, duration of hospital stay, severity of pain syndrome, morphological assessment of the prevalence of laser and electrical effects on the tissues in the affected area.. All surgical interventions were performed in the Department of General and Vascular Surgery of the PNCO "Kyiv City Hospital №1, Shalimov's National Institute Of Surgery And Transplantation National Academy Of Medical Sciences Of Ukraine and Republican Clinical Hospital Of Batumi in 2020. The cutting mode in an electrosurgical apparatus is accompanied by tissue wrinkling and smoke in the operating field. The laser device is devoid of these disadvantages. At the same time, laser coagulation requires practical skills of the operator to select the optimal distance between the optical fiber and the object. The operating time and the duration of hospital stay in patients of the first group are significantly shorter. The severity of pain in the early postoperative period was comparable in both groups. In the late postoperative period, the pain syndrome was more severe in the second group - it accompanied 6.1% of patients in the first group and 15.2% in the second group. Analysis of the morphological material showed significantly less tissue trauma in the affected zone in the first group - the coagulation zone is 372.91 µm versus 835.88 µm in the second group. A laser coagulator with a wavelength of 1470 nm has a number of significant advantages over an electrosurgical coagulator: more efficient cutting and coagulation modes; optical clarity of the operating field; minimal thermal damage of the underlying tissues (the depth of tissue damage in the first case is 166.36 microns, in the second 835.88 microns); significant reduction of operating tine and the duration of hospital stay; significant reduction of pain in the postoperative period. This opens up new perspectives for its use in laparoscopic surgery of inguinal hernia.

USING THE METHOD OF PANCREATOGASTROSTOMY AT THE STAGE OF RECONSTRUCTION IN PANCREATODUODENECTOMY.

The goal of this study was to analyze the effectiveness of pancreatogastrostomy at the stage of reconstruction by assessing its technical aspects and analysis of the frequency of postoperative complications. The article represents results of the study held with a total of 35 pancreatoduodenectomies performed, followed by reconstruction pancreatogastrostomy. The average patients age was 53.2 years. Men - 13, women - 22. The study non-inclusion criterion was pancreatoduodenectomy with vascular reconstruction. The most common symptom was obstruction jaundice, observed in 29 (82.8%) patients. In 9 (25.7%) cases diabetes mellitus was diagnosed. Eleven (68.7%) patients underwent preoperative endobiliary stenting, five (31.3%) - percutaneous transhepatic biliary drainage. The pancreatoduodenectomy was performed with bilirubinemia not exceeding 100 mcM /l. The most common determined pathology was the pancreatic head carcinoma- 14 (40.2%) cases and the ampulla of Vater carcinoma - 12 (34.2%). The other pathologies were as follows: distal cholangiocarcinoma- 5 (14.3), duodenal cancer - 3 (8.5%) and chronic fibrous-degenerative pancreatitis -1 (2.8%). Biochemical leakage was registered in 6 cases (17.1%), the B grade pancreatic fistula - in 3 cases (8.5%), C grade - in 1 case (2.8%). The postoperative gastroparesis was observed in 5 (14.2%) patients: grade А-3 cases, grade В-2 cases, grade С no cases. The pancreatic stump hemorrhage into the gastric lumen was registered in 4 patients (11.4%). No patient required for relaparotomy, the hemorrhage was arrested by endoscopic argon-plasma coagulation (ERBE 200 D) and conservative treatment. The pancreatogastrostomy method can be used irrelevant of the pancreas parenchyma structure and the main pancreatic duct diameter.

PERIOPERATIVE MULTIMODAL PROGRAM OF ENHANCED RECOVERY FOLLOWING PANCREATICODUODENECTOMY.

Mortality after pancreaticoduodenectomy (PD) decreased from 25% to 1-3% in the last decade. However, the number of early postoperative complications varies from 29.5% to 70%. Therefore, there is a need in new methods of perioperative management of patients after PD to improve the immediate results.  To analyze the effectiveness of perioperative treatment regimens, a prospective retrospective study of the results of 78 patients after PD with diseases of the head of the pancreas and the periampular zone for the period from 2003 to 2017 was conducted. For comparative analysis, the patients were divided into 2 groups: group I included 39 patients for the period from January 2015 to December 2017, the perioperative treatment of which was carried out in accordance with the enhanced recovery program, group II -39 patients from January 2003 to December 2014, which were conducted according to the traditional method. We studied the time of the restoration of oral nutrition, postoperative complications, the length of hospital stay (LoS).There were no mortality in groups. The overall incidence of Clavien-Dindo complications in I group was less than in II (10 (25.6%) vs. 18 (46.1%), p = 0.029). In I group, the incidence of delayed gastric emptying (DGE) was lower compared to II (15.4% (6 patients) versus 35.9% (14 patients), p=0.009). Pancreatic fistula (PF) in I and II groups did not differ significantly - 10.2% (4 patients) and 12.8% (5 patients), respectively (p=0.36). The incidence of surgical wound infections in I group was reduced in comparison with II (5.1% (2 patients) versus 17.9% (7 patients), (p=0.031).The LoS in I group was significantly less compared with II (14 days 95% CI: [13, 17] vs. 18 days 95% CI: [16, 18], p=0.012). The results of the ERAS program after PD shows the reducing number of postoperative complications and LoS, demonstrating the feasibility in clinical practice.

[STUDYING OF MORPHOLOGICAL PECULIARITIES OF SUBMANDIBULAR SALIVARY GLANDS AFTER GASTRIC RESECTION IN EXPERIMENT].

The impact of gastric resection on the submandibular salivary gland (SSG) state, using histological and histochemical methods of investigation in experiment, was studied up. A relative mass of a SSG after gastric resection conduction have had reduced, and the accompanying changes in stroma were revealed with the gland's secretion enhancement. Essential dystrophic changes in the SSG parenchyma and stroma after gastric resection conduction may cause a pronounced disorders of their function.

[CHARACTERISTICS OF LIPID METABOLISM AND COMPLICATIONS OF ARTERIAL HYPERTENSION DEPENDING ON THE PSYCHOSOMATIC STATUS OF THE PATIENT AND TREATMENT OPTIONS].

It is established that on the investigated physiological (body mass index, body fat, the index «waist circumference/hip circumference¼) and biochemical (total cholesterol, lipoproteins of high, low and very low density, triglycerides) indicators of a condition of the lipid metabolism group of patients highanxiety the phlegmatic and melancholic are groups at higher risk of developing complications of hypertension. I highanxiety the phlegmatic and melancholic, unlike the choleric and sanguine, the high content of atherogenic lipid fractions and obesity is combined not only with the highest level of complications, but three times the prevalence of acute myocardial infarction on acute ischemic stroke (3:1). Effect of antihypertensive therapy aimed at relief features of the psychosomatic status of patients, manifested prior 6 months compared with «empiric¼ treatment option; in addition, after 12 months of therapy the values of the investigated parameters approached or were equal in the groups of healthy persons of corresponding temperament and anxiety. Also decreased the number of complications of arterial hypertension. Antihypertensive therapy based on the relief features of psychosomatic status in patients with arterial hypertension, has proven to be more effective in groups highanxiety and lowanxiety patients.

[Features of oxygen utilization by the body of patients with arterial hypertension in the days of magnetic storms depending on the psychosomatic status and treatment options].

During magnetic storms the observed increase in γ-background environment and the reduction of the rate of oxygen utilization by the tissues, but the increase in the number of angina attacks per day to magnetic storms the choleric, in the days of magnetic storms in sanguine, for 3-4 days at a phlegmatic, and 4-5 days in the melancholic especially in groups high anxiety phlegmatic and melancholic. Last-risk group severe arterial hypertension and ischemic heart disease. Antihypertensive therapy based on the blockade of the features of the psychosomatic status, significantly reduced the number of attacks and brought the values of the utilization of oxygen and coefficient of oxygen utilization bu the tissues of all the days to those in healthy individual relevant anxiety and temperament.

[TG13: THE UPDATED TOKYO'S CLINICAL RECOMMENDATIONS FOR TREATMENT OF AN ACUTE CHOLANGITIS AND CHOLECYSTITIS].

Basing on analysis of the multicenter clinical investigations results, as well as meta-analysis and consensuses, the main suggestions of the updated Tokyo's clinical recommendations for the treatment of an acute cholangitis and an acute cholecystitis (TG13), diagnostic criteria and the scales of estimation for the patients' state severity, were elaborated. Indications and the drainage methods of a gallbladder were substantiated - in an acute cholecystitis, and of biliary ducts - in an acute cholangitis, as well as peculiarities of surgical treatment of an acute cholecystitis. Empirical antibacterial therapy was enlightened, taking into account the characteristics for biliary infection microorganisms and the disease severity.

[Characteristics of central nervous system activity in patients with complications of arterial hypertension and dependence on psychomotor status and treatment].

Changes in certain CNS characteristics were used as indicators of the efficacy of antihypertensive therapy (AHT) both targeted (T-AHT) and empirical (E-AHT) designed to suppress activity of the sympathetic component of vegetative nervous system (VNS) and renin-angiotensin-aldosterone system (RAAS) in patients of different psychic status and AH. A group of 835 men (mean age 54.2+-1.8yr) was divided into cholerics, sanguinics, melancholics and phlegmatics with a high and low anxiety level (HA and LA). 416 healthy men served as controls. The following parameters were estimated: mobility of cortical processes, balance between sympathetic and parasympathetic activities, blood corrisol and aldosterone levels, oxygen utilization coefficient, resistance to breath holding, severity of dyscirculatory encephalopathy and the fraction of patients with AH complications during 12 month T-AHT for the suppression of sympathetic activity in cholerics and sanguinics by beta-adrenoblockers and PAA C- ACE inhibitors in phlegmatics and melancholics and during E-AHT (ACE inhibitors in cholerics and sanguinics, BAB in phlegmatics and melancholics). The functional activity of CNS in phlegmatics and melancholics before and during AHT was lower and severity of encephalopathy and the number ofAH complications higher than in cholerics and sanguinics. . The changes wiere more pronounced in patients with HA than in those with LA. Unlike E-AHT T-AHT (anxiolytics for cholerics and sanguinics with HA, antidepressants for phlegmatics and melancholics with HA) normalized the study parameters and decreased the frequency of complications by 2-3 times.

[Aggregation, deformation and morphology of erythrocytes in patients with ischemic heart disease after injection of ioversol, iodixanol and gadobutrol].

In patients with ischemic heart disease, the administration of contrast agents iodixanol, ioversol and gadobutrol improves (due to the effect of dilution) the aggregation of erythrocytes in vivo, but does not change their deformation ability and the percentage of different morphological forms of erythrocytes (discocytes and ehinocytes) in the blood. The effect of gadobutrol on the aggregation of erythrocytes is characterized by more expressed antiaggregant effect due special molecular properties of this drug.

[Deformation properties of human erythrocytes in the presence of x-ray contrast agents].

It is established that the x-ray contrast agents urografin (76 %), omnipaque-300, optiray-350, ultravist-300, and visipaque-270 produce a dose-dependent decrease in the deformation properties of human erythrocytes in vitro. The degree of manifestation of this negative influence increases with the osmotic activity of agents in the following order: visipaque = ultravist < or = omnipaque < or = optiray < urografin. The effect of these x-ray contrast agents on the deformation of erythrocytes is reversible. Erythrocytes restore their normal deformation properties upon removal of the osmotic pressure induced by the x-ray contrast agents.

Ultrahot electron formation under excess electron drift through solid Xe.

The formation of "hot" (8 eV) electrons under excess electron drift in a moderate electrostatic field through solid xenon has been experimentally proved by observation of secondary electrons emitted from the photocathode. At T=77 K and U=1000 V one drifting electron produces about 20 (172 nm) photons, the efficiency of electric field-to-vacuum ultraviolet emission conversion is 15% tending to grow with temperature. A self-sustained electric discharge has been generated in solid Xe using a three-electrode cell with a zinc cathode.

In vitro and in vivo opioid activity of [DPro(6)]dermorphin, a new dermorphin analogue.

To study the effects of inducing stereo-chemical modifications in the structure of dermorphin (DM) so as to improve its mu-opioid receptor affinity and its resistance to C-terminal enzymatic degradation, in the Institute of Molecular Genetics of Moscow, we synthesized a new DM analogue ([DPro(6)]DM) and analyzed the changes induced in the biological activities of DM by substituting the Pro(6) residue with DPro(6). We compared the activity of the new DM analogue and DM in in vitro assays and in in vivo tests of analgesia, thermoregulation, heart rate recordings, and gastrointestinal motility in rats. In the in vitro tests, guinea pig ileum (GPI) and mouse vas deferens (MVD), although the opioid activities of [DPro(6)]DM indicated that the peptide was always less potent than DM, its lower IC(50) ratios (mu/delta) showed that it had higher mu-opioid receptor selectivity. In the in vivo analgesic test, [DPro(6)]DM, when injected intraperitoneally (i.p.) (0.5-5 and 10mg/kg) in rats, had the same antinociceptive efficacy as DM and when injected intranasally (i.n.) (0.005 and 0.02 mg/kg) it induced a more stable and long-lasting analgesia than DM (the AUC was about 91% higher for [DPro(6)]DM than for DM). Moreover, these data confirm that the intranasal route is advantageous for peripheral drug administration. In the heart rate study, [DPro(6)]DM and DM (0.5mg/kg, i.p.), induced a similar, weak bradycardia. The only difference was that [DPro(6)]DM induced a longer-lasting effect than DM. Conversely, in body temperature regulation [DPro(6)]DM induced weaker inhibitory activity than DM (56% of the DM-induced response); it did so only in a cold environment and at the maximal used dose (0.5mg/kg, i.p.) without inducing vasomotor effects. In the gastrointestinal study, [DPro(6)]DM and DM (0.005, 0.05, and 0.5mg/kg, i.p.) significantly slowed upper gastrointestinal transit of a charcoal meal and inhibited colonic propulsion. Comparison of the ED(50) values of [DPro(6)]DM (0.03 mg/kg) and DM (0.009 mg/kg) showed that the DM analogue was about three times less potent than DM in slowing gastrointestinal and colonic transit. In conclusion, all these data overall suggest that structural maneuvering in the Pro(6)-residue of the DM molecule changes its affinity for mu-opioid receptor subtypes and confirms the usefulness of experimental studies involving structural modifications in obtaining new therapeutic agents.

[Effect of structural changes of Pro6 in dermorphin molecule on its antinociceptive activity]. / Vliianie strukturnykh izmenenii Pro6 v molekule dermorfina na anal'geticheskuiu aktivnost'.

We studied effect of dermorphin (H-Tyr-DAla-Phe-Gly-Tyr-Pro-Ser-NH2) and its analogs with modified amino acid residue proline in position 6, H-Tyr-DAla-Phe-Gly-Tyr-[DPro]-Ser-NH2, H-Tyr-DAla-Phe-Gly-Tyr-[dehydro-Pro]-Ser-NH2, and H-Tyr-DAla-Phe-Gly-Tyr-[D-dehydro-Pro]-Ser-NH2, on nociception in the tail-flick and hot plate tests after intraperitoneal injection. Replacement of LPro with the stereoisomer DPro as well as Pro dehydration (LdHPro) was shown to increase antinociceptive activity. Replacement of LdHPro with DdHPro cancelled the activity in the tail-flick test. All three dermorphin analogs retained antinociceptive activity in the hot plate test; however, the effect of dermorphin was more pronounced.

[Effect of dermorphin analogs on thermoregulation of rats under various thermal conditions]. / Vliianie analogov dermorfina na termoreguliatsiiu krys v razlichnykh temperaturnykh rezhimakh.

We studied the influence of dermorphin (dermorphin) analogs with stereochemical modification of the amino acid residue proline in position 6 (Pro6), Tyr-D-Ala-Phe-Gly-Tyr-Hyp-Ser-NH2, Tyr-D-Ala-Phe-Gly-Tyr-[D-Pro]-Ser-NH2, Tyr-D-Ala-Phe-Gly-Tyr-[dehydro-Pro]-Ser-NH2, and Tyr-D-Ala-Phe-Gly-Tyr-[D-dehydro-Pro]-Ser-NH2, after their intraperitoneal injection at 0.5 mg/kg dose in the cold (4-7 degrees C), thermoneutral (27-28 degrees C), and hot (31-33 degrees C) environment. Stereochemical modifications of amino acid residue Pro6 proved to induce specific changes in the thermoregulatory effect of the peptide. Substitution of DPro6 for Pro6 has the most dramatic consequences: it considerably attenuates the thermoregulatory effect of dermorphin in the cold environment, cancels it in the hot environment, and inverts the dermorphin-specific thermoregulatory response in thermoneutral conditions. The data obtained indicate the important role of Pro6 residue in realization of this physiological activity of dermorphins.

[Dermorphins--a natural opioids with unique primary structure that determines their biological specificity]. / Dermorfiny--prirodnye opioidy s unikal'noi pervichnoi strukturoi, opredeliaiushchei spetsifiku ikh biologicheskoi aktivnosti.

Based on the authors' and published data, the spectrum of biological activities of dermorphins was theoretically analyzed for the first time from the viewpoint of specific structural features of their molecule that determine selective affinity to mu-opiate receptors. It was shown that specific distribution of dermorphins and corresponding opiate receptors in tissues and organs, especially in the CNS structures, determines the role of dermorphins in the regulation of functions of the most important physiological systems.