[Perioperative prevention of complications in surgery of ventral hernias]. / Perioperatsionnaya profilaktika oslozhnenii v khirurgii ventral'nykh gryzh.

OBJECTIVE: To improve perioperative algorithm of prevention of complications in patients with ventral and incisional hernias via differentiated choice of mesh implants and hernia repair technique. MATERIAL AND METHODS: The study included 144 patients with abdominal wall hernia, who were divided into two representative groups. RESULTS: Original algorithms for choosing the method of hernia repair depending on type and position of mesh implant, as well as methods of perioperative prevention of complications are proposed. CONCLUSION: These algorithms significantly reduced the incidence of postoperative wound complications after sublay hernia repair and posterior separation with TAR.

[Risk factors of abdominal wound dehiscence in abdominal surgery]. / Faktory riska razvitiya eventratsii v abdominal'noi khirurgii.

OBJECTIVE: To evaluate the role of various perioperative risk factors on the incidence of abdominal wound dehiscence. MATERIAL AND METHODS: A retrospective controlled randomized trial of the risk factors of abdominal wound dehiscence was conducted in 62 patients for the period 2013- 2018. The research was performed at the Perm City Clinical Hospital No. 4. All patients were divided into two groups: the main one (n=31) with abdominal wound dehiscence in early postoperative period and the control group (n=31) without this event. Both groups were comparable by gender, age and surgical abdominal diseases. Between-group differences in numerical indicators were analyzed using Mann-Whitney U-test, qualitative variables were analyzed using contingency tables. Differences were significant at p-value <0.05. RESULTS: Incidence of abdominal wound dehiscence was similar in patients who admitted in emergency and elective fashion (p=0.54). Anemia upon admission (p=0.71), diabetes mellitus type 2 (p=1.00), COPD (p=0.13) and obesity (p=0.76) were not significant predictors of abdominal wound dehiscence. There were significant between-group differences in CRP level (p=0.04). Among intraoperative risk factors, duration of surgery (p=0.78), surgical approach (p=1.00), aponeurosis suturing technique (p=0.39) and stoma (p=0.71) did not significantly affect the incidence of abdominal wound dehiscence. In early postoperative period, abdominal wound dehiscence correlated with peritonitis (p=0.04), SSI (p<0.01) and redo laparotomy (p=0.02). CONCLUSION: Despite the variety of pre-, intra- and postoperative risk factors, only infectious postoperative complications (SSI, peritonitis) and redo surgical interventions influenced the development of abdominal wound dehiscence. Thus, the concept of abdominal wound dehiscence prevention should be inextricably associated with the concept of prevention of postoperative infectious complications from the abdominal wall and abdominal cavity.

Thermodynamic temperature assignment to the point of inflection of the melting curve of high-temperature fixed points.

The thermodynamic temperature of the point of inflection of the melting transition of Re-C, Pt-C and Co-C eutectics has been determined to be 2747.84 ± 0.35 K, 2011.43 ± 0.18 K and 1597.39 ± 0.13 K, respectively, and the thermodynamic temperature of the freezing transition of Cu has been determined to be 1357.80 ± 0.08 K, where the ± symbol represents 95% coverage. These results are the best consensus estimates obtained from measurements made using various spectroradiometric primary thermometry techniques by nine different national metrology institutes. The good agreement between the institutes suggests that spectroradiometric thermometry techniques are sufficiently mature (at least in those institutes) to allow the direct realization of thermodynamic temperature above 1234 K (rather than the use of a temperature scale) and that metal-carbon eutectics can be used as high-temperature fixed points for thermodynamic temperature dissemination. The results directly support the developing mise en pratique for the definition of the kelvin to include direct measurement of thermodynamic temperature.

[Comparative analysis of different methods of geroprotective].

In the monitoring process 110 representatives of different age groups held a comparative analysis of the efficacy and safety of several geroprotective techniques, including the use of dry carbon dioxide baths, hyperbaric oxygen therapy, therapeutic massage and receiving Oligopeptide preparations containing complexes lysyl-glutamyl-asparagin and glutamyl-asparagin-arginine (Vezugen and Pinealon). The most pronounced positive impact on indicators of biological age were detected during the combined use of these two Oligopeptide complexes. The most safe from the point of view of influence on a number of biochemical, immunological parameters, clinical condition of the patients were therapeutic massage and Oligopeptide drugs. The use of dry carbon dioxide baths and hyperbaric oxygenation with an undoubtedly positive influence on the indices of biological age has a number of limitations and contraindications regarding its security.

[Age and gender aspects of the status of lipid profile and stress-realizing systems of the human body in the aging process].

In the course of inspection 1136 persons of different age and sex data on dynamics of the main components of lipid profile, the concentration of brain-derived neurotrophic factor (BDNF) in blood plasma and indicators of levels of free cortisol, melatonin sulfate, metanephrine and normetanephrine in urine daily were obtained. Clear age and gender differences related both to the content of atherogenic fractions of lipids in the blood, and types of dyslipidemia were revealed. Fundamental differences in the age dynamics of indicators of stress-realizing systems in men and women and the correlation of these indicators with the level of low density lipoproteins and atherogenic coefficient were identified. The data obtained may indicate different mechanisms of development of atherosclerosis and its associated pathological aging in people of different sex and age, which enables the practical use of research results for the earliest diagnosis and prognosis of a number of associated with age and pathological conditions.

[Advantages and limitations of interspecies associations in northern migratory sandpipers (Charadrii, Aves)].

Investigations were carried out at two stations of Ornithological Unit, IBPN FEB RAS, located in Nizhnekolymsk District, Yakutia, starting from May 15-20 in 1984, 1985, 1987, 1988, and 1990; at the northern coast of Pukhovoy Bay, Southern Island of Novaya Zemlya starting from June 1 in 1994; at Cape Beliy Nos, the Yugorsky Peninsula, starting from June 1 in 1995-1997. Classic associations are detected in interspecies flocks of sandpipers between the following species: the Pacific golden plover and the curlew sandpiper, the pectoral sandpiper and the long-billed dowitcher, the pectoral sandpiper and the dunlin, the grey plover and the dunlin. However, total amount of birds that form associations is not large. In species of group "A" (the grey plover, the Pacific golden plover, the pectoral sandpiper), no difference has been observed in migratory birds behavior within inter- or conspecific flocks. Species of group "B" (the dunlin, the curlew sandpiper, the long-billed dowitcher), on the contrary, change their behavior sharply depending on whether they belong to an association or not. Species of group "A" do not get any advantages when forming an association. Unlike them, species of group "B" profit from associating: a part of time spent in foraging substantially increases; more time is spent on rest and less time is spent on reconnaissance and vigilance (readiness for actions); safety of birds is enhanced. On the other hand, in species of group "B" there are also disadvantages related with associating: i.e., interspecies competition for food; foraging in suboptimal habitats which, in turn, may lead to notable increase of time spent by birds in foraging. An assumption is put forward that in species of group "B" advantages and limitations of associating cancel each other to a certain extent, and this explains rather small number of birds forming associations.

[Duration of the pre-nesting period and its relation with social organization in sandpipers (Charadrii, Aves) nesting in north-east Yakutia].

Investigations were carried out at two stations of Ornithological Unit, IBPN FEB RAS, located in Nizhnekolymsk District, Yakutia, starting from May 18-20 in 1984, 1985, 1987, 1988 and 1990. Duration of the pre-nesting period in 11 sandpiper species with different social organization was studied and compared with each other by allometric equations. As a characteristic of bird size the body mass was selected. Sandpipers come flying to the tundra at almost critical temperatures, to begin breeding as early as possible. Tining of breeding depends on birds feeding manner and the proximity to sites of overwintering. Duration of the pre-nesting period is invariable for every bird species and sex. There are sexual distinctions in time spent for the pre-nesting period in jointly-nesting sandpipers. The exponents in allometric equations that relate duration of the pre-nesting period with body mass are constant within a particular sex and differ between males and females. In different sexes, time spent for the pre-nesting period depends on mating, parental, and territorial systems. In sandpipers' males and females, this time is determined by the type of social organization. Relatively large sandpiper species seek to shortening of the pre-nesting period calendar time, which constrains their social organization. Monogamy and pair parental care lead to a necessity for spatial population structure to be controlled more strictly and maintained for a longer time. This, in turn, causes the increasing of males' time expenditures for such a behavior.

[Aviation medicine laboratory of the North Fleet air base celebrates the 70th anniversary].

The article is dedicated to the history of formation and development of the oldest aviation medicine department and its role in a flight safety of the North Fleet naval aviation. The aviation medicine laboratory was created in the years of the Great Patriotic war for medical backup of flights, medical review board, delivering of combat casualty care, prophylaxis of hypothermia and exhaustion of flight and ground crew. In a post-war period the aviation medicine laboratory made a great contribution to development of medical backup of educational and combat activity of the North Fleet aviation. Participation in cosmonaut applicants selection (incl. Yu.A. Gagarin), optimization of flight services during the transmeridian flights, research of carrier-based aircraft habitability and body state of the contingent during the longstanding ship-based aviation, development of treatment methods for functional status of sea-based aviation crew are the achievements of aviation medicine laboratory. Nowadays medicine laboratory is performing a research and practice, methodic and consultative activity with the aim of improving the system of medical backup, aviation medicine, psychology, flight safety, improvement of air crew health, prolong of flying proficiency.

[Organisation of scientific and research work of Navy medical service].

The main issues of organization of scientific and research work of medical service in the North Fleet are considered in the present article. Analysis of some paragraphs of documents, regulating this work at army level is given. The authors give an example of successful experience of such work in the North Fleet, table some suggestions which allow to improve the administration of scientific and research work in the navy and also on the district scale.

[Ecological, functional, and thermodynamic prerequisites and consequences of homoeothermy origin and development, with avian energetics as a case study].

Homoeothermy has formed in birds and mammals independently and in different geological ages. However, in both groups it originated as a side effect of selection for aerobic metabolism improvement that provided a higher level of activity. Advantages of having high and stable body temperature, which are inevitably related with metabolism intensification, led to development of thermoregulatory adaptations such as fur and feathers. This made it possible to retain the metabolically generated heat and reduce heat absorption in hot environments. Emergence of homoeothermy with aerobic supply of motion activity, possibilities to regulate the level of metabolism and thermolysis, has opened a lot of opportunities for homoeothermic animals. Achieving such a level of energy utilization allowed them to maintain activity for a longer time, while its sensory support led to complication and diversification of birds' behavioral repertoire (as well as that of mammals) facilitating the conquest of almost entire part of the biosphere that is suitable for living. This process was favoured by the development of nurturing and passing on the information, collected throughout the life, to new generations. Formation of high levels of aerobic metabolism in birds and mammals was proceeding in parallel among different groups of reptilian ancestors. The level of homoeothermy, at which aerobic metabolism is able to maintain prolonged activity, developed in birds and mammals in different ways: they have got dissimilar partitioning of venous and arterial networks, erythrocytes with or without a cell nucleus, different lungs design--but, at that, similar minimum metabolic power and rather close body temperatures which correspond well to the environmental conditions on the Earth. Natural selection allowed animals with high energetic metabolism to increase their diversity and abundance, but only when homoeothermic animals could satisfy their demands for food resources, that have risen manifold. That happened in the middle of Cretaceous, in time with the appearance of angiosperms and expansion of related fauna of invertebrates.

[Healthy person's cerebral reactions to the rhythmic transcranial magnetic stimulation of different intensity].

At 8 healthy examinees-volunteers of 22-25 years the functional effects of super-threshold (above 1.2 T) and subthreshold (70-80% of a motor threshold) rTMS of premotor cortexes medial departments were compared. Functional brain activity changes were estimated (before and 1 hour after stimulation) by comparing data including neuropsychological testing, visual and spectral-coherent EEG-analysis, and also haemodynamic parameters. The number of the work's problem included selection of activating orientated stimulation's frequency, and also specification objective EEG--criteria of efficiency rTMS. It is established the effect of EEG-analysis during different frequency photostimulation for a choice of activating rTMS. The received results reveal EEG-coherence as one of the most informative characteristics of cerebral neuro-dynamics under rTMS-influence. Dependence of stimulation's functional effects (activated or brake character) from initial level of the intercentral coherent communications is noted. It is revealed that rTMS of the healthy examinees causes certain changes of functional activity of a brain, distinct from placebo-effects. rTMS-effect dependent on intensity (super--or sub-threshold), and also from features of an initial intercentral rations. More expressed functional changes are observed in the left hemisphere. It is shown big by reactance of the left hemisphere on this influence. In formation of brain responses on rTMS the active role of the vascular factor is shown.

Low dose chemotherapy in combination with insulin for the treatment of advanced metastatic tumors. Preliminary experience.

Toxic effects and chemoresistance are serious problems concerning chemotherapy administration. Until now adequate solutions have not been found. In the past few years, while searching for possibilities to decrease toxicity, chemotherapy given in low, frequent doses - a novel strategy called "metronomic" administration - showed promising results. There is also another method for applying low doses of chemotherapeutics at short intervals, called Insulin Potential Therapy (IPT). It combines standard chemotherapy schemes, using lower doses of anticancer drugs and the hormone insulin which is administered intravenously (i.v.). We present hereby 3 cases of our original practice, which demonstrate the efficiency of IPT in the treatment of metastatic tumors, following failure of standard chemotherapy.

[Radiofrequency ablation of the great saphenous vein in lower-limb varicose disease].

The authors herein share their experience gained in comprehensive treatment of patients diagnosed with lower-limb varicose disease treated by means of one the most state-of-the-art technologies, i. e., radiofrequency ablation. The work deals with the outcomes of managing a total of seventy-eight patients suffering from lower-limb varicose diseases with valvular insufficiency of the great saphenous vein. All the patients were subjected to radiofrequency ablation of the compromised great saphenous vein by means of the portable radiofrequency device "Surgitron" manufactured by the Company "Ellman International" (USA). Examination included ultrasonographic duplex and triplex scanning of the veins of the lower extremities. Intraoperative radiofrequency ablation of the great saphenous vein was performed by means of an original appliance consisting of a metallic probe whose length corresponded to that of the lower extremity concerned, with a figure-of-eight olive at the distal end and external plastic tube catheter. The construction of the probe made it possible to maximally free the great saphenous vein from blood through the lateral ports of the catheter, to reduce the risk of complications, to diminish the duration of the intervention, and to increase its effectiveness. Efficacy of radiofrequency ablation of the great saphenous vein amounted to 93.6%, with recanalization of the greater saphenous vein being established in five (6.4%) patients. Good functional and cosmetically pleasing therapeutic outcomes were observed in the majority of the patients (87.2%).

[Comprehensive outpatient treatment of varicose disease of the lower limbs].

The article deals with the findings obtained in examining a total of 8,000 people presenting with varicose disease of the lower extremities. The examination included a clinical (physical) examination and coloured duplex scanning of the lower-limb veins. The examination was carried out in outpatient conditions, whereas surgical treatment was performed either out-patiently, or at a <> hospital. Revealing complete valvular insufficiency of the great saphenous vein was followed by surgical treatment - intraoperative stem catheter scleroobliteration (SSO) or short-term screening and postoperative puncture sclerotherapy. Detecting partial valvular insufficiency of the greater saphenous vein (pathological sapheno-femoral reflux only in the vertical position) was managed by applying the principle of the so-called <>: i. e. the patients were subjected to the procedure of puncture sclerotherapy of varicose veins on the crus in ambulatory conditions to be followed by secondary ultrasonographic scanning with permanent dynamic follow-up. The cases of preserved reflux along the greater saphenous vein were subjected to sclerosurgical management. Valvular insufficiency of perforating veins was coped with by minimally invasive surgical interventions: subtotal endoscopic dissection of incompetent perforating veins, suprafascial ligation from a miniaccess and echosclerotherapy of the perforating veins. Also performed were histological and histochemical studies of the portions the greater saphenous vein and surrounding tissues procured during cross-ectomy of the sapheno-femoral anastomosis in 43 patients, who had endured preliminary puncture sclerotherapy on the crus. Good functional and cosmetically pleasing outcomes were achieved in the majority of cases. In 75% of the patients with partial valvular insufficiency of the greater saphenous vein, we managed to avoid operations since repeat ultrasonographic study revealed no pathological veno-venous shunts.

[First experience of bilateral hip joint prosthesis using DePuy ASR system].

Simultaneous bilateral hip joints prosthesis owes advantages over two-staged procedure, including the patients stationary treatment shortage, as well as duration of total operative time, total period of his disablement and financial expenses. Decision about application of such operations must be done individually, comparing the real criteria of risk for patient's life.

[First experience of the hip joint prosthesis using DePuy ASR system].

The system of the hip joint total endoprosthesis DePuy owes undoubted advantages over standard metal-polymer systems and constitutes the optimal one on the modern stage of endoprosthesis development for young patients, it permits to escape the revision prosthesis. Early return of the patients to labour activity and short period of adaptation constitute economical efficacy of the construction applied.

[Choice of the method of video-thoracoscopic esophagectomy].

Video-thoracoscopic esophagectomy was performed in 51 patients including 25 patients with esophageal cancer, 18 -- with cicatricial stenosis of the esophagus and 8 -- with esophageal achalasia of stage IV. Video-thoracoscopic esophagectomy and laparotomy for gastroplasty may be performed simultaneously with 2 surgery teams that reduce time of surgery. Simultaneous thoracoscopic and transhiatal approaches to the esophagus permit avoiding conversion in severe periesophagitis.

Fos expression and task-related neuronal activity in rat cerebral cortex after instrumental learning.

Learning has been shown to induce changes in neuronal gene expression and to produce development of task-specific neuronal activity. The connection between these two features of neuronal plasticity remains of a great interest. To address this issue we compared distribution of c-Fos expressing and task-related neurons in the rat cerebral cortex following instrumental learning of appetitive lever-press task. The number of Fos-positive neurons was determined immunohistochemically in the retrosplenial and the motor cortex of naive ("control" group), newly trained ("acquisition" group) and overtrained ("performance" group) animals. A significant activation of c-Fos expression was observed in the neurons of the retrosplenial but not motor cortex in the "acquisition" group rats, as compared with the "control" and "performance" groups. In accordance with this c-Fos expression difference, the retrosplenial cortex of the trained animals contained significantly more neurons with lever-press-related activity than the motor cortex. Therefore, the two examined cortical areas showed a parallel between experience-dependent induction of c-Fos and development of task-related neuronal activity. These data support a notion that learning-induced activation of c-Fos is associated with long-term neurophysiological changes produced by training.

Frequency and temperature dependence of skin bioimpedance during a contralateral cold test.

A study of the α- and ß-dispersion of skin bioimpedance dependence on temperature and micro-hemodynamics is presented. The vascular tone changes during the cold test are verified by the wavelet-analysis of skin temperature signals obtained simultaneously with impedance measurements. Thirty three normal healthy subjects of 28  ±  7 years old were entered into the study. The tetra-polar electrode system was used to record the resistance and reactance; measurements were carried out at 67 frequencies, in a frequency range from 2 Hz to 50 kHz. It has been found that the impedance decreases with vasodilation and increases with vasoconstriction. The high values of correlation among thermal oscillation amplitudes and Nyquist diagram parameters prove the impedance dependence on blood flow in three frequency bands corresponding to the myogenic, neurogenic and endothelial vascular tone regulation mechanisms. Using an equivalent RC circuit, we obtained the changes in the Nyquist diagram matching the experimental data. The proposed descriptive α-dispersion model can be used to study mechanisms responsible for intercellular interaction.

Metabolic effects of gamma-linolenic acid-alpha-lipoic acid conjugate in streptozotocin diabetic rats.

Data suggesting the involvement of increased oxidative stress in the pathophysiology of diabetes has raised interest in the potential therapeutic benefit of antioxidants. Although beneficial metabolic effects of antioxidant supplementation have been suggested, an antioxidant mode of action, particularly in skeletal muscle, has not been documented. In the present study, we evaluate the metabolic effects of a gamma-linolenic acid-alpha-lipoic acid conjugate (GLA-LA) in streptozotocin-induced diabetic rats, and assess its potential mode of action by comparing its effects with equimolar administration of LA and GLA alone. Ten days of oral supplementation of 20 mg/kg body weight GLA-LA, but not LA or GLA alone, caused a mild reduction in fasting blood glucose concentration as compared with vehicle-treated diabetic rats (375 +/- 11 vs. 416 +/- 16 mg/dl, p = 0.03), with no change in fasting plasma insulin levels. A peripheral insulin-sensitizing effect could be observed with GLA-LA, LA, and GLA treatments, as demonstrated by a significant (p < 0.04) 23%, 13%, and 10% reduction, respectively, in the area under the glucose curve following an intravenous insulin tolerance test. This effect was associated with a 67% and 50% increase in GLUT4 protein content in the membranes of gastrocnemius muscle of GLA-LA and LA-treated animals, respectively; however, no change was observed with GLA treatment alone. Interestingly, both GLA-LA and LA treatments corrected a diabetes-related decrease in the gastrocnemius muscle low-molecular-weight reduced thiols content. These data demonstrate insulin-sensitizing properties of the GLA-LA conjugate by distinct mechanisms attributable to each of its components, which are associated with antioxidant effects.