[Role of Mitochondria in Intestinal Epithelial Barrier Dysfunction in Inflammatory Bowel Disease].

Inflammatory bowel disease (IBD) is widespread in industrial countries with every 20th citizen being affected. Dysregulation of the epithelial barrier function is considered to play a key role in IBD. Permeability of the intestinal epithelium depends mostly on its self-renewal potential and the condition of intercellular junctions. Mitochondria are involved in regulating various intracellular processes in addition to their energy function. Recent data implicate mitochondria in intestinal epithelial barrier regulation and IBD. Mitochondrial dysfunction is possibly one of the factors that underlie the structural abnormalities of tight junctions and the cytoskeleton in intestinal epithelial cells and decrease the self-renewal capacity of the epithelium. The barrier function of the intestinal epithelium is consequently distorted, and IBD develops. The mechanisms of these processes are still unclear and require further research.

[Prospects for development of laparoscopic surgery in the Central Federal District of the Russian Federation]. / O perspektive razvitiya laparoskopicheskoi khirurgii v Tsentral'nom federal'nom okruge Rossiiskoi Federatsii.

OBJECTIVE: To analyze the achievements of laparoscopic surgery in the Central Federal District of Russia and outline perspective trends for further application. MATERIAL AND METHODS: The study included adult patients with abdominal surgical diseases hospitalized in general surgical departments of the Central Federal District between 2014 and 2021. We analyzed the prevalence of elective and emergency laparoscopic surgeries. Incidence and results of laparoscopic interventions between 2018 and 2021 were estimated considering primary statistical data presented in the annual collections of the Chief Surgeon of the Ministry of Health of Russia «Surgical care in the Russian Federation¼. RESULTS: The absolute number of laparoscopic surgeries in the Central Federal District increased from 23.686 to 80.489 (by 3.4 times) between 2014 and 2021. The annual number of elective laparoscopic surgeries exceeded the number of emergency ones up to 2019. In 2020-2021, this situation changed in favor of emergency abdominal procedures. Laparoscopic surgeries are the most common for in acute cholecystitis (71.06-81.10% of all laparoscopic interventions annually) and acute appendicitis (46.85-55.60%). In 2020 and 2021, the absolute number of laparoscopic appendectomies exceeded the number of laparoscopic cholecystectomies. These values are lower for perforated ulcers (15.44-20.39%) and acute pancreatitis (32.40-36.71%). Laparoscopic operations are rare for acute intestinal obstruction, strangulated hernia and ulcerative gastroduodenal bleeding. In elective surgery, high availability of laparoscopic surgeries was noted in patients with cholelithiasis (89.40-93.78%), hiatal hernia (62.12-77.27%) and adrenal gland diseases (64.23-87.25%). The most intensive increment of availability (by 2.4 times) was noted for inguinal hernia from minimum level (10.98%) in 2018 to 26.00% in 2021. Mortality after some laparoscopic operations decreased in comparison with laparotomy by 12-45 times (2018-2021). However, this aspect and results of laparoscopic surgeries in case of delayed hospitalization require additional study. CONCLUSION: Analysis of laparoscopic surgery showed the timeliness of beginning and development of this direction In Russia. The prospect of further development of laparoscopic surgery for abdominal diseases is determined by modern trends. These are increase in the number of laparoscopic operations for acute appendicitis, acute cholecystitis and perforated ulcers, as well as higher number of early (after admission) operations.

[Enteral nutrition in the treatment of acute pancreatitis]. / Enteral'noe pitanie v lechenii ostrogo pankreatita.

The review presents literature data on enteral nutrition in the treatment of acute pancreatitis. The authors provide pathophysiological substantiations of the need for nutritional support in patients with various forms of acute pancreatitis and basic principles of enteral nutrition in this disease. The results of numerous studies evaluating the outcomes of enteral nutrition are presented. These data indicate advisability of early enteral nutrition in acute pancreatitis because this approach reduces systemic inflammatory response, risk of bacterial translocation and purulent-septic complications, improves treatment outcomes.

[History of congresses of surgeons in Russia (1900-2022)]. / Istoriya s"ezdov khirurgov Rossii (1900­2022).

The authors describe a history of surgical congresses in the Russian Empire, the USSR and the Russian Federation from the I Congress of Russian Surgeons held on December 28-30, 1900 in Moscow in the building of the Moscow Meeting of Doctors to the XLVIII (XIV) Congress of Surgeons of Russia held on November 25-27, 2022 in Moscow in the hotel «Cosmos¼. The time and place of congresses, as well as chairmen are named. The main issues are listed. Scientific issues of congresses between 1900 and 1986 are summarized in tables. The authors present a brief history of Russian surgical societies including the current Russian Society of Surgeons. Surgical forums of the 21st century are considered in detail (Congresses of Surgeons of Russia, National Surgical Congresses, All-Russian Surgical Forums). Finally, the authors came to conclusion that 55 surgical forums have been held in Russia for more than 120 years. Surgeons presented all aspects of surgery in Russia. Their issues are essentially the history of Russian surgery, and their works are sources for analysis of the past and present of Russian surgery.

Insight into the Temperature-Dependent Canting of 4f Magnetic Moments from 4f Photoemission.

The orientation of the 4f moments offers an additional degree of freedom for engineering the spin-related properties in spintronic nanostructures of lanthanides. Yet, precise monitoring of the direction of magnetic moments remains a challenge. Here, on the example of the antiferromagnets HoRh2Si2 and DyRh2Si2, we investigate the temperature-dependent canting of the 4f moments near the surface. We demonstrate that this canting can be understood in the framework of crystal electric field theory and the exchange magnetic interaction. Using photoelectron spectroscopy, we disclose subtle but certain temperature-dependent changes in the line shape of the 4f multiplet. These changes are directly linked to the canting of the 4f moments, which is different for the individual lanthanide layers near the surface. Our results illustrate the opportunity to monitor the orientation of the 4f-moments with high precision, which is essential for development of novel lanthanide-based nanostructures, interfaces, supramolecular complexes, and single-molecule magnets for various applications.

[Laparoscopic versus laparoscopy-assisted suturing of perforated peptic ulcers (meta-analysis)]. / Laparoskopicheskoe i laparoskopicheski assistirovannoe ushivanie probodnoi yazvy (metaanaliz).

OBJECTIVE: To compare laparoscopic and laparoscopy-assisted repair of perforated peptic ulcer using evidence-based methods. MATERIAL AND METHODS: A systematic review and meta-analysis were carried out in accordance with the recommendations of the Ministry of Health of Russian Federation and Cochrane Handbook for Systematic Reviews.Data searching was carried out in Russian and English languages using the E-library, Cochrane Library and PubMed databases. We analyzed titles and references in specialized journals and thematic reviews, respectively. Clarifying information was obtained via personal contacts with the heads of surgical hospitals. The RevMan 5.4 software was used for statistical analysis. RESULTS: We found no randomized trials devoted to comparison of laparoscopic and laparoscopy-assisted surgeries in patients with perforated peptic ulcer. Meta-analysis was based on non-randomized trials with satisfactory methodological quality according to the I-ROBINS formalized assessment. Overall clinical material included 478 observations: 229 (47.9%) laparoscopic surgeries and 249 (52.1%) laparoscopy-assisted procedures via minimally invasive access. There were no conversions. Incidence of postoperative complications was 4.36 and 8.83% (OR=0.39, 95% CI 0.08, 1.87), postoperative mortality 0.87 and 0.81%, respectively (OR=1.26, 95% CI 0.08, 8.24). Laparoscopic surgeries were shorter (MD= -8 min, 95% CI -9.7, -6.4). Length of hospital-stay was also shorter after laparoscopic surgery (MD= -4.6, 95% CI -9.7, -6.4). CONCLUSION: Laparoscopic operations are shorter and accompanied by lower incidence of postoperative complications and less hospital-stay. Large statistical power is required to confirm these differences.

[Disconnected pancreatic duct syndrome in acute pancreatitis]. / Sindrom raz"edinennogo glavnogo protoka podzheludochnoi zhelezy pri ostrom pankreatite.

The review is devoted to diagnosis and treatment of disconnected pancreatic duct syndrome (DPDS) in patients with acute pancreatitis. Data on terminology, indications and options for endoscopic transluminal interventions are presented in detail. The results of numerous studies evaluating clinical efficacy of various endoscopic and open surgical procedures are analyzed. Available data confirm advisability of staged treatment of DPDS with primary endoscopic drainage of pancreatic fluid accumulations in specialized centers.

[Surgical approach for small bowel obstruction in the Russian Federation. National survey of surgeons]. / Khirurgicheskaya praktika pri tonkokishechnoi neprokhodimosti v Rossiiskoi Federatsii. Rezul'taty natsional'nogo oprosa khirurgov.

OBJECTIVE: To study surgical approach for small bowel obstruction (SBO) regarding national and international guidelines. MATERIAL AND METHODS: Considering literature data, national and international guidelines and clinical practice, we have formulated 15 questions regarding surgical approach for non-neoplastic SBO. Questions were sent by e-mail to the members of the Russian Society of Surgeons. Survey lasted 60 days. We used the program that provides the respondent with the possibility of visual control of survey results. Survey results were compared with national and international clinical guidelines, Russian- and English-language scientific publications. Restriction of the number of votes >1 and identification of respondents were not provided by the program. There was no reward for survey. A summary is provided on the main issues. RESULTS: There were 557 respondents (3.0% of surgeons in the Russian Federation). We obtained 481-620 answers for each question. CONCLUSION: This study is a valuable tool for primary assessment of current surgical practice for SBO in the Russian Federation. Study design did not imply conclusions on the optimal strategy based on opinions of majority of respondents. According to our survey, a significant number of respondents use the treatment strategy that differ from clinical guidelines. Their approach is based on their own clinical experience and local guidelines for the treatment of SBO. Less than half of the answers matched to national clinical guidelines, less than 10% - to the WSES guidelines. Despite the formal coincidence of some statements in national clinical guidelines and English-language recommendations, significant nonconformities require scientific discussion.

[Endoscopic transluminal interventions in the treatment of acute necrotizing pancreatitis]. / Endoskopicheskie translyuminal'nye vmeshatel'stva v lechenii ostrogo nekrotiziruyushchego pankreatita.

The review is devoted to endoscopic transluminal interventions in the treatment of acute necrotizing pancreatitis. Terminology, indications and options for transluminal drainage procedures and endoscopic sequestrectomy are presented in detail. The authors analyzed the results of numerous studies devoted to effectiveness of endoscopic interventions and possible combination of treatment options. Modern international clinical guidelines indicating the feasibility of endoscopic treatment of acute necrotizing pancreatitis in multi-field specialized centers are considered.

Insight into the Temperature Evolution of Electronic Structure and Mechanism of Exchange Interaction in EuS.

Discovered in 1962, the divalent ferromagnetic semiconductor EuS (TC = 16.5 K, Eg = 1.65 eV) has remained constantly relevant to the engineering of novel magnetically active interfaces, heterostructures, and multilayer sequences and to combination with topological materials. Because detailed information on the electronic structure of EuS and, in particular, its evolution across TC is not well-represented in the literature but is essential for the development of new functional systems, the present work aims at filling this gap. Our angle-resolved photoemission measurements complemented with first-principles calculations demonstrate how the electronic structure of EuS evolves across a paramagnetic-ferromagnetic transition. Our results emphasize the importance of the strong Eu 4f-S 3p mixing for exchange-magnetic splittings of the sulfur-derived bands as well as coupling between f and d orbitals of neighboring Eu atoms to derive the value of TC accurately. The 4f-3p mixing facilitates the coupling between 4f and 5d orbitals of neighboring Eu atoms, which mainly governs the exchange interaction in EuS.

[Koblenz algorithm for open abdomen management]. / «Koblentsskii algoritm¼ lecheniya bol'nykh s laparostomoi.

The issue of laparostomy treatment is still controversial, since there are insufficient evidence-based data. German military surgeons have developed and implemented the «Koblenz algorithm¼ of laparostomy treatment into everyday practice. The algorithm was developed at the Bundeswehr Central Hospital in Koblenz (Germany). Today, approximately 50% of German civilian hospitals use the «Koblenz algorithm¼. The database for laparostomy treatment was created on the basis of international platform European Registry of Abdominal wall Hernias (EuraHS) in May 2015. These data will be valuable for further multipla-center studies. This manuscript is devoted to analysis of clinical effectiveness of the «Koblenz algorithm¼ in the treatment of patients with laparostomy. Searching of Russian, English and German studies devoted to «Koblenz algorithm¼ in the treatment of patients with laparostomy was carried out in the eLIBRARY, Elektronische Zeitschriftenbibliothek, the Cochrane Library and the PubMed databases. The authors comprehensively described «Koblenz algorithm¼. Mortality in the group of VAC - therapy was 57% (31/54), in case of «Koblenz algorithm¼ - 33% (33/100). Between-group differences were significant (OR 0.36, 95% CI 0.18-0.72, p=0.003). However, an efficacy of «Koblenz algorithm¼ should be confirmed in further multiple-center studies including national evidence-based trials.

[Open and laparoscopic surgery via minimally invasive approach in the treatment of perforated ulcer: a systematic review and metaanalysis]. / Laparotomnye i laparoskopicheski assistirovannye operatsii iz minidostupa v lechenii probodnoi yazvy. Sistematicheskii obzor i metaanaliz.

OBJECTIVE: Systematic review and metaanalysis of the effectiveness of open and minimally invasive laparoscopic suturing of perforated peptic ulcer. MATERIAL AND METHODS: Searching for Russian and English language reports included Scientific Electronic Library, Cochrane Collaboration Library and PubMed databases. We have analyzed contents of specialized journals, reviews and their references. Unpublished data were obtained via communication with chiefs of national surgical hospitals. RevMan 5.3 software was used for metaanalysis. RESULTS: We found no international randomized trials in available literature. Metaanalysis was based on national non-randomized studies. Total sample was 1177 cases. Laparoscopic minimally invasive surgery was performed in 43% of cases (n=503), open suturing - in 57% (n=674) of patients. Choice of these procedures is not currently not standardized. Minimally invasive procedures are shorter in time (mean difference -8.02, 95% CI -11.26 - -4.77, p<0.00001) and ensure less hospital-stay (mean difference -1.93, 95% CI -2.97 - -0.88, p=0.0003). Complications were less common (OR 0.14, 95% CI 0.07-0.27, p<0.00001) after minimally invasive operations (2.4%, 12/503) compared to laparotomy (11.4%, 77/674). Incidence of suture failure was similar (OR 0.4, 95% CI 0.1-1.6, p=0.2) (0.4% (2/503) vs. 0.7% (5/674)). Postoperative mortality was higher (OR 0.14, 95% CI 0.05-0.37, p<0.0001) after laparotomy (8%, 54/674) compared to laparoscopy (0.8%, 4/503). CONCLUSION: A metaanalysis indicates the advantage of laparoscopy-assisted suturing of perforated ulcer via minimally invasive approach over laparotomy. The absence of a standardized approach in choosing of minimally invasive laparotomy and conventional approach is a limitation of these results.

Combustion of sewage sludge in a fluidized bed of catalyst: ASPEN PLUS model.

This paper presents the results of the simulation of a sewage sludge combustion plant with a productivity of 6 tons per hour using the ASPEN Plus. It is shown that catalytic combustion technology can be used for the efficient utilization of mechanically dehydrated sludge with the moisture of ~75% in autothermal mode (without the use of additional fuel). At the same time, the plant for utilization of 6.0 tons of sludge per hour enables us to obtain 3.07 MW of heat energy. It is shown that the sludge moisture and its calorific value significantly affect the combustion process. Thus, at the moisture of less than 72%, additional water supply is necessary to avoid overheating of the catalyst bed. In the case of an increase in sludge moisture of more than 76%, an additional supply of fuel (for example, brown coal) is required. Also, the article discusses the emissions of harmful substances generated during sewage sludge combustion and methods for their utilization.

[Distal subtotal gastrectomy and gastreectomy in surgical treatment of patients with gastric cancer: a systematic review and meta-analysis]. / Sravnitel'naya otsenka subtotal'noi distal'noi rezektsii i gastrektomii v khirurgicheskom lechenie bol'nykh rakom zheludka.

OBJECTIVE: To analyze the randomized controlled trials (RCTs) devoted to distal subtotal gastrectomy and gastrectomy with D2 lymphadenectomy in patients with distal gastric cancer. MATERIAL AND METHODS: RCTs were searched in the electronic library, the Cochrane Community database, and PubMed database. A systematic review and meta-analysis were carried out in accordance with the recommendations of the Cochrane Community experts (Higgins et al. 2019). Mathematical calculations of a meta-analysis were made using RevMan 5.3 software package. Statistical criteria were calculated for relative risk (RR), hazard ratio (HR), 95% confidence interval (95% CI) and significance level (p). RESULTS: Seven primary RCTs were selected. A total number of 1463 surgical interventions with D2 lymphadenectomy were observed (805 patients underwent distal subtotal gastrectomy, 658 - gastrectomy). Postoperative mortality is significantly higher (6.5% and 2.6%) after gastrectomy compared to subtotal distal gastrectomy (RR 2.2, 95% CI 1.34-3.64, I2 0%, fixed effect model). Postoperative complications are also significantly more common (28% and 14%) after gastrectomy (RR 1.72, 95% CI 1.16-2.55, I2 heterogeneity 49%, random effect model). Differences in overall five-year survival after gastrectomy and subtotal distal resection (51.6% and 60.8%) are insignificant (HR 0.74, 95% CI 0.45-1.22, I2 90%, random effect model, general reverse inversion). CONCLUSION: The choice of distal subtotal gastrectomy and gastrectomy with D2 lymphadenectomy in patients with distal gastric cancer is not regulated by evidence-based medicine. The boundaries of minimal surgical clearance from the tumor edge vary from 2.5 cm to 6 cm. An updated meta-analysis shows that postoperative mortality and morbidity are significantly higher after gastrectomy compared to distal subtotal gastrectomy while overall 5-year survival is similar.

[Surgical care during the new coronavirus (Covid-19) pandemic]. / Khirurgicheskie operatsii v usloviyakh pandemii novoi koronavirusnoi infektsii (Covid-19).

Safe and reasonable surgical care in the context of COVID-19 pandemic is difficult task. The main current issues are selection of patients for surgical treatment, principles of surgical treatment in cancer patients, possibilities of endoscopic surgery, organization of surgical department and operating theatre, surgical strategy in infected patients. Own experience and rational implementation of the recommendations developed by international research and practical communities are extremely important for optimizing surgical treatment of patients in a pandemic, as well as for ensuring the safety of patients and medical staff.

[Diagnostic and treatment approaches for acute appendicitis in the Russian Federation. Results of the all-Russian survey]. / Diagnosticheskie i lechebnye podkhody pri ostrom appenditsite v praktike khirurgov Rossiiskoi Federatsii. Rezul'taty obshcherossiiskogo oprosa.

OBJECTIVE: To improve treatment outcomes in patients with acute appendicitis (AA). MATERIAL AND METHODS: An internet survey was performed. Questionnaire consisted of 15 questions concerning diagnosis and treatment of AA: application of prognostic scales, incidence and technical aspects of laparoscopic appendectomy (LA), antibiotic prophylaxis, postoperative management, compliance with international and national clinical guidelines. A total of 690 questionnaires were received and analyzed (3.67% of all surgeons in the Russian Federation). RESULTS: Eighteen percent of respondents use at least one prognostic scale. The vast majority of surgeons (92%) use antibiotic prophylaxis. Almost half of respondents place trocars in the triangulation position (44%), one third of surgeons ligate the mesentery of the appendix (35%), most respondents perform mesoappendectomy (60%) with monopolar and bipolar cautery. Forty-five percent of all respondents do not invert the appendix stump. Significant number of respondents use abdominal drainage routinely. Only 3.5% of surgeons use multimodal postoperative analgesia. Less than 22% of patients are operated under low-pressure pneumoperitoneum. Standardization of surgical technique and perioperative approaches including those specified in the guidelines is absent. We also found insufficient awareness of surgeons about international and national clinical guidelines. CONCLUSION: This study may be useful for standardizing treatment approaches, choosing the best practice, popularizing and improving of current clinical guidelines.

[Mononeuropathy of dorsal interosseous nerve: compression by return radial arteries]. / Mononeiropatiia zadnego mezhkostnogo nerva: kompressiia vozvratnymi luchevymi arteriiami.

Among many causes of compression neuropathies involving the radial nerve, compression of the posterior interosseous nerve (PIN) by the returning radial arteries is rare. OBJECTIVE: To describe the clinical instrumental characteristics of cases of mononeuropathy caused by compression of the return radial arteries. MATERIAL AND METHODS: Two observations with neuropathy of the deep branch of the radial nerve, manifested by weakness in the corresponding muscles, inconsistent pain syndrome with previous stereotypic (recurring) physical activity are presented. RESULTS: According to the results of ultrasound examination of posterior interosseous nerve, a local hypoechogenic increase in the cross-sectional area of nerve of different lengths was revealed. During surgical decompression of the nerve, in the first case, a tight arterial loop was found around the nerve, in the second case, expanded arterial trunks, one of which, of small diameter, covered the nerve in the 'loop', and the other, larger, pierced the nerve. After the operation, regression of motor deficiency and relief of pain were noted.

[General methodology of meta-analysis and data interpretation in surgery]. / Obshchaia metodologiia provedeniia i interpretatsii rezul'tatov meta-analiza v khirurgii.

Meta-analysis is a leading methodology used in systematic secondary researches. Review Manager software is the main tool used by leading world expert groups for meta-analysis. The authors analyzed the features of meta-analyzes evaluating the results of surgeries. It is shown that the majority of baseline clinical parameters correspond to normal distribution (in accordance with central limit theorem) considering the fact that surgical outcomes depend on various and often unpredictable factors. Moreover, multiple heterogeneous variables are compared in the meta-analysis due to the differences in diagnostic scales and methods of evaluating the results in primary researches. Therefore, both absolute and standardized measurements are required for these purposes. The authors describe the features of meta-analysis for dichotomous, continuous and skewed data, as well as for ordinal outcomes, time-to-event, counts and ratios. These data are useful to interpret numerical values, objectively evaluate the majority of surgical outcomes and predict the effectiveness of interventions.

[Large outpatient surgery. Are there prospects?] / Bol'shaia ambulatornaia khirurgiia. Est' li perspektivy?

AIM: To study frequency of 'hospital registry' operations in the polyclinics of the Central Federal district, to analyze previous experience of outpatient surgical care and to assess perspective directions of its development. MATERIAL AND METHODS: Over 48 million people who referred to polyclinics for medical care in 17 regions of Central Federal district for 6 years (2011-2016) were studied. RESULTS: Mean surgical activity in the polyclinics of Central Federal district is 4.5%. The annual number of 'hospital registry' operations does not exceed 150-200 (0.01%) for the entire district. Large outpatient surgery in Russia has evolved from active development to complete apathy and was almost always associated with health care reforming and attempts to reduce the volume of 24-hour in-patient surgical care. CONCLUSION: Advanced outpatient surgery is able to compensate routine in-hospital operations and to focus resources of these hospitals on the development of high-tech surgical care. It is necessary to change the insurance share of financing of patients operated in day surgical hospitals for successful development of 'large outpatient surgery'.

[Surgical treatment of ulcerative pyloroduodenal stenosis]. / Khirurgicheskoe lechenie iazvennogo piloroduodenal'nogo stenoza.

AIM: To obtain the most reliable information about surgical treatment of ulcerative pyloroduodenal stenosis based on the methodology of evidence-based medicine. MATERIAL AND METHODS: Searching platforms were elibrary, Cochrane Library and PubMed database. The probability of major systematic errors in randomized controlled trials (RCTs) was evaluated. RESULTS: Systematic review included 20 RCTs for the period 1968-2009 with overall sample of 1794 patients. Evaluation of external validity allows to generalize the results of these studies to the entire population of patients with ulcerative pyloroduodenal stenosis. Assessment of internal validity based on the number of systematic errors showed that 7 (35%) of 20 of RCTs corresponded to the highest level of evidence (level 1), 13 (65%) of 20 had systematic errors and were downgraded in the rating (level 1-). Significant heterogeneity of RCTs impedes metaanalysis. Conclusions and practical recommendations for the treatment of ulcerative pyloroduodenal stenosis are formed according to the results of individual RCTs. CONCLUSION: Selective vagotomy may be performed for functional stenosis. In case of organic stenosis, truncal vagotomy should be combined with drainage surgery (pyloroplasty, gastroenterostomy) or Roux/Billroth-1 antrectomy. Treatment of decompensated stenosis within evidence-based medicine is unclear. We have not identified target researches with evidence level 1 for this form of stenosis.