How to dissect the pelvic nerves: from microanatomy to surgical rules. An evidence-based clinical review.

Background: Advanced gynaecological procedures often include extensive pelvic dissections, with the nervous structures involved in the disease. Nerve-sparing and preservation is a key factor in reducing postoperative morbidity. Objectives: The goal of this review is to describe in detail the structure of the pelvic nerves and to gather information from other surgical specialties to give recommendations for safe nerve dissection applied in different gynaecological subspecialties. Materials and Methods: An extensive literature review was carried out in PubMed and Google Scholar. The search included articles concerning peripheral nerve anatomy, mechanisms of injury and different dissection techniques, with the most exhaustive being analysed for the review. Articles from different fields of medicine like orthopaedics, plastic surgery, maxillofacial surgery dealing with peripheral nerve injuries and repair have been reviewed. Results: The following review demonstrates the in-depth anatomy and mechanism of injury of the peripheral nerves, describes the different techniques for neurolysis and proposes some directions for safe nerve dissection. Conclusion: When performing complex gynaecological surgeries, the surgeon should avoid unnecessary nerve handling, apply nerve-sparing techniques whenever possible and use the new devices to preserve the nervous structures. Advanced gynaecological surgeries should be performed in specialised centres by expert surgeons with comprehensive knowledge in neuropelveology. What is new?: To our knowledge, this is the first article focused on peripheral nerves that collects data from such a wide range of specialties in order to propose the most comprehensive recommendations that could be applied in pelvic surgery.

The Effect of TLR4 Blockade on Some Indicators of Systemic Inflammatory Response to Proteus mirabilis LPS in Rats.

The effects of TLR4 blocker on blood cell morphology, concentrations proinflammatory cytokines, and functional state of the liver and kidneys were studied in outbred male rats (n=60) after intravenous injection of 20 mg/kg LPS isolated from opportunistic Proteus mirabilis strain ATCC 51393. TLR4 blocker TLR4-IN-C34 was injected intravenously in a dose of 1 mg/kg/day over 3 days. Systemic inflammatory reaction induced by LPS was characterized by elevation of serum TNFα, IL-1ß, IL-6, erythrocyte sedimentation rate, leukocytosis, and thrombocytosis. Increased activity of hepatocyte enzymes (ALT, alkaline phosphatase, and lactate dehydrogenase), retention of nitrogen metabolites (urea and creatinine), elevated content of protein oxidation products, and enhanced protein catabolism were also observed. Administration of TLR4 blocker reduced parameters of inflammatory reaction and prevented the development of hypercatabolic syndrome; endotoxicosis and kidney function indicators approached the normal levels.

Usefulness of animal models of aspergillosis in studying immunity against Aspergillus infections.

Aspergillosis represents a spectrum of fungal diseases which are caused by fungi of the genus Aspergillus. Animal models have been developed and used to address immune-based mechanisms of defense against these fungi. Invertebrate models enabled mass screening of virulence attributes of Aspergillus species as well as mechanisms of acquired resistance to antifungal agents. This review represents a concise view of cellular and humoral participants in an immune response to Aspergillus gained mostly from rodent models of aspergillosis. The survey of immune defense mechanisms was given, including the role of innate immune cells (macrophages, neutrophils, monocytes, eosinophils, innate-like lymphocytes) and receptors in antifungal response, the significance of dendritic cells in activation of specific adaptive T cell-mediated immune responses and the regulatory mechanisms of excessive response. Insight into innate immune defense mechanisms gained using non-vertebrate models of infections with Aspergillus sp. was given as well. The contribution of animal models to the current knowledge of immune mechanisms of resistance or susceptibility to these fungi was stressed and the significance of data gained from these models in forming the basis for the design of therapeutic strategies in prevention and/or treatment of aspergillosis was pointed out.

[Additive technologies in neurosurgery]. / Additivnye tekhnologii v neirokhirurgii.

Modern achievements of technical progress, in particular additive technologies (ATs) and three-dimensional printing, have been increasingly introduced in neurosurgical practice. The increasing complexity of surgical interventions requires thorough planning of surgery and a high level of training of young neurosurgeons. Creation of full-scale three-dimensional models for planning of surgery enables visualization of the anatomical region of interest. Additive technologies are especially extensively used in reconstructive surgery of skull defects. ATs enable fast and efficient solving of the following tasks: - generation of accurate models of the skull and an implant; - development and fabrication of individual molds for intraoperative formation of implants from polymeric two-component materials (e.g., PMMA); - fabrication of individual implants from titanium alloys or polyetheretherketone (PEEK) for further use in surgery.

Efficacy of Arbidol in the prevention of virus-induced exacerbations of bronchial asthma and chronic obstructive pulmonary disease.

AIM: To assess the efficacy and safety of Arbidol in the influenza and ARVI preventing in patients with asthma and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: This study was an open label and prospective during epidemic period of 2016-2017 years. 100 outpatients aged 18 to 80 years with verified asthma and/or COPD, were enrolled to therapy group, and received oral umifenovir 200 mg once daily for 14 days and then 200 mg twice a week for 3 weeks.The medical records data for the same epidemic period of 2016-2017 seasons of the same patients during witch they received no prophylaxis was taken as a control. The data analysis was made by applying parametric and nonparametric statistical methods. RESULTS: Seasonal and post-exposure prophylaxis using umifenovir was associated with 2.6-times reduction in influenza and ARVI morbidity compared to control. In diseased patients (ARVI) of the therapy group the number of patients with mild illness prevailed (62.2%) and was significantly differed from control (37.1%). Severity of catarrhal symptoms and intoxication, was reduced with umifenovir prophylaxis course and were mild in 67.6% and 67.6% respectively of therapy group compared with 43.3% and 46.4% of control. Influenza and ARVI complications were only detected in control group (4 cases). The percentage of patients with incidents of underlying disease exacerbation was 42% in therapy group and 93% in control group. Also, exacerbation in the therapy group were mild in 59.5% and 34.4% in control group, while moderate exacerbation prevailed in control group and was in 59.1% of cases with was significantly higher then in therapy group (39.3%). Results in more frequent use of adjuvant in the control group compared with the therapy group (81.7% and 59.5% respectively). Patients of control group had a higher risk of hospitalizations due to underlying disease aggravation (11.8%), compared with therapy group (9.5%) but these differences were not significant. CONCLUSION: Seasonal and post-exposure prophylaxis with Arbidol reduce influenza and ARVI morbidity in patients with asthma and COPD during epidemic period, frequency and severity of chronic obstructive pulmonary disease aggravations resulting in decrease in the number of hospitalizations. Also, prophylaxis with Arbidol reduced the severity of catarrhal symptoms and intoxication.

[Thrombectomy and plication of veins as a method of preventing pulmonary artery thromboembolism at a multidisciplinary surgical hospital].

The authors assessed efficacy and safety of the operation of plication of deep veins of lower extremities, pelvic veins, and the inferior vena cava as a method of preventing fatal pulmonary artery thromboembolism. A total of 48 patients were operated on. Of these, 23 patients belonged to traumatological-and-orthopaedical cohort, 3 to general surgical cohort, 4 to gynaecological, and 18 to vascular cohort (isolated deep vein thrombosis). The length of the floating head of the thrombus varied from 2 to 10 cm. The presence of a floating thrombus in traumatological, surgical and gynaecological patients, regardless of the length of the floating part was an absolute indication for thrombectomy and venous plication. Vascular patients were operated on in accordance with the National Guidelines (with the length of the thrombus floating portion of not less than 4 cm). In all cases, surgical management envisaged direct and indirect thrombectomy. Plication was always performed above the level of venotomy. It was shown that thrombectomy combined with plication of major veins is a reliable and safe method of prophylaxis, being in some cases the only possible method of preventing fatal pulmonary artery thromboembolism. The operation of plication makes it possible not to cancel a scheduled surgical intervention in patients with a detected floating thrombus of major veins. The operation of thrombectomy and plication above the level of the floating head of the thrombus may be considered an operation of choice in the conditions where there is no possibility to use endovascular methods of treatment (implantation of a cava filter, endovascular catheter thrombectomy), as well as in pregnant women. Restoration of the venous lumen occurs at safe terms spontaneously, not requiring repeat surgical intervention. Simultaneous plication of the vein does not complicate the course of the postoperative period of the main surgical intervention. Thrombectomy and plication do not lead to the development of severe chronic venous insufficiency.

[Postoperative wound complications in cardiosurgery].

Presented in the article are the results of examination and treatment of 65 patients with infectious wound complications of the sternotomic injury after open heart surgery. The main risk factors for their development in our patients were as follows: obesity, chronic obstructive pulmonary disease, diabetes mellitus, severe heart failure, prolonged operation, sternal instability. The leading pathogenic microorganisms were Gram positive staphylococci. Treatment varied from prolonged antibiotic therapy with surgical debridement of the wound to subtotal resection of the sternum with various plastic reconstructive interventions. The scope of treatment was determined by the type and severity of infectious wound complications. Due to lack of standardized approaches in diagnosis, treatment and prevention this problem remains to be of current importance.

Differential effects of cadmium administration on peripheral blood granulocytes in rats.

Infiltration of circulatory inflammatory cells is a common histopathological finding in target organs following cadmium administration, but there is paucity of data concerning their activity. In this study, the effects of sublethal (1 mg/kg) cadmium on peripheral blood polymorphonuclear (PMN) cells were examined 48 h following administration in rats, when tissue (liver and lung) infiltration of these cells was observed. Cadmium administration resulted in systemic inflammatory cytokine and acute phase response with an increase in circulatory neutrophil numbers and cells that express CD11b molecules. Rise in basic aspects of oxidative activity including intracellular myeloperoxidase (MPO), reactive oxygen (nitroblue tetrazolium/NBT cytochemical assay) and nitrogen (Griess assay) species production was observed in PMNs from cadmium-administered rats. A decrease in levels of mRNA for IL-1ß, TNF-α and IL-6 was noted, but production of these cytokines was affected differentially. Described effects of cadmium on PMNs add further to the understanding of inflammatory potential of this environmental contaminant.

[Are we ready for the growing threat of virus dependent cervical cancer and the initiation of screening in conditions of insurance medicine?].

The dynamics is presented of the rates of virus dependent diseases, in particular cervical cancer (CC), which are directly connected with the level of organization of screening and subsequent treatment of cancer. It is shown that in conditions of insurance medicine a reduction of examination rooms and female enrollment in cytology screening is observed. As a result, over the past 5 years, CC incidence in the Novgorod region increased 1.2 times, and in Russia as a whole, the proportion of such cases in female population under 29 years since 2000 increased 4.5 times (from 2.0% to 9%). The urgent task of cancer control is to restore examination rooms, to overcome disagreements between government institutions and medical departments, to increase coverage of women by cytology screening by means of formation of the program of individual accounting of women.

[Principles of treatment of early stage glaucoma: surgery vs. therapy (review of literature)].

Swift development of ophthalmopharmacology in last years has led to loss of starting positions surgery in glaucoma treatment, especially in early stage. Medical therapy is considered safer and not less effective in spite of problems of compliance, intolerance to hypotensive drugs in some patients with ocular surface diseases and less significant reduction of baseline intraocular pressure. There are many glaucoma guidelines refer to this data which led to significant decrease of proportions of surgery. Whether such an approach is applicable in all cases?

[The diagnostics and treatment of the postoperative mediastinitis].

Treatment results of 48 patients with mediastinitis after the open cardiac surgery were analyzed. The main mediastinitis risk factors were: the chronic obstructive lung desease, diabetes mekkitus, severe cardiac insufficiency, prolonged operation, the use of artificial blood circulation and sterna instsbility. Major infective agents of mediastinitis were the Gram-positive cocci. The treatment options varied from the prolonged antibiotic therapy to plastic reconstructive surgery, which were determined by the severity of mediastinitis.

[Surgical treatment of posttraumatic deformity of the orbital floor].

The article is devoted to an actual problem of surgical treatment of patients with posttraumatic deformities of the orbital floor. On the material of 21 observations it was shown that for the successful treatment of deformities of the orbit bottom autogenous costal cartilage graft should be used as a plastic material. Removal of enophthalmos in longstanding fractures can be reached only by reducing the volume of the orbit which can be achieved by retrobulbar placement of the graft. An analysis of the results demonstrated high efficiency of this method in the treatment of such patients.

[General surgical procedures in patients with electrical pacemaker].

Work of the implanted electric pacemaker (EP) was assessed in 99 patients, aged 62.4±9.6 years, during non-cardiological surgery. Inhibition of the EP stimuli was registered in 9 (9.1%) patients, short episodes of uneffective stimulation with synchronization disturbation--in 2 (2%) patients and change of stimulation regimen was registered in the same number of patients by electocoagulation. Episodes of myopotential inhibition not assotiated with electrocoagulation was registered in 4 cases. The ascertained rhythm disturbances require a thorough preoperative check-up, intraoperative ECG control and short use of monopolar electrocoagulation.

[Assessment of risk of cardiovascular diseases in persons of young age].

Cardiovascular pathology appears to be big socially meaningful problem as it occupies leading place in structure of mortality and loss of working capacity in economically developed countries. Social value of the problem is enforced by observed in recent years tendency to increase of mortality of cardiovascular diseases (CVD) in young age persons. It has been shown in large prospective studies that traditional CVD risk factors such as sex, lipid spectrum of blood, smoking, arterial hypertension, obesity, and hyperglycemia correlate with pathologoanatomical findings of atherosclerotic plaques in coronary arteries and abdominal aorta of young people aged 15-34 years. Proper and well-defined stratification of risk in young people will allow to approach solution of the problem of morbidity and mortality in older age. This work contains data on results of prospective multicenter epidemiological and clinical studies devoted to investigation of established and novel risk factors in the young, their contribution to development of atherosclerotic process, morbidity and mortality caused by CVD in later age. We also analyze prognostic potential of existing at this moment in the world scales for assessment of cardiovascular risk specifically in this group of population, and present data on prognostic models created specially for assessment of CVD risk in persons of young age.

[Psychosomatic relationships in patients with primary fibromyalgia syndrome].

This clinical and psychological study involved 100 patients aged 24-51 years with primary fibromyalgia syndrome (PFS). The patents exhibited clinical manifestations of neurotic disorders, low level of subjective control, dysadaptive attitude toward the disease, and an intense spectrum of protective psychological mechanisms. The main clinical manifestations of PFS correlated with psychological status of the patients. It is concluded that objective evaluation of clinical conditions of PFS patients requires integrated psychosomatic assessment of their health status.

[Arterial hypertension in extreme situations].

Wartime arterial hypertension (AH) is AH that debuts or changes its character under the influence of specific wartime factors or military labor. The features of wartime AH were determined. They included the following: AH incidence during war grows; AH incidence in the battlefront servicemen is higher than in those who serve on the home front; there is a direct correlation between AH prevalence and how often the person participates in the battles; the patients are relatively young. Acute AH forms usually debuted as a result of extremely strong of lingering stressful factors. Acute AH development was characteristic of subjects having family predisposition to hypertensive reactions. The clinical picture of acute AH had features of a hypertensive crisis, frequent complications of which were acute cardiac insufficiency and/or acute hypertensive encephalopathy, which required urgent medical aid. AH was resistant to pharmacotherapy. Further on, high AH level remained, crises occurred, and lesions of target organs progressed. The features of AH in military operators were characterized by medium, high, and very high risk of complications. II and III degrees of AH prevailed. The main risk factors in patients with workplace arterial hypertension (WAH), in addition to emotional tension, often were smoking, family background, hyperlipidemia, excessive body weight (metabolic syndrome). In 87% of patients with WPAH behavioral type A was revealed, mostly with medium or prominent elevation of the level of personal, reactive, and total anxiety. Persons with prognostically unfavorable 24-hour profiles of BP--non-dippers and night-peakers--prevailed (p < 0.001). Imidazoline receptor agonists (moxonidine) in patients with WAH normalized BP level. Twenty-four-hour BP profiles became normal in 90% of the WAP patients. Positive antihypertensive effects of moxonidine in patients with WAP become clear after 12 weeks of drug application; the psychological status becomes normal too.

[Cardiorenal syndrome in diabetes mellitus: risk factors and developmental mechanisms].

The term "cardiorenal syndrome" means the development of pathology of the cardiovascular system, causally associated with kidney damage. The role of kidney pathology as an independent risk factor in the development and progression of atherosclerosis has been intensively discussed only in the last 10 years, and therefore the term "cardiorenal" or "nephrocardial" syndrome has also appeared only in recent years. It was found that pathology of the kidneys leads to a more rapid progression of atherosclerotic vascular changes, which cannot be explained only by traditional risk factors such as arterial hypertension (AH), dyslipidemia, obesity, smoking, etc.

pH dependence of the efficiency of binding of iron cations to the donor side of photosystem II.

Light-induced interaction of Fe(II) cations with the donor side of Mn-depleted photosystem II (PS II(-Mn)) results in the binding of iron cations and blocking of the high-affinity (HAZ) Mn-binding site. The pH dependence of the blocking was measured using the diphenylcarbazide/2,6-dichlorophenolindophenol test. The curve of the pH dependence is bell-shaped with pK1 = 5.8 and pK2 = 8.0. The pH dependence of the O2-evolution mediated by PS II membranes is also bell-shaped (pK2 = 7.6). The pH dependence of the process of electron donation from exogenous donors in PS II(-Mn) was studied to determine the location of the alkaline pH sensitive site of the electron transport chain. The data of the study showed that the decrease in the iron cation binding efficiency at pH > 7.0 during blocking was determined by the donor side of the PS II(-Mn). Mössbauer spectroscopy revealed that incubation of PS II(-Mn) membranes in a buffer solution containing 57Fe(II) + 57Fe(III) was accompanied by binding only Fe(III) cations. The pH dependence of the nonspecific Fe(III) cation binding is also described by the same bell-shaped curve with pK2 = 8.1. The treatment of the PS II(-Mn) membranes with the histidine modifier diethylpyrocarbonate resulted in an increase in the iron binding strength at alkaline pH. It is suggested that blocking efficiency at alkaline pH is determined by competition between OH- and histidine ligand for Fe(III). Because the high-affinity Mn-binding site contains no histidine residue, this fact can be regarded as evidence that histidine is located at another (other than high-affinity) Fe(III) binding site. In other words, this means that the blockage of the high-affinity Mn-binding site is determined by at least two iron cations. We assume that inactivation of oxygen-evolving complex and inhibition of photoactivation in the alkaline pH region are also determined by competition between OH- and a histidine residue involved in coordination of manganese cation outside the high-affinity site.

[Preoperative care and surgical treatment of small-intestinal fistulas in children]. / Predoperatsionnaia podgotovka i khirurgicheskoe lechenie tonkokishechnykh svishchei u detei.

Experience in using complex treatment in 42 children with unformed small-intestinal fistulas, generalized defects of the anterior abdominal wall and severe disorders of alimentary status is presented. Their preoperative preparation included parenteral alimentation, enteral probe feeding with special elementary milk formulas, correction of metabolic disorders. Intestinoplication during surgery was carried out with the medicinal glue MK-7 to prevent intestinal obstruction and formation of interloop abscesses. The use of portions of the tendinous part of the musculus tensor fasciale late was one the simple and effective methods for plasty of anterior abdominal wall defects.