[AUTOVENOUS REVASCULARIZATION OF THE LOWER EXTREMITY ARTERIES IN PATIENTS WITH VARIANT ANATOMY OF THE PERIPHERAL BLOOD FLOW AND THE PROGRESSIVE ATHEROSCLEROTIC PROCESS].

Obliterating diseases of the lower extremity arteries occupy a high proportion in the structure of cardiovascular morbidity in the population among the developed countries. The steadily progressing course of obliterating atherosclerosis leads to the critical lower limb ischemia and causes an unfavorable prognosis for preserving the extremity, as well as the patient's life. Nowadays, there are two ways of surgical management of this pathology: endovascular and open reconstructive interventions. The choice of the method is based on a comprehensive keeping of the patient-specific records, including the anatomical characterization of the arterial bed lesions. In case of extended occlusion of the superficial femoral artery, the open reconstructive surgery using a large saphenous vein as a transplant is recommended. This circumstance is confirmed by the autovein patency in the long term compared with a synthetic prosthesis according to the results of randomized clinical trials. Therefore, with the formation of a distal anastomosis below the gap of the knee joint, the patency of the autovein and synthetic prosthesis after 5 years is 71% and 44% respectively. In this article, we represent a clinical case of successful treatment of a patient with progression of atherosclerotic lesions of the infrainguinal segment arteries. A staged revascularization of the femoral-popliteal segment arteries using technique of a reversed vein on both lower extremities after attempts of the conservative treatment and x-ray endovascular intervention was performed. A feature of this case is the creation of a new bifurcation of the popliteal artery during the formation of a distal anastomosis below the fissure of the knee joint under the contitions of a high discharge of the anterior tibial artery.The given clinical case demonstrates the advantages of invasive surgical tactics with the aim of preserving the limb and improving the patient's quality of life.

[Endotheliotropic effects of venotonic drugs in treatment of patients with varicose veins]. / Éndoteliotropnye éffekty venotoniziruiushchikh preparatov pri lechenii bol'nykh s varikoznoi bolezn'iu.

The authors analysed the effect of Venarus on the endothelial function in patients suffering from lower limb varicose veins. Our open-label prospective study included a total of 100 patients diagnosed as having CEAP class C1-C2 varicose veins and divided into two equal groups. Dynamic assessment of the clinical course of the disease in Group One patients was carried out on the background of taking Venarus and compression therapy, with Group Two patients evaluated without taking Venarus. At defined stages we determined the level of biochemical markers of endothelial function. The obtained findings demonstrated that the use of phlebotonic Venarus resulted in decreased activity of lipid peroxidation processes and reduced activity of antioxidant system enzymes. Using Venarus was followed by a statistically significant decrease in the concentration of malonic dialdehyde (from 1.220±0.190 µmol/l at baseline to 0.858±0.231 µmol/l after 2 months of treatment), whereas in Group Two patients the changes were insignificant (1.191±0.204 µmol/l before treatment and 1.138±0.175 µmol/l at 2 months thereafter). Patients taking Venarus were also found to have a higher level of nitric oxide metabolites compared with the patients treated by compression therapy alone (51.646±11.757 and 36.310±6.921 µmol/l in Groups One and Two, respectively). Hence, an evidence-based conclusion was drawn that Venarus proved efficient and may therefore be prescribed as pharmacotherapy for correction of endothelial dysfunction.

[Gene-mediated induction of angiogenesis in inoperable patients with atherosclerosis and diabetes mellitus]. / Gennaia induktsiia angiogeneza u neoperabel'nykh patsientov s aterosklerozom i sakharnym diabetom.

Analysed in the article are the results of a comprehensive approach to treatment of patients presenting with lower limb critical ischaemia and diabetes mellitus by means of gene-induced angiogenesis. The study comprised a total of 65 patients found to have an ill-suited for surgical reconstruction peripheral arterial bed and undergoing conservative therapy. The patients were divided into two groups. The Study Group patients additionally to the conventional conservative therapy received 2 intramuscular injections of therapeutic agent Neovasculgen at a course dose of 2.4 mg. The active period of follow up amounted to 6 months followed by evaluating limb salvage and lethal outcomes at a further 6 months thereafter. Efficacy of treatment was determined both by primary criteria (lethality rate, amputations, dynamics of necrosis healing, clinical relief of critical ischaemia) and secondary criteria (pain-free walking distance, ankle-brachial index, transcutaneous oxygen tension, linear velocity of blood flow, the Michigan Neuropathy Screening Instrument (MNSI) and Neurological Symptom Score (NSS) scale). After 6 months of follow up, the statistical significance in the intragroup and intergroup comparisons was reached for the pain-free walking distance (increment up to 72.9±9.2 m, p=0.032), transcutaneous oxygen tension (increment by 34.4%, p=0.028), linear velocity of blood flow (increment by 65.3%, p=0.047). Induction of angiogenesis also made it possible to statistically significantly decrease the manifestations of diabetic neuropathy, as was evidenced by the data of the MSNI (p=0.009) and the NSS scale (p=0.044). The findings of the study also demonstrated the best value of the limb salvage rate (p=0.049) and a lower number of lethal complications at 1 year of follow up.

Hybrid mode-locked erbium-doped all-fiber soliton laser with a distributed polarizer.

A soliton-type erbium-doped all-fiber ring laser hybrid mode-locked with a co-action of arc-discharge single-walled carbon nanotubes (SWCNTs) and nonlinear polarization evolution (NPE) is demonstrated. For the first time, to the best of our knowledge, boron nitride-doped SWCNTs were used as a saturable absorber for passive mode-locking initiation. Moreover, the NPE was introduced through the implementation of the short-segment polarizing fiber. Owing to the NPE action in the laser cavity, significant pulse length shortening as well as pulse stability improvement were observed as compared with a SWCNTs-only mode-locked laser. The shortest achieved pulse width of near transform-limited solitons was 222 fs at the output average power of 9.1 mW and 45.5 MHz repetition frequency, corresponding to the 0.17 nJ pulse energy.

Transform-limited pulse generation in normal cavity dispersion erbium doped single-walled carbon nanotubes mode-locked fiber ring laser.

We demonstrate an erbium doped fiber ring laser mode-locked with a carboxymetylcellulose high-optical quality film with dispersed single-walled carbon nanotubes (SWCNT). The laser with large normal net cavity dispersion generates near bandwidth-limited picosecond inverse modified soliton pulses at 1.56 µm.

Thulium-doped mode-locked all-fiber laser based on NALM and carbon nanotube saturable absorber.

We present a thulium-doped fiber laser mode-locked by a carboxymetylcellulose high-optical quality film with dispersed single-walled carbon nanotubes. Laser system based on the nonlinear amplifying loop mirror generates the shortest pulses earlier obtained in SWCNT mode-locked thulium-doped fiber lasers with a duration of 450 fs and 18 mW maximum average power at 1870 nm.

[Construction of the new Escherichia coli K-12 wild-type strain with improved growth characteristics for application in metabolic engineering].

MG1655 of Escherichia coli K-12 is frequently used in metabolic engineering as the wild-type strain. However, its two mutations, ilvG and rph-1 provide a negative effect on culture growth. The "polar effect" of rph-1 decreases the level of pyrE expression, causing partial auxotrophy for pyrimidines. Mutation ilvG leading to the appearance of Val(S) phenotype causes retardation of cell growth rate on media containing amino acids. In this work, the substitution of two loci in the genome of MG1655 with the recovery of the wild-type phenotype was accomplished. Gene rph(wt) from the chromosome of E. coli TG1 was marked via Red-dependent integration of DNA fragment carrying lambda attL-Cm(R)-lambda attR and transduced with phage P1 into MG1655; later, the Cm(R) marker was removed with the use of lambda Xis/Int recombinase. Parallel to this procedure, a spontaneous Val(R) mutant of E. coli MG1655 yielding colonies of maximal size on M9 medium with glucose in the presence of Val (50 microg/ml) was isolated. It was shown that a nucleotide deletion in the isolated Val(R) strain had been generated in the region of the identified E. coli K-12 ilvG mutation, which led to the recovery of the reading frame and active protein synthesis. This mutation named ilvG-15, which is the only reason for the Val(R) phenotype in the obtained strain, was transferred to MG1655-rph(wt) using cotransduction, by analogy to the transfer of rph(wt). Evaluation of rates of aerobically growing cells (microm, hour(-1)) on M9 medium with glucose produced the following values: 0.56, 0.69, and 0.73 for strains MG1655, MG1655-rph(wt), and MG1655-(rph(wt), ilvG-15), respectively.

[New method of construction of artificial translational-coupled operons in bacterial chromosome].

The new method of translational-coupled operons construction in bacterial chromosome has been developed on the basis of recombineering approach. It includes construction in vitro of the artificial operon with efficiently translated proximal cistron followed by its insertion E. coli chromosome, modification of the operon due to Red-driven insertion of the special "Junction" with excisable selective marker in the intercistronic region of the initial operon and excising the marker. The structure of this Junction has been designed and tested in the present investigation. It consists of: 1) E. coli rplC-rplD intercistronic region for placing the TAA-codon of the proximal operon's gene in the SD-sequence (TAAGGAG) of rplD; 2) Cm(R)-gene flanked by lambdaattL/R-sites in such a fashion that after lambdaInt/Xis-driven excision of the marker the residual lambdaattB-site would not contain the termination codons in frame with ATG of rplD; 3) E. coli trpE-trpD intercistronic region for location of ATG of trpD at the position of initiation codon of the distal gene of original operon. The general design of desired construction provides the conversion of the original two-cistronic operon into three-cistronic operon with translational-coupled genes, where the coupling of the artificial ORF (rplD'-lambdaattB-'trpE) with the proximal gene is occurred due to rplC-rplD intercistronic region and the coupling of this ORF with the distal gene--due to trpE-trpD. The experimental implementation of the described strategy was showed by construction of artificial operon P(tac-aroG4-serA5, where expression optimization of the distal serA5 gene was achieved via construction of three-cistronic operon with translational-coupled genes.

[Prospects and approaches to improving pathologo-anatomic services from the standpoint of the therapist]. / Perspektivy i puti sovershenstvovaniia patologoanatomicheskoi sluzhby s pozitsii terapevta.

The paper defines the morphologic basis of modern clinical medicine as one of the determining factors of its further development. Approaches to improvement of studies of the life-time biopsy specimens are discussed, as well as variants of cooperation between the pathoanatomists and clinical morphologists. The system of pathoanatomical reports, the work of treatment- and- control commissions and conferences on clinical anatomy are considered from the physician's point of view. Optimal measures should be taken to make the analysis of the physician's errors comprehensive and useful. Combined efforts are needed for the further improvement of the nomenclature, classification and terminologic characteristics of the diseases. Closer interactions between the pathoanatomists and therapists are suggested.

[Effect of infection foci and preexisting pathology on immunological shifts and the course of the disease in myocardial infarct patients]. / O vliianii ochagov infektsii i predshestvuiushchei patologii na immunologicheskie sdvigi i techenie zabolevaniia u bol'nykh infarktom miokarda.

The course of the disease and the dunamics of immunologic shifts were compared in 277 patients suffering from myocardial infarction, 87 of whom had foci of infection and chronic infectious-allergic diseases while 190 had no complications. In patients of the first group the disease was usually of a lingering character and anticardiac antibodies were found in circulation for lengthy periods of time. The incidence of chronic tonsillitis and odontogenous infectious foci was higher among patients with myocardial infarction complicated by the postinfarction syndrome than among those with a noncomplicated course of the disease (in 12 out of 20 and in 3 out of 20 patients, respectively).

[Fungus invasion in the morphogenesis of gastro-duodenal ulcers]. / Gribkovaia invaziia v morfogeneze gastroduodenal'nykh iazv.

The goal of the study was the clarification of the role of the fungus Candida in the course of the ulcer. The combination of morphological, cultural and immunological methods was used for the diagnosis of the fungus involvement. Inhibition of the reparative processes by the fungus Candida was shown in the experiment on the model of the chronic gastric ulcer. It is concluded that in patients with chronic ulcers histological examination of the biopsies for fungi should be performed.

[Peptic ulcer combined with other pathology. The clinical manifestations, course and therapy]. / Iazvennaia bolezn' v sochetanii s drugoi patologiei. Klinicheskie proiavleniia, techenie, terapiia.

The author describes and classifies the most frequently occurring combinations of peptic ulcer and pathology of other organs and systems on the basis of examining more than 2,000 patients. Diseases and syndromes associated with peptic ulcer are distributed into 2 groups: within the gastrointestinal tract and outside it. The former ones include cardia insufficiency, deranged bowel function, rectal syndrome, diseases of the gallbladder, pathology of the liver and pancreas; among the latter ones are essential hypertension, atherosclerosis, coronary heart disease, chronic nonspecific pulmonary diseases, and diabetes mellitus. Different pathogenetic relations and clinical load are shown to exist between the underlying disease and concomitant illnesses. Evidence is provided for the concept of enlarged spasms (phenomenon of the spastic dominant) common to peptic ulcer. Efficient methods of the individualized treatment of patients with concomitant pathology are described.

[Addison-Biermer anemia: the clinical problems during diagnosis and therapy]. / Anemiia Addisona--Birmera: klinicheskie problemy v period diagnostiki i terapii.

Analysis is made of the diagnostic and therapeutic problems related to Addison-Biermer anemia based on studying disease histories of 15 patients afflicted with the disease and placed under the author's observation. Under the outpatient conditions, the disease, in many cases, is not diagnosed accurately whereas the treatment is carried out without any control. The diagnostic role of examining the bone marrow puncture biopsy, reticulocyte and erythrocyte sedimentation crisis, gastric secretion, and the neurological status is outlined. Among rare complications of the treatment with vitamin B12, abacterial feverish reactions, hypertonic crises and cerebral circulatory disorders are recorded. Emphasis is laid on the necessity of oncological apprehension both in the period of the patients' entry into the stage of remission and in long-term dynamic observation.

[Acute pneumonias against a background of chronic nonspecific lung diseases]. / Ostrye pnevmonii na fone khronicheskikh nespetsificheskikh zabolevanii legkikh.

The origin, course, diagnosis and treatment aspects of acute pneumonia have been studied in 394 patients with chronic bronchitis and 158 bronchial asthmatics. In chronic bronchitis, acute pneumonia was diagnosed resting on clinical physical data in one-third of the patients, the rest cases simulated exacerbations of bronchitis and were detected only at x-ray. Clinical relationships between acute pneumonia and bronchial asthma are variable (prepneumonic asthma aggravation , its early and late severe episodes because of pneumonia). Chronics with nonspecific diseases of the lungs are referred to high-risk-for-pneumonia groups, while acute pneumonias are considered affections negatively influencing background bronchopulmonary disorders.

[Acute respiratory diseases in patients with chronic pathology of the internal organs]. / Ostrye respiratornye zabolevaniia u bol'nykh s khronicheskoi patologiei vnutrennikh organov.

Follow-up of 2400 patients aged 17-84 who had previously had influenza or other acute respiratory diseases documented aggravation of the background illness in 34.1% of them. Because of the aggravation 15.3% of the cases were referred to hospitals. Augmentation of symptoms was primarily observed in chronic nonspecific pulmonary lesions (57.9%), bronchial asthma (30.5%), rheumatic fever (38.1%), peptic ulcer (31.6%), renal (42.7%) and thyroid (42.9%) diseases, climacteric neurosis (31.3%), neurovegetative disorders (61.1%). Typical symptoms and syndromes of aggravated background illnesses, principles of managing combined diseases and of respiratory affections prevention in the above patients are presented.

[The significance of the chordal apparatus of the heart in forming "innocent" murmurs (clinical echocardiographic research)]. / Znachenie sostoianiia khordal'nogo apparata serdtsa v formirovanii "nevinnykh" shumov (kliniko-ékhokardiograficheskoe issledovanie).

Clinical and echocardiographic studies were carried out in 100 young men (mean age 18.0 +/- 3.0 years) with "harmless" murmur (HM). 20 young men (mean age 17.0 +/- 2.0 years) were examined as control. In these men, murmur could not be detected both at rest and after 15 squattings and the hyperventilation test. No relationship was discovered between the murmur intensity and gravity of heart hyperdynamia, although in persons with HM, the predominance of hyperdynamia could be observed. It is believed that the intensity of HM is due to the morphofunctional features of the cardiac structures. The chordal apparatus of the heart is viewed as one of them. In 37% of persons with HM, echocardiography revealed a phenomenon of the "fluttering" chorda, which lies in diastolic-systolic hypermobility of one of the commonly attached chordae of the mitral valve because of its excessive length and weak tonic tension. That phenomenon is usually associated with so-called Steele's murmur. It is concluded that via the phenomenon of the "fluttering" of the chorda of the mitral valve there may occur labile and, in some cases, of "musical" non-regurgitation systolic murmur in local dysfunction of the papillary muscles.

[The differential diagnosis of various forms of hypertrophic cardiomyopathy and hypertension with inadequate left ventricular hypertrophy]. / K voprosu o differentsial'noi dianostike razlichnykh form gipertroficheskoi kardiomiopatii i gipertonicheskoi bolezni s neadekvatnnoi gipertrofiei levogo zheludochka.

In order to develop the tentative criteria of the differential diagnosis, 18 patients with obstructive hypertrophic cardiomyopathy (OHCMP), 3 with nonobstructive hypertrophic cardiomyopathy (NOHCMP), 8 with essential hypertension (EH) with inadequate left ventricular hypertrophy (LVH) and 10 normal persons were subjected to clinical examination and to ultracardiosonography. The patients with OHCMP mainly complained of dizziness and syncopes. Since childhood they had systolic murmur and ECG abnormalities. Ultracardiosonography showed asymmetrical LVH, a considerable decrease of the ventricular cavity as well as abnormalities of the localization and function of the papillary muscles. NOHCMP was marked by the combination of the good well-being of the patients with gross abnormalities on the ECG. Ultracardiosonography demonstrated moderately pronounced and asymmetrical LVH. The group suffering from EH with inadequate LVH was characterized by the early development of severe circulatory failure with arterial hypertension of moderate intensity. The changes in the architectonics of the left ventricle and its subvalvular structures turned out to be similar to those in OHCMP but were less remarkable.

[Infrared irradiation of the anterior abdominal wall in pathology of the gastroduodenal area (mechanisms of formation of the radiation foci and clinical evaluation)]. / Infrakrasnoe izluchenie perednei briushnoi stenki pri patologii gastroduodenal'noi zony (mekhanizmy formirovaniia, klinicheskaia otsenka).

The data obtained during endoscopy, thermography electromyography, myotonometry and electroalgesimetry were compared in patients with gastroduodenal pathology. It was established that in patients with peptic ulcer, the times of the appearance of the foci of intense infrared radiation in the projection areas did not coincide completely with the period of ulcerous defect revelation by means of endoscopy and indicated the phases of the disease activity more precisely. The foci of intense infrared radiation agreed with the zones of protective muscular tension. Since as a result of muscular contraction the skin temperature above the muscles rises, the data obtained should be taken into account in the design of the theory of thermography. The complex of the studies proposed is conducive to an objective differential diagnosis and to better results in the observation over patients suffering from gastroduodenal diseases.

[Physiological substantiation and experience with the therapeutic use of oxygenated mineral water]. / Fiziologicheskoe obosnovanie i opyt lechebnogo ispol'zovaniia oksigenirovannoi mineral'noi vody.

The accumulated experimental data indicate to the existence of two types of enterocyte respiration: apical and basolateral. Their interrelationships change with regard to small intestine function. Duodenal ulcer was chosen as a clinical model for a study of the therapeutic role of enteral oxygenation. Faster penetration of oxygenated mineral water into the duodenum was shown as compared to oxygen foam. Oxygenated mineral water therapy (as compared to water saturated with carbon dioxide and nitrogen) speeds up the rate of wound healing, shortens the time of arresting the pain syndrome and makes it possible to discharge patients earlier for outpatient treatment.

[Acute pneumonia in the practice of polyclinical internists (current problems of prevention, diagnosis, treatment and rehabilitation)]. / Ostraia pnevmoniia v praktike terapevtov poliklinik (aktual'nye voprosy profilaktiki, diagnostiki, lecheniia i reabilitatsii).

The overwhelming part of patients with acute pneumonias are treated at home by district internists (only 10.2% of the sick was admitted to hospitals). Early disease diagnosis, adequate selection of patients who need hospitalization, adequacy of the treatment, control over rehabilitation, wise decision as to the time of reporting to work, and efficient dispensarization largely depend on the activities of district internists. Considerable reserves for improving this trend in the activities of polyclinics have been revealed.