[Bile duct repair after complete intersection]. / Opyt vosstanovleniya nepreryvnosti zhelchnykh protokov pri polnom ikh peresechenii.

OBJECTIVE: To determine the training period for imposing hepaticojejunostomy for bile duct repair. MATERIAL AND METHODS: Reconstructive surgery on the bile ducts was performed in 53 patients. We analyzed the learning curves based on the incidence of anastomotic leakage after hepaticojejunostomy. RESULTS: The learning curve has a downward nature. The number of anastomotic failures decreases by 2 times after 42 procedures. Surgeon had to perform 39-42 operations to reduce the incidence of this complication. CONCLUSION: Treatment of patients with iatrogenic intersections of the bile ducts should be provided in appropriate hospitals.

Measurement of the 2S_{1/2}-8D_{5/2} Transition in Hydrogen.

We present a measurement of the hydrogen 2S_{1/2}-8D_{5/2} transition performed with a cryogenic atomic beam. The measured resonance frequency is ν=770649561570.9(2.0) kHz, which corresponds to a relative uncertainty of 2.6×10^{-12}. Combining our result with the most recent measurement of the 1S-2S transition, we find a proton radius of r_{p}=0.8584(51) fm and a Rydberg constant of R_{∞}=10973731.568332(52) m^{-1}. This result has a combined 3.1σ disagreement with the Committee on Data for Science and Technology (CODATA) 2018 recommended value.

[Diagnostic efficiency of transcutaneous laryngeal ultrasound in assessing the mobility of vocal cord in patients with thyroid disease]. / Diagnosticheskaya effektivnost' ul'trasonografii gortani u patsientov s zabolevaniyami shchitovidnoi zhelezy.

OBJECTIVE: To assess the diagnostic efficiency of transcutaneous laryngeal ultrasound. MATERIAL AND METHODS: Ultrasound examination of the larynx and laryngoscopy was performed in 103 patients with thyroid disease. 26 (34.21%) patients who underwent surgery on the thyroid gland direct laryngoscopy and ultrasound of the vocal folds were performed twice, before and after the operation. RESULTS: Voice folds were visualized in 76 (73.8%) people. Of the 24 men, these anatomical structures were visualized in 8 (33.3%) and in 68 (86.1%) women out of 79 cases. Violations of the function of the vocal cords during laryngoscopy were detected in 5 people, sonographically in 6 people. The coincidence of the revealed pathology with ultrasound was in 4 patients, in 3 - with sonography the diagnosis was erroneous, in 1 patient it was falsely negative and in 2 cases it was falsely positive. CONCLUSIONS: In connection with the diagnostic capabilities of the method, it is advisable to use it as a screening study in the perioperative period in patients with diseases of the thyroid gland. Laryngoscopy is indicated for patients with non-visualized vocal folds, with identified pathology with ultrasound, and with clinical signs of dysfunction of the vocal cords.

[The organizational aspects of security support of participants of clinical testing of vaccine "Gam-COVID-Vac"].

The COVID-19 pandemic resulted in many aftermaths, economic crisis and extra charging of health care. The development of vaccine against SARS-nCoV-2 agent turned out as the priority task of world and Russian medicine and pharmaceutics. The investigation of efficiency and safety of vaccines can be prolonged for many years that can aggravate the observed crisis. Having regard to the global scope and speed of pandemic spreading, the vaccine "Gam-COVID-Vac" was registered with special procedure by the Decree of the Government of the Russian Federation No. 441 of 03.04.2020 for accelerated access to civic turn-over. To monitor safety of vaccine on the basis of international experience, the decision was made to organize the independent Committee of monitoring data concerning efficacy and safety of vaccines applied to prevent COVID-19. The article presents rationale for necessity to create independent committee and to implement such a practice.

[Learning curves in acquisition of experience for new technologies]. / Izuchenie opyta osvoeniya novykh tekhnologii metodom postroeniya krivykh obucheniya.

OBJECTIVE: Analysis of national and foreign trials investigating accumulation of experience in innovative technologies using the learning curves. MATERIAL AND METHODS. S: Earching for Russian-language manuscripts was carried out within the references of the articles and in the ELIBRARY database. Foreign trials were selected from the PubMed database according to the keywords «learning curves in surgical practice¼. The discovered publications were studied for accordance with the objectives of this study. RESULTS: Accumulation of experience in new technologies by using of learning curves is valuable to improve the training, determine duration of development of new technology and the factors affecting its characteristics. CONCLUSION: The method is high-quality for comprehensive analysis of experience accumulation in new surgical technologies.

[Reperfusion syndrome: state of the art]. / Reperfuzionnyi sindrom. Sovremennoe sostoianie problemy.

Reperfusion syndrome is a complex series of clinical manifestations resulting from restoration of blood flow to previously ischaemic tissues. It is accompanied by damage to cells, tissues and organs at various levels, followed by the development of multiple organ failure. This review deals with the main pathophysiological mechanisms of the development of reperfusion syndrome in lesions of cardiac, cerebral and lower-limb vessels. Oxidative stress is considered to be the most important marker of ischaemia-reperfusion injury irrespective of the type of tissues affected. Presented herein are the data on contemporary possibilities of influencing various stages and components of the development of reperfusion injury by means of drug therapy, demonstrating that due to the importance of oxidative stress as a key link of reperfusion injury, antioxidant therapy should be the main component of prevention and treatment of reperfusion injury.

[Joint work of surgeon and assistant in minimally invasive video-assisted hemithyroidectomy and its effect on duration of surgeries and learning period]. / Sovmestnaya rabota khirurga i assistenta pri vypolnenii mini-invazivnykh videoassistirovannykh gemitireoidektomii i ee vliyanie na prodolzhitel'nost' vypolnennykh operatsii i perioda osvoeniya metodiki.

OBJECTIVE: To analyze assistants` influence on duration of surgery and learning period in minimally invasive video-assisted hemithyroidectomy. MATERIAL AND METHODS: The same surgeon performed 67 minimally invasive video-assisted hemithyroidectomies. Duration of surgery was analyzed in assistants with various number of interventions. Learning curves were designed using logarithmic function. RESULTS: Eight specialists with the same professional skill assisted to surgeon. Each of these specialists performed certain number of operations. Learning period made up 19, 26 and 44 procedures for mean numbers of assistances 21, 8 and 3, respectively. Duration of surgery in the group with 21 assistances was 63.96±2.94 min, for 3 assistances - 80.53±7.07 min in each of 6 assistants (z= -2.38; p<0.017). CONCLUSION: Constant surgeon`s assistants is a factor reducing surgery time. Higher number of operations with the same assistant has a reliable inverse correlation with surgery time and duration of learning period.

[Adverse drug reactions of local anesthetics used in dentistry]. / Nezhelatel'nye reaktsii na mestnye anestetiki pri ikh primenenii v stomatologii.

The aim. Study the adverse drug reactions (ADR) that occur when using local anesthetics (LA) in patients living in the Republic of Crimea and registered during the period 2010-2018. MATERIAL AND METHODS: The objects of the study were 122 notification forms about LA ADR recorded in the regional base (Register) of spontaneous reports called ARCADe (Adverse Reactions in Crimea, Autonomic Database). In most cases, ADR was associated with the use of amide LA Lidocaine - 69 cases (56.55% of the total number of cases for LA ADR), less often, ADR was caused by combinations containing Articaine (34 cases, 27.87%). Rare cases of ADR were reported for Novocaine/Procaine (9 cases, 7.38%), Bupivacaine (8 cases, 6.56%) and Mepivacaine (2 cases, 1.64%). The main clinical manifestations of reactions were hypersensitivity-like reactions (38 cases), cardiac and vascular disorders (29 cases) and central nervous system disorders (19 cases). Lack of effectiveness of LA occurred in 13 cases (10.66%). RESULTS: A study of the outcome of ADR revealed a high incidence of life-threatening conditions associated with LA use - 31 cases (25.4%), which indicates the severity of the event and the need to cancel the suspected drug and prescribe additional medications for correction. The need for hospitalization or prolongation of hospitalization was necessary in 7 cases (5.8%), and temporary disability of patients was revealed in 5 cases (4.1%). Of particular interest are 2 cases (1.6%) of the development of a fatal outcome as a result of the suspected anaphylactic shock (1 case) and disorders of the central nervous system (convulsions, development of respiratory failure). CONCLUSION: The high frequency and severity of unwanted effects resulted from the use of LA requires healthcare professionals to make rational choices and strictly monitor patient safety.

[A role of MRI-Ultrasound fusion targeted biopsy of prostate in the diagnosis of prostate cancer].

AIM: To compare the results of the MRI-ultrasound fusion targeted biopsy (MRF-TB) and systematic 12-core biopsy (SB) of the prostate and analyze the relationship between biopsy results and the prebiopsy multiparametric MRI. MATERIAL AND METHODS: The study included 380 men aged from 45 to 80 years with a total PSA level of 4 to 10 ng/ml (according to Hybritech calibration) and a negative result of digital rectal examination. All men underwent the multiparametric MRI of the prostate before biopsy. MRI results were assessed according to the PI-RADS Version 2 criterion. In all men (n=247) with PI-RADS category 2 or higher lesion were performed MRF-TB (4 targeted columns) and SB (12 standard points) of the prostate. RESULTS: There were no significant differences in the detection of all types of prostate cancer (PCa) in all patients between MRF-TB and SB (p=0.731). At the same time, significantly less low-risk PCa (Gleason 6) (p<0.001) and significantly more aggressive PCa (Gleason more or equal 7) (p<0.001) were detected in MRF-TB group in comparison with SB group. In addition, MRF-TB allowed to detect significantly more aggressive type of PCa (Gleason more or equal 4 + 3) compared to SB (p=0.025). CONCLUSION: MRF-TB allows to detect more significant PCa (Gleason more or equal 7) in comparison with SB, while limiting the detection of low-risk PCa (Gleason 6) in general population of men.

[Conservative treatment of chronic lower limb ischemia in ambulatory practice (in Russian only)]. / Konservativnoe lechenie khronicheskoi ishemii nizhnikh konechnostei v praktike ambulatornogo khirurga.

Peripheral artery disease is still one of the most important surgical problems. General surgeons treat the majority of patients with chronic lower limb ischemia due to the lack of specialized surgical care. Current methods for risk factors adjustment, exercise therapy and the most common drugs for intermittent claudication management are reviewed in the article. The effect of these medicines on subjective (pain-free walking distance, maximal walking distance, etc.) and objective (ankle-brachial index) parameters and the incidence of complications are analyzed.

[Objective assessment of the degree of ischaemia and efficacy of treatment in chronic arterial insufficiency of lower limbs]. / Ob''ektivnaia otsenka stepeni ishemii i éffektivnosti lecheniia pri khronicheskoi arterial'noi nedostatochnosti nizhnikh konechnostei.

Presented in the review is the data concerning contemporary criteria for assessing the degree of chronic lower limb ischaemia and quality of the treatment performed. Problems regarding objectivization of the degree of an ischaemic lesion of an extremity and assessment of quality of conservative treatment still remain unresolved. Currently, in the world practice along with instrumental methods (assessment of the ankle-brachial index) subjective criteria are mainly employed: assessment of pain-free walking distance or maximum distance walked. In order to work out appropriate regiments of conservative treatment and compare efficacy of various drugs for treatment of chronic lower limb ischaemia and, in particular, intermittent claudication, it is necessary to use objective criteria. Detailed consideration is hence given to the possibilities of using morphological, biochemical and histological criteria such as determination of vascular endothelial growth factor A (VEGF-A) in peripheral blood and determination of apoptosis markers (BNIP3) and hypoxia-inducible factor (HIF-1) in a biopsy sample of the gastrocnemius muscle of the ischaemized extremity.

[Embryology, anatomy and rare pathologies of the popliteal artery: Peculiarities of surgical treatment]. / Émbriologiia, anatomiia i redkie patologii podkolennoi arterii: osobennosti khirurgicheskogo lecheniia.

Knowledge of anatomical variations of the division of the popliteal artery and specific lesions of the arterial segment involved is necessary for the surgeon, traumatologist-orthopaedist, vascular surgeon. The article contains a review of recent literature data on the prevalence of different variants of branching patterns of the arteries of the crus, also providing a detailed discussion of embryological development of the arterial system of the lower extremities, in many ways explaining the appearance of rare pathologies of the popliteal artery, such as for example popliteal artery entrapment syndrome. Particular attention is paid to cystic damage of the popliteal artery, describing currently known theories of the development of this rare pathology, this is accompanied by sharing own experience in surgical treatment of the patients involved. Awareness of anatomical variants and peculiarities of embryonic development contributes to decreasing the possibility of iatrogenic damage of the popliteal artery during orthopaedic operations and to appropriate decision-making as to the method of revascularization.

Virtual Experimental Validation of Dynamic Osteosynthesis in the Treatment of Fractures of the Proximal Femur.

Volume model of transtrochanteric fracture of the femoral bone fixed by Targon PF dynamic fixator was studied by the finite element analysis. The following parameters were measured: magnitude and direction of displacement of system elements, pressure between fragments, and von Mises stress distribution in the fixator depending on support screw plunging into the sleeve. The results indicate that stability of the bone-nail system increases during fracture union and 10-mm shortening of the femoral neck axis, which is seen from a decrease in system deformation under load by 16.8%, stress in the implant by 20.2%, and pressure in the zone of fragments contact by 19.8%.

[Clinical and morphological signs of viral damage to a kidney transplant]. / Kliniko-morfologicheskie priznaki virusnogo porazheniia pochechnogo transplantata.

AIM: Тo compare morphological changes and results of immunohistochemical (IHC) identification of viruses (polyomaviruses, adenoviruses, and herpesviruses) in the biopsy specimens with their clinical manifestations in recipients of renal transplants. MATERIAL AND METHODS: Morphological and IHC studies were conducted using 71 needle renal transplant biopsy specimens from patients in the study group and 10 renal biopsy specimens from those in the control group. A number of clinical indicators were estimated. RESULTS: IHC examination revealed the expression of adenoviral antigens more commonly in patients with posttransplant nephritis than in recipients without nephritis or in control individuals (p<0.05). The association of patient age and time after kidney transplantation with the severity of viral damage was confirmed: graft loss in children occurred within the first months of surgery (p<0.05). Polyomavirus was detected by PCR in patients with the morphological patterns of polyomavirus nephropathy. Determination of HSV-1 and HSV-2 in the biopsy specimens showed no significant associations with morphological changes. CONCLUSION: By taking into account a variety of factors that influence the development of viral nephritis, morphological and IHC examinations should be combined with evaluation of clinical findings.

[The analysis of the effectiveness of the combined treatment of the patients presenting with laryngeal papillomatosis]. / Analiz éffektivnosti kombinirovannogo lecheniia bol'nykh papillomatozom gortani.

The objective of the present work was to evaluate the effectiveness of the application of the inducer of endogenous interferon synthesis in the course of the combined treatment of the adult patients presenting with laryngeal papillomatosis. A total of 50 patients with this pathology were admitted and examined at the ENT Clinics of I.M. Sechenov First Moscow State Medical University and M.F. Vladimirsky Moscow Regional Research Clinical Institute during 24 months. The patients comprising group 1 (n=25) were treated with the use of cold plasma surgery and the inducer of endogenous interferon synthesis while those included in group 2 (n=25) received only surgical treatment. It was shown that the combined treatment including the surgical step (cold plasma surgery) followed by the treatment with the inducer of endogenous interferon synthesis to prevent relapses makes it possible to reduce the number of secondary surgical interventions, increase the duration of the intervals between relapses, and decrease the content of types 6 and 11 human papilloma virus in the saliva.

Active fiber-based retroreflector providing phase-retracing anti-parallel laser beams for precision spectroscopy.

We present an active fiber-based retroreflector providing high quality phase-retracing anti-parallel Gaussian laser beams for precision spectroscopy of Doppler sensitive transitions. Our design is well-suited for a number of applications where implementing optical cavities is technically challenging and corner cubes fail to match the demanded requirements, most importantly retracing wavefronts and preservation of the laser polarization. To illustrate the performance of the system, we use it for spectroscopy of the 2S-4P transition in atomic hydrogen and demonstrate an average suppression of the first order Doppler shift to 4 parts in 106 of the full collinear shift. This high degree of cancellation combined with our cryogenic source of hydrogen atoms in the metastable 2S state is sufficient to enable determinations of the Rydberg constant and the proton charge radius with competitive uncertainties. Advantages over the usual Doppler cancellation based on corner cube type retroreflectors are discussed as well as an alternative method using a high finesse cavity.

[Diagnostics of tooth supporting structures]. / Diagnostika sostoyaniya oporno-uderzhivayushchego apparata zubov.

The aim of the study was to assess alveolar bone resorption in patients with periodontal disease and individuals with normal periodontal status and coordinate resorbtion rates with tooth mobility. Tooth mobility was measured in 19 patients with periodontal disease and 17 healthy individuals by two-parametrical periodontometry in two different positions: in equilibrium and after pre-loading. The level of bone resorption was determined by periodontal probe. Previously unknown correlation between tooth mobility and alveolar bone resorption was found out meaning that bone atrophy can be determined by tooth mobility.

[Lifestyle and health of students].

The article presents the results of the evaluation of the most significant risk factors related to lifestyle and health of medical students of different courses andfaculties. The obtained data testify that out of the total number of factors that have a significant influence on the formation of bases of student's healthy lifestyle and health, the most typical are the mode of employment, the total workload, material well-being, living conditions of the majority of today's students, as well as the conditions of nutrition, physical activity, the presence or absence of such factors as smoking, frequency of consumption of alcoholic beverages.

Acceleration of Angiogenesis after Paravasal Injection of Mesenchymal Stem Cells at the Site of Modeled Venous Thrombosis.

The results of transplantation of autologous bone marrow multipotent mesenchymal stem cells carrying GFP gene and labeled with cell nucleus-specific dye DAPI near the thrombosed vein in rat hind limb were studied by methods of luminescent microscopy. It was demonstrated that autologous multipotent mesenchymal stem cells participate in the formation of granulations at the site of surgery. The blood fl ow in the thrombosed great vein was always restored through thrombolysis. We observed no signs of incorporation of the transplanted cells into the wall of the great vessel, clot recanalization, or formation of collaterals. Small branches of the great vein in the affected region were also thrombosed. The blood fl ow in these branches was always restored with participation of the transplanted cells or through clot recanalization or through obliteration of the thrombosed vessels and formation of new vessels. The transplanted cells and structures formed by them were gradually replaced by the recipient cells.

SIMULATION OF GENERAL ANESTHESIA ON THE "SIMMAN 3G" AND ITS EFFICIENCY.

In recent years in medical educational process new innovative technologies are widely used with computer simulation, providing the reality of medical intervations and procedures. Practice-training teaching with using of simulation allows to improve the efficiency of learning material at the expense of creating imaginary professional activity and leading barring material to practical activity. The arm of the investigation is evaluation of the students training efficiency at the Medical Institute on the topic "General Anesthesia with using a modern simulation "SimMan 3 G". The material of the investigation is the results, carried out on the basis of the Centre of Practical skills and medical virtual educational technologies (Simulation Centre) at the Medical Institute of NEFU by M.K. Ammosov. The Object of the investigation was made up by 55 students of the third (3) course of the Faculty of General Medicine of the Medical Institute of NEFU. The investigation was hold during practical trainings (April-May 2014) of the General Surgery Department on the topic "General Anesthesia". A simulation practical course "General Anesthesia" consisted of 12 academic hours. Practical training was carried out using instruments, equipments and facilities to install anesthesia on the SimMan 3G with shooting the process and further discussions of the results. The methods of the investigations were the appreciation of students background knowledge before and after practical training (by 5 points scale) and the analysis of the results. The results of the investigation showed that before the practical course only 23 students (41.8%) had dot positive marks: "Good"--7 students (12.7%) and "Satisfactory"--16 (29.1%) students. The rest 22 (58.2%) students had bad results. The practical trainings using real instruments, equipments and facilities with imitation of installation of preparations for introductory anesthesia, main analgesics and muscle relaxants showed a patients reaction on the virtual trainer SimMan 3 G. Students were divided into anesthetic team, co-assisting of an anesthesiologist, an assistant and nurses anesthetist, who conducted general anesthesia (the mask anesthesia, intravenous anesthesia, endotracheal anesthesia). After finishing the practical course 16 students (29.1%) got 5 marks (Excellent), 35 students (63.6%)--4 (Good) and 4 students (7.3%)--3 mark (Satisfactory).