ANALYSIS OF POLYMORPHISM OF MATRIX METALLOPROTEINASE-2 (C-1306 → T) AND TISSUE INHIBITORS OF METALLOPROTEINASE-2 (G303 → A) GENES IN PATIENTS WITH ANASTOMOTIC LEAK IN HOLLOW DIGESTIVE ORGANS.

THE AIM: To analyze the frequency of polymorphic variants of MMP-2 (C-1306 → T) and TIMP-2 (G303 → A) genes in patients with anastomotic leak in hollow digestive organs. The object of the study comprises 61 patients with anastomotic leak and connective tissue pathology, all treated at the Shalimov National Institute of Surgery and Transplantology during 2016-2019. Laboratory, genetic, histological studies and statistical analysis were performed. As a result of genetic and statistical analysis of the MMP-2 (C-1306 → T) and TIMP-2 (G303 → A) gene polymorphisms, genotype variants have been identified that are associated with the risk of anastomotic leak in hollow digestive organs. Significant differences in the distribution of genotypes in the studied groups were revealed. Analysis of the multiplicative model of inheritance of MMP-2 and TIMP-2 genes showed compliance of genotype distribution with Hardy-Weinberg's law. All models of inheritance were analyzed and the best model with the lowest Akaike Information Criterion, which turned out to be a recessive model, has been determined. Anastomotic leak in hollow digestive organs is 1.36 times more common in carriers of homozygous CC genotype of the MMP-2 gene and twice less common in minor homozygotes of TT (5.9% vs. 10%, p>0.05). It is statistically significant that in the group of patients with anastomotic leak in hollow digestive organs the GG variant of the TIMP-2 gene was detected 1.6 times more often. Carriers of minor homozygotes of AA genotype in the group with suture failure were not detected, while a similar genotype in the control group was found in 10% (p<0.05).

Upper Bounds on Spontaneous Wave-Function Collapse Models Using Millikelvin-Cooled Nanocantilevers.

Collapse models predict a tiny violation of energy conservation, as a consequence of the spontaneous collapse of the wave function. This property allows us to set experimental bounds on their parameters. We consider an ultrasoft magnetically tipped nanocantilever cooled to millikelvin temperature. The thermal noise of the cantilever fundamental mode has been accurately estimated in the range 0.03-1 K, and any other excess noise is found to be negligible within the experimental uncertainty. From the measured data and the cantilever geometry, we estimate the upper bound on the continuous spontaneous localization collapse rate in a wide range of the correlation length r_{C}. Our upper bound improves significantly previous constraints for r_{C}>10^{-6} m, and partially excludes the enhanced collapse rate suggested by Adler. We discuss future improvements.

ТRANSANAL MINIINVASIVE SURGERY (TAMIS): FIRST EXPERIENCE OF APPLICATION.

Incidence of cancer recti (CR)in Ukraine constitutes 38 in 100 thousands of population. There are two main trends in surgical treatment of precancerous states and early stage CR: radical rectal resection and local transanal excision of the affection zone. After a single­port procedure introduction into laparoscopic surgery the alternative method of rectal tumors resection have had evolved ­ a transanal minimally invasive surgery with single­port (TAMIS). In the clinic the TAMIS procedure was applied in 3 patients for adenomatous rectal polyps. Оperative intervention was done using transanal videoen' doscopic excision of villous rectal tumor. First experience of application of TAMIS wit' nessed the method efficacy, its relatively low cost and low risk of complications occur' rence. Application of this adopted procedure contributes for improvement of the treat' ment results in rectal tumors.

[MORPHOLOGICAL AND IMMUNOPHENOTYPE OF DESCRIPTION OF LIPOASPIRATE CELLS].

In an experimental investigation immunophenotype and morphological characteristics of cells isolated from adipose tissue were studied. It is establised that cells derived from lipoaspirate, namely the third subpopulation cells, characterized by the features inherent to mesenchymal stem cells (SC) and SC similar to those of bone marrow. The presence of cells isolated from lipoaspirate, features that characterize them as the SC, is the perspective of their use in clinical practice.

[ЕXPERIMENTAL ESTIMATION OF THE LOCAL APPLICATION EFFICACY OF BIOLOGICAL STIMULATOR FOR THE SOFT TISSUES REPARATION IN TREATMENT OF CHRONIC GASTRIC ULCERS].

Results of experimental investigation for studying of the local application possibility for the reparative processes stimulators, including autologic purified lipoaspirate, dalargin and a platelet­rich plasma (PRP) for treatment of chronic gastric ulcers, were analyzed. The advantages of PRP application, as the growth factors donator, independently and in combination with dalargin, were proved. The PRP capacity to stimulate the fibroblasts activity and creation of vessels in young connective tissue was proved, what have leaded to the ulcer tissues oxygenation improvement and cellular proliferation promotion, acceleration of the connective tissue maturation, and the ulcer healing.

[MODERN METHODS OF PROGNOSTICATION OF THE RECURRENCES OCCURRENCE AFTER SURGICAL TREATMENT OF THE MAMMARY GLAND BENIGN TUMORS].

Modern schemes of the recurrences predicting after surgical treatment of benign tumors of mammary gland (BTMG) were estimated. In accordance to data of retrospective investigation obtained, the recurrences occurrence rate through a five-year period of observation have constituted 2.3%. While doing prospective observation, the recurrences after treatment have occurred in 12 (24.0%) patients, suffering phylloid histologic form of tumor. The BTMG recurrences were noted predominantly in women--carriers of mutant alleles with polymorphism rs8190924 of gene GSR and AA rs3763511--of gene DKK4. Nethertheless, there are no data, which confirm the recurrence occurrence risk to be considered genetically determinated, the possibilities ratio for this kind of polymorphism have costituted 12.0 (trustworthy interval 95% 0.8 - 14.9).

[MORPHOLOGICAL PECULIARITIES OF MUSCULO-APONEUROTIC TISSUES OF ANTERIOR ABDOMINAL WALL IN PATIENTS, SUFFERING MORBID OBESITY].

Results of morphological investigation of musculo-aponeurotic structures of anterior abdominal wall were presented in the morbid obesity patients. The role of obesity as a primary cause for morphofunctional insufficience of musculo-aponeurotic structures was established.

[COMBINATION OF CELLS TECHNOLOGIES AND MINSIINVASIVE SURGERY IN THE TREATMENT OF CHRONIC GASTRIC ULCER].

The results of experimental and clinical use of stimulants of local reparative processes (autologous purified lipoaspirate and platelet-rich plasma) in the treatment of chronic gastric ulcer were analyzed. In the experimental part of the study the benefits of using platelet-rich plasma as donator growth factors were proved. The ability to stimulate the activity of fibroblasts and vessels formation in the young connective tissue with improving of oxygenation in ulcers and enhancing of cell proliferation, differentiation and accelerating of connective tissue maturation and healing of ulcers were demonstrated. In clinical studies the advantages of combination of standard antiulcer therapy and local endoscopic injection of platelet-rich plasma compared to only conservative therapy were shown.

[Peculiarities of heterotopic transplantation of adipose graft enriched by allogeneic cryopreserved stem cells from adipose lipoaspirate].

Possibilities of application of the donor cryoconserved cellular material (mesenchymal stem cells, obtained from adipose tissue) for defense of transplanted adipose graft from the tissue resorption were studied. The adipose graft enrichment, using cryoconserved allogenic mesenchymal multipotent stem cells, obtained from adipose tissue, caused activation of destructive-inflammatory processes in adipose graft, the adipocytes survival worsening, and in further--the transplant mass deficiency. We suggest inexpedient to apply in clinical practice the donor cryoconserved stem cells for defense of transplanted adipose tissue from the tissue resorption.

[SURGICAL TACTICS IN CHRONIC PANCREATITIS WITH SIGNS OF BILIARY HYPERTENSION].

The results of treatment of 84 patients for chronic pancreatitis with the biliary hypertension signs were depicted. In 83 patients operative interventions were performed, and in 1--positive results were achieved after pancreatic cyst puncture under ultrasonographic control. In 51 patients the conduction of Frey operation have permitted to achieve a lower pressure inside biliary system, in 25--the additional procedures were applied for a biliary hypertension elimination. In 20 patients a method of pressure measurement in biliary system was used.

[Surgical treatment of patients for abdominal sepsis].

Results of surgical treatment of 201 patients, suffering abdominal sepsis (AS), which have occurred after operations on abdominal organs, were analyzed. Expediency of application of modern scales for the patients state severity estimation, prognostic sign-posts and dynamic of the pathological process course in every patient was substantiated. Existing systems of prognostication (APACHE II, SOFA, MODS) are applied restrictedly for diagnosis of infection in patients, what demands relaparotomy performance in presence of clinical signs of intraabdominal infection, which persists. For prognostication of the treatment result and determination of indications for relaparotomy conduction in patients, suffering severe AS and infectious-toxic shock (ITSH), the most informative is application of the Manheim's index of peritonitis together with analysis of clinico-laboratory indices for formation of groups of patients in risk, to whom reoperation is indicated. Advantages of relaparotomy "on demand" conduction were proved in comparison with "programmed" relaparotomy during the staged surgical treatment of patients, suffering severe AS and ITSH. Complex surgical treatment with substantiation of indications and choice of adequate method of intervention secures improvement of the treatment results in these severely ill patients.

[Classification of an acute pancreatitis: revision by international consensus in 2012 of classification, adopted in Atlanta].

In 1992 on symposium in Atlanta the general classification of an acute pancreatitis, adopted by world medical society for practical application, was proposed. Due to results of multiple investigations there were enhanced the data about an acute pancreatitis pathophysiology, the organs insufficiency, and improvement of the noninvasive and invasive methods of visualization and treatment, what caused necessity to revise the classification. Web-consultations were conducted in 2007 yr to guarantee a wide participation of pancreatologists. After first meeting the working group have directed the document project to 11 national and international associations of pancreatologists. In 2012 yr the definite conclusions, concerning consensus, were published.

[Surgical treatment of cardial achalasia].

There was analyzed a 35-years experience of surgical treatment of 683 patients, suffering achalasia of cardia. Comparative analysis of different methods of operative interventions efficacy, including those, using laparoscopic access, was conducted. There was established, that esophagocardiomyotomy together with partial widening fundoplication guarantees good late results achievement in 96.6% of patients. Application of laparoscopic esophagocardiomyotomy and anterior widening fundoplication permits to secure all advantages of miniinvasive access and efficacy, comparable with such of the open access.

Atomic resolution scanning tunneling microscopy in a cryogen free dilution refrigerator at 15 mK.

Pulse tube refrigerators are becoming more common, because they are cost efficient and demand less handling than conventional (wet) refrigerators. However, a downside of a pulse tube system is the vibration level at the cold-head, which is in most designs several micrometers. We implemented vibration isolation techniques which significantly reduced vibration levels at the experiment. These optimizations were necessary for the vibration sensitive magnetic resonance force microscopy experiments at milli-kelvin temperatures for which the cryostat is intended. With these modifications we show atomic resolution scanning tunneling microscopy on graphite. This is promising for scanning probe microscopy applications at very low temperatures.

Magnetic resonance force microscopy of paramagnetic electron spins at millikelvin temperatures.

Magnetic resonance force microscopy (MRFM) is a powerful technique to detect a small number of spins that relies on force detection by an ultrasoft magnetically tipped cantilever and selective magnetic resonance manipulation of the spins. MRFM would greatly benefit from ultralow temperature operation, because of lower thermomechanical noise and increased thermal spin polarization. Here we demonstrate MRFM operation at temperatures as low as 30 mK, thanks to a recently developed superconducting quantum interference device (SQUID)-based cantilever detection technique, which avoids cantilever overheating. In our experiment, we detect dangling bond paramagnetic centres on a silicon surface down to millikelvin temperatures. Fluctuations of such defects are supposedly linked to 1/f magnetic noise and decoherence in SQUIDs, as well as in several superconducting and single spin qubits. We find evidence that spin diffusion has a key role in the low-temperature spin dynamics.