[The effectiveness of local application of vancomycin powder in the prevention of surgical site infections in spine surgery: a meta-analysis]. / Effektivnost' lokal'nogo primeneniya poroshka vankomitsina v profilaktike infektsii oblasti khirurgicheskogo vmeshatel'stva v spinal'noi khirurgii: metaanaliz.

OBJECTIVE: To perform a meta-analysis of studies examining the effectiveness of the local application of vancomycin powder for the prophylaxis of surgical site infections (SSIs) in spine surgery. MATERIAL AND METHODS: Retrospective cohort studies and prospective randomized clinical trials were searched for in the Pubmed, EMBASE, Cochrane Library and eLibrary databases published from 2008 to December 2018. For the resulting variables, the odds ratio and 95% confidence interval were calculated using random and fixed effects models. Estimation of the degree of heterogeneity is estimated using the coefficient I2. Statistically significant differences were considered differences p<0.05. RESULTS: The meta-analysis included 28 clinical studies that included the results of the local application of vancomycin powder in 17,469 patients after performing various spinal surgical interventions. Two publications had a prospective, randomized, controlled study design. Topical application of vancomycin powder reduces the incidence of SSIs after spine surgery (p<0.0001). The use of vancomycin powder reduces the incidence of SSIs in patients operated on with stabilizing implants (p=0.004). On the other hand, the topical application of vancomycin powder did not affect the prevalence of SSIs in respondents who were operated on without the use of stabilizing implants (p=0.12) or due to deformities of the spine (p=0.06). CONCLUSION: Topical application of vancomycin powder is highly effective in preventing the development of SSIs in patients after spinal surgical interventions.

[Comparison of the long-term outcomes of total arthroplasty and anterior spinal fusion in the treatment of cervical degenerative disc disease: a metaanalysis]. / Sravnenie otdalennykh rezul'tatov primeneniia total'noi artroplastiki i perednego spondilodeza v lechenii degenerativnogo zabolevaniia sheinykh mezhpozvonkovykh diskov: metaanaliz.

AIM: The study aim was to perform a meta-analysis based on the results of randomized clinical trials comparing long-term outcomes of total intervertebral disc arthroplasty (TA) and anterior cervical spinal fusion (ACSF) in the surgical treatment of cervical degenerative disc disease. MATERIAL AND METHODS: We searched Pubmed, EMBASE, ELibrary, and Cochrane Library databases for randomized clinical trials reported between 2008 and August 2018. The relative risk and 95% confidence interval were calculated for dichotomous variables; for continuous variables, we used the standardized mean difference and their 95% CI with application of a random effects model. RESULTS: The metaanalysis involved 9 randomized controlled clinical trials including the long-term outcomes of surgical treatment in 2,439 patients. A pooled analysis of the data showed that regression of neurological symptoms (p<0.00001), improvement in the quality of life of patients (Neck Disability Index), and lower pain severity (visual analogue scale for upper extremities) were significantly more often observed (p=0.02) in the group of TA patients. In addition, the TA technique was characterized by a statistically significantly lower rate of re-surgery (p<0.0005) and degeneration of the superjacent segment (p<0.0001), with the rate of adverse events being slightly increased (p=0.04). CONCLUSION: Compared to anterior cervical spinal fusion, TA of cervical intervertebral discs is characterized by significantly better clinical efficacy in patients with cervical degenerative disc disease in the long-term postoperative follow-up.

The Landau-de Gennes free energy expansion of a melt of V-shaped polymer molecules.

The phase behavior of a monodisperse melt of polymer molecules consisting of two rod-like segments joined at an angle α has been inspected within the Landau theory of phase transitions. The interactions between monomer units were assumed to be of the Maier-Saupe form. The Landau-de Gennes expansion of the free energy of the melt has been obtained up to the sixth order in powers of the nematic order parameter, the coefficients of this expansion have been calculated from the microscopic model of polymer molecule. The phase diagram contains the regions of stability of isotropic, prolate uniaxial, oblate uniaxial, and biaxial nematic phases. The isotropic-uniaxial nematic and uniaxial-biaxial nematic transitions are of the first and second order, respectively. We found two Landau points in the phase diagram at which continuous transition from biaxial nematic state to isotropic phase occurs.

Microphase separation in polydisperse rod-rod diblock copolymer melt.

The stability limits of the isotropic state of melt of rod-rod AB polydisperse diblock copolymer have been studied within weak segregation theory. The number of units in A block is assumed to be a random variable distributed by the Schulz-Zimm distribution. Inspection of the spinodal curves shows that the copolymer melt with polydisperse rigid blocks is less stable with respect to formation of the nematic and microphase separated states than the monodisperse melt. The values of ratios between strengths of isotropic and anisotropic interactions in the system strongly influences the forms of isotropic-nematic boundary curves.

The Landau free energy of a melt of graft copolymers.

New graphical algorithm is proposed to find vertex functions which are the coefficients of expansion of the Landau free energy of polydisperse multigraft copolymers whose macromolecules comprise an arbitrary number of types of side chains. This algorithm imposes no restriction on length distributions of side chains in copolymer macromolecules as well as on distribution of distances between two successive grafting points along the backbone. By way of example, with this algorithm the expressions for the second, third, and fourth order contributions into the free energy have been derived. The obtained results can be used for construction of the phase diagrams of polydisperse multigraft copolymers.

Phase behavior of the thermotropic melt of asymmetric V-shaped molecules.

The phase behavior of the monodisperse melt of V-shaped molecules composed of two rigid segments of different lengths joined at their ends at an external angle α has been examined within the Landau-de Gennes approach. Each rigid segment consists of a sequence of monomer units; the anisotropic interactions in the system are assumed to be of the Maier-Saupe form. The coefficients of the Landau-de Gennes free-energy expansion have been found from a microscopic model of V-shaped molecule. A single Landau point at which the system undergoes direct continuous transition from isotropic to biaxial nematic phase is found for asymmetry parameter ϕ=1/3 or ϕ=2/3, where ϕ is the number fraction of monomer units in one of the segments. Two Landau points are found in a range 1/3<ϕ<2/3. Only isotropic and nematic states are found to be stable for 0≤ϕ<1/3 and 2/3<ϕ≤1. Regions of stability of isotropic, prolate uniaxial, and biaxial nematic phases are found for ϕ=1/3 and ϕ=2/3. In addition, a stable oblate uniaxial phase is revealed if asymmetry parameter falls in the range 1/3<ϕ<2/3. The region of stability of the biaxial nematic phase becomes smaller as parameter ϕ increases from 1/3 to 1/2 (or decreases from 2/3 to 1/2). Coefficients of the gradient terms have been found; for certain values of asymmetry parameter these coefficients can become negative in some ranges of angles.

Surgical treatment of complicated abdominal aortic aneurysms.

The clinical data presented in the given work are based on the treatment of 166 patients with complicated abdominal aortic aneurysms, operated on during 20 years, namely between 1984 and 2004. Of these, aneurysmal rupture was identified in 51 (30.7%) and the risk of rupture in 115 (69.2%) cases. Coexistent pathology was present in 150 (90.4%) patients. Coronary artery disease was prevalent - 105 (63.3%) cases. The lethal outcome was recorded in 21.6% of cases (36 pts.). The basic cause of patients' death in the short-term postoperative period was acute cardiovascular insufficiency (9.6%).

[Surgical approach in bilateral and combined echinococcosis of the lung].

One hundred and two patients aged from 4 to 65 years with echinococcosis were treated. Solitary cysts in both lungs were diagnosed in 69 patients, multiple cysts -- in 33 patients. In 10 cases small and middle cysts were in the upper parts of both lungs. These patients underwent one-stage operation consisting in lateral thoracotomy, removing of the cyst from one lung, incision of retrosternal mediastinal pleura, removing of the cyst from the second lung, drainage of pleural cavity. Fifteen patients with combined echinococcosis of the upper lobe of the right lung and liver were operated with another one-stage surgical method through thoracotomy in the third and sixth or seventh intercostal space. These methods are characterized by low traumaticity, decreased number of postoperative complications and hospital stay.

[Reconstructive-reparative surgeries on the esophagus in burn cicatricial strictures].

Esophagoplasty was performed in 196 patients. Combined disease of the esophagus and stomach was in 71 patients. Esophagogastroplasty was performed in 122 patients, including 104 with gastric tube, 12 -- with whole stomach, 6 -- by means of lengthening of whole stomach. Insufficiency of cervical anastomosis was revealed in 17.2% cases. Long-term results (from 6 months to 9 years) were studied in 77.9% patients. Lethality was 4.2%. Esophagocoloplasty was performed in 74 patients. Insufficiency of cervical anastomosis was seen in 14.5% cases. Long-term results (from 5 months to 9 years) are available in 87.8% patients. Lethality was 4.1%.

[Adequate gas exchange in two-sided and combined surgeries on thoracic and abdominal organs].

Method of combined artificial lung ventilation during simultaneous two-sided operations on the lungs was studied in 60 patients. This method is based on traditional ALV with parameters calculated according to functional state of the patient's respiratory system, and additional high-frequency jet pulmonary ventilation. The developed method was not accompanied by any severe disorders of gas exchange and mechanics of ventilation.

[Transbiliary interventions under videolaparoscopic control].

Transbiliary interventions under videolaparoscopic control were performed in 203 patients with benign diseases of bile ducts, in 78 of them the procedures were of purely diagnostic character. Laparoscopic microcholecystostomy was fulfilled in 117 patients. In 11 of them no desirable results were obtained. All of them had been operated upon for emergency indications. In the "cold" period operations were performed on 88 patients.

[Changes in conditioned reflex activity during adaptation of the rat to pressure-chamber and high-altitude hypoxia]. / Izmenenie uslovnoreflektornoi deiatel'nosti v protsesse adaptatsii krys k barokamernoi i vysokogornoi gipoksii.

A group of rats with a stereotype of conditioned reflexes was preliminarily trained to hypoxia effects during 30 days (at the "altitude" of 6000 m, time of exhibition--from 10 to 60 min, for 18 days--only 60 min). Adaptive changes in the process of training consisted in a weakening of differentiation inhibition, partial amnesia of the conditioned reaction of active avoidance and appearance of phasic states (equalization and paradoxical phases) in the cerebral cortex. The following adaptation of hypoxia "trained" rats to new natural conditions of Alpine altitude (3200 m) proceeded favourably, without disturbance of differentiation inhibition and without phasic states. Rats without preliminary training to altitude chamber hypoxia, in mountains (3200 m) were subjected to moderate tension resulting in protective inhibition, partial amnesia and transient disturbance of differentiation inhibition.

[Prostacyclin-thromboxane imbalance after adrenergic damage of the heart and aorta and its correction with calcium antagonist finoptin and the adaptation to high-altitude climate]. / Prostatsiklin-tromboksanovyi disbalans pri adrenergicheskom povrezhdenii serdtsa i aorty i ego korrektsiia antagonistom kal'tsiia finoptinom i adaptatsiei k gornomu klimatu.

Adrenergic cardiac and aortic lesion was reproduced by using intramuscularly a stress-necrogenic epinephrine dose of 2 mg/kg. Following 24 hours, the levels of malonic dialdehyde (MDA) as a TxA2 marker, were measured in the platelets. The antiaggregability of the aortic wall where PGI2 is synthesized was also examined. The adrenergic lesion was found to impair the platelet function-vascular wall balance, creating the condition for enhancing spontaneous platelet aggregation. This led to 50% death of experimental "lowland" rats. The short-term high-altitude adaptation failed to substantially modify the death rates in adrenergic lesion, though the platelets showed a 30% decrease in MDA generation. The combination of high-altitude adaptation and the calcium antagonist finoptin completely prevented the stress-induced increase in the platelet generation of MDA, a TxA2 marker, which was followed by a drastic reduction (16.6% versus 50%) in sudden death cases among the rats during adrenergic cardiac and aortic lesion.

[Morphologic changes in the esophagus in chronic hemodialysis and after kidney transplantation]. / Morfologicheskie izmeneniia pishchevoda pri khronicheskom gemodialize i posle peresadki pochki.

Oesophageal biopsies were studied in 80 patients with terminal stage of chronic kidney failure (CKF) treated with programmed hemodialysis and in 27 kidney transplant recipients. The following changes in the oesophagus were found: chronic oesophagitis, degenerative changes (oedema with balloon degeneration), intercellular oedema with formation of cavities filled with oedematous liquid, calcium deposits in the mucosa and submucosa. Degenerative changes occur more frequently in patients treated with hemodialysis and soon after the kidney transplantation. This can explain more frequent occurrence of Mallori-Weiss syndrome and erosions and ulcer of the oesophagus at CKF.

[Changes in lipid peroxidation and the antioxidative system of the myocardium in adrenaline-induced damage of the heart]. / Izmenenie perekisnogo okisleniia lipidov i antioksidantnoi sistemy miokarda pri adrenalinovom povrezhdenii serdtsa.

Epinephrine-induced cardiac injury (ECI) was simulated in rabbits. The indices of the system of peroxidation of lipids (LPO) and antioxidants were examined during various periods (3 hours, 3 and 9 days) of ECI. It was found that lower lipid antioxidative activity of blood, i.e. weaker body's antiperoxide protection, was found most early, then there was higher malonic dialdehyde (MDA) (a marker of thromboxane, TBA2) generation. The increase in antiperoxidase protection occurred at the level of the target organ (heart). There was a rise in the activity of the antioxidative enzyme superoxide dismutase and inhibited formation of primary products of LPO such as dien conjugates from early to 9 hours of the observation. When the natural antioxidant alpha-tocopherol was given prior to ECI, it prevented enhanced MDA formation in the platelets, optimized prostacyclin synthesis in the vascular wall, and stabilized blood lipid antioxidative activity.

[Ultrastructural changes in tissues in postburn cicatricial esophageal stenosis during bougienage and prolonged intubation]. / Ul'trastrukturnye izmeneniia tkanei v posleozhogovykh rubtsovykh suzheniiakh pishchevoda pri buzhirovanii i dlitel'noi intubatsii.

The ultrastructure of tissues in postburn esophageal strictures was studied in 24 patients varying in ages from 23 to 70 years with the postburn period ranging from 1 1/2 months to 36 years. Biopsy samples for the study were collected during fibroesophagoscopies before treatment, after bougienage and longterm intubation with the Tkachenko tube. Before treatment, pathologically altered granulation tissue forming the surface of ulcerated esophageal strictures was found to contain such mature forms of fibroblasts as collagenoblasts with moderate collagen-producing activity, myofibroblasts, and fibrocytes. Mechanical effects of bougienage and intubation of the esophagus stimulated formation of young granulation tissue in the area of ulcerated strictures, intubation of the strictures stimulating both biosynthesis and catabolism of collagen. Mature forms of fibroblasts of young granulation tissue formed in bougienage were represented by collagenoblasts with intensive collagen-producing activity, myofibroblasts, fibrocytes, and after long-term esophageal intubation also by fibroclasts.

[Effect of hormone-induced stress and high altitude on the higher nervous activity of rats]. / Vliianie gormonalno indutsirovannykh stressov i vysokogor'ia na vysshuiu nervnuiu deiatel'nost' krys.

The hormonally induced stresses have been studied for their effect on higher nervous activity (HNA) of rats under conditions of low-(1760 m above the sea level) and highland (3200 m above the sea level). Hydrocortisone-induced stress (HIS) in mountains decreases to an optimal degree the latent period (LP) of conditioned reflex of active avoidance (CRAA) and strengthens differentiating inhibition (DI). In mountains and on plain it impedes appearance of extinctive inhibition (EI). DOCA-induced stress (DIS) has the same effect though in the emergency period of adaptation it sharply (unlike GIS) increases the number of cases of CRAA amnesia manifestation and prolongs their LP. ACTH-induced stress (AIS) makes the appearance of amnesia cases more frequent and prolongs LP of realized CRAA, unlike DIS, over all the periods of Alpine adaptation. However, DI strengthens, while EI is hindered irrespective of the altitude level. Injection stress in mountains occurs with deviations of HNA; the number of cases of the CRAA amnesia increases as well as differentiation disinhibition. DI fails rapidly being tested for strength. Adaptation of intact rats to highland occurs faithfully without essential changes of LP but with impeded development of EI.

[The characteristics of suppurative wounds treated with xenogenic splenic homogenate]. / Kharakteristika gnoinykh ran pri lechenii gomogenatom ksenogennoi selezenki.

The authors discuss the results of treatment of 60 patients with persistent purulent wounds by applications of pig spleen homogenate (30 patients) and by the commonly accepted method (30 patients). The cytologic and microbiological data studied during the course of the wound process in both groups are analysed. The terms of cleansing, regeneration, and epithelialization of the wound surface were analysed comparatively; they were found to be 1.5 times shorter in treatment with a homogenate of xenogeneic spleen. It was thus established that a pig spleen homogenate produces a good antiinflammatory and necrolytic effect and absorbs the detritus, microbes, and toxins.

[Microsurgical reconstructive-rehabilitative operations in traumatic lesions of the peripheral nerves]. / Mikrokhirurgicheskie rekonstruktivno-vosstanovitel'nye operatsii pri travmaticheskikh povrezhdeniiakh perifericheskikh nervov.

Microsurgical reconstructive-restorative operations were conducted on the peripheral nerves of the limbs in 381 patients at the Kazakh centre of microsurgery from 1983. The patients were divided into 3 groups: group 1-60 patients who underwent emergency neurography during replantation of limbs and their segments; group 2-186 patients in whom neurovascular bundles of the limbs were restored (320 nerves were restored) in the late period after the trauma; group 3-135 patients who were subjected to operative interventions on the brachial plexus and the adjacent vessels. In sequelae of injury to the neurovascular bundles of the limbs and the trunks of the brachial plexus one-stage operations must be carried out on the peripheral nerves and the accompanying vessels. The result of the operation is determined by the lapse of time from the moment of the injury, the type of reconstruction, and the length of the graft used.

[The treatment of joint cicatricial lesions of the esophagus and stomach]. / Lechenie sochetannykh rubtsovykh porazhenii pishchevoda i zheludka.

Treatment of 108 patients with concurrent cicatricial stenosis of the esophagus and stomach is analysed. Various operations were performed on the stomach in 70 patients. The patency of the esophagus was restored by forced bougienage and intubation. The late-term results were studied in 48 patients in follow-up periods of 2-13 years. Forty-two patients feel quite well and are engaged in physical work, they live on a common diet. Six have to chew their food thoroughly. Two patients died in the postoperative period.