[Outcomes of endoprosthetic repair of abdominal aortic aneurysm]. / Rezul'taty éndoprotezirovaniia anevrizmy briushnogo otdela aorty.

AIM: The study was aimed at assessing efficacy and safety of endovascular treatment of abdominal aortic aneurysms based on 11-year experience with implantation of stent grafts. PATIENTS AND METHODS: We retrospectively analysed outcomes of treatment of 242 patients with abdominal aortic aneurysm during the period from 2008 to 2019. Of these, 210 (86.78%) were males, mean age 69.32±7.36 years. Diagnosis was made using colour duplex scanning and contrast-enhanced multislice spiral computed tomography, with implanting the following stent grafts: Ella - 44, Ovation Prime - 33, Anaconda - 13, Endurand - 77, Aortix - 2, Zenith - 33, Seal - 39, with one endoprosthesis placement failed. Assessing safety of the operation, we took into consideration lethality due to aortic rupture/thrombosis. Efficacy was taken to mean technical success of the operation (implantation of all components of the endograft without switch to open surgery), the number of reoperations. RESULTS: Technical success of the operation was achieved in 98.35% of cases. In 1 case due to pronounced arterial calcification for technical reasons we failed to position the stent graft and in another case - the contralateral leg of the Ella prosthesis. The early postoperative period revealed: type A1 endoleak - 3.7%, type IB - 4.13%, type IIA - 6.6%, type IIB - 4.54%, type III - 0.83%, type IV - 0.83%. Repeat operations were performed in 20 (8.2%) patients within 30 days after the intervention and in 32 (13.22%) in the remote period. In the early postoperative period two conversions were performed: 1) iliorenal bypass grafting for restoration of blood flow through the renal artery occluded by endoprosthesis wall; 2) evacuation of retroperitoneal haematoma due to rupture of the common femoral artery. Lethality during the whole period of follow up amounted to 32 (13.22%) cases. Of these, due to aortic complications 4.54% (n=11) and due to accompanying pathology 8.67% (n=21). A direct correlation was revealed between the aortic diameter and duration of the operation which in turn increases the risk of complications requiring re-operation or resulting in a lethal outcome (RR - 1; 95% CD 1- 1; p=0.026). CONCLUSION: Our experience showed high safety and efficacy of stent graft implantation in treatment of patients with abdominal aortic aneurysms and high surgical risk.

[Robotic-assisted operations for pathology of the aortoiliac segment: own experience]. / Robot-assistirovannye operatsii pri patologii aorto-podvzdoshnogo segmenta: nash opyt.

AIM: The present study was aimed at assessing the results of a total of 40 vascular operations carried out using the robotic-assisted da Vinci surgical system. PATIENTS AND METHODS: Between January 2013 and September 2019, a total of 40 robotic-assisted vascular operations were performed at the Department of Vascular Pathology and Hybrid Technologies of the Centre of Vascular and Hybrid Surgery. Of these, 31 interventions were carried out for occlusion of the aortoiliac segment and 9 for removal of an aneurysm of the infrarenal portion of the abdominal aorta. The patients were arbitrarily divided into 2 groups: the first group included those subjected to aortofemoral bypass grafting procedures for atherosclerotic steno-occlusive lesions of the aorta and iliac arteries, whereas the second group comprised the patients who underwent aneurysmoectomies with linear prosthetic repair of the abdominal aorta. RESULTS: Altogether, elective robotic-assisted operations were successfully performed in 38 (95%) cases. Conversion to a laparotomic approach was required in 2 (5%) patients. The mean time of creating an anastomosis with the abdominal aorta amounted to 51 minutes (range 30-90), being 42±4.75 min for aortofemoral bypass grafting and 83±5.00 min for aneurysmoectomies with linear prosthetic repair of the abdominal artery. The average blood loss was 316 (range 50-1000) ml, amounting to 280±209 ml and 438±322 ml for group I and group II, respectively. With the exception of one case, all patients spent 24 hours in the intensive care unit to be then transferred to the specialized ward. The average length of hospital stay amounted to 9.8 days. One patient experienced haemorrhage from the central anastomosis in the early postoperative period and was emergently operated on from a laparotomic approach. Four (10%) patients developed nonlethal complications which were treated conservatively. During the 30-day follow-up period, no lethal outcomes, thromboses, nor infections of the prostheses were observed. CONCLUSION: From a practical point of view, the major advantages of using the robotic-assisted complex include minimal surgical trauma, reduced blood loss, a wide range of high-precision movements of the manipulators, 3-D visualization with a 5-fold magnification, thus making it possible to create a vascular anastomosis sufficiently fast in very tight spaces in the body. Our experience with laparoscopic robotic-assisted surgery demonstrated feasibility of using this technique for treatment of pathology of the aortoiliac segment.

Stenting of the carotid artery with CGuard and Acculink stents: interim results of a randomized trial. / Stentirovanie sonnoi arterii stentami CGuard i Acculink: promezhutochnye rezul'taty randomizirovannogo issledovaniia.

AIM: The study was undertaken to evaluate safety and efficacy of carotid stents Acculink (open-cell carotid stent) and CGuard (closed-cell type stent) in treatment of patients presenting with atherosclerotic lesions of carotid arteries. PATIENTS AND METHODS: The study enrolled a total of 50 patients diagnosed with haemodynamically significant stenosis of the carotid artery and divided into two groups of 25 patients each. Group One patients received Acculink stents and Group Two patients underwent implantation of CGuard stents. Ultrasonographic examination was performed in all patients before and after surgery, as well as at 6 and 12 months thereafter; magnetic resonance imaging of the brain was carried out before and after surgery (at 24-48 postoperative hours and on POD 30). The entire period of follow up included 5 examinations of each patient by a neurologist. The obtained findings were statistically analysed using the Statistica 12 software (StatSoft, USA). The level of deviation of the null hypothesis of the absence of differences between the groups was regarded as significant at p<0.05. RESULTS: The technical success of the operation amounted to 100% in both groups. There were no complications (such as haematoma, arterial dissection, etc.) in the area of the approach in either group. The findings of ultrasonographic examination of the extracranial portion of the carotid arteries demonstrated a significant difference in the form of a decrease in the degree of narrowing of the operated vessel (p<0.05) as compared with its initial parameters. The number of the detected foci of acute cerebral ischaemia in the postoperative period (24-48 h) amounted to: in the Acculink group - 14 (56%), in the CGuard group - 12 (48%), p>0.77. Of these, multiple foci in Group One were encountered significantly more often than in Group Two (p=0.02). The patients with the Acculink stent implanted were found to develop 2 (4%) episodes of acute cerebral circulation impairment: the first one occurring after 24 hours and the second one at 28 days after stenting, with no such complications observed in Group Two patients. CONCLUSION: Comparing the two stents (Acculink and CGuard) demonstrated no advantages with respect to safety and efficacy of either stent in endovascular treatment of patients with atherosclerotic lesions of brachiocephalic arteries.

[Endoprosthetic repair of the aorta for an infrarenal aneurysm combined with occlusion of one of the iliac arteries]. / Éndoprotezirovanie aorty pri anevrizme infrarenal'nogo otdela v sochetanii s okkliuziei odnoi iz podvzdoshnykh arterii.

Described herein is a clinical case report regarding successful endovascular treatment of a patient presenting with an abdominal aortic aneurysm combined with occlusion of one of the iliac arteries. Cases concerning elimination of such pathology appear to be reported only sporadically in the available literature. The patient underwent reconstructive repair in two stages. The first stage comprised recanalization with stenting of the occluded iliac artery on the right and implantation of the Zenith stent graft. The findings of intraoperative check angiography showed no evidence of endoleak, with the preserved patency of both the stent graft and iliac arteries on the right. The second stage consisted of balloon angioplasty of stenosis of the external iliac artery on the left. The results of the follow-up examination at 3 years showed that the iliac arteries on both sides and the aortic endograft were free from significant stenoses, with no evidence of endoleaks.

[The use nicergoline in the treatment of diabetes mellitus]. / Ispol'zovanie nitsergolina v terapii oslozhnenii sakharnogo diabeta.

Presented herein is a literature review aimed at investigating the appropriateness and possibility of using nicergoline (sermion) for treatment of patients suffering from diabetes mellitus. The analysis includes the most clinically significant results of scientific studies. The material to be reviewed was retrieved using the following key words: 'nicergoline', 'sermion', and 'diabetes mellitus' (with their respective Russian equivalents) in such databases as Medline, PubMed, ScienceDirect, PMC, Cochrane, as well as archives of both Russian and foreign journals, guidelines (clinical guidelines on rendering medical care for patients with diabetes mellitus, selected lectures on endocrinology). A broad spectrum of action and no significant side effects have made it possible to use this drug in various pathological conditions. At the same time, because of limited experience of using nicergoline for vascular diseases and an insufficient number of the carried out studies the precise role of this therapeutic agent in clinical practice has not yet been conclusively defined. Special attention is given to the analysis of efficacy of nicergoline in atherosclerosis and diabetes mellitus.

[Treatment of type IB endoleak after endoprosthetic repair of infrarenal aneurysm]. / Lechenie éndolika IV tipa posle éndoprotezirovaniia infrarenal'noi anevrizmy.

The article deals with a case report regarding successful surgical management of late type IB endoleak caused by dislocation of the leg of the stent graft, occurring three years after endoprosthetic repair of an aneurysm of the aortic infrarenal portion with the COOK stent graft, aneurysmectomy with prosthetic repair of the right common femoral artery using the linear vascular graft Intergard 8Ч20. The patient underwent surgical treatment: endoprosthetic repair of the iliac branch ZSLE-24-90-90 ZT of the Zenith Spiral AAA stent graft. The findings of the check-up angiography and ultrasonographic examination revealed no evidence of endoleak, with the stent graft's patency preserved. The early postoperative period was marked with moderate manifestations of asthenic syndrome. The patient was discharged in a satisfactory condition. Cases concerning removal of similar complication in the remote period following endoprosthetic repair of the aorta are mentioned sporadically in the available literature.

[Staged implantation of an abdominal stent graft]. / Étapnaia implantatsiia abdominal'nogo stent-grafta.

The article deals with a case report regarding successful surgical management of a patient presenting with an anatomically complicated aneurysm of the aortic infrarenal portion and iliac arteries. The first stage consisted in performing implantation of the Ovation Prime stent graft into the abdominal aorta. One month later, the second stage carried out for residual type IB endoleak consisted in implantation of the iliac components of the stent graft into the external iliac arteries on the right and the left. The postoperative period turned out uneventful. The findings of the check ultrasonographic examination showed no evidence of endoleak, with the stent graft's patency preserved. The patient was discharged in a satisfactory condition. The check multispiral computed tomography performed 30 days after the operation also demonstrated complete isolation of the aneurysm of the aorta and iliac arteries from blood flow, with the graft's being patent. The presented herein clinical case report is of sporadic occurrence and is of practical importance for extending the indications for aortic endoprosthetic repair.

[Study of patency of vascular grafts manufactured by means of electrospinning].

UNLABELLED: In vivo experiments were carried out to study functioning of vascular grafts manufactured by means of electrospinning from solutions of polycaprolactone (PCL) and hexafluoroisopropanol (HFIP), PCL with 10% gelatine and a low-permeability inner layer (LPIL) 10 µm thick and PCL with 10% gelatine and LPIL (10 µm) wherein as polymeric base instead of PCL copolymer of lactic and hydroxyacetic acids (polylactide-co-glycolide, PLGA) was used. The grafts were implanted into the infrarenal portion of the aorta to 45 rats, 15 rats for each type of the graft. Patency of artificial vessels was assessed by means of magnetic resonance tomography and diagnostic ultrasound Dopplerography at 2, 4 and 20 weeks (5 animals for each time point). The state of the graft and surrounding tissues was analysed by means of intraoperative assessment, survey microscopy and survey fluorescent microscopy. CONCLUSION: The obtained findings demonstrated that vascular grafts made by electrospinning technique with a low-permeability inner layer are less prone to formation of the neointima and stenosing as compared with grafts having no such layer.

[Effect of extracellular matrix components on adhesion of bone marrow multipotent mesenchymal stromal cells to polytetrafluoroethylene].

Search for new bioengineering materials for creation of small-diameter vascular grafts is currently a priority task. One of the promising trends of creating tissue engineering constructions is coating the internal layer of implants made of polytetrafluoroethylene (PTFE) with autologous mesenchymal multipotent stromal cells. In the study we assessed the ability of separate components of the extracellular matrix such as fibronectin, type I collagen and type IV collagen to influence adhesion, proliferation and morphology of mesenchymal multipotent stromal cells being cultured on PTFE. Bone marrow multipotent stromal cells taken from second-passage Wistar rats in the amount of 106 per 1 cm2 were applied onto PTFE. We used the following variants of preliminary treatment of the material prior to seeding: fibronectin with type I collagen, fibronectin with type IV collagen, fibronectin with a mixture of type I and IV collagens, as well as a control group without coating. After six weeks of cell growth on PTFE patches the samples were subjected to fixation in 10% formalin followed by haematoxylin-eosin stain and morphometric assessment of adhered cells by calculation using the software AxioVision (Carl Zeiss), assessing the number of cells, area of the cellular monolayer, dimensions and ratios of the area of separate cells and the area of cellular nuclei. The maximal area of the monolayer from mesenchymal multipotent stromal cells on the PTFE surface was revealed while culturing with a mixture of fibronectin and type I and IV collagens. Cell colonization density while treatment of the synthetic material with mixtures of fibronectin with type I collagen, type IV collagen and type I and IV collagens demonstrated the results exceeding the parameters of the control specimen 5-, 2.5- and 7-fold, respectively. Hence, extracellular matrix components considerably increase enhance adhesion of cells to PTFE, as well as improve formation of a monolayer from mesenchymal multipotent stromal cells.

[Comparative characteristics of the physiometric parameters of schoolchildren' physical development].

The physiometric parameters (exercise performance, muscle strength, and lung capacity) were monitored in schoolchildren over the 15-year period. There has been a reduction in exercise performance, muscle strength and an increase in lung capacity in the past 15 years, which the pediatricians should take into account to detect physical development abnormalities in schoolchildren.

[Impact of ambient air pollution on the prevalence of main symptoms of asthma in children].

The impact of ambient air pollution on the prevalence of main symptoms of asthma was analyzed in children. A total of 3,506 children were interviewed using the ISAAC questionnaire. The prevalence of the abnormality was studied via continuous questioning in children aged 7-8 and 13-14 years, who lived in areas with varying aerogenic loads. The higher rates of main asthma-like symptoms and clinically diagnosed asthma were ascertained in the children living in higher ambient air pollution areas.

[The predictors of development of bronchial asthma in children].

The study of the predictors impacting the development of bronchial asthma in children was implemented. For each risk factor the chances ratio and its 95% confidence interval were calculated. The sample consisted of 280 children with bronchial asthma aged from 7 to 14 years and 210 healthy children of the same age. The risk factors having priority significance for the development of bronchial asthma in children are identified. The research data can be applied to calculate of the individual risks in population to forecast the development of bronchial asthma and its timely prevention.

[Comparative analysis of childhood morbidity depending on the type of feeding].

Retrospective and prospective studies were made in 1248 infants of the first year of life and in 642 children aged 7 to 14 years who lived in Kirov and its region. The purpose of the study was to evaluate the impact of different types of feeding on their morbidity. The children who had received an artificial feeding were ascertained to be more frequently ill both in their first year of life and at an older age.

[Comparative characteristics of physical development of first year infants].

Physical development data of 3740 first year infants born in 2002-2004 as compared with their 2782 coevals born in 1992-1994 is presented. Study results allowed to elaborate local standards of physical development of first year infants. It is established that in infants born in 2002-2004 increase of body mass and body height values occurs more steady than in their coevals born 10 years before. The reason is in altered approaches to infant feeding mode. Today, asthenization of first year infants relates to increase of chest circumference predetermining disharmonic development.

[Primary biliary cirrhosis of the liver]. / Pervichnyi biliarnyi tsirroz pecheni.

Primary biliary cirrhosis (PBC) of the liver is considered to be an autoimmune liver disease in which an immune aggression is directed against small biliary ducts--mitochondrial antigens of a biliary epithelium. The targets of an immune aggression in PBC may also be the histocompatibility antigens of the biliary ducts epithelium. This makes PBC resembling so-called disease "graft against host". The destruction of bile ducts in PBC is brought about through the mechanisms of an immune cytolysis and is manifested morphologically by the symptoms of the delayed hypersensitivity response. Cholangiole proliferation develops along the ductal destruction, sclerotic changes and cholestasis increase in their intensity. Small-nodular cirrhosis develops at the final stage of disease. Systemic manifestations of PBC are associated with a circulation of immune complexes containing hepatobiliary antigens. Cross-immune reactions are also of importance in the mechanisms of extrahepatic lesions.

[A statistical morphological analysis of cirrhosis and primary liver cancer (based on autopsy data from the clinics of the I. M. Sechenov 1st Moscow Medical Institute)]. / Morfologostatisticheskii analiz tsirroza i pervichnogo raka pecheni (po materialam prozektury klinik I MMI im. I. M. Sechenova).

Liver cirrhosis (LC) comprises 2.1% of 17,458 autopsies in the pathology department for the period from 1962 to 1987, the incidence has increased during the last decade. LC is more frequent in males than in females (ratio 1.36:1.0), the highest incidence in males being at the age of 40-49 years, in females 50-59 years. The main etiological factors of LC, growing in importance, are hepatitis B virus (28.6%) and ethanol (26.1%). The incidence of primary liver carcinoma is 0.9% of all the autopsies, hepatocellular carcinoma (HCC) being predominant (86.3%); it develops more frequently in LC of viral and ethanol etiology. This liver carcinoma has become more frequent in the last decade. Primary liver carcinoma, particularly HCC, is more frequent in males than in females (ratio 3.1:1.0), age peak between 50 and 59 years in males and 60-62 years in females.

[An evaluation of the degree of the morphological activity and the stage of the process in patients with chronic liver diseases caused by coinfection with the hepatitis B, C and/or D viruses]. / Otsenka stepeni morfologicheskoi aktivnosti i stadii protsessa u bol'nykh khronicheskimi zabolevaniiami pecheni, obuslovlennymi koinfektsiei virusov gepatitov B, C i/ili D.

In order to determine the differences in histological grade of activity and the stage of fibrosis in patients with chronic liver diseases due to multiple hepatitis virus infection and single infection of HBV and HCV we assessed the 68 liver biopsies samples according to Knodell and Scheuer scoring systems. Retrospectively, 216 liver biopsies reports from consecutive patients with chronic viral hepatitis were analysed. Histological activity index (HAI) in HBV/HCV coinfection was higher than in a single HCV infection; it did not differ in groups of HBV/HBC and HBV. The difference was due to the interface hepatitis; lobular activity and portal inflammation were the same. In HDV superinfection HAI was high due to both portal-periportal and lobular hepatitis. HAI depended mainly upon the presence of HBV replication; in patients with chronic hepatitis C with HBV-DNA HAI was also higher than in single HCV group. No difference in HAI between triple and dual hepatitis virus infection was found. In patients with HBV/HCV coinfection and especially with HDV superinfection the advanced stages occurred more than often than in patients with single infections.

[Cortical-cell thymomas with predominance of so-called nurse-cells in patients with myasthenia]. / Kortikal'nokletochnye timomy s preobladaniem kletok-"nianek" u bol'nykh miasteniei.

30 thymomas in patients with generalized myasthenia studied histologically and immunohistochemically are classified as cortico-cell thymomas (n-15), medullary-cell (n-1), mixed-cell (n-10) and cortical-cell thymomas consisting mainly of thymic "nurse"-cells. Pronounced histological features of thymomas with the predominance of "nurse"-cells allow one to consider them as a special variant of thymic tumours. Production of thymic hormones by tumour cells in combination with the loss of HLA-DR antigen expression may be of importance in the pathogenesis of autoimmunization in patients with myasthenia.