Experimental Model for the Study of Reparative Bone Regeneration in the Reconstruction of the Lower Jaw.

An experimental in vivo model has been developed on the rabbit mandible to study reparative regeneration of alveolar bone after intercortical split osteotomy and the role of the periosteum in the process of reparative osteogenesis. The peculiarity of this model is fixation of the periosteum over the reconstruction zone, which allows preserving the bone block displaced during surgery and leads to the formation of an organotypic structure of the regenerate with cortical and spongy bone.

[Prevalence and risk factors of delirium in COVID-19]. / Rasprostranennost' i faktory riska deliriya pri COVID-19.

OBJECTIVE: To assess the frequency and risk factors of delirium in patients hospitalized with COVID-19. MATERIAL AND METHODS: Four hundred and forty patients admitted to the Infectious Diseases Hospital of the University Clinical Hospital No.3 of Sechenov University were included in the study. The Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Screening Questionnaire-7 (GAD-7), the Insomnia Severity Index (ISI), the Delirium severity rating scale (DRS-R-98) were administered. RESULTS: Delirium was detected in 27.8% of patients. Significant risk factors were age (p=0.002), severity of respiratory failure (p=0.005), concomitant somatic disease (p=0.003), and respiratory therapy (p<0.001). There was an association between severe anxiety (p<0.001) and insomnia (p=0.07) observed at admission with the risk of developing delirium during the hospital stay. CONCLUSION: The study reveals a high prevalence of delirium in patients with COVID-19. In order to prevent delirium and/or reduce the risk, early diagnosis and identification of preclinical forms are of particular importance.

[Soy protein as part of a low-protein diet is a new direction in cardio- and nephroprotection in patients with 3B-4 stages of chronic kidney disease: prospective, randomized, controlled clinical study].

BACKGROUND: It has been established that the use of a low-protein diet (LPD) in combination with ketoanalogues (KA) of essential amino acids can contribute to cardio- and nephroprotection in chronic kidney disease (CKD). Moreover, it has been shown that replacing part of the animal protein with soy protein (SP) in the diet contributed to more pronounced nephro- and cardioprotection in CKD, however, the data, available in the literature, are mainly represented by experimental studies. AIM: To compare the effects of 2 types of diets on the main parameters of nephro- and cardioprotection in patients with CKD. MATERIALS AND METHODS: We have conducted a prospective, randomized, controlled clinical study which included 85 patients with 3B4 stages of CKD, compliant to LPD (0.6 g of protein/kg body weight) + KA (1 tablet/5 kg body weight). 43 patients (Group 1) received LPD with replacing animal protein with soy (60% soy protein + 40% another vegetable proteins) + KA, and 42 patients (control group, Group 2) received LPD (60% animal protein + 40% vegetable protein) + KA, within 12 months. RESULTS: The dietary substitution of animal protein with SP to a greater extent delayed the decrease in glomerular filtration rate (-5.9% vs -13.3%; p=0.048), the increase in left ventricular hypertrophy (+4.7% vs +12.3%; p=0.042), as well as the increase in central systolic blood pressure (+2.6% vs +13.0%; p=0.021), augmentation index (+7.6% vs +23.3%; p=0.010), slowed down the decrease in lean body mass in men (+0.9% vs -11.2%; p=0.017) and women (-1.8% vs -10.3%; p=0.024), increase in phosphorus (-10.3% vs +13.0%; p=0.029), cholesterol (-10.7% vs -3.4%; p=0.047) and urea (+6.3% vs +19.6%; p=0.035) serum levels. CONCLUSION: The use of LPD with substitution of animal protein with soy protein + KA provides a more pronounced effect on nephro- and cardioprotection as well as maintenance of nutritional status, than conventional LPD + KA in patients with 3B4 stages of CKD.

Micro X-ray Spectral Analysis and Comprehensive In Vivo Study of Modified Titanium Implants.

We developed a technique for the complex modification of the surface of dental implant made of VT1-0 titanium that included sequential mechanical treatment and irradiation with powerful ion beams. The chemical composition and physical properties of the surface of titanium implants (VT1-0 grade) sandblasted with subsequent acid etching, as well as subjected to complex treatment (sandblasting and irradiation with powerful ion beams) were evaluated using micro-X-ray spectral analysis. In in vivo experiments, osseointegrative properties of the implants subjected by these treatments were compared. Microrentgenospectral analysis of dental implants subjected to irradiation with powerful ion beams revealed higher indicators of surface cleanliness; in in vivo experiments, morphometric analysis also demonstrated high osseointegrative properties.

Scaffolds Based on Poly(3-Hydroxybutyrate) and Its Copolymers for Bone Tissue Engineering (Review).

Biodegradable and biocompatible polymers are actively used in tissue engineering to manufacture scaffolds. Biomedical properties of polymer scaffolds depend on the physical and chemical characteristics and biodegradation kinetics of the polymer material, 3D microstructure and topography of the scaffold surface, as well as availability of minerals, medicinal agents, and growth factors loaded into the scaffold. However, in addition to the above, the intrinsic biological activity of the polymer and its biodegradation products can also become evident. This review provides studies demonstrating that scaffolds made of poly(3-hydroxybutyrate) (PHB) and its copolymers have their own biological activity, and namely, osteoinductive properties. PHB can induce differentiation of mesenchymal stem cells in the osteogenic direction in vitro and stimulates bone tissue regeneration during the simulation of critical and non-critical bone defects in vivo.

Growth of Mesenchymal Stem Cells on Poly(3-Hydroxybutyrate) Scaffolds Loaded with Simvastatin.

We studied the effect of porous composite scaffolds based on poly(3-hydroxybutyrate) (PHB) loaded with simvastatin on the growth and differentiation of mesenchymal stem cells. The scaffolds have a suitable microstructure (porosity and pore size) and physicochemical properties to support the growth of mesenchymal stem cells. Scaffold loading with simvastatin suppressed cell growth and increased alkaline phosphatase activity, which can attest to their osteoinductive properties.

[Rationale for the use of bioactive cements by in vitro simulation of accidental pulp opening]. / Obosnovanie primeneniya bioaktivnykh tsementov dlya sokhraneniya zhiznesposobnosti pul'py pri ee sluchainom vskrytii.

OBJECTIVE: To study the features of reparative dentinogenesis when using biomaterials during accidental opening of the pulp in an experiment. MATERIAL AND METHODS: In an experiment on 3 dwarf pigs of the Svetlogorsk breed a traumatic opening of the tooth cavity was carried out in 18 teeth (6 molars, 6 premolars, 6 incisors), then Biodentin (9 teeth) and Aurosil (9 teeth) were applied on the opened pulp horn. After 14, 30 and 60 days, dwarf pigs were euthanized, and jaw blocks taken. Histological examination of the teeth was carried out using the method of embedding in methyl methacrylate (OsteoBead, Sigma, USA). Thin sections of 35-50 microns were made from the samples and stained using the «Heavenly Trichrome¼ method. Documentation was carried out using a Leica DM100 microscope and an EC3 digital camera in reflected and transmitted light. RESULTS: Histological examination of the thin sections of teeth stained according to the «Heavenly Trichrome¼ method revealed that 2 weeks after the pulp opening and applying of Aurosil and Biodentin, comparable processes occurred in the tooth cavity. Thus, the proliferation of odontoblasts was noted on the lateral surfaces of the chamber. New dentin layers and odontoblasts spread over the lower surface of the material with the formation of dentinal bridges by 4 weeks of observation in both groups. By week 12, there was a decrease in the proliferative activity of odontoblasts and dentin maturation in all cases. At the initial stages of the experiment, some pulp edema and moderate plethora were noted, which was no longer observed at 4 weeks. By 12 weeks, because of the proliferation of odontoblasts, the volume of the tooth cavity was reduced by a third. By the 6th month in the experiment, no significant changes in the structure of dentin and pulp were revealed. CONCLUSION: According to morphological data the studied biomaterials (Aurosil and Biodentin) contribute to dentin regeneration equally.

Biocompatibility and Bioresorption of 3D-Printed Polylactide and Polyglycolide Tissue Membranes.

We studied biocompatibility and bioresorption of 3D-printed polylactide and polyglycolide tissue membranes. Ultrasound microscopy and histological examination showed that membranes fabricated of a copolymer of lactic and glycolic acids in a mass ratio of 1:9 are bioresorbed and have good biocompatibility with soft tissues (connective tissue, adipose tissue, and epithelium). An important feature of the copolymer membranes, which differs them from pure polylactide membranes, is the formation of a thin fibrous capsule that did not interfere its destruction by the mechanism of hydrolytic resorption.

[Organ changes found by postmortem examination in COVID-19 patients]. / Izmeneniya organov, vyyavlennye pri posmertnom issledovanii patsientov s COVID-19.

The postmortem study results presented in 20 sources of literature on 186 COVID-19 patients were analyzed. Pathological changes were noted in multiple organs, by involving predominantly the respiratory, circulatory, and excretory systems. The changes in the lungs were characterized by an increase in organ weight (59.3%), a dark red color of the parenchyma (47.4%), compaction of lung tissue (56%), and signs of lung congestion (37.3%). The histological characteristics found during postmortem lung tissue examination, which were indicative of diffuse alveolar damage, were proliferation of type II alveolocytes in 65.2% of cases, the appearance of hyaline membranes lining the alveoli in 64.4%, and interstitial edema in 54.2%. In the analyzed sources, 22% of cases were noticed to have severe thrombosis and pulmonary artery branch embolism that was associated with lower extremity deep vein thrombosis. In all the sources of literature, acute tubular necrosis, tubular luminal dilatation, and interstitial edema were detected in the kidneys.

Structural Dynamics of the Fibrous Basis of Reparative Regenerate during Spontaneous Healing of the Skin Wound.

Structural dynamics of the fibrous basis of the reparative regenerate during spontaneous skin wound healing comprises multiple stages, it successively transforms from one organization level to another more complex level, forms a multilevel 3D structure including molecular, supramolecular, fibrillar, fiber, and tissue elements. The formed reparative regenerate is integrated with the preserved skin, together they have common fibrous basis consisting of three parts that are different in organization of fibrous structures: atypical (central), tissue organospecific (peripheral), and transitional.

Bilateral thalamic stroke in patient with patent foramen ovale and hereditary thrombophilia.

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

[Regeneration of dental pulp tissue using pulpal autologous mesenchymal stem cells and platelet-rich plasma]. / Regeneratsiia pul'py zuba s ispol'zovaniem autologichnykh mezenkhimal'nykh stvolovykh kletok pul'py i obogashchennoi trombotsitami plazmy.

Regeneration of pulp and dentin could be important in operative dentistry as a method to save teeth. Currently cell population from dental pulp of deciduous and permanent teeth of humans and laboratory animals are isolated and characterized. The paper presents a study on pulp regeneration using autologous mesenchymal stromal cells from pulp of molars in combination with fibrin clot, transplanted in pulp chamber of miniature pigs after pulp removal. The results proved that transplantation of autologous multipotent stromal cells of dental pulp in combination with autologous platelet-rich plasma in pulp chamber of miniature pigs after pulp removal leads to pulp restoration and reparative dentinogenesis with dentinal bridge formation on the 30th day. However, the completion of regeneration also results in a decrease in the pulp chamber volume due to the neodentin bedding. Tissue regeneration of dental pulp by direct pulp capping in the absence of inflammatory processes is a promising direction of the use of cellular technologies.

Peculiarities of vitalization of grafts made of porous polytetrafluoroethylene in reconstruction of major veins (an experimental study). / Osobennosti vitalizatsii protezov iz poristogo politetraftorétilena pri rekonstruktsii magistral'nykh ven (éksperimental'noe issledovanie).

Increased incidence of locally disseminated malignant neoplasms with invasion of major veins compels modern surgery to search for an optimal material for reconstruction of major veins. Presented herein are the results of an experimental study aimed at exploring patency and peculiarities of vitalization of grafts made of porous polytetrafluoroethylene (7th generation, 2010) manufactured by the Closed Joint Stock Company 'Research and Production Complex 'Ecoflon' (St. Petersburg, Russia) with an internal diameter measuring 4.0 mm and used for reconstruction of major veins and arteries with a follow up period up to 270 days. Vitalization of porous polytetrafluoroethylene grafts in the venous position is comparable to that in the arterial position, having similar patterns. Both in the arterial and venous position, vitalization of the graft proceeds at the expense of 'crawling' of the neointima from the anastomoses to the centre of the graft. To distinctive peculiarities of vitalization of grafts in the venous position belong statistically significantly larger thickness of the neointima in the venous position at all stages of the study, lack of statistically significant difference of the neointimal thickness near the edges and in the central part of the graft in the venous position at 270 days. Neither thromboses nor haemodynamically meaningful stenoses of the porous polytetrafluoroethylene grafts and anastomoses in the venous position, despite low velocity of blood flow and its laminar pattern, were observed at any terms of follow up. The obtained findings are indicative of the possibility and validity of using porous polytetrafluoroethylene grafts for reconstruction of major veins in clinical practice.

[ISCHEMIA - the Largest Ever R andomized Study in Stable Coronary Artery Disease. Baseline Characteristics of Enrolled Patients in One Russian Site].

Indications for coronary revascularization in patients with stable coronary heart disease (CHD), presented in the current international guidelines are largely based on the clinical trials conducted sometimes more than 30 years ago. ISCHEMIA is the major multicenter international randomized trial intended to answer the question about the optimal treatment strategy in stable coronary artery disease at the present time. PURPOSE: To analyze the most important baseline characteristics of patients enrolled in the ISCHEMIA study in one Russian site. METHODS: The principal inclusion criteria are a positive stress test (in our center, exercise stress echocardiography) of at least moderate risk and obstructive coronary heart disease confirmed by coronary computed tomography angiography (CCTA). Main exclusion criteria are a significant stenosis of the left main coronary artery by CCTA, clinical progression/destabilization of the ischemic heart disease, angina of IV CCS class, left ventricular ejection fraction (EF) 80% - beta blockers, >80% - ACE inhibitors/ARBs. They are at well controlled resting heart rate (.

[The age-specific changes in the histological structure of the thyroid cartilage in the men]. / Vozrastnye izmeneniia gistologicheskoi struktury shchitovidnogo khriashcha u lits muzhskogo pola.

The objective of the present study was to elucidate the morphological and morphometric characteristics of the human thyroid cartilage during different periods of life. The thyroid cartilages were harvested from 70 cadavers of the subjects of the masculine gender who had died at the age from 1 to 93 years from the non-violent causes and had neither injuries nor signs of pathological changes in the neck organs. The microscopic studies were carried out using the standard methods for the staining of the preparations with hematoxylin and eosin. The following parameters were evaluated: the area of the cartilaginous and bone tissues, the average area of the cartilaginous and bone tissues in the field of vision, the average width of the cartilaginous plate, the thickness of the cortical plate, the number of trabeculae, the average area and length of the trabeculae, the average, minimal, and maximum area of the trabeculae, the number of the young and mature chondrocytes, the width of the zones of the young and mature cartilage and their ratio, the area of the reticular-fibrous and adipose tissues and their ratio. In addition, we also determined mean values, standard deviations, correlation coefficients, and the significance of differences (p). The following characteristics exhibited the most significant correlation with the age: the average area of the bone (r=0.69) and cartilaginous (r=-0.63) tissues, adipose (r=0.67) and reticular fibrous (r=0.61) tissues, the average length of the trabeculae (r=0.7), the number of young chondrocytes in the field of vision (r=-0.789). It is concluded that the described correlations can be helpful in the practical forensic medical activities as the additional diagnostic criteria for the determination of the human age.

[Behçet's disease: Intracardiac thrombosis (a description of two cases and a review of literature)]. / Bolezn' Bekhcheta: vnutriserdechnyi tromboz (opisanie dvukh nabliudenii i obzor literatury).

Behçet's disease (BD) is systemic vasculitis of unknown etiology, which is more common in the countries located along the Great Silk Road. The disease is diagnosed if a patient has 4 key diagnostic signs: aphthous stomatitis, genital sores, and eye and skin lesions. Vascular diseases referred to as minor criteria for BD are characterized by the formation of aneurysms and thrombosis, predominantly in the venous bed. In venous disorders, a blood clot can form in any vessel, including caval, cerebral, pulmonary, and other veins. The paper describes two clinical cases of BD with intracardiac thrombosis. In one case, a 24-year-old male patient with a documented diagnosis of BD, echocardiography revealed a left ventricular spontaneous echo contrast phenomenon that disappeared due to immunosuppressive therapy. The other case was a 34-year-old female patient, in whom the diagnosis was based on the international disease criteria: aphthous stomatitis, skin lesions (pseudopustulosis, erythema nodosum), and genital sores. Computed tomographic angiography showed a 3.7×2.2-cm mass (thrombus) in the right atrium. In addition, blood clots were present in the hepatic and inferior vena cava. No abnormalities in the coagulation system were found in both cases.

[COMPLEX IMMUNOGLOBULIN PREPARATION FOR THERAPY OF PERTUSSIS IN YOUNG CHILDREN].

AIM: Study the possibility of inclusion of complex immunoglobulin preparation (CIP) pos- sessing specific activity against pertussis exotoxins into complex therapy of pertussis infection in young children. MATERIALS AND METHODS: -2 groups of children with.pertussis younger than 3 years were examined. The main group (50 individuals) received CIPper os - 1 dose 1 - 2 times per day for 5 days, comparison group (34 children) received only basic therapy. Evaluation of clinical effectiveness of CIP was carried out, the content of anti-pertussis class G antibodies and total IgE in patients were studied. RESULTS: A good clinical effectiveness of the preparation was shown, as well as immune modulating activity against humoral immune response to pertussis infection. CONCLUSION: The detected positive effect of CIP on pertussis -course in children has indicated a principally novel use of this per oral drug form.

[N-terminal pro-brain natriuretic peptide levels and diastolic dysfunction in patients with early rheumatoid arthritis before the administration of disease-modifying antirheumatic drugs].

AIM: To determine N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with early rheumatoid arthritis (RA) before the use of disease-modifying antirheumatic drugs (DMARDs); to compare NT-proBNP values with traditional risk factors (TRF), cardiovascular diseases (CVD), inflammatory markers, and left ventricular (LV) diastolic dysfunction (DD). SUBJECTS AND METHODS: The investigation enrolled 74 patients with a valid RA diagnosis (the 2010 ACR/EULAR criteria), 56 (74%) women, median (Me) age, 54 years; disease duration, 7 months; seropositive for IgM rheumatoid factor (87%) and/or anti-cyclic citrullinated peptide antibodies (100%) with no history of the use of DMARDs and glucocorticosteroids. Duplex scanning and echographic findings were used to assess TRF for CVD and carotid artery atherosclerosis (CAA) in all the patients with early RA prior to therapy. An E/A ratio was used as a criterion for LVDD. RESULTS: NT-proBNP concentrations in patients with early RA proved to be higher than those in the control group (p<0.0001). Higher-than-normal NT-proBNP levels were seen in 36 (49%) patients. The patients with early RA and elevated NT-proBNP values were older and had a higher body mass index (BMI) than those with normal NT-proBNP levels. Those with elevated NT-proBNP concentrations were more frequently found to have CAA, coronary calcification, and coronary heart disease; their intima-media thickness was also larger and C-reactive protein (CRP) levels higher than in those with normal NT-proBNP values. There were correlations between NT-proBNP levels and erythrocyte sedimentation rate, CRP, simplified disease activity index, and clinical disease activity index. Multivariate analysis revealed that chronic heart failure (CHF), CAA, CRP and low-density lipoprotein (LDL) levels, and BMI correlated with NT-proBNP concentrations. LVDD was detected in 35 (48%) patients with early RA. The level of NT-proBNP in patients with DD was higher than in those without DD. Higher-than-normal NT-proBNP values were observed in 23 (65%) and 12 (32%) patients with and without LVDD, respectively. The optimal NT-proBNP level for CHF detection was equal to 237.4 pg/ml (86% sensitivity and 85% specificity); the area under the ROC curve was 0.879. CONCLUSION: Just at the early disease stage, the patients are noted to have a high NT-proBNP level that is influenced by higher BMI, low LDL levels, CAA, CHF, and high CRP values. In the patients with early RA, the diagnostically significant NT-proBNP concentration for CHF detection was higher (237 pg/ml) than in those without RA (125 pg/ml). The patients with early RA should undergo NT-proBNP determination, LVDD screening, correction of TRF for CVD, atherosclerosis treatment, and remission achievement.

[EXPERIENCE WITH THE USE OF EPTIFIBATIDE IN ACUTE CORONARY SYNDROME DURING CORONARY INTERVENTION IN PATIENTS OLDER AGE GROUP].

Acute coronary syndrome is the leading cause of death in patients older age group. Primary PCI is nearly uncontested revascularization method because of its efficacy in reperfusion achievement and less hemorrhagic complications compared to systemic thrombolytic therapy. Nevertheless, the age of the patients is a significant bleeding risk factor, sophisticating the choice and dosing antiplatelet and anticoagulant therapy during coronary angioplasty and stenting. Blocker 2b/3a receptor eptifibatide are used to avoids the development of ischemic complications and improves myocardial perfusion, but accompanied with bleeding risk during common infusion (12-18 hours). Combined intracoronary and intravenous infusion eptifibatide during only coronary intervention enhance procedure safety.

[THE DYNAMICS AND STRUCTURE OF INDICATORS OF SECONDARY DISABILITY DUE TO CEREBROVASCULAR DISEASES IN THE ELDERLY IN ST. PETERSBURG IN THE PERIOD 2005-2014].

The article presents data about secondary disability due to cerebrovascular diseases in the elderly based on results of examination in the Bureau of medical-social expertise of Saint Petersburg in the period from 2005 to 2014. Тhe analysis revealed a high proportion of the disabled elderly in the structure of disability due cerebrovascular diseases; and the growth of the share of people with disabilities elderly in the analyzed period.