[Role of superoxide dismutase in acute pancreatitis: from antioxidant protection to gene regulation]. / Rol' superoksiddismutazy pri razvitii ostrogo pankreatita: ot antioksidantnoi zashchity do regulyatsii aktivnosti genov.

We present modern data on the role of superoxide dismutase (SOD) in antioxidant protection and gene regulation in acute pancreatitis. Antioxidant enzymes are essential in pathogenesis of numerous diseases. SOD is one of the key enzymes of antioxidant system. In this review, we analyzed activity of this enzyme depending on various factors, mechanisms and role in physiological and pathological processes, in particular, acute pancreatitis. SOD is significantly less active in patients with severe acute pancreatitis accompanied by renal failure, severe circulatory disorders and high mortality. There are some SOD gene polymorphisms, in particular, acute destructive pancreatitis R213G, contributing to acute inflammation. Thus, SOD is not only one of the key antioxidant enzymes, but also potential transcription factor regulating activity of signaling pathways. These aspects can underlie new therapies for diseases.

[The efficiency of totally tubeless percutaneous nephrolithotomy: analysis of 40 cases].

INTRODUCTION: Previously, the placement of a nephrostomy tube was considered standard practice during percutaneous nephrolithotomy (PCNL) to ensure repeat access and kidney assessment. However, some publications have shown that in certain cases, a totally tubeless approach may be a viable alternative, provided that PCNL is performed properly and safely. AIM: To analyze the results and complications of totally tubeless PCNL. MATERIALS AND METHODS: A retrospective analysis of 40 patients with renal stones who underwent totally tubeless PCNL using a single percutaneous access of 16 Ch or 26 Ch at the urology department of NUZ KB "RJD-Medicine", Krasnoyarsk, Russia, from September 2021 to March 2023, was carried out. Factors that could affect the efficiency and safety of PCNL were analyzed. RESULTS: The mean duration of the procedure was 39.6 +/- 14.4 minutes. The average decrease in hemoglobin level was 5.9 +/- 5.5. Narcotic analgesics were used postoperatively in 17.5% (7) of patients. The mean length of stay was 4.7 +/- 1.1 days. Transient fever was observed in 4 (10%) cases. In one case, an exacerbation of chronic pyelonephritis developed. There were no cases of significant bleeding during the PCNL, and no patients required blood transfusion. CONCLUSIONS: Our results confirm that totally tubeless PNL is a safe alternative to standard procedure and is not associated with an increased risk of early postoperative complications. This technique is efficient and safe for kidney stones and may be recommended for a select group of patients.

[Features of nephrotransplant blood flow during kidney transplant].

INTRODUCTION: Kidney transplantation, which provides a high quality of life for patients with terminal chronic renal failure worldwide, is recognized as one of the main achievements of modern medicine. Graft dysfunction is an urgent problem, the one-year survival rate of renal transplants is from 93% (from cadaveric donors) to 97% (from living donors), the five-year survival rate is on average 95%. The aim of the study consisted in determining the features of renal graft blood flow in the early post-transplantation period. MATERIALS AND METHODS: The results of operative treatment of 110 patients who underwent orthotopic kidney transplantation for various reasons were analyzed. The indication for transplantation was chronic kidney disease of 5 st in the outcome of the main disease: in 70 (64%) in chronic glomerulonephritis, in 22 (20%) patients in autosomal dominant polycystic kidney disease, 10 (9%) patients in diabetic nephropathy, in 8 (7%) patients in chronic pyelonephritis. The five-year survival rate of the renal graft during catamnestic follow-up was 88%. All patients underwent ultrasound dopplerography of a renal graft in dynamics from the first day to discharge. RESULTS: After transplantation of a renal graft, blood flow disorders are caused by swelling in the early postoperative period, but further to discharge there was a normalization of the blood flow rates of the renal graft. Which suggests a satisfactory functional state of the renal graft and is a favorable prognostic feature. Reduced blood flow in the graft and increased resistance index (RI) in ultrasound with dopplerography are signs of developing graft dysfunction. CONCLUSION: In almost all cases, postoperative postoperative renal transplant transplants continued to cause blood flow disturbances due to early postoperative edema. The use of ultrasound and Doppler imaging to assess graft status is a diagnostically valuable non-invasive method.

[Blebbing of plasma membrane of lymphocytes in infectious complications of urolithiasis].

INTRODUCTION: About 200 thousand operations for urolithiasis are performed annually in Russia, but the frequency of postoperative complications reaches 30%. Infectious complications occur with a frequency of up to 40% in the form of various forms of pyelonephritis, urosepsis is recorded in 3% of patients. The aim of the study determine the intensity of blebbing of the plasma membrane of lymphocytes in infectious complications of urolithiasis. MATERIALS AND METHODS: A prospective study examined 1,240 patients with urolithiasis. Inflammatory complications were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. Complications of infectious nature were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. During the study, complications of an infectious nature were detected in 148 patients, which amounted to 11,93% of cases. The control group consisted of - 25 persons with urolithiasis and a favorable course of the postoperative period. Lymphocyte membrane condition was evaluated by phase contrast microscopy. RESULTS: Changes in plasma membrane structure were more frequently reported in patients with postoperative purulent pyelonephritis and urosepsis. When assessing the presence of circulating microparticles, the highest number was recorded in patients with urolithiasis complicated by purulent pyelonephritis or urosepsis - 1318 [982; 2007] and 1531 [1028; 1963], respectively. A relationship was established between the degree of severity of terminal blebbing of the plasma membrane of lymphocytes and the nature of inflammatory complications in urolithiasis.

[Hemorrhagic complications risk forecast of operative treatment of urolithiasis].

INTRODUCTION: In the structure of hospital urological pathology, urolithiasis is about 40%, while 2/3 of patients are hospitalized for emergency reasons. Surgical treatment, even in a modern minimally invasive format, can cause postoperative complications in 10-30% of cases, of which up to 5% are hemorrhagic complications requiring blood transfusion in 0.7-1.4% of cases. MATERIALS AND METHODS: To determine the diagnostically significant risk factors for postoperative bleeding, the results of treatment of urolithiasis in 574 patients using remote lithotripsy were used. Based on the results of the statistical analysis, a computer program module "Method for predicting the development of hemorrhagic complications of the postoperative period in patients with urolithiasis" was developed. RESULTS: Of the 45 alleged risk factors for postoperative bleeding, 9 diagnostically significant ones were selected, including recurrent urolithiasis, a history of bleeding, hematuria, size and density of the calculus, and some indicators of the coagulogram. The threshold value of the amount of bleeding risk assessment in points is set to 8, that is, a result of more than 8 points corresponds to a high risk of bleeding. It was established that the risk of hemorrhagic complications in the postoperative period in urolitiasis increases with large stones (size from 5 mm) with high density (from 400 HU), with a decrease in the number of platelets (from 1701012/l) and lengthening of AChTV (from 40 c), PV (from 15 s) and TV (from 16 s), as well as in the presence of a history of recurrent urolithiasis, bleeding and preoperative microhematuria. CONCLUSION: The developed computer program module allows you to quickly and objectively assess the risk of hemorrhagic complications at the stage of choosing the method of surgery, conduct preoperative prophylaxis and increase the effectiveness of surgical treatment of urolithiasis.

DIAGNOSTIC VALUE OF THE INTEGRAL HEMATOLOGICAL INDEXES AND CHEMILUMINESCENCE OF NEUTROPHILS IN SEVERE ACUTE PANCREATITIS.

Research aim is estimation of dependence between integral hematological indexes and chemiluminescence of neutrophils at severe acute pancreatitis. MATERIALS AND METHODS: The 70 patients with acute pancreatitis were examined, severity of disease were reviled based on integral score Ranson, results of clinical and laboratories examinations, diagnosis was confirmed by instrumentals methods of diagnostics. Patients were divided into two clinical groups: 35 patients with no severe acute pancreatitis and 35 patients with severe acute pancreatitis. Integral hematological indexes were calculated based on results of clinical blood test. Functional activity of neutrophils were estimated by chemiluminescence analysis, activator of reaction was luminal. RESULTS: Severe acute pancreatitis was characterized by lowering of intensity chemiluminescence with prevalence hypoxic type of active oxygen's generation 94,28% patients. High negative correlations between integral indexes of inflammatory reaction and degree of endotoxicosis (Kaif - Kalif's leukocytal index of intoxication, index of correlation between neutrophils and lymphocytes, G.D. Dashnayahtsa nuclear index and reactive response of neutrophils) and indexes of chemiluminescence reaction, which show type of active oxygen's generation (intensity of reaction and peak reaction time) were revealed. It allowed talking about high degree of oxidative stress at expressed inflammatory and necrotic process in pancreatic tissue. Decrease of antioxidant resources against a background expressed pathologic process at severe acute pancreatitis was confirmed by High negative correlations between N index of correlation between neutrophils and square under curve of chemiluminescence reaction (-0,62, p=0,001 at spontaneous reaction and -0,72, p=0,001 activated).

[Diagnostic value of integral scoring systems in assessing the severity of acute pancreatitis and patient's condition].

OBJECTIVE: The aim of the study was to evaluate the diagnostic value of specific and nonspecific scoring systems Tolstoy-Krasnogorov score, Ranson, BISAP, Glasgow, MODS 2, APACHE II and CTSI, which used at urgent pancreatology for estimation the severity of acute pancreatitis and status of patient. METHODS: 1550 case reports of patients which had inpatient surgical treatment at Road clinical hospital at the station Krasnoyarsk from 2009 till 2013 were analyzed. Diagnosis of severe acute pancreatitis and its complications were determined based on anamnestic data, physical exami- nation, clinical indexes, ultrasonic examination and computed tomography angiography. Specific and nonspecific scores (scoring system of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow, BISAP, MODS 2, APACHE II, CTSI) were used for estimation the severity of acute pancreatitis and patient's general condition. Effectiveness of these scoring systems was determined based on some parameters: accuracy (Ac), sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). RESULTS: Most valuables score for estimation of acute pancreatitis's severity is BISAP (Se--98.10%), for estimation of organ failure--MODS 2 (Sp--100%, PPV--100%) and APACHE II (Sp--100%, PPV--100%), for detection of pancreatonecrosis sings--CTSI (Sp--100%, NPV--100%), for estimation of need for intensive care--MODS 2 (Sp--100%, PPV--100%, NPV--96.29%) and APACHE II (Sp--100%, PPV--100%, NPV--97.21%), for prediction of lethality--MODS 2 (Se-- 100%, Sp--98.14%, NPV--100%) and APACHE II (Se--95.00%, NPV-.99.86%). CONCLUSION: Most effective scores for estimation of acute pancreatitis's severity are Score of estimation by Tolstoy-Krasnogorov, Ranson, Glasgow and BISAP Scoring systems MODS 2, APACHE I high specificity and positive predictive value allow using it at clinical practice.