[Ankle replacement for severe post-traumatic deformation of the distal tibia: a case report]. / Endoprotezirovanie golenostopnogo sustava pri lechenii gruboi posttravmaticheskoi deformatsii distal'nogo otdela bol'shebertsovoi kosti. Klinicheskii sluchai.

OBJECTIVE: To evaluate the immediate results of ankle replacement with original prosthesis in a patient with severe post-traumatic deformation of the distal tibia. MATERIAL AND METHODS: When developing the original design of ankle prosthesis, we considered foreign analogues of classical and revision models of ankle prostheses taking into account their shortcomings. In this case, an integrated approach was used. Extensive work has been carried out to select materials for prosthetic components. Experimental work with mesenchymal stromal cells of bone marrow was aimed at testing cytotoxicity and biological compatibility. The staff of the department of designing biomechanical structures of the Research Institute of Bionics and Personalized Medicine of the Samara State Medical University carefully studied the proposed design of endoprosthesis using the Ansys software. After cadaver tests on full-scale models, we performed surgical intervention in a patient with severe post-traumatic deformity of the lower third of the left tibia. RESULTS: Our studies revealed convenience and certain advantages of intraoperative installation of original ankle prosthesis. Along with this, this clinical example indicated come features that must be taken into account in revision ankle replacement to avoid possible postoperative consequences. CONCLUSION: Original ankle prosthesis makes it possible to replace the distal tibia and preserve limb function.

[Comprehensive treatment of adynamic depression with the combined use of traditional psychopharmacotherapy, transcranial magnetic stimulation and virtual reality technologies]. / Kompleksnoe lechenie adinamicheskikh depressii s sochetannym ispol'zovaniem traditsionnoi psikhofarmakoterapii, transkranial'noi magnitnoi stimulyatsii i tekhnologii virtual'noi real'nosti.

OBJECTIVE: To study the efficacy and safety of activity-dependent neuromodulation using transcranial magnetic stimulation with intermittent theta flashes (iTBS) as priming stimulation with multimodal parameters of the virtual environment (VR) for the treatment of adynamic depression in comparison with psychopharmacotherapy (PFT). MATERIAL AND METHODS: The comparative study included 85 patients with adynamic depression who were randomized into four groups: iTBS + VR + PFT (n=19), iTBS + PFT (n=19), VR + PFT (n=23), PFT (n=24). The duration of therapy was 20 days, the procedures were carried out daily, with a break for weekends, followed by an assessment of side-effects and control over compliance with the patient's drinking regimen. The study was conducted by clinical, standardized and statistical methods. RESULTS: After 4 weeks of therapy, a final analysis of efficacy and safety indicators was performed. When testing the main statistical hypothesis of the study, the combined therapy of adynamic depression with the use of traditional PFT, iTBS and VR technologies proved to be more effective than traditional PFT. A significant decrease in the parameters of adynamic depression after 4 weeks on the Hamilton psychiatric rating scale for depression by 76%, according to the Clinical Global Impression scale - by the severity of the disorder by 65%, the dynamics of the overall improvement by 76% versus 55% (p=0.0199), 37%, (p=0.0033) 43% (p=0.0047), respectively, in the PFT group. CONCLUSION: Activity-dependent neuromodulation using transcranial magnetic stimulation with intermittent theta flashes (iTBS) as priming stimulation with multimodal parameters of the virtual environment is an effective and safe way to treat adynamic depression, having an advantage over traditional psychopharmacotherapy.

[Lower jawbone structures symmetry evaluation using cone beam computed tomography]. / Otsenka simmetrichnosti kostnykh struktur nizhnei chelyusti po dannym konusno-luchevoi komp'yuternoi tomografii.

OBJECTIVE: To assess the prevalence and quantitative characteristics of skeletal asymmetries of the body and lower jaw branches in three-dimensional space. MATERIALS AND METHODS: Using depersonalized data archive, of 400 CBCT scans, forty studies were picked randomly. Patients aged 25 to 35 years participated in research, no history of maxillofacial reconstructive surgery; gender, race, and facial anomaly were ignored. Three experienced doctors, independently, identified 15 reference points on radiographic images of AUTOPLAN software. Expert consensus found in the orientation determination. Six planes and eight points were constructed, using Math algorithms and the Python OOP; body and branches of the lower jaw length measurements performed and processed automatically. RESULTS: The study identified symmetry, using a method for determining parameters of the lower jaw in 3D space (Priority Reference No.2023100466 at 10.01.2023), modern dentistry research method. Both sides of data obtained shown asymmetry of the body and branches of the lower jaw occurred in 45% (18 people) and 67.5% (27 people) of cases. Forty percent of cases were noted with Mild asymmetry of the lower jaw body (16 people), moderate asymmetry noted in 5% (2 people). These parameters were 57.5% for branches, (23 people) and 10% (4 people). Combined form of anomaly observed in 37.5% (15 people) of cases, among which 12 people (75%) showed adaptive compensation of anomalies, which requires further investigation on a larger number of patients. CONCLUSION: Lower body jaw asymmetry is prevalent (80%). Patients with moderate and serious anomaly form appeared in 15% of cases.

[Biomechanics of the first metatarsophalangeal joint after replacement]. / Analiz biomekhaniki pervogo plyusnefalangovogo sustava posle endoprotezirovaniya.

OBJECTIVE: Analysis of biomechanics of the first metatarsophalangeal joint after arthroplasty, interaction between bones and two implants of the first metatarsophalangeal joint using skeletal model of the foot. MATERIAL AND METHODS: We developed anatomically adapted all-ceramic non-coupled endoprosthesis of proximal interphalangeal joint between 2016 and 2021. To create a model of the foot, we used diagnostic computed tomography whose images were applied in 3D sculpting system and computer-aided design system for final geometric modeling of the joint. RESULTS: In dorsal flexion of the first metatarsophalangeal joint under 45° with the presence of implant, cortical bone tissue can withstand a load of up to 40 kg. Cortical bone tissue with implant can withstand a load of up to 305 kg without dorsal flexion. Strength of implant elements made of zirconium ceramics significantly exceeds strength of bone tissue within implant-bone tissue connection. CONCLUSION: Postoperative axial load on the first metatarsophalangeal joint up to 35 kg with maximum dorsal flexion up to 45° is the most appropriate. Higher load and hyperextension over 45° may be followed by postoperative complications such as implant instability, dislocation and periprosthetic fracture.

[Motor rehabilitation of patients in the acute period of stroke using virtual reality technology]. / Dvigatel'naya reabilitatsiya patsientov v ostrom periode insul'ta s ispol'zovaniem tekhnologii virtual'noi real'nosti.

OBJECTIVE: To study an effect of adjuvant rehabilitation using implicit virtual reality on the dynamics of the motor function of the lower extremities in patients in the acute period of ischemic stroke. MATERIALS AND METHODS: The study was carried out to assess the effectiveness and safety of rehabilitation using virtual reality in 60 patients with lower central paresis in the acute period of ischemic stroke, lasting from 3 to 5 days. Patients of the study group additionally received rehabilitation using the hardware-software complex ReviVR, which allows to stimulate the patient's plantar surface by means of pneumo cuffs synchronously with the step of his animated body. Animation of movement was demonstrated to the patient using virtual reality glasses. The duration of the classes was 10 days, 20-25 minutes each. The total duration of rehabilitation measures in the study and comparison groups was 3-4 hours. RESULTS: A significant regression on NIHSS (3 [-4; -1] and -1 [-2; 0], p<0.001) and a progress on RMI (3 [1; 3] and 2 [0; 2], p<0.001, respectively), between the study group and the control group were found. Changes on FMA-LE section (E-F) occurred on day 10, between the study and comparison groups (9 [5; 16] and 4 [0; 7], respectively, p=0.04). The improvement in FMA-LE out of synergy, in the standing position, indicated an increased readiness of the patient to form an independent walk. CONCLUSION: The study has shown that the use of virtual reality rehabilitation increases the effectiveness of motor rehabilitation in patients with lower central paresis in the acute period of stroke.

[Consistency of expert opinions on localization of the reference points for studying a soft tissue face profile in digital teleradiological images of the skull lateral projection]. / Soglasovannost' mnenii ekspertov pri izuchenii pozitsii opornykh tochek dlya izucheniya myagkotkannogo profilya litsa na tsifrovykh telerentgenologicheskikh snimkakh bokovoi proektsii cherepa.

OBJECTIVE: The aim of the study is to identify the consistency of expert opinions when manually identifying the reference points positions for studying the soft-tissue face profile in digital teleradiological images of the skull lateral projection. MATERIAL AND METHODS: The study involved 11 orthodontists having a 1 to 8 year experience. They localized the reference points manually, using the software with image enhancement options. Each doctor processed 100 X-ray images of the skull lateral projection. Totally, 1100 positions were identified (11 parameters in 100 images). The average position of 11 manual localizations was taken as the baseline. Then, manually identified positions were automatically compared with the basic localization. RESULTS: We have a good consistency of expert opinions when determining the reference points of the soft-tissue face profile. Herewith, the highest consistency of expert opinions is observed for soft-tissue reference points of the upper and lower lips (LL and EN points) with the average variation coefficients equal to 0.557726 and 0.566349 respectively; and the lowest consistency is observed for the hard tissue point Po with the average variation coefficient of 0.819904. Despite rather serious shortcomings in determining separate points (such as Or, DT, Po) in teleradiological images of the lateral skull projection, the method for determining soft-tissue profilometric reference points gives satisfactory results for more than 85.87% cases. In general, the method can be considered clinically reliable. However, the means and methods for identifying reference points require improving.

[Cephalometric analysis of lateral skull X-ray images using soft computing components in the search for key points]. / Tsefalometricheskii analiz rentgenologicheskikh snimkov bokovoi proektsii cherepa s pomoshch'yu komponentov myagkikh vychislenii v poiske klyuchevykh tochek.

THE AIM OF THE STUDY: Was to investigate the efficiency of decoding teleradiological studies using an algorithm based on the use of convolutional neural networks - a simple convolutional architecture, as well as an extended U-Net architecture. MATERIALS AND METHODS: For the experiment, a dataset was prepared by three orthodontists with over 10 years of clinical experience. Each of the orthodontists processed 100 X-ray images of the lateral projection of the head according to 27 parameters, 2700 measurements were made. The coordinates of the control points found by orthodontists in the images were compared with each other and a conclusion was made about the consistency of experts in the data obtained. RESULTS: The results of convolutional neural network CNN were not satisfactory in 17 (62.96%) features, satisfactory in 10 (37.04%). The assessment of orthodontists resulted in non-satisfactory evaluation in 6 (22.22%), satisfactory in 8 (29.63%), good in 8 (29.63%), and excellent in 5 (18.52%) coordinates. Neural networks with U-Net architecture showed satisfactory results in 9 (33.3%) cases, good in 16 (59.3%) and excellent in 2 (7.4%) cases, with no non-satisfactory results. CONCLUSION: The neural network of the U-Net architecture is more effective than a simple fully convolutional neural network and its results of determining anatomical reference points on two-dimensional images of the head are relatively comparable with the data obtained by medical specialists.

[Surgical treatment of pulmonary tuberculosis]. / Khirurgicheskoe lechenie bol'nykh tuberkulezom legkikh v XXI veke.

The main surgical approaches to the treatment of pulmonary tuberculosis were developed and introduced into surgical practice in the 60s of the last century. However, epidemiological changes and new medical technologies justify advisability of further improvement of surgical management of pulmonary tuberculosis. Computed tomography with 3D-nodeling and preoperative planning are valuable to analyze spread of pathological process and visualize pulmonary structures for improvement of surgical treatment.

[Technology of manufacturing of personalized reconstructive allogenic bone graft (in Russian only)]. / Tekhnologiia proizvodstva personifitsirovannogo rekonstruktivnogo allogennogo kostnogo implantata.

AIM: To develop the technology of manufacturing of reconstructive allogenic bone graft with individual parameters by using of digital prototyping and modeling. MATERIAL AND METHODS: Allogeneic cadaveric bone blocks were used as material. The following methods were used to develop a manufacturing technology for personalized allogenic reconstructive bone implant: harvesting and special preparation of cadaveric material, primary disinfection, viral inactivation, ultrasound management, lyophilization of bone material, CT-examination of patients with various bone defects, digital prototyping and modeling, milling on a machine with numerical program control, X-ray sterilization. RESULTS: The technology of manufacturing of reconstructive allogenic bone graft with individual parameters was successfully tested in the treatment of 24 patients with post-traumatic, destructive-dystrophic and degenerative defects of jaws in 2012-2015. Final reconstructive allogenic bone implant has a personalized 3D-geometry in accordance with individual maxillofacial anatomy of particular patient. One of implant surfaces is fully congruent to the jaw bone defect, the others form the width, height and volume of reconstructive bone implant considering personified maxillofacial features. All above-mentioned features of bone implant are important to restore chewing function of dental system. CONCLUSION: The problem of bone implant personification may be resolved by using of computed tomography followed by digital analysis of jaw structure, technologies for digital reconstruction of bone defects (digital prototyping and modeling) and digital manufacturing.

[Estimated error of bone digital solid 3D-model construction algorithm]. / Otsenka pogreshnosti algoritma postroeniia tsifrovoi tverdotel'noi 3D-modeli kostnogo fragmenta.

The aim of the study was an experimental estimation of precision of maxilla bone digital solid 3D-model construction algorithm. The experiment was carried out on 12 mutton mandibles used 3D-model construction based on CT data. Estimated error was calculated for each of the stages of proposed processing algorithm including 3 software: ScanIP (triangle mesh calculation, primary solid 3D-model), ArtecStudio 9 (secondary procession for artefacts elimination), ZBrush 4R6 (triangle mesh simplification, final 3D-model). The proposed algorithm provides satisfactory precision for solid 3D-model with individual maxillary bone features.

[Methods for detection the indicators of metabolism in the oral liquid (a rewiew).]

The search for new ways to diagnose diseases of different etiologies and their introduction into practical health care remains one of the priority areas of modern medicine. Among the known methods for the analysis of biological fluids, a special place is occupied by the methods of express diagnostics of various pathological conditions by markers found in the oral fluid. This article presents a critical review of the latest developments of domestic and foreign researchers (56 sources are analyzed) concerning both existing and widely used devices and those that are at the development stage. The prospects of using oral fluid as a diagnostic medium, as well as various methods for the rapid detction of markers of pathological conditions, are discussed. The main principles, advantages and disadvantages of immunochromatographic tests, electrochemical, microfluidic analysis, isothermal amplification, and devices based on smartphones for express diagnostics of various markers in oral fluid are presented.

[The significance of detection of nitrites in oral fluid of healthy people.]

The nitric oxide is a signal molecule in human organism characterized by a wide spectrum of biological effects. The exogenous nitric oxide is formed from food nitrates received with such green leafy vegetables as spinach, parsley, sorrel and also beet, cucumbers and tomatoes. The bacteria in oral cavity metabolize received with food nitrates up to nitrites. The nitrites as some intermediate metabolites of nitric oxide sufficiently exact reflect concentration of nitric oxide. The purpose of study is to examine analytical dependence and efficiency of express-device for detecting nitrites in saliva. The article presents the results of confirmation of testsystem for half-quantitative detection of content of nitrites in saliva. The device represents a hollow tube with a sensorial element within functioning by the principle of "dry chemistry". The concentration of nitrites in oral cavity was measured in 100 healthy people of both genders aged from 16 to 45 years. In case of consuming vegetables every day or 3-5 times a week higher levels of nitrite-anions (14,9-15,7 mg/l) are registered than in case of consuming vegetables and juices 1-2 times a week and rarely (9,9 mg/l). The concentrations of nitrites in saliva both in cases of regular training and low-activity life-style are within the limits of standards (11,9-14,9 mg/l). The average level of nitrites in saliva of participants of experiment with normal pressure made up to 16.5 mg/l that is significantly higher than in individuals from groups with increased and decreased arterial pressure (10,2 and 10,4 mg/l correspondingly).

[Preclinical tests of additive materials for personified endoprostheses of hand joints]. / Doklinicheskie ispytaniia additivnykh materialov dlia izgotovleniia personifitsirovannykh éndoprotezov sustavov kisti v éksperimente.

AIM: To evaluate the biocompatibility of additive materials for personified endoprostheses of hand joints in vivo. MATERIAL AND METHODS: We tested a material based on titanium that was implanted into muscles and bone tissue in experiment on rabbits. Follow-up was 30 and 90 days. RESULTS: Implantation into muscle tissue is accompanied by reaction against foreign body followed by fibrosis without concomitant inflammation. Induction of osteogenesis and trabecular structures remodeling were detected after implantation into bone tissue. CONCLUSION: Biocompatibility of tested titanium-based material was confirmed.

[Efficiency of Quantitative Analysis of Lung Computed Tomography Findings in Patients with Chronic Obstructive Pulmonary Disease].

Objective: To evaluate the efficiency of detection of emphysema in the analysis of lung computed tomography (CT) images using the "Autoplan" program and to compare the data of quantitative analysis and clinical indicators. Material and methods. Sixty patients with chronic obstructive pulmonary disease (COPD) were examined; the diagnosis was confirmed by external respiratory function evaluation; all the patients underwent inspiratory-expiratory CT using a 32-row multidetector CT scanner, followed by postprocessing in the "Autoplan" system. The features of the system were a floating threshold value, constructing a histogram, and the possibility of preserving a report and polygonal models. Echocardiography was performed to evaluate the right heart and to estimate pulmonary arterial pressure. Material and Methods: Sixty patients with chronic obstructive pulmonary disease (COPD) were examined; the diagnosis was confirmed by external respiratory function evaluation; all the patients underwent inspiratory-expiratory CT using a 32-row multidetector CT scanner, followed by postprocessing in the "Autoplan" system. The features of the system were a floating threshold value, constructing a histogram, and the possibility of preserving a report and polygonal models. Echocardiography was performed to evaluate the right heart and to estimate pulmonary arterial pressure. Results: The obtained numerical values of lung density assessment (mean lung density and emphysema index) showed a high efficiency (a sensitivity of as high as 78%, a specificity of as high as 81%) in detecting emphysema. There was evidence for a relationship between the data of quantitative analysis and the values of external respiration function. Analysis of echocardiographic findings revealed that there was a relationship between emphysema index and systolic and diastolic right ventricle wall thickness (Spearman's rank correlation coefficient from -0.56 to -0.66). Conclusion. Thus, analysis of the lung density CT characteristics provides a physician with objective numerical values, which affect the progression of obstructive changes in patients and the development of signs of chronic cor pulmonale. Conclusion: Thus, analysis of the lung density CT characteristics provides a physician with objective numerical values, which affect the progression of obstructive changes in patients and the development of signs of chronic cor pulmonale.

[The development of express-test for semiquantitative detection of thiocyanate ions in saliva.]

The article presents the results of approbation of the express test-system for semi-quantitative detection of content of thiocyanate ions in saliva as markers of tobacco smoking. The device corresponds to hollow tube with sensory element inside functioning on the principle of "dry chemistry". At saliva intake, the analyzing component (thiocyanate ion) interacts with reagents of sensory element with formation of colored thiocyanate complex. The intensity of color of formed complex permits to judge about content of thiocyanates in saliva by comparison with standard scale. The concentration of of thiocyanate ions in oral fluid of 100 health people of both genders aged from 16 to 45 years was analyzed. The questionnaire survey of respondents was carried out to establish smoking and non-smoking contingents. The analysis established that 30% were active tobacco smokers. The everyday smokers made up to 50% out of them, non-regular smokers (several cigarettes per week or month) - 50%. The reliable relationship between intensity of smoking and concentration of thiocyanate ions in saliva is established. The level of thiocyanate ions in saliva is significantly higher (2.5 mmol/l) in the group of everyday smokers than in saliva of non-smokers of periodically using tobacco articles (0.3-0.5 mmol/l) The increased concentrations of thiocyanate ions in saliva (≥ 1,5 mmol/l) were established in 7% of nonsmokers and are possible related to consumtion of food containing glucosinolates. The test is efficient for detecting smokers using from 1 to 10 cigarettes per day. However, it is of no use in case of sporadic type of smoking.

[Recent medical techniques for peripheral nerve repair: nerve guidance conduits update].

The review deals with recent medical methods of reconstruction of peripheral nerve injuries, especially using the technology of nerve guidance conduits (NGCs), as well as scientific and applied prospects of further development of clinical and technical research in this area. In neurosurgery established techniques for the treatment of peripheral nerve injures include the matching and suturing of severed nerve fibers (however, it is important to avoid tension in gaps for effective regeneration of the nerve fiber), as well as allo/autologous nerve grafting for larger gaps (gold standard of repair). Unfortunately, this treatment is not always feasible in a number of clinical situations, has drawbacks and is associated with a potential risk of postoperative complications; in particular applying of donor transplants is complicated immunological incompatibility reactions. The use of implantable artificial tunneling device known as a nerve guidance conduit is an alternative method of reconstruction, contributing to the physiological regeneration of nerve fiber. The article describes technical engineering constructions - including by using various non- and biomaterials, liquid metals, light/laser, methods of electrospinning and microstereolithography - which are either commercially available or pre-tested and clinical studies detailing outcomes and reconstructive options. The review emphasizes that the further development of scientific research in the field of new materials and polymers, as well as techniques for the preparation and implantation of nerve conduits and their subsequent practical assessment is necessary for clinical medicine and rehabilitation.

[Radionuclide imaging in the evaluation of the functional state of the transplanted kidney in the post-transplant period].

OBJECTIVE: The aim of our clinical study was to evaluate the possibility of diagnosis of postrenal-transplantation complications in recipients using dynamic scintigraphy basing on temporaly parameters standard zones of interest and medullay zone of renal transplantat comparing the results with the histological findings. METHODS: We determined time of maximum and one-half maximal activity of radiopharmaceutical medication in renal transplantat, parenchyma and medullary zone the graft. According to pathological diagnosis, patients were categorized into three groups: first - normals (n =32), second - acute rejection (n =43), third - chronic nephropathy (n =43). RESULTS: In this study 118 patients aged 21-60 (38.4±9,8) years were included who underwent dynamic renal scintigraphy and biopsy renal transplantat. The time of maximum activity radiopharmlaceuticals parenchyma the graft in patients in first group - 3.24±0.54 min, second - 6.61±3.28 min, third - 6.21±4.17 mnin (p <0,001). The time of maximum activity radiopharmaceuticals medullary zone the graft in patients in first group - 3.95±0.95 ,min, second - 8.94±5.23 min (p <0,001), third - 7.29±4.16min (p <0,01). The time of maximum activity radiopharmaceutical the whole graft in patients in first group - 3.87±0.62 mi, second - 7.4±3.82 min (p <0,001), third - 8.03±4.28 min (p <0,01). The time one-half maximal activity radiopharmaceuticals parenchyma the graft in first group - 10.4±2.95 min, second - 37.09±3.89 min (p <0,001), third - 29.67±3.1 min (p <0,005). The time one-half maximal activity radiopharmaceuticals medullary zone the graft in first group - 11.71-5.93 min, second - 79.34±9.81 min (p <0,001), third - 29.67±3.95 min (p <0,005). The time one-half maximal activity radiopharmaceuticals the whole graft in first group - 12.31±3.91 min, second - 53.29±8.22 min, third - 52.71±7.86 mil (p <0,001). Anderson-Bahadur distance: T1/2 medullary zone the graft most significant between first and second groups patients (17.43), gives maximum index value at chronic nephropathy (-9.07), at differentiation between acute rejection and chronic nephropathy (8.48). Estimate of the area under the ROC indicate most infomative time of maximum accumulation of the radiopharmaceutical of the whole graft (SROC =0.907) in acute rejection and Tmax parenchyma the renal transplantat (SRoc =0.847) in patients with chronic nephropathy the graft. Sensitivity and specificity renal scintigraphy parameters of diagnosing on postrenal transplantation complications amounted 71.43-98.7% and 67.7-96.43% respectively. CONCLUSION: Renal scintigraphy is an additional test for early detection on postrenal transplantation complications and correct tactics conducting recipients. The parameters of kinetics of nephrotropic radiopharmaceuticals provide diagnosis of acute rejection and chronic nephropathy the graft. Inclusion of radionuclide diagnostics to monitor the state renal transplantat optimizes approach to bioosies graft.