[Outcomes of bimanual vitreoretinal surgery in the treatment of diabetic retinopathy complications]. / Rezul'taty bimanual'noi vitreoretinal'noi khirurgii v lechenii oslozhnenii diabeticheskoi retinopatii.

The incidence of diabetic retinopathy (DR) requiring vitreorentinal surgery is increasing. The search for new effective and safe methods of treatment, the choice of the optimal time for surgery, and the assessment of long-term treatment outcomes are relevant problems. PURPOSE: This study evaluates the long-term results of vitreorentinal surgery using the bimanual technique in DR with different stages of fibrovascular proliferation. MATERIAL AND METHODS: The study included 135 patients (135 eyes) who were divided into groups depending on the predominant type of proliferation - vascular or fibrous. Patients underwent vitrectomy with membranectomy using the bimanual technique, with peripheral panretinal endolaser coagulation of the retina and tamponade of the vitreous cavity with balanced salt solution. The postoperative observation period lasted up to 12 months. RESULTS: Both groups showed statistically significant improvement in visual function and anatomical changes in central retinal thickness. A statistically significant improvement in best corrected visual acuity (BCVA) was found in patients with initially predominantly vascular proliferation. Correlation analysis showed that initially higher BCVA tends to persist in the postoperative period. A negative correlation was found between the final BCVA and the presence of type 2 diabetes mellitus, fibrous stage of proliferation, high central retinal thickness, and the presence of diabetic macular edema (DME) - both initially and after treatment. The frequency of complications in the groups was comparable, except for postoperative DME, which was more often detected in patients with fibrous proliferation. CONCLUSION: The bimanual technique of vitreorentinal surgery for complications of DR allows achieving high anatomical and functional results. Higher BCVA is noted in patients with the vascular stage of proliferation and initially high BCVA. The obtained data allow us to form a hypothesis about the possibility of earlier surgery in patients with high BCVA, but require further investigation.

[An integrated approach for early recovery of function in patients after fractures of the humerus in its proximal section]. / Kompleksnyi podkhod dlya rannego vosstanovleniya funktsii konechnosti u patsientov posle perelomov plechevoi kosti v ee proksimal'nom otdele.

The frequency of fractures of the proximal humerus (PH) is 4-5% of fractures of all human bones and can reach 80% of all bone injuries of the humerus. An analysis of the long-term results of the methods used to treat fractures of the proximal humerus showed the absence of a generally accepted universal method that provides consistently good results for all variants of fractures of the PH. PURPOSE OF THE STUDY: Creation of a complex highly effective system for the treatment of PH fractures, which includes a minimally invasive method of surgical treatment using the method of cephalomedullary osteosynthesis with direct locking pins and a highly specialized program of rehabilitation measures using a biofeedback (BFB) device, which will reduce the duration of treatment and improve the results of functional recovery injured limb. MATERIAL AND METHODS: The results of treatment of 214 patients with fractures of the proximal humerus were analyzed. Of these, in 122 (57%) patients (the main group) osteosynthesis was used with a direct cephalomedullary fixator with the possibility of blocking the screws in the nail in different planes. The comparison group included 92 (43.0%) patients treated using other surgical techniques. Rehabilitation measures were started in the early postoperative period (from the 2nd day) in both groups and included a complex of physiotherapeutic treatment, physical exercises in different modes, in addition in the main group of the study, training was performed using a device with biofeedback. RESULTS: It is shown that the used treatment approach allows to increase the frequency of achieving good and excellent (52.4% in the main group and 27.2% in the comparison group) results and reduce the frequency of unsatisfactory results of treatment (9.8% in the main group and 21.7% in the comparison group) on the Constant score. CONCLUSION: The data obtained prove the high efficiency of the developed complex method for the treatment of proximal humerus fractures and restoration of the function of the upper limb.

[Modern concepts of pathogenesis of diabetic retinopathy]. / Sovremennye kontseptsii patogeneza diabeticheskoi retinopatii.

This literature review presents modern view on the pathogenesis of diabetic retinopathy (DR) paying particular attention to the molecular mechanisms leading to its development, as well as the manifestations of retinal neurodegeneration in such patients. Assessment of this condition and its clinical manifestations makes it possible to diagnose DR at the stage of absent initial vascular changes. Investigating the neurodegeneration mechanisms could supplement the existing understanding of the disease pathogenesis and could possibly help find new ways of treatment and prevention of DR.

[The role of neurodegeneration biomarkers in the management of patients with diabetic retinopathy]. / Rol' biomarkerov neirodegeneratsii pri diabeticheskoi retinopatii.

This literature review focuses on the role of disease biomarkers in the management of patients with diabetic retinopathy (DR) investigating in detail the problem of retinal neurodegeneration in such patients. Identification and assessment of the significance of qualitative and quantitative biomarkers of DR and neurodegeneration can complement screening examination, as well as help predict the course of the disease and the response to therapy. A comprehensive analysis of these factors allows for effective treatment and prevention of complications in patients with DR based on prognostic models and dynamic monitoring of these indicators.

[Viscodissection with staining of epiretinal membranes in surgery of proliferative diabetic retinopathy]. / Viskodissektsiya s kontrastirovaniem epiretinal'nykh membran v khirurgii proliferativnoi diabeticheskoi retinopatii.

PURPOSE: To develop a method of viscodissection involving staining of epiretinal membranes, and to evaluate its efficacy and safety in surgical treatment of proliferative diabetic retinopathy (PDR). MATERIAL AND METHODS: The study included 30 patients with type 1 diabetes mellitus and PDR with tractional retinal detachment (TRD). All patients were divided into two groups. In the first (main) group, at the initial stages of the operation, viscodissection with staining of epiretinal structures was performed, followed by segmentation and removal of membranes; in the second (control) group, segmentation and removal of membranes was performed using a vitreotome and endovitreal forceps. RESULTS: During the follow-up, all patients showed positive trends of morphological and functional indicators. While the number of intraoperative stages was the same in both groups, the total operation time in patients of the main group was significantly lower (p≤0.001) than in patients of the control group (main - 41.3±2.8 min; control - 53.8±6.2 min). With equal number of posterior hyaloid membrane to inner limiting membrane (PHM to ILM) fixation points in both groups, iatrogenic retinal rupture occurred significantly less frequently in patients of the main group (main - 0.6±0.7, control - 3.1±2.9) (p≤0.001). In this regard, among the patients of the control group, in the overwhelming majority of cases, it was necessary to use a silicone oil tamponade (60%) or gas-air mixture (33%), while in the first group the main postoperative media were sterile BSS solution (73%) and gas-air mixture (27%).

Dual-polarization single-chord plasma interferometry in stellarators/torsatrons.

The well known ordinary wave based interferometry is of frequent use for plasma diagnostics in fusion facilities. With the probing direction being perpendicular to the magnetic field of the facility, the ordinary wave phase shift is proportional to the average density along the probing path at frequencies much higher than the plasma frequency of electrons. In the case of extraordinary waves, the phase shift depends on both the plasma density and the confining magnetic field. For the facilities of stellarator/torsatron types, the magnetic field is known; therefore, the measurement of the extraordinary wave phase shift can also provide information on the plasma density profile. The plasma density measurements with the use of dual-polarization interferometers were carried out on the Uragan-3M and Uragan-2M torsatrons. For correct interpretation of the experimental results, numerical simulation was performed to describe the probing wave propagation through the plasma in the magnetic field of variable direction. The transmitting-to-receiving horn scattering matrix has been obtained in a wide range of plasma parameters. In the course of the interpretation of measurements, restrictions on the use of the Wentzel-Kramers-Brillouin approximation were determined. This has made it possible to develop the optimized layout of the dual-polarization interferometer for measuring the plasma density in stellarators/torsatrons. The here proposed upgrade of the interferometers on Uragan-2M will enable one to obtain additional information on the temporal evolution of the plasma density.

[The indices of severity of disability because of malignant neoplasms in individuals of young age in Moscow in 2016-2018].

The article presents the results of analysis of primary and secondary disability due to malignant neoplasms among young people in Moscow in 2016-2018. The study established that in the structure of young patients recognized as disabled for the first time made up the smallest percentage with tendency of increasing the level of primary disability. The study established the predominance of people with disabilities of group II with high level of primary disability. The second position is taken by patients with disabilities of group III with tendency of increasing their specific severity. The number of patients repeatedly recognized as disabled is much higher than patients recognized as disabled for with the first time. The study established prevalence of disabled patients of group III with tendency of increasing level of repeated disability.

Cold parenting is associated with cellular aging in offspring: A retrospective study.

BACKGROUND: Early life stress is a known risk factor for diseases and premature death. We tested whether parenting style impacts telomere length (TL), a cellular aging biomarker. METHODS: Information on parents' style of parenting was obtained from 199 participants in the Adventist Health Study-1 (AHS-1) who 27+ years later also enrolled in the AHS-2 where blood was collected for relative TL (rTL) assessment. RESULTS: Subjects describing their mothers' parenting style as cold had on average 25% smaller rTL compared to subjects not reporting a cold mother (1.89 vs 2.53). This association was greatest among those with less education, and those who stayed overweight/obese or put on weight during follow-up. CONCLUSIONS: These results support previous findings that early life stress may have health implications by promoting cellular aging, and expands these stressors to include cold parenting during an individuals' formative years. Higher education and normal weight seem to provide some resilience.

[The factors affecting the results of mechanical jaundice management]. / Faktory, vliyayushchie na rezul'taty lecheniya bol'nykh s mekhanicheskoi zheltukhoi.

AIM: To improve the results of obstructive jaundice management by rational diagnostic and treatment strategies. MATERIAL AND METHODS: Outcomes of 820 patients with obstructive jaundice syndrome were analyzed. RESULTS: Diagnostic and tactical mistakes were made at pre-hospital stage in 143 (17.4%) patients and in 105 (12.8%) at hospital stage. Herewith, in 53 (6.5%) cases the errors were observed at all stages. Retrospective analysis of severe postoperative complications and lethal outcomes in patients with obstructive jaundice showed that in 23.8% of cases they were explained by diagnostic and tactical mistakes at various stages of examination and treatment. CONCLUSION: We developed an algorithm for obstructive jaundice management to reduce the number of diagnostic and tactical errors, a reduction in the frequency of diagnostic and tactical errors. It reduced the number of postoperative complications up to 16.5% and mortality rate to 3.0%.

[Estimation of regional blood flow in reimplanted segments of upper extremity].

AIM: To examine the state of regional circulation in replanted segment of upper limb and hand, to determine diagnostic and prognostic value of radionuclide scintigraphy. MATERIAL AND METHODS: The study included 26 patients who underwent replantation of upper extremity segments. The control group included 12 patients who underwent autologous transplantation of toes on hand. All patients underwent isotope scintigraphy, ultrasound Doppler and pulse oximetry. Groups were comparable by gender, age, severity of injury. RESULTS: Depending on postoperative course two groups were determined: with favorable (27 patients) and complicated postoperative period (11 patients). Two types of regional circulation were identified according to dynamic scintigraphy: prevalence of blood flow in operated limb (type 1); prevalence of blood flow in healthy limb, or equal volumetric blood flow in operated and healthy limbs (type 2). Favorable early postoperative period was associated with prevalence of blood flow in operated limb. Only in 2 (7.7%) patients patients in this group acute arterial thrombosis was diagnosed. At the same time thrombosis of microanastomosis occurred in 45.4% of cases in the second group what is 5.5 times higher than in the first group. CONCLUSION: Significant prevalence of blood flow in operated limb is favorable prognostic sign of the early postoperative period. On the other hand the identity of blood flow or prevalence of such in healthy limb predispose to acute vascular complications in replantate or autoplantate. Radionuclide scintigraphy provides detailed assessment of regional blood flow in operated limb. However clinical monitoring has leading role in diagnosis of acute circulatory disorders in replantate or autoplantate.

[Life quality parameters in prenosologic evaluation of health state in residents of protective measures area near objects of storage and destruction of chemical weapons].

The article presents results of life quality assessment and subjective evaluation data on health state, used for prenosologic evaluation of health state in residents of protective measures area near objects of storage and destruction of chemical weapons. Considering specific features of residence near potentially dangerous objects, the authors conducted qualitative evaluation of satisfaction with various life facets, with taking into account the objects specificity, established correlation between life quality and self-evaluation of health with factors influencing public health state.

Athermal directions in KGd(WO4)2 and KLu(WO4)2 crystals under uniform heating.

Athermal (AT) propagation directions in KGd(WO4)2 and KLu(WO4)2 crystals are found for two configurations (monolithic and laser cavity) at two wavelengths of 633 and 1064 nm. Four branches of solutions for AT directions exist for both configurations in KGd(WO4)2 and for the laser cavity configuration in KLu(WO4)2; for the monolithic configuration there are one or two branches for wavelengths of 633 and 1064 nm, respectively. Two of the branches for the laser cavity configuration pass in the vicinity of the crystal optical axis, where solutions are extremely sensitive to the direction of propagation. In some cases discrepancy in thermo-optic and thermal expansion parameters found by different authors may lead to the appearance (or disappearance) of AT directions.

[Optimization of ostheogenesis with the use of vascularized periosteal-cortical autotransplants in patients with false joints of long bones].

The issue analyzes the use of free revascularizable or rotatable periosteal-cortical autotransplants as an additional source of ostheogenesis in patients with false joints of long tubular bones. The experience of treatment of 58 patients was summarized. The terms of fracture consolidation was similar to that after non-complicated fractures of the same localization.

[The microsurgical tissue autotransplantation as a way of local radiation skin injuries' treatment].

The experience of 127 microsurgical autotransplantations of skin-muscular flaps in 93 patients with severe radiation skin injuries was analyzed. As free revascularized flaps the greater omentum, the skin-muscular thoracodorsal flap, the scapular, the radial flap, including flaps with a part of the radial bone, the deltoideus, the rotated skin-muscular flap of the abdominal rectus muscle, the scapular and/or serratus anterior fascia were used. The transplants' acception was registered in all cases. 31 patients demonstrated the development of late radiation ulcers during the long term follow up period, requiring further dissection and replantation.

[Managerial, scientific, and practical measures for health protection of the population living and working in the protective actions zone of chemical weapons storage and destruction facilities].

The results of health assessment of the population living and working in the protective actions zone by the evidence obtained during general and special meadical examinations are summarized.

[Results of study concerning possible influence of rocket space activities on public health].

Using special medical examination results and specified criteria of objective evaluation, the authors summarized results of studies concerning health state of population dwelling in area possibly influenced by rocket space activities factors.

[Surgical treatment of consequences of humeral [correction of femoral] fractures].

55 patients, aged 19 to 77 years, with consequences of humeral [correction of femoral] fractures were surgically treated. 1st group consisted of 17 patients with slow fracture consolidation, 2nd group contained 31 patients with uninfected false joints and the 3rd group consisted of 7 patients with infected false joints. Surgical tactics of treatment in each group was thoroughly described. Long-term results were analyzed in 38 patients. Good results were achieved in 27 cases, satisfactory--in 7 cases and unsatisfactory results were registered in 4 patients. Cases of nonconsolidation of bone fragments, requiring repeated operations, were assessed as unsatisfactory.

[Registers of health for workers exposed to extremely dangerous toxic chemicals--basis for early diagnosis and prevention of occupational intoxications].

The article deals with results of specification and functioning of a register of health for workers exposed to extremely dangerous toxic chemicals. The authors demonstrated patterns of diseases development in workers according to length of work with toxic chemicals and to work conditions. The identified cause-effect relationships of the diseases development necessitate health registers to minimize negative consequences in work conditions, for early diagnosis and occupational diseases prevention.

[Role of lung biopsy in diagnosis of pulmonary pathology at the prehospital level].

The aim of the work was to assess the value of biopsy techniques for fibrobronchoscopy under local anesthesia in patients with pulmonary pathology at the prehospital level. It included 706 subjects with lobular, segmental or diffuse lesions in the lungs of specific (tuberculosis), non-specific (pneumonia, exogenous alveolitis), and other origin. All known methods of endobronchial biopsy were employed (bronchoalveolar lavage or liquid lung biopsy, tissue biopsy, transbronchial biopsy, brush biopsy, puncture and aspiration biopsy) with subsequent cytomorphological and bacteriological studies of bioptates. Diagnostic efficiency of direct biopsy was estimated at 97%, transbronchial biopsy at 5-90% depending on nosological form of lung disease, brush and puncture biopsy 20-50 and 6% respectively. Reversible complications occurred in 1.4% and were resolved by therapeutic methods. Cost effectiveness of prehospital instrumental examination of patients with pulmonary pathology is 10 times the intrahospital one.

600 W power scalable single transverse mode tapered double-clad fiber laser.

Pump propagation and absorption in active tapered double-clad fiber has been analyzed based on a ray optics approach. Optimization of the longitudinal shape, absorption and angular distribution of the pump beam allowed for power scaling of a ytterbium fiber laser up to 600 W with high beam quality (M2