[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.

[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.

[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.

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.

[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.

[Endobronchial use of low-frequency ultrasound and ultraviolet laser radiation in the complex treatment of patients with suppurative bronchial diseases]. / Endobronkhial'noe primenenie nizkochastotnogo ul'trazvuka i ul'trafioletovogo lazernogo oblucheniia v kompleksnom lechenii bol'nykh s gnoíno-vospalitel'nymi zabolevaniiami bronkhov.

The efficiency of endobronchial therapy with low-frequency ultrasound (LFUS) and ultraviolet laser radiation (UVLR) were studied in patients with pyoinflammatory diseases of the lung. A hundred and sixty two patients with chronic bronchitis (CB) and bronchoectatic disease (BD) were clinically followed up. The complex treatment of pyoinflammatory diseases of the bronchi was supplemented by endobronchial LFUS in 86 patients, by UVLR in 29. Routine bronchoscopy (without endobronchial application of LFUS and UVLR) was included into the treatment of 47 patients with CB and BD. Bronchoscopy with LFUS and UVLR was found to have a high efficiency in patients unresponsive to drug therapy. The number of bronchoscopies per treatment regimen could be reduced, the time of a remission and the interval of hospitalization were increased.

[The clinico-cytological parallels in exacerbated bronchial asthma]. / Kliniko-tsitologicheskie paralleli pri obostrenii bronkhial'noi astmy.

The authors provide the data on estimation of the character and intensity of inflammation in the proximal and distal bronchi as well as in the respiratory compartment of the lungs, obtained as a result of an all-round examination including a cytological assay of the bronchoalveolar washing off of 31 bronchial asthma patients in the period of disease exacerbation. A correlation analysis is given between the interrelationship between the intensity of bronchial obstruction and the level of eosinophilia in peripheral blood, sputum and in bronchoalveolar washing off. It has been revealed that the relative content of eosinophils in bronchoalveolar washing off is in the best agreement with the intensity of bronchial obstruction.

[Difficulties in the diagnosis of chronic toxoplasmosis with lung involvement]. / Trudnosti diagnostiki khronicheskogo toksoplazmoza s porazheniem legkikh.

A case of chronic acquired toxoplasmosis combined with lung impairment is described. The diagnosis was made on the basis of the data obtained as a result of the use of the latest clinical and instrumental research methods and a specific serologic test. The diagnosis was verified morphologically on thin sections of the sputum. The authors provide data on the diagnostic search for approaches to the differentiation between parasitic diseases resulting in dissemination to the lungs with calcification of the foci and broncholithiasis, tuberculosis.

[The complex assessment of disordered bronchial patency in chronic obstructive lung diseases]. / Kompleksnaia otsenka narusheniia bronkhial'noi prokhodimosti pri khronicheskikh obstruktivnykh zabolevaniiakh legkikh.

There were 63 patients with infectious-allergic bronchial asthma and 13 patients with chronic obstructive bronchitis. The clinical and bronchoscopic manifestations of the broncho-obstructive syndrome were compared to external respiratory function (ERF) reflecting the status of bronchial patency at different levels of the bronchial tree and the measurement data on the rheological properties of bronchial secretion. A reverse interrelationship was discovered between the intensity of asphyxia attacks and patency of the distal bronchial according to the ERF estimates. A correlation was noted between the magnitude of bronchial secretion viscosity and some characteristics: intensity of asphyxia attacks, dyspnea, number of dry rales; bronchial patency according to the ERF estimates. The values of secretion viscosity turned out to be most closely interrelated with the patency of small bronchi. A correlation was discovered between the bronchoscopic findings and bronchial patency of the proximal bronchi (ERF estimates). It is believed that bronchoscopic examination plays an important part in the diagnosis of obstruction of the bronchi accessible to inspection and has a high information content. Hyperdiscrinism intensity determines in many respects the clinical manifestations of the broncho-obstructive syndrome, measurement data on viscosity and adhesion of bronchial secretion can be used for assessing the efficacy of the action on bronchial obstruction at the level of small bronchi.

[A case of alveolar microlithiasis]. / Sluchai al'veoliarnogo mikrolitiaza.

A case of alveolar microlithiasis diagnosed on the basis of a clinical and x-ray picture was described. The diagnostic value of an endopulmonary cytogram in this patient was discussed. The authors investigated bronchoalveolar washing off obtained from bronchoalveolar lavage for morphological diagnosis of this pathology.

[Mitotic activity of alveolar macrophages in nonspecific diffuse lung pathology]. / Mitoticheskaia aktivnost' al'veoliarnykh makrofagov pri nespetsificheskoi diffuznoi legochnoi patologii.

Endopulmonary cytograms and mitotic activity of alveolar macrophages (AM) in the bronchoalveolar lavage (BAL) from 30 patients with diffuse lung pathology have been studied. AM mitosis was found in 24 cases. Mitotic index for all the patients was 0.65% and ranged from 0.25 to 2.75%. Electron microscopy revealed the capacity of differentiated forms of AM for mitotic division. Free AM may be regarded as slowly proliferating cell population, capable of self-reproduction in lung pathology.

[Role of the carboxylic groups in interaction of phenylalanyl-tRNA synthetase with substrates]. / Rol' karboksil'nykh grupp vo veaimodeistvii fenilalanil-tRNK-sintetazy s substratami.

The effect of modification of carboxylic groups of phenylalanyl-tRNA synthetase by p-toluene sulfonate N-cyclohexyl-N'-beta-(4-methylmorpholine) ethylcarbodiimide (CMEC) on the activity of the enzyme was investigated. It was shown that modification of two moles of carboxylic groups per mole of the enzymes leads to the diminution of negative charge of the enzyme and to inactivation in ATP-[32P]PPi-exchange and aminoacylation reactions. The inactivation is completely reversed by mild alkaline hydrolysis. ATP in concentration 2 X 10(-4) M partially protects the enzyme against inactivation, protective effect being stimulated by Mg2+ and 0.4-0.7 moles of carboxylic groups per mole of the enzyme are protected against inactivation is observed although the depth of modification is increased. Other substrates do not have protective effect. Modification of the enzyme by CMEC increases Kdiss value of [14C]-Phe-tRNA enzyme complex and Km value for tRNAPhe in aminoacylation by factor of three. Vmax for all substrates in both aminoacylation and leads to 40% increase of Hill's coefficient for ATP in ATP-[32P]PPi-exchange reaction but not in aminoacylation. The carboxylic groups modified by CMEC are assumed to take part in ATP recognition and in catalysis of the ATP conversion and in catalysis of transfer of activated amino acid residues on tRNA.