[Ala54Thr polymorphism of the fatty acid transporter gene (FABP2) in patients with type 2 diabetes mellitus in Yakutia].

AIM: To study the contribution of the Ala54Thr genetic polymorphism of the FABP2 gene to the risk of developing type 2 diabetes mellitus among the Yakut population. MATERIALS AND METHODS: The study included participants who filled out a questionnaire approved by the Local Committee on Biomedical Ethics at the Yakut Science Centre of complex medical problems and voluntarily signed an informed consent to conduct a genetic study. The sample consisted of 181 patients of the endocrinological department of the Republican Hospital No. 2 of the State Budgetary Institution "Center for Emergency Medical Care" with a diagnosis of type 2 diabetes. The comparison group was a sample of 336 volunteers without chronic diseases of the Yakut ethnicity. For molecular genetic analysis, genomic DNA samples were isolated from whole blood. Single nucleotide polymorphism was determined by polymerase chain reaction followed by analysis of restriction fragment length polymorphism. RESULTS: Study showed that polymorphism in the FABP2 gene has an impact on anthropometric parameters and blood biochemical parameters. The risk of developing type 2 diabetes was 1.7 times higher in carriers of the Ala/Thr genotype (odds ratio 1.755, 95% confidence interval - 1.212-2.542; p<0.005) compared with carriers of other genotypes. When comparing the average biochemical values, the levels of aspartate transaminase, alanine aminotransferase, glucose and total bilirubin in homozygous carriers of the Ala/Ala genotype were significantly lower than in carriers of other genotypes (р<0.05). Carriers of the heterozygous Ala/Thr genotype (р<0.05) had the highest level in terms of aspartate aminotransferase and alanine aminotransferase. The highest indicator of the average level of HbA1c and an indicator of total bilirubin were carriers of the Thr/Thr genotype (р<0.05). CONCLUSION: The high prevalence of the negative Thr allele among the Yakut population is probably associated with living conditions in the North, as well as in the traditional type of diet.

[Psychological characteristics of working and non-working elderly people.]

A comparative analysis of the psychological characteristics of the working and non-working population in the context of personal employment, demand and quality life. The study was conducted with the participation of 51 women and 58 men, age 65,35±5,25 years. Randomization into two groups: the 1st group - 59 people of those continuing to work in the field of higher and vocational education; the 2nd group (50 people) consisted of non-working pensioners whose labor activity was related to teaching, taking care of their families, children and grandchildren, the circle of their social contacts is limited by the connections necessary to ensure life. An assessment was made of the orientation of the personality, the level of prevailing needs, the formation and strength of motives, the degree of adequacy of one's own attitude to various life situations, and the psycho-emotional state. It is shown that working pensioners have a higher indicator of the personality's orientation to the task and a low indicator of the personality's orientation to oneself. In the 1st group a stable psycho-emotional state was revealed for a number of functional indicators of a physical, role, social nature, significantly higher indicators of vitality and the physical component of health, they strive to maintain professionalism, financial freedom, and independence. In the 2nd group the desire to overcome social isolation, the desire to develop creativity in oneself prevails. In the 1st and 2nd groups, there were no differences in the levels of the motivational-need sphere. To expand the possibilities of the life potential of an elderly person, it is necessary to study the psychological characteristics older working and non-working population.

[Methodical approaches to annotation and labeling of histological images in order to automatically detect the layers of the stomach wall and the depth of invasion of gastric cancer]. / Metodicheskie podkhody k annotirovaniyu i razmetke gistologicheskikh izobrazhenii v tselyakh avtomaticheskogo raspoznavaniya sloev stenki zheludka i glubiny invazii raka zheludka.

OBJECTIVE: Development of original methodological approaches to annotation and labeling of histological images in relation to the problem of automatic segmentation of the layers of the stomach wall. MATERIAL AND METHODS: Three image collections were used in the study: NCT-CRC-HE-100K, CRC-VAL-HE-7K, and part of the PATH-DT-MSU collection. The used part of the original PATH-DT-MSU collection contains 20 histological images obtained using a high performance digital scanning microscope.Each image is a fragment of the stomach wall, cut from the surgical material of gastric cancer and stained with hematoxylin and eosin. Images were obtained using a scanning microscope Leica Aperio AT2 (Leica Microsystems Inc., Germany), annotations were made using Aperio ImageScope 12.3.3 (Leica Microsystems Inc., Germany). RESULTS: A labeling system is proposed that includes 5 classes (tissue types): areas of gastric adenocarcinoma (TUM), unchanged areas of the lamina propria (LP), unchanged areas of the muscular lamina of the mucosa (MM), a class of underlying tissues (AT), including areas of the submucosa, own muscular layer of the stomach and subserous sections, image background (BG). The advantage of this marking technique is to ensure high efficiency of recognition of the muscularis lamina (MM) - a natural «line¼ separating the lamina propria of the mucous membrane and all other underlying layers of the stomach wall. The disadvantages of the technique include a small number of classes, which leads to insufficient detailing of automatic segmentation. CONCLUSION: In the course of the study, an original technique for labeling and annotating images was developed, including 5 classes (types of tissues). This technique is effective at the initial stages of teaching mathematical algorithms for the classification and segmentation of histological images. Further stages in the development of a real diagnostic algorithm to automatically determine the depth of invasion of gastric cancer require the correction and development of the presented method of marking and annotation.

Spectroscopy of structurally disordered hydrated iron fluoridotitanate in the regions of vibrational and electronic excitations.

Raman and optical absorption spectra of disordered hydrated iron fluoridotitanate (HITF) single crystal were studied. Temperature transformations of the Raman spectra indicate independent ordering processes of the [TiF6]2- and [Fe(H2O)6]2+ complexes below the structural phase transition. The absorption spectrum in the near-infrared and visible ranges includes transitions from the high spin ground state 5T2 of Fe2+ ion to the excited 5E state and a set of excited triplets. Analysis by Tanabe-Sugano method gives crystal field Dq = 490 cm-1 and Racah parameters B = 340 cm-1 and C = 1904 cm-1. Considerable decrease of B parameter as compared to the free ion value indicates a decrease of interelectron repulsion in the disordered neighborhood of Fe2+ ions.

High-pressure transformation of dithiazolylidene-dithiazolium polyiodide with N-H N hydrogen bond: A Raman Spectroscopy study.

The insight into the behavior of polyiodides under non-ambient conditions can enrich the practical applications due to obtaining materials with adjustable and tunable conducting properties. In this work Raman spectroscopy study in the range 0 - 6.5 GPa has been performed for dithiazolylidene-dithiazolium zigzag polyiodide with N-H…N hydrogen bond. Variations of band positions in the low-wavenumber region of Raman spectra have been attributed to the changes in the anionic part of the unit cell. The association of different interacting polyiodide subunits at pressure above 1.5 GPa leads to the emergence of the bands at 98 and 115 cm-1 due to consistent vibrations in the I82- zigzag. The emergence of the band at 159 cm-1 above 0.28 GPa can be assigned to N-H…N hydrogen bond vibration. The obtained results depict undergoing structure transformations: the stronger are cation…cation and anion…anion interactions the more likely is the observation of conducting properties due to the formation of polyiodide zigzag and strongly-bound hydrogen-bonded fragment.

[Severe spine lesion following alkaptonuria. Case report]. / Tyazheloe porazhenie pozvonochnika pri alkaptonurii. Opisanie klinicheskogo sluchaya.

Alkaptonuria is a rare autosomal recessive disease. In these patients, melanin-like compounds as the final products of impaired metabolism of homogentisic acid are deposited mainly in connective tissue, including cartilage tissue of intervertebral discs. Similar to other degenerative spine diseases, lumbar segment is often damaged. The authors report a 67-year-old patient with alkaptonuria. Compression of cauda equina by damaged cartilage masses of intervertebral discs and spine ligaments with deposits of ochronotic pigment is described. Previously diagnosed alkaptonuria in this patient was confirmed by surgical findings (black pigmentation) and histological data.

Photoelectron photofragment coincidence spectroscopy of aromatic carboxylates: benzoate and p-coumarate.

Photoelectron-photofragment coincidence spectroscopy was used to study the dissociation dynamics of the conjugate bases of benzoic acid and p-coumaric acid. Upon photodetachment at 266 nm (4.66 eV) both aromatic carboxylates undergo decarboxylation, as well as the formation of stable carboxyl radicals. The key energetics are computed using high-level electronic structure methods. The dissociation dynamics of benzoate were dominated by a two-body DPD channel resulting in CO2 + C6H5 + e-, with a very small amount of stable C6H5CO2 showing that the radical ground state is stable and the excited states are dissociative. For p-coumarate (p-CA-) the dominant channel is photodetachment resulting in a stable radical and a photoelectron with electron kinetic energy (eKE) <2 eV. We also observed a minor two-body dissociative photodetachment (DPD) channel resulting in CO2 + HOC6H4CHCH + e-, characterized by eKE <0.8 eV. Evidence was also found for a three-body ionic photodissociation channel producing HOC6H5 + HCC- + CO2. The ion beam contained both the phenolate and carboxylate isomers of p-CA-, but DPD only occurred from the carboxylate form. For both species DPD is seen from the first and second excited states of the radical, where vibrational excitation is required for decarboxylation from the first excited radical state.

[Management of surgical complications following prolonged warfarin therapy in a general surgical hospital]. / Lechenie khirurgicheskikh oslozhnenii prolongirovannoi terapiei varfarinom v obshchekhirurgicheskom statsionare.

OBJECTIVE: To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital. MATERIAL AND METHODS: The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients - over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests - thromboelastography (TEG) and thrombodynamics test (TT). RESULTS: Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications - in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment - 25 patients, after two days - 2 patients). Ten patients underwent endoscopic hemostasis, two patients - ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy. CONCLUSION: The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.

ROLE OF THROMBODYNAMICS GLOBAL COAGULATION TEST IN IMPROVING TREATMENT RESULTS IN PATIENTS WITH CORONAVIRUS INFECTION AT A COVID-19 HOSPITAL.

The aim of the study was to evaluate the effectiveness of the global coagulation test of thrombodynamics for monitoring and correcting the hemostatic system and improving the results of complex treatment in patients with SARS-CoV-2 in the COVID hospital. From April 2020 to December 2020 on the basis of the University Clinical Hospital No. 4 of the First Moscow State Medical University named I.M. Sechenov (Sechenov University) of the Ministry of Health of the Russian Federation 245 patients between the ages of 27 and 89 with SARS-CoV-2 associated pneumonia were treated. The mean age of the patients was 56.7 ± 4.2 years. All patients participating in the study were divided by simple randomization into two groups. The volume of lesion of the lung parenchyma was assessed according to the data of computed tomography. All patients were treated for SARS-CoV-2 in a comprehensive manner in accordance with the temporary guidelines of the Ministry of Health of the Russian Federation with the mandatory prescription of low molecular weight heparins (LMWH). Assessment and correction of the hemostasis system in 177 patients (47.7%) of group 1 was carried out daily using local coagulation tests (LCT), including APTT, PT, TT, PTI, INR, Fibrinogen and D-dimer level. The second group included 128 patients (52.3%), who, in addition to local coagulation tests, used the integral coagulation test - the thrombodynamics test- to assess and correct the state of the hemostatic system. Assessment and correction of hemostasis were performed at the control points (1, 7, 14 days) of the study. Compared to LCT, the thrombodynamics test reliably more often revealed the state of hypercoagulability, which was promptly corrected by increased doses of LMWH in group 2. Positive dynamics of clinical symptoms were detected in patients of group 2 1.8 times more often than in group 1 (p<0.05): fever and shortness of breath in group 2 decreased faster, the SpO2 index recovered more rapidly, especially in patients with severe hypoxia (with SpO2<90), the number of patients with moderate and severe severity by the third point of the study in group 2 was 1.8 times less than in group 1 (p<0.05). Severe forms of lung damage (CT-3 and CT-4) were detected in group 2 3.2 times less frequently (p <0.01) compared with group 1, and the number of deaths was 3.3 times less frequent (p<0.01) by the end of the study. The average bed-day in group 2 of patients (15±1.6 days) was 1.6 times shorter than in group 1 (24±7.2 days). Hemorrhagic complications were not recorded, despite the therapeutic doses of LMWH in patients of group 2. The severity of the condition of patients with SARS-CoV-2 and the dynamics of their symptoms depend on the state of microcirculation in the lungs and in the periphery and on the volume of thrombotic lesions. Anticoagulant therapy prescribed as early as possible in adequate therapeutic doses in patients with SARS-CoV-2 associated viral pneumonia made it possible to achieve positive treatment results. The use of the global coagulation thrombodynamics test has shown high efficiency for the timely assessment and correction of the state of the hemostasis system.

[COMPLEX TREATMENT OF PATIENTS WITH VENOUS TROPHIC ULCER IN THE CONDITIONS OF COVID-19 HOSPITAL].

The aim of the study was to study the effectiveness of complex treatment of decompensated chronic venous insufficiency (CVI) using innovative techniques and proteolysis inhibitors with a wide spectrum of activity in patients with SARS-CoV-2 (COVID-19) in COVID hospital. This study was performed in the surgical department of COVID hospital on the basis of the Clinical Hospital No. 4 of the First Moscow State Medical University named I.M. Sechenov (Sechenov University). During the period from April 2020 to February 2021, 32 patients with confirmed SARS-CoV-2 (COVID-19) and the presence of venous trophic ulcers (VTU) of the lower extremities were treated. All patients underwent complex therapy for viral pneumonia in accordance with the order of the Ministry of Health of the Russian Federation. The protease inhibitor Aprotinin (Gordox ™) was used to improve microcirculation and prevent the development of a "cytokine storm". To accelerate the cleansing and epithelialization of venous trophic ulcers, the surface of the trophic ulcer was treated with an air plasma flow of NO and injections into the trophic ulcer of autoplasma. Against the background of complex treatment, all patients showed positive dynamics of the clinical picture: relief of hyperthermia, increase or stabilization of SpO2 values from 95% and above, significant decrease in CRP, LDH, D-dimer indices, increase in the number of lymphocytes, decrease in the VTU area by 1.5 times, active granulation and marginal epithelialization of the ulcer. In 14 patients (43.8%), complete epithelialization of the VTU defect was noted by the end of the third week. According to the CIVIQ-20 questionnaire, all 32 patients participating in the study showed positive dynamics. There were no lethal outcomes. Multicomponent therapy of decompensated forms of CVI of the lower extremities in the COVID hospital in patients with moderate severity of coronavirus infection with the use of proteolysis inhibitors leads to a rapid relief of symptoms of intoxication, prevents the progression of lung tissue and parenchymal organ damage and contributes to the positive dynamics of healing of ulcerative defects in the vast majority of patients.

Resonant Inelastic X-Ray Scattering Reveals Hidden Local Transitions of the Aqueous OH Radical.

Resonant inelastic x-ray scattering (RIXS) provides remarkable opportunities to interrogate ultrafast dynamics in liquids. Here we use RIXS to study the fundamentally and practically important hydroxyl radical in liquid water, OH(aq). Impulsive ionization of pure liquid water produced a short-lived population of OH(aq), which was probed using femtosecond x-rays from an x-ray free-electron laser. We find that RIXS reveals localized electronic transitions that are masked in the ultraviolet absorption spectrum by strong charge-transfer transitions-thus providing a means to investigate the evolving electronic structure and reactivity of the hydroxyl radical in aqueous and heterogeneous environments. First-principles calculations provide interpretation of the main spectral features.

[EXPERIENCE OF TREATMENT OF THE SEPTIC PHLEGMONS OF THE LOWER LIMBS AFTER THE COMBINED PHLEBECTOMY].

The aim of the study - to identify the causes and develop methods of treatment and prevention of septic phlegmons of the lower extremities after combined phlebectomy. The article presents the experience of treating 6 patients between the ages of 21 and 69 years with severe pyo-inflammatory complications (septic phlegmons) of the lower extremities after combined phlebectomy between 2012 and 2019. All patients had signs of a expressed systemic inflammatory response (SIRS3 and SIRS4) when they received admission. Against the background of intensive detoxification therapy in intensive care department, all patients were operated on emergency indications. Under anesthesia, they were performed an opening the subcutaneous phlegmons of the lower extremities using wide stripes incisions. Comprehensive therapy included the prescribing of antibiotics, anti-inflammatory drugs, stage necrectomy, the treatment of purulent wounds with various variants of surgical energy (plasma flows and NO-therapy) in various modes. The results of the treatment were estimated in the near and distant periods. Timely diagnosis, surgical treatment with the opening of purulent cavities with a wide excision of necrotized subcutaneous fat and fascia, as well as the subsequent plasmadynamic stage wound purification in therapeutic mode allowed in all cases to stop systemic inflammatory syndrome, to achieve rapid cleansing and healing of wounds. All patients were discharged for outpatient treatment. There were no fatalities. The long-term results of treatment were found to be satisfactory, and no patients were found to be disabled. The careful compliance to the main stages of the combined phlebectomy, especially the quality control of postoperative hemostasis, can minimize the development of septic complications. The comprehensive treatment with active surgical tactics and the use of air-plasma technologies allow to achieve a rapid cleansing of wounds and a speedy recovery of patients.

Synthesis of Samarium OxysulfateSm2O2SO4 in the High-Temperature Oxidation Reaction and Its Structural, Thermal and Luminescent Properties.

The oxidation process of samariumoxysulfide was studied in the temperature range of 500-1000 °C. Our DTA investigation allowed for establishing the main thermodynamic (∆Hºexp = -654.6 kJ/mol) and kinetic characteristics of the process (Ea = 244 kJ/mol, A = 2 × 1010). The enthalpy value of samarium oxysulfate (ΔHºf (Sm2O2SO4(monocl)) = -2294.0 kJ/mol) formation was calculated. The calculated process enthalpy value coincides with the value determined in the experiment. It was established that samarium oxysulfate crystallizes in the monoclinic symmetry class and its crystal structure belongs to space group C2/c with unit cell parameters a = 13.7442 (2), b = 4.20178 (4) and c = 8.16711 (8)Å, ß = 107.224 (1)°, V = 450.498 (9)Å3, Z = 4. The main elements of the crystalline structure are obtained and the cation coordination environment is analyzed in detail. Vibrational spectroscopy methods confirmed the structural model adequacy. The Sm2O2SO4luminescence spectra exhibit three main bands easily assignable to the transitions from 4G5/2 state to 6H5/2, 6H7/2, and 6H9/2 multiplets.

Observation of the fastest chemical processes in the radiolysis of water.

Elementary processes associated with ionization of liquid water provide a framework for understanding radiation-matter interactions in chemistry and biology. Although numerous studies have been conducted on the dynamics of the hydrated electron, its partner arising from ionization of liquid water, H2O+, remains elusive. We used tunable femtosecond soft x-ray pulses from an x-ray free electron laser to reveal the dynamics of the valence hole created by strong-field ionization and to track the primary proton transfer reaction giving rise to the formation of OH. The isolated resonance associated with the valence hole (H2O+/OH) enabled straightforward detection. Molecular dynamics simulations revealed that the x-ray spectra are sensitive to structural dynamics at the ionization site. We found signatures of hydrated-electron dynamics in the x-ray spectrum.

[Surgical treatment of rupture of the anterior wall of the left ventricle in the apical region with the formation of a false aneurysm in the acute stage of myocardial infarction].

One of the most dangerous complications of acute myocardial infarction (MI) is external or internal left ventricular rupture. Despite multiple studies on early diagnostics and algorithms for routing of patients with complicated MI, mortality in this patient group remains extremely high. Presently available publications on the tactics of managing patients with cardiac rupture are very scarce, and expectancies of surgical treatment are questionable. The provided clinical example demonstrates effectiveness of early open-heart surgical intervention, which supports the requirement for aggressive tactics for patients with cardiac rupture.

[AUTOVENOUS REVASCULARIZATION OF THE LOWER EXTREMITY ARTERIES IN PATIENTS WITH VARIANT ANATOMY OF THE PERIPHERAL BLOOD FLOW AND THE PROGRESSIVE ATHEROSCLEROTIC PROCESS].

Obliterating diseases of the lower extremity arteries occupy a high proportion in the structure of cardiovascular morbidity in the population among the developed countries. The steadily progressing course of obliterating atherosclerosis leads to the critical lower limb ischemia and causes an unfavorable prognosis for preserving the extremity, as well as the patient's life. Nowadays, there are two ways of surgical management of this pathology: endovascular and open reconstructive interventions. The choice of the method is based on a comprehensive keeping of the patient-specific records, including the anatomical characterization of the arterial bed lesions. In case of extended occlusion of the superficial femoral artery, the open reconstructive surgery using a large saphenous vein as a transplant is recommended. This circumstance is confirmed by the autovein patency in the long term compared with a synthetic prosthesis according to the results of randomized clinical trials. Therefore, with the formation of a distal anastomosis below the gap of the knee joint, the patency of the autovein and synthetic prosthesis after 5 years is 71% and 44% respectively. In this article, we represent a clinical case of successful treatment of a patient with progression of atherosclerotic lesions of the infrainguinal segment arteries. A staged revascularization of the femoral-popliteal segment arteries using technique of a reversed vein on both lower extremities after attempts of the conservative treatment and x-ray endovascular intervention was performed. A feature of this case is the creation of a new bifurcation of the popliteal artery during the formation of a distal anastomosis below the fissure of the knee joint under the contitions of a high discharge of the anterior tibial artery.The given clinical case demonstrates the advantages of invasive surgical tactics with the aim of preserving the limb and improving the patient's quality of life.

[Extensive purulent processes after combined phlebectomy]. / Obshirnye nagnoitel'nye protsessy posle kombinirovannoi flebéktomii.

OBJECTIVE: To analyze the causes and develop methods for the treatment of extensive purulent processes after combined phlebectomy in patients with lower limb varicose veins. MATERIAL AND METHODS: The authors reported 3 cases of extensive phlegmon after phlebectomy for the period from 2014 to 2018. It is shown that comprehensive debridement of purulent-inflammatory lesion with application of additional methods including high-energy exposure by the air-plasma flow is essential for effective treatment of this complication. In addition, literature review showed only few observations of severe septic complications after traditional varicose vein surgery. RESULTS: Radical debridement of purulent wounds with wide excision of necrotic subcutaneous tissue and fascia, combination of standard surgical technique and plasma scalpel, as well as subsequent plasmodynamic staged wound repair in a therapeutic mode prevented severe purulent-inflammatory process, stopped systemic inflammatory syndrome and resulted fast wound healing. CONCLUSION: Active surgical approach combined with air-plasma technology was followed by high-quality correction of extensive suppurative process. Minimally invasive management of varicose disease with improvement of surgical techniques will minimize the likelihood of these complications.

[Surgical strategy for acute biliary pancreatitis]. / Khirurgicheskaia taktika v ostroi stadii biliarnogo pankreatita.

OBJECTIVE: To develop a rational surgical strategy for acute biliary pancreatitis and its complications. MATERIAL AND METHODS: A 10-year follow-up enrolled 378 patients with acute biliary pancreatitis. Mild pancreatitis was diagnosed in 304 (80%) patients, moderate and severe course - in 74 (20%). Almost all patients with mild acute biliary pancreatitis underwent surgery within 3-7 days after the attack resolution. Patients with severe biliary pancreatitis had general and local complications that required differentiated treatment strategy. CONCLUSION: Strangulation of the calculus in the major duodenal papilla requires emergency endoscopic papillosphincterotomy. Choledocholithiasis, cholangitis and obstructive jaundice in acute biliary pancreatitis are indications for endoscopic papillosphincterotomy. Cholecystectomy should be performed after resolution of inflammatory changes in the gallbladder and pancreas in patients with severe biliary pancreatitis.

Two-Stage Revascularization in Patients with Acute Myocardial Infarction and Massive Coronary Thrombosis.

AIM: to investigate safety and angiographic efficacy of two-stage revascularization with percutaneous coronary intervention (PCI) with stenting delayed by one day in patients with acute myocardial infarction (MI) and massive coronary thrombosis. MATERIALS AND METHODS: We included in this study 12 patients with massive infarct related coronary artery thrombus which length was greater than thrice the vessel diameter in the presence of TIMI grade II-III blood flow as detected by coronary angiography (CAG). The emergency PCI was not performed, and conservative antithrombotic therapy continued for 24 hours. After this day, CAG was repeated. RESULTS: Repeat CAG in all patients showed thrombus regression which visually appeared as complete lysis in 8, and partial lysis - in 4 patients. Stenting of residual stenosis was performed in 11 patients without complications. In 1 patient residual stenosis was considered insignificant (<50 %) therefore stenting was not performed. No-reflowphenomenon and recurrent MI were not observed. CONCLUSION: These data suggest that in patients with massive coronary artery thrombosis conservative antithrombotic therapy for 24 hours followed by repeated CAG and, if required, by stenting of residual stenosis, is safe treatment tactics that might reduce the risk of the no-reflow phenomenon.

[Endotheliotropic effects of venotonic drugs in treatment of patients with varicose veins]. / Éndoteliotropnye éffekty venotoniziruiushchikh preparatov pri lechenii bol'nykh s varikoznoi bolezn'iu.

The authors analysed the effect of Venarus on the endothelial function in patients suffering from lower limb varicose veins. Our open-label prospective study included a total of 100 patients diagnosed as having CEAP class C1-C2 varicose veins and divided into two equal groups. Dynamic assessment of the clinical course of the disease in Group One patients was carried out on the background of taking Venarus and compression therapy, with Group Two patients evaluated without taking Venarus. At defined stages we determined the level of biochemical markers of endothelial function. The obtained findings demonstrated that the use of phlebotonic Venarus resulted in decreased activity of lipid peroxidation processes and reduced activity of antioxidant system enzymes. Using Venarus was followed by a statistically significant decrease in the concentration of malonic dialdehyde (from 1.220±0.190 µmol/l at baseline to 0.858±0.231 µmol/l after 2 months of treatment), whereas in Group Two patients the changes were insignificant (1.191±0.204 µmol/l before treatment and 1.138±0.175 µmol/l at 2 months thereafter). Patients taking Venarus were also found to have a higher level of nitric oxide metabolites compared with the patients treated by compression therapy alone (51.646±11.757 and 36.310±6.921 µmol/l in Groups One and Two, respectively). Hence, an evidence-based conclusion was drawn that Venarus proved efficient and may therefore be prescribed as pharmacotherapy for correction of endothelial dysfunction.