Ra-226 in building materials as a source of indoor radon in high-rise residential buildings in Russian cities.

The problem of indoor radon in high-rise buildings is mostly associated with exhalation from building materials. Characterization of the radon entry from building materials by diffusion is required to provide a proper control of the population indoor radon exposure. To analyze the relationship between the content of Ra-226 in building materials and the indoor radon concentration the results of the following surveys in high-rise buildings in Russian cities were used: 1) indoor radon (>1000 apartments), 2) natural radionuclides in the building materials in existing buildings by means of non-destructive field gamma spectrometry (100 apartments). The surveys were carried out in nine large cities in different climatic zones. The radon entry rate due to diffusion from building materials, D, normalized to Ra-226 activity concentration, Ra, is in the range of 0.2-0.6 (Bq/m3/h)/(Bq/kg), depending on the type of building materials and building construction. In new multi-story buildings, the typical D/Ra ratio can be assumed to be 0.4 (Bq/m3/h)/(Bq/kg). In new energy-efficient buildings, the ratio of the radon concentration to Ra-226 activity concentration is on average 2.1 times higher than in multi-story buildings of lower energy efficiency built before 2000. The average radon exhalation rate from the building materials, normalized to Ra-226 activity concentration, is estimated to be 0.25 Bq/m2/h.

Relationship between Ra-226 activity concentration in building materials and indoor radon concentration: An example of Russian high-rise residential buildings.

The worldwide trend toward the construction of high-rise buildings with high energy efficiency highlights the role of building materials as a source of indoor radon in the modern urban environment. The aim of the study is to analyze the relationship between the Ra-226 activity concentration in building materials and indoor radon concentration using the example of multi-story buildings in Ekaterinburg. Measurements of the activity concentration of natural radionuclides in building materials were carried out using a new non-destructive method. A radon survey conducted early provided the data on indoor radon concentrations in the same apartments. The obtained Ra-226 activity concentrations in building materials in high-rise buildings were found to be relatively low, ranging from 9.1 to 51 Bq/kg. The typical radon entry rate by diffusion from building materials for modern Russian multi-story buildings can be accepted as equal to 0.5 Bq/(m3∙h) per 1 Bq/kg of Ra-226 activity concentration. Ra-226 in building materials has been shown to be a primary source of indoor radon in modern high-rise buildings, where this factor can cause indoor radon concentrations above the reference level of 100 Bq/m3 at low air exchange rates. The activity concentration of Ra-226 in building materials should be considered a separate parameter for regulation within the national radiation protection systems.

[Models of bone defects in rabbits used to evaluate the bone graft materials efficacy]. / Modeli kostnykh defektov u krolikov, ispol'zuemye dlya otsenki effektivnosti kostno-plasticheskikh materialov.

The review deals with the main types of experimental models of bone defects of the skull in rabbits. The information about the types of critical defects, methods of their modeling and the possibilities of application of the described models in the studies of bone graft materials in dentistry and maxillofacial surgery is systematized.

[Robot-assisted prostatectomy for PT3. Oncological and functional outcomes].

In 2020, prostate cancer (PCa) ranked third in the structure of the most significant oncological diseases. In the Russian Federation, in terms of the frequency of detection among men, prostate cancer is second only to tumors of the upper respiratory tract and lungs, accounting for 14.9%. Radical prostatectomy (RP) in various modifications is still the most common treatment for localized prostate cancer, despite the existence of alternatives such as active surveillance, hormonal and radiation therapy, cryoablation, and others. And the technological pinnacle of the surgical treatment of prostate cancer at the moment is robot-assisted prostatectomy, the widespread use of which was marked by the publication of J. Binder back in 2002. This technology combined the advantages of minimally invasive laparoscopic RP with improved surgeon ergonomics and technical ease of vesicourethral anastomosis reconstruction and has now become the preferred minimally invasive approach. This article will consider the use of a robot-assisted technique in the stage of T3 prostate cancer.

[Advantages and disadvantages of bone graft materials activated by BMP-2 and constructs carrying its gene]. / Preimushchestva i nedostatki kostno-plasticheskikh materialov, aktivirovannykh BMP-2 i nesushchimi ego gen konstruktsiyami.

In the review gene constructs and proteins used to impart osteoinductive properties to bone graft materials are compared. On the basis of clinical and experimental data the experience and prospects of their application in maxillofacial surgery and dentistry are described. Information about complications associated with the use of bone morphogenetic protein-2 (BMP-2) and vectors carrying its gene is provided.

[Treatment options for external inflammatory root resorption]. / Sposoby lecheniya naruzhnoi vospalitel'noi rezorbtsii kornya zuba.

THE AIM OF THE STUDY: Was to compare the efficacy of various treatment options for external inflammatory root resorption according to literature data. MATERIALS AND METHODS: Literature was searched in electronic databases «eLibrary¼ and «PubMed¼ for key words «external inflammatory resorption treatment¼, «external inflammatory resorption management¼. Inclusion criteria comprised publications in Russian or English, clinical and experimental studies, full description of treatment protocol and obtained results. Studies with no full text, describing root resorption of orthodontic origin, clinical cases and clinical case series were excluded from the study. RESULTS: The problem of external inflammatory root resorption is poorly described in the Russian scientific literature. There are no registered protocols for its prevention and treatment or therapeutic agents with proved efficacy available in Russia. The only accessible approach for external inflammatory root resorption remains timely pulp extirpation after dental trauma which importance is underlined by all authors involved in the field of dental trauma studies. MTA and calcium hydroxide being popular as intracanal medications still have significant inconveniences as they potentially provoke root dentine fractures or replacement resorption. CONCLUSION: There is a need for elaboration and implementation of new prevention and treatment options for external inflammatory root resorption after dental trauma.

[HIFU therapy of localized prostate cancer using image-guided robotic HIFU Focal One].

INTRODUCTION: Prostate cancer (PCa) is the second most commonly diagnosed malignant tumor in men after lung cancer and is the fifth leading cause of death worldwide. In November 2019, the spectrum of alternative treatment for PCa was added by a novel minimally invasive method, namely high-intensity focused ultrasound (HIFU) using the latest Focal One machine (with the possibility of combining intraoperative ultrasound and preoperative MRI data). MATERIALS AND METHODS: During the period from November 2019 to November 2021, HIFU using Focal One device (manufactured by EDAP, France) was performed in 75 patients with PCa. Total ablation was done in 45 cases, while 30 patients undergone to focal prostate ablation. The average age of the patients was 62.7 (51-80) years, the total PSA level was 9.3 (3.2-15.5) ng/ml and the prostate volume was 32.0 (11-35) cc. The maximum urinary rate was 13.3 (6.3-36) ml/s, IPSS score was 7 (3-25) points, IIEF-5 score was 18 (4-25). Clinical stage c1N0M0 was diagnosed in 60 patients, 1bN0M0 in 4 patients, 2N0M0 in 11 patients. In 21 cases, transurethral resection of the prostate was performed within 4-6 weeks prior to total ablation. Before surgery, all patients underwent magnetic resonance imaging (MRI) of the pelvis with intravenous contrast and PIRADS V2 assessment. MRI data were used intraoperatively for precision planning of the procedure. RESULTS: In all patients, the procedure was performed under endotracheal anesthesia in accordance with the technical recommendations of the manufacturer. Prior to surgery, a silicone urethral catheter of 16 or 18 Ch was placed. The average duration of the intervention was 101 (56-147) minutes. The postoperative period was uneventful in all cases.Patients received antibiotic therapy via parenteral route for 4 days, followed by oral administration for another 10 days, as well as alpha-blockers (at least 1 month after procedure). After removal of urethral catheter on the 4th day, all patients started to void. In 9 cases there was acute urinary retention in the evening and in 4 patients in the next morning, requiring temporary bladder catheterization. A year after the procedure, 53 patients were fully examined: the average total PSA level in patients who underwent total ablation (n=53) was 0.96+/-0.11 ng/ml, the IPSS score was 6.9+/-0,6 points (no difference compared to baseline). Follow-up biopsy revealed PCa in 6 patients; in other cases, prostate fibrosis was determined. CONCLUSIONS: HIFU in patients with localized PCa using image-guided robotic HIFU (Focal One) is promising and feasible. This method has shown good oncological results with a short follow-up period. It is advisable to carry out further prospective analysis.

[Relative survival and cell adhesion of multipotent mesenchymal cells from primary teeth pulp on the surface membranes and sponges produced from collagen]. / Otnositel'naya vyzhivaemost' i adgeziya mul'tipotentnykh mezenkhimal'nykh kletok iz pul'py molochnykh zubov na poverkhnosti membran i gubok, proizvodimykh iz kollagena.

OBJECTIVE: To study the behavior of SHED cell culture on different types of materials for the regeneration of periodontal tissues with different porosity. MATERIAL AND METHODS: Porous collagen material Fibro-Gide (Geitstlich Pharma AG, Switzerland), designed to increase the volume of the gum and the barrier collagen membrane Bio-Gide (Geitstlich Pharma AG, Switzerland) were studied in vitro on SHED cultures. As a control sample, a Spongostan sponge made of gelatin (Johnson & Johnson Medical, UK) with the most pronounced porosity and wettability was used. Acute cytotoxicity was determined using a screening method for assessing the number of living cells in a sample (MTT test). SHED cells were sown on the materials to study the attachment of cells to materials and their migration inside the samples. Before seeding, the cells were stained with vital fluorescent dye PKH26 (red fluorescent cell linker kit, Sigma, Germany) for further visualization. RESULTS AND DISCUSSION: Using the MTT test it was shown that they do not have cytotoxic effects. At the same time by the 8th day of the experiment in the presence of Fibro-Gide and Bio-Gide the cells showed an increase in proliferative activity by 19% and 12%, respectively compared with the control group. The cells attached and spread out on the surface of the materials and migrated into the thickness of porous Fibro-Gide and Spongostan. CONCLUSION: The in vitro study showed that the most favorable material for SHED cell culture is the collagen material Fibro-Gide with sufficient porosity, elasticity and hydrophilicity. SHED cells attach to the collagen matrix and easily penetrate into the sample, filling the entire internal space, while the proliferative capacity of the cell culture increases.

[Short-term experience of intravitreal brolucizumab in treatment of diabetic macular edema]. / Kratkosrochnyi opyt primeneniya brolutsizumaba v lechenii diabeticheskogo makulyarnogo oteka.

PURPOSE: This study examines the efficacy and safety of brolucizumab in the treatment of diabetic macular edema (DME) in real clinical practice in the Russian Federation. MATERIAL AND METHODS: The study included 14 consecutive treatment-naïve DME patients, among them 7 males and 7 females (21 eyes in total) with mean age of 65.1±8.0 years. Patients underwent standard ophthalmological examination and multimodal imaging, including optical coherence tomography. All patients received intravitreal injections of brolucizumab every 6 weeks. A total of 73 injections were performed. A data analysis was performed for 10 eyes of 10 patients 6 months after initiation of the treatment. RESULTS: After 4 injections of brolucizumab, best-corrected visual acuity (BCVA) increased statistically significantly from 35.8±13.7 to 41.5±11.9 ETDRS letters (p=0.03), central retinal thickness (CRT) and macular volume (MV) decreased from 411.5±107.4 to 280.2±64.6 microns (p=0.014) and from 7.39±0.92 to 6.16±7.37 mm3 (p=0.0006), respectively. The average gain of visual acuity was 5.7±7.0 letters, average decrease of CRT was -131.3±91.2, and average decrease of MV was -1.21±0.75 mm3. There were no adverse events associated with intraocular inflammation. CONCLUSION: Intravitreal injections of brolucizumab provide significant anatomical and functional improvement to DME patients in real clinical practice with results comparable to that of randomized clinical trials.

Durvalumab with or without tremelimumab versus the EXTREME regimen as first-line treatment for recurrent or metastatic squamous cell carcinoma of the head and neck: KESTREL, a randomized, open-label, phase III study.

BACKGROUND: Patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) have a poor prognosis. The phase III KESTREL study evaluated the efficacy of durvalumab [programmed death-ligand 1 (PD-L1) antibody] with or without tremelimumab [cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) antibody], versus the EXTREME regimen in patients with R/M HNSCC. PATIENTS AND METHODS: Patients with HNSCC who had not received prior systemic treatment for R/M disease were randomized (2 : 1 : 1) to receive durvalumab 1500 mg every 4 weeks (Q4W) plus tremelimumab 75 mg Q4W (up to four doses), durvalumab monotherapy 1500 mg Q4W, or the EXTREME regimen (platinum, 5-fluorouracil, and cetuximab) until disease progression. Durvalumab efficacy, with or without tremelimumab, versus the EXTREME regimen in patients with PD-L1-high tumors and in all randomized patients was assessed. Safety was also assessed. RESULTS: Durvalumab and durvalumab plus tremelimumab were not superior to EXTREME for overall survival (OS) in patients with PD-L1-high expression [median, 10.9 and 11.2 versus 10.9 months, respectively; hazard ratio (HR) = 0.96; 95% confidence interval (CI) 0.69-1.32; P = 0.787 and HR = 1.05; 95% CI 0.80-1.39, respectively]. Durvalumab and durvalumab plus tremelimumab prolonged duration of response versus EXTREME (49.3% and 48.1% versus 9.8% of patients remaining in response at 12 months), correlating with long-term OS for responding patients; however, median progression-free survival was longer with EXTREME (2.8 and 2.8 versus 5.4 months). Exploratory analyses suggested that subsequent immunotherapy use by 24.3% of patients in the EXTREME regimen arm contributed to the similar OS outcomes between arms. Grade 3/4 treatment-related adverse events (TRAEs) for durvalumab, durvalumab plus tremelimumab, and EXTREME were 8.9%, 19.1%, and 53.1%, respectively. CONCLUSIONS: In patients with PD-L1-high expression, OS was comparable between durvalumab and the EXTREME regimen. Durvalumab alone, and with tremelimumab, demonstrated durable responses and reduced TRAEs versus the EXTREME regimen in R/M HNSCC.

[Short-term efficacy and safety of Brolucizumab for neovascular age-related macular degeneration in the Russian Federation]. / Kratkosrochnye dannye effektivnosti i bezopasnosti primeneniya preparata «Brolutsizumab¼ pri lechenii neovaskulyarnoi vozrastnoi makulyarnoi degeneratsii na territorii Rossiiskoi Federatsii.

PURPOSE: To analyze the short-term efficacy and safety of Brolucizumab in the treatment of patients with neovascular age-related macular degeneration (nAMD). MATERIAL AND METHODS: This retrospective pilot study included 154 patients (51 males and 103 females, mean age 73.9±8.1 years). Among the 154 patients, 97 (63.0%) had previously been treated with anti-VEGF drugs and were included in this study due to continuing disease activity. All study patients underwent standard ophthalmological examination and optical coherence tomography at the initial visit as well as at each monthly visit. RESULTS: A total of 283 Brolucizumab injections were performed in two ophthalmic care centers. In total, 49.4%, 24.0%, 20.1%, 6.5% of patients received 1, 2, 3 and 4 injections, respectively. Central retinal thickness has significantly decreased from 301±79 to 230±41 µm (p<0.05) in the ophthalmic center of the Military Medical Academy (site 1), and from 418±102 to 217±50 µm (p<0.05) in the ophthalmic center of the Institute of the Human Brain (site 2). The prevalence of subretinal and sub-RPE fluid has decreased statistically significantly (p<0.05) in patients of both sites. Visual acuity has not changed significantly (p>0.05) in patients of both sites. One case of mild vitreitis was registered, it was successfully treated with topical steroids. CONCLUSIONS: Both treatment-naive nAMD patients and those with the disease remaining active despite anti-VEGF therapy showed a significant decrease in disease activity. In this short-term study, the cumulative risk of intraocular inflammation associated with brolucizumab therapy amounted to 0.65%.

[Biofilm control in urological practice].

Urinary tract infections (UTIs) have long been among the most common diseases. In the structure of the general infectious morbidity, UTIs rank second after acute respiratory viral infection. Every year, researchers note an increasing number of mutations in the genomes of bacteria that cause infectious diseases, which leads to the formation of more and more aggressive forms of pathogens. Patients with infectious diseases of the urinary system have the highest risk of biofilm formation, the frequency of which is directly proportional to the length of time the urethral catheter is located and accounts for more than half of all nosocomial infections. The presence of resistant strains of pathogenic bacteria and the development of bacterial biofilms are major problems in the treatment of urinary tract infections. The increasing number of nosocomial bacterial strains in the hospital increases the postoperative bed-day, the frequency of readmission and the number of antibacterial drugs used. In light of increasing antibacterial resistance, the use of medical resources is dramatically increasing, which ultimately leads to an increase in the cost of treatment. Along with this, the selection of resistant strains brings to the fore both the rational use of antibacterial drugs and the search for alternative methods of therapy. This review of publications on the problem of bacterial biofilm formation in urological practice demonstrates updated information on the role of enzymes, probiotics, and bacteriophages in preventing biofilm formation on various medical biomaterials, such as urethral catheters.

Factors influencing temporal variations of radon concentration in high-rise buildings.

Long-term radon time series were analyzed in 14 rooms and offices to search factors influencing indoor radon concentration in high-rise buildings. Radon entry to living rooms is determined both by diffusion from building materials and advection from adjoined low-ventilated spaces. Humans affect on seasonal and diurnal radon concentration changes in high-rise buildings by activating ventilation system. Indoor-outdoor temperature difference significantly influence on the air exchange rate under uncontrolled ventilation, which is especially important in new energy efficient buildings.

[IATROGENIC INJURIES DURING PREOPERATIVE MARKING OF NON-PALPABLE PATHOLOGICAL AREAS OF THE MAMMARY GLANDS].

The purpose of the study is to identify the types and frequency of medical mistakes made during preoperative marking of non - palpable pathological areas of the breast. We analyzed 60 clinical observations of patients with non-palpable, morphologically verified pathological areas in breast tissues, who underwent surgical intervention at the first stage of treatment with mandatory preoperative marking with a guide needle. The obtained data indicates that the error rate of radiologists when installing a tissue marker in a non-palpable breast neoplasm is 13.3% and is most often manifested by syntopia of the guide needle, which is detected at the beginning of the operation and requires implantation of additional tags. All clinical observations were accompanied by an increase in both the equivalent dose received by the patient and duration of the anesthesia. To improve the quality of interventional techniques performed on the breast, also to minimize the number of iatrogenic injuries, the radiologist must have spatial thinking, a sufficient amount of theoretical knowledge and practical skills.

[Alpha1-adrenergic blockers therapy and sexual function].

An increase in life expectancy and the number of older and elderly men, an improvement in the quality of medical care and socio-economic factors in most countries contributed to an increase in the number of patients with benign prostatic hyperplasia (BPH). Currently, improvement of the quality of life is the mainstay of strategy for managing patients with BPH, as well as prevention of complications and the need for surgery. In this regard, the pharmacotherapy with 1-adrenergic blockers (1-AB) is widely used as an effective method for improving lower urinary tract symptoms and reducing the risk of BPH progression. Given that the quality of life is becoming increasingly important in evaluating the efficiency of BPH treatment, including therapy in elderly patients, it is necessary to take into account its effect on sexual function, when choosing a particular drug. The use of 1-AB can be accompanied by side effects manifested by various sexual disorders. Alfuzosin does not adversely affect sexual function in men with BPH, may improve erectile and ejaculatory function and should be considered as the drug of choice, especially in sexually active men and patients who already suffer from worsening ejaculatory function while using another 1-AB.

RADON MEASUREMENTS IN BIG BUILDINGS: PILOT STUDY IN RUSSIA.

Detailed analysis of indoor radon concentration distribution by floors was conducted in four children institutions, one office building and two residential houses in Russian cities to develop approaches to draw up a program of radon survey for big buildings. Higher variability of radon concentration was found in high geogenic radon potential (GRP) area when the soil is the main source of radon. No essential dependence of radon concentration on the floor in high-rise buildings was found in low GRP area. The number of required radon measurements is estimated using obtained characteristics of radon variability.

[ORGANIZATION OF MEDICAL CARE FOR ELDERLY PATIENTS UNDER THE CONDITIONS OF THE COVID-19 PANDEMIC].

The first report of the new coronavirus infection (COVID-19) appeared at the end of December 2019 and in March,2020 the World Health Organization announced COVID-19 a pandemic. The steady number of newly detected cases increase predetermined the modernization of the global healthcare system, shifting the paradigm of fighting with the COVID-19 pandemic towards maximum resource conservation. The change in the medical care provision for infectious patient's approach led first to a gradual decrease, and then to a complete cessation of planned surgical treatment, outpatient examinations, as well as observation of high-risk patients, which primarily include elderly patients. As a result of this, the key objective of this systematic review was to analyze sources of existing practice of providing urological care to patients of the older age group in the context of the COVID-19 pandemic. In accordance with the search for the keywords, the study reflects world and its own experience of MSMSU Urology Department in the treatment of age-related patients in the current epidemiological situation. The analysis showed that infectious complications from the urinary system take a leading position among the common complications inherent in elderly patients with COVID-19. The development of catheter-associated infection, the occurrence of antibiotic-resistant forms of bacteria, asymptomatic bacteriuria are only a small part of the problems clinicians have to face in newly profiled departments.

RADON TIME SERIES IN FOUR FLATS IN ENERGY EFFICIENT MULTI-STOREY BUILDING.

Influence of living habits and meteorological parameters on indoor radon concentration in a new energy efficiency multi-storey flat building typical for Russian cities was studied using radon time series analysis. Continuous indoor radon measurements were conducted in four flats of the same multi-storey residential building in Ekaterinburg, Russia. Factors influencing indoor radon in surveyed building (by rank) are as follows: ventilation regime> indoor/outdoor temperature difference > wind direction. Intentional ventilation frequency, temperature difference and wind direction explain together up to 46% of indoor radon variability in a flat of multi-storey building.

Development prospects of curable osteoplastic materials in dentistry and maxillofacial surgery.

The article presents classification of the thermosetting materials for bone augmentation. The physical, mechanical, biological, and clinical properties of such materials are reviewed. There are two main types of curable osteoplastic materials: bone cements and hydrogels. Compared to hydrogels, bone cements have high strength features, but their biological properties are not ideal and must be improved. Hydrogels are biocompatible and closely mimic the extracellular matrix. They can be used as cytocompatible scaffolds for tissue engineering, as can protein- and nucleic acid-activated structures. Hydrogels may be impregnated with osteoinductors such as proteins and genetic vectors without conformational changes. However, the mechanical properties of hydrogels limit their use for load-bearing bone defects. Thus, improving the strength properties of hydrogels is one of the possible strategies to achieve the basis for an ideal osteoplastic material.

[New directions of immunocorrection in multiple sclerosis]. / Novye napravleniia immunokorrektsii pri rasseiannom skleroze.

Multiple sclerosis is a central nervous system disease with autoimmune and neurodegenerative mechanisms of development. This disease can lead to severe disability and neurological defects. Although its etiology and pathogenesis remain unclear, research data show that multiple sclerosis is a multifactorial disease, the development of which depends on environmental factors, as well as a genetic predisposition. The impact of these factors lead to the death of neural cells, accompanied by demyelination of nerves and neuronal dysfunction. Therapy of multiple sclerosis is based on the use of anti-inflammatory and immunomodulating substances, however, there are certain disadvantages associated with the constant use of these drugs and a possible change in dosage over time. This review discusses the pathogenesis of multiple sclerosis and the role of various subpopulations of immune cells in the development of diseases, as well as existing approaches to therapy. It is noted that immunoreconstitution therapy has advantages over immunomodulation and immunosuppression maintenance therapy for some patients. Thus, short courses of therapy provide more adequate treatment for patients and lower risks of adverse events associated with chronic immunosuppression. The review also discusses the data of clinical studies on the immunoreconstitution therapy drugs, such as alemtuzumab, ocrelizumab and cladribine. It is noted that nowadays the exact mechanisms underlying this type of therapy remain unclear. In this regard, further studies are needed to explain the therapeutic effects. It is assumed that patients with a high risk of multiple sclerosis progression are the optimal group of patients for the early use of selective immunoreconstitution therapy. Thus, immunoreconstitution therapy may be the treatment of choice for many patients with highle active multiple sclerosis.