[Computed tomography diagnostics of acute and chronic mesenteric ischemia]. / Komp'yuterno-tomograficheskaya diagnostika ostroi i khronicheskoi mezenterial'noi ishemii.

BACKGRAUND: Chronic mesenteric ischemia is more often accompanied by clinical signs characteristic of colitis. Acute mesenteric ischemia, unlike chronic, is accompanied by nonspecific symptoms and is a serious disease that requires urgent diagnosis. AIMS: The aim of the study was to evaluate the effectiveness of MSCT in the diagnosis of acute and chronic mesenteric ischemia based on our observations. MATERIALS AND METHODS: The retrospective study included 135 patients with abdominalgia and suspected mesenteric ischemia who underwent multiphase CT of the abdominal cavity with intravenous bolus contrast enhancement. Group 1 included 105 patients with mesenteric ischemia; group 2 included 30, without confirmed mesenteric ischemia, with the presence of a symptom of mesenteric ischemia in the form of abdominalgia. RESULTS: We studied 135 patients, including 105 patients with mesenteric ischemia, 59 women and 46 men of average age 60±14.9 years. The acute form of ischemia (58%) was determined 1.5 times more often than the chronic one. Occlusive and nonocclusive acute mesenteric ischemia occurred in equal proportions. Mesenteric arterial thrombosis was the cause of acute mesenteric ischemia in 23% of cases. Mesenteric venous thrombosis was the cause of chronic intestinal ischemia in 61%, in 5% - acute form. Mixed arterial-venous genesis of mesenteric ischemia was determined in 4% against the background of strangulation obstruction. Dunbar syndrome as a cause of chronic intestinal ischemia was diagnosed in 16%. Chronic ischemic enterocolitis accounted for 10% of all cases of mesenteric ischemia and 23% of chronic ischemia. Symptoms and symptom complexes characteristic of the studied series of diseases with acute or chronic mesenteric ischemia were delineated. Sensitivity, specificity and prognostic value of CT with intravenous bolus contrast enhancement in diagnostics of diseases accompanied by mesenteric ischemia reached 100%. CONCLUSIONS: Multiphase CT of the abdominal cavity with bolus contrast enhancement is highly informative in the diagnosis of acute and chronic forms of mesenteric ischemia. Direct CT signs of impaired blood flow in the arteries or veins of the mesentery were indisputable. Indirect signs of mesenteric ischemia were aimed at a thorough analysis of the condition of mesenteric vessels.

Properties of liquid-crystal wave-guiding structures.

The paper presents the results of an experimental and numerical study of some properties of multimode liquid crystal waveguide structures. The nematic 4-cyano-4'-pentylbiphenyl (5CB) was used as a liquid crystal. A description of the experiments performed and some of the techniques used are given. Scattering diagrams are presented that characterize the features of propagation in a multimode liquid-crystal waveguide of one and many modes. It is shown that when an external repetitively pulsed electric field is switched on, the attenuation and size of inhomogeneities decrease. To explain this effect, the classical theory of liquid crystal director fluctuations is used. For the first time some properties of a liquid-crystal waveguide are described with explicit allowance for the two-dimensional Frederiks model. The two-dimensional nature of the liquid crystal director reorientation effects in our case (including under the action of an electric impulse-periodic field) required the involvement of the three-dimensional theory of light scattering in an LC waveguide and, as a consequence, the study of two-dimensional scattering diagrams in experiments, which make it possible to consider the two-dimensional nature of the behavior of the LC director. The relevance and importance of such studies are related both to the practical use and prospects of using liquid crystal materials in various high-speed and low-energy integrated-optical devices, for example, in communication elements, modulators, and sensors.

Apoptosis and Cell Proliferation Markers in Inflammatory-Fibroproliferative Diseases of the Vessel Wall (Review).

Apoptosis is the main feature of inflammatory-fibroproliferative disorders of the vessel wall. Studies in animal models have shown that smooth muscle cells (SMCs) cultured from endarterectomy specimens from the affected area proliferate more slowly and display higher apoptotic indices than SMCs derived from the normal vessel wall. Apoptotic cells were found in the destabilized atherosclerotic plaques, as well as in the samples with restenosis of the reconstruction area. Injury to the vessel wall causes two waves of apoptosis. The first wave is the rapid apoptosis in the media that occurs within a few hours after injury and leads to a marked reduction in the number of vascular wall cells. The second wave of apoptosis occurs much later (from several days to weeks) and is limited by the SMCs within the developing neointima. Up to 14% of the neointimal SMCs undergo apoptosis 20 days after balloon angioplasty. Ligation of the external carotid artery in a rabbit model led to a marked decrease in blood flow in the common carotid artery, which correlated with the increased apoptosis of endothelial cells and SMCs. Angioplasty-induced death of SMCs is regulated by a redox-sensitive signaling pathway, and topical administration of antioxidants can minimize vascular cell loss. On the whole, studies show that apoptosis is prevalent in vascular lesions, controlling the viability of both inflammatory and vascular cells, determining the cellular composition of the vessel wall. The main markers of apoptosis (Fas, Fas ligand, p53, Bcl-2, Bax) and cell proliferation (toll receptor) have been considered in the current review.

[Effect of an antioxidant on vascular wall cell apoptosis markers after reconstructive operations]. / Vliianie antioksidanta na markery apoptoza kletok sosudistoi stenki posle rekonstruktivnykh operatsii.

AIM: This study was aimed at determining Bcl-2 and Bax proteins expression before and after reconstructive-repairing operations in patients with atherosclerosis obliterans of lower extremities and at assessing the effect of an antioxidant (vitamin E at a dose of 100 mg once daily for 1 month after surgery) on the dynamics of changes of Bcl-2 and Bax proteins in the postoperative period. PATIENTS AND METHODS: The study included a total of 60 patients with stage III-IV lower limb atherosclerosis obliterans. All patients underwent reconstructive-repairing operations on the arteries of the aortofemoral segment. After surgery the patients were divided into two groups. Group A included 30 patients who during 1 month received additionally to basic therapy vitamin E at a daily dose of 100 mg. Group B was composed of 30 patients receiving basic therapy alone according to the National guidelines of managing patients with peripheral artery disease. All patients before, on POD 1, and 1 month after surgery were subjected to venous blood test aimed at determining Bcl-2 and Bax apoptosis proteins expression by means of enzyme-linked immunosorbent assay. RESULTS: In patients of groups A and B, the baseline level of Bcl-2 protein (4.75 and 4.2 ng/ml, respectively) was comparable with that in apparently healthy volunteers (5.3 ng/ml). The baseline levels of Bax protein in patients of the operated groups (26.9 and 26.0 ng/ml, respectively) were increased compared with the values in healthy volunteers (16.5 ng/ml). On POD 1 there was increased expression of Bax protein in Group A and B patients to 39.4 and 30.2 ng/ml, respectively. One month after surgery, Group B patients demonstrated a decrease in the Bcl-2 values below the baseline level - 1.1 ng/ml (p=0.003), with the Bax level continuing to increase - 36 ng/ml (p=0.004). In turn, Group A patients after 1 month were found to have increased levels of the Bcl-2 protein - 5.75 ng/ml, with the Bax level returning to the baseline values - 27.4 ng/ml. CONCLUSION: In stage III and IV lower limb obliterating atherosclerosis, the level of the Bax proapoptoric protein was higher than that in healthy volunteers. On POD 1, there occurred increased expression of the pro-apoptotic protein Bax and activation of apoptosis markers. On the background of using vitamin E at a dose of 100 mg once daily for 1 month, there was a decrease in level of the Bax propapoptotic protein (p=0.003) and an increase in level of the anti-apoptotic Bcl-2 protein level (p=0.0007).

[The place of arterial allograft in reconstructive surgery of the main arteries of the lower extremities]. / Mesto arterial'nykh allograftov v rekonstruktivnoi khirurgii magistral'nykh arterii nizhnikh konechnostei.

Critical limb ischemia, especially in the absence of autologous vein, prosthetic and native vascular infections are isolated diseases for which there currently doesn't have best surgical treatment. Vascular allografts may be the treatment of choice for these patients. In this analysis, we tried to reflect the directions of development of vascular allotransplantation, global trends related to indications for their use, methods of conservation, degradation and endothelial dysfunction. At the present time there doesn't have meta-analyzes on the efficiency of using arterial allografts or other options for implantation (synthetic graft, xenografts) for critical limb ischemia and graft and native infections. Now it is wrong to recommend using them always. Further studies of their performance are necessary. In addition, development of graft control techniques is also needed when rejection develops. Currently, there are no special diagnostic markers, the assessment of which could save patients with immune-mediated dilatation and dysfunction of allografts.

[Successful treatment of an aortoduodenal fistula after operation on the abdominal portion of the aorta]. / Uspeshnoe lechenie aorto-duodenal'noi fistuly posle operatsii na briushnom otdele aorty.

Gastrointestinal haemorrhage is a common cause of emergency admission of patients to surgical hospitals. Within the structure of nosological entities, not unreasonably referred to the rarest causes of gastrointestinal bleeding is the formation of an aortointestinal fistula whose early diagnosis is of paramount importance. The clinical picture may be different but it is mostly represented by gastrointestinal haemorrhage. The incidence of gastrointestinal fistulas following a surgical intervention ranges from 0.6 to 2.3%. Unless timely diagnosed and with incorrect therapeutic decision-making, the mortality rate amounts to 90%. In this article we present a clinical case report regarding successful treatment of a patient presenting with a secondary aortoduodenal fistula occurring 5 years after previously performed aortofemoral bypass grafting and complicated by relapsing intestinal bleeding and acute ischaemia of the right lower extremity.

[Clinical and psychological features of people with internet dependence: experience of a pilot study]. / Kliniko-psikhopatologicheskie osobennosti lits s internet-zavisimost'yu: opyt pilotnogo issledovaniya.

OBJECTIVE: The prevalence of Internet addiction (IA) is growing steadily, especially among the younger generation. The purpose of this multicenter study was to investigate the socio-demographic characteristics, clinical varieties, and profile of psychopathological symptoms of mental disorders in patients with IA. MATERIAL AND METHODS: The study included 2 groups: the main group consisted of 44 people, aged 16 to 34 years, average age 22.00±0.66 years, 33 (75%) men, 11 (25%) women; the control group included 120 people, aged 19 to 30 years, average age 23.13±0.18 years, 90 (74.3%) men, 30 (26.7%) women. Groups were identified at the testing stage based on the total score on the Chen Internet Addiction Scale (CIAS). The main group included individuals who scored CIAS 65 points or higher. The specially developed Unified Study Card, The Mini international neuropsychiatric interview (MINI), the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Questionnaire (BDI), the Prodromal Questionnaire-16 (PQ-16), the Symptom Checklist-90-Questionnaire Revised (SCL-90-R). RESULTS AND CONCLUSION: There were more people with secondary specialized education and unemployed in the main group. The family burden of addiction and psychiatric disorders did not differ in both groups, and the heredity of somatic diseases was lower in the IA group. In the IA group, a psychiatric diagnosis was made 9 times more often. The severity of affective and anxiety disorders was higher in the IA group, while the risk of psychosis was low that allows considering the symptoms of IA outside the framework of subpsychotic mental disorders. The features of the psychopathological symptoms of IA were: total «tension¼ of the psychopathological profile; a relatively uniform and slightly specific profile of psychopathological symptoms with a certain tendency to the prevalence of personality-related stress manifestations.

[Recirculation syndrome in hemodialysis patients]. / Prichiny sindroma retsirkuliatsii pri programmnom gemodialize.

OBJECTIVE: To study the causes of recirculation syndrome and optimize surgical correction. MATERIAL AND METHODS: There were 2329 procedures of formation and restoration of permanent vascular access in 2109 patients for the period from 1998 to 2018. Recirculation syndrome occurred in 66 (3.1%) patients. Instrumental diagnosis of the causes of recirculation syndrome included Doppler ultrasound of permanent vascular access (100%) and angiography in accordance with indications. All patients were divided into 4 groups. The first group included 39 (59.1%) patients with native arteriovenous fistula. The second group included 12 (18.2%) patients with high arteriovenous fistula (between the brachial artery and the cephalic vein). The third group included 10 (15.1%) patients with major vein transposition. Synthetic prosthesis to create an arteriovenous fistula was used in the fourth group (n=5, 7.6%). RESULTS: In the first group, recirculation syndrome was caused by the presence of a large branch in close proximity to the arteriovenous anastomosis, its combination with significant stenosis of the anastomosis, hypoplasia of the outflow pathways of the fistulous vein. In the second group, the reasons were subclavian vein stenosis and dilated tributaries of the saphenous veins. In the third group, the main cause of recirculation syndrome was major vein stenosis in the upper third of the shoulder. In the fourth group, recirculation syndrome was caused by stenosis of the prosthetic-venous anastomosis. CONCLUSION: Recirculation syndrome in hemodialysis patients is usually caused by malfunction of permanent vascular access. Ultrasound or angiography may be successfully used to diagnose dysfunction. Effective treatment of this problem implies surgical or endovascular correction of permanent vascular access.

[Effect of genetic polymorphisms on functioning of a permanent vascular access in patients on dialysis]. / Vliianie geneticheskikh polimorfizmov na funktsionirovanie postoiannogo sosudistogo dostupa u patsientov na dialize.

Thromboses and stenoses of permanent vascular access appear to be a serious hazard for patients with end-stage kidney disease on programmed haemodialysis. Relapses of these pathological conditions are the cause of repeated hospitalization, secondary surgical interventions and may eventually lead to impossibility of carrying out procedures of haemodialysis. Often, vascular access dysfunction occurs for no apparent reason, thus underlying the importance of studies aimed at revealing additional factors of intravascular thrombogenesis and neointimal formation in a vascular access, including the works dedicated to studying genetic predictors of the development of the above-mentioned complications. The authors examined herein the role of polymorphisms of the genes of endothelin-1 (END-1), nitric oxide synthase-3 (NOS-3), angiotensinogen-2 (AGT-2), angiotensinogen-1 (AGT-1), angiotensinogen 2 receptor type 1 (AGTR1), mitochondrial superoxide dismutase-2 (SOD-2), catalase (CAT) superoxide dismutase-1 (SOD-1) and angiotensin converting enzyme (ACE) in the functional state of permanent vascular access in patients on dialysis. The obtained results demonstrated direct cause-and-effect relationships between polymorphisms lys-198 asn in the END-1 gene, C60T, T58C in the SOD-2 gene and the function of vascular access. The presence of END-1 gene lys-198 asn polymorphism in a homozygous state (allele 1) was associated with a high risk of an unsatisfactory condition of permanent vascular access (p=0.019).

Silver-Doped Calcium Phosphate Bone Cements with Antibacterial Properties.

Calcium phosphate bone cements (CPCs) with antibacterial properties are demanded for clinical applications. In this study, we demonstrated the use of a relatively simple processing route based on preparation of silver-doped CPCs (CPCs-Ag) through the preparation of solid dispersed active powder phase. Real-time monitoring of structural transformations and kinetics of several CPCs-Ag formulations (Ag = 0 wt %, 0.6 wt % and 1.0 wt %) was performed by the Energy Dispersive X-ray Diffraction technique. The partial conversion of ß-tricalcium phosphate (TCP) phase into the dicalcium phosphate dihydrate (DCPD) took place in all the investigated cement systems. In the pristine cement powders, Ag in its metallic form was found, whereas for CPC-Ag 0.6 wt % and CPC-Ag 1.0 wt % cements, CaAg(PO3)3 was detected and Ag (met.) was no longer present. The CPC-Ag 0 wt % cement exhibited a compressive strength of 6.5 ± 1.0 MPa, whereas for the doped cements (CPC-Ag 0.6 wt % and CPC-Ag 1.0 wt %) the reduced values of the compressive strength 4.0 ± 1.0 and 1.5 ± 1.0 MPa, respectively, were detected. Silver-ion release from CPC-Ag 0.6 wt % and CPC-Ag 1.0 wt % cements, measured by the Atomic Emission Spectroscopy, corresponds to the average values of 25 µg/L and 43 µg/L, respectively, rising a plateau after 15 days. The results of the antibacterial test proved the inhibitory effect towards pathogenic Escherichia coli for both CPC-Ag 0.6 wt % and CPC-Ag 1.0 wt % cements, better performances being observed for the cement with a higher Ag-content.

[Surgical treatment of patients with atherosclerotic occlusion of the aortoiliac segment combined with distal-bed lesions].

Analysed herein are the outcomes of surgical management of a total of 108 patients presenting with atherosclerotic alterations in the aortoiliac segment in a combination with distal-bed lesions. All patients were subdivided into 3 groups. Group One patients were subjected to surgical treatment consisting in isolated aortoiliac bypass grafting. The deep femoral artery according to the findings of the angiographic study appeared to be large and anastomosed with the popliteal artery. Group Two patients underwent simultaneously performed reconstructions on the aortofemoral segment in a combination with femoropopliteal bypass grafting above and below the knee-joint fissure. Reconstructions in Group Three patients were supplemented with indirect revascularizations of the extremities. The operations performed were represented by the following interventions: arterialization of the venous blood flow of the foot, lumbar sympathectomy, revascularizing osteotrephi nation, administration of gene-engineering complexes. The reconstructions in the aortofemoral segment in this group of patients were supplemented with indirect revascularization due to the presence of diffuse lesions of the distal-bed arteries. Analysing both immediate and remote outcomes of surgical management of these patients made it possible to compare its therapeutic efficacy in the represented groups.

[Methods of treatment in patients with lower extremity arterial occlusive disease in presence of distal arterial lesion. (Part II)].

This report is based upon the data published in Russian and foreign reference sources and represents the analysis of methods of treatment in patients with lower extremity arterial occlusive disease in presence of distal arterial lesion.

[Traditional open vascular surgery and roentgenosurgical intervention--competition or interaction leading to hybrid surgeries?].

On the basis of data published in Russian and foreign medical literature the article analyses traditional open surgical and roentgenosurgical methods of treating vascular diseases and the effectiveness of their joint application.

[Production of monoclonal antibodies to the prion protein and their characterization].

Antibodies to the prion protein (PrP), particularly, monoclonal antibodies, are necessary tools in the diagnostics and study of prion diseases and potential means of their immunotherapy. For the production of monoclonal antibodies, BALB/c mice were immunized by a recombinant bovine PrP. Three stable hybridomas producing antibodies of IgM class were prepared. The antibodies were bound to PrP in a solid-phase enzyme immunoassay and immunoblotting. The epitope mapping accomplished with the use of synthetic peptides showed that an epitope located in region 25-36 of PrP corresponds to one antibody, and epitopes located in region 222-229, to the other two. The antibodies to fragment 222-229 purified by affinity chromatography recognized with a high specificity conglomerates of a pathogenic prion in the brain tissue of cows suffering from spongiform encephalopathy. Thus, in nontransgenic mice, PrP-specific monoclonal antibodies were produced, useful in studies and diagnostics of prion diseases.

[Optimization of anesthesia during surgery for bullous lung emphysema].

The paper considers a complex of methods for estimating the adequacy of anesthesia, which involves the simultaneous analysis of both the parameters of central hemodynamics, oxygen transport, blood gases, and acid-base balance and those of cardiac rhythm variability. Based on the findings, the authors propose recommendations for optimizing the routine procedure of basis-anesthesia utilizing propofol and basis-anesthesia using ftorotan at surgery for bullous emphysema.

[Expediency of switching from combined therapy with prostamol Uno and alpha-1-adrenoblockers to monotherapy with prostamol Uno in patients with prostatic adenoma].

A 9-month randomized open comparative trial was performed of efficacy and safety of combined treatment with prostamol Uno and tamsulosin followed by monotherapy with prostamol Uno. A total of 58 patients with prostatic adenoma (PA) treated with prostamol Uno in combination with tamsulosin were divided into two groups: 28 patients continued the above combined therapy, 30 patients were switched to monotherapy with prostamol Uno. All the patients were examined in the course of 4 visits according to standard protocol requesting information on the disease history, complaints, digital rectal examination, IPSS questionnaire, QOL, uroflowmetry with test for residual urine, transrectal ultrasonography of the prostate, blood test for PSA. The results of the trial show reduction of IPSS and QOL indices in 87% patients. QOL improved both in group 1 after 3 months of combined treatment and in group 2 who continued on monotherapy with prostamol Uno to the end of month 9 (p < 0.05). Q(max) change was statistically the same in both groups. To the end of treatment month 9 the size of the prostate diminished by 6.7 cm3, on the average, in both groups. PSA levels changed insignificantly (p > 0.05). Prostamol Uno was especially safe for hypotensive patients and those on antihypertensive therapy. After discontinuation of tamsulosin 100% patients of group 2 stopped exhibiting symptoms of retrograde ejaculation. None cases of a hypotonic reaction to the drug were registered. Mean cost of a course of therapy in group 1 to that of group 2 was 1:3.16. Thus, pharmacotherapy with prostamol Uno in moderate symptoms of PA is comparable in efficacy with combination prostamol Uno + tamsulosin, is safe and cost-effective.

[Quality of life in patients after radical prostatectomy].

According to the literature, after radical prostatectomy the patients had normal micturition and erectile function in 50 and 10-30%, respectively. A total of 647 patients with diagnosis prostatic cancer (PC) stage T1a-T4 were examined in two clinics in 1997-2003. Of them, 43 patients (PC stage T1a-T3a) have undergone retropubic radical prostatectomy (RRP) by a modified nerve-preserving technique (preservation of the urinary bladder neck, puboprostatic joints in prostate size > 60 cm). Preoperative and postoperative examinations for urine continence and erectile function after RRP were made in 20 patients. The proposed operative technique of nerve-preserving RRP preserves urine continence and erectile function in many cases. This improves social adaptation of the patients and extends indications for operative treatment.

[Validity of using physical therapy in combined treatment of chronic prostatitis].

To evaluate efficacy of combined physiotherapy in patients with chronic prostatitis (chronic bacterial, chronic abacterial prostatitis), an open comparative trial was made by specialists of the Research Institute of Urology in 2003-2004 of the unit Andro-Gin. Before the treatment, a standard examination was made including analysis of case history and complaints, rectal palpation, questionnaire filling-in, prostatic secretion tests, PCR diagnosis, transrectal ultrasonic scanning and uroflowmetry. In group 1 (chronic bacterial prostatitis) given monotherapy with an etiotropic drug (ED) or combination of ED with Andro-Gin treatment, a significant improvement was achieved by the scale NIH-CPSI, Sorensen scale (p < 0.05). In group 2 (chronic abacterial prostatitis with inflammation) subgroups C,D,E patients showed significant improvement by the scales NIH-CPSI and Sorensen (p < 0.05). The highest symptomatic effect was recorded in the subgroup D in combined treatment with ED and Andro-Gin physiotherapy. In group 3 low NIH-CPSI scale score occurred due to alleviation of pain in subgroup F (p < 0.05), In subgroup G symptoms by the above scales did not change. Uroflowmetry featured moderate dynamics of the increment in maximal voiding speed. Voiding improved significantly in subgroup F in patients with chronic abacterial prostatitis in the absence of inflammation.