[The first experience of small intestinal autotransplantation for advanced digestive cancer]. / Pervyi opyt autotransplantatsii tonkoi kishki pri mestno-rasprostranennykh opukholyakh zheludochno-kishechnogo trakta.

Usually, gastrointestinal tumors (GIT) invading great vessels are acknowledged to be irresectable. Along with that, we can expect positive oncological results only when there is combination treatment with radical surgery (R0 resection). In this article we share the first experience of small intestinal autotransplantation as a method of radical surgery in locally advanced GIT. We conducted the analysis of outcomes of three patients (with pancreas cancer (n=2) and neuroendocrine tumor of caecum (n=1), with neoplastic process involving to superior mesenteric artery and vein. We analyzed intraoperative aspects and algorithm of small intestinal autotransplantation. Long-term outcomes with 1.5-13 months of observing time are presented. On the basis of conducted analysis the authors suggest the possibility of small intestinal autotransplantation in referral centers with strict personalized approach and multidisciplinary surgical team.

[Simultaneous surgery for upper gastrointestinal cancer and cardiovascular diseases]. / Simul'tannye operatsii pri rake zheludka, pishchevoda i serdechno-sosudistykh zabolevaniyakh.

OBJECTIVE: To analyze the immediate and long-term results of simultaneous surgical treatment in patients with upper gastrointestinal cancer and cardiovascular diseases. MATERIAL AND METHODS: There were 9 patients with upper gastrointestinal cancer and cardiovascular diseases who underwent simultaneous surgical treatment. We assessed safety and efficacy of this approach. Mean age of patients was 65.7±5.7 years. Coronary artery disease was diagnosed in 3 patients, aortic valve disease - 1 patient, abdominal aortic aneurysm - 2; 4 patients suffered from isolated mitral valve disease, stenosis of the left vertebral artery, internal and external carotid arteries and Leriche syndrome. RESULTS: Considering immediate and long-term postoperative results, we can emphasize advisability of simultaneous surgeries in appropriate patients.

The health-preserving culture of family of Russian serviceman.

The article considers specifics of health-preserving culture of family members of serviceman and parameters of its sociological assessment. It is proved that military personnel consider family as social element of military collective and at the same time as sociocultural subsystem of military unit. The latter determines subordination of sociocultural interests of serviceman family to interests of development of military organization, which manifests itself as a factor complicating development, strengthening contradictions in system of health-preserving culture of this family. It is proved that in modern conditions it is necessary to strengthen state regulation of processes of formation of health-preserving culture of family of serviceman by inclusion in system of existing programs of physical culture and sports of military units of entire serviceman family, activation of interaction of military health experts in order to develop knowledge, formation of specific norms, rules of health-preserving behavior of family of military personnel; by provision of organizational, sociocultural, economic conditions for self-development of culture of health-preserving behavior of family members of serviceman; by activation of external social control, expansion and improvement of effectiveness of army social services, prevention and suppression of destructive health behavioral practices not only of serviceman, but also of his family members.

Amorphization and nanocrystal formation in a Pd-Ni-Cu-P alloy after cooling under different conditions.

Structure formation during solidification of a Pd-Ni-Cu-P melt is studied. It is demonstrated that changes in the heat transfer conditions lead to a nonlinear change in the characteristics of the structure. The article presents the regimes of cooling the samples and the results of their structure and composition studies. It is found that a decrease in the cooling rate of the alloy leads to an increase in the size, proportion and composition of nanoinclusions in an amorphous matrix. X-ray diffraction method, electron probe microanalysis, transmission microscopy and scanning calorimetry are used for samples characterization. This article is part of the theme issue 'Transport phenomena in complex systems (part 2)'.

[A comparative analysis of clinical efficiency of laser and radiofrequency denervation in patients with primary trigeminal neuralgia]. / Sravnitel'nyi analiz klinicheskoi effektivnosti primeneniya lazernoi i radiochastotnoi denervatsii u patsientov s pervichnoi nevralgiei troinichnogo nerva.

OBJECTIVE: To compare the clinical efficacy of laser and radiofrequency denervation in patients with primary trigeminal neuralgia. MATERIAL AND METHODS: The study included 50 patients with primary trigeminal neuralgia who were operated on by laser (group I, n=25) or radiofrequency denervation (group II, n=25) in the period from 2018 to 2019. To assess the clinical efficacy, we analyzed the dynamics of the pain syndrome level according to the scale of facial pain and the quality of life according to the Short Form Medical Outcomes Study (SF-36), as well as patient satisfaction with the operation according to the Macnab scale, the presence of postoperative surgical complications and adverse effects of anesthesia. RESULTS: In the postoperative period, according to the scale of facial pain, a decrease in its intensity was noted in both study groups (p<0.001). Comparative analysis showed a comparable level of pain in the early postoperative period: at discharge (p=0.43) and 6 months after surgery (p=0.07). At the same time, after 12 months, lower scores on the scale of facial pain were noted in patients of group I (p=0.02). According to SF-36, a significant improvement in the physical and psychological components of health was determined in group I (p<0.001) and group II (p<0.05). Comparison of SF-36 scores in the long-term postoperative period revealed the best indicators in group I (p=0.02 and p=0.01, respectively). Comparative analysis verified a greater subjective satisfaction with the operation in group I, compared with group II (p<0.001). A comparable number of adverse effects of anesthesia was determined in both groups. Comparative analysis revealed a significantly greater number of postoperative surgical complications in group II (p=0.0017). CONCLUSION: Laser denervation and radiofrequency denervation are highly effective methods of minimally invasive treatment of primary trigeminal neuralgia.

[Analysis of the results of laser destruction of the articular branch of the obturator nerve in elderly and senile patients with degenerative coxarthrosis.]

The aim of the study was to analyze the results of the use of laser destruction of the articular branch of the obturator nerve in elderly and senile patients with degenerative coxarthrosis. The results of treatment of 34 patients over 65 years of age with symptomatic degenerative diseases of the hip joint (HJD) and somatic contraindications for total hip arthroplasty have been prospectively studied. In the study group, in the period from 2017 to 2019, laser destruction of the articular branch of the obturator nerve (970 nm, frequency 9 Hz and power 3 W in a total dose of 100 J) was carried out. The average follow-up was 12 months. To assess the effectiveness of surgical treatment, the dynamics of the pain syndrome in the hip joint was analyzed according to the visual analogue scale, the quality of life according to the SF-36 questionnaire, the functional state of the hip joint according to the W.H.Harris scale and the presence perioperative surgical complications. As a result, it was found that the use of laser destruction of the articular branch of the obturator nerve in degenerative coxarthrosis in elderly and senile patients (if total hip arthroplasty was not possible) made it possible to significantly reduce the level of preoperative pain syndrome, restore the quality of life and improve the functional state of patients with low risks of surgical complications.

[Functional rehabilitation of patients after endovitreal surgery of rhegmatogenous retinal detachment with complete retinal attachment]. / Otsenka rezul'tatov primeneniya novogo farmakoterapevticheskogo podkhoda v funktsional'noi reabilitatsii patsientov posle endovitreal'noi khirurgii regmatogennoi otsloiki setchatki s polozhitel'nym anatomicheskim rezul'tatom.

Rhegmatogenous retinal detachment (RRD) is one of the most severe eye diseases typically occurring in people of working age. The annual rates of primary vision disability in patients with RRD is 2-9%. PURPOSE: To increase the functional effectiveness of endovitreal surgery in patients with RRD by including Cytoflavin in the system of postoperative rehabilitation. MATERIAL AND METHODS: The study involved 68 patients with RRD aged 37 to 65 years. Patients underwent vitrectomy using the 25 Gauge technology with endolaser coagulation of rupture zones and silicone oil tamponade in the vitreous cavity. Three months after the surgery, silicone oil was removed from the vitreous cavity. Patients were divided into 2 groups: the main - 34 people who received Cytoflavin in addition to standard therapy, and the control - 34 people receiving only standard postoperative treatment. The time course of the treatment's functional effectiveness was analyzed using best corrected visual acuity (BCVA) and macular photosensitivity. Laser Doppler flowmetry (LDF) was used to register the microcirculation and microcirculation efficiency indices. Morphological signs of macular ischemia were registered by optical coherence tomography angiography (OCT-A). RESULTS: Patients of the main group showed higher level of restoration of macular function compared with the control group. The increase in functional activity of the macular area correlated with postoperative dynamics of restoration of central retinal thickness. Analysis of LDF and OCT-A indices showed that improvement of visual functions in patients treated with Cytoflavin is directly related to restoration of chorioretinal blood flow. CONCLUSION: The use of Cytoflavin in patients after endovitreal surgery of RRD led to improvement of BCVA by an average of 2.6 times and photosensitivity of the macula by 2 times. The visual functions of patients improved after using Cytoflavin due to its positive effect on chorioretinal microcirculation and the density of macular capillary plexuses.

[Laparoscopic and robot-assisted procedures in patients with gastrointestinal stromal tumors (GIST) of stomach]. / Laparoskopicheskie i robot-assistirovannye operatsii u bol'nykh gastrointestinal'noi stromal'noi opukhol'iu zheludka.

OBJECTIVE: To analyze the results of minimally invasive surgical procedures in patients with gastric GIST. MATERIAL AND METHODS: The study included 30 patients aged 52.2±9.8 years. ASA grade II (44%), III (26%) and I (23%) were predominant. Lesion of stomach body was noted in 17 (56%) patients, antrum - in 8 (27%), fundus - in 2 (7%) and cardia - in 3 (10%) patients. GIST was located on the anterior wall of stomach in 56% of patients. Exophytic growth was observed in 16 (53%) patients, endophytic - in 12 (40%), transmural growth - in 2 (7%) cases. T2 grade of tumor was noted in 67% of cases (TNM 8). All patients underwent laparoscopic or robot-assisted ('daVinci Si') partial resection of the stomach. RESULTS: Radical resection (R0) without injury of pseudocapsule of tumor was made in all patients. Laparoscopic procedures were performed in 25 (83%) patients, robot-assisted - in 5 (17%). Early postoperative complications (Clavien-Dindo II) were observed in 3 patients. Spindle cell structure of tumors (93%) with low mitotic activity (63%) prevailed. Tumor stage I was observed in 56% of patients. Patients with high mitotic tumor index (44%) were directed to targeted therapy. Recurrence and/or metastasis in long-term period were absent in 26 (87%) patients. CONCLUSION: Laparoscopic surgery for gastric GIST is safe and characterized by the absence of significant postoperative complications and long-term recurrence-free period. The use of robotic surgical system is effective and justified for anatomically difficult localization of GIST.

[Analysis of the results of surgical treatment of primary trigeminal neuralgia using laser destruction of the sensitive root in elderly and senile patients.]

The aim of the study was to analyze the results of surgical treatment of primary trigeminal neuralgia using laser destruction of the sensitive root in elderly and senile patients. The results of treatment of 25 patients older than 65 years with conservative treatment-resistant trigeminal pain who underwent laser destruction of the sensitive trigeminal root (970 nm, 9 Hz and 3 W power in a total dose of 100 J) in the period from 2018-2019 were prospectively studied. The average follow-up was 12 months. As a result, a significant decrease in the intensity of pain on the scale of facial pain was found from 87 (83,5; 91,5) mm to 15,5 (12,5; 18,5) mm (p=0,002) in the long-term period. On average, 12 months after the operation, a significant improvement in the indicators of the physical and psychological components of health was revealed on the SF-36 questionnaire (p=0,02 and p=0,01, respectively). In the follow-up on the Macnab scale, predominantly excellent (n=23; 92%) and good (n=2; 8%) treatment results were noted. Registered 1 (4%) perioperative complication and 2 (8%) adverse effects of anesthesiology benefits. Thus, the use of laser denervation of the sensitive root in primary trigeminal neuralgia in elderly and senile patients can significantly reduce the level of preoperative pain and improve the quality of life, with low risks of adverse effects.

[Choice of surgical approach to insulin-producing pancreatic tumors]. / Vybor metoda khirurgicheskogo lecheniia insulinprodutsiruiushchikh opukholei podzheludochnoi zhelezy.

AIM: To determine the optimal surgical approach to insulin-producing pancreatic tumors via an analysis of early postoperative results. MATERIAL AND METHODS: There were 134 patients with insulin-producing pancreatic tumors followed by organic hyperinsulinism who have undergone surgery in the faculty-based surgical clinic of the Sechenov First Moscow State Medical University for the period 1990-2017. Patients were divided into three groups depending on type of surgical intervention. Surgical procedure was determined after comprehensive preoperative and intraoperative examination including intraoperative ultrasound. RESULTS: Incidence of postoperative complications was 32.8%. Ten (7.5%) patients required redo surgical interventions. Overall postoperative mortality was 4.5%. The best immediate results were observed in patients undergoing distal pancreatectomy. There was a correlation between incidence of early postoperative complications and tumor location depth in the enucleation group. CONCLUSION: Enucleation is advisable for insulinoma of pancreatic head or uncinated process, as well as superficial tumors of the left half of the pancreas. Distal pancreatectomy is indicated for deep tumors of the left half of the pancreas. Indications for pancreatoduodenectomy are individual.

[Prevention of thromboembolic and hemorrhagic events in patients with atrial fibrillation undergoing elective surgery]. / Profilaktika tromboémbolicheskikh i gemorragicheskikh oslozhnenii u patsientov s fibrilliatsiei predserdii pri provedenii planovogo khirurgicheskogo lecheniia.

OBJECTIVE: To compare incidence of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF) undergoing elective surgery on different schemes of perioperative anticoagulant therapy (ACT). MATERIAL AND METHODS: There were 86 patients (56 (65.1%) men and 30 (34.9%) women, mean age was 69 (64; 78) years) with non-valvular AF who underwent elective interventions. Forty (46.5%) patients underwent abdominal surgery, 34 (39.5%) - cardiovascular procedures, 12 (14.0%) patients underwent surgery for malignant diseases. We have analyzed incidence of thromboembolic and hemorrhagic events and compliance of perioperative ACT modes with current international guidelines. RESULTS: Thromboembolic and hemorrhagic events developed in 14 (16.3%) patients. Thromboembolic complications were noted in 6 (7.0%) patients, hemorrhagic events - in 8 (9.3%) cases. Maximum complication rate was observed in case of bridge-therapy (n=12, 20.0%). Cancellation of ACT was followed by 2 (9.5%) complications, bridge-therapy - by 4 (6.7%) thromboembolic complications. Hemorrhagic events were 2 times more common in case of this therapy (n=8, 13.3%). It was found that ESC guidelines for perioperative ACT were applied in less than half of patients (41, 47.7% patients with AF undergoing elective surgery). Half of complications (8 out of 16) occurred if unapproved modes of ACT were used (including 7 cases of bridge-therapy was not necessary). The causes of these complications were inadequate assessment of perioperative risk of thromboembolic and hemorrhagic events; unreasonable administration of bridge therapy. CONCLUSION: An unambiguous clinical effect of bridge therapy has not been confirmed in patients with high risk of thromboembolic complications. Cancer patients have higher risk of complications compared with others. These events occur mainly due to non-compliance with clinical guidelines and insufficient prevention of thromboembolic events.

[A phylogenetic analysis of plant communities of Teberda Biosphere Reserve].

Phylogenetic analysis of communities is based on the comparison of distances on the phylogenetic tree between species of a community under study and those distances in random samples taken out of local flora. It makes it possible to determine to what extent a community composition is formed by more closely related species (i.e., "clustered") or, on the opposite, it is more even and includes species that are less related with each other. The first case is usually interpreted as a result of strong influence caused by abiotic factors, due to which species with similar ecology, a priori more closely related, would remain: In the second case, biotic factors, such as competition, may come to the fore and lead to forming a community out of distant clades due to divergence of their ecological niches: The aim of this' study Was Ad explore the phylogenetic structure in communities of the northwestern Caucasus at two spatial scales - the scale of area from 4 to 100 m2 and the smaller scale within a community. The list of local flora of the alpine belt has been composed using the database of geobotanic descriptions carried out in Teberda Biosphere Reserve at true altitudes exceeding.1800 m. It includes 585 species of flowering plants belonging to 57 families. Basal groups of flowering plants are.not represented in the list. At the scale of communities of three classes, namely Thlaspietea rotundifolii - commumties formed on screes and pebbles, Calluno-Ulicetea - alpine meadow, and Mulgedio-Aconitetea subalpine meadows, have not demonstrated significant distinction of phylogenetic structure. At intra level, for alpine meadows the larger share of closely related species. (clustered community) is detected. Significantly clustered happen to be those communities developing on rocks (class Asplenietea trichomanis) and alpine (class Juncetea trifidi). At the same time, alpine lichen proved to have even phylogenetic structure at the small scale. Alpine (class Salicetea herbaceae) that develop under conditions of winter snow accumulation were more,even at the both.scale, i.e., contained more diverse and distantly related plant species compared with random samples. (Scheuchzerio-Caricetea fuscae) aquatic communities in cold (Montio-Cardaminetea), sedge meadows (Carici rupestris-Kobresietea bellardii), and communities, in which shrubs and predominated (juniper and rhododendron elfin woods, class Loiseleurio-Vaccinietea), have been studied only at the larger scale and showed significant evenness of species composition, i.e., were phylogenetically more diverse compared with random samples.

Self-assembled nanoparticle patterns on carbon nanowall surfaces.

We observed that thermally treated carbon nanowalls serve efficiently as templates governing the formation of quasiperiodic patterns for nanoparticles deposited. Here we report self-assembled quasi-regular structures of diverse nanoparticles on a freestanding multilayer graphene-like material, i.e. carbon nanowalls. Metallic (Ag, Al, Co, Mo, Ni, and Ta) and semiconductor (Si) nanoparticles form coaxial polygonal closed loop structures or parallel equidistant rows, which evolve upon further deposition into bead-like structures and, finally, into nanowires. Weakly bonded nanoparticles decorate atomic steps, wrinkles and other extended defects on the carbon nanowalls as a result of anisotropic diffusion of atoms or clusters along the hexagonal sp(2)-carbon network followed by their aggregation and agglomeration. The decorated carbon nanowalls are found to be promising materials for surface enhanced Raman scattering (SERS) analysis.

[Solid pseudopapillary tumors of the pancreas: clinical and morphological characteristics, specific features of their immunophenotype, and diagnostic problems].

OBJECTIVE: To analyze 60 cases of solid pseudopapillary tumors (SPTs) of the pancreas, to reveal their most characteristic clinical and morphological features, and to study their possible histogenesis. MATERIAL AND METHODS: Sixty cases of SPTs of the pancreas underwent clinical, morphological, and immunohistochemical (IHC) examinations; a comparison group consisted of 86 pancreatic tumors of other histogenesis. RESULTS: It has been shown for the first time that SPTs are characterized by the nuclear expression of claudin 3 and the cytoplasmic expression of claudin 7. It has been also ascertained that the aberrant perinuclear (dot-like) expression of CD99 is a unique feature of these tumors. CONCLUSION: SPTs of the pancreas are distinguished by a diversity of clinical manifestations and morphological features, but have a unique immunophenotype, which can differentiate them from other types of pancreatic tumors.

[Study of some aspects of the mechanism of bacterial synthesis of silver sulfide nanoparticles by mMetal-reducing bacteria Shewanella oneidensis MR-1].

In the present work it was shown that biosynthesis of silver sulfide nanoparticles from silver nitrate and sodium thiosulfate solutions of millimolar concentration occurs efficiently by living Shewanella oneidensis MR-1 cells, as well as by ultrasonically-disrupted cells and by the membrane fraction of the cells. The size of nanoparticles synthesized in the presence of living cells was 7.8 ± 1.5 nm, while in the presence of ultrasonically-disrupted cells--it was 6.52 nm. The shape of nanoparticles in both cases was close to spherical. It was also shown, that synthesis of nanoparticles occurs in a cell-free solution of sodium thiosulfate that has been incubated with cells previously and to which then a silver nitrate solution was added. In this case the nanoparticles were of elongated shape and their size was (11 ± 4) x (24 ± 6) nm. In the control experiment, when only silver nitrate and sodium thiosulfate solutions not incubated with cells were used, the nanoparticles were not detected. It was shown that biosynthesis of nanoparticles occurs both in aerobic and anaerobic conditions. Nanoparticles are not formed by using thermally inactivated cells as it was shown by us previously. The results show the important role of the native structures of cells for the nanoparticles formation.

Carbon nanowalls: the next step for physical manifestation of the black body coating.

The optical properties of carbon nanowall (CNW) films in the visible range have been studied and reported for the first time. Depending on the film structure, ultra-low total reflectance up to 0.13% can be reached, which makes the CNW films a promising candidate for the black body-like coating, and thus for a wide range of applications as a light absorber. We have estimated important trends in the optical property variation from sample to sample, and identified the presence of edge states and domain boundaries in carbon nanowalls as well as the film mass density variation as the key factors. Also we demonstrated that at much lower film thickness and density than for a carbon nanotube forest the CNWs yield one order higher specific light absorption.

[Neuroendocrine tumors of a pancreas: 30 year's experience of clinic of faculty surgery of N.N. Burdenko].

N.N. Burdenko surgery clinic have an experience of treatment of 342 patients with gastroenteropancreatic neuroendocrine tumors. Original algorithms of diagnosis, complex treatment and postoperative management were applied. We achieved 100% five-year survival rate after radical surgery and reduced postoperative complications 1.6 times.

[The use of Octreotide-depo for the pancreatitis' prophylaxis after radical surgery of gastric cancer with lymphadenectomy].

The efficacy of the medicamentous prophylaxis of the acute postoperative pancreatitis (APP) was estimated in 594 patients. They all were divided into 3 groups: 1st was treated with octreotide, 2nd - with octreotide-depo, 3rd - with 5-ftoruracil and dalargin. Patients of the 3rd group showed the highest levels of α-amylase in both blood and drainage fluid during the early postoperative period. The frequency and severity of postoperative complication rates were the lowest in those patients, who received octreotide-depo and was 3,06%; whereas among patients of the 2nd group it was 16,8% and among those, who were treated with 5-ftoruracil and dalargin, it was 22,4%. The destructive forms of pancreatitis were registered in 2nd and 3rd groups in 1 and 3 patients, respectively. Intraabdominal abscesses were registered in 1 patient of the 1st and 6 patients of the 3rd group, respectively. The lethality rate was 0.9% in the 1st group; 1.02% in the 2nd and 1.8% in the 3rd group. The use of somatostatine analogues in the prophylaxis of postoperative complications proved to decrease overall complications' rate and, first of all, the rate of postoperative destructive pancreatitis. The use of the prolonged forms of somatostatine analogues, i.e., octreotide depo 10 mg is considered to be highly effective.