[Bilateral stenting for malignant tracheal and bronchial stenosis]. / Bilateral'noe stentirovanie opukholevogo stenoza trakhei i glavnykh bronkhov: pervyi opyt (klinicheskoe nablyudenie).

Malignant lesions of tracheal bifurcation usually lead to respiratory failure and risk of mortality. Airway stenting is the only minimally invasive method for these patients. The authors present a patient with T4N3M0 left-sided lung cancer (inoperable stage IIIc) complicated by respiratory failure due to tracheal bifurcation obstruction. Bilateral stenting by self-expanding stents with perforated coatings was effective for airway recanalization and provided subsequent chemotherapy.

[Endoscopic vacuum therapy in minimally invasive treatment of esophageal perforations]. / Effektivnost' endoskopicheskoi vakuumnoi terapii v kompleksnom minimal'no invazivnom lechenii perforatsii pishchevoda.

OBJECTIVE: To compare the results of endoscopic vacuum therapy (EVT) and open surgery for esophageal perforations. MATERIAL AND METHODS: The study included 60 patients with esophageal perforations between 2010 and 2022. The main group included 29 patients who underwent minimally invasive treatment with EVT, the control group - 31 patients after open surgical interventions. RESULTS: Pneumonia occurred in 21 (72%) and 14 (45%) patients (p=0.04), esophageal stenosis within the perforation zone - in 4 (13.8%) and 1 (3.2%) patient, respectively (p=0.188). Chronic esophageal fistulas were significantly more common in the control group (6 (20.7%) versus 15 (48.4%) patients, p=0.032). The overall duration of treatment (median) among survivors was significantly shorter in the main group: 33 (23; 48) versus 71.5 (59; 93.7) days (p=0.5). However, length of ICU-stay was slightly higher (11 (6; 16) versus 8.5 (5; 12.75) days, p=0.32). Mortality rate was 13.8% (n=4) and 29% (n=9), respectively (p=0.213). Minimally invasive technologies decreased the risk of fatal outcome by 10 times (OR 10.123, 95% CI 1.491-124.97, p=0.035) compared to traditional surgery. CONCLUSION: EVT in complex minimally invasive treatment of patients with mechanical esophageal injuries is an effective method significantly reducing mortality and duration of inpatient treatment compared to traditional surgical approach.

Millisecond dynamics of deformation bands during discontinuous creep in an AlMg polycrystal.

Formation of bands of macroscopic strain localization during staircase creep in an AlMg polycrystal is studied by the acoustic emission (AE) technique and high-speed video recording with an image acquisition rate up to 50 000 frames per second. The simultaneous measurements by two methods allow us to distinguish different types of embryo deformation bands and concomitant AE signals, and to establish correlations between the band evolution and the acoustic response. It is found that the fastest stages of band formation, associated with its emergence to the surface and subsequent accelerated expansion, generate complex AE bursts in the frequency band ∼0.05-1 MHz. The correlations hidden in the complex structure of an individual acoustic burst are investigated by methods of statistical and fractal analysis. On the other hand, relationships between average parameters of various physical responses to discontinuous creep are assessed. Particularly, a close correspondence is found between the envelope of the acoustic burst and the rate of stress change during formation of a single deformation band. Evolution of dynamical behavior of embryo bands with increasing creep stress is discussed. Notably, a qualitative change in the AE waveform observed on approaching the ultimate stress is considered from the viewpoint of anticipation of the oncoming fracture.

[Spontaneous diffuse chylous peritonitis during pregnancy]. / Spontannyi khileznyi peritonit vo vremia beremennosti.

Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Moreover, etiology, epidemiology, pathophysiology, diagnosis and treatment of patients with spontaneous chylous peritonitis and chiloperitoneum are analyzed. The authors consider laparoscopy as a safe and efficient method of treatment of patients with spontaneous chylous peritonitis including pregnant women.

THE ROLE OF MYOSTATIN AND PROTEIN KINASE-B IN THE DEVELOPMENT OF PROTEIN-ENERGY DEFICIENCY IN PATIENTS WITH END-STAGE RENAL DISEASE ON HEMODIALYSIS.

In patients with chronic renal failure receiving hemodialysis, the development of protein-energy wasting (PEW) has a significant impact on the quality and duration of life. Myostatin (MSTN) and protein kinase-ß (AKT) play an important role in this process. The aim of our study was to assess the contribution of these molecular markers of muscle metabolism to the development of PEW in patients with chronic kidney disease stage 5D (CKD5D). The study included 80 patients with CKD5D. All patients underwent anthropometric research, hand dynamometry, bio-impedancemetry. MSTN and AKT levels were determined in the blood by ELISA. In the study, the prevalence of PEW was 90%. We have proposed a catabolic muscle tissue index (CMTI), which takes into account the complex effect of the relationship between MSTN and AKT on the development of PEW. An increase in this index in degrees from 0-2 characterizes the prevalence of catabolic processes in muscle tissue. There is an increase in CMTI with the progression of nutritional disorders in patients on hemodialysis (HD). An increase in CMTI is associated with a decrease in muscle strength, muscle mass (measured by the diameter of the shoulder). No correlation was found between CMTI and gender, age, or bio-impedance indicators, which requires further investigation.

FEATURES OF THE UBIQUITIN-PROTEASOME SYSTEM IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 5D.

The aim of the study was to assess the activity of the ubiquitin-proteasome system in patients with chronic kidney disease stage 5D (CKD5D) and its relationship with clinical and laboratory parameters. We examined 80 patients with CKD5D on hemodialysis (HD). The mean age was 51.7±11.6 years, the duration of HD was 33.5 (19.7; 58.25) months. All patients underwent physical examination, bio-impedancemetry. Hypoxia-inducible factor 1-alpha (HIF-1α) and 20S-proteasome (20S-PSM) levels were determined in the blood by ELISA. The hemoglobin level as well as its fluctuation over the preceding 12 months did not differ in the groups with normal and elevated 20S-PSM levels, however, there were some features of ferrokinetics depending on the level of serum transferrin (p=0.04), its fluctuations over the preceding 12 months (p=0.03) and its saturation (p=0.03). It was shown that as the level of 20S-PSM in the blood increases, the probability of detecting protein-energy wasting (PEW) increases (χ2=4.8, p=0.029). This is probably due to the implementation of the catabolic link of protein metabolism involving the ubiquitin-proteasome system. There was a strong negative correlation between the HIF-1a and 20S-PSM parameters (r=-0.86, p<0.05), which was confirmed when building the logistic regression model (χ2=65.9, p<0.0001). Depending on the level of hemoglobin and HIF-1a, we divided all patients into groups with hemoglobin and hypoxia-dependent 20S-PSM increase mechanisms. The found interrelations of these molecular markers with ferrokinetics parameters, features of renal replacement therapy (RRT) require additional study.

[Optimal time of surgery for acute adhesive small bowel obstruction]. / Vybor sroka operativnogo lecheniia pri ostroi spaechnoi tonkokishechnoi neprokhodimosti (mul'titsentrovoe prospektivnoe randomizirovannoe issledovanie).

AIM: To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction. MATERIAL AND METHODS: The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience. RESULTS: It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.

CLINICAL FEATURES OF THERAPY OF ANEMIA AND THE SIGNIFICANCE OF ITS FLUCTUATION IN THE DEVELOPMENT OF ANEMIA IN DIALYSIS PATIENTS.

The aim of our study was to examine the features of therapy of anemia, and the influence of fluctuation in dose of antianemic drugs on hemoglobin levels in dialysis patients. The study included 100 patients with chronic kidney disease stage 5D receiving hemodialysis, mean age was 53,4±15,8 years. The clinical and anamnestic data were studied and laboratory tests were performed in all patients. The correlation between hemoglobin level and fluctuations in dose of antianemic drugs for 12 months: erythropoietin (R= -0,51, p=0,004) and iron (R= -0,46, p=0,01) was determined. The higher doses of erythropoietin and their fluctuation and the fluctuation in dose of iron drugs were observed in the group of patients with middle degree anemia. The least fluctuation of erythropoietin and iron drugs was detected among patients with normal hemoglobin level. There were the correlation between the dose of erythropoietin used in the last month with transferrin (R=-0,25, p=0.011) and ferritin (R=0,22, p=0.028)and the relationship of fluctuations in dose of antianemic drugs and parameters of ferrokinetic, in particular, between the fluctuation in dose of iron drugs for 6 months and ferritin index (R=0,38, p=0.008), and soluble transferrin receptors (R=-0,37, p=0.01). Thus, high variability of doses of antianemic drugs determines less successful erythron's response to the treatment in dialysis patients, which indicates the need of monitoring the fluctuation of drug's doses.

[The causes of recurrent ulcerative gastroduodenal bleeding]. / Prichiny retsidiva yazvennogo gastroduodenal'nogo krovotecheniya.

AIM: To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. MATERIAL AND METHODS: The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. RESULTS: Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. CONCLUSION: Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.

Technology of minimally invasive cryodestruction of recurrent tumors.

In oncology practice it has been introduced minimally invasive technology of puncture access for cryodestruction of tumors of various sites as well as obtained positive clinical results.

[Dopamine receptor agonists: new forms and new possibilities in the treatment of Parkinson's disease].

Main mechanisms of action of dopamine receptor agonists, efficacy of their use according to the results of earlier clinical trials and possible side-effects are discussed. The authors present their experience of prescription of rotigotine transdermal system in an open study of 30 patients with Parkinson's disease. The duration of the study was 8 weeks. There was a significant improvement of both motor and nonmotor (pain sensations, sleep, mood). The effective dose for treatment of initial stages was 4-6 mg daily and for the full-blown stage - 6-8 mg daily. The tolerability was good.

[Ð formation of algorithms to determine the severity of endotoxemia in peritonitis].

We have analyzed the results of treatment of 110 patients admitted to a clinic with diagnosed acute peritonitis for the period from 2010 to 2014. Patients were divided into three groups according to the classification of B. Savchuk. The first group included 40 patients who admitted into clinic within 24 hours after the attack. There were 36 patients who admitted in terms from 24 to 48 hours after the first attack in the second group. The third group included 34 patients who admitted in 48 to 72 hours or more after the first attack. After further diagnosis all patients have undergone emergency surgery under endotracheal anesthesia. Peritonitis focus was eliminated and abdominal cavity sanitation was carried out. Depending on the size and nature of exudate abdominal cavity was drained. Based on these data we have created an algorithm reflecting the severity of endotoxemia in peritonitis, which allows to monitor the dynamics of the endotoxemia development. Our suggested algorithm is simple and may be used in all clinics, even in district hospitals.

[The role of lipid peroxidation in pathogenesis of hepatic enzymatic dysfunction during peritoneal intoxication].

We have investigated the role of lipid per oxidation in pathogenesis of hepatic enzymatic dysfunction during peritoneal intoxication. The investigations were carried out on 36 albino rats. I group were included intact animals, II group were included animals that peritoneal exudates reached with products of lipid per oxidation were injected to abdominal cavity and III group were included reached with animals that superoxiddismutase together with products of lipid per oxidation were injected to abdominal cavity. In all group of animals the concentration of AST, ALT, LDH, alkaline phosphates, GGT enzymes were studied and the results were compared. It was revealed that after injection peritoneal exudates to abdominal cavity, the concentration of AST is decreased and the other (ALT, LDH, alkaline phosphates, GGT) concentration are increased. In further days the blood concentration of all enzymes reached to maximal level. Additionally the injection of superoxiddismutase solution significantly decreases the concentration of these enzymes. It confirms the role of superoxiddismutase in prevention of poliorgan incipiency developing in peritonitis, as well ass in correction of hepatic dysfunction.

[Receptor regulation of the platelet activity]. / Retseptornaia regukliatsiia aktivnosti trombotsitov.

Classification of thrombocyte receptors is given, their functions are discussed, and their endogenous and exogenous ligands are considered as potential targets for antithrombotic drugs.