[Airway stenting in patients with complex benign tracheobronchial stenosis]. / Odnomomentnoe endoprotezirovanie trakhei i glavnykh bronkhov pri rubtsovom stenoze.

Tracheal and bronchial stenting is actively used for cancer and benign airway stenosis. This procedure is common in patients with advanced cancer. Stenting ensures breathing and availability of early chemo- and radiotherapy without the need for tracheostomy. This procedure is less common in patients with benign tracheal stenosis. In this case, isolated tracheal or bronchial stenting is performed. Complex tracheobronchial stenosis is extremely rare and creates significant difficulties. We present 3 cases of tracheobronchial stenting for cicatricial stenosis. In each case, stenosis was dilated with a rigid bronchoscope or balloon dilatation. Then, a silicone stent was installed. Resection with an appropriate anastomosis was contraindicated due to advanced pathological process. Thus stenting was regarded as a palliative operation. The follow-up periods were 9 months, 3 and 10 years. Each patient underwent inhalation therapy, endoscopy and repeated stenting if necessary.

The formation and migration of non-equivalent oxygen vacancies in PrBaCo2-xMxO6-δ, where M = Fe, Co, Ni and Cu.

The ab initio calculated defect formation energies are used for assessment of high-temperature thermodynamic functions that govern the appearance of oxygen vacancies in PrBaCo2-xMxO6-δ, where M = Fe, Co, Ni and Cu. The free energy of oxygen vacancy formation is shown to depend on the dopant and total oxygen content in the cobaltite. The experimentally observed trend for the oxygen vacancy concentration to increase with the atomic number of 3d dopants from Fe to Cu is explained as a result of the decrease of bond strength. The preferable location of oxygen vacancies near impurity atoms is accompanied by an anisotropic redistribution of electronic charge density. The most pronounced development of this effect in the case of iron doping leads to a low probability of tetrahedrally coordinated iron to exist in the layered cobaltites. It is shown that the calculated enthalpies of defect formation satisfactorily explain the experimentally observed changes of oxygen non-stoichiometry in the doped cobaltite. The energy barriers for oxygen jumps are found to vary only weakly at the doping thus suggesting rather insignificant dependence of the oxygen ion conductivity on 3d dopant nature. The earlier findings and results in the present work are indicative of promising properties combination in PrBaCo2-xNixO6-δ for the application as an electrode material in IT-SOFCs.

Telomere Length of Individual Chromosomes in Patients with Rheumatoid Arthritis.

We analyzed telomere length of individual chromosomes in peripheral blood lymphocytes of healthy individuals and patients with rheumatoid arthritis. Quantitative fluorescent in situ hybridization and subsequent computer analysis of metaphase chromosomes showed that distribution of telomere length on individual chromosomes is different under normal and pathological conditions. Patients with rheumatoid arthritis had significantly shorter chromosome 4p telomeres, which can be essential for pathogenesis of this multifactorial disease. Additionally, disease activity inversely correlated with telomere length on chromosome 10p carrying genes involved in T cell differentiation and proliferation.

[Comparison of modern methods of respiratory oxygenation during double level tracheal resection and reconstruction (clinical report)].

UNLABELLED: The problem of respiratory support in tracheal surgery is still discussed in recent days. Anaesthesiologist must choose the most effective and safe respiratory technique during tracheal resection and reconstruction. The article deals with a case of comparison of apneic oxygenation (AO) and high frequency jet ventilation (HFJV) during double level tracheal resection and reconstruction in patient with multifocal tracheal stenosis and underlying cerebral trauma. MATERIALS AND METHODS: AO and HFJV were used due to surgical need for 20 min each technique. PvO2, PvCO2, hematocrit, blood glucose, acid-base balance in the v. Jugularis interna, noninvasive arterial pressure, heart rate, ECG and body temperature were fixed before and after the changing of respiratory support type. Additionally peak systolic speed (S) of blood flow in the a. Cerebralis media sinister was fixed by transcranial Doppler ("Angiodin BIOSS", Russia). RESULTS: Oxygenation of venous blood was sufficient after the both HFJV and AO use; PvO2 was 67.6 and 74.3 torr respectively. Speed of PvCO2 increasing was higher during AO (1.46 torr per min) than during HFJV (0.73 torr per min). Increase of S was bigger during AO than HFJV as well (59 vs 37%). The changes of PvCO2 and S were normalized in 15 min after reconnection to conventional mechanical ventilation. Other fixed parameters were normal and same during the use of both respiratory techniques. The patient involved in the study did not have any neurological or surgical complications in early postoperative period. CONCLUSIONS: Both studied respiratory techniques provide sufficient blood oxygenation and can be accompanied with hypercapnia and cerebral hyperemia. These observations evident about the necessity to study the role of hyperoxia, hypercapnia and cerebral hyperemia in patients with underlying cerebral trauma undergoing tracheal resection and reconstruction. The study will help to make a strategy of the foreground use of HFJV and AO in these patients.

[Transesophageal tracheal intubation in patient with tracheoesophageal fistula and double level cicatricial tracheal stenosis].

The article deals with a case of successful anaesthesia management during the surgery due to tracheoesophageal fistula and double level cicatricial tracheal stenosis. Such surgeries are accompanied with technical and organizational difficulties both for an anaesthesiologists and endoscopist. The article discusses tactics of anaesthesia management during transesophageal balloon dilatation of tracheal stenosis, transesophageal tracheal intubation and respiratory techniques during the separation of tracheoesophageal fistula and tracheal resection.

Telomere lengthening in CD8(+)cells in polyclonal in vitro stimulation is associated with an increase in protein content of catalytic subunit of telomerase (hTERT).

Culturing of polyclonally activated T lymphocytes for 7 days in vitro leads to telomere lengthening in CD8(+), but not CD4(+)lymphocytes. Under these conditions, CD8(+)lymphocytes more intensively express telomerase catalytic subunit protein (hTERT) and divide more often than CD4(+)lymphocytes. It changes the ratio of CD4(+)and CD8(+)subpopulations in favor of the latter by the end of culturing.

[A differentiated approach to the diagnosis and treatment of portal hypertension in children].

The authors analyze their experience with diagnosis and treatment of 182 children with syndrome of portal hypertension (PH) from 1991 through 2010. Two groups of patients were considered. The first group included 74 newborns with high risk of the development of PH (infants after catheterization of the umbilical vein who endured omphalitis with USI diagnosed thrombosis of the portal vein, patients with cavernous transformation of the portal vein, hepatosplenomegaly). The second group consisted of 108 children aged from 6 months to 14 years with realized syndrome of PH. Investigation of hemostasis (international normalized ratio, fibrinogen, VIII and IX factors) immunogram of the 2nd level, determination of gene polymorphism (prothrombin, V factor, MTHFR, PAI-1), Bonacini index were included in the complex of examination, besides clinical and biochemical analyses of blood. The degree of disturbance of hemodynamics in the portal system was estimated by the data of USI, dopplerography, FEGS. It was established that children with extrahepatic portal hypertension have markers of hereditary thrombophilia in 98% of cases. Bonacini index allows determination of early signs of the development of secondary fibrosis of the liver in children with PH without using liver biopsy.

Processes of homeostatic proliferation in the pathogenesis of autoimmune glomerulonephritis induced by chronic graft-versus-host reaction.

Lymphopenia developing at the early stage of chronic graft-versus-host reaction is associated with increased content of IL-7 in the peripheral blood and leads to an increase of the CD4(+)and CD8(+)cell subpopulations in the spleen of the recipient. After 3 months, some animals develop autoimmune glomerulonephritis (lupus recipients). High levels of IL-7 and T-cells with the memory cell phenotype (CD4(+)CD45RB(low)and CD8(+)CD45RB(low)) persist in these animals, in contrast to nonlupus recipients without signs of autoimmune disease. This can attest to the involvement of homeostatic proliferation processes in the formation of autoimmune disease in this model.

[Intraoperative myocardial protection with extracellular cardioplegic solutions in patients with cardiac valve diseases].

A hundred patients operated on under extracorporeal circulation (EC) with bicaval cannulation in the moderate general hypothermia mode were intraoperatively examined. According to the used cardioplegic solution, all the patients were divided into three groups: 1) Konsol; 2) Konsol MF; 3) St. Thomas (a control group). All the groups were matched by age, gender, the duration of myocardial ischemia (MI) (37-128 min), that of EC (52-186 min), and the nature of surgical interventions, of which mitral valve replacement amounted to 72-78%. To prepare a modified solution, 20 ml of 40% glucose, 20 units of insulin, and 200 mg of creatine phosphate (Neoton) were added to a flask containing 400 ml of Konsol. The efficiency of myocardial protection was evaluated by the data characterizing cardiac arrest and cardiac performance resumption, as well as by heart rate and the use of inotropic support in the reperfusion period. The parameters of central hemodynamics and systemic coronary blood flow, the concentrations of glucose and lactate, the blood gas and electrolyte composition of the coronary sinus (CS), myocardial oxygen consumption and the oxygen-utilizing coefficient were monitored. The cardioplegic solutions Consol and Consol MF were found to have a more effective cardioprotective activity in patients with cardiac valvular disease, operated on under EC and moderate hypothermia that St. Thomas'solution. Modification of the Consol solution by adding glucose, creatine phosphate, and insulin improves the protective effect of the solution, promoting a rapider transition of the myocardium from anaerobic to aerobic metabolism.

[An association of the reduction in the count of T1 cells in the peripheral blood of patients with pulmonary tuberculosis with the lower monocytic expression of costimulatory CD80 molecules].

The percentage of T1 lymphocytes in the presence of the unchanged content of T2 cells were shown to be decreased in the peripheral blood of patients with pulmonary tuberculosis as compared with apparently healthy donors. In addition, the patients were found to have a significantly reduced quantity of CD80-expressing monocytes, the relative quantities of Th1 and Tc1 cells were directly related to the count of CD80+ monocytes. It is suggested that decreased CD80+ cells is a cause of ineffective antigen presentation that results in a systemic reduction in the count of CD4+ and CD8+ cells producing T1 cytokines and in impairment of an effective specific T1 response.

[Effect of nitrogen-containing derivatives of the plant triterpenes betulin and glycyrrhetic acid on the growth of MT-4, MOLT-4, CEM, and Hep G2 tumor cells].

Derivatives of the available plant triterpenes glycyrrhetic acid and betulin (betulin succinates and amides of betulonic and 18beta-glycyrrhetic acids containing fragments of long-chain amino acids and a peptide) were synthesized. The inhibitory action of these compounds on the growth of MT-4, MOLT-4, CEM. and Hep G2 tumor cells and their effect on the apoptosis of these cells were studied. It was shown that betulonic acid amides are more effective inhibitors of the tumor cell growth than the corresponding amides of glycyrrhetic acid. It was also found that betulonic acid amides containing fragments of caprylic, pelargonic, and undecanoic acids are more effective inhibitors of tumor cell growth than betulinic acid. The 17-dipeptide derivative of betulonic acid N-{N-[3-oxo-20(29)-lupen-28-oyl]-9-aminononanoyl}-3-amino-3-phenylpropionic acid exhibited the maximum inhibitory activity toward the tumor cells studied. Data on the induction of apoptosis in tumor cells by betulin derivatives at a concentration of 10 microg/ml were obtained by flow cytometry. The amides of betulonic acid proved to be the most effective inducers of apoptosis.

[Hypnosis for rehabilitation of immunological status in neoplasia].

The study group included 21 patients with malignant melanoma stage II-IV, aged 25-67, and 25 patients, aged 28-68, (control) with stomach tumors stage I-IV. All patients received individually-tailored hypnosis. Our newly-developed methods used batteries of suggestive images to deal with non-psychotic disorders and to map out strategies to support immunocompromised patients. In group 1, suggestion stimulated the "devouring" effect of the "patroling" cells. Quantitative and qualitative characteristics of immunocompetent cells of peripheral blood were assessed by flow cytometry, immuno-enzymatic analysis and other procedures to evaluate immunological status. Correlation analysis of data on group 1 identified 7 negative coefficients (p < 0.05 and p < 0.01) exactly in the monocytic macrophageal link thus suggesting the modulating effect of hypnosis. Our results support evidence available on the potential of hypnosis for cancer patient immunity and point for the first time to feasibility of differentiated targeting specific links of the immune system.

[Use of sevoflurane during cardiosurgical and endovascular operations in children].

The good tolerability of sevoflurane, the mild and prompt onset of a hypnotic state, the absence of airway irritation, and the safe use of the agent make the anesthetic of choice for introductory anesthesia in pediatric cardiosurgery. The purpose of the study was to develop and assess the procedure of sevoflurane anesthesia during cardiosurgical and endovascular operations in children with congenital heart diseases. Twenty-five children aged 2-9 years (of them 15 children with congenital heart disease) operated on under extracorporeal circulation (EC) were examined. Ten children underwent X-ray surgical endovascular interventions: closure of the patent arterial duct with an "Amplatzer ductus occluder" system. The duration of operations under EC was 116 to 289 min; that of EC was 60-20 (49 +/- 8) min. Endovascular operations lasted 60-80 min. Premedication was made with ketamine, midazolam, and methacin during cardiosurgical operations. The children were referred without premedication, escorted by their parents for endovascular surgical interventions where in the parents' presence the children were given inhalational sevoflurane at a concentration of 5-6% through the mask of an anesthetic apparatus until they fell asleep. This made it possible to avoid the child's weeping and resistance and to puncture the peripheral vein without pain. Steady-state hemodynamics and metabolism suggest that combined anesthesia using sevoflurane at a concentration of 1.3-22% of the minimal alveolar one is adequate in correcting congenital heart disease in children. The application of this anesthetic procedure permitted extubation of 73% of children within 1-2 hours when their condition met the criteria for early activation and extubation.

[Changes in cerebral circulation in patients with coronary heart disease during myocardial revascularizing operations under combined xenon anesthesia].

Twenty-five patients with coronary heart disease were examined in the preperfusion stage of myocardial revascularing operations under extracorporeal circulation. All the patients received combined anesthesia with xenon (Xe) as minimum flow anesthesia with flow of gases: oxygen, 0.4 l/min; Xe, 0.9 to 0.4 l/min. Cerebral circulation was investigated by transcranial Doppler study. The following parameters of the circulation: maximum systolic and diastolic blood flow velocities and pulsatile index were bilaterally estimated, by insonating the middle cerebral artery (MCA). When the concentration of Xe was as high as 50-60%, systolic and diastolic blood flow velocities along the MCA increase and the pulsatile index decreased. Opposite results were obtained 8 minutes after Xe feed was stopped. The findings provide evidence that Xe increases cerebral circulation and has a significant hypnotic effect. The increased systolic and diastolic blood flow velocities with the decreased peripheral resistance index in the MCA suggest that Xe diminishes peripheral vascular resistance in the pial arteries of the brain.

[Immunological indices in gastric cancer].

Immunological indices were assayed in 167 patients with gastric cancer. Tumor growth involved reduction in levels of neutrophil peroxide (p<0.05), CD3+ and CD19+-cells (p<0.05) as well as intensification of apoptosis of lymphocytes (p<0.05). As monocytic and granulocytic phagocytosis (p<0.001) and HLA-DR-expression in monocytes (p<0.001) diminished, and mitogen-induced proliferative activity of mononuclear cells suppressed (p<0.05), total and relative levels of CD8+-cells (p<0.05) and spontaneous proliferative activity of mononuclear cells (p<0.05) in peripheral blood increased. Such changes should not be reganded as expression of immunosuppression alone. Mechanisms of immunological failure inherent in tumor growth need to be investigated further.

[Comparative evaluation of clinical use of cardioplegic solutions custodiol and konsol in the correction of cardiac valvular diseases].

The efficiency of myocardial protection with cold crystalloid cardioplegia (CC) during operations on the heart under total ischemia and extracorporeal circulation was studied. Two hundred and fifty patients who underwent prosthetic or plastic repair of the aortic and mitral valves or plastic repair of the tricuspid valve were examined. Group 1 comprised 218 patients in whom the myocardium was protected with Konsol solution ("Biofarm "research-and-production enterprise, Russia); Group 2 included 32 patients in whom Custodiol solution ("Dr Franz Kohler Chemia GMBH", Germany). The volume of the Konsol solution required for CC was 400-2000 ml, with the duration of myocardial ischemia (MI) being 75 +/- 33 min; that of the Custodiol was 2000-4000 ml, with the duration of MI being 80 +/- 22 min. The used algorithm of administration of the solutions provided a persistent cardioplegic effect in both groups. After aortic declamping, there was a spontaneous recovery of cardiac performance in 84 and 40% in Groups 1 and 2, respectively. In the reperfusion period (RP), no significant differences were found in the basic hemodynamic parameters (heart rate, blood pressure, and central venous pressure) in both groups. After defect correction, cardiac output equally increased in both groups. The groups did not differ in the rate of inotropic support either. In RP, transient cardiac rhythm and conduction disturbances occurred in 19 and 28% in Groups 1 and 2, respectively.