Minimally Manipulated Bone Marrow-Derived Cells Can Be Used for Tissue Engineering In Situ and Simultaneous Formation of Personalized Tissue Models.

Red bone marrow and autologous bone tissue (bone fragments and bone chips) of the donor were harvested intraoperatively during autoplasty of talus bone defect. Titanium chips were obtained by grinding a fragment of a microporous titanium-coated hip arthroplasty (Zimmer). Bone marrow mononuclear cells were isolated in the operating room, and bone and titanium fragments were incubated with a suspension of mononuclear cells. The quality of revitalization was assessed by fluorescence microscopy and histological examination after culturing of adherent cells on the bone and titanium fragments. During culturing on bone chips, bone marrow mononuclear fraction cells demonstrated significantly higher metabolic activity than bone marrow cells (p=0.04). Mononuclear fraction cells were also capable of stable colonization of titanium fragments with the formation of composite tissue model.

Postmortem MRI Characterization of Cadaveric Hypostases in Deceased Newborns.

Using postmortem MRI, we studied the features of the development of internal cadaveric hypostasis in dead newborns. Postmortem radiological and pathoanatomical examination of 62 bodies of newborns and infants who died at the age of 1.5 h to 49 days was carried out. After the death was ascertained, prior to MRI, the bodies were stored in a refrigerator at 4°C in the supine position. Depending on the duration of the postmortem period (2-72 h), all observations were divided into eight groups. Prior to autopsy, an MRI scan was performed in T1 and T2 standard modes, followed by analysis of the presence and severity of the gradient line of the intensity of the MR signal in the liver and lung tissue in the ventral (overlying) and dorsal (underlying) areas, as well as the presence of a gradient of the intensity of the blood signal in the heart cavity and in the aortic lumen. The main manifestations of cadaveric hypostasis in the liver and lungs are changes of the MR signal intensity in the ventral and dorsal regions with the appearance of a horizontal gradient of the MR signal intensity, which reflects the location of the body after death. In the heart cavity and in the aortic lumen, there is also a gradient of the blood signal intensity of various severity with the visualization of two or three of its layers. The revealed features of the MRI signal intensity and, accordingly, the presence of its horizontal gradient depended not only on the MRI mode of the study, but also on the studied organ and the duration of the postmortem period. This should be taken into account when analyzing the results of virtopsy and determining the links of thanatogenesis of dead newborns and infants.

[Dual-energy computed tomography in the diagnostics of urolithiasis].

THE AIM: To assess the diagnostic performance of dual-energy computed tomography (DECT) in the evaluation of the composition of urinary stones "in vivo". MATERIALS AND METHODS: A total of 91 patients aged from 20 to 70 years old (mean 42.7) with urinary stone disease were examined at Sechenov University, including 68 men (75%) and 23 women (25%). Prior to surgery, all patients underwent DECT (Canon, Japan) in order to predict the chemical composition of urinary stones in vivo. Extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) was performed in 53 (58.2%), 18 (19.7%) and 20 (22.1%) patients, respectively. Postoperatively, all stones or stone fragments (n=91; 100%) were examined using a comprehensive physical and chemical analysis (X-ray phase analysis, electron microscopy, infrared spectroscopy). RESULTS: In 6 patients (6.6%) staghorn stones were diagnosed, while in 15 (16.5%), 17 (18.7%), 22 (24.2%) and 31 (34.1%) stones were located in ureteropelvic junction, pelvis and ureter, respectively, including 24 patients with lower ureteric stones (26.4%). Prediction of the stone composition in vivo was carried out on the basis of the one indicator, the dual energy ratio (DER). The threshold values of DER for different types of stones were taken from the literature. All stones were divided into 4 groups according to the DECT results: vevellite stones (n=40, 43.9%), Ca-containing stones without vevellite (n=34, 37.3%), uric acid stones (n=10, 10.9%) and struvite stones (n=7, 7.9%). Thus, when comparing the results of DECT and physical and chemical analysis, in the first group four stones were incorrectly assigned by DECT to the group of Ca-containing stones without vevellite and three stones were incorrectly assigned to the group of struvite stones; in the second group four stones were incorrectly assigned to the group of vevellite stones; in the third group one stone was incorrectly assigned to the group of struvite stones; in the fourth group one stone was incorrectly assigned to the group of vevellite stones and one stone in the group of uric acid stones. In order to increase the diagnostic efficiency of DECT, we performed a comprehensive analysis of five specific DECT indicators (stone density at 135 kV, Z eff of the stone, DER, DEI, DED) using discriminant analysis. Thus, the sensitivity, specificity and overall accuracy of DECT with the use of just one indicator (DER) were 83.3%, 89.8%, 86.8% for vevellite, 88.2%, 92.9%, 91.2% for Ca-containing stones without vevellite, 90%, 98.8%, 97.8% for uric acid stones and 60%, 95.3%, 93.4% for struvite stones, respectively. When using discriminant analysis with five specific DECT indicators, higher values of sensitivity, specificity and overall accuracy were seen: 95.2%, 89.8%, 92.3% for a vevellite, 85,3%, 96,4%, 92,3% for Ca-containing stones without a vevellite and 100%, 100% and 100% for both uric acid and struvite stones, respectively. CONCLUSIONS: Dual-energy computed tomography is a highly informative method which allows to perform preoperatively the reliable assessment of the chemical composition. DECT in patients with urinary stone disease allows to optimize the treatment strategy and carry out preventive measures on individual basis, taking into account the stone type.

[Clinical value of CT-perfusion in patients with ureteric stones].

INTRODUCTION: Urinary stone disease is one of the most significant urologic diseases, since its prevalence increases annually, which makes it necessary to study and improve effective preventive measures, diagnostic methods and to implement new treatment interventions. AIM: to study changes in blood flow in the renal cortex and medulla in patients with ureteral stones using CT perfusion. MATERIALS AND METHODS: From 2017 to 2019, a total of 53 patients with upper ureteric stones were evaluated at the Russian-Japanese Center for Imaging and the Institute of Urology and Reproductive Health of the FGAOU VO I.M. Sechenov First Moscow State Medical University. Preoperatively, all patients underwent CT perfusion. The study was performed on a Toshiba Aquilion One 640 in volume mode with a slice thickness of 0.5 mm. In this study, blood flow changes were evaluated depending on the degree of dilatation of collecting system. RESULTS: In patients without dilatation of the collecting system, the average values of cortical and medullary blood flow and blood volume were within normal values. In patients with a dilatation of collecting system, there were significant differences cortical and medullary blood flow between the affected renal unit and contralateral side (27% and 34%, respectively). A decrease in cortical and medullar perfusion by 55% and 58%, respectively, in patients with the dilatation of calyxes was more pronounced in comparison with a decrease in perfusion in patients with the dilatation of only the ureter and pelvis. CONCLUSION: CT perfusion performed on the 640-slice CT scan allows an objective assessment of changes in renal blood flow in patients with ureteric stones.

[Use of volumetric dynamic voiding multispiral computed cystourethrography in diagnosis and evaluation of treatment efficiency of congenital and acquired pathology of the urogenital area].

AIM: The aim of this study was to determine the possibilities of volumetric dynamic voiding multispiral computed cystourethrography (VDMMCT) for assessment of the lower urinary tract during voiding. MATERIALS AND METHODS: VDMMCT was performed in a series of 22 patients with various urethral pathologies using 320 detector rows (640 unique slices; row width 0,5 mm). This method allows to cover the scan area of 16 cm per one rotation of the X-ray tube. In all patients, the cross-sectional area of the various urethral parts was estimated and the urinary bladder volume and average urine flow rate during all voiding phases were calculated. RESULTS: VDMMCT was performed for dynamic evaluation of bladder volumes changes and analyzing a passage of contrasted urine throughout the urethra. The average volume of the urinary bladder was 356.3+/-179.9 ml, while the voiding volume was 299.5+/-154.8 ml. The average pre- and postoperative urine flow rate was 4.1+/-1.1 ml/s and 7.9+/-5.1 ml/s, respectively. The maximum urine flow rate was 19 ml/s. The average urethral diameter according to the VDMMCT after urethroplasty was 7.6+/-2.1 mm. The minimum length of urethral strictures was 17 mm, while the maximum length was 32 mm. CONCLUSION: Our results demonstrate the efficiency of the VDMMCT for assessing of the urethra throughout its length. VDMMCT can multidimensionally and dynamically represent the change of the bladder volume and the urine flow rate.

[Modern radiology diagnostics methods for assessment of renal perfusion in patients with urinary stone disease].

Urinary stone disease is the current issue for healthcare system worldwide. High prevalence of urinary stone disease (at least 5% of the population of developed countries) determines clinical significance of the studying of its etiology and pathogenesis, improving of diagnostic methods and novel treatment technologies. The development of endoscopic devices, creation of new eswl machines and improvement of endourology interventions under X-ray guidance allowed to solve the problem of surgical treatment. Therefore, one of the actual issue is the choice of X-ray method for predicting and evaluating of treatment efficiency in patients with urinary stone disease. The changes of renal blood flow depend on urodynamic disturbances, stone location and size, the duration of disease, complications, patients age. Therefore, for comprehensive studying of renal function the hemodynamics evaluation is needed. In this review the advantages, drawbacks and perspective on developing of different radiologic methods for renal hemodynamic assessment are given.

[Clinical implications of dual-energy computed tomography in the diagnosis and treatment of urolithiasis].

Urolithiasis (urolithiasis) is one of the most common urologic diseases with an estimated prevalence of no less than 3% in the population, usually affecting active working-age patients of 30-50 years. Taking into account major public health and economic significance of this problem, there is the need for the development of effective modern diagnostic techniques. Rapid medical-technological advances of the past two decades have led to the wide spread use of minimally invasive surgery the management of urolithiasis. Nevertheless, surgical intervention only removes the result of a long pathological process and does not change its course. Thus, there is a need for a detailed understanding of the etiology, epidemiology, and pathogenesis of urolithiasis. Diagnostic imaging plays a key role in the diagnosis of urolithiasis. Multislice spiral computed tomography (MSCT) is the gold standard for the diagnosis of urolithiasis. It provides information about the size, location, and density of the calculus. Over the past decade, the use of dual-energy computed tomography (DECT) in urological practice has been widely discussed in the international and domestic literature. One of the main advantages of DECT is the ability to determine the chemical composition of urinary stones. Previous studies have reported a high diagnostic value of the method, including the ability to predict treatment outcomes. However, the shortcomings of the method and the absence of standardized examination protocols leave a wide field for further research. This article reviews major distinctive features of using DECT in the diagnosis of urolithiasis.

[Radiodiagnostics of odontogenic maxillary sinusitis]. / Luchevaia diagnostika odontogennogo verkhnecheliustnogo sinusita.

The objective of the present study was to analyze the potential of such techniques as X-ray, multi-slice computed tomography (MSCT), and cone-beam computed tomography (CBCT) for diagnostics of odontogenic maxillary sinusitis. The secondary objective was to describe changes in maxillary sinuses identifiable with the help of the above methods. The study included 166 patients at the age varying from 21 to 81 years presenting with odontogenic maxillary sinusitis. All of them underwent the roentgenological examination. The study has demonstrated the low effectiveness of the projection radiography techniques. The use of computed tomography made it possible to verify the diagnosis in 110 (66.2%) of the 166 examined patients, to reveal the radiological characteristics of the deyected changes suggesting their odontogenic etiology, and to choose the proper strategy for the further treatment. It is concluded that MSCT and CBCT are the most informative methods to be used for diagnostics of odontogenic maxillary sinusitis.

[Cone beam CT in diagnostics of facial trauma]. / Konusno-luchevaia komp'iuternaia tomografiia v diagnostike povrezhdenii litsevogo skeleta.

The article provides a review of domestic and international scientific literature to reveal the possibilities of cone-beam computed tomography in facial trauma diagnostics. The ratio of maxillofacial trauma continues to grow progressively. The current situation increases the need for high-quality, fast and extremely informative radiology diagnosis for such conditions. At the moment the possibilities of multislice computed tomography are well examined in the facial trauma diagnosis. But the potential of cone-beam computed tomography aren't fully known yet by radiologists and maxillofacial surgeons. This review presents an analysis of the method's technical features, its advantages, disadvantages and special application aspects in facial trauma.

[Multislice computed tomography in the diagnosis of orbital fractures].

OBJECTIVE: To improve radiodiagnosis of orbital fractures at pre- and postoperative treatment stages, to provide a rationale for detailed evaluation of orbital osseous and soft tissue structures to prevent early postoperative complications. MATERIAL AND METHODS: The I.M. Sechenov First Moscow State Medical University Clinic examined 52 (100%) patients on days 1-2 after injury. A patient group consisted of 49 (94%) men and 3 (6%) women whose age was 17 to 49 years. Multislice computed tomography (MSCT) was carried out prior to surgery on the day of their admission. Postoperative MSCT was done within 7-10 days after surgical treatment. RESULTS: Preoperative MSCT could reveal fractures of the inferior and lateral orbital walls in all 52 (100%) patients. Fractures of the medial and superior orbital walls were identified in 8 (15%) and 3 (6%) cases, respectively. In 12 (23%) patients, prolapse of the fat and oculomotor muscles into the respective maxillary sinus was imaged, which gave rise to enophthalmos and an increase in orbital volume. Three (6%) patients were identified as having sequels of eyeball trauma. Optic nerve abnormality was detected in 11 (21%) patients. Oculomotor muscle injury was encountered in 20 (38%) patients. After surgical treatment, 4 (8%) patients had a persistent inferior orbital wall defect in the posterior portions where the retrobulbar fat prolapsed into the maxillary sinus. Three (6%) out of the 20 (38%) patients with different oculomotor abnormalities had persistent postoperative muscle injuries that were mainly associated with erroneous orbital floor implantation. The number of patients with eyeball disease remained unchanged--3 (6%). Among 11 (21%) patients with a postoperative pathologically changed tortuous nerve course, the optic nerve attained its correct even course all the way in 5 (10%) cases; it remained pathologically changed as before in 6 (12%) cases. CONCLUSION: MSCT is the preoperative technique of choice for examining patients with orbital injuries. After surgery, MSCT in the early postoperative period makes it possible to assess the results of treatment and to reveal possible complications and it is a decisive guide for a doctor in charge when planning resurgery.

[31P Magnetic Resonance Spectroscopy in Patients With Various Genesis of Left Ventricular Hypertrophy].

PURPOSE: to assess status of myocardial energy metabolism in patients with different etiology of left ventricular hypertrophy by phosphorus magnetic resonance spectroscopy (MRS) compared with healthy individuals. METHODS: The study included 94 people: 30 healthy volunteers (group 1), 35 patients with arterial hypertension and left ventricular hypertrophy (group II), 29 patients with hypertrophic cardiomyopathy (group III). All persons underwent cardiac magnetic resonance imaging (MRI) and MRS on high field MR scanner. Energy metabolism index (ratio of phosphocreatine and adenosine triphosphate concentrations [Pcr/ATP]) was used for evaluation of myocardial energy metabolism. RESULTS: Values of Pcr/ATP were 2.11 ± 0.29, 1.65 ± 0.12, and 1.32 ± 0.16 in groups I, II, and III, respectively (p < 0.05). CONCLUSION: 31P MRS is an effective tool of detection of disordered energy metabolism in hypertrophic myocardium. Combined use of MRI and MRS can become an effective method of comprehensive study of the heart.

[Multislice computed tomography in the diagnosis of toxic phosphorus necrosis of the jaw].

Objective: To estimate the possibilities of using and systematizing computed tomographic findings in patients with toxic phosphorus necrosis of the jaw. Material and Methods: The investigation enrolled 87 patients diagnosed as having toxic phosphorus osteonecrosis. Radiation examination consisted of two stages: primary and repeated radiologic examinations in the postoperative period (final examination before hospital discharge). All the patients underwent skull X-ray and multislice computed tomography (MSCT). Results: Clinical and radiation examination revealed toxic phosphorus osteonecrosis of the maxilla and mandible in 29 (33%) cases. Osteonecrosis affected only the mandible in 40 (46%) cases and only the maxilla in 18 (21%) cases. In all the patients, computed tomography showed main trends in the X-ray semiotics of toxic phosphorus necrosis of the facial skeleton, such as periostitis; osteosclerosis; development a lesion having a "soap-bubble" appearance; nonspecific and inflammatory bone destruction. The bone, being destroyed, was replaced by pus; inflammatory granulations were absent; osteonecrosis occurred. These processes were characterized by the absence of an obvious demarcation zone along the edges of the process. Sequestration commonly occurred to form sinus tracts. The process involved the adjacent bones; there were reactive changes in the accessory sinuses. Conclusion: MSCT data are of highly informative value in evaluating the status of bone tissue and teeth and in detecting a concomitant abnormality in patients with osteonecrosis of the facial skeleton and may be used to plan surgical treatment for this category of patients.

[Analysis of a change in the position of the hyoid bone when displacing the lower jaw in patients with dentofacial malformations].

OBJECTIVE: To estimate the magnitude of a change in the position of the hyoid bone when displacing the lower jaw during surgical treatment in patients with dentofacial abnormalities. MATERIAL AND METHODS: Fifty patients with dentofacial abnormalities (25 and 25 patients with distal and mesial occlusion, respectively) were examined and treated. All the patients underwent multislice spiral computed tomography before and 6 months after surgery. The authors developed linear quantities to analyze the position of the hyoid bone with respect to the skull base and cervical spine. The paired Wilcoxon signed-rank test was used. RESULTS: None of the examined groups was noted to have a statistically significant change in the distance between the basihyoid and the vertebral column, suggesting that the datum was moderately changed. No case of worse respiratory function was found. CONCLUSION: Our investigation has revealed that mandible displacement during orthognathic surgery causes no critcal change in the position of the hyoid bone and hence it has no significant impact on upper airway patency in this area.

[Radiodiagnosis in the planning of surgical treatment for extensive jaw cysts].

OBJECTIVE: To make an algorithm for the optimal planning of a surgical procedure in patients with jaw cysts. MATERIAL AND METHODS: Sixty-six patients were operated on using cystotomy. The planning stage used radiation examination, including 7 survey radiographies, 62 orthopantomographies, and 33 computed tomographies (CT). The informative indicators of the most commonly used radiation techniques for this abnormality were compared. High technology radiation techniques (CT) showed the highest informative and diagnostic values. CONCLUSION: The investigation indicated the relationship of a surgical technique and the anatomic and topographic relations of a pathological process. The findings make it possible to prevent complications and recurrences during this treatment modality and to create favorable conditions for bone regeneration.

[Role of multislice spiral computed tomography in the evaluation of changes in upper airway volume during surgical treatment in patients with dentomaxillary abnormalities].

OBJECTIVE: To assess the role of multislice spiral computed tomography in the calculation of upper airway volume and its change in patients with different types of dentomaxillary abnormalities after orthognathic surgery. MATERIAL AND METHODS: Twenty-five patients with dentomaxillary abnormalities (19 and 6 patients with Classes III and II dentomaxillary abnormalities, respectively) were examined. All the patients underwent two-jaw operations. Facial skeleton computed tomography was performed before treatment initiation and 6 months after surgery. The DICOM data were loaded in Dolphin Imaging 11.5 and a special program package was applied to calculate the volume of air space in the upper airway. The hard tissue and soft tissue points used to construct the planes setting the detection limits of air space in the upper airway were determined. RESULTS: After surgery, the patients with Class II dentomaxillary abnormalities display unilateral changes in our measured upper airway values (by increasing or reducing the air space); the majority of cases exhibiting higher values. Half of the patients with Class III had unilateral hanges, the increase or reduction in air space values varying in approximately equal proportions. CONCLUSION: Computed tomography permits the calculation of upper airway volumes before and after orthognathic treatment in patients with dentomaxillary abnormalities, which is in its turn of significant scientific and practical interest.

[Potentialities of ultrasound study in the evaluation of developing chronic placental insufficiency].

The paper clarifies the ultrasound semiotics of the normal echographic pattern of the placenta in physiological pregnancy. It gives and systematizes the possible variants of the atypical placental structure in placental insufficiency in patients with spontaneous pregnancy and in women undergoing in vitro fertilization.

[Dental implantation planning in the cases of bone deficiency and prevention of perioperative complications. Part 1. Radiological diagnostics].

The primary goal of reconstructive procedures before dental implantation is restoration of bone volume to prevent the damage of anatomic structures during implantation. Radiological methods are the important component of complex follow-up. Application of radiological methods in planning of the given kind of treatment allows choosing optimum tactics of surgical treatment and their dynamic application in the postoperative period gives the chance to reveal and address in time the developing complications thus improving the success rate.

[Radiodiagnostic methods for dental anomalities].

OBJECTIVE: To determine the capacities of radiologic studies in the examination of patients with dental anomalies. SUBJECT AND METHODS: One hundred and twenty patients with dental anomalies were examined. Conventional X-ray and high-technology radiology techniques (multislice spiral computed tomography (MSSCT) and cone-beam computed tomography (CBCT)) were used. RESULTS: Orthopantomography is the most common method for radiologic examination of patients with dental anomalies. However, X-ray procedures do not provide complete information on the position and status of an abnormal tooth, which is required to define further patient management tactics. While planning the management, MSSCT and CBCT were performed in 56 (46.7%) and 64 (53.3%) patients, respectively. In addition, 72 (60.0%) patients in whom orthodontic treatment had been recommended at the first stage underwent MSSCT or CBCT following 7 months. CBCT showed that 4 (3.3%) patients had dental ankylosis previously undiagnosed by MSSCT. The high-technology radiology techniques could assess the position of a tooth in relation to its important anatomic structures and identify the comorbidity that keeps from being treated. CONCLUSION: MSSCT and CBCT can make in full measure the topical diagnosis of abnormal teeth and hence choose an optimal algorithm for comprehensive treatment of patients.