[Surgery in patients with severe or inhibitory hemophilia A under prevention injection of emicizumab]. / Khirurgicheskie vmeshatel'stva u bol'nykh tyazheloi ili ingibitornoi formoi gemofilii A na fone profilakticheskogo vvedeniya emitsizumaba.

OBJECTIVE: To determine the features of preoperative hemostatic therapy and laboratory control in patients with severe and inhibitory forms of hemophilia A under preventive treatment by FVIII. MATERIAL AND METHODS: Four patients with severe and inhibitory forms of hemophilia A underwent surgery between 2021 and 2022. All patients received Emicizumab (the first monoclonal drug for «non-factor¼ therapy of hemophilia) for prevention of specific hemorrhagic signs of hemophilia. RESULTS: Surgical intervention under preventive Emicizumab therapy was essential. Additional hemostatic therapy was not carried out or performed in reduced mode. There were no hemorrhagic, thrombotic or other complications. Thus, the so-called «non-factor¼ therapy is one of the variants for uncontrollable hemostasis in patients with severe and inhibitory forms of hemophilia. CONCLUSION: Preventive injection of Emicizumab ensures certain buffer of hemostasis system and stable lower limit of coagulation potential. This is the result of stable concentration of Emicizumab when used in any of the registered forms regardless of age and other individual characteristics. The risk of acute severe hemorrhage is excluded, while the probability of thrombosis is not increased. Indeed, FVIII has higher affinity than Emicizumab and displaces Emicizumab from coagulation cascade that does not result summation of total coagulation potential.

Study of tribological properties of human buccal epithelium cell membranes using probe microscopy.

In this work demostrates a unique method for determining the absolute value of the friction force of a nanoobject on the surface of a cell membrane using atomic force microscopy. The tribological properties of membranes of adult human buccal epithelium cells in the presence of a protective adsorption buffer layer of ~ 100 nm on their surface were studied using atomic force microscopy in the contact scanning mode. Local mapping of the tribological characteristics of the surface was carried out, viz. friction FL = FL(x, y) and adhesion Fadh = Fadh(x, y) forces were measured. Studies of the friction force Ffr on the membrane surface at the nanolevel showed that its value varies discretely with an interval equal to lLF ≈ 100 nm. It was shown that such discreteness is determined by the interval lLF of the action of adhesive forces Fadh and indicates the fractal nature of the functional dependence of the friction force on the coordinate Ffr = Ffr(x). Thus, for nano-objects with dimensions ≤ lLF, the absolute value of Ffr decreases according to a power law with an increase in the size of the object, which contradicts the similar dependence of the friction force for macro-objects in the global approximation.

Expression of Genes Encoding Cell Motility Proteins during Progression of Head and Neck Squamous Cell Carcinoma.

The model of head and neck squamous cell carcinoma (HNSCC) was used to study the expression of genes encoding actin-binding proteins depending on the type of cell motility. The expression of SNAIL1 and CAPN2 mRNA in HNSCC tissue was higher than in specimens of dysplastic epithelium of the larynx and hypopharynx, which can be explained by activation of mesenchymal and amoeboid types of cell motility. In biopsy material of HNSCC patients with T1-2N0M0, expression of genes responsible for actin-binding proteins differed from that of patients with pretumor pathology of the larynx and hypopharynx: expression of FSCN was lower, while expressions of EZR and CAP1 were higher. The data attest that progression of HNSCC is associated with activation of both types of cell motility and with the changes in the expression of mRNA encoding cell motility proteins.

[The problems associated with the treatment of stenosing laryngotracheitis in the children (the results of the 35 year-long experience)]. / Problemy lecheniia stenoziruiushchego laringotrakheita u detei (rezul'taty 35-letnego opyta).

Stenosing laryngotracheitis (SLT) affecting the children is considered to be an emergency pediatric condition associated with ENT pathology. Its treatment presents a serious challenge for otolaryngologists, pediatricians, specialists in communicable diseases, allergologists, etc. We have undertaken a retrospective analysis of the available data with a view to summarizing the tendencies in the evolution of SLT morbidity. The results of the 35 year-long experience with the use of the currently available therapeutic strategies for the treatment of the children suffering from stenosing laryngotracheitis are presented. Special emphasis is laid on the advantages of the combined treatment of the patients presenting with this condition based at a specialized infectious department with the participation of an otorhinolaryngologist.

[LUNG ULTRASOUND IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES AND ACUTE RESPIRATORY FAILURE DUE TO PNEUMONIA.]

PURPOSE: To compare the accuracy of bedside lung ultrasound (LUS) and chest computed tomography (CT) for the de- tection of lung lesions in patients with hematological malignancies and acute respiratory failure (ARF). MATERIALS AND METHODS: 39 patients with hematological malignancies and ARF were enrolled in prospective study. The investigation of the patients included LUS, chest C, extravascular lung water index (EVLW) by transpulmonary ther- modilution, and bronchoalveolar lavage (BAL). RESULTS: There was correlation between the total number of B-lines and E VLW index (r = 0,40; p <0,05). The sensitivity, specificity of LUS in the total number of B-lines were 78% and 70%, respectively (and A UC 0,7). There were correla- tions between A-lines and volume of hyperaerated lung regions (r = 0,40; p <0,05) and normally ventilated (r = 0,60; p = 0,001) regions, between A-lines and the total lung volume (r = 0,50; p = 0,001), between A-lines and volume of poorlyventilated lung regions (r = -0,40; p = 0,001), A-lines and weight of normally ventilated lung regions (r = 0,50; p = 0,001), A-lines and weight of poorly ventilated regions (r = -0,35; p <0,05), total count of B-lines and volume of poorly ventilated lung regions (r = 0,4; p = 0,001), between total count of B-lines and weight poorly ventilated lung regions (r = 0,4; p = 0,001). There were associations between USfeathers and etiology ofpneumonia. A-lines were often detected in patients with gram-negative bacterial pneumonia and fungal pneumonia more than in patients with pneu- mocystis pneumonia. B-lines were detected often in patients with Pneumocystis pneumonia. Sensitivity ofLUS pleural effusion assessment was 95%, specificity was 90%. CONCLUSION: LUS is high sensitivity and specificity method to detect lung lesions in patients with ARF.

[Effect of radio frequency discharge plasma on surface properties and biocompatibility of polycaprolactone matrices].

Surface modification of bioresorbable polymer material (polycaprolactone, PCL) with abnormal glow discharge, initiated during radio-frequency magnetron sputtering of a hydroxyapatite target was investigated. Plasma treatment resulted in an increase of surface roughness of PCL, crystallite size, the surface free energy and hydrophilicity. Increased treatment time (30, 60, 150 seconds) provoked the polymer surface saturation with the sputtering target ions (calcium, phosphorus). The assessment of plasma exposure of PCL surface on bone marrow multipotent mesenchymal stromal cells behavior (BM MSCs) has been performed. Modification of the polymer surface with the abnormal glow discharge stimulated adhesion and subsequent proliferation of BM MSCs; thus, maximum values were achieved with the surface treatment for 60 s. This type of plasma modification did not affect cell viability (apoptosis, necrosis). Thus, the surface modification with abnormal glow discharge, initiated during radio-frequency magnetron sputtering of a hydroxyapatite target, appear to be a promising method of surface modification of bioresorbable polymer material (PCL) for tissue engineering.

[Combined treatment in malignant tumors of the head and neck with reconstructive-plastic surgery].

The article is devoted to conservative and reconstructive-plastic surgical interventions using biocompatible implants accompanied by various types of radiotherapy and modern anticancer drugs that have allowed improving basic survival with maintaining a high level of quality of life. Our method of combined treatment for larynx, hypopharynx, oral cavity and oropharynx cancer of stage II-III by chemoradotherapy shows high immediate effectiveness and allows achieving statistically significant increase of overall and disease-free survival in the remote period of observation. The use of NiTi implants provides reliable recovery of deleted structures, pressurization of the cranial cavity, reduces the duration of surgery, shortens the time of wound healing.

[ASSESSMENT OF EXTRAVASCULAR LUNG WATER BY QUANTITATIVE COMPUTER IMAGE ANALYSIS IN PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME].

PURPOSE: To evaluate the possibility of quantitative computed tomography (CT) of the lungs in patients with acute respiratory distress syndrome (ARDS) for assessment of the severity of the condition and the effectiveness of treatment. MATERIALS AND METHODS: The study included 29 patients with ARDS and 22 with no signs of lung disease (control group). We measured extravascular lung water (EVLW) by transpulmonary thermodilution (TTD) and analysed CT of the lungs in patients with ARDS. Patients in the control group underwent CT of the lungs only. CT images were processed using the "Gamma Multivoks". RESULTS: According to CT poorly ventilated lung areas accounted for 2% of the total in the control group. Normally ventilated and hyper-ventilated lung areas prevailed in these patients. In the group of ARDS hyper-ventilated areas almost were not identified and normality and poorly ventilated areas we found. In patients with ARDS total lung volume was 1.5 times less than in the control group (median volume of 3393 and 4955 mL respectively). Pulmonary weight in ARDS group was bigger than in controls (median weight of the lungs 1233 and 812 g respectively). Effects of treatment according to quantitative CT evaluated in 14 survived patients. Notes the increase in lung volume (median 4656.5 ml) (p = 0.0001) and a decrease in lung weight (median 862 g) (p = 0.0012). The weight and volume of the lungs, the ratio of hyper, normal and poorly ventilated areas of the lung in patients with acute respiratoy distress syndrome after treatment did not differ from those in the control group. CONCLUSIONS: Quantitative analysis of CT reveals changes in the mass and volume of the lungs and can be used to diagnose and evaluate the effectiveness of the treatment. Pulmonary weight calculated by CT correlates with EVLW determined by TTD.

[The use of fast neutrons in treatment of malignant tumors of the head and neck].

The article presents issues of the application of neutron therapy in the combined and radiation therapy for head and neck tumors. There were developed methods of neutron and neutron-photon therapy in pre- and postoperative periods as well as in stand-alone option in unresectable tumors. The data obtained clearly demonstrate the superiority of new ways over standard methods of treatment. Neutron therapy is satisfactorily tolerated and allows improving the results of combined and radiation therapy patients with malignant tumors of the head and neck.

[Lung ultrasonography for the diagnosis of pneumonia in pregnant women with blood system tumors].

AIM: To estimate the informative value of ultrasonography (USG) in the diagnosis of lung injuries in pregnant women with blood system tumors. SUBJECTS AND METHODS: Lung ultrasound was performed in 5 pregnant patients with blood cancers. The women's age was 29-38 years; gestational age was 14-33 weeks. Four women had different types of acute leukemia; one had primary mediastinal large B-cell lymphoma. All the women received chemotherapy for blood cancer. When there were signs of lung injury, USG was conducted, the results of which necessitated therapy or bronchoalveolar lavage (BAL). RESULTS: Three patients developed acute respiratory failure; 2 of them required noninvasive ventilation. Based on the detection of consolidation with a dynamic air bronchogram and pleural effusion, the authors diagnosed bilateral pneumonia and alveolar-interstitial syndrome in 1 patient, right-sided pneumonia in 1, left-sided one in 1, and transfusion-related pulmonary edema in 1. Lung ultrasound did not verify the diagnosis of pneumonia in 1 patient. According to USG data, BAL procedures were performed in 2 patients; one of them was diagnosed as having Pneumocystis pneumonia; the other was found to have no pathogens in lavage fluid. Treatment resulted in clinical improvements and normalization of the lung ultrasound pattern in all the pregnant women. Later on, 4 women delivered via cesarean section done at 32-34 weeks' gestation and gave birth to healthy babies. One patient died from infectious complications after chemotherapy. CONCLUSION: Lung sound may be used to diagnose lung injury in pregnant women with blood cancers.

[About development of operativeness of medical information data system of central military clinical hospital n. a. N.N.Burdenko].

The authors presented the data about the development of operativeness of medical automated information data system of CMCH n. a. N.N.Burdenko with developing and formation of control center of hospitalization, data processing center, situation room and central archives of diagnostic data. It significantly improved diagnostic and treatment processes in hospital medical and preventive association. Consolidation of dependent prevention and treatment facilities of Moscow Region will provide effective administration of medical supply of attached cohort, administration of hospital association of CMCH n. a. N.N.Burdenko and medical service of the Armed Forces of Russian Federation, in general.

[A case of spontaneous chylothorax complicating pregnancy].

The paper gives a clinical case of left-sided chylothorax developing in a young woman in the second half of pregnancy due to thrombosis of the left internal jugular vein, left subclavian vein, and brachiocephalic trunk. Cesarean section was made. Medical treatment thereafter proved to be effective. The possible mechanisms for spontaneous venous thrombosis and chylothorax during pregnancy and the methods of their diagnosis and treatment are discussed.

[Major-General of Medical Service--Alexander Egorovich Deviatkin (to his 70th birthday anniversary)].

The article is devoted to the 70th anniversary of Armed Forces veteran, a distinguished physician of the Russian Federation, former head of the medical service of the North Caucasian Military District (1991-1999), Major-General of Medical Service Alexander Egorovich Devyatkin (27.02.1942-15.04.2003). With the outbreak of hostilities in the Chechen Republic A.E. Devyatkin was appointed to chief of medical service combined grouping of troops (forces). In the current environment, when combat operations had a number of specific features, he showed a high organizational abilities. It was he who, abandoning the pattern, planned and implemented a new system of medical care. Under the leadership of A.E. Devyatkina was then applied to a new system of medical evacuation. To evacuate the wounded and sick from the front edge of the medical company, medical battalion used armored vehicles, and the evacuation of the military hospitals was carried out only by air. All life is a worthy example of the general selfless service to the Motherland and was devoted to the noble cause of preserving and strengthening the health of the Armed Forces of our country.

[1602th district military hospital--70 years].

An important role in medical care of troops (forces) of the North Caucasian military district, and most recently--the Southern Military District under martial of action and crisis situations, as well as in peacetime, performs 1602th District Military Hospital of Defense Ministry of Russia. Hospital team has achieved significant results in treatment and diagnostic work, and became a leading military medical institution in the North Caucasus and the Southern Federal District. Today the hospital is not only a medical-diagnostic, but a methodical, scientific, educational and teaching center in the county. He has good material and technical basis and equipped with modern medical equipment. The article described the historical path of the hospital and its current status.

[Effect of imunofan on several indexes of immunity and pyoderma incidence among cadets of educational institutes].

It was discovered that during the first several months military service men have suppression of several indexes of immunity and a high level of morbidity by pyoderma. Was shown a high effectiveness of immunomodulatory agent Imunofan on correction of immunity status of servicemen and decrease of morbidity by pyoderma (more than on threefold): the effectiveness index is 3,25, the defense index is 69,2%. In addition, it was marked hepatitis- and stress-protect effect of the agent. It was made a conclusion about necessity of further examination of questions of correction of immunity status of military servicemen for the purpose of decrease of morbidity by infections, actual for studying units of the Armed Forces of RF.