[General anesthesia and intensive care for patients surgically treated for deep neck odontogenic infections]. / Osobennosti anesteziologicheskogo obespecheniia i intensivnoi terapii bol'nykh pri khirurgicheskom lechenii odontogennykh flegmon dna polosti rta.

The study objectives were to determine the significance of deep neck odontogenic infections severity to predict the postoperative morbidity. Observational study was conducted in 2014-2015. A continuous sample of 38 patients who were urgently hospitalized in the Novosibirsk Regional Clinical Hospital with deep neck odontogenic infections and operated on the day of hospitalization was analyzed. SAPS scale rates correlated positively with the duration of the artificial lungs ventilation (ALV). The positive balance of the introduced and withdrawn liquid in the first day of the postoperative period is associated with the ALV duration, which requires accurate dosing of the infusion volumes. The described protocol of perioperative care significantly decreases morbidity in patients with deep neck odontogenic infections.

PROTOCOL NUTRITION THERAPY OF CRITICALLY ILL CHILDREN.

The Protocol isn't seen as directive. The goal of the Protocol is to define theframes ofdiagnostic criteria and therapeutic action, within which a doctor working in an intensive therapy children have freedom of choice. The Protocol takes into account that the critical and postagressive states are characterized by the features of malnutrition, particularly manifested in the period of intensive growth (first life year). The Protocol submitted by: contraindications to artificial nutricion in any form; indications for parenteral nutrition; components ofparenteral nutrition; calculation of water and energy needs; calculation of substrate requirements; the system of "two in one" and "three in one "; monitoring the effectiveness ofparenteral nutrition; the use of adjuvants and active additives to artificial nutrition, indications for early enteral nutrition, time of the beginning of enteral nutricion and tolerance to it: trial feeding; trophic nutricion; the technique ofprobe feeding; selection offormulas for enteral nutrition; monitoring the effectiveness of enteral nutrition. The Protocol does not discuss the issues of planned nutritional preparation for surgery, nutritional support in chronic malabsorption, sipping.

[The experience of submental intubation for severe maxillofacial injuries]. / Opyt submental'noi intubatsii trakhei pri tyazhelykh chelyustno-litsevykh povrezhdeniyakh.

Oral and nasal routes for intubation are often not feasible in maxillofacial fractures. The paper presents our experience of midline and paramedial approaches for submental intubation in the airway management of facial trauma patients. The prospective study included 47 patients with maxillofacial trauma in whom submental orotracheal intubation was performed in 2005-2014. When using midline approach the tube does not always accurately fit into the mandibular lingual groove creating an inconvenience for the surgeon. By paramesial approach the working conditions for the surgeon were the most comfortable. The average duration of the procedure was 5-6 minutes. At the end of the surgery the tube was reversed, the submental wound was stitched, patients were extubated (10 of them were extubated through the submental approach). Eight patients required short-term post-operative mechanical ventilation. In all patients the submental intubation allowed simultaneous reduction and fixation of fractures and intraoperative control of the dental occlusion without interference from the tube during the operation. There were no significant operative or postoperative complications. Submental intubation is a simple, secure and effective procedure for operative airway control in maxillofacial traumas. It is an attractive alternative to tracheotomy in the surgical management of selected cases of maxillofacial trauma.

THE USE OF DEXMEDETOMIDINE IN COMBINATION NEFOPAM FOR POSTOPERATIVE ANALGESIA AFTER LAPAROSCOPIC CORRECTION OF MORBID OBESITY.

AIM: To study the possibility of using a combination of dexmedetomidine with nefopam for postoperative analgesia in patients with morbid obesity after bariatric surgery in anesthesia quality aspects and theimpact of the study on the combination during the inflammatory response to surgical trauma. SUBJECTS AND METHODS: A prospective cohort study of 48 patients with obesity. RESULTS: Based on the analysis of hemodynamic parameters, evaluation of pain using a numeric rating scale pain concluded that selective agonist of o-2 adrenergic dexmedetomidine in combination with nefopam provides effective postoperative pain relief in patients who underwent bariatric surgery, and is not a factor for suppression of postoperative inflammatory response Unlike the effects of ketorolac tromethamine, do not always provide a sufficient level of analgesia and reduce the rate of growth in the level of IL-6. CONCLUSION: The combination of dexmedetomidine with nefopam provides sufficient analgesic effect after bariatric surgery, with noted a more rapid onset of analgesia than with ketorolac. Postoperative analgesia and dexmedetomidine nefopam, unlike the use of ketorolac tromethamine, are not violated ratio of interleukins 1 and 6 was not a factor and suppression of postoperative acute phase inflammatory response.

[Problems of dental services in closed administrative units assessed by a survey of dentists].

The article presents the results of the survey of 150 dentists from 10 closed administrative units of FMBA health care system of Russia in connection with the dynamics of dental staff withdrawal and reduce of volume of preventive work in schools and factories. These problems were found to be associated with the lack of regulations on mandatory preventive dental examinations of workers with occupational hazards, low tariffs for dental services in obligatory medical insurance program, poor wages an lack of apartments for young dentists.

[The effect of T-lymphocytes on epithelial proliferation of the jejunal mucosa in thymectomized mice]. / Vliianie T-limfotsitov na proliferatsiiu épiteliia slizistoi obolochki toshchei kishki u timéktomirovannykh myshei.

Following 1.5 month period after thymectomy of adult mice the crypt 3H-thymidine labelling index is decreased and the proliferative zone is reduced. Analysis of labeled cell distributions in the crypt revealed that thymectomy resulted in the initiation of enterocyte entering a maturation phase in the site shifted to the crypt base. Syngeneic T-lymphocytes injected intravenously to thymectomized mice increased the labeling index, but exerted no effect on the size of proliferative zone. The proliferative changes described were not due to changes in the number of divisions of rapidly proliferating enterocytes. The role of T-lymphocytes in modulation of intestinal epithelium proliferation and steady state maintenance is discussed.

[Intensive care of children with DIC syndrome based on the use of low molecular weight heparins]. / Intensifikatsiia terapii DVS-sindroma u detei na osnove primeneniia nizkomolekuliarnykh geparinov.

The first section of this paper presents data on low-molecular-weight heparins: pharmacokinetics and pharmacodynamics, advantages in comparison with common heparin. The second section presents the results of fraxiparin and clivarin use in 43 children aged 9 months to 14 years with acute/subacute DIC syndrome of infectious origin. Therapeutic and maintenance doses, the mode of injection of low-molecular-weight heparins, and methods for laboratory monitoring of their efficiency and safety are presented.

[Adjuvants to the treatment of acute cerebral insufficiency in newborns].

Efficacy of cortexin as a cerebral protector and stress-limiting drug in acute cerebral pathology of newborns, severe cranial-brain damage, infection encephalitis has been confirmed during prospective placebo-controlled trials. Early administration of cortexin had the most useful effects that confirm the rule of "gold hour". Cortexin, if used timely, may be regarded as the adjuvant of means of intensive treatment of acute cerebral insufficiency.

Cellular proliferation in the crypt epithelium of human small intestinal xenografts.

The present study investigates the spatial organisation of epithelial cell proliferation in human small intestinal xenografts, in order that direct comparisons can be made with paediatric small bowel. For this purpose we employed the MIB-1 (Ki-67) monoclonal antibody and [3H]thymidine to analyse the crypt growth fraction and DNA synthesising (S-phase) cells, respectively. The spatial distribution of cycling (MIB-1+) cells was appropriately confined to the xenograft crypts where it closely resembled that of paediatric intestine, both in terms of the labelling index and an ability to form runs of labelled cells, thereby demonstrating synchronous patterns of cell division. In addition, the S-phase representation in xenograft intestine was uniform throughout the crypt proliferation compartment thereby indicating cell-cycle homogeneity. This chimeric model system now provides a new approach to investigate altered proliferative responses of human gut to a number of potentially harmful substances e.g. carcinogens, the assessment of which is not feasible in patients or volunteers.

[The immune system and its regulatory role in the processes of proliferation and differentiation in the body]. / Immunnaia sistema i ee reguliatornaia rol' v protsessakh proliferatsii i differentsirovki v organizme.

The reported and original research data on immune regulation of cellular proliferation and differentiation in diverse tissues are summarized. Such regulative function is considered to be the expression of the proposed role of the immune system in the realization of genetic information at the integral bodily level. It is postulated that in addition to the information flow: DNA--RNA--protein (in each cell), another information flow may exist: the central organs of the lymphoid system--lymphocytes migrating to different organs and tissues--organs and tissues characterized by specific organ, tissue and differentiation antigens.

[Kinetics of cell population of the jejunal mucosal epithelium in mice after administration of syngeneic lymphocytes]. / Kinetika kletochnoi populiatsii épiteliia slizistoi obolochki toshchei kishki myshi posle vvedeniia singennykh limfotsitov.

By means of the radioautographic method the state of cellular restoration of the gastric epithelium has been estimated after administration of syngenic lymphocytes to mice. Under conditions of physiological regeneration T-lymphocytes are able to inhibit proliferation of the epithelial cells and to limit the size of the proliferation zone in crypts. The inhibition degree of the proliferative activity depends on the doze of the T-cells administered. In order to demonstrate their activity, T-cells do not need DNA and RNA synthesis de novo. At the same time, protein synthesis is necessary; it occurs on long-living mRNA lymphocytes. The T-lymphocyte action is reversible at the tissue, but not at the cellular level. The mechanism of decreasing cell reproduction under effect of T-lymphocytes is described. In the process of lymphoid regulation of the cellular restoration in the intestinal epithelium changes in the size of the proliferative pool play the main role.

[Effect of syngeneic thymocytes on the proliferation of the small intestine epithelium in mice]. / Vliianie singennykh timotsitov na proliferatsiiu épiteliia tonkoi kishki myshei.

The effect of syngeneic thymocytes on the proliferative compartment of the small intestinal epithelium was studied in CBA mice. In mice that intravenously received thymus cells, the proliferative enterocyte activity was depressed, the proliferative zone reduced and the maturation zone enlarged. The data obtained indicate that medullary thymocytes are responsible for this effect. The regulatory role of the immune system with regard to cell proliferation is discussed.

Diverse patterns of expression of the 67-kD laminin receptor in human small intestinal mucosa: potential binding sites for prion proteins?

It has been shown that the 67-kD laminin receptor (LR) may function as a receptor for Sindbis and tick-born encephalitis viruses. Recent data indicate that the 37-kD precursor (LRP) for this molecule acts as a receptor for prion proteins (PrP), self-proteins implicated in the pathogenesis of transmissible spongiform encephalopathies including new variant Creutzfeldt-Jakob disease (nvCJD). Laminin and PrP share the same binding site on LRP, which is incorporated into the mature LR as a functional binding domain. To localize PrP binding sites potentially relevant to oral infection, the expression of the LR in human small intestinal mucosa was studied. Expression of the LR was determined by immunohistochemistry in duodenal and jejunal biopsies using a monoclonal antibody (MLuC5) which specifically recognizes the 67-kD LR. Biopsy material was obtained from 39 control patients, 15 patients with ulcerative colitis, 15 patients with Crohn's disease and uninvolved small bowel, and 28 patients with active coeliac disease. Two distinctive patterns of LR expression were found within each group of patients. One pattern was characterized by LR expression in the brush border and Golgi apparatus region of villus and crypt enterocytes. Paneth cell secretory granules were positive for LR in these samples. Brush border expression of LR was found in approximately 40% of samples, with the exception of Crohn's disease (6.7% of samples were positive). Another pattern of LR expression was characterized by positively stained endothelium, while the epithelium was generally negative (45 of 97). The use of two polyclonal antibodies which recognize both the LRP and the LR confirmed brush border and paranuclear expression of the LR, but also showed varying cytoplasmic and apical surface immunoreactivity in MLuC5-negative epithelium, reflecting the distribution of LRP as opposed to the mature receptor. In conclusion, expression of the LR in the brush border and in Paneth cell secretory granules suggests that this molecule might be involved in both secretory and endocytotic functions. The major implication of intestinal epithelial/brush border expression of the LR may be an increased susceptibility to oral infection with prion proteins.

Epithelial cell proliferation in childhood enteropathies.

BACKGROUND/AIM: The aim of this study was to investigate epithelial cell turnover in childhood enteropathy to establish whether common disease related mechanisms operate. Levels of epithelial cell proliferation were measured in children with food intolerance (cows' milk protein intolerance and coeliac disease), and after infection with Giardia lamblia, Cryptosporidium, and enteropathogenic Escherichia coli. METHODS: Comparative measures of epithelial cell proliferation were performed by recording mitotic activity and MIB-1 immunoreactivity in proximal small intestinal biopsy specimens. RESULTS/CONCLUSIONS: A hyperplastic crypt response was evident in all of the disease states examined and was particularly pronounced in coeliac disease and in infection with enteropathogenic E coli, where mitotic and MIB-1 labelling indices were significantly raised above control values. In contrast with coeliac disease, increased crypt cell production rates in enteropathogenic E coli infection were also due to an expansion of the crypt proliferation compartment, without a comparable increase in crypt cell numbers. Crypt hyperplasia is therefore a common tissue response to mucosal damage in food allergy and infection, although disease specific mechanisms are evident.

Characterization of conditions for the primary culture of human small intestinal epithelial cells.

Intestinal epithelial cells (IECs) are important for many aspects of gut physiology and pathology. Different approaches have been tried for the primary culture of human IECs, with varying degrees of success, as apoptosis easily occurs. Our aim was to develop a method for primary culture of human IECs from biopsy material. IECs and Lamina propria (LP) cells were liberated from duodenal biopsies obtained from subjects undergoing routine endoscopy for clinical investigations, whose small bowel was macroscopically normal. IECs were cultured on collagen membranes in a 12-well tissue culture cluster, with LP cells and allogeneic Epstein-Barr Virus (EBV)-transformed B lymphocytes (allo-B cells) underneath, in the well. Cultured IECs were characterized by light and confocal microscopy. Cytokine levels in culture supernatants were measured by ELISA. Cells showed the columnar morphology of IECs, even after several days in culture. Best results were obtained from IECs cultured above both LP and allo-B cells. IECs did not form monolayers as do transformed epithelial cell lines, but they did preserve their original cell-cell contacts. Analysis of culture supernatants showed that IL-10 was produced by IECs initially, but IL-1ra was produced by LP cells in the underlying wells with increasing time in culture. Very little IL-1 beta was produced from any cultures. These results show that IECs can be isolated and maintained in primary culture for a short while, which could open new possibilities for research using patient material instead of cell lines.

Human intestinal development in a severe-combined immunodeficient xenograft model.

The present work describes a severe-combined immunodeficient murine xenograft model used to investigate human gastrointestinal ontogenesis. Specifically, the study has tested whether carefully selected regions of human fetal gut are able to undergo region-specific morphogenesis and epithelial cytodifferentiation when transplanted subcutaneously into immunodeficient mice. In addition, double-label in situ hybridisation techniques, utilising specific human and mouse DNA probes, have been adopted to characterise host and donor cell types and to investigate the potential developmental roles for non-epithelial cells in the regulation of epithelial differentiation pathways in vivo. Human fetal small and large bowel developed to form a characteristic mucosa 10 weeks after transplantation, which displayed clear region-specific structural and functional gradients. The initial phase of xenograft epithelialisation closely resembled the stratified type of epithelium which is present during early fetal gastrointestinal development. Idiosyncratic epithelial differentiation pathways were recorded during xenograft regeneration, with an absence of Paneth cells and an abundance of enteroendocrine cells when compared with developed xenograft and paediatric intestine. Such differences may, therefore, be important in ensuring rapid and region-specific development in the absence of conventional luminal stimuli and hormonal changes that occur normally during pregnancy. In situ hybridisation demonstrated an exclusively human origin for the intestinal xenograft epithelium and muscularis mucosa and externa. Although the submucosa and lamina propria were comprised of a chimeric mixture, murine cells were rarely seen to contact with the epithelium, which interacted primarily with human myofibroblasts and human intraepithelial lymphocytes. It is proposed that a 'selection' process operates to maintain species-specific cellular interactions, and this mechanism may subsequently play an important role in regulating epithelial cell differentiation, orchestrated in part by juxtaposed non-epithelial cell types.