Genetic damage in lymphocytes of lung cancer patients is correlated to the composition of the respiratory tract microbiome.

Recent findings indicate that the microbiome may have significant impact on the development of lung cancer by its effects on inflammation, dysbiosis or genome damage. The aim of this study was to compare the sputum microbiome of lung cancer (LC) patients with the chromosomal aberration (CA) and micronuclei (MN) frequency in peripheral blood lymphocytes. In the study, the taxonomic composition of the sputum microbiome of 66 men with untreated LC were compared with 62 control subjects with respect to CA and MN frequency and centromere fluorescence in situ hybridisation analysis. Results showed a significant increase in CA (4.11 ± 2.48% versus 2.08 ± 1.18%) and MN (1.53 ± 0.67% versus 0.87 ± 0.49%) frequencies, respectively, in LC patients as compared to control subjects. The higher frequency of centromeric positive MN of LC patients was mainly due to aneuploidy. A significant increase in Streptococcus, Bacillus, Gemella and Haemophilus in LC patients was detected, in comparison to the control subjects while 18 bacterial genera were significantly reduced, which indicates a decrease in the beta diversity in the microbiome of LC patients. Although, the CA frequency in LC patients is significantly associated with an increased presence of the genera Bacteroides, Lachnoanaerobaculum, Porphyromonas, Mycoplasma and Fusobacterium in their sputum, and a decrease for the genus Granulicatella after application of false discovery rate correction, significance was not any more present. The decrease of MN frequency of LC patients is significantly associated with an increase in Megasphaera genera and Selenomonas bovis. In conclusion, a significant difference in beta diversity of microbiome between LC and control subjects and association between the sputum microbiome composition and genome damage of LC patients was detected, thus supporting previous studies suggesting an etiological connection between the airway microbiome and LC.

[The Case of Fulminant Myocarditis].

Fulminant myocarditis (FM) is a severe form of inflammatory myocardial injury rapidly developing as acute heart failure, cardiogenic shock, or life-threatening disturbances of cardiac rhythm. FM requires intensive treatment including drug therapy, mechanical circulatory support, and in some cases - heart transplantation. Echocardiography can be used as a screening method of diagnostics. Magnetic resonance imaging of the heart often cannot be performed because of hemodynamic instability of a patient, therefore endomyocardial biopsy with histological and immunohistochemical studies as well as molecular-genetic analysis of obtained samples is required for final diagnosis. Prognosis of the disease is determined by histological picture. In most cases, after cessation of acute stage of the inflammatory process, FM has a favorable long-term prognosis. In this article we present a clinical case of FM and review of current literature on diagnosis and treatment of this disease.

[Surgical treatment of giant thymoma complicated by intrathoracic compression syndrome]. / Khirurgicheskoe lechenie gigantskoi timomy, oslozhnennoi kompressionnym sindromom organov grudi.

The problem of giant chest tumors is still actual despite the progress in diagnostics of intrathoracic cancer. Surgical treatment of giant tumors should always be considered as a part of combined antitumor treatment. Large tumor is not a contraindication for surgery per se. The results of explorative thoracotomy may be assessed in expert centers once again if redo surgery may be followed by favorable outcome. These operations require the coordinated work of the entire operating team.

[Tracheolaryngeal resection for cicatricle stenosis]. / Trakheogortannaia rezektsiia pri rubtsovom stenoze.

AIM: To determine the safest and the most effective surgical treatment of patients with cicatricle stenosis of tracheolaryngeal segment via analysis of different approaches. MATERIAL AND METHODS: For the period 1963-2015 at Petrovsky Russian Research Center for Surgery and Sechenov First Moscow State Medical University 1128 patients with cicatricle tracheal stenosis have been treated. There were 683 men and 445 women. 684 (60.6%) patients were young and the most employable (21-50 years). All patients were divided into 2 groups depending on time of treatment: the first one included 297 patients between 1963 and 2000, the second group - 831 patients between 2001 and 2015. In group 1 tracheolaryngeal anastomosis was made in 10 (16.9%) out of 59 patients who underwent tracheal resection. Previously indication for this surgery was cicatricle stenosis of cervical trachea and larynx with upper borderline of cicatricle changes at least 2 cm from vocal folds. In group 2 these procedures were more frequent. 94 (28.5%) out of 330 patients underwent tracheolaryngeal resection. Cranial borderline of lesion was within 0.5 cm from the vocal folds (only if posterior laryngeal wall at the level of cricoid cartilage was intact). Difficult patients are those who need for double-level or redo repair and procedures with tracheostomy. RESULTS: In the second group overall morbidity after tracheal resections followed by anastomosis was 5.6%. These complications were more common after tracheolaryngeal anastomosis (17%). There were no lethal outcomes after 94 tracheolaryngeal resections. Good long-term results were observed in 89.8% of patients after circular resection. Their quality of life was similar to that of healthy people. Preserved cicatricle tracheal segments during tracheal repair with T-shaped airway tube adversely affects quality of life in these patients in long-term period.

[Circular tracheal resection for cicatrical stenosis and functioning tracheostomy]. / Tsirkuliarnaia rezektsiia pri rubtsovom stenoze trakhei i funktsioniruiushchei trakheostome.

AIM: To analyze the results of tracheal resection for cicatricial stenosis depending on the presence of tracheostomy. MATERIAL AND METHODS: 1128 patients with tracheal cicatricial stenosis were treated for the period 1963-2015. The first group consisted of 297 patients for the period 1963-2000, the second group - 831 patients for the period 2001-2015. Most of them 684 (60.6%) were young and able-bodied (age from 21 to 50 years). In the first group 139 (46.8%) out of 297 patients had functioning tracheostomy. For the period 2001-2015 tracheostomy was made in 430 (51.7%) out of 831 patients with cicatricial stenosis. Time of cannulation varied from a few weeks to 21 years. RESULTS: Re-tracheostomy within various terms after decanulation was performed in 68 (15.8%) patients. Tracheal resection with anastomosis was performed in 59 and 330 in both groups respectively. At present time these operations are performed more often in view of their standard fashion in everyday practice. In the second group tracheal resection followed by anastomosis was observed in 110 (25.6%) out of 430 patients with tracheostomy that is 4.4 times more often than in previous years. In total 2 patients died after 330 circular tracheal resections within 2001-2015 including one patient with and one patient without tracheostomy. Mortality was 0.6%. Moreover, this value was slightly higher in patients operated with a functioning tracheostomy compared with those without it - 0.9 vs. 0.5% respectively. The causes of death were bleeding into tracheobronchial lumen and pulmonary embolism. The source of bleeding after tracheal resection was innominate artery. Overall incidence of postoperative complications was 2 times higher in tracheostomy patients compared with those without it - 22 (20%) vs. 26 (11.8%) cases respectively. Convalescence may be achieved in 89.8% patients after circular tracheal resection. Adverse long-term results are associated with postoperative complications. So their prevention and treatment will improve the outcomes.

APPLICATION OF APNEIC OXYGENATION IN TRACHEAL SURGERY.

BACKGROUND: The tracheal surgery is associated with opening of airways and historically used different methods of maintaining gas exchange: System "shunt-breathing", the injection ventilation, high frequency jet ventilation and even artificial circulation. In recent years increased the interest of use of apneic oxygenation (A 0). THE AIM: to study the impact ofthe application ofA o on the gas exchange, acid-base balance of arterial blood, in patients undergoing reconstructive surgery on the trachea and bronchi with AO. MATERIALS AND METHODS: The study included 130 patients with stenotic disease of the trachea, operated in the period from 2011 to 2014 usingAO. RESULTS: Application ofAO provides a high level of oxygenation and is accompanied by a moderate increase in pCO2 level and the development of acidosis. Hypercarbia and acidosis were not accompanied with hemodynamic disturbances on ECG, heart rate and invasive measurement of blood pressure at high values of Pa O2.

[POSTRESUSCITATION CICATRICIAL TRACHEAL STENOSIS. CURRENT STATE OF THE PROBLEM - THE SUCCESSES, THE HOPES AND DISAPPOINTMENTS.]

BACKGROUND: Currently, the trend continues to increase the number ofpatients with cicatricial tracheal stenosis (CTS). Therefore, prevention and treatment ofthis disease remains topical. The main cause ofcicatricial tracheal stenosis is damaging the trachea during mechanical ventilation. The scheme ofprevention of this disease in Russia hasn't brought the desired results. THE AIM: to clarify the modern etiology of cicatricial tracheal stenosis, to identify the trend in incidence rates, to determine whether there is an optimal safe alternative to tracheostomy including the use of minimally invasive techniques, to improve diagnostic and therapeutic algorithm at various stages of assistance, and also to study the results of innovative operations and new ways of maintaining gas exchange. MATERIALS AND METHODS: 1128 patients with cicatricial tracheal stenosis was treated from 1963 to 2015 in Petrovsky National Research Centre of Surgery and IMSechenov First Moscow State Medical University. Over time methods of di- agnosis, methods of anesthesia and operations have been varied. In this regard all patients were divided into two groups depending on the period of time from 1963 to 2000 (297 patients) andfrom 2001 to 2015 (831 patients). In recent decades there is a steady increase in the number of treated patients. So, if in the first group during the year operational treatment about the CTS 8,0 patients were underwent, in the second - to 55.4. Cicatricial tracheal stenosis appeared after lung mechanical ventilation at 1025 (for 90.9%) patients. They have undergone both radical one-stage treatment and multi-stage and sequential intraluminal procedures. In general there is a clear trend towards more aggressive surgical tactics. So, if in thefirst group, the tracheal resection with anastomosis was performedin 59 patients only, the second-330. Thefrequency ofpostoperative complications and mortality in the second group ofpatients was 12.9 and 0.7 %, respectively. RESULTS: Only a reasonable combination of all treatment methods, the principle of "every patient his own version of operation" allows to minimize the risk oftreatment and to get a good lasting result. Proof of such provision may be the fact that the frequency of complications and postoperative mortality at our patients have had a tendency to decrease and currently stands at 12.9 and 0.7 %, respectively for many years. It is 2.3 and 9.6 times less, respectively, than in the periodfrom 1963 to 2000. It appears that further reduction of these indicators will be at a slower pace, afurther solution of the CTS problem will be based on the prevention of disease. CONCLUSION: Prevention of cicatricial tracheal stenosis in the departments of reanimation and intensive care is currently inadequate. It requires fundamentally new approaches, but reform still has not brought the desired results. Diagnosis of the CTS at an early stage allows early treatment and to avoid complex and risky operations. Increasingly important, apart tracheoscopy for diagnosis of tracheomalacia purchase dynamic computed tomography and magnetic resonance - tomography. Treatment ofpatients with CTS requires a multidisciplinary approach, individual selection operations for a particular patient. The general trend of the further development of tracheal surgery is associated with an increase in the number of simultaneous resections, including at the long, two-level stenosis, as well as at relapse. The patients who had refused treatment or have elected him palliative options made possible surgery. The frequency of postoperative comnlications and mortality decreased significantiv, including after extensive and traumatic operations on the trachea.

[REVIEW OF THE CURRENT METHODS OF RESPIRATORY SUPPORT FOR TRACHEAL SURGERY.]

Currently, surgery on the trachea underwent significant progress including in the latest methods of complex resections and reconstructions of the respiratory tract. In this regard, anesthesiologist needs the knowledge and skills of using various special respiratory techniques. Modern respiratory methods in tracheal surgery are "shunt-breath", high frequency jet ventilation, methods of extracorporeal oxygenation and respiratory relatively new technology - apneic oxygenation. This review deals with the pathophysiologicalfeatures of each of these techniques. Searching for information was made on the database: Scientific electronic library, Central Scientific Medical Library, PubMed, Scopus and Web of Science.

[Actual respiratory technologies in thoracic surgery: traditional problems and innovative solutions].

The problem of efficient gas exchange maintenance is always actual in anesthetic management of thoracic surgery and determines the selection of appropriate method of anesthesia. The article presents an experience of anesthesia during operations on lungs, trachea, bronchi and mediastinal structures performed from 1963 to 2015. Current concept of safety and efficacy of anesthetic management in thoracic surgery is presented. The role of actual current respiratory technologies and methods of anesthesia per se to maximize the efficiency of gas exchange in all stages of thoracicsurgery is emphasized. Absolute coherence of anesthesiologist and surgeon based on correct interaction is the most important condition of successful surgery. Effectiveness of special respiratory technologies for thoracic surgery associated with one-lung ventilation and prolonged wide dissection of airways is described. The research results and pathophysiological rationale for the use of special respiratory technologies including different variants of differentiated independent lung ventilation especially important for patients with concomitant cardiorespiratory pathology are presented. We reported experience of effective gas exchange maintenance in reconstructive surgery of trachea and main bronchi including traditional mechanical ventilation with "shunt-breath" system, use of jet high-frequency ventilation and relatively new respiratory technology such as flow apnoeic oxygenation.

[Simultaneous resection of the two tracheal fragments for cicatrical stenosis].

Treatment of multifocal and extended tracheal stenosis is associated with considerable difficulties in comparison with local lesions. Resection with restoration of respiratory lumen by using of direct intertracheal anastomosis substantially entered into common clinical practice. But these interventions in patients with two-level lesion are performed rarely. Among 900 operated patients with cicatrical tracheal stenosis resection of two tracheal segments with forming of anastomoses was performed only in 5 patients. We presented an experience of single-stage resections of different segments of respiratory tract for nonneoplastic cicatrical stenosis. Indications and contraindications are defined. Technical features of resection are discussed. Our data show that such operations are possible and safe. All patients recovered. Their breath was completely restored. Risk of postoperative complications after similar operations is not higher than after one-level resection. But at present time these techniques may be used by specialists and institutions with serious experience in tracheal surgery.

[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.

[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.

[Association of the polymorphism of dna repair genes with chromosomal aberrations in lung cancer patients].

The results of the examination of association of polymorphisms of DNA repair genes and chromosomal aberrations in lung cancer patients are discussed. A significant positive association between the hOGG1 G/G genotypes, XPD G/G genotype and lung cancer was found. The hOGG1 C/C genotypes were significantly negatively associated with lung cancer. The patient chromosomal aberration frequencies were significantly higher than in control. Carriers of all APE1 and XPD genotypes, XRCC1 G/G genotype, ADPRT T/T genotype, hOGG1 C/C and Ser/Cys genotypes had statistically significant differences in the level of the chromosomal aberrations between patient and control groups. Statistically significant differences in the level of chromosomal aberrations between XPD T/T and G/G genotype of lung cancer patients were observed.

[Respiratory support in anaesthetic management for thoracic surgery and their comparative characteristics: over 2000 anaesthesia experience].

The article deals with the first comparative study of haemodynamics, gas exchange, and metabolic lung finction in patients with underlying respiratory and cardiovascular diseases. Different anaesthesia and ventilation (conventional AVL, OLV differentiated ALV) techniques were used. Respiratory support methodology with the use of HFV or CPAP during the main phase of thoracic surgery in patients with severe associated cardio-respiratory diseases was developed. Indications for differentiated AL V in thoracic surgery were developed.

[Ketamine versus propofol during one-lung ventilation in thoracic surgery].

A comparative analysis of gas, the metabolic rate, pressor, resistive and volumetric characteristics of pulmonary blood flow, central and intracardiac hemodynamics in patients undergoing thoracic surgery was conducted. 2 methods of anesthesia maintenance: on the basis of ketamine - fentanyl - pipecuronium and propofol - fentanyl - pipecuronim were compared. Invasive monitoring system PiCCOplus for the behaviour of the transpulmonary thermodilution (TT) in combination with VoLEF for the pulmonary thermodilution (PT) the change of ventilation mode ALV - OLV - ALV was used. OLV lasted for more than 1.5 hours.

[High level thoracic epidural analgesia as a special component of anesthesia during thoracic surgeries].

This article is devoted to assessing the adequacy and safety of total intravenous anesthesia based on constant dosed infusion of propofol and high thoracic epidural analgesia in thoracic surgical procedures requiring an artificial one-lung ventilation in patients with concomitant chronic cardiorespiratory disorders compared to TIVA without a high thoracic epidural analgesia. Comparative analysis of gas exchange, metabolic rate, pressor, resistance and volumetric characteristics of pulmonary blood flow, central and intracardiac hemodynamics was conducted. We used high technology invasive monitoring system PICCOplus for transpulmonary thermodilution in combination with VoLEF for pulmonary thermodilution in changing modes of ventilation MV-MSL V-MV. MSL V lasted more than 1.5 hours.

[Etiology, prophylaxis and treatment of extensive, multifocal cicatricial tracheal stenosis at the junction of sciences--surgery and anesthesia].

759 patients with cucatritial stenosis of trachea were treated in the Russian Scientific Center of Surgery in the period from 1963 to 2009. Extensive or multifocal stenosis was diagnosed in 172 patients. 157 patients were previously operated in other hospitals. The lesion of larynx during admission was diagnosed in 122 cases. All patients were operated in compliance with the principle of alternation methods of anesthesia and respiratory support. As a result of consistent application of the landmark reconstructive-plastic operations and resection in combination with endoscopic surgery good results were achieved. Based on the data, treatment algorithm of extended and multifocal cicatricial stenosis of the trachea was developed.

[Respiratory provision of reconstructive operations for extended and multifocal tracheal stenosis].

The paper describes new approaches to anesthetic maintenance of reconstructive operations for multifocal and extended tracheal stenoses. The authors state a pathophysiological concept of and guidelines for respiratory approaches ensuring effective gas exchange and adequate hemodynamics at stages of various plastic repairs. Specifically, they describe the specific features of respiratory provision of rare surgical interventions: two-level tracheal resection and reconstruction and thyrotracheal complex transplantation in subtotal tracheal lesion. The advantages of high-frequency jet artificial ventilation using a Mansoon apparatus (Acutronic Medical Systems AG, Switzerland) are given.