Experimental Correction of Homeostasis Changes during Alloxan-Induced Diabetes by Implantation of Islet Cells Cultured in Fibrous TiNi-Based Scaffold.

The use of fibrous scaffolds made of titanium nickelide and carrying islet cells (IC) after a course of alloxan administration was studied in vivo. Scanning electron microscopy showed good adhesion of IC in the pore space of the scaffolds. In 28 days, mature tissue comprising both cellular and fibrous components filled the inner space of the scaffold by 90%. The advantage of intraperitoneal implantation of IC in vitro seeded in fibrous titanium nickelide scaffolds in comparison with injection of IC (6×105 cells) to Wistar rats was demonstrated in the dynamics of pancreatic function recovery (normalization of blood glucose and glycosylated hemoglobin concentrations by day 21 of the experiment), regeneration of the white hematopoietic lineage cells, and lengthening (by 2 times) of the lifespan of animals with alloxan-induced diabetes. Injection of IC improved rat survival by only 40%. Thus, the hybrid tissue-engineered construct (fibrous titanium nickelide scaffold+IC) is biocompatible when administered intraperitoneally, stimulates regeneration in rats with alloxan-induced diabetes, improves blood glucose utilization processes, and restores suppressed leukopoiesis. It is assumed that hepatocytes can be the main target cells of the hybrid tissue-engineering construct.

[ERAS protocol for perioperative management of patients with non-small cell lung cancer]. / Opyt primeneniya printsipov ERAS dlya perioperatsionnogo soprovozhdeniya patsientov s nemelkokletochnym rakom legkogo.

OBJECTIVE: To evaluate an effectiveness of enhanced recovery program for perioperative support of patients with lung cancer. MATERIAL AND METHODS: A prospective single-center study on effectiveness of ERAS protocol in perioperative support of patients with lung cancer was conducted at the Tomsk Regional Cancer Center. According to the study design, patients were divided into three groups. The first group included patients after VATS surgery followed by accelerated recovery. The second and the third groups comprised of patients after open interventions. In these groups, patients were randomized into traditional management or accelerated recovery management groups using the blind envelope method. Patients with indicated lobectomy or bilobectomy were included only. In postoperative period, we analyzed morbidity, pain syndrome and hospital-stay. RESULTS: A total of 235 patients were treated. VATS surgery followed by enhanced recovery program was applied in 61 patients. Eighty-seven patients underwent open operations followed by accelerated recovery protocol and traditional management. ERAS protocol ensured less postoperative morbidity compared to traditional management (p<0.001). Pain syndrome was less pronounced after VATS surgery and did not require an appointment of narcotic analgesics. In the group of open surgery followed by accelerated recovery protocol, narcotic analgesics within 3 postoperative days were required in 38 (43.6%) cases, in the group of traditional management - in 63 (72.4%) patients. Mean postoperative hospital-stay after VATS operations was 6.4 days, after open interventions followed by ERAS protocol - 8.7 days. In patients after open surgery and traditional postoperative management, mean hospital-stay was 14.2 days. One patient died after open surgery followed by ERAS protocol and 3 patients died in the group of traditional management. CONCLUSION: ERAS protocol ensures less postoperative morbidity, early activation of patients and reduced hospital-stay.

Co-Transplantation of Pancreatic Islet Cells and Mesenchymal Bone Marrow Precursors on Titanium Nickelide Scaffolds in Alloxan-Induced Diabetes Mellitus.

We studied therapeutic activity of co-transplantation of allogeneic pancreatic islet cells and mesenchymal bone marrow progenitors on TiNi scaffolds in Wistar rats with experimental alloxan-induced diabetes mellitus. In preliminary experiments with co-culturing of cells in different proportions followed by their transplantation on tissue-engineered constructs, the optimum ratio of these cells was determined - 3:1. Regeneration was assessed by biochemical methods by the blood levels of glucose and glycosylated hemoglobin on days 15, 30, and 5. In the group with combined cell transplantation on TiNi scaffold, normalization of the studied biochemical parameters occurred earlier than after monotherapy with allogenic islet cells and was associated with an increase in animal lifespan. Normalization of the parameters of bone marrow hemopoiesis, in particular, the number of myelokaryocytes and erythroblasts was also noted.

Development and Differentiation of Mesenchymal Bone Marrow Cells in Porous Permeable Titanium Nickelide Implants In Vitro and In Vivo.

We studied the structure of porous permeable titanium nickelide used as the scaffold. In vitro population of the porous scaffold with multipotent mesenchymal stem bone marrow cells on days 7, 14, 21, and 28 was analyzed by scanning electron microscopy. Stage-by-stage histogenesis of the tissues formed from the bone marrow cells in the titanium nickelide scaffold in vivo is described in detail. Using mesenchymal stem cells, we demonstrated that porous permeable titanium nickelide scaffolds are unique incubators for cell cultures applicable for tissue engineering.

Tissue reaction to a titanium-nickelide mesh implant after plasty of postresection defects of anatomic structures of the chest.

We studied morphological features of the regenerate formed after postresection defect plasty of the pericardium, diaphragm, and thorax with a mesh implant made of nanostructural titanium-nickelide threads. The newly formed tissue grew through the implant with the formation of an integrated tissue regenerate ensuring anatomic and physiological restoration of this area.

[The application of the cryosurgical and lymphotropic technologies for the combined treatment of postintubation tracheal stenosis].

The combined treatment of 10 patients presenting with postintubation thracheal stenosis was carried out with the application of the cryosurgical and lymphotropic technologies. Cryogenic treatment of ciatrical stenosis was performed through the tracheostoma using a titanium nickelide cryoappliactor. The effect of the cryogenic treatment was enhanced by a lymphotropic mixture composed of diprospan and longidaza and administered retrosternally as a course of up to three injections once in a week. In the intervals between the injections and after the termination of the course, the patients were asked to inhale longidaza dissolved in a broncho- or mucolytic preparation through a nebulizer (up to 5 inhalations). All the treated patients reported the recovery of normal breathing through the natural airways.

[The replacement of postresectional defects of the thorax with the use of tissue implant of nanostructural nickelid-titan thread].

The original method of the replacement of postresectional defects of the pericardium, diaphragm and the thoracic wall with the use of tissue implant of nanostructural nickelid-titan thread was tested in vivo on 30 outbred dogs. The efficacy of the plasty was assessed radiologically and pathomorphologically. The nickelid-titan thread implant proved to be a good plastic substance, allowing the replacement of major postresectional defects of various thoracic structures. The newly formed tissue intergrows the implant mass, thus forming the entity of regenerative tissue, which completely provides anatomic and physiologic reconstruction of the injured area.

Morphological assessment of different ways of bronchial stump closure after pneumonectomy.

A method is developed to close the stump of the primary bronchus by outer compression with a shape-memory device. The process of bronchial stump healing under compression suture was morphologically examined. The novel method was compared with the routine Sweet-type hand-operated and the mechanical sutures. The compression suture heals the stump by primary intention with restoration of the typical airway epithelium on the stump bottom and prevention of the development of the bronchial fistulas.

[A comparative analysis of bronchus stump closure methods after pneumonectomy].

Original method of bronchus stump closure after pneumonectomy is presented. Developed compression bronchial suture was compared with manual Sweet suture and mechanical sutures in the experiment with 36 non-pedigreed dogs. Efficacy of different methods was evaluated basing on the clinical findings, radial, endoscopic and morphological observations. Macro- and microscopic investigations signify about the healing of main bronchus stump by primary intention with bronchial epithelium repair in the stump fundus under conditions of compression suture in 30 days after operation. It is ascertained that compression suture creates optimal conditions for stump repair compared with traditional manual and mechanical sutures healing by secondary intention.

[Function of the heart conduction system in patients with progressive muscular dystrophy]. / Sostoianie provodiashchei sistemy serdtsa u bol'nykh s progressiruiushchei myshechnoi distrofiei.

Intracardiac electrophysiologic studies were carried out in 9 patients with progressive muscular dystrophy. Diagnostic stimulation of the heart demonstrated no sinus mode dysfunction. The intra-atrial conduction time increased to 72 +/- 7.1 ms (p less than 0.05), and the interatrial conduction time, to 97 +/- 12.5 ms (p greater than 0.05) in response to shortened testing stimulus delay in 3 patients. All 9 patients showed great variation in the duration of effective refractory atrial and atrioventricular periods (97.0 +/- 12.5 ms). The H-V interval increased from 43.9 +/- 4.3 to 73.9 +/- 7.6 ms (p less than 0.01) in response to shortened delay in 7 of 9 patients. Atrial pre-excitation resulted in a block of the right and left limbs of the His bundle in 5 of 7 patients. Third-degree atrioventricular block was recorded by continuous ECG monitoring in 7 patient. It is suggested that an apparent or latent intraventricular conductivity disorder may be present in most cases of progressive muscular dystrophy.

[A reflux-free Y-shaped gastroenteroanastomosis in the surgery of cancer of the distal portion of the stomach]. / Arefliuksnyi Y-obraznyi gastroénteroanastomoz v khirurgii raka distal'nogo otdela zheludka.

A procedure for formation of jejunal valve in addition to Y-shaped gastroenteroanastomosis following subtotal resection of the stomach is described. Surgery was performed in 44 patients with cancer of the distal part of the stomach. No anastomosis-related complications were observed. One (2.3%) patient died. Function of the anastomosis was studied early and at later periods following surgery. The valve proved reliably free from reflux. Partial return of the reservoir function of the gastric stump was observed.

[Prevention of early and late complications after gastrectomy]. / Profilaktika nekotorykh rannikh i pozdnikh oslozhnenii posle gastréktomii.

A procedure for making esophago-intestinal anastomosis was experimentally developed and integrated with clinical practice. The method consists in formation of a muscular constrictor in the distal part of the gullet and a mucosa valve. Surgery was performed in 52 patients: gastric cancer--50 (stage II--3, III--44 and IV--3) and subcardial ulcer--2 cases. Extended combined gastrectomy was used in 14 patients (27.0%). Neither anastomotic failure nor lethality was observed. Late-onset 2. reflux-esophagitis was diagnosed in 2 out of 39 (5.1%) endoscopically examined patients.

[Plastic surgery of gastric and duodenal perforations (an experimental study)]. / Plastika perforatsionnykh otverstii zheludka i dvenadtsatiperstnoi kishki (éksperimental'noe issledovanie).

The plastic properties of the greater omentum cannot be used to a full measure in the existing methods of closure of perforating ulcers. The authors suggest a method of plastic repair of gastric and duodenal perforations with the greater omentum using a metal design with shape storage. The plastic properties of the greater omentum are used fully in the suggested method. The supply of blood in the area of the omentum placed into the stomach is maintained for 2-3 days after the operation. And later the blood supply to the region of the ulcerous defect improves due to the formation of anastomoses between the vessels of the omentum and the stomach. The obturation of the perforation is more reliable in this method than in Oppel-Polikarpov's method. The suggested method was tested in experiments with good results.

[Diagnosis of osteomyelitis using Ga-67 citrate]. / Diagnostika osteomielita s pomoshch'iu 67Ga-tsitrata.

To increase the specificity of radionuclide diagnosis of purulent bone affections the authors used Ga-67 citrate which is incorporated into the circulating leukocytes. From the results of examination of 32 patients a comparative characteristics of the diagnostic value of osteotropic agents labeled with Tc-99m and Ga-67 citrate are given. The expediency of using Ga-67 citrate for indicating an inflammatory process in the phase of abscess formation is shown.

[Prevention of reflux gastritis after distal resection of the stomach in peptic ulcer]. / Profilaktika refliuks-gastrita posle distal'noi rezektsii zheludka po povodu iazvennoi bolezni.

A complex pre- and postoperative examination of 181 patients with ulcer disease of the stomach (86) and duodenum (95) was performed. The patients were operated on by an original authors' method with the formation of artificial sphincter in the anastomosis area. The investigations performed have shown that the method of gastric resection with the formation of functionally active anastomosis allows to considerably decrease probability of the appearance of duodenogastric reflux and reflux gastritis.