[Surgical treatment and different preoperative preparation of patients with malignant tumors of hepatopancreatoduodenal zone].

Different tactical approaches present to optimize surgical treatment of patients with malignant tumors hepatopancreatoduodenal zone. This research based on diagnosis and results of treatment of tumors of this localization, which included 357 analyzed case histories of patients treated in the Chelyabinsk Regional Hospital from 2010 to 2014. During this study was considered the preoperative preparation of patients with malignant obstructive jaundice genesis, and was assessed its impact on the level of postoperative complications and mortality. Farther was found effectiveness of a two-stage surgical treatment of patients with obstructive jaundice malignant etiology for the reduction of postoperative mortality. The complication rate is significantly reduced radically operated patients with bilirubin level below 40 mmol/l, palliative - 80 mmol/l. Also were presented results of treatment of chronic pain.

[Results of investigation of ticks in Volga river delta (Astrakhan region, 2017) for Crimean-Congo hemorrhagic fever virus (Nairoviridae, Orthonairovirus, CCHFV) and other tick-borne arboviruses.]

INTRODUCTION: There are natural foci of Crimean-Congo hemorrhagic fever (CCHF) that vectored by Hyalomma marginatum ticks in Volga river delta (Astrakhan region, South of Russia). The circulation of Dhori virus (DHOV) (Thogotovirus: Orthomyxoviridae) has been also shown here. We hypothesized that other tick-borne arboviruses are also likely to circulate in the region. In particular, Bhanja virus (Phlebovirus: Phenuiviridae), Wad Medani virus (Orbivirus: Reoviridae), and Tamdy virus (Orthonairovirus: Nairoviridae), which were found to circulate in neighboring regions and are vectored by Haemaphysalis spp., Dermacenter spp., and Hyalomma spp. ticks. OBJECTIVES: The aim of the study was to examine ixodid ticks in Volga river delta for the presence of CCHFV, DHOV, Bhanja virus, Wad Medani virus, and Tamdy virus. MATERIAL AND METHODS: Ticks were collected in Volga river delta in 2017. We used molecular genetic methods for the detection and analysis of nucleic acids (PCR, sequencing, phylogenetic analysis). RESULTS: We detect CCHFV and DHOV RNA in H. marginatum ticks. The rate of infected H. marginatum ticks was 1.98% for CCHFV and 0.4% for DHOV. The results of genetic analysis showed that found DHOV strains are almost identical (99-100% in the M gene) and forms a separate genetic lineage alongside of Batken virus from Central Asia. At the same time, Bhanja virus, Wad Medani virus, and Tamdy virus were not found in ticks, collected in this region. CONCLUSIONS: DHOV is circulating in the natural foci of CCHF in the Volga river delta. The ratio of infection of H. marginatum with CCHFV and DHOV was determined for the first time.

[Lipids and apoproteins in the blood plasma of children with a hereditary disposition to ischemic heart disease]. / Lipid i apoproteiny v plazme krovi detei s nasledstvennoi predraspolozhennost'iu k ishemicheskoi bolezni serdtsa.

An investigation of children with aggravated heredity (coronary disease), and those with vegetovascular dystonia whose parents had no clinically apparent coronary disease demonstrated unidirectional shifts in the lipoprotein system of the two samples as compared to the controls: increased cholesterol levels in low-density lipoproteins and lowered cholesterol in high-density lipoproteins and apoprotein A1. In children with aggravated heredity, these changes are also associated with vegetovascular dystonia, whereas in the absence of the latter they are not apparent or minimal. At the same time, certain differences in cholesterol distribution over lipoprotein fractions and protein/lipid ratios suggest that mechanisms of changes are not identical in children with aggravated heredity and those free from it.

[Atherogenic dyslipidemia in adolescents: its relation to ischemic heart disease in their fathers and the possibility of its prognosis]. / Aterogennye dislipidemii u podrostkov: svia'z s nalichiem ishemi- cheskoi bolezni serdtsa u ottsov, vozmozhnos't prognozirovaniia.

Comparison of a group of adolescents aged 11-16 years whose fathers had angiographically documented coronary atherosclerosis in youth with those matched by sex and age whose parents were clinically healthy yielded the following discriminant function (DF) involving lipid and apoprotein indices of the plasma lipid system: DF = [apo B] X 0.03-[HDL cholesterol] X 0.04-0.81. DF greater than or equal to 0 discriminates from the controls 32% of the offsprings from the fathers with a history, DF less than 0 correctly classifies 98% of adolescents from the controls. The adolescents who have DF greater than or equal to 0 amounted to about 19% in representative samples of Moscow adolescents. Moreover, DF with 80% probability makes it possible to predict the time course of serum lipid levels in adolescents within 2 years.

[Study of arterial pressure, body weight, motor activity and prevalence of smoking in two independent samples of Moscow schoolchildren 11 and 14 years of age]. / Izuchenie arterial'nogo davleniia, massy tela, dvigatel'noi aktivnosti i rasprostranennosti kureniia na dvukh nezavisimykh vyborkakh Moskovskikh shkol'nikov 11 i 14 let.

The paper treats the results of a comparative 6-year study of arterial blood pressure, body weight, motor activity, and tobacco-smoking prevalence with respect to two representative samples of schoolchildren aged 11 and 14 years living in one of the districts of Moscow. A total of 1999 and 1219 persons were examined. The scope of examination amounted to 88 to 93 percent. From 1978-1980 to 1985-1986 the levels of systolic and diastolic arterial blood pressure increased whereas the physical activity of the schoolchildren of the same age declined. The situation with tobacco-smoking changed towards better. Thus the number of tobacco-smoking boys aged 14 years reduced almost 2-fold in spite of the lack of any prophylactic interventions in that population.

[Comparative characteristics of the plasma lipid composition of 10-11-year-old schoolchildren in Moscow and Novosibirsk]. / Sravnitel'naia kharakteristika lipidnogo sostava plazmy krovi u shkol'nikov v vozraste 10-11 let Moskvy i Novosibirska.

The role of lipoproteins in the etiology of atherosclerosis has been proved by the present time and dyslipoproteinemia is considered one of the main risk factors like smoking and arterial hypertension. In 1983-1984 an epidemiological survey of a representative sample of schoolchildren was conducted in one of the Moscow districts and according to a unified program among standardized participants in Novosibirsk. As a result, regional normal limits and mean values of blood plasma lipids were established in the populations of schoolchildren aged 10-11 in Moscow and Novosibirsk, their comparative characteristics and interrelationships between physical development and a degree of puberty were studied. Considerable differences in the TG level of plasma were found. The fact might be due to regional nutrition habits.

[Nutrition and dyslipoproteinemias in schoolchildren aged 13 to 16]. / Pitanie i dislipoproteidemii u shkol'nikov v vozraste 13--16 let.

In current studies of dyslipoproteinemia (DLP) development great emphasis is laid on the type of nutrition, its quantitative and qualitative characteristics, harmful habits, their formation in childhood and an attempt to influence them. However the problem of the start of stable DLP development and the role of dietary habits is yet to be solved. A random subsample of 169 school children aged 13 to 16 in the Krasnopresnensky District of Moscow was examined, among them 73 boys and 96 girls. High values of mean alimentary cholesterol, total and saturated fats and low mean amounts of consumed polyunsaturated fats were revealed. It could be inferred that the examined population was characterized by a high risk of the formation of atherogenic DLP stability. An analysis of the findings showed a considerable increase in the consumption of total and saturated fats as well as food rich in cholesterol in the group of children with stable DLP forms confirming the effect of the environmental factors including the alimentary ones, on processes of DLP formation in childhood. Further investigation of DLP in children should be conducted in the form of prospective studies otherwise design of activities in early prevention of atherogenic DLP seems impossible.

[The regional characteristics of the prevalence of elevated arterial pressure in the schoolchildren of Moscow, Tallinn and Novosibirsk (a cooperative study)]. / Regional'nye osobennosti rasprostraneniia povyshennogo arterial'nogo davleniia u shkol'nikov Moskvy, Tallinna i Novosibirska (kooperativenoe issledovanie).

The authors describe the results of a cooperative epidemiological screening of schoolchildren aged 11 to 14 years, living in Moscow, Tallinn and Novosibirsk. 1219 persons underwent screening in Moscow, 923 in Novosibirsk, and 1227 in Tallinn; the screening coverage was 88.3, 92 and 87.2%, respectively. The mean values of systolic and diastolic arterial pressure (AP), the anthropometric parameters, and of the degree of puberty are given with respect to the cities. The structure as well as predictors of high AP in schoolchildren differed with respect to the above-indicated cities. The highest AP values were identified in Moscow schoolchildren whereas the least ones in schoolchildren living in Tallinn. The data obtained were compared to those of the epidemiological screening of the male population aged 20 to 54 years, living in the same cities. A reverse correlation has been established.

[The regional characteristics of the blood plasma lipid levels and of the indices of arterial pressure and physical development in schoolchildren of Russian nationality living in different climatic-geographic areas (based on the data from a single study in Ashgabad, Moscow, Orenburg, Tyumen and Tallinn)]. / O regional'nykh osobennostiakh urovnei lipidov plazmy krovi, pokazatelei arterial'nogo davleniia i fizicheskogo razvitiia u shkol'nikov russkoi natsional'nosti, prozhivaiushchikh v razlichnykh klimatogeograficheskikh zonakh (po dannym odnomomentnogo issledovaniia v Ashgabade, Moskve, Orenburge, Tiumeni i Tallinne).

Random samples from a schoolchildren population living in different climatic and geographic regions were entered in the standard epidemiological survey. They were examined for plasma lipids vs. arterial pressure and physical development. Region-specific predictors of atherosclerosis were elucidated in Russian schoolchildren as an example. Cholesterol levels proved significantly higher in Tallinn schoolchildren (northwest territories), while the lowest ones occurred in Ashkhabad children (south territories).

[Epidemiologic characteristics of nutrition of school children at high risk for developing ischemic heart disease and atherosclerosis]. / Epidemiologicheskaia kharakteristika pitaniia shkol'nikov v gruppakh vysokogo riska razvitiia ishemicheskoi bolezni serdtsa i ateroskleroza.

The results of the investigation of a representative sample of Moscow schoolchildren, aged 11-14 years, are described. The investigation included a triple arterial pressure measuring, anthropometry, numerical score of sexual development, assay of cholesterol, triglycerides and high-density lipoprotein cholesterol levels in the blood serum. The character of nutrition of 250 (20% of the sample) schoolchildren was studied by the method of dietary inquiry (daily ration) with the use of food patterns. The data of the multivariative analysis have shown that sexual development, a low educational level of the parents (among them subjects engaged in the manual labor being predominant) influence the development of the risk factors of ischemic heart disease and atherosclerosis. Composition of food is of great importance, especially for boys with dislipoproteinemias (low consumption of starch per 1 kg bw, high consumption of total protein, low consumption of fat in cal %), and for those with excessive body mass and low physical activity (low consumption of total fat, polyunsaturated fat per 1 kg bw, as well as high consumption of total protein in cal %).

Plasma lipid and apolipoprotein levels in children hereditarily predisposed to coronary heart disease.

Plasma lipids and apoproteins A-I, A-II and B levels were measured in 125 children whose fathers had coronary atherosclerosis (paternal coronary heart disease group), in 172 children with blood pressure lability and in 154 children selected at random from a representative subsample (reference). The paternal coronary heart disease group had, compared with the reference group, lower levels of high density lipoprotein cholesterol and apoprotein A-I, higher levels of low density lipoprotein cholesterol, triglycerides and apoprotein B, and also a higher ratio of apoprotein B to apoprotein A-I. The paternal coronary heart disease group subjects with blood pressure lability had the most pronounced changes in the lipoprotein spectrum, which were similar to atherogenic changes in the lipoprotein profile, characteristic of patients with coronary atherosclerosis.

Epidemiology of atherogenic dyslipoproteinaemias in pubertal children (a prospective study).

The study presents the results of a two-year prospective study of a random representative sample of 772 Moscow pupils, aged 10-13 years. Response rate at entry was 95%, one year later--83%, and 80% two years later. The epidemiological situation regarding various atherogenic dyslipoproteinaemias in pubertal children was studied. The most threatening, i.e., stable dyslipoproteinaemias were detected most often in children with an increased number of risk factors of ischaemic heart disease. Dyslipoproteinaemia stabilization is affected mainly by physical and sexual development of children and their physical activity. These findings can be used for targeted non-medicamentous prevention in pubertal children.

Epidemiological characteristics of dyslipoproteinaemia and certain other risk factors of atherosclerosis and ischaemic heart disease in 11- and 14-year children in different climatogeographic zones. Results of a cooperative study.

The authors compare the prevalence of risk factors of atherosclerosis and ischaemic heart disease (dyslipoproteinaemia, elevated arterial pressure, overweight, smoking, low physical activity) in representative samples of 11- and 14-year old school-children in Moscow, Novosibirsk and Tallin. The number of pupils subjected to medical examination totalled 3369; the respondence rate was 87-92%. There appeared a number of regional differences: the study in Moscow showed the highest prevalence of elevated arterial pressure and overweight, in Novosibirsk - hypertriglyceridaemia, in Tallin - hypercholesterolaemia. The most unfavourable situation was registered in school-children in Novosibirks. The authors conclude that when planning preventive measures among the population it is necessary to take into account regional specificities and differences in the intensity of risk factors in children populations.