[Genetic architecture of anterior abdominal wall hernias]. / Geneticheskaya arkhitektura gryzh perednei bryushnoi stenki.

OBJECTIVE: To analyze genome-wide studies devoted to polymorphisms of factors of anterior abdominal wall hernias, to study the association of the most common polymorphism In Russian population. MATERIAL AND METHODS: Searching for literature data was carried out in the RSCI and PubMed databases. We enrolled national and foreign reports. The study on Russian population included 577 people. RESULTS: We found 5 genome-wide studies performed by foreign authors. We identified the loci responsible for genetic predisposition to inguinal hernias: WT1, EFEMP1, EBF2 and ADAMTS6. The Japanese scientists revealed an important role of loci TGFB2, RNA5SP214/VGLL2, LOC646588, HMCN2, ATP5F1CP1/CDKN3. In other studies, loci 1q41 (ZC3H11B), 2p16.1 (EFEMP1), 6p22.1 (MHC region), 7q33 (CALD1) and 11p13 (WT1) determined different hernias. The EFEMP1 gene polymorphism was among genes most associated with anterior abdominal wall hernias in all studies. Analysis of this polymorphism In Russian population revealed significant association with anterior abdominal wall hernias. CONCLUSION: The obtained data on target correction of DNA chains can significantly reduce the incidence of anterior abdominal wall hernias. In turn, this will significantly reduce the cost of surgical treatment and risk of complications with recurrences of hernias. Moreover, identifying the most associated polymorphisms may be valuable to determine the most appropriate surgical treatment.

[Endoscopic treatment of mine-explosive spine injuries: 3 clinical cases and literature review]. / Endoskopicheskoe lechenie minno-vzryvnykh ranenii pozvonochnika: 3 klinicheskikh nablyudeniya i obzor literatury.

Modern warfare is characterized by common mine-explosive injuries. The last ones are accompanied by multiple injuries, large area of damage and severe clinical status of victims. OBJECTIVE: To demonstrate treatment of mine-explosive spinal injuries using modern minimally invasive endoscopic techniques. MATERIAL AND METHODS: The authors present 3 victims with various mine-explosive injuries. Endoscopic removal of fragments from the lumbar and cervical spine was successful in all cases. DISCUSSION: Most of victims with injuries of the spine and spinal cord do not require urgent surgery and can underwent surgical treatment after clinical stabilization. At the same time, minimally invasive techniques provide surgical treatment with minimal risk and earlier rehabilitation, as well as reduce the risk of infectious complications associated with foreign bodies. CONCLUSION: Careful selection of patients for spinal video endoscopy will ensure positive outcomes. Minimization of iatrogenic postoperative injuries is especially important in patients with combined trauma. However, well-experienced surgeons should perform these procedures at the stage of specialized medical care.

Temporal characterization of a two-color laser field using tunneling ionization.

The superposition of a fundamental laser pulse and its second harmonic can form an asymmetric laser field that is useful in many applications. The temporal characterization of the two-color laser field becomes necessary. However, the temporal characterization of the two-color laser pulse is a challenging task due to its broad bandwidth and a spectral gap between the two frequency components. Here we demonstrate the temporal characterization of the two-color laser field using multiple ionization yield measurements near the laser focus. This new approach enables the complete temporal characterization of the two-color laser field, including the relative phase between the two frequency components.

Synthetic Analogs of 6-Bromohypaphorine, a Natural Agonist of Nicotinic Acetylcholine Receptors, Reduce Cardiac Reperfusion Injury in a Rat Model of Myocardial Ischemia.

The data available to date indicate that the activation of nicotinic acetylcholine receptors (nAChR) of α7 type can reduce heart damage resulting from ischemia and subsequent reperfusion. We have studied two new synthetic D-analogs of 6-bromohypaphorine, which are selective agonists of α7 nAChR, in a rat model of myocardial ischemia. Acute myocardial infarction in animals was induced by occlusion of the left coronary artery with its subsequent reperfusion under mechanical lung ventilation. It was found that one of the analogs was more active, and treatment with it at the onset of reperfusion statistically reduced infarct size. This analog also prevented changes in the concentration of potassium and sodium ions in the blood, occurring during occlusion/reperfusion injury. The data obtained indicate that hypaphorine analogs are promising for the development of drugs that reduce the adverse effects of myocardial infarction.

[Experience of anticipatory therapy with IL-6 receptor inhibitors and perspectives for its use in the evolution of COVID-19].

The Advisory Board chaired by the chief specialist in infectious diseases of the Ministry of Health of Russian Federation, Professor V.P. Chulanov was held on June 18, 2022 in Saint Petersburg. Aim. The main purpose of the Board was following discussion: the analysis of the real-world data of levilimab as an anticipatory therapy for COVID-19 in hospitalized patients; the review of the experience and perspectives of levilimab as an anticipatory anti-inflammatory option for outpatient patients who meet defined clinical and laboratory criteria. Results. The analyzed data on clinical efficacy and safety formed the basis of recommendations proposed by experts for the use of levilimab in the inpatient and outpatient medical care for COVID-19.

[Morphological features of non-traumatic intramuscular hemorrhage]. / Morfologicheskie osobennosti netravmaticheskikh vnutrimyshechnykh krovoizliyanii.

The formation of non-traumatic intramuscular hemorrhages does not depend on the cause of death. They usually occur in the muscles attached to the rib cage, which are or may be involved in the inhalation process (84.6%). More often, non-respiratory muscles are damaged (66%), less often auxiliary respiratory muscles (15.5%), extremely rarely - the main respiratory muscles (3.3%). In hypothermia, the majority of hemorrhages are formed in the iliopsoas muscles (13.9%). The main reason for the appearance of hemorrhages is muscle overstrain in the agonal period due to increased respiratory activity and seizures. The motor activity of the upper extremities during drowning, prolonged static muscle tension during hypothermia may matter. A microscopic picture usually indicates the formation of hemorrhages shortly before death, and occasionally signs of anxiety are noted.

[The confidence limits of self-education of medical workers in matters of competences to provide quality and safety].

The article considers possible risks according analysis of comprehension by workers of necessary competencies ensuring quality and safety of medical activities at performing their duties as well as assessment of factors affecting completeness of choice. It is proposed to apply corporate training as component targeted to improving quality and safety of medical activities by addressed training of necessary competencies within the framework of continuous medical education, supplementing existing self-education.

[Evidence-based proposals for improving the Zemsky Doctor program].

Currently, more and more attention is paid to the shortage of medical staff in rural and remote areas. In order to ensure the staffing of medical institutions with workers in rural areas, in the regions one-time compensations are paid as part of an event called "Zemsky Doctor". However, "Zemsky Doctor" has shown a fading effect over the years of implementation, including due to the unwillingness of medical students to participate in this program. The purpose of the work is to identify the attitude of students of medical universities to participation in the "Zemsky Doctor" program and develop measures to increase the attractiveness of the program. To achieve the goal of the study, we conducted a survey of 250 medical students from all over Russia, interviews with medical students, with medical staff, including former and current participants. The novelty of the work lies in the study of the attitude of current and potential participants in the program in order to develop proposals for its improvement. To improve the program, it is necessary to choose the term for concluding the contract, differentiate payments depending on the distance from the regional center, create an information site, defer the army for the duration of the contract.

Pharmacokinetic investigation of branched oligohexamethyleneguanidine hydrochloride in a liquid composition for the treatment of stomatitis and gingivitis.

Branched oligohexamethyleneguanidine hydrochloride (branched OHMG-HC) possesses high biocidal activity. This study aimed at evaluating the pharmacokinetics of branched OHMG-HC and is mandatory for obtaining permission to conduct clinical studies. The thermal activation method was used to obtain radioactive-labeled drugs for the investigation of substance distribution in various tissues of experimental animals (rats and rabbits). Substance administration was carried out both orally (a dose was split into two equal volumes that were applied to buccal zones of the oral cavities of the animals) and intravenously to get a clear pharmacokinetic profile. In this research, the drug was applied in the concentration of 0.77 mg/kg with the addition of 0.037 mg/kg 3H-OHMG for rats, and 0.42 mg/kg with the addition of 0.015 mg/kg 3H-OHMG for Chinchilla rabbits. The selected samples of blood, organs, and urine underwent alkaline mineralization. A quantitative determination of 3H-OHMG was carried out using a liquid ß-, γ-counter according to the level of scintillation in the sample. Branched OHMG-HC displayed uniform distribution within all main organs and tissues upon oral administration. The highest concentrations were found in liver and kidney tissues, whereas the lowest in blood, cardiac muscle tissue, and brain. The closeness of the fabs values obtained from different animals (24.5% for rats and 29.0% for rabbits) demonstrated the absence of the species specificity in response to the pharmaceutical substance. The main parameters of excretion were established, and the half-life time was estimated to be 15 h.

[The value of bone mineral density assessment by dual-energy x-ray absorptiometry for prediction of cardiovascular mortality in patients treated with hemodialysis].

AIM: Determine whether bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry can be used as predictor of increased risk of death in hemodialysis patients. MATERIALS AND METHODS: A prospective study was performed of 516 patients with chronic kidney disease treated with hemodialysis (men 265, women 251, mean age 44.811.4 years) who were observed for 5.73.2 years. Before inclusion in the study, in all patients was analyzed bone mineral density using dual-energy X-ray absorptiometry in three standard departments: lumbar vertebrae, proximal femur and distal forearm. The probability analysis of the outcome was carried out using the KaplanMeier method and Cox. RESULTS: During follow-up period 111 (21.5%) patients died, 50.5% from cardiovascular events. Survival analysis by KaplanMeier method allowed to prove the increased risk of death from cardiovascular pathology in hemodailysis patients with low bone mineral density of all evaluated areas. Step-by-step multivariate Cox regression analysis showed that the T score of the femur, showing the difference of BMD of the patient with normal value of BMD for young adult, had the greatest prognostic significance. CONCLUSION: Reduced bone mineral density in patients receiving hemodialysis is associated with an increased risk of death from cardiovascular disease. Dual energy x-ray absorptiometry can be used for assessment of this risk.

[Role of health resort factors in the treatment of delayed puberty in teenage girls]. / Rol' sanatorno-kurortnykh faktorov v lechenii zaderzhki polovogo razvitiia u devochek-podrostkov.

Both treatment and effective rehabilitation play an important role in preserving the reproductive health of the girl, the future mother. Along with the search for new drug therapies for various gynecological pathologies, it is important to use physical and natural factors that are natural stimuli for the patient's body. AIM: To examine the effect of health resort factors and methods of physiotherapy on the general condition and hormonal status of girls with delayed sexual development. MATERIAL AND METHODS: 83 patients with delayed sexual development who were examined at the children's clinical sanatorium 'Zdravnitsa' in Yevpatoria (Crimea) were examined: 52 girls were included in the primary group, 31 - in the comparison group. Both groups, depending on age, were divided into subgroups: 13-14 years old and 15-17 years old. Patients in both groups received a standard treatment complex (STC). In addition to SCR, the girls of the main group were prescribed: 5% brine electrophoresis by sinusoidal modulated currents, sage and sea baths. The control group included gynecologic ally healthy adolescents: thirteen 13-14 year-old girls old in the subgroup K1 and twelve 15-17 year-old girls in the subgroup K2. Before and after treatment, all patients underwent standard clinical, gynecological, and laboratory examinations. In both groups, the dynamics of clinical and laboratory parameters, as well as gonadotropic and sex steroid hormones in the blood serum were analyzed. RESULTS: The complex of climatic and physical factors had a nonspecific general stimulating effect. There was a positive dynamics in the general condition of patients, their anthropometric indicators, hormonal status, which was more pronounced in the primary group than in the comparison group. Negative dynamics of the course of diseases in girls of both groups was not observed. CONCLUSION: The use of hardware physiotherapy and sage baths increases the effectiveness of STC. The best clinical and laboratory dynamics of the primary indices was noted in patients 13-14 years old than in patients 15-17 years old. The use of natural and preformed physical factors in treatment makes it possible to minimize the drug effect on the body and achieve the most positive treatment results with a minimum of side effects.

[The increasing of awareness of patients and medical personnel of security issues: the results of questionnaire survey within the framework of the World Patient Safety Day in the Russian Federation].

The specially developed questionnaires on the basis of the WHO materials developed for the World Patient Safety Day were applied in sociological survey of patients and medical workers. The sampling included 3946 respondents (1747 patients and 2199 medical workers). The study was carried out to establish awareness about course of treatment and medications taken, communication with the attending physician and nurse, involvement in decision-making regarding treatment and care provided, clinical decision-making, interaction with patients, informing patients on prescribed drugs and their possible adverse reactions.

[The export of medical services as a driver of development of the National system of quality management and safety а medical activities].

The article presents definition of concepts of exporting medical services in foreign and Russian practice. It includes overview of the elements of strategy of developing export of medical services (within the framework of the National project "Health Care"). The article considers the need to develop marketing strategy, information exchange system and conditions ensuring compliance of medical services with high standards of quality and safety of medical activities at the national level. The perspective direction development of the quality and safety system in Russia during implementation of the Federal project "Development of export of medical services" through improving the efficiency of medical organizations and their accreditation is determined.

Probing the uniformity of hydrogen intercalation in quasi-free-standing epitaxial graphene on SiC by micro-Raman mapping and conductive atomic force microscopy.

In this paper, micro-Raman mapping and conductive atomic force microscopy (C-AFM) were jointly applied to investigate the structural and electrical homogeneity of quasi-free-standing monolayer graphene (QFMLG), obtained by high temperature decomposition of 4H-SiC(0001) followed by hydrogen intercalation at 900 °C. Strain and doping maps, obtained by Raman data, showed the presence of sub-micron patches with reduced hole density correlated to regions with higher compressive strain, probably associated with a locally reduced hydrogen intercalation. Nanoscale resolution electrical maps by C-AFM also revealed the presence of patches with enhanced current injection through the QFMLG/SiC interface, indicating a locally reduced Schottky barrier height (ΦB). The ΦB values evaluated from local I-V curves by the thermionic emission model were in good agreement with the values calculated for the QFMLG/SiC interface using the Schottky-Mott rule and the graphene holes density from Raman maps. The demonstrated approach revealed a useful and non-invasive method to probe the structural and electrical homogeneity of QFMLG for future nano-electronics applications.

Effects of home reading training on reading and quality of life in AMD-a randomized and controlled study.

BACKGROUND: Age-related macular degeneration (AMD) causes reading impairment, reduced quality of life (QoL), and secondary depression. We have shown that support with magnifying aids improved reading speed (RS), emotional and cognitive status, and QoL. The present study investigates whether additional reading training (RT) (after adapting to appropriate visual aids) can further improve vision rehabilitation. METHODS: Patients with dry AMD were randomly assigned to 2 groups. The primary RT group (P-RTG, n = 25) trained with sequentially presented text (RSVP), and the control group (CG, n = 12) performed placebo training (crossword puzzles) and later crossed over to RT, so that altogether 37 participants performed reading training. Patients trained at home on a PC for 6 weeks. RS was assessed during reading printed paragraphs of text aloud. Using a scanning laser ophthalmoscope, we examined fixation stability and preferred retinal locus (PRL) for fixating a cross, as well as PRL and eye movements during reading single words. We assessed emotional status by Montgomery-Åsberg Depression Rating Scale (MADRS), cognitive status by dementia detection test ( DemTect ) and QoL by Impact of Vision Impairment (IVI) profile. Visual acuity and magnification requirement were examined by standard procedures. All variables were measured before and after placebo training, before and after RT, and after 6 weeks without training (follow-up). RESULTS: RS improved significantly in the P-RTG during RT, but not in the CG during placebo training. The effect remained stable at follow-up. Fixation performance and eye movement variables did not change. Emotional status (MADRS) improved in P-RTG during RT and showed a significant difference of the change of scores between the 2 groups. Complete IVI scores improved significantly during RT and remained stable. CONCLUSION: The results indicate that patients with AMD, who already use magnifying aids, benefit from additional RT and that it can contribute in preventing depression and improve QoL. TRIAL REGISTRATION: The study was registered at the German Clinical Trials Register (DRKS00015609).

Thermal sensitivity and haemolysis of erythrocytes with membranopathy.

Measuring the impedance of heated suspensions of erythrocytes and erythrocyte ghost membranes, two thermally-induced alterations are registered in the plasma membrane at TA (denaturation of spectrin with inducing temperature at 49,5 °C) and TG (hyperthermic activation of basal ion permeability with inducing temperature at 60.7 °C). In this study erythrocytes from 9 healthy patients and 15 patients with hemolytic anemia were studied and divided into four groups depending on their TA and TG top temperatures. The TA and TG of erythrocytes with hemoglobinopathy were the same as those of control erythrocytes while those of erythrocytes with membranopathy were significantly reduced. In erythrocytes with severe membranopathy, the TG was decreased by about 5 °C. In latter cells the normal value of TG was restored and the resistance to thermal haemolysis was increased by 90% after the specific stabilization of band 3 protein by 4,4'-diisothiocyanato-stilbene-2,2'-disulfonic acid (DIDS). Obtained results indicate the involvement of band 3 in the membrane alteration at TG and in the heat target responsible for thermal haemolysis.

Dimeric Disintegrins from the Steppe Viper V. ursinii Venom.

Four dimeric disintegrins were isolated from the venom of the steppe viper V. ursinii using liquid chromatography. Disintegrins prevented adhesion of MCF7 cells to fibronectin, which indicates their interaction with integrin receptors of the αVß1 type. According to mass spectrometry data, the molar masses of disintegrins are about 14 kDa. The method of peptide mapping established the structure of a new heterodimeric disintegrin weighing 13 995.5 Da and shows that it belongs to the class of RGD/KGD-containing disintegrins.

[Preventative repair of postoperative ventral hernia considering the markers of connective tissue dysplasia]. / Opredelenie pokazaniia k preventivnomu éndoprotezirovaniiu na osnovanii markerov displazii soedinitel'noi tkani u bol'nykh s posleoperatsionnymi ventral'nymi gryzhami.

OBJECTIVE: To define the indication for preventive mesh implantation in patients scheduled for laparotomy. MATERIAL AND METHODS: There were 108 patients divided into the control (52 patients without anterior abdominal wall hernia) and the main (56 patients with ventral hernia) groups. RESULTS: Predominance of collagen type III over type I was observed in patients older 60 years in the main group. The maximum ratio of collagen types I and III was 1.4 in the main group. The minimum number of inter-fiber spaces (n=5) was noted in patients aged 30-40 years. The maximum density of connective tissue was 250 pixels per inch. CONCLUSION: Analysis of connective tissue structures revealed some important age-related features and markers of connective tissue dysplasia in the main group. An indication for preventive mesh implantation in patients scheduled for laparotomy was determined.

[Monitoring of adverse event triggers as a tool for managing the medical care quality at a neurosurgical clinic. Invitation to the discussion]. / Monitoring triggerov neblagopriiatnykh sobytii kak instrument upravleniia kachestvom meditsinskoi pomoshchi v neirokhirurgicheskoi klinike. Priglashenie k diskussii.

Management of the healthcare quality and safety is one of the priorities of state policy for protecting health of Russian citizens. We describe modern technologies for managing the quality of medical care and patient safety based on a systematic approach. Potential applications of these technologies in neurosurgical practice are defined. Quantitative, qualitative, and basic indicators are proposed for evaluation of outcomes (results) as part of implementation of an integrated quality management system in neurosurgical practice.

[The quality and safety of rendering emergency and urgent medical care in hospitals].

The article presents the results of external auditing on the section "The organization of emergency and urgent medical care in hospital. Organization of admitting office functioning" in 30 medical organizations of the Russian Federation based on "The proposals (practical guidelines) of Roszdravnadzor for organizing internal quality control and safety of medical activity in medical organization (hospital)". The level of compliance with requirements of the Proposals is determined. The complex and structural problems of organization of rendering of emergency and urgent medical care.