[Analysis of the learning curve in laparoscopic partial nephrectomy in patients with localized renal parenchymal lesions depending on the nephrometric score].

AIM: to analyze the learning curve of surgeons while performing laparoscopic partial nephrectomy in patients with localized renal parenchymal lesions by calculating the MIC (negative surgical margin, ischemia, and complications) index depending on tumor complexity according to the R.E.N.A.L. and PADUA nephrometric scores. MATERIALS AND METHODS: the retrospective study included the results of laparoscopic partial nephrectomies in 320 patients with localized renal parenchymal lesions. The procedures were carried out by four surgeons from the Institute of Urology and Human Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia (EC-1; ESH-4; EB-7; ME-13) from January 2014 to June 2019. At baseline, all operators had experience of performing at least 30 laparoscopic interventions. In addition to the standard preoperative examination, a 3D virtual planning was carried out using the Amira 3D modeling program. In all cases, the nephrometric assessment of complexity was performed according to the R.E.N.A.L. and PADUA scores. The learning curve was assessed based on the results of operations based on the MIC index. All surgical interventions were divided into eras. In the era, 40 consecutive procedures for each operator were evaluated. Acquired skills were assessed over two eras. RESULTS: The average age of patients, of which 191 (59.7%) were men, was 54.4+/-11.37 years. The average body mass index was 28.55+/-3.85 kg/m2, the absolute volume of kidney lesions was 26.72+/-43.72 cm3, the average Charlson comorbidity index was 1.46+/-1.29, the average R.E.N.A.L. and PADUA scores were 6.38+/-1.75 and 7.92+/-1.51, respectively, the average duration of procedure was 150.36+/-50.18 min, the average blood loss was 227.94+/-280.22 ml, the average time thermal ischemia was 13.28+/-7.82 min. Postoperative complications were seen in 36 (11.2%) cases, of which grade III and more according to Clavien-Dindo developed in 8 patients (2.5%). A positive surgical margin was found in 4 (1.2%) patients. The overall MIC index was achieved in 243 (75.9%) cases; in era 1 it was seen in 71.9% cases in comparison with 80% in era 2. With the 1st degree of complexity (152 (47.5%) patients), MIC was achieved in 80.9% of cases, compared to 76.6% and 56.8% in patients with 2nd degree of complexity (n=124, 38.8%) and 3rd degree of complexity (n=44, 13.8%), respectively. Rate of MIC achievement in eras 1 and 2 for different surgeons were as following: 65% and 72.5%, 75 and 80%, 87.5 and 85% and 60 and 82.5%, for operator 1, 4, 7 and 13, respectively. Age, tumor complexity, R.E.N.A.L. score and PADUA score were the most significant parameters for determining MIC, identified on the basis of the criterion of equality of group means of discrete analysis. CONCLUSION: In all surgeons, the MIC index increased with the accumulation of experience in performing laparoscopic partial nephrectomy, but was lower with an increased degree of complexity of procedures. The minimum number of laparoscopic partial nephrectomies required to achieve an MIC more or equal 70% should be at least 40.

Graphene active sensor arrays for long-term and wireless mapping of wide frequency band epicortical brain activity.

Graphene active sensors have demonstrated promising capabilities for the detection of electrophysiological signals in the brain. Their functional properties, together with their flexibility as well as their expected stability and biocompatibility have raised them as a promising building block for large-scale sensing neural interfaces. However, in order to provide reliable tools for neuroscience and biomedical engineering applications, the maturity of this technology must be thoroughly studied. Here, we evaluate the performance of 64-channel graphene sensor arrays in terms of homogeneity, sensitivity and stability using a wireless, quasi-commercial headstage and demonstrate the biocompatibility of epicortical graphene chronic implants. Furthermore, to illustrate the potential of the technology to detect cortical signals from infra-slow to high-gamma frequency bands, we perform proof-of-concept long-term wireless recording in a freely behaving rodent. Our work demonstrates the maturity of the graphene-based technology, which represents a promising candidate for chronic, wide frequency band neural sensing interfaces.

Effects of naltrexone with nicotine replacement on smoking cue reactivity: preliminary results.

Although several studies have examined the effects of opioid antagonists on smoking behavior, there have been no reports of the potentially therapeutic combination of naltrexone and nicotine replacement therapy. The primary objective of the present study was to determine whether naltrexone reduced reactivity to smoking cues among abstinent smokers treated with nicotine replacement. Twenty participants were instructed to abstain from smoking cigarettes for 9 h while using nicotine replacement therapy. Participants were subsequently treated with either naltrexone (50 mg) or placebo before being exposed to smoking cues. Results indicated that the smokers who received the placebo responded to smoking cue exposure with increases in urge to smoke and increases in negative affect. Participants who received naltrexone did not show any increase in urge or negative affect and showed a decrease in withdrawal symptoms after exposure to smoking cues. Although preliminary, the findings suggest that naltrexone may work in combination with nicotine replacement therapies to block the effects of smoking stimuli in abstinent smokers.

Cue exposure treatment for smoking relapse prevention: a controlled clinical trial.

AIMS: In an additive design, test the efficacy of cue exposure treatment for smoking relapse prevention as an adjunct to current standard cognitive behavioral and pharmacological treatments. DESIGN: Randomized, controlled clinical trial. SETTING: Outpatient behavioral medicine clinic. PARTICIPANTS: One hundred and twenty-nine cigarette smokers recruited through newspaper advertisements. INTERVENTION: After receiving an initial counseling session for cessation and setting a quit day, 129 smokers were randomly assigned to one of four relapse prevention treatment conditions: (1) brief cognitive behavioral; (2) cognitive behavioral and nicorette gum; (3) cognitive behavioral and cue exposure; and (4) cognitive behavioral and cue exposure with nicorette gum. All smokers met individually with their counselor for six RP sessions. MEASURES: Seven-day, point-prevalence abstinence rates (CO verified) taken at 1, 3, 6 and 12-months post-treatment and time to first slip. FINDINGS: All manipulation checks and process measures suggested that the treatments were delivered as intended. There were no significant differences between conditions in point-prevalence abstinence rates or in time to first slip. CONCLUSIONS: These results call into question the utility of cue exposure treatment for smoking relapse prevention.

Cue exposure with coping skills treatment for male alcoholics: a preliminary investigation.

Although early investigations were promising, no controlled follow-up studies have investigated the effectiveness of cue exposure treatment for alcoholics. In this study, inpatient alcoholics received either cue exposure integrated with urge coping skills training (CET, n = 22) or a contrast condition (CC) involving daily contact with assessment only (n = 18) in addition to standard treatment. Comprehensive assessment measures were used to investigate change in process and outcome variables. In the second 3 months after treatment, the CET group included more patients who were completely abstinent, had a higher percentage of abstinent days, and tended to report fewer drinks per day than did patients in the contrast condition. The significantly greater use of coping skills during follow-up by the CET group and the significant relationship of these coping skills to decreased drinking suggest that treatment effects were due, at least in part, to the coping skills training, consistent with recent formulations. Theoretical and treatment implications are discussed.

Cue reactivity as a predictor of drinking among male alcoholics.

Social learning theories suggest that conditioned responses may increase the risk for relapse. Responses to alcohol use cues (cue reactivity) are associated with variables suggestive of risk but little research exists on the relationship of cue reactivity to treatment outcome. Alcoholic men admitted for detoxification to a treatment program (n = 45) underwent a cue reactivity assessment protocol, and 91% received 3-month follow-up interviews. Greater salivary reactivity predicted greater frequency of drinking during follow-up. Attentional factors added independent variance to the prediction of drinking outcome, with greater attention to stimulus or to response predicting less drinking. Cue reactivity did not predict length of hospital stay or latency to first drink. Results are discussed in the context of information processing, social learning theories, and clinical implications for relapse prevention.

A simple laboratory method for inducing anger: a preliminary investigation.

To facilitate the experimental study of anger, we developed a simple laboratory method to induce anger. This anger induction (AI) is similar in format to the Velten Mood Induction Procedure for depression (VMIP-D), and involves reading descriptors of anger experience, recalling relevant personal memories, and evoking the mood suggested by the sentence/memory. We administered the AI and VMIP-D to 81 undergraduate men and women and collected mood ratings before, during, and after each mood induction. The AI exhibited good sensitivity and specificity in that it induced moderate to greater increases in anger (>1 SD change) in 68% of the sample, significant decreases in happiness, and minimal changes in other emotions. Mood responses to the AI and VMIP-D were influenced by gender and order of presentation. Uses and limitations of this method are discussed.

The effects of cue exposure on reaction time in male alcoholics.

The present study investigates reaction time (RT) as a measure of attentional deficits produced during alcohol cue exposure. Twenty-four male alcoholic patients responded to a series of computer-generated tones as rapidly as possible during baseline and again during either an alcohol cue exposure period or exposure to a control beverage (water). Patients required increased time to respond to the tones when exposed to alcohol cues. No such increase in RT was found during exposure to a control beverage. In addition, RT was significantly correlated with self-reported urge to drink. These data provide initial validation for the use of RT as an objective measure of cue reactivity. Both theoretical and clinical implications for the use of RT as a measure of the effects of cue exposure are discussed.

Alcohol cue reactivity: effects of detoxification and extended exposure.

Alcoholics' reactions to drinking-related stimuli (cue reactivity) have been well documented and alcohol cue exposure treatment has been conducted recently in several clinical trials. Prior to conducting large-scale clinical trials it is important to know what effects detoxification may have on cue reactivity. However, no information is available about the effects of stage of detoxification or of detoxification medication on alcohol cue reactivity. In this study, 45 male alcoholics, detoxified without medication, were assessed during either their second, fourth or sixth day of withdrawal. Further, their reactivity was compared to that of alcoholics detoxified with chlordiazepoxide (n = 15), and to that of alcoholics in their fourth week after drinking (n = 28). Cue reactivity assessment investigated salivation and urge to drink after 3 minutes of water cue exposure and then after 3 minutes of alcohol cue exposure. Urges to drink were assessed during an additional 15 minutes of alcohol exposure to explore latency to maximum reactivity and habituation. Reactivity did not differ as a function of group membership, although salivation was elevated to both beverages during the first week of detoxification. Of the sample, 70% reacted to alcohol with increased urge and 65% with increased salivation, with no difference between groups in proportions of reactors. The maximum urge to drink occurred in the first 6 minutes of alcohol exposure, followed by a gradual and significant decrease. There were no differences on these measures between alcoholics in their first or fourth week after their last drink. Implications for theory and clinical applications are discussed.

Alcohol cue reactivity and mood induction in male and female alcoholics.

The purpose of this study was twofold: to investigate gender differences in alcohol cue reactivity, and to study the effect of individualized mood induction on cue reactivity. Male (n = 38) and female (n = 19) alcoholics were exposed to an alcoholic beverage before and after mood induction to assess their reactivity to the beverage cues. The mood induction was based on a situation the subject had identified as being high risk for relapse. Subjects showed urge and salivary reactivity in response to alcohol beverage cues prior to mood induction, and the induction of mood enhanced urge reactivity in both men and women. Analyses with alcohol urge reactors (subjects that demonstrate an increased urge to drink alcohol in response to an alcoholic beverage cue) suggested that women show more urge reactivity in response to negative moods than do men. No gender differences were seen in reactivity to beverage cues alone. These results identify an important gender difference in the effect of negative moods on cue reactivity and suggest that negative mood situations may place women at a higher risk for relapse than men.

Scripted imagery manipulations and smoking cue reactivity in a clinical sample of self-quitters.

The affectively valenced scripts used by S. Tiffany (1990) suggest that different scripts produce relatively equivalent levels of cue reactivity, although it is unclear if these laboratory findings generalize to clinical samples. In this study, cessation-motivated smokers were tested 7 days before they tried to quit smoking and were exposed to 3 audiotaped scripts that depicted different affectively valenced situations (neutral, positive, or negative). The latter 2 scripts also contained smoking cues. The findings using a clinical sample differed considerably from those using analogue laboratory samples across affective, cognitive, and physiological response measures. Reactivity to these standardized scripts failed to predict treatment outcome through a 30-day follow-up. The use of affectively valenced scripts beyond a laboratory sample is questioned.

Individual differences in cue reactivity among smokers trying to quit: effects of gender and cue type.

Across studies, when presented with a variety of smoking cues, smokers and ex-smokers evidence distinct patterns of self-reported, physiological, and behavioral reactions. However, few studies have compared more than two different kinds of cues within the same experiment. Furthermore, despite the importance of examining the moderating effect of gender on smoking outcomes, few studies have examined gender differences in smoking cue reactivity. We examined the effect of eight distinct cue manipulations on heart rate, mean arterial pressure, smoking urges, and self-efficacy in a sample of 129 participants (50% female) who had recently quit smoking. Cue manipulations included (a) in vivo exposure, (b) an idiographically designed exposure of subjects' most recent relapse, (c) an idiographically designed exposure to subjects' highest risk situation, and (d) affectively valenced standardized scripts depicting situations generally associated with relapse. These manipulations were compared to a standard cognitive stressor (mental arithmetic) and to a resting baseline. Results revealed differences in the degree of reactivity to different manipulations, with in vivo cues producing the greatest changes. Gender differences in reactivity between the type of cues presented were found for mean arterial pressure, with standardized scripts producing greater changes for women. These findings have implications for understanding the reasons for differences in cue reactivity across manipulations and for gender differences in cue reactivity.

[Computer analysis of band variability in DNA fingerprints]. / Komp'iuternyi analiz variabel'nosti polos na DNK-fingerprintakh.

Through the example of the distribution of PCR products DNA matrices of mouse tail tissue, a method of comparative analysis of DNA fingerprints is described. The PCR products were obtained using a 20-mer random primer flanking the Atp1b2 locus on mouse chromosome 11. A software program was designed that permits the simplification of comparison of DNA fragments variability or polymorphism detected on electrophoregrams from different individuals.

[Characteristics of the molecular diversities of human and rat aldolase via starch and agar gel electrophoresis]. / Kharakteristika molekuliarnykh raznovidnostei al'dolazy cheloveka i krysy s pomoshch'iu élektroforeza na krakhmal'nom i agarovom geliakh.

Content of aldolase isoenzymes was reinvestigated in human and rat tissues by means of agar and starch gel electrophoresis. Heterogeneity of the A type aldolase is established and possible causes of formation of the multiple forms of the enzyme are discussed. The ratio of various fractions of aldolase A was different in erythrocytes of newborn and aldult persons. The patterns of the aldolase isozyme spectra were characterized in blood sera of newborns, in acute hepatitis and myocardial infarction.

[Exocrine function of the pancreas in children]. / Sostoianie vneshnesekretornoi funktsii podzheludochnoi zhelezy u detei.

Thirty-three children were followed up. There were 14 girls and 7 boys with constitutional-exogenous obesity and 12 normal children. To study proteolytic function of the pancreas, the activity of trypsin was determined by the Erlanger method modified by V.A. Shaternikov and that of its inhibitor in the blood serum by the Haverback et al. method modified by V.A. Shaternikov . Activation of trypsin and its inhibitor, depending on the degree of obesity was discovered. Activation of trypsin inhibitor points to the preservation of the compensatory possibilities of the pancreas in children with constitutional-exogenous obesity. Therefore, it is desirable that a complex of different measures should include wise dietetics promoting the normalization of disturbed processes in pathology under consideration.

[Changes in the proteolytic enzyme activity of the blood against the background of a high-protein diet in children with pancreatitis]. / Izmenenie aktivnosti proteoliticheskikh fermentov syvorotki krovi na fone diety s povyshennym soderzhaniem belka u detei, bol'nykh pankreatitom.

Fifty-one children aged 5 to 14 years suffering from pancreatic diseases received the diet enriched with protein. The control group included 44 children of the same age with analogous pathology. These children were kept on the diet with common protein content. The dietetic treatment lasted 3 weeks. The effect of the high-protein diet on pancreatic function was evaluated from the time course of the activity of blood serum proteolytic enzymes (trypsin, trypsin inhibitor, elastase). The data obtained suggest that in case of administering the high-protein diet to children with inflammatory pancreatic diseases one should consider the stage of the inflammatory process and compensatory potentialities of the pancreas.

[Change in proteolytic enzymatic activity in the blood serum in children with chronic diseases of the digestive organs]. / Izmenenie aktivnosti nekotorykh proteoliticheskikh fermentov v syvorotke krovi u detei s khronicheskimi zabolevaniiami organov pishchevareniia.

The activity of trypsin, common trypsin inhibitor and elastase was evaluated in the blood serum of children with chronic diseases of the digestive organs. The activity of trypsin and its inhibitor was shown to be elevated in most children with both concomitant pancreatitis and without it. Increased activity of the trypsin inhibitor reflects a positive compensatory response of the body to excess trypsin supply to the blood. The activity of serum elastase rises only with exacerbation of chronic pancreatitis.

[The late results of using fixed dentures made of stainless steel with a titanium nitride-based finish coating]. / Otdalennye rezul'taty primeneniia nes''emnykh protezov iz nerzhaveiushchei stali s dekorativnym pokrytiem na osnove nitrida titana.

Forty-four patients fitted with fixed dentures made of stainless steel with TiN-based decorative coating were followed up for 2 years. Abrasion of the decorative coating at the site of the crown contact with the basis and clammers of plate dentures and at the site of cutting edges of frontal teeth was recorded in 11 (25 percent) subjects. Measurements of the electric potentials have revealed their essential increase in the patients fitted with dentures with TiN-based coating vs. those with dentures made of gold and steel.

[Electro-optic method of recording antigen-antibody interactions in detection of antiplatelet antibodies in hemorrhagic thrombocytopathies]. / Elektroopticheskii metod registratsii vzaimodeistviia antigenov s antitelami dlia vyiavleniia antitrombotsitarnykh antitel pri gemorragicheskikh trombotsitopatiiakh.

A new electrooptic method was used to study the antiplatelet autoimmune process. Antiplatelet antibodies were assessed in 60 patients with idiopathic thrombocytopenic purpura and 60 ones with acquired hemorrhagic thrombocytopathies. The reference group consisted of 50 donors. The relationship between the autoimmune process intensity and the disease severity, as well as blood platelet counts over the course of corticosteroid therapy was studied.