[Microbiome of the external auditory canal and preoperative preparation of patients in otosurgery (literature review)]. / Mikrobiom naruzhnogo slukhovogo prokhoda i predoperatsionnaya podgotovka patsientov v otokhirurgii (obzor literatury).

OBJECTIVE: To analyze the effectiveness of methods of antiseptic and hygienic preoperative preparation of the operating field in otosurgery. MATERIAL AND METHODS: A review and an expert assessment of the corresponding research objectives of scientific publications contained in the PubMed and Google Scholar databases have been carried out. RESULTS: Various studies indicate a lower ototoxicity of 5-10% of the drug povidone-iodine compared to others. Drugs, such as Miramistin, Okomistin, Dioxidine, are actively used in otiatrics in Russia, but no data on their ototoxicity have been noted. The collected data point to the relevance and prospects of studying the microbiome of the external auditory canal, assessing its effect on the course of the postoperative period, depending on various methods of preparation (antiseptic, removal of earwax and hair depilation) of the surgical field for otosurgery.

[The main steps in treatment of the children with otitis media with effusion]. / Osnovy okazaniya meditsinskoi pomoshchi pri ekssudativnom srednem otite.

MATERIAL AND METHODS: 361 children at age from 11 months to 18 years with otitis media with effusion (OME) were inspected after tympanostomy during 2013-2018 years. Treatment was carried out in accordance with the stages of OME: secretory, mucous, fibrous. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, computed tomography. Surgical treatment may be required already at the secretory stage of the disease, as well as in all cases with mucous and fibrous stages of OME. RESULTS: In children with recurrences of OME and in patients with congenital cleft lip and palate, it is preferable to use long-wearing ventilation tubes and balloning of the auditory tubes. The effectiveness of surgical treatment of OME was 97.6%. CONCLUSION: The authors recommend dispensary observation of patients with OME for 12-24 months.

[The main steps in treatment of the children with otitis media with effusion]. / Osnovy okazaniya meditsinskoi pomoshchi pri ekssudativnom srednem otite.

THE AIM: Of the investigation was to establish the standard and improve the treatment of otitis media with effusion (OME) in children. 361 children at age from 11 months to 18 years were inspected after tympanostomy during 2013-2018 years. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, CT. MATERIAL AND METHODS: Treatment takes into consideration the reveal of OME: surgical initially. The tympanostomy preferable place is anterior-inferior quadrant. RESULTS: In cases with cleft palate or reccurence OME long-term tubes and balloonisation of ET are preferable. CONCLUSION: Authors received normalization of the hearing thresholds in 97.6% cases, but after surgery the patients have to be followed-up during 12-24 months.

[Obliteration of the middle ear cavity in children: the current state of the problem and our first experience]. / Obliteratsiya polostei srednego ukha u detei: sovremennoe sostoyanie problemy i nash pervyi opyt.

Chronic otitis media is one of the most common ear pathologies among children. This article provides a short overview of publications on surgical techniques. Currently, the most effective treatment is the surgical sanitation of the middle ear cavities. There are two fundamentally different approaches of operations in relation to the posterior wall of the external auditory canal - «open¼ and «closed¼ types. Both methods have their advantages and disadvantages, which are especially noticeable in pediatric revision otosurgery. Surgical obliteration of the sanitized middle ear cavities is an effective compromise option. However, the techniques of bone obliteration, which are actively applied among adults, are difficult if we discuss children ear. A way out of this situation may be the use of modern osteoplastic materials for filling large trepanation cavities. The article describes in detail the technique of revision sanitizing surgery on the middle ear using osteoplastic granules. Purpose of the study. The analysis of the first results of separate obliteration of paratympanic cavities in children using osteoplastic materials. MATERIAL AND METHODS: In the period from May 2018 to November 2020, on the basis of the Federal State Autonomous Institution «National Medical Research Center of Children's Health¼ of the Ministry of Health of Russia, 28 children aged from 6 to 17-year-old with chronic otitis media and cholesteatoma were operated using osteoplastic obliteration, who had previously sanitizing operation on the middle ear. All children on admission to the hospital and 6-12 months after the operation underwent a complex examination. The condition of each patient was assessed using the OMO-22 quality of life questionnaire, to which the parents answered the questions twice - before and 1 year after surgery. RESULTS: During the postoperative period none of the patients had clinical signs of recurrence of cholesteatoma, which was confirmed by CT scan. When assessing the quality of life of children using a questionnaire, the average score before the operation was 130.2±27.7, after the operation - 61.5±21.1. The indicator of the bone-air interval before surgery in patients averaged 29.8±9.7 dB, 1 year after surgery - 13.0±10.9 dB (p>0.05). FINDINGS: The first experience of using osteoplastic materials for obliterating the paratympanic spaces in children has shown high efficiency, ease of use and safety.

[Treatment of exudative (secretory) otitis media in young children taking into account the anatomical features of the auditory tube]. / Lechenie ékssudativnogo srednego otita u detei rannego vozrasta s uchetom anatomicheskikh osobennostei slukhovoi truby.

AIM: To study the efficacy and safety of treatment of exudative (secretory) otitis media (EOM) in children of early age taking into account the anatomical features of the auditory tube. MATERIAL AND METHODS: We examined and treated 30 children (51 ears) by balloon dilatation (BD) at the age of 1 to 3 years, with recurrent EOM (more than 6 months). The 21st child was diagnosed with a 2-sided process, and 9 with a one-sided process. All patients have previously unsuccessfully used conservative methods of treatment. According to the results of the examination and treatment, the children were divided into 2 groups. In group 1 (16 children, 30 ears) included children suffering from ESR in combination with hypertrophy of adenoids 2-3 art. with a block of pharyngeal mouths of auditory tubes, which at stage 1 of treatment was carried out endoscopic adenotomy and shunting of the tympanic cavities. In follow-up, this group of children after shunt loss was diagnosed with relapse of EOM (type B was registered on tympanometry). In this group, balloon dilation of auditory tubes was performed in the second stage after adenotomy and bypass surgery. In group 2 (14 children, 21 ear) included children with relapsing course of EOM, the adenoid vegetation 1 degree without block the pharyngeal orifices of the auditory tubes, which in the first phase was conducted on bypass the tympanic cavity. After the loss of shunts, during the control examination, a relapse of EOM was diagnosed, in connection with which, the children underwent balloon dilation of the auditory tubes. RESULTS: During tympanometry in 1 month. complete restoration of middle ear function in 17 children (56.7%, 28 ears) (tympanograms type A) was revealed. 4 children (13.3%, 6 ears) were diagnosed with partial recovery of middle ear function (tympanograms type C). 9 children (30%, 17 ears) retained exudate in the tympanic cavity, these patients underwent a second course of conservative therapy, after which the function of the middle ear was restored. 9 children after BD with persistent exudate in the middle ear cavities underwent tympanostomy (in this case, long-term wearing shunts were used). CONCLUSION: Balloon dilation of the cartilaginous part of the auditory tube is minimally invasive, effective in 70% of cases and a safe approach to the treatment of children suffering from a recurrent course of EOM.

[Surgical treatment of chronic otitis media in children using three-dimensional imaging]. / Khirurgicheskoe lechenie khronicheskogo srednego otita u detei s ispol'zovaniem trekhmernoi vizualizatsii.

The introduction of three-dimensional exoscopy has opened a new stage in microsurgery in recent years. Researchers from various specialties give mostly positive reviews. There are very few works on the use of three-dimensional imaging in otorhinolaryngology, and there are practically no such works on otosurgery. This article presents a short review of publications and our own clinical examples, which are the first detailed description of VITOM 3D KARL STORZ exoscope use for cholesteatoma surgery in children, published in the available world literature. The first experience allowed us to draw preliminary conclusions about the comparability of this method of intraoperative imaging with a microscope. In addition, we have identified additional benefits of the exoscope. Further research will make it possible to better adapt the technique to the peculiarities of otosurgery, and it should take its place in the arsenal of ENT surgeons, along with microscopy.

[The Diagnostic Accuracy of Сoronary Сomputed Tomography Angiography in the Diagnosis of Stable Coronary Artery Disease in Patients Aged 70 Years and Older].

AIM: The purpose of this study was to evaluate the diagnostic accuracy of сoronary сomputed tomography angiography (CCTA) in the diagnosis of stable coronary artery disease (CAD) in patients aged ≥70 years. MATERIALS AND METHODS: The study included 390 patients aged ≥70 years with symptoms suggested stable CAD which underwent elective coronary artery angiography (CAG). Initially the prevalence of angiographically significant CAD was estimated according to the gender and chest pain character, and identifications of patients in whom CCTA was appropriate. After that diagnostic accuracy and сost-efficiency of CCTA in the diagnosis of stable CAD in 82 patients with atypical angina and non-anginal chest pain were evaluated. RESULTS: The prevalence of obstructive CAD in patients with typical angina was very high and they were excluded from the final analysis. Among 82 patients with atypical angina and non-anginal pain which underwent CCTA 48 (59%) patients had obstructive CAD. CСTA data matched with results of CAG in all cases. Among 34 patients that had non-obstructive CAD the results of CCTA and CAG matched in 88% cases. CCTA has sensitivity, specificity, positive predictive value, negative predictive value of 100%, 88%, 92% and 100% respectively. The likelihood ratio for positive result was 8.3, likelihood ratio for negative result was 0.3. Positive result increased post-test probability of obstructive CAD from 42% to 86%, negative result reduced post-test probability of obstructive CAD to 0%. CONCLUSION: negative CCTA result in patients aged 70 years and older with atypical angina and non-anginal pain allows to exclude the presence of obstructive CAD.  The likelihood ratio for positive result indicates a moderately difference between the pre-test and post-test probability of the presence of obstructive CAD. In patients aged ≥70 years with atypical angina or non-anginal chest pain which have inconclusive results of functional testing or unable undergo functional testing CCTA allows to increase diagnostic yield of CAG and reduce the frequency of minor complications and diagnostic evaluation costs.

[The Diagnostic Accuracy of Exercise Treadmill Testing and Stress Echocardiography for the Detection of Obstructive Coronary Artery Disease in Patients Aged ≥ 70 Years].

AIM: to compare diagnostic accuracy of exercise treadmill testing and stress echocardiography in the diagnosis of stable coronary artery disease (CAD) in patients aged >70 years. MATERIALS AND METHODS: The study included 390 patients aged >70 years with suspected stable ischemic heart disease, who underwent elective coronary artery angiography (CAG). Exercise treadmill testing (ETT) according to the modified Bruce protocol was carried out in 189 patients (48 %), bicycle stress echocardiography - in 179 patients (46 %). Initially we determined the prevalence of angiographically significant CAD according to the gender and chest pain character, and identified persons in whom stress testing was appropriate. After that diagnostic accuracy of both tests was evaluated in patients with atypical angina and non-anginal chest pain. RESULTS: Among 72 patients with atypical angina and non-anginal pain who underwent ETT and had unequivocal results, 38 (53 %) had obstructive CAD. ETT for detection of obstructive CAD had sensitivity 79 %, specificity 82 %, positive likelihood ratio (LR+) 4.4, and negative likelihood ratio (LR-) 0.3. Positive result increased probability of obstructive CAD from 53 % to 83 %, negative result reduced probability of obstructive CAD to 25 %. Among 111 patients with atypical angina and non-anginal pain who underwent stress echocardiography and had unequivocal results, 69 (62 %) had obstructive CAD. Sensitivity, specificity, LR+, and LR- of stress echocardiography were equal to 89 %, 95 %, 17.8, and 0.1, respectively. Positive result increased probability of obstructive CAD from 62 % to 95 %, negative result reduced probability of obstructive CAD to 16 %. CONCLUSION: bicycle stress echocardiography was found to be more accurate than ETT to rule in or rule out obstructive CAD in patients aged ≥ 70 years with atypical angina and non-anginal pain.

[The ratio of fungi and bacteria in the biomass of different types of soil determined by selective inhibition].

Tundra, chernozem (virgin and arable), sod-podzolic (coniferous forest, meadow, and arable), and grey forest (larch forest) soils were used to separate the contributions of fungi and bacteria to substrate-induced respiration (SIR) with the help of antibiotics. For soils with a high content of organic matter (tundra and chernozem: 12 and 8%, respectively), the procedure of selective inhibition of SIR has been optimized. The optimized procedure includes the application of high concentrations of streptomycin (50-120 mg/g of soil) and cycloheximide (50-80 mg/g of soil) and decreasing the weight of the analyzed soil sample. Soils under study have shown the predominant contribution of fungi (63-82%) to the total SIR. The fungal-bacterial ratio in the soils of natural ecosystems (0-5 cm, without litter) was 4.32, 2.19, 1.5, and 1.5 for tundra soil, virgin chernozem, coniferous (sod-podzolic soil), and larch (grey forest soil) forests, respectively. The lower layers of sod-podzolic (5-10 cm) and grey forest (48-58 cm) soils showed a decrease in the fungal and increase in the bacterial component in the total SIR.

[Effect of intratracheal administration of heparin on the status of the mast cell population in the rat]. / Vliianie intratrakheal'nogo vvedeniia heparina na sostoianie tuchnokletochnoi populiatsii u krys.

The relationship between the blood coagulation changes after intratracheal injection of heparin and the mast cell population condition was studied. A single intratracheal injection of heparin (3500 U/kg) was found to induce a long-term hypocoagulability effect developing parallel to heparin accumulation by mast cells of the peritoneal and pleural cavities.

[Effect of the quaternary ammonium salts of the monodisperse oligomers of conidine on a mast cell population]. / Issledovanie vliianiia na populiatsiiu tuchnykh kletok chetvertichnykh ammoniinykh solei monodispersnykh oligomerov konidina.

The authors studied the effect of mast cell population of a new group of synthetic heparin antagonists--quaternary ammonium salts of monodispersed conidine oligomers of different molecular masses and the effect of conidine monomer under the conditions of heparin neutralization and without preliminary administration of the anticoagulant. The conidine monomer was discovered to be a solitary compound that produced a significant shift of the mast cell population toward light forms. Administration of both conidine monomer and oligomers after the neutralization doses of heparin did not disturb the equilibrium of the mast cell population. At the same time no relationship was established between the changes in the status of labrocytes and molecular mass of conidine derivatives. Degranulation of mast cells remained significantly unchanged in all the series of experiments.

[Antiheparin and toxic properties of quaternary ammonium salts of the monodispersed oligomers of conidine]. / Issledovanie antigeparinovykh i toksicheskikh svoistv chetvertichnykh ammoniinykh solei monodispersnykh oligomerov konidina.

A distinct relationship has been demonstrated of antiheparin and toxic properties of quaternary ammonium salts of monodispersed oligomers of conidine to their molecular weight and, therefore, to the length of the macromolecular chain. Conidine monomer having the highest acute toxicity does not interact with heparin. As the number of functional links is increased up to 25, antiheparin activity of the compounds under study ascends, whereas toxic effects become less powerful. An oligomer with 25 functional links has appeared to be the best combination of the characteristics under consideration. Further increase of the chain length and, therefore, of the molecular weight is followed by a slight lowering of anticoagulant activity and increase of acute toxicity.