STUDY OF THE HEMOMICROCIRCULATORY CHANNEL IN PATIENTS WITH DIABETES AND THREATENING ISCHEMIA OF THE LOWER LIMB.

Purpose of work - to investigate the hem microcirculatory channel (HCMC) in chronic critical lower extremity ischemia (CHLIC) in patients with diabetes mellitus (DM). To develop a method for calculating the indicator of the degree of diabetic microangiopathy (PSDMAP). Skin and muscle samples of 63 patients with type 2 diabetes mellitus with CKD and skin and muscle samples of 30 patients without systemic diseases. Histological and immunohistochemical studies were conducted to detect type IV collagen, CD31, and smooth muscle action. We measured the diameters of blood vessels of the skin and muscles, the density of capillaries per unit area for the calculation of PSDMAP. Characteristic changes were revealed in the morphometric parameters of the HCMC of the skin in patients with type II diabetes mellitus with CKD. A method for calculating PSDMAP was developed. It was revealed a correlation between the type of diabetic microangiopathy and the probability of thrombosis after hybrid arterial reconstruction, and an algorithm for the examination of patients in the postoperative period was developed.

[VALUE OF INTRAOPERATIVE DEBITOMETRY IN SELECTING OF SURGICAL TREATMENT TACTICS FOR PATIENTS WITH DIABETES MELLITUS WITH CHRONIC CRITICAL ISCHEMIA OF THE LOWER LIMB].

Aim - analyze the results of surgical treatment of patients with diabetes mellitus (DM) with chronic critical lower limb ischemia (CCLLI) against the background of the combined stenotic-occlusive lesions (SOL) of the femoral arterial segment (FAS) and popliteo-tibial arterial segment (PTAS), considering the data of the intraoperative debitometry (ID). The results of surgical treatment of 97 patients with diabetes mellitus with CCLLI caused by combined SOL of FAS and PTAS arteries after 1 month and 12 months of treatment were analyzed. All patients were treated at the Vascular Surgery Center of the Clinical Hospital "Feofania" of State Directorate for Affairs, Kiev, Ukraine during 2014 - 2018yrs. All patients underwent femoro-popliteal bypass grafting without intervention on arteries of PTAS.According to the obtained results of the ID, the patients were divided into groups: group 1 - 32 patients with a debit of the shunt (SD) greater than 60 ml/min, group 2 - 35 patients with SD 30-60 ml/min, group 3 - 30 patients with SD lesser than 30 ml/min. In case of the femoro-popliteal shunt (FPS) thrombosis, performed repeated surgery as a hybrid revascularization (HR) - thrombectomy from the shunt and endovascular balloon angioplasty of the arteries of PTAS. The primary patency of the arterial reconstruction zone of the patients from group 1 after 1 month was 93.75% (30 of 32), after 12 months - 78.13% (25 of 32); group 2 - after 1 month it was 82.8% (29 out of 35), after 12 months - 68.57% (24 out of 35); group 3 - after 1 month it was 46.66% (14 out of 30), after 12 months - 23.33% (7 out of 30). Thrombosis of the femoropopliteal shunt (FPS) within 12 months was diagnosed in 41 (42.27%) of 97 patients, within these patients 1 month after primary shunting in 26 (63.41%), and during the next 11 months in 15 (36.59 %)cases.With repeated intervention on thrombosis ofFPSin form ofHR, secondary patency within 12 months was 78.05% (32 of 41 patients).Restoration of the outflow from the popliteal artery in one of the tibial arteries by HR was possible in 28 of 41 (68.29%) patients, within 12 months rethrombosis of the arterial reconstruction zone occurred in 8 patients (28.57%) - with secondary patency after 12 months of 71.43% (20 of 28 patients). The restoration of the outflow from the popliteal artery into two tibial arteries by HR was possible in 13 of 41 (31.71%) patients, from them rethrombosis of the FPS within 12 months occurred in 1 patient (7.69%) - the secondary patency within 12 months was 92.31% (12 of 13 patients). In the case of combined SOL of FAS and arteries of PTAS, reconstruction of FAS without intervention on the arteries of PTAS requires performing of ID with determining of SD. Performing of ID with determining of SD is an effective diagnostic technique that allows to formulate a differentiated approach to the tactics of surgical treatment of patients with diabetes mellitus with CCLLI, caused by the SOL of FAS and PTAS. The indicator which allows to restore the patency of FAS without intervention on the arteries of the PTAS is SD>60 ml/min; with SD 30-60 ml/min, the reconstruction of the arteries of the PTAS after the restoration of the patency of FAS can be delayed and performed as elective surgery at the second stage; with SD<30 ml/min, simultaneous reconstruction of FAS and PTAS arteries is required by performing HR or two-stage open arterial reconstruction. The HR is an effective method of blood circulation restoration in patients with diabetes mellitus with CCLLI, caused by a combined SOL of FAS and PTAS, and according to the results: the patency of the FPS within 12 months is 78.05% and does not significantly differ from the results of FAS reconstruction in 1st group of patients with SD>60 ml/min - where patency of the FPS within 12 months is 78.13% (p>0.05). In case of thrombosis of the FPS, thrombectomy from the shunt, supplemented by the restoration of the magistral blood flow from the popliteal artery into two tibial arteriesby the method of balloon angioplasty, demonstrates reliably better secondary patency of the femoropopliteal shunt after 12 months - 92.31% in comparison with the secondary patency of the FPS within 12 months after restoration of the magistral blood flow from the popliteal artery into one tibial artery - 71.43% (p<0.05).

Development of betavoltaic cell technology production based on microchannel silicon and its electrical parameters evaluation.

In the paper a manufacturing process of three-dimensional (3D) microchannel structure by silicon (Si) anodic etching was discussed. The possibility of microchannels formation allows to increase the active area more than 100 times. In this structure the p-n junction on the whole Si surface was formed. The obtained data allowed to evaluate the characteristics of the betavoltaic converter with a 3D structure by using isotope 63Ni with a specific activity of 10Ci/g.

[HYBRID SURGICAL INTERVENTIONS IN PATIENTS FOR ISHEMICAL FORMS OF DIABETIC FOOT SYNDROME].

The experience of the hybrid surgical interventions performing in 24 patients with diabetes mellitus type II of complicated ischemic form of diabetic foot syndrome was adduced. According to the results of preoperative examination of patients showed a multilevel occlusive­stenotic lesions of the lower limb arteries. The hybrid arterial reconstruction operations performing has improved the results of surgical treatment of such patients.

[The case of hairy cell leukosis in pediatrics].

According publications' data, hairy cell leukosis encounters in humans aged from 26 to 70 years and in males four times more often than in females. The disease is manifested by impotence, splenomegaly, and presence in blood and bone marrow clone of lymphoid cells with particular morphology, cytochemic markers and immune phenotype (sIg+, CD19+, CD20+, CD5-, CD10-, with marked expression of CD25+, CD103+). The presented clinical case of illness with hairy cell leucosis is the first one detected in pediatric practice in adolescent of 16 years old.

[The application of methods of physical therapy in the military health resort].

Presented the main guidelines concerning the application of methods and forms of physical therapy in the complex sanatorium treatment and rehabilitation in sanatoria and health resorts of the Ministry of Defence of the Russian Federation. It is concluded that the basis for the application and further development of forms and methods of physical therapy should be based on the methodological principle of a differentiated approach to the assessment of the severity of dysfunction cardiorespiratory and nervous system, musculoskeletal system, the mode of motor activity and exercise tolerance.

Role of heat shock protein 27 in regulation of glutathione system and apoptosis of Jurkat tumor cells and blood lymphocytes.

Reaction of the glutathione system of Jurkat tumor cells and blood lymphocytes was evaluated under conditions of culturing with 5-(5-ethyl-2-hydroxy-4-methoxyphenyl)-4-(4-methoxyphenyl) isoxazole (KRIBB3), a selective inhibitor of heat shock protein Hsp27. The results indicated the regulatory role of Hsp27 in the maintenance of the functional activities of glutathione reductase, glutathione peroxidase, and realization of apoptotic death of Jurkat cells and blood lymphocytes. Inhibition of Hsp27 in Jurkat tumor cells led to imbalance of the glutathione system and increase of the share of annexin-positive cells.

[Surgical treatment of symptomatic aneurysm of popliteal artery].

The results of treatment of 17 patients, suffering symptomatic aneurysm of popliteal artery (APA) were analyzed. According to angiographic data, the APA thrombosis was revealed in 6 patients, and according to ultrasonographic Doppler scanning data the APA rupture with hematoma in adjacent tissues was diagnosed in 5 patients. The tactics of treatment was established in accordance with the distal blood flow character: the conservative therapy was conducted in the presence of APA up to 40 mm in diameter in condition of the artery passability preservation and poor distal blood flow--in 6 observation operative treatment was conducted in the presence of satisfactory distal blood flow--in 4, according to urgent indications due to critical ischemia--in 2, and for the aneurysm rupture--in 5. Operative treatment of symptomatic APA showed ineffective in presence of thrombotic complications in 23.1% patients. In conservative and surgical treatment of APA, complicated by an acute thrombosis, the poor results (the lower extremity amputation) were noted in 33.3% patients.

[The morphological evaluation of a heart ventricle made from the latissimus dorsi muscle in an experiment]. / Morfologicheskaia otsenka zheludochka serdtsa, izgotovlennogo iz shirochaishei myshtsy spiny v éksperimente.

In experiment of 16 animals the morpho-functional transformations taking place in skeletal-muscular transplant while various methods of artificial heart ventricle creation and his training application were studied. It was established that, as a rule, in autotransplant the reversible structural changes are taking place, what stipulates the necessity of keeping of the "latent" period 14-21 days long between the operation conducted and the beginning of training stimulation of heart ventricles, manufactured of a skeletal muscle.

[Regulation of corticoliberin and corticotropin incretion in old age]. / Reguliatsiia inkretsii kortikoliberina i kortikotropina v starosti.

Experiments on adult and old rats have shown age-related decrease of the CRF incretion in the hypothalamus, weakening of its response to dexamethasone, as well as a decrease of receptor corticosterone binding. Against this background in the hypophysis of old rats sensitivity ox CRF and serotonin increased, in stress the same content of ACTH as in adult rats secreted, it more markedly reacted to dexamethasone, and receptor of corticosterone binding increased in hypophysis. In old age, the role of hypophyseal link in control of the adrenocortical function is assumed to increase in stress.

[The effect of hemosorption on the aldosterone and vasopressin content of the blood in patients with decompensated chronic cor pulmonale]. / Vliianie gemosorbtsii na soderzhanie al'dosterona i vazopressina v krovi bol'nykh s dekompensirovannym khronicheskim legochnym serdtsem.

The dynamics of the content of blood aldosterone and vasopressin after hemosorption studied in 17 patients with decompensated chronic cor pulmonale revealed a significant reduction of their concentration. Reduction of the content of hormones in the blood occurred due to the effect of the sorbent and is not related to the influence of heparine.

Steroid-hormone-secretion-regulating system under effect of stress in old age.

Experiments on adult (6-8 months) and old (24-28 months) male rats under chronic emotional-pain stress showed that in aging the reliability of the control system of corticosterone secretion remains unchanged while that of aldosterone secretion decreased.

[Late results of mitral recommissurotomy]. / Otdalennye rezul'taty mitral'nykh rekomissurotomii.

Late results of 394 operations for mitral restenosis (or 90.6% of discharged cases) were reviewed, the average duration of follow-up being 5.6 +/- 0.6 years. Late results were good in 41.9%, satisfactory in 27.2% and poor in 19.5% of the patients. Long-term mortality was 11.4%. Moderate valvular regurgitation did not significantly affect the outcome of surgery. Long-term outcomes were shown to deteriorate progressively with the increment of valvular calcinosis. The comparative actuarial analysis in long-term outcomes of mitral commissurotomies and recommissurotomies showed no significant variations. It is emphasized that mitral recommissurotomy is a promising approach to surgical treatment of mitral restenosis.