[Organizing the medical care for the COVID-19 patients in non-infectious Moscow hospital: reassignment experience].

AIM: To present the results of work of National Medical Research Center of Treatment and Rehabilitation, reassigned for COVID-19 patients treatment during pandemic. Run-up methodology, procedures and working process organization are detailed. MATERIALS AND METHODS: 354 COVID-19 patients were treated from 13.04.2020 to 10.06.2020 [age 59 (470) years, 56% women, body mass index 28.5 (24.932.2) kg/m2]. Patients were admitted at 8 (611) day of sickness. In-hospital stay was 16 (1420) days. RESULTS: NEWS scale at the day of admittance was 2 (14); 2 (13) in patients discharged alive and 6 (47) in died patients, p=0.0001. So prognostic accuracy of NEWS scale was confirmed as very well (area under ROC-curve = 0.819). 69 patients (19.5%) were treated at intensive care department for 7 (413) days. 13 patients died, 11 of them had COVID-19 as direct or indirect cause of death. Total in-hospital mortality was 3.67%, in-hospital mortality of COVID-19 patients 3.1%. 17 healthcare workers (HCW), contacted with COVID-19 patients were infected (2.67%). 4 HCW, who had no direct contact with patients were also infected and 7 HCW were infected before the first patient was admitted. No one of them died. CONCLUSION: Complex tasks of healthcare organization during COVID-19 pandemic can be solved quickly with acceptable quality, characterized by low levels of patients; mortality and HCW infection.

[Ecological interpretation of higher units of steppe vegetation in southern mountains of Middle Siberia via quantitative ordination method].

Detrended correspondent analysis is used for constructing an ecological ordination model of higher units of steppe vegetation in southern mountains of Middle Siberia. The model is based on 326 complete geobotanical descriptions and correlation analysis between the values of major axes and climatic, soil-ground, and geographical parameters. In the space of two first principal ordination axes, ecological series of steppe vegetation coenofloras are observed which are orientated along climatic factors of annual and seasonal precipitation, temperature, oceanity-continentality, and ground stoniness. A syntaxonomic interpretation of observed ecological-geographical steppe types is given, and the hierarchy of higher classification units is substantiated from the ecological point of view.

Endoscopic ultrasonography for intra-abdominal textiloma.

INTRODUCTION: The term textiloma is used to describe foreign body (swab) forgotten during surgery. We don't know any case of the description of endoscopic ultrasonography (EUS) for intra-abdominal textiloma. OBJECTIVES: To determine the EUS capabilities in the topical diagnosis of intra-abdominal textiloma. MATERIALS AND METHODS: Patient, female, 57-year-old was admitted to our hospital with post-operative hernia. 10 months before the patient underwent surgery (laparotomy, splenectomy) in another hospital. For ethical reasons, we do not name that hospital. Intra-abdominal lesion has been accidentally revealed by computed tomography during the pre-operative examination prior to hernioplasty. Ultrasound unclear detected hyperechoic lesion with a dense acoustic shadow. The patient was sent to the EUS to clarify the diagnosis and to determine the topography of the lesion, fine-needle aspiration - if required. RESULTS: EUS revealed a hyperechoic corrugated border of the lesion with a dense acoustic shadow - between the gastric wall and the lower surface of the liver. Taking into account preceding surgery EUS suspected textiloma. The patient underwent hernioplasty and revision of the abdominal cavity. Textiloma has been revealed between the stomach and liver. CONCLUSION: EUS correctly diagnosed textiloma and accurately determined its location.

[Experience of two-staged liver resection (ALPPS)].

The aim was to estimate single center results of ALPPS. It was performed 5 ALPPS-procedures in our center during the period from February 2013 to March 2014. There were 1 female and 4 males in the age of 58-64 years. The indications for surgery were colorectal cancer metastases in 4 cases, bladder cancer metastases in 1 observation. The operations included 3 right-sided hemihepatectomies, 2 extended right-sided hemihepatectomies. In 3 cases operations were accompanied by additional atypical resection of residuary liver lobe. In 2 observations unsuccessful embolization of the portal vein was done. The waiting time between procedures consisted 18 days in the first case and 6 days in other cases. Final hepatectomy was performed in all observations. Hypertrophy of left liver lobe was more than 50% in all cases. Postoperative complications happened in 3 out of 5 cases. One patient died because of progressive thrombosis of inferior vena cava and developed multiorgan failure. There were 1 complication of level 2 and 1 complication of level 4a according to Dindo-Clavien classification. One patient had biliary fistula after final hepatectomy. It wasn't observed cases of severe liver failure. ALPPS is appropriate method for fast residuary liver lobe hypertrophy. It allows to perform R0-resection of liver but ALPPS has high postoperative complication rate.

[Clinicopathogenetic characteristics of cardiorenal syndrome in non-alcoholic fatty liver disease].

AIM: To study clinicopathogenetic characteristics of cardiorenal syndrome (CRS) in non-alcoholic fatty disease of the liver (nAFDL). MATERIAL AND METHODS: Insulin resistance markers, plasma leptin and serum adiponectin concentrations. albuminuria, intima-media thickness (IMT) of the common carotid artery (CCA) were assessed in 80 patients with metabolic syndrome (60 males and 20 females, mean age 44+-11 years) and NAFDL. RESULTS: With increasing signs of affection of target organs in NAFDL there was a trend to a significant rise in detection of chronic kidney disease (CKD) and carotid artery atherosclerosis, aggravation of albuminuria and CCA IMT, lowering of glomerular filtration rate. Leptinemia was maximal in CKD patients and directly correlated with albuminuria. Patients with CCA atherosclerosis had a significant fall of serum adiponectin which negatively correlated with CCA IMT. The latter positively correlated with insulinemia, a C-peptide plasma level and HOMA index. Serum concentration of adiponectin positively correlated with DeRitis index. CONCLUSION: CRS in NAFDL is characterized with frequent development of CKD and CCA atherosclerosis defined also by unbalance of adiponectin and leptin production.

[To the problem of evaluation of public health: screening for gastroduodenal pathology on the example of atrophic gastritis in mass medical examination of the population].

Assessment of health status of the population - the most important issue in preventive medicine. The objective of this work - to determine the possibility of nonendoscopic screening for gastroduodenal pathology, by the example of atrophic gastritis, in mass medical examinations of working residents in Moscow. Minimally invasive diagnostic test system GastroPanel ("Biohit", Finland) has been used. It allows with the ELISA method to determine both serum indicators of the function of the stomach -pepsinogen 1, gastrin 17 and the presence of H. pylori infection. 758 persons have been examined. The performed study confirms the possibility with the use of a set of mentioned indicators to identify individuals suspected for the presence of gastroduodenal disorders, especially atrophic gastritis, recognized as a precancerous condition. The use in preventive medicine complex diagnostic system, firstly, will make assessment of the health of the population more correct, increase the effectiveness of preventive measures and quality of life, and secondly, will contribute to the diagnosis of diseases of the stomach and duodenum in the early stages.

[The role of leptin, adiponectin and insulin-resistance markers in development of early stages of chronic kidney disease and atherosclerosis of carotid arteries in obese patients].

AIM: To characterize clinicopathogenetically factors influencing development of early chronic kidney disease (CKD) and impairment of other target organs in obese patients. MATERIAL AND METHODS: The examination of 86 obese patients (64 males and 22 females, mean age 44 +/- 11 years) included standard clinical tests, test for albuminuria, calculation of glomerular filtration rate (GFR) by MDRD formula, ultrasound investigation of the carotid arteries to detect atherosclerotic lesion of the carotid arteries, assessment of insulin resistance - IR (plasma concentration of insulin before meal and blood C-peptide, HOMA-index), test for plasma adipokinins (leptin, adiponectin). RESULTS: Significant direct correlations were found between blood plasma leptin concentration, body mass index (BMI), plasma concentration of insulin and C-peptide, HOMA index, adiponectinemia and albuminuria. CKD patients have significantly higher than patients free of CKD levels of IR markers, waist circumference, BMI, leptinemia (38.2 +/- 28.8 and 21.6 +/- 19.8 ng/ml, respectively; p < 0.01). Obstructive sleep apnea syndrome was associated with higher IR and albuminuria, significantly lower estimated GFR (81 +/- 2 and 95 +/- 2 ml/min/1.73 m2, respectively; p < 0.05). Ultrasound evidence for atherosclerotic lesions of the carotid arteries was associated with a significant increase in blood plasma concentration of C-peptide, reduction of adiponectinemia (14.9 +/- 10.8 and 32.5 +/- 22.5 mcg/ml; p < 0.01), a rise in proportion fasting insulinemia/adiponectinemia (1.6 +/- 1.2 and 0.6 +/- 0.8, respectively; p < 0.05) and reduction of estimated GFR (86 +/- 19 and 102 +/- 25 ml/min/1.73 m2, respectively; p = 0.001). CONCLUSION: In obesity, CKD at early stages develops in parallel with atherosclerotic lesion of the carotid arteries, which correlates with progression of leptinemia, IR and attenuation of organ-protecting properties of adiponectin.

[Epidemiological characteristics of Helicobacter pylori infection in Moscow].

The authors studied the prevalence and a number of epidemiological features of Helicobacter pylori (Hp) infection in Moscow. A prophylactic medical examination revealed the infection in 863 working residents of the megapolis. A mini-invasive study was used. Enzyme immunoassay was carried out to determine serum IgG antibodies against Hp. The authors' questionnaire was used in 634 interviews. There was an extremely high incidence (88%) of Hp infection. The prevalence of the infection was found to be related to age, social status (social position, educational level), living conditions (shared or hostel habitation, no sewerage system), contact with waste waters. No association was found between the rate of the infection and the examinees' gender, the intake of raw Moscow tap drinking water, and the contact with domestic animals. Moscow was rated among the cities with a high prevalence of Hp infection. The study revealed a number of epidemiological features of the infection in the megapolis, a knowledge of which is required to elaborate measures for its prophylaxis and the prevention of its associated diseases.

[Prognostic, diagnostic, and therapeutic prospects of using adiponectine as a biomarker in cardiobascular diseases].

The role of adipose tissue as an important endocrine organ is today beyond doubt. The adipose tissue is known to be a source of many biologically active substances, adipocitokines, one of them being the adiponectine possessing anti-inflammatory, antiatherogenic and cardioprotective properties; it is believed to be one of prospective biomarkers for risk assessment, for diagnostics and, possibly, for therapy of cardiovascular diseases.

Thermovoltaic properties of hornet silk.

In silk from the larval silk caps of the Oriental hornet Vespa orientalis (Hymenoptera, Vespinae), temperature-dependent changes in the electric voltage have been recorded, with rise in the voltage occurring mainly upon rise in the temperature between 10-36 degrees C. The peak voltage was measured between 32-38 degrees C and attained 240-360 mV, but with further increase in temperature, the voltage decreased, dropping to 0 mV at about 45-50 degrees C. Upon second measurement (of same silk specimen), the voltage peak usually occurred later (by 8-9 degrees C) and at higher temperature than in the first measurement. Continuous measurements during warming up to 30 degrees C followed by cooling down to 15 degrees C yielded an hysteresis between the warming "line" and the cooling "line", the former often straight and the latter usually curved. Maintaining the silk specimen at a fixed temperature for a prolonged period (hours) initially causes the voltage to rise, then remain steady, and finally drop. Boiling the silk caps in tap water for 7-10 min exerts some changes in the silk properties, mainly a decrease in voltage level. The general behavior of the silk suggests that it is a polymer endowed with the qualities of an organic semiconductor. The various properties of the larval silk are discussed in great detail.

[Transillumination phlebectomy in minimally-invasive surgical treatment of varicose disease].

Transillumination phlebectomy with TriVex was used in 72 patients for the surgical treatment of lower extremities varicose veins. Diagnostic protocol, indications and surgical technique are described in detail. Short- and long-term results are assessed. Transillumination guarantees clear visualization of subcutaneous veins. It is an effective method in surgical treatment of varicose disease, permits to decrease number and length of incisions, time of surgery, to achieve good functional and esthetic results.

Perovskites in the comb roof base of hornets: their possible function.

On the ceiling of the Oriental hornet comb cell, there are mineral granules of polycrystalline material known to belong to the group of perovskites. In a comb cell intended to house a worker hornet, the roof base usually carries one or several such perovskite granules containing titanium (Ti), whereas in the roof base of a cell housing a developing queen, there are usually several granules containing a high percentage of silicon (Si), aluminum (Al), calcium (Ca), and iron (Fe), but very little if any Ti. In worker comb cells, Ti usually appears as ilmenite (FeTiO3). Besides documenting the above-mentioned facts, this report discusses possible reasons for the appearance of ilmenite crystals in worker cells only and not in queen cells.

[The potential of conservative therapy and surgical treatment of microcirculatory distress in chronic venous insufficiency of the lower extremities in a stage of trophic disorders]. / Vozmozhnosti konservativnoi terapii i khirurgicheskogo lecheniia narushenii mikrotsirkuliatsii pri khronicheskoi venoznoi nedostatochnosti nizhnikh konechnostei stadii troficheskikh rasstroistv.

The present work describes the results of an all-round examination and treatment of 120 patients suffering from different forms of chronic venous insufficiency (CVI) of the lower extremities with trophic disorders of soft tissues. Of these, varicosis was present in 91 (75.8%) patients and postthrombotic disease - in 29 (24.2%), patients. Hemomicrocireulation was examined by laser Doppler flow-metry. Assessment was made of the functional activity of neutrophilic granulocytes of the microcirculatory bed. The data were obtained indicating the decrease of skin perfusion and activation of neutrophils in the hemomicrocirculatory bed of the involved extremity at venous outflow decompensation. Of the 120 persons, conservative treatment was provided to 23 patients, in 45 patients, the conservative measures represented a stage in the preoperative preparation. Ninety-seven patients were operated on. The studies of hemomicrocirculation carried out at different times after treatment have demonstrated that conservative treatment produces a beneficial effect on hemomicrocirculatory disorders in the lower extremities of patients with CVI. However, the effects of conservative therapy are unstable and not long-lasting. Surgical correction of the venous outflow in patients with decompensated forms of CVI of the lower extremities leads to a stable improvement of the functional parameters of microcirculation.

[The clinical and pharmaco-economic aspects of chronic venous insufficiency of the lower limbs]. / Klinicheskie i farmakoékonomicheskie aspekty khronicheskoi venoznoi nedostatochnosti nizhnikh konechnostei.

Presented, herein is a review of the paper "Chronic venous insufficiency; effect of public health reforms on the cost of treatment and hospitalization. Italian prospects" by C.Allegra. The paper evaluates the effect of public health reforms carried out in Italy on the cost of the treatment of patients suffering from chronic venous insufficiency of the lower limbs. It is demonstrated that the change over in Italy to the American system of the classification of the diagnoses and discontinuance of donations for phlebotropic drugs has led to a 23.6 million euro rise of the annual expenditures for the treatment of this group patients due to an increase of the expenditures for hospitalization as well as to material redistribution of the financial expenditures from outpatients to inpatients. The review also contains the results of the author's investigations related to the clinical and economic estimation of the treatment of patients with different forms of varicosity using different types of analysis of the financial expenditures.

[Phlebosclerosing treatment of telangiectasias of lower extremities]. / Fleboskleroziruiushchee lechenie teleangiéktazii nizhnikh konechnostei.

Our experiences include 124 patients (women) aged 25-50 years. Microsclerotherapy was used with 0.5% solution of etoxisclerole and 0.2% solution of fibrovein. The compressive microsclerotherapy proved to be an effective and harmless method of treatment of telangiectasias giving good cosmetic results and arresting clinical symptoms thus improving quality of life.

[2. Diagnostic resources and clinical indications]. / Soobshchenie 2. Diagnosticheskie vozmozhnosti i klinicheskie pokazaniia.

Preliminary investigations, dedicated to the diagnostic application of three-dimension ultrasonic angioreconstruction, confirmed the feasibility of using the above method in ophthalmologic practice in cases of suspected intraocular and orbital neoplasms. 32 patients (37 eyes) with various pathologies of the eye and orbital cavity, including choroidal melanoma, facial angiomatosis, retinal detachment, chronic uveitis etc.) were examined. The results are indicative of that the three-dimension ultrasonic angioreconstruction makes it possible to detect the latent vascular neoplasms, which cannot be defined by the standard visual and ultrasonic examinations, and the dislocation of structural elements of the eyeball tunics. Besides, it provides for evaluating their special localization and their interrelations with the neighboring anatomic elements.

[Toxic lesions of the organ of vision caused by chloroquine derivatives]. / Toksicheskoe porazhenie organa zreniia proizvodnymi khlorokhina.

An analysis of complications resulting from a long-term administration of chloroquinine derivatives is presented in the paper. The efficacy of chloroquinine derivatives for patients with rheumatological and dermatological pathologies was demonstrated. However, the remote results showed, after the administration of the above preparations, highly serious complications in different organs and primarily in the organ of vision. As for our practice, complications of various severity degrees were found in 6 patients with rheumatoid arthritis, who received the preparations in question, such complications were classified as highly severe in 1 patient. Taking into consideration that the chloroquinine derivatives have been widely used, while many doctors are not aware of the complications caused by them. We found it advisable to compile a literature survey and to enlarge it with our own observations. Eventually, we concluded that the pathogenesis of disorders in visual functions could be explained by a toxic effect produced by the chloroquinine derivatives not only on the retina but also on the optic nerve and chiasm. Our opinion is that a thorough and differentiated approach is needed to patients with the mentioned pathologies while using the chloroquinine derivatives for treatment.

[Synthesis of protective antigens during submerged cultivation of Vibrio cholerae]. / Dinamika sinteza protektivnykh antigenov v protsesse glubinnogo kul'tivirovaniia Vibrio cholerae.

The effectiveness of dot immunoanalysis for evaluating the dynamics of the synthesis of O-antigen, cholera toxin, neuraminidase, adhesin CFA1 in the process of the reactor cultivation of V. cholerae used for the production of oral chemical cholera vaccine is shown. The established regularities of the synthesis of the protective antigens of V. cholerae in the process of scaled-up cultivation are discussed.

[Use of endothelial protector Softel in surgery of the anterior eye segment]. / Primenenie protektora éndoteliia "Softel'" v khirurgii perednego otdela glaza.

Endothelium protector SOFTEL is developed by Ekran firm and Institute of Eye Diseases, Russian Academy of Medical Sciences. The drug was used in 157 patients aged 28-79 years. Perforating keratoplasty for corneal leukoma and keratoconus was carried out in 46 patients, cataract extraction with implantation of intraocular lens (IOL) in 94, and cataract extraction without IOL implantation in 17 patients. Two patients developed slight hypertension in the postoperative period, which resolved within 24 h, and four patients developed moderate corneal edema persisting for 1-2 days postoperation. The protective effect of softel is compatible with that of its foreign analog Healon. The drug is effective in cataract extractions with IOL implantation and perforating keratoplasty.

[Derivatives of 4-phenylpiperidine as substrates of rat brain monoamine oxidase]. / Proizvodnye 4-fenilpiperidina--substraty monoaminoksidazy mozga krysy.

A rate of utilization of 4-phenyl piperidine and its 12 derivatives by brain monoamine oxidase (MAO) was studied as compared with typical neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). The enzyme was isolated from P2 synaptosomal fraction of brain corpus striatum of Sprague-Dawley rats. 10 drugs were oxidized in the MAO-catalyzed reaction with the rate close or similar to the MPTP oxidation while 6 of them exhibited the neurotoxic effect. Analysis of MAO inhibition, using 1 microM of chlorgyline and/or deprenyl, enabled to evaluate the contribution of MAO-A and MAO-B forms to utilization of 1 mM content of the substances studied. MAO-B was shown to oxidize preferably the drugs radicals of which were substituted at 3rd position of the piperidine ring, while MAO-A preferred the derivatives with radical substitution at 4th position. The rate of substrate oxidation was decreased distinctly after introduction of complete substituents into the 3rd and 4th positions of the nitrogenous heterocycle; at the same time, presence of cyclic fluorine-containing structures increased the rate of utilization, similar to that of MPTP oxidation. Derivatives of 4-phenyl piperidine, which contained in a number of drugs, were oxidized in the MAO-catalyzed reactions and might exhibit direct- or side-neurotoxic effects.