Use of Additive Technologies in Surgical Treatment of Chronic Posterior Dislocations of the Shoulder.

The aim of the study was to evaluate the efficiency of additive technologies in surgical treatment of patients with osteochondral defects of the humeral head articular surface against the background of chronic posterior dislocation of the shoulder by means of comparing clinical and radiological results with the McLaughlin procedure. Materials and Methods: A prospective randomized comparative group clinical study was conducted, which included 20 patients who in 2019-2021 underwent surgical treatment of chronic posterior dislocation of the shoulder in the Traumatological and Orthopedic Department of the Institute of Traumatology and Orthopedics of the Privolzhsky Research Medical University (Nizhny Novgorod, Russia). Depending on the type of surgery, all patients were divided into 2 groups: group 1 (n=10) was subject to McLaughlin procedure, whereas group 2 (n=10) - to reconstruction of the humeral head using a customized implant based on additive technologies (3D printing). To assess postoperative results, 6 months after the surgery all patients underwent the following procedures: X-ray imaging of the shoulder joint in two projections, CT scanning, and angulometry as well as provided their responses in line with the following questionnaires: Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant Shoulder Score (CSS), Shoulder Rating Questionnaire (SRQ), and the Hospital for Special Surgery Shoulder Surgery Expectations Survey (Survey of patient, SP). Results: Both the McLaughlin procedure and the reconstruction of the humeral head using a customized implant made using additive 3D printing technologies increased the range of motion in the shoulder joint, mitigated the pain syndrome and improved the patients' quality of life. During the postoperative period, there were no infectious complications in both groups. The total bed-day in group 1 was 7 [5; 9] days; in group 2, it was 8 [6; 9] days. There was no recurrence of dislocation or progression of osteoarthritis of the shoulder joint in patients in both groups during 6 months after the surgery. The ASES, SP, SRQ, CSS, DASH, and VAS questionnaires assessment for both groups showed a statistically significant improvement for all indicators in the postoperative period. There were no statistically significant differences found between the groups as to the results of angulometry and answering the questionnaires. Conclusion: Customized implants made using additive technologies can shorten the surgery duration by 1.3 times, whereas the volume of intraoperative blood loss - by at least 1.5 times compared to the McLaughlin procedure.

Review: immunomodulatory activity of pregnancy-associated plasma protein-A.

This mini-review highlights the growing number of indications for the immunological importance of pregnancy-associated plasma protein-A (PAPP-A), which is a remote member of the alpha-macroglobulin plasma protein family. PAPP-A can bind a variety of cytokines and specifically cleave a binding protein for insulin-like growth factors, thereby serving as a modulator of cytokine activity. Important immune functions, such as lymphocyte proliferation response to alloantigens and lectins and expression of HLA-DR molecules are predominantly suppressed in vitro by PAPP-A. It is likely that the immunoregulatory properties of PAPP-A are very similar to that of alpha 2-macroglobulin. The experimental data allows us to suppose that PAPP-A serves to prevent the recognition of the fetus by the maternal immune system and to suppress locally the host's immune response to the tumour.

[Ultrasonography of placenta previa at the third trimester of pregnancy: research for signs of placenta accreta/percreta and vasa previa. Prospective color and pulsed Doppler ultrasonography study of 45 cases]. / Placentas bas insérés échographiquement au 3e trimestre de la grossesse: recherche de signes de placenta accreta/percreta et de vaisseaux praevia. Etude prospective en échographie Doppler couleur et pulsé de 45 cas.

OBJECTIVES: In a population of 45 placenta previa observed at third trimester of gestation we have tried to make the prenatal diagnosis of placenta percreta and vasa previa with color and pulsed Doppler ultrasonography. MATERIALS AND METHODS: We used a transabdominal sonography with full bladder and a transvaginal sonography with empty bladder. The first images obtained showed 20 placenta previa over the internal cervical os, 3 marginal and 22 low-lying placenta previa. We tried to find evidence of placenta percreta with gray-scale ultrasonography (loss of normal hypoechoic retroplacental myometrial zone, focal disruption of the uterine serosa and surrounding tissues, presence of intra placental lacunae) and with color and pulsed Doppler (arterial vessels with a diastolic flow value less than the flow value of a spiral artery behind the placenta, arterial vessels crossing from the placenta to surrounding tissues, intraplacental lacunae with arterial flow). We tried to find evidence of vasa previa in color and pulsed Doppler (a fetal vessel in seen above the lower segment of the uterus and below the fetal head. There is no change in the location of the vessel despite positional changes in both mother and fetus). The positivity of one sign in gray-scale ultrasonography or in color and pulsed Doppler led us to believe that the patient was affected by the anomaly. The final diagnosis of abnormal adherence of the placenta and of vasa previa was made on histological examination. RESULTS: Among the 20 placenta previa over the internal cervical os, we found 1 placenta percreta, 1 placenta accreta and 3 cases of vasa previa. In spite of our limited sample of cases of abnormal adherences, our results showed that gray-scale ultrasonography was sufficient to make a prenatal diagnosis of placenta accreta/percreta. Negative predictive value is 100% on a sample of 43 patients with no abnormal placental adherence. Color and pulsed Doppler brought no further evidence. In our population, color and pulsed Doppler had 100% positive predictive value for diagnosis of vasa previa. CONCLUSION: We found the only 2 cases of abnormal adherent placental fragments and the 3 cases of vasa previa present in our population. The study of the lower segment of the uterus should be thorough as abnormal zones may be small-sized. Color Doppler is the reference technique for sighting vasa previa and gray-scale ultrasonography for abnormal adherences of the placenta.

The effects of alpha 2-antiplasmin complex and alpha 2-antiplasmin on the secretion of IgG and IgM by cultured human mononuclear cells.

We tested alpha 2-antiplasmin (AP) and its complex with plasmin (PL) for their capacity to modulate spontaneous secretion of immunoglobulins (Ig) G and M by mononuclear cells (MNC). MNC were obtained from peripheral blood of 10 donors (5 males and 5 females) and cultured for 7 days in the presence of various concentrations of AP and AP-PL complex. The 18 hr incubation of MNC with AP-PL complex resulted in a dose-dependent increase in IgG and IgM secretion but the stimulatory effect was less significant than under conditions of incubation of MNC with the complex during a 7 day culture period. The AP-PL complex-induced stimulation occurred only in the cultures in which the dose of the complex was either close to or higher than the mean value of the complex levels in plasma of healthy donors. Elevation of IgG secretion in AP-PL complex-treated cultures from females was slightly higher than in those from males. No significant change in IgG and IgM secretion was observed in the presence of native AP.

[Pregnancy-associated alpha2-glycoprotein and trophoblastic beta1-glycoprotein in the diagnosis of pyoinflammatory diseases after Cesarean section]. / Assotsiirovannyi s beremennost'iu alpha2-glikoprotein i trofoblasticheskii beta1-glikoprotein v diagnostike gnoino-vospalitel'nykh zabolevanii posle operatsii kesareva secheniia.

Blood serum pregnancy-associated alpha 2-glycoprotein and trophoblastic beta 1-glycoprotein were measured in puerperants with the normal postpartum period and with that complicated by pyo-inflammatory diseases after abdominal delivery. The levels of both proteins were found reduced in the patients with pyo-inflammatory diseases developing after cesarean section as early as on day 1 postpartum. that of alpha 2-glycoprotein by 1.2 times, that of trophoblastic beta 1-glycoprotein twofold.

[Study of structural features of macroglobulins complexed with plasmin]. / Izuchenie strukturnykh osobennostei kompleksov makroglobulinov s plazminom.

Activities of plasmin and trypsin contained in complexes with alpha 2-macroglobulin, related to pregnancy alpha 2-glycoprotein and with protein A were studied in presence of various inhibitors with a molecular mass of 0.2-70.0 kDa. Specific characteristics of interaction between plasmin and these macroglobulins inhibitors as well as with alpha 1-inhibitor of proteinases, antithrombin III and alpha 2-antiplasmin were studied using electrophoresis and immunoblotting.

[Hepatocyte receptors for proteinase inhibitor complexes with plasmin]. / Izuchenie retseptorov gepatotsitov dlia kompleksov ingibitorov proteinaz s plazminom.

Hepatocyte receptors have been found for such complexes as alpha 2-macroglobulin-plasmin, pregnancy-associated plasma protein A-plasmin, and pregnancy-associated alpha 2-glycoprotein-plasmin, molecular masses of these receptors being estimated. The proteinaceous component of hepatocyte membranes contains heavy chains of plasmin and a 50 kDa fragment of plasmin molecule. These chains and the fragment are able to bind the native alpha 2-antiplasmin. Using immunoblotting no hepatocyte receptors for native macroglobulins, and alpha 2-antiplasmin-plasmin, alpha 1-proteinase inhibitor were detected.

[The immunohistochemical detection in the human placenta of proteins related to the blood coagulation system]. / Immunogistokhimicheskoe vyiavlenie v platsente cheloveka nekotorykh belkov, sviazannykh s sistemoi svertyvaniia krovi.

Distribution in mature human placenta of plasminogen, pregnancy-associated inhibitors of proteases (pregnancy-associated protein A (PAPP-A) and alpha 2--pregnancy-associated glycoprotein, and also of not associated with pregnancy alpha 2-macroglobulin and alpha 1-antitrypsin was examined. Primary monospecific antibodies and secondary antibodies labeled with colloid gold were used. Plasminogen was detected in the fetal and maternal blood, and also on the surface of some placental villi (as thin positively stained rims). Pregnancy-associated protease inhibitors were detected in the syncytium of the villi of all histological types and also in the fetal and maternal blood. Staining for alpha 2-macroglobulin was most intensive. This antigen was detected in the maternal and fetal blood and on the surface of the villi. alpha 2-antitrypsin was detected in the fetal and maternal blood. It has been shown that both free plasminogen and its inhibitors are retained on the surface of the placental villi.

[Comparative study of immunosuppressive properties of pregnancy- associated protein A, alpha 2-glucoprotein and alpha 2-macroglobulin]. / Sravnitel'noe izuchenie immunosupressivnykh svoistv assotsirovannykh s beremennost'iu proteina A i alpha 2-glikoproteina, a takzhe alpha 2-makroglobulina.

Effects of high-molecular proteinase inhibitors on spontaneous and mitogen-induced lymphocyte proliferation were examined in males and pregnant and non-pregnant females. All three proteins, A protein, alpha 2-glycoprotein, and alpha 2-macroglobulin were found to be potent immunosuppressors and their activity was determined by the stage of pregnancy, the dose and mode of mitogenic lymphocyte stimulation.

[The effect of steroid sex hormones on the biosynthesis of alpha 2-macroglobulin and pregnancy-associated alpha 2-glycoprotein in cultures of peripheral blood mononuclear cells]. / Vliianie steroidnykh polovykh gormonov na biosintez al'fa 2-makroglobulina i assotsiirovannogo s beremennost'iu al'fa 2-glikoproteina v kul'turakh perifericheskikh mononuklearnykh kletok krovi.

The peripheral blood mononuclears are capable of intense biosynthesis of alpha 2-macroglobulin and of weak biosynthesis of pregnancy-associated alpha 2-glycoprotein. Sex hormones of men and non-pregnant women exert no influence on the protein biosynthesis. During pregnancy alpha 2-macroglobulin biosynthesis is shortly activated, although it does not depend on the influence of sex hormones. All the steroid sex hormones provide a short-term biosynthesis of this protein during the II trimester of pregnancy, while testosteron inhibits it during the III trimester. Possible mechanisms of control of biosynthesis of these proteins are discussed.

[Distribution of alpha 2-macroglobulin and pregnancy-associated protein A and alpha 2-glycoprotein in human placenta]. / Raspredelenie alpha2-makroglobulina, assotsiirovannykh s beremennost'iu proteina-A i alpha2-glikoproteina v platsente cheloveka.

By means of immunoperoxidase technique staining localization in the mature placenta of a number of highly molecular proteins--alpha 2-macroglobulin and associated with pregnancy alpha 2-glycoprotein and protein-A--has been determined. These proteins are predominantly determined in syncytiotrophoblast and decidual cells. Similarity in distribution of the proteins in question is determined not only by identity of their receptors, but is evidently caused by community of their functional properties.

[Pregnancy-associated alpha 2-glycoproteins in the diagnosis of postpartum suppurative and septic diseases]. / Assotsirovannyi s beremennost'iu alpha 2-glikoprotein v diagnostike poslerodovykh gnoino-septicheskikh zabolevanii.

The levels of pregnancy-associated alpha 2-glycoprotein (alpha 2-GP) were measured in the blood sera of puerperants with physiologic postpartum and postoperative (after cesarean section) periods, and with those complicated with pyoseptic diseases. alpha 2-GP levels were changed in the blood sera of puerperants with postpartum infectious diseases. The authors discuss the possibility of predicting the postpartum complications with the use of alpha 2-GP measurements.

[An immunoenzyme method of determining pregnancy-associated alpha 2-glycoprotein]. / Immunofermentnyi metod opredeleniia assotsiirovannogo s beremennost'iu al'fa 2-glikoproteina.

Methods for purification of pregnancy-associated alpha 2-glycoprotein, obtained antibodies to it, and enzyme immunoassay of this protein are described. Enzyme immunoassay permits measurement of this protein in blood serum and mononuclear cell cultures in a wide range of concentrations. The method sensitivity may be improved by removing the antibodies cross-reacting with animal proteins.

[Effects of nirmin on central hemodynamics in patients with heart failure in the acute period of myocardial infarct]. / Vliianie nirmina na tsentral'nuiu gemodinamiku u bol'nykh s serdechnoi nedostatochnost'iu v ostrom periode infarkta miokarda.

Nirmin, a novel dosage form of nitroglycerin, was used to treat heart failure in 47 patients on days 1-3 after acute myocardial infarction. The drug was intravenously injected at 12-400 micrograms/min for 3-24 hours. Central hemodynamic changes were evaluated from equilibrium radionuclide ventriculographic data and pulmonary diastolic and central venous pressures. Nirmin improved the clinical status in 89.3% of the patients. Hemodynamic effects of the agent were manifested by reduced myocardial preload and its improved contractility, followed by elevated left ventricular ejection fraction and decreased hypokinesia of the myocardial affected areas.