Correlation of synovial caspase-3 concentration and the photodynamic effectiveness in osteoarthritis treatment.

BACKGROUND: The present study focuses on investigation of Intra-articular PDT mechanisms for OA treatment. Also, a search for determination of the most effective dose of chlorin e6 (Ce6) for anti-inflammatory PDT of OA was carried out. METHODS: The study was carried out on laboratory animals (11 Chinchilla rabbits, 1 year, 2.5 kg) with a gonarthritis model of post-traumatic OA. According to the instructions for using Photoditazin (Ce6 based PS) for PDT of human oncological and non-oncological diseases, the recommended dose is 0.7-1.2 mg/kg. For studies on rabbits, taking into account the conversion coefficient (3.2), the PS doses of 2.4, 3.2 and 6.4 mg/kg were selected. Fluorescence spectra were measured intra-articular before and after PDT using spectrometer with fiber-optic probe. The intrajoint PDT was carried out using a laser (662 ± 10 nm) and a fiber-optic catheter with a cylindrical diffuser inside a sapphire needle for a uniform distribution of the laser radiation. The immunohistochemical study was carried out by staining the samples with caspase-3. RESULTS: Histological and immunohistochemical analysis showed that the best PS dose for intravenous administration for PDT of rabbit gonarthritis is 3.2 mg/kg. The PS concentration directly in the synovial tissue was 0.5 mg/kg, and this was enough to achieve the most positive results to reduce the caspase-3 level. CONCLUSION: The caspase-3 level correlates well with other signs of inflammation in the synovial membrane (edema, etc.). Therefore, to assess the PDT effectiveness in the treatment of gonarthritis accompanied by synovitis, it is sufficient to analyze only for caspase-3. The efficacy of PDT with Ce6 showed that 3.2 mg/kg PS dose (1 mg/kg for a human) is the most effective.

Reconstruction of Ligament and Tendon Defects Using Cell Technologies.

We studied the possibility of restoring the integrity of the Achilles tendon in rabbits using autologous multipotent stromal cells. Collagen or gelatin sponges populated with cells were placed in a resorbable Vicryl mesh tube and this tissue-engineered construct was introduced into a defect of the middle part of the Achilles tendon. In 4 months, histological analysis showed complete regeneration of the tendon with the formation of parallel collagen fibers, spindle-shaped tenocytes, and newly formed vessels.

Gonarthritis photodynamic therapy with chlorin e6 derivatives.

BACKGROUND: The new methods of osteoarthritis treatment are in constant demand due to the complexity of the early diagnosis and therapy. Specific features of Сhlorin e6 derivative (Ce6) accumulation in knee joint tissues and the efficiency of photodynamic therapy (PDT) of gonarthritis were studied. METHODS: The experimental research was conducted on the model of posttraumatic gonarthritis on rabbits. The analysis of dynamics of change of Ce6 concentration in tissues of a knee joint was carried out by the method of fluorescent diagnostics. The intra-joint PDT was carried out using 662nm laser with energy density of 120-150J/cm(2) and a sapphire diffuser. An analysis of slices was conducted to confirm the anti-inflammatory effect through apoptosis. RESULTS: The method of fluorescent spectroscopy revealed that the highest amount of Ce6 was accumulated in the synovial membrane of a damaged knee joint 2.5h after its intravenous introduction. On 14th day after gonarthritis modeling but before PDT the synovial membrane showed signs of synovitis. On 21st day after PDT the synovial membrane possessed noticeable villous structure, and no cells of inflammatory nature were observed. CONCLUSION: Fluorescent diagnostics in knee joint tissues can be used in clinical practice of gonarthritis before, during and after PDT for monitoring the Ce6 accumulation and for treatment control. Optimal radiation energy density was determined to be 150J/cm(2). In the studied time intervals (5-25min) no dependency of PDT effect on irradiation time at the same energy density was observed. The analysis of results of clinical and morphological research shows that PDT is a low-invasive method of gonarthritis treatment with a high degree of efficiency and selectivity.

[Application of mini-invasive technologies in the treatment of gastrointestinal bezoars].

The data on etiology, clinical signs, diagnosis and variety of approaches to the treatment of gastrointestinal bezoars were presented, basing on the worldwide literature analysis. The results of surgical treatment of patients for bezoars, using miniinvasive methods, are presented.

[The surgical risk factors in the use of laparoscopic cholecystectomy]. / Faktory khirurgicheskogo riska pri primenenii laparoskopicheskoi kholetsistéktomii.

The increased risk factors--gender, age of the patient, the cholelithic disease existence duration, the acuteness of inflammation, the operations performed earlier on the abdominal cavity organs, influencing the laparoscopic cholecystectomy conduction for Courvoisier's gallbladder--were analyzed. The increase of intraoperative complications occurrence (hemorrhage, perforation of gallbladder, the outhepatic biliary ducts) in patients of elder age with durable disease was noted.

Tendencies in the development of gall-stone surgery with high medical technologies applied.

At present the endoscopic methods are the most acceptable in the treatment of gall-stone disease and its complications. Obstructions of terminal part of common bile duct and bile duct stones are removed by means of endoscopic sphincterotomy. Cholecystectomy is performed by means of laparoscope. A decrease in mortality and post-operative complications has been noted. At the same time negative affects of endoscopic operations in patients with concomitant somatic diseases were revealed. These patients require individual methods of approach to guarantee safe operation.

[Evaluation of the results of the treatment of pseudarthroses of the forearm bones based on the analysis of the data of radionuclide studies]. / Otsenka rezul'tatov lecheniia lozhnykh sustavov kostei predplech'ia, osnovannaia na analize dannykh radionuklidnykh issledovanii.

The work is based on the analysis of the results of radionuclide examination and treatment of 14 patients with ununited tractures and pseudoarthroses of the forearm bones. Treatment was accomplished by means of external fixation apparatuses which in comparison with intramedullary and epiosseous osteosynthesis provide a better stability of the site of bone injury and create ortimal biomechanical conditions for consolidation of ununited fractures and pseudoarthroses of the forearm bones. Radionuclide examination was conducted before the treatment to determine the initial activity of reparative regeneration in the zone of the pseudoarthrosis and the adjacent healthy regions, 2-3 weeks after perosseous osteosynthesis when the bone fragments were reduced and the compression or distraction regimen was established, and before removal of the apparatus when consolidation of the pseudoarthrosis was demonstrated radiologically. This made it possible to control the activity of reparative regeneration during treatment and to introduce corrections, if necessary. The radionuclide method is preferable to the radiological method in the intermediate stages of treatment not only because of the lesser exposure of the patient to radiation but because of the higner informativeness.