Urethroplasty with balloon catheterization in fetal lower urinary tract obstruction: observational study of 10 fetuses.

OBJECTIVE: To present the preliminary outcomes of fetal urethroplasty using a coronary angioplasty balloon catheter in lower urinary tract obstruction (LUTO). METHODS: We included 10 consecutive male fetuses diagnosed with LUTO caused by presumed isolated posterior urethral valves (PUVs), who underwent urethroplasty with a balloon catheter in our center between 2015 and 2018. During urethroplasty, the fetal urethra was dilated using a balloon catheter (diameter, 0.014 inches; balloon size, 2 × 9 mm) inserted under ultrasonographic guidance via an 18-gauge needle introduced into the fetal bladder. RESULTS: Mean gestational age at the time of urethroplasty was 17.8 (range, 16.5-20.4) weeks. All fetuses survived the procedure without any complications and there was no case of preterm prelabor rupture of the membranes. The procedure was successful in 5/10 (50%) fetuses, while in the other five (50%), we were unable to insert the balloon catheter into the urethra. In the five successfully treated cases, mean gestational age at delivery was 38 (range, 36-40) weeks and presence of PUVs was confirmed after birth. All five neonates micturated spontaneously and presented with normal urine output after birth. During the follow-up period, the parameters of kidney function were within normal limits in two neonates, whereas signs of impaired renal function were seen in another two. The other was diagnosed with renal insufficiency and required kidney transplant with bladder sparing at 2 years of age. CONCLUSIONS: Urethroplasty with a balloon catheter is a new prenatal treatment option for fetuses with PUVs. By restoring fetal micturition, the procedure can preserve normal urinary bladder and kidney function. Although data on its efficacy and potential to differentiate the etiology of LUTO are sparse, a significant advantage of this method is its safety for the fetus and the mother. Even if the neonates develop renal insufficiency, they may be eligible for kidney transplant with connection to their own bladder, without the need for urostomy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

[Efficiency of preventive dental care in school dentistry system].

Ways of development of Russian school dentistry are defined and justified based on the analysis according to logistics, personnel, legal, financial and economic basis for the reorientation of the service for preventive direction, which should be a priority in the current conditions. The implemented model of school dental care based on team work of the dentist and dental hygienist proved to be highly efficient and may be recommended for wide introduction in practice.

[Effectiveness of adjuvant chemotherapy in patient with early stages of non-small cell lung cancer depending on proliferation index of tumor].

UNLABELLED: Adjuvant chemotherapy is a debatable question in patients with early stages of non-small cell lung cancer (NSCLC). Prognostic/predictive markers should be used for individualizing prescription of adjuvant chemotherapy. The aim of our study was to investigation effectiveness adjuvant chemotherapy in patients with early stages of NSCLC due to proliferation index of tumor. We included in study 254 patients with I-II stages of NSCLC that conducted treatment in department of thoracic surgery Zaporozhye regional clinical oncology center since June 2008 to December 2012. Expression Ki-67, proliferation marker, measured in 95 patients that used adjuvant chemotherapy and in 122 patients with out additional treatment. Measuring of proliferation index was don by next method: 0-5% immunopositive cells--0 point, 6-25%--1 point, 26-50%--2 point, 51-75%-- 3 point, 76-100%--4 point. High expression was > or = 2 points. RESULTS: Mean of proliferation index in patients with early stages of NSCLC was 37.6% (95% CI, 33.8-41.5%). Median of survival in patients with II stage of NSCLC was 39.7 month if patients conducted adjuvant chemotherapy and 21.4 month with out treatment. It was tendencies increasing survival in patients with II stage of NSCLC after adjuvant chemotherapy, but it was not statistically significant (P = 0.16). Survival patients with high proliferation index was 10.5 month--75 percentile, 18 month--median, 29.9 month--25 percentile. In patients after adjuvant chemotherapy 75 percentile of survival was 34.4 month, median of survival not complete. Survival differences of two group were statistically significant (P < 0.0001). Thus individualization of prescription adjuvant chemotherapy in patient with early stages of NSCLC helps improves results of treatment and avoid unreasonable toxic therapy.

[Effect of the intercellular adhesion molecule E-cadherin on the prognosis of non-small cell lung cancer].

The effect of E-cadherin on the prognosis of Stage I-II non-small cell lung cancer (NSCLC) was investigated. Tumor E-cadherin expression and its correlation with the clinical and morphological characteristics of a patient, as well as the prognostic role of this marker were studied. It was ascertained that the E-cadherin expression did not depend on patient gender and age, tumor histological pattern, location, grade, and pT category, but it was significantly related to the pN1 category (p < 0.0001). Univariate analysis revealed that the histological pattern of a tumor, nodal status, resection type (lobectomy/pulmonectomy), and E-cadherin expression level were significantly correlated with patient survival. Multivariate analysis showed that the important predictors were tumor histological pattern and resection type (p = 0.01 and p = 0.00004, respectively). A more complete study of the prognostic and predictive role of E-cadherin expression in patients with Stage I-II NSCLC will help identify a prognostically unfavorable group of patients who may be given additional treatment in the postoperative period.

[Lymph node dissection in patient operated for non small cell lung cancer in early stage].

At present time volume of lymph node dissection in patients with lung cancer is discussed. The aim of study was comparison efficiency of complete and partial mediastinal lymph node dissection. In 154 patients, who treated Zaporozhye Regional Clinical Oncology Center for non small cell lung cancer in early stage, complete mediastinal lymph node dissection was done in 44, and partial--in 110. Patients with T2-T3, peripheral tumor and pneumonectomy had worth survival if partial mediastinal lymph node dissection was completed. Independent prognostic factors were histologyc form of tumor, volume of operative intervention, volume of lymph node dissection. Therefore, complete mediastinal lymph node dissection increasing survival patients with early stage of lung cancer.

[The influence of microvessel density in the tumor on the prognosis in patients with stage I-II non-small cell lung cancer after surgical treatment].

A study of the prognostic role of microvessel density in tumors of patients with stage I-II non-small cell lung cancer (NSCLC) was performed from June 2008 to June 2011. Determination of microvessel density using the marker CD31 was conducted in 114 patients. Microvessel density was significantly correlated with tumor size: so at greater than 3 cm in diameter, the content of microvessels was 68.7 +/- 3.1, with a smaller tumor size--48.6 +/- 4.5. Independent prognostic markers in patients with stage I-II NSCLC after surgery are histological type (HR = 2.97), tumor size (HR = 4.5), and the number of microvessels in tumor (HR = 3.2).

Possible usefulness of echocardiographic Z-scores in autopsy routine of the foetal great vessels.

BACKGROUND: Abnormal diameters of foetal vessels are common findings in congenital heart defects. However, it is difficult for pathologist to assess whether the diameters of the vessels are normal or not and to compare with echocardiographic data. The Z-score is a dimensionless quantity representing the distance between the raw score and population mean in standard deviation units. Using Z-score, we can compare single cases to average standards in the population. AIM: To compare diameters of great arteries measured in specimens fixed in 10% formalin solution to normal values obtained on echocardiography using Z-scores. MATERIAL AND METHODS: The study was performed on 43 formalin-fixed normal foetal hearts aged from 19 to 40 weeks of gestation. Each specimen was dissected and the following diameters were measured: aortic valve (AoV), ascending aorta (AAo), descending aorta (DAo), aortic isthmus (AoI), ductus arteriosus (DA), pulmonary trunk valve (PV), and pulmonary arteries (RPA and LPA). Z-score parameters were calculated for all structures using the Foetal Echo Z-score Calculator. RESULTS: Z-score values of all measured foetuses were mostly found to fit within the echocardiographic norms, although the most reliable results were obtained for foetuses aged 23 weeks. This group was represented by the highest number of specimens. The minimal and maximal Z-score values were, respectively: AoV -3.45, 1.4; AAo -4.24, -0.11; DAo -2.12, 1.29; PV -3.21, 0.69; RPA -3.4, 0.84; LPA -2.25, 0.31; AoI -1.97, 0.96; DA -3.56, -1.52. CONCLUSIONS: The diameters of great arteries measured on autopsy are comparable to the results obtained from echocardiographic measurement. Z-score values for foetal echocardiography can be applied to post-mortem examination.

[School stomatology condition in some regions of Russia].

Representative for the whole country study on school stomatology condition was performed in 9 regions of Russia. There were received data about the functioning of school stomatological rooms in 7165 schools including 3230 rural schools in which 1 606 138 children studied from which 33% were primaries. Several problems were disclosed in school dentistry system functioning including absence of unified licensing, manpower shortage, absence of stomatological rooms in new schools, re-equipment of earlier existed stomatological rooms by school administration decision, not allotment of dental hygienist into functioning. Necessity of school dentistry functioning reorganization into the side of stomatological diseases prevention was underlined.

The study of arterial anastomoses in the region of the alveolar process and the anterior maxilla wall in foetuses.

The anterior maxilla wall and alveolar process are covered by the arterial network. Procedures in this region can cause heavy bleeding. Knowledge of the anatomical course of a particular artery is essential for performing surgery in this area. The aim of this study was to search for and then analyse anastomoses between the infraorbital and posterior superior alveolar artery. In the study, 19 maxillas of foetuses were analysed. The arteries were injected with coloured latex. The dissection was carried out using a surgical microscope and microsurgical equipment. The lower eyelid with cheek skin was separated and the facial muscles were cut to expose the maxilla and arteries of the alveolar process. The study revealed that in 10 out of 19 of the specimens there was an arterial connection between the infraorbital and posterior superior alveolar artery. The course of the analysed anastomosis was diverse. In all cases we observed an anterior superior alveolar artery. In all specimens the alveolar process was vascularised by many arteries originating from the analysed anastomosis. The location of the analysed anastomosis can be stated before operation, on the line between the medial eye angle and the sixth tooth of the same side. The anastomosis described in the study means that caudally running arteries are important in choosing incisions in procedures performed at the alveolar process.

Anatomy of branches of the musculocutaneous nerve to the biceps and brachialis in human fetuses.

Forty upper limbs (20 right and 20 left) of spontaneously aborted human fetuses were examined to determine the branching patterns of the musculocutaneous nerve. The mean age of the fetuses was 21.3 weeks. We identified three branching patterns of the musculocutaneous nerve to the biceps muscle. Type I with a single primary branch occurred in 47.5% of cases. Type II with two primary branches each to a separate head of the biceps muscle was observed in 42.5% of cases. Type III consisted of two primary branches, the proximal dividing into two branches, each to a different head of the biceps, and the distal branch supplying the common belly. Type III was present in 10% of cases. We found only one branching pattern for the brachialis muscle, a single primary branch. In our material communicating branches between the median and musculocutaneous nerves were found in 20% of specimens. We measured the distances between the acromion and the exit points of the first and second branch to the biceps, which averaged 36.3% for the first branch regardless of the type of branching pattern, 54.2% for the second branch in Type II, 60.7% for the second branch in Type III and 60.9% for the branch to brachialis, expressed as a percentage of the distance between the acromion and the lateral epicondyle.

[Method for determination of human individual sensitivity to fluoride].

Study for determination of human individual sensitivity to fluoride was performed on 140 patients of CRIS clinics of the age from 20 to 65 years. It was established that even in cases of F-concentrations analogous to high physiological F-concentrations in blood serum (0.19 ppm) in 11.4% of the examined patients the signs of higher F-sensitivity were observed. Human individual sensitivity to fluoride was dependant upon the severity of patient's status. The results received can be used as a base for tactics development of timely and adequate correction of F-dosage.

[The contingency of the parameters of the human brain electroencephalograms and electromagnetic fields of the Schuman resonator based on monitoring studies].

The contingency of the variations in the amplitude frequency parameters of the main modes of extremely-low-frequency resonances ionosphere waveguide (Shuman resonances) and changes in the parameters of human electroencephalograms in the range of the frequency "window" (6-16 Hz) was studied. The results of studies in the regimes of synchronized monitoring suggest that the contingency of the parameters of electroencephalograms and extremely-low-frequency resonances, expressed in the parameters of the cross-correlation function, is statistically significant and varies from 0.12 to 0.65 at alpha = 0.95. It was found that the magnitude of contingency is largely the function of the current value of the solar and geomagnetic activity.

[Milk fluoridization efficacy in a controlled study and dental caries experience dynamics in conditions of wide availability of local F-containing means].

Cross-over, controlled, randomized and triple-blind study of F-milk efficacy and monitoring of F excretion with urine under conditions of wide availability of fluoride containing toothpastes was performed in Voronezh during last 10 years. F-milk project increasingly covered annually from 10 to 15 thousand of pre-school children. From them 335 children (11 kindergarteners -- age 6 years) regularly consuming F-milk during 3 years and 175 children (6 kindergarteners -- age 6 years) of the control group were examined. Statistics of the received data with 2 tail t-test has shown that between dmf (1.59+/-1.82) in children consuming F-milk and dmf (2.58+/-2.67) in children of the control group there is significant difference (p<0.001) with 96% of the statistical power. When implementing F-milk for 10 years running there were collected and analyzed data on caries experience in children 3, 6, 9 and 12 years (2004 vs. 1994). There is considerable reduction of caries incidence in all age groups in 2004, probably due to F containing toothpastes wide use and very active hygienic education of the population in Voronezh. At the same time dmf index in 6 year old children receiving F-milk was by 39% lower than in their contemporaries from the control group. F-intake monitoring in children 3, 4, 5 and 6 years of age has shown that F-milk (daily appr. 0.2 l with the level 2.5 ppm) use is a very effective method of F-deficiency elimination, leaving out any possibility of F-overdosage exceeding its physiologic needs.

[Monitoring of fluoride levels in children receiving fluorinated milk for a long time and time course of their permanent teeth]. / Monitoring postupleniia ftorida v organizm detei, dlitel'noe vremia poluchaiushchikh ftorirovannoe moloko, i dinamika kariesa ikh postoiannykh zubov.

Measurements of fluorine concentrations in 1320 urine samples collected from 440 children in the city of Maikop showed low levels of fluorine (0.43-0.72 mg) in this group in comparison with the groups receiving prophylactic treatment with optimal safe doses of fluorine with milk (0.88-1.19 mg). Consumption of physiological amounts of fluorine does not lead to its accumulation in the body even after long (up to 5 years) consumption of fluorinated milk. Permanent ratio between the values in the control and prophylactic groups allows less frequent monitoring of fluorine levels: during the first month of prevention and then after 2 and 4 years of prophylaxis with fluorinated milk. Clinical evaluation of anticaries efficiency of fluorinated milk in 920 children aged 6-8 years (309 in the control and 611 in prophylactic groups) showed a significant decrease of caries prevalence (by 12.5-24.5%) and intensity in permanent teeth (by 50.6-56.7% by the CDL index and by 47.6-52.9% by the CDLp index) after 3-5 years of regular consumption of fluorinated milk.