[Is vTAPP for small ventral hernias a potential «gold standard¼ for less than 24 hours hospitalization?] / Operatsiya vTAPP pri nebol'shikh ventral'nykh gryzhakh ­ potentsial'nyi «zolotoi standart¼ dlya dosutochnoi gospitalizatsii?

OBJECTIVE: To evaluate clinical efficacy and cost-effectiveness of vTAPP for small/M3W1 hernias compared to IPOM. MATERIAL AND METHODS: We retrospectively analyzed a prospectively recruited group of patients. Study objects were patients undergoing ventral laparoscopic transabdominal preperitoneal hernia repair (vTAPP) for primary Midline/Lateral Small hernias up to 2 cm. The control group comprised patients after IPOM procedure. RESULTS: We analyzed 179 patients: vTAPP (n=132) and IPOM groups (n=47). The vTAPP group was characterized by significantly shorter hospitals-stay (Q1-Q3: 8-70 hours, p<0.001), fewer relapses (n=2, p=0.047) and slightly longer surgery (Q1-Q3: 40-80 min, p=0.037). Cost-effectiveness analysis revealed 3.39 times more profitable vTAPP compared to IPOM. CONCLUSION: Laparoscopic preperitoneal hernia repair is a safe and effective method not requiring special tools and consumables. This approach is applicable as an outpatient (or <24h hospital-stay) method.

Endothelial dysfunction markers and immune response indices in cosmonauts' blood after long-duration space flights.

Space flight factors are known to cause a malfunction in the human immune system and lead to damage to blood vessels. The hemostatic function of endothelium during space missions and its interaction with human immunity has not been determined so far. In this work, we investigated the markers of endothelial activation and damage (plasma concentrations of soluble thrombomodulin fraction (sTM), von Willebrand factor (vWF), highly sensitive C-reactive protein (hs-CRP)), as well as the level of D-dimer and compared them to the immunological parameters characterizing the state of human humoral and cellular immunity. The immune status of long-duration ISS crewmembers was assessed by whole-blood testing, and comprehensive postflight immune assessment included the analysis of leukocyte distribution. Flow cytometry was applied to determine the absolute counts and the percentage of lymphocyte subsets: B cells (CD19+), T cells (CD3+, CD3+CD4+, CD3+CD8+), NK cells (CD3-CD16+CD56+, CD11b+CD56+), and activated subsets (CD3+CD25+ and CD3+HLA-DR+). The in vitro basal cytokine production was investigated in whole blood cell culture. The cytokines IFN-gamma, IL-1-beta, IL-4, IL-6, IL-10, IL-18, and TNF-alpha were measured in plasma and the 24-h supernatants by a sensitive enzyme-linked immunosorbent assay. A significant increase in the plasma levels of vWF and hs-CRP and a decrease in the concentration of sTM after spaceflights were detected. Divergent changes in the parameters characterizing the state of the immune system were observed. We propose that the changes revealed may lead to an increase in the procoagulant activity of blood plasma, suppression of protein C activation and thrombin inhibition, as well as to an increase in the adhesive-aggregate potential of platelets, especially in case of changes in the rheological characteristics of blood flow during re-adaptation to ground conditions. We also speculate that the immune system might play an important role in vessel damage during long-duration missions.

Quantitative target proteomics of chromosome 13 human blood plasma proteins.

Quantitative proteomic analysis of 50 blood plasma samples of healthy volunteers who underwent a comprehensive medical examination and were found eligible for space flights was performed. As a result of directed mass spectrometric analysis, signals for 128 proteins, which accounted for nearly 40% of the total number of chromosome 13 gene products, were detected. The analysis of interindividual variation of concentrations of chromosome 13 proteins showed the presence of a pool comprising 41 proteins with a low variation (CV < 30%), which can potentially be used as biomarkers.

Reference Values of the Hemostasis System Indices in Cosmonauts.

The values of 11 diagnostically significant hemostasis system indices in venous blood were determined during the preflight (30-45 days before start) clinical and physiological examination of 39 cosmonauts aged 35 to 54 who were the members of the main and backup crews of missions to the International Space Station in the period from 2007 to 2014. Since most of the cosmonauts performed several flights during this period, and they were repeatedly included in backup crews, each of the cosmonauts underwent preflight examinations one to five times. The reference values were calculated for each of the studied indices. It was'found that the reference ranges for parameters indicative of integral pro-, anticoagulant and fibrinolytic potential were narrowed and close to the boundaries of ranges for the general population,- which indicates that the cosmonauts had relatively decreased procoagulant potential and increased hemostasis regulative.potential. This was probably due to the criteria of selection, physical training status, and emotional status of crew members during the preflight professional activity, when the adaptive changes against the stress-inducing effects occur in the organism. The cosmonauts who underwent strict medical examination may also have some genetic features which provide higher body resistance and more rapid adaptation processes.

[Oxidation Stress Markers Dynamics in the Experiment of Long-Term Antiorthostatic Hypokinesia (Retrospective Study)].

In blood serum of 9 volunteers aged 27 to 42, participated in the experiment with 370-day antiorthostatic hypokinesia (-5 degrees), the lipid peroxidation derivates concentration--diene conjugates (DC), malonic dialdehyde (MDA), Schiff bases (SB) as well as antioxidant defense system indices--tocopherol (TP) concentration and total antioxidative activity level (AOA) were measured. The volunteers were divided into two groups subjected to physical training regimes and used prophylactic measures. In both groups the lipoperoxidation processes initial stages depression (by 54-73%) was observed starting from 50th day, thus the lipid peroxidation final product--SB level was decreased (by 50-61%) only to the 230 day and remains approximately at the same level till the end of the experiment. The restorative period was characterized by decreasing (in 1.6-2.3 times) of MDA and SB concentrations. The decrease in lotal AOA during the aftereffect period was detected in all volunteers, and its level was significantly lower physiological norm range. Probably, long-term adaptation to the simulated weightlessness conditions is accompanied by expressed decrease in biological oxidation processes intensity and significant stress effect, as indicates by essential depression of lipid free radical oxidation in the course of the experiment. At the same time the restorative period after 370-day antiorthostatic hypokinesia was characterized by significantly expressed and prolonged readaptation stress progress. It is evidenced by practically twofold decrease in lipoperoxidation processes intensity against significant increase in TP concentration and water-soluble antioxidants functional reserves exhaustion. Lipid peroxidation activation absence in all terms of examination reflects appropriate compensation of studying impact by volunteers.

[Lipid Peroxidation and Antioxidant Defense System in Humans after Hypergravitational Influence of Different Force.]

In the group of 14 volunteers in age from 25 to 45 years the effects +Gz (head-pelvis) overloads, amount to 3, 5 and 7 g with a rising rate of 0.03 g/s, intensity of lipid peroxidation (LPO) and the state of the system of antioxidant protection (AOP) had been studied. In the blood the content of LPO products - diene conjugates, malon dialdehyde, shiff bases and the condition of water-phase(activity of catalase, glutathione peroxidase) and lipid-phase (content of tocopherol) based components of the AOP system determined. It is found that hypergravitational influence of the size of 3 g was accompanied by signs of a slight LPO activation with its subsequent inhibition; when the value of the overload was observed in 5 g only signs of LPO inhibition took place; in case of overload force in 7 g was not observed statistically significant changes in all studied parameters. The most likely explanation of the observed phenomenon may be the activation of a passive protection mechanisms of the biomembrane, providing change its phase state. Further investigation of the mechanisms of compensation and control the intensity of free radical processes in hypergranulation influence is necessary.

HUMAN'S BREATH DURING MODELED PROLONGED HYPODYNAMIA.

Low-molecular volatile metabolites were studies in breath of healthy human subjects exposed to prolonged hypodynamia and verified as potential biomarkers of hypoxia in skeletal muscles and myocardiur by comparison with energy metabolism biochemical indices. cs) was explored Profile of volatile organic compounds (VOCs) was explored in breath of human subjects whose motor activities were limited due to 520-d isolation and connnemnerK nVIC - Analysis of detected voCs and comparison with dynamics of energy metabilism resulted in suggesting acetol as a potential breath biomarker of tissue hypoxia in skeletal muscles and myocardium. origination of acetol, the lactate precursor in methylglyoxal glucose oxidation, was hypothesized. It was shown that acetol decreases in consequence of low motor activity correlates with changes in biochemical indices of enzymes involved in energy metabolism and glycolysis, and also creatinine indicative of underloading the skeletal muscles. Decline in the activities of muscular and myocardial constellation enzymes during hypodynamia matches with the reliable dicrease in breath acetol.

[The Status of Hemostasis System in Hypoxic Nitrogen-Oxygen and Argon-Oxygen Diving Gases].

In this study the effect of factors of hermetic chamber with modified gas medium on the hemostasis system is analyzed in order to estimate and to compare different diving breathing gases. The parameters characterizing pro-, anticoagulant as well as fibrinolytic components of hemostasis were determined using clotting, chromogenic and immunological methods. The applied exposure did not affect the activity and regulatory potential of hemostasis significantly; however, the nitrogen-oxygen and argon-oxygen diving gases have a different effect on the hemostasis functioning, especially in the recovery period.

[COMPREHENSIVE ASSESSMENT OF THE HEMOSTASIS SYSTEM IN TEST-SUBJECTS IN EXPERIMENT "MARS-500"].

The paper is devoted to the hemostasis studies in the course of long-term (520 d) isolation in an airtight chamber. Measured parameters included activated partial thromboplastin time (APTT), international normalized ratio (INR), thrombin time (TT); concentrations of fibrinogen (FBG), plasminogen (PG), Willebrand factor (WF), tissue factor pathway inhibitor (TFPI), and tissue plasminogen activator (TPA), thrombomodulin (TM); activities of the coagulation cascade factors (II, V, VII, X, VIII, IX, XI, XII), antithrombin III (ATIII), protein C (PC), C1-inhibitor (C1), α2-antiplasmin (AP), TPA and TFPI. The investigation revealed a diversity of changes in the plasma fibrinogen concentration, slower blood coagulation in the intrinsic pathway and the final stage, and a relative rise in the activities of ATIII and PC-inhibited factors. The rest parameters showed different trends.

[TESTING THE PROTECTIVE PROPERTIES OF ARGON DURING SUBACUTE EXPOSURE TO HYPOXIC HYPOXIA].

Previously it has been shown that argon has a stimulating effect on biological processes including, specifically, strong protective properties during exposure to acute (1-4 hrs.) hypoxic hypoxia. Experiments with animals under hypoxia gradually growing over 3 to 7 days may give insight into mechanisms of the argon protective action. Purpose of the work was to explore character and severity of developing disorders, to attempt their prognosis and to test potentiality of argon as a protector from the effects of subacute hypoxic exposure. In two series of experiments Wistar male rats were housed in pressure chambers with different rates of O2 reduction without argon and with argon in concentration of 32-38%. Oxygen reduction from 20.9 to 9.0% in 3 days led to the death of 50% animals. Oxygen reduction to 12.0% in 7 days and one day in low-oxygen atmosphere was harmless for animals. Argon in air makes the response to hypoxia almost twice as sharp on virtually every level (red blood system, physiological, morphological and biochemical shifts) validating the concept that argon acts as a stimulator. In context of the most critical processes of adaptation to hypoxia--activation of blood formation and lipid metabolism--this sharpening of the response results in depletion of body resources and instigates irreversible shifts.

[Effect of physical countermeasures against support load deficiency on the hemostasis system in an experiment with 7-day immersion].

In an experiment with 7-d dry immersion for testing the mechanic foot and electrical muscle stimulation procedures of compensating the support load deficiency the following biochemical parameters were studied: activated partial thromboplastin time, prothrombin time, prothrombin index, international normalized ratio, thrombin time (TT), fibrinogen, soluble fibrin-monomer complexes, D-dimer (DD), plasminogen (PG); antithrombin III activity (ATIII), protein C (PC) and alpha2-antiplasmin (AP). Control subjects (immersed w/o stimulation) did not exhibit significant shifts in the hemostasis system: however, they decreased ATIII, PC and PG in the post-experimental period. Mechanic foot stimulation did not have a noteworthy effect on the hemostasis system functioning during immersion, whereas electromyostimulation increased procoagulant and fibrinolytic activity in blood plasma.

[Status of the water-soluble component of the antioxidant defense system in the conditions of 520-day isolation].

In the 520-d chamber experiment within the international project Mars-500 blood samples of 6 male test-subjects of 28 to 39 years of age were analyzed for water-soluble antioxidants: total bilirubin and uric acid; in addition, total antioxidant capacity of blood plasma was determined. Maximal values of these parameters were associated with the most stressful periods of the experiment, i.e. adaptation to the life in isolation and confinement, simulation of the egress onto Martian surface, and change of the diet. On attainment of the homeostatic equilibrium the parameters stabilized on levels slightly lower relative to baseline (pre-isolation) values. Therefore, dynamics of the water-soluble antioxidants reflected adequately the homeostatic reactions to and compensation by organism of the effects of the 520-day life in isolation and confinement.

[Reference values of Russian cosmonauts blood biochemical indices].

Within the period of 2000 to 2012 the values of 40 diagnostically significant biochemical indices in venous blood were being determined during the pre-flight clinical and physiological examination of 28 Russian cosmonauts aged 35 to 54, members of main and back-up crews of expeditions to the International Space Station. The above examination was conducted 45-30 days prior to the launch. Taking account of the fact that each of the most of the cosmonauts performed several flights over the mentioned period and they were repeatedly included in back-up crews over and over again, each of cosmonauts participated in pre-flight examinations 1 to 5 times. Reference values were calculated for each of the studied indices. It was found that reference interval boundaries for 15 indices were narrower as compared to the generally accepted ranges. The upper boundaries of activity reference ranges of a number of enzymes, as well as of concentration of some metabolites of energy and plasticity metabolism were raised relative to mean population values. Thus, it was found that Russian cosmonauts being a specific professional team featured inherent reference values which differed from mean population values in a number of blood biochemical indices. It is conditioned by peculiarities of selection, physical training and psychic and emotional status of crew members during a pre-flight period.

[Intensity of lipid peroxidation and antioxidant protection system indices in the course of a 3-day "dry" immersion experiment].

In the course of a 3-day "dry" immersion experiment involving participation of five male test volunteers aged 25 to 40, in the blood serum of participants were determined the content of LPO (lipid peroxidation) products, namely diene conjugates, malon dialdehyde, shiffbases, as well as the values of the antioxidant protection system (AOP) indices - the concentration of tocopherol as the main lipid antioxidant and the level of general antioxidant activity. During the immersion action no deviations of indices under study from the background values were revealed, with the exception of a certain increase in tocopherol concentration within two hours after experiment beginning. At the restoring period after two hours upon immersion completion a reliable increase of lipid peroxidation products, particularly diene conjugates in participants' blood serum was made evident. At this, the tocopherol content was significantly below the background values. It is therefore concluded that the test participants' adaptation to the simulated weightlessness conditions shows no pronounced stress component, whereas bringing back to normal vital functions after exposure to immersion occurs with significantly pronounced stress reaction development, as demonstrated by considerable growth of LPO processes against the background of AOP system functional activity reducing.

[Metabolic effects of physical countermeasures against deficient weight-bearing in an experiment with 7-day immersion].

Metabolic effects of physical countermeasures against deficient weight-loading were studied in three groups of 21-30 y.o. volunteers for 7-d dry immersion. Blood serum was investigated for 38 biochemical parameters that characterize myocardium, skeletal musculature, hepatobiliary system, kidney, pancreas, GI tract, prostate, and protein-nucleic, carbohydrate, electrolyte and mineral metabolism. Seven-day DI w/o countermeasures (n = 5) increased concentration of conjugated bilirubin, suppressed activities of muscular (creatine phosphokinase MM) and myocardial enzymes (CPK MB, OBDH), and caused an upward trend in cholesterol, its atherogenic LDP fraction and triglycerides. Mechanic sole stimulation (n = 6) intensified, within the physiological norm, erythrocyte hematolysis raising total bilirubin and potassium. Despite the stimulation, activity of muscle and myocardial enzymes made a decrease. Blood creatinine decreased to a less extent than in the immersed group w/o stimulation, however, lipid parameters did not rise. High-frequency stimulation of the lower leg and hip muscles in the course of immersion (n = 5) was noted to heighten the activity of muscle enzymes and potassium level in blood beyond the physiological norm. Change in creatinine did not reach a statistical significance and lipid metabolism parameters were not different from baseline values. Application of these physical methods of counteracting deficiency of weight bearing did not interfere with redistribution of body liquids due to immersion. Values of the parameters under study were mostly within the normal limits throughout the experimental exposure suggesting absence of pathological developments during DI or in consequence of physical stimulation. Therefore, the reactions were obviously of normal adaptive character.

[Intensity of lipid peroxidation and antioxidant protection system indices during re-adaptation period after long-term space flights at the international space station].

In the blood serum of seventeen members of crews which participated in 14 orbital expeditions to the International Space Station with the duration of 125 to 217 days, during the pre-flight period and on the day of landing on the 1st, 7th and 14th days of the rehabilitation period (RP) the content of LPO products was determined, namely diene conjugates (DC), malon dialdehyde (MDA), shiffbases (SB) and the main lipid oxidant - tocopherol (TP). The group of astronauts who made landing in the Space Shuttle spacecraft (8 persons) and the group of astronauts who accomplished space mission in the Soyus TM spacecraft (9 persons) demonstrated a decrease in DC and MDA levels with a rise in TF concentration in the course of the rehabilitation period. Changes in the group of the American spacecraft astronauts were more pronounced. LPO inhibition during the rehabilitation period is recognized [treated] as an adequate reaction to the stress caused by re-adaptation to the ground conditions. Also are discussed probable mechanisms of intergroup differencies in LPO intensity degree: biomembrane phase state changing under the influence of overloads during de-orbiting and stress response intensity during landing in different types of spacecraft.

[Hemostasis system indices in the course of a 105-day hermo chamber isolation experiment].

The present paper deals with studying of hemostasis system indices in the course of the experiment with a 105-day isolation in a hermo chamber. The following values were determined: activated partial thromboplastin time, prothrombin time (PT), prothrombin index (PI), international normalized ratio [relationship] (INR), thrombin time, fibrinogen concentration, soluble fibrin-monomer complexes, D-dimer, plasminogen (PG), activity of antithrombin III, protein C, alpha2-antiplasmin. According to the experiment results, isolation is accompanied by PT prolongation (PI decreasing, INR increasing) which conserves up to the 7th day of the aftereffect period, as well as by PG concentration decreasing. Changes are likely to be connected with peculiarities of reduced motion activity conditions, compensatory physical activity influence, protein and lipid metabolism characteristics changing.

[Scatological investigations during 105-day isolation].

Dynamics of the gastrointestinal functioning was reconstructed by analysis of the scatological data from volunteered subjects before, on days 16, 35, 45, 60, 90 and after completion of 105-day isolation experiment. The analysis showed that scatological investigations performed in the conditions imitating life in an exploration vehicle environment are instrumental in detecting deviations in the GI function indicative of pancreas excretory and hepar biliary excretion and synthetic hypofunction that can be responsible for intestinal dysfunction. Normalization of scatological parameters following the experiment witnesses to functional genesis of the changes observed during the exploration mission simulation.

[Dynamics of the protein content of human urine during 5-day immersion].

Variations in the protein spectrum (12 groups) of native daily urine were studied during 5-day dry immersion (DI) of 14 subjects at the age of 19 to 26 years using gradient electrophoresis in polyacrylamide gel. Protein excretion with urine did not alter in the course of the experiment. However, the urine proteins spectrum trended to some shifts. Excretion of low-molecular proteins decreased and of albumin increased pointing to remodulation of tubular reabsorption initiated by the experimental conditions. Steady growth of the Tamm-Horsfall protein concentration seems to be a defense reaction. There was an incremental decrease in immunoglobulins that could be associated with a reduction of glomerular filter permeability for high-molecular proteins.

[Hemostasis system indices after short-term space flights and during 7-day "dry" immersion experiment].

The present paper deals with studying ofhemostasis system indices after short-term (10-11 days) space flights as well as in the course of the experiment with a 7-day "dry" immersion. The following values were determined: activated partial thromboplastin time, prothrombin time, prothrombin index, international normalized ratio (INR), thrombin time (TT); fibrinogen, soluble fibrin-monomer complexes, D-dimer, plasminogen (PG) concentration; activity of antithrombin III (ATIII), protein C (PC), alpha2-antiplasmin (AP). In the 1st day after space flights a fibrinogen concentration was increased significantly as well as TT shortening tendency and fibrinolysis activation tendency were observed. There were no significant changes in ATI I11 and PC activities. During the immersion period there were no significant changes in investigated indices, with the exception of AP activity increase in 3rd day of experiment. In readaptation period, however, a decrease in ATIII and PC activities as well as PG concentration was observed. Hemostasis system response features after space flights and during immersion are probably due to different intensity and duration of external factors effects.