[Late diagnosis of rhinocerebral mucormycosis in patients with COVID-19 (case studies)]. / Pozdnyaya diagnostika rinotserebral'nogo mukormikoza u bol'nykh COVID-19 (klinicheskie nablyudeniya).

From the beginning of the COVID-19 pandemic, the incidence of secondary infections (both bacterial and fungal) has increased due to immune suppression associated with the use of corticosteroids or broad-spectrum antibiotics as a part of COVID-19 treatment protocol, which may exacerbate a pre-existing fungal disease or cause a new infection. Ophthalmologists are often involved in taking medical and surgical decisions in these complex cases. In this regard, a strong clinical suspicion should be applied to possible secondary fungal infections in COVID-19. Their early diagnosis and treatment may reduce mortality due to COVID-19 associated rhinocerebral mucormycosis (ROCM). This article describes two clinical cases of late detection of ROCM with two different scenarios, and compare the features of these cases with the literature data.

Hypoxia as a Factor Involved in the Regulation of the apoA-1, ABCA1, and Complement C3 Gene Expression in Human Macrophages.

Hypoxia plays a critical role in progression of atherosclerosis. Local oxygen deficiency in a plaque creates a specific microenvironment that alters the transcriptome of resident cells, particularly of macrophages. Reverse cholesterol transport from plaque to liver is considered a main mechanism for regression of atherosclerosis. Ubiquitously expressed ATP-binding cassette transporter A1 (ABCA1) and liver- and small intestine-derived apolipoprotein A-1 (ApoA-1) are two main actors in this process. We recently reported endogenous apoA-1 expression in human macrophages. While ABCA1 and ApoA-1 have antiatherogenic properties, the role of complement factor C3 is controversial. Plasma C3 level positively correlates with the risk of cardiovascular diseases. On the other hand, C3 gene knockout in a murine atherosclerosis model increases both plaque size and triglycerides level in blood. In the present study, we show for the first time that a hypoxia-mimicking agent, CoCl2, induces the upregulation of the apoA-1 and C3 genes and the accumulation of intracellular and membrane protein ApoA-1 in THP-1 macrophages. The MEK1/2-Erk1/2 and MKK4/7-JNK1/2/3 cascades are involved in upregulation of ABCA1 and C3 via activation of transcription factor NF-κB, which interacts with the HIF-1α subunit of hypoxia-inducible factor 1 (HIF-1). The three major MAP-kinase cascades (Erk1/2, JNK1/2/3, and p38) and the NF-κB transcription factor are involved in the hypoxia-induced expression of the apoA-1 gene in THP-1 macrophages.

[Significance of Thoracic Surgery for Treatment of Pleural Empyema in Childhood and Adolescence]. / Stellenwert der Thoraxchirurgie im Gesamtkonzept der Behandlung von Pleuraempyemen bei Kindern.

BACKGROUND: There still is controversy about surgical treatment of pleural empyema in children. PATIENTS AND METHODS: Retrospective analysis of treatment strategy, focussing on indication for surgery and outcome of children treated in 2 centres for pleural complications due to primary pneumonia from January 1(st) 2008 to December 31(st) 2012. RESULTS were compared to studies published within the last 10 years. RESULTS: 1 451 children with pneumonia were treated during the 5 year period. 187 (average age 6.1 years, sex: 86/101 f/m) developed a pleural effusion. THERAPY: pleural punction in 22 children, chest tube in 78 and operation in 37 children. In 9 cases microorganisms were identified. 34 children were operated for empyema stage II, only 3 for stage III. 3 children were operated due to septicaemia not responding to antibiotics. Time from admission to operation (including referring hospital):14.5 days. Time from operation to discharge: 12,5 days. All children but one were operated by thoracoscopy. COMPLICATIONS: 1 bronchopleural fistula, 1 delayed healing of the wound. All children survived and fully recovered mean (observation period 28 months postoperatively). SUMMARY: In experienced hands thoracic surgery yields excellent results for children suffering from pleural empyema stage II and III. Recent randomised prospective trials comparing fibrinolysis with VATS do not convince regarding the treatment protocols of their surgical arms. Fibrinolysis is nevertheless a valuable treatment in early stage II empyema, especially if thoracic surgical experience is not available. However, the further advanced the empyema presents, the sooner surgical experience should be gathered.

[Endovideosurgery (minimally invasive surgery) in treatment for malignant tumors of female genital organs: a 5-year experience of the clinic of the N.N.Petrov Research Institute of Oncology].

During the period of 2010-2015 laparoscopic surgery was performed in 1263 patients: 1113 with endometrial cancer (588 hysterectomies, 509 hysterectomies with pelvic lymphadenectomy, among them 16 with sentinel lymph node (SLN) mapping with Indocyanine green (ICG)); 86 with cervical cancer (80 nerve-sparing radical hysterectomies (NSRH), among them 15 with SLN mapping, 6 radical vaginal trachelectomies with endovideoassisted lymphadenectomy); 64 with ovarian malignancies. The average operating time in the group of hysterectomies was 101 minutes, in the group of hysterectomies with pelvic lymphadenectomy - 184 minutes, in the group of NSRH - 230 minutes. Average blood loss was less than 50 ml. No intraoperative complications were registered. Asymptomatic lymph cysts were observed in 122 cases. Symptomatic lymph cysts requiring surgical treatment were registered in 9 cases. Inconsistencies of vaginal sutures after radical hysterectomy were in two cases, ureterovaginal fistulas - in two cases. During a 3-year follow-up period twelve recurrences were observed in endometrial cancer patients (12/443; 2,7%), four patients (0,9%) died from disease. After NSRH two local recurrences (2,5%) were registered in patients with cervical cancer, after radical trachelectomy -two local recurrences (33%). One patient became pregnant in the group of vaginal trachelectomies. Therefore laparoscopic approach in treatment of female genital malignacies allows performing an adequate volume of surgery with minimal risk of intra- and postoperative complications, favorable course of the rehabilitation period, and oncological safety.

[Pre-surgical hormonal-metabolic state in endometrial cancer patients who underwent laparoscopy or laparotomy].

73 randomly selected from the entire array menopausal endometrial cancer patients (34 of whom were subjected to further surgery by laparotomy and 39 - by laparoscopic ap- proach) were examined 48-72 hours before surgery. Patients passed anthropometry, their medical history was collected, and in the blood serum, taken on an empty stomach, glucose, gly- cated hemoglobin, lipid fractions, insulin, thyrotropin, estradiol and testosterone levels were measured while insulin resistance index was calculated. Although patients who later went through laparoscopic surgery were characterized by somewhat higher body mass and waist circumference, other investigated pa- rameters did not differ between laparoscopy and laparotomy groups. Moreover a frequency of so called "metabolically healthy" obesity appeared to be even higher in laparoscopic group. Taken together this confirms the fact that the overweight should not be considered as contraindication for videosurgery in patients with endometrial cancer. At the same time it is desirable to compare distant oncological results with individual characteristics of pre-surgical hormonal-metabolic status of pa- tients depending on the surgery type and obesity phenotype.

[RESULTS OF LAPAROSCOPIC SURGERY FOR ENDOMETRIAL CANCER: EXPERIENCE OF THE N. N. PETROV RESEARCH INSTITUTE OF ONCOLOGY].

For the period from September 2010 to September 2014 there were operated 513 patients with endometrial cancer using laparoscopic installation the Karl Storz company. 304 patients (59.2%) underwent hysterectomy with appendages, 209 (40.8%)--hysterectomy with appendages and pelvic lymphadenectomy, including 11 patients (2.2%) with the addition of omentectomy in serous and serous-papillary forms of endometrial cancer. The average age of patients was 58.4 years (44-75 years). Body mass index over 25.0 was determined in 456 patients (88.9%), of whom 183 patients (35.6%) had an excess of body weight, in 159 (31.0%)--obesity of I degree, in 79 (15.5%)--obesity of II degree and in 35 patients (6.8%)--obesity of III degree. There were no reported complications during surgery. The postoperative period in the majority of patients was characterized by the minimal complications and absence of contraindications for adjuvant radiotherapy. During follow-up period there were registered 4 relapses: in 1 patient with serous--papillary form of endometrial cancer during the first year after surgery--in the form of dissemination of tumor in the abdomen and pelvis; in 3 patients--in the form of a cytological detection of glandular cancer cells in vaginal stump. As a result, regardless of age and comorbidities, laparoscopy allows performing to endometrial cancer patients the entire volume of planned radical surgery with minimum damage and with minimal risk of intra- and postoperative complications, favorable and accelerated rehabilitation period.

[LAPAROSCOPIC SURGERY FOR ENDOMETRIAL CANCER IN PATIENTS OVER 70 YEARS OF AGE].

Surgery is the main method in treatment for endometrial cancer. The complexity of treatment of endometrial cancer patients in elderly age is a result of a large number of comorbidities and, as a consequence, the potential possibility of a large number of intra--and postoperative complications. The article presents the international data and the analysis of own results of a use of laparoscopy in surgical treatment of these patients. A comparison with a group of operations performed by laparotomy is carried out as well as it is evaluated the main intra--and perioperative parameters and also complications, and immediate outcomes of patients treated at the Oncogynecology Department of the N.N.Petrov Research Institute of Oncology.

[INDOCYANINE GREEN (ICG) IN THE DETECTION OF SENTINEL LYMPH NODES IN ENDOMETRIAL AND CERVIX CANCER].

We analyzed the international and our own experience of using different dyes in the identification of sentinel lymph nodes in oncogynecological practice. We evaluated the possibility of using indocyanine green (ICG) in the detection of sentinel lymph nodes in patients with endometrial and cervical cancer. The first results of the use of ICG at the Oncogynecology Department of the N.N.Petrov Research Institute of Oncology are presented.

[Radiation preconditioning of mouse retina results in tolerance to MNU-induced degeneration and stimulates retinal recovery].

Emerging body of data indicate protecting effect of low level of stress (preconditioning) on retina. Our previous studies have revealed a non-linear dose-response relationship for cytotoxic effect of both ionizing radiation and N-methyl-N-nitrosourea (MNU) on mouse retina. Moreover, non-cytotoxic dose of MNU increased tolerance of retina to following challenge dose of MNU. This result displays protection of retina through mechanism of recovery. In the present study we used the mouse model for MNU-induced retinal degeneration to evaluate the adaptive response of the retina to proton irradiation and implication of glial Muller cells in this response. In this paper, we have shown that the recovery of the retina after exposure to genotoxic agents is associated with an increased efficiency of DNA damage repair and lowered death of retinal photoreceptors.

[Laparoscopic radical hysterectomy with pelvic lymph node dissection for endometrial cancer in obese patients].

The results of treatment of 61 endometrial cancer patients with various forms of obesity are presented. Two groups of patients were compared: the first group comprised 26 patients who had undergone the laparoscopic surgery; the second group included 35 patients who had open surgery. Te laparoscopic approach improved the results of surgical treatment of endometrial cancer in patients with obesity. This technique allowed to reduce intraoperative blood loss, to diminish the duration of analgesics' administration, to shorten the period of bowel function recovery, 3 times to reduce the incidence of postoperative complications.

[Laparoscopic surgery for treatment of endometrial cancer].

Surgery is the cornerstone of the treatment of endometrial cancer. With introduction of new technologies the laparoscopic intervention becomes increasingly popular for treatment of endometrial cancers. Forty five patients with endometrial cancer were operated in N.N. Petrov Research Institute of Oncology from September 2011 to March 2011. Laparoscopic hysterectomy with appendages was performed in 30 patients (66.7%), in 14 (66.7%) patients was also performed pelvic lymphadenectomy and in 1 (2.2%) case additional omentectomy was required. There were no intraoperative complications. The postoperative period was characterized by early mobilization, satisfactory intestinal peristaltic in the first 24 hours, minimal complication rate and absence of contraindications for adjuvant radiotherapy.

[Efficiency of combination therapy for acute otitis media].

The clinical efficiency of treatment was evaluated in 60 patients aged 18 to 60 years with protracted acute otitis media (AOM) who had residual tympanic membrane inflammation and exudates in the tympanic cavity. The patients were divided into 2 groups of 30 each, who received equal basic medical treatment; Group 1 patients were additionally given eurespal (fenspiride) 80 mg thrice daily for 2 weeks. The patients were examined by clinical, endoscopic, and audiometric studies; the transport function of the nasal ciliated epithelium was also explored. The findings suggest the benefits of the additional use of eurespal in the treatment of the catarrhal stage of AOM.

[Effect of prednisolon on trachea smooth muscle of normal rats and rats with fibrosing alveolitis].

Effect of prednisolone on isolated preparations of trachea of normal rats and rats with fibrosing alveolitis was studied. Prednisolone at a concentration of 0.4 microg/l decreased responses of smooth muscle on stimulation of preganglionar nerve fibers at trachea areas with intramural ganglia in rats with acute alveolitis by 48%, while in normal rats--by 19% of control. In trachea preparations without ganglia, prednisolone at a dose of 10 microg/l decreased responses of muscle to the nerve fiber stimulation by 21.3%. The higher prednisolone doses were less efficient: 0.1-10 microg/l glucocorticoid practically did not affect the smooth muscle responses produced by stimulation of muscle cells. In rats with fibrosing alveolitis, 10 microg/l prednisolone restored the smooth muscle responses to control values in preparations of trachea with intramural ganglia. After the prednisolone treatment, amplitude of the rat trachea muscle contraction in response to the nerve fiber electric stimulation did not differ statistically significantly from control and 0.1-10 microg/l prednisolone did not change the response value. The conclusion is made that prednisolone affected the diseased rats more efficiently than the healthy animals. The character of the glucocorticoid effect depends on the presence of intramural ganglia in the trachea wall.

[Development of diffuse toxic goiter in the presence of prior hypothyroidism].

We present a clinical example of a differential diagnostic search for the causes of thyrotoxicosis in a patient with previous hypothyroidism.

[Sodium nitrite-induced potentiation of spontaneous and 1,2-dimethylhydrazine-induced carcinogenesis in male mice F1 (C57 B1xCBA)]. / Potentsiruiushchee deistvie nitrita natriia na razvitie spontannykh i indutsirovannykh 1,2- dimetilgidrazinom opukholei u myshei-samtsov F1 (C57Bl x CBA).

Chronic sodium nitrite (SN) treatment potentiated spontaneous and 1,2-dimethylhydrazine (DMH)-induced carcinogenesis. Mice injected with SN alone showed a higher incidence of leukemia and lung cancer than in controls. Combined treatment with DMH and SN induced most of benign and malignant tumors (hepatic hemangioendothelioma, hepatocarcinoma, renal adenoma, etc.). The difference in the numbers of DMH- and SN-induced tumor bearers was not significant until a concentration of 500 mg/l was reached (64.7%). The level of multiple tumor incidence increased when SN 50 and 500 mg/l was used. Unlike DMH alone, cumulative incidence of DMH-specific tumors and leukemia after combined treatment was higher. An evaluation of cumulative incidence and relative risk established an indirect but positive correlation between SN dose, on the one hand, and spontaneous and induced carcinogenesis, on the other. The strongest carcinogenic effect was reported when DMH was used in combination with SN 500 mg/l. Our data confirmed the carcinogenic hazard of chronic exposure to SN which increased when in combination with that to a specific carcinogenic substance.

Interaction of histamine and glucocorticoids with neural structures of the respiratory tract.

The effects of dexamethasone on the actions of histamine on isolated tissue and large bronchus preparations and the interactions of these substances with intramural neural structures were studied. Low histamine concentrations (10(-12)-10(-8) g/ml) decreased muscle responses induced by stimulation of preganglionic nerve fibers, while high concentrations (10(-7)-10(-4) g/ml) increased these responses. Dexamethasone at concentrations of 10(-7)-10(-6) g/ml decreased muscle responses, while concentrations of 10(-5)-10(-6) g/ml produced biphasic changes in responses. Dexamethasone decreased the effects of histamine at high concentrations. Atropine eliminated the effects of simultaneous application of histamine and dexamethasone on respiratory tract preparations; hexamethonium blocked the effects of substances associated with decreased responses and had virtually no effect on those potentiating responses. Novocaine eliminated the actions of histamine at low and high concentrations and the dilatory effect of dexamethasone. These experimental results led to the conclusion that changes in the responses of muscles from the rat respiratory tract induced by stimulation of preganglionic nerve fibers were modified by low concentrations of histamine and dexamethasone and that these modifications were associated with interactions of these substances with tracheobronchial receptors.

[Interactions of histamine and glucocorticoids with nerve structures of respiration passages]. / Vzaimodeistvie gistamina i gliukokortikoidov s nervnymi strukturami dykhatel'nykh putei.

Histamine was shown to exert various effects upon respiratory pathway wall's structures in rats. Glucocorticoids were shown to inhibit an increase in intracellular calcium induced by histamine. This investigation involved study of the interaction mechanisms between histamine and dexamethasone, on one hand, and intramural neural structures, on the other hand.

[Modifying effect of nitrites on pulmonary blastogenesis and viral leukogenesis in mice: role of nitric oxide and dioxide]. / Modifitsiruiushchee deistvie nitritov na legochnyi blastomogenez i virusnyi leikogenez u myshei: vozmozhnaia rol' okisi i dvuokisi azota.

The long-term effects of sodium nitrite (NaNO2) on carcinogenesis induced by urethane (total dose 1.0 mg/g body weight) in low-grade cancer F1 (C57BLxCBA) and high-grade A/Snell mice and on viral (Rausher leukemia virus) leukomogenesis in Balb/c mice. The murine intake of NaNO2 with water (50 mg/l) causes a statistically significant increase in the number of adenomas in the lung. Examining the mechanism of conversion of NO2- to NO led to the assumption that the free radical compounds NO and NO2 are involved in the potentiating action of NO2 on blastomogenesis. The use of the oxidant emoxypine (3-hydroxypyridine) confirmed the above. The role of NO and NO2 in the intracellular processes under the modifying effects of nitrites and nitrates on blastomogenesis is analyzed.