[Endoscopic intraluminal treatment of pancreatic fluid collections after pancreas transplantation]. / Endoskopicheskoe vnutriprosvetnoe lechenie pankreaticheskikh zatekov posle transplantatsii podzheludochnoi zhelezy.

OBJECTIVE: To improve the outcomes after pancreas transplantation complicated by pancreatitis using percutaneous drainage and endoscopic stenting of the main pancreatic duct. MATERIAL AND METHODS: There were 64 transplantations of the pancreatoduodenal complex between January 1, 2012 and December 31, 2021 at the Sklifosovsky Research Institute for Emergency Care. In 11 (17.2%) cases, early postoperative period was complicated by acute pancreatitis and parapancreatic fluid accumulations. Of these, 7 patients underwent ultrasound-guided percutaneous drainage of focal destructions. This procedure was effective and did not require additional treatment. In 4 patients, debridement and drainage were ineffective and required additional endoscopic stenting of the main pancreatic duct. RESULTS: All patients underwent percutaneous drainage of peripancreatic fluid collections and subsequent fistulography. All patients had inhomogeneous cavities with irregular shape and volume of 19.6±1.8 cm3. In 3 (75%) out of 4 patients, there was a passage of contrast agent into the main pancreatic duct of the graft and donor duodenal stump. We did not find contrast enhancement of ductal system in 1 (25%) patient since filling of the cavity with a contrast agent was not tight. Sensitivity of this method for detecting pancreatic ductal defects was 75%. Indications for stenting of the main pancreatic duct were established in 22.5±9.6 days after transplantation. Drainage and debridement were ineffective in 2 (50%) patients. In other 2 (50%) patients, peripancreatic fluid collections enlarged. All patients underwent endoscopic stenting of the main pancreatic duct. CONCLUSION: Endoscopic stenting of the main pancreatic duct of the donor pancreas combined with percutaneous drainage of peripancreatic fluid accumulations is a highly effective and minimally invasive approach for fluid collections after transplantation of the pancreatoduodenal complex. This method also minimizes the incidence of postoperative complications. Thanks to this method, we avoided redo open surgeries in all cases.

[Advanced glycation end products and oxidative stress as a basis for metabolic abnormalities in patients with type 1 diabetes after successful simultaneous pancreas-kidney transplantation].

AIM: To compare advanced glycation end-products (AGE, RAGE) and 3-nitrotyrosine (3-HT) in patients with DM 1 after successful simultaneous pancreas-kidney transplantation (SPK) and kidney transplantation alone (KTA). To assess relationship between levels of AGE, RAGE, 3-HT and renal transplant (RT) function, carbohydrate and mineral metabolism. MATERIALS AND METHODS: The study included 58 patients who received kidney transplantation in end-stage renal disease (ESRD). 36 patients received SPK. There were performed routine laboratory, examination of AGE, RAGE, 3-NT, parathyroid hormone (PTH), 25(OH)vitamin D, calcium, phosphorus, FGF23, osteoprotegerin (OPG), and fetuin-A levels. RESULTS: All patients after SPK reached normoglycemia (HbA1c 5.7 [5.3; 6.1] %; C-peptide 3.24 [2.29; 4.40] ng/ml) with the achievement of significant difference vs patients after KTA. Arterial hypertension (AH) was more frequent in recipients of SPK before transplantation than after (p=0.008). AH also persisted in greater number of cases in patients after KTA than after SPK. Patients after SPK had higher AGE (р=0.0003) and lower RAGE (р=0.000003) levels. OPG in patients after SPK was significantly higher (р=0.04). The correlation analysis revealed significant positive correlation between 3-HT and OPG (p0.05; r=0.30), RAGE and eGFR (r=-0.52), HbA1c (r=0.48), duration of AH (r=0.34), AGE with HbA1c (r=0.51). CONCLUSION: The results of the "metabolic memory" markers analysis may indicate their contribution to the persistence of the metabolic consequences of CKD and DM 1 after achievement of normoglycemia and renal function restoration and their possible participation in development of recurrent nephropathy, vascular calcification, and bone disorders.

[Preparation of the dialysis patient with type 1 diabetes mellitus for kidney transplantation].

Kidney transplantation is unique method of renal replacement therapy, allowing to improve quality and duration of life for patients with diabetes mellitus type 1 (DM1) and end-stage renal disease (ESRD) on dialysis therapy. Recently using of innovation technologies for diabetes management and modern immunosuppression enable achieving better results of posttransplant rehabilitation for patients with DM1, especially if kidney transplantation is performed early after initiation of dialysis. Detailed examination of patient with DM1 before potential kidney transplantation is very important to reduce of early and late postoperative complications. Kidney transplantation preparation includes effective glycemic control, adequate dialysis therapy, treatment of diabetes and ESRD complications and concomitant conditions, especially cardiovascular diseases, accounting for kidney transplantation perspective. Furthermore, diagnostics and treatment of any infectious process, timely vaccination, cancer screening are basic approaches of kidney transplantation preparation program, providing the best survival rate of kidney graft and patient.

[Pancreas transplantation with isolated blood supply through the splenic artery]. / Transplantatsiia podzheludochnoi zhelezy s izolirovannym krovosnabzheniem po selezenochnoi arterii.

In multiple organ procurement, taking into consideration certain peculiarities of the vascular architectonics of the celiac trunk or an iatrogenic injury to the superior mesenteric artery, it is impossible to perform standard arterial reconstruction of a pancreas transplant with the use of a Y-shaped vascular allograft. This results in refusal from transplanting a potentially suitable organ. The purpose of our study was to assess the possibility of transplantation of the pancreatoduodenal complex with isolated blood supply via the splenic artery. Between January 2008 and November 2016, transplantation of the pancreas was carried out in a total of 20 patients (9 men and 11 women aged from 26 to 40 years, mean age 37.2±5.6 years). Depending on the number of the major arteries supplying the pancreas, the patients were divided into 2 groups. No statistically significant between-group differences in the parameters of volumetric blood flow determined by means of CT perfusion, in the majority of laboratory findings or therapeutic outcomes were revealed. Based on assessment of the function and quality of pancreatic blood supply, we proved feasibility of transplantation of the pancreatoduodenal complex with isolated blood supply through the splenic artery.

[Pancreas transplantation followed by stumpless duodenal exocrine drainage]. / Transplantatsiia podzheludochnoi zhelezy s bezkul'tevym duodenal'nym drenirovaniem.

Pancreas transplantation followed by stumpless duodenal exocrine drainage was performed in 2 patients. Primary kidney and pancreas graft function was noted in both cases. Two procedures of pancreas transplantation followed by stumpless duodenal exocrine drainage were carried out for the first time. Perhaps, absent donor duodenal stump has several advantages for the further course of postoperative period that may be confirmed in prospective trials.

[Treatment of postoperative ventral hernias in recipients of solitary organs]. / Lechenie posleoperatsionnykh ventral'nykh gryzh u retsipientov solidnykh organov.

AIM: To perform retrospective analysis of treatment of postoperative ventral hernias (PVH) in kidney and extrarenal organs recipients, to assess its safety and effectiveness. MATERIAL AND METHODS: Hernia repair has been performed in 84 PVH patients for the period from May 2006 to November 2017. The main group consisted of 41 patients (24 males, 17 females, mean age 55 (44; 59)) years with PVH due to previous transplantation. The control group included 43 PVH patients (21 males, 22 females, mean age 51 (50, 56)) years without previous transplantation. RESULTS: Incidence of surgical complications was similar in two groups: 63.4% in group 1 vs. 53.5% in group 2 (p>0.05). There were no significant differences in the incidence of surgical complications depending on immunosuppressive therapy and synthetic endoprosthesis deployment technique. CONCLUSION: Treatment of postoperative ventral hernias using synthetic endoprostheses in recipients of solid organs is effective and safe and should be considered as a preferable in treatment of this pathology.

[Preventive anterior abdominal wall repair in recipients of renal allograft]. / Preventivnaia proteziruiushchaia plastika perednei briushnoi stenki u retsipientov pochechnogo allotransplantata.

AIM: Retrospective analysis of safety and efficacy of preventive anterior abdominal wall repair in recipients of renal allograft. MATERIAL AND METHODS: Kidney transplantation was performed in 396 patients with terminal renal failure within January 2015 - May 2017. Preventive endoprosthetics (PE) was applied in 28 (7.1%) patients. There were 7 women (26.9%) and 19 men (73.1%) aged 25-69 years (mean 44.5 (35, 56) years). Median of body mass index (BMI) was 27.5 (23.9, 29.9) kg/m2. RESULTS: Postoperative morbidity was 42.3%. Complications were mild (type I and II) and did not require invasive treatment. Postoperative morbidity was similar regardless protocol of immunosuppressive therapy (IST). CONCLUSION: Preventive abdominal wall repair after kidney transplantation is effective and safe to prevent postoperative hernia.

[The characteristic of diarrheagenic Escherichia separated from children aged under 5 years old in Yaroslavl.]

The diarrheagenic bacteria coli take a significant place among agents of acute intestinal infections in children aged under 5 years. The main danger among these pathogens is represented by both enterotoxigenic E. coli causing enteritis and enterocolitis accompanied by acute dehydration diarrhea and Escherichia producing shiga-toxin being agents of hemorrhagic colitis and hemolytic uremic syndrome. The fast and proper identification of agents of these two groups of pathogens is an important task of bacteriologists to be resolved for successful treatment of patient because tactics of therapy of enterotoxigenic diarrhea and hemorrhagic colitis and hemolytic uremic syndrome significantly differ. The high capacity of Escherichia coli to form populations resistant to anti-microbial medications, including pan-resistant ones, also is a serious problem for science and public health. The object of study was a collection of isolates of E. coli (n = 112), separated from 112 children aged under 5 years with clinical manifestations of acute intestinal infection, food toxic infection hemocolitis and diarrhea of obscure etiology in Yaroslavl in 2015-2017. Initially, the strains of E. coli were tested using diagnostic agglutinating coli-serums and then using reagents' kit «AmpliSens®Escherichiosis-FL¼ for detection and differentiation DNAof diarrheagenic bacteria coli and also with specific oligonucleotide primers to genes of virulence and O-serum group belonging. The obtained data permitted to determine belonging of analyzed strains of E. coli to four sub-groups: ЕНЕС (n = 9), EPEC (n = 17), ETEC (n = 1) и EAgEС (n = 1). All of them were agents of genes of pathogenicity specific for every pathogroup. The most numerous group EPEC was represented by strains of five serogroups with dominating among them serogroup O26 (9 strains). Therefore, studying collection of strains of diarrheagenic Escherichia isolated during 2015-1017 in Yaroslavl from children aged under 5 years with acute intestinal infections permitted to demonstrate efficiency of application of molecular genetic methods of analysis for characterizing E. coli i.e. establishment their serogroups, detection of genes of virulence and attributing to pathogroups.

Retroperitoneal Pancreas Transplantation With the Use of Duodenal Drainage via "Button Technique": First Clinical Practice (Case Report).

The persistent relative high incidence of duodenum-associated surgical complications significantly reduces pancreas grafts' (PG) and recipients' survival rates. A 31-year-old female patient underwent retroperitoneal pancreas transplantation with the use of PG exocrine drainage into the recipient's duodenum via the "button technique" approach. An uncomplicated postoperative period with satisfactory function of both transplants (pancreas and kidney) was noted. This was the 1st time ever that the transplantation was performed with the use of retroperitoneal placement of the pancreas transplant and duodenal drainage via the "button technique" approach. It is possible that the absence of the duodenal stump in the donor's transplant has a number of benefits in the postoperative period, which can be confirmed during the follow-up observations.

CURRENT CAPABILITIES OF COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING FOR THE DETECTION OF COMPLICATIONS AFTER COMBINED PANCREAS AND KIDNEY TRANSPLANTATION.

Objective: to give computed tomography (CT)- and magnetic resonance imaging (MRI)-based new anatomic-topographic relationships in patients after combined pancreas and kidney transplantation and to describe main visualization tasks and the types and frequency of various complications occurring in different periods after transplantation. Material and methods. Spiral CT and MRI images were analyzed in 45 patients after pancreas and kidney transplantation. A total of 51 studies (35 CTs and 16 MRIs) using intravenous contrast enhancement (n=34 (66%)) were performed. Results. A total of 55 complications, among which pancreatitis after pancreas transplantation was most common (55%), were found. Necrotizing pancreatitis following pancreas transplantation, which required open operative or percutaneous intervention, was diagnosed in 6.6%. Vascular complications were detected in 22%. Conclusion. The current capabilities of CT and MRI enable us to quickly obtain objective information on the status of transplanted organs, their vascular architectonics, as well as on the presence and type of occurred complications. Timely correction of identified complications positively affects the survival of transplanted organs and quality of life in a recipient.

[Diagnostic and Prognostic Possibilities of the Redox-Potential Electrochemical Measurements in Blood Plasma].

AIMS: Determination of operating characteristics of the test based on blood plasma redox potential monitoring in patients with different patho- logical conditions associated with impaired oxygen metabolism during treatment in postoperative period and expanding the range of parameters of the developed method of investigation of blood plasma redox potential. METHODS: It were examined healthy volunteers group as following group (n = 63), groups of patients with transplanted liver (n = 64), kidney (n = 59), and lungs (n = 7). Redox potential measurements were done by platinum electrode, reference electrode was silver-chlorine one. Potentiostate IPC-ProL was used to registrate and record a dependence redox potential via time. Time of measurement was 15 min. RESULTS: statistically significant differencees of redox potentials ranges was found in healthy volunteers and patients with transplanted kidney and liver. Ratio of measured redox potentials coincident with the values within the confidence interval in healthy volunteers was 12% in patients with transplanted kidney and 10% in patients with transplanted liver. We observed significant differences in the nature of changes of blood plasma's redox potential values in course of monitoring of subgroups of patients with and without complications after liver transplantation. It was found that sensitivity of electrochemical method was 85%, selectivity--69.8%, precision--85.2%. CONCLUSION: we discovered value ranges of blood plasma redox potential typicalfor different pathological states; we detected an interaction between the effect of treatment and quantitative changes in the values of the blood plasma redox potentials; criterion for early predicition of complications in patients with transplanted liver was proposed basing on redox potential monitoring during postoperative period.

Simultaneous pancreas-kidney transplantation with duodeno-duodenal anastomosis.

Simultaneous pancreas-kidney transplantation (SPKT) is now accepted as the method of choice for patients with insulin-dependent diabetes mellitus (type I) who have end-stage renal disease (ESRD). We believe that retroperitoneal positioning of the donor pancreas with the formation of duodeno-duodenal anastomosis is the most physiologically relevant. Starting in January 2008, the SPKT was chosen as the treatment method of 32 patients with diabetes mellitus. In 15 cases comprising group I (46.9%), the pancreas was placed intra-abdominally (including the formation of the duodeno-jejunal anastomosis). In the remaining 17 patients (53.1%) comprising group II, the pancreas was positioned retroperitoneally (including the formation of the duodeno-duodenal anastomosis). We compared the main parameters of the early postoperative period in these groups. There were no substantial differences between the groups in the prevalence of immunological (13.3% and 11.8%, P = .9), surgical (20% and 23.5%, P = .81), and infectious complications (20% and 5.9%, P = .23). On discharge there were no significant differences in the values of the following between the two groups, respectively: serum creatinine values, 112.7 ± 31.2 and 104.8 ± 54.6 µmol/L, P = .17; glomerular filtration rate, 73.5 ± 28.6 and 78.7 ± 24.9 mL/min, P = .55; α-amylase, 121.9 ± 63.6 and 150.1 ± 72.1 U/L, P = .27; pancreatic amylase, 102 ± 51.5 and 122.5 ± 75.4 U/L, P = .6; lipase, 115.4 ± 67.3 and 96 ± 65.7 U/L, P = .5; С-peptide, 4.44 ± 1.9 and 4.02 ± 2.4 ng/mL, P = .47; HbA1c, 5.45 ± 0.8% and 5.56 ± 1.12%, P = .9; and intact insulin, 12.2 ± 5.4 and 12.9 ± 8.8 mcIU/mL, P = .95). SPKT remains the best method of medical and social rehabilitation for patients who have diabetes mellitus (type-I) with ESRD. Compared to the classic method, we have seen no significant deviations in either of the following: the qualitative features marking the restoration of function of the two transplanted organs and/or the quality of compensation of carbohydrate metabolism, incidence of rejection, and graft loss. At the same time, retroperitoneal positioning of the pancreas exhibited lower repeat surgery rates.

Homogenization of quasi-1d metamaterials and the problem of extended bandwidth.

We derive approximate analytical expressions for the effective permittivity tensor of two-phase metamaterials whose geometry is close to one-dimensional (quasi-one-dimensional metamaterials). Specifically, we consider the metamaterial made of parallel slabs with width given by a linear or parabolic function. Using our approach, the design of epsilon-near-zero, ultra-low and high refractive index metallodielectric metamaterials with extended bandwidth has been demonstrated. In addition, generalizations to the three-dimensional case and some limitations of the presented technique are briefly considered.

[Variants of surgical treatment of cholecystitis]. / Varianty khirurhichnoho likuvannia kholetsystytu.

Basing on analysis of the treatment results of 375 patients with cholecystitis the indications for application of broad laparotomy, variable laparotomy, mini access, endotracheal narcosis and epidural anesthesia are substantiation.

Long-range intermolecular interaction between broken DNA fragments.

We analyzed the long-range intermolecular interaction between fragments of broken DNA. We considered two constituents of long-range intermolecular interaction. The first is a net electrostatic Coulomb interaction between charges, involved in a structure of opposite nucleotides, which we evaluate using Debye-Huckel theory. The second one is the Van der Waals interaction between the nucleotides. The general Lifshitz theory of Van der Waals forces was used to evaluate this interaction. Numerical calculations showed that a repulsive force between broken DNA fragments can arise in specific cases. This repulsion can prevent DNA from repairing itself after a double-strand break. The height of the barrier decreases with an increase of the ionic strength of the intracellular milieu, or with a reduction of its viscosity.

Synthesis of the C(29)-C(45) bis-pyran subunit (E-F) of spongistatin 1 (Altohyrtin A).

A synthesis of the C(29)-C(45) bis-pyran subunit 2 of spongistatin 1 (1a) is described. The synthesis proceeds in 19 steps from the chiral aldehyde ent-7, and features highly diastereoselective alpha-alkoxyallylation reactions using the gamma-alkoxy substituted allylstannanes 17 and 19, as well as a thermodynamically controlled intramolecular Michael addition to close the F-ring pyran. The E ring was assembled via the Mukaiyama aldol reaction of F-ring methyl ketone 3 and the 2,3-syn aldehyde 4.

Peculiarities of long-range interaction between the nucleotides after DNA damage.

In this work, the long-range interaction between the pairs of nucleotides situated on the opposite ends of a double broken DNA helix have been studied theoretically. The long-range energy was considered as a sum of electrodynamics Van der Waals and electrostatic Coulomb interactions. The most important region for the problem under consideration is about 5-15 A between the nucleotides. The calculations of the energy of long-range interaction have shown that during the interaction between the pairs CG-CG, there is a potential repulsive barrier with the amplitude of about 4 kT at the distance of 7-9 A, and during the interaction between the pairs TA-TA, there is a potential repulsive barrier with the amplitude of about 1.5 kT at the same distance, which can prevent DNA from enzyme selfrepairing after a double DNA break. This barrier vanishes as the pH of intracellular medium increases. The remainder pairs of nucleotides do not have such barrier, and there is always an attraction like interaction.

[The performance of cholecystectomy using a small access]. / Vikonannia kholetsistektomiï z vykorystanniam maloho dostupu.

The indications for application, technique of performance and results of cholecystectomy, conducted through a small access in right epigastric region, were adduced in 19 patients.