[Fast track recovery protocols for extended pelvic surgery]. / Protokoly uskorennogo vyzdorovleniya pri rasshirenno-kombinirovannykh operatsiyakh na organakh malogo taza.

OBJECTIVE: To compare the immediate results of extended pelvic surgery before and after introduction of standardized fast track surgery (FTS) protocol into routine clinical practice. MATERIAL AND METHODS: The study included 111 patients with pelvic tumors who underwent extended pelvic surgery. The control group included 59 patients whose perioperative management implied traditional approaches (2018-2019), the main group - 52 patients with FTS protocol (2020-2021). Age, BMI and ECOG status were similar. In the main group, females (90.4% vs. 74.6%; p=0.046), patients with recurrent (46.2% vs. 22.0%; p=0.009) and complicated tumors (26.9% vs. 11.9%; p=0.054) prevailed. Obstructive resection without anastomosis was less common in the main group (28.8% vs. 47.5%; p=0.068). RESULTS: Surgery time was higher (319±125 min vs. 236±79 min, p<0.001) in the main group, but blood loss (238±154 ml vs. 282±150 ml, p=0.029) and incidence of blood transfusions (23.1% vs. 42.4%, p=0.043) were lower. Moreover, complications (36.6% vs. 54.3%; p=0.086), mild complications (Clavien-Dindo class I-II) (11.6% vs. 28.8%; p=0.034) and local infectious complications (19.2% vs. 42.4%; p=0.009) were less common in the main group. Two patients died in the control group due to sepsis following colonic anastomosis and bladder suture failure, respectively. Postoperative hospital-stay was similar (14±9.1 days vs. 14.4±9 days; p=0.89). CONCLUSION: FTS protocol is possible and safe in patients with locally advanced and recurrent malignant pelvic tumors. This approach reduces blood loss, the number of blood transfusions and risk of postoperative infections.

[Medical rehabilitation for children with scoliosis]. / Meditsinskaya reabilitatsiya detei so skoliozom.

The article presents a literature review on the prevalence, relevance, social significance, and principles of medical rehabilitation of children with different types of scoliosis in scoliotic disease. The current classification, diagnostics features, and clinical course of the disease are addressed. Current approaches to the choice of medical rehabilitation methods for scoliotic disease in children are described: therapeutic exercise, hydrokinesiotherapy, massage, physiotherapeutic treatment, kinesiotaping, and corseting. Special consideration is given to postoperative management and stages of medical rehabilitation of children with scoliosis, including resort treatment.

[The alteration of the structure of mortality of endocrine system diseases, nutrition disorders and metabolic disturbances in individuals of able-bodied age and older in conditions of pandemic].

The elderly age and endocrine diseases are among death risk factors at contamination with new coronavirus infection. To reply the question of how the influence of these risk factors is summing up, differences were determined concerning patterns of changes in structure of mortality of endocrine system diseases, nutrition disorders and metabolic disturbances in individuals of able-bodied age and older against the background of COVID-19 pandemic. on the basis of information from the Moscow database of deaths of endocrine system diseases, nutrition disorders and metabolic disturbances, the changes in contribution of individual diseases to the death causes structure in 2019-2021 were analyzed. The groups of individuals of able-bodied age and older were compared. It was established that in both groups rate of indicating SARS-CoV-2 virus infection as concomitant disease decreased while rate of indicating concomitant diseases at death of COVID-19 increased. The group differences in changes of structure of death causes were established in 2021. The percentage of undetermined forms of diabetes and obesity in structure of death causes increased in the elderly, while in individuals of able-bodied age increased. The percentage of obesity as concomitant disease of death of COVID-19 in individuals of able-bodied age increased and did no change were detected in the elderly group. The input of poly-glandular dysfunction as consequence of old infection into mortality is five times higher among individuals of able-bodied age. On the basis of received results, assumption was made SARS-CoV-2 virus contamination ruinously affects development of pathological process under endocrine diseases regardless of age, while age affects spreading of endocrine diseases and degree of resistance to development of infectious process directly. The differences in patterns of changes of structure of death causes of population of able-bodied age and older are associated with low quality of diagnostics of death causes in individuals of elder age groups.

[Quality of accounting of death causes for elderly people].

Programs to increase the life expectancy of old people are becoming increasingly relevant in an aging society. Their adequacy depends on the quality of accounting death causes. Objective: To evaluate the quality of accounting of death causes for population over the working age. For 98 061 deaths of people over working age registered in Moscow dead database, the structure of underline and multiple causes of death were compared. To determine whether information on morbidity of elderly can improve the diagnosis of death causes the structure of death causes was compared with officially registered prevalence and detected prevalence. The last was calculated on the basis of the household survey of health of elderly population in Nizhny Novgorod Region (22 558 people). We find fundamental difference between the structure of causes for officially registered prevalence, detected prevalence and mortality. In the structure of death causes the nervous diseases are in the second place and the proportion of uncertain death causes is 6.7%. The difference in the structure of underline and multiple causes of death is not so great. For people over working age, the coding errors were detected in 9.8% underline death causes. Thus, morbidity statistics cannot provide informational support for diagnosing causes of death in full. To improve the quality of accounting of death causes, it is advisable to introduce the institution of coders and to give them the possibility of verifying death diagnoses in medical organizations where the diagnosis has been established.

[C-reactive protein as early predictor of anastomotic leakage after surgery for colorectal cancer. Systematic review and meta-analysis]. / S-reaktivnyi belok kak rannii marker nesostoyatel'nosti shvov tolstokishechnogo anastomoza posle rezektsii tolstoi kishki po povodu raka. Sistematicheskii obzor i metaanaliz.

OBJECTIVE: Systematic review and meta-analysis of data on C-reactive protein (CRP) as a predictor of anastomotic leakage (AL) after surgery for colorectal cancer. MATERIAL AND METHODS: Literature searching was performed in Medline, Elibrary, Scopus, Web of Science databases. Literature request consisted of keywords «CRP¼, «colorectal surgery¼, «anastomotic leakage¼ for the period 2008-2018. Meta-analysis included 2 manuscripts for the second postoperative day, 7 articles for the third postoperative day and 6 articles for the fourth postoperative day. ROC-analysis was made to determine optimal prognostic values. RESULTS: ROC-curve for the second postoperative day - AUC 0.758; optimal CRP value - 154 mg/l (sensitivity 70.1%, specificity 55.6%), 95% confidence interval 0.698-0.819. ROC-curve for the third postoperative day - AUC 0.715; optimal CRP value - 144.5 mg/l (sensitivity 79.1% specificity 60.3%), 95% confidence interval 0.68-0.75. ROC-curve for the fourth postoperative day - AUC 0.767; optimal CRP value - 122.91 mg/l (sensitivity 72.3% specificity 60%), 95% confidence interval 0.73-0.804. CONCLUSION: Increased CRP is an early predictor of AL after surgery for colorectal cancer. CRP level ≥144.5 mg/l on the third postoperative day can predict AL (sensitivity 79%, specificity 60%).

[The mortality of diabetes mellitus from the perspective of multiple causes of death: encoding problems].

The statistics of causes of death is the informational basis for identifying public health problems. That is why the accurately accounting for mortality from diabetes mellitus, which is a global medical and social problem for society, is important. The study was carried out to analyze the correctness of coding death causes of diabetes mellitus and the frequency of alleged death. MATERIALS AND METHODS: The Moscow deceased population database of July 2018 - July 2019 was analyzed. Using the decision tables on codes linkages from ICD-10, incorrect codes for underline cause were established for 342 death cases from diabetes mellitus. Among 43044 cases of cardiovascular death the cases of presumed death from diabetes were detected. The analysis was carried out in the Microsoft Access 2007 software. THE RESULTS: In 18.4% of cases, the cause of death from diabetes was encoded incorrectly. If a modification of the underline death cause is assumed due to the mention of certain diseases in any line of the Death Certificate, cases of coding for death from diabetes with wrong fourth character are more often detected when mentioning kidney diseases. If modification of the underline cause is provided for cases when information in the Death Certificate indicates that diabetes has caused the development of some diseases then the largest number of cases with incorrect coding was detected when mentioning circulatory diseases. Only in one medical organization the frequency of incorrect coding is 3.4%, in the rest it varies from 15.4% to 52.2%. Among all death causes, diabetes was only 0.41%. If to add cases of presumptive death from diabetes mellitus, then the proportion of diabetes in the structure of death causes will almost triple and reach up to 1.2%. CONCLUSIONS: The quality of diagnosis and coding of death causes from diabetes has not improved in recent years. To increase it, it is advisable to organize and establish the institution of coders. It is advisable to indicate the presence of diabetes mellitus in the Death Certificate without fail and use the information from the diabetes register. It is proposed to encode the death cause from diabetes mellitus with multiple complications use line D in the Death Certificate to indicate damage to various organs and systems if it is necessary.

Vector-Resonance-Multimode Instability.

The modulation and multimode instabilities are the main mechanisms which drive spontaneous spatial and temporal pattern formation in a vast number of nonlinear systems ranging from biology to laser physics. Using an Er-doped fiber laser as a test bed, here for the first time we demonstrate both experimentally and theoretically a new type of a low-threshold vector-resonance-multimode instability which inherits features of multimode and modulation instabilities. The same as for the multimode instability, a large number of longitudinal modes can be excited without mode synchronization. To enable modulation instability, we modulate the state of polarization of the lasing signal with the period of the beat length by an adjustment of the in-cavity birefringence and the state of polarization of the pump wave. As a result, we show the regime's tunability from complex oscillatory to periodic with longitudinal mode synchronization in the case of resonance matching between the beat and cavity lengths. Apart from the interest in laser physics for unlocking the tunability and stability of dynamic regimes, the proposed mechanism of the vector-resonance-multimode instability can be of fundamental interest for the nonlinear dynamics of various distributed systems.

Unveiling Temporal Correlations Characteristic of a Phase Transition in the Output Intensity of a Fiber Laser.

We use advanced statistical tools of time-series analysis to characterize the dynamical complexity of the transition to optical wave turbulence in a fiber laser. Ordinal analysis and the horizontal visibility graph applied to the experimentally measured laser output intensity reveal the presence of temporal correlations during the transition from the laminar to the turbulent lasing regimes. Both methods unveil coherent structures with well-defined time scales and strong correlations both, in the timing of the laser pulses and in their peak intensities. Our approach is generic and may be used in other complex systems that undergo similar transitions involving the generation of extreme fluctuations.

Pattern Generation by Dissipative Parametric Instability.

Nonlinear instabilities are responsible for spontaneous pattern formation in a vast number of natural and engineered systems, ranging from biology to galaxy buildup. We propose a new instability mechanism leading to pattern formation in spatially extended nonlinear systems, which is based on a periodic antiphase modulation of spectrally dependent losses arranged in a zigzag way: an effective filtering is imposed at symmetrically located wave numbers k and -k in alternating order. The properties of the dissipative parametric instability differ from the features of both key classical concepts of modulation instabilities, i.e., the Benjamin-Feir instability and the Faraday instabiltyity. We demonstrate how the dissipative parametric instability can lead to the formation of stable patterns in one- and two-dimensional systems. The proposed instability mechanism is generic and can naturally occur or can be implemented in various physical systems.

Stochasticity, periodicity and localized light structures in partially mode-locked fibre lasers.

Physical systems with co-existence and interplay of processes featuring distinct spatio-temporal scales are found in various research areas ranging from studies of brain activity to astrophysics. The complexity of such systems makes their theoretical and experimental analysis technically and conceptually challenging. Here, we discovered that while radiation of partially mode-locked fibre lasers is stochastic and intermittent on a short time scale, it exhibits non-trivial periodicity and long-scale correlations over slow evolution from one round-trip to another. A new technique for evolution mapping of intensity autocorrelation function has enabled us to reveal a variety of localized spatio-temporal structures and to experimentally study their symbiotic co-existence with stochastic radiation. Real-time characterization of dynamical spatio-temporal regimes of laser operation is set to bring new insights into rich underlying nonlinear physics of practical active- and passive-cavity photonic systems.

[The economic analysis of the total cost of rehabilitation of the patients suffering from coronary heart disease].

OBJECTIVE: To report the results of analysis of the economic efficiency of physical rehabilitation of the patients surviving after myocardial infarction with the use of physical exercises. MATERIAL AND METHODS: The study included 110 patients (mean age 58,3±9,8 years) who were randomized into two groups: the group where the patients were treated with the use of physical training (n=53) and the control group (n=57). The physical training included natural walking over the level ground at a speed corresponding to 60% of the maximum heart rate achieved during the initial 6 minute of the walking test. RESULTS: The results of the analysis indicate that the cost of the full course of medicamental therapy for the patients of the control group was 790.043,83 rubles higher than that for the patients treated with the use of physical exercises. The expenses for the instrumental and laboratory studies in the former group proved to be 142.776,8 rubles higher than in the latter. CONCLUSION: The inclusion of controlled physical exercises in the program in the rehabilitative treatment of the patients surviving after myocardial infarction makes it possible to achieve a higher quality of their life with the more favourable cost-benefit ratio compared with use of medicamental therapy alone.

[The application of pulsed magnetic stimulation in the rehabilitation of the children operated for the treatment of grade III-IV scoliosis].

In the present paper, we for the first time provide a rationale for the application of a new physical factor, pulsed magnetic stimulation, in pediatric practice. Our observations have demonstrated positive dynanfics of the parameters characterizing the functional state of the neuro-muscular apparatus and equalization of the amplitude of M-response as appears from the results of electromyographic studies. The data obtained by electrocardiography and estimation of the external respiratory function give evidence of favourable dynamics of the cardio-respiratory system. The results of the study have been used to substantiate the application of a new method of pulsed magnetic stimulation in pediatric medicine at the early stages of rehabilitation of the children following surgical treatment of grade Ill-IV scoliosis.

[Optimization of surgical treatment of pelvic prolapse in women].

The study was aimed to improving the efficiency and reducing the incidence of complications after transvaginal pelvic reconstructive surgery with the installation of synthetic mesh prosthesis for pelvic organ prolapse. The study involved 228 patients with II-IV stage pelvic prolapse, of which 144 (63.2%) underwent surgery by the TVM (Tension-free Vaginal Mesh) method, and 84 (36.8 %)--by the original method with the installation of patented mesh implant. In the group of patients who underwent reconstruction of the pelvic floor with the implantation of mesh prosthesis, original in form and method of installation, in the postoperative period significantly less stress urinary incontinence was detected, better functional results have been found, and significantly fewer intra- and postoperative complications were diagnosed. Transvaginal pelvic floor reconstruction with the use of technology to minimize operational approaches when setting the original mesh implant allows to effectively restoring the normal anatomy of the vagina, and characterized by high safety and good functional results.

[The role of AmtB, GlnK and glutamine synthetase in regulation of transcription factor TnrA in Bacillus subtilis].

The nitrogen is a macroelement for all alive cells, from bacteria to animals. Although NH3/NH4+ are highly toxic to animal, they are the preferred source of nitrogen for the most microorganisms and are assimilated by glutamine synthetase in the GOGAT cycle. The nitrogen limitation triggers a number of regulatory processes and activates many genes, providing the utilizing of alternative nitrogen sources. In Bacillus subtilis the genes of nitrogen metabolism are regulated by the transcription factor TnrA. In a cells it is bound to AmtB-GlnK proteins, the interaction with Glutamine synthetase (GS) represses its DNA-binding activity. Here we show the lack of AmtB leads to the nitrogen deficiency in a cell and, consequently, the increased expression of TnrA-dependent genes. In the lack of GlnK the transcription factor TnrA is constitutive bound to GS, the TnrA activity is repressed even under nitrogen limit conditions. Apparently, the TnrA activity is subjected to permanent repression by GS. In the absence of GS, the TnrA activity is strongly higher in compare to control, even under nitrogen limitation, when GS is active. These data allow to suggest that TnrA activity is regulated by the competitive binding to GlnK and GS.

[Efficacy of combined treatment of large prostatic adenoma with doxasozine and finasteride].

Combined treatment with doxasozine and finasteride was performed for 7.26 months in 38 patients with large-size prostatic adenoma (89.54 +/- 11.64 cm3). The study group of 38 patients given the above combination benefited from the treatment (18 patients avoided surgery, TUR of shorter duration with removal of a less amount of tissue and less blood loss was conducted in 20 patients). Bladder draining with the urethral catheter was also shorter in the study group. The control group (28 patients with large prostatic adenoma) received surgical treatment alone. Long-term results were good in both the groups. Thus, combined treatment with doxasozine and finasteride can be the first-line treatment in patients with large prostatic adenoma.

[Choice of a surgical treatment of genital prolapse in women].

The trial enrolled 64 females with genital prolapse corrected in 2003-2007 with transvaginal synthetic aids. Urinary incontinence of effort was detected in 53.1% patients with cystocele. Efficacy of surgical treatment of vaginal prolapse was 73.3% in use of anterior colporaphy with implantation of prolen net and 100% in reconstruction of the pelvic fundus by PROLIFT technique. Early postoperative complications (vaginal wall erosion) occurred in 16.7 and 15% patients, respectively. Thus, reconstruction of the pelvic fundus is an operation of choice in severe and combined forms of pelvic prolapse in women.

[Choice of surgery in the treatment of recurrent varicocele].

The article presents the results of examination and surgical treatment of 48 patients with varicocele recurrence after Ivanisevich operations. Ultrasound dopplerography revealed principal causes of the recurrences: unperformed ligation of vein-satellites, undetected renospermatic reflux with hypertension in the renal vein, undetected ileospermatic or mixed reflux. Depending on the detected hemodynamic disorders, we made microsurgical ligation of veins-satellites, created proximal vein-veinous testiculosafic or distal testiculosafic anastomoses with good clinical results and correction of pathospermia. Ultrasound dopplerographic control of anastomoses after 1 year of their creation showed satisfactory function of anastomoses in 80.1% cases. Thus, choice of surgical method in varicocele recurrence must be based on assessment of hemodynamic disorders in the territory of genital veins.

[MRT assessment of metabolic and thrombolytic therapy effects on postinfarction left ventricular remodeling].

AIM: To examine effects of trimetasidine on morphofunctional indices of the left ventricle (LV) in myocardial infarction (MI) patients on combined treatment. MATERIALS AND METHODS: Seventy five patients with primary macrofocal MI were randomized into 2 groups. Patients of group 1 (n = 38) received a combination of bisoprolol (beta-blocker) with enalapril (ACE inhibitor) in individual doses under control of blood pressure and blood creatinine level. Group 2 (n = 37) patients received the same combination of drugs and, in addition, trimetasidine in a dose 70 mg/day from postmyocardial day 7-10 for 6 months. Two subgroups from the groups were given systemic thrombolytic therapy (STLT) with streptokinase. MRT and cine-MRT of the heart were made for measurement of LV morphofunctional parameters. RESULTS: Low-field MRT of the heart in MI patients treated with adjuvant STLT (1500000 U within 6 hours after MI onset) and trimetasidine (preductal MB) in a dose 70 mg/day from the disease day 7-10 registered a significant inhibition of pathological LV postinfarction remodeling: a decrease of body surface indexed LV end diastolic volume by 10.3%, systolic volume--by 15.4%, LV myocardial tension--by 14.0%, sphericity index--by 7.1%; an increase in the index of relative wall thickness by 5.3%, cardiac index--by 9.2% compared to the group treated without trimetasidine. CONCLUSION: 6-month therapy with trimetasidine of MI patients leads to a significant regress of morphofunctional changes accompanying LV remodeling. Pathological LV postinfarction remodeling inhibits significantly in MI patients combined treatment of whom included STLT (streptokinase in a dose 1500,000 U within 6 hours after acute MI onset and trimetasidine in a dose 70 mg/day on postmyocardial infarction day 7-10).

[Sildenafil citrate in diagnosis of erectile dysfunction].

We examined 86 patients: 24 with functional and 62 with organic erectile dysfunction (EDF). In functional EDF, sildenafil citrate (SC) in a dose 25-50 mg or intracavernous injection of 2% solution of papaverin always resulted in satisfactory erection. In EDF, SC, papaverin injection and LOD test results were compared. Morphological examinations of cavernous tissue and tunical albuginea of the penis. Correlations were found between clinical findings, results of SC and intracavernous papaverin solution administration, LOD-test, morphological evidence. This provides objective data for classification of EDF into three stages (I, II and III). Stages I and II were defined as compensated, stage III--as a decompensated stage of organic erectile dysfunction. SC has some advantages over other tests, therefore it is recommended as a monomethod for diagnosis of functional forms, indirect staging of organic EDF.

Experimental and clinical study of the demineralized bone allografts manufactured in the tissue bank of CITO.

The technology for producing demineralized bone allografts (DBA) with definable degree of demineralization and sterilization by high energy electron bean was developed in the tissue bank of Central Institute of Traumatology and Orthopaedics (CITO). The authors consider the technology to be one of the ways of producing demineralized bones. The results of the experiments show that time of demineralization process as well as the absorption dose of radioactive high energy electron beam change substantially mechanical toughness and osteoinductive properties of DBA. Mechanical properties of DBA were tested by the universal testing machine 'Zwick 1464'. Quantitative assessment of DBA osteoinductive properties resulted from the investigation of DBA samples in the culture of stromal precursor bone marrow cells and in the culture of human skin fibroblasts. Cloning efficiency of fibroblasts was considered as indecies of proliferative potential of stromal bone marrow cells, i.e. osteogenic precursor cells. The growth of the cell mass after definite time as well as the index of 3H-timidin marked cells within biological inductor were considered as indecies of proliferative potential of skin fibroblasts. The obtained results showed, that inductive properties of allografts improve when the degree of their demineralization increases whereas the dose of high energy electron radiation decreases. Mechanical toughness of DBA deteriorates when both degree of their demineralization and radiation doses increase. This emphasizes the importance of optimizing technological stages in DBA producing. Since 1998 DBA have been used in Russian clinics for bone plasty in traumatology and orthopaedics, maxilla-facial surgery, ophthalmology, and neurosurgery. The resulting analysis is based on case histories of 257 patients operated from March 1998 to July 2002. The majority of patients were children and teenagers of 3-18 years old with prime tumors, tumor-like and systemic inherited diseases of skeleton, post-traumatic complications. Observation periods were from 1.5 to 5 years and 10 months. Good and satisfactory results were obtained in 93.4% cases.