[Advanced regenerative rehabilitation technologies. Successful use of autologous adipose tissue in a patient with cutaneous tracheal fistula]. / Sovremennye tekhnologii regenerativnoi reabilitatsii patsientov. Opyt uspeshnogo ispol'zovaniya autologichnoi zhirovoi tkani u patsienta s kozhno-trakheal'nym svishchom.

According to the published data, the rate of fistula formation in the postoperative period ranges from 0.3% to 29%. Currently, due to the high risk of suture failure in the postoperative period and tracheal and esophageal fistulas formation, the options for fistulas treatment by the regenerative rehabilitation methods are under consideration. The frequency of fistula healing and reduction of scar deformities after adipose tissue autografting ranges from 43% to 55%. OBJECTIVE: To develop the minimally invasive technology for postoperative fistulas treatment and describe the real-world experience of its use in terms of hospital stay reduction and patients' quality of life improvement. MATERIAL AND METHODS: Patients were selected as part of a pilot research project (Development of Personalized Approaches to Regenerative Rehabilitation for Surgical Patients, # 0394-2020-0011). Patients' quality of life was assessed using the Russian version of the EQ-5D-5L questionnaire (Russian version for Russia). This article presents a clinical example of successful repair of a cutaneous tracheal fistula by autografting of adipose tissue three months after fistula formation. RESULTS: In one month after autografting of adipose tissue, the tracheobronchial secretion through the fistula has stopped. According to the follow-up computed tomography of the neck and tracheobronchoscopy, the fistulous passage is not observed. CONCLUSION: The presence of a fistula worsens the patient's quality of life and increases the risk of secondary infection. When treating patients with tracheal fistulas of high and extremely high surgical risk, the method of autografting of adipose tissue can be a safe and effective alternative to conventional surgery. Further study of this method of regenerative rehabilitation is required.

ELECTRICAL IMPEDANCE TOMOGRAPHY OF THE LUNGS IN THE PRACTICE OF THE ANESTHESIOLOGIST.

THE AIM: To assess validity of EITL for mechanical ventilation optimization during GA. MATERIALS: 26 cardiac surgery patients participated in non-randomized comparative study. Everyone was ventilated with protective regimen: Vt - 6-8 ml/kg, breath rate - by normal EtCO2, i/e - 1.1,5. PEEP setting in group A (n = 15) was based on EITL data, in group B (n = 11, controls) - on the discretion of the anesthesiologist. We compared PEEP peak airway pressure (PAP), dynamic compliance, SpO2 and postoperative pulmonary complications. Bronchoscopy (FTBS) was performed after the onset of mechanical ventilation in 15 patients. RESULTS: Mask ventilation contributed redistribution of ventilation to ventral regions in 88,4% ofpatients. Ventilation by the end of surgery was remained un-changed more often in gr A than in gr B (86,6% vs. 36,6%, p = 0,026). PAP was higher in gr B by the end of surgery (19?1,4 vs. 17,3±2,2 cm H20; p = 0,03). Compliance by the end of surgery was not reduced below baseline's more frequently in gr A (73,3% in gr A vs. 27,2% in gr B, p = 0,053). After FTBS, ventilation after of mechanical ventilation renewal was comparable with baseline ' in 80%, deteriorated in 13,3% and improved in 6,6% ofpatients. CONCLUSIONS: 1) EITL is a convenient toolfor ventilation dynamic evaluation during anesthesia; 2) EITL advances the mask ventilation, allows to set up appropriate PEEP during anesthesia and to evaluate safety of the disconnection during FTBS; 3) EITL contributes to professional education of anesthesiologists.

[EPISTAXIS DURING NASOTRACHEAL INTUBATION. ATTILA'S SYNDROME.]

BACKGROUND: Nasal bleeding is a common complication during nasotracheal intubation (NTI). This is due to the ana- tomical prerequisites and the hemostatic system failure. Using of various research methods in practice can reduce the frequency of such complications. The purpose of the study is to identify predictors of high probability of epistaxis associated with the NTI and the pecu- liarities of the anatomical mucous membrane structure of the nasal passages, and to assess significance of blood coag- ulationfailures in these cases. MATERIALS AND METHODS: 45 patients (f-25 and m-20), aged 23 to 47 years, with physical status I-IIASA were analyzed. Depending on the degree of surgical trauma manipulation during intubation were formed three groups of patients in whom the NTI was atraumatic, moderately traumatic and overly traumatic. During preoperative period all patients underwent a rhinoscopy. Intubation trauma of the trachea was assessed by visual analogue scale. The results and discussion. The study of the nasal mucosa structure showed that with atraumatic intubation (Group 1; n=9) were dominated by deep type of bedding nonplethoric nonkinking vessels (66.7% ofpatients (n=6)). During mod- erate trauma intubation (Group 2; n=24), superficial and deep vessels were found equally (50% and 50%). In patients with severe trauma during intubation (Group 3; n=13), 100% of the patients, the vessels were located superficially, 75 % were convoluted, plethoric, mucosa contact bleeding. There were no anatomical changes. CONCLUSION: The source of bleeding are superficial, plethoric, kinking vessels of the mucous membrane. Hypocoagu- lation disorders, observed in patients during reconstructive surgeries, exacerbate such bleeding and can lead to fatal complications.

[USE OF PROTECTIVE LUNG VENTILATION REGIMEN IN CARDIAC SURGERY PATIENTS.]

BACKGROUND: In cardiac surgery, protective lung ventilation and/or preventive brdnchoscopy (PB) are able to decrease lung injury effects of cardiopulmonary bypass (CPB) and mechanical ventilation. OBJECTIVES: define lung complication risks, evaluate the effect ofprotective lung ventilation (PLV) on lung functioning, and investigate the feasibility ofpreventive PB in higher pulmonary risk (PR) patients. MATERIALS AND METHODS: 66 patients participated in prospective randomized research. Allocation was based on PR and intraoperative mechanical ventilation type. PLV includedfollowing parameters: PCK PIP - up to 20 cm H20, Vt - 6 ml/ kg of PBW, PEEP - 5-10 cm H20, IE ratio - 1:1.5-1:1, EtCO2 - 35-42 mm Hg, FiO2 - 45-60%, lung ventilation during CPB, alveolar recruitment. Four groups were formed: A - higher PR plus PLV- B - higher PR plus conventional LV (CLV), C - lower PR plus PLV- D - lower PR plus CLV PIP PEEP dynamic compliance, p/f ratio and intrapulmonary shunt (Qs/Qt) were recorded. Seventeen patients of group A underwent PB. RESULTS: Advanced dynamic compliance, higher p/f ratio and lower Qs/Qt were seen in group A, in comparison with group B (p< 0.05). Lower Qs/Qt was seen in group C, in comparison with group D (p<0.05). Mucus obstruction of subsegmental bronchi was observed in 53.3% of higher PR patients. More than half ofpatients without PB sufferedfrom postoperative lung complications (70.4 vs. 34.2 7%, p

[DIAGNOSTIC AND THERAPEUTIC BRONCHOSCOPY IN PATIENTS UNDERGOING CARDIAC SURGERY IN INTRA- AND POSTOPERATIVE PERIODS].

The article presents research conducted to evaluate the use of diagnostic and therapeutic fiberoptic bronchoscopy in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis in patients in cardiac ICU. The paper presents the results of the study and comparison of invasive techniques for sampling from the respiratory tract for bacteriological analysis. We studied the bacterial profile of ICU, original content of the respiratory tract of cardiac patients in the intraoperative period and possible ways for prevention of VAP and tracheobronchitis in the postoperative period using bronchoscopy. In addition data on the effect of bronchoscopy on the respiratory and cardiovascular systems in cardiac surgical patients undergoing mechanical ventilation presented.

[THE DIAGNOSTIC AND THERAPEUTIC BRONCHOSCOPY IN CARDIAC PATIENTS UNDERGOING MECHANICAL VENTILATION IN THE POSTOPERATIVE PERIOD].

The review presents an analysis of domestic and foreign literature on the use of bronchoscopy in patients with obstructive respiratory failure in the ICU. Separately considered the issue of additional research when performing bronchoscopy and create an algorithmfor the application of diagnostic and therapeutic bronchoscopy in cardiac surgical patients undergoing mechanical ventilation.

[Case of successful prevention of multiple organ dysfunctions in 74 years old patient with sepsis after Crawford surgery complicated with pleural empyema, chest wall tissues infection and osteomyelitis of ribs].

The article deals with a clinical case demonstrating that patient's elderly age is not an absolute contraindication for complex surgery in spite of high risk of postoperative complications. Early diagnostics, target treatment of the infection cite with vacuum-assisted therapy for wounds and the treatment of infectious complications based on individual characteristics of elderly patient with sepsis as an outcome of prosthetic thoracoabdominal aortic repair allowed avoiding multiple organ dysfunctions in the patient.

[Mechanisms of interaction between HIV and Mycoplasma arginini in vitro].

AIM: Until now, the problem of effective therapy of HIV-infection is not resolved due to integrative type of interaction of HIV virus with target cell - T-lymphocyte. The study was aimed on search of method of deletion of HIV DNA-provirus from cell's genome. MATERIALS AND METHODS: Non-pathogenic for humans Mycoplasma arginini was used for coinfection of HIV-infected cells in model systems in vitro. RESULTS: Complex of mechanisms was documented leading to: blocking up to 50 - 60% of extracellular virus (according to titration results), cancel of apoptosis in infected cells stained on Hoechst, formation of defective vif(-) virions, which together with arginine-desaminase of M. arginini arrange permissive conditions for activation of cellular APOBEC3G with subsequent disruption of DNA- provirus and blocking of viral infection. As studies of ultrastructure showed, listed events resulted from direct interaction of HIV with mycoplasma. CONCLUSION: The elimination of HIV DNA-provirus is possible by co-infection of T-lymphocytes with M. arginini.

[Standards for laboratory diagnostics of legionellosis and their application during epidemic outbreak of pneumonia in town Verkhnyaya Pyshma].

High effectiveness of application of international standards for legionellosis laboratory diagnostics was confirmed during investigation of pneumonia outbreak in town Verkhnyaya Pyshma. Use of immunochromatographic method and enzyme immunoassay for detection of Legionella antigen in urine of patients allows to confirm diagnosis of Legionella infection during several hours, promptly begin etiologic antibacterial treatment and reveal possible sources of infection in potentially dangerous environmental objects.

[A comparative study of the role of the yadA, invA, and psaA genes in the pathogenicity of Yersinia pseudotuberculosis].

The roles of yadA, invA, and psaA genes introduced into the genetic background of the Y. pseudotuberculosis strain possessing the large p VM82 plasmid in virulence and invasion capacity were studied. Isogenic single mutants as well as double and multiple mutants of these genes were constructed and used. LD50 was used as a measure of virulence and the estimation of the ability to invade mammalian cells and the effect of infection on the weight changes of infected mice were used as additional indicators of pathogenicity. It was shown that the YadA had a major effect on the bacterial virulence when compared with the effects of PsaA and InvA. InvA appears to mediate the main pathway of the cellular invasion. YadA is responsible for the weight loss after infection of mice with sublethal doses of Y. pseudotuberculosis. The effects of YadA on virulence and of InvA on bacterial invasion were independent of the expression of the other genes studied. To our knowledge, this study showed for the first time the direct involvement of YadA in the virulence of Y. pseudotuberculosis in mice. Further pathomorphological studies are required to reveal the differences in the pathogenesis of pseudotuberculosis caused by yadA mutants or yadA+ bacteria of Y. pseudotuberculosis.

[HIV reproduction inhibition by amino acid and dipeptide derivatives of fullerene C60]. / Ingibirovanie reproduktsii VICH s pomoshch'iu aminokislotnykh i dipeptidnykh proizvodnykh Fullerena C60.

Target-aimed synthesis of a new class of water soluble amino acid and dipeptide derivatives of fullurene (C60 - X) for inhibition of specific virus enzymes, i.e. protease and reverse transcriptase of HIV (P HIV and RT HIV) in cell culture lytic and chronic infections was performed. Out of 13 tested substances, 8 showed inhibitory activity and 5 were effective in pharmacological doses (ID50 varied within 0.46 to 1.0 mcm/ml with respect to the lytic infection and 5.0 to 12.5 mcm/ml with respect to the chronic infection). The activity of (1), (2), (6), (7) and (8) was comparable to that of azidothymidine, a nucleozide inhibitor of RT HIV in the cell culture lytic infection. The substances also showed marked virucidal action. The cytotoxicity (survival, antiproliferative effect) varied from low to very low with respect to the rapidly dividing cells MT4 and HTHIV27 (CD50 > 200-800) and was somewhat higher with respect to PBL (CD50 > 100). The selectivity index (SI = CD50/ID50) was equal to 165-2000 for various samples. The prototype derivatives (1) and (2) had a selective (competitive) inhibitory action on the recombinant protease of HIV with IC50 = 1.25-2.76 mcM, while derivatives (1), (la) and (2) had a noncompetitive inhibitory action on the recombinant reverse transcriptase of HIV (Ki = 7.9-12.1 mM). The pharmacokinetic study of the prototype derivative (1) on laboratory animals revealed no acute or chronic toxicity up to the terminal high concentrations. As for (1), its high interspecies (mice--rabbits) relative bioavailability equal to 110% was shown.

Expression of neuronal and inducible nitric oxide synthases in the thymus under normal conditions and after administration of bacterial endotoxin.

The topography of thymocytes expressing neuronal and inducible nitric oxide synthases and changes in the content of luminescent immunoreactive products in these cells after intraperitoneal injection of bacterial lipopolysaccharide were studied by double immunohistochemical labeling. Under normal conditions neuronal nitric oxide synthase-immunopositive cells formed a wide network in thymus medulla (except for perivascular regions). Inducible nitric oxide synthase was expressed in single cells at the corticomedullary boundary. Lipopolysaccharide markedly increased the intensity of luminescence and number of inducible nitric oxide synthase-immunoreactive cells. However, this agent sharply decreased the intensity of luminescence in neuronal nitric oxide synthase-immunopositive cells of the stroma. Our results indicate that neuronal and inducible nitric oxide synthases are synthesized in various stromal cells of the thymus. Expression of these enzyme isoforms undergoes opposite changes during inflammation.

Association between large aortic arch atheromas and high-intensity transient signals in elderly stroke patients.

BACKGROUND AND PURPOSE: Aortic arch atheromas (AAs) have been shown to be a risk factor for ischemic stroke (IS) in the elderly because of their potential for cerebral embolization. However, the association between AAs and the presence of cerebral microemboli has not been clearly established. The aim of this study was to determine whether large AAs are associated with an increased frequency of high-intensity transient signals (HITS) in elderly patients with IS. METHODS: We performed bitemporal simultaneous HITS monitoring of both middle cerebral arteries in 62 consecutive elderly patients with acute IS (mean age 72.5+/-8.8 years, 65% men). In 16 patients, one or both temporal windows were inadequate; therefore, the analysis of HITS was performed in the remaining 46 patients. All patients underwent omniplane transesophageal echocardiography (TEE), and they had no significant extracranial or intracranial artery disease and no cardiac prosthetic valves. Large AA was defined as > or = 4 mm in thickness. Complex AA was defined as ulcerated or mobile, regardless of plaque thickness. HITS monitoring was performed within 24 hours of TEE and analyzed by an experienced neurologist-sonographer blinded to TEE findings. A 9-dB threshold was chosen to discriminate HITS from background Doppler signal. The HITS counts in the left and in the right middle cerebral arteries were added and reported as a total number of HITS in 30 minutes. RESULTS: HITS were detected in 14 (78%) of 18 patients with large AAs versus 8 (29%) of 28 patients with no or small AAs (odds ratio [OR] 8.8, 95% CI 2.2 to 34.8; P=0. 001). The association was also present in 27 patients with no other cardiac embolic sources, such as atrial fibrillation, patent foramen ovale, spontaneous echo contrast, and thrombus (7 of 10 patients with large AAs versus 3 of 17 patients with small or no AA; OR 10.9, 95% CI 1.7 to 68.5; P=0.013). Complex AAs were associated with a higher frequency of HITS than were noncomplex AAs (6 of 6 patients with complex AAs versus 15 of 39 patients with noncomplex AAs; OR 2. 6, 95% CI 1.7 to 3.9; P=0.005). CONCLUSIONS: HITS are significantly associated with large AAs in elderly stroke patients. This observation may support the causal role of large AAs in IS.

Localization of HTLV-1 and HIV-1 proviral sequences in chromosomes of persistently infected cells.

Integration sites for HTLV-1 and HIV-1proviruses were detected by FISH on the chromosomes of HTHIV27 cells persistently infected by HIV-1 (strain IIIB). HTLV-1 signals were found on 9 loci of chromosomes 4, 6, 9, 15 and 16. Integration sites of GC-rich HTLV-1 provirus are located in GC-rich isochores, confirming an 'isopycnic' integration, namely an integration in which the GC level of the host sequences around the integration site match the GC level of the provirus. This conclusion is not only derived from the compositional map of human chromosomes, but also from HTLV-1 hybridization on compositional fractions of human DNA. Integration of GC-poor HIV-1 provirus was found on 4 loci of chromosomes 2, 7, 17 and 19. One copy of a complete HIV-1 provirus, which is active, was integrated in H1 isochores, whereas other defective copies were located in GC-poor L isochores. These results are discussed in terms of regional integration of retroviral sequences.

[The HTHIV27 highly productive continuous cell line and its use for solving the fundamental and applied problems of HIV infection]. / Vysokoproduktivnaia persistentnaia liniia kletok HTHIV27 i ee ispol'zovanie dlia resheniia fundamental'nykh i prikladnykh voprosov VICh-infektsii.

For the first time the detailed description of continuous cell line HTHIV27, remaining stable for more than 10 years, has been made. The stability of all biological characteristics and high productivity of the strain has made it possible to use it as a HIV producing strain for the construction of a diagnostic test system for the detection of antibodies to HIV. The lysate obtained on the basis of HIV producing cells HTHIV27 has been shown to possess a number of advantages in comparison with the analogous system based on lytically infected cells. On the basis of strain HTHIV27 an in vitro cell system for the analysis of the specific activity of chemotherapeutic preparations intended for the inhibition of HIV has been developed. The use of this newly obtained continuous cell line HTHIV27 has been shown to permit the evaluation of the antiviral activity of compounds, characterized by different molecular mechanisms for the suppression of viral activity.

[The genetic transfer, heredity and phenotypic expression of plasmid RP4::Mu cts genes in Bacillus cereus]. / Geneticheskii perenos, nasledovanie i fenotipicheskoe vyrazhenie genov plazmidy RP4::Mu cts v Bacillus cereus.

The transcipients were obtained in intrageneric matings of E.coli donor harbouring the plasmid PR4::Mu cts 62 with Bac. cereus GP7 recipient cells with the frequency 10(-9). The transcipient clone Bac. cereus 682 was selected having stably inherited and expressed the hybrid plasmid PR4::Mu cts 62 genes for antibiotic resistance and temperature sensitivity. Production of the bacteriophage Mu cts 62 particles was not registered in the bacillary transcipient cells. The plasmid RP4::Mu cts 62 genes were localized in the chromosome of Bac. cereus 682 transcipient by the blot-hybridization technique with 32P-labelled DNA of the bacteriophage Mu cts 62 and the plasmid PR4. The transcipient of Bac. cereus 682 has the donor properties and transfers the RP4::Mu cts 62 genes to recipient cells of Bac. cereus DSM 318 with the frequency of 10(-6)-10(-7). The expression and transfer of the gram-negative plasmid genes in gram-positive bacterial cells are discussed.

[Change in the ultrastructure of the cell wall of Bacillus cereus, determined by RP4 MUCTS62 plasmid]. / Izmenenie ul'trastruktury kletochnoi stenki Bacillus cereus, determiniruemoe plazmidoi RP4 MUCTS62.

The influence of plasmid RP4 Mucts62, heterologous for B. cereus, on the growth rate of B. cereus strains GA 682 and 319 obtained in our earlier experiments and on changes in the ultrastructure of their cell walls in comparison with B. cereus initial strains GP 7 and DSM 318 has been studied. Plasmid RP4 Mucts62 with a wide spectrum of action has been found not only to determine the functional signs of resistance to antibiotics and thermal sensitivity in the heterologous host, but also to take part in the morphological organization of the cell surface structure, and in particular in the structure of the S-layer. B. cereus strains containing plasmid RP4 Mucts62 are characterized by slower growth rate and cell fragility.