[Successful treatment of an aortoduodenal fistula after operation on the abdominal portion of the aorta]. / Uspeshnoe lechenie aorto-duodenal'noi fistuly posle operatsii na briushnom otdele aorty.

Gastrointestinal haemorrhage is a common cause of emergency admission of patients to surgical hospitals. Within the structure of nosological entities, not unreasonably referred to the rarest causes of gastrointestinal bleeding is the formation of an aortointestinal fistula whose early diagnosis is of paramount importance. The clinical picture may be different but it is mostly represented by gastrointestinal haemorrhage. The incidence of gastrointestinal fistulas following a surgical intervention ranges from 0.6 to 2.3%. Unless timely diagnosed and with incorrect therapeutic decision-making, the mortality rate amounts to 90%. In this article we present a clinical case report regarding successful treatment of a patient presenting with a secondary aortoduodenal fistula occurring 5 years after previously performed aortofemoral bypass grafting and complicated by relapsing intestinal bleeding and acute ischaemia of the right lower extremity.

[AUTOVENOUS REVASCULARIZATION OF THE LOWER EXTREMITY ARTERIES IN PATIENTS WITH VARIANT ANATOMY OF THE PERIPHERAL BLOOD FLOW AND THE PROGRESSIVE ATHEROSCLEROTIC PROCESS].

Obliterating diseases of the lower extremity arteries occupy a high proportion in the structure of cardiovascular morbidity in the population among the developed countries. The steadily progressing course of obliterating atherosclerosis leads to the critical lower limb ischemia and causes an unfavorable prognosis for preserving the extremity, as well as the patient's life. Nowadays, there are two ways of surgical management of this pathology: endovascular and open reconstructive interventions. The choice of the method is based on a comprehensive keeping of the patient-specific records, including the anatomical characterization of the arterial bed lesions. In case of extended occlusion of the superficial femoral artery, the open reconstructive surgery using a large saphenous vein as a transplant is recommended. This circumstance is confirmed by the autovein patency in the long term compared with a synthetic prosthesis according to the results of randomized clinical trials. Therefore, with the formation of a distal anastomosis below the gap of the knee joint, the patency of the autovein and synthetic prosthesis after 5 years is 71% and 44% respectively. In this article, we represent a clinical case of successful treatment of a patient with progression of atherosclerotic lesions of the infrainguinal segment arteries. A staged revascularization of the femoral-popliteal segment arteries using technique of a reversed vein on both lower extremities after attempts of the conservative treatment and x-ray endovascular intervention was performed. A feature of this case is the creation of a new bifurcation of the popliteal artery during the formation of a distal anastomosis below the fissure of the knee joint under the contitions of a high discharge of the anterior tibial artery.The given clinical case demonstrates the advantages of invasive surgical tactics with the aim of preserving the limb and improving the patient's quality of life.

Intranasal oxytocin increases facial expressivity, but not ratings of trustworthiness, in patients with schizophrenia and healthy controls.

BACKGROUND: Blunted facial affect is a common negative symptom of schizophrenia. Additionally, assessing the trustworthiness of faces is a social cognitive ability that is impaired in schizophrenia. Currently available pharmacological agents are ineffective at improving either of these symptoms, despite their clinical significance. The hypothalamic neuropeptide oxytocin has multiple prosocial effects when administered intranasally to healthy individuals and shows promise in decreasing negative symptoms and enhancing social cognition in schizophrenia. Although two small studies have investigated oxytocin's effects on ratings of facial trustworthiness in schizophrenia, its effects on facial expressivity have not been investigated in any population. METHOD: We investigated the effects of oxytocin on facial emotional expressivity while participants performed a facial trustworthiness rating task in 33 individuals with schizophrenia and 35 age-matched healthy controls using a double-blind, placebo-controlled, cross-over design. Participants rated the trustworthiness of presented faces interspersed with emotionally evocative photographs while being video-recorded. Participants' facial expressivity in these videos was quantified by blind raters using a well-validated manualized approach (i.e. the Facial Expression Coding System; FACES). RESULTS: While oxytocin administration did not affect ratings of facial trustworthiness, it significantly increased facial expressivity in individuals with schizophrenia (Z = -2.33, p = 0.02) and at trend level in healthy controls (Z = -1.87, p = 0.06). CONCLUSIONS: These results demonstrate that oxytocin administration can increase facial expressivity in response to emotional stimuli and suggest that oxytocin may have the potential to serve as a treatment for blunted facial affect in schizophrenia.

Application of Laser Correlation Spectroscopy for Measuring Virus Size.

Dynamic light scattering method or laser correlation spectroscopy was applied to evaluation of the size of viruses. We measured correlation functions of the light scattered by human immunodeficiency viruses (HIV) and hepatitis A viruses (HAV) and found that size of HIV-1 (subtype A and B) and HAV virions were 104 nm and 28 nm, respectively. Comparison of these findings with electron microscopy data for fixed samples of the same viruses showed good agreement of the results.

A Validated Tropical-Extratropical Flood Hazard Assessment for New York Harbor.

Recent studies of flood risk at New York Harbor (NYH) have shown disparate results for the 100-year storm tide, providing an uncertain foundation for the flood mitigation response after Hurricane Sandy. Here, we present a flood hazard assessment that improves confidence in our understanding of the region's present-day potential for flooding, by separately including the contribution of tropical cyclones (TCs) and extratropical cyclones (ETCs), and validating our modeling study at multiple stages against historical observations. The TC assessment is based on a climatology of 606 synthetic storms developed from a statistical-stochastic model of North Atlantic TCs. The ETC assessment is based on simulations of historical storms with many random tide scenarios. Synthetic TC landfall rates and the final TC and ETC flood exceedance curves are all shown to be consistent with curves computed using historical data, within 95% confidence ranges. Combining the ETC and TC results together, the 100-year return period storm tide at NYH is 2.70 m (2.51-2.92 at 95% confidence), and Hurricane Sandy's storm tide of 3.38 m was a 260-year (170-420) storm tide. Deeper analyses of historical flood reports from estimated Category-3 hurricanes in 1788 and 1821 lead to new estimates and reduced uncertainties for their floods, and show that Sandy's storm tide was the largest at NYH back to at least 1700. The flood exceedance curves for ETCs and TCs have sharply different slopes due to their differing meteorology and frequency, warranting separate treatment in hazard assessments.

Nanogel-Conjugated Reverse Transcriptase Inhibitors and Their Combinations as Novel Antiviral Agents with Increased Efficacy against HIV-1 Infection.

Nucleoside reverse transcriptase inhibitors (NRTIs) are an integral part of the current antiretroviral therapy (ART), which dramatically reduced the mortality from AIDS and turned the disease from lethal to chronic. The further steps in curing the HIV-1 infection must include more effective targeting of infected cells and virus sanctuaries inside the body and modification of drugs and treatment schedules to reduce common complications of the long-term treatment and increase patient compliancy. Here, we describe novel NRTI prodrugs synthesized from cholesteryl-ε-polylysine (CEPL) nanogels by conjugation with NRTI 5'-succinate derivatives (sNRTI). Biodegradability, small particle size, and high NRTI loading (30% by weight) of these conjugates; extended drug release, which would allow a weekly administration schedule; high therapeutic index (>1000) with a lower toxicity compared to NRTIs; and efficient accumulation in macrophages known as carriers for HIV-1 infection are among the most attractive properties of new nanodrugs. Nanogel conjugates of zidovudine (AZT), lamivudine (3TC), and abacavir (ABC) have been investigated individually and in formulations similar to clinical NRTI cocktails. Nanodrug formulations demonstrated 10-fold suppression of reverse transcriptase activity (EC90) in HIV-infected macrophages at 2-10, 2-4, and 1-2 µM drug levels, respectively, for single nanodrugs and dual and triple nanodrug cocktails. Nanogel conjugate of lamivudine was the most effective single nanodrug (EC90 2 µM). Nanodrugs showed a more favorable pharmacokinetics compared to free NRTIs. Infrequent iv injections of PEGylated CEPL-sAZT alone could efficiently suppress HIV-1 RT activity to background level in humanized mouse (hu-PBL) HIV model.

Oxytocin administration selectively improves olfactory detection thresholds for lyral in patients with schizophrenia.

BACKGROUND: Olfaction plays an important role in mammalian social behavior. Olfactory deficits are common in schizophrenia and correlate with negative symptoms and low social drive. Despite their prominence and possible clinical relevance, little is understood about the pathological mechanisms underlying olfactory deficits in schizophrenia and there are currently no effective treatments for these deficits. The prosocial neuropeptide oxytocin may affect the olfactory system when administered intranasally to humans and there is growing interest in its therapeutic potential in schizophrenia. METHODS: To examine this model, we administered 40IU of oxytocin and placebo intranasally to 31 patients with a schizophrenia spectrum illness and 34 age-matched healthy control participants in a randomized, double-blind, placebo-controlled, cross-over study. On each test day, participants completed an olfactory detection threshold test for two different odors: (1) lyral, a synthetic fragrance compound for which patients with schizophrenia have specific olfactory detection threshold deficits, possibly related to decreased cyclic adenosine 3',5'-monophosphate (cAMP) signaling; and (2) anise, a compound for which olfactory detection thresholds change with menstrual cycle phase in women. RESULTS: On the placebo test day, patients with schizophrenia did not significantly differ from healthy controls in detection of either odor. We found that oxytocin administration significantly and selectively improved olfactory detection thresholds for lyral but not for anise in patients with schizophrenia. In contrast, oxytocin had no effect on detection of either odor in healthy controls. DISCUSSION: Our data indicate that oxytocin administration may ameliorate olfactory deficits in schizophrenia and suggest the effects of intranasal oxytocin may extend to influencing the olfactory system. Given that oxytocin has been found to increase cAMP signaling in vitro a possible mechanism for these effects is discussed.

Amphiphilic cationic nanogels as brain-targeted carriers for activated nucleoside reverse transcriptase inhibitors.

Progress in AIDS treatment shifted emphasis towards limiting adverse effects of antiviral drugs while improving the treatment of hard-to-reach viral reservoirs. Many therapeutic nucleoside reverse transcriptase inhibitors (NRTI) have a limited access to the central nervous system (CNS). Increased NRTI levels induced various complications during the therapy, including neurotoxicity, due to the NRTI toxicity to mitochondria. Here, we describe an innovative design of biodegradable cationic cholesterol-ε-polylysine nanogel carriers for delivery of triphosphorylated NRTIs that demonstrated high anti-HIV activity along with low neurotoxicity, warranting minimal side effects following systemic administration. Efficient CNS targeting was achieved by nanogel modification with brain-specific peptide vectors. Novel dual and triple-drug nanoformulations, analogous to therapeutic NRTI cocktails, displayed equal or higher antiviral activity in HIV-infected macrophages compared to free drugs. Our results suggest potential alternative approach to HIV-1 treatment focused on the effective nanodrug delivery to viral reservoirs in the CNS and reduced neurotoxicity.

[Telemedical approach to the organization of the advisory dermatologic care].

Considered the introduction to the health practice of the remote medical help by the information and Communication Technologies to improve the quality of diagnostics of dermatological patients in the remote garrisons. Developed the scheme and the map of teleconsultation, and also defined indications for its conduct. Given the example of online consultation resulted in a diagnosis of pathomimics (Munchausen's disease), and in the recommendations for survey and treatment of the patient. It is concluded that the development of remote consultation of the patients needing dermatovenereological medical care from any health care facility will bring closer the highly specialized dermatovenereological assistance to the remote garrisons and will significantly save the cost of such assistance.

[The concept "a case in outpatient treatment" in military policlinic activity].

Substantiates the necessity of transition of military policlinics to the accounting system and evaluation of their activity on the finished cases of outpatient treatment. Only automating data-statistical processes can solve this problem. On the basis of analysis of the literature data, requirements of the guidance documents and observational results concludes that preliminarily should be done revisal (formalisation) of existing concepts of medical statistics from the position of information environment which in use - electronic databases. In this aspect specified the main features of outpatient treatment case as a unit of medical-statistical record, and formulated its definition.

Oxytocin administration enhances controlled social cognition in patients with schizophrenia.

BACKGROUND: Individuals with schizophrenia have functionally significant deficits in automatic and controlled social cognition, but no currently available pharmacologic treatments reduce these deficits. The neuropeptide oxytocin has multiple prosocial effects when administered intranasally in humans and there is growing interest in its therapeutic potential in schizophrenia. METHODS: We administered 40 IU of oxytocin and saline placebo intranasally to 29 male subjects with schizophrenia and 31 age-matched, healthy controls in a randomized, double-blind, placebo-controlled, cross-over study. Social cognition was assessed with The Awareness of Social Inference Test (TASIT) and the Reading the Mind in the Eyes Test (RMET). We examined the effects of oxytocin administration on automatic social cognition (the ability to rapidly interpret and understand emotional cues from the voice, face, and body); controlled social cognition (the ability to comprehend indirectly expressed emotions, thoughts, and intentions through complex deliberations over longer time periods); and a control task (the ability to comprehend truthful dialog and perform general task procedures) in individuals with and without schizophrenia using mixed factorial analysis of variance models. RESULTS: Patients with schizophrenia showed significant impairments in automatic and controlled social cognition compared to healthy controls, and administration of oxytocin significantly improved their controlled, but not automatic, social cognition, F(1, 58)=8.75; p=0.004. Conversely, oxytocin administration had limited effects on social cognition in healthy participants. Patients and controls performed equally well and there were no effects of oxytocin administration on the control task. DISCUSSION: Intact social cognitive abilities are associated with better functional outcomes in individuals with schizophrenia. Our data highlight the potentially complex effects of oxytocin on some but not all aspects of social cognition, and support the exploration of intranasal oxytocin as a potential adjunct treatment to improve controlled social cognition in schizophrenia.

Association between schizophrenia symptoms and neurocognition on mobility in older adults with schizophrenia.

OBJECTIVES: Older persons with schizophrenia develop problems associated with aging, such as poor mobility, at more rapid rates than people without serious mental illness. Decrements in mobility contribute to poor health outcomes. Impaired neurocognitive function and psychiatric symptoms are central aspects of schizophrenia. The purpose of this study was to determine the association between neurocognitive impairment and schizophrenia symptoms to mobility in older adults with schizophrenia. METHODS: A cross-sectional study with 46 older adults with schizophrenia. Participants were assessed on neurocognitive function (MATRICS Consensus Cognitive Battery), psychiatric symptoms (Positive and Negative Syndrome Scale or PANSS), and mobility (Timed Get Up and Go or TGUG test). Pearson's bivariate correlations (two-tailed) and a simultaneous regression model were used. RESULTS: Lower severity of negative symptoms and faster speed of processing tests were associated with faster TGUG time in bivariate correlations and multivariate regression analyses (p < .05). CONCLUSION: Our data suggest that lower negative symptoms and faster speed of processing positively impact mobility in older patients with schizophrenia. Mobility interventions for this population need to target neurocognitive impairment and schizophrenia symptoms for optimal results.

Quantitative assessment of brain microvascular and tissue oxygenation during cardiac arrest and resuscitation in pigs.

Cardiac arrest is associated with a very high rate of mortality, in part due to inadequate tissue perfusion during attempts at resuscitation. Parameters such as mean arterial pressure and end-tidal carbon dioxide may not accurately reflect adequacy of tissue perfusion during cardiac resuscitation. We hypothesised that quantitative measurements of tissue oxygen tension would more accurately reflect adequacy of tissue perfusion during experimental cardiac arrest. Using oxygen-dependent quenching of phosphorescence, we made measurements of oxygen in the microcirculation and in the interstitial space of the brain and muscle in a porcine model of ventricular fibrillation and cardiopulmonary resuscitation. Measurements were performed at baseline, during untreated ventricular fibrillation, during resuscitation and after return of spontaneous circulation. After achieving stable baseline brain tissue oxygen tension, as measured using an Oxyphor G4-based phosphorescent microsensor, ventricular fibrillation resulted in an immediate reduction in all measured parameters. During cardiopulmonary resuscitation, brain oxygen tension remained unchanged. After the return of spontaneous circulation, all measured parameters including brain oxygen tension recovered to baseline levels. Muscle tissue oxygen tension followed a similar trend as the brain, but with slower response times. We conclude that measurements of brain tissue oxygen tension, which more accurately reflect adequacy of tissue perfusion during cardiac arrest and resuscitation, may contribute to the development of new strategies to optimise perfusion during cardiac resuscitation and improve patient outcomes after cardiac arrest.

SU-E-I-94: External Beam Radiation Cherenkov Emission in Tissue Used for Tissue Oxygen Sensing.

PURPOSE: To show that Cherenkov emission is generated by external radiotherapy beam in tissue, and could serve as optical source to excite an oxygen sensitive phosphor, Oxyphor G4, within tissue. The intensity and lifetime of the phosphorescence was measured with a time-gated system and reveals the oxygenation levels in the tissue phantom. METHODS: A tissue phantom made with PBS, 1% v/v Intralipid-20% (Sigma Aldrich), 1% v/v whole blood and Oxyphor G4 in 1 µM concentration is irradiated by 18MeV external radiotherapy electron beam at a dose rate of 4 Gy/min generated by a medical linear accelerator (Varian LINAC 2100C, Varian Medical Systems). On one side of the phantom, a fiber bundle is used to conduct optical signal to a spectrometer connected to a fast gating ICCD (PI-MAX3, Princeton Instruments). For each oxygenation level, a series of spectrum of phosphorescence at different time points is measured by the time domain gating technique. Lifetime of phosphorescence is analyzed by exponential fitting and is validated by comparison to an independent analysis by frequency domain phosphorimetry. Monte Carlo simulations using GEANT4, of the fiber optic collection of Cerenkov light were performed to decide the sensitivity of the optical system for a range of specified geometries and beam types. Simulation results identify the effective depth within the phantom that is sampled by the optical collection of the Cerenkov signal. RESULTS: Simulations show that we can detect the Cherenkov signals comes from an approximately 5 mm depth from within the tissue phantom. Lifetime of the phosphorescence and pO2 of the phantom could be measured and calculated correctly by the time domain gating system. CONCLUSIONS: This work indicates time domain gating techniques combined with an oxygen sensitive phosphor are capable of accurately monitoring tissue oxygenation from a reasonable sampling depth in tissue in vivo during external beam radiotherapy. NIH grant R01CA109558.

Principles of strategic drug delivery to the brain (SDDB): development of anorectic and orexigenic analogs of leptin.

The blood-brain barrier (BBB) presents a tremendous challenge for the delivery of drugs to the central nervous system (CNS). This includes drugs that target brain receptors for the treatment of obesity and anorexia. Strategic drug delivery to brain (SDDB) is an approach that considers in depth the relations among the BBB, the candidate therapeutic, the CNS target, and the disease state to be treated. Here, we illustrate principles of SDDB with two different approaches to developing drugs based on leptin. In normal body weight humans and in non-obese rodents, leptin is readily transported across the BBB and into the CNS where it inhibits feeding and enhances thermogenesis. However, in obesity, the transport of leptin across the BBB is impaired, resulting in a resistance to leptin. As a result, it is difficult to treat obesity with leptin or its analogs that depend on the leptin transporter for access to the CNS. To treat obesity, we developed a leptin agonist modified by the addition of pluronic block copolymers (P85-leptin). P85-leptin retains biological activity and is capable of crossing the BBB by a mechanism that is not dependent on the leptin transporter. As such, P85-leptin is able to cross the BBB of obese mice at a rate similar to that of native leptin in lean mice. To treat anorexia, we developed a leptin antagonist modified by pegylation (PEG-MLA) that acts primarily by blocking the BBB transporter for endogenous, circulating leptin. This prevents blood-borne, endogenous leptin from entering the CNS, essentially mimicking the leptin resistance seen in obesity, and resulting in a significant increase in adiposity. These examples illustrate two strategies in which an understanding of the interactions among the BBB, CNS targets, and candidate therapeutics under physiologic and diseased conditions can be used to develop drugs effective for the treatment of brain disease.

[Optimization of work of polyclinic in medical supply of attached contingents on the base of using of informational technologies].

The article presents review of experience of forming of information system of recording of visiting of policlinics and analyze of treatment measures. Functioning of this system on the base of local computer net permitted considerably improve indexes of work of policlinics.

The sympathetic neural apparatus of the rat uterus during the sexual cycle.

A microspectral fluorescence-histochemical method was used to study the sympathetic neural apparatus of the rat uterus at different phases of the sexual cycle. Most nerve fibers, as perivascular plexuses and terminals emanating from them, were located in the myometrium. It is suggested that the uterus contains reserve ("silent" nerve fibers, which explains the variability in their appearance in this organ. Microspectrofluorimetric studies identified catecholamines and serotonin in varicose swellings and intervaricosity segments of nerve fibers; levels at test points showed a strong linear correlation at all stages of the sexual cycle. The greatest bioamine levels in most structural elements of the sympathetic neural apparatus of the uterus were seen in late diestrus. Early and late estrus and proestrus were characterized by low monoamine levels in adrenergic fibers. A number of significant differences were seen between the level of saturation with bioamines and the spatial distribution density of nerve fibers in the body and cervix of the uterus.

[Dynamics of histamine content in the rat uterus compartments according to the stages of the estrous cycle (a fluorescence histochemical study)].

The purpose of the present study was to detect the main histamine-containing structures of the rat uterus and to study the changes of its content during the estrous cycle. The work was performed during the autumn-winter period using 120 female rats that were divided into groups according to the stages of the estrous cycle: early estrus, late estrus, metestrus, early diestrus, late diestrus, proestrus. Cryostat sections of uterine corpus and cervix were studied using fluorescent-histochemical method with the orthophthalic aldehyde. The histamine content was determined in mast cells, macrophages, surface and glandular epithelial cells, smooth myocytes in the tunics of the uterine corpus and cervix, as well as in the contents of the uterine cavity. During the sexual cycle, the highest histamine concentrations were detected in mast cells, especially in those located in the myometrium. In most of the bioamine-positive cellular elements of the uterine wall, the minimal histamine content was found in metestrus. As a result of a computer-statistical analysis, it was demonstrated that the intraorgan histamine metabolism in the structures of the uterine tunics studied, was characterized by phase and regional specificity together with the dynamic nature of temporal coupling of histamine content.

[Uterus sympathetic nervous apparatus in sexual cycle dynamics in rats].

Uterus sympathetic nervous apparatus in various phases of sexual cycle in rats was studied with the microspectral fluorescent method. The main part of nervous fibers in the form of perivascular plexus and terminals deviating from them are localized in myometrium. We suppose presence of reserve ("silent") nervous fibers in uterus which explains the inconstancy of their revealing in the organ. Catecholamines and serotonin are identified in varicose enlargements and intervaricose parts of nervous fibers by the way of microspectrofluorometry. Their concentration in probing places is characterized by high degree of linear correlation at all stages of sexual cycle. Maximal concentration of bioamines in most structural elements of uterus sympathetic nervous apparatus in detected in late diestrus. Stages of early and late estrus and proestrus are characterized by low levels of monoamines in adrenergic fibers. A number of reliable differences between bioamines saturation and spatial distribution density of nervous fibers in the neck and body of the womb are revealed.

[Bioamine-positive structures in the rat mesometrium and their changes in the estrous cycle].

The objective of this study was to demonstrate main bioamine-positive structures in rat mesometrium, to detect their spatial cooperations and to define their catecholamine, serotonin and histamin content during the sexual cycle. The study was performed in 120 female rats of reproductive age, which were divided into groups according to the stages of sexual cycle: early estrus, late estrus, metestrus, early diestrus, late diestrus, proestrus. By using the microspectrofluorometric histological methods, the following bioamine-positive structures were differentiated in rat mesometrium that were cooperated in space: sympathetic nerve fibers (containing catecholamines and serotonin), mast cells and macrophages (containing catecholamines, serotonin and histamine). Regular dynamics of individual bioamine indices was detected during the sexual cycle. The role of mesometrium in the system of uterine extraorganic bioamine supply is discussed.