[Analysis of the work of the Immunohistochemical Quality Control Center of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia in 2023]. / Analiz raboty Tsentra kontrolya kachestva immunogistokhimicheskikh issledovanii FGBOU DPO «RMANPO¼ Minzdrava Rossii v 2023 godu.

The article demonstrates a detailed analysis of the results of the rounds of quality control of immunohistochemical studies conducted by the Central Committee of the Immunohistochemical Quality Control Center of the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of Russia in 2023. Typical shortcomings and errors in the immunohistochemical examination of various tumors have been identified and ways to eliminate them are given. Particular attention is paid to defining a panel of standard breast cancer markers and eliminating the shortcomings of immunohistochemical examination of markers of accompanying diagnosis.

[Features of diagnosis and treatment of elderly and senile patients with adhesive small bowel obstruction.]

Adhesive small bowel obstruction is a common pathology with a tendency to increase characterized by a complex pathogenetic course with a high percentage of complications and deaths. Among the forms of intestinal obstruction caused by mechanical obstacles acute small bowel obstruction ranges from 64,3 to 80% with a mortality rate of 5,1 to 8,4% in the structure of urgent diseases. The complexity of early diagnosis along with an erased clinical picture severe course against a burdened background as well as age - in elderly and senile people leads to the search for new optimized treatment and diagnostic protocols. The purpose of this study was to study the nature of the course of adhesive small bowel obstruction in elderly and senile people to establish the information content of various diagnostic methods to determine the indications for the choice of the optimal period and method of treatment. A comparative analysis of 191 patients aged 60 to 90 years and older who received treatment in the surgical departments of St. Elizabeth Hospital (St. Petersburg) in the period from 2016-2019 was carried out. All patients were divided into 2 groups: the main group consisted of 106 patients (2018-2019) the comparison group included 85 patients (2016-2017). All patients of the main group used an improved diagnostic and treatment algorithm with the use of an original point-assessment scale which made it possible to optimize diagnostics and improve treatment results. Patients in the comparison group were examined in accordance with standard protocols and surgical treatment was carried out exclusively by traditional methods. The use of the proposed therapeutic and diagnostic algorithm made it possible to increase the probability of conservative resolution of acute adhesive small bowel obstruction from 20% (17) to 33% (35) and to reduce the incidence of postoperative complications from 60,2% (41) to 25,3% (18), p<0,01, and the mortality rate from 23,5% (16) to 7% (5), p<0,05.

Reconstruction of Fingers Using Skin-Bone Grafts with Microvascular Anastomoses.

The aim of the study was to present a clinical and anatomical rationale for transplantation of skin-bone grafts with microvascular anastomoses for treating terminal and segmental defects of the hand and fingers. MATERIALS AND METHODS: Finger and metacarpal bones were reconstructed in 25 hands of 25 patients by transplanting skin-bone tubular fragments with microvascular anastomoses. Transplants from the second metatarsal bone (n=22) and fibula (n=3) were used. Clinical, radiological, morphological, biomechanical, biophysical, and statistical research methods were used. The developed technology is adjustable to individual vascular anatomy of the foot. The proposed use of non-free skin-fat flaps and skin-bone fragments with microvascular anastomoses has been implemented for reconstructing lost segments. RESULTS: The engraftment of skin-bone fragments was observed in 25 cases. In two cases, partial necrosis of the transplants was detected. Sufficient resistance of the transplanted bone graft to resorption was noted. According to the X-ray evidence, the length of the finger with the metacarpal bone after surgery was 8.44±0.32 cm, in the short term after surgery - 8.10±0.36 cm, and in the long term - 7.87±0.45 cm, indicating mild resorption. We used an individual approach to the transplant selection, which made it possible to obtain generally good long-term results in 3 patients, and satisfactory results - in 22 patients. CONCLUSION: The study showed the feasibility of transplanting skin-bone fragments with microvascular anastomoses for replacing various anatomical defects of the hand and fingers. The proposed modification takes into account the variability of vascular anatomy of the donor region.

[Surgical treatment strategy for common peritonitis in the elderly patients.]

Despite the obvious progress in the treatment of secondary peritonitis common forms, the results are far from satisfactory, especially among patients of older age groups. In some cases, a single surgical intervention is not enough for a complete elimination of the intra-abdominal infection source, which leads to repeated sanitation interventions, the order and timing of which are currently not strictly regulated. The effectiveness of the treatment algorithm, which considers a differentiated approach to planned surgical interventions in a short time in patients with severe pathomorphological changes in the abdominal cavity, was studied. The results of treatment using planned sanitation interventions demonstrated the effectiveness of the developed algorithm, allowing to reduce the overall postoperative mortality by reducing the proportion of abdominal sepsis in the structure of adverse outcomes.

[Changes in the quality of life in patients with multiple sclerosis treated with ocrelizumab]. / Izmeneniia kachestva zhizni patsientov s rasseiannym sklerozom na fone kursa lecheniia okrelizumabom.

AIM: To study the quality of life (QoL) in patients with multiple sclerosis (MS) treated with ocrelizumab for at least 12 months. MATERIAL AND METHODS: Thirty-eight patients were observed, including 13 with primary progressive MS (PPMS), 15 with highly active relapsing-remitting MS (HAMS) and 10 with secondary progressive MS (SPMS) with relapses. QoL was studied using unspecific SF-36 and MS-specific MusiQoL questionnaires. Depression and fatigue were assessed with the Beck Depression Scale (BDS) and the Modified Fatigue Impact Scale (MFIS). RESULTS AND CONCLUSION: Basic characteristics of QoL indexes of the patients were similar to those previously reported for these MS variants. After 6 and 12 months, a significant increase in the indexes of the majority of SF-36 and MusiQoL scales was identified that shows a significant improvement in both physical and psychological domains of QoL. The significant and rapid decrease in depression severity after 6-month treatment with ocrelizumab may at least in part be associated with improvement of indexes of vitality, general health, social relations and the total QoL score.

[Additional possible mechanisms of the action of ocrelizumab in multiple sclerosis on example of a case-report]. / Vozmozhnye dopolnitel'nye mekhanizmy deistviia okrelizumaba pri rasseiannom skleroze na primere klinicheskogo sluchaia.

Anti-B-cells products, including the anti-CD20 monoclonal antibody ocrelizumab, are widely coming to multiple sclerosis (MS) therapy. Its clinical-MRI efficacy in MS with relapses as well in primary progressive MS (PPMS) was proved by three phase III clinical studies. One example of the use of ocrelizumab use in aggressive MS showed the possibility of action on the leptomeningeal folliculi, seen at contract-enhancing MRI images.

CROSS-PROTECTIVE PROPERTIES OF AN INFLUENZA VACCINE BASED ON HBC4M2E RECOMBINANT PROTEIN.

One of the main problems in the area of influenza prophylaxis and pandemic prevention is the development of cross-reactive vaccines, i.e. vaccines directed against all subtypes of human influenza viruses. Such vaccines are being developed in many countries for more than 10 years. A number of vaccines are presently undergoing clinical trials. We created Uniflu candidate vaccine based on recombinant HBc4M2e protein consisting of 4 tandem-connected copies of the highly conserved ectodomain of M2 protein of the influenza A virus. These 4 copies were genetically fused to the carrier protein, namely hepatitis B core antigen. Commercially available Derinat was used as adjuvant in the candidate vaccine. Preclinical studies on laboratory animals (mice, ferrets) demonstrated that immunization with Uniflu leads to significantly higher level of specific immunoglobulins in the blood and bronchoalveolar lavages. Moreover, it produces immunoglobulins belonging to subtype IgG2a that is the most important mediator of antibody-dependent cytotoxicity. The vaccine under review stimulates the proliferation of T-lymphocytes, as well as the formation of CD4+ and CD8+ T-cells synthesizing ɣ-IFN. When infected with the lethal doses (5 LD50) of influenza A viruses of the subtypes H1N1, H2N2, H3N2, and H1N1pdm09, immunized animals typically developed mild form of illness. This kept them alive in 90-100% of cases, which demonstrated almost complete protection from death. Replication of the virus in the lungs of immunized mice was reduced by 1.8-4.8 log10. High immunogenicity of the vaccine, and reduced clinical symptoms following experimental infection, were demonstrated in ferrets as well. The developed recombinant vaccine Uniflu has high specific activity and cross-protection. Uniflu can be proposed as pre-pandemic vaccine, provided that it passes clinical trials.

[Clinical and morphological characteristics of gastrointestinal stromal tumors]. / Kliniko-morfologicheskaia kharakteristika gastrointestinal'nykh stromal'nykh opukholei.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Despite this, GISTS comprise about 2% in the structure of digestive tract cancers. They are usually localized in the stomach; however, they can be found in the small intestine and more rarely in the colon and esophagus. Although approximately 70% of the GISTs consist predominantly of spindle cells; the epithelioid cell tumors represent 20% of cases; there are also mixed variants. This variability in the morphological structure of GISTs complicates their diagnosis.

[Impact of mutations in nucleoprotein on replication of influenza virus A/Hong Kong/1/68/162/35 reassortants at different temperatures].

The nucleoprotein (NP) of influenza virus is a multifunctional RNA binding protein. The role of NP in the adaptation of influenza viruses to a host has been experimentally proved. Ambiguous data are available on the role of nucleoprotein in the attenuation of influenza A viruses, which is characterized by ability to replicate at low temperature (26°C) and inability to replicate at high temperature (39°C). Influenza virus donor strain A/Hong Kong/1/68/162/35 (H3N2), adapted to growth at low temperature, differs from the wild type virus by 14 amino acid mutations in the internal and non-structural proteins. Two mutations occurred in the NP: Gly102Arg and Glu292Gly. We have obtained viruses with point reverse-mutations in these positions and compared their replication at different temperatures by measuring infectious activity in chicken embryos. It has been shown that reverse mutation Gly292Glu in the NP reduced virus ability to replicate at low temperature, the introduction of the second reverse mutation Arg102Gly completely abolished virus cold adaptation.

[Metaphylaxis of urolithiasis: new look, modern approach, implementation in a mobile application].

AIM: To analyze the sub-segment of mHealth devoted to assessing of the risk of recurrent stone formation and metaphylaxis of stone formation. To design a smartphone application (app.) in Russian language for urolithiasis patients. MATERIALS AND METHODS: Three working groups of urologists from three St. Petersburg clinics searched for downloadable medical applications relevant to the above requirements. After searching and analyzing existing medical applications, the most acceptable design and structure of our own application were identified. RESULTS: The developed "Urolithiasis" application is available for free download in Russian language versions in App Store (Apple, Inc.) and Google Play (Android market, Google, Inc.). It features the following sections: 1) "Take the test" (personalized calculation of the risk of kidney stone recurrence and providing relevant recommendations using ROKS nomogram), 2) "Water" (with reminders to drink water and automatic logging of the water intake), 3) "Food" (Nutrition facts on the content of calcium, oxalate, purine, protein, citrate and calories in common foods), 4) "My doctor" (in the future this option will allow for on-line communication with a patients physician), 5) "Feedback" (if the patient does not find the desired product or has a question - this section is for him/her). CONCLUSIONS: The smartphone application "Urolithiasis" in Russian may be recommended to patients with urolithiasis for improving the effectiveness of metaphylaxis.

RECONSTRUCTIVE AND RESTORATIVE OPERATIONS ON EXTRAHEPATIC BILE DUCTS USING MICROSURGICAL TECHNOLOGIES: EXPERIMENTAL SUBSTANTIATION AND CLINICAL EXPERIENCE.

The authors proposed the new methods of forming of microsurgical biliary-enteric anastomoses with sphincteric and antireflux properties. Development and anatomico-experimental substantiation of the new methods were performed on 68 experimental animals (dogs) and 20 organocomplexes of human cadavers. An experimental approbation of microsurgical biliary-enteric anastomoses showed the possibility, safety and high function of anastomoses. Microsurgical technique and developed methods of biliary-enteric anastomoses were applied on 65 patients with good results.

PRIMARY HYPERTROPHIC PYLORIC STENOSIS IN ADULTS.

THE AIM: to present some information-about the rare primary hypertrophy of the pylorus in adults and a clinical case of a patient with this disease. MATERIALS AND METHODS: the patient A., 52 years of age, after which clinical-instrumental and laboratory research was diagnosed with infiltrative form of cancer of the pylorus with decompensated stenosis. The used: videothoracoscopy, fluoroscopy, peripheral computer electrogastrogram, local fluorescence spectroscopy. The General blood and urine tests, biochemical blood tests, PCR for the determination of tumor markers. RESULTS: The resection of 2/3 of the stomach Billroth I. histological examination of the pylorus diagnosed with hypertrophy of circular muscle fibers, to a lesser extent, hypertro- phy of the longitudinal fibers with inflammatory changes. CONCLUSION: in cases of suspected infiltrative form of cancer of the pylorus in adults differential diagnosis it is advisable to include the primary hypertrophy of his.

MIOBLASTOMA GRAINYCLY CELL OF ESOPHAGEAL.

PURPOSE OF THE STUDY: Pay attention endoscopists doctors, oncologists surgeons, gastroenterologists on the ability to detect mioblastoma in the esophagus, as well as to present its endoscopic semiotics. MATERIAL AND METHODS: 32583 A primary esophagogastroduodenoscopy and only one patient S., 39 years old (0.0031%) showed polypoid masses in the lower third of the esophagus. Esophagogastroscopy underwent endoscopy XP iSON system Exera II. Patients underwent clinical evaluation and morphological study of endoscopically resected of education. RESULTS: Patient 39 years old 20.01.2012, in the lower third of the esophagus revealed polypoid formation with a flat, smooth surface covered with a mucous membrane, not different from the surrounding mucosa. Morphologic study after endoscopic resection of the tumor - grainycly cell mioblastoma. When viewed within four years of changes in the mucosa and not detected change in the esophageal wall. CONCLUSION: Abrikosov tumor in the esophagus is extremely rare localization has exophytic growth after endoscopic rernoval requires regular endoscopic surveillance.

EXPERIMENTAL SUBSTANTIATION AND CLINICAL APPLICATION OF MICROSURGICAL ANTIREFLUX GASTROINTESTINAL ANASTOMOSES IN GASTRIC RESECTION.

AIM: An improvement of the stomach through the development of reconstructive operations results of anatomical - the experimentally study and clinical testing of a series of new microsurgical areflux gastrointestinal anastomosis with sphincter properties. MATERIALS AND METHODS: The study was performed on 60 animals (dogs) and 52 organocomplexes people dead. 4 A series of experiments, developed new ways to 4 gastro-intestinal anastomosis with sphincter properties gastroduodenostomii way to "end to end" (patent number 2,197,903); pilorosohranyayuschey gastrectomy method (patent number 2,201,714); gastronesteostomy way to "end to side" (patent number 2,201,716); gastroduodenostomii way to the formation of artificial pyloric sphincter (patent number 2,212,195). RESULTS: Anatomical studies on cadaveric organocomplexes installed, but that the use of the formation of the gastro-intestinal anastomosis of microsurgical techniques and a separate cross-linking methods of internal and external casings of hollow organs without entrainment into the joint mucosa anastomosis gives high.impermeability and durability, retains histotopography linkable tissues. Gastric resection methods developed to form microsurgical gastrojejunal anastomosis and gastro used in clinical practice in 20 patients. Operated patients were examined after 1-6 years after surgery. When gastroscopia they celebrated, good function Form-balanced, the sphincter, the absence of duodenal reflux. CONCLUSION: The use of microsurgical techniques with gastric resection with the formation of functionally active gastroduodenal and gastrojejunal anastomosis can create gastrointes.inal anastomosis with anti-reflux properties and save the porter, without violating its contractile function, ensures minimum trauma to the tissues, the exact adaptation of the histologic homogeneous layers of the walls of bound bodies.

Medical Service of the Polish Armed Forces.

The article is a brief description of the current state of Polish Armed Forces medical service and is based on the study of open access foreign sources. At the beginning, general information about Poland, its Aimed Forces, and their medical service is presented. Then the medical service particular features are described with more detail, namely, the organization of the inpatient and outpatient treatment, medical supply, scientific research, combat medicine, medical staff education and training, medical service personnel income.

Highly reproductive attenuated H2N2 and H7N9 reassortants on the basis of A/Hong Kong/1/68/162/35 donor virus.

Reassortants with surface antigens from potentially pandemic A/H2N2 and A/H7N9 influenza viruses were created on the basis of attenuated and highly reproductive A/Hong Kong/1/68/162/35(H3N2) donor virus obtained in the Research institute of influenza. High reproductive activity of reassortant viruses and immunogenicity of live and inactivated influenza vaccines based on these viruses indicate the possibility to use obtained reassortants for production of live and inactivated vaccines against potentially pandemic influenza A viruses.

[Experience of the development special medical technical laboratory for studies of effects caused by potent electromagnetic radiation in biologic objects].

This article covers topics of creating special medical technical laboratory for medial and biologic studies concerning influence of potent high-frequency elecromagnetic radiation on various biologic objects. The authors gave example of such laboratory, described its construction features, purpose and main characteristics of the included devices.

[CLINICAL, ENDOSCOPIC AND MORPHOLOGICAL FEATURES OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH CERTAIN SURGICAL DISEASES OF THE UPPER GASTROINTESTINAL TRACT].

OBJECTIVE: To reveal the peculiarities of manifestations and treatment of gastroesophageal reflux disease (GERD) in patients with peptic ulcer disease of the stomach and duodenum, hiatal hernia (HH) and after stomach resection. MATERIALS AND METHODS: 387 patients with GERD, peptic ulcer disease of the stomach and duodenum (200 patients), after resection of the stomach Billroth II (150 patients), 37 patients with HH. Videoendoscopic equipment company OLYMPUS (Japan) was used. Biopsies of the mucous membranes of the pylorus, body, angle of the stomach and esophagus were studied to identify preneoplastic changes. HP was determined histologically, cytologically, urease tests. RESULTS: The patients with GERD and peptic ulcer disease of the stomach and duodenum were complained on the heartburn, the patients after resection of the stomach--on feeling bitterness in the mouth, with HH--on the pain behind the breastbone. More severe degree of GERD (C and D) was endoscopic feature in patients with HH and A degree or endoscopic negative form--after resection of the stomach. Preneoplastic changes of the esophageal mucosa with columnar epithelium were found in cases of less severe degrees of inflammation. The degree of esophagitis, presence of preneoplastic changes were determined depending on the presence of Helicobacter pylori. Antireflux surgery was performed under strict indications. CONCLUSION: Clinical features, endoscopic, morphological manifestations of GERD in patients with pectic ulcer disease of the stomach and duodenum, with resection of the stomach and patients with HH were determined. This is dictated the individual differentiated approach to the choice of the treatment.

[Ligninolytic Activity of Bacteria of the Genera Azospirillum and Niveispirillum].

Capacity of associative soil bacteria of the genera Azospirillum and Niveispirillum for degradation of lignin model compounds was demonstrated. Lignin and Mn-peroxidases were detected in the culture liquid of the type strains of these genera. The data on involvement of nonspecific bacterial peroxidases in lignin degradation were obtained.