[Risk of postoperative morbidity and mortality after conversion of osteosynthesis in patients with polytrauma]. / Opredelenie riskov posleoperatsionnykh oslozhnenii i letal'nogo iskhoda posle konversionnogo osteosinteza u patsientov s politravmoi.

OBJECTIVE: To reduce the incidence of postoperative complications and mortality after conversion of external fixation device into various types of submerged osteosynthesis in patients with polytrauma. MATERIAL AND METHODS: A retrospective and prospective analysis of treatment outcomes in 351 patients with polytrauma was divided into 2 stages. At the first stage, we analyzed significant predictors of complications after conversion of osteosynthesis in the 1st group (retrospective analysis). At the second stage, we estimated the efficacy of the developed scale for assessing the risk of complications after conversion of osteosynthesis in a prospective group of patients. RESULTS: According to the complication risk assessment scale for conversion of osteosynthesis, analysis of time to surgical treatment depending on objective criteria in patients with polytrauma can significantly reduce the incidence of postoperative complications by 14% and mortality rate by 1.7%. CONCLUSION: The complication risk assessment scale after conversion of osteosynthesis will personalize the approach to timing and methods of conversion. This measure will eliminate the «second hit¼ in damage control orthopedics and improve the results of treatment.

[Unformed conglomerate debilitating jejunal fistulas and their two-stage surgical treatment via posterolateral laparotomy]. / Nesformirovannye konglomeratnye istoshchayushchie toshchekishechnye svishchi i ikh dvukhetapnoe khirurgicheskoe lechenie iz zadnebokovogo laparotomnogo dostupa.

OBJECTIVE: To create a method of two-stage repair of high unformed conglomerate delimited debilitating jejunal fistulas via posterolateral laparotomy with low risk of surgical complications. MATERIAL AND METHODS: Methodology and treatment outcomes were analyzed in 37 patients with unformed conglomerate high debilitating delimited jejunal fistulas. Of these, 22 patients underwent one-stage treatment through 2 converging incisions and/or two-stage treatment through anterolateral access. They made up a control group. Fifteen patients in the main group underwent two-stage treatment via posterolateral left-sided laparotomy with unilateral disconnection of jejunum with fistula. In most patients of both groups, fistulas complicated surgery for acute adhesive intestinal obstruction. Topography of adhesions that caused acute intestinal obstruction in both groups was studied in 172 other patients. Identical jejunal fistulas and two different surgical approaches made it possible to consider our groups representative. RESULTS: Two-stage treatment via posterolateral left-sided laparotomy reduced mortality from 63.6±10.2% to 20.0±10.3% (t=11.8; p<0.001). This approach simplified intraoperative diagnostics that became more informative. Posterolateral access increased the quality of anastomosis and safety of viscerolysis. CONCLUSION: A new two-stage approach with posterolateral left-sided laparotomy allowed atraumatic imposing of inter-intestinal anastomosis with proximal disconnection of jejunal fistula. This exclusion turns the fistula into analogue of the definitive Meidl's jejunostomy, unloads the intestinal anastomosis and increases the quality of suture. New strategy reduced the risk of complications and mortality.

Novel technology for controlled fabrication of aperture cantilever sensors for scanning near-field optical microscopy.

This paper presents a new technique for forming SNOM (Scanning Near-Field Optical Microscopy) cantilevers. The technique is based on the continuous growth of a conical hollow tip using local ion-induced carbon deposition on standard tipless cantilever chips. This method offers precise control of the geometric parameters of the cantilever's tip, including the angle of the tip, the probe's curvature radius, and the input and output aperture diameter. Such control allows to optimize the probe for specific tasks. The use of local structure methods based on FIB (Focused Ion Beam) enables the production of SNOM cantilevers with high radiation transmittance, tip robustness, and the capability to measure sample topography in semi-contact AFM (Atomic Force Microscopy) mode. The research focused on optimizing the technology for manufacturing tips with specific geometric characteristics, facilitating accurate navigation and positioning in the area of interest. The manufactured probe samples being tested demonstrate sufficient accuracy and mechanical durability of the tip. Overall, this technique offers a novel approach to forming SNOM cantilevers, providing precise control over geometric parameters and promising enhanced performance in various applications.

A comparative study of photocatalytic activity of Na+-Ag+ ion-exchanged glass-ceramics with metallic Ag, semiconductor AgBr, and hybrid Ag-AgBr nanoparticles.

Photocatalytic glass-ceramics doped with metallic Ag, semiconductor AgBr, and hybrid metal-semiconductor Ag-AgBr nanostructures were synthesized via low-temperature Na+-Ag+ ion exchange. The spectral features of the nanostructures in the silicate glass matrix as well as their photocatalytic performance were studied in detail. Glass-ceramics containing hybrid metal-semiconductor nanostructures were shown to possess one order of magnitude higher photocatalytic activity compared to their counterparts with metallic and semiconductor nanostructures. Hybrid metal-semiconductor nanostructures allow enhancement of the net density of photogenerated hot electrons.

[Advanced endoscopic vacuum therapy for anastomotic leakage in the upper gastrointestinal tract]. / Usovershenstvovannaya endoskopicheskaya vakuumnaya terapiya pri nesostoyatel'nosti anastomozov verkhnikh otdelov zheludochno-kishechnogo trakta.

OBJECTIVE: To evaluate the effectiveness and clinical aspects of advanced endoscopic vacuum therapy for esophagogastric, esophagointestinal and gastrointestinal anastomotic leakage, to identify disadvantages and further possibilities for its improvement. MATERIAL AND METHODS: The study included 69 people. Esophagodudodenal anastomotic leakage was detected in 34 patients (49.27%), gastroduodenal anastomotic leakage - in 30 patients (43.48%), esophagogastric anastomotic leakage - in 4 (7.25%) patients. Advanced endoscopic vacuum therapy was used for these complications. RESULTS: Vacuum therapy in patients with esophagodudodenal anastomotic leakage led to complete healing of defect in 31 (91.18%) cases. In 4 (14.8%) cases, minor bleeding was noted during replacement of vacuum dressing. There were no other complications. Three (8.82%) patients died from secondary complications. Treatment of gastroduodenal anastomotic failure resulted complete healing of defect in 24 (80%) patients. Six (20%) patients died including 4 (66.67%) cases associated with secondary complications. Vacuum therapy for esophagogastric anastomotic leakage resulted complete healing of defect in 4 (100%) patients. CONCLUSION: Advanced endoscopic vacuum therapy is a simple, effective and safe method of therapy for esophagogastric, esophagoduodenal and gastrointestinal anastomotic leakage.

[Different methods of femoropopliteal bypass grafting with autologous vein: propensity score matching analysis]. / Sravnitel'nye rezul'taty razlichnykh metodov bedrenno-podkolennogo shuntirovaniya autologichnoi venoi s primeneniem analiza metodom sopostavleniya otsenok sklonnostei (propensity score matching).

OBJECTIVE: To analyze immediate and long-term results of various methods of femoropopliteal bypass grafting with autologous vein using propensity score matching. MATERIAL AND METHODS: A retrospective single-center open study included 464 patients who underwent femoropopliteal bypass grafting with an autologous vein between January 10, 2016 and December 25, 2019 at the Research Institute - Ochapovsky Regional Clinical Hospital No. 1. The following types of autovenous conduits were used: n=266 - reversed autologous vein (group 1); n=59 - in situ autologous vein (group 2); n=73 - upper limb autologous vein (group 3); n=66 - ex situ autologous vein (group 4). The long-term period was 16.6±10.3 months. RESULTS: We used propensity score matching analysis because patients were not comparable for some indicators. Groups 2-4 included small samples of patients, and their number was reduced to less than 10. This did not allow us to draw reliable conclusions about treatment outcomes. In this situation, we decided to allocate two groups: group 1 - ex situ femoropopliteal bypass grafting; group 2 - other variants of femoropopliteal bypass grafting with autologous vein. Propensity score matching allocated 299 people in group 1 and 46 patients in group 2. There were significant differences in early postoperative incidence of autologous vein thrombosis (group 1: n=3 (6.5%), group 2: n=79 (26.4%), p=0.003; OR= 0.19; 95% CI 0.05-0.64) and postoperative wound suppuration (group 1: n=2 (4.3%), group 2: n=52 (17.4%); p=0.02; OR=0.21; 95% CI 0.05-0.91). In long-term postoperative period, significant differences were obtained in the incidence of limb amputation (group 1: n=6 (13%), group 2: n=85 (28.4%); p=0.02; OR=0.37; 95% CI 0.15-0.92) and myocardial infarction (group 1: n=1 (2.2%), group 2: n=43 (14.4%); p=0.02; OR 0.13; 95% CI 0.01-0.98). CONCLUSION: Femoropopliteal bypass grafting ex situ is characterized by lower incidence of graft thrombosis, amputations of the limb, mild decrease in the incidence of infectious complications and all adverse cardiovascular events in early and late postoperative period compared to conventional surgery (reversed autologous vein, in situ autologous vein, upper limb autologous vein).

[Damage control strategy in surgical treatment of patients with severe gastroduodenal bleeding]. / Primenenie strategii Damage control pri khirurgicheskom lechenii patsientov s tyazhelymi gastroduodenal'nymi krovotecheniyami.

OBJECTIVE/: To objectify patient condition and improve treatment outcomes in patients with benign severe gastroduodenal bleeding. MATERIAL AND METHODS: We analyzed the immediate results of staged surgical treatment of patients with benign severe gastroduodenal bleeding according to the accepted concept of «Damage Control Surgery¼. The Rockall risk scoring system and the Glasgow-Blatchford score (GBS) were used. We preferred two-stage intervention in patients with Rockall score ≥5 and Glasgow-Blatchford score ≥11. RESULTS: Staged approach according to the concept of «Damage Control Surgery¼ in patients with benign severe gastroduodenal bleeding ensures positive results by minimizing surgical trauma and perioperative bleeding, early stabilization of hemostasis and subsequent successful restoration of digestive function. CONCLUSION: The concept of «Damage Control Surgery¼ in patients with benign severe gastroduodenal bleeding can reduce mortality and incidence of postoperative complications.

[Surgical treatment of a patient with mine blast abdominal injury complicated by damage to the duodenum]. / Khirurgicheskoe lechenie patsienta s sochetannymi povrezhdeniyami pri minno-vzryvnoi travme.

The authors describe successful treatment of a patient with consequences of a mine-explosive wound of the right thigh and abdomen, including damage to the duodenum. Staged surgical treatment made it possible to identify and eliminate defects in primary surgical treatment in time. Thus, favorable treatment results were obtained.

Effect of Mild Traumatic Brain Injury on Behavioral Reactions and Neocortical Morphology in Rats.

The original weight-drop model was employed to examine the effect of mild traumatic brain injury (TBI) on behavioral phenotype and neocortical morphology in rats. The neurological examination of rats with moderate TBI revealed the focal symptoms corresponding to pronounced neurological disorders, whereas in rats after mild TBI, there were only minor coordination disorders. On day 7 after injury, the rats with mild TBI demonstrated enhanced anxiety assessed by conditioned passive avoidance response. The morphometric analysis of the brain tissues revealed narrowing of the capillaries and increased score of hyperchromic neocortical neurons, which attested to cerebral hypoxia. The manifestations of mild TBI in original rat model demonstrated a close similarity to the symptoms of TBI in humans.

[Immediate outcomes of pancreatoduodenectomy after different digestive reconstruction procedures]. / Blizhaishie rezul'taty pankreatoduodenal'noi rezektsii posle razlichnykh variantov rekonstruktsii pishchevaritel'noi sistemy.

OBJECTIVE: To study the immediate results of pancreatoduodenectomy depending on digestive reconstruction procedure. MATERIAL AND METHODS: We analyzed 242 patients who underwent pancreatoduodenectomy for the period from January 2013 to December 2019. There were 32 combined procedures: 28 (11.6%) with portal vein resection and 8 (3.3%) simultaneous operations (right-sided hemicolectomy - 4, right-sided adrenalectomy - 2, gastrectomy with splenectomy - 2). Pancreatic stump was inserted into the jejunum in 156 (64.5%) patients, into the stomach - in 86 (35.5%) cases. RESULTS: Postoperative period was uneventful in 180 (74.4%) patients. Eighty postoperative complications were observed in 62 (25.6%) patients; 221 (91.3%) patients were discharged, 21 (8.7%) patients died. Pancreatic necrosis was the most common postoperative event and provoked 65 (82.5%) various complications (38 (72.1%) in patients with pancreaticojejunostomy and 20 (71.5%) in those with pancreaticogastrostomy). Incidence of complications was similar in both groups. However, pancreaticojejunostomy was followed by severe pancreatic fistula type C in 12 (23.1%) patients, type B in 24 (46.1%) cases. In case of pancreaticogastrostomy, pancreatic fistula type C occurred in 4 (14.3%) cases, type B - in 8 (28.6%) patients. CONCLUSION: Pancreatic necrosis was the most common postoperative event after pancreatoduodenectomy. Fewer severe pancreatic fistulae (type C) were recorded after pancreaticogastrostomy although these patients had lower density of the pancreas and unclear pancreatic duct. Choice of pancreatic-digestive anastomosis should be determined by features of pancreatic parenchyma, pancreatic duct diameter. Nevertheless, final decision is a prerogative of surgeon. Pancreaticogastrostomy is especially advisable in minimally invasive PDEs that will simplify inclusion of the pancreas into digestive system and reduce the incidence of complications and mortality.

[Transsternal occlusion of main bronchi fistulae after pneumonectomy]. / Transsternal'naya okklyuziya svishcha glavnogo bronkha posle pnevmonektomii.

OBJECTIVE: To summarize our experience in transsternal occlusion of main bronchus fistula. MATERIAL AND METHODS: We have performed 146 transsternal occlusions of the main bronchi for the period from 1979 to 2018. There were 123 (84.2%) men and 23 (15.7%) women. Mean age of patients was 63 years. Lung tuberculosis was diagnosed in 36 (24.7%) patients, lung cancer - 91 (62.3%) patients, non-specific suppurative lung diseases - 14 (9.6%) patients, trauma - 5 (3.4%) patients. All patients underwent transsternal occlusion of the main bronchi fistulae with or without pericardial cavity dissection. Wedge-shaped bronchial resection or tracheal bifurcation resection were carried out for a short stump fistula. RESULTS: Perioperative complications occurred in 28 (19.2%) out of 146 patients. Intraoperative complications developed in 4 (2.6%) patients. Postoperative complications were observed in 25 (17.1%) patients. Intraoperative mortality rate was 1.4% (n=2), postoperative mortality - 6.2% (n=9). Thus, overall mortality rate was 7.6% (n=11 It should be noted that intraoperative complications were absent if dissection of the pericardium and pulmonary artery stump ligation were not performed. CONCLUSION: Transsternal occlusion of the main bronchi fistulae was successful in 80.8% of patients. In these cases, healing of fistulae was not associated with any complications. Thus, we believe that transsternal occlusion of the main bronchial stump fistula should be considered as preferable surgical strategy.

[Results of anterior abdominal wall repair with mesh implants in patients with postoperative ventral hernia]. / Rezul'taty vosstanovleniia perednei briushnoi stenki pri posleoperatsionnykh ventral'nykh gryzhakh s ispol'zovaniem setchatykh implantatov.

AIM: To analyze the results of the restoration of the anterior abdominal wall in postoperative ventral hernias using mesh implants. MATERIAL AND METHODS: The study was of 680 patients, who underwent abdominal wall reconstruction using mesh implants. RESULTS: A total of 105 postoperative complications (15.44%) in 84 (12.35%) patients; the postoperative period was without complications in 596 (87.65%) patients. The greatest number of complications was noted after laparoscopic IPOM - 13 patients (20.31%); the smallest - after posterior component separation - 24 (7.5%). Also described 10 systemic complications: 8 of which were stopped by conservative therapy, in 2 cases repeated surgical intervention was required with a change in the type of wall reconstruction. Statistical analysis did not show statistically significant differences in the incidence of complications between the different versions of the performance of hernioplasty, except for the posterior muscular plastics. Statistical analysis also showed a link between the likelihood of various complications and the type of ventral hernia repair. CONCLUSION: Conducting different methods abdominal wall reconstruction using mesh implants is techniques with a low level of postoperative complications and comparable results when performing various types of plastics.

[Percutaneous endoscopic gastrostomy]. / Chreskozhnaia éndoskopicheski-assistirovannaia gastrostomiia.

Percutaneous endoscopic gastrostomy (PEG) was developed in 1980. Since that time this method has become preferable for long-term enteral nutrition. PEG is an effective and relatively safe procedure for enteral nutrition of patients with impaired enteral feeding. However, complications and mortality are also observed. Indications, contraindications and potential complications of PEG are reviewed in the article.

[Treatment of patients with multiple trauma in multi-field hospital]. / Rezul'taty lecheniia bol'nykh s politravmoi v mnogoprofil'noi klinike.

AIM: To analyze treatment of victims with multiple trauma in multi-field hospital. MATERIAL AND METHODS: Retrospective analysis of 2139 medical records of patients with multiple trauma (NISS score over 17) was performed. In-hospital mortality, patient transfer time, dominant injury, hospital-stay, gender and age of victims were assessed. RESULTS: New diagnostic and treatment options allowed achieving significant decrease of mortality from 39.7% (2004) to 10.8% (2016). CONCLUSION: Improved mortality was achieved due to organized work of the 'regional traumatological systems'. Mortality rate was below 10.7% if victims were transferred to the hospital within 6 hours after trauma. The highest mortality was observed in patients who were transferred to the hospital within 6-12 hours after injury (20.3%).

[Outcomes of minimally invasive biliary decompression in obstructive jaundice]. / Analiz rezul'tatov miniinvazivnoi dekompressii zhelchevyvodiashchikh putei pri mekhanicheskoi zheltukhe.

AIM: To study postoperative complications and mortality after minimally invasive biliary decompression in patients with mechanical jaundice. MATERIAL AND METHODS: Prospective analysis included 2.072 patients with mechanical jaundice who underwent differential biliary decompression depending on the cause, level of obstruction, severity of jaundice and patient's condition. RESULTS: Relief of bilirubinemia and stabilization of the state were achieved in 1696 patients of the main group (98,6%) and in 328 (93.18%) patients of the control group. Mortality was similar in both groups: 8 (0.46%) and 2 (0.56%) patients. The best results were obtained in the main group for in-hospital and post-hospital complications after retrograde interventions (χ2=4.440821; df=0.891435; p<0.05) and post-hospital complications after antegrade interventions (χ2=35.52869; df= 1; p<0.05). CONCLUSION: Differentiated approach to minimally invasive biliary decompression is followed by reduced postoperative morbidity.

[Early outcomes of open, laparoscopic and robot-assisted pancreatoduodenectomy]. / Blizhaishie rezul'taty otkrytykh, laparoskopicheskikh i robot-assistirovannykh pankreatoduodenal'nykh rezektsii.

AIM: To study immediate results of open, laparoscopic and robot-assisted pancreatoduodenectomy for malignancies. MATERIAL AND METHODS: There were 158 patients with cancer of biliopancreatoduodenal area. Open procedures were performed in 118 cases, laparoscopic in 17, robot-assisted pancreatoduodenectomy - in 23. RESULTS: After 'standard' pancreatoduodenectomy 31 (62.0%) complications were registered, after laparoscopic - 12 (24.0%) and aWfter robot-assisted surgery - 7 (14.0%) complications. Relationship between probability of complications was absent (correlation coefficient 0.10491), however, significant differences in incidence of complications after various surgical approaches were observed (c2=6.8832; df=0.9679; p<0.05). CONCLUSION: Laparoscopic and robot-assisted pancreatoduodenectomy was not followed by advanced early postoperative morbidity. Moreover, minimally invasive approach was associated with improved outcomes.

Magnetization-induced effects in second harmonic generation under the lattice plasmon resonance excitation.

We present an experimental study of optical second harmonic generation (SHG) from arrays of nanostructures exhibiting collective plasmon resonances in the visible spectral range. Gold nanoparticles with the lateral diameter of 100 nm are packed in a square lattice with the period of 400 nm and are covered by a 90 nm thick iron garnet layer. We show an enhancement of SHG in the spectral vicinity of the lattice surface plasmon resonance. It is demonstrated that application of the external DC magnetic field results in a spectral shift of the SHG maximum up to 5 nm, accompanied by a pronounced phase modulation of the second harmonic wave. This spectral shift significantly prevails over the analogous linear magneto-optical effect and is explained by the interference of resonant and nonresonant SHG contributions of various nature.

Superconducting Coplanar Waveguide Filters for Submillimeter Wave On-Chip Filterbank Spectrometers.

We show the first experimental results which prove that superconducting NbTiN coplanar-waveguide resonators can achieve a loaded Q factor in excess of 800 in the 350 GHz band. These resonators can be used as narrow band pass filters for on-chip filter bank spectrometers for astronomy. Moreover, the low-loss coplanar waveguide technology provides an interesting alternative to microstrip lines for constructing large scale submillimeter wave electronics in general.

Approach to visualization of and optical sensing by Bloch surface waves in noble or base metal-based plasmonic photonic crystal slabs.

The Bloch surface wave resonance (SWR) was visualized with the aid of plasmon absorption in a dielectric/metal/dielectric sandwich terminating a one-dimensional photonic crystal (PhC). An SWR peak in calculated spectra of such a plasmonic photonic crystal (PPhC) slab comprising a noble or base metal layer was demonstrated to be sensitive to a negligible variation of refractive index of a medium adjoining to the slab. The considered structure of PPhC slabs can be of practical importance because the metal layer is protected by a capping dielectric layer from contact with analytes and, consequently, from deterioration. We found that, in case of PPhC slabs, gold (the key element of the surface plasmon resonance-based biosensors) can be replaced by other metals. The PPhC-based sensors can be low-cost, reusable, and robust sensors having a sensitivity surpassing that of the known optical sensors.

Phase locking of a 2.7 THz quantum cascade laser to a microwave reference.

We demonstrate the phase locking of a 2.7 THz metal-metal waveguide quantum cascade laser (QCL) to an external microwave signal. The reference is the 15th harmonic, generated by a semiconductor superlattice nonlinear device, of a signal at 182 GHz, which itself is generated by a multiplier chain (x12) from a microwave synthesizer at approximately 15 GHz. Both laser and reference radiations are coupled into a bolometer mixer, resulting in a beat signal, which is fed into a phase-lock loop. The spectral analysis of the beat signal confirms that the QCL is phase locked. This result opens the possibility to extend heterodyne interferometers into the far-infrared range.