Endoscopic transversus abdominis release in the treatment of midline incisional hernias: a prospective single-center observational study on 100 patients.

BACKGROUND: For W2-3 incisional hernias of the midline, a component separation is often needed to achieve closure of the fascia during repair with a mesh. Posterior component separation has been initially performed via open surgical approach, but more recently interest in minimally invasive reconstruction has grown. The aim of this work is to describe the technical aspects of endoscopic hernia repair with posterior component separation and to assess its feasibility in midline incisional hernias, based on the analysis of the results. METHODS: We prospectively evaluated and analyzed patients with midline incisional hernias who underwent endoscopic posterior component separation by transversus abdominis release (TAR). RESULTS: A group of 100 patients was operated between April 2017 and September 2021. The median follow-up was 27 ± 13.5 months, mean age 59 ± 10.2 years, ASA 2.5 ± 0.7; 94% of patients had comorbidity. There were 7 (7%) complications observed in the early postoperative period-retromuscular hematoma (1), infection of the retromuscular space (4), and thrombophlebitis of superficial veins (2). In 4 (4%) patients, late complications were observed-persistent seroma (3) and chronic pain (1). There were no hernia recurrences in the follow-up period. CONCLUSION: The use of TAR endoscopic separation can reduce the number of unfavorable surgical site events, compared to the published data on a similar open surgery, while maintaining a low recurrence rate.

[Investigation of ligand-receptor interaction and biodistribution of a drug containing cattle retinal polypeptides in various administration routes]. / Issledovanie ligand-retseptornogo vzaimodeistviya i bioraspredeleniya pri razlichnykh rezhimakh vvedeniya lekarstvennogo sredstva, soderzhashchego polipeptidy setchatki glaz skota.

It is important to understand the features of the interaction of drug components with body receptors and obtain data on its distribution in various administration routes in recommended doses in order for its usage in clinical practice to be safe and effective. PURPOSE: To investigate in vitro the interactions of a drug consisting of water-soluble polypeptide fractions produced on animal retina with a wide range of receptor targets, and to assess its biodistribution in the organs of laboratory animals. MATERIAL AND METHODS: The biodistribution of the radioactively marked drug in different organs and tissues of laboratory mice in various routes of administration was studied at the National Research Centre «Kurchatov Institute¼. Evaluation of the ligand-receptor interaction of the drug was carried out in the laboratory at Eurofins Pharma Discovery Services by the method of competitive radioligand binding. RESULTS: A significant effect of the interaction of the polypeptide drug was revealed with different subtypes of glutamate receptors: AMPA, NMDA, and mGluR1. As a result of an in vivo test, we have obtained biodistribution data of the drug for intravenous, intramuscular and parabulbar administration, and the dynamics of drug accumulation in the tissues of the brain and eyes. CONCLUSION: According to the study results, the peptide drug binds to receptors associated with the loss of retinal ganglion cells. Interaction with these receptors potentially provides the test subject with neuroprotective effect. The content dynamics of the studied drug in the blood of animals depends on the route of administration and the amount of drug administered. At the time point of 0.5 hours for intravenous and intramuscular administration in the dose of 1.7 mg/kg, the studied drug has sufficiently high bioavailability in the tissues of the brain and eye. The data suggest that the main route of excretion of the studied drug is through kidneys.

['Point of no return' in diabetic neuropathies: a dangerous delusion]. / 'Tochka nevozvrata' pri diabeticheskikh neiropatiiakh: opasnoe zabluzhdenie.

Polyneuropathy in patients with diabetes mellitus is manifested by a lesion of peripheral sensory, motor and autonomic nervous system. Different severity of damage of sensory, motor and autonomic fibers in typical and atypical forms of diabetic polyneuropathy, requires a differentiated approach to therapy, but not the rejection of its implementation. In an interdisciplinary consensus, consultations are held with physicians from different regions of the Russian Federation, and modern methods of diagnosing and assessing the severity of diabetic polyneuropathies, which determine the algorithm for treating patients, are discussed.

Specific features of immune complexes in patients with sarcoidosis and pulmonary tuberculosis.

Clinical and radiological features of tuberculosis and sarcoidosis are quite overlapping, and therefore, a diagnostic dilemma often persists. There are no commonly accepted criteria for the diagnosis of sarcoidosis due to the lack of data on the etiology of the disease. The exclusion of tuberculosis in every patient with suspected sarcoidosis is a mandatory stage of diagnosis, especially in countries with a high burden of tuberculosis. A prospective study was conducted with two groups of patients: group I (n = 50)-patients with pulmonary sarcoidosis established according to standard criteria; group II (n = 28)-patients with pulmonary tuberculosis with bacterial excretion. The control group (n = 24) was presented by healthy subjects. The examination complex included x-ray, bacteriological, immunological (Mantoux test with 2 TE, TB.SPOT test), and histological methods. All patients and healthy subjects were assessed for immune complexes with the use of the dynamic light scattering (DLS) method and adding of "healthy lung tissue extract" antigens and specific tuberculosis antigens ESAT-6 and SFP-10 in vitro. Significant differences were found in determining specific immune complexes in patients with pulmonary sarcoidosis and pulmonary tuberculosis. Registration of specific immune complex formation with "healthy lung tissue extract" in 100% cases may indicate the autoimmune nature of sarcoidosis. The absence of the immune complex formation in response to ESAT-6/SFP-10 antigens can be used for the differential diagnosis of two diseases. The diagnostic significance of the DLS method was 100% for sarcoidosis and 92.2% for tuberculosis. The data obtained in the study allows not only understanding the etiology of sarcoidosis, but also obtaining new criteria for the differential diagnosis of tuberculosis and pulmonary sarcoidosis.

AGGREGATION BY LECTIN-METHODICAL APPROACH FOR EFFECTIVE ISOLATION OF EXOSOMES FROM CELL CULTURE SUPERNATANT FOR PROTEOME PROFILING.

Exosomes are small membrane vesicles secreted by most cell types in vivo and in vitro. Exosomes are found in cell culture media, blood, urine, amniotic fluid, malignant ascite fluids and contain distinct subsets of microRNAs and proteins depending upon the tissue from which they are secreted. Thus exosomes constitute potential biomarkers of human diseases, such as cancer. A major bottleneck in the development of exosome-based diagnostic assays is the challenging purification of these vesicles; this requires time-consuming and instrument-based procedures. Isolation of exosomes can be a tedious, non-specific, and difficult process. Here, we provide a preparative technique for isolation of exosomes based on their ability to aggregate in the presence of lectins. The new method for lectin-based isolation of exosomes from cell culture media was developed as a sample preparation step for exosome-based protein biomarker research.

[Histone deacetylase inhibitors cause the TP53-dependent induction of p21/Waf1 in tumor cells carrying mutations in TP53].

p21/Waf1 protein is one of the main cell cycle arrest regulators and one of the most well-known transcriptional targets of TP53 protein. Here, we demonstrated the activation of expression of the p21/Waf1 gene when the cells were treated to sodium butyrate (NaBu)--one of the natural inhibitors of deacetylase, and investigated whether this phenomenon depends on the presence of functionally active TP53 protein. We compared the effect of the NaBu treatment on the human cell line with different TP53 mutation profile, including: wild-type TP53, single nucleotide substitutions, and the complete absence of TP53 gene. NaBu activated the TP53 protein via hyper acetylation at lysine residue K382, without significant changes in the level of protein expression. Western blotting demonstrated that the addition of NaBu triggers a significant increase in the p21/Waf1 protein level in both the TP53 wild-type cells and in the cells with single nucleotide substitutions in the domain responsible for the binding of TP53 protein to DNA. At the same time, no the p21/Waf1 protein induction was observed in the cells with complete deletion of the TP53 gene. However, NaBu was not able to induce the p2 1/Waf1 production when the expression of TP53 was transiently knocked down by the p53 siRNA. Overall, our results suggest that the NaBu-dependent induction of p21/Waf1 does require the presence of TP53 protein but unexpectedly it can occur regardless of mutational changes in the domain responsible for the TP53 binding to DNA. One of the hypothetical explanations is that NaBu increases the level of TP53 acetylation, and the modified protein is able to establish a new network of protein-protein interactions or trigger some conformational changes affecting the TP53-dependent transcriptional machinery even when its DNA binding ability is impaired.

[Mathematical simulation of the acute period of ischemic stroke of different pathogenetic types].

The analysis of 650 cases of ischemic stroke in accordance with the TOAST criteria showed that atherothrombotic subtypes of ischemic stroke (p < 0.05) appeared most commonly. Based on the results of the analysis of basic clinical and paraclinical signs in the acute period of ischemic stroke, we worked out two models for the prediction of fatality by severity of atherothrombotic and cardioembolic subtypes which allowed to improve the quality of outcome. In the group of patients with more severe strokes, more favorable outcomes were found for the atherothrombotic pathogenetic variant compared to atherothrombotic stroke (p < 0.05). Synergetic characteristics of the developed models were shown.

[Integrative analytic prediction systems in treating a patient in the acute period of ischemic stroke].

Basing on the results of the analysis of the main clinical-paraclinical syndromes of ischemic stroke in its acute period, two integrative analytic-prognostic systems have been designed. These systems improve quality of disease prognosis. More accurate prognosis is achieved by the model, which shows that outcome of ischemic stroke depends both on the initial condition of the disease and on its dynamics in the acutest period. The computerized system of early prognosis of ischemic stroke allows to give a detailed prognosis of complications and outcome of the disease. The use of the computerized system of early prognosis helps to gain the reliable improvement in groups of moderately severe and severe ischemic stroke.

[Multifactor analysis in prediction of outcome for ischemic stroke with combined cardiac symptomatology]. / Mnogofaktornyi analiz v prognozirovanii iskhodov ishemicheskogo insul'ta s sochatannoi kardial'noi simptomatikoi.

Basing on the results of multiple classifications of 70 clinical, paraclinical and anamnestic signs of ischemic stroke with combined cardiac symptomatology, the models predicting clinical outcome in acute period of the disease and an original scale of numerical score have been worked out. It is mathematically proved that the severity of ischemic stroke with combined cardiac symptomatology, scoring 75 and above, inevitably results in progression of fatal outcome. A group of unfavorable clinical predictors was singled out. The periods with high rate of fatal outcome within exacerbation of ischemic stroke and pathogenic types of stroke were studied. It is first-ever shown that a role of cardiac and neurological symptoms in predicting fatal outcome depends on ischemic stroke severity. A relation between the probable fatal outcome and dynamics of severity of stroke with combined cardiac symptomatology within the first 3 days of the disease was also revealed for the first time.

[Ecological aspects of myasthenia gravis in the Orenburg region]. / Ekologicheskie aspekty miastenii v Orenburgskoi oblasti.

The paper reflects the problem of adverse environmental factors on human health, including those on the prevalence of myasthenia and on the blood levels of trace elements in the patient. It outlines the environmental status in the Orenburg Region, which is most unfavorable in the Eastern and Central areas. Myasthenia morbidity trends for its increase are covered in 1967 to 2006. The paper also shows the prevalence of myasthenia, with predominance per 100,000 individuals in the Eastern and Central areas, which coincides with the highest anthropogenic load in these areas. The data of a preliminary analysis of trace elements, such as copper, zinc, manganese, nickel, lead, strontium, chromium, cadmium, cobalt, iron, in the blood of patients with myasthenia as compared with those in controls and by regions reflect a general trend for the blood levels of these trace elements to be decreased, as well as their imbalance by the areas of the Orenburg Region.

[Treatment of patients with neurocirculatory asthenia by intermittent hypobaric hypoxia]. / Lechenie bol'nykh vegetososudistoi distoniei s pomoshch'iu preryvistoi gipobaricheskoi gipoksii.

Rheoencephalography and electroencephalography were employed during 25 days of hypobarotherapy of 62 patients suffering from vegetovascular dystonia with different types of brain +blood circulation. The efficacy of the treatment with the aid of periodic hypobaric hypoxia turned out inconclusive which was specified by the initial status of vegetative regulation of the vascular tone and initial dyscirculatory arteriovenous alterations determining in many respects specific features of cerebrovascular reactions. The positive response to intermittent hypoxia seen in the majority of patients allows recommending the given treatment schedule for hemodynamic disorders in patients suffering from vegetovascular dystonia with different types of brain +blood circulation.

[Factor analysis of the coagulative-rheological properties of blood and plasma and cerebral and general hemodynamics in patients with the initial forms of cerebrovascular insufficiency]. / Faktornyi analiz koaguliatsionno-reologicheskikh svoistv krovi i plazmy, tserebral'noi i obshchei gemodinamiki u bol'nykh s nachal'nymi formami nedostatochnosti krovosnabzheniia mozga.

Coagulation and rheological, cerebrovascular and total hemodynamic factors were studied and compared in patients with the initial manifestations of brain blood supply insufficiency (IMBBSI) associated with vegetovascular dystonia, essential hypertension and atherosclerosis by means of factor analysis. Interrelations between the parameters under study appeared multiple in nature, possessing a high capacity for differentiation between those conditions. As IMBBSI progressed, namely from vegetovascular dystonia to the hypertonic and atherosclerotic disease forms, there was a rise in the rate of the prognostically unfavourable ++inter-systemic relations between hemostasis and hemodynamics attesting to a certain risk of cerebral ischemias.

[Therapeutic effect of antiaggregants in patients with neurocirculatory asthenia with the initial signs of cerebral ischemia]. / Lechebnyi éffekt antiagregantov u bol'nykh vegetativnososudistoi distoniei s nachal'nymi proiavleniiami nedostatochnosti krovosnabzheniia mozga.

Therapeutic effect of antiaggregation drugs in patients with vasoautomomic dystonia with initial signs of insufficient blood supply to the brain. In 43 patients with vasoautonomic dystonia and initial manifestations fo cerebral circulation insufficiency, the effects of aggregation-inhibiting drugs (dipyrodamol, metindol, stugeron, prodectin) on blood coagulation and rheology, platelet aggregation and general hemodynamics were studied. Antiaggregation drugs were shown to be the tools of choice which could be administered with due account of baseline hemostasis and the type of cerebral hemocirculation, and of their selective action on the carotid and vertebrobasilar cerebral vessels.