ADVANCES IN MINIMALLY INVASIVE SURGERY FOR PECTUS EXCAVATUM: ENHANCING OUTCOMES AND PATIENT CARE.

Pectus excavatum, also called sunken chest, is the most common deformation of the sternum (90%). The deformation is caused by the depression of the sternum and costal cartilages, which causes reduction of the chest cavity and dysfunction of cardio-pulmonary systems in it. Sunken chest is more common in males than females, prevalence is 5/1. Most of the cases appear in the first year of life, however severity of the pathology is formed during puberty. Etiopathogenesis, genetic factors, and associated diseases of Pectus Excavatum are various and are still the subject of study. The manifestation of the disease is determined by the degree of chest deformation, which is calculated using the "Haller index". Providing that a high degree of deformation can lead to pathological functioning of the cardiovascular and respiratory systems. The treatment of this condition is an urgent, complex, and developing issue. The main method of treatment for sunken chest is surgical intervention; However, in cases of mild degrees of the mentioned deformation, different approaches are used. Our goal is to discuss contrasting treatment techniques and present our improved repairing technique for sunken chest, which is performed in Georgia.

EFFECTS OF MATERNAL BLOOD LEAD IN THE PRENATAL PERIOD ON NEWBORNS AND THE SPECIFICS OF THE CONDITION AT BIRTH.

The study aimed to study the aspects of the impact of lead in newborns in the perinatal period.Clusters of 354 pregnant women and newborns were studied. Determination of the lead index in the venous blood of pregnant women was carried out and their results were analyzed at birth. Lead was determined in the mother's blood using the atomic-absorption spectrophotometry method. Blood was taken for analysis in the third trimester of pregnancy. Ordinal multinomial logistic regression (ordinal multinomial logistic regression) was used to reveal the causal relationship between the logarithm of lead content in the mother's blood (Log10(Pb)) and Apgar scores of the newborn during pregnancy and to assess its credibility. Different methods of parametric and non-parametric statistics. Statistical software package - SPSS12 was used for data processing and visualization of results.It was revealed that the deterioration of the Apgar score is observed with a high degree of certainty in newborns of 37 weeks of gestational age and less. Gender specificity of sensitivity to lead exposure has been revealed - it has been established that female newborns are more sensitive than male newborns. Which was manifested by worsening Apgar score in the first minute of life. Based on the mentioned study, it is necessary to strengthen the antenatal surveillance of pregnant women in endemic areas to detect the risks of low Apgar scores. Also, we recommend the screening of high-risk individuals for blood lead content before planning a pregnancy. Further determination of lead index should be done immediately after diagnosis of pregnancy, blood lead monitoring should be done according to local guideline. Since the specificity of the effects of lead in the mother's blood is known, the clinician is able to predict the risks in relation to the sex of the newborn at birth and to find the appropriate help in the maternity unit at the moment of birth.

COMPARATIVE ASSESSMENT OF RISK-BENEFIT RATIO OF USE OF SILICONE BOUGIE VERSUS ALTERNATIVE METHODS IN POSTOPERATIVE MANAGEMENT OF ESOPHAGEAL ATRESIA.

The aim of the present research is to assess the beneficial and adverse effects of silicone bougie use in comparison to alternative methods of post-operative management of esophageal atresia. The study was carried on 28 patients treated at our healthcare institution for esophageal atresia during the period from May, 2017 to September, 2020. As an alternative to the use of esophageal bougie these patients were managed postoperatively, by utilizing the contrast imaging of the esophagus on the 7th and 14th days after surgery, and at the age of 1, 3, 6 months and one year. Unless the esophageal stricture has developed, the procedures are repeated annually until the age of 5. The aim of utilizing the contrast imaging technique is to prevent the stricture of the esophagus and recurrence of trachea esophageal fistula.

[STUDY OF TOTAL ANTIOOCIDANT STATUS OF THE ORGANISM AS A POSSIBLE BIOMARKER OF DOSE AND EFFECT OF RADIATION EXPOSURE].

In presented article, by means of a comparative analysis of the relationship between the dose-dependent alterations in the organism's redox status, measured by the innovative method developed by us and the standard methods used for assessing catalase and superoxide dismutase activity, and an end radiobiological effect, was attempted the preliminary assessment of the possibility to apply the parameter of blood plasma total antioxidant activity (TAA) as marker of dose and effect of radiation exposure. The experiments were carried out on white mice randomly divided into groups of irradiated and sham irradiated animals. The mice were exposed to a whole body gamma irradiation by source Cesium-137 (137Cs) at doses of 5 and 7 Gr, a dose rate of 1.1 Gr / min. After 5 days of beginning of observation in animals' blood measurements of the activity of antioxidant enzymes (superoxide dismutase - SOD and catalase - CAT) and total antioxidant activity by spectrophotometric method were evaluated. Parallel monitoring of animal survival was conducted. At the given stage of the study, applicability of OAA as a marker of dose-dependent alterations in antioxidant status was assessed by the criteria of sensitivity and linearity, and as a marker of the effect the strength of the relation between the antioxidant status indicators and the final radiobiological effect, measured by animal life span in post- radiation period (time-effect) For comparative analysis of the effects of radiation on the levels of antioxidant status indicators (SOD, catalase, OAA), ANOVA methods were used, the nature of the causal relationship between levels of antioxidant status and the life span of laboratory animals was analyzed on the basis of the Cox proportional intensity model with time covariates, preliminary processing of data, basic calculations and visualization of the results were carried out using a mathematical package that " STATISTIC 12". The received results testify to the significantly high sensitivity of the total redox-status indicator (OAA) to the dose of irradiation, which makes it possible with full justification to consider it as a promising candidate of the biological exposure dose marker. In addition, the indicator of the total antioxidant status (OAA) of the body allows predicting the dose dependence of the survival of laboratory mice more accurately than the indices of the activity of individual antioxidant enzymes (catalase and SOD), which makes it possible to consider it as a promising candidate for the biomarker of the dose and the effect of radiation exposure.

[RADIOPROTECTIVE ACTIVITY OF POLYMETOXY-LATED FLAVONOIDS OF CITRUS EXTRACT].

The aim of the study was to establish the radioprotective activity of citrus polymetoxylated flavonoids extract (CPMFE) on the X-irradiated rats. The experiments were carried out on white Wistar rats. Animals were irradiated with X rays in doses of 5 Gy and 7 Gy. The control group consisted the sham-irradiated rats. Part of animals of each group were treated with intramusculary injections of CPMFE (dose 30 mg/kg) during 7 days; blood was taken from the tail vein (0.5 ml) for detection of lipoperoxides (LOO.) content. On the 3rd day after irradiation 3 animals from each group were sacrificed (under ether anesthesia) and blood samples were taken for the study of antioxidant status. The activity of antioxidant enzymes (catalase (CAT) and superoxidedismutase (SOD)) was determined by the spectrophotometric method; the content of LOO.in the blood was determined by electron paramagnetic resonance (EPR) mrthod. In group of irradiated rats a sharp dose-dependent inactivation of blood antioxidant enzymes (SOD, CAT) and intensification of the lipid peroxidation were detected. The direct and feedback mechanism in the regulation of CAT and SOD activity, ensuring the implementation of antioxidant protection in the body was revealed. Under irradiation with 7Gy rapid death of animals (on 3-d day after irradiation the mortality of animals was 70%, and on the 5th day all died) were detected. During irradiation with dose 5 Gy the survival of animals increased (on the 8-th day after irradiation - 50% survival rate). CPMFE in dose-dependent manner supported the reduce the intensity of lipid peroxidation processes - at relatively low doses of radiation (5Gy) during the first 3 days the content of LOO.in the blood decreased insignificantly compared with indices in untreated animals, whereas with an increase in the dose of irradiation (7Gy) a statistically significant antiradical effect of CPMFE (a statistically significant decrease in the LOO. content) was detected. Under the effect of CPMFE in the blood of rats irradiated with a dose of 5 Gy and 7 Gy, the activity of CAT and SOD, not statistically significant tends to increase (more significant with a dose of 7 Gy). CPMFE did not affect the cumulative survival of animals irradiated with a dose of 5 Gy, but reduced the mortality of rats by 20% (on the 3rd day of irradiation), and contributed to an increase in the life expectancy of animals by 2 times (up to 7 days) in the case of dose 7 Gr. Based on the analysis of the research results, it can be assumed that under conditions of radiation damage, exogenous antioxidants synergistically with a dose-dependently activated endogenous non-enzymatic antioxidant system of the body (especially at 7Gy) contribute to the effective suppression of chain reactions of peroxidation, reduction of mortality and increase in life expectancy of animals.