[Use of a controlled attenuation parameter for the diagnosis of non-alcoholic fatty liver disease].

AIM: To evaluate the efficacy of vibration-controlled transient elastography (VCTE) with a controlled attenuation parameter (CAP) in a population of patients with non-alcoholic fatty liver disease (NAFLD)and to compare to US and different non-invasive indices. MATERIALS AND METHODS: Single center NAFLD patients' database of 2021-2023 years was retrospectively analysed. Data of VCTE evaluation with CAP (FibroScan 530® and FibroScan 630 Expert®) as well as liver US examination results and values of HSI, FLI, BAAT and NAFLD-LFS were extracted. AUROCs for all methods used were constructed and sensitivity and specificity analysis was performed. RESULTS: The data of 1081 patients were available for analysis (385 with steatosis, 274 with NASH, 422 without NAFLD as a control). Ultrasound examination in the diagnosis of liver steatosis compared to VCTE with CAP showed sensitivity and specificity of 94.6 and 63.7%, respectively. Diagnosis of liver steatosis using indices and scales showed sensitivity and specificity of HSI: 97.9 and 60.1% (AUROC 0.90), FLI: 92.5 and 85.3% (AUROC 0.93), BAAT: 76.6 and 73.5% (AUROC 0.82), NAFLD-LFS: 56.7 and 81.8% (AUROC 0.85). CONCLUSION: The sensitivity of the US of the liver was consistent with previous studies, but the specificity was low. The HSI index had the best indicators of sensitivity and specificity in relation to the diagnosis of liver steatosis. Combination of liver US and HSI can be used in screening of liver steatosis, however, for the complete diagnosis better tools which can simultaneously evaluate liver steatosis and fibrosis should be used.

[Clinical evaluation of the efficacy of innovative spread of a given fatty acid composition enriched by adaptogens].

Adaptogens are a group of substances capable to increase the nonspecific resistance of the organism to a wide range of harmful effects and stress. However, only limited data exist on their use in the composition of foods for special dietary uses. The aim of the study was to evaluate the effect of a diet that included vegetable-fat spread enriched with 5-hydroxytryptophan, L-theanine and γ-aminobutyric acid on memory, general well-being and emotional status of healthy volunteers. Material and methods. The single-center, single-blind randomized prospective trial that enrolled persons without signs of significant organic pathology have been performed. Participants were randomly allocated to receive either 45 g/day standard spread enriched with 5-hydroxytryptophan (0.67%), L-theanine (0.56%) and γ-aminobutyric acid (0.45%) (main group, MG) or 45 g/day standard spread (control group, CG) for 10 days. Beside this, all participants followed a standard diet. Initially, as well as on the 10th day after the start of using the diet, the emotional state was assessed using the HADS anxiety and depression scale and Beck's depression inventory (BDI), general well-being by SAN questionnaire, memory according to the Lurie method; reaction time and attention concentration were assessed using the Krepelin counting test and the Burdon correction test. A 5-point Likert visual-analogue scale was used to assess the palatability (pasting) of the product, the severity of feelings of hunger and satiety at the baseline and on the 10th day of the study. All tests were performed under the supervision of staff. During the study, daily monitoring of the presence of adverse events was performed. Results. There were 70 subjects in MG and 70 in CG. Lurie memory score significantly increased in the MG (59.9±6.7 vs 58.1±7.4 points at the baseline; p=0.001), but not in the CG (58.0±6.9 vs 57.3±7.3 points, p>0.05). According to the SAN questionnaire, significant increase of well-being values (46.9±13.4 vs 44.2±13.5 points; p=0.01) and mood (49.9±12.6 vs 47.4±12.9 points; p=0.01) was found in MG, while in CG there was an increase of the mood category only (54.4±10.8 vs 52.2±12.1, p=0.04). At the end of the study an increase of «Satiety¼ (60.3±22.8 vs 51.5±24.8, p=0.022) and decrease of «Hunger¼ score (24.1±19.8 vs 29.1±19.4, p=0.02) were revealed in CG but not in the CG. No significant change was found by the results of other tests, stool form and its frequency in both groups. Conclusion. Newly developed spread enriched with 5-hydroxytryptophan, L-theanine, γ-aminobutyric acid was well-tolerated, did not affect the feeling of hunger and satiety, and improved memory and well-being parameters.

[Reversal of Hartmann's procedure in patients with diverticular disease]. / Rekonstruktivno-vosstanovitel'nye vmeshatel'stva posle operatsii Gartmana u patsientov s divertikulyarnoi bolezn'yu.

OBJECTIVE: To analyze intraoperative and early postoperative results of open and laparoscopic reversal of Hartmann's (HR) procedure in patients with diverticular disease. MATERIAL AND METHODS: A single-center retrospective non-randomized study included 31 patients with complicated form of diverticular disease between 2018 and 2022. Patients underwent reversal of Hartmann's procedure (laparoscopic surgery - 19, laparotomy - 12). RESULTS: Mean time of laparoscopy and open surgery was 202±36.7 and 223±41 min, respectively. There were no intraoperative complications in both groups and conversions of laparoscopic reversal of Hartmann's procedure. No preventive stoma was required. Mean postoperative hospital-stay was 7.6±3.2 and 9.5±4.6 days, respectively. Overall incidence of postoperative complications was 32.2% (n=10), i.e. 4 (21%) and 6 (50%) patients in both groups, respectively. Anastomotic leakage occurred in one patient after open surgery. CONCLUSION: In our sample, incidence of complications was low after reversal of Hartmann's procedure in patients with complicated diverticular disease. There was 1 (3.2%) patient with anastomotic leakage, and no temporary stoma was formed. In patients who underwent laparoscopic Hartmann's procedure at the first stage and selected patients after open surgeries, laparoscopic reversal procedures were accompanied by no conversions. There were favorable results typical for minimally invasive surgery. Selection criteria for laparoscopic access are discussable. Large-scale studies including randomized trials are needed to verify selection criteria for minimally invasive reversal of Hartmann's procedure and demonstrate its advantages over open surgery.

Complicated catheter ablation of premature ventricular contractions from the left sinus of Valsalva in a young female. Case presentation.

Idiopathic premature ventricular complexes (PVCs) are usually benign and are often treated conservatively. Data regarding radiofrequency catheter ablation (RFA) of PVCs from the aortic sinus of Valsalva are spare. Furthermore, there are limited data regarding complications and their solutions during RFA of PVCs from the aortic sinus of Valsalva. Here we describe a clinical case of symptomatic PVCs in a 27yrold young woman with reduced exercise tolerance and dyspnea. The patient had taken anti-arrhythmic group Ic, II, and III drugs with no significant effect. Successful catheter ablation of PVCs from the left sinus of Valsalva was complicated by acute occlusion of the left main coronary artery (LCA) followed by polymorphic ventricular tachycardia and ventricular fibrillation. Cardioversion and intravenous antiarrhythmic administration restored the sinus rhythm. The LCA was stented with a bioresorbable Magmaris stent with the support of extracorporeal membrane oxygenation that was required due to severe hypotension and ineffectiveness of vasopressors. After the procedure, a favorable angiographic effect was noted. The result of stenting was monitored with IVUS intravascular navigation. The patient was discharged in a satisfactory condition on the 10th day after the procedure. Special attention should be applied to prevent complications and to careful patient selection for RFA in the left sinus of Valsalva, and care must be taken to avoid injury to the LCA. Timely and correct procedures can result in patient survival even after acute LCA injury and occlusion.

[The results of colorectal resection for bowel deep infiltrating endometriosis]. / Osobennosti kolorektal'nykh rezektsii pri glubokom infil'trativnom endometrioze.

OBJECTIVE: To study the early postoperative outcomes of segmental bowel resections in patients with colorectal endometriosis. MATERIAL AND METHODS: A retrospective study included 60 patients diagnosed with deep infiltrative endometriosis who underwent surgical treatment with segmental bowel resection between 2016 and 2022. RESULTS: All surgeries performed by two teams (gynecologic & colorectal). 59 operations were performed by laparoscopic access and one open. The average operation time was 263.5±86.0 min, estimated blood loss 126.1 ml (10-400 ml). There were no intraoperative complications. There were no conversions during laparoscopic surgery. A protective stoma was not required in any patient. The median postoperative hospital stay was 7.5±4.2 days. Bowel function was restored by an average of 4.3±3.1 days. Postoperative complications were in 7 cases (11.6%). Anastomotic leakage occurred in one patient (1.6%). The incidence of urine retention requiring repeated bladder catheterization was 2 (3.3%). CONCLUSION: The use of a minimally invasive multidisciplinary approach makes it possible to perform the required volume of surgery with excision of all tissues affected by endometriosis with a low level of complications and the absence of conversions.

[Modification of dietary patterns in patients with non-alcoholic steatohepatitis].

AIM: To assess efficacy of dietary patterns modification with the use of specialized food in patients with non-alcoholic steatohepatitis (NASH). MATERIALS AND METHODS: We developed new specialized food (SPP2) based on literature data on the role of dietary patterns in pathogenesis of NASH. It contained -3 PUFAs, soluble dietary fiber, phospholipids, -lipoic acid, coenzyme Q10, L-carnitine, complex of vitamins. Patients with NASH (per EASL guidelines), were invited to participate in the study and were randomly assigned to receive either isocaloric diet (ICD) alone (based on the results of indirect calorimetry Cosmed, Italy) or isocaloric diet with specialized food (2 portions of SPP2 a day), for 14 days. Repeated examinations of body composition with phase angle analysis (InBody, Republic of Korea) and blood chemistry were performed at baseline (BL) and after 14 days (EOT). The patients were advised to follow usual physical activity during the study. Non-parametric statistics was used to compare BL and EOT characteristics in the groups. RESULTS: The groups did not differ by age, proportion of females, and baseline characteristics of body composition. Adherence to the diet was 87.5% in the ICD group and 88.2% in the ICD+SPP group (p=0.65). Compliance with the use of SPP was 100%. In the ICD+SPP group significant reduction of body weight was achieved (117.530.1 kg initially, vs 114.928.8 kg at EOT; p=0.007), whereas in the ICD group it was not statistically significant (106.722.1 kg at BL vs 104.016.8 kg at EOT, respectively; p=0.07). In contrast to the ICD group, in those who received ICD+SPP significant decrease in cholesterol (5.31.3 mmol/L at BL vs 4.61.3 mmol/L at EOT; p=0.003), LDL (3.71.0 mmol/L vs 3.31.0 mmol/L, respectively; p=0.009), alkaline phosphatase (132.699.1 vs 112.087.0 U/L; p=0.04), GGT (54.533.2 vs 37.519.7 U/L; p=0.04), insulin resistance index (6.13.2 vs 3.21.5, respectively; p=0.04) was detected. CONCLUSION: Modification of dietary patterns with the use of a specialized food in combination with low-calorie diet allows achieving significant reduction of weight and improve lipid and carbohydrate metabolism, reduce severity of cholestasis in patients with NASH.

[Abnormal development of the hard palate revealed during the forensic examination of bone remains]. / Anomal'noe razvitie tverdogo neba, vyyavlennoe pri sudebno-meditsinskoi ekspertize kostnykh ostankov.

In the forensic practice of examining bone remains there are cases of anomalies' detection of the skeleton development which have a high identification value for the search for a missing person. The most valuable ones are the features of the facial skull anatomical structure since they are usually well visible and recorded in photographic and medical documents. In the presented case an anomaly in the hard palate development was revealed on the skull of an unknown person found in the Leningrad region - a cleft caused by its underdevelopment.

Novel experimental setup for megahertz X-ray diffraction in a diamond anvil cell at the High Energy Density (HED) instrument of the European X-ray Free-Electron Laser (EuXFEL).

The high-precision X-ray diffraction setup for work with diamond anvil cells (DACs) in interaction chamber 2 (IC2) of the High Energy Density instrument of the European X-ray Free-Electron Laser is described. This includes beamline optics, sample positioning and detector systems located in the multipurpose vacuum chamber. Concepts for pump-probe X-ray diffraction experiments in the DAC are described and their implementation demonstrated during the First User Community Assisted Commissioning experiment. X-ray heating and diffraction of Bi under pressure, obtained using 20 fs X-ray pulses at 17.8 keV and 2.2 MHz repetition, is illustrated through splitting of diffraction peaks, and interpreted employing finite element modeling of the sample chamber in the DAC.

Anemia as a Risk Factor for Organ Dysfunctions in Patients Operated on Heart Valves.

Aim      To study the effects of pre- and postoperative anemia on the risk and the structure of internal organ dysfunction in patients undergoing surgery for acquired heart diseases (AHD).Material and methods  This was a retrospective cohort study including 610 primarily operated patients with AHD. A comparative analysis of the incidence and the structure of internal organ dysfunction was performed, and the likelihood of intraoperative hemotransfusion was determined for patients with preoperative anemia (Hb <130 g/l) and without it. The incidence and the nature of internal organ damage were compared in patients with postoperative Hb < 90 g/l and 90-130 g/l.Results The presence of postoperative anemia detected in 45 % of patients at two days after the surgery 6-fold increased the risk of acute heart failure (odds ratio [OR], 5.75; 95 % confidence interval [CI], 1.23-26.84; р=0.016), 4-fold increased the risk of multiorgan failure (MOF) (OR, 4.2; 95 % CI, 1.16-15.64; р=0.03), and 5-fold increased the likelihood of hemotransfusion (OR, 4.74; 95 % CI, 3.12-7.19; р<0.0001). Severe and moderate anemia (Hb <90 g/l) was observed in 11.2 % of patients, which presence 6-fold increased the risk of brain dysfunction (OR, 5.72; 95 % CI, 2.17-15.06; р=0.001) and MOF (OR, 5.97; 95 % CI, 1.94-18.35; р=0.004) compared to patients with Hb 90-130 g/l.Conclusion      In patients with AHD, postoperative anemia increases the risk of circulatory decompensation at two days after the surgery and of MOF and also increases the likelihood of intraoperative hemotransfusion; postoperative anemia with Hb <90 g/l increases the risk of brain damage and MOF.

[Death of Pyotr Stolypin: forensic medical aspects]. / Smert' Petra Stolypina ­ sudebno-meditsinskie aspekty.

The article continues the cycle of scientific research devoted to the reconstruction of the tragic events of Russian history by the methods of forensic medical examination. The archival data of the criminal case on the murder in Kiev in 1911 of the Prime Minister of Russia P.A. Stolypin has been published in the scientific literature first time. Formulation a forensic diagnosis and reconstruction of the posture of the victim were done based on comparison of the data from the inspection of the scene, the characteristics of the firearms and the results of the examination of the body. The obtained data arguably disprove the positions of the victim and the killer, which are generally accepted in journalism and artworks.

[Acute complications of gastrointestinal stromal tumors]. / Ostrye oslozhneniia stromal'nykh opukholei zheludochno-kishechnogo trakta.

OBJECTIVE: To analyze acute complications of stromal gastrointestinal tumors and determine diagnosis and optimal treatment of these patients. MATERIAL AND METHODS: There were 33 patients with acute complications of GIST aged 40-74 years. RESULTS: Acute complications were presented by gastrointestinal and (or) intratumoral (interstitial) bleeding (n=31). Hemorrhage was combined with stomach perforation in 1 case, intussusception and obstruction of the duodenum in 1 patient, small bowel obstruction in 2 patients. All findings were confirmed by the marker CD 117 (+). One patient died in long-term period after R0-resection and chemotherapy. Targeted therapy was used in 2 patients. CONCLUSION: Clinical examples indicate the progress in diagnosis and treatment of GIST due to development of instrumental imaging techniques, histological and histochemical verification of the process.

RNA Editing by ADAR Adenosine Deaminases: From Molecular Plasticity of Neural Proteins to the Mechanisms of Human Cancer.

RNA editing by adenosine deaminases of the ADAR family attracts a growing interest of researchers, both zoologists studying ecological and evolutionary plasticity of invertebrates and medical biochemists focusing on the mechanisms of cancer and other human diseases. These enzymes deaminate adenosine residues in the double-stranded (ds) regions of RNA with the formation of inosine. As a result, some RNAs change their three-dimensional structure and functions. Adenosine-to-inosine editing in the mRNA coding sequences may cause amino acid substitutions in the encoded proteins. Here, we reviewed current concepts on the functions of two active ADAR isoforms identified in mammals (including humans). The ADAR1 protein, which acts non-specifically on extended dsRNA regions, is capable of immunosuppression via inactivation of the dsRNA interactions with specific sensors inducing the cell immunity. Expression of a specific ADAR1 splicing variant is regulated by the type I interferons by the negative feedback mechanism. It was shown that immunosuppressing effects of ADAR1 facilitate progression of some types of cancer. On the other hand, changes in the amino acid sequences resulting from the mRNA editing by the ADAR enzymes can result in the formation of neoantigens that can activate the antitumor immunity. The ADAR2 isoform acts on RNA more selectively; its function is associated with the editing of mRNA coding regions and can lead to the amino acid substitutions, in particular, those essential for the proper functioning of some neurotransmitter receptors in the central nervous system.

Radioprotective Properties of Neomitilan in Experimental Radiation Pneumonia.

The efficiency of neomitilan, a polysaccharide isolated from Crenomytilus grayanus mussels, was studied in experimental model of radiation pneumonia (irradiation of the animal lungs with a total dose of 14 and 28 Gy). Histological study showed that an increase in the number of nucleated components in the lungs of animals subjected to neomitilan inhalation prior to irradiation. Proliferation of bronchial epitheliocytes and the formation of additional lymphoid structures were also revealed in these animals. The absence of a tendency to lung tissue recovery in animals irradiated with 28 Gy is due to extreme radiation toxicity.

Effect of Neoadjuvant Chemoradiation Therapy on Proteasome Pool in Rectal Cancer.

In untreated rectal cancer patients, the chymotrypsin-like activity of proteasomes in tumor tissue was 3-fold higher than that in conventionally normal tissue, which is explained by up-regulation of expression of immunoproteasomes and total pool of proteasomes. After neoadjuvant chemoradiation therapy, expressions of the total pool of proteasomes and immunoproteasomes in the tumor as well as the relative ratios of these indices to those in conventionally normal tissue were smaller by 1.4-3.3 times in comparison with the untreated patients. These changes were paralleled with pronounced (4.5-fold) down-regulation of proteasome activity in the tumor and a 3.7-fold decrease of activity ratio for the proteasomes in tumor and in conventionally normal tissue. The number of immunoproteasome subunits and the chymotrypsin-like activity of proteasomes can be viewed as potential markers to prognosticate effectiveness of neoadjuvant chemoradiation therapy in rectal cancer patients.

[Roentgen endovascular treatment of common carotid artery dissection after eversion carotid endarterectomy]. / Rentgenendovaskulyarnoe lechenie dissektsii obshchei sonnoi arterii posle eversionnoi karotidnoi endarterektomii.

The article deals with the use of self-expanding stents for endovascular treatment in patients presenting with dissection of the common carotid artery, exemplified by two clinical case reports. In both cases, dissection of the common carotid artery developed after eversion carotid endarterectomy. Intimal detachment was eliminated in both cases by implanting self-expanding stents. These cases demonstrated possibilities of roentgen endovascular methods of treatment making it possible to successfully replace a repeat, technically difficult surgical intervention for iatrogenic dissection of the common carotid artery.

[Prevention of paracolostomic hernia]. / Profilaktika parakolostomicheskoi gryzhi.

AIM: To improve the prevention of paracolostomic hernias. MATERIAL AND METHODS: We studied the prevention of paracolostomic hernia using mesh allograft. The study involved 73 patients with low-ampullary rectal cancer. Open or laparoscopic abdominoperineal extirpation of rectum was performed in all observations. 21 patients underwent prophylactic Sugarbaker's repair of paracolostomic area. We used the modifications of this surgical stage for transabdominal and retroperitoneal stoma. RESULTS: There were no postoperative complications associated with the use of allograft. The hernia occurred in one case (4.8%) of prevention group and in 14 (26.9%) patients of control group. CONCLUSION: The first results of composite allograft application to prevent paracolostomic hernias are encouraging. The absence of specific complications and favorable long-term results allow to continue the investigation.

[Cardiac damage in liver cirrhosis in alcohol abusers]. / Porazhenie serdtsa pri tsirroze pecheni u bol'nykh, zloupotreblyayushchikh alkogolem.

AIM: to estimate the contribution of liver cirrhosis (LC) to the development of heart diseases in alcohol abusers. SUBJECTS AND METHODS: The investigation included 80 patients with alcoholic LC without a history of cardiovascular and respiratory diseases and, as a control group, 32 alcohol abusers without a history of chronic diseases of the liver and cardiovascular and respiratory systems; 45 patients with alcoholic cardiomyopathy (ACM) and congestive heart failure without a history of coronary heart disease and valvular diseases, among whom 11 patients were found to have LC. In addition to standard clinical examination, all the patients underwent electrocardiography, by estimating the corrected QT interval (QTc), standard echocardiography; and those without ACM underwent estimation of left ventricular (LV) kinetics using speckle-tracking echocardiography. RESULTS: The patients with alcoholic LC were found to have a higher LV ejection fraction and a more obvious impairment of LV global longitudinal deformity, and more commonly LV diastolic dysfunction. 16 of the 80 patients with LC were observed to have moderate pulmonary hypertension while the mean pulmonary artery pressure (MPAP) was within the normal range in all the patients without LC. A prolonged QTc interval was revealed in the patients with LC. The duration of QTc was directly correlated with the MELD severity of LC. The patients with chronic heart failure in the presence of ACM and CL showed a more obvious LV diastolic dysfunction, as estimated by E/E', a greater LV mass index, and a higher MPAP than those with ACM without LC. CONCLUSION: The LC patients both with ACM and without a history of diseases of the heart were noted to have its more evident disorders as diastolic dysfunction and elevated MPAP. Those without ACM were observed to have impaired LV global deformity and a prolonged QTc interval.

Erythropoietin exerts direct immunomodulatory effects on the cytokine production by activated human T-lymphocytes.

The effect of erythropoietin-ß (Epo-ß) on the functional profile of activated human T-lymphocytes remains largely unknown, which hinders clinical application of Epo as an immunomodulatory agent. We studied the direct impact of Epo on the activation status of human T lymphocytes following activation by particles loaded with antibodies (Abs) against human CD2, CD3, and CD28. T cell activation was assessed by the surface expression of CD38 activation marker. Epo did not significantly affect activation status of both CD4(+) and CD4(-) T cells, as well as of naive (CD45RA(+)CD197(+)), central memory (CD45RA(-)CD197(+)), effector memory (CD45RA(-)CD197(-)), and terminally-differentiated (CD45RA(+)CD197(-)) T cells. However, Epo markedly augmented production of IL-2, IL-4 and IL10 by activated T cells with concomitant reduction in IFN-γ secretion. Taken together, our data showed that Epo could directly down-regulate pro-inflammatory T cell responses without affecting T cell activation status.

Novel modification of Hall-type ion source (study and the first results).

We present the original approach to use plasma accelerators with closed electron drift (Hall-type ion sources), which, unlike traditional accelerators with metal and dielectric walls, have open walls and can be applied for creation cost effective low maintenance plasma devices based on plasma lens configuration for production of converging towards axis accelerated ion beams. The paper describes pilot sample of Hall-type plasma accelerator, the first experimental results, one-dimensional theoretical model, and exact analytical solutions following from it.