First Russian experience with endovascular balloon occlusion of the aorta in a zone of combat operations. / Pervyi otechestvennyi opyt primeneniia éndovaskuliarnoi ballonnoi okkliuzii aorty v zone boevykh deistvii.

Resuscitative endovascular balloon occlusion of the aorta has increasingly been used all the world over for arresting ongoing intraabdominal and intrapelvic bleeding accompanied by unstable haemodynamics. However, the use of resuscitative endovascular balloon occlusion of the aorta in a zone of military operations has been limited to sporadic cases only. This article deals with 3 clinical case reports regarding rendering medical care for the wounded presenting with extremely unstable haemodynamics and/or a terminal state in a field hospital, where insertion of a balloon into the aorta made it possible to stabilize the condition, to perform the basic scope of diagnosis, and to finally control the continuing bleeding: in one case - intraabdominal (due to splenic rupture) and in 2 cases - intrapelvic (unstable fractures of pelvic bones). In two cases, despite low readings of blood pressure, puncture of the femoral artery was performed 'blindly' and in one case - in an open fashion. The balloons used were the 7 Fr Rescue Balloon (Japan) and 10 Fr balloons manufactured by the Limited Liability Company 'Minimally Invasive Technologies' (Russia). The balloons were positioned in the aorta also 'blindly' and only in one case we managed to perform an X-ray examination confirming the correct position of the balloon. The mean time of occlusion of the thoracic aorta in the survivors amounted to 20 minutes. The operations were accompanied by intensive therapy and massive haemotransfusion. The introducers were removed using the fascia suture technique (without closure of the arterial wall). Two of the three wounded were saved, to be evacuated to a central hospital and discharged 170 and 75 days thereafter, which was due to long-term treatment of severe concomitant fractures of pelvic bones and lower extremities. No complications on the background of resuscitative endovascular balloon occlusion of the aorta were revealed. Two years after surgery both men continue serving in the Armed Forces, with no significant functional impairments. Our third injured patient delivered in a condition of clinical death, despite restoration of the rhythm after inflation of the balloon unfortunately died. Our case reports demonstrate high efficacy of resuscitative endovascular balloon occlusion of the aorta in unstable haemodynamics induced by combat injury to the abdomen and pelvis. The technique of this method makes it possible not only to stabilize haemodynamics, to improve perfusion of the vital organs but also to staunch continuing haemorrhage, hence allowing additional time to carry out haemotransfusion. In future, resuscitative endovascular balloon occlusion of the aorta may become one of the methods of the extended protocol of prehospital care.

[Complex morphological (cytological, histological) diagnostics of desmoid fibroma associated with a breast implant (case report from practice).]

A rare clinical observation of desmoid fibroma associated with a breast implant is presented. When making a morphological (cytological, histological) diagnosis at the light-optical level before surgery, a differential morphological diagnosis was performed between cicatricial changes, the stromal component of the phyloid tumor and desmoid fibroma. Only immunohistochemistry allowed us to establish a diagnosis of desmoid fibroma, since tumor cells expressed diffusely SMA, focally desmin, and most importantly, ß-catenin expression was observed in some cells.

Effects of critical fluctuations of storage temperature on the quality of dry dairy product.

Whole milk powder (WMP) is a universal raw material component that can overcome the problem of seasonality of raw milk. It can be used to provide high-nutritional products to remote areas experiencing a raw milk shortage. Its long shelf life depends on the conditions of storage and transportation, which are recommended to be carried out in a range from 0 to 10°C. At higher temperatures, the quality of WMP deteriorates because of a substantial increase in the degradation of fat and protein fractions. A range of low negative temperatures for storage have not been systematically investigated. Previous studies have shown that freezing WMP results in protein denaturation, crystallization of lactose, and extraction of free fat, all of which reduce the quality characteristics of the product, including deterioration of solubility, quick rancidification, and microbiological changes. However, these previous studies did not simulate the possible situations of transportation and storage of milk powder at low negative temperatures that occur in practice. Given the volume of transportation, distances and climatic characteristics of transportation routes play an important role in WMP preservation. In this study, we simulated storage and transport of WMP at -20°C. The samples were periodically thawed to 10 and 20°C and examined for physicochemical, functional-technological, thermodynamic, microbiological, and organoleptic parameters. Based on our results, storage of WMP at -20°C for 40 d did not have a significant effect on its qualitative characteristics. We observed some compaction of product structure and clustering or clumping, which was reversible by slight mechanical impact. Artificial contamination of the packaging surface with yeast and molds, followed by thawing of the samples, indicated the absence of the contaminants, which was explained by possible redistribution of moisture in the system.

[Possibilities of cytological diagnostics of lactated breast adenoma. Clinical report.]

We describe a case of lactating adenoma in pregnant woman, 32 week of gestation. Typical features of disease presented in this article was revealed by clinical and microscopic methods and it make possible to diagnose the process before operation. The diagnosis was confirmed by histological investigation of surgical material.

[The complex morphologic diagnostic of marginal zone lymphoma.]

The purpose of study: To determine possibilities of complex morphological diagnostic (routine cytology and histology, immunocytochemistry and immunohistochemistry, molecular genetics) of lymphoma of marginal zone. The study included 10 patients with diagnosis of lymphoma of marginal zone cells, established on the basis of application of morphological (cytological and histological), immunomorphologic (immunocytochemical and immunohistochemical) and molecular genetic techniques. The immunofenotyping was implemented using immunocytochemical technique (EnVision FLEX) applying monoclonal antibodies by DAKO manufacturer. The immunofenotyping was implemented by flow cytofluorometry technique (flow cytofluorometer FACS Calibur by Becton Dikinson, USA) using antibodies by DACO manufacturer labeled by fluorescent marks (FITC or RPE). The antibody panel included: common leukocytic antigen, common cytokeratins CD19, CD20, CD79a,CD10, Bcl2, Bcl6, CD23, CD34, TdT, CD3, CD4, CD5, CD8, CyclinD1, Ki67, κ, λ. The FISH technique was applied using probes Bcl2 FISH DNA Probe, Split Signal и MALT1 FISH DNA Probe Split Signal by DAKO manufacturer. In one patient a gene Bcl2 change was detected with purpose of differentiating diagnostic with follicular lymphoma. In three patients, diagnosing lymphoma of marginal zone was implemented by FISH technique using detection of translocation (11;18)(q21;q21), involving gene of inhibitor of apoptosis API2 and gene MALT1. The routine cytological analysis of ten cases permitted to establish an exact diagnosis of lymphoma only in five cases and with no indication that it is lymphoma of marginal zone. In two cases under routine cytological analysis only a suspicion about lymphoma was suggested. In all ten patients a positive expression of pan-B-cellular markers CD19, CD20, CD79a was observed both under immunocytochemistry and immunohistochemistry and flow cytofluorometry. In 6 patients (60%) a positive expression of gene Bcl2 was observed both under immunocytochemistry and immunohistochemistry and flow cytofluorometry. The comparison of immunocytochemistry and immunohistochemistry and flow cytofluorometry established absence of expression of CD5, CD3, CD10, CD34, CD23, Bcl6, TdT, cyclin D1. Under immunocytochemistry and immunohistochemistry in ten cases proliferative activity protein Ki-67made up no more than 30%. Under flow cytofluorometry clonality on light chains of immunoglobulins κ or λ (Igλ/Igκ) were established. Overall, correlation coefficient (r, p < 0,05) between immunocytochemistry and immunohistochemistry, flow cytofluorometry made up to 1. The four patients were applied FISH-reaction for adjustment of diagnosis. In patient with nodal lymphoma of marginal zone gene Bcl2 change was absent. In three patients with MALT-lymphoma a gene MALT1 change was established. Thereby, accuracy of routine cytological analysis at diagnosing lymphoma without indication of its type in case of lymphoma of marginal zone made up to 50%, sensitivity - 50%, specificity - 100%. The accuracy of immunofenotyping permitting diagnosing lymphoma of marginal zone made up to 100%, sensitivity - 100%, specificity - 100%. The correlation coefficient (r, p < 0,05) between data of immunocytochemistry and immunohistochemistry, flow cytofluorometry made up to 1. The accuracy, sensitivity and specificity of complex analysis (cytology, immunocytochemistry and FISH-technique) in diagnostic of lymphoma of marginal zone made up to 100%.

[The difficulties of cytologic diagnostic of breast diseases based on trepanobiopsy samples.]

The article analyses, on the basis of scientific publications and original data, the causes of erroneous cytological conclusion concerning samples of trepanobiopsies of mammary gland. The most prevalent benign affections that are characterized by most frequent hyper diagnostic of cancer are fibro-adenoma with proliferation of epithelium and sclerosing adenosis. At the same time, certain modifications of lobular carcinoma of mammary gland, tubular, papillary cancer as well as highly differentiated invasive carcinoma of nonspecific type from cells with ulterior nuclear atypism sometimes it is difficult to diagnose at the cellular level. The sensitivity of cytological diagnostic of pathology of mammary gland using samples of trepanobiopsies makes up 97.5%, specificity - 98.5%. The number of false positive cytological conclusions about presence of malignant tumor makes up to 0.6%, false negative - 1.5%. The reliability of cytological analysis makes up to 97.4%, efficiency - 96.3%.

[Influence of the carbohydrateprotein phytolactate drink on the physical working capacity and endurance of experimental animals].

The study analyzes the effect of a new carbohydrate-protein phyto-lactate drink on the physical performance and endurance of BALB/c mice. The main carbohydrate and protein component in the new product was carrot juice and skim milk. Data on the technology of manufacturing a sterilized beverage have been presented. The study of the influence of the milk-carrot drink on the performance and endurance, carried out in accordance with the Porsolt test («forced swimming¼), was performed on 34 male BALB/c mice, with initial bode weight 22-24 g. An experimental group of animals (n=12) was injected daily with a milk-carrot drink per os in a volume of 0.8 ml (32 ml/kg of body weight) for 28 days, carrot juice or distilled water in the same volume were administered per os in the control groups. It was shown that the introduction of the drink improved the physical working capacity of laboratory animals, confirmed by an increase in the duration of swimming of mice by 34.6% (р<0.05). At the same time, the introduction of pure carrot juice to mice on the basis of which the milk-carrot drink was created also increased physical working capacity, compared to the control group, who received per os a similar volume of water by 17.8% (р<0.05). However, the duration of swimming of the mice of this group was shorter in comparison with the same index in mice injected with the drink (р<0.05).

[Current aspects of counteraction of foodstuff's falsification].

Food products are the objects of the consumer's market, and human's health and life are directly depended on these product's quality and safety. In this regard, the government is paying close attention to entrepreneurial activity aimed at the production and turnover of food products, including their realization to the final consumer. In the absence of proper state control, designed to ensure, first of all, the quality and safety of food products, the consequences may be more than the negative. A significant risk to public health can represent some of the falsification of food products. Typically, these are species of assortment counterfeiting, which may lead to the use of hazardous raw substitutes. In general, the falsification is divided into: assortment, qualitative, quantitative, informational, cost and complex. Herewith it should be noted that falsification in reality is consumer frand and it's necessary to fight against it on the State and social levels. Accordingly the ideology of the measures aimed at prevention and punishability of food products falsification has been proposed.

[Scientific bases and technological principles of the production of gerodietetic canned milk].

It is well known that aging is the natural growing multisection biological process inevitably leading to limitation of body adaptive capabilities. The body ageing is the result of self-regulation mechanism limitation, reduction of their potential capabilities at molecular-genetic, energetic, cellular and general-regulatory levels. It should be noted that due to lack of the unified theory of aging the importance of nutrition factor has been acknowladged particularly initiation and intensity of the process, and the role of antioxidants is discussed much in detail. As the result of long term investigations at model and natural objects the technologies of powder and condensed sterilized gerodietetic milk based preserved foods have been developed. The multicomponent receipts modules balanced by fatty-acid and amino-acid composition as well as enriched with lycopene have been theoretically substantiated and realized. The new gerodietetic products are characterized by the following coefficients of RL3/RL6 not less than for the products: powdered - 0.871/0.615 and condensed sterilized - 0.883/0.648. The following amino-acid balance of Rp/σ protein for the products: powdered - 0.46/15.00, condensed -0.44/15.76 has been obtained. The obtained velues of the balanced criteria of the protein-lipid composition of the product are higher comparing to similar values for milk fat and protein. Two lycopene dosages in the products are provided: prophylactic - 5 mg and antioxidant - 1.5 mg in 400 ml of the reconstituted milk. On the basis of the carried out studies two technologies of the manufacture of condensed milk gerodietetic products adapted to actual conditions of concentrated milk factories have been developed.

CP-violating effect of the Th nuclear magnetic quadrupole moment: accurate many-body study of ThO.

Investigations of CP violation in the hadron sector may be done using measurements in the ThO molecule. Recent measurements in this molecule improved the limit on the electron electric dipole moment (EDM) by an order of magnitude. Another time-reversal (T) and parity (P)-violating effect in 229ThO is induced by the nuclear magnetic quadrupole moment. We perform nuclear and molecular calculations to express this effect in terms of the strength constants of T, P-odd nuclear forces, neutron EDM, QCD vacuum angle θ, quark EDM, and chromo-EDM.

[Pathogenesis and early diagnosis of deep vein thrombosis in case of polytrauma].

Pathogenesis and early diagnosis characteristics of acute deep vein thrombosis (advt) have been studied in 323 polytrauma patients (iss: 29.4 +/- 2.0 score). Acute vein thrombosis, confirmed by us examination, was determined in 22.3% of patients (in the case of severe craniocerebral trauma--scct--12.6%, extremity trauma--60.5%, spinal trauma 75%, severe sepsis--25%). Despite the complex diagnosis and prophylaxis (thrombus removal, thrombosed veins ligation, external iliac vein and inferior vena cava clipping, permanent and removable cava-filters positioning) pulmonary artery thromboembolism (pate) developed in 3.1%. ADVT in patients with polytrauma developed as a pathogenic basis of systemic inflammatory response syndrome (sirs), which was observed to be associated with endothelium damage and thrombophilia. Hence, thrombophilia values (high levels of crp, f.viiia, D-dimer, low levels of antithrombin iii--at-iii), which are characteristic of sirs, lose their informativeness in the early diagnosis of advt and pate risks identification. In this regard, early advt diagnosis in polytrauma should be based on doppler study results, and the adequacy of anticoagulant and antiplatelet therapy should be determined by the levels of crp, f.viiia, D-dimer, activated partial thromboplastin time--aptt, anti- xa heparin activity, international normalized ratio--inr, platelet aggregation, thrombodynamic potential, at-iii.

[Metanephric adenoma of the kidney].

The paper describes metanephric adenoma, a rare adenoma, diagnosed in a patient 20 years after surgery. It provides a histological description of the tumor and a concise review of the literature.

Communication: theoretical study of ThO for the electron electric dipole moment search.

An experiment to search for the electron electric dipole moment (eEDM) on the metastable H(3)Δ1 state of ThO molecule was proposed and now prepared by the ACME Collaboration [http://www.electronedm.org]. To interpret the experiment in terms of eEDM and dimensionless constant kT, P characterizing the strength of the T,P-odd pseudoscalar-scalar electron-nucleus neutral current interaction, an accurate theoretical study of an effective electric field on electron, Eeff, and a parameter of the T,P-odd pseudoscalar-scalar interaction, WT, P, in ThO is required. We report our results for Eeff (84 GV/cm) and WT, P (116 kHz) together with the hyperfine structure constant, molecule frame dipole moment, and H(3)Δ1 → X(1)Σ(+) transition energy, which can serve as a measure of reliability of the obtained Eeff and WT, P values. Besides, our results include a parity assignment and evaluation of the electric-field dependence for the magnetic g factors in the Ω-doublets of H(3)Δ1.

[Prognostic value of the expression of adhesion molecules for non-clear-cell variants of renal cell carcinoma].

The prognostic value of the expression of the adhesion molecules CD44, EMA, and E-cadherin was studied using surgical specimens of 105 renal cell carcinomas (54 papillary, 39 chromophobic, and 12 clear-cell ones). Stages 3-4 tumors showed hyperexpression of all the above proteins (the distribution was estimated by chi2 and Fisher's exact tests). Furthermore, CD44 was found to be an independent unfavorable factor to predict renal cell carcinoma: with its hyperexpression, the 5-year estimated survival rate decreased by 52% (Kaplan-Meier method; p = 0.018). The expression of EMA and E-cadherin was significantly associated with the stage and, to some extent, grade of tumor differentiation; however, it is necessary to study more observations to define the prognostic role of these proteins.

[Perspective technologies of surgical care to the wounded].

A goal of this study is to review perspective technologies of surgical care to the wounded on the basis of an analysis of the experience in medical support in local armed conflicts and a study of the achievements of modern trauma surgery. The study is based on the analysis of personal experience, results of scientific researches being carried out in the Military Medical Academy and a comparison review of available papers and works in the field of our study. Perspective technologies of surgical care to the wounded are strongly dependent on the pre-hospital care: high technologies in personal medical equipment, special disposable devices used in case of life-threatening consequences of injuries and traumas during emergency medical care and advanced trauma management. The main innovation of the last ten years in war surgery is considered to be damage control surgery. Wide application of abbreviated surgical operations (the first phase of damage control surgery) makes the use of remote surgery (telesurgery) for treatment of the wounded more practicable. Increasing effectiveness of military surgeon education is based on the use of all possible achievements in education and information technologies. Feedback in surgical care to the wounded is supplied with analysis of its results in the medical Register of the wounded military.

[Injury of subclavian artery in severe trauma of the shoulder girdle and chest].

The authors consider one of possible variants of surgical treatment of shoulder girdle trauma, which is accompanied by an injury of the main artery. It is based on the application of the principle of staged surgical treatment (damage control orthopedic). The well-timed sufficient diagnostics and treatment of bone-arterial trauma, coordinated work of several surgical teams, the appropriate postoperative management of patients with the using of postponed high-technology intervention allowed obtaining an optimal functional result for extremely severe multitrauma of the chest and limb.

[Implantation of stent- graft because of aorta rupture in polytrauma].

The article describes the clinical case and analyzes the literature concerning endoprosthesis replacement in the case of traumatic thoracic aortic injury in polytrauma. Current strategy of diagnostics and treatment of patient in critical condition with rupture of isthmic aortic part is based on the principle of multistage surgical treatment (damage control orthopedic). The external fixation of multiple pelvis and extremities fractures and on-time implantation of stent-graft in thoracic aortic part were performed at first hours after the admission. A condition of the patient was stabilized. The delayed reconstructive operations on pelvis and extremities bones allowed obtaining the satisfactory functional result. The principles of staged surgical treatment and the use of on-time high-technology methods allowed saving life for the patient even in critical situation in I level traumatologic centre.

[Ways of improving of intensive care for victims with severe concomitant injury].

In terms of prognosis of the outcome of traumatic disease as a disease of adaptation particularly significant is a functional component. Updating of options of the course of traumatic disease allow to combine two principles of intensive care such as individual focus and standardization. Innovations of recent years, embedded into the battlefield surgery clinic of Military Medical Academy n. a. S.M.Kirov in tactics and content of intensive care, improved the current situation on the results of treatment of patients with polytrauma.

[The apoptosis inhibitor survivin in transitional cell carcinoma of the urinary bladder].

Whether the expression of the apoptosis inhibitor survivin was correlated with the degree of differentiation and the stage of transitional cell carcinoma of the urinary bladder was studied. Sixty samples of surgical specimens from patients with urothelial carcinomas of various degrees of differentiation and different stages were examined. An immunohistochemical study using the monoclonal antibodies obtained by the authors was conducted. The high expression of survivin was shown to be correlated with the lower-grade differentiation of a tumor and its higher stage.