[Modern view on the effectiveness of surgical methods for treating obstructive sleep apnea syndrome]. / Sovremennyi vzglyad na effektivnost' khirurgicheskikh metodov lecheniya sindroma obstruktivnogo apnoe sna.

Obstructive sleep apnea (OSA) syndrome is not only a widespread pathology, but also has far-reaching social consequences due to patients' poor quality of nighttime sleep and high daytime sleepiness. To date, a large number of methods, both conservative and surgical, have been developed for the treatment of OSA. Surgeries performed for OSA are aimed at correcting the structures of the nose, pharynx, larynx, as well as the hyoid and jaw bones and the muscles attached to them. Despite the seventy-five-year history of the use of surgical treatment methods, there is still no complete clarity regarding the advisability of certain types of operations. The article presents data from meta-analyses published over the last ten years and devoted to various types of surgical procedures aimed at combating OSA in adult and pediatric populations. Rhinosurgical approaches, uvulopalatopharyngoplasty, surgical advancement of the lower jaw in adults and expansion of the upper jaw in children, interventions on the hyoid bone and mental tubercle, removal of the palatine and pharyngeal tonsils, operations for laryngomalacia and bariatric surgery are considered. Data on the effectiveness of the most common operations: tonsillectomy in adults (85%), multilevel pharyngoplasty (60%); and about a wide range of data on the effectiveness of uvulopalatoplasty (25 to 94%) are presented. Effective surgical options and criteria for a positive prognosis of such treatment, the possibility of complete cure of OSA, that is, reducing the apnea/hypopnea index (AHI) below 5 events per hour in adults, are discussed. In conclusion, the need to continue research using Sher's criteria for the effectiveness of surgical operations is emphasized: a reduction in AHI by 50% or more or below 20 events per hour. Research that includes long-term postoperative follow-up is especially important.

[The use of autologous platelet-rich plasma in the treatment of chronic pharyngitis]. / Primenenie obogashchennoi trombotsitami autoplazmy v terapii khronicheskogo faringita.

The results of a prospective open cohort study of the use of platelet-rich plasma (platelet-rich plasma - PRP) in patients with chronic pharyngitis during the exacerbation of the disease are presented. OBJECTIVE: To evaluate the clinical efficacy of autologous PRP in the treatment of chronic pharyngitis. MATERIAL AND METHODS: Autologous PRP was injected into the posterior pharyngeal wall as a course of endopharyngeal blockages as part of the complex therapy of chronic pharyngitis. Patients in the control group received standard therapy, without the use of autologous PRP. The effectiveness of the studied technique was evaluated by statistical analysis of the intensity of symptoms of the disease, determined by patients throughout the entire period of treatment in the patient's diary, as well as by analyzing data from mass spectrometry of microbial markers and bacteriological examination of the pharyngeal mucosa, collected at the beginning of the study and 14 days after completion of the course of therapy. CONCLUSION: The use of a course of endopharyngeal blockades with autologous platelet-rich plasma as part of the complex therapy of chronic pharyngitis, according to our estimates, provides a significant effect in the form of higher rates of reduction in the severity of symptoms of the disease, a significant reduction in the number of microorganisms deviating from the reference values (by 2 times or more), a decrease in the duration of the disease compared with the control group.

[Gut microbiota in patients with relapsing-remitting multiple sclerosis]. / Mikrobiota kishechnika u patsientov s remittiruyushchim rasseyannym sklerozom.

Microorganisms in human life play a huge role: in particular, those that coexist with the host organism, inhabiting the skin, upper respiratory tract, external genitalia and especially the digestive tract. The intestinal microbiota, including bacteriome, mycobiome and virome, not only takes part in the digestion process, but also provides the synthesis of a number of vitamins. The intestinal microbiome also serves as the basis for a system of extensive bidirectional neuroendocrine pathways that connect microbiota with various regions of the central nervous system, the hypothalamic-pituitary-adrenal system, and the peripheral parts of the autonomic nervous system. This system of connections has got the name of gut-brain axis and has attracted close attention of scientists over the past two decades, since a targeted impact on the intestinal flora is potentially capable of changing the nature of nervous system regulatory influences on the whole body. It is especially important to study patterns of functioning of the gut-brain axis in patients with the nervous system pathology, namely neurodegenerative and demyelinating diseases. Methods for their treatment continue to improve, and perhaps the correction of the gut microbiotic composition will serve as an additional therapeutic approach. The review article describes current views on the role of the intestinal microbiota, provides the latest data on the composition of bacteriome, mycobiome, and virome in patients with relapsing-remitting multiple sclerosis.

[COMPREHENSIVE ASSESSMENT OF THE SPECIES COMPOSITION AND SENSITIVITY OF MICROFLORA IN PATIENTS WITH ODONTOGENIC MAXILLARY SINUSITIS].

Objective - to study the species composition of microflora and its sensitivity in patients with odontogenic maxillary sinusitis. The study included 230 patients of both sexes aged 18 to 70 years, who were treated at the Moscow Regional Scientifics Research and Clinical Institute named after M. F. Vladimirsky with a diagnosis of Odontogenic maxillary sinusitis. Of these, there were 155 patients with odontogenic sinusitis, complicated by perforation of the maxillary sinus and the presence of an oro-antral fistula, and 75 patients with maxillary aspergillosis. All patients underwent microbiological examination of smears and flushes from the maxillary sinus cavity with the determination of the species composition and antibiotic sensitivity. In the majority of the patients with perforative forms of odontogenic maxillary sinusitis, coccal flora (streptococci and various species) was detected, in a smaller number compared to it - facultative and obligate anaerobes, pathogenic fungi (Candida). A comparative analysis of the microflora, depending on the duration of the maxillary sinus perforation, showed that the rhinogenic microorganisms (Moraxella spp.) were found only in intraoperative perforations (up to 20% of cases). The presence of obligate anaerobes (Fusobacterium spp. Bacteroides spp.) was typical for long-existing perforations. In patients with maxillary aspergillosis facultative and obligate anaerobes were found less frequently and in a smaller variety than in patients with perforative maxillary sinusitis. There were no cases of sinus contamination by pathogenic fungi of the genus Candida in this group. At the same time, rhinogenic microgranisms (Moraxella spp.) were detected with a higher frequency (up to 27.3%) in this group of patients.

[The changes in urine microflora in patients with urinary stone disease].

INTRODUCTION: Since the results of treatment of chronic pyelonephritis (CP) depend on timely and rationally selected targeted antibiotic therapy, when choosing a treatment regimen, it is necessary to rely on the local data obtained by monitoring the state of microflora in a particular hospital. AIM: to monitor the changes in urine microflora in patients with urinary stone disease. MATERIALS AND METHODS: A total of 598 isolated bacteria and yeast-like fungi from patients with urinary stone disease who were treated in the Department of Urology during different time periods (1997-1999, 2010-2014 and 2015-2017 yy) were analyzed. A comparison of the urine microbiota in patients with single kidney stone (n=154) and staghorn stone (n=147) for the period 2015-2017 yy. was carried out. RESULTS: The significant changes of gram-positive and gram-negative bacteria were found with a tendency to decrease in the proportion of the latter (from 80.6% to 50.6%, p<0.05) due to a decrease in the proportion of P. mirabilis and complete absence of Enterobacter spp, Serraciae spp and Citrobacter spp. as well as an increase in the number of gram-positive bacteria (from 18 to 48.7%, p<0.05) owing to increase in the proportion of E. faecium + E. faecalis. During observation period, E. Coli has remained the leading pathogen (26.4+/-0.32%). During observation period, a permanent fourfold prevalence of gram-negative bacteria in clinically significant concentrations (>104 CFU/ml) was found: E. coli (36.8+/-4.1%). The proportion of K. Pneumonia increased from 8.5% to 17.4%, and proportion of P. mirabilis decreased from 20.3 to 10.4%. Despite a significant increase in the proportion of Enterococcus spp. (from 4.6 to 26.6%) in the general population, the incidence of microorganisms in clinically significant concentrations during analyzed period remained unchanged and did not exceed 8.46+/-4.76%. In patients with single stones and patients with staghorn stones there was no significant difference in the proportion of analyses with clinically significant concentrations of bacteria fer (p>0.05). The percentage of analyses with clinically significant concentration was 70.06%, while in all patients with urolithiasis it was 59.7%. In patients under and over 60 years old, the largest number of bacterial pathogens were represented by E. coli. (29.7% and 32.1%, respectively). CONCLUSION: E. Coli remains the leading bacterial causative agent of calculous pyelonephritis, both in the general population and in analyses with clinically significant concentrations of bacteria. There were no significant differences in urine microflora in patients with staghorn and single stones.

[The use of the enzymes for the enhancement of the effectiveness of antimicrobial photodynamic treatment of the patients presenting with chronic tonsillitis].

The objective of the present study was to enhance the effectiveness of the treatment of the patients presenting with various forms of chronic tonsillitis (CT) by means of antimicrobial photodynamic therapy (APDT). The study included 48 patients at the age from 18 to 55 years divided into three groups; all of them suffered from various forms of CT. Group 1 was comprised of 12 patients given a course of traditional conservative therapy. Group 2 consisted of 17 patients treated by APDT while group 3 included 19 patients in whom a course of antimicrobial photodynamic therapy was preceded by the treatment of the mucous membrane of the palatine amygdalae with a lidase solution. The microbiological testing was performed on days 5, 12, and 24 after APDT and also within the next 6-9 months. The results of the microbiological and clinical studies give evidence of the possibility to improve the effectiveness of the treatment of chronic tonsillitis by means of antimicrobial photodynamic therapy with the use of the preventive treatment of palatine tonsillar mucosa with a lidase solution. Such treatment was found to facilitate degradation of theintercellular matrix of the biofilm and reduced its resistance to the photodynamic impact.

[Five-year analysis of microbial landscape of transplantation and dialysis center (20112015)].

INTRODUCTION: Treatment of bacterial infections is pressing and difficult task of modern transplantology. AIM: To analyze the spectrum of bacterial microflora and bacterial sensitivity to antibiotics in patients of the transplantation and dialysis center. RESULTS: The study analyzed the results of bacteriological tests performed in 534 patients with chronic kidney disease stage 5 in 2011-2015. Biomaterials for the examination included urine, blood, wound discharge and sputum. Gram-positive bacteria, Gram-negative bacteria, fungi and mixed flora were found in 42%, 39%, 4% and 15%, respectively. Among observed associations 51% were presented by a combination of Gram-positive and Gram-negative bacteria and the others were different combinations of fungi. The most often detected bacteria were Enterococcus spp. (37%), Klebsiella pneumoniae (25%), Staphylococcus spp. (19%), E. coli (13%), Streptococcus spp. (6%), P. aeruginosa (5%). Fungi of the genus Candida were isolated from 11% of all cultures. Enterococci and Klebsiella had pronounced resistance to most antibiotics. All gram-positive bacteria were highly sensitive to vancomycin and linezolid. DISCUSSION: The findings suggest that the percentage of Gram-negative bacteria that are resistant to antibiotics is increasing. CONCLUSION: Significant changes in the microbial landscape and the growing antibiotic resistance dictate the need for periodic analysis of the bacterial flora in the transplantation and dialysis center.

[Characteristics of inflammatory response in patients after senile cataract surgery].

The aim of the work was to study prognostic value of some laboratory markers (anti-DNA antibodies, cell adhesive molecules, neopterin) in heriatric patients with exudative inflammation after cataract surgery. 12 in-patients with postoperative iridocyclitis and endophthalmitis were included. The assays were taken twice: after admission and before discharging. The follow-up period was 6 months. Preliminary data show that high serum levels of sVCAM, sICAM and anti-DNA antibodies, as well as very low levels of anti-DNA antibodies seems to be associated with poor outcomes in those patients (enucleation, blindness, lens extraction). Small cohort doesn't allow us to make strict conclusion about prognostic value of these laboratory markers. The study should be continued.

[THE HYGIENIC CONDITIONS OF THE INTERNAL ENVIRONMENT OF SYLVINITE CHAMBERS OF VARIOUS MODIFICATIONS].

The performed comparative physiological-hygienic assessment of the conditions of the internal environment of salt sylvinite structures allowed to establish the complex of physical factors that have a favorable influence on the functional condition of the basic systems of the organism of patients.

[ACTIVITY OF ANTIMICROBIAL NANOSTRUCTURED BARRIER LAYERS BASED ON POLYETHYLENETEREPHTHALATE IN RELATION TO CLINICAL STRAINES OF MICROORGANISMS FOR SICK PERSONS OF GASTROENTEROLOGICAL PROFILE].

Homeostasis transgressions of enteral medium including disbiotic ones are often accompanying deseases of digestive tract. Espessially it touches upon sick persons connected with probe nourishing. One of the way for solving this problem is normalization of digestion microflore by means of wares with nanotechnological modifications of walls (probes, stomic tubes) which provide them antimicrobial properties and assist to normalization of digestive microbiotis and enteral homeostasis completely. The aim to study is research of antimicrobial activity of of nanostructured barrier layers based on polyethyleneterephthalate (PET) in relation to clinical straines of microorganisms. For barrier layer creation the approach on the base of methods of ion-plasma technology was used including ion-plasma treatment (nanostructuring) of the surface by ions noble and chemically active gases and following formation nanodimensional carbon films on the surface/ For the study of antimicrobial activity in relation to clinical straines of microorganisms we used the technique which allowed to establish the influence of parting degree of microorganisms suspension and time for samples exposing and microorganisms adsorbed on the surface. In experiment clinical straines obtained from different materials were used: Staphylococcus Hly+ and Calbicans--from pharyngeal mucosa, E. coli--from feces, K.pneumoniae--from urine. Sharing out and species identification of microorganisms were fulfilled according with legasy documents. In results of the study itwas obtained not only the presence of staticticaly confirmed antimicrobial activity of PET samples with nanostructured barrier layers in relation to different stimulators of nosocomical infections but also the influence of different factors connected with formation of nanostructured layers and consequently based with them physicochemical characteristics such as, in particular, surface energy, surface relief parameters, surface charg and others, as well as influence of microorganisms nature onto the interaction of between barrier layers and microorganisms.

[The synopsis of clinical cytometry: acute megakaryoblastic leukemia.]

The acute megakaryoblastic leukemia is a rather rare form of pathology even in practice of specialized oncological hematological departments. The data of cytometry analysis of 2363 patients monitored from 2007 to 2014 carried out in The Dmitrii Rogachev Federal research clinical center of children hematology, oncology and immunology and The academician I.P. Pavlov First St. Petersburg state medical university was used to diagnose acute megakaryoblastic leukemia. The corresponding diagnosis was established in 24 patients of various age categories, including 16 children (11 boys and 5 girls) and 8 adults (ratio male/female 1:1). The trisomy on chromosome 21 was revealed only in 4 children out of 13 of early age (younger than 3 years). The article describes characteristics of samples taking preparation and interpretation of data of multicolor with regard to experience of national and foreign colleges.

[Dioxidin: antimicrobial activity and prospects of its clinical use at present].

In vitro activity of dioxidin against pathogens of nosocomial infections and its cytotoxicity were estimated. The study involved 300 isolates from patients with nosocomial infections. The MICs of dioxidin were determined with the method of serial dilutions in broth. The dioxidin cytotoxicity was investigated with the MTI assay to assign the cell culture viability. In concentrations of 2 to 1024 meg/mi dioxidin was active against 279/300 (93%) strains. The drug inhibited the growth of all the gramnegative isolates. The highest activitywas observed against Enterobacteriaceae vs. nonfermenting gramnegative bacteria: the median, minimum and maximum MICs of dioxidin were 12 (4-32) and 32 (16-64) mcg/ml respectively. The dioxidin activity against gramnegative bacteria and fungi was lower. The MIC of dioxidin for 7/70 (10%) staphylococcal isolates, 9/28 (32%) enterococcal isolates and all the Candida isolates was > 1024 mcg/ml. The IC50 of dioxidin was 2.4+/-0.3 mM (low cytotoxicity). The results showed that the use of dioxidin as an antimicrobial for local application was advisable in the treatment of gramnegative bacterial infections provided adequate tissue concentrations were attained.

[In vitro comparison of antibacterial properties of antiseptics used in periodontology].

Antibacterial properties of antiseptics most commonly used in periodontology were examined in vitro showing al agents containing chlorhexidine to be the most effective against gram-negative (E. coli), gram-positive (staphylococcus, streptococcus, enterococcus) germs as well as а C. аlbicans.

[Choice of urinary tract drainage in different age groups of patients with urolithiasis].

Retro- and prospective analyses of 802 case histories of patients with nephrostomic drainage (n=272), ureteral catheter (n=27) and ureteral stent (n=503) treated for urolithiasis in the urological department of M.F. Vladimirsky Moscow Region Research Clinical Institute and Zhukovsky city hospital hospitalized in 1995 to 2009 made it possible to develop algorithms of choice of upper urinary tract drainage depending on clinical and laboratory indices. Nephrostomic drainage is preferable in a single functioning kidney, acute obstructive pyelonephritis, anuria, hyperthermia above 38 degrees C, marked supravesical urodynamic disorder, in renal failure, serum creatinine over 200 mcmol/l, urea over 10 mmol/l, blood potassium over 5 mmol/l, uric acid over 380 mcmol/l and leukocytosis over 8 x 10(9) l. Draining with ureteral stent was used primarily in elective surgery--extracorporeal shock-wave lithotripsy and transurethral operations. Stenting was better tolerated and entailed less frequent complications. In the rest cases choice of drain method should be made by the urologist. In active inflammation, before getting antibioticogram, the drain should be followed by antibiotic treatment with fluoroquinolones, cephalosporines of the third or forth generation, aminoglycosides, carbapenems in standard doses.

[Transcutaneous nephrolithotripsy in presenile and senile patients].

A total of 323 transcutaneous roentgenoendoscopic operations were made in 212 patients from January 2000 to December 2009 including 96 operations in 81 presenile and senile patients (87 and 9 operations, respectively). Transcutaneous nephrolithotripsy (TCNT) eliminated concrement from the kidney for one session in 59 (72.8%) patients. It proved to be the most sparing treatment in serious clinical situations and provided maximally complete evacuation of the concrement from the kidney. A total complication rate was 14.8%. All the complications were cured with conservative pharmacotherapy. TCNT has the same indications as open surgery, is a method of choice in presenile and senile patients with large, stag-horn and recurrent concrements of the kidney, impacted pelvicoureteral concrements, in impaired renal urodynamics and high bacteriuria. TCNT can be used as a second-line treatment in failure of extracorporeal shock-wave lithotripsy or in combination with it (sandwich-therapy) for complete concrement elimination.

[Rapid bioluminescent antibiotic susceptibility assay].

Rapid testing of pathogen susceptibility to antibiotics is of great practical value for rational chemotherapy of pyoinflammatory deseases and postoperative complications of microbial etiology. The standard microbiological methods, i.e., the disk diffusion method and the method of serial dilutions are labour- and time-consuming (not less than 18-36 hours). The method of the authors is based on measuring bioluminescence resulting from interaction of adenosine-5'-triphosphate (ATP) and ATP reagent, a standard reaction mixture of firefly luciferase (an enzyme) and luciferin. The bioluminescence intensity is proportional to the ATP concentration in the reaction mixture and the ATP concentration is proportional to the number of the pathogen viable cells in the sample. The bioluminescence intensity value in the pathogen suspension aliquots with and without (control) the antibiotic were compared after the incubation for 5 hours and the coefficient of the microbial cell growth inhibition was calculated. Satisfactory correlation (R2 > 88%) of the results of the bioluminescent assay and the assay with the disk diffusion method and the method of serial dilutions was observed.

[Comprehensive study of lighting at a higher educational purpose].

The visual fatigue-affecting conditions of the classes of a higher educational institute were examined in students. The authors determined the light level of working places and its compliance with hygienic regulations of the factors influencing the students' visual perception. They analyzed and identified avoidable causes of variance of the light level and conjugate variables. Guidelines for optimizing the light level have been developed, by taking into account the lowest required tangible cost. A program of organizational actions, which aimed at following the sanitary-and-hygienic specifications at higher school, has been worked out.

[Some current aspects of diagnosis of calculous pyelonephritis].

Immunomicrobiological examination was made of 656 urine and 71 blood samples from 71 patients with chronic pyelonephritis and coral nephrolithiasis. Bacteriuria in blood agar was quantified in colony-forming cells (CFC) in 1 ml of the urine. Identification of the bacterial strains was made by conventional methods. Blood samples were examined for phagocytic activity (PA) of neutrophils and phagocytic index (PI) in incomplete (30 min) and complete (2 hours) variants (S.aureus-209P), levels of IgA, IgM, IgG (in IU/ml), complement (CH50), T- and B-lymphocytes and 0-cells. Opportunistic bacteria (OB) in titer from Ig 2 to Ig 5 CFC/ml and more were identified in 428 (65.25%) samples. OB monocultures prevailed (48.6%). In exacerbation of the disease the majority of the examinees (73.0%) showed deficiency of both cellular and humoral components of antiinfection resistance system (AIRS). First-line defense against bacterial invasion was impaired as shown by incomplete neutrophil digestion in 62.0% of examinees. Among patients with humoral immunodeficiency, those with low IgM were the minority (45.0%). T-RFC and B-RFC deficiency (in 68.0 and 52.0%, respectively), low levels of IgG and IgA (66.0 and 73.0% cases, respectively) indicated deficiency of immunocompetent cells and their functional activity. The study of the AIRS established significance of its components for early and significant diagnosis of calculous pyelonephritis. Pyelonephritis in nephrolithiasis runs with deficiency of both cellular and humoral components of AIRS.

[The role of nebulizer therapy in acute laryngeal inflammation].

The addition of nebulizer therapy with antiedematous, steroid and mucolytic drugs to antibacterial therapy in patients with different forms of acute laryngitis was assessed. Basing on the main symptoms of the disease, three variants of nebulizer therapy were proposed. As shown by the results of treatment of 48 patients with catarrhal laryngitis, 19 patients with laryngeal angina and 27 patients with phlegmonous laryngitis, nebulizer therapy is highly effective in different forms of laryngeal diseases including purulent process with stenosis.