[Anemia and quality of life of chronic kidney disease patients on renal replacement therapy by programmed hemodialysis].

AIM: To study relationship between anemia and health-related quality of life (HRQOL) of chronic kidney disease stage 5 patients (CKD) undergoing renal replacement therapy by programmed hemodialysis. MATERIALS AND METHODS: The study was conducted on the basis of dialysis centers/departments in Moscow. The Russian-language version of the KDQOL-SFTM questionnaire, validated in Russia, was used to assess the HRQOL of patients on hemodialysis. A total of 723 patients were interviewed. Hemoglobin (Hb) levels were assessed in 442 patients based on outpatient records. To identify the relationship between Hb level and HRQOL scales, a correlation analysis was performed, as well as a HRQOL analysis in the three groups differing in hemoglobin levels (<100; 100-120 and >120 g/l). Statistical data processing was carried by SPSS.22 and using parametric and nonparametric statistical methods. RESULTS: Correlation relationship was revealed between Hb and HRQOL of patients on hemodialysis on the scales "symptoms/problems", "pain", "vital activity, energy" and "total physical component of health". According to the scales "symptoms/problems" and "vital activity, energy", higher rates were noted among patients with Hb higher than the target level, which confirms the recommendations concerning the possibility of achieving higher Hb among individual patients who have not serious concomitant diseases and cardiovascular complications in order to improve their quality of life. CONCLUSION: HRQOL assessment is important tool for planning and evaluating the effectiveness of anemia drug therapy among patients with CKD on hemodialysis.

Increased reliability of CT-imaging signs of bleeding into soft tissue in patients with COVID-19 for planning transarterial embolization.

INTRODUCTION: Spontaneous bleeding into the soft tissues of the abdominal and thoracic wall is described as complication of anticoagulant therapy. Computed tomography (CT) allows to detect the presence of extravasation of the contrast agent into a hematoma, which is indicated as a sign of ongoing bleeding. Other specific CT signs of such coagulopathic bleeding have been described earlier. AIM OF THE STUDY: To evaluate the significance of specific coagulopathic CT signs for predicting the dynamics of spontaneous bleeding into soft tissues in patients with COVID-19. MATERIALS AND METHODS: A retrospective study included 60 patients with COVID-19 with spontaneous bleeding into soft tissues and extravasation of a contrast agent on CT. In addition to extravasation, a "hematocrit effect" was detected in 43 patients on CT. Of these, 39 had extravasation in the form of a "signal flare." All patients underwent transarterial catheter angiography (TCA). To assess the prognostic value of CT signs, the results of CT and TCA compared. The absence of extravasation on the TCA more often corresponded to stopped bleeding. RESULTS: Extravasation on TCA found in 27 (45%) patients. The presence of the "hematocrit effect" or the combination of this sign with the phenomenon of a "signal flare" on CT (n = 43) led to more frequent confirmation of extravasation on TCA than in their absence (n = 17): 23.5% vs. 53.4% (p = 0.028). CONCLUSION: The presence of a fluid level and the phenomenon of a "signal flare" on CT in the structure of spontaneous hematomas of the soft tissues of the abdominal and thoracic wall in COVID-19 patients more often corresponded to ongoing bleeding on the TCA. The absence of coagulopathic CT signs more often corresponded to stopped bleeding.

Mechano-bactericidal anisotropic particles for oral biofilm treatment.

Bacterial biofilms play a major etiological role in dental diseases worldwide. Currently, toothpastes with bactericidal chemicals and abrasive materials are used as preventive care methods. However, chemicals can cause adverse side effects, with the use of antibiotics, fluorides, and antiseptics drastically reducing quality of life. At the same time, the rational design of bulk toothpaste materials has remained unexplored. In this work, we demonstrated a mechano-bactericidal strategy as an antibiotic-free and tooth-safe approach for dental biofilm elimination based on shape-anisotropy CaCO3 (cubic-, stick-, and urchin-shaped). As proof-of-concept, we demonstrated superior efficiency during biofilm eradication from ex vivo teeth using urchin- and stick-shaped microparticles involving both Escherichia coli K12 (227 ± 32.6% and 215 ± 33%, respectively) and Staphylococcus aureus ATCC 209P (210 ± 54.7% and 202 ± 55.5%, respectively) compared to the spherical particles that are employed in conventional toothpastes. These findings will potentially give rise to the development of novel and safer toothpastes with antibiotic-free bactericidal activity for the prevention of dental diseases.

[A clinical case of radio-induced neurogenic sarcoma of the soft tissues of the neck]. / Osobennosti nablyudeniya i soprovoditel'noi terapii patsientov posle khimioluchevogo lecheniya raka gortani. Klinicheskii sluchai.

The article presents a clinical observation of the surgical treatment of a patient with radio-induced neurogenic sarcoma of the soft tissues of the neck that occurred 6 years after radiation therapy with SOD 66 Gy for stage II laryngeal cancer T2N0M0.

[Modern methods of early diagnosis of tumors of the larynx and pharynx]. / Sovremennye metody rannei diagnostiki opukholei gortani i glotki.

Worldwide, there is a constant increase in mortality from malignant neoplasms, which is largely due to late diagnosis. One of the reasons for late detection is the lack of conditions for conducting a detailed examination at the outpatient level, since the routine method of examining ENT organs today remains examination using mirrors, but in recent decades, endoscopic methods of examination have become widespread - indirect endoscopy, fibrolaryngoscopy, contact endoscopy, NBI-endoscopy, endoscopy using light filters of the SPIES system, as well as diagnostics using fluorescent technologies. Also, a promising and new direction is the diagnosis of malignant neoplasms at the preclinical stage and precancerous conditions, for which molecular diagnostic methods are used - SCCA and microRNA. OBJECTIVE: To analyze the effectiveness of various methods of endoscopic and molecular diagnostics of malignant neoplasms of the larynx and pharynx. MATERIAL AND METHODS: A study was conducted In the Department of ENT Oncology of the National State Research Center of Otorhinolaryngology of the Federal Medical-Biological Agency of Russia, which involved 46 patients with suspected malignant neoplasms of the larynx and pharynx. All patients underwent direct laryngoscopy under endotracheal anesthesia with simultaneous NBI-endoscopy, spies examination, contact endoscopy, and fluorescence testing, followed by biopsy and tissue sampling for microRNA concentration analysis, as well as blood sampling for SCCA concentration.

[Timing of surgery, intestinal ischemia and other real factors of mortality in acute adhesive small bowel obstruction: a multiple-center study]. / Faktory riska letal'nogo iskhoda pri ostroi spaechnoi tonkokishechnoi neprokhodimosti. Rezul'taty mnogotsentrovogo issledovaniya.

OBJECTIVE: To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (ASBO). MATERIAL AND METHODS: A retrospective multiple-center study included 143 (85.6%) patients with ASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. All patients were divided into 3 groups: early surgery group (within 12 hours after admission), late surgery (after 12 hours), non-surgical management group. The outcomes and Kaplan-Meier survival were compared in all groups. RESULTS: ASBO was resolved without surgery in 77 (53.8%) patients 19.6±17.4 (M=14) hours. In the Early Surgery Group (n=36), 24 patients had strangulation, 12 ones had non-strangulated bowel obstruction. In the Late Surgery Group (n=30), 15 patients had strangulation and 15 ones had no strangulation. Mortality was similar in early and late surgery (p=0.287), early and late surgery in patients with strangulation (p=0.940), early and late surgery in patients without strangulation (p=0.76). Patients died (n=10) after surgery only. Thus, postoperative mortality was 15.2%, overall mortality - 7.0%. All patients who underwent surgery after 24 hours (n=14) survived. Surgery increased the mortality risk compared to non-surgical management (95% CI 0 - 15.9, p=0.001). There was no effect of surgery time (more or less than 12 hours) on mortality for strangulation (95% CI 13.0-16.7, p 0.788) and non-strangulated obstruction (95% CI 29.4-5.4, p=0.061), bowel resection (95% CI 33.3-14.0, p=0.187), presence of bowel ischemia (95% CI 14.3-17.9, p 0.613). CONCLUSION: Delayed surgery may be advisable in patients with ASBO and no obvious signs of strangulation due to less mortality.

[Solitary ganglioneuroma of the oropharynx]. / Solitarnaia ganglionevroma rotoglotki.

Mucosal neuromas, or ganglioneuromas, attract attention as a frequent component of multiple endocrine neoplasia (MEN) syndrome type 2B. The paper describes a clinical and morphological case of solitary oropharyngeal ganglioneuroma in a 60-year-old man, whose observation has not revealed its apparent association with the MEN syndrome.

[The histiocytoma of the oropharynx (clinical cases)]. / Fibroznaia gistiotsitoma zaglotochnogo prostranstva (klinicheskoe nabliudenie).

The paper presents a case of rare localization histiocytoma of the oropharynx. Some authors consider the existence of this category of tumors controversial, others prefer to consider them tumors of unclear Genesis. Benign fibrous histiocytoma is quite common in the form of a small node with fairly clear boundaries, most often localized on the skin of various parts of the body. We have not found any cases of fibrous histiocytoma localization in the head and neck in the available literature. Given the results of the patient survey (data endoscopy, ultrasound soft tissues of the neck and MRI neck) were diagnosed with benign tumors retrofaringealny space and, given its location, the decision about the feasibility of transoral removal of the tumor with subsequent histological examination of tissue.

Metal-organic frameworks as competitive materials for non-linear optics.

The last five years have witnessed a huge breakthrough in the creation and the study of the properties of a new class of compounds - metamaterials. The next stage of this technological revolution will be the development of active, controllable, and non-linear metamaterials, surpassing natural media as platforms for optical data processing and quantum information applications. However, scientists are constantly faced with the need to find new methods that can ensure the formation of quantum and non-linear metamaterials with higher resolution. One such method of producing metamaterials in the future, which will provide scalability and availability, is chemical synthesis. Meanwhile, the chemical synthesis of organized 3D structures with a period of a few nanometers and a size of up to a few millimeters is not an easy task and is yet to be resolved. The most promising avenue seems to be the use of highly porous structures based on metal-organic frameworks that have demonstrated their unique properties in the field of non-linear optics (NLO) over the past three years. Thus, the aim of this review is to examine current progress and the possibilities of using metal-organic frameworks in the field of non-linear optics as chemically obtained metamaterials of the future. The review begins by presenting the theoretical principles of physical phenomena represented by mathematical descriptions for clarity. Major attention is paid to the second harmonic generation (SHG) effect. In this section we compare inorganic single crystals, which are most commonly used to study the effect in question, to organic materials, which also possess the required properties. Based on these data, we present a rationale for the possibility of studying the non-linear optical properties of metal-organic structures as well as describing the use of synthetic approaches and the difficulties associated with them. The second part of the review explicitly acquaints the reader with a new class of materials which successfully combines the positive properties of organic and inorganic materials. Using recently synthesized metal-organic frameworks and coordination polymers in the field of non-linear optics as an example, we consider synthetic approaches used for obtaining materials with desired properties and the factors to be considered in this case. Finally, probable trends towards improving the quality of the synthesized materials with regards to their further use in the field of non-linear optical effects are described.

[The results of proton radiosurgery for pituitary endosellar adenomas].

465 patients with pituitary endosellar adenomas have passed irradiation on the synchrocyclotron PNPI (1000 MeV). Due to the high energy of the proton beam the rotating-convergent shoot-through technique was used. The single dose of 80-100 Gy was given. In patients with prolactin adenomas clinical remission was detected in 80%, and the stabilization of the disease was achieved in 15%. Pregnancies in 21 patients ended in the birth of healthy children, and 4 of them gave the birth twice. Complete clinical remission was observed in 92% of patients with Cushing's disease. Sustained recovery and full normalization of growth hormone level were observed during long-term follow-up in 86% of patients with acromegaly. There was significant reducing of the high hormone level on the fifth year of follow-up in any clinical form of pituitary adenomas while the development of the secondary hypopituitarism was not defected in the most of the patients. Clinical remission in patients with non-secreting adenomas was 95%. Irradiation by the proton beam was not accompanied by serious life-threatening complications. Thus this type of treatment for pituitary endosellar adenomas is highly effective and safe and, sometimes, the only method.

[Preliminary experience with assessing the motor pathways and central inhibition in patients with malignant cerebral gliomas in preparation for conformal radiotherapy].

We investigated central motor pathways and central inhibition in patients with brain gliomas by transcranial magnetic stimulation (TMS). 10 glioma patients and 16 matching controls were enrolled. Central motor conduction time, MEP latencies and amplitudes and silent period were evaluated. In 90% glioma patients TMS parameters were abnormal, mostly MEP shapes and thresholds were affected. In 40% of the cases central inhibition in glioma affected hemisphere was abnormally high. We propose that TMS is safe and informative tool in glioma patients; central inhibition seems to be affected in some cases by the glioma presence in the hemisphere. One of the possible causes of that may be GABA system activation.

[Use of local induced hyperthermia in the treatment of malignant tumors].

The way of a local contactless hyperthermal induction heating for biological tissues is developed on the basis of implantation of substituting composite applicator made of a polymeric material with incorporated ferromagnetic particles. The simplified mathematical model of the physical processes proceeding at a sample heating is presented. Model results are used for approximation of the experimental data.

[Experience with outpatient treatment for thromboses and thrombophilias].

AIM: To evaluate the efficiency of diagnosis and treatment of thromboses in patients with thrombophilia in an outpatient setting. SUBJECTS AND METHODS: One hundred and seventy-two patients with different forms of thrombophilic states were examined. One hundred and thirty-two patients were found to have genetic mutations, of them 125 patients had multiple mutations. Thromboses were diagnosed in 130 patients with genetic disorders. RESULTS: The most common laboratory markers of thrombophilias were hyperhomocysteinemia (55%), sticky platelet syndrome (41%), and laboratory findings of antiphospholipid syndrome. Thrombogenic mutations, such as plasminogen activator plasminogen inhibitor-1 (73%), methylene tetrahydrofolate reductase (60%), platelet glycoprotein 1a receptors (50%), and fibrinogen (42%), were most often diagnosed. The efficiency of treatment was shown to largely depend on the duration of an initial thrombotic process. CONCLUSION: Outpatient treatment for thromboses is more economical and comfortable for patients. To avoid hospital admissions, it is necessary to time detect the disease and to start its treatment as soon as possible. The concurrent use of ultrasonography, genetic and laboratory diagnostic methods accelerates the identification and localization of the pathology, which facilitates its treatment and frequently rules out the need for patient hospitalization.

[The problem of hemorrhagic syndrome in its treatment with vitamin K antagonists (a review of literature)].

Vitamin K antagonists (warfarin, syncumar, phenylin, etc.) are commonly used to treat and prevent thrombotic diseases. The risk for varying degrees of hemorrhagic syndrome (intracranial hemorrhage in particular) is the most important problem in the use of drugs from this group. The rapid neutralization of the effects of used anticoagulants, which is verified by correcting the international normalized ratio (INR), is required in these cases and when emergency surgical interventions are needed. Transfusions of prothrombin complex concentrates (PCCs) in combination of vitamin K preparations are optimal for this purpose. The reason for the rational use of PCCs to promptly correct INR is the balanced composition of this transfusion medium (a combination of blood coagulation factors and biological anticoagulants). This regimen for emergency correction of INR minimizes the risk of thrombotic events.

Synthesis, structure and properties of superhard nanostructured films deposited by the C60 ion beam.

In this work, we present results on study of DLC, nanocomposite and nanocrystal nanographite films synthesized utilizing mass-separated beam of C60-ions with energy in range from 2 to 6 keV (energy dispersions approximately 1 keV) and at Ts in the range of RT - 873 K. The dependence of the structure, mechanical and electrical properties from the ion energy and substrate temperature was revealed. We demonstrate a possibility to control the orientation of the base planes in the nanographite grains during the film growth. The dependence of mechanical properties of the films from the orientation of the base planes was defined. It is discussed a mechanisms of oriented growth for nanocrystal graphite. Possible applications of the textured nanocomposite and nanographite films are nanodevices, thin-filmed lithium batteries and field-emitter arrays.

[First experience with intrasurgical brachytherapy in the combined treatment for locally advanced laryngeal cancer].

Results of combined radiosurgical treatment with larynx preservation, and pre- and postoperative distant external irradiation, were evaluated. Forty-eight patients with locally advanced laryngeal cancer received single-step individually-tailored tissue application, followed by high-dose brachytherapy. Discriminative function of the larynx was restored in all patients within 2 days involving swallowing disturbances in 8%. Breathing function was restored in 98% within 2 days to 6 months after completion of treatment. Three-year relapse-free survival was 95.8%.

[Stereotactic proton irradiation of cerebral arteriovenous malformations in patients with onset of disease in childhood].

The report discusses the results of proton stereotactic irradiation in 27 children, aged 6-15 (mean--12.5 yrs.), and 21 adults, aged 16-47 (mean--23 yrs.), with arteriovenous malformations (AVM) in the brain. The AVM volume ranged 0.2-37.7 cu cm; absorbed dosage at dose field maximum--40-80 Gy. Complete AVM obliteration was attained in 17 (35%) (mean AVM volume--3.1 cu cm); 50% decrease and more--12 (25%)(mean AVM volume--7 cu cm). When AVM volume was cut down to less than 50% (9) (19%) (mean AVM volume--9.2 cu cm) and 10 (21%) (mean AVM volume--19.6 cu cm), no effect was reported.

[Role of single-photon emission computer tomography in dynamic evaluation of combined treatment of malignant cerebral glioma].

Thirty-nine patients with malignant glioma of the brain were examined at the Center's Clinic. Tumor volume ranged 0.8-175.1 cu cm. Radionuclide diagnosis was obtained with the aid of single-photon emission tomography (E.Cam, Siemens). 99mTc-DTPA, 3-6 MBc/body, was injected intravenously. Smaller size of tumor and lower ratio of differentiated marker accumulation focus/contralateral area were registered in 34%. Simultaneously, a high index of the marker accumulation in the brain was reported, thus suggesting hyperimpermeability of the blood brain barrier. Another 26% revealed larger size of tumor and higher ratio of differentiated 99mTc-DTPA accumulation, likely due to lower impermeability of the blood brain barrier. Hence, use of single-photon emission tomography in diagnosis of malignant cerebral glioma provides a means of evaluating the level of the marker in a tumor node.

[The rare case of laryngeal lesion in idiopathic Kaposi's sarcoma].

The case report of laryngeal Kaposi's sarcoma (KS) in 59 year old HIV-negative man infected by herpes virus 8 (HHV-8) is in the paper. The primary onset of KS was on the legs. Lesion of laryngeal mucosa was developed sequentially, resulted in laryngeal stenosis and led to application of tracheostome. The skin and laryngeal mucosa lesions had homotypic histological structure and corresponded to early manifestation of KS preceded tumor node appearance.