Current Role and Potential of Oesophogeal and Gastric Fluoroscopy in the Choice of Surgical Treatment for Achalasia of Cardia

Background. Fluoroscopy of the esophagus and stomach provides a reliable assessment of the specific radiological criteria for achalasia (of cardia), which underlie the classification of the disease by stages. The stage of achalasia is one of the key factors to determine the management of treatment, including the choice of a specific type of surgical intervention. However, no methodological standards for performing and interpreting fluoroscopy of the esophagus and stomach in achalasia have been developed.Objectives. Creation of a unified protocol for performing and interpreting fluoroscopy of esophagus and stomach in achalasia and development of an algorithm for diagnosing achalasia based on fluoroscopy of the esophagus and stomach, which will help to determine the appropriate surgery.Methods. The developed algorithm was applied in a study of 104 patients. The examination was carried out using Duodiagnost X-ray machine by Philips, equipped with a remote control. The X-ray technician’s workplace was tooled with a personal computer, a digital identifier (ID) and a digitizer-scanning device. Drystardt 5000B film (by AGFA) was used for X-ray examinations. The description of X-ray examination was carried out by a radiologist in a separate office equipped with two workstations.Results. A protocol for fluoroscopy of the esophagus and stomach in patients with achalasia and a checklist for the description of fluoroscopy in achalasia have been developed. Conclusion. The developed algorithm for diagnosing achalasia of cardia based on fluoroscopy of the esophagus and stomach showed its high efficiency for clarifying the stage of the disease, and, consequently, choosing the right treatment and method of surgical intervention, as well as for providing objective control over the dynamics of the disease after surgery. In addition, the introduction of the developed algorithm into the widespread practice of radiologists will ensure continuity at all stages of treatment of patients with achalasia in different medical institutions: from diagnosis to dynamic monitoring of the patient’s condition after surgical treatment in specialized centers

Organization experience of diagnostic and medicosocial services for patients with Charcot—Marie—Tooth disease in Krasnoyarsk region

Hereditary neuropathy Charcot-Marie-Tooth (CMT) is the most common form of hereditary polyneuropathies. Goal of the study was the development of evidence-based diagnostic and treatment algorithms using patients with CMT (for example, in Krasnoyarsk Territory).Materials and methods: A total of 324 people. (probands and their relatives 1 and 2 lines of kinship). We analyzed 125 (38,5 %) clinical cases of CMT, 64/125 (51,2 %) clinical cases were include to statistical analysis (probands and their family trees, past the full range of clinical and laboratory findings according to the protocol this study). Age ranged from 6 to 81 years, median age — 30,5 years, including women 24 (37,5 %), median age — 33,5 years; males 40 (62,5 %), median age — 28,5 years. Methods of diagnosis: clinical, genetic, neurophysiological, molecular genetic, assessment of quality of life assessment of anxiety and depression.Results: The family history of CMT noted in 53/57 (93,0 %) cases, with a predominance of autosomal dominant type of inheritance —52 (91,2 %) cases. As a result of DNA testing duplication of peripheral myelin protein gene (RMR22) on chromosome 17, held 34 survey, this mutation was found in 17 (50,0 %) patients. Modified method of computer esthesiometry for CMT diagnosis using domestic diagnostic equipment “Vibrotester-MBN” BT-02-1 has a high sensitivity in the early stages of the disease and can be recommended for more widespread adoption of on par with other subjects of the Russian Federation

Error threshold in optimal coding, numerical criteria and classes of universalities for complexity

The free energy of the Random Energy Model at the transition point between ferromagnetic and spin glass phases is calculated. At this point, equivalent to the decoding error threshold in optimal codes, free energy has finite size corrections proportional to the square root of the number of degrees. The response of the magnetization to the ferromagnetic couplings is maximal at the values of magnetization equal to half. We give several criteria of complexity and define different universality classes. According to our classification, at the lowest class of complexity are random graph, Markov Models and Hidden Markov Models. At the next level is Sherrington-Kirkpatrick spin glass, connected with neuron-network models. On a higher level are critical theories, spin glass phase of Random Energy Model, percolation, self organized criticality (SOC). The top level class involves HOT design, error threshold in optimal coding, language, and, maybe, financial market. Alive systems are also related with the last class. A concept of anti-resonance is suggested for the complex systems.Comment: 17 page

Monitoring of optical properties of deep waters of Lake Baikal in 2021-2022

We present the results of the two-year (2021-2022) monitoring of absorption and scattering lengths of light with wavelength 400-620 nm within the effective volume of the deep underwater neutrino telescope Baikal-GVD, which were measured by a device Baikal-5D No.2. The Baikal-5D No.2. was installed during the 2021 winter expedition at a depth of 1180 m. The absorption and scattering lengths were measured every week in 9 spectral points. The device Baikal-5D No.2 also has the ability to measure detailed scattering and absorption spectra. The data obtained make it possible to estimate the range of changes in the absorption and scattering lengths over a sufficiently long period of time and to investigate the relationship between the processes of changes in absorption and scattering. An analysis was made of changes in absorption and scattering spectra for the period 2021-2022

Search for directional associations between Baikal Gigaton Volume Detector neutrino-induced cascades and high-energy astrophysical sources

Baikal-GVD has recently published its first measurement of the diffuse astrophysical neutrino flux, performed using high-energy cascade-like events. We further explore the Baikal-GVD cascade dataset collected in 2018-2022, with the aim to identify possible associations between the Baikal-GVD neutrinos and known astrophysical sources. We leverage the relatively high angular resolution of the Baikal-GVD neutrino telescope (2-3 deg.), made possible by the use of liquid water as the detection medium, enabling the study of astrophysical point sources even with cascade events. We estimate the telescope's sensitivity in the cascade channel for high-energy astrophysical sources and refine our analysis prescriptions using Monte-Carlo simulations. We primarily focus on cascades with energies exceeding 100 TeV, which we employ to search for correlation with radio-bright blazars. Although the currently limited neutrino sample size provides no statistically significant effects, our analysis suggests a number of possible associations with both extragalactic and Galactic sources. Specifically, we present an analysis of an observed triplet of neutrino candidate events in the Galactic plane, focusing on its potential connection with certain Galactic sources, and discuss the coincidence of cascades with several bright and flaring blazars.Comment: 10 pages, 3 figure

Studies of the ambient light of deep Baikal waters with Baikal-GVD

The Baikal-GVD neutrino detector is a deep-underwater neutrino telescope under construction and recently after the winter 2023 deployment it consists of 3456 optical modules attached on 96 vertical strings. This 3-dimensional array of photo-sensors allows to observe ambient light in the vicinity of the Baikal-GVD telescope that is associated mostly with water luminescence. Results on time and space variations of the luminescent activity are reviewed based on data collected in 2018-2022

Large neutrino telescope Baikal-GVD: recent status

The Baikal-GVD is a deep-underwater neutrino telescope being constructed in Lake Baikal. After the winter 2023 deployment campaign the detector consists of 3456 optical modules installed on 96 vertical strings. The status of the detector and progress in data analysis are discussed in present report. The Baikal-GVD data collected in 2018-2022 indicate the presence of cosmic neutrino flux in high-energy cascade events consistent with observations by the IceCube neutrino telescope. Analysis of track-like events results in identification of first high-energy muon neutrino candidates. These and other results from 2018-2022 data samples are reviewed in this report

Опыт организации диагностической и медико-социальной помощи больным с наследственной нейропатией Шарко–Мари–Тута в Красноярском крае

Hereditary neuropathy Charcot-Marie-Tooth (CMT) is the most common form of hereditary polyneuropathies. Goal of the study was the development of evidence-based diagnostic and treatment algorithms using patients with CMT (for example, in Krasnoyarsk Territory).Materials and methods: A total of 324 people. (probands and their relatives 1 and 2 lines of kinship). We analyzed 125 (38,5 %) clinical cases of CMT, 64/125 (51,2 %) clinical cases were include to statistical analysis (probands and their family trees, past the full range of clinical and laboratory findings according to the protocol this study). Age ranged from 6 to 81 years, median age — 30,5 years, including women 24 (37,5 %), median age — 33,5 years; males 40 (62,5 %), median age — 28,5 years. Methods of diagnosis: clinical, genetic, neurophysiological, molecular genetic, assessment of quality of life assessment of anxiety and depression.Results: The family history of CMT noted in 53/57 (93,0 %) cases, with a predominance of autosomal dominant type of inheritance —52 (91,2 %) cases. As a result of DNA testing duplication of peripheral myelin protein gene (RMR22) on chromosome 17, held 34 survey, this mutation was found in 17 (50,0 %) patients. Modified method of computer esthesiometry for CMT diagnosis using domestic diagnostic equipment “Vibrotester-MBN” BT-02-1 has a high sensitivity in the early stages of the disease and can be recommended for more widespread adoption of on par with other subjects of the Russian Federation.Наследственная нейропатия Шарко–Мари–Тута (ННШМТ) — наиболее распространенная форма наследственных полинейропатий.Цель исследования — разработка научно обоснованных алгоритмов лечебно-диагностической помощи больным ННШМТ (на примере Красноярского края).Материалы и методы. Обследовано 324 лица (пробанды и их родственники 1-й и 2-й линии родства). Проанализировано 125 (38,5 %) из 324 клинических случаев ННШМТ, из них для последующего статистического анализа в выборку включено 64 (51,2 %) случая (пробанды и члены их родословных, прошедшие весь комплекс клинических и лабораторных исследований согласно протоколу настоящего исследования). Возраст отобранных 64 лиц варьировал от 6 до 81 года: медиана возраста — 30,5 года, в том числе 24 (37,5 %) женщины, медиана возраста 33,5 года; 40 (62,5 %) мужчин, медиана возраста 28,5 года. Методы диагностики: клинико-генетический, клинический неврологический, нейрофизиологический, молекулярно-генетический, оценка качества жизни, оценка тревожности и депрессии.Результаты. Отягощенный семейный анамнез по ННШМТ отмечен в 53 (93,0 %) из 57 случаев с преобладанием аутосомно-доминантного типа наследования — 52 (91,2 %) случая. В результате ДНК-тестирования дупликации гена белка периферического миелина (РМР22) на 17-й хромосоме, проведенного у 34 обследуемых, данная мутация обнаружена у 17 (50,0 %) больных. Модифицированная методика компьютерной паллестезиометрии с использованием отечественного диагностического оборудования «Вибротестер-МБН» ВТ-02-1 является чувствительным методом диагностики генетически детерминированной демиелинизации при ННШМТ на ранних стадиях развития заболевания и может быть рекомендована к более широкому использованию в других регионах Российской Федерации

OPPORTUNITIES OF LAPAROSCOPY IN THE TREATMENT OF ESOPHAGEAL ACHALASIA

The article describes opportunities and results of laparoscopic oesophagocardiomiotomy and laparoscopic transhiatal oesophagus removal without hand assistance in esophageal achalasia (cardiospasm). In total, such operations were performed in 196 and 31 of cases (of 423 patients), respectively. There were minimal numbers of relapses (below 2.3%) after laparoscopic oesophagocardiomiotomy done by the proposed technique. All cases of reflux esophagitis were diagnosed after esophagocardiomiotomy with Dor fundoplication.After cardiodilatation, disease relapses were registered in 57% of patients. The advantages of a laparoscopic access for oesophagectomy are shown and technical particular of this intervention are analyzed based on a case history. The principles of Fast track surgery in this patient category are discussed that allow for reduction of the length of hospital stay by 40%

LAPAROSCOPIC FUNDOPLICATION IN THE TREATMENT OF BARRETT’S ESOPHAGUS

The  results  of  treatment  of  Barrett's  oesophagus diagnosed in 22 (9.2%) of 238 patients  with gastroesophageal reflux disease  and  hiatal  hernia are  presented. A high  degree  dysplasia  was found  in 54.5%  (12/22) of patients. All patients were administered combination therapy with proton   pump  inhibitors, prokinetics, third  generation  H2 histamine  receptor  blockers  for 3 to 4 weeks. If no regress of dysplasia was obtained,   Barrett's epithelium  was removed  by a holmium laser  (14 patients). The advantages of a laparoscopic fundoplication  technique proposed by the authors  in the treatment of Barrett's oesophagus were shown. This surgical intervention reliably prevents  the gastroesophageal reflux that has led to the development of this disease