Хирургическая коррекция опущения передней стенки влагалища и шейки матки при помощи сетчатых титановых имплантатов

Background: Regardless of a variety of surgical techniques and hi-tech materials for pelvic prolapse treatment, there is no decrease in the disease recurrences. Aims: Evaluation of the efficacy of the developed method of surgical correction of IIIV degree colpoptosis anterior combined with IIIII degree C-prolapse with the use of titanium mesh implants in reproductive, pre- and postmenopausal female patients. Methods: Female patients (group I, n = 25) with colpoptosis anterior and cervical prolapse were examined and operated on according to the developed know-how technique with the use of titanium mesh implants. Evaluation of the efficacy of surgical correction of the disease was performed using questioning, pelvic exam with Valsalva manoeuvre, transvaginal and transperineal ultrasound, pelvis MRI. The findings were compared with the result of surgical treatment of 46 (group II) and 32 (group III) female patients operated on without the use of titanium implants. After surgical treatment according to the three-stage surgical program that provides for multifocal fixation of anatomical formations with the use of titanium implants, the case follow-up was performed in 321 months. Results: Questioning the patients in group I demonstrated their satisfaction with the surgical treatment results that positively affected the quality of life, mood, and contributed to an increase in sexual activity and community commitment. Check-up showed that the surgical correction of prolapse was completely preserved in the patients of group I during 1821 months. Pelvic exam at rest and with Valsalva manoeuvre, transvaginal and transperineal ultrasound, pelvis MRI did not reveal any significant extrusion of the pelvic organs or titanium implants. No mesh-associated complications were observed during the follow-up. Recurrence of genital prolapse was diagnosed in 12 (26%) patients of group II, mesh-associated complications were detected in 6 (18.8%) women of group III. Conclusions: The preserving three-stage surgical program, developed by us, contributed to optimize the results of surgical treatment, decrease the rate of the disease recurrence, and reduce the risk of the development of mesh-associated complications.Обоснование. Несмотря на наличие разнообразных хирургических методик и высокотехнологичных материалов для лечения пролапса тазовых органов, количество рецидивов заболевания не снижается. Цель исследования ― оценка эффективности разработанного способа хирургической коррекции опущения передней стенки влагалища IIIV степени в сочетании с С-пролапсом IIIII степени при помощи титановых сетчатых имплантатов у пациенток репродуктивного, пре- и постменопаузального возраста. Методы. Обследованы и прооперированы по разработанной оригинальной методике с применением сетчатых титановых имплантатов пациентки (I группа, n = 25) с опущением передней стенки влагалища и шейки матки. Эффективность хирургической коррекции заболевания оценивали путем анкетирования с помощью валидированных опросников, гинекологического исследования с пробой Вальсальвы, трансвагинальной и трансперинеальной эхографии, магнитно-резонансной томографии (МРТ) малого таза. Полученные данные сравнивали с результатами оперативного лечения 46 (II группа) и 32 (III группа) пациенток, прооперированных без применения титановых имплантатов. Объем хирургического вмешательства у пациенток II группы ― передняя кольпорафия, III группы ― передний Prolift полипропиленовыми имплантатами. После оперативного лечения по разработанной трехэтапной хирургической программе, предусматривающей мультифокальную фиксацию анатомических структур при помощи титановых имплантатов, проводили динамическое наблюдение через 3, 6, 9, 12, 15, 18 и 21 мес. Результаты. Анкетирование пациенток I группы показало удовлетворенность результатами оперативного лечения, что положительно отразилось на качестве жизни и настроении, способствовало повышению сексуальной и социальной активности. Комплексное клиническое обследование показало сохранение полной хирургической коррекции пролапса у пациенток I группы на протяжении 1821 мес наблюдения. При гинекологическом исследовании в покое и при пробе Вальсальвы, по данным трансвагинальной и трансперинеальной эхографии, МРТ, значимого смещения тазовых органов и титановых имплантатов не выявлено. Mesh-ассоциированные осложнения за время наблюдения отсутствовали. У 12 (26%) пациенток II группы диагностирован рецидив генитального пролапса, у 6 (18,8%) женщин III группы выявлены mesh-ассоциированные осложнения. Заключение. Разработанная нами органосберегающая трехэтапная хирургическая программа способствовала оптимизации результатов оперативного лечения, уменьшению частоты рецидивов заболевания, снижению риска развития mesh-ассоциированных осложнений

Subducted, detached, and torn slabs beneath the Greater Caucasus

© 2014 Published by Elsevier Ltd. The Greater Caucasus Mountains contain the highest peaks in Europe and define, for over 850. km along strike, the leading edge of the second-largest active collisional orogen on Earth. However, the mechanisms by which this range is being constructed remain disputed. Using a new database of earthquake records from local networks in Georgia, Russia, and Azerbaijan, together with previously published hypocenter locations, we show that the central and eastern Greater Caucasus Mountains are underlain by a northeast-dipping zone of mantle seismicity that we interpret as a subducted slab. Beneath the central Greater Caucasus (east of 45°E), the zone of seismicity extends to a depth of at least 158. km with a dip of ~40°NE and a slab length of ~130-280. km. In contrast, beneath the western GC (west of 45°E) there is a pronounced lack of events below ~50. km, which we infer to reflect slab breakoff and detachment. We also observe a gap in intermediate-depth seismicity (45-75. km) at the western end of the subducted slab beneath the central Greater Caucasus, which we interpret as an eastward-propagating tear. This tear coincides with a region of minimum horizontal convergence rates between the Lesser and Greater Caucasus, as expected in a region of active slab breakoff. Active subduction beneath the eastern Greater Caucasus presents a potentially larger seismic hazard than previously recognized and may explain historical records of large magnitude (M 8) seismicity in this region

Waveguide lasers and neodymium-glass amplifiers

Available from VNTIC / VNTIC - Scientific & Technical Information Centre of RussiaSIGLERURussian Federatio

Study of the independence of younger schoolchildren in educational activities

Объектом исследования явилась школьная самостоятельность учащихся младших классов. Предметом исследования стал уровень и проявления самостоятельности младших школьников в учебной деятельности. Магистерская диссертация состоит из введения, двух глав, заключения, списка литературы (78 источников) и приложения, включающего в себя бланки применявшихся методик. Объем магистерской диссертации 89 страниц, на которых размещены 16 рисунков. Во введении раскрывается актуальность проблемы исследования, разработанность проблематики, ставятся цель и задачи исследования, определяются объект и предмет исследования, формулируются основная и дополнительные гипотезы, указываются методы и эмпирическая база, а также этапы проведения исследования, научная новизна, теоретическая и практическая значимость работы. Первая глава включает в себя обзор иностранной и отечественной литературы по теме школьной самостоятельности учеников 6-10 лет. Представлены разделы, посвященные исследованию показателей структурных составляющих школьной самостоятельности и их взаимосвязей у учащихся младших классов. Выводы по первой главе представляют собой итоги по изучению теоретического материала. Вторая глава посвящена эмпирической части исследования. В ней представлено описание организации и методов проведенного исследования и результатов, полученных по всем использованным методикам: Диагностика параметров учебной самостоятельности младших школьников (по методике Н. В. Калининой), Методика «Нерешаемая задача» и экспертная оценка самостоятельности учащихся (А.К. Осиницкий), Карта проявлений самостоятельности (А.М. Щетинина), Анкета «Оценка уровня развития силы воли (Л.В. Балясникова). Также в главе представлен корреляционный и статистический анализ результатов исследования. Выводы по главе 2 включают в себя основные результаты эмпирического исследования. В заключении в обобщенном виде изложены результаты теоретической и эмпирической частей работы, а также выводы по выдвинутым гипотезам, обоснована практическая значимость исследования и описаны возможные перспективы дальнейшей разработки данной проблематики.The object of the research was the school independence of primary school students. The subject of the research was the level and manifestations of the independence of primary schoolchildren in educational activities. The master's thesis consists of an introduction, two chapters, a conclusion, a list of literature (78 sources) and an appendix, which includes the forms of the applied methodologies. The volume of the master's thesis is 89 pages, on which are placed 16 figures. The introduction reveals the relevance of the research problem, the development of the problematics, the purpose and objectives of the research are set, the object and the subject of research are determined, the basic and additional hypotheses are formulated, the methods and the empirical base are specified, as well as the stages of the research, the scientific novelty, the theoretical and practical significance of the work. The first chapter includes a review of foreign and domestic literature on the topic of school independence for children 6-10 years old. The sections devoted to the study of indicators of the structural components of school independence and their interconnections in primary school students are presented. Conclusions on the first chapter are the results of the study of theoretical material. The second chapter is devoted to the empirical part of the study. It provides a description of the organization and methods of the study and the results obtained using all the methods used: Diagnostics of the parameters of educational independence of junior schoolchildren (according to the method of N. V. Kalinina), Method "Unsolvable problem" and expert assessment of the independence of students (A. K. Osinitsky), Map of manifestations of independence (A. M. Shchetinina), Questionnaire "Assessment of the level of development willpower (L.V. Balyasnikova). Also, the chapter presents a comparative, correlation and statistical analysis of the results of the study. The findings of Chapter 2 are the main results of the empirical study. In conclusion, brief results of the theoretical and empirical parts of the work are presented, as well as conclusions on the hypotheses. The practical significance of the study is substantiated and possible prospects for further development of the problematics are described

Predicting preeclampsia course based on endothelium-dependent dilation

R.Kh. Shavaeva, A.V. Murashko, V.M. Zuev, S.A. Timofeev, T.A. Dzhibladze I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation Aim: to determine prognostic criteria of severe preeclampsia based on the assessment of endothelium-dependent (ED) flow-mediated dilation (FMD) of the brachial artery (BA). Patients and Methods: 97 pregnant women (&gt;28 weeks of pregnancy) with moderate preeclampsia were enrolled. These women were retrospectively divided into two groups. Group 1 included 42 pregnant women (mean age 30.0±0.5 years) in whom the severity of preeclampsia increased after treatment. Group 2 included 55 pregnant women (mean age 31.0±0.7 years) whose severity of preeclampsia did not increase after treatment. Group 3 (control group) included 20 women with a healthy pregnancy. ED FMD of BA was assessed by vascular ultrasound using a reactive hyperemia test. In addition, BA diameter and peak systolic velocity (PSV) 15 sec and 1 min after cuff deflation were measured. These measurements were performed at enrollment and after one week (or in feeling worse). Results: healthy pregnancy was characterized by a gradual increase in BA diameter in response to cuff inflation (by 15.7% and 23.9% after 15 sec and 1 min, respectively, at baseline and by 17.8% and 21.3% after 15 sec and 1 min, respectively, after one week). In pregnant women with preeclampsia, baseline changes in BA diameter were less significant. Meanwhile, after one week, a reduction in BA diameter was reported in group 1, and close-to-normal BA diameter was reported in group 2. In group 3, BA PSV increased by 5.2% and 16% in 15 sec and 1 min, respectively, after cuff inflation. In pregnant women with preeclampsia, BA PSV, in contrast, was reduced (more significant after 1 min). Conclusion: increased BA diameter and PSV by less than 10% 15 sec and 1 min after cuff inflation indicate endothelial dysfunction. A negative pattern of changes in these parameters suggests an unfavorable course of preeclampsia and its transition to severe disease. Keywords: preeclampsia, e ndothelial dysfunction, vasodilation, brachial artery, peak systolic velocity, prognosis. For citation: Shavaeva R.Kh., Murashko A.V., Zuev V.M. et al. Predicting preeclampsia course based on endothelium-dependent dilation. Russian Journal of Woman and Child Health. 2021;4(4):317–321 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-317-321. <br

Role of determination of molecular genetic markers in the diagnosis and prediction of the course of cervix uteri diseases

Forty-six patients with various cervix uteri (CU) diseases were examined and treated. The examinees’ age was 21 to 72 years (mean age 37.4 ± 1.1 years).In 16 patients, the rate of N33, MLH1, p16 gene hypermethylation was determined in the tissue samples of the CU in its various dis- eases: there was hypermethylation of the p16 (83%) and MLH1 (66%), and N33 (33%) genes in CU leukoplakia; the p16 (100%) and MLH1 (100%), and N33 (62%) genes in CU dysplasia, and the p16 (100%) and MLH1 (50%), and N33 (50%) genes in squamous cell carcinoma of the CU.A follow-up of patients with established gene hypermethylation revealed a recurrence in 50% of cases of CU leukoplasia and in 37.5% of cases of CU dysplasias. No recurrences were observed in a group of 30 patients without abnormal gene methylation in CU tissues during the follow-up