Modern approaches to the treatment of genital prolapse in obese women

Introduction. The problem of female genital prolapse (GP) remains in the sportlight of gynecologists, because despite the variety of surgical methods, there are still recurrences of the disease, which are associated not only with the failure of the restored ligaments, fascia, muscles, damaged pelvic floor and perineum, but with the imperfection of the operation. The solution of this problem is especially important in the treatment of patients with extragenital pathology, in particular obesity. The purpose: to optimize the treatment of genital prolapse in obese patients by determining an individual approach to planning surgical treatment taking into account the degree of obesity and concomitant pathology. Materials and methods. We examined 65 patients of which 20 had genital prolapse and obesity (main group), 25 had genital prolapse and normal weight (comparison group), 20 women did not have gynecological diseases and extragenital pathology made up control group. To diagnose obesity and determine its degree we calculated body mass index (BMI). To determine the degree of GP its quantitative assessment was used (POP-Q; 1996). Surgical intervention included transvaginal extirpation of the uterus without appendages, anterior colporrhaphy, colpoperineoraphy with levatoplasty, sacrospinal colpopexy. Transabdominal and laparoscopic colposacropexy in obese women were not used due to the presence of relative contraindications for laparoscopy (cardiovascular disease, respiratory pathology, adhesions, the condition after hernias’ surgery). Therefore, all operations on women with GP and obesity were performed transvaginally due to the inability to perform abdominal access. In comparison group transvaginal surgery was performed. All the groups under study were representative. Before the use of polypropylene mesh "Polymesh" to minimize purulent-septic complications associated with the use of synthetic prostheses aquadissection was performed with 0.9% saline with the addition of 1 g of ceftriaxone per 200 ml. After the operation, the women used suppositories with hyaluronic acid (revitax). Results. The results of surgical treatment have been analyzed and the following data were obtained: recurrences in the main and in the comparison group were 4% (2 women in whom operations were performed with the use of their own tissues without  mesh prosthesis). Infectious complications, dyspareunia and pelvic pain were not observed. Conclusions. Surgical treatment of GP in obese women by using polypropylene mesh "Polymesh" for colposacropexy after transvaginal uterine extirpation increases the effectiveness of treatment  and redduces the number of recurrences. Hydropreparation of the mesh with an antibacterial agent and postoperative use of hyaluronidase intravaginally helps to reduce purulent-septic complications of surgery and improves the patients’quality of life

Investigation of two-photon 2s -> 1s decay in one-electron and one-muon ions

We have studied the radiative decay of the 2s state of one-electron and one-muon ions, where the two-photon mechanism plays an important role. Due to the nuclear size corrections the radiative decay of the 2s state in the electron and muon ions is qualitatively different. Based on the accurate relativistic calculation, we introduced a two-parameter approximation, which makes it possible to describe the two-photon angular-differential transition probability for the polarized emitted photons with high accuracy. The emission of photons with linear and circular polarizations was studied separately. We also investigated the transition probabilities for the polarized initial and final states. The investigation was performed for ions with atomic numbers 1 < Z < 120.Comment: 18 pages, 8 figure

ЭКСПЕРИМЕНТАЛЬНОЕ ОБОСНОВАНИЕ МИКРОХИРУРГИЧЕСКОГО ПИЩЕВОДНО-ТОНКОКИШЕЧНОГО АНАСТОМОЗА

In the experimental study on 6 mongrel dogs the comparative morphometry of layers of the wall of abdominal section of esophagus and small intestine was carried out. Tworowed microsurgical esophago-enteroanastomosis “end-to-end” was formed in 12 animals. From the surplus of the outer case of the esophagus a sphincter-like structure was created. The dynamics of anastomosis adhesion in the postoperative period was studied macroscopically and on longitudinal histotopograms. A good epithelization has been recorded by the 7th day as well as a formation of thin and firm cicatrix without a rough fibrillar tissue by the 21st day.В экспериментальном исследовании на 6 беспородных собаках выполнена морфометрия слоёв стенок абдоминального отдела пищевода и тонкой кишки. У 12 животных сформирован двухрядный микрохирургический эзофагоэнтероанастомоз конец в конец. Из избытка наружного футляра пищевода сформирована сфинктероподобная структура. Изучена динамика заживления анастомоза в послеоперационном периоде. Показана хорошая эпителизация к 7 суткам и формирование тонкого прочного рубца на 21 сутки после операции.

АНАЛИЗИРУЮЩИЙ МАГНИТ ДЛЯ ТЕХНОЛОГИЧЕСКОГО УСКОРИТЕЛЯ ЭЛЕКТРОНОВ ЛУ-10М

Основной проблемой при использовании магнитов из редкоземельных материалов в ускорительных технологиях является изменение магнитных свойств материала под действием излучения. Особенно актуальна эта задача для мощных технологических ускорителей электронов с энергией до 10 МэВ. Для выбора наиболее стойкого материала были проведены исследования радиационной стойкости образцов магнитов из Sm2Co17 и Nd-Fe-B сплава. Постоянные магниты типа Sm2Co17 и Nd-Fe-B были изгтовлены методом порошковой технологи с использованием PLP процесса в производстве последних. Магнитные образцы подвергались прямому воздействию электронного пучка с энергией 10 МэВ и воздействию тормозного излучения этого пучка. Поглощённая доза от электронов для образцов составляла 16 Град (общий поток электронов, попавший на 1 см2 образца, был равен 1,4х1017) и 160 Град. Активность образцов после облучения изменилась в пределах допустимых норм. Этот факт существенно упрощает использование редкоземельных магнитных материалов в готовых изделиях ускорителей. В процессе облучения магниты охлаждались водой с температурой 38 °С для избежания перегрева. Для оценки изменения величины поля, создаваемого вокруг образца, использовался интеграл интерполированной нормальной к поверхности образца составляющей магнитного поля S по области интерполяции данных в относительных единицах. Для образцов из Nd-Fe-B сплава магнитный поток вокруг образца уменьшился и составил 0,92 и 0,717 от начального значения для указанных доз облучения. Магнитное поле вокруг образцов из Sm2Co17 сплава не изменилось в пределах точности измерений для тех же доз. На основе образцов из Sm2Co17 сплава размерами 30х24х12 мм было проведено моделирование и конструирование магнита для анализа пучка электронов технологического ускорителя на энергию до 10 МэВ. Наибольшее значение поля в медианной плоскости магнита равно 0,3110 Тл. Расстояние между полюсами магнита равно 25,25 мм. Эффективная длина магнита – 33,53 мм. Измеренные параметры поля магнита удовлетворяют заданным при разработке величинам. Магнит также может быть использован для настройки ускорителя в диапазоне энергий до 10 МэВ

Fatal Tuberculosis in a Free-Ranging African Elephant and One Health Implications of Human Pathogens in Wildlife

Tuberculosis (TB) in humans is a global public health concern and the discovery of animal cases of Mycobacterium tuberculosis (Mtb) infection and disease, especially in multi-host settings, also has significant implications for public health, veterinary disease control, and conservation endeavors. This paper describes a fatal case of Mtb disease in a free-ranging African elephant (Loxodonta africana) in a high human TB burden region. Necropsy revealed extensive granulomatous pneumonia, from which Mtb was isolated and identified as a member of LAM3/F11 lineage; a common lineage found in humans in South Africa. These findings are contextualized within a framework of emerging Mtb disease in wildlife globally and highlights the importance of the One Health paradigm in addressing this anthroponotic threat to wildlife and the zoonotic implications

Oral vaccination with heat inactivated Mycobacterium bovis activates the complement system to protect against tuberculosis

Tuberculosis (TB) remains a pandemic affecting billions of people worldwide, thus stressing the need for new vaccines. Defining the correlates of vaccine protection is essential to achieve this goal. In this study, we used the wild boar model for mycobacterial infection and TB to characterize the protective mechanisms elicited by a new heat inactivated Mycobacterium bovis vaccine (IV). Oral vaccination with the IV resulted in significantly lower culture and lesion scores, particularly in the thorax, suggesting that the IV might provide a novel vaccine for TB control with special impact on the prevention of pulmonary disease, which is one of the limitations of current vaccines. Oral vaccination with the IV induced an adaptive antibody response and activation of the innate immune response including the complement component C3 and inflammasome. Mycobacterial DNA/RNA was not involved in inflammasome activation but increased C3 production by a still unknown mechanism. The results also suggested a protective mechanism mediated by the activation of IFN-γ producing CD8+ T cells by MHC I antigen presenting dendritic cells (DCs) in response to vaccination with the IV, without a clear role for Th1 CD4+ T cells. These results support a role for DCs in triggering the immune response to the IV through a mechanism similar to the phagocyte response to PAMPs with a central role for C3 in protection against mycobacterial infection. Higher C3 levels may allow increased opsonophagocytosis and effective bacterial clearance, while interfering with CR3-mediated opsonic and nonopsonic phagocytosis of mycobacteria, a process that could be enhanced by specific antibodies against mycobacterial proteins induced by vaccination with the IV. These results suggest that the IV acts through novel mechanisms to protect against TB in wild boar

Mycobacterium tuberculosis Lipolytic Enzymes as Potential Biomarkers for the Diagnosis of Active Tuberculosis

BACKGROUND: New diagnosis tests are urgently needed to address the global tuberculosis (TB) burden and to improve control programs especially in resource-limited settings. An effective in vitro diagnostic of TB based on serological methods would be regarded as an attractive progress because immunoassays are simple, rapid, inexpensive, and may offer the possibility to detect cases missed by standard sputum smear microscopy. However, currently available serology tests for TB are highly variable in sensitivity and specificity. Lipolytic enzymes have recently emerged as key factors in lipid metabolization during dormancy and/or exit of the non-replicating growth phase, a prerequisite step of TB reactivation. The focus of this study was to analyze and compare the potential of four Mycobacterium tuberculosis lipolytic enzymes (LipY, Rv0183, Rv1984c and Rv3452) as new markers in the serodiagnosis of active TB. METHODS: Recombinant proteins were produced and used in optimized ELISA aimed to detect IgG and IgM serum antibodies against the four lipolytic enzymes. The capacity of the assays to identify infection was evaluated in patients with either active TB or latent TB and compared with two distinct control groups consisting of BCG-vaccinated blood donors and hospitalized non-TB individuals. RESULTS: A robust humoral response was detected in patients with active TB whereas antibodies against lipolytic enzymes were infrequently detected in either uninfected groups or in subjects with latent infection. High specifity levels, ranging from 93.9% to 97.5%, were obtained for all four antigens with sensitivity values ranging from 73.4% to 90.5%, with Rv3452 displaying the highest performances. Patients with active TB usually exhibited strong IgG responses but poor IgM responses. CONCLUSION: These results clearly indicate that the lipolytic enzymes tested are strongly immunogenic allowing to distinguish active from latent TB infections. They appear as potent biomarkers providing high sensitivity and specificity levels for the immunodiagnosis of active TB