ANATOMICAL AND TOPOGRAPHICAL FEATURES OF ANTERIOR VITREOUS CORTEX

Introduction. The vitreous body (VB) is limited  by anterior cortex (AC) layers, consisting of densely interconnected collagen fibers. There is no consensus regarding the structural AC organization and its relationship with the structures of the eyeball.Purpose. To study the anatomical and topographical features of the anterior cortical layers of VB.Material  and  methods.  We  developed an  original method  for contrasting the VB structures  using an ultra-fine Vitreokontrast suspension based on a water-insoluble inorganic salt of barium sulfate in the isotonic solution. The study was performed in 20 cadaveric donor eyes. the  original technology.  Dissection was carried  out  according to a proposed original technology. The scleral incision was made at a 4mm distance from the limbus along the circumference. Then we cut the sclera between the rectus muscles, then the petals of choroid and retina were formed, and also they were cut off. Then we cut the sclera between the rectus muscles, then the petals of choroid and retina were formed, and also cut them off. We stained the vitreous structures using the Vitreokontrast suspension with a sequential removal of the anterior cortex up to the posterior lens capsule.Results. After the cortex removal in the cadaveric donor eyes several membranous structures  (on an average of four) were detected with a covering the retrolental space with an ability to exfoliate, with sites of the attachment to the Wieger ligament and fibers of ciliary zonula and pars plana. After the removal of the membranous structures and their restaining a layer of vitreous fibers was contrasted on the posterior capsule of the lens in the area of Berger space projection. Conclusion. The study revealed no case of a true full anterior cortex detachment. The anterior cortex exfoliation occurred with the formation of a multilayer membranous structure, covering the posterior surface of lens and ciliary body.The presence of vitreous fibers closely associated with the posterior capsule of the lens in the projection area  of Berger space, allows to suppose a possibility of retrolental bag existence, one of walls of which is associated with the posterior lens capsule

Macro-microscopic study of posterior vitreous detachment variants in an ex vivo experiment

Purpose. The key to understanding the development of any vitreoretinal pathology is a presence of a clear conception to possible variants of changes in the anatomical and topographic relationships of the posterior cortical layers of the vitreous body and the retinal internal limiting membrane (ILM) in a formation of posterior vitreous detachment (PVD).An original method of macro-microscopic examinations of anatomical objects proposed by professor V.P. Vorobyov, which includes investigations of morphological objects whose dimensions lie in the boundary area between macroscopic parameters studied by anatomists and microstructures studied by histologists, discover a new boundary area for the study of anatom ical structures.However, it has not been practically used in ophthalmology until now. The study of a process for changes in the vitreoretinal interface during the PVD occurrence is difficult due to a complexity of simulation, a possibility of visualization, and an absence of approved protocols for macro-microscopic research.Purpose. To study variants of anatomical and topographical changes in the vitreoretinal interface during the formation of induced PVD in ex vivo experiments using the method of macro-microscopic examination.Material and methods. The study was performed in 24 eyeballs of cadaver donors. To assess changes in the vitreoretinal interface in the process of PVD induction, an original method of dissection was used, that allows to isolate layer-by-layer the cortical layers of the vitreous body and the retinal ILM, with a possibility of further evaluation of changes in the vitreoretinal interface by the macro-microscopic examination. Salt barium sulfate suspension Video-contrast was used with the purpose to contrast vitreous fibers. Macroscopic investigation was carried out using the Topcon OMS-800 operating microscope with an indication from x8 to x21 magnification, microscopic changes were evaluated by the light microscopy method with x50, x100, x200, x400 x630 magnification using the Leica DM LB2 microscope with the subsequent photo r egistration.Results. During the macro-microscopic study, three variants of possible changes in the vitreoretinal interface during the development of induced PVD were revealed, which were interpreted as the normal (true) PVD and abnormal PVD, which occurred both with the formation (the variant A) of vitreoschisis zones (exfoliation of the cortical layers of the vitreous body) and with the zones of retinal ILM exfoliation (the variant B).Conclusion. The proposed method of macro-microscopic investigation of the vitreoretinal interface allows to dissect isolated sequentially layerby- layer the cortical layers of the vitreous body and the retinal ILM with subsequent fixation on a special substrate according to the original method and the possibility to carry out a histological section and its evaluation by the light m icroscopy method. The application of the developed method allows to accurately assess changes in the vitreoretinal interface on any isolated site of the vitreoretinal surface. The presented work demonstrates possibilities for the application of the method to detect variants of changes in the vitreoretinal interface within the formation of i nduced PVD

Determination of the probability of the damage to the health of workers in aluminium production due to the exposure to toxic substances

In the electrolytic aluminium production fluorides in the form of hydrogen fluoride and solid fluorides, alumina-containing dust, carbon monoxide, resinous substances and benz(a)pyrene are released into the air of the working zone representing a hazard to the workers' health. The paper presents the results of the researches of the working conditions of the workers employed in the electrolytic aluminium production. The concentrations of toxic substances in the air of working areas of those engaged in anode works and electrolysis, and crane operators are given; on their basis the risks of occupational diseases (fluorosis), of acute toxic effects, of chronic intoxication, and of cancer are calculated. The average-shift concentrations of hydrogen fluoride in the air of working areas of those engaged in electrolysis are 0.40-0.46 MPC, soluble fluorine salts - 0.31-0.38 MPC, insoluble fluorine salts -0.08-0.09 MPC. In the air of the working areas of those engaged in anode works MPC excess is noted for the aerosols of mostly fibrogenic action - in 1.25 times, for resinous substances - in 1.10 times. In the air of the working areas of those engaged in electrolysis MPC excess for resinous substances is registered in 1.06 times. The average-shift concentration of insoluble fluorine salts, and carbon monoxide in the air of the working areas of those engaged in anode works and electrolysis and crane operators are within the MPC. The risk of occupational disease development (fluorosis) due to the air pollution of the working zone in the aluminium production for the workers of the major occupational groups is ranging from 0.045 to 0.0482. Hydrogen fluoride is the most hazardous contaminant in air of the working zone contributing more than 55 % to the risk of fluorosis. The risk of acute toxic effects for the workers of the major occupational groups associated with the achievement of the concentrations of the contaminants in the air of the working areas of their maximum values are ranging from 0.181 to 0.230

Современные представления о возможности применения антиангиогенных препаратов в качестве адъювантной терапии при неоваскулярной глаукоме

The article analyzes literature data on the use of modern antiangiogenic drugs in the treatment of neovascular glaucoma (NVG) presenting information on the mechanisms of action of inhibitors of vascular endothelial growth factor (VEGF) as adjuvant therapy in NVG, as well as the clinical effectiveness of these drugs in modulating the activity of ocular tissue healing processes after surgical treatment of glaucoma.The article also considers the results of studies on the use of VEGF inhibitors bevacizumab, ranibizumab, and aflibercept by different routes of administration. Usage of these drugs is indicated to require taking into account the contraindications, as well as the possibility of side effects associated with the intravitreal route of drug administration. The effects of anti-VEGF drugs in the treatment of NVG have been noted to be temporary and last 4–6 weeks, so the result of using a combination of these drugs and standard methods of treating the disease is assumed to be more pronounced and lasting.Выполнен анализ данных литературы о применении современных антиангиогенных лекарственных средств в лечении неоваскулярной глаукомы (НВГ). Приведены сведения о механизмах действия ингибиторов сосудистого фактора роста эндотелия сосудов (VEGF) в качестве адъювантной терапии при НВГ, а также клинической эффективности этих препаратов в отношении модулирования активности процессов заживления тканей глаза после хирургического лечения глаукомы.Рассмотрены результаты исследований применения ингибиторов VEGF: бевацизумаба, ранибизумаба и афлиберцепта при разных путях введения. Указано, что при использовании этих препаратов следует учитывать противопоказания к их применению, а также возможность возникновения побочных эффектов, связанных с интравитреальным путем введения. Отмечено, что эффекты анти-VEGF препаратов в лечении НВГ носят временный характер и длятся обычно 4–6 недель, в связи с этим предполагается, что более выраженным и длительным может быть результат использования комбинации этих лекарственных средств и стандартных методов лечения заболевания

Estimation of carcinogenic risk for aluminium workers health

The research aim was the estimation of carcinogenic risk tor aluminium workers health. Average shift concentrations of resinous substances and benz(a)pyrene in working zone air were defined. The levels of carcinogenic risk which exceed admissible one in 2.5-2.84 times were calculated and were the largest ones in the workers engaged in electrolysis. The medical technology “The automated information system of occupational risk estimation for health of the workers of industrial tnterprises" was developed.Целью исследования явилась оценка канцерогенного риска для здоровья работников алюминиевого производства. Определены среднесменные концентрации смолистых веществ и 6енз(а)пирена в воздухе рабочей зоны. Рассчитаны уровни канцерогенного риска, которые превышают приемлемый в 2,5-2,84 раза и являются наибольшими у электролизников. Разработана медицинская технология ‘Автоматизированная информационная система оценки профессионального риска для здоровья работников промышленных предприятий”

Oil and gas:a blessing for the few. Hydrocarbons and inequality within regions in Russia

Building on earlier work on regional inequality in Russia the article seeks to demonstrate that the regional oil and gas abundance is associated with high within-region inequality. It provides empirical evidence that hydrocarbons represent one of the leading determinants of an increased gap between rich and poor in the producing regions. The discussion focuses on a possible cluster of geographic, economic and political factors underlying the phenomenon

Применение превентивных стом в хирургическом лечении колоректального рака

Objective: to investigate the efficiency of defunctioning stomas in protection of the anastomosis formed during the resection of the colon due to cancer including the complicated colorectal cancer.Materials and methods. Retrospective analysis of treatment outcomes of patients with a colorectal cancer whom resections of the rectum were performed, treated at the V.A. Oppel Clinic of Hospital Surgery of the North-West I.I. MechnikovState Medical University from 2010 till 2015.Results. The article presents a retrospective analysis of the results of treatment of 46 patients with colorectal cancer. All the patients underwent a resection of the rectum with the formation of preventive colostoma and without it. The patients were divided into 2 matched by sex, age groups. Resection of the rectum with defunctioning stoma forming due to the complicated colorectal cancer was performed to 3 patients. Complications were found in 6 patients: 2 patients after resection of the rectum with the formation of preventive colostoma and in 4 patients after resection without its formation. Death rate was 4.3 %. 2 patients died, to both patients defunctioning stomas weren’t performed.Patients with defunctioning stomas stayed in hospital in average for 3 days longer comparing with patients whom defunctioning stoma wasn’t formed. The stoma closure operations were performed to 89.5 % of the patients with defunctioning stomas.Conclusion. The data demonstrate efficiency of defunctioning stoma in prevention of anastamosis complications in surgical treatment of colorectal cancer including complicated colorectal cancer. However, must be conducted a clear definition of indications for its formation.Цель исследования – определение эффективности использования превентивных стом для защиты первично сформированного анастомоза при резекции кишки по поводу колоректального рака, в том числе на фоне осложнений рака толстой кишки.Материалы и методы. Проведен ретроспективный анализ результатов лечения больных колоректальным раком, находившихся на лечении в клинике госпитальной хирургии им. В. А. Оппеля СЗГМУ им. И. И. Мечникова за период с 2010 по 2015 г., которым были выполнены резекции прямой кишки.Результаты. Проведен анализ результатов лечения 46 больных раком прямой кишки, которым были выполнены резекции прямой кишки с формированием превентивной колостомы и без. Пациенты были рандомизированы на 2 сопоставимые по полу и возрасту группы по наличию или отсутствию превентивной колостомы. У 3 больных превентивные стомы были сформированы при резекциях прямой кишки на фоне осложнений колоректального рака. Осложнения в послеоперационном периоде выявлены у 6 пациентов: у 2 после резекции прямой кишки с формированием превентивной колостомы и у 4 после резекции без ее формирования. Общаялетальность составила 4,3 %. В ходе исследования было зарегистрировано 2 летальных исхода, оба в группе пациентов без превентивно сформированных стом.В группе пациентов со сформированными превентивными стомами среднее число койко-дней было на 3 больше по сравнению с группой пациентов без превентивно сформированных стом. Восстановление непрерывности толстой кишки с устранениемпревентивной стомы выполнено 89,5 % больных.Заключение. Полученные данные показывают эффективность формирования превентивной стомы при резекции прямой кишки по поводу колоректального рака для защиты первично сформированного анастомоза, в том числе при осложнениях. Однако с учетом необходимости повторных операций для устранения превентивной стомы, большего числа койко-дней необходимо более четкое определение показаний к формированию превентивной стомы

Using of method of preventive stomas formation in surgical treatment of rectal cancer

The article presents a retrospective analysis of the results of treatment of 47 patients with colorectal cancer who were treated in clinic of hospital surgery named after V.A. Oppel of NWGMU named after l.l. Mechnikov. All the patients underwent a resection of the rectum with the formation of preventive colostomy and without its formation. The patients were divided into two matched by sex, age group. Complications in the study were found in 7 patients: 2 patients after resection of the rectum with the formation of preventive colostomy (enough holding conservative therapy) and in 5 patients after resection of the rectum without its formation (required repeated surgery in all cases). The data demonstrate the effectiveness of preventive stoma in prevention of complications in surgical treatment of colorectal cancer. However, must be conducted a clear definition of the indications for formation of preventive stoma and identification of predictive factors for its formation.В статье приведены данные ретроспективного анализа результатов лечения 47 больных раком прямой кишки, проходивших лечение в клинике госпитальной хирургии им. В.А. Оппеля СЗГМУ им. И.И.Мечникова, которым выполнены резекции прямой кишки с формированием превентивной колостомы и без её формирования. Больные были разделены на две сопоставимые по полу, возрасту группы. Осложнения в ходе исследования выявлены у 7 пациентов: у 2 пациентов после резекции прямой кишки с формированием превентивной колостомы (было достаточно проведение консервативной терапии) и у 5 пациентов после резекции прямой кишки без её формирования (потребовалось повторное оперативное вмешательство во всех случаях). Полученные данные показывают эффективность формирования превентивной стомы при резекции прямой кишки по поводу рака. Однако необходимо более чёткое определение показаний к формированию превентивной стомы и выявление предиктивных факторов для её формирования

КОМПЕНСАТОРНЫЕ ВОЗМОЖНОСТИ ТОНКОЙ КИШКИ ПОСЛЕ ОБШИРНОЙ ДИСТАЛЬНОЙ И ПРОКСИМАЛЬНОЙ ЕЕ РЕЗЕКЦИИ (ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ)

Resection of certain parts of the small intestine is common in clinical practice for various diseases and traumatic injuries. The significant decrease in bowel functioning leads to the development of a specific “short bowel syndrome” (SBS). There is an opinion that the remaining parts of the intestine after resection perform a compensatory function as a result of the development of morphological changes in the intestinal wall. Histological examination of the intestinal wall with evolved compensatory changes is of undoubted interest from the scientific and clinical point of view.Material and Methods. To create the experimental model of SBS, 107 laboratory Wistar male rats were used, weighing 500–600 g, which underwent resection with removal of 1/2 or 2/3 of the small intestine length in proximal or distal parts. The observation period for the animals was 1, 2, 4 and 6 months. Upon expiration of indicated dates, samples of the small intestine and liver were taken from rats for autopsy to be used for histological examination. At the indicated terms, the animals had signs of SBS (diarrhea, weight loss), as well as morphological changes in the intestinal mucosa.Results and Conclusion. According to the results of the study, we concluded that the loss of 1/2 the length of the small intestine is overcome without consequences, and the loss of 2/3 of its length, especially of its proximal part, is accompanied by a longer period of adaptation and more significant morphological alteration of the mucosa, which has to perform not only digestion, but also absorption. Резекция тех или иных участков тонкой кишки (ТК) распространена в клинической практике при различных заболеваниях и травматических повреждениях. Значительное снижение функции кишечника ведет к развитию специфического «синдрома короткой кишки» (СКК). Существует мнение, что оставшиеся после резекции отделы кишечника выполняют компенсаторную функцию в результате развития морфологических изменений в стенке кишки. Гистологическое исследование стенки ТК с развившимися компенсаторными изменениями представляет несомненный интерес с научно-клинической точки зрения.Материал и методы. Для создания экспериментальной модели СКК было использовано 107 лабораторных крыс линии Wistar, самцов весом 500–600 г, у которых была проведена резекция с удалением 1/2 или 2/3 длины ТК в проксимальном или дистальном отделах. Сроки наблюдения за животными составляли 1, 2, 4 и 6 мес. По истечении указанных сроков у крыс на вскрытии были взяты образцы ТК и печени для гистологического исследования. В указанные сроки у животных прослежены признаки СКК (диарея, потеря веса), а также динамика морфологических изменений слизистой оболочки ТК.Результаты и заключение. По результатам исследования сделан вывод о том, что потеря 1/2 длины ТК преодолевается лабораторными крысами без вредных последствий, а потеря 2/3 длины ТК, особенно проксимальной ее части, сопровождается более длительным периодом адаптации и более выраженной морфологической перестройкой слизистой оболочки, вынужденной выполнять функцию не только переваривания, но и всасывания.

Ранние изменения клинико-лабораторных показателей у пациентов, умерших от COVID-19

261,435,768 COVID-19 infections were detected worldwide, of them 5,207,634 deaths were registered. Identifying markers of the patient severity early in the course of the disease can facilitate the assessment of the risk of adverse outcome.The objective: To compare values of laboratory parameters and their changes during treatment of patients with a complicated course of COVID-19 infection.Subjects and Methods. 56 patients were included in the study, all of them were hospitalized to COVID Hospital of the Clinic of Bashkir State Medical University, Russian Ministry of Health, from September 30, 2021 to November 15, 2021, and their complicated course of the disease necessitated transfer to the intensive care unit (ICU). The laboratory evaluation included the following: a general blood and urine counts, blood chemistry including urea and creatinine, liver transaminases, and blood coagulogram (prothrombin time (PTT), prothrombin index (PTI), thrombin time, fibrinogen, and blood clotting time).Results. In the group of patients with a fatal outcome on the day of transfer to ICU, lymphocytopenia, eosinopenia, elevated values of creatinine, total bilirubin, transaminases, C-reactive protein, D-dimer, and ferritin were noted. Also on this day, microscopic hematuria, proteinuria and cylindruria were detected in the urine tests of most patients in this group during treatment.Conclusion. Critical deviations in the results of hematological and biochemical tests were revealed. Particular attention should be paid to such parameters as the level of erythrocytes, lymphocytes, eosinophils, glucose, urea, creatinine, total bilirubin, aspartate aminotransferase, alanine aminotransferase, creatine kinase, C-reactive protein, D-dimer, and ferritin.По данным на 01.12.2021 г., во всем мире выявлено 261 435 768 заболевших COVID-19, из которых 5 207 634 умерли. Выявление маркеров тяжести состояния пациентов на ранних сроках заболевания может облегчить оценку риска неблагоприятного исхода.Цель: сравнить значения лабораторных показателей и их динамику в процессе лечения пациентов с осложненным течением COVID-19.Материал и методы: в исследовании приняли участие 56 пациентов, госпитализированных в ковид-госпиталь клиники ФГБОУ ВО «БГМУ» Минздрава России с 30.09.2021 г. по 15.11.2021 г., осложненное течение заболевания которых вызвало необходимость перевода в отделение реанимации и интенсивной терапии (ОРИТ). Объем лабораторного обследования: общий анализ крови и мочи, биохимический анализ крови с определением уровней мочевины и креатинина, печеночных трансаминаз, коагулограмма крови (протромбиновое время, протромбиновый индекс, тромбиновое время, фибриноген, время свертывания крови).Результаты. В группе пациентов с летальным исходом в день перевода в ОРИТ отмечены лимфоцитопения, эозинопения, повышенные значения креатинина, общего билирубина, трансаминаз, С-реактивного белка, D-димера и ферритина. Также в этот день в анализах мочи у большинства пациентов данной группы в ходе лечения были обнаружены микроскопическая гематурия, протеинурия и цилиндрурия.Заключение. Выявлены критические отклонения в результатах гематологических, биохимических анализов. Особое внимание должно быть уделено таким показателям, как уровень эритроцитов, лимфоцитов, эозинофилов, глюкозы, мочевины, креатинина, общего билирубина, аспартатаминотрансферазы, аланинаминотрансферазы, креатинкиназы, С-реактивного белка, D-димера, ферритина