The Concept of "Fast Track Surgery" as an Influencer on the Dynamics of Components of Stress-Realizing and Stress-Limiting Systems in the Perioperative Period

The concept of "Fast Track Surgery" has been of increasing interest, which implies accelerated recovery and a decrease in the frequency of postoperative complications, namely, a decrease in the body's stress response to surgery. The study aimed to assess the effect of Fast Track Surgery on the degree of surgical treatment trauma based on the dynamics of the functional integration of hormonal components of the stress-realizing / stress-limiting systems in the perioperative period. The study was conducted in 3 groups of patients. Groups of patients are comparable in age, sex, diagnosis of an underlying disease, degree of operative-anaesthetic risk ASA, intraoperative parameters, which allowed to carry out an analytical evaluation of the results of the study as objectively and reliably as possible. In the postoperative period, the maximum increase in stress-realizing system parameters in all groups was registered in patients after 1 day after surgery, less significant after LSSI-F: the concentration of daily excretion of dopamine exceeded the preoperative values by 1.2 times, epinephrine 2.0 times, norepinephrine in 1.3 times. Along with the activation of the stress-realizing system, a dynamic increase in the activity of the stress-limiting system was noted: after LSSI-F, the level of GABA increased by 1.3 times, after TSSI, the GABA secretion increased 1.2-fold. Laparoscopic SSI in combination with "Fast Track Surgery" contributed to a decrease in the intensity of the patient's stress response to the operating injury, which, in turn, significantly increased the effectiveness of simultaneous treatment and the quality of life of patients

CLINICAL AND IMMUNOHISTOCHEMICAL STUDIES IN THE DIAGNOSIS OF UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA IN PATIENTS WITH CHOLELITHIASIS

There were examined 132 patients in the age of 29-77 years old. Morphological features of abnormal shape or position of gallbladder were detected at 26.9% of patients with undifferentiated connective tissue dysplasia, and this may contribute to the formation of gallstones

Comparative evaluation of chitosan-based multifunctional wound dressings: a multistage randomised controlled experimental trial

Background. Wounds of various aetiology are among the most frequent traumatic injuries. A prospective route to improve treatment of this nosology is the development of novel or advancement of the already on-stage dressing materials.Objectives. A comparative experimental assay of novel chitosan-based wound dressings in the healing of soft tissue wounds of different genesis using ultrasound to control biodegradation of the developed dosage form.Methods. Soft tissue wounds were modelled in experimental animals, conventional and lineage male rats, 275 (± 25) g body weight, and male rabbits, 2,900 (± 150) g weight, using a proprietary methodology (Patent on invention RU No. 2703709 dated 23 August, 2018).Two wound dressing samples selected as most promising and applicable in large-volume soft tissue aseptic wounds were tested in the final step of experiment. Ultrasound imaging of the model wound area during the sample material biodegradation was used to control the wound process in more detail. At all steps of experiment, animal models were handled in compliance with GOST 33044-2014 “Principles of Good Laboratory Practice”.Histomorphological assays were carried out with common protocols. Variation statistics was used for the data analysis, including the mean (M) and standard mean error (± m) estimation. The level of statistical significance was p < 0.05.Results. The animal assays and comprehensive evaluation of the obtained data revealed a high healing efficacy of chitosan-based wound coatings. The analyses of wound dressing samples have confirmed their predesigned properties: scaffold stability, capillarity, biodegradability and matrix capacities for the carried drug delivery.Additionally, ultrasound was proved effective to estimate dynamics of the coated wound healing and biopolymer biodegradation processes.Conclusion. The developed chitosan-based wound dressings exhibited efficacy in an experimental model of the soft tissues wound process.The use of ultrasound to study dynamics of the wound process and coating biodegradation provided an adequate congruence between the imaging and tissue histomorphology data, as well as the structure and properties of coating material

Vacuum Therapy in Complex Treatment of Purulent-Necrotic Diseases of Soft Tissues: Clinical Cases

Background. Radical surgeries for phlegmons, abscesses, necrotizing infection are often followed by extensive wounds which require an individual approach to their rapid closure by means of plastic surgery methods. In such a case, the optimal wound therapy is primary healing with the use of vacuum therapy.Cases description. The study involved three clinical trials of patients with acute purulent-necrotic diseases of soft tissues of various localizations, volumes and grades, for which vacuum therapy was used as a part of complex therapy. Surgical interventions are proved to be urgently performed in acute purulent-necrotic diseases. Early reconstructive skin and bone plastic surgery aimed at closing post-operative wound defects is also very important.Conclusion. In the demonstrated clinical cases, the purulent process was stopped and wound therapy was performed by means of primary healing, which undoubtedly ensures medical and social rehabilitation of such patients. Notably, vacuum drainage is not an independent method, but an important component in the complex active surgical treatment of purulent wounds

Advances in and Issues With Minimally Invasive Surgery for Rectal Cancer in Elderly Patients

Colorectal cancer ranks third after breast cancer in terms of incidence and second after lung cancer in terms of mortality.Management of rectal cancer requires a multidisciplinary approach, with the surgical management playing the main role. There are currently three resective techniques that complement the traditional open surgery: laparoscopic surgery, robotic surgery, and transanal total mesorectal excision.Rectal cancer in elderly patients is particularly hard to diagnose and treat surgically due to multiple comorbidities and limited functional reserve. Treatment of such patients may be associated with poorer outcomes after both open and minimally invasive surgery.This article reviews the current state of advances in minimally invasive surgery for rectal cancer in general and in elderly patients in particular

Pharmacological correction of formation of connective tissue with mesh hernia repair in experiment

The use of foreign materials in modern herniology, on the one hand, reduces the number of recurrences, and on the other - increases the risk of several complications: profuse exudation and possible infection in the postoperative wound, extensive cicatricial deformation of a zone of operations, persistent pain syndrome and possible reduced fertility in men. In the experiment 30 rats were studied influence of drugs «mesogel®» and «iodopiron» in the course of wound process during operations using mesh explant. Histological methods were evaluated the usefulness of the formation of connective tissue, degree of involvement in cicatricial process is located in the area of operation of tissues and structures. Compared with the control group of animals is set to a relatively low density and fewer collagen fibers. In the control group of animals had a marked proliferative response in the surrounding tissue prosthesis, gross deformity and involvement in the scar process near structures

Хроническая обструктивная болезнь легких и COVID-19: актуальные вопросы

The problem of comorbidity of new coronaviral infection (COVID-19) and chronic obstructive pulmonary disease (COPD) is acute, considering similarity of clinical manifestations, diagnostic difficulties, the potential severe disease course. Patients with COPD represent a vulnerable group of infected SARS-CoV-2, with a complicated disease course and frequent adverse outcome. Features of the spread of the virus limit treatment and diagnosis for patients with COPD, making it difficult to provide medical care during the pandemic. The negative results of some clinical studies of antiviral drugs for patients with COVID-19 indicate the need for a search for new drugs; for this reason, analysis of the anti-inflammatory effect on the lungs in infection COVID-19 of drugs of basic COPD therapy is promising.Актуальность проблемы коморбидности новой коронавирусной инфекции COVID-19 и хронической обструктивной болезни легких (ХОБЛ) обусловлена схожестью клинических проявлений, сложностью диагностики, потенциальной тяжестью течения и взаимоотягощением этих патологий. Больные ХОБЛ, инфицированные SARS-CoV-2, представляют собой уязвимую группу лиц с осложненным течением и часто неблагоприятным исходом болезни. Особенности распространения вируса накладывают значительные ограничения на многочисленные диагностические и лечебные мероприятия при ХОБЛ, затрудняя оказание медицинской помощи больным данной категории в период пандемии на всех ее этапах. Необходимость поиска новых терапевтических решений продиктована отрицательными результатами текущих клинических исследований по изучению эффективности применения ряда препаратов у больных COVID-19; перспективным представляется изучение действия на SARS-CoV-2 препаратов базовой терапии ХОБЛ с доказанным противовоспалительным действием на бронхолегочную систему

The modulation of auditory novelty processing by working memory load in school age children and adults: a combined behavioral and event-related potential study

<p>Abstract</p> <p>Background</p> <p>We investigated the processing of task-irrelevant and unexpected novel sounds and its modulation by working-memory load in children aged 9-10 and in adults. Environmental sounds (novels) were embedded amongst frequently presented standard sounds in an auditory-visual distraction paradigm. Each sound was followed by a visual target. In two conditions, participants evaluated the position of a visual stimulus (0-back, low load) or compared the position of the current stimulus with the one two trials before (2-back, high load). Processing of novel sounds were measured with reaction times, hit rates and the auditory event-related brain potentials (ERPs) Mismatch Negativity (MMN), P3a, Reorienting Negativity (RON) and visual P3b.</p> <p>Results</p> <p>In both memory load conditions novels impaired task performance in adults whereas they improved performance in children. Auditory ERPs reflect age-related differences in the time-window of the MMN as children showed a positive ERP deflection to novels whereas adults lack an MMN. The attention switch towards the task irrelevant novel (reflected by P3a) was comparable between the age groups. Adults showed more efficient reallocation of attention (reflected by RON) under load condition than children. Finally, the P3b elicited by the visual target stimuli was reduced in both age groups when the preceding sound was a novel.</p> <p>Conclusion</p> <p>Our results give new insights in the development of novelty processing as they (1) reveal that task-irrelevant novel sounds can result in contrary effects on the performance in a visual primary task in children and adults, (2) show a positive ERP deflection to novels rather than an MMN in children, and (3) reveal effects of auditory novels on visual target processing.</p

Abnormal Distracter Processing in Adults with Attention-Deficit-Hyperactivity Disorder

Background: Subjects with Attention-Deficit Hyperactivity Disorder (ADHD) are overdistractible by stimuli out of the intended focus of attention. This control deficit could be due to primarily reduced attentional capacities or, e. g., to overshooting orienting to unexpected events. Here, we aimed at identifying disease-related abnormalities of novelty processing and, therefore, studied event-related potentials (ERP) to respective stimuli in adult ADHD patients compared to healthy subjects. Methods: Fifteen unmedicated subjects with ADHD and fifteen matched controls engaged in a visual oddball task (OT) under simultaneous EEG recordings. A target stimulus, upon which a motor response was required, and non-target stimuli, which did not demand a specific reaction, were presented in random order. Target and most non-target stimuli were presented repeatedly, but some non-target stimuli occurred only once (‘novels’). These unique stimuli were either ‘relative novels ’ with which a meaning could be associated, or ‘complete novels’, if no association was available. Results: In frontal recordings, a positive component with a peak latency of some 400 ms became maximal after novels. In healthy subjects, this novelty-P3 (or ‘orienting response’) was of higher magnitude after complete than after relative novels, in contrast to the patients with an undifferentially high frontal responsivity. Instead, ADHD patients tended to smaller centro-parietal P3 responses after target signals and, on a behavioural level, responded slower than controls