Drainage methods in patients with unformed intestinal fistulas during the preparation to the surgical treatment

The aim of the study is to analyze the data of the modern foreign and domestic literature on intestinal fistulas, including high unformed small intestinal fistulas, their classification, treatment methods, drainage methods, their types and effectiveness. Research method: the search in the elibrary, CyberLeninka, PubMed and SpringerLink databases. Intestinal fistulas, often found in the surgical practice, appear due to a number of reasons (errors in the surgical technique and conservative treatment, tactical errors, the presence of severe concomitant diseases, etc.) and present a high-risk factor for death. Clinically, intestinal fistulas can differ depending on their localization, etiology, morphology, function, complications, etc., that causes certain difficulties in choosing the treatment method and reduces its success. Special attention is paid to high unformed small intestinal fistulas, which are accompanied by pronounced impairment of the body's homeostasis system, on the one hand, and the need for a multi-stage treatment, on the other hand. The treatment regimen for high unformed small intestinal fistulas includes both conservative and surgical approaches. The conservative method of treatment includes an intensive infusion therapy, control of the source of infectious complications, reduction of irretrievable losses, nutritional therapy, and a local treatment, which consists in protecting the tissues from the aggressive intestinal content and various methods of adequate drainage of the wound. The drainage methods used for intestinal fistulas differ depending on the principle of their operation, the surgical drain material, the configuration of the wound, the fistula morphology, the number of fistulas, etc. Active and vacuum methods seem to be used most frequently and efficiently in the local treatment of high unformed small intestinal fistulas. So far, according to the (very limited) modern literature, there has been a diversity in the effectiveness of the drainage treatment approaches in patients with high unformed small intestinal fistulas, thus, further studies are needed to study and evaluate their pathogenetic role and effectiveness

Two-Stage Treatment of Enterocutaneous Fistulas

Aim: to determine the most efficient treatment of enterocutaneous fistulas.Materials and methods. Eighty-eight patients with intestinal fistulas underwent a two-stage treatment, including: the first stage — multicomponent therapy, the second stage — reconstructive surgery. Enterocutaneous fistulas were diagnosed in 61 patients, enteroatmospheric fistulas — in 26 patients, and combined fistula (enterocutaneous and enteroatmospheric) — in 1 patient.Results. All 88 patients underwent reconstructive surgery after the multicomponent therapy. Resection of the intestine with a fistula with the formation of an entero-entero anastomosis was performed in 72 (81.8 %) patients; marginal resection of the intestine with a fistula, followed by suturing of the defect — in 7 (8.0 %); resection of the intestine with fistulas in combination with excision and suturing of the fistula — in 5 (5.7 %); an operation aimed at disabling the fistula from the passage of intestinal contents — in 3 (3.4 %); resection of the intestine with a fistula in combination with fistula exclusion — in 1 (1.1 %) patient. Postoperative complications in the group of patients with enteroatmospheric fistulas occurred in 13 cases, in the group with enterocutaneous fistulas — in 25 patients. Three (3.4 %) patients with enterocutaneous fistulas died from complications unrelated to the underlying disease and surgical interventions.Conclusion. Two-stage treatment including multicomponent therapy (nutritional support, infection generalization control, local wound treatment) and reconstructive surgery allowed to reduce mortality rates to 3.4 %, which proves the effectiveness of this method

Текстурные и КТ-признаки в дифференциальном диагнозе гиперваскулярных нейроэндокринных опухолей поджелудочной железы и метастазов почечно-клеточного рака: диагностическая модель

Objective: to develop a diagnostic model that includes CT and radiomic features for the differential diagnosis of pancreatic neuroendocrine tumors (PNETs) G1 and G2 and pancreatic renal cell carcinoma (RCC) metastases.Material and Methods. 78 patients with 79 hypervascular PNETs and 17 patients with 24 pancreatic RCC metastases who underwent pancreatic resection and histological verification were selected in the study. All the patients underwent preoperative contrast enhanced CT (CECT). We assessed tumor attenuation, composition (cystic/solid), homogeneity (homogeneous/heterogeneous), calcification and presence of the main pancreatic duct (MPD) dilation. We calculated lesion-to-parenchyma contrast (LPC), relative tumor enhancement ratio (RTE) and extracted 52 texture features for arterial phase of CECT. Qualitative and texture features were compared between PNETs and pancreatic RCC metastasis. The selection of predictors for the logistic model was carried out in 2 successive stages: 1) selection of predictors based on one-factor logistic models, the selection criterion was p < 0.2; 2) selection of predictors using L2 regularization (LASSO regression after standardization of independent variables). The selected predictors were included in a logistic regression model without interactions, the coefficients of which were estimated using the maximum likelihood method with a penalty of 0.8.Results. There was no difference in composition, homogeneity (homogeneous/heterogeneous) and presence of the MPD dilation between groups. We did not find calcification in pancreatic RCC metastasis, in contrast to the PNETs (9% contained calcifications). After selection, the LCR, CONVENTIONAL_HUmin, GLCM_Correlation, NGLDM_Coarseness were included in the final diagnostic model, which showed a sensitivity and specificity of 95.8%; 62% in the prediction of pancreatic RCC metastases.Conclusion. The diagnostic model developed on the basis of texture and CT-features has high sensitivity (95.8%) with moderate specificity (62%), which allows it to be used in complex diagnostic cases to determine the patient's treatment tactics.Цель исследования: разработать диагностическую модель, включающую КТ-характеристики и показатели радиомики для дифференциальной диагностики нейроэндокринных опухолей поджелудочной железы (ПНЭО) G1 и G2 и метастазов почечно-клеточного рака (ПКР).Материал и методы. В исследование были отобраны 78 пациентов с 79 гиперваскулярными ПНЭО и 17 пациентов с 24 метастазами ПКР, которым была выполнена резекция поджелудочной железы с гистологической верификацией. Всем пациентам перед операцией была проведена КТ с контрастным усилением. Мы оценивали плотность опухоли, структуру (кистозная/солидная), гомогенность (гомогенная/гетерогенная), кальцификацию и наличие расширения главного протока поджелудочной железы (ГПП). Мы рассчитали отношение плотности опухоли к плотности паренхимы (LPC) и относительный коэффициент контрастирования опухоли (RTE) и вычислили 52 текстурных показателя для артериальной фазы КТ-исследования. Качественные и текстурные характеристики сравнивали между ПНЭО и метастазами ПКР. Отбор предикторов в логистическую модели осуществлялся в 2 последовательных этапа: 1) отбор предикторов на основе однофакторных логистических моделей, критерием отбора служило p < 0.2; 2) отбор предикторов с помощью L2-регуляризации (LASSO-регрессия после стандартизации независимых переменных). Отобранные предикторы включались в логистическую регрессионную модель без взаимодействий, коэффициенты которой рассчитывались с использованием метода максимального праводоподобия со штрафом 0,8.Результаты. Не было различий в структуре, гомогенности (гомогенные/гетерогенные) и наличии дилатации ГПП между группами. Мы не обнаружили кальцификации при метастазах ПКР, в отличие от ПНЭО. После отбора LCR, CONVENTIONAL_HUmin, GLCM_Correlation, NGLDM_Coarseness были включены в окончательную диагностическую модель, которая показала чувствительность и специфичность 95.8%; 62% в прогнозировании метастазов ПКР.Заключение. Разработанная на основании текстурных и КТ-признаков диагностическая модель обладает высокой чувствительностью (95.8%) при умеренной специфичности (62%), что позволяет использовать ее при сложных диагностических случаях для определения тактики лечения пациента

Трансплантация тканевых эквивалентов в лечении некоторых повреждений кожи

Chronic ulcers are a common and socially significant problem worldwide. Autodermoplasty is the gold standard treatment for chronic ulcers. However, it is not always possible to perform this surgical procedure for a rather large group of patients, due to some reasons, which include high risk of autodermotransplant rejection, lack of donor material, and patient’s unwillingness to undergo surgery with an often unpredictable result. A potential solution to the problem is to use skin equivalents from allogeneic donor material. The use of allogeneic (donor) human cells makes it possible to fill the deficit of the patient’s donor resources and close wound without causing additional injury to the patient. This paper provides an overview of the application of foreign and domestic biomedical cell products in clinical trials and real clinical practice. We draw conclusions on the efficiency of the considered biomedical cell products in the treatment of chronic ulcers, evaluate the conducted research, and make recommendations on the most efficient use of allogeneic dermatotropic biomedical cell products.Хронические раны являются распространенной и социально значимой проблемой во всем мире. Золотым стандартом лечения хронических ран является аутодермопластика, однако ее выполнение не всегда возможно у довольно большой группы больных, в том числе из-за высокого риска отторжения аутодермотрансплантата, дефицита донорского материала, нежелания пациента подвергать себя хирургической операции с часто непредсказуемым результатом. Возможным решением проблемы является использование эквивалентов кожи из аллогенного донорского материала. Использование аллогенных (донорских) человеческих клеток позволит восполнить дефицит донорских ресурсов пациента, выполнить закрытие раневого дефекта без нанесения пациенту дополнительного повреждения. В настоящей статье представлен обзор применения в клинических исследованиях и реальной клинической практике зарубежных и отечественных биомедицинских клеточных продуктов. Сделаны выводы об эффективности рассмотренных биомедицинских клеточных продуктов в лечении хронических ран, дана оценка проведенным исследованиям, даны рекомендации по наиболее эффективному использованию аллогенных дерматотропных биомедицинских клеточных продуктов

Update on the Combined Analysis of Muon Measurements from Nine Air Shower Experiments

Over the last two decades, various experiments have measured muon densities in extensive air showers over several orders of magnitude in primary energy. While some experiments observed differences in the muon densities between simulated and experimentally measured air showers, others reported no discrepancies. We will present an update of the meta-analysis of muon measurements from nine air shower experiments, covering shower energies between a few PeV and tens of EeV and muon threshold energies from a few 100 MeV to about 10GeV. In order to compare measurements from different experiments, their energy scale was cross-calibrated and the experimental data has been compared using a universal reference scale based on air shower simulations. Above 10 PeV, we find a muon excess with respect to simulations for all hadronic interaction models, which is increasing with shower energy. For EPOS-LHC and QGSJet-II.04 the significance of the slope of the increase is analyzed in detail under different assumptions of the individual experimental uncertainties

Structures of Polymetallaorganosiloxanolates—a Novel Class of Organosilicon Metal Complexes

Single crystal X-ray diffraction studies have revealed the nature and structure of eight types (I–VIII) of polymetallaorganosiloxanolates, representatives of a novel class of the organosilicon metal complexes. Most of the complexes (types I–VII) have sandwich structures with a layer of metal cations between two macrocyclic siloxanolate ligands. In type VIII a single such ligand envelops four inner Cu2+ ions to form a globular species

Macrobicyclic D-Metal Tris-dioximates Obtained by Cross-linking with P-Block Elements. Part VI. Preparation, Molecular Structure and Mössbauer (\u3csub\u3e57\u3c/sub\u3eFe, \u3csub\u3e119\u3c/sub\u3eSn) Parameters of an Iron (II) Complex with a Macrobiocyclic Tin-containing Tris-nioximate Ligand

The tin-containing clathrochelate complex of Fe(II) with cyclohexanedione-1,2-dioxime (nioxime, H2Nx), [FeNx3(SnCl3)2]2- · (Et2NH+ 2)2 · Et2NH2 + · Cl− · 2Pri OH was prepared by slowly adding diethylamine to a solution containing the macrobicyclic [FeNx3(SnCl3)2]2- anion. The structure of the complex has been determined by X-ray methods. Crystal data: monoclinic, space group P21/c, a = 10.565(2), b = 25.413(5), c = 20.198(4)Å, β=95.40(3)°, Z = 4. The iron atoms is encapsulated by the clathrochelate ligand and surrounded by a distorted trigonal antiprismatic coordination sphere comprising by six nitrogen atoms of three dioxime residues. The experimental value of the distortion angle (ca 37.5°) is close to that predicted by the Mössbauer (57Fe) parameters (ca 40°). The average Fe-N bond length of 1.923Å is somewhat greater than that in boron-containing analogues. The Sn atoms have a slightly distorted octahedral coordination, which also correspond to Mössbauer (119Sn) spectroscopic data. The six-membered carbocycles in the dioxime fragments have a half-chair conformation with both β-carbons displaced to the opposite sides of the mid-plane of the remaining atoms. All the active hydrogen atoms of the structure are involved in a hydrogen bond system. The possibilities of use of Mössbauer parameters and their temperature dependences to determine the geometry of iron(II) tris-dioximates and the sign of Δ in Mössbauer (57Fe) spectra are discussed

Aminals in the Synthesis of 1,3-Substituted Propargylamines and 3\u3cem\u3eH\u3c/em\u3e-2-Vinylidene-3-Aminobenzofuran Derivatives

Aminals of aromatico-hydroxyaldehydes react when heated with terminal acetylenes to form, depending on the reaction conditions and the nature of the starting compounds, 1,3-substituted propargylamines or 3H-2-vinylidene-3-aminobenzofuran derivatives, the structures of which were established by X-ray diffraction

Structure of 2,2-bis(trifluoromethyl)-7,7-bis(trifluoromethyl)-hydroxymethyl-1,3,6-trioxaspiro [4.4]non-8-ene

The chemical structure of the unusual condensation product of hexafluoroacetone with 2-hydroxymethylfuran, namely 2,2-bis(trifluoromethyl)-7,7-bis(trifluoromethyl) hydroxymethyl-1,3,6-trioxaspira[4.4]non-8-ene, has been unequivocally established by x-ray structural analysis. The spiroannelated dihydrofuran and dioxalane heterocycles exist in flattened envelope and envelope conformations, respectively. An intramolecular unsymmetrical, bifurcated H-bond is also present