Лапароскопічна герніопластика у лікуванні защемлених гриж у хворих похилого та старечого віку

Results of treatment of 118 (5.3 %) patients with strangulated hernia were analyzed. The age of patients ranged from 52to 92 years. Among them, 92 (69.0 %) patients underwent performed hernioplasty using polypropylene (PPI) implant; thesecond – 26 (31.0 %) patients who underwent autoplasty. Patients with strangulated hernia were divided into two groups:the fi rst included 60 (50.8 %) patients who underwent HP using the PPI for the "open" method; the second – 32 (27.1 %)patients who underwent laparoscopic alohernioplasty. 54 (45.8 %) patients were operated with strangulated inguinal hernia.Transabdominal preperitoneal endovideohernioplasty (TPEVH) was used in 12 (5.7 %) patients with strangulated inguinalhernia. In 39 (31.1 %) patients there was a strangulated femoral hernia, where 10th (8.5 %) performed TPEVH. 21 (17.8 %)patients with ventral hernias were operated on emergency indications. 14 (6.1 %) of them had strangulated umbilical hernia,6 (2.6 %) had a hernia linea alba, 1 (0.4 %) – hernia l. semilunaris. 2 (%) patients with hernia linea alba and 1 (0.4 %) patientswith hernia l. semilunaris were operated laparoscopically. In patients with postoperative and recurrent hernias of abdominalwall jamming was observed in 39 (33.1 %) cases in patients older than 60 years. Laparoscopic surgeries were 7 (5.9 %) patients.Postoperative complications of the wound were: Seroma – 12 (14.3 %) patients, festering wounds – in 5 (6.0 %) patients,evisceration – in 1 (1.2 %) patients. 2 died (2.4 %) patients from progression of peritonitis. In laparoscopic – 1 (1.2 %) in caseof bleeding from the lower epigastric artery and 1 (1.2 %) – intraoperative damage to the small intestine. Thus, the use ofendoscopic therapies strangulated hernia elderly patients may need further study and improvement.Проаналізовано результати хірургічного лікування 118 (5,3 %) хворих із защемленою грижею. Вік хворих склав від 52до 92 років. Із них 92 (69,0 %) хворим було виконано герніопластику із застосуванням поліпропіленового імплантата, 26(31,0 %) хворим було виконано аутопластику. Хворих із защемленою грижею поділили на дві групи: в першу увійшли60 (50,8 %) хворих, яким було виконано герніопластику із застосуванням поліпропіленового імплантата за “відкритим”способом; в другу – 32 (27,1 %) хворих, яким було виконано лапароскопічну алогерніопластику. 54 (45,8 %) пацієнтибули оперовані із защемленою пахвинною грижею, трансабдомінальна преперитонеальна ендовідеогерніопластика булазастосована 12 (5,7 %) хворим. У 39 (31,1 %) пацієнтів мало місце защемлення стегнової грижі, де 10-м (8,5 %) із них та-кож виконали трансабдомінальну преперитонеальну ендовідеогерніопластику. При первинній серединній локалізаціїгрижових дефектів, що були прооперовані за екстреними показаннями з приводу даної патології, був 21 (17,8 %) хворий,із них у 14 (6,1 %) пацієнтів мала місце защемлена пупкова грижа, у 6 (2,6 %) – грижа білої лінії живота, в 1 (0,4 %)– грижа спігелієвої лінії. Із них 2 (2,4 %) хворих із грижею білої лінії живота та 1 (0,4 %) – з грижею спігелієвої лініїбули прооперовані лапароскопічно. У групі хворих з післяопераційними та рецидивними грижами передньої черевноїстінки защемлення спостерігали в 39 (33,1 %) випадках у пацієнтів, старших 60 років. Лапароскопічно було проопе-ровано 7 (5,9 %) хворих. Ускладнення в групі з “відкритим” способом оперування в післяопераційному періоді з бокупісляопераційної рани були такі: серома – у 12 (14,3 %) хворих, нагноєння рани – у 5 (6,0 %) пацієнтів, евісцерація – у1 (1,2 %) хворого. Померли 2 (2,4 %) хворих від прогресування перитоніту. При лапароскопічних – 1 (1,2 %) випадоккровотечі з нижньої епігастральної артерії та 1 (1,2 %) – інтраопераційне пошкодження тонкої кишки. Отже, застосу-вання ендоскопічних методів лікування защемленої грижі хворих похилого віку можливе, потребує подальшого вив-чення та вдосконалення

Features of the frequency of occurrence of T-330G <i>IL2</i> gene polymorphism in patients with COVID-19

SARS-CoV-2 infection is the etiopathogenetic factor of the new coronavirus infection. Susceptibility to the virus and, accordingly, the incidence differs in children and adults. On the one hand, this reflects the age-related features of the immune response. On the other hand, it is realized through the production of a number of cytokines, including IL-2, and reflects the genetically determined features of cytokine production. The aim of the study was to analyze the frequency of occurrence of T-330G polymorphic variants of the IL2 gene in patients with a new coronavirus infection. A total of 145 patients were examined, including 31.0% of children (n = 45) and 69.0% of adults (n = 100). The diagnosis of a new coronavirus infection was verified by RT-PCR confirming the presence of the SARS-CoV-2 virus and identifying clinical symptoms of an upper respiratory tract infection. The control group consisted of 50 healthy volunteer donors. Allele-specific PCR with electrophoretic detection in 3% agarose gel (Litech, Russia) was used to analyze the T-330G polymorphism of the IL2 gene. To compare the frequencies of allele combinations, the χ2 test and the odds ratio OR and (95% CI) were used.The dominant genotype in patients with COVID-19 was the heterozygous GT genotype of the T-330G polymorphism of the IL2 gene. In the group of children at risk of developing a new coronavirus infection, the GG genotype of the T-330G polymorphism of the IL2 gene was associated (31.1% in children and 18.0% in the control group, p &lt; 0.05, OR = 2.047). While the homozygous TT genotype of the T-330G polymorphism of the IL2 gene was a protective genotype (its occurrence rate was 26.7% in patients, 54.0% in the control group, p &lt; 0.05, OR = 0.315). In adults, the heterozygous GT genotype of the T-330G polymorphism of the IL2 gene was associated with the risk of developing a new coronavirus infection (in the group of patients – 44.0% versus control – 28.0%, p = 0.028, OR = 2.020). A low risk of developing the disease was associated with the homozygous TT variant of the T-330G polymorphism of the IL2 gene (in the group of patients 37.0% versus control – 54.0%, p = 0.024, OR = 0.500).The T-330G polymorphism of the promoter zone of the IL2 gene differently affects its production. The direction of the immune response and its effectiveness depend on the level of IL-2. Understanding the individual factors that determine the features of the immune response can help in understanding the mechanisms of development of COVID-19-associated diseases and the selection of approaches to personalized methods of their treatment

Influence of antibiotic therapy on indicators of endotoxinemia and systemic inflammation in acute SARS-CoV-2 lung damage

Background. Prescribing antibacterial drugs for the treatment of a new coronavirus infection at the outpatient stage is often unreasonable and can also lead to an aggravation of the patient’s condition due to the effect of this group of drugs on the intestinal microflora and lead to other undesirable effects.The aim: to assess the level of lipopolysaccharide-binding protein and indicators of systemic inflammation in patients with moderate viral SARS-CoV-2 lung disease on the background of antibiotic therapy.Materials and methods. 60 patients hospitalized in the infectious diseases department with a positive PCR result for SARS-CoV-2 in the age group 44–70 years old were examined. The patients were divided into 2 groups: group 1 (n = 26) – patients who did not receive antibacterial drugs at the outpatient stage, group 2 (n = 34) – patients who received antibiotic therapy. The control group was also selected (n = 20). Patients underwent a study of the level of lipopolysaccharide-binding protein (LBP), ferritin and C-reactive protein in the peripheral blood.Results. In the group of patients with new coronavirus infection who were admitted to the inpatient stage of treatment and received antibacterial therapy at the outpatient stage, a significantly higher levels of LBP – 37.3 [13.8; 50.4] µg/ml (p˂0.05) and ferritin – 276.00 [184.00; 463.00] µg/ml (p˂0.05) were revealed, compared with group 1 and the control group.Conclusions. In the group of patients who received antibiotic therapy at the outpatient stage, a significantly higher level of LBP was revealed compared to the group in which this group of drugs was not used. These results indicate the possible impact of uncontrolled and early intake of antibacterial drugs on the gut microbiome and intestinal permeability, and also prove the need for a more responsible approach to the choice of starting therapy for new coronavirus infection

Influence of health resort treatment on the level of systemic inflammation in patients after new coronavirus infection

Background. Low-grade inflammation is currently one of the main risk factors for the development of adverse events in the cardiovascular system, including death from cardiovascular diseases or their complications that cause mortality in the postCOVID period.The aim of the study. To assess the impact of health resort treatment in the conditions of the Southern Coast of Crimea on clinical and functional parameters, as well as on the level of systemic inflammation in patients after a new coronavirus infection.Materials and methods. The study included 67 patients (54.9 ± 9.05 years) in the post-COVID period who underwent health resort treatment at the I.M. Sechenov Academic Research Institute of Physical Treatment Methods, Medical Climatology and Rehabilitation. Methods of health resort treatment included climatic treatment on the Southern Coast of Crimea, therapeutic breathing exercises, terrainkur, and various methods of respiratory therapy. In all patients, the study of the C-reactive protein (CRP) in peripheral blood upon admission and at discharge was carried out.Results. Despite a statistically significant improvement in most clinical and functional parameters, the level of CRP and the number of leukocytes and their subpopulations in peripheral blood in patients who underwent health resort treatment did not differ significantly (p &gt; 0.05) from the baseline values obtained upon admission at the I.M. Sechenov Academic Research Institute of Physical Treatment Methods, Medical Climatology and Rehabilitation. The CRP index upon admission and at discharge corresponded to the lower limit of the interval specific for low-grade inflammation (from 3 to 10 mg/l).Conclusion. Our results indicate the lack of effectiveness of the presented plan of health resort treatment in the correction of low-intensity inflammation, as well as the necessity for deeper scientific research in the direction of studying the mechanisms of low-grade inflammation development and the methods of its management

Global forest management data for 2015 at a 100 m resolution

Spatially explicit information on forest management at a global scale is critical for understanding the status of forests, for planning sustainable forest management and restoration, and conservation activities. Here, we produce the first reference data set and a prototype of a globally consistent forest management map with high spatial detail on the most prevalent forest management classes such as intact forests, managed forests with natural regeneration, planted forests, plantation forest (rotation up to 15 years), oil palm plantations, and agroforestry. We developed the reference dataset of 226 K unique locations through a series of expert and crowdsourcing campaigns using Geo-Wiki (https://www.geo-wiki.org/). We then combined the reference samples with time series from PROBA-V satellite imagery to create a global wall-to-wall map of forest management at a 100 m resolution for the year 2015, with forest management class accuracies ranging from 58% to 80%. The reference data set and the map present the status of forest ecosystems and can be used for investigating the value of forests for species, ecosystems and their services

Design of Systems for Integrated Processing of Dairy Raw Materials in the Cheese Industry

For the functioning of integrated systems for processing dairy raw materials in the cheesemaking industry, it is proposed to consider the basic concepts of synthesis of production systems. In order to implement the concept of waste minimization, it is proposed to separate the industrial wastewater into flows based on the concentration and values of the main parameters, as well as to protect the cheese whey from entering the water treatment facilities and direct it for disposal. The possibilities of implementing the concepts of deep raw materials processing into a target product have been analyzed, as well as the full utilization of raw and auxiliary materials. To this end, an experimental study was performed on the extraction of protein clots and adjusting the buffer capacity of infant dairy products using cheese whey. The study results indicate the insufficient effect of extracting the protein clot from whey (5–50 %) by combining the thermal and chemical processes. It was established that the redox conditions of the medium, in terms of the Eh indicator, can significantly affect the results, in close connection with the pH parameter and the estimated value of rH2. It was found that the optimal conditions for the functioning of lactic acid microflora in the production of soft cheeses can be ensured by adjusting the Eh indicator through the introduction of whey of pH=4.4–4.6 units, Eh≤–0.1 V. Whey is introduced at the stage of dairy raw material fermentation, which creates optimal conditions for the formation of a clot until reaching rH2 in the range from −5 to –7, and increases the product output by 1.5–7 %. The results of the experimental study indicate the high potential of using whey desalinated by ion exchange in order to reduce the buffer capacity in terms of acidity and adjust the redox conditions for infant milk mixtures until achieving rH2=15.5–15.9. The research reported in this paper could be the basis for the further development of systems for the integrated processing of dairy raw materials in the cheesemaking industr