Modern concepts of anal sphincter insufficiency and its treatment

The international clinical analysis of the treatment of topical issues - failure of the anal sphincter, which has not only medical but also social value is presented. The comparative analysis of effectiveness of suggested above operating methods and modern approaches of different surgical methods of anal incontinence correction was conducted.Представлен мировой клинический анализ лечения актуальной проблемы – недостаточности анального сфинктера, которая имеет не только медицинское, но и социальное значение. Проведен сравнительный анализ эффективности как предлагавшихся ранее оперативных вмешательств, так и современные подходы различных хирургических методик коррекции анальной инконтиненции

Beta-thalassemia

Beta-thalassemias are a group of hereditary blood disorders characterized by anomalies in the synthesis of the beta chains of hemoglobin resulting in variable phenotypes ranging from severe anemia to clinically asymptomatic individuals. The total annual incidence of symptomatic individuals is estimated at 1 in 100,000 throughout the world and 1 in 10,000 people in the European Union. Three main forms have been described: thalassemia major, thalassemia intermedia and thalassemia minor. Individuals with thalassemia major usually present within the first two years of life with severe anemia, requiring regular red blood cell (RBC) transfusions. Findings in untreated or poorly transfused individuals with thalassemia major, as seen in some developing countries, are growth retardation, pallor, jaundice, poor musculature, hepatosplenomegaly, leg ulcers, development of masses from extramedullary hematopoiesis, and skeletal changes that result from expansion of the bone marrow. Regular transfusion therapy leads to iron overload-related complications including endocrine complication (growth retardation, failure of sexual maturation, diabetes mellitus, and insufficiency of the parathyroid, thyroid, pituitary, and less commonly, adrenal glands), dilated myocardiopathy, liver fibrosis and cirrhosis). Patients with thalassemia intermedia present later in life with moderate anemia and do not require regular transfusions. Main clinical features in these patients are hypertrophy of erythroid marrow with medullary and extramedullary hematopoiesis and its complications (osteoporosis, masses of erythropoietic tissue that primarily affect the spleen, liver, lymph nodes, chest and spine, and bone deformities and typical facial changes), gallstones, painful leg ulcers and increased predisposition to thrombosis. Thalassemia minor is clinically asymptomatic but some subjects may have moderate anemia. Beta-thalassemias are caused by point mutations or, more rarely, deletions in the beta globin gene on chromosome 11, leading to reduced (beta+) or absent (beta0) synthesis of the beta chains of hemoglobin (Hb). Transmission is autosomal recessive; however, dominant mutations have also been reported. Diagnosis of thalassemia is based on hematologic and molecular genetic testing. Differential diagnosis is usually straightforward but may include genetic sideroblastic anemias, congenital dyserythropoietic anemias, and other conditions with high levels of HbF (such as juvenile myelomonocytic leukemia and aplastic anemia). Genetic counseling is recommended and prenatal diagnosis may be offered. Treatment of thalassemia major includes regular RBC transfusions, iron chelation and management of secondary complications of iron overload. In some circumstances, spleen removal may be required. Bone marrow transplantation remains the only definitive cure currently available. Individuals with thalassemia intermedia may require splenectomy, folic acid supplementation, treatment of extramedullary erythropoietic masses and leg ulcers, prevention and therapy of thromboembolic events. Prognosis for individuals with beta-thalassemia has improved substantially in the last 20 years following recent medical advances in transfusion, iron chelation and bone marrow transplantation therapy. However, cardiac disease remains the main cause of death in patients with iron overload

Erosive-ulcerative lesions of the mucous membrane of the stomach and duodenum during therapy with 5-fluorouracil

Aim of the study was to improve the idea of the possibility of erosive and ulcerative lesions of the stomach and duodenum during treatment with 5-fluorouracil in patients with malignant tumors of the colon and rectosigmoid and the factors that aggravate their course, as well as to highlight the problem of prevention and treatment of gastrointestinal complications.Цель исследования – усовершенствование представления о возможности возникновения эрозивно-язвенных повреждений желудка и двенадцатиперстной кишки на фоне лечения 5-фторурацилом больных со злокачественными опухолями ободочной кишки и ректосигмоидного отдела и факторах, усугубляющих их течение, а также освещение проблемы профилактики и лечения гастроинтестинальных осложнений

COVID-19 infection in adult patients with hematological malignancies: a European Hematology Association Survey (EPICOVIDEHA)

Background: Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. Methods: The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. Results: The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March–May 2020) and the second wave (October–December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value < 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases. Conclusions: This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases.EPICOVIDEHA has received funds from Optics COMMITTM (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223)

CRACK RESISTANCE AND DURABILITY OF PRESTRESSED WALL PANELS CONSTRUCTED FROM CELLULAR CONCRETE

Objectives The aim of the studyis to develop ways to increase the crack resistance and durability of prestressed wall panels made of cellular concrete.Method A complex study was carried out at the stage of factory manufacturing of two-module, aerated concrete wall panels with prestressed rods of class A-III reinforcing steel, 10 mm in diameter, located in the middle of the panel in the longitudinal and transverse directions.Results It was found that the total stress losses in straining rods prior to casting of the aerated concrete mix, connected with stress relaxation in the reinforce and with deformations of the headings of the straining rods in the gripping jaws, the steel mould deformations, as well as the losses after the panel exit from the autoclave during the transfer of force to the concrete, are 15-20% of the initial level. At the same time, depending on the dimensions of the straining rods, the length of the strain transfer zone was in the range of 150 to 250 mm. A study of the effect of pre-compression on the closure of possible technological cracks in concrete test panels showed that, due to biaxial compression of concrete, new cracks do not appear when they work on bending and stretching (during the decking and transportation). Moreover, initial cracks that sometimes can appear during the autoclave processing become closed.Conclusion Comparative tests of prestressed and typical panels for short-term load in accordance with GOST 8829-94 requirements indicate a significant increase in their rigidity and crack resistance, as well as the shear strength of their bridge part. The design of straining reinforcing rods with the end transverse anchor in the form of a horseshoe, together with attached flat welded frameworks made of Vr-I wire with a diameter of 5 mm, which are installed along the contour of the window openings of the test panels, ensure its reliable adhesion to cellular concrete and effective anchoring in the panel's body until the end of its useful life. Biaxial prestressed reinforcement by single rods in combination with conventional frame reinforcement opens up possibilities for the production of external wall panels from non-autoclaved cellular concrete with ordinary heat treatment, instead of ceramsite concrete panels

Could hyaluronic acid (HA) reduce Bacillus Calmette-Guérin (BCG) local side effects? Results of a pilot study

Bacillus Calmette-Guérin (BCG) is considered the most effective treatment to reduce recurrence and progression of non-muscle invasive bladder cancer (NMIBC) but can induce local side effects leading to treatment discontinuation or interruption. Aim of this exploratory study is to investigate if the sequential administration of Hyaluronic acid (HA) may reduce local side effects of BCG

Mechanical Thrombectomy Using Transradial Access in a Variation of the Origin of the Brachiocephalic Trunk and Left Common Carotid Artery by the Common Ostium from the Aortic Arch

The paper describes a clinical case of successfully applying a transradial access during mechanical thrombus extraction in a patient in the acutest stage of ischemic stroke with a congenital anatomical feature (the left common carotid artery and brachiocephalic trunk with the common ostium from the aortic arch).X-ray endovascular interventions were performed in an operating room equipped with a digital angiographic unit including an Axiom Artis dTA flat detector (Siemens Medical System).Mechanical recanalization for acute occlusion of the M2 segment of the left middle cerebral artery (MCA) was carried out using a right radial access into and catheterization of the left internal carotid artery. A stent retriever was inserted into the occlusion area through a microcatheter and was opened. Double thrombus extraction from the left MCA was made using the stent retriever to restore TICI 2B blood flow. There were no signs of dissection, thrombosis, or distal thromboembolism