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Year 2024 Vol. 32 No 1

SCIENTIFIC PUBLICATIONS

D.V. OSIPENKO 1, V.V. KRIVENCHUK 2, A.V. MAROCHKOV 3, H.D. ASIPENKA 2

ENDOCRINE-METABOLIC MONITORING DURING CARDIAC SURGERY UNDER GENERAL MULTICOMPONENT ANESTHESIA

Gomel Regional Clinical Cardiology Center 1,
Gomel State Medical University 2, Gomel,
Mogilev Regional Clinical Hospital 3, Mogilev,
Republic of Belarus

Objective. To determine the dynamics of changes in cortisol, prolactin, and thyroid-stimulating hormone (TSH) during cardiac surgery with artificial circulation under general multicomponent endotracheal anesthesia and to assess their potential use as markers of endocrine monitoring.
Methods. The study included 30 patients who underwent planned cardiac surgery under artificial circulation. For anesthesia maintenance, general multicomponent endotracheal anesthesia based on sevoflurane (before and after artificial circulation), propofol (during artificial circulation), fentanyl, and pipecuronium were used. For endocrine-metabolic monitoring, cortisol, prolactin, and TSH in blood serum were controlled at the stages of the study: before the onset of the operation (1st stage), 15 minutes before the start of artificial circulation (5th stage), and after suturing the skin (7th stage).
Results. Cardiac surgeries with artificial circulation under general multicomponent endotracheal anesthesia are accompanied by endocrine changes at the 5th and 7th stages of the study in the form of an eleration in the level of cortisol (by 1.6 (1.1; 1.9) and 2.6 (2.1; 3.7) times), prolactin (by 2.7 (1.4; 4.1) and 3 (1.6; 4.9) times) and TSH (by 1.2 times (1.0; 1.9) and 1.2 (0.9; 1.9) times)? respectively.
Conclusion. Indicators of endocrine-metabolic monitoring of cortisol, prolactin, glucose, and lactate characterize the effectiveness of patient analgesia during cardiac interventions with artificial circulation.

Keywords: cortisol, prolactin, thyroid-stimulating hormone, cardiac surgery, artificial circulation, general anesthesia, analgesia
p. 5-12 of the original issue
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    • Address for correspondence:
    246046, Republic of Belarus,
    Gomel, Meditsinskaya st., 4,
    Institution «Gomel Regional
    Clinical Cardiology Center»,
    Department of Anesthesiology
    and Intensive Care with Intensive Care Wards,
    tel./fax: + 375 29 6146598,
    e-mail: osipenko081081@mail.ru,
    Osipenko Dmitry V.
    Information about the authors:
    Osipenko Dmitry V., PhD, Assistant at the Department of Surgical Diseases No. 1 with a Course in Vascular Surgery, Gomel State Medical University. Anesthesiologist-resuscitator (Head) of the Department of Anesthesiology and Intensive Care with Intensive Care Wards, Gomel Regional Clinical Cardiology Center, Gomel, Republic of Belarus.
    https://orcid.org/0000-0003-4838-1140
    Krivenchuk Vadim V., 4th Year Student of the Faculty of Medicine, Gomel State Medical University, Gomel, Republic of Belarus.
    https://orcid.org/0009-0001-6594-4569
    Osipenko Georgy D., 1st Year Student of the Faculty of Medicine, Gomel State Medical University, Gomel, Republic of Belarus.
    https://orcid.org/0009-0006-2059-4987
    Marochkov Alexey V., MD, Professor, Anesthesiologist-Resuscitator, Head of the Scientific and Practical Department of the Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus.
    https://orcid.org/0000-0001-5092-8315

    I.V. MAKAROV, R.A. GALKIN, R.M. ROMANOV, V.N. KUDASHKIN

    GENETIC ASPECTS OF THE EFFECTIVENESS OF REPLACEMENT THERAPY AND THE SCOPE OF SURGICAL INTERVENTION IN PATIENTS WITH TOXIC GOITER

    Federal State Educational Institution of Higher Education
    "Samara State Medical University" of the Ministry of Health of the Russian Federation, Samara,
    Russian Federation

    Objective. To investigate the frequency of Val174Ala polymorphism in SLCO1B1 gene in patients with toxic goiter (TG) and to evaluate the influence of the revealed mutations on the efficacy of substitutive hormonotherapy and adequacy of the choice of the extent of TG surgery.
    Methods. The study of Val174Ala polymorphism in 41 patients operated on TG was carried out. The mean age of patients was 48.2±13.0 years; 7 men and 34 women. Toxic diffuse goiter (TDG) was diagnosed in 19 patients, toxic multinodular goiter (TMG) – in 22; thus thyroidectomy (TE) was performed in 21 cases, subtotal thyroid resection (STR) – in 20 cases.
    Results. The study revealed polymorphism in 16 patients (39.02%): heterozygous (CT type) – in 15 patients (36.59%); normal homozygous / mutant type (CC type) – in 1 patient (2.44%). Normal homozygous / wild type (TT), indicating the absence of polymorphism, was detected in 25 patients (60.98%). When L-T4 was administered based on the dose specified in clinical recommendations, in 6 of 16 patients with polymorphism in the postoperative period subclinical thyrotoxicosis symptoms (TSH from 0.38 to 0.02 mMe/l) were observed, in 4 patients - partial return of thyrotoxicosis symptoms (TSH – 0.01 mMe/l). All these patients underwent TE. As a result, the Thyroxine dose of 125 mcg was reduced to 75 mcg in 6 patients, and in 4 patients – to 100 mcg per day. The remaining 6 patients with preoperative polymorphism underwent STR with Thyroxine administration considering this factor.
    Conclusion. Significant relationship between the daily dosage of L-T4 and the presence of SLCO1B1 polymorphism has been revealed in the study. When prescribing substitutive hormonotherapy, its necessary to consider the results of genetic testing of SLCO1B1 polymorphism, which was detected in 39% of patients. In case of polymorphism detection, the STR should be preferred in order to prevent adverse reactions of substitutive therapy and adequate dose selection.

    Keywords: SLCO1B1 polymorphism, L-thyroxine, toxic goiter, surgical treatment
    p. 13-20 of the original issue
    References
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    3. Mihajlichenko VYu, Karakursakov NE, Bezrukov OF, Kerimov EYa, Samarin SA. Kompressionnyj sindrom pri patologii shchitovidnoj zhelezy. TMBV. 2020;. 23(2): 143-147. doi: 10.37279/2070-8092-2020-23-2- 143-147
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    10. International Transporter Consortium; Giacomini KM, Huang SM, Tweedie DJ, Benet LZ, Brouwer KL, Chu X, Dahlin A, Evers R, Fischer V, Hillgren KM, Hoffmaster KA, Ishikawa T, Keppler D, Kim RB, Lee CA, Niemi M, Polli JW, Sugiyama Y, Swaan PW, Ware JA, Wright SH, Yee SW, Zamek-Gliszczynski MJ, Zhang L. Membrane transporters in drug development. Nat Rev Drug Discov. 2010 Mar;9(3):215-36. doi: 10.1038/nrd3028
    11. Hagenbuch B, Meier PJ. Organic anion transporting polypeptides of the OATP/ SLC21 family: phylogenetic classification as OATP/ SLCO superfamily, new nomenclature and molecular/functional properties. Pflugers Arch. 2004 Feb;447(5):653-65. doi: 10.1007/s00424-003-1168-y
    12. van der Deure WM, Friesema EC, de Jong FJ, de Rijke YB, de Jong FH, Uitterlinden AG, Breteler MM, Peeters RP, Visser TJ. Organic anion transporter 1B1: an important factor in hepatic thyroid hormone and estrogen transport and metabolism. Endocrinology. 2008 Sep;149(9):4695-701. doi: 10.1210/en.2008-0169.
    13. Aleksandrov YuK, SirotkinaAM, Hohlov AJI, Pamputis SN, Dyakiv AD. Snizhenie reabilita­cionnyh riskov posle operacij na shchitovidnoj zheleze. Prakt Medicina. 2019;17(4):133-36. https://cyberleninka.ru/article/n/snizhenie-reabilitatsionnyh-riskov-posle-operatsiy-na-schitovidnoy-zheleze
    14. Klinicheskie rekomendacii po diagnostike i lecheniyu tireotoksikoza s diffuznym zobom (bolezn’ Grejvsa), uzlovym/mnogouzlovym zobom [Elektronnyj resurs] [data obrashcheniya 2022 Fev 22]. Rezhim dostupa: https://webmed.irkutsk.ru/doc/pdf/hyperthyr_rae.pdf
    Address for correspondence:
    443099, Russian Federation,
    Samara, Chapaevskaya st., 99,
    Samara State Medical University,
    Department of General Surgery
    and Surgical Diseases,
    tel. +7 903 334-22-59,
    e-mail: makarov-samgmu@yandex.ru,
    Makarov Igor V.
    Information about the authors:
    Makarov Igor V., MD, Professor, Head of the Department of General Surgery and Surgical Diseases of the Federal State Budgetary Educational Institution of the Ministry of Health of the Russian Federation.
    http://orcid.org/0000-0002-1068-3330
    Galkin Rudolf A., MD, Professor of the Department of General Surgery and Surgical Diseases of the Federal State Budgetary Educational Institution of the Ministry of Health of the Russian Federation.
    http://orcid.org/0000-0003-3665-3161
    Romanov Roman M., Assistant of the Department of General Surgery and Surgical Diseases of the Federal State Budgetary Educational Institution of the Ministry of Health of the Russian Federation.
    http://orcid.org/0000-0001-7799-4865
    Kudashkin Vyacheslav N., 6th Year Student of the Institute of Pediatrics.
    http://orcid.org/0000-0001-9099-3517

    S.A. TACHYLA 1, 2, A.M. DZYADZKO 3, A.V. MAROCHKOV 1, 2, A.L. LIPNITSKI 1, 2, Y.G. POKHODNYA 4, O.P. SAVACHKA 4, V.A. LIVINSKAYA 5

    CONCENTRATIONS OF TRACE ELEMENTS (COBALT, CHROMIUM, COPPER, SELENIUM, ZINC) IN PATIENTS WITH ABDOMINAL SEPSIS IN THE POSTOPERATIVE PERIOD

    Healthcare institution “Mogilev Regional Clinical Hospital” 1, Mogilev,
    Educational institution “Vitebsk State Medical University” 2, Vitebsk,
    State Institution “Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology” 3,
    Healthcare institution “National Anti-Doping Laboratory” 4, Minsk,
    Interstate educational institution of higher education “Belarusian-Russian University” 5, Mogilev,
    Republic of Belarus

    Objective. The aim of the study was to examine the dynamics of microelements (cobalt, chromium, copper, selenium, zinc) and the need for their correction in patients with sepsis and multiple organ failure syndrome (MODS) after abdominal surgery.
    Methods. A prospective observational study was conducted in 45 patients who had surgical pathology of the abdominal organs requiring surgical treatment. All patients were divided into 2 groups: group 1 (n=18) – with the absence of sepsis and MODS; group 2 (n=27) – with the presence of sepsis and MODS. During the 1st day of admission to the anesthesiology and resuscitation department (1st stage), as well as on the 5th (2nd stage) and 10th day (3rd stage) from admission, venous blood was take for determination of cobalt, chromium, copper, selenium, zinc.
    Results. The level of cobalt was statistically significantly reduced in group 1 compared to group 2 at all stages: in group 1 at stage 1 – 0.4 (0.27-0.66) μg/l, at the 2nd stage – 0.31 (0.24-0.44) µg/l, at the 3rd stage – 0.35 (0.26-0.61) µg/l. Chromium levels were within normal limits in all patients in the study groups. The copper content was statistically significantly lower in group 2 compared to group 1 at all stages: in group 2 at stage 1 – 819.3 (721.5-949) μg/l, at stage 2 – 1st stage – 825.2 (762.5-977.4) µg/l, 3rd stage – 819.7 (759.2-981.5) µg/l. Selenium levels were below normal in group 1: stage 1 – 52.3 (41.5-67.7) µg/l, stage 2 – 51.9 (38.8-63.7) µg /l, stage 3 – 54.8 (33.8-66) µg/l; and in the 2nd group: 1st stage – 47.6 (33.8-66.2) µg/l, 2nd stage – 57.5 (42.7-68.7) µg/l, 3 stage – 47.4 (40.2-57.8) µg/l. A decrease in zinc levels was noted in patients of both groups below normal in group 1: stage 1 – 5624.3 (4911.2-6293.5) mcg/l, stage 2 – 5709.7 (5057.6 -6038.7) µg/l, stage 3 – 5438.5 (4998.8-6168.7) µg/l; and in the 2nd group: 1st stage – 5298.7 (4554.3-6011.4) µg/l, 2nd stage – 5519.5 (4702.4-6315.4) µg/l, 3 stage – 5370.6 (4528.8-6014.8) µg/l.
    Conclusion. Analysis of the dynamics of the level of concentrations of trace elements showed that the level of copper was lower and the level of cobalt was higher in patients with abdominal sepsis in the postoperative period compared with the comparison group.

    Keywords: trace elements, cobalt, chromium, copper, selenium, zinc, sepsis, multiple organ dysfunction syndrome
    p. 21-30 of the original issue
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    Address for correspondence:
    212016, Republic of Belarus,
    Mogilev,Belynitskij-Biruli, st. 12,
    Mogilev Regional Clinical Hospital,
    Department of Anesthesiology and Reanimation,
    tel.: +375 222 62-75-95,
    e-mail: tsa80@inbox.ru,
    Tachyla Siarhei A
    Information about the authors:
    Tachyla Siarhei A, PhD, Associate professor, Anesthesiologist-Resuscitator of the Department of Anesthesiology and Resuscitation, Mogilev Regional Clinical Hospital, Head of the Branch of the Departments of Anesthesiology and Resuscitation with a Course of FAK and PK and Hospital Surgery with a course of FAK and PK Vitebsk State Medical University «, Mogilev, Republic of Belarus.
    https://orcid.org/0000-0003-1659-5902
    Dzyadzko Alexander M., MD, Professor, Honored Doctor of the Republic of Belarus, Head of the Department of Anesthesiology, Resuscitation and Intensive Care, State Institution «MNPC KhTiG», Minsk, Republic of Belarus.
    https://orcid.org/0000-0003-1965-1850
    Marochkov Alexei V., MD of Medical Sciences, Professor, Anesthesiologist-Resuscitator of the Department of Anesthesiology and Resuscitation, Mogilev Regional Clinical Hospital, Professor of the Branch of the Departments of Anesthesiology and Reanimatology with a Course of FAK and PK and Hospital Surgery with a Course of FAK and PK Vitebsk State Medical University «, Mogilev, Republic of Belarus.
    https://orcid.org/0000-0001-5092-8315
    Lipnitski Artur L., PhD, Associate Professor, Anesthesiologist-Resuscitator, Head of the Department for Coordinating the Collection of Organs and Tissues for Transplantation, Mogilev Regional Clinical Hospital, Associate Professor of the Branch of the Departments of Anesthesiology and Resuscitation with a Course of FAK and PC and Hospital Surgery with a Course of FAK and PC EE «Vitebsk State Medical University», Mogilev, Republic of Belarus.
    https://orcid.org/0000-0002-2556-4801
    Pokhodnya Yury G., PhD (Biol), Associate Professor, Director of the National Anti-Doping Laboratory, Minsk, Republic of Belarus.
    https://orcid.org/0009-0009-3898-255X
    Savachka Aleh P., Master of Chemical Sciences, Chemist of the Department of Chemical-Toxicological Research of the National Anti-Doping Laboratory, Minsk, Republic of Belarus.
    https://orcid.org/0000-0002-3952-4974
    Livinskaya Viktoriya A., PhD, Associate Professor, Associate Professor of the Department of Finance and Accounting, Interstate Educational Institution of Higher Education «Belarusian-Russian University».
    https://orcid.org/0000-0001-8953-8533

    A.T. SHCHASTNIY, A.S.OSOCHUK, A.F. MARTSINKEVICH, S.S.OSOCHUK, O.A. GROMOVA, A.M. MUKADESOVA, A.CH. VERSHININA

    DYNAMICS OF CHANGES IN THE BLOOD LIPID TRANSPORT SYSTEM, GLUCOSE AND C-PEPTIDE LEVEL 1, 3 AND 5 YEARS AFTER KIDNEY TRANSPLANTATION IN PEOPLE RECEIVING TACROLIMUS

    Vitebsk State Medical University, Vitebsk
    Republic of Belarus

    Objective. To study the dynamics of changes in the level of glucose, C-peptide and the composition of native lipoprotein complexes in the blood of patients 1, 3 and 5 years after kidney transplantation.
    Material and Methods. The study group included 15 men (36-60 years old) and 15 women (36-55 years old) 1, 3 and 5 years after kidney transplantation. The control group included 15 healthy men and women of the same age. Fasting venous blood was collected in vacutainers with 3.8% sodium citrate. Native blood lipoprotein complexes were isolated by preparative ultracentrifugation. The amount of protein in native blood lipoprotein complexes was determined using the Lowry method, the amount of cholesterol, apoproteins A/B, cholesterol esters and triacylglycerides, glucose, creatinine and urea were determined using biochemical kits. The amounts of proprotein convertase subtilisin kexin 9 and C-peptide were determined using enzyme immunoassay kits. Statistical analysis was performed in the application package R version 4.0.5 (2021-03-31).
    Results. At all times after kidney transplantation, an increase in the concentration of C-peptide and glucose was observed. Gender differences characteristic of healthy people in the content of VLDL cholesterol, LDL cholesterol, total protein and apoprotein-B100 are leveled out, equalizing them with the values characteristic of healthy men; no significant effect on the composition of HDL was found, however, the amount of their main protein – apoprotein A1 and cholesterol esters – increases in blood plasma.
    Conclusion. The findings regarding changes in C-peptide and glucose levels may indicate that renal allograft recipients treated with tacrolimus may have compensated insulin tolerance, which may ultimately lead to post-transplant diabetes mellitus. Changes in lipid transport system indicate the proatherogenic effect of immunosuppressive therapy in women.

    Keywords: Post-transplant diabetes mellitus, C-peptide, lipoproteins, tacrolimus, kidney transplantation
    p. 31-38 of the original issue
    References
    1. Hecking M, Sharif A, Eller K, Jenssen T. Management of post-transplant diabetes: immunosuppression, early prevention, and novel antidiabetics. Transpl Int. 2021 Jan;34(1):27-48. doi: 10.1111/tri.13783
    2. Davidson J, Wilkinson A, Dantal J, Dotta F, Haller H, Hernández D, Kasiske BL, Kiberd B, Krentz A, Legendre C, Marchetti P, Markell M, van der Woude FJ, Wheeler DC; International Expert Panel. New-onset diabetes after transplantation: 2003 International consensus guidelines. Proceedings of an international expert panel meeting. Barcelona, Spain, 19 February 2003. Transplantation. 2003 May 27;75(10 Suppl):SS3-24. doi: 10.1097/01.TP.0000069952.49242.3E
    3. Sarno G, Muscogiuri G, De Rosa P. New-onset diabetes after kidney transplantation: prevalence, risk factors, and management. Transplantation. 2012 Jun 27;93(12):1189-95. doi: 10.1097/TP.0b013e31824db97d
    4. Hecking M, Kainz A, Werzowa J, Haidinger M, Döller D, Tura A, Karaboyas A, Hörl WH, Wolzt M, Sharif A, Roden M, Moro E, Pacini G, Port FK, Säemann MD. Glucose metabolism after renal transplantation. Diabetes Care. 2013 Sep;36(9):2763-71. doi: 10.2337/dc12-2441
    5. Sharif A, Hecking M, de Vries AP, Porrini E, Hornum M, Rasoul-Rockenschaub S, Berlakovich G, Krebs M, Kautzky-Willer A, Schernthaner G, Marchetti P, Pacini G, Ojo A, Takahara S, Larsen JL, Budde K, Eller K, Pascual J, Jardine A, Bakker SJ, Valderhaug TG, Jenssen TG, Cohney S, Säemann MD. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant. 2014 Sep;14(9):1992-2000. doi: 10.1111/ajt.12850
    6. Edgar L, Akbar N, Braithwaite AT, Krausgruber T, Gallart-Ayala H, Bailey J, Corbin AL, Khoyratty TE, Chai JT, Alkhalil M, Rendeiro AF, Ziberna K, Arya R, Cahill TJ, Bock C, Laurencikiene J, Crabtree MJ, Lemieux ME, Riksen NP, Netea MG, Wheelock CE, Channon KM, Rydén M, Udalova IA, Carnicer R, Choudhury RP. Hyperglycemia Induces Trained Immunity in Macrophages and Their Precursors and Promotes Atherosclerosis. Circulation. 2021 Sep 21;144(12):961-82. doi: 10.1161/CIRCULATIONAHA.120.046464
    7. Valderhaug TG, Hjelmesæth J, Hartmann A, Røislien J, Bergrem HA, Leivestad T, Line PD, Jenssen T. The association of early post-transplant glucose levels with long-term mortality. Diabetologia. 2011 Jun;54(6):1341-49. doi: 10.1007/s00125-011-2105-9
    8. Shchastniy AT, Osochuk AS, Osochuk SS, Martsinkevich AF. Izmenenija spektra zhirnyh kislot lipoproteinov ochen’ nizkoj plotnosti pacientov s hronicheskoj pochechnoj nedostatochnost’ju i v rannie sroki posle peresadki pochki Vestn VGMU. 2023;22(3):86-96. doi: 10.22263/2312-4156.2023.3.86.(In Russ.)_
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    11. Bates D, Machler M, Bolker B, Walker S. Fitting Linear Mixed-Effects Models Using lme4. J Stat Softw. 2015;67(1):1-48. 10.18637/jss.v067.i01
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    14. Oh-i K, Keino H, Goto H, Yamakawa N, Takeuchi M, Usui M, Iwasaki T. Upregulation of neurotrophic factor-related gene expression in retina with experimental autoimmune uveoretinitis by intravitreal injection of tacrolimus (FK506). Br J Ophthalmol. 2007 Nov;91(11):1537-40. doi: 10.1136/bjo.2007.116525
    15. Furusyo N, Ai M, Okazaki M, Ikezaki H, Ihara T, Hayashi T, Hiramine S, Ura K, Kohzuma T, Schaefer EJ, Hayashi J. Serum cholesterol and triglyceride reference ranges of twenty lipoprotein subclasses for healthy Japanese men and women. Atherosclerosis. 2013 Dec;231(2):238-45. doi: 10.1016/j.atherosclerosis.2013.09.008
    16. Cooke AL, Morris J, Melchior JT, Street SE, Jerome WG, Huang R, Herr AB, Smith LE, Segrest JP, Remaley AT, Shah AS, Thompson TB, Davidson WS. A thumbwheel mechanism for APOA1 activation of LCAT activity in HDL. J Lipid Res. 2018 Jul;59(7):1244-55. doi: 10.1194/jlr.M085332
    17. Tripolino C, Irace C, Carallo C, De Franceschi MS, Della Valle E, Gnasso A. Blood urea impairs brachial artery flow mediated dilation. Int Angiol. 2015;34(4):392-97.
    18. Lü RX, Li YS, Huang ZG, Wang YJ, Peng ZY. Source of variations of serum urea levels and consideration of reference interval in urban Chengdu. Sichuan Da Xue Xue Bao Yi Xue Ban. 2010 Jul;41(4):684-87.
    Address for correspondence:
    210009, Republic of Belarus,
    Vitebsk, Frunze ave., 27,
    Vitebsk State Medical University,
    Department of Hospital Surgery with
    a Course of FAT and PT.
    tel.: +375-29-595-04-03,
    e-mail: aos19950207@gmail.com,
    Osochuk Alexander Sergeevich
    Information about the authors:
    Shchastniy Anatoly T., MD, Professor, Head of the Department of Hospital Surgery with a Course of FAT and PT. Vitebsk State Medical University, Vitebsk, Republic of Belarus.
    https://orcid.org/0000-0003-2796-4240
    Osochuk Alexander S., Assistant of the Department of Hospital Surgery with a Course of FAT and PT. Vitebsk State Medical University, Vitebsk, Republic of Belarus.
    https://orcid.org/0000-0003-3655-4489
    Martsinkevich Alexander F., PhD., Associate Professor of the Department of General and Clinical Biochemistry with the Course of FAT and PT, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
    https://orcid.org/0000-0002-5942-3601
    Osochuk Sergey S., MD, Professor, Head of the Research Laboratory of VSMU, Vitebsk State Medical University. Vitebsk, Republic of Belarus.
    https://orcid.org/0000-0003-2074-3832
    Gromova Olga A., Nephrologist at the Department of Surgical Hepatology and Transplantation of the Healthcare Institution “VOKB”, Vitebsk, Republic of Belarus. https://orcid.org/0009-0007-8192-1950
    Mukadesova Anastasia Maratovna, Researcher at the Scientific Department of the State Institution «Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology». Minsk, Republic of Belarus.
    https://orcid.org/0009-0007-1631-2681
    Vershinina Anna Ch., Nephrologist, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
    https://orcid.org/0009-0006-1945-9286

    A.A. KINZERSKIY, M.S. KORZHUK, V.T. DOLGIKH, T.S. SOLOV’YOVA

    THE MODELING OF SEVERE CLOSED BLUNT LIVER TRAUMA

    Omsk City Emergency Hospital 1 1, Omsk, the Russian Federation,
    NMRC of Oncology named after N.N.Petrov of MoH of Russia 2, St. Petersburg,
    Military Medical Academy named after S.M.Kirov 3, of MoD of Russia,
    Federal Scientific Center of Reanimatology and Rehabilitology
    of Russian Academy of Science 4, Moscow,
    St. Petersburg Clinic Hospital of Russian Academy of Science 5, St. Petersburg, Russian Federation

    Objective. The determination of the necessary damage energy and anatomical landmarks for modeling severe blunt closed liver injury by the «impact» mechanism using developed device.
    Material and Methods. The experiments were carried out on male Wistar rats (n=42) weighing 379 ±23 g. It was necessary to get a liver injury of III-IV according to J.M. Cox and J.E. Kalns: ruptures from 2 to 3.5 cm and more . At the first stage, the optimal height of the fall (mass 425 g) in the epigastrium at the level of the base of the xiphoid processus was determined, at which liver damage of more than 2 cm is achieved without damage of the inferior vena cava. The rats were randomized into 3 groups according to the height of the load drop: I-I (n=4) – height 40 cm, I-II (n=4) – 20 cm, I-III (n=5) – 28 cm. At the second stage, the search for anatomical landmarks for the impact was carried out to avoid damage to other organs of the abdominal and thoracic cavity. 4 zones were selected on the anterior abdominal wall of the animal to focus the impact: in the left hypochondrium (group II-I, n=5), in the right hypochondrium 5 mm below and 10 mm to the right of the tip of the xiphoid process (group II-II, n=5), in the epigastrium at the level of the tip of the xiphoid process (Group II-III, n=5), 5 mm to the right and above the tip of the xiphoid process (group II-IV, n=14). A device developed by the authors implementing the «impact» mechanism was used to inflict injury. Considering that the number of animals in the groups is small, a median with a 95% confidence interval (CI) was used for the average value of the liver rupture length.
    Results. The height of the load drop of 40 cm turned out to be excessive, since the inferior vena cava was injured, and the height of 20 cm was insufficient, since the length of the liver rupture did not reach 2 cm in length. The optimal height was 28 cm for a load of 425 g – the impact energy was 1.17 joules. Only in group II-IV, focusing the impact 5 mm above and to the right of the tip of the xiphoid process led to extensive damage to the parenchyma of the right and left median lobe, upper and lower caudate lobe of the liver with a median [95% CI] rupture length of 5.5 [2.49;7.8] cm, without injuries of the thoracic and abdominal organs, and also the inferior vena cava.
    Conclusion. The developed device with selected landmarks and impact energy allows it to be used as experimental model of a closed liver injury. Stable achieving of homogeneous liver injuries III-IV is becoming.

    Keywords: liver trauma, animal trauma model, Wistar rats
    p. 39-45 of the original issue
    References
    1. Dyer M, Haldeman S, Gutierrez A, Kohut L, Sen Gupta A, Neal MD. Uncontrolled hemorrhagic shock modeled via liver laceration in mice with real time hemodynamic monitoring. J Vis Exp. 2017 May 21;(123):55554. doi: 10.3791/55554
    2. Nemzek-Hamlin JA, Hwang H, Hampel JA, Yu B, Raghavendran K. Development of a murine model of blunt hepatic trauma. Comp Med. 2013 Oct;63(5):398-408. https://europepmc.org/article/pmc/pmc3796750
    3. Girish A, Hickman DA, Banerjee A, Luc N, Ma Y, Miyazawa K, Sekhon UDS, Sun M, Huang S, Sen Gupta A. Trauma-targeted delivery of tranexamic acid improves hemostasis and survival in rat liver hemorrhage model. J Thromb Haemost. 2019 Oct;17(10):1632-44. doi: 10.1111/jth.14552
    4. Wu X, Benov A, Darlington DN, Keesee JD, Liu B, Cap AP. Effect of tranexamic acid administration on acute traumatic coagulopathy in rats with polytrauma and hemorrhage. PLoS One. 2019 Oct 3;14(10):e0223406. doi: 10.1371/journal.pone.0223406
    5. Kinzerskij AA, Korzhuk MS, Dolgih VT. Ustrojstvo dlja modelirovanija tupoj travmy pecheni u melkih laboratornyh zhivotnyh po mehanizmu «Udar». Patent RF 163861. 2016 Okt 08.https://www1.fips.ru/Archive/PAT/2016FULL/2016.08.10/DOC/RUNWU1/000/000/000/163/861/DOCUMENT.PDF ( In Russ.)
    6. Lipatov VA, Severinov DA, Krjukov AA, Saakjan AR. Jeticheskie i pravovye aspekty provedenija jeksperimental’nyh biomedicinskih issledovanij in vivo. Chast’ II. Ros Med-Biol Vestn im Akad IP Pavlova. 2019;27(2):245-57. doi: 10.23888/PAVLOVJ2019272245-257 (In Russ.)
    7. Cox JM, Kalns JE. Development and characterization of a rat model of nonpenetrating liver trauma. Comp Med. 2010 Jun;60(3):218-24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890397/
    8. Branco BC, Musonza T, Long MA, Chung J, Todd SR, Wall MJ Jr, Mills JL Sr, Gilani R. Survival trends after inferior vena cava and aortic injuries in the United States. J Vasc Surg. 2018 Dec;68(6):1880-88. doi: 10.1016/j.jvs.2018.04.033
    9. Darlington DN, Wu X, Keesee JD, Cap AP. Severe Trauma and hemorrhage leads to platelet dysfunction and changes in cyclic nucleotides in the rat. Shock. 2020 Apr;53(4):468-75. doi: 10.1097/SHK.0000000000001379
    10. Kafadar H, Kafadar S, Tokdemir M. Comparison of internal organ injuries by blunt abdominal trauma in rats with empty or full stomach. Ulus Travma Acil Cerrahi Derg. 2014 Nov;20(6):395-400. doi: 10.5505/tjtes.2014.92331
    11. Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, Biffl W, Peitzman A, Horer T, Abu-Zidan FM, Sartelli M, Fraga GP, Cicuttin E, Ansaloni L, Parra MW, Millán M, DeAngelis N, Inaba K, Velmahos G, Maier R, Khokha V, Sakakushev B, Augustin G, di Saverio S, Pikoulis E, Chirica M, Reva V, Leppaniemi A, Manchev V, Chiarugi M, Damaskos D, Weber D, Parry N, Demetrashvili Z, Civil I, Napolitano L, Corbella D, Catena F; WSES expert panel. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020 Mar 30;15(1):24. doi: 10.1186/s13017-020-00302-7
    Address for correspondence:
    644074, Russian Federation,
    Omsk, Komarov Ave. 17/3, 96,
    BHIOR «City Clinical Emergency Hospital No. 1»,
    Surgical Department,
    tel.: +7-913-151-39-89,
    e-mail: kinzerskij@mail.ru
    Kinzerskiy Alexander A.
    Information about the authors:
    Kinzerskiy Alexander A., Surgeon of the Surgical Department of the BHIOR «City Clinical Emergency Hospital No. 1»,
    http://orcid.org/0000-0001-5749-1873
    Korzhuk Mikhail S., MD, Professor, Lecturer in the Department of Naval Surgery of the Federal State Budgetary Educational Institution of Higher Education «Military Medical Academy named after. CM. Kirov» of the Ministry of Defense of the Russian Federation, Researcher at the Scientific Laboratory of Cancer Chemoprevention and Oncopharmacology of the Federal State Budgetary Institution «National Medical Research Center of Oncology named after. N.N. Petrov» of the Ministry of Health of Russia of the Russian Federation, St. Petersburg, Russian Federation.
    http://orcid.org/0000-0002-4579-2027
    Dolgikh Vladimir T., MD, Professor, Honored Scientist of the Russian Federation, Chief Researcher of the Research Institute of General Reanimatology named after. V.A. Negovsky Federal State Budgetary Institution «Federal Scientific and Clinical Center of Reanimatology and Rehabilitation», Moscow, Russian Federation.
    http://orcid.org/0000-0001-9034-4912
    Solovyova Tatyana S. Pathologist of the St. Petersburg Clinical Hospital of the Russian Academy of Sciences, ã. Ñàíêò-Ïåòåðáóðã, Ðîññèéñêàÿ Ôåäåðàöèÿ.
    http://orcid.org/0009-0005-2672-276X

    M.M. MIRZAKHMEDOV, M.A. AKHMEDOV

    SURGICAL TACTICS FOR CROHN’S DISEASE OF THE COLON

    Tashkent Medical Academy of the Republic of Uzbekistan

    Objective. Òo improve the results of surgical treatment of Crohn’s disease of the colon by applying the modern diagnostic methods and adequate surgical tactics.
    Ìethods. The study included 84 patients who underwent conservative and surgical treatment in the proctological department of the 1st Republican Clinical Hospital of the Ministry of Health of the Republic of Uzbekistan. for the period from 2010 to 2022 for Crohn’s disease of the colon. 53 patients (63%) were men, 31 (37%) women. The age of the patients ranged from 15 to 61 years. The average age was 37.1+1.2 years.
    Results. Indications for surgery for Crohn’s disease of the colon are a total lesion of the inflammatory-ulcerative process, the presence of intestinal and extra-intestinal complications, the ineffectiveness of conservative therapy and the progression of the disease.

    Keywords: intestinal fistulas, fistulography, irrigation, ileostomy, closure of the fistula
    p. 46-51 of the original issue
    References
  • Adler G. Bolezn’ Krona i iazvennyi kolit. Moscow, RF: GEOTAR-Media; 2001. 527 p. (In Russ.)
  • Vorob’ev GI. Bolezn’ Krona. V kn: Vorob’ev GI, red. Osnovy koloproktologii. Rostov-na Donu, RF: Feniks; 2001. p. 261-79. (In Russ.)
  • Grigor’eva GA. Iazvennyi kolit bolezn’ Krona – problema XXI veka. Vestn Smol Gos Med Akad. 2011;10(1):12-14 (In Russ.)
  • Vorob’ev GI, Khalif IL. Nespetsificheskie vospalitel’nye zabolevaniia kishechnika. Moscow, RF: Miklosh; 2008. 422 p. (In Russ.)
  • Zakharash MM, Poida AI, Mel’nik VM. Khirurgicheskaia taktika pri iazvennom kolite. Materialy I S”ezda koloproktologov SNG; 2009 Okt 22-23; Tashkent, Uzbekistan; 2009. p. 30-31.(In Russ.)
  • Klinicheskie rekomendatsii «Bolezn’ Krona». Rossiiskaia Gastroenterologicheskaia assotsiatsiia, Assotsatsiia koloproktologov Rossii. MZ RF; 2020. 54 s. https://webmed.irkutsk.ru/doc/pdf/kr176.pdf (In Russ.)
  • Navruzov SN, Navruzov BS. Bolezn’ Krona. Tashkent: Shark; 2009. 351 p. (In Russ.)
  • Polunin GU, Giul’mamedov FI, Sedakov IE. Khirurgicheskoe lechenie nespetsificheskogo iazvennogo kolita i bolezni Krona. Novosti Meditsiny i Farmatsii. Gastroenteralogiia (tematicheskii nomer). 2012;(407). http://www.mif-ua.com/archive/article/28292 (In Russ.)
  • Khalif IL, Loranskaia ID. Vospalitel’nye zabolevaniia kishechnika (nespetsificheskii iazvennyi kolit i bolezn’ Krona). Klinika, diagnostika i lechenie. Moskva, RF: Miklosh; 2004. 88 s.
  • Shelygin IuA, Kashnikov VN, Bolikhov KV, Vardanian AV, Khalif IL. Effektivnost’ ileostomii pri bolezni Krona tolstoi kishki s perianal’nymi porazheniiami. RZhGGK. 2006;(6):64-68. (In Russ.)
  • Beglinger Ch, Gyr N. Incapacity to work, occupational disability and disability in inflammatory bowel disease. Ther Umsch. 2007 Aug;64(8):457-62. doi: 10.1024/0040-5930.64.8.457 [Article in German]
  • Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg. 2005 Mar;241(3):465-69. doi: 10.1097/01.sla.0000154551.06768.e1
  • Fedorov VD, Oleinikov PN, Alip’ev VIu. Rekonstruktivnaia khirurgiia u bol’nykh nespetsificheskim iazvennym kolitom i bolezn’iu Krona. Khirurgiia Zhurn im NI Pirogova. 1989;65(10):74-77. (In Russ.)
    • Address for correspondence:
    100060, Republic of Uzbekistan,
    Tashkent,. S. Azimova st, 74,
    Republican Clinical Hospital ¹1,
    Tel. mob: + 998 97 414-14-59,
    e-mail: myradbek@mail.ru,
    Mirzakhmedov Murad Mirkhaidarovich
    Information about the authors:
    Mirzakhmedov Murad Mirkhaidarovich, MD, Professor. Department of Surgical Diseases of Tashkent Medical Academy of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan.
    https://orcid.org/0000-0001-6760-7120
    Akhmedov Mukhamedzhan Akhmedovich, MD, Professor of the Department of Surgical Diseases of Tashkent Medical Academy of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan.
    https://orcid.org/0000-0003-0699-5232

    M.D. LEVIN

    CONGENITAL ANAL STENOSIS (ETIOLOGY, PATHOGENESIS, DIAGNOSIS AND TREATMENT)

    Department of Pediatric Radiology of the 1st State Hospital, Minsk,
    Republic of Belarus
    Dorot Medical Center for Rehabilitation and Geriatrics Netanya, Israel

    Objective. Congenital anal stenosis (CAS) is a rare form (2%) of anorectal malformations (ARM). All authors acknowledge the presence of the anal canal, but there are different ideas about the pathological anatomy and physiology of the CAS. Some believe that stenosis occupies a short distance between the wall of the anal canal and the anus. Others claim a long taper up to the dentate line. The volume of the operation depends on this. In the first case, the stenosis is dissected, and in the second, a pull-through operation is performed that destroys the anal canal.
    Methods. To detail the anatomy of the CAS, we analyzed X-ray studies of the CAS from our own experience and from literature sources to determine the length and location of the narrowed segment, as well as the width of the rectum, using our radiometric method.
    Results. A total of 7 X-ray studies of patients with CAS were analyzed, as well as 82 X-ray studies of different types of ARM. It has been shown that all forms of ARM, except for the true cloaca, develop in the embryological period in the same way with the formation of the anal canal because of the advancement of the internal anal sphincter (IAS) in the craniocaudal direction. The absence of the anus indicates that the exogenous rudiment of the anal canal does not move upward to meet the endogenous one. Therefore, penetration of the IAS beyond the anal canal leads to the formation of a narrow, rigid ring. If IAS penetrates through the subcutaneous tissue and skin, then CAS is formed. In other cases, the anus moves forward and upward, emerging outward or into any cavity, forming an ectopic anus onto the perineum, vestibule, urethra, or into the vagina.
    Conclusion. Congenital anal stenosis is one of the forms of ARM, characterized by the presence of a normal anal canal, where the stenosis of the normally located anus has a length of 2 to 5 mm. X-ray examination provides an accurate anatomical and physiological characteristic of the defect. Treatment should be carried out as early as possible to prevent the development of megacolons. Dissection of the rigid ring and insertion of a tube into the anal canal can lead to complete recovery. A hypothesis of the embryological development of ARA is described.

    Keywords: Anorectal malformations; congenital anal stenosis; embryology of anorectal malformations; X-ray examination; surgery
    p. 52-60 of the original issue
    References
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    Address for correspondence:
    4220200, Dorot
    Medical Center for Rehabilitation and Geriatrics
    Netanya. Israel
    Tel: 972 53 8281393
    e-mail: nivel70@hotmail.com
    Levin Michael D.
    Information about the authors:
    Levin Michael D., MD, PhD, DSc, Radiologist, Department of Pediatric Radiology of the 1st State Hospital, Minsk, Republic of Belarus, Dorot. Medical Center for rehabilitation and geriatrics, Netanya, Israel.
    https://orcid.org/0000-0001-7830-1944

    M.F. CHERKASOV, I.I. BABICH, Y.N. MELNIKOV, I.O. BAGNOVSKY

    CURRENT ASPECTS OF TREATMENT OF ACUTE PURULENT DESTRUCTIVE PNEUMONIA IN CHILDREN

    Federal State Budgetary Educational Establishment of Higher Education "Rostov State Medical University" of the Ministry of Health of the Russian Federation,
    State Budgetary Institution of the Rostov Region "Regional Children's Clinical Hospital", Rostov-on-Don,
    Russian Federation

    Acute purulent destructive pneumonia (APDP) is focal or confluent pneumonia of various etiologies, characterized by necrosis and purulent melting of lung tissue with the addition of pleural complications. The severity of the disease is due to a combination of respiratory and heart failure against the background of a pronounced intoxication syndrome, and a high mortality rate (2 - 13%). In children of the first year of life, mortality can reach from 22 to 51%. At the same time, hospitalization periods, according to various literature sources, can vary from 15 to 47 bed days. The study analyzed domestic and foreign literature data on surgical treatment of destructive pneumonia in children, published over the past 10 years. The search was carried out using keywords in such search engines as: eLibrary, PubMed, Medline, Scopus, Google Scolar. The article presents a review of 49 literature sources, which contains studies on the epidemiology, classification, diagnosis and treatment of destructive pneumonia in children. The work separately emphasizes the importance of early thoracoscopy in children with pulmonary-pleural forms of destructive pneumonia. The problem of treating destructive pneumonia in children currently remains extremely relevant. Despite the development of medical technologies and the introduction of new treatment methods, mortality in childhood remains at a fairly high level. The length of hospitalization due to the development of pulmonary-pleural complications can reach 47 bed-days. The issue of radical relief of bronchopleural fistulas, according to the authors remains open and requires the development of new treatment methods.

    Keywords: destructive pneumonia, bronchopleural fistula, thoracoscopy, children
    p. 61-69 of the original issue
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    Address for correspondence:
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    Rostov region, Rostov-on-Don,
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    tel. +7 9508492721,
    e-mail: pobzder@rambler.ru,
    Melnikov Yuri Nikolaevich
    Information about the authors:
    Cherkasov Mikhail Fedorovich, MD, PhD, Professor, Head of the Department of Surgery No. 4, Rostov State Medical University, Rostov-on-Don, Russian Federation.
    https://orcid.org/0000-0001-7587-8406
    Babich Igor Ivanovich, MD, PhD, Professor, Professor, Department of Surgery No. 4, Rostov State Medical University, Rostov-on-Don, Russian Federation,
    https://orcid.org/0000-0001-8282-2785
    Bagnovsky Igor Olegovich, PhD, Head of the Endoscopic Department of the State Budgetary Institution RO «Regional Children’s Clinical Hospital», Rostov-on-Don, Russian Federation.
    https://orcid.org/0000-0003-3672-4177
    Melnikov Yuri Nikolaevich, PhD, Assistant of the Department of Surgery No. 4, Rostov State Medical of University, Rostov-on-Don, Russian Federation.
    https://orcid.org/0000-0002-7035-0415
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