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Background: Posterior component separation with transversus abdominis release (TAR) is considered to be the optimal technique for large incisional ventral hernia repair. Endoscopic TAR (eTAR) that gets all the benefits of minimally invasive surgery (MIS) gives a possibility to enhance results of the treatment. The aim of our study was to make the comparison between open and endoscopic TAR procedures with an emphasis on frequency and severity of postoperative complications in comparable groups. Materials and methods: All patients had midline incisional hernia and underwent either open (open TAR group) or endoscopic (eTAR group) Rives-Stoppa repair in combination with bilateral transversus abdominis release in Moscow City Hospital №1 from January 2018 to December 2022. A propensity score matching (PSM) was used to make groups comparable. Postoperative complications were classified according to Clavien-Dindo Classification, and Comprehensive complication index was calculated. Results: We performed 133 open and endoscopic TAR separation for midline incisional hernia. After PSM analysis 51 patients were matched to each group. Overall surgical morbidity in the open TAR group (56.9%) was statistically significantly higher than in the eTAR group (29.4%) (p = 0.009). There were more severe complications (Clavien IIIa-V) in the open TAR group (11.8% vs. 0%, p = 0.027). Length of hospital stay after surgery was shorter in eTAR group (p < 0.001). The Comprehensive complication index in the open TAR group was significantly higher than in eTAR group, 8.7 (0–20.9) vs. 0 (0–8.7) (p = 0.011). Conclusion: Based on the data from our study, the entire MIS procedure including endoscopic TAR is a safe and optimal technique for surgery of midline incisional ventral hernia, requiring TAR separation in terms of reducing the rate of postoperative complications, their severity and hospital length of stay, compared to open TAR procedure. [ABSTRACT FROM AUTHOR]

The state of alcohol dependence is usually accompanied by emotional disorders, such as anxiety, depression, and aggressiveness. They arise against the background of disturbances in central neurotransmission and neurotrophic processes. Exercise is effective in restoring some damaged brain functions. The aim of our work was to identify disturbances in the g-aminobutyric acid (GABA) and brain-derived neurotrophic factor (BDNF) regulatory systems and the possibilities of their correction by exercise in rats with alcohol dependence. Alcohol dependence was modeled by ingesting food with alcohol at a dose of 1.25 g/kg body weight for 30 days, followed by alcohol withdrawal for 10 days. In rats under alcohol withdrawal, we found an imbalance of GABAergic activity between the frontal neocortex, hippocampus, and amygdala, a decrease in BDNF concentrations in the frontal neocortex, hippocampus, and serum, accompanied by increased anxiety levels. Wheel running during alcohol withdrawal (30 min daily for 10 days) restored the balance of GABA content in the brain structures and the reduced levels of BDNF (excluding reduced GABA and BDNF content in the frontal neocortex), and also reduced anxiety. Exercise increased hippocampal weight, which was decreased in alcohol-dependent animals. The negative correlation was found between indices of hippocampal weight and GABA concentration in hippocampus in intact and alcohol-dependent animals, which persisted even after exercise. The findings suggest that exercise is effective in restoring GABAergic and BDNF signaling impaired by alcohol intake. Restoration of synchronizing GABAergic regulation and BDNF levels contributes to anxiety reduction in alcohol-dependent rats. [ABSTRACT FROM AUTHOR]

Under the conditions of stress caused by the hostilities in Ukraine, steroid hormones play a leading role in regulating the body's adaptive functions Combat traumatic brain injury (TBI) creates an additional burden on the system of neurosteroid epigenetic regulation, the reaction of which is transformed internally systemically during the development of the consequences of trauma. This transformation over time requires serious study, as it should be taken into account when choosing tactics for effective treatment of patients. The aim of the study was to investigate changes in the concentration of progesterone, cortisol and testosterone in the blood serum and cerebrospinal fluid (CSF) of combatants with mild combat TBI in the acute and intermediate periods after contusion or concussion. In 65 patients with combat TBI: 15 - in the acute and 16 - in the intermediate period after brain contusion; 16 - in the acute and 18 - in the intermediate period after concussion, as well as in 7 conditionally healthy male subjects, the levels of progesterone, cortisol and testosterone in the blood serum (in patients with combat TBI - also in CSF) were studied by ELISA upon admission to the hospital. Studies have shown that serum progesterone levels significantly decrease in patients with contusions (by about 40%) in the acute period after TBI and do not recover in the future. Concussion causes a 30% decrease in serum levels of the hormone in the intermediate period after the injury. In CSF during the intermediate period, the concentration of the hormone significantly decreases by 20-25% compared to the acute period in both groups of combatants. Serum cortisol tends to increase significantly after combat TBI both in the acute and intermediate periods. In CSF during the intermediate period, the concentration of the hormone increases by 1.5-2.0 times compared to the acute period in both groups of combatants. Serum testosterone has a decreased level in the acute period after brain contusion with a tendency to recover in the future. In CSF during the intermediate period, the concentration of the hormone decreases by 3.5-4.0 times compared to the acute period in both groups of combatants. The ratio of cortisol/testosterone in the blood serum practically does not change over time, but the effects of cortisol over testosterone after brain contusion are much more prevalent. In CSF, the ratio of hormones increases in favor of cortisol by 6-8 times in the intermediate period after injury in both groups of combatants. The ratio of cortisol/progesterone in the blood serum of combatants also has a significant advantage in favor of cortisol, especially in the intermediate period after brain contusion. In CSF, the ratio of hormones increases in favor of cortisol by 2.0-2.5 times in the intermediate period after i njury in both groups of combatants. Thus, cortisol levels increase after combat TBI The level of testosterone, which was reduced in the blood serum in the acute period after brain contusion, is somewhat restored, but in the CSF in the intermediate period after the injury, the hormone content is sharply limited in both groups of combatants. in both serum and CSF, with the most pronounced increase in CSF in the intermediate period. The level of progesterone, a precursor of cortisol and testosterone, is significantly reduced in both serum and CSF, especially in the intermediate period after trauma. Changes in the ratio of cortisol/testosterone and cortisol/progesterone in favor of cortisol indicate the dominance and intensification of stress and catabolic effects of cortisol, especially at the brain level, in combatants of both groups, most of all in the intermediate period after trauma. The obtained data demonstrate an increase in the deficit of compensatory and restorative capabilities of the neurosteroidal regulation in the dynamics of time after combat TBI. This fact requires special attention to the choice of the temporal strategy for the treatment of combatants with TBI. [ABSTRACT FROM AUTHOR]

The progression of purulent inflammation in any acute surgical abdominal pathology can lead to local or diffuse peritonitis. The parameters characterizing the degree and specificity of the inflammatory response in blood such as cytokine concentration, neutrophil activity, plasma antioxidant capacity (thiols concentration) could be considered as potential predictors of complications. The luminol-dependent chemiluminescence (CL) response of blood activated by the phorbol ester (PMA), levels of cytokines IL-6, IL-8, IL-10, myeloperoxidase (MPO) and thiols were measured in plasma of patients with uncomplicated conditions (group 1, n = 8), local peritonitis (group 2, n = 9) or diffuse peritonitis (group 3, n = 9) at admission (before surgery, b/s), immediately after surgery (a/s) and a day after surgery (1 day) as well as in healthy volunteers (norm, n = 12). At all time-points the concentrations of cytokines and MPO measured by the ELISA method, in group 3 were higher than in healthy volunteers and in patients in groups 1 and 2. Blood CL demonstrated a more than 5-fold increase above the normal values in all patients, and it was also higher in group 2 as compared to group 1. In group 3 there were patients with both maximal and minimal CL values, which could be a consequence of neutrophil priming or exhaustion ("immune paralysis"), respectively. In these patients the plasma thiol content demonstrated a more than 3-fold decrease below normal values. In patients with fatal outcomes (group 3, n = 2) within a day after surgery, either a decrease of the CL to zero values concurrently with elevated IL-8 and IL-6 concentrations and low thiol levels was observed, or CL exceeded normal values more than 20 times with concurrent complete exhaustion of the plasma thiol pool. No clear dependency between the plasma parameters and neutrophil activity was found. This suggests that a panel of parameters for prognosis and/or early diagnostics of infectious complications in acute abdominal pathology should include different biomarkers of the inflammatory response: cytokine profile (IL-6, IL-8, IL-10), MPO and neutrophil activity, antioxidant plasma capacity (e.g., total thiols concentration). [ABSTRACT FROM AUTHOR]

Background: Monopolar energy (ME) is routinely used in appendectomy. This study aimed to investigate the degree of lateral thermal spread generated by ME and to evaluate the thermal injury sustained by the close-lying tissues.Methods: Appendectomy with a monopolar Maryland dissector was performed in 8 rabbits (at 30 and 60 W power settings). A high-resolution infrared camera was used to record tissue heating during the intervention. After autopsy macroscopic changes were evaluated and tissue samples were subjected to myeloperoxidase (MPO) assay and histological examination.Results: No significant differences in the extent of thermal spread, MPO activity and histological signs of inflammation were observed between groups. Regardless of the power settings, the heat spread exceeded 2 cm laterally along the mesoappendix when application time exceeded 3 s. The spread of heat through tubular structures in both groups caused a significant temperature rise in the nearby intestinal loop, resulting in perforation (n = 3) and necrosis (n = 1).Conclusions: Application time is critical in thermal spread during appendectomy aided by ME. Tubular anatomic structures can enhance thermal injury on distant tissues. The observed effects of ME bear clinical relevance that need further investigation. [ABSTRACT FROM AUTHOR]

Standard and light surgical meshes with identical knitted structure: Parietene Standard/Parietene Light and Premilene/Optilene were chosen for hernioplasty in 20 rats. Six months after surgery, the complications were primarily related to inflammation in groups with implanted standard meshes and with prosthesis deformation in groups with light meshes. The character of complications was determined by characteristics of knitting structure and mechanical proprieties of surgical meshes. [ABSTRACT FROM AUTHOR]