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Introduction. Metastatic spinal lesion remains one of the most difficult problems of modern medicine. The purpose of treatment of patients with metastatic spinal lesion is to reduce pain, improve the quality of life, restore stability in the affected segment, prevent or reduce neurological deficits. In order to build the right treatment tactics, it is necessary to evaluate the prognosis of the life of a patient with spinal metastases before treatment.The study objective is to evaluate the prognostic significance of the Tokuhashi scale in patients with metastatic spinal lesion.Materials and methods. The study included 124 patients with metastatic spinal lesion operated in the spinal department in the period from March 2013 to July 2019 (64 (52 %) men and 60 (48%) women). The average age was 59 years and ranged from 18 to 78 years. The catamnesis ranged from 1 month to 6 years. 6 (5 %) spinal tumors were radically removed, palliative removal was performed in 77 (62 %) cases. In the remaining cases, 41 (33 %) underwent vertebroplasty. The mandatory diagnostic protocol of the preoperative examination included oncological status, clinical and neurological examination. The functional status of the patient was assessed on the Karnofski scale, life expectancy – on the Tokuhashi scale. In terms of preoperative examination, patients underwent computed tomography examination with intravenous contrast of three zones: the thoracic, abdominal cavities and pelvic region to determine the degree of dissemination of the process and, in some cases, to identify the primary focus. Currently, positron emission tomography is the optimal method of investigation at the preoperative stage. However, this method is not yet available in all clinics, so performing computed tomography scans of three zones is currently the optimal “gold standard” for examining this category of patients..Results. The life expectancy estimate was calculated for each patient according to the Tokuhashi scale (2005). Survival analysis was performed using Kaplan-Meier curves within the Tokuhashi prognostic groups. The median survival within the Tokuhashi groups was more than 3 years for the group of 12–15 points (life expectancy over a year), 14 months for the group of 9–11 points (life expectancy 6 to 12 months) and 7 months for the group of 1–8 points (life expectancy less than 6 months). The Cox model was used to identify factors related to survival.Conclusion. Determining the tactics of surgical treatment of a patient with a metastatic lesion of the spine is a complex and multicomponent question to which there is no unambiguous answer. A multidisciplinary consultation is currently the most adequate and reliable way to determine the treatment strategy for this category of patients. The use of the Tokuhashi prognostic scale is an additional effective tool for determining the life expectancy of patients with spinal metastases, and thus, in some cases, serve as the tool with which it is possible to determine the tactics of surgical treatment of patients.

Follicular lymphoma (FL) is the second most common non-Hodgkin’s lymphoma. In this work, comparative analysis was carried out of transcriptomes of tumor tissue samples from patients with FL in comparison with control samples of lymph nodes with reactive follicular hyperplasia in order to search for intracellular signaling pathways of the immune response, the functioning of which is altered in the tumor and its microenvironment. Nine hundred and ninety-seven genes were found, the expression of which differs in tumor and control samples. Of these, 430 genes are overexpressed in FL, while 567 genes exhibit decreased expression. Signaling pathways for the regulation of the cell cycle, cell response to stress and DNA damage, chromosome organization, and RNA processing have been activated. Among genes with reduced expression, genes associated with signaling pathways that control the immune response predominate. One of the most suppressed signaling pathways in FL controls the activation of T-lymphocytes. Of the 29 genes involved in the activation of T cells, the expression of which is suppressed in FL, three genes (CD28, LAT, and ZAP70) are involved in signal transduction in anti-PD-1 therapy. Thus, the level of expression of these genes in a patient can potentially be a biomarker of predictive value in anti-PD-1 therapy in FL.

The pharmacokinetics of two substances containing recombinant insulin-like growth factor 1 (IGF1) as an active substance was considered. The first substance (IGF1) contains the actual recombinant IGF1, and the second (IGF2) contains IGF1, which is translated from plasmid DNA encoding the IGF-1 gene for this protein. It was established that, with intramuscular administration of IGF1, the delay time for its entry into the bloodstream is 1.5–2 h, while that with IGF2 is 24–25 h. This indicates the presence of various mechanisms of accumulation of these substances in the systemic circulation. The maximum concentration of IGF1 in the blood was determined 5 h after administration and that of IGF2 was determined 125 h after administration. The maximum concentrations of these substances are comparable to each other. The concentration of IGF1 in the blood decreases to its initial value 12 h after its administration, and the concentration of IGF2 does so after 216 h. The clearance parameters (Cl) and elimination constants (Kel) of the considered substances also had significant differences, which confirms the presence of fast and slow dynamics of the decrease of their maximum concentrations after intramuscular injection. The different dynamics of the accumulation of substances in the blood and their elimination from the bloodstream after administration, as well as the different values ​​of the area parameters under the pharmacokinetic curve (AUCt, AUC∞) demonstrate that IGF2 has been in the systemic circulation for a longer time than IGF1. This is essential for the appearance and severity of pharmacodynamic effects.

The article approaches conceptual aspects of analyzing and modeling adaptive protection systems of operational cybersecurity centers. The conditions of global information environment are constantly changing which provides security systems an opportunity to automatically adapt to requirements of modern software. The problem of integrating a complex security system into an operational cybersecurity center and defining interaction rules between the functional components consists of several tasks. The main of them are analysis and implementation of various formalized procedures for ensuring integrated security. An adaptive integrated security system is considered as an object that either implements the ability to control and promptly build a protection model, depending on the problem being solved, or assists in preventing or eliminating an incident.

The study examined the relationship between the contents of principal flavones of Scutellaria baicalensis Georgi and the activity of endogenous b-glucuronidase (sGUS) in differentiated and undifferentiated in vitro cultures grown on solid and liquid medium. Using RP-HPLC, it was shown that sGUS activity did not correlate with the increase in biomass of cultures, but depended on tissue differentiation. In hairy roots cultured both on liquid and solid medium, it was ten times higher than in undifferentiated cultures. At the same time, the share of aglycone forms in the total content of flavones during the culture cycle depended on the growing conditions. It was significantly higher on agar medium than on liquid medium. A correlation between sGUS activity and total aglycone content, as well as wogonin content, was observed only in hairy roots grown in the liquid medium.

The study objective is to analyze the effectiveness of the use of minimal invasive polyetheretherketone (PEEK) rod systems in the treatment of lumbar spine degenerative diseases.Materials and methods. The minimal invasive semi-rigid stabilization using PEEK rod systems was performed in 24 patients (4 (17 %) male and 20 (83 %) female) patients (mean age 46.3 ± 8.4, ranging from 32 to 63). The average follow-up duration was 15 months. Inclusion criteria: mechanical low back pain, White–Panjabi instability: 5 points, degenerative changes of the disc by C. Pfirrmann scale: II–IV grade. Follow-up at the 6 and 12 months postoperatively.Results. In the postoperative period, the majority of patients had a complete or significant regression of pain (on average, from 6.3 to 1.8 points on the visual analog scale). The Oswestry disability index decreased from 64/66 [64; 68] to 33/34 [32; 36] in 6 months (p Conclusion. The PEEK rod fixation in patients with mechanical low back pain provides good and excellent clinical results on the I. Macnab scale in 83.4 % of cases. Within 12 months, the minimal volume of movements on the operated segment remains, without signs of continued degeneration of adjacent intervertebral discs.

Objectives: is to investigate the reparative effect of used platelet rich plasma (PRP-therapy) on cartilage structure Patients and methods: The study included sixty six patients. First group received hyaluronic acid. Second group were undergoing arthroscopy (AS) and received PRR. The third group received $\mathbf{HA}+\mathbf{PRP}$ via arthroscopy Analysis of cartilage thickness were performed before treatment and after 3 and 6 months by ultrasounds imaging. The function activity were evaluated by WOMAC and Lequesne score. Results: Among patients of the first group, we revealed increasing the thickness of cartilage in upper patella region in three months. After 6 months increasing the thickness of cartilage were also established in the second and the third group (1.7 vs 2.0, $\mathbf{p}=0.05$ for $\mathbf{HA}+\mathbf{AS}$ ) and (1.7 vs 2.2, $\mathbf{p}=0.03$ for $\mathbf{HA}+\mathbf{PRP}$ ). In addition, in all groups, the level of pain according VAS score was significantly reduced after 6 months (46 vs 33, $\mathbf{p}=0.01$ ). Also, according to the WOMAC, stiffness and restriction were decreased, most of all in the $\mathbf{HA}+\mathbf{PRP}$ group. Conclusions: The data obtained indicated that combination strategy using hyaluronic acidy and PRP-therapy are most effective for cartillagines structure and allows to achieve a good clinical response.

In the article, we describe a clinical case of syringomyelia associated with an Arnold-Chiari type 1 malformation, evaluate the efficacy of syringosubarachnoid shunting, and analyze the literature data of domestic and international researchers involved in investigation and treatment of the pathology. Application of syringosubarachnoid shunting in the described case resulted in a clinical improvement in the form of regression of paresis and hypoesthesia, which demonstrated the efficacy of the shunting technique for correction of the syringomyelia symptoms.Описан клинический случай сирингомиелии, ассоциированной с аномалией Арнольда-Киари 1-го типа, проведена оценка эффективности метода сирингосубарахноидального шунтирования, а также проанализированы данные литературы отечественных и зарубежных авторов, занимающихся изучением и лечением данной патологии. Результатом применения метода сирингосубарахноидального шунтирования в описываемом случае явился регресс пареза и гипестезии, что продемонстрировало эффективность шунтирующей методики для коррекции симптомов сирингомиелии.

As the life span and proportion of people over 65 years increase, the incidence of degenerative lumbar spine stenosis grows proportionally. Various parameters of the spinopelvic relationships are used to predict surgical treatment outcomes in patients with degenerative spine diseases. There are no unified protocols for evaluation, in terms of the sagittal balance, of surgical treatment outcomes in elderly patients.To study the impact of sagittal balance parameters on the life quality of elderly and senile patients after surgery for degenerative stenosis of the lumbar spine.The study included 109 patients. Decompression was performed in the first group of 53 patients. Decompression and stabilization were performed in the second group of 27 patients. In the third group of 29 patients, XLIF indirect decompression, scoliosis correction, reconstruction of disturbed spinopelvic relationships, and stabilization were carried out. We evaluated the following sagittal balance parameters: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and PI minus LL (PI-LL). The quality of life indicators were assessed using VAS, ODI, and SF36 scores.In the first group, there were not statistically significant differences for PT≤20° and PT20°. A statistically significant change in the PI-LL parameter (p=0.0263) was in the first group. A decrease in PI-LL was accompanied by regression of pain (p10-4). In the second group, comparison of the quality of life indicators revealed no statistically significant differences between PT≤20° and PT20° as well as PI-LL≤10° and PI-LL10 in the postoperative period. In the third group, postoperative improvement in PT (p=0.0002) and PI-LL (p=0.0008) parameters was accompanied by a decrease in pain in the legs (p=0.0002) and lumbar spine (p=0.0001).Improvement in the quality of life indicators in 48.6% of cases was achieved by decompression only; the sagittal balance parameters had no significant impact on quality of life. In 24.8% of cases, improvement in the quality of life indicators was achieved by decompression and stabilization because the dominant clinical neurological syndrome was instability. Reduced quality of life in 26.6% of patients was caused by disturbed spinopelvic relationships. Application of the XLIF technique in these patients provides statistically significant restoration of the sagittal balance parameters, PT and PI-LL, which improves quality of life.В связи с увеличением продолжительности жизни и увеличением доли людей старше 65 лет заболеваемость дегенеративным стенозом поясничного отдела позвоночника пропорционально увеличивается. Для прогнозирования результатов хирургического лечения у пациентов с дегенеративными заболеваниями позвоночника используют различные параметры позвоночно-тазовых взаимоотношений. Нет единых протоколов оценки результатов хирургического лечения пациентов старшей возрастной группы с позиции сагиттального баланса. Цель исследования - изучить влияние параметров сагиттального баланса на качество жизни пациентов пожилого и старческого возраста, оперированных по поводу дегенеративного стеноза поясничного отдела позвоночника. Материал и методы. В исследование включены 109 пациентов. В 1-й группе из 53 пациентов проведена декомпрессия. Во 2-й группе из 27 пациентов проводены декомпрессия и стабилизация. В 3-й группе из 29 пациентов проведены непрямая декомпрессия по XLIF, коррекция сколиотической деформации, восстановление нарушенных позвоночно-тазовых взаимоотношений и стабилизация. Оценивали параметры сагиттального баланса: PI - Pelvic incidence, SS - Sacral slope, PT - Pelvic tilt, LL - lumbal lordosis, PI–LL (PI минус LL). Показатели качества жизни оценивали по шкалам: VAS, ODI, SF-36. Результаты. В 1-й группе при PT≤20° и PT20° не выявлено статистически значимых различий. Статистически значимо в 1-й группе изменился показатель PI–LL (р=0,0263). Уменьшение PI–LL сопровождалось регрессом болевого синдрома (p10–4). Во 2-й группе при сравнении показателей качества жизни в послеоперационном периоде с PT≤20°, PT20°, P– LL≤10° и PI–LL10° не выявлено статистически значимых различий. В 3-й группе в послеоперационном периоде улучшение показателей PT (р=0,0002), PI–LL (р=0,0008) сопровождалось уменьшением болевого синдрома в ногах (p=0,0002), поясничном отделе позвоночника (p=0,0001). Заключение. Улучшение показателей качества жизни в 48,6% случаев достигается только декомпрессией, параметры сагиттального баланса на качество жизни достоверно не влияют. В 24,8% случаев улучшение показателей качества жизни достигается декомпрессией и стабилизацией, поскольку доминирующим клинико-неврологическим синдромом является нестабильность. Сниженное качество жизни у 26,6% больных обусловлено нарушенными позвоночно-тазовыми взаимоотношениями. Применение метода XLIF у этих больных обеспечивает статистически достоверное восстановление показателей сагиттального баланса PT, PI–LL, что приводит к улучшению качества жизни.

Aim. To compare long-term results of coronary artery (CA) angioplasty and stenting. To assess dyslipidemia, diabetes mellitus and systemic inflammation effects on angina recurrence during five post-intervention years. Material and methods. During 1989-2005, five-year follow-up results for 793 patients with CA stenting and 272 patients with angioplasty were analyzed. Results. At five years after endovascular intervention, comparing to hospitalization period, the number of patients with recurrent angina substantially increased. Long-term recurrent angina rates were affected by increased levels of total cholesterol, low-density lipoproteins, alpha-lipoprotein, C-reactive protein, and concomitant diabetes mellitus. Conclusion. Comparing to conservative treatment, coronary intervention was associated with better quality of life, reduced rates of III-IV functional class angina and death. In five-year follow-up, repeated endovascular intervention is as effective as coronary artery stenting, but as many as 2,6 repeated angioplasty procedures might be needed.

A comparison of long-term angioplasty vs coronary bypass surgery results, together with assessment of dyslipidemia, diabetes mellitus, and systemic inflammation effects on recurrent angina rate, was performed during a five-year follow-up period. In 1989-2005, long-term results for 793 coronary bypass patients and 272 angioplasty patients, followed up for 5 years, were analyzed. Statistical analysis was performed with Analysis ToolPak - VBA. Comparing to in-hospital period, in 5 years after the intervention, the number of patients with recurrent angina substantially had increased. Long-term recurrent angina rates were influenced by increased levels of total cholesterol, low-density lipoprotein cholesterol, alpha-lipoprotein, C-reactive protein, and diabetes mellitus. Comparing to conservative treatment, intervention was associated with quality of life improvement, decreased angina rate and mortality. During five-year follow-up, endovascular re-intervention is as effective as coronary bypass surgery, but the need for possible 2-6 angioplasty should be taken into account.

Aim. To study long-term results of balloon coronary angioplasty (BCA) and coronary artery stenting (CAS), according to baseline CA lesion severity, by morphological stenosis classification. To assess restenosis influence on myocardial contractility dynamics, recurrent angina incidence, and physical stress tolerance. Material and methods. The study included 228 men after BCA and 184 men after CAS with non-drug-coated wire stents. Another coronary angiography was performed one year after the intervention, in 358 participants. All patients were divided into two groups: Group I (n=161; 180 stents implanted); Group II (n=197; 266 BCA procedures performed). Standard methods of variation statistics were used, with statistical package Analysis ToolPak-VBA (Microsoft Excel 97). Results. One year later, after all types of endovascular intervention, in comparison with hospitalization period, the number of patients without angina symptoms substantially reduced, and the number of angina patients significantly increased. In Group II, restenosis rate and the number of angina patients were substantially higher, and the number of angina-free individuals was significantly lower, comparing with Group I. Long-term restenosis rate after endovascular intervention was affected by initial CA lesion morphology. In Type C, comparing to Type A of CA lesions, restenosis incidence was higher by 2-2.5 times, regardless of endovascular intervention type. Conclusion. Choosing coronary heart disease management tactics, initial CA lesion morphology should be taken into account. CAS is more preferable than BAP, especially in Type C CA lesions.

The study aim was to evaluate the effectiveness of intraoperative monitoring of motor evoked potentials (MEPs) for predicting changes in the neurological status of patients with cervical spinal cord tumors in the early postoperative period.The study included 74 patients with intradural cervical spinal cord tumors who were operated on using motor evoked potential monitoring in the period from 2013 to 2016. There were 29 (39%) males and 46 (61%) females. Group 1 included 26 (35%) patients with intramedullary tumors; group 2 included 48 (65%) patients with intradural extramedullary tumors. The neurological status was assessed by using a six-grade muscle power MRC scale; a modified McCormick scale was used to evaluate the functional status. Transcranial electrical stimulation of the precentral gyri was performed. Recording electrodes were located in the peripheral target muscles of the upper and lower limbs. Total intravenous anesthesia with propofol and fentanyl was used.In Group 1, MEPs decreased in 19 (73%) of 26 patients; MEPs remained unchanged in 7 (27%) patients. Among the patients with decreased MEPs, 14 (74%) patients had postoperative deterioration of the neurological status; 6 (32%) patients had a preoperative severe neurological deficit; 4 (21%) patients had no changes in the neurological status. The sensitivity and specificity of MEPs from the upper limb muscles were higher than those from the lower limb muscles. In Group 2, improvement of the neurological status occurred in all 48 patients. There was no case of a true positive decrease in the MEP amplitude.1. Registration of MEPs is a highly sensitive and highly specific method for diagnosing corticospinal tract dysfunction in patients with intramedullary tumors of the cervical spinal cord. The sensitivity and specificity of MEPs recorded from the upper limbs are higher than those from the lower limb muscles. 2. The sensitivity of MEPs in patients with extramedullary intradural tumors was 0%, the diagnostic effectiveness of MEPs amounted to 86% from the upper limb muscles and 93% from the lower limb muscles. 3. When the MEP amplitude in patients with extra- and intramedullary tumors of the cervical spinal cord decreases, a change in the surgion's approach may reduce or completely eliminate surgically-induced damage to the spinal cord.Цель исследования - оценить эффективность интраоперационного мониторинга моторных вызванных потенциалов при прогнозировании динамики неврологического статуса в раннем послеоперационном периоде у пациентов с опухолями шейного отдела спинного мозга. Материал и методы. Обследованы 74 пациента: 29 (39%) мужчин и 46 (61%) женщин с интрадуральными опухолями шейного отдела спинного мозга, оперированных с использованием мониторинга двигательных вызванных потенциалов с 2013 по 2016 г. В 1-ю группу интрамедуллярными опухолями включили 26 (35%) пациентов; во 2-ю группу - 48 пациентов с (65%)- интрадуральными, экстрамедуллярными опухолями. Неврологический статус оценивали по шестибалльной шкале мышечной силы (MRC-scale), для определения функционального статуса применяли модифицированную шкалу McCormick. Проводилась транскраниальная электрическая стимуляция прецентральных извилин. Регистрирующие электроды распологали в периферических мышцах-мишенях рук и ног. Проводилась тотальная внутривенная анестезия пропофолом и фентанилом. Результаты. В 1-ю группу: снижение моторных вызванных потенциалов (МВП) 19 (73%) из 26 пациентов, без изменений МВП - 7 (27%). Среди больных со снижением МВП у 14 (74%) ухудшение неврологического статуса после операции, у 6 (32%) из них грубый неврологический дефицит до операции, у 4 (21%) - без изменения неврологического статуса. Чувствительность и специфичность МВП с мышц рук оказалась выше, чем с мышц ног. Во 2-й группе: улучшение неврологического статуса выявили у всех 48 пациентов. Не зарегистрировано ни одного случая истинно положительного снижения амплитуды МВП. Выводы. 1. Регистрация МВП является высокочувствительным и высокоспецифичным методом диагностики нарушения функции кортикоспинального тракта у больных с интрамедуллярными опухолями шейного отдела спинного мозга. Чувствительность и специфичность МВП, зарегистрированных с верхних конечностей, выше данных показателей МВП с мышц нижних конечностей. 2. Чувствительность МВП у пациентов с экстрамедуллярными интрадуральными опухолями соответствует 0%, диагностическая эффективность с мышц рук составила 86%, с мышц ног - 93%. 3. При снижении амплитуды МВП у больных экстра- и интрамедуллярными опухолями шейного отдела спинного мозга изменение тактики хирурга обеспечивает возможность уменьшить или полностью нивелировать хирургически индуцированное повреждение спинного мозга.

Aim. To compare long-term results of coronary artery (CA) angioplasty and stenting, according to baseline CA stenosis morphology. To assess clinical course of coronary heart disease (CHD) during long-tem follow-up after endovascular intervention. Material and methods. During 1989-2005, 228 males with angioplasty and 184 males with non-eluted CA stents were recruited. One year later, 358 patients were examined, 5 years later - 273. Results. At five years after endovasular intervention, comparing to baseline and one-year results, the number of patients without angina symptoms substantially decreased, and the number of participants with angina increased. Long-term restenosis incidence was affected by initial CA stenosis morphology. In С Type, comparing to A Type, restenosis developed more often, by 2-2,5 times, regardless of endovascular intervention type. Conclusion. Choosing the therapeutic tactics in CHD, initial CA stenosis morphology should be taken into account. Stenting is more effective than angioplasty, especially in С Type pathology.