Search

In order to find out the mechanisms of pathogenesis of degenerative-dystrophic diseases of the spine, it is of particular interest to search for body parameters which are directly or indirectly interrelated with the key factors of peripheral conversion of nidus iodothyronines and constitute a system of network interactions, affecting metabolic indicators at the local and systemic level.The aim. To search for correlations of local key factors of peripheral conversion of Ligamentum flavum iodothyronines with indicators of biochemical, hematological and hormonal blood profiles of patients with stenosing processes of the spinal canal and dural sac in the lumbar spine.Materials and methods. 33 patients (15 males, 18 females) with stenosing processes of the spinal canal and dural sac in the lumbar spine were examined (mean age – 45.73 ± 1.95 years). The expression of deiodinase genes and other candidate genes was determined in Ligamentum flavum biopsies collected during surgical treatment. Biochemical, hematological and hormonal parameters were determined in peripheral blood. The resulting data array was processed in order to find correlations between the parameters of systemic and local metabolism.Results. The relationships of deiodinases with the expression of GDF5, MMP1, MMP3 and TIMP1 in Ligamentum flavum (p < 0.05) were found. Of the hormonal profile of the blood serum, the most significant indicators were thyreotropin, free triiodothyronine and thyroperoxidase antibodies. In the biochemical profile, levels of direct bilirubin, total cholesterol, HDL and LDL cholesterol and triglycerides changed along with the expression of deiodinases. Correlative relationships with the expression of deiodinases were found for the following hematological analytes of whole peripheral blood: hemoglobin, mean corpuscular hemoglobin concentration, numbers of granulocytes, lymphocytes, eosinophils, monocytes, band neutrophils, red cell distribution width and platelet crit. The data obtained indicate the involvement of peripheral conversion factors in the pathogenetic process and provide information to form a new view on the pathogenesis of degenerative-dystrophic processes in the Ligamentum flavum of patients with stenosing processes of the spinal canal and the dural sac in the lumbar spine.

Background. The results of treatment of the elderly patients operated for spinal stenosis allow us to suggest that a cascade of degenerative changes in the spinal motion segments causes the formation of an adjacent level syndrome, pseudarthrosis, and in some cases – the instability in the fixing structure.The aim of the study. To determine the prognostic factors for the adjacent level syndrome in patients after decompressive and stabilizing spinal surgeries.Methods. We carried out a retrospective cohort study of the surgical treatment of 129 elderly patients (over 60 years of age) for the period from January 2018 to March 2022, who underwent surgery at the lumbosacral level of spine for degenerative spinal stenosis.Results. The outcomes of surgical treatment of 129 patients and the results of discriminant analysis of morphometric studies of computed tomography data indicate that the most significant indicators for the development of the adjacent level syndrome are the lordosis angle in the segment adjacent to the operated one (the mean value in the analyzed group is 12.87 ± 2.22°; in the control group – 11.92 ± 2.97°); the anterior height of the adjacent intervertebral disc (the mean value in the analyzed group is 12.70 ± 2.44 mm; in the control group – 11.46 ± 3.58 mm) and the difference of anterior and posterior disc heights at the adjacent level (the mean value in the analyzed group is 5.48 ± 2.84 mm; in the control group – 6.27 ± 2.71 mm).Conclusion. When analyzing the treatment outcomes of 129 elderly patients operated for degenerative spinal stenosis using instrumented spinal fusion, we revealed that in 16 patients, the adjacent level syndrome developed with an increase in the lordosis angle at the level adjacent to the operated segment. An increase in the anterior height of the adjacent intervertebral disc and the decrease in the difference of anterior and posterior disc heights at the adjacent level can be considered as unfavorable prognostic factors (p = 0.83).

Background: Among the modern methods of surgical treatment of the lumbar spines degenerative stenoses, decompressive-stabilizing surgical interventions using transpedicular screw-rod structures occupy an important place. The use of metal structures is justified not so much by the degenerative process specifics, degree or length of stenosis, but by the presence of instability in the spinal motion segments. In turn, the widespread use of fixing structures has naturally led to an increase in the specific complications, reaching 1020 per cent of the total number of operated patients. One of the threatening complications of decompressive-stabilizing operations is the fracture of structural elements, often with the formation of pathology at the adjacent levels. The reasons for these complications are associated with both an erroneous choice of the construct parameters and a violation of the technique for installing the transpedicular fixation system (TPS). Clinical case description: The article presents an analysis of the clinical symptoms appearing with the formation of the adjacent level syndrome due to a fracture of the TPS system screws used to treat central stenosis of the spinal canal at the LIV -LV level. The correction of the pathology was carried out with a repeated surgical intervention. Conclusion: This clinical example draws attention to the combination of the adjacent level syndrome with a fracture of the metal structure in a patient after a decompressive-stabilizing operation using screw-rod fixation. An early diagnosis and adequate correction of the pathology helps to avoid the aggravation of symptoms and disability of patients.

An analysis of the effectiveness of laser vaporization in 67 patients (23 men, 44 women) with the syndrome of the “adjacent level” of the lumbarspine, who had previously undergone decompressive-stabilizing operations, is presented. The mean age of the patients was 48.3 years (from37 to 54 years).The most common cause of pain syndrome recurrence was protrusion of the intervertebral discs (60 people, 90 %). A positive result of laservaporization in the early postoperative period was achieved in 62 patients (92.5 %). Analysis of the results of treatment in 32 patients in the interimperiod revealed excellent results in 5 (15.5 %) patients, good results – in 12 (37.5 %) patients, and satisfactory results – in 15 (47 %) patients.

Background: Degenerative pathology of the facet joints of the lumbar spine remains a significant medical and social problem due to persistent pain syndrome, high incidence and disability rate. Clinical case description: A patient complaining of pain and discomfort in the lumbosacral spine on the right, arising in the upright position, intensifying with bending and flexion-extension of the trunk, and periodically spreading to the right gluteal region and along the posterior surface of the thigh, was admitted to the neurosurgical department of the Irkutsk Scientific Center of Surgery and Traumatology. A surgical treatment was performed in the form of dereception of the LIILIII, LIIILIV, LIVLV arch-process joints. In the postoperative period, the patient noted a decrease in the intensity of pain in the lumbosacral spine to 3 points by a visual analog scale and was discharged from the department on the 5th day after the surgery in a satisfactory condition. Conclusion: Facet joint pathologies represent a most common nosological form of the degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and chronic pain syndrome. The complex anatomical and topographic relationships between the facet joints, intervertebral discs, and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. Understanding the morphological, clinical, and radiological features of the course of the facet joint degeneration makes it possible to increase the diagnostic capabilities for detecting facet syndrome of the lumbar spine and effectively apply transcutaneous surgical technologies for the treatment of chronic pain syndromes.

Terminal Heart Failure with reduced Ejection Fraction (HFrEF) is associated with severe morbidity and mortality. Mechanical Left Ventricular Assist Devices (LVAD) are often used to provide these patients with a last resort therapy and as bridge to transplant. However, HFrEF patients with LVAD have significant myocardial substrate for ventricular arrhythmias and the LVAD itself might be regarded as pro-arrhythmogenic. Aim of the current study was to investigate the mechanism of ventricular arrhythmias in LVAD patients and to provide evidence for the hypothesis that ad-hoc ablation/substrate modification during surgical LVAD implantation might reduce the risk of VT. We retrospectively analyzed invasive ablation procedures in patients with VT±LVAD and determined the mechanism of arrhythmia during electrophysiological examination (using 3D electroanatomical and local activation time mapping; Carto; Biosense Webster) in LVAD (n=17) and non-LVAD (n=12) subgroups. Mean age of the predominantly male (97%) patients was 60±2 years. VTs were directly LVAD associated (i.e. focal, adjacent to LVAD insertion or macro-reentry, around LVAD) in almost half of the LVAD patients. Number of radiofrequency ablation (RF) lesions and RF time were not significantly different between LVAD associated VT and non-LVAD associated VT patients. Within the LVAD patient group, freedom from VT (mean follow-up 40±6 months) was 50% upon ablation in patients with VTs originating from the LVAD region and 70% if ablation was conducted in non-LVAD regions. None of the LVAD associated and 22% of non-LVAD associated VT patients died during follow-up of these critically ill patients. Moreover, to reduce LVAD related arrhythmias and based on additional ex-vivo/in-silico derived data, we propose a distinctive (i.e. “star” shaped, LVAD encirclement) epicardial substrate modification during surgical LVAD implantation. In summary, a significant percentage of patients with LVAD exhibit LVAD-associated focal/macro-reentry VT and recurrence rates are high. VT likelihood is reduced ex-vivo/in-silico upon substrate modification targeting myocardium adjacent to a possible LVAD implantation site. Epicardial RF ablation during surgical LVAD implantation might allow prevention of LVAD-associated focal/macro-reentry VT. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DFG

The fact of increasing the elasticity of polyethylene gas pipelines in the process of long-term aging has been found. resumably, the increase in elasticity is due to the accumulation of mercaptans present in natural gas in the wall of the polyethylene pipe. It is shown that a specific mechanism for increasing elasticity during long-term operation consists in creating conditions for the development of secondary necking.

Every year, the number of operations on the lumbar spine with the use of various spinal fusion techniques increases, which leads to an increase in the number of cases in the long-term period of surgical treatment, the formation of pathology of the adjacent segment (ASP), which is part of the structure of the failed back surgery syndrome (FBSS). It is known that the pathology of the adjacent segment is a general term and covers two concepts: the degeneration of the adjacent segment (ASDeg) and the disease of the adjacent segment (ASDis). ASDeg is represented by radiographic changes occurring in the adjacent spinal motion segments during spinal surgery with spinal fusion, and ASDis refers to the clinical symptoms that develop during radiographic changes in these segments. With the pathology of an adjacent segment, clinically significant degenerative changes in it are not always formed. If these X-ray changes are formed and correlate with clinical and neurological manifestations, then surgical treatment is indicated. This pathology can be treated with repeated surgical intervention, which this article demonstrate with the clinical example of surgical treatment of the adjacent segment of the spine during fusion.

Pain in the spine is one of the most common pathological conditions and holds the second place in terms of disability throughout the world. Pain syndrome has a great influence on the functional capabilities of the spine and the professional activity of a person, and that carries a serious social and economic problem. The main causes of pain in the spine are: pathology of the intervertebral discs and the zygapophysial joints; dynamic instability of the spinal motor segment; spondylosis; stenosis of the spinal canal and dural sac with compression of the neurovascular structures; spondylolisthesis; osteoporotic compression fractures of the vertebrae; infectious diseases of the spine, etc. In connection with the aforementioned, of particular interest to clinicians is the pathology of the zygapophysial joints (spondylarthrosis), its diagnosis, and targeted ethiopathogenetic treatment using puncture surgical technology in the treatment of facet syndrome. This paper presents the results and features of puncture surgical technology in the treatment of facet syndrome in degenerative-dystrophic lesions of the zygapophysial joints of the lumbar spine. The analysis is based on 55 sources of literature of domestic and foreign authors. The article presents data on the anatomical and topographic features of the zygapophysial joints, their biomechanics, innervation and their function. The ethiopathogenetic features of pain during degeneration of facet joints are considered. The effectiveness of the use of methods of using radio and laser denervation of the zygapophysial joints in the treatment of facet syndrome is analyzed. The materials of the article describe the methods of using chemodeception, cryodestruction, and intra-articular administration of hyaluronic acid preparations.

The purpose of the study : assessment of the use of laser vaporization of the disc with hernial protrusion on the lumbar spine and its effectiveness in the treatment of pain. Material and methods . We analyzed the effectiveness laser vaporization in 230 patients with degenerative-dystrophic diseases of the lumbar spine (protrusions and hernias of the intervertebral discs) treated in the neurosurgical department of the Irkutsk Scientific Centre of Surgery and Traumatology for the period from 2011 to 2018. There were 122 men and 108 women. The average age of the patients was 41 years. The duration of the disease before surgical treatment is 11 ± 3 weeks. Clinical and neurological examination revealed lumbalgia in 102 patients (44.3 %), lumbar ischalgia in 98 (42.6 %) and radiculopathy in 30 patients (13.1 %). Median hernias of the intervertebral discs were revealed in 130 patients (56.4 %), lateral hernias - in 41 (17.8 %) and protrusions - 59 (23.8 %). The leading localization of the pathological process was the L IV -L V segment (138 patients, 60 %). Assessment of the effectiveness of surgical treatment was carried out using VAS and Macnab scales. Results . In 100 % of cases were laser vaporization was applied a decrease in the intensity of the pain syndrome was achieved in terms of up to 3 months. The analysis of the long-term results of this treatment in 124 patients from 3 months to 3 years by Macnab scale revealed excellent results in 25 (20.1 %) patients, good results - in 50 (40.3 %), satisfactory - in 42 (33.8 %), and unsatisfactory results - in 7 (5.6 %) cases. Conclusion . Thus, laser vaporization of hernias of the intervertebral disc is effective in the treatment of pain, which does not stop with conservative treatment for 4-6 weeks; with a hernia of up to 6 mm; with a median localization and with no signs of sequestration.

We investigated the clinical outcomes after cardiac valvular surgery procedures concomitant (CCPs) with left ventricular assist device (LVAD) implantation compared to propensity score (PS) matched controls using the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data.Between 2006 and 2018, 2760 continuous-flow LVAD patients were identified. Of these, 533 underwent a CCP during the LVAD implant.Cardiopulmonary bypass time (p 0.001) and time for implant (p 0.001) were both significantly longer in the LVAD+CCP group. Hospital mortality was comparable between the two groups from the unmatched population (15.7% vs. 14.1%, p = 0.073). Similarly, short-to-mid-term survival was similar in both groups, with 1-year, 3-year, and 5-year survival rates of 67.9%, 48.2%, and 27.7% versus 66.4%, 46.1%, and 26%, respectively (log-rank, p = 0.25). The results were similar in the PS-matched population. Hospital mortality was comparable between the two groups (18.9% vs. 17.4%, p = 0.074). The short-to-mid-term Kaplan-Meier survival analysis was similar for both groups, with 1-year, 3-year, and 5-year survival rates of 63.4%, 49.2%, and 24.7% versus 66.5%, 46%, and 25.1%, respectively (log-rank, p = 0.81). In the unmatched population, LVAD+CCP patients had longer intensive care unit (ICU) stays (p 0.0001), longer mechanical ventilation time (p = 0.001), a higher rate of temporary right ventricular assist device (RVAD) support (p = 0.033), and a higher rate of renal replacement therapy (n = 35, 6.6% vs. n = 89, 4.0%, p = 0.014). In the PS-matched population, the LVAD+CCP patients had longer ICU stays (p = 0.019) and longer mechanical ventilation time (p = 0.002).The effect of additive valvular procedures (CCPs) does not seem to affect short-term survival, significantly, based on our registry data analysis. However, the decision to perform CCPs should be balanced with the projected type of surgery and preoperative characteristics. LVAD+CCP patients remain a delicate population and adverse device-related events should be strictly monitored and managed.

The paper presents the experience of surgical treatment of 58 patients with discogenic lumbosacral radiculitis. The aim of the surgical treatment was to eliminate the compression of the spinal roots of the herniated disc with the subsequent stabilization of the spinal-motor segment with implantable interspinous system COFLEX. Indications for surgical treatment were persistent radicular pain syndrome, which was not stopped by conservative methods of treatment, and disco-radicular conflict in the area of the interested vertebral-motor segment, confirmed by radiation research methods. In the diagnosis, the following research methods were used: clinical and neurological examination, survey and functional spondylography of the lumbar spine, computed tomography with contrast myelography, morphometric and statistical methods. The effectiveness of treatment was evaluated in 49 patients (84 % of operated) one and a half years after surgery. All patients showed complete regression of neurological deficit and satisfactory standing of the implanted interstitial dynamic system COFLEX in the operated vertebral-motor segment. Thus, the use of the implantable COFLEX dynamic system for the above indications is the choice method for operating surgeons, in which it is assumed that the function of the interested vertebral-motor segment is preserved.

The probabilistic-temporal characteristics of multi-packet message delivery over a logical point-topoint channel in a data transmission system with decision feedback are presented. The information exchange procedure between the data transmission equipment is determined by the X.25 protocol. The problem of analyzing the timeliness and reliability of multi-packet messaging in a data transmission system, as well as X.25 protocol key parameter synthesis, which ensures a given information delivery quality, is solved. To accomplish this, mathematical models of the multi-packet message delivery process in the considered data transmission system are constructed taking into account all system parameters of the logical data transmission channel based on absorbing fi nite Markov chains. These models serve as the basis for solving analysis and synthesis problems. On the basis of absorbing fi nite Markov chains, a scientifi c and methodological apparatus is presented that adequately describes the multi-packet messages delivery process in the considered X.25 data transmission system, while situational-bipartite graphs and invariant graphs are used. The developed approach allows us to fi nd the maximum allowable number of retries for each packet while taking into account the client’s requirements regarding the reliability and timeliness of the information delivery.

Background. Periarticular cysts of the facet joint, due to their rare occurrence, often slip away from the attention of clinicians. However their formation and progression may cause compression of vascular-neural structures with subsequent manifestations of severe neurological disorders. Description of the clinical case. We present a rare clinical case of surgical treatment of a periarticular cyst of the facet joint. A comprehensive examination of the patient S. revealed: Dorsopathy with degenerative spinal canal stenosis at LV-SI level; spondyloarthrosis; periarticular facet cyst at LV-SI level on the left; radiculopathy LV on the left, in the acute stage; pronounced pain and musculo-tonic syndrome. Complaints of the patient: constant pain in the lumbar spine, extending to the left lower extremity and aggravating when walking at a distance of 50-100 meters; feeling numb when walking on the plantar surface of the left foot. When examining the local status, a forced posture with a bowed head and torso forward was noted; smooth lumbar lordosis and antalgic right-sided scoliosis; tension of paravertebral muscles. Neurological examination revealed LVradiculopathy on the left with moderate paresis of the extensor muscles of the left foot and ipsilateral Lasègue's positive test. MRI examination revealed spinal canal stenosis, facet joint cyst at the level of LV-SI with dimensions of 14×8×8.5 mm. An operative intervention was performed: reconstructive decompressive-stabilizing spinal surgery with a single block removing the articular facet with a periarticular cyst at the left LV-SI level with subsequent posterior transpedicular fixation of the vertebral motor segment. Two months after the operation, complete medical and social rehabilitation of the patient was achieved. No complaints. Conclusion. In case of compression of a periarticular cyst of vascular-neural structures with severe neurological disorders, surgical treatment with the cyst removal is recommended.

The majority (89%) of left ventricular assist device (LVAD) patients have an implantable cardioverter-defibrillator (ICD) in place. Due to the advances of modern-day LVAD therapy, more patients are on support for longer. This inevitably leads to more LVAD patients facing ICD generator battery depletion. Until now, there are insufficient data regarding periprocedural risks of generator replacements in a high-risk group like the LVAD cohort.A retrospective, single-center analysis of pocket-related outcomes of all ICD generator replacements in LVAD and Non-LVAD patients between January 2014 and December 2018. The primary outcome was the combined endpoint of clinically significant pocket hematoma and/or cardiac implantable electronic device (CIED) infection in the first 6 months after ICD generator exchange. The clinically significant hematoma was defined as hematoma requiring reoperation, prolongation of hospitalization, or interruption of anticoagulation. The cumulative incidence function was calculated for the primary endpoint.Two hundred seventy-seven patients underwent ICD generator exchange in our clinic in this time. Of these, 251 patients had a complete 6-month follow-up regarding clinically significant pocket hematomas and pocket infections. One hundred ninety patients had no LVAD, and 61 patients were on LVAD support. The rate of the primary combined endpoint clinically significant pocket hematoma and/or CIED infection was 3.5 times higher in LVAD patients compared to the non-LVAD cohort (event rate 39.14 vs 11.07 per 100 patient-years, p = 0.048). Clinically significant pocket hematomas necessitating revision occurred nearly 4 times more often in the LVAD group (p = 0.042). Pocket device infection rates were around 16 times higher in LVAD patients compared to non-LVAD patients (p = 0.002).Compared to Non-LVAD patients, LVAD patients exhibit a relevant higher rate of clinically significant pocket hematoma and CIED infection after ICD generator exchange. This information should additionally be considered in the decision-making process regarding the indication for ICD generator exchange.

Modification of bitumen with polymers is one of the ways to improve the physical and mechanical properties of the binder. However, polymer additives have a high cost. However, this problem can be solved by inserting fine fillers of natural origin into the polymer matrix to reduce the consumption of the polymer while maintaining, and in some cases improving, the performance properties of the composite. Recently, the active filler – shungite, which has a unique fullerene-like structure and high adsorption properties, has been widely studied in various industries. Due to this, as well as due to its bipolarity, it has broad prospects for use in the composition of polymers and in the road industry. The work is devoted to the study of the impact of rubber and the composite “rubber:shungite” at different ratios on the characteristics of bituminous-rubber binder (BRB). It is shown that the use of a rubber-shungite composite in the composition of BRB has the same effect as rubber without filler. At the same time, the polymer content in the composition of BRB is much lower, which is economically advantageous. The introduction of shungite into the polymer led to an increase in the viscosity of the BRB, an increase in the softening temperature, extensibility, and elasticity, which should have a positive effect on the deformative stability of the road surface.

The paper presents the results of surgical treatment of 12 patients with stenosing processes of the vertebral canal at the craniovertebral transition due to chronic, unstable type 2 injuries of the C odontoid process (classification of fractures of odontoid process proposed in 1974 by Anderson and D’Alonzo). Patient examination included clinical-neurologic examination, review spondylograms of the cervical spine in 2 projections, MSCT, MRI. All patients were admitted to the clinic with external fixators (cervical support collar or Philadelphia collar). In the preoperative period, all patients were divided into 2 groups according to indications and contraindications for the application of the HALO-device. The first group consisted of 7 people, with cervical spine still fixed with the cervical support collar or Philadelphia collar, and the second group consisted of 5 patients with CII fracture fixed and corrected in the preoperative period by the HALO-device. All patients underwent surgical intervention – posterior approach decompression of the spinal canal and dural sack in the craniovertebral passage by CI laminectomy, partial resection of the posterior margin of the occipital aperture followed by the implementation of atlanto-axial occipitospondylodesis (a clamp with shape-memory effect for posterior occipitospondylodesis, OOO “MITS SPF”, Novokuznetsk, Russia). A comparative analysis of the results of surgical treatment of posttraumatic stenoses of the vertebral canal with and without the use of the HALO-traction device was performed. The results was better in the second group, which makes it possible to consider the second variant of surgical treatment more pathogenetically justified. Thus, HALO-traction restors anatomo-topographic relationships in the craniovertebral zone creating hard external fixation, helping to avoid intraoperative complications.

Epidural fibrosis is formed around the dural sac and the neurovascular structures of the vertebral canal in the postoperative period. It is one of the common causes of Failed Back Surgery Syndrome (FBSS) syndrome. It occurs in 100 % with repeated surgical interventions, in connection with which the operational technique of working with the dural sac and on neurovascular structures of the vertebral canal becomes more complicated and sometimes leads to their damage. Despite the development of modern technologies, in medicine, there are no specific and sensitive methods for diagnosing epidural fibrosis, which would help to establish the correct diagnosis in 100 % of cases. The review summarizes and systematizes domestic and foreign literature data on etiology, pathogenesis and pathophysiology of cicatricial and epidural adhesion. The analysis includes 22 sources of Russian literature and 28 sources of foreign literature.

Purpose Mechanical circulatory support (MCS) treatment of end stage heart failure (HF) is known to induce sensitization. But development of HF by itself is intimately associated with antibody-mediated diseases, T cell-mediated immune reactions and infections, all of which induce activation of the complement system via the classical and lectin pathways, which converge at level C3 to form the membrane attack complex, causing further tissue injury. The potential role of C4d (a split product formed as a result of the activation of both complement pathways) as a biomarker is currently being investigated in various autoantibody-induced diseases which cause tissue damage. This retrospective study investigates the impact of capillary C4d depositions in LV myocardium of pts with HF on MCS therapy outcome. Methods We compared immunohistochemical (IHC) findings of anterior LV of 10 non-heart beating donors with LV apex from the site of MCS implantation of 12 patients, submitted over a 4 year period, from whom follow-up tissue from LV was available at the time of MCS weaning, heart transplantation (HTx) or necropsy. MCS pts were separated into 3 groups according to therapy outcome. HTx was performed in 10 pts [3 pediatric, 3 female, 1 with complex congenital heart defect, 1 with hypertrophic cardiomyopathy, 8 with dilated cardiomyopathy (DCM), age 3- 61 years]. A 3-year-old female with DCM was weaned from MCS, another 32-year-old female myocarditis pt died whilst on MCS. Three µm thick paraffin-embedded sections were analyzed using conventional histology and IHC for capillary depositions of C4d and C1q- the recognition molecule of the classical complement pathway. Results In the HTx group, compared to the explanted heart a stronger (and at least focal 2+) linear capillary C4d staining was observed in the apex. C1q was not detected in all but one non-heart beating donors and in the weaned and fulminant myocarditis pts, but was present in varying amounts in the remainder of samples, often not correlating with C4d depositions. Conclusion Our results suggest that detection of complement activation in native myocardium is an indicator for progression of immune reactions, although MCS appears to limit or silence the autoimmune response. The possible role of C4d as a biomarker to detect patients at risk for autoimmunity-triggered mechanisms associated with HF merits further evaluation.

This article provides an overview of the currently acquired information concerning the phenomenon of epithelialmesenchymal transition and its role in the formation of interstitial kidney fibrosis and the mechanisms of its development and possible points of application to produce a therapeutic effect. Particularly interesting in this respect was the transforming growth factor-ß apparently plays a key role in induction of epithelial-mesenchymal transition.

The article presents the analysis of effectiveness of laser vaporizationfor treatment of pain syndrome caused by lumbar disc herniation. We treated 149 patients (average age - 40 years). 62 (41.7 %) patients had lumbodynia, 67 (45.2 %) patients had lumbar ischialgia. Nerve root disorders (radiculopathy, radiculoneuritis) are found in 20 (13.1 %) patients. 86 (57.4 %) patients had median hernias of intervertebral disc (disc bulging for 0.6 ± 0.2 cm), 36 (24.3 %) patients had intervertebral disc protrusion and 27 (18.3 %) patients had lateral intervertebral hernia (disc bulging for 0.55 ± 0.15 cm). Satisfactory and good results of laser vaporization are registered in 140 (94 %) patients with circular protrusion and median hernias with disc bulging up to 7-8 mm. Also the decrease in VAS scores of pain syndrome by 2-5 points in comparison with initial condition is found. Unsatisfactory results are registered in 9 (6 %) patients with lateral hernias of more than 5 mm and with disease duration more than 6 months. Prospective (from 3 to 13 months) follow-up was conducted in 49 patients. 5 patients from the group with lateral hernias needed open surgeries.

Modification of bitumen with various additives, including polymer ones, is one of the most effective ways to regulate the performance properties of asphalt concrete. Due to the high cost of polymers, a promising area of research is to reduce the polymer content, for example, by introducing mineral filler into its composition. A wide range of properties and unique structure of fullerene-containing natural shungite allow it to be used in various branches of science, industry and technology to create a variety of materials and determine the search for new areas of its application. One of the ideas that are currently under development is the use of shungite in conjunction with an organic binder used for the production of asphalt concrete. The work is devoted to the study of the influence of fine shungite on the characteristics of polymer-bituminous binder (PBB) and asphalt concrete. It is shown that the introduction of shungite into the PBB increases its viscosity, adhesive and cohesive properties, and the homogeneity of the mixture. This is due to the unique composition, structure and properties of shungite. The positive influence of the use of polymer shungite binder on the quality of asphalt concrete was established. With the introduction of 5% shungite in the PBB composition, the strength at 20 and 50°C, the strength of water-saturated samples, and the shear stability of polymer asphalt concrete significantly increased. This made it possible to reduce the polymer content of PBB by 10%.

A promoter of adhesion of a rubber to a metal cord based on precipitated silica modified by cobalt was developed. The analysis of its qualitative and quantitative composition was carried out. The effect of the obtained compounds on the technological and physico-mechanical properties of filled elastomeric compositions based on synthetic polyisoprene rubber and on the properties of metal cord–rubber systems was studied. It was shown that application of modified precipitated silica allows both making elastomeric compositions cheaper and improving their adhesive properties.

Molecular mobility of the polymer composition in the interfacial layer at the boundary of shungite and elastomers (ethylene/propylene copolymer and natural rubber) was investigated by electron paramagnetic resonance spin probe technique. In both cases, the molecular mobility of interfacial layer is approximately one order smaller than the mobility of the bulk polymer. The layer is characterized by high polarity, which is, apparently, due to the penetration of polar molecules and groups in this layer from shungite surface. An attempt was made to estimate the thickness of the interfacial layer (2–4 nm).

The article is devoted to the analysis of the results of examination and treatment of patients with spine pathology in lumbar segment. The data on the actuality of the problem of spine pathology (frequency of occurrence, invalidization). On the basis of their experience the authors propose complex approach to the treatment of patients with discogenic lumbar-sacral rediculitis, complicated by the disks hernias and pain syndrome, based on the definite algorithm in the form of treatment program. Lumbodynia and lumbar ischialgia prevailed in neurological status of the patients (45,2 %). Radicular disorders (radiculopathy, radiculoneuritis) are registered in 13,1 % of patients. Pain syndrome by the visually analogue scale corresponded to 7-6 (40 % of patients) and 5-4 points (60 % of patients). Protrusion of the disks (bulging of the disk up to 4 mm) are revealed in 24,3 % of cases. Median and paramedian hernias of disks (bulging of the disk from 4 to 8 mm) are revealed in 57,4 % patients. Posterolateral hernias of disks (bulging of the disk from 4 to 7 mm) are revealed in 18,3 % of patients. At the estimation of the effectiveness of treatment of 115 patients favorable results of treatment in the terms up to 1 year were registered in 99 of them.

The review presents modern ideas about morphology of afterbrain malformations - Chiari, type I. Main criteria of introscopic diagnistics of Chiari malformation of type I and of combined anomalies of development of craniovertebral articulation are discussed. The theories of pathogenesis of craniocervical dysplasias of afterbrain and development of intramedullary cavities are presented. The criteria of differential diagnostics of hydromyelia and syringomyelia and also modern methods of surgical treatment of bone and neural dysplasias are determined. Main clinical features of the course of disease that appears in mosaic picture of cerebellum affection, caudal group of craniocerebral nerves, medulla, brain hemispheres and spine cord are revealed, the characteristics of the mostfrequent syndromes is given. The reconstruction of anatomic symmetry of cone and neural structures of craniocervical articular and restoration of circulation of cerebrospinal fluid through outcomes of the IV ventricle guarantees favorable results of treatment. Promptly and adequately performed operation at the pathology of afterbrail allows to prevent development of irreversible and low-curable morphofunctional defects of neural system.

The time dependence of the mechanical losses of low density polyethylene (LDPE) filled with fine particles of shungite in the process of periodic dynamic loading at changing frequency of loading and temperature was studied. It was shown that upon increasing the filler concentration and loading frequency these dependences are either similar in nature or shifted in the time-temperature scale on the graphs. The temperature and time dependent parameters and the interpretation of their physical meaning were proposed. It was confirmed that development of relaxation processes occurs in filled polymers under dynamic loading. A relationship between the parameters of these processes is described by logarithmic and exponential functions. These dependencies are determined by both the polymer matrix and the transition polymeric layer formed on the filler surface.

Mechanical circulatory support devices were first developed to permanently replace the failing heart. Today, however, the majority of these devices are used as a mechanical bridge in patients awaiting heart transplantation. With this indication, important information on using mechanical assist devices has been assembled. We present our experience, which has been gained since 1987 in the area of patient selection, post-implant patient care and device maintenance. More than 450 patients have since been implanted with assist devices at our institution. Mechanical circulatory support may not only lead to recovery from secondary organ failure, but also to myocardial reremodeling and recovery of the heart function in some patients. Additionally we report our experience with a newly developed implantable axial flow pump and discuss the possibility and costs of permanent support in some patients.

Die Implantation von Herzunterstutzungssystemen („ventricular assist devices“, VAD) ist mittlerweile eine effektive und anerkannte chirurgische Behandlungsmoglichkeit fur Patienten mit terminaler chronischer oder akuter Herzinsuffizienz. In Deutschland leben schatzungsweise ca. 400–600 Patienten mit Herzunterstutzungssystemen verschiedener Art in hauslicher Umgebung. Dennoch ist die Unterstutzung mit einem Herzunterstutzungssystem nicht komplikationsfrei. Eine adaquate Einschatzung von Notfallsituationen durch den Ersthelfenden und die schnelle und richtige Reaktion darauf sind gerade bei Patienten mit Herzunterstutzungssystemen von hochster Wichtigkeit. Dieses Leitthema soll einen Uberblick uber die unterschiedlichen Arten von Herzunterstutzungssystemen und Kunstherzsystemen geben und aufzeigen, welche Notfallmasnahmen sinnvoll und notig sind.

The properties, structure, and molecular mobility of a polymer–solid interface layer largely determine the performance and applications of polymer compos� ites [1–3]. Therefore, the determination of features of the molecular dynamics of interface layers is an important problem. In this work, we attempted to evaluate the mobility and sizes of a shungite–elastomer interface layer. The elastomer was ethylene propylene diene (EPDM) rub� ber. The investigation method was spin probe EPR spectroscopy [4–6]. This method is very popular for studying liquids, polymers, and micellar and biologi� cal systems. Shungite is a mineral, which has recently become widely used [7]. It has high electrical conductivity, sorption capacity, thermal conductivity, sound absorp� tion, ability to absorb various types of electromagnetic radiation, and also pronounced bactericidal and fun� gicidal properties [8]. The shungite we used comprised carbon (30–40 wt %) of various modifications (graph� ite, fullerene, nanocarbon tubes, etc.), silicon dioxide and its derivatives (50–55 wt %), and also a large num� ber of chemical elements [8]. Shungite is used in civil engineering, metallurgy, water filters, and so on. It has recently been shown that using shungite as a filler enables one to obtain highly filled polymer composites with valuable physicochemical properties [8–10]. It