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Aim of investigation. To estimate efficacy and safety of various variants of sclerosing treatment of hemorrhoids at patients with severe concomitant diseases.Material and methods. At 13 patients with chronic hemorrhoids of 2–4 stages sclerosing treatment in combination to ultrasound cavitation, at 14 patients – sclerosing treatment without additional procedures was carried out.Results. Good and satisfactory results of treatment (termination or essential decrease of frequency and intensity of bleedings, decrease of degree of prolapse of hemorrhoids) after a week and month in both groups were identical. In 12 months good result after sclerosing treatment in combination to ultrasound cavitation is ascertained in 58,3% of cases, in the other group – in 15,4% (p

Aim: to summarize the literature data of use of laser technologies in the treatment of anorectal diseases. Key points. Lazer intervention technologies in the treatment of anorectal diseases such as haemorrhoids, anal fistula, anal fissure and pilonidal disease makes it possible to significantly reduce the intensity of pain syndrome, shorten the time of wound healing and also reduce the duration of the period of disability of the patient without worsening the quality of life. The main advantages of minimally invasive techniques are the absence of extensive wounds, minimal complications and reduction of the disease recurrence rate, minimally invasive methods are almost as effective as traditional ones. Besides, the use of laser allows to perform minimally invasive interventions under local anaesthesia in a day hospital. Conclusion. It is necessary to further study and improve the use of laser technologies in the treatment of anorectal diseases, and to actively introduce techniques into practice to improve the results of treatment of patients with these nosologies.

Aim: to improve the results of treatment in patients with hemorrhoids of the 2nd and 3rd stages.Materials and methods. The prospective study included 60 patients with hemorrhoids of the 2nd and 3rd stages. All patients underwent destruction of internal hemorrhoids with a fiber laser with a diode pump with a wavelength of 1940 nm. The technique is based on the effect of laser energy on the cavernous tissue of the internal hemorrhoidal node and on the terminal branches of the upper rectal artery. The efficiency of the destruction of internal hemorrhoids and the frequency of relapses of the disease were evaluated. The effectiveness of the proposed method was evaluated using anoscopy, measurement of the size of internal hemorrhoidal nodes, transrectal ultrasound with dopplerography. The analysis of the intensity of the pain syndrome, the consumption of nonsteroidal anti-inflammatory drugs and the assessment of the quality of life on the SF-36 scale was carried out. Sphincterometry was performed in all patients to determine the possible effect of laser radiation on the rectal locking apparatus. To assess the possible causes of complications, a single-factor analysis of the amount of energy transferred to each hemorrhoidal node and the total amount of energy spent on the operation was conducted.Results. In all patients, by day 7 after surgery, the pain syndrome in 43 patients (75.4 %) corresponded to 0 points according to VAS. In 3 patients (5 %) intraoperative hemorrhage developed. In the early postoperative period, 5 patients (8.3 %) had 7 complications: 5 cases of thrombosis of the external hemorrhoidal node and 2 — of acute urinary retention. The conducted single-factor analysis showed the dependence of the development of complications on the energy transferred to each hemorrhoidal node and its total amount for the entire operation. In terms of up to 6 months, there were no signs of a return of the disease in any case (hemorrhoidal prolapse and blood discharge). The detected hemorrhoids before the operation, a month after the operation, were not visualized, which persisted after 6 months. The performed transrectal ultrasound examination with spectral-wave dopplerography for up to 6 months allowed to diagnose a persistent decrease in blood flow along the terminal branches of the upper rectal artery compared with preoperative values. When performed sphincterometry, there was no change in the parameters of the anal sphincter function compared to preoperative parameters.Conclusion. The proposed method applying a fiber laser with a diode pump with a wavelength of 1940 nm makes it possible to affect transdermally the internal hemorrhoidal node without damaging the mucosa of the anal canal. The absence of postoperative wounds in the anal canal leads to a decrease in pain syndrome, and by day 7 there are no clinical manifestations of hemorrhoids. The method of laser destruction of internal hemorrhoids can be used in outpatient conditions and can improve the quality of life of patients in the early postoperative period.

Aim: to improve the results of treatment of patients with hemorrhoidal disease of the 2nd and 3rd stages by using a diode laser with a wavelength of 1940 nm.Materials and methods. The study included 28 patients with hemorrhoids of the second or third stage. A new treatment method based on the use of a diode laser with a wavelength of 1940 nm was applied to all patients. This technique (laser hemorrhoidoplasty) provides for the thermal effect of laser radiation on the cavernous tissue of the internal hemorrhoid node and the terminal branches of the upper rectal artery. The intensity of postoperative pain syndrome was assessed and the clinical symptoms of hemorrhoidal disease manifestations were studied before and after surgery. To study the effectiveness of the proposed method and to assess the depth of thermal exposure to laser radiation, transrectal ultrasound with Dopplerography and pathomorphological examination were performed. The functional state of the rectal locking apparatus before surgery and in the postoperative period was assessed using sphincterometry. The quality of life of patients who underwent laser hemorrhoidoplasty was studied according to the SF 36 questionnaire.Results. Surgical intervention was performed under both local and spinal anesthesia. Intraoperative complications in the form of hemorrhoidal node bleeding were noted in 3 patients. In the early postoperative period, inflammatory edema of external hemorrhoids was diagnosed in 4 patients. The intensity of the pain syndrome was assessed on the VAS scale and by day 7 in 93 % of patients it did not exceed 1 point. All 28 patients were followed up within 1 to 6 months after the operation. All had no complaints characteristic of hemorrhoidal disease, no relapse of the disease was detected in any observation. Transrectal ultrasound with Dopplerography was performed, which made it possible to diagnose a 2–3-fold decrease in blood flow along the terminal branches of the upper rectal artery, and internal hemorrhoids determined earlier, before surgery, were not visualized already 1 month after surgery. According to sphincterometry, no violations of anal retention function were detected in all 28 patients.Conclusion. Surgical treatment of hemorrhoids of the 2nd and 3rd stages with the use of a diode laser with a wavelength of 1940 nm. with proper technical performance and the choice of optimal energy, it allows to achieve a good clinical effect. The proposed method of intervention ensures the absence of a pronounced pain syndrome, which does not lead to a significant decrease in the quality of life already in the early postoperative period and allows to shorten the period of labor rehabilitation. Laser hemorrhoidoplasty is a highly effective method of treating hemorrhoids at stages 2 and 3 of the disease and opens up the possibility of treatment on an outpatient basis.

Aim. To review available information on the use of low-temperature argon plasma in the treatment of postoperative and long-term non-healing wounds.General findings. Low-temperature argon plasma is an ionised gas, one of the four classical aggregate states of matter. Its therapeutic effect is achieved by means of the gas-dynamic effect, i.e. an argon flow with a high heat content and wide-spectrum recombination radiation — from the vacuum ultraviolet region to the near infrared range, as well as by means of the pronounced catalytic properties of gaseous argon, which is important for a number of biochemical reactions. Low-temperature argon plasma has a pronounced antibacterial effect. In a number of studies, the wound healing effect of low-temperature argon plasma was demonstrated.Conclusion. The use of low-temperature argon plasma can reduce the time of wound healing, the titre of clinically significant microorganisms and the time spent by patients in hospital. In addition, the use of low-temperature argon plasma can improve patients’ quality of life in the postoperative period.

Aim. To generalize and present current data on the development of approaches to hemorrhoidectomy, as well as to analyse the function of the rectal closing apparatus after surgery.Key findings. The haemorrhoid disease is one of the most common human diseases and the most common reason for visiting a coloproctologist. In Russia, the prevalence of haemorrhoids amounts to 130–145 people per 1,000 adult population, with its proportion in the structure of colon diseases varying from 34 to 41 %. Minimally invasive methods for treating such conditions have been shown to be effective in patients with 1–3 stage haemorrhoids. However, these methods have shown little value at stage 4 hemorrhoids, largely because they fail to affect all parts of the disease pathogenesis. Thus, hemorrhoidectomy remains to be the “gold standard” for stage 4 hemorrhoids treatment, which is aimed at eliminating the three main vascular collectors. Hemorrhoidectomy is accompanied by the risk of stricture and postoperative anal sphincter failure. In this regard, it is necessary to assess the functional state of the rectal closing apparatus after hemorrhoidectomy. Improving hemorrhoidectomy, for example, by the use of an ultrasonic scalpel, allows the hemorrhoidectomy to be performed without additional sewing of vessels and coagulation, and the injury of the anal sphincter to be minimized.Conclusion. The possibility of injuring the anal sphincter is a serious problem in anal surgery. Anal sphincter incontinence is a serious illness that exacerbates the patients’ social life. Unfortunately, the issue of anal sphincter incontinence after hemorrhoidectomy is under-investigated, resulting in few rehabilitation programs.

Aim of review. To present literature data on diagnosis and treatment of incomplete internal rectal fistulas. Summary. Incomplete internal rectal fistulas is an insufficiently studied «niche» in proctology. First of all, the definition itself is a terminological void which does not permit definition of these fistulas as a separate nosological entity. Second, as difficult diagnostic procedures are required (due to the absence of external orifice) preoperative assessment of the structure of fistulous tract is complicated. In regards to this the standard treatment of these fistulous does not exist. According to literature data, the frequency of recurrence of incomplete internal fistulous ranges from 8 to 22%. Conclusion. The literature analysis demonstrated that there is a small number of publications in which this problem is considered. Because of lack of classification of this pathology there is no uniform treatment approach which would allow to decrease the risk of relapses, and maintain retention function as well.

Aim of investigation. To improve the short­term and long­term results of transsphincteric rectal fistulas treatment by patented two­stage method that includes elimination of fistulous tract with the subsequent enzyme treatment of the wound channel and delayed sealing by two­component biological glue. Material and methods. The method of cryptogenic transsphincteric rectal fistulas treatment is proposed. The method is based on elimination of fistulous tract by resection of internal lining. This is followed by sealing of the wound channel by biological glue which provides hermetic sealing as well as indirect stimulation of tissue regeneration. Treatment results of the patient group that matched inclusion criteria were analyzed: straight fistulous tract, absence of inflammatory changes and severe fibrosis in the area of fistula internal orifice. Prospective nonrandomized study which included 14 patients with cryptogenic transsphincteric rectal fistulas was carried out. At pre­hospital stage patients underwent transrectal ultrasound, fistulography and physiological tests. Results. Surgical intervention was carried out under local anesthesia, duration averaged 16 min (12 to 26), no intra­operative morbidity was registered. Pain intensity in postoperative period was minimal. Relapse developed in three patients (21.4%) of the 2nd, 3rd and 5th month of follow­up. Two patients (66%) underwent repetitive surgery by similar technique followed by complete elimination of the signs of disease. In one case at the 3rd month of follow­up transrectal ultrasound revealed the signs of relapse combined to ischioanal fat tissue leak that was probably undiagnosed at initial operation; reoperation was carried out - segmented proctoplasty by mucosal and muscular rectal graft. Assessment of anal sphincter continence after carried out surgery revealed no disorders. Conclusion. Surgical treatment of cryptogenic transsphincteric rectal fistulas by two­stage method including elimination of fistulous tract followed by wound channel enzyme treatment and sealing by two­component biological glue allows to achieve good clinical effect at strict indications and rectal sphincter sparing. Its lowinvasiveness and minimal tissue traumatization provides decrease in postoperative morbidity rate and decreases patient rehabilitation time. At repeated administration of this method the recurrence rate decreases to 6% at preservation of anal sphincter function. Strict patient selection with transsphincteric rectal fistulas and careful preoperative investigation allow to improve treatment results due to technical simplicity of the method as well as due to low complication rate both in early, and in remote periods.

Objective: to investigate the impact of a neutron beam formed with the accelerator-based epithermal neutron source designed at the G.I. Budker Institute of Nuclear Physics (INP) on the viability of human and animal tumor cells cultured in the presence of boron-10 isotope.Material and methods. Human U251 and T98G glioma cells and Chinese hamster CHO-K1 and V-79 cells were incubated at various concentrations in the culture medium containing 10B-enriched L-boronophenylalanine. The cells were irradiated with a neuron beam using the accelerator-based epithermal neuron source. A clonogenic assay was used to evaluate the viability of the irradiated cells. The absorbed doses obtained from elastic scattering of fast neutrons by substance nuclei and the doses obtained from boron neutron capture were calculated using the NMS code. The absorbed doses of gamma-radiation were measured with a mixed radiation dosimeter.Results. The viability of boron-containing and intact human U251 and T98G cell lines and Chinese hamster CHO-K1 and V-79 cells was analyzed after neutron beam radiation. Irradiation of all four cell lines were cultured in the presence of 10B was shown to reduce their colony-forming capacity compared with the control. Elevated boron levels in the culture medium resulted in a significant decrease in the proportion of survived cells. Radiation had the most pronounced impact on the proliferative capacity of the human U251 glioma cell lines.Conclusion. The cultures of human tumor cells and mammalian cells demonstrated that the neutron beam formed with the accelerator-based epithermal neutron source designed at the INP, was effective in reducing the viability of tumor cells in the presence of 10B

Aim of review. To present literature data of the treatment of incomplete rectal fistulas with application of biological substances. Summary. Treatment of rectal fistulas remains burning issue in coloproctology due to unsatisfactory results of surgery resulting in high relapse rate, usually regardless of applied surgical method and high risk of severe complications as anal sphincter incompetence. This is why development of sparing methods of rectal fistula treatment that will allow to decrease intraoperative trauma of the anal sphincter at minimal risk of disease recurrence and, therefore, to prevent development of sphincter incompetence is important. Application of biological materials in rectal fistulas treatment result in reduction of the wound size, accelerates reparative processes and decreases degree of traumatization. Minimization of surgical impact on the anal sphincter allows repetitive application of biological materials up to the achievement of positive effect. Conclusion. Application of biological materials at sphincter-preserving technique provides decreased risk of development of postoperative anal sphincter incompetence.

Aim of investigation. Improvement of presacral tumors treatment results.Material and methods. Data of surgical treatment 21 patients with true presacral tumors, operated in Federal government-financed institution «Ryzhikh State Scientific Center of Coloproctology», Ministry of healthcare of the Russian Federation with 2004 on 2013 was analyzed. Study group included 16 women (76%) and 5 men (24%) with mean age of 46,3±15,1 years.Results. Tumor relapse was revealed in 4 (5,6%) of operated patients, tumors in these cases had various histological structure.Conclusion. Experience of surgical interventions at benign retrorectal presacral tumors allows to consider surgical method as adequate treatment approach. The highest relapse rate was observed at malignant tumors; such patients require the combined treatment at specialized oncologic clinic. The choice of surgical access is determined, first of all, by neoplasm localization.

The aim of review. To present literature data on surgical treatment of extrasphincteric and transsphincteric fistulas of rectum.Key points. Treatment of fistulas of rectum remains a challenge because of risk of frequent relapses varying from 4,7 to 60%. Radical treatment methods are overly traumatic and result in severe fibrotic changes in the anal canal structures that are accompanied by high risk of anal sphincter incompetence - up to 83%. Now highly effective methods with application of various implants to eliminate tissue defect and improve regeneration are presented in the literature more and more commonly. Application of collagenic implants allows to decrease traumatization of sphincter fibres and thus to reduce to minimum risk of anal sphincter incompetence.Conclusion. Elimination of postoperative anal incontinence is a priority task in treatment of extrasphincter fistulas of rectum.

Aim of investigation. To improve results of treatment of extrasphincter and transsphincteric fistulas of rectum.Material and methods. Treatment experience of 70 patients aged 22 to 61 years with extrasphincteric and transsphincteric rectal fistulas using new surgical technique: resection of fistulous tract, internal ostium plastic by allocollagen membrane and sealing of excised fistulous tract by bioplastic material is presented.Results. In remote postoperative period, in 5 months to 3 years, 45 (64,3 %) patients were followed-up. In 4 (5,7%) patients relapse of disease was detected: in 3 (4,3%) cases fistula relapse in its initial location, these patients underwent segmentary proctoplasty, the fistula was closed, in one case (1,4%) after 2 months postsurgery intrasphincteric fistula was found that required resection into intestinal lumen. Good functional results were confirmed by sphincterometry and profilometry both in preoperative period, and in 3 months after surgery in 15 (21,4%) patients. No decrease of obturative rectum device scores was revealed.Conclusion. Application of bioplastic material can be technique of choice at treatment of extrasphincter and transsphincteric fistulas with involevement of deep portion of sphincter.

Aim of investigation. Lynch's syndrome is hereditary syndrome caused by germline mutation in one of reparation genes not coupled bases and causing high risk of colorectal cancer development. At present there are no criteria, allowing to reveal all mutation carriers, and development of new guidelines is still going on, that became a task for original study. Material and methods. Search of microsatellite instability (MSI), characteristic for Lynch's syndrome, was carried out in tumor samples of 73 patients by fragment analysis method. At its detection search of germline mutations by polymerase chain reaction methods, electrophoresis and direct sequencing was carried out.Results. Microsatellite instability was found out in 17 neoplastic samples (23%, 17 of 73). At 9 person germline mutations that has allowed to attribute this group to patients to Lynch's syndrome were revealed. Three of 9 mutations were described for the first time in the world.Conclusions. According to neoplastic MSI, age and family history two new criteria for Lynch's syndrome search in the Russian patients have been offered. Efficacy of the first criterion was 60%, that of the second — 85,7%.

Data on tests of chickens for their immune responses to infection with low pathogenic А/Н9N2 avian influenza virus isolates belonging to Y-280 and G1 genetic lines are presented in the paper. CD4⁺/CD8⁺ ratios were determined with flow cytometry for initial immune status examination and for detection of apparent immune system disorders. Quantitative analysis of peripheral blood lymphocyte subpopulations in chickens revealed changes characteristic of the immune suppression. Analysis of dynamics of T- and B-lymphocyte levels in blood of the infected chickens revealed decrease in relative T-lymphocyte counts and increase in relative B-lymphocyte counts. T-lymphocyte subpopulation composition expressed as CD4⁺/CD8⁺ ratio (%) changed after the infection: CD4⁺ cell proportion was found to decrease whereas CD8⁺ cell proportion increased. According to literature data, immune response activated by vaccination induces the reverse dynamics towards to increase in CD4⁺/CD8⁺ ratio. Both cell-mediated immunity and humoral immunity play role in development of the immune response in chickens infected with avian influenza viruses. Apparent humoral immune response was detected by serological tests of sera taken from chickens on day 14 after infection. Mean specific anti-A/H9N2 AIV antibody titre in all groups of test chickens infected with low pathogenic avian influenza virus isolates was higher than 6 log₂ . High level of specific antibodies to avian influenza virus was indicative of postvaccinal humoral immune response development.

Due to the genetic diversity of low pathogenic avian influenza (LPAI) viruses of subtype H9N2, it deemed appropriate to study the potency of the vaccines based on the antigens of strains А/chicken/Amursky/03/12 and A/chicken/Chelyabinsk/314-1/20 that represent currently circulating in the Russian Federation genetic lineages Y280 and G1, respectively. While low pathogenicity of the agent does not allow demonstrating the vaccine protective properties by the direct methods generally used for potency assessment (e.g. morbidity and mortality), the indirect methods were used: determination of antigenic relatedness of the strains, level of the postvaccinal homologous and heterologous humoral immunity, analysis of the virus genome synthesis inhibition (reduction) in vaccinated birds following their challenge. The strains used in the vaccines were determined to have some antigenic differences, which were demonstrated in the hemagglutination inhibition (HI) assay during control of the postvaccinal immunity in birds. Both vaccines generally induced strong humoral immunity in vaccinated birds (9–10 log2 determined using HI assay) with some difference in the levels of the immune response following the use of homologous or heterologous antigens. It was also reliably determined that homologous immunity facilitated more expressed inhibition of the virus reproduction after the challenge. The level of inhibition (reduction) of the virulent LPAI virus genome synthesis in vaccinated birds following their challenge with H9N2 virus of genetic lineage G1 was higher in birds following homologous vaccination, while the time periods of the genome detection in the biomaterial samples were the same. It was demonstrated that due to antigenic and immunogenic differences between LPAI H9N2 strains, use of both antigenic components in the inactivated vaccines is appropriate.

In 2019, the situation regarding Newcastle disease in the Russian Federation worsened radically due to the spread of NDV subgenotype VII-L throughout the country from the Primorsky Krai to the Kursk Oblast. As a result, 17 infected settlements with backyard farms where unvaccinated poultry was kept were registered. In this study, immunogenicity of the vaccines produced by the FGBI “ARRIAH”, as well as the effectiveness of various vaccination schedules to prevent genotype VII NDVs, relevant for the Russian Federation, was studied. It is known that the currently circulating ND agent is significantly more virulent compared to the viruses isolated in previous years, and it is able to bypass the immunity provided by live vaccines. Test results demonstrated that the vaccines against genotype VII NDVs produced by the FGBI “ARRIAH” are highly immunogenic, which allows to effectively prevent the disease when using them as part of a standard vaccination schedule. A 2-dose vaccination schedule using live vaccine from the La Sota strain as well as the “complete” vaccination schedule using inactivated vaccines provides immunity in 100% of chicks. The use of live vaccines in a single- and double-dose vaccination schedules prevents mortality and clinical disease in poultry, but does not prevent virus replication, while the addition of an inactivated vaccine to the immunization schedule does prevent the replication of the virulent virus. Thus, the use of domestically produced live and inactivated vaccines, primarily the ones containing the La Sota strain, with the following control of the immunity level and booster vaccination, if required, is the main tool for the disease control.

The work highlights the problem of extracting handwritten text on the image for further recognition. Describes common methods of segmentation, allowing to solve this problem: method of color image analysis the binary image segmentation method of fixing level, as well as, a method for the separation and analysis of circuits. The proposed algorithm for text segmentation based on the use of the mask of the original image to simplify the segmentation of text in images with a non-monotonic background. Also the comparative analysis methods is done.

MutYH-associated polyposis is the only polyposis syndrome with an autosomal recessive type of inheritance, often phenotypically similar to a weakened form of familial adenomatous polyposis. For the development of the disease mutations in both alleles of the gene are required, but an increased risk of developing colorectal cancer in carriers of monoallelic mutations is noted. The diagnosis of MutYH-associated polyposis should be suspected in a patient with colorectal cancer over 45 years old on the background of polyps in the colon. The review presents modern algorithms for diagnostic and treatment of the disease.

The data on studying immunogenic activity of the inactivated vaccine produced on the basis of avian adenovirus isolate FAdV-2 are demonstrated in the paper. The dynamics of antibody accumulation in chicken blood is shown. The high resistance of immunized chicks to homologous virus (FAdV-2) infection and lack of protection against heterologous virus (FAdV-4) infection are also demonstrated.