Vol 44, No 2 (2016)



Baum O.I., Romanov O.G., Gamidov A.A., Fedorov A.A., Romanov G.S., Zheltov G.I., Sobol E.N.


Background: This is a theoretical and experimental study of the thermomechanical effects of laser radiation with a wavelength of 1.06 microns on the eye tissues during a laser surgery on the secondary cataract (pupillary membrane). Its relevance is related to the rates of complications after laser surgery of the eye associated with the choice of energy and time parameters of the laser irradiation. These parameters are related to the occurrence of such factors as unstable fields of thermal stress and pressure that are difficult to take into account and indirectly lead to adverse events when removing the secondary cataract. Aim: To minimize side effects and to optimize the existing technology of laser removal of the secondary cataract. Materials and methods: Samples of a  normal lens capsule and of lens capsules with various types of opacities taken during a  cataract surgery, with various optic characteristics and thickness, were treated with an infrared laser (Nd:YAG laser, 1064 nm). We performed morphometric measurements and built up a  theoretical model of the processes in a continuous medium under the effects of impulse laser irradiation. Results: The results of numerical modelling with this newly developed theoretical model are in satisfactory agreement with the experimental data on development of deformities obtained with the autopsy materials (posterior capsule of the human lens with various optical characteristics and thickness, from thin transparent membranes to more thick opaque samples). Conclusion: This study would allow for optimization of the technology of laser treatment for secondary cataracts by changing the irradiation parameters during the procedure. 

Almanac of Clinical Medicine. 2016;44(2):130-139
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Belousov A.V., Belyanov A.A., Chernyaev A.P.


Background: Providing quality insurance for radiation therapy implies high level of precision for determining absorbed dose, and therefore high level of precision for fitting radial dose function. 3-5  degree polynomials provide required precision, however, uncertainty of their coefficients may cause substantial errors. Aim: To investigate dependence of errors of calculating radial dose function with consideration of uncertainty of coefficients from different degrees of fitting polynomial. Materials and methods: Calculations were performed with software package GEANT4.9.6. Geometry and materials of the source correspond to the model BEBIGCo0.A86. Spectral structure of the source corresponds to the NuDat 2.6 database. Statistical processing was done using nonlinear least-square method. Results: Values of the radial dose function of Cobalt source for brachytherapy were calculated for given geometry. Conducted comparison of precisions of 3 to 5 degree polynomial approximations and possible uncertainties of results of radial dose function calculations. Conclusion: Withrequired precision of 25% and higher at the radius of 10 cm the optimal choice for radial dose approximation is the 3rd degree polynomial. 

Almanac of Clinical Medicine. 2016;44(2):140-147
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Gamayunov S.V., Skrebtsova R.R., Korchagina K.S., Sapunov D.A., Shakhova M.A., Shakhova N.M.


Background: Photodynamic therapy (PDT) is a  modern minimally invasive technique for treatment of a wide range of diseases, including malignancies. One of directions for PDT development is the individualization of exposure modes that can be achieved with effective treatment monitoring. There are a  number of approaches employing imaging techniques, the most promising of them being optical ones. Aim: To analyze factors affecting clinical outcomes of PDT in non-melanoma skin tumors, and to evaluate the prospects of optical imaging techniques for PDT planning and monitoring. Materials and methods: We retrospectively analyzed various aspects of the results PDT obtained in 855 patients with non-melanoma skin tumors. PDT was performed with systemic chlorine photosensitizers. As a  source of irradiation, the laser at a wavelength of 662 nm was used following exposure modes: mean power density 0.3 W/cm², the laser irradiation dose of 200 J/cm² for basal cancer and 300 J/cm² for squamous cell carcinoma. Clinical evaluation was performed based on tumor response according to RECIST criteria, by the presence or absence of recurrence during long term follow up and by the presence or absence of cosmetic defects. Fluorescence imaging and optical coherence tomography were used as non-invasive imaging techniques. Results: It was found that clinical predictors of treatment failure included tumor recurrence, squamous type of tumor, and advanced exophytic or infiltrative component. Fluorescence imaging showed an association between clinical outcomes of PDT and fluorescence characteristics of the photosensitizer. The best clinical outcomes were achieved in 147 patients with a combination of high contrast fluorescence (FC>1.2) and a high degree of photobleaching of the agent (ΔIt/IN >25%): the number of complete tumor responses was 94% (138 of 147), with recurrence seen in 3 (2%) patients only with the follow up from 6 to 53 month duration. Clinical predictors of PDT cosmetic failures are tumor recurrence and tumor stage above T2. The most vulnerable zones are the outer ear and nose wings; this fact is related to an involvement of the cartilage located directly beneath the thin skin in the photodynamic reaction. This was demonstrated by optical coherence tomography. Conclusion: Presence of clinical predictors of PDT failure justifies correction of light exposure modes that can be optimally implemented with techniques for objective evaluation of the tumor borders, photosensitizer accumulation and photobleaching. Dynamic non-invasive monitoring of PDT procedure with fluorescence imaging and optical coherence tomography seems promising for implementation of an individual approach resulting in optimal oncological and functional outcomes.
Almanac of Clinical Medicine. 2016;44(2):148-157
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Gibizova V.V., Anenkova K.A., Maslennikova A.D., Fedorova K.V., Sergeeva I.A., Petrova G.P.


Background: A fundamental problem of medical diagnostics as an assessment of human plasma and serum proteins in various pathologic states. Physical molecular and dynamic characteristics of proteins that are significantly changed during a  disease have been proposed as diagnostic parameters. Aim: To conduct fundamental research on molecular properties of serum proteins, such as their mobility, intermolecular interactions, aggregation/formation of nanoscale protein clusters, abnormalities of the surface charge, etc., for subsequent development of methods for early diagnostics of cancer based on laser light scattering and fluorescence. Materials and methods: The parameters of protein dynamics were assessed by laser light scattering methods. Results: We performed comparative assessments in model systems and native serum samples for cancer diagnostics and analyzed the possibility to use optical parameters of water serum solutions for development of cancer diagnostic methods. Conclusion: Light scattering methods provide sufficient information on changes of the static and dynamic properties of the serum proteins over time during various pathological conditions.
Almanac of Clinical Medicine. 2016;44(2):158-164
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Guseva I.A., Kulikova P.A., Bychenkov O.A., Rogatkin D.A., Kulikov D.A., Chursinova Y.V., Bobrov M.A.


Background: Laser fluorescence spectroscopy (LFS) is widely used in various medical areas, oncology being the most known of them. In general, the LFS is used for in vivo diagnostics of tumors. Recent studies have shown that this method could be used for diagnostics of local inflammation, induced by thermal or mechanical injury. It is of interest if LFS could be used for assessment of soft biological tissue injury caused by radiation exposure. Aim: To study fluorescence of an exogenous photosensitizer and its changes over time in the radiation injury area by LFS method in vivo. Materials and methods: The experiment was done in 12 outbred SHK mice whose right hind limbs were irradiated using a gamma-therapy device ROKUS-AM (source, 60Co, at dose of 15 Gy). Before irradiation, the photosensitizer Photosens was administered to all animals intraperitoneally at dose of 2.5 mg/kg. For 21 days fluorescence was assessed in vivo with a laser diagnostic system LAKK-M in the “fluorescence” operation mode, with an excitation wavelength of 635 nm. At days 7 and 21, tissue samples from the irradiated areas of the model animals were studied histologically and differential blood cell counts were assessed simultaneously. Results: The LFS method showed an increase in the accumulation of the photosensitizer in the affected area, compared to an intact contralateral area, with higher signal intensity from the irradiated limb. The changes in the fluorescence signal from the affected over time had two characteristic peaks at days 3 and 14, probably reflecting the stage of local radiation injury. Conclusion: The use of LFS with an exogenous photosensitizer has a potential for a personalized assessment of radiation reactions in radiology.
Almanac of Clinical Medicine. 2016;44(2):165-171
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Dmitriev A.K., Konovalov A.N., Kortunov V.N., Ul'yanov V.A.


Background: Elaboration of automatized and robotic systems for precision and minimally traumatic surgery is one of the main areas of modern surgery. The concept of the so-called “smart” laser scalpels seems a  promising technical solution in this field. Aim: To develop organizational principles of a  feedback smart surgical laser devices based on CO₂ and fiber lasers. Materials and methods: As laser sources, we used a one mode wave CO₂ laser with a power of up to 25 W, high frequency pumping of the active media and radiation wavelength of 10.6 mcm, as well as a one mode fiber Er laser with a power of up to 5 W and radiation wavelength of 1.54  mcm. The laser device feedback was organized with an autodynic control of laser evaporation of biological tissues. The “smart” laser scalpel effects were studied in the porcine tissues in  vitro. The feedback laser devices were tested on normal and tumor animal tissues (white rats) in vitro and in vivo. Also, we tested the possibility of diagnostics of laser evaporation on human tumor tissues. Results: Taking the one mode CO₂ laser and one mode fiber Er laser as examples, it was shown that an autodynic signal arising during evaporation of various biological tissues has different spectral characteristics. This makes the bases for organization of a  feedback in surgical devices functioning as a  “smart” scalpel. A “smart” surgical feedback device based on CO₂ laser and a  decoy of a  “smart” surgical device based on a fiber Er laser were developed. We studied the possibilities of differential diagnostics of a type of a tissue being evaporated in vitro with the use of the data from laser scalpels. Also, pre-clinical trials of a CO₂ laser-based “smart” surgical device on biological tissues were performed. The trials showed that such a “smart” laser scalpel allows for intra-operative differentiation between normal and tumor tissues that would give the possibility to implement minimally traumatic surgery principles. Conclusion: The method of autodynic diagnostics of laser evaporation of biological tissues allows for development of surgical devices functioning as a “smart” laser. It gives the possibility of a real-time differentiation of various types of tissues, including normal and tumor ones.
Almanac of Clinical Medicine. 2016;44(2):172-178
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Dumler A.A., Podtaev S.Y., Stepanov R.A., Frick P.G.


Background: The impedance rheocardiography is a  simple, inexpensive, noninvasive method of assessment of central hemodynamics that can be used for detection of cardiovascular remodeling and thus promote an improvement of cardiovascular mortality. Modern mathematical methods of data management could help to discover new possibilities of rheographic signal analysis. Aim: To demonstrate the potential of a  wavelet-analysis of rheocardiograms for identification of myocardial remodeling of patients with cardiovascular disorders. Materials and methods: The proposed method was validated in 12  healthy men aged from 20  to 25  years and 14  patients with arterial hypertension. We used a  polyreocardiograph, which records simultaneously the impedance (ICG), the electrocardiogram (ECG) and the phonogram (PCG). The function of the cardiovascular system was assessed based on the two-dimensional time-frequency distributions of wavelet transformed coefficients of differential rheogram curves. Results: The results of an isometric load test confirm the adequacy of stroke volume estimation based on the amplitude of wavelet coefficients and the scale of the E wave. In this technique, ISTI parameter was defined as the time interval between the R wave in the ECG and the maximum of the E wave in the wavelet image. The simultaneous time-frequency analysis of both the pulse and respiratory component of an ICG signal can be a basis for the development of complex functional respiratory tests. Conclusion: The approach proposed demonstrates the possibility to obtain the characteristics of the diastolic phase of the cardiac cycle, and allows for a more precise determination of the stroke volume. Data management is done automatically. These advantages are expected to be used for producing a mobile cardiograph for screening diagnostic.
Almanac of Clinical Medicine. 2016;44(2):179-185
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Kotliar K.E., Glazkov A.A., Kovaleva Y.A., Drozdova G.A., Kulikov D.A.


Background: Abnormalities of microvasculature could be an early marker of diabetic complications. Therefore, its non-invasive assessment in diabetic patient seems highly relevant. Aim: To assess microcirculation in the skin and retina of patients with diabetes mellitus using optical diagnostic techniques: laser Doppler flowmetry (LDF) and Retinal Vessel Analyser (RVA). Materials and methods: Cutaneous microcirculation rhythms were analyzed in 18 patients with type 2 diabetes mellitus and 16 healthy volunteers in the MONIKI (Moscow, Russia). Microcirculation in the dorsal hand and foot skin was assessed by LDF for 2 minutes. The amplitude and frequencies of perfusion oscillations corresponding to the rhythms of various etiologies were computed by Waveletanalysis. Retinal vasomotions and their changes were studied in 33 type 1 diabetic patients compared to 33 healthy volunteers in the Aachen University of Applied Sciences (Germany). Original recordings made by the RVA were used for the analysis with a  Fourier transformation, cross-correlation and autocorrelation. Results: There was no significant difference in the hand skin microcirculation rhythms assessed by LDF between patients with diabetes mellitus and healthy volunteers, whereas in the lower extremities, statistically significant differences were found in the amplitude of high-frequency oscillations corresponding to the range of the heart rhythm. These results correlate well with the results of the optical assessment of retinal vasculature, where statistically significant differences in the amplitude of high frequency oscillations corresponding to the heart rate were found. In type 1 diabetic patients the periodicity of venous pulsation was higher than in the control healthy group. Conclusion: Both dynamic analysis of the pulsations and vasomotions of retinal vessels assessed by RVA and analysis of the rhythms of blood circulation in the skin of the lower extremities measured by LDF revealed a  statistically significant abnormalities of the microcirculatory dynamics in diabetic patients. The combination of these methods can be successfully applied for a  more comprehensive evaluation of the nature of microvascular abnormalities in diabetic patients and for comparison of the information obtained with clinical data.
Almanac of Clinical Medicine. 2016;44(2):186-192
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Matveychuk I.V., Rozanov V.V., Litvinov Y.Y.


Background and aim: The volume of reconstructive surgery in traumatology in recent decades has increased significantly due to an increase in traumas, numbers of affected in local military conflicts, and environmental deterioration. This has led to an increase in demand for plastic materials, and the need to create modern high technologies to meet this need, including alternative sources of bone implants. Any solution to this problem would involve an in-depth study of bone biophysical properties with innovative techniques to develop requirements to elaboration of new effective implants based on natural bone, as well as on natural or synthetic analogues. This study aimed exactly at these aspects. Materials and methods: We studied human bone samples taken from various parts of the skeleton aged from 3 to 89 years and animal (bovine) bone samples aged from 1.5 to 2 years. Biophysical characteristics of the studied materials were assessed at the stage of sample preparation with original author's methods of physical and mechanical processing, in the process of analysis of patterns of normal changes in the bone structure and function, as well as during changes in its composition with age, anisotropy of the material and the level of structural organization. Structure patterns were studied by classical (light, scanning electron microscopy) and advanced (acoustic microscopy) techniques. Methods of engineering biomechanics were used to assess functional changes in macro and micro volumes of bone samples. Results: The main study results involve the development of innovative methods of sample preparation and structural and functional analysis. First of all, these are the methods of mechanical processing of bone fragments based on the use of hollow cylindrical milling cutters in the environment of limited amounts of mineralized biological tissues, as well as on the application of hydrodynamic cutting ensuring a delicate and highly efficient bone cut. Another distinctive feature of the study is the elaborated methodology for morphological and mechanical analysis of bone samples at the macro and micro levels, with consideration of real physical and chemical condition of samples. To ensure sample sterility, the authors proposed innovative techniques using of ozone-oxygen mixtures. The study results gave a  complex of quantitative characteristics describing age-related compositional changes of the human bone, anisotropy of its physical and mechanical characteristics, osteon parameters and physical and mechanical characteristics of bone tissue depending on its composition. Conclusion: The use of the proposed methodology allowed for obtaining of new data on biophysical properties of bone tissue that are of interest for bioimplantology, biomaterial science and expands basic information on the bone as a natural biocomposite. They can be the basis for development of practical guidelines on optimization of the choice of bone fragments for manufacture of implants based on the detected patterns of changes in macro- and microstructure, physical and mechanical characteristics and bone composition in the studied age range.
Almanac of Clinical Medicine. 2016;44(2):193-202
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Meller A.E., Motovilova T.M., Panteleeva O.G., Kuznetsov S.S., Stroykova K.I., Kondrat'eva O.A., Kirillin M.Y., Shakhova N.M.


Introduction: The distinctive features of modern inflammatory diseases are their indolent course and predisposition to chronicity. Chronic inflammation is the basis for the development of serious disorders, including autoimmune and oncologic ones, and a  cause of major functional abnormalities of the human body. Diagnostics of chronic inflammation is associated with a number of problems which originate from a variety of clinical phenotypes and morphological forms, on the one hand, and from the rising prevalence of their latent course, on the other. In its turn, an adequate treatment choice may be based on understanding and accurate detection of etiological and morphological types of the disease. In this connection, development of novel diagnostic techniques, such as optical coherence tomography (OCT), is of utmost importance. Aim: To demonstrate feasibility of OCT in detection of morphological abnormalities associated with chronic inflammatory disorders of various localizations. Materials and methods: OCT diagnostics was performed in addition to standard diagnostic procedures in 225 patients with chronic inflammatory disorders of various localizations, such as chronic recurrent rhinitis, chronic latent salpingitis and chronic endometritis. For OCT, an “OCT-1300U” system was used, with central wavelength of 1280 nm, spatial resolution of 15–20 μm, image acquisition rate of 8 frames per second, imaging depth of 1.4 mm and a probe diameter of 2.4 mm. The following techniques of quantitative processing were used for processing of the OCT images. Quantitative characterization of histograms and image texture was performed with further determination of values typical for various images groups corresponding to particular states of biological tissues. Neural network was also employed with histograms and 2D Fourier transforms of the images as input data. Results: OCT laparoscopy allowed to obtain three types of OCT images of fallopian tubes with features typical for healthy and inflammatory states. Presence of heterogeneity in the structure of an OCT image indicated heterogeneity in the muscle layer of the fallopian tube, which allowed for a conclusion on chronic salpingitis. With OCT hysteroscopy we demonstrated the ability of OCT to visualize pathomorphologic features of chronic endometritis. The diagnostic data obtained by OCT-rhinoscopy allowed to draw preliminary conclusions on the OCT ability to detect specific features of various types of chronic rhinitis. Numerical processing of diagnostic OCT images resulted in their higher objectivity and an improvement of diagnostic accuracy of the technique. Conclusion: OCT is able to detect morphological changes induced by a  chronic inflammatory process. OCT criteria were shown to be universal for various organs. We demonstrated the possibility of non-invasive diagnostics of pathomorphologic forms of disease, showed some challenges in the development of OCT for diagnostics of non-tumor disorders and ways to overcome them are proposed, in particular, the use of image numerical processing. Further studies seem to be justified.
Almanac of Clinical Medicine. 2016;44(2):203-212
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Molochkov A.V., Kil'dyushevskiy A.V., Molochkova Y.V.


Background: Lichen planus rubrum (LPR) belongs to the group of papulosquamous dermatoses. Pathophysiology of this most common lichenic dermatosis is related to autoimmune destruction of basal keratinocytes. Treatment of LPR includes systemic corticosteroids, cytotoxic agents, immunosuppressants, aromatic retinoids, PUVA-therapy, as well as biological preparations (rituximab, efalizumab), which all are insufficiently effective and associated with multiple side effects and complications. Aim: To evaluate efficacy of extracorporeal photochemotherapy (EPCT) in generalized typical and atypical LPR. Materials and methods: We performed a prospective active-controlled cohort study. Thirty three patients with different types of LPR treated with EPCT were divided into 2 groups. Group 1 included 19 patients with typical generalized (including subacute and chronic) LPR, group 2, 14 patients with atypical (pigmented, follicular, hypertrophic, erosive ulcerated, vulvovaginal/ gingival syndrome) LPR. At 2 hours before a EPCT session patients were administered 8-methoxypsoralen, then mononuclear cells were isolated with a cell separator Haemonetics MCS+ and treated with UV A radiation (at a wavelength from 320 to 400  nm), then monocyte mass was reinfused to the patient. The treatment course consisted of 4  sessions performed every other day. Results: Positive clinical effect and satisfactory tolerability of EPCT were demonstrated in all 33 patients. In patients with generalized subacute typical LPR, EPCT promoted activation of natural immunosuppressive mechanisms (there was no correlation between CD8+ and HLA-DR+ , as well as between CD8+ and CD11b+: r=0.52 (р>0.05) and r=0.35 (р>0.05), respectively). In patients with generalized chronic LPR the treatment led to restoration of immune tolerance to genuine body antigens (correlation between CD16+ and CD11b+ was preserved and correlation between CD16+ and HLA-DR+ was lower: r=0.77 (p<0.05) and r=0.62 (p>0.05), respectively). Conclusion: The data obtained confirms high clinical efficacy of EPCT and its pathophysiological effects at early and later stages of generalized typical LPR.
Almanac of Clinical Medicine. 2016;44(2):213-220
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Petritskaya E.N., Rogatkin D.A., Rusanova E.V.


Rationale: The problem of the resistance of microorganisms to many classes of antimicrobial agents becomes increasingly threatening. This promotes the search of new formulations for prevention and treatment of infectious inflammation. Aim: To evaluate antibacterial effects of silver nanoparticle colloid solutions on gram-negative, gram-positive and fungal microflora compared to already known formulations based on silver salts and nitrates of other metals. Materials and methods: The effects of silver nanoparticle colloid solutions (with concentration of nanoparticles of 50 and 100 mg/mL, particle diameter of 15±5 nm) on the microorganism growth were studied in Staphylococcus aureus (# 209P), Escherichia coli (# 26941), Klebsiella pneumoniae (#  43062) and clinical isolates of Candida albicans. For comparison, silver proteinate, nitrofural, and solutions of NaNO₃, Sn(NO₃)₂, Co(NO₃)₂ and Zn(NO₃)₂ at equimolar concentrations to AgNO₃ 1% were used. Results: After the plates with test cultures were treated with silver nanoparticle solutions and with comparator solutions, there was sheer culture growth in the areas of silver nanoparticle application (at both concentrations) and no growth in the areas of the comparator solutions application. Conclusion: The results obtained indicate that silver nanoparticle colloid solutions 50 and 100 mg/mL do not influence the growth of the studied cultures, whereas the comparator solutions exert an advanced antibacterial effect.
Almanac of Clinical Medicine. 2016;44(2):221-226
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Rocheva V.V., Sholina N.V., Derevyashkin S.P., Generalova A.N., Nechaev A.V., Khochenkov D.A., Semchishen V.A., Khaydukov E.V., Stepanova E.V., Panchenko V.Y.


Background: To improve quality of surgery in oncology, it is necessary to completely remove the tumor, including its metastases, to minimize injury to normal tissues and to reduce duration of an intervention. Modern methods of detection based on radiological computerized tomography and magnetic resonance imaging can identify a tumor after its volume has become big enough, i.e. it contains more than 10 billion cells. Therefore, an improvement of sensitivity and resolution ability of diagnostic tools to identify early stages of malignant neoplasms seems of utmost importance. Aim: To demonstrate the potential of a new class of anti-Stokes luminescence nanoparticles for deep optical imaging with high contrast of malignant tumors. Materials and methods: Upconversion nanoparticles with narrow dispersion and a  size of 70 to 80  nm, with a  core/shell structure of NaYF4:Yb3+:Tm3+/NaYF4 were used in the study. The nanoparticles have an intensive band of anti-Stokes photoluminescence at a wavelength of 800  nm under irradiation with a  wavelength of 975  nm (both wavelengths are within the transparency window for biological tissues). The conversion coefficient of the excitation radiation into the anti-Stokes luminescence was 9%. To increase the time during which nanoparticles can circulate in blood flow of small animals, the nanoparticles were covered by a  biocompatible amphiphilic polymer shell. As a  tumor model we used Lewis epidermoid carcinoma transfected to mice. Results: We were able to obtain stable water colloids of nanoparticles covered with amphiphilic polymer that could preserve their initial size at least for one month. The use of upconversion nanoparticles with a  hydrophilic shell made of intermittent maleic anhydride and octadecene co-polymer with subsequent coating with diglycidyl polyethylene glycol ether allowed for reduction of non-specific reaction of nanoparticles with plasma proteins. In its turn, it resulted in an increased time of their circulation in blood flow of small animals for up to 1 hour. With the Lewis lung carcinoma transfected to mice model we demonstrated аn in-life transportation of upconversion nanoparticles into the tumor with a  high degree of localization due to a passive EPR effect. The contrast of luminescent signal in the tumor compared to adjacent tissues was at least 70%. The possibility of visualization of upconverted nanoparticles up to 15 mm of biological tissue was shown. Conclusion: The optical imaging techniques with anti-Stokes photoluminescent markers ensure a  high contract real-time detection of tumor tissues that allows for their use for intra-operative diagnostics.
Almanac of Clinical Medicine. 2016;44(2):227-233
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Sergunova V.A., Chernyaev A.P., Kozlov A.P., Bliznyuk U.A., Borshchegovskaya P.Y., Kozlova E.K., Chernysh A.M.


Background: The effects of toxins on nanostructure of blood cells are one of the key problems of biophysics and medicine. Erythrocyte morphology and membrane structure are recognized as the main parameters of blood quality. Therefore, analysis of membrane defects under toxin effects seems an urgent issue. Aim: To identify characteristic features and patterns of changes in membrane nanostructure under hemin intoxication and during extended storage of erythrocyte suspension. Materials and methods: The study was done in vitro in human whole blood with addition of hemin, аnd in erythrocyte suspension with a CPD blood preservative stored at 4 °С for 30 days. The nanostructure of erythrocyte membrane was assessed by atomic force microscopy. Results: Characteristic size of space periods between “granules” was from 120 to 200 nm. “Granule” numbers within a topological defect varied from 4 to 5 and to several dozens. Such domains arose virtually on all cells in erythrocyte suspension, as well as after hemin addition to the blood. An increase in hemin intoxication and an increase in a storage time were associated by increases in echinocyte numbers that subsequently transformed into spherical echinocytes. Both under hemin and during the storage of erythrocyte suspension for 9 to 12 days, a specific abnormality in nanostructure of erythrocyte membrane was observed: structural clusters, i.e., domains with granular structure, were formed. Conclusion: The experiments showed that both hemin and oxidative processes in the blood can specifically affect the nanostructure of erythrocyte membranes with formation of domains on their surface. The specific size of granular structures in the domains is from 100 to 200 nm that coincides with a  specific size of spectrin matrix. These results can be used in basic and applied medicine, in blood transfusion, for the analysis of a toxin effects in the human body. The biophysical mechanisms of domain formation can become a  basis for the study on a toxin – membrane cross-talk.
Almanac of Clinical Medicine. 2016;44(2):234-241
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Gudebskaya V.A.


Rationale: One of the most complicated and unresolved problems in clinical medicine is the choice of an optimal method for organ-preservation treatment of uterine fibroids in women of childbearing age. Aim: To assess clinical efficacy of robot-assisted laparoscopic myomectomy. Materials and methods: The search was performed in PubMed, Embase, Trip, Cochrane, DocMe databases by keywords: “fibroids”, “robot”, “da Vinci”, “robotic myomectomy”, “robot-assisted myomectomy”. Results: We found 25 publications on robot-assisted laparoscopic myomectomy, including 6  papers on its reproductive outcomes (levels of evidence II–IV). Duration of robot-assisted surgery ranged from 132 to 261 minutes, intraoperative blood loss was in the range from 50 to 387 mL, postoperative hospital stay ranged from 1 to  3.9  days. There was a  lower percentage of intra- and postoperative complications after the robot-assisted interventions, compared to abdominal or classic laparoscopic access, as well as a lower percentage of conversion laparotomies compared to laparoscopy. Pregnancy rates after robotic myomectomy ranged from 16.7 to 69%. Only one case of uterine rupture after robot-assisted laparoscopic myomectomy has been described in the literature. Conclusion: Due to high cost of the method, the number of conducted studies is insufficient to evaluate the role of robotic technologies in the organ-preservation approach to uterine fibroids. Nevertheless, they suggest that robot-assisted laparoscopic myomectomy is justified in women of childbearing age who are planning pregnancy, with big centripetally growing intramural nodes and deformation of the uterine cavity. This technique on its own is an independent method for fertility restoration and could be the first step before the use of assisted reproductive technology.
Almanac of Clinical Medicine. 2016;44(2):242-248
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Lapitan D.G., Rogatkin D.A.


The paper presents a  review of the research update on the blood microcirculation system assessed with laser Doppler flowmetry (LDF). Specific procedures for measurement of the microcirculation index by LDF and individual variability of microcirculation parameters during their real time assessment in vivo are discussed. In physiological conditions, a relative deviation of the results of measurements by LDF is within the range±35% and above from the mean value of the microcirculation index. This imposes certain limitations on the interpretation of the diagnostic results in terms of the “normal or pathologic”. Specifics of performance of functional stress tests on the microcirculation system are reviewed. Diagnostic criteria based on functional stress testing of the microcirculation system, which can be implemented with methodologically strict normatives and regulations, for examples, those for the occlusion test, are more reliable from metrologic perspective and significant compared to the results obtained without stress testing. Problems of implementation of the functional tests into clinical practice are discussed. It was shown that they may have a potentially wide spectrum of clinical indications, from functional diagnostics and early detection of microcirculatory abnormalities in diabetes mellitus, arterial hypertension and other diseases associated with microcirculatory disorders, to the physical rationale of exposure parameters, as well as objectification of efficiency of medical procedures aimed to stimulation of the microcirculatory functions in a patient's tissues and organs.
Almanac of Clinical Medicine. 2016;44(2):249-259
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Chernyaev A.P., Varzar' S.M.


Methods based on accelerative and radionuclide technologies are more and more invading clinical practice of modern medicine. The aim of this review is to demonstrate the role of nuclear physics techniques for treatment and diagnostics of various disorders. We analyzed data published in the last 50 years in research papers, reports and other open sources considering particulars of electron accelerators and heavy charged particles in radiation and nuclear medicine and presenting the information on prevalence of accelerators and other high-tech medical equipment in Russia and worldwide.
Almanac of Clinical Medicine. 2016;44(2):260-268
pages 260-268 views

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