Vascular calcification is a widely-spread pathology with high mortality. It is active bioregulated process that is observed in pathogenesis of different desires, associated with metabolic dysfunction, congenital tissue desires and aging. Signal pathways and transcription factors that are involved in vascular calcification are also takes place in normal osteogenesis and/or vascular development. In the review the main attention is payed to the role of signaling pathways BMP (bone morphogenic protein), Notch, Wnt and to the role of transcription factors BMP2, RUNX2, Msx2 in vascular calcification. Probably, dysfunction of osteogenic signal pathways and transdifferentiation of vascular cells to osteoblast-like cells is a common prosses not only for vascular calcification or mineralization, but is a way of vascular degradation in general. Proosteogenic changes at cellular and molecular level may play role in pathogenesis of a disease without manifestation of vascular mineralization, such as thoracic aortic aneurysm. Ability of vascular cells to change their phenotype to osteophenotype is very likely biologically important ability. Over weakness of calcific signaling pathways activity can also lead to vascular pathology. The aim of the review is to overlook the mechanisms of vascular calcification focusing at the role of signal pathways and vascular cells at this process with particular attention to aortic calcification. Understanding the mechanisms of biological regulation of pro- and antiosteogenic processes in pathology and normal conditions opens new opportunities to influence this prosess in order to correct vascular pathologies.

Purpose. To identify the peculiarities of the dynamics of fibrosis markers of C-terminal procollagen propeptide type I (PICP) and N-terminal collagen propeptide type III (PIIINP) in patients with ST segment elevation myocardial infarction (STEMI) and preserved myocardial contractility.

Material and methods. 86 patients with STEMI and preserved left ventricular ejection fraction were examined. In addition to the standard laboratory and instrumental examinations, all the patients underwent the estimation of the concentrations of C-terminal procollagen propeptide type I (PICP) and N-terminal collagen propeptide type III (PIIINP) by enzyme-linked immunoassay using BCM Diagnostics laboratory kits (USA) on the 1st and the 12th days of disease and 1 year later.

Results. The concentration of PICP was significantly reduced in all groups during the entire observation period. Significant correlations were found between PICP and visceral obesity index, age and left ventricular ejection fraction. A relationship was found between PIIINP and an increased visceral obesity index.

The literature review presents the possibilities and current trends in the use of hybrid surgery in patients with multilevel multifocal lesions of the arterial bed of the lower extremities with obliterating lesions. Methods of open bypass surgery for chronic atherosclerosis of the arteries have long been developed, put into practice and can be considered individually for each patient. However, given the frequent complicated atherosclerotic history in patients with multifocal lesions of various arterial pools, most patients can be recommended more gentle endovascular methods of blood flow correction — balloon angioplasty or stenting. But given certain technical and general parameters (prolonged occlusion, severe calcification, kidney disease, an allergic reaction to a contrast drug, etc.), it is not yet possible to use intravascular correction in absolutely all patients, as a result of which the method of simultaneous or phased hybrid surgery seems to be very relevant and can be used even in patients at extremely high risk. The review describes the possible uses of hybrid technology depending on the level of steno-occlusive lesion and the general prolongation of narrowing of the arterial bed. Also considered are some features of the use of simultaneous or multi-stage hybrid operations. On the basis of modern literature data, the advantage of using a combination of open surgeries and endovascular interventions in comparison with any one revascularization method is shown.

The idea of proportional assist ventilation, in which the patient himself sets the respiratory pattern — the frequency and depth of breathing — was suggested in 1992, but has not yet found widespread practical application. One of the possible reasons for this is the complex algorithm of regime adjustment on first-generation respiratory devices. Over time, the accumulated body of information on the early damage of the diaphragm because of its atrophy in patients on respiratory support formed the basis of the awareness of the importance of maintaining the physiological state of the diaphragm during artificial lung ventilation and led to the emergence of the term “myotrauma”.

At the turn the 21st century, the idea of the maximum possible preservation of spontaneous breathing of the patient during mechanical lung ventilation realized in the formation of the concept of “diaphragm-protective ventilation”. The need for further development of assisted lung ventilation technologies designed to reduce the risk of diaphragm damage, the frequency of asynchrony in the pair “respirator-patient”, and to facilitate the process of weaning of the patient from the artificial lung ventilation became apparent. This article, based on scientific literature and own clinical experience of using proportional ventilation, describes the peculiarities of regime adjustment on different respirators, places the accents necessary for successful practical use of proportional lung ventilation. Describes key conditions for its use, advantages and limitations.

Background. Data on the effect of the number of received oocytes on the outcomes of assisted reproductive technology (ART) programs are contradictory. The frequency of obtaining a small number of cells ranges from 5.6 to 35.1 %. Identifying women who have chances of getting pregnant, despite this situation, is important for drawing up an adequate treatment plan.

Objective of this study is to assess the pregnancy rate depending on the number of retrieved oocytes in ART cycles with ovarian stimulation, which ended with the transfer of embryos, as well as determining the characteristics of patients with a reduced response, in whom the pregnancy occurred.

Design and methods. The study included 526 women who were treated for infertility in the department of ART of the Almazov National Medical Research Centre in 2017. Patients were divided into three groups depending on the number of oocytes retrieved: less than 5, from 5 to 9 and 10 or more. Group 1 (number of oocytes less than 5) included 126 women, group 2 (from 5 to 9) — 223 women and group 3 (number of oocytes 10 and more) — 177 patients. The average age of the patients was 33.37 years (from 22 to 48 years).

Results. The frequency of obtaining a positive blood test and clinical pregnancy rate were comparable in groups 2 and 3 (53.81 % and 49.72 %, respectively) and significantly lower in group 1 (41.27 %, p > 0.05). Clinical pregnancy in group 1 occurred in 34.13 % of cases, which was significantly different from the indicators of group 2 + 3, where the gestational egg visualized in 47.5 % of cases (p < 0.05). In a group of women with a small number of oocytes, the most important predictors of pregnancy were obtaining 2 or more oocytes, and anti-mullerian hormone (AMH) level above 1 ng / L.

Conclusion. The number of oocytes is an important predictor of pregnancy rate. The chances of becoming pregnant in women with a small number of oocytes depend on the level of AMH and the number of oocytes obtained.

Background. 3D scaffolds plays an important role in developing new approaches in modern dentistry. They are used to establish optimal conditions for cell differentiation, vascularization and remodeling of regenerating bone tissue.

Objective. Evaluation of the possibility of creating scaffolds developed on the basis of 3D modeling of periodontal bone defects and containing tooth pulp stem cells.

Materials and Methods. The computer tomography data of the maxillar bone tissue defect were analysed. Anatomical prototype — a mold representing defects of the vestibular and palatal fragments of bone tissue was created by 3D printing. This 3D form was filled with fibrin glue and dental pulp stem cells. The fibrin glue was prepared from autologous blood plasma and mixed with dental pulp stem cells.

Results. Fibrin glue prepared from an autologous plasma concentrate (fibrinogen 20 g/l) retains its shape for 4 days. On the day 5, the clot retraction became clearly visible and on the day 7, the clot diameter decreased to 50 % of the original size. The proliferation rate of cells, grown both inside the scaffold and in 2D conditions, did not differ. The immunophenotype of cells of both groups corresponded to the immunophenotype of mesenchy mal stromal cells. The mesenchymal immunophenotype is a feature of dental stem cells. Alizarin red staining of cells both grown on adhesive culture plastic and extracted from glue on day 10 after the induction of osteogenic differentiation did not differ.

Conclusion. The fibrin glue is a good material for creation a scaffold with suitable mechanical characteristics. The cells enclosed in the fibrin glue maintain their viability, immunophenotype and osteogenic potential. This technology can be used for bone tissue repair in dentistry and maxillofacial surgery.

Introduction. The article presents a clinical case of a robot-assisted extended left-sided radical nephrectomy with removal of conglomerate of the lymph nodes with preliminary renal artery embolization in a patient with histologically verified papillary kidney cancer; the technique of the operation is described, the main perioperative indicators are presented. The purpose of the study is to share the experience gained from a unique case.

Materials and methods. Patient 21 years old, female. The patient had a history of macrohematuria in October 2018, and therefore was hospitalized in a city hospital, where examination, according to ultrasound, CT, revealed the formation of the left kidney. In November 2018, a targeted biopsy of a tumor of the left kidney was performed under ultrasound control; pathomorphological examination revealed papillary carcinoma. According to CT: In the upper and middle third of the left kidney, there wsa hypervascular, heterogeneous cystic-solid formation with an uneven contour, 52 × 44 × 49 mm in size, spreading into the abdominal system of the kidney, compressing the tail of the pancreas (without distinct signs of invasion), also the thrombosis of the branches of the renal vein pathomorphological was determined. A robot-assisted extended left-sided radical nephrectomy with removal of conglomerate of the lymph nodes with preliminary renal artery embolization was performed. Results. The duration of the first stage of the operation (endovascular embolization of a. renalis sinistra) was 50 minutes. The duration of the second stage of the operation (robotic radical nephrectomy) was 225 minutes. Console time is 180 minutes. The volume of blood loss did not exceed 100 ml. There were no major complications during postoperative period.

Conclusions. The combination of preliminary renal artery embolization and a robot-assisted extended radical nephrectomy is an effective and safe method of surgical treatment in high-risk patients.

Case report: robot-assisted extended radical nephrectomy with removal of conglomerate of the lymph nodes

Introduction. The case of a robot-assisted laparoscopic radical prostatectomy in a patient with an 81-gram prostate with a large medial lobe (39-gram) is presented. We describe the technique of operation, show the main perioperative indications and summarize the rehabilitation period.

The aim of the study is to detect possible technical difficulties of this operation, to attract the interest of urologist to this topic and to share our experience.

Materials and methods. А 73-year-old male presented to the urology clinic because of elevated PSA level (18 ng/ml); transrectal ultrasound-guided biopsy of the prostate revealed a Gleason score 6 (3 + 3) acinar adenocarcinoma involving left lateral and medial zone; according to the magnetic resonance scan prostate size is 81 g, asymmetric with a prevalence of the left lobe, median lobe size is about 39 g, median lobe prolapses into the bladder for 4,6 cm, the prostatic part of the urethra is shifted to the left, there is no data for extracapsular extension, the lymph nodes haven’t got any changes, there are no signs of specific bone damage according to the bone scan. The patient underwent robot-assisted laparoscopic radical prostatectomy with bilateral nerve sparing.

Results. The procedure length was about 200 min; console time — 155 min. Blood loss was 120 ml. The hemoglobin level decreased by 7.6 % of the initial value. Pelvic drain removed on 2rd day. The urethral catheter was removed on 7th day. On the 8th day patient was discharged from hospital.

Conclusions. A robot-assisted laparoscopic radical prostatectomy in a patient with a large medial lobe give to the operative surgeon several problems: the large size of the prostate, the difficulty of bladder neck reconstruction, special attention on the stage of mobilization of the ureteral opening.