[IMPROVEMENT OF ETIOLOGICAL DIAGNOSIS OF THE CEREBRAL TOXOPLASMOSIS IN HIV-INFECTED PERSONS]

The objective of the study was to determine the diagnostic value of the parallel detection of the avidity index of the IgG to Toxoplasma gondii in the blood and cerebrospinal fluid by a three-step solid-phase enzyme immunoassay using T. gondii antigen, protein dissociating agent and monoclonal antibodies against human IgG at HIV-infected individuals with a focal damage of the brain. The results of the study showed that conducting of the enzyme-linked immunosorbent assay by a direct and dissociated method makes it possible to detect specific intrathecal and serum immunoglobulins, which is proposed in terms of improving diagnosis of cerebral toxoplasmosis in HIV-infected individuals. The high informative ability of the test system for detecting the avidity index of IgG antibodies to T. gondii allows the possibility to apply it in the algorithm for diagnosing an etiological factor of neuroinfection in HIV-infected individuals.

Cobalt oxide as a selective co-catalyst for water oxidation in the presence of an organic dye

In photobiocatalytical processes involving the simultaneous oxidation of water and reduction of specific organic molecules (e.g., cofactors), the lack of physical separation of the redox half-reactions adversely affects the product stability. This is largely because organic molecules are generally less stable within harsh oxidative environments. In general, surface co-catalysts are able to improve the selectivity of photocatalysts towards water oxidation. However, harsh oxidative environments reduce the chemical stability of the organic molecules. Herein, we show that the use of Co₃O₄ as a surface co-catalyst on silver orthophosphate improve water photo-oxidation in the presence of organic dye molecules, such as methylene blue, that typically exhibits susceptibility toward photodegradation. The presence of Co₃O₄ on the photocatalyst surface prevents the adsorption of the organic dye, thus reducing its degradation rate. These findings provide a promising scenario for the visible light-driven reduction of organic molecules using water as an electron donor.

Intraoperative Probe-Based Confocal Laser Endomicroscopy in Surgery and Stereotactic Biopsy of Low-Grade and High-Grade Gliomas: A Feasibility Study in Humans

BACKGROUND

The management of gliomas is based on precise histologic diagnosis. The tumor tissue can be obtained during open surgery or via stereotactic biopsy. Intraoperative tissue imaging could substantially improve biopsy precision and, ultimately, the extent of resection.

OBJECTIVE

To show the feasibility of intraoperative in vivo probe-based confocal laser endomicroscopy (pCLE) in surgery and biopsy of gliomas.

METHODS

In our prospective observational study, 9 adult patients were enrolled between September 2014 and January 2015. Two contrast agents were used: 5-aminolevulinic acid (3 cases) or intravenous fluorescein (6 cases). Intraoperative imaging was performed with the Cellvizio system (Mauna Kea Technologies, Paris). A 0.85-mm probe was used for stereotactic procedures, with the biopsy needle modified to have a distal opening. During open brain surgery, a 2.36-mm probe was used. Each series corresponds to a separate histologic fragment.

RESULTS

The diagnoses of the lesions were glioblastoma (4 cases), low-grade glioma (2), grade III oligoastrocytoma (2), and lymphoma (1). Autofluorescence of neurons in cortex was observed. Cellvizio images enabled differentiation of healthy "normal" tissue from pathological tissue in open surgery and stereotactic biopsy using fluorescein. 5-Aminolevulinic acid confocal patterns were difficult to establish. No intraoperative complications related to pCLE or to use of either contrast agent were observed.

CONCLUSION

We report the initial feasibility and safety of intraoperative pCLE during primary brain tumor resection and stereotactic biopsy procedures. Pending further investigation, pCLE of brain tissue could be utilized for intraoperative surgical guidance, improvement in brain biopsy yield, and optimization of glioma resection via analysis of tumor margins.

ABBREVIATIONS

5-ALA, 5-aminolevulinic acidpCLE, probe-based confocal laser endomicroscopyPpIX, protoporphyrin IX.

[Results of surgical treatment of five cases with phlegmon of the scrotum for the 2012-2015 period]

Phlegmon of the serotum is a severe form of suppurative inflammatory process, which causes are extremely various. For the 2012 - 2015 year period at the department of urology we had five cases of phlegmon of the scrotum, where incision was performed as well as debridement and drainage and the wound was closed with the available tissues of the scrotum. Aggressive debridement of all necrotic tissues and all fascial planes that were separating easily during the blunt dissection were excised until well vascularized tissue was reached. The wounds were left wide opened until the appearance of healthy granulation tissue and then assessment of their secondary closing. Tissues were sent for histological and microbiological assessment.

[Laparoscopic ureteroneocystostomiya a modo Boari - hitch operative technique and results]

OBJECTIVE

To present the first laparoscopsic ureteroneotsistostomies we have performed by the Boari methods - operative technique and results.

MATERIALS AND METHODS

We investigated 9 patients for a period of two years -from 2015 to 2016 year, 9 had had previous surgery, in 2 of them followed by radiotherapy (one man and one woman). The average age of the patients was 45 (29-61) years. Women in the study were 7, men - 2. We performed 9 laparoscopic operating procedures following the open operative technique of Boari.

RESULTS

All patients we have operated and who have no previous radiotherapy had excellent results - no hydronephrosis, recovering the kidney parenchyma and absence of reflux. In two patients who had undergone radiotherapy we had to perform an open procedure because of severe adhesions.

CONCLUSIONS

The experience we have gained with open operative technique and the development of laparoscopic techniques allow us to look for more - often and less invasive methods of surgery. We have best results when indications for operative technique are strictly followed.

Intrahospital Transfer of Patients with Traumatic Brain Injury: Increase in Intracranial Pressure

AIM

To assess the dynamic of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and dynamic pressure reactivity index (PRx) during intrahospital transport.

MATERIALS AND METHODS

There were 33 comatose patients with severe traumatic brain injury (TBI). The mean age was 36.3 ± 4.8 years (range 19-45 years), and there were 17 men and 16 women. The median Glasgow Coma Scale score at admission was 6.2 ± 0.7. Computed tomography (CT) included native CT, perfusion CT, and CT angiography.

RESULTS

The mean CPPs before and after the CT scans were 95.9 ± 10.7 and 81.5 ± 12.5 mmHg respectively. The mean ICP before transport was 19.98 ± 5.3 mmHg (minimum 11.7; maximum 51.7). It was statistically significantly lower (p < 0.001) than during the transfer (26.1 ± 13.5 mmHg). During the period described all patients had increased ICP, especially during vertical movement in an elevator. During horizontal movement on the floor ICP remained higher (p < 0.05). The mean dynamic PRx before and after intrahospital transport was 0.23 ± 0.14 and 0.52 ± 0.04, respectively (p < 0.001). Average duration of the transfer and CT study was 15.3 ± 3.4 min.

CONCLUSION

Intrahospital transport of patients with TBI may lead to a significant increase in ICP, dynamic PRx, and decreased CPP. The results suppose that the decision to perform brain CT in comatose patients with TBI should be carefully considered by clinicians.

5-Aminolevulinic Acid-Protoporphyrin IX Fluorescence-Guided Surgery of High-Grade Gliomas: A Systematic Review

The current first-line treatment of malignant gliomas consists in surgical resection (if possible) as large as possible. The existing tools don't permit to identify the limits of tumor infiltration, which goes beyond the zone of contrast enhancement on MRI. The fluorescence-guided malignant gliomas surgery was started 15 years ago and had become a standard of care in many countries. The technique is based on fluorescent molecule revelation using the filters, positioned within the surgical microscope. The fluorophore, protoporphyrin IX (PpIX), is converted in tumoral cells from 5-aminolevulinic acid (5-ALA), given orally before surgery. Many studies have shown that the ratio of gross total resections was higher if the fluorescence technique was used. The fluorescence signal intensity is correlated to the cell density and the PpIX concentration. The current method has a very high specificity but still lower sensibility, particularly regarding the zones with poor tumoral infiltration. This book reviews the principles of the technique and the results (extent of resection and survival).

5-Aminolevulinic Acid-Protoporphyrin IX Fluorescence-Guided Surgery of High-Grade Gliomas: A Systematic Review

The current first-line treatment of malignant gliomas consists in surgical resection (if possible) as large as possible. The existing tools don't permit to identify the limits of tumor infiltration, which goes beyond the zone of contrast enhancement on MRI. The fluorescence-guided malignant gliomas surgery was started 15 years ago and had become a standard of care in many countries. The technique is based on fluorescent molecule revelation using the filters, positioned within the surgical microscope. The fluorophore, protoporphyrin IX (PpIX), is converted in tumoral cells from 5-aminolevulinic acid (5-ALA), given orally before surgery. Many studies have shown that the ratio of gross total resections was higher if the fluorescence technique was used. The fluorescence signal intensity is correlated to the cell density and the PpIX concentration. The current method has a very high specificity but still lower sensibility, particularly regarding the zones with poor tumoral infiltration. This book reviews the principles of the technique and the results (extent of resection and survival).

Long-term results of carmustine wafer implantation for newly diagnosed glioblastomas: a controlled propensity-matched analysis of a French multicenter cohort

BACKGROUND

The standard of care for newly diagnosed glioblastoma is maximal safe surgical resection, followed by chemoradiation therapy. We assessed carmustine wafer implantation efficacy and safety when used in combination with standard care.

METHODS

Included were adult patients with (n = 354, implantation group) and without (n = 433, standard group) carmustine wafer implantation during first surgical resection followed by chemoradiation standard protocol. Multivariate and case-matched analyses (controlled propensity-matched cohort, 262 pairs of patients) were conducted.

RESULTS

The median progression-free survival was 12.0 months (95% CI: 10.7-12.6) in the implantation group and 10.0 months (9.0-10.0) in the standard group and the median overall survival was 20.4 months (19.0-22.7) and 18.0 months (17.0-19.0), respectively. Carmustine wafer implantation was independently associated with longer progression-free survival in patients with subtotal/total surgical resection in the whole series (adjusted hazard ratio [HR], 0.76 [95% CI: 0.63-0.92], P = .005) and after propensity matching (HR, 0.74 [95% CI: 0.60-0.92], P = .008), whereas no significant difference was found for overall survival (HR, 0.95 [0.80-1.13], P = .574; HR, 1.06 [0.87-1.29], P = .561, respectively). Surgical resection at progression whether alone or combined with carmustine wafer implantation was independently associated with longer overall survival in the whole series (HR, 0.58 [0.44-0.76], P < .0001; HR, 0.54 [0.41-0.70], P < .0001, respectively) and after propensity matching (HR, 0.56 [95% CI: 0.40-0.78], P < .0001; HR, 0.46 [95% CI: 0.33-0.64], P < .0001, respectively). The higher postoperative infection rate in the implantation group did not affect survival.

CONCLUSIONS

Carmustine wafer implantation during surgical resection followed by the standard chemoradiation protocol for newly diagnosed glioblastoma in adults resulted in a significant progression-free survival benefit.

[Prevalence of lower urinary tract symptoms among male population in Russian Federation: analysis of population study results]

The purpose of the present research is to study the incidence and severity of lower urinary tract symptoms (LUTS) in male population of the Russian Federation and to establish the relationship with the most common diseases. Based on the materials of population survey of 1083 men (mean age - 42,8±14,1 years) held in the Russian Federation in 2011-2012 the relationship between age, weight, height, sexual activity, addictions, co-morbidities and the answers to the questionnaire IPSS with the assessment of quality of life in relation with existing disorders of urination (QoL) was studied in six federal districts. 649 (59.9%) respondents had urinary system disorders (IPSS>0), the mean (±SD) of the sum IPSS questionnaire score was 5,0±7,0. LUTS severity was greater in: older men (τB=0,441; p<0,001); in men who had undergone surgeries of the pelvic organs (τB=0,242; p<0,001); in the presence of coronary artery ischaemic disease (τB=0,242; p<0,001), arterial hypertension (τB=0,255; p<0,001); diabetes mellitus (τB=0,154; p<0,001); obesity (τB=0,148; p<0,001); depression (τB=0,126; p<0,001); and sexual disorders (τB=-0,425; p<0,001). The prevalence of LUTS in men of the Russian Federation is high, their relationship with age and comorbidities require a comprehensive approach to prevention, diagnosis and treatment.

Combining intraoperative carmustine wafers and Stupp regimen in multimodal first-line treatment of primary glioblastomas

BACKGROUND

The study investigated if intraoperative use of carmustine wafers, particularly in combination with Stupp regimen, is a viable and safe first-line treatment option of glioblastomas.

METHODS

Eighty-three consecutive adult patients (50 men; mean age 60 years) with newly diagnosed supratentorial primary glioblastomas that underwent surgical resection with intraoperative carmustine wafers implantation (n = 7.1 ± 1.7) were retrospectively studied.

RESULTS

The median overall survival (OS) was 15.8 months with 56 patients dying over the course of the study. There was no significant association between the number of implanted carmustine wafers and complication rates (four surgical site infections, one death). The OS was significantly longer in Stupp regimen patients (19.5 months) as compared with patients with other postoperative treatments (13 months; p = 0.002). In addition patients with eight or more implanted carmustine wafers survived longer (24.5 months) than patients with seven or less implanted wafers (13 months; p = 0.021). Finally, regardless of the number of carmustine wafers, median OS was significantly longer in patients with a subtotal or total resection (21.5 months) than in patients with a partial resection (13 months; p = 0.011).

CONCLUSIONS

The intraoperative use of carmustine wafers in combination with Stupp regimen is a viable first-line treatment option of glioblastomas. The prognostic value of this treatment association should be evaluated in a multicenter trial, ideally in a randomized and placebo-controlled one.

Biocatalytic etching of semiconductor cadmium sulfide nanoparticles as a new platform for the optical detection of analytes

The enzymatic etching of cadmium sulfide nanoparticles catalyzed by horseradish peroxidase leads to a decrease in the intensity of fluorescence.

Association of NOS3 gene variants and clinical contributors of hypoxic-ischemic encephalopathy

The aim of this study was to analyze the association of different clinical contributors of hypoxic-ischemic encephalopathy with NOS3 gene polymorphisms. A total of 110 children with hypoxic-ischemic encephalopathy and 128 control children were selected for this study. Association of gender, gestational age, birth weight, Apgar score, cranial ultrasonography, and magnetic resonance imaging findings with genotypic data of six haplotype-tagging single nucleotide polymorphisms and the most commonly investigated rs1800779 and rs2070744 polymorphisms was analyzed. The TGT haplotype of rs1800783, rs1800779, and rs2070744 polymorphisms was associated with hypoxic-ischemic encephalopathy. Children with the TGT haplotype were infants below 32 weeks of gestation and they had the most severe brain damage. Increased incidence of the TT genotype of the NOS3 rs1808593 SNP was found in the group of hypoxic-ischemic encephalopathy patients with medium and severe brain damage. The probability of brain damage was twice as high in children with the TT genotype than in children with the TG genotype of the same polymorphism. Furthermore, the T allele of the same polymorphism was twice as frequent in children with lower Apgar scores. This study strongly suggests associations of NOS3 gene polymorphism with intensity of brain damage and severity of the clinical picture in affected children.

Synchronous and metachronous primary malignant colorectal tumors and associated primary extracolonic malignant tumors--diagnostics and surgical treatment

The publications considering multiple primary tumors date back even to the XIXth century, however the scientific interest towards this problem still remains significant. The classification of these tumors is changing through the years, and their frequency remains higher than the expected one. The colon is one of the organs, where multiple primary lesions are often found, as well as primary lesions, associated with extracolonic primary malignant tumors. The multiple primary tumors are still found to be a diagnostic challenge, while there is still no complete solidarity regarding the surgical treatment of lesions found simultaneously. The question whether the multiple primary lesions have a poorer prognosis as regards the survival rate, compared to the solitary tumors, has always aroused interest.