The nature, properties and mechanism of formation of alcohol hyalin

The term "alcohol hyalin" designates several types of acidophilic inclusions in the cytoplasm of hepatocytes in acute alcoholic hepatitis. While similar material occurs in a number of non-alcoholic hepatopathies and extrahepatically, alcohol hyalin serves as an important marker of the alcohol-induced liver disease. Alcohol hyalin is mainly a protein material (fibrillar or granular) containing a number of polypeptides related to cytokeratin system, as well as some unique components. Its formation has multiple pathologic consequences including necrosis of hepatocytes, inflammatory processes in the liver resulting in cirrosis, and systemic autoimmune disorders. Three main hypotheses on mechanism of alcohol hyalin formation are discussed.     

Dynamic thyroid function after the surgical treatment of patients with diffuse toxic goiter

The time course of thyroid function and hypophyseal thyrotropic activity were investigated in 182 patients with diffuse toxic goiter of severe and moderately severe forms of thyrotoxicosis before operation and in short- and long-term periods after operation using radioimmunoassay in a hospital and outpatient clinic. The determination of blood T3, T4 and TSH at the height of clinical manifestations of thyrotoxicosis and before operation was shown to reflect the gravity of disease and could serve as a diagnostic test of the efficacy of preoperative preparation. A T4 concentration index varied at different time after operation. A considerable decrease in blood TSH on the first days after the operation and its rise in the following 6 mos. resulted from the patients' adaptation to new conditions and were of transient nature in the overwhelming majority of the patients. Final assessment of the thyroid and pituitary function was possible only 12 mos. after operation.     

Postnatal maturation of subcortical projections from the prefrontal cortex in the rhesus monkey

Orbital and dorsolateral prefrontal lesions were performed on a series of rhesus monkeys at 2, 6, or 24 months of age. The consequent degeneration in the efferent pathways from these cortical regions to the caudate nucleus, the dorsomedial nucleus of the thalamus and adjacent structures was studied at 5- and 15-day survival times by a modification of the Nauta-Gygax method for tracing degenerating fibers. Following dorsolateral lesions, considerable numbers of black-impregnated degenerating fibers were found in the parvocellular division of the dorsomedial nucleus and in the fiber bundles of the internal capsule and the subcallosal fasciculus at all ages. In contrast, the degree of Nauta-Gygax degeneration in the anterodorsal sector of the head of the caudate nucleus was age-dependent: degenerating fibers were found in increasing numbers from two months of age, when virtually none could be detected, to 24 months of age, when they appeared in relatively dense concentration. Similar results were obtained following orbital prefrontal lesions at the same three ages: degeneration in the magnocellular division of the dorsomedial nucleus of the thalamus and in the internal capsule were not related to age, but anterograde degeneration in the ventral and lateral capsular region of the caudate increased substantially with advancing age. Negative results with the Nauta-Gygax technique in very young animals may not signify an actual absence of the connection in question, but our findings, together with those of other studies employing silver degeneration methods, at least suggest that in the primate, certain cortical efferents undergo maturational changes during postnatal life, a fact which may be related to the differential behavioral consequences of cortical injuries at different stages of development.     

Current principles of cholelithiasis prophylaxis in the practice of district physician

The key task of the district physician is staged diagnostic search and clinical detection of functional disorders--conduction of laboratory tests and device investigations (in cholelithiasis patients--ultramicroscopic investigation of bile, x-ray methods, ultrasonography) to initiate prophylactic-therapeutic measures (medico-social, pharmacological and therapeutic-dietary).     

Application of a polarizable force field to calculations of relative protein-ligand binding affinities

An explicitly polarizable force field based exclusively on quantum data is applied to calculations of relative binding affinities of ligands to proteins. Five ligands, differing by replacement of an atom or functional group, in complexes with three serine proteases—trypsin, thrombin, and urokinase-type plasminogen activator—with available experimental binding data are used as test systems. A special protocol of thermodynamic integration was developed and used to provide sufficiently low levels of systematic error along with high numerical efficiency and statistical stability. The calculated results are in excellent quantitative (rmsd = 1.0 kcal/mol) and qualitative (R² = 0.90) agreement with experimental data. The potential of the methodology to explain the observed differences in the ligand affinities is also demonstrated.     

Application of robotized radiosurgical system CyberKnife for the treatment of neurosurgical patients

Robotized system for radiosurgery CyberKnife (Accuray Inc., USA) is the first device dedicated and optimized for advanced irradiation during 1-7 fractions (i.e. radiosurgery and hypofractionation). CyberKnife is characterized by elaborate guidance system, high precision of dose delivery, possibility of conformal dose distributions with high gradient of target borderline dose which is most important in proximity of critical structures. The first CyberKnife system in Russia was installed in Burdenko Neurosurgery Institute. The paper presents 2-year experience of treating patients using CyberKnife. From April 2009 till October 2011 896 patients were treated using CyberKnife. Mean age was 48 years. Overall number of sessions was 2626. Radiosurgical procedures were performed in 21.8% of patients. 91% of cases were treated for intracranial lesions. Limited follow-up period in all kinds of pathology demonstrated results consistent with standard fractionation or radiosurgery. The rates of observed complications were also comparable with accepted techniques. CyberKnife system plays significant role in everyday activity of department of radiation therapy. In careful and thorough selection of patients it allows efficient and high-quality treatment of patients with neurosurgical diseases.     

First experience of stereotactic radiation therapy for vestibular schwannoma using CyberKnife

Currently stereotactic radiosurgery has become the treatment of choice in small vestibular schwannomas. This paper discusses our first experience of application of CyberKnife system for stereotactic irradiation of these tumors. From April 2009 till June 2011 we treated 62 patients (35 female and 27 male) with vestibular schwannomas. Stereotactic radiosurgery using CyberKnife system was performed in 33 patients. Mean tumor volume was 2 +/- 1.4 cm3. Hypofractionated treatment was used in 30 cases (31 tumor). Mean tumor volume reached was 7 +/- 6.2 cm3 (range - 0.5-31.3 cm3). In a case of a patient with NF2 simultaneous irradiation of bilateral tumors was performed. Most frequently we applied 3 fractions 6 Gy each (17 observations of 31, or 55%) and 5 fractions with mean dose 5 Cy (10 cases, or 32%). Follow-up period varied from 1 to 26 months (mean 9 +/- 4.5 months). By the end of this study (June 30, 2011) surgical resection was required in the only case of 47-years old male patient with cystic schwannoma of left vestibular nerve 5 months after radiation treatment, due to progressive growth of the cyst and increased brainstem compression. Tumor growth control was established in 97.5% of cases. Stabilization of auditory function was achieved in 77.5% of series. Effective hearing was preserved in 75% of patients. Facial nerve palsy after stereotactic radiation treatment was observed in 2 cases (3%). Incidence of trigeminal nerve dysfunction was significantly higher: sensation disturbances occurred in 6 (10%) patients: 3% after radiosurgery and 16.7% after hypofractionation. We did not obtain significant correlations between risk of cranial nerve complications and dosimetric or demographic factors. However we observed stable tendency: larger initial volume of the tumor and presence of trigeminal nerve dysfunction before treatment were poor prognostic factors for trigeminal neuropathy. Stereotactic irradiation using CyberKnife system is effective and sufficiently safe technique for management of vestibular schwannoma. The paper demonstrates high rates of tumor stabilization, hearing preservation and minimal incidence of complications associated with trigeminal or facial nerve.