Closure Of Cavity Research Articles

Comparative Analysis of Coronal Sealing Materials in Endodontics: Exploring Non-Eugenol Zinc Oxide-Based versus Glass-Ionomer Cement Systems.

The proper closure of the access cavity between appointments during endodontic treatment is paramount and relies on temporary fillings. This systematic review evaluates the effectiveness of zinc oxide-based materials and glass-ionomer cement (GIC) as temporary coronal sealers after root canal treatment in extracted human teeth. Three databases were searched to identify randomized clinical trials that examined the sealing properties of various temporary sealing materials using dyes or stains as indicators. A total of seven in vitro studies that fulfilled the eligibility criteria were critically analyzed. These indicated significant variations in the relative sealing ability of the coronal breach of endodontically treated teeth, either by zinc oxide or GIC-based materials. While GIC-based material (e.g., Fuji IX and Fuji II) exhibited superior sealing of single-rooted teeth, zinc oxide-based material (e.g., Cavit, Coltosol, Caviton) also showed promising attributes. Resin-modified GIC formulations displayed enhanced physical properties, yet challenges related to adhesive failure and shrinkage during polymerization were observed. Zinc oxide-based materials have demonstrated superior coronal sealing effectiveness over certain GIC in controlled settings. Their premixed nature ensures consistent application and hygroscopic properties improve cavity sealing. However, the focus on dye penetration tests for microleakage in vitro may not fully represent the risk of bacterial infiltration. Thus, in vivo studies are crucial for validating these findings in clinical contexts.

The first experience of the abdominal VAC- therapy application on role II medical support of combat actions

Purpose. To conduct an analysis of the first experience of using abdominal VAC therapy during the implementation of Damage Control Surgery (DCS) tactics in the treatment of combat surgical abdominal trauma during large-scale combat operations.
 Material and methods. An analysis of the use of abdominal VAC therapy in the conditions of the advanced surgical group of the Military Mobile Hospital at the Role II of medical support in 45 wounded with penetrating gunshot wounds to the abdomen and damage to internal organs was carried out.
 Results. The paper describes the injuries of the abdominal organs in the case of a combat surgical injury of the abdomen, which underwent abdominal VAC therapy at the Role II of medical care. The technique of using abdominal VAC therapy in the irrigation mode is described in detail, with the specifics of its implementation for various injuries. The features of performing abdominal VAC therapy during the evacuation of the wounded are highlighted. The purpose of abdominal VAC therapy at the Role II of MS in the conditions of large-scale combat operations, indications, contraindications to its use and the peculiarities of its implementation in combat surgical abdominal trauma are summarized. 
 Conclusions. Abdominal VAC therapy for combat surgical injury of the abdomen is the optimal way to temporarily close the abdominal cavity at the end of the I phase of the DCS tactics at the Role II of combat medical support, which allows you to remove pathological exudate effectively from the abdominal cavity and rehabilitate it (including during medical evacuation to the next level of medical care ) and is preparation for performing reconstructive operations and final closure of the abdominal cavity in the III phase DCS tactics.

Efficacy and safety of negative wound pressure in the treatment of surgical complications after radical cystectomy: a retrospective cohort study

Background: Negative pressure wound treatment (NPWT) is a relatively new, but promising method for management of surgical site infection (SSI). The literature data on the use of NPWT for complications in oncology surgery, and after radical cystectomy (RC) in particular, is scarce.
 Aim: To evaluate the short-term results of NPWT dressings in the management of SSI after RC.
 Materials and methods: We retrospectively analyzed data from 446 patients who had RC with various uroderivation types in the Department of Oncourology of the N. N. Petrov National Medical Research Center of Oncology from January 2012 to December 2021. A total of 62 cases of SSI emerging up to day 30 after RC were identified with complete data. Thirty six (36) cases of SSI were managed according to standard procedures, and 26 patients with SSI were treated with NPWT (VivanoTec® S 042) at constant negative pressure mode. The physical condition of the patients before RC was assessed according to the American Society of Anesthesiology (ASA) classification, and the severity of the patient's condition at SSI diagnosis within APACHE II scale. The following parameters were also analyzed: body mass index, median number of days in the hospital, number of program wound sanitations (surgical debridement) or frequency of changing NPWT dressings, changes over time in C-reactive protein and leukocyte index of intoxication, and events of clinical interest (intestinal fistulas and lateralization of the median wound margins, hernias).
 Results: Most cases of post-RC SSIs were identified in men (57/62, 91.93%). The standard management and NPWT study groups were well balanced for age, body mass index, and ASA physical status. The median time from the first surgical debridement of the wound to its closure was significantly shorter in the standard surgical management group: 4 days (0; 8.75) versus 8.5 days (3.25; 12.0) in the NPWT group (p = 0.026). However, this did not negatively affect the length of hospitalization (28.08 ± 12.80 and 30.03 ± 16.27 days, respectively, p = 0.599). The 30-day mortality rates were not significantly different between the groups (p = 0.137). In our series with NPWT dressings, there were no cases of intestinal fistulas in the early and late postoperative periods.
 Conclusion: Negative pressure wound treatment is a safe and effective method of SSI management. It is not inferior to the generally accepted treatment standard with surgical wound debridement, staged sanitations or dressings. NPWT dressings allow for early primary muscular-fascial closure of the abdominal cavity and does not increase the duration of hospital stay, postoperative death rates and the risk of intestinal fistulas.

Vacuum-assisted laparostomy for advanced peritonitisis

To evaluate the efficacy of negative pressure therapy in patients with peritonitis. The study included 127 patients with advanced secondary peritonitis between 2019 and 2022. All patients were divided into 2 groups. All ones underwent staged sanitation of the abdominal cavity. In the first group (n=76), re-laparotomies were accompanied by skin suture only and passive abdominal drainage. The second group included patients (n=51) with open abdominal cavity strategy and negative pressure therapy (vacuum-assisted laparostomy). We analyzed the number of surgeries, postoperative complications, duration of hospital-stay and mortality. In the second group, there were significantly lower morbidity, mean number of surgeries and hospital-stay. In addition, incidence of fascial closure of abdominal cavity was higher and mortality rate was lower in the same group. Vacuum-assisted laparostomy in patients with advanced peritonitis can reduce the number of secondary purulent complications and mortality, as well as increase the incidence of fascial closure of abdominal cavity. This approach reduces the number of surgical interventions and duration of in-hospital treatment.

Vascularization of a bone stump

<p><strong>Aim</strong> <br />To study the character of blood circulation in the bone stump at tight and loose closure of the medullary cavity.<br /><strong>Methods</strong> <br />Two series of experiments on 39 rabbits with mid-third femoral amputation and muscular plasty were carried out. In the<br />1st (experimental) series, the bone scapula was closed by thin cortical autograft taken from the epimetaphyseal area, and then the muscles were sutured, and in the 2nd – the scapula was closed by myoplasty only. Follow-up periods: 1st series – 7, 14, 21 days and 1, 3, 6 months, 2nd series – 1, 3, 6 months. Histological methods with infusion of vessels with ink-gelatin mixture and morphometry was used.<br /><strong>Results</strong> <br />In the 1st series there was a rapid restoration of the disturbed macro- and microcirculation due to the reserve sources of<br />blood circulation and the development of extravascular ways of microcirculation. In the 2nd series, blood circulation recovery was significantly slower and occurred mainly due to the development of extravascular microcirculatory pathways.<br /><strong>Conclusion</strong> <br />The study established undeniable usefulness of tight closure of the bone marrow cavity during amputation.</p>

Treatment of open abdomen combined with entero-atmospheric fistula: A retrospective study

Objective: The purpose of this study was to analyze the course and outcome of patients with combined entero-atmospheric fistulas in open abdomen treatment. Methods: In this retrospective observational study, we collected data on 214 patients with open abdomen complicated by entero-atmospheric fistulas admitted to Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School from January 2012 to January 2021. We collected their basic characteristics, aetiology, treatment plan, and prognosis, including the durations of hospitalization and open treatment, time to resumption of enteral nutrition, duration and prognosis of definitive surgery, and overall prognosis. Results: Of the 214 patients with open abdomen complicated with entero-enteral fistulas, 23 (10.7%) died (11 of multiple organ failure caused by abdominal infection, five of abdominal cavity bleeding, four of pulmonary infection, one of airway bleeding, one of necrotizing fasciitis, and one of traumatic brain injury). The remaining 191 underwent definitive surgery at our hospital. The patients who underwent definitive surgery were predominantly male (156 patients, 81.7%); their age was (46.5±2.5) years. Trauma and gastrointestinal tumors (120 cases, 62.8%) predominated among the primary causes. The reasons for abdominal opening were, in order, severe abdominal infection (137 cases, 71.7%, damage control surgery (29 cases, 15.2%), and abdominal hypertension (25 cases, 13.1%). Temporary abdominal closure measures were used to classify the participants into a skin-only suture group (104 cases) and a skin-implant group (87 cases). Compared with the skin-implant group, in the skin-suture-only group the proportion of male patients was lower (74.7% [65/87] vs. 87.5% [91/104], χ2=5.176, P=0.023), the mean age was older ([48.3±2.0] years vs. [45.0±1.9] years, t=-11.671, P<0.001), there were fewer patients with trauma (32.2% [28 /87] vs. 58.7% [61/104), χ2=13.337, P<0.001), intensive care stays were shorter ([8.9±1.0] days vs. [12.7±1.6] days, t=19.281, P<0.001), total length of stay was shorter ([29.3±2.0] days vs. [31.9±2.0] days, t=9.021,P<0.001), there was a higher percentage of colonic fistulas (18.4% [16/87] vs. 8.7% [9/104], χ2=3.948, P=0.047), but fewer multiple fistulas (11.5% [10/87] vs. 34.6% [36/104], χ2=14.440, P<0.001). As to fistula management, a higher percentage of fistula sealing methods using 3D-printed intestinal stents were implemented in the skin-only suture group (60.9% [53/87] versus 43.3% [45/104], χ2=5.907, P=0.015). Compared with the implant group, the skin-only suture group had a shorter mean time to performing provisional closure ( [9.5±0.8] days vs. [16.0±0.6] days, t=66.023, P<0.001), shorter intervals to definitive surgery ( [165.0±10.7] days vs. [198.9±8.3] days, t=26.644, P<0.001), and less use of biopatches (56.3% [49/87) vs. 71.2% [74/104], χ2=4.545, P=0.033). Conclusions: Open abdomen complicated with entero-enteral fistulas is more common in male, and is often caused by trauma and gastrointestinal tumor. Severe intra-abdominal infection is the major cause of open abdomen, and most fistulae involves the small intestine. Collection and retraction of intestinal fluid and 3D-printed entero-enteral fistula stent sealing followed by implantation and skin-only suturing is an effective means of managing entero-enteral fistulas complicating open abdominal cavity. Earlier closure of the abdominal cavity with skin-only sutures can shorten the time to definitive surgery and reduce the rate of utilization of biopatches.

Effects of lignite composition on reservoir structure, water–gas-bearing features and gas enrichment

The significant variation in production in different blocks has seriously restricted the large-scale breakthrough of China’s low-rank coalbed methane industry for a long time. This study describes in detail the effects of lignite composition on reservoir structure, gas-bearing characteristics, and methane enrichment in the Erlian Basin, thus providing a theoretical basis for accurate exploration of lignite methane. Homogenization of huminite-rich lignite results in the disappearance of cellular structure, closure of cell cavity, small pore size, and low proportion of macropore. The cell wall of inertinite-rich lignite is thin, the cell structure is well preserved, and many cellular pores are developed, providing abundant macropore space. The inertinite-rich lignite contains larger pores and throats, and the content of high coordination number pores is also more abundant. Reservoir characteristics further control the occurrence, migration, and preservation of methane. The inertinite bands provide good seepage space and channels for lignite. The inertinite-rich lignite has high permeability and a low proportion of adsorbed methane, so methane has high mobility in it. The huminite-rich lignite has an excellent “self-sealing” effect on the gas. Overall, huminite-rich lignite in the stagnant area and inertinite-rich lignite in the regional structural culmination are potential favorable positions for the enrichment of lignite methane. Moreover, the interbedded thick coal seam of huminite-rich lignite and inertinite-rich lignite can provide advantageous conditions for water infiltration and gas preservation, thus forming a complete combination of “source, reservoir, and cap rock” in the thick lignite itself.

Factors affecting the precision of age determination of sperm whales (Physeter macrocephalus)

Teeth from 92 sperm whales were prepared by etching for age determination. The total number of growth layer groups (GLGs) in the dentine of each tooth was determined from three to five reading sessions by a single reader. Four other readers, as part of a cross-reading experiment, read a subset of these teeth (n = 5). This study investigated: (1) intra- and (2) inter-reader precision in GLG counts; (3) possible variation in growth structure deposition between different teeth within the same individual; (4) the use of photographs to identify and count GLGs and the effect of this technique on the precision of counts; and (5) mineralisation anomalies in tooth sections and the possible effects these may have on GLG count precision. Intra- and inter-reader precision was determined using coefficients of variation (CV) and indices of precision (D). Total numbers of GLGs estimated from individual teeth ranged from 0.75-64 (¯x = 32.8, n = 92). Intra-reader mean CV was 10.6 and mean D was 4.8. Inter-reader mean CV ranged from 4.8-12.3 and mean D ranged from 2.8-7.1. Differences in final counts between readers appeared to be the result of differing interpretation of GLGs and this was the largest factor affecting the precision of GLG counts. While GLG counts between teeth in the same individual varied, it is possible that this variation was due to within reader variation rather than variation in the development of growth structures, but establishment of this cause is confounded by differential tooth wear. Use of photographs increased the definition of growth structures, decreasing the variation between GLG counts within reading sessions. The incidence of mineralisation anomalies and the closure of the pulp cavity increased with increasing GLG counts in individuals, but were not consistent between teeth from the same individual. These factors, while potentially affecting the accuracy of GLG counts in relation to age estimates, had little effect on the precision of GLG counts. The lack of an ability to validate age estimates in this species and the large inter-reader variation seen in this study suggests that age estimates based on GLG counts in this species are subjective and can only be regarded as relative. High-quality photographs of tooth sections should be used to verify GLG counts with other readers, resulting in ‘consensus counts’ generated by a number of readers, ensuring interpretation of the same structures and confidence in comparing GLG counts produced in different studies.

Experience in using the method of valve bronchial block in Primorsky Krai in treatment of respiratory tuberculosis in a child

This paper presents a clinical case of destructive pulmonary tuberculosis in a child with drug resistance successfully treated using endoscopic bronchial valve therapy. In the context of the developed drug resistance to the causative agent of tuberculosis, ineffectiveness of the conducted treatment and negative radiological dynamics, the method of endoscopic bronchial valve treatment allows the patient’s condition and their clinical and radiological indicators to be improved. In the presented case, a positive X-ray dynamic was achieved in the form of closure of the decay cavity after the installation of an endobronchial valve. Following nine months, the installed endobronchial valve was removed during bronchoscopy and the continuation of chemotherapy was recommended.

МІНІІНВАЗИВНА ТОРАКОПЛАСТИКА ПРИ ХІРУРГІЧНОМУ ЛІКУВАННІ ДЕСТРУКТИВНОГО ТУБЕРКУЛЬОЗУ ЛЕГЕНЬ

Aim: to evaluate results of application of the developed technique of minimally invasive extrapleural thoracoplasty in the surgical treatment of patients with destructive pulmonary tuberculosis. Object and methods. Minimally invasive thoracoplasty was performed in 15 patients (study group): men made up 100 %, in the age range from 26 to 58 years. Chronic forms of pulmonary tuberculosis were diagnosed in 10 (66.6 %) patients, newly diagnosed tuberculosis in 5 (33.4 %). Multidrugresistant tuberculosis was observed in 78 % of patients. Bacterial excretion was observed in 86 % of patients. The size of the cavity in the lung did not exceed 6 cm. All patients in the pre- and postoperative periods received chemotherapy regimens based on the prescription of the CMAC / CRTB treatment regimen. The following effectiveness criteria were assessed: cessation of bacterial excretion 1 month after surgery (negative Bactec culture); closure of the destructive cavity confirmed on chest CT scan, the number of postoperative complications and the presence of relapses in the postoperative period. A new method of minimally invasive thoracoplasty was developed to improve the method of collapse-surgical treatment of patients with destructive pulmonary tuberculosis. It uses a resection of small segments of ribs, both in length and in number, extrapleural apicolysis and mediastinal pneumolysis, fixation of the lowered apex of the lung with polypropylene mesh, sealing the created extrapleural cavity with collagen to achieve adequate collapse of the lung in the cavernous zone and accelerate reparative pericavitary processes. The results. 15 patients were operated on according to this technique. Postoperative complications were observed in 1 (6.6 %) patient. Cessation of bacterial excretion after 1 month of treatment was registered in 100 % of patients, closure of the cavity after 2 months of treatment was achieved in 14 (93.3 %) patients. Key words: minimally invasive thoracoplasty, destructive pulmonary tuberculosis, polypropylene mesh, collagen plates.

Second surgery for complications of major pulmonary resection—the technique of thoracoplasty with muscle flap

: Second surgery for postoperative complications after lung resection is one of the important issues that thoracic surgeons must overcome. Chronic empyema after lung resection, which is caused by bronchopleural or pleural fistula remains a challenge in modern medicine. Especially in cases in which decortication is not indicated, treatment is difficult, hospitalization is prolonged, and the condition is sometimes life-threatening. Surgical treatment of chronic empyema requires not only decortication and debridement, but also closure of the bronchopleural fistula and obliteration of dead space. From this viewpoint, thoracoplasty and muscle flap transposition are important techniques that lead to complete and reliable closure of the empyema cavity. Although they are performed less frequently today, they are procedures with which every thoracic surgeon should be familiar. This clinical practice review focuses on the use of muscle flaps in thoracoplasty and describes the historical background, types of muscle flaps, tips on surgical techniques, and treatment results. There is a wide variety of types and utilization of muscle flaps. Since the selection of an appropriate muscle flap is directly related to the success of the treatment, careful preoperative planning is necessary. It is important to understand the characteristics of each type of muscle flap and to select the appropriate technique for the patient’s pathological and general condition.

Individual approach in treating patients with pulmonary and tracheobronchial tuberculosis, with a long history of tobacco smoking and decompensated diabetes mellitus

Introduction. At the end of 2020, the clinical cure rate in all registration groups of patients with pulmonary tuberculosis was 48.2 %. There is now ample evidence that additional risk factors influence the more severe course of pulmonary tuberculosis and reduce the effectiveness of standard anti-tuberculosis therapeutic programs. Diabetes mellitus and tobacco use are among the significant risk factors. Complementing standard TB therapeutic programs with nicotine addiction and diabetes mellitus treatment programs with the formation of an individual comprehensive patient treatment plan will increase the effectiveness of TB treatment. Thus, the goal of this work is to demonstrate the high effectiveness of an individualized approach to the treatment of a patient with pulmonary tuberculosis with a comorbid background.The aim of the work was to demonstrate the high effectiveness of an individualized approach to the treatment of a patient with pulmonary tuberculosis with a comorbid background.Materials and methods At the Central TB Research Institute the patient underwent a comprehensive examination, including mandatory, additional and facultative methods of investigation. Based on the findings, the patient underwent complex treatment: antituberculosis chemotherapy, correction of carbohydrate metabolism disorders using oral antidiabetic drugs, nicotine replacement therapy according to the selected scheme, taking into account the degree of nicotine addiction.Results and Discussion Against the background of complex treatment, by four months of therapy the following was achieved: knockdown of systemic inflammatory reactions, cessation of bacterial excretion, compensation of diabetes mellitus. X-ray examination revealed closure of a large decay cavity, resorption and consolidation of focal infiltrative changes. There was regression of infiltrative changes of trachea and bronchi. The patient completely stopped using tobacco due to nicotine replacement therapy.Conclusion This clinical example demonstrates the high effectiveness of an individualized approach to the treatment of tuberculosis, including the need for an individualized regimen of anti-tuberculosis therapy, adequate compensation for diabetes mellitus, and the implementation of relevant smoking cessation techniques among smokers with pulmonary tuberculosis.

Abstract 15471: Neonatal Mesenchymal Stem Cells Rejuvenate Cardiac Myocardium by Regulating Macrophage Polarization Revealed by Single Cell Sequencing After Ischemia-Reperfusion Injury in Rats

Introduction: Stem cells are an emerging therapy for cardiovascular disease. The immune system is modulated by stem cell administration, therefore we sought to characterize the immune environment following stem cell administration. Hypothesis: Neonatal cardiac mesenchymal stem cells (nMSC) improved heart function through an acute sterile immune response characterized by the temporal and regional of macrophages. Methods: nMSC were isolated from healthy neonatal myocardium. Brown Norway rats underwent ischemia-reperfusion injury (IRI) by temporary ligation of left anterior descending artery for 45 minutes. Following closure of the chest cavity, neonatal mesenchymal stem cells (nMSCs), dead nMSCs (dnMSCs), or placebo was administered by intra-coronary injection. At day five heart was collected for single cell suspensions. CD45 positive selection was performed and fed into the Chromium Single Cell Gene Expression workflow (Pleasanton, CA). Single cell sequencing analysis was completed using the Seurat package on RStudio v1.3.1093 (Boston, MA). Echocardiography was completed on post-operative days 7 and 28 for rats not sacrificed for single cell sequencing. Results: Our results demonstrate that nMSC treatment after IRI injury can significantly recover left ventricular ejection fraction. Single-cell sequencing analysis of CD45+ cells identified multiple unique CD68+ clusters. Notably, macrophage cluster 2 primarily consisted of cells from the nMSC treated group, whereas the macrophage cluster 1 was primarily cells from the dnMSC and placebo groups. Gene ontology analysis of macrophage cluster 2 demonstrated that this cluster primarily consisted of macrophages strongly associated with various aspects of the activated immune response, including lymphocyte activation and cytokine production. Conversely, macrophage cluster 1 gene ontology analysis revealed a weaker immune response signature. Conclusions: nMSCs are a promising therapeutic candidate for the treatment of myocardial infarction. The mechanism of this therapy is likely related to macrophage activation that further enhances the immune response in the impacted and at-risk myocardium following IRI injury.

CRANIOTOMY WITH A HERMETIC CLOSURE OF THE CRANIAL CAVITY

Surgical intervention on the contents of the cranial cavity is universally carried out by applying several burr holes, which remain uncovered and serve as a site for the development of a number of postoperative complications. The lack of hemeticity of the skull in some cases require repeated intervention. The purpose of the proposal is to create a trepanation method that excludes the formation of burr holes and promotes hermetic closure of the cranial cavity, excluding the possibility of postoperative complications.The goal is achieved by sawing out conical holes in the skull with the simultaneous formation of small bone flaps in the form of a truncated cone. A large bone fragment of a derivative form is cut out with the proposed tool or in the usual way with a Gigli or Olivecrona saw. In the absence of contraindications, a large bone flap is placed in place, and small bone fragments are combined with the place of their sawing, thereby restoring the integrity of the skull, which is closed at the end of the intervention.The hermetic craniotomy method eliminates the possibility of developing postoperative complications inherent in craniotomy methods, carried out by applying burr holes.The method of craniotomy, which provides for hermetic closure of the cranial cavity, among other things, returns the brain to its natural state, protected from all kinds of external influences, including postoperative complications

Botulinum Toxin Type A Injection Improves the Intraperitoneal High Pressure in Rats Treated with Abdominal Wall Plasty.

The aim of the study is mainly to study the subject of BoNT-A injection to improve IAH in rats undergoing abdominal angioplasty. The study problem in surgery, especially in ICU, burn, and trauma centers, intra-abdominal hypertension (IAH), and abdominal compartment syndrome (ACS) are common complications. At present, there are various treatments for IAH. The intramuscular injection of Botulinum toxin type A (BoNT-A) into the abdominal wall has received a lot of attention. Based on this, this study proposes a method for measuring abdominal pressure, applies BoNT-A to reduce abdominal pressure in the IAH state of abdominal wall angioplasty, and explores a way to increase the compliance of the abdominal wall under the premise of maintaining the sealing of the abdominal cavity, so as to realize the expansion of the abdominal cavity. A method is achieved to reduce intra-abdominal pressure and eliminate or alleviate ACS. The results of the experiment showed that when the rats in the control group were injected with the same amount of normal saline as the rats in the experimental group, the IAP was significantly higher than that in the experimental group (P < 0.05). This shows that BoNT-A increases the compliance of the abdominal wall while maintaining the closure of the abdominal cavity, thereby increasing the volume of the abdominal cavity and alleviating the state of IAH in rats.

Immediate Lipo-Filling as a Novel Technique for Volume Replacement in Oncoplastic Breast Conservative Surgery.

We aimed to evaluate the feasibility of immediate lipofilling as a volume replacement technique in breast conservative surgery (BCS) in terms of the volume of fat graft resorption after radiotherapy, patient satisfaction, and oncological safety. This was a prospective study that included female patients with breast cancer, with small- or medium-sized breasts. The patients underwent BCS followed by lipofilling into the deformed areas away from the tumor site that resulted from direct closure of the tumor cavity. They were followed up for early and late postoperative complications, including recurrence. Volumetric computed tomography was performed before and after radiotherapy to determine percentage fat resorption. Postoperative patient satisfaction was assessed using the Kyungpook National University Hospital Breast Reconstruction Satisfaction Questionnaire. The study included 54 female patients with a mean age of 47.57 ± 9.26 years. The mean follow-up period was 31.02 ± 4.47 months. Local recurrence was observed in three patients (5.56%). The volume reduction of the injected fat graft ranged from 10.15% to 55.67%, with a mean of 29.27 ± 10.06%. Fifty-two patients (96.30%) reported postoperative satisfaction, and nine of them expressed satisfaction only after a second lipofilling session. Immediate lipofilling as a volume replacement technique in BCS is a safe and simple technique without major complications. It has a locoregional recurrence rate similar to BCS alone, with an acceptable fat resorption percentage and high postoperative patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Аssessment of segmental bronchial blocking success in the comprehensive treatment of patients with destructive pulmonary tuberculosis

The experience of using bronchial valve placement in emphysema treatment and studies on the effect of collateral ventilation in lobar bronchial blocking cast doubt on the effectiveness of this technique at the level of segmental bronchi using a single blocker. The aim of the study is to evaluate the effectiveness of segmental valve placement in the comprehensive treatment of patients with destructive pulmonary tuberculosis. The study is based on the results of evaluation of chest CT data of patients with destructive forms of pulmonary tuberculosis before and after valve placement. The correlations between the selected features were assessed and a model for predicting the cavity closure was built. A statistically significant cor-relation was found between the change in the segment volume after valvular blocking and the closure of the de-struction cavity. As a result, the low efficiency of segmen-tal valve placement in the comprehensive treatment of patients with pulmonary tuberculosis was revealed.

DESIGNING AND 3D PRINTED PLA BASED IMPLANT USED IN TREATMENT FOR UNILATERAL VOCAL CORD PARALYSIS

Vocal cord paralysis (VCP) is considered as a closure of glottal cavity during phonation. Vibration impairment in the vocal mucosa to loss of voice is as a result of the glottic space not closing. Many implant biomaterials are used for VCP. These implants, which can be applied to restore the cord function of the paralyzed cord and to improve the sound quality, are applied in Medialization thyroplasty (MT) type 1 surgeon. The aim of this study is to produce customizable poly (lactic-acid) (PLA) based vocal cord (VC), also called as vocal fold, implant by using 3D printer and compare this implant with other biomaterials. This VC 3D PLA implant (VC3DPLAI) biomaterial can be specially designed and manufactured for the individual.

РОЛЬ ТА МІСЦЕ «DAMAGE CONTROL SURGERY» У ВІЙСЬКОВІЙ ЛІКУВАЛЬНО-ЕВАКУАЦІЙНІЙ ДОКТРИНІ ПІД ЧАС БОЙОВИХ ДІЙ В СУЧАСНІЙ ВІЙНІ.

Introduction: The severity of the combined injury, traumatic shock, blood loss and traumatic prolonged primary surgery are the cause of high mortality injured patients. In civilian medicine, damage control technology is widely used to treat patients with severe polytrauma, which has improved the survival of this group of patients. Objective: Analyze the effectiveness of using "damage control" technology in wounded with polytrauma at the second level of medical care during war conflict in Eastern Ukraine and organization of combat casualty care. Methods: Medical and statistical analysis of the effectiveness medical treatment for patients combat-ralated injuried and polytrauma performed on the basis of a mobile military hospital during 2015-2019 period. Results: In 660 patients with combat multiple and combined injuries and in 1027 - with severe military combined trauma, medical tratment was provide by "damage control" technology. The main task of the first stage of surgery intervention was to stop the bleeding and stabilize the patient condition. 130 patients with intra-abdominal bleeding underwent laparotomy, temporary stop of bleeding, blood sampling for autotransfusion and temporary closure of the abdominal cavity. For the purpose of temporary hemostasis in 15 patients abdominal tamponade was performed, in 26 - liver tamponade, in 24 - splenectomy, in 6 - nephrectomy and in 6 - put the clamps were applied to bleeding vessels. In 14% injured patients definitive stage of surgical procedures were performed at the second level of medical care on the background of abdominal compartment syndrome in 10, visceral edema in 14 and peritonitis in 40 patients. Conclusions: Providing emergency medical treatment, surgical procedures and intensive care at the second level of medical tretment using the technology of "damage control" and timely patients evacuation are the key to reducing mortality and complications of military surgical trauma

Effect of hot isostatic pressing on the cast Ti6Al4V alloy with shrinkage cavities inside: Healing behavior, microstructure evolution and tensile property

Healing behavior, microstructure evolution and tensile properties of cast Ti6Al4V alloy with the millimeter-scale shrinkage cavities inside during hot isostatic pressing (HIP) were investigated. X-ray computed tomography (CT) has been used to track pore closure process during a standard HIP cycle. The comparison of the CT scans before and after HIP indicates that HIP has the potential to close the millimeter-sized shrinkage cavities and the main closure mechanism of shrinkage cavity is plastic deformation which can be deduced by the rapid closure of the shrinkage cavity. The microstructure in the closure region was characterized in detail using scanning electron microscope (SEM) and electron backscattered diffraction (EBSD). It is inferred that closure interface can be partially healed by HIP-1 while can be totally healed by HIP-2. In addition, it was found that as the HIP duration became longer, the Burgers orientation relationship between α and β phases gradually deviated, and the misorientation along and across the single α colony gradually became larger, which could be attributed to the rotation of the crystalline lattice after hot deformation. In the individual α lamella, the rotation axis changed where the point-to-point misorientation was not continuous, thus the low-angle boundaries were formed. With the accumulation of strain energy, the low-angle boundaries transformed into high-angle boundaries, which resulted into the breakdown of α lamellae. The sub-division of α lamellae and recrystallized grain growth are determined to be the main spheroidization mechanisms of α lamellae during HIP. After HIP treatment and with the increase of HIP duration, the yield strength and tensile strength increased first and then slightly decreased, but the elongation was progressively increased due to the enhanced metallurgical bonding.