BackgroundTotal knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) is considered the most effective intervention reducing knee pain and improving physical function. However, higher risk of late complication and worse surgery outcomes may be observed in patients with active disease.[1]ObjectivesTo study the knee joint function and pain before and after the TKA in patient with rheumatoid arthritis.Methods69 RA patients (10 (14,5%) males and 59 (85,5%) females) with an average age of 59 [52; 64] years were included into the study group. 81 osteoarthritis (OA) patients (38 males (46,9%) and 43(53,1%) females) aged 66 [61; 73] years, were included into the control group. 23,2% of RA patients had a highly active disease at the moment of intervention. All patients underwent cemented TKA and completed Oxford Knee score (OKS) before the surgery, after discharge and 3 and 12 months after the surgery. Knee pain was assessed using VAS score also before intervention, straight after and 3 and 12 months after the surgery. All analyses were performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA). A p value of less than 0.05 was considered statistically significant.ResultsPatients in RA group had significantly lower preoperative OKS results, than OA patients (25.0 [23.5; 27.0] versus 29.0 [26.5: 30.0], p=0.00, Mann-Whitney) as well as lower postoperative OKS results before the discharge (34.0 [34; 38] versus 40.0 [35; 40] p=0.00, Mann-Whitney). 3 months after the intervention OKS scores were comparable within the two groups (43.0 [42; 44] versus 43.0 [42; 44], p=0.557; Mann-Whitney). The same was found for OKS scores 12 months after the surgery (44.0 [44; 47] versus 44.0 [44; 47], p=0.328, Mann-Whitney). Pain intensity in RA patients varied from 60 to 90 mm according to VAS prior to surgery and was lower than among OA patients (80.0 [80; 90] versus 90.0 [80; 100], p=0.00, Mann-Whitney) which can be explained by patients’ higher pain tolerance due to “usual” pain in RA. The same tendency was observed immediately after the intervention (55.0 [50; 60] versus 65.0 [50; 65], p=0.00, Mann-Whitney). 3 months after the surgery pain intensity was similar in both groups (30.0 [30; 35], p=0.349, Mann-Whitney). 1 year after the intervention RA patients reported higher VAS scores probably due to RA activity (20.0 [20; 20] versus 10.0 [10; 15], p=0.00, Mann-Whitney).ConclusionThe effectiveness of TKA for pain reduction and improvement of knee function in patients with RA was comparable to that among patients with OA. OKS scores were lower in RA group prior to surgery, however, 3 and 12 months after the intervention they did not differ between the patients with RA and OA.Reference[1]Lee DK, Kim HJ, Cho IY, Lee DH. Infection and revision rates following primary total knee arthroplasty in patients with rheumatoid arthritis versus osteoarthritis: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017 Dec;25(12):3800-3807. doi: 10.1007/s00167-016-4306-8. Epub 2016 Sep 7. PMID: 27605127.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundOne of the most important issues of orthopedics remain long-standing synovitis despite the treatment after traumas and arthroscopy even after removal of mechanical irritating factor (meniscal resection, chondroplasty). In the long term prolonged treatment of arthritis may lead to irreversible joint damage progression. Current generally accepted strategy is to start the treatment as early as possible which affects the following disease course. Due to this, the study of pathogenetic features of posttraumatic synovitis is of interest as based on them, the choice of the most specific and effective treatment may be made.ObjectivesTo study the features of cytokine level changes in synovial fluid in knee synovitis.MethodsThe prospective study of patients with long-standing knee synovitis included knee arthroscopy and outcome registration, measurement of cytokines in aspirated prior to surgery synovial fluid using flow fluorometry.ResultsThe study included 41 patients (31.7% males and 68.3% females) with an average age 51.3±12.5 years. Trauma was present in 48.8% of patients. The duration of synovitis below 1 years was observed in 68.3% of patients, 56.1% of them had it for less than 6 months. Osteoarthritis stage 1 was observed in 24.4% of patients, stage 2 – in 22%, stage 3 – in 39%, stage 4 – in 14.6% of patients. The average VAS score on inclusion prior to arthroscopy was 3.56±0.72. Improvement immediately after the surgery was observed in 28 patients (68.3%). Other patients (31.7%) had long-standing synovitis (for over 2 weeks after the intervention), and 7 of them (17%) – for over 2 months. In the synovial fluid the level of IL-10 and TNFα decreased with increasing age (rs=-0,637, p=0,014 и rs=-0,481, p=0,044, respectively). The level of IL-10 positively correlated with synovitis duration (rs=0,830, p=0,011). Besides, in patients with synovitis duration more than a year, the level of IL-4 (r=0,578, p=0,024) and IL-10 (r=0,769, p=0,022) was higher. IL-4 was also higher with higher intensity of pain according to VAS score (rs=0,799, p=0,041). Also, there was a correlation of IL-6 level and presence of trauma in past medical history (p=0.05).ConclusionProinflammatory TNFα and anti-inflammatory IL-10 positively correlated with the age. If synovitis was present for over a year, patients had higher levels of IL-4 and IL-10, which could be explained by proliferation processes in osteoarthritis. High pain intensity was associated with higher levels of IL-4. Trauma was associated with increased levels of IL-6 in synovial fluid, which may probably be the trigger factor of inflammation.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

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Введение. Кистозная гипоплазия легкого -порок развития, при котором терминальные отделы бронхиально го дерева на уровне субсегментарных бронхов или бронхиол представляют собой расширения кистообразной формы различных размеров. Она составляет 60-80 % всех пороков развития.

Background. Aortic valve stenosis is common with prevalence of about 0.5 %, peaking in people aged over 70 years mostly due to age-related valve calcification. The year 2002 was marked by the invention and use of the endovascular aortic replacement valve by an A. Cribier’s group of French surgeons. Russian endovascular surgery introduced transcatheter aortic valve replacement in 2009, having since built an extensive experience in this practice. Perioperative mortality in patients under 70 years with no serious comorbidity ranges from 1 to 3 %, however, reaching two-fold 4–8 % in elderly patients. The emergence of minimally invasive technologies offered cure to critical patients, who would merely not get over an open surgery.Materials and methods. This case study provides video recordings of transcatheter aortic valve replacement (Accurate Neo) in transfemoral approach performed for the first time in the Republic of Bashkortostan. Patient K., 70 yo, diagnosis: Atherosclerosis. Aortic valve stenosis. FC III. Complications: aortic valve calcification st. III, CHF II A, FC III, persistent atrial fibrillation, tachysystole. Comorbid: CHD. Exertional angina. FC III. CHF II A, FC III.Results and discussion. Improving the transcatheter valve type facilitates an optimal individual aortic valve selection. Pre-replacement valvuloplasty was performed in all patients. The valve replacement is followed by transoesophageal echocardiography to justify possible aortic valve post-dilatation upon marked paravalvular regurgitation. The implant positioning relative to the aortic valve fibrous crown and mitral valve flaps is precisely controlled with ultrasound.Conclusion. Interventional radiology currently provides high-quality, effective, minimally invasive medical aid even in aortic stenosis patients with multiple comorbidity. In the patient’s denial of open surgery, transcatheter aortic valve replacement represents a sole alternative treatment, also increasing the life expectancy and quality. A wider diversity of available transcatheter devices enables a better personalisation of the biological valve replacement procedure.