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В настоящее время высокоспециализированным методом дифференциальной диагностики этиологии верхнечелюстного синусита является конусно-лучевая компьютерная томография. Цель исследования. Выявить наиболее патогномоничные признаки осложненных и неосложненных форм одонтогенного верхнечелюстного синусита на основании оценки результатов компьютерной томографии. Материалы и методы. Были оценены результаты конусно-лучевой компьютерной томографии 58 пациентов с верхнечелюстным синуситом различной этиологии средним возрастом 43,6 года в период с 2006 по 2017 год. С помощью одно-и многофакторного статистического анализа были выявлены маркеры (предикторы) наличия у пациентов неосложненных и осложненных форм одонтогенного верхнечелюстного синусита. Результаты. Предрасполагающими факторами развития неосложненной формы верхнечелюстного синусита при проведении конусно-лучевой компьютерной томографии являлись наличие причинного зуба (ОШ = 8,8; р < 0,001), выраженный альвеолярный карман (АК) (ОШ = 5,7; р = 0,029), фистула периапикального абсцесса (ОШ = 5,3; р = 0,019), нарушение проходимости среднего носового хода (ОШ = 12,1; р = 0,007); вариантная анатомия остиомеатального комплекса (ОШ = 3,3; р = 0,016). Лучевые предикторы осложнений одонтогенного верхнечелюстного синусита включали: наличие причинного зуба (ОШ = 6,0; р < 0,001), этмоидит (ОШ = 44,7; р < 0,001), блок соустья ВЧП (ОШ = 2,6; р = 0,026), расширение периодонтальной щели (ОШ = 6,2; р = 0,001), костную деструкцию альвеолы (ОШ = 14,0; р < 0,001), утолщение заднебоковой стенки верхнечелюстной пазухи (ОШ = 2,4; р = 0,037). Заключение. Улучшению результатов лучевой диагностики одонтогенных заболеваний ЛОР-органов может способствовать использование разработанных логистических моделей и выявленных предикторов наличия одонтогенного верхнечелюстного синусита при интерпретации данных конусно-лучевой компьютерной томографии. Ключевые слова: одонтогенный верхнечелюстной синусит, предикторы осложнений, конусно-лучевая компьютерная томография, дифференциальная диагностика, осложнения синусита.

(1) Introduction: An imbalance of the genetically determined cytokine response plays a key role in the etiology of ENT-associated encephalitis. In recent years, an attempt has been made to evaluatethe prognostic role of chronic pathology of the paranasal sinuses in the development of acute, subacute and chronic encephalitis and meningitis, which in clinical practice are manifested both as cerebral and focal neurological symptoms and as mental disorders: from borderline to psychotic ones. The problem requires a multidisciplinary approach on the part of the specialists in the following clinical disciplines: neurology (as well as neurobiology), psychiatry, immunology, experimental medicine, otorhinolaryngology, and pharmacogenetics. The solution of this problem is possible with the involvement of preventive and personalized medicine.(2) The purpose: Evaluation the prognostic role of genetic polymorphisms of pro- and antiinflammatory cytokines in the development of ENT-associated encephalitis.(3) Materials and Methods: We conducted a keyword-based analysis of the English and Russian-language articles published within the past 30 years (from 1988 to 2018). The following databases were used in the study: PubMed, MedLine, Web of Science Core Collection (Clarivate Analytics), Web Science, Russian Science Citation Index, Scopus, Scientific Research, Google Scholar, Oxford Press, and eLibrary.(4) Results: In a number of the analyzed works, regardless of the causative agent and viral load, an increased level of pro-inflammatory cytokine production was noted in patients with more severe disease progression, neurological complications and unfavorable outcomes, both in viral encephalitis and in bacterial one. Based on this, 30 single nucleotide variants (SNV), their influence on the expression of pro- and anti-inflammatory cytokine genes, as well as their predictor role in the development of ENT-associated encephalitis were analyzed. Due to the nature of the systemic immune response, the analysis included both cerebral and extracerebral pathology-associated SNV. The inconsistency of the previously obtained results was noted, an attempt to explain this phenomenon was made. The analysis of the dynamics and geography of publications on the stated topic was made, the leading Russian scientific centers in the field were defined. The most promising SNV for further studies were identified.(5) Conclusion: The risk of developing ENT-associated encephalitis is associated with a genetically determined status of the cytokine response and its regulation. Studies of the association of various SNV of genes encoding pro- and anti-inflammatory cytokines in the Russian Federation need to be continued.

Introduction. The problem of phonosurgery remains relevant today since the prevalence of benign and tumor-like laryngeal lesions is up to 55%–70% among diseases of the upper respiratory tract. Photoangiolytic lasers are actively used among laser systems in phonosurgery today. A new 445 nm surgical laser (TruBlue, A.R.C. Laser Company), having a high hemostatic and resection effects, was certified for the medical market in 2018. TruBlue laser operation is possible in an atmosphere of inert gas (helium) by connecting the optional Flow Control unit. To date, there are very few works in foreign and Russian literature devoted to the use of that laser device in ENT practice, particularly, in laryngology. Objective. To select the optimal 445 nm laser mode for use in phonosurgery based on an experimental study of biological material. Material and methods. An experimental study was conducted on a model of the larynx (chicken muscle tissue) using a 445 nm laser in contact constant and pulsed modes, including an atmosphere of an inert gas (helium). The zones of destruction, coagulation necrosis, and ischemia were measured by histological examination using a morphometry system. The total number of experiments was 142, the total number of micro-preparations studied was 284. Results. While working in continuous wave mode, we received an extensive zone of thermal exposure, which in clinical practice correlates with deep damage of the vocal fold and violation of its vibratory function. This confirms the axiom that the optimal mode for laryngeal surgery is a pulsed one. According to the evaluation results of the pulse mode at standard laser settings (without helium supply), the parameters with the smallest pause between pulses—that is, 8 W pulse 10–20 ms, 9–10 W pulse 10 ms with a pause of 150 ms—were the most optimal for practical activity in terms of combined resection and coagulation effect. These parameters are acceptable for use in phonosurgery since the maximum destruction zone does not exceed 600 nm. While working in an inert gas atmosphere, we recommend using a laser at a power of 6–8 W with a pulse duration of 10 ms and a pause of 100–130 ms; with an increase in the pulse, lengthen the pause 6–7 W 20 ms 120–130 ms, 8 W 20 ms with a pause of 130 ms. Conclusion. During the experiment, blue laser showed high resection and coagulation effects. According to the results of the study, the parameters of laser exposure were obtained, which are optimal for the surgical treatment of benign and tumor-like laryngeal lesions.