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卷 31, 编号 3 (2023)
- 年: 2023
- ##issue.datePublished##: 12.10.2023
- 文章: 16
- URL: https://journals.eco-vector.com/pavlovj/issue/view/8034
- DOI: https://doi.org/10.17816/PAVLOVJ.313
Original study
Peculiarities of Systemic Hemodynamics and Autonomic Status in Medical Personnel of PCR-Laboratories with Different Emotional Intelligence
摘要
INTRODUCTION: The ongoing pandemic of a new coronavirus infection COVID-19 (COronaVIrus Disease 2019) places high demands on the activity of PCR-laboratories (laboratories performing polymerase chain reaction). The medical personnel experience overloads due to stay in the ‘red zone’ wearing the individual protection means, and also in association with a high personal responsibility for the result of their work. One of the criteria that is proposed for professional selection with the aim of increasing the effectiveness of the work of personnel of PCR-laboratories, is the emotional quotient (EQ).
AIM: To analyze the state of systemic hemodynamics and heart rate variability in medical workers of PCR-laboratories with different emotional intelligence working in condition of COVID-19 pandemic using means of individual protection against the biological factor.
MATERIALS AND METHODS: The extent of health risk and tension of adaptation mechanisms during the work were evaluated by parameters of systemic hemodynamics (tonometry, pulse oximetry) and heart rate variability (cardiorhythmography). Thirty three individuals with the working period in a PCR-laboratory from 1 to 33 months were examined. The average age of the participants at the time of inclusion in the study was 32.4 ± 1.44 years. In 33.7%, EQ corresponded to the medium level (81–120 points), and in 66.7% — to the high level (121–168 points).
RESULTS: Before the start of the work shift, increased blood supply to tissues in personnel with high EQ was achieved by increased heart activity: cardiac output (CO) — 3938.9 ml/min, interquartile range (IQR) = 3404.2–4230.2 ml/min — with the underlying reduction of vessel tone: total peripheral vascular resistance (TPVR) — 1922.8 dyn × s/cm5, IQR = 1636.5–2085.8 dyn × s/cm5. After the end of the shift, to these compensatory mechanisms (CO — 4284.7 ml/min, IQR = 3935.4–4688.8 ml/min; TPVR — 1692.4 dyn × s/cm5, IQR = 1584.6–1903.1 dyn × s/cm5), increased myocardial oxygen consumption (MOC; 7917.5 RU, IQR = 7430.2–8811.0 RU) added as a reaction to the muscular component of labor activity. In individuals with average EQ, these mechanisms were less pronounced in considerable mental stress: before the shift CO — 3722.0 ml/min, IQR = 3163.1–3739.0 ml/min, p = 0.013; TPVR — 2303.1 dyn × s/cm5, IQR = 2058.1–2402.1 dyn × s/cm5, p = 0.016; after the shift CO — 3375.0 ml/min, IQR = 3372.0–4402.0 ml/min, p = 0.010; TPVR — 2010.5 dyn × s/cm5, IQR = 1972.6–2351.9 dyn × s/cm5, p = 0.017; MOC — 7450.0 RU, IQR = 6653.3–7867.3 RU, p = 0.023.
CONCLUSION: The extent of tension of mechanisms of self-regulation of systemic circulation, apart from characteristics of used technical means and the working regime, significantly depends on the level of emotional intelligence. With this, personnel with high emotional intellect are preferable for the work in the ‘red zone’ because of lower tension of regulatory mechanisms.
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Hypoxia-Like Effect of L-Arginine in Seminal Vesicle and Epididymis of Rats
摘要
INTRODUCTION: The effect of L-arginine on metabolic processes is mediated by nitric oxide (II), whose pool is regulated by several enzymes. In the literature, the mutual influence of oxygen deficit and NO production is described. Besides, both processes can be regulated by exogenous L-arginine.
AIM: To evaluate participation of L-arginine in the development of adaptive response to chronic normobaric hypoxia of tissues of reproductive system of male rats and to study its influence on metabolic changes in normoxia.
MATERIALS AND METHODS: The experiment was conducted on Wistar stock rats (males, n = 8) which were divided to the following groups: (1) animals receiving L-arginine injections of 500 mg/kg of body weight for 10 days; (2) animals of control group receiving 0.9% NaCl solution; (3) animals subjected to chronic normobaric hypoxia in a hermetic chamber, observed once a day for 14 days until the oxygen concentration in the air decreased by 10%; (4) animals of the control group observed in a ventilated chamber; (5) animals subjected to hypoxia and injections of L-arginine. The material for analysis was the mitochondria and mitochondria-free fraction of the cytoplasm of the seminal vesicles, of the head and tail of the epididymis. The parameters were evaluated photometrically using diagnostic and enzyme immunoassay kits.
RESULTS: The animals receiving L-arginine showed increase in the amount of α-subunit of hypoxia-induced factor in the cytoplasm of seminal vesicles by 132% (p = 0.01), in the tail of epididymis by 32% (p = 0.02) and reduction in mitochondria by 45% (p = 0.01) and 60% (p = 0,002), respectively, a decrease in succinate levels by 40% (p = 0.005) and 51% (p = 0.0009), an increase in the concentration of lactic acid in the cytoplasm by 194% (p = 0.03) and 253% (p = 0.018), a decrease in cytochrome oxidase activity from 0.96 [0.66; 1.69] RU/mg of protein to 0.27 [0.23; 0.32] (p = 0.0009) and from 1.04 [0.84; 1.33] to 0.26 [0.14; 0.37] (p = 0.003), relative to the control group. The observed changes are characteristic of the state of hypoxia and are explained by the cell switching over to glycolytic pathway of energy production, in contrast to mitochondrial pathway in normoxia. The combined effect of hypoxia and arginine partially enhanced each other's effects.
CONCLUSION: L-arginine causes hypoxia-like state in cells through activating α-subunit by hypoxia-induced factor, reducing cytochrome oxidase activity, increasing glycolysis, and also partially enhances the effects of chronic normobaric hypoxia.
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Effectiveness of Surgical Treatment of Patients with Respiratory Tuberculosis Complicated with Chronic Pleural Empyema Depending on Spread of Intrapleural Pathological Alterations
摘要
INTRODUCTION: Chronic tuberculous pleural empyema (CTPE) is a severe form of tuberculous lesion characterized by a purulent-destructive process in the residual pleural cavity, gross irreversible morphofunctional specific alterations in the pleura forming within three-five months after appearance of clinical signs of pleurisy. Patients with respiratory tuberculosis (RT) complicated with pleural empyema, are the most severe contingent of patients in tuberculosis (TB) hospitals.
AIM: To study effectiveness of surgical treatment of patients with RT complicated with CTPE depending on spread of pathological alterations in the parietal pleura.
MATERIALS AND METHODS: The study included 65 patients (43 men, 66.2%, aged 23–61 years; 22 women, 33.8%, aged 26–65 years) with RT complicated with CTPE, who underwent surgical treatment in the volume of pleurectomy with decortication of lung. Patients were divided to 3 groups depending on spread of pathological alterations in the parietal pleura: group 1 (n = 40, 61.5%) with spread of CTPE not exceeding the surface area of one anatomical wall of the pleural cavity; group 2 (n = 15, 23.1%) with CTPE involving 2–3 anatomical walls of the pleural cavity; group 3 (n = 10, 15.4%) with CTPE involving all anatomical walls of the pleural cavity.
RESULTS: The effectiveness of complex treatment of patients with RT complicated with CTPE was 92.3% (n = 60). In the period from 2014 to 2021, the rate of postoperative complications after pleurectomy with decortication of lung including simultaneous resection, was 12.3%, mortality rate 0% and postoperative recurrences of empyema 7.7%. Despite adequate postoperative conservative treatment, the achievement of clinical effect and the absence of postoperative recurrences were directly proportional to the spread of intrapleural alterations. The destructive widespread forms of PT with multiple and wide-range drug resistance of mycobacterium tuberculosis are more common among the patients with subtotal and total forms of CTPE.
CONCLUSION: The obtained results evidence a high effectiveness of surgical treatment of the given category of patients irrespective of spread of pathological alterations in the pleura and lung.
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Analysis of Prevalence of Lower Extremity Varicose Vein Disease of in One of Major Regions of Central Federal District of Russian Federation Using Multi-Variant Approach
摘要
INTRODUCTION: The majority of epidemiological studies on lower extremity varicose veins (LEVV) published to date have cross-sectional character, therefore, understanding the relationships between the disease and other epidemiological variables in them is mainly based on data analysis in a short period of time and does not take into account the influence on the main parameters of functioning national health systems. It is relevant to analyze the epidemiological parameters of LEVV in the long term, taking into account the influence of the state health system in a large region of the Russian Federation.
AIM: To identify changes in the distribution of LEVV in different territories of the Yaroslavl region (YaR) over 10 years (2011–2021).
MATERIALS AND METHODS: A retrospective study of statistical parameters of the work of medical organizations of the YaR in 2011–2021 was conducted, namely, of the total number of attached adult population, the dynamics of the number of attached population, the total number and dynamics of the number of patients with the established diagnosis of LEVV. The weighted average value for continuous variables with a 95% confidence interval (CI) was evaluated. Heterogeneity was evaluated based on the I2 value.
RESULTS: The static weighted average value of the prevalence of LEVV in Yaroslavl at the end of the year in 2011–2021 was 1.040% (95% CI: 1.031–1.049). When analyzing the data for 2011–2021, the trend for a decline in the recorded prevalence of LEVV was determined. At the end of 2021, the prevalence of LEVV in Yaroslavl declined by 0.715%, in Pereslavl district — by 0.466%, in Tutaev district — by 0.4%, in Rostov district — by 0.392%, in Rybinsk — by 0.192% with high heterogeneity of data depending on the territory and period (I2 > 99). Besides, during the analyzed 10 years, there occurred significant changes in approaches to surgical treatment of LEVV, such as appearance of hospital-substituting technologies that have become widely used in the territory of the YaR by non-governmental medical organizations in the vast majority of cases.
CONCLUSIONS: According to official data, the decline in the morbidity with LEVV in the studied territories of the YaR over 10 years (2011–2021) contradicts the published results of epidemiological studies. The information obtained, together with the high heterogeneity of statistical data for individual territories and periods, may indirectly indicate the low efficiency of the existing system of providing medical care to the population with LEVV.
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Analysis of In-Hospital Mortality of Patients with New Coronavirus Infection (COVID-19) of Clinical Centre of Sechenov University
摘要
INTRODUCTION: The epidemic of a new coronavirus infection (COVID-19) required a restructure of the entire healthcare system of the Russian Federation within a limited period of time. Here, the mortality of patients is the most important effective parameter that reflects successfulness of organization measures for improvement of the activity of medical institutions. The initial preparedness of the infrastructure permitted to rapidly deploy a hospital on the base of the Clinical Centre of Sechenov University for providing medical assistance to patients with COVID-19.
AIM: To analyze the in-hospital mortality of patients with COVID-19 at the Clinical Center of Sechenov University.
MATERIALS AND METHODS: The COVID-19 database (n = 19 230) of the Clinical Centre of Sechenov University for 2020–2022 was analyzed.
RESULTS: The overall in-hospital mortality in COVID-19 hospitals of the Clinical Centre of Sechenov University was 8.5%, which is the lower level compared to the data of foreign studies (Italy, Spain, Great Britain, USA, Iran). The main predictors of mortality are: basic — male gender, age (mainly > 75 years); existence of malignant neoplasms, diseases of the nervous system, diseases of the cardiovascular system, diseases of the endocrine system in patients; diseases occurring in the course of hospital treatment — artificial lung ventilation, past surgical interventions.
CONCLUSION: The working experience of the Clinical Center of Sechenov University shows a possibility for quick salvation of organizational tasks facing the healthcare system in the period of COVID-19 pandemic, with the results characterized by low lethality of hospitalized patients.
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Analysis of Influence of Cigarette Smoke on Signaling Pathways of Innate Immune System in Monocytes of Peripheral Blood
摘要
INTRODUCTION: Tobacco smoking is an important medical problem since it has a significant impact on the development and progression of chronic obstructive pulmonary disease (COPD). The components of tobacco smoke can initiate and support local and systemic inflammation with participation of monocytes and macrophages.
AIM: To study molecular mechanisms associated with the impact of cigarette smoke on signaling pathways of the innate immune system in monocytes of peripheral blood.
MATERIALS AND METHODS: The methods of in silico analysis was used to identify genes associated with the impact of tobacco smoke. On the basis of the data obtained, a cellular model of inflammation was created in vitro using tobacco smoke extract and monocytes of peripheral blood isolated by immunomagnetic separation. An enzyme-linked immunoassay (ELISA) kit was used to measure the concentration of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) in cell supernatants, and of Toll-like receptor 4 (TLR4), ATP-binding cassette A1 (ABCA1) in homogenates of cell membranes of native monocytes and monocytes exposed to 4% tobacco smoke extract. These data were compared with the levels of TNF-α, IL-1β, TLR4 and ABCA1 in monocytes of peripheral blood of patients with COPD with frequent exacerbation phenotype and with obliterating atherosclerosis of lower limb arteries (OALLA). For statistical processing and visualization of the data, MedCalc 20.1.4 and R (version 4.2.2) software was used.
RESULTS: Tobacco smoke influences TLR4, TNF-α signaling pathways and lipid metabolism. Cigarette smoke extract enhanced the expression of proinflammatory cytokines TNF-α and IL-1β in cell supernatants, increased the level of TLR4 and decreased that of ABCA1 in plasmolemma of monocytes of peripheral blood. In patients with COPD with frequent exacerbation phenotype and with OALLA, there were shown increase in the levels of proinflammatory TNF-α and IL-1β cytokines in cell supernatants, increase in the level of TLR4 and reduction of the level of ABCA1 in plasmolemma of monocytes of peripheral blood compared to native monocytes of healthy individuals.
CONCLUSION: Cigarette smoke enhances the production of proinflammatory TNF-α and IL-1β cytokines, increases the levels of TLR4 protein and reduces the amount of ABCA1 transporter in membranes of monocytes of peripheral blood. This may partially explain the cause of the influence of cigarette smoke on development of the pulmonary and cardiovascular diseases. COPD with frequent exacerbation phenotype and OALLA are characterized by enhancement of inflammation with participation of monocytes.
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Dynamics of Prescribing Antithrombotic Therapy to Patients with Atrial Fibrillation Hospitalized for Myocardial Infarction in 2016–2021
摘要
INTRODUCTION: At present, the issue of optimal antithrombotic therapy (ATT) in patients with myocardial infarction (MI) and atrial fibrillation (AF) has not been finally resolved, it requires an individual approach and is of interest for study.
AIM: To study the dynamics of prescribing ATT to patients with AF of non-valvular etiology hospitalized in cardiology hospital in 2016–2021 for MI.
MATERIALS AND METHODS: The study included 599 patients with MI and AF: in 2016–2017 — 104 patients, in 2018–2019 — 256 patients, in 2020–2021 — 239 patients. The median and interquartile range of age of patients hospitalized in 2016–2017 were 70 (61.0; 78.0) years, in 2018–2019 — 71 (65.0; 79.3) years, in 2020–2021 — 72 (65.0; 80.0) years, p = 0.09.
RESULTS: In 2016–2017, 76.9% of patients with MI and AF were prescribed double antiplatelet therapy (DAPT) from the first day of hospitalization; 16.3% of patients were prescribed therapy with oral anticoagulants (OACs), here, in 6.7% — as part of triple ATT, in 8.7% — as part of double ATT (OACs + antiplatelet agent), in 1.0% — as monotherapy with OACs; in 3.8% monotherapy with an antiplatelet agent was prescribed; in 2.9% of cases ATT was not prescribed. In 2018–2019, DAPT was used in 37.9% of cases; therapy with OACs — in 54.7% of cases: in 44.9% cases as part of triple ATT, in 9.8% as part of double therapy; in 7.4% of cases monotherapy with antiplatelet agent was prescribed. In 2020–2021, DAPT was prescribed in 15.9% of cases; therapy with OACs in 74.5%, of them in 59.8% — triple АТТ, in 14.2% — double АТТ; monotherapy with an antiplatelet agent - in 7.5%; in 1.7% АТТ was not prescribed.
CONCLUSION: In the study, the frequency of prescription of triple ATT to patients with AF and MI in 2020–2021 increased 1.3 times as compared to 2018–2019, and 8.9 times as compared to 2016–2017 and made 59.8% (p < 0.001 for all periods). The frequency of OAC also increased 1.3 times as compared to 2018–2019 and 4.6 times as compared to 2016–2017 and made 74.5% (p < 0.001 for all periods). This dynamics of increase in the frequency of prescription of oral anticoagulants to patients with a combination of AF and MI should be considered a positive result of introduction of the Clinical recommendations in the treatment of cardiologic patients.
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Overload of the Right Ventricle in Patients with Pulmonary Embolism: Analysis of New Evaluation Criteria
摘要
INTRODUCTION: The increasing incidence of pulmonary embolism (PE) and high mortality from it necessitates development of new echocardiographic (EchoCG) criteria for assessing the severity of pressure and volume overload of the right ventricle (RV) in patients with PE.
AIM: To perform critical analysis of the developed EchoCG criteria of overload of the right heart chambers in PE with the aim to determine severity of the course and outcomes of the disease.
MATERIALS AND METHODS: The study included 428 patients with PE divided to 4 groups: group 1 — 42 patients with recorded death, group 2 — 51 patients with hemodynamically significant disease, group 3 — 193 hemodynamically stable patients with EchoCG signs of the overload of the right ventricle, group 4 — 142 patients with no identified symptoms. Comparison of the developed EchoCG criteria was conducted: the volume of tricuspid regurgitation, its ratio to the volume of the right atrium and the stroke volume of the heart, and also the pressure in the pulmonary trunk, the pressure gradient on the pulmonic valve and its ratio to the pressure gradient on the tricuspid valve in the studied groups with the determination of threshold values having diagnostic and prognostic significance.
RESULTS: It was found that the level of the estimated pressure gradient on the pulmonic valve has statistically significant correlation with the hemodynamic significance of the course of the disease (r = 0.91, р < 0.01) and fatal outcome (r = 0.99, р < 0.01) and possesses high sensitivity (more than 92.7%) and specificity (more than 97.8%). This parameter is proved to be the most important prognostic EchCG criterion. To determine the expression of the RV dysfunction and the priority flow of blood from its cavity, the following parameters equivalent to EhcoCG, such as the ratio of pressure gradient on the pulmonic artery to the pressure gradient on the tricuspid valve and the ratio of the tricuspid regurgitation volume to the stroke volume, are also significant.
CONCLUSION: Calculation of the pressure gradient on the pulmonic valve and its correlation with the pressure gradient on the tricuspid valve, just as the ratio of the volume of tricuspid regurgitation to the stroke volume can be reliable criteria for assessment of the hemodynamic significance of PE and predictors of its outcome.
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Characteristics of Adaptive Capabilities of Frequently Ill Primary School-Aged Children
摘要
INTRODUCTION: In childhood, the immune system is actively formed, among other things, through the contact with viral and bacterial pathogens. Children over 5 years who suffer from acute respiratory diseases more than 4 times a year, are referred to the group of frequently ill children (FIC) requiring increased attention of doctors.
AIM: To identify peculiarities of the autonomic regulation, metabolic, regulatory parameters of immune system cells in FIC of the primary school age.
MATERIALS AND METHODS: The study involved 114 children aged 7–11 years. On the basis of the data of the card of child’s individual development, a group of FIC was identified with recurrence rate of acute respiratory diseases more than 4 times a year (n = 28). A control group included episodically ill children (1–3 times a year, n = 86). The condition of the autonomic system of a child was evaluated by the data of heart rate variability using ORTO Valeo hardware–software complex. The content of serotonin and catecholamines in blood lymphocytes was determined using luminescent histochemical method. Activity of succinate dehydrogenase and acid phosphatase were evaluated by cytochemical methods.
RESULTS: The study of regulatory-metabolic parameters of immune cells in the group pf FIC showed reduced activity of succinate dehydrogenase (р < 0.01) and reduced content of serotonin (р < 0.01), and high activity of acid phosphatase (р < 0.05) and catecholamines (р < 0.001) in comparison with the control group. The analysis of parameters of autonomic regulation in FIC group showed predominance of parameters characterizing the sympathetic division of the autonomic nervous system and reduction of parameters characterizing the activity of the parasympathetic division (р < 0.05).
CONCLUSION: The results evidence a sharp imbalance between metabolic and catabolic processes in the immune system of FIC of the primary school age with the underlying predominant activity of the sympathetic nervous system. This gives the ground to study the reasonability of administration of medications and physiotherapeutic procedures for correction of the parameters of the autonomic regulation in the inter-recurrence period with the aim of improving the general adaptive capacities of FIC of the primary school age.
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Transcultural Validity of Concept of Internalized Stigma in Patients with Mental Illnesses (Psychometric Properties of Russian Version of Internalized Stigma of Mental Illness Scale)
摘要
INTRODUCTION: One of the commonest methods of evaluation of internalized stigma is Internalized Stigma of Mental Illness (ISMI) scale where the differences in the prevalence and perception of mental stigma in different cultures are specified.
AIM: Validation of Russian version of ISMI scale and evaluation of peculiarities of perception of stigma by Russian-speaking patients with severe psychiatric disorders.
MATERIALS AND METHODS: Four hundred thirty nine patients with severe psychiatric disorders (F2 and F3 according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision) were examined. The psychometric properties of the Russian version of ISMI scale were evaluated using internal consistency analysis. Exploratory and confirmatory factor analysis (EFA and CFA, respectively) were performed. To check age- and gender-related invariance, MIMIC and MIFA models were used, and discriminative power and accuracy of scoring were identified using generalized partial credit model (GPCM). The results of EFA were compared with the data obtained in the Regional Clinical Hospital (n = 120) using independent alternative version of ISMI translation into Russian.
RESULTS: The internal consistency of the Russian version of ISMI questionnaire was high: Chronbach’s α — 0.90. EFA permitted to identify 4 factors. The first factor (‘Demoralization’, F1) combined elements corresponding to subscale 1 (‘Alienation’) and subscale 2 (‘Social withdrawal’) of the original version of ISMI questionnaire. The other three factors identified in this study according to the content of the items, corresponded to the remaining subscales of the original ISMI scale. In all kinds of the conducted analysis, item 14 had low factor weight. CFA confirmed the four-factor structure. In the sample, MIMIC and MIFA showed the general age- and gender-related invariance with their insufficient power. GPCM showed good characteristics of discriminative power and difficulties in choice of scoring for all factors except the fourth one (‘Resistance to stigma’). EFA performed on the data of the alternative sample, neither could reliably reproduce the five-factor structure of the original ISMI scale due to eclectic mixing of the items of the original scale within five isolated structures.
CONCLUSION: The suitability of using the internalized stigma assessment tool for the Russian-speaking population has been confirmed. The study highlights the relevance and necessity of expanding transcultural studies of psychological reactions of psychiatric patients.
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The Role of Inflammatory Biomarkers of Crevicular Fluid Involved in Modulating of Immune Protection Mechanisms in Chronic Periodontitis
摘要
INTRODUCTION: Chronic periodontal inflammation is provoked by persistence of subgingival bacterial flora and is mediated through the production of proinflammatory cytokines that induce the innate immune reactions.
АIM: To establish the interrelation of secretion of interleukin 1ß and immune component of soluble CD14 co-receptor with the main periodontopathogenic microorganisms in patients with chronic generalized periodontitis.
MATERIALS AND METHODS: A clinical and laboratory examination of patients with chronic generalized periodontitis (n = 100) and individuals with the intact parodontium (n = 63) was conducted. Molecular genetic studies (isolation of periodontal pathogens by polymerase chain reaction in real time), immune enzyme assay (isolation of interleukin 1ß and soluble CD14 co-receptor) and statistical analysis of the data obtained were performed.
RESULTS: The frequency of isolation of periodontopathogenic bacteria in patients with the diagnosis of chronic periodontitis was 96.4% (T. forsythia — 81%, р < 0.001; P. gingivalis — 69%, р < 0.001; Tr. denticola — 63%, р = 0.054). In 25% of cases, C. Albicans (р < 0.001), in 37% — Pr. intermedia (р < 0.001) and in 30% — A. actinomycetemcomitans (р < 0.001) were isolated. The average concentrations of soluble CD14 co-receptor were 2.13 [1.89; 2.76] pg/ml in the control group and 20.3 [17.3; 22.5] ng/ml in the group of patients with chronic periodontitis (р < 0.001). Concentrations of interleukin 1ß were 3.187 [2.356; 4.633] pg/ml in the control group and 33.68 [17.255; 56.915] pg/ml in the group of patients with chronic periodontitis (р < 0.001).
CONCLUSION: Inflammation of periodontal tissues is supported by the factors of aggression and toxins not only of known periodontal pathogens, but also by their associations, which leads to enhancement of virulence factors and increase in secretion of interleukin 1ß and soluble CD14 co-receptor, which, in turn, causes destruction of alveolar bone.
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Clinical reports
Experience in Treatment of Patients with First Type Secondary Endoleaks
摘要
INTRODUCTION: First type secondary endoleaks (EL) require quickest elimination, primarily using the endovascular methods. Despite the existence of a sufficiently large number of methods of their elimination, the results of treatment remain ambiguous.
AIM: Analysis of our own experience of elimination of the first type ELs in patients after endoprosthetics of infrarenal abdominal aortic aneurysm.
MATERIALS AND METHODS: The study is retrospective with prospective observation. All patients underwent computed tomography (CT) for identification of the type of EL and choosing a method of its elimination. The term ‘first type secondary EL’ was understood as EL which developed in the long-term period after the primarily negative CT-angiography after endoprosthetic repair of the aorta.
RESULTS: ELs of Ia type were diagnosed in 14 cases, in one case EL of Ib type was identified. On average, first type secondary ELs were identified in 34 months after the primary operation for endograft implantation. In 2 of 15 patients, EL were symptomatic. The elimination of the first type EL required an individualized approach in all cases. The main methods of elimination of the first type EL were: elongation using Jotec E-iliac (n = 1); coiling with implantation of Gore cuff and Chimney-stenting of the left renal artery (LRA; n = 2); implantation of Gore cuff (n = 4); reinforcement with Aptus EndoAnchors (n = 2); Cuff Gore implantation and LRA stenting by Chimney-technique (n = 1); implantation of Cuff Jotec and reinforcement with Aptus EndoAnchors (n = 1); aneurysmal sac coiling (n = 2); Gore cuff implantation with fixation with EndoAnchors and LRA stenting using Chimney-technique (n = 1). The technical success of EL elimination was 100% (in all cases, the success was confirmed by intraoperative angiography, as well as by CT angiography or ultrasound duplex scanning with contrast enhancement after surgery), there were no deaths. In the long-term period (from 6 to 60 months), re-interventions were performed in two cases, fatal outcome happened in one case, after a late open conversion for elimination of EL.
CONCLUSION: In 13% of cases, first type ELs were symptomatic, and their elimination required individual approach with taking into account anatomical factors and the implanted graft. The medium-term results of the elimination of the first type EL are good, no fatal cases have been reported, and the number of reinterventions has reached 20%, which requires monitoring in the postoperative period.
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Reviews
Peculiarities of Clinical Symptoms, Somatic Complications, Approaches to Therapy and Outcomes of Delirium Induced by Exposure to Synthetic Cannabinoids: Systematic Review
摘要
INTRODUCTION: The use of synthetic cannabinoids (SCs) is an urgent healthcare problem, due to, among other things, a high number of complications.
AIM: To systematize the peculiarities of clinical presentation, somatic complications, effectiveness of empirical approaches to therapy, and probable outcomes of delirium induced by exposure to SCs.
MATERIALS AND METHODS: The analysis of scientific publications selected by the keywords in eLibrary, СNKI, PubMed databases, was conducted. According to PRISMA recommendations, 20 articles were taken for analysis.
RESULTS: Today, it is impossible to predict the period when SC-induced delirium may occur. It can start after one-time intake of even small dose, and can occur both due to intoxication and with the underlying withdrawal state — on the 2nd–4th days after the last use. Besides classic symptoms, the clinical picture of delirium is characterized by many symptoms of schizophrenic psychoses: hallucinations of threatening or drug-addicted content; secondary paranoid delusion, less expressed than hallucinations; aggressiveness and agitated behavior; some formal thinking disorders; rarely, Kandinski–Clerambault and oneiroid syndromes. There are reported cases of severe somatic complications in the form of depression of consciousness, rhabdomyolysis, acute renal failure, cardiomyopathy, myocardial infarction, epilepsy, infectious complications with the underlying weakened immunity. Therapy of SC-induced delirium includes detoxification and metabolic therapy, administration of antipsychotics and tranquilizers; use of resuscitation measures in case of depression of consciousness and development of life-threatening conditions. SC-induced delirium lasts from several hours to several days. In most cases, it terminates with complete recovery with amnesia of the period of confusion and asthenia, but in some cases fatal outcomes are reported caused not only by accidents such as road accidents or suicide, but also by somatic complications (most often of infectious character, or multi-organ failure).
CONCLUSION: SСs remain relevant due to high frequency of their use and continuous emergence of new analogs to substances of this group. They have multidirectional effect, and so far it is difficult to predict at what period the delirium induced by them may occur.
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Pathogenetic Aspects of Intraventricular Hemorrhages in Extremely Premature Infants
摘要
INTRODUCTION: Intraventricular hemorrhage (IVH) is one of the most common types of the brain damage in newborns with extremely low and very low body mass. The main source of IVH in the extremely premature infants is the germinal matrix. This is a subependymal structure of the brain consisting of poorly differentiated, randomly arranged cells, well vascularized with vessels with a poor connective-tissue support. The germinal matrix a key supplier of neurons and glial cells of the brain is unique among the brain regions for its specific rate of angiogenesis and selective vulnerability to hemorrhages during its development. Etiology and pathogenesis of IVH in premature infants are highly multifactorial and have not been fully studied. In this review, the data on the key points of the pathogenesis of IVH in premature infants are generalized.
CONCLUSION: IVH is a potentially destructive disease, in the study of which a certain progress has been achieved in elucidating the causes and mechanisms of brain damage. In-depth understanding of the key points of the pathogenesis of intraventricular hemorrhage will permit to choose the optimal management tactics and develop new approaches to prevention and treatment of this pathology.
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Surgical Tactics in Perforations of Stomach and Small Intestine in Children (Literature Review)
摘要
INTRODUCTION: Currently, the number of pediatric patients urgently hospitalized with different variants of gastrointestinal perforations complicated with peritonitis, remains high. In the given work, the variants of the surgical treatment depending on the location of the perforation defect (stomach, duodenum, small intestine) are presented, and the most common causes of such conditions encountered in clinical practice, are described (perforation of Meckel’s diverticulum, spontaneous perforation of small intestine and stomach in children with extremely low body mass, patients with Ehlers–Danlos syndrome).
AIM: To determine the most relevant variants of surgical tactics in children with perforations of different parts of the gastrointestinal tract (in particular, stomach, small intestine) in conditions of peritonitis.
MATERIALS AND METHODS: In the process of studying the literature, 142 scientific publications were analyzed on Google Academy, PubMed, eLIBRARY information resources, published from 2002 to 2022. With this, works describing intestinal perforation with the underlying necrotic enterocolitis, were excluded from the study, since this category of patients requires a separate discussion and description of approaches to treatment.
CONCLUSION: According to the results of the analysis of scientific literature, variants of surgical tactics used in perforations of the gastric wall include (in the order from the most commonly used to the least common): laparotomy and suturing with excision of the edges of the defect; suturing in conditions of laparoscopy; atypical resection with the formation of a gastric ‘tube’ on the probe; resection of stomach. In duodenal perforations, the following methods are used: rhomboid duodeno-duodenoanastomosis according to Kimura, intracorporeal suture with endovideosurgical access; laparotomy and suturing of the defect in extensive necrosis. In spontaneous perforation in the small intestine, resection of the part of the intestine is advisable — anastomosis according to Santulli in combination with terminal ileostomy, simultaneous end-to-end anastomosis or application of intestinal stomas.
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Diagnostic Significance of Proinflammatory Cytokines in Planning Dental Implantation in Patients with General Somatic Pathologies
摘要
INTRODUCTION: The current stage of development of dental implantology permits to perform a complete dental rehabilitation even in complicated clinical situations. However, there are some difficulties which prevent achievement of a high success of implantological treatment in certain somatic pathologies that manifest in the form of systemic inflammation, and present relative contraindications for implantation. Important general somatic pathologies include chronic obstructive pulmonary disease, atherosclerosis, non-insulin-dependent diabetes mellitus, osteoporosis, etc., they are associated with the risk of acute inflammatory response of an organism to surgical implantological intervention. The risk of unpredictable complications also increases because of insufficiently wide laboratory diagnostic spectrum for planning dental implantation that includes a biochemical blood test, coagulogram, reaction to the presence of specific infections and viral diseases. This list of diagnostic data is not always sufficient for a complete prognosis of success of planned treatment in patients with a complicated general somatic or dental status. Besides, the interrelation between dental chronic diseases and general somatic pathologies which in some cases have common etiopathogenetic factors, is often not taken into account, but without the adequate diagnostic range they often remain unnoticed and lead to persistent complications in different periods after completion of treatment. Development of technologies of surgical and orthopedic dentistry permits to provide full dental care to patients even with different pathologies of organs and systems. But in this case, of importance is extended laboratory diagnostics aimed at identification of factors of chronic systemic inflammation, vascular risk, bacterial threats, for example, evaluation of some interleukins, tumor necrosis factor, C-reactive protein.
CONCLUSION: A complex of clinical, laboratory and instrumental diagnostic methods will permit to adequately evaluate risk for treatment failure and construct a prognostic tactics of complex therapy, thereby reducing the probability for unpredictable complications in dental implantation in patients with different somatic pathologies.
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