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Rupture of posterior meningeal artery aneurysm: case report 脑膜后动脉瘤破裂1例
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-97-103
N. A. Mamonov, S. Goroshchenko, L. Rozhchenko, K. Samochernykh
An aneurysm of the posterior meningeal artery is a rare pathology. However, rupture of this aneurysm can lead to serious consequences for the patient's health. For the surgical treatment, both microsurgical and endovascular methods are used. A 19-year-old patient was admitted to our hospital on day 21 after suffering a subarachnoid-ventricular hemorrhage from an aneurysm of the right posterior meningeal artery. On admission, the patient complained of a headache. Cerebellar symptoms were noted in the neurological status. According to digital subtraction angiography, the patient had an anastomosis between the posterior meningeal artery and the hypoplastic p1-segment of the right posterior inferior cerebellar artery distal to the aneurysm. Endovascular method was used to occlude the aneurysm with a detachable coil. The patient was discharged on the third day with total regress of neurological symptoms. Control cerebral angiography 3 months later showed thrombosis of the aneurysm with the supporting segment of the parent artery, as well as restructuring of the main blood flow of this basin through the previously hypoplastic posterior inferior cerebellar artery. In the literature, we found only 9 such cases. Endovascular treatment of this pathology is, in our opinion, effective and safe, and the presence of an anastomosis distal to the aneurysm made it possible to avoid disruption of blood supply in the vascular basin of the affected artery.Received 21 September 2021. Revised 11 October 2021. Accepted 18 October 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
脑膜后动脉动脉瘤是一种罕见的病理。然而,动脉瘤破裂会对病人的健康造成严重后果。对于外科治疗,显微手术和血管内手术方法都被使用。一位19岁的患者因右侧脑膜后动脉动脉瘤引起的蛛网膜下脑室出血于第21天入院。入院时,病人主诉头痛。在神经系统状态中注意到小脑症状。数字减影血管造影显示,患者脑膜后动脉与动脉瘤远端右侧小脑后下动脉发育不良p1段吻合。采用血管内方法用可拆卸线圈闭塞动脉瘤。患者于第三天出院,神经症状完全消退。3个月后对照脑血管造影显示动脉瘤与载动脉的支撑段形成血栓,该盆地的主要血流通过先前发育不全的小脑后下动脉重构。在文献中,我们只发现了9例这样的病例。在我们看来,这种病理的血管内治疗是有效和安全的,并且动脉瘤远端吻合的存在可以避免受影响动脉血管盆地的血液供应中断。收到2021年9月21日。2021年10月11日修订。2021年10月18日接受。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
The role and therapeutical potential of melatonin in oncology practice 褪黑素在肿瘤学实践中的作用和治疗潜力
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-44-54
I. I. Eremenko, V. Ponomarev, S. Polikarpova, E. Bogush, V. Y. Kirsanov, B. A. Zisman, M. Davydov
This review describes the available works on four main trends of prospective application and study of melatonin in oncology: the main properties and mechanisms of the antitumor effect of melatonin, melatonin as a direct antitumor agent, melatonin as a drug for the accompanying therapy of psychoemotional disorders and sleep disorders in cancer patients, and melatonin as a drug for the accompanying therapy of chronic pain syndrome in oncology. Currently, researchers focus on fundamental and clinical relationships between circadian rhythms and carcinogenesis, and one of the key problems is the potential of melatonin as an agent capable of interfering with the molecular processes of formation and maintenance of the viability of malignant tumors. An equally important problem is the potential of melatonin in terms of using its physiological properties for the prevention and accompanying therapy of undesirable effects of the main treatment in oncological practice, which is emphasized in this review. The purpose of this review is an unbiased study of the prospects for the multidirectional use of melatonin both as a direct antitumor agent and as a component of complex therapy of concomitant adverse events associated with tumor and the treatment. Based on a detailed analysis of original scientific articles and scientific reviews in the PubMed search system, as well as peer-reviewed Russian journals, authors have made an attempt to characterize the current state of melatonin in oncology based on principles of evidence-based medicine. Authors also suggests and justify key prospects for use of melatonin in oncology practice and the range of studies necessary to clarify its properties and place in the combined therapy of malignant neoplasms.Received 9 July 2021. Revised 18 August 2021. Accepted 19 August 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Conception and study design: I.I. Eremenko, V.E. Ponomarev Drafting the article: I.I. Eremenko, V.E. Ponomarev, S.B. Polikarpova, E.A. Bogush, V.Yu. Kirsanov, B.A. Zisman, M.M. Davydov Critical revision of the article: I.I. Eremenko, V.E. Ponomarev Final approval of the version to be published: I.I. Eremenko, V.E. Ponomarev, S.B. Polikarpova, E.A. Bogush, V.Yu. Kirsanov, B.A. Zisman, M.M. Davydov
本文综述了褪黑激素在肿瘤领域的主要应用和研究方向,即褪黑激素的主要特性和抗肿瘤作用机制、作为直接抗肿瘤药物的褪黑激素、伴随治疗肿瘤患者的心理情绪障碍和睡眠障碍的褪黑激素、伴随治疗肿瘤慢性疼痛综合征的褪黑激素。目前,研究人员主要关注昼夜节律与肿瘤发生之间的基础和临床关系,其中一个关键问题是褪黑激素作为一种能够干扰恶性肿瘤形成和维持生存能力的分子过程的药物的潜力。一个同样重要的问题是,褪黑素在利用其生理特性来预防和伴随治疗肿瘤实践中主要治疗的不良影响方面的潜力,这在本综述中被强调。本综述的目的是对褪黑激素作为直接抗肿瘤药物和作为与肿瘤和治疗相关的伴随不良事件的复杂治疗的组成部分的多向应用前景进行无偏见的研究。基于对PubMed搜索系统中的原始科学文章和科学评论以及同行评议的俄罗斯期刊的详细分析,作者试图基于循证医学原则描述褪黑素在肿瘤学中的现状。作者还提出并论证了褪黑素在肿瘤学实践中应用的关键前景,以及阐明其特性和在恶性肿瘤联合治疗中的地位所必需的一系列研究。收到2021年7月9日。2021年8月18日修订。2021年8月19日接受。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。构思和研究设计:I.I. Eremenko, V.E. Ponomarev文章起草:I.I. Eremenko, V.E. Ponomarev, S.B. Polikarpova, E.A. Bogush, v.u u。对文章的关键性修改:I.I. Eremenko, V.E. Ponomarev最终批准出版版本:I.I. Eremenko, V.E. Ponomarev, S.B. Polikarpova, E.A. Bogush, v.u u。基尔萨诺夫,齐斯曼,达维多夫
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引用次数: 0
Percutaneous mitral edge-to-edge repair 经皮二尖瓣边缘到边缘修复
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-9-23
E. Golukhova, I. I. Skopin, M. Latyshev, I. Slivneva
Functional mitral regurgitation, now better known as secondary mitral regurgitation, is the most common acquired heart disease in the world. In most cases, patients with secondary mitral regurgitation have a rather poor prognosis, for example, about 50% of patients are at high risk of surgery or are inoperable, while mortality within 1 year without surgery is 57%. The tactics of treating these patients is the subject of much debate. According to the American Association for Thoracic Surgery (Ischemic Mitral Regurgitation Consensus Guidelines Writing Committee), mitral valve reconstruction is accompanied by a large number of relapses of mitral insufficiency in the long term after surgery, and mitral valve replacement is characterized by high mortality (≥ 13%). With the optimal selected conservative therapy (Guideline-directed medical therapy), in most patients, there is no significant improvement in their condition. Since the 2000s the development of methods of interventional influence on the mitral valve for the treatment of such patients is underway. In the 2010s, interventional treatment techniques began to be widely used, and recommendations for their use began to be developed. In some cases, the results of using the techniques are superior to open surgery. Is it possible to say that the problem of treating patients with functional mitral insufficiency of high operative risk has been solved? In order to answer this question, a literature review was carried out on the interventional treatment of secondary mitral regurgitation using the "edge-to-edge" technique.We used PICO strategy (Patient, Intervention, Comparison, Outcome) for searching articles. A systematic search for information on the research topic was carried out in the PubMed and Google Scholar databases using search queries, keywords, and logical operators AND, OR. Key words: mitral regurgitation, functional mitral regurgitation, chronic mitral regurgitation, MitraClip, percutaneous mitral repair, mitral insufficiency, mitral valve, Edge-to-Edge repair. In the initial selection, 1,180 publications were received. After analyzing the titles and abstracts, 94 articles were selected, and full-text copies were studied. The final analysis included 43 articles and 2 randomized clinical trials. We have compiled a literature review on the interventional treatment of secondary mitral regurgitation using the "edge-to-edge" technique.Received 13 July 2021. Revised 4 August 2021. Accepted 9 August 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
功能性二尖瓣反流,现在更好地称为继发性二尖瓣反流,是世界上最常见的获得性心脏病。在大多数情况下,继发性二尖瓣返流患者预后较差,约50%的患者手术风险高或无法手术,而不手术的1年内死亡率为57%。治疗这些病人的策略是很多争论的主题。根据美国胸外科协会(缺血性二尖瓣返流共识指南编写委员会),二尖瓣重建术后长期伴有大量二尖瓣功能不全复发,二尖瓣置换术的特点是死亡率高(≥13%)。选择最佳保守治疗(指南指导的药物治疗),在大多数患者中,他们的病情没有明显改善。自2000年代以来,对此类患者的二尖瓣介入治疗方法的发展正在进行中。进入2010年代,介入治疗技术开始得到广泛应用,并开始提出使用建议。在某些情况下,使用该技术的结果优于开放手术。是否可以说治疗高手术风险的功能性二尖瓣功能不全患者的问题已经解决了?为了回答这个问题,我们对采用“边缘对边缘”技术介入治疗继发性二尖瓣反流的文献进行了回顾。我们使用PICO策略(患者、干预、比较、结果)检索文章。使用搜索查询、关键词和逻辑运算符and、OR,在PubMed和Google Scholar数据库中对研究主题的信息进行系统搜索。关键词:二尖瓣反流,功能性二尖瓣反流,慢性二尖瓣反流,MitraClip,经皮二尖瓣修复,二尖瓣功能不全,二尖瓣,边缘到边缘修复。在最初的选择中,收到了1 180份出版物。在对题目和摘要进行分析后,选取了94篇文章,并对全文拷贝进行了研究。最终的分析包括43篇文章和2项随机临床试验。我们整理了一篇关于应用“边缘对边缘”技术介入治疗继发性二尖瓣反流的文献综述。收到2021年7月13日。2021年8月4日修订。2021年8月9日接受。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
Clopidogrel in clinical practice for myocardial revascularisation: from the origins to the latest recommendations 氯吡格雷在心肌血运重建中的临床应用:从起源到最新推荐
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-32-43
I. Grazhdankin, V. Baystrukov, E. Kretov, A. Chernyavskiy
Ischaemic heart disease is a common cause of death and disability globally. Myocardial revascularisation is one of the most important components of the complex therapy of atherosclerosis. Clopidogrel has long been an attractive antiplatelet drug in clinical practice. Large amounts of evidence and data for P2Y12 platelet inhibitors support the use of clopidogrel in various clinical situations.The pharmacokinetic and pharmacodynamic features of the drug should be considered in everyday practice. Current guidelines clearly define the place and role of clopidogrel in the treatment of patients before and after revascularisation. This article focuses on various aspects of antiplatelet therapy, considering the patient-related risks, based on the European guidelines for the treatment of patients with acute and chronic coronary syndrome.Received 21 September 2021. Revised 16 October 2021. Accepted 18 October 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
缺血性心脏病是全球死亡和残疾的常见原因。心肌血管重建是动脉粥样硬化复杂治疗的重要组成部分之一。氯吡格雷长期以来一直是一种有吸引力的抗血小板药物。P2Y12血小板抑制剂的大量证据和数据支持氯吡格雷在各种临床情况下的使用。药物的药代动力学和药效学特征应在日常实践中加以考虑。目前的指南明确定义了氯吡格雷在患者血运重建术前后的治疗中的地位和作用。本文以欧洲急性和慢性冠状动脉综合征患者治疗指南为基础,重点介绍抗血小板治疗的各个方面,考虑到患者相关的风险。收到2021年9月21日。2021年10月16日修订。2021年10月18日接受。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
A case report of successful surgical treatment of mitral valve disease 38 years after implantation of ball-valve mechanical prosthesis in aortic position 主动脉位置球阀机械假体植入术38年后二尖瓣病变手术治疗成功一例
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-83-89
Yu. V. Zheltovskii, V. I. Batekha, E. V. Peshkov, V. A. Podkamennyy
The application of ball-valve prostheses in clinical practice marked a new age in the treatment of valvular heart pathology. Ball-valve prostheses are made of long-living and hard-wearing materials; however, these properties confer significant disadvantages resulting from the large dimensions and weight, increased pressure gradient and risk of valve thrombosis and systemic embolism. With the advent of more advanced disk structures, the use of ball-valve prostheses was ended.In Russia and other counties, the scientific literature shows an increase in reoperation after implantation of ball-valve prostheses over the long-term, which is associated with the occurrence of another valve defect. The need to replace a functioning ball-valve prosthesis with a modern mechanical or biological prostheses during surgery for another valve is still controversial.We present a case report of a 55-year-old patient with rheumatic mitral stenosis and functional insufficiency of the tricuspid valve, who underwent repeat surgery 38 years after implantation of a ball-valve prosthesis in the aortic position. From the echocardiography findings, the peak transmitral gradient was 16 mm Hg, the average gradient was 5.5 mm Hg, the area was 1.3 cm2 and regurgitation was third-degree. On the tricuspid valve, there was third-degree regurgitation.Adequate hemodynamic parameters of the ball-valve prosthesis (the maximum blood flow rate was 2.65 m/sec, the peak gradient was 30 mm Hg, the average gradient was 18 mm Hg and there was no regurgitation) and the absence of valve-dependent complications enabled us to perform mitral prosthetics and tricuspid valve plastic surgery without replacing the aortic prosthesis, which reduced the operation time and decreased the risk of complications.The patient was examined two years later. The patient’s active lifestyle and adequate hemodynamic parameters proved the rationality of our treatment policy.The reported case indicates that mitral valve defect that develops a long time after aortic valve prosthetics can be treated surgically without the replacement of a ball-valve prosthesis in the case that it has good function.Received 25 July 2021. Revised 22 August 2021. Accepted 23 August 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
球阀假体在临床上的应用,标志着瓣膜性心脏病理的治疗进入了一个新的时代。球阀假体采用寿命长、耐磨的材料制成;然而,这些特性带来了显著的缺点,即尺寸和重量大,压力梯度增加,瓣膜血栓形成和全身栓塞的风险。随着更先进的椎间盘结构的出现,球阀假体的使用结束了。在俄罗斯和其他国家,科学文献显示,长期植入球阀假体后再手术增加,这与另一种瓣膜缺损的发生有关。在手术中,是否需要用现代机械或生物假体替换功能正常的球阀假体仍存在争议。我们报告了一例55岁的风湿性二尖瓣狭窄和三尖瓣功能不全的患者,在主动脉位置植入球瓣假体38年后再次手术。超声心动图显示,透射梯度峰值为16 mm Hg,平均梯度5.5 mm Hg,面积1.3 cm2,三度反流。在三尖瓣上,有三度反流。球阀假体血流动力学参数充足(最大血流速率2.65 m/sec,峰值梯度30 mm Hg,平均梯度18 mm Hg,无反流),无瓣膜依赖并发症,无需更换主动脉假体即可行二尖瓣和三尖瓣整形手术,缩短了手术时间,降低了并发症的发生风险。两年后,病人接受了检查。患者积极的生活方式和充足的血流动力学参数证明了我们治疗政策的合理性。本病例提示主动脉瓣置换术后长时间形成的二尖瓣缺损,在功能良好的情况下,可以手术治疗,无需更换球阀假体。收到2021年7月25日。2021年8月22日修订。2021年8月23日接受。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
1-year outcomes results of coronary artery bypass grafting in patients with target artery distal calcinosis 靶动脉远端钙质沉着患者冠状动脉旁路移植术1年疗效观察
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-55-65
R. Akchurin, A. Shiryaev, D. M. Galayutdinov, V. Vasiliev, S. Kurbanov, A. Andreev, V. Y. Zaikovkii, G. Mayorov
Aim. Comparative assessment of the surgical strategies and one-year results of coronary artery bypass grafting (CABG) in patients with and without target artery distal calcinosis.Methods. A prospective study from January 2017 to October 2018 included 462 patients with coronary artery disease. All patients underwent CABG. Groups were formed according to coronary angiography data. Group 1 — patients with target artery distal calcinosis (n = 108). Group 2 — patients without any marks of coronary calcification (n = 354). To minimize systematic errors and maximize their comparability, computer correction was performed using propensity score matching (group 1, n = 106, group 2, n = 106). Intraoperative data and one-year outcomes were analyzed and compared.Results. Following the strategy for complete revascularization, we had to form a greater number of distal anastomosis in group 1 due to severe coronary atherosclerosis. The index of revascularization was higher in group 1 (4.4 ± 0.7 and 3.9 ± 0.8, p = 0.001). We registered a higher frequency of using prolonged patch-angioplasty (21.7 versus 1.8 %, p < 0.001), anastomosis with artery diameter < 1.5 mm (33.9 versus 16 %, p < 0.003), coronary artery endarterectomy (13.2 versus 0.9%, p < 0.001) in patients with coronary artery calcinosis. As well as the creation of composite grafts, such as Y-graft (33 versus 8.5 %, p < 0.001) and sequential graft (13.9 versus 5.7 %, p = 0.03) were higher in group 1. The use of adjunctive surgical techniques in the main group significantly increased the duration of cardio-pulmonary bypass and aortic cross-clamp time. The primary endpoints – coronary ischemic events – angina recurrence (10.3 versus 6.3 %, p = 0.307), myocardial infarction (3.1 versus 2.1 %, p = 0.654), the need for re-revascularization (3.1 versus 1 %, p = 0.318) were comparable in 1 year after surgery. Overall mortality was relatively low in both groups.Conclusion. CABG in patients with target artery distal calcinosis is associated with similar one-year outcomes compared to CABG in patients without coronary artery calcification. The positive results of CABG in patients with target artery distal calcinosis indicate the benefits of complete myocardial revascularization, despite the long duration and complexity of interventions.Received 29 September 2021. Revised 20 October 2021. Accepted 22 October 2021.Funding: The work was carried out within the framework of the state assignment (No. AAAA-A18-118022290040-7).Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: Conception and study design: A.A. Shiryaev, G.B. Mayorov, D.M. Galayutdinov Data collection and analysis: G.B. Mayorov, S.K. Kurbanov, V.Yu. Zaikovkii Statistical analysis: S.K. Kurbanov, G.B. Mayorov Drafting the article: G.B. Mayorov, A.V. Andreev, S.K. Kurbanov Critical revision of the article: R.S. Akchurin, A.A. Shiryaev, D.M. Galayutdinov, V.P. Vasiliev Final approval of the version to be published: R.S. A
的目标。目标动脉远端钙质沉积与非目标动脉远端钙质沉积的冠状动脉旁路移植术(CABG)手术策略及1年疗效比较。2017年1月至2018年10月的一项前瞻性研究包括462名冠状动脉疾病患者。所有患者均行冠脉搭桥。根据冠状动脉造影资料分组。第一组:目标动脉远端钙质沉着症患者(n = 108)。第二组:无冠状动脉钙化迹象的患者(n = 354)。为了最大限度地减少系统误差并最大化其可比性,使用倾向评分匹配进行计算机校正(组1,n = 106,组2,n = 106)。分析比较术中资料和1年预后。1组由于冠状动脉粥样硬化严重,采用完全血运重建策略,需要形成更多的远端吻合。血运重建指数1组高于对照组(4.4±0.7和3.9±0.8,p = 0.001)。我们记录到冠状动脉钙化患者使用长时间补片血管成形术(21.7%比1.8%,p < 0.001)、动脉直径< 1.5 mm吻合(33.9%比16%,p < 0.003)、冠状动脉内膜切除术(13.2比0.9%,p < 0.001)的频率更高。以及复合移植物的产生,如y型移植物(33比8.5%,p < 0.001)和顺序移植物(13.9比5.7%,p = 0.03)在组1中更高。主组辅助手术技术的使用显著增加了心肺分流术的持续时间和主动脉交叉钳夹时间。主要终点-冠状动脉缺血事件-心绞痛复发(10.3%对6.3%,p = 0.307),心肌梗死(3.1%对2.1%,p = 0.654),再血运重建需求(3.1%对1%,p = 0.318)在手术后1年内具有可比性。两组患者的总死亡率均较低。与无冠状动脉钙化的CABG患者相比,靶动脉远端钙化患者的CABG与相似的一年预后相关。靶动脉远端钙化患者行冠脉搭桥的阳性结果表明,尽管干预时间长且复杂,但完全心肌血运重建术是有益的。收到2021年9月29日。2021年10月20日修订。2021年10月22日接受。资助:这项工作是在国家任务的框架内进行的。aaaa级-那么- 118022290040 - 7)。利益冲突:作者声明无利益冲突。作者贡献:研究构思与设计:A.A. Shiryaev, G.B. Mayorov, D.M. Galayutdinov数据收集与分析:G.B. Mayorov, S.K. Kurbanov, v.u yu。Zaikovkii统计分析:S.K. Kurbanov, G.B. Mayorov文章起草:G.B. Mayorov, A.V. Andreev, S.K. Kurbanov文章关键修改:R.S. Akchurin, A.A. Shiryaev, D.M. Galayutdinov, V.P. Vasiliev最终定稿:R.S. Akchurin, A.A. Shiryaev, D.M. Galayutdinov, V.P. Vasiliev, S.K. Kurbanov, A.V. Andreev, v.u yu扎伊科夫基,G.B.马约罗夫
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引用次数: 0
Cognitive impairment in patients with atrial fibrillation and arterial hypertension 心房颤动合并高血压患者的认知功能障碍
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-66-72
A. Kovaleva, V. Lukinov, G. Lifshits

Aim. To study the influence of atrial fibrillation on the severity of cognitive impairment in patients with arterial hypertension.

Methods. The study included 25 patients with atrial fibrillation and arterial hypertension, the control group of 25 patients with arterial hypertension, but without cardiac arrhythmias. All patients underwent general clinical and instrumental examination of the cardiovascular system. The Montreal Cognitive Assessment test was used to assess memory and attention, the degree of mastering visual-constructive skills, abstract thinking and speech.

Results. Cognitive functions in patients with atrial fibrillation were significantly worse than in patients in the control group (testing to assess indicators: 22.7 ± 3.2 and 25.6 ± 2.2 points, respectively, p < 0.001). Cognitive indicators such as memory, speech and abstract thinking are most severely affected in patients with arrhythmia.

Conclusion. Atrial fibrillation creates conditions for the development of cognitive deficits. Cerebral hypoperfusion, the occurrence of "silent" cerebral infarctions and hypercoagulation are important pathogenetic factors of cognitive impairment in patients with atrial fibrillation.

Received 29 July 2021. Revised 11 September 2021. Accepted 20 September 2021.

Funding: The research was carried out within the state assignment of the Siberian Branch of the Russian Academy of Sciences (No. 121031300045-2).

Conflict of interest: Authors declare no conflict of interest.

Contribution of the authors: The authors contributed equally to this article.

的目标。目的:探讨心房颤动对高血压患者认知功能障碍严重程度的影响。本研究纳入25例心房颤动合并动脉性高血压患者,对照组25例动脉性高血压患者,但无心律失常。所有患者都接受了心血管系统的一般临床和仪器检查。蒙特利尔认知评估测试用于评估记忆力和注意力、掌握视觉构建技能的程度、抽象思维和演讲能力。心房颤动患者的认知功能明显差于对照组(评价指标测试:分别为22.7±3.2分和25.6±2.2分,p < 0.001)。心律失常患者的记忆、言语、抽象思维等认知指标受到的影响最为严重。心房颤动为认知缺陷的发展创造了条件。脑灌注不足、“无症状性”脑梗死和高凝血是房颤患者认知功能障碍的重要致病因素。收到2021年7月29日。2021年9月11日修订。2021年9月20日接受。资助:该研究是在俄罗斯科学院西伯利亚分院的国家任务范围内进行的(编号121031300045-2)。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
Remote magnetic navigation for treatment of patients with atrial fibrillation 远程磁导航治疗心房颤动
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-24-31
V. Beloborodov, V. Shabanov, N. A. Yelemessov, A. Filippenko, I. Mikheenko, E. Fisher, A. Romanov
Atrial fibrillation (AF) remains an important medical and social health problem occupying a leading position among all cardiac arrhythmias in clinical practice. AF increases overall mortality by 1.9 times and the risk of stroke by 5 times, leads to disability among the working-age population, and reduces the quality of life.Pulmonary veins isolation is the main approach in the treatment of AF symptomatic patients who are resistant to antiarrhythmic therapy. However, the use of this technique is associated with the need for long-term use of fluoroscopy and monitoring of the contact force of the ablation catheter with the heart tissue for an effective and safe exposure on the arrhythmia substrate. In addition, the complication rate can reach up to 5% even when using non-fluoroscopic navigation systems.Over the past decade, robotic magnetic navigation was established as a safe and effective technology in the treatment of patients with different cardiac arrhythmias. The advantages of this technology are the flexibility and mobility of the ablation catheter to reach difficult areas during ablation procedure, as well as high efficiency and safety, with a low fluoroscopy exposure time. This review analyses the current literature and documents the experience of using robotic magnetic navigation for the treatment of patients with different forms of AF. We conducted searches on Scopus, Web of Science databases and PubMed.The reviewed studies demonstrated that the use of robotic magnetic navigation is a safe and highly effective method of treating patients with AF. It also helps to reduce the time of fluoroscopy during ablation procedure.Received 26 August 2021. Revised 21 September 2021. Accepted 22 September 2021.Funding: This work was carried out within the framework of the state task of Ministry of Health of Russian Federation No. 121031300225-8.Conflict of interest: The authors declare no conflict of interest.Contribution of the authorsConception and study design: V.V. Beloborodov, A.G. Filippenko, A.B. RomanovData collection and analysis: V.V. Beloborodov, N.А. Yelemessov, E.V. Fisher, A.G. Filippenko, V.V. Shabanov, A.B. RomanovStatistical analysis: A.B. Romanov, I.L. MikheenkoDrafting the article: V.V. Beloborodov, A.G. Filippenko, A.B. RomanovCritical revision of the article: A.B. Romanov, I.L. Mikheenko, A.G. Filippenko, V.V. ShabanovFinal approval of the version to be published: V.V. Beloborodov, V.V. Shabanov, N.А. Yelemessov, A.G. Filippenko, I.L. Mikheenko, E.V. Fisher, A.B. Romanov
心房颤动(AF)仍然是一个重要的医学和社会健康问题,在临床实践中占据所有心律失常的主导地位。房颤使总死亡率增加1.9倍,卒中风险增加5倍,导致工作年龄人口残疾,并降低生活质量。肺静脉隔离是治疗抗心律失常治疗无效的房颤症状患者的主要方法。然而,该技术的使用需要长期使用透视检查和监测消融导管与心脏组织的接触力,以便有效和安全地暴露在心律失常基底上。此外,即使使用非透视导航系统,并发症发生率也可达5%。在过去的十年中,机器人磁导航被确立为一种安全有效的技术,用于治疗各种心律失常患者。该技术的优点是消融导管的灵活性和移动性,可以在消融过程中到达困难的区域,并且效率和安全性高,透视暴露时间短。本文分析了目前的文献,并记录了使用机器人磁导航治疗不同形式房颤患者的经验。我们在Scopus、Web of Science数据库和PubMed上进行了检索。综述的研究表明,使用机器人磁导航是治疗房颤患者的一种安全、高效的方法。它还有助于减少消融过程中透视的时间。收到2021年8月26日。2021年9月21日修订。2021年9月22日接受。资助:这项工作是在俄罗斯联邦卫生部第121031300225-8号国家任务的框架内进行的。利益冲突:作者声明无利益冲突。作者贡献。研究构思和设计:V.V. Beloborodov, A.G. Filippenko, A.B. romanov数据收集和分析:V.V. Beloborodov, N.А。Yelemessov, E.V. Fisher, A.G. Filippenko, V.V. Shabanov, A.B. Romanov统计分析:A.B. Romanov, I.L. Mikheenko撰写文章:V.V. Beloborodov, A.G. Filippenko, A.B. Romanov文章的关键修改:A.B. Romanov, I.L. Mikheenko, A.G. Filippenko, V.V. Shabanov最终批准发表的版本:V.V. Beloborodov, V.V. Shabanov, N.А。叶利梅索夫,A.G.菲利潘科,I.L.米赫申科,E.V.费雪,A.B.罗曼诺夫
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引用次数: 0
Implantation of a transcatheter valve in the tricuspid position in a patient with Ebstein's anomaly using the valve-in-valve technique: case report 应用瓣中瓣技术在Ebstein畸形患者的三尖瓣位置植入经导管瓣膜:病例报告
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-90-96
A. Karadzha, A. Voitov, A. Bogachev-Prokophiev, R. Sharifulin, I. I. Tihonova, O. Malakhova
The article presents the first experience of implantation of the Russian transcatheter prosthesis "MedLab-KT" in the tricuspid position. The procedure was performed on a high-risk patient with a history of five open surgical interventions for Ebstein's anomaly with developed dysfunction of a previously implanted biological prosthesis. Implantation was carried out by transatrial valve-in-valve technique to the position of a biological prosthesis. The postoperative period was uneventful. The presented clinical case showed to the effectiveness and safety of the transcatheter PTFE prosthesis "MedLab-KT" during valve-in-valve implantation in case of dysfunction of the biological prosthesis in the tricuspid position.Received 10 October 2021. Accepted 29 October 2021.Funding: The research was carried out within the state assignment of Ministry of Health of Russian Federation (No. 121032300337-5).Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Literature review: I.I. Tihonova, O.Yu. Malakhova Drafting the article: A.V. Karadzha Critical revision of the article: A.V. Bogachev-Prokophiev, A.V. Voitov, R.M. Sharifulin Surgical treatment: A.V. Voitov, R.M. Sharifulin Final approval of the version to be published: A.V. Karadzha, A.V. Voitov, A.V. Bogachev-Prokophiev, R.M. Sharifulin, I.I. Tihonova, O.Yu. Malakhova
本文介绍了俄罗斯经导管假体MedLab-KT在三尖瓣位置植入术的首次经验。该手术是在一名高风险患者身上进行的,该患者曾因Ebstein畸形进行过5次开放性手术,并伴有先前植入的生物假体功能障碍。植入是通过经心房瓣膜技术进行的生物假体的位置。术后顺利。本临床病例表明,在三尖瓣位置生物假体功能障碍的情况下,经导管PTFE假体“MedLab-KT”在瓣膜植入过程中是有效和安全的。收到2021年10月10日。2021年10月29日接受。资助:该研究是在俄罗斯联邦卫生部的国家任务范围内进行的(编号121032300337-5)。利益冲突:作者声明无利益冲突。文献综述:I.I. Tihonova, O.Yu。Malakhova文章起草:A.V. Karadzha文章关键修改:A.V. Bogachev-Prokophiev, A.V. Voitov, R.M. Sharifulin手术治疗:A.V. Voitov, R.M. Sharifulin最终批准出版版本:A.V. Karadzha, A.V. Voitov, A.V. Bogachev-Prokophiev, R.M. Sharifulin, I.I. Tihonova, o.u yu。Malakhova
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引用次数: 0
Evaluation of the effectiveness of interventional treatment of ventricular arrhythmias of rare localizations using non-invasive mapping 应用无创定位介入治疗罕见室性心律失常的疗效评价
Q4 Medicine Pub Date : 2022-03-31 DOI: 10.21688/1681-3472-2022-1-73-82
E. Artyukhina, M. V. Yashkov, E. Dedukh, I. Taymasova, A. Revishvili
Background. Atypical localization of the focus of ventricular arrhythmias is a rather difficult group for invasive mapping and subsequent radiofrequency ablation. Invasive electroanatomical mapping, multipolar electrophysiological electrodes in combination with electrophysiological study for searching an early zone of arrhythmia focus, and substrate mapping, are aimed to identifying critical areas of the arrhythmia contour. However, there are still situations in which arrhythmia cannot be eliminated, despite the use of these systems. The method of superficial non-invasive mapping of the heart seems to be relevant, which makes it possible to estimate the volume of surgery and select the necessary technology to eliminate arrhythmias.Aim. To compare the effectiveness of interventional treatment of patients with ventricular arrhythmias of atypical localization with and without the use of superficial non-invasive mapping.Methods. The study included 40 patients with ventricular arrhythmias of rare localization. The patients were divided into two groups. Group I included 21 patients who underwent non-invasive superficial and invasive electrophysiological cardiac mapping. Group II included 19 patients who underwent invasive electrophysiological cardiac mapping.Results. Over a follow-up period of 12 months, the freedom from arrhythmia in group I was 76%, in group II — 61%. The total operation time, duration and dose of fluoroscopy were less in group I compared to the group II.Conclusion. The study results demonstrated that the method of non-invasive surface mapping of the heart is highly effective in ventricular arrhythmias of atypical localization. The time of radiofrequency ablation, interventional intervention, fluoroscopy is lower with the use of superficial non-invasive mapping, compared with the control group.Received 13 July 2021. Revised 20 October 2021. Accepted 9 December 2021.Funding: This work is supported by a grant of the Russian Science Foundation (project No. 19-15-00406).Conflict of interest: The authors declare no conflict of interest.Contribution of the authorsConception and study design: E.A. Artyukhina, A.Sh. RevishviliData collection and analysis: E.A. Artyukhina, M.V. Yashkov, E.V. Dedukh, I.A. Taymasova, A.Sh. RevishviliStatistical analysis: M.V. YashkovDrafting the article: E.A. Artyukhina, M.V. YashkovCritical revision of the article: E.A. Artyukhina, M.V. Yashkov, A.Sh. RevishviliFinal approval of the version to be published: E.A. Artyukhina, M.V. Yashkov, E.V. Dedukh, I.A. Taymasova, A.Sh. Revishvili
背景。室性心律失常病灶的非典型定位是一组相当困难的有创定位和随后的射频消融。有创电解剖作图、多极电生理电极结合电生理研究寻找心律失常病灶的早期区域、底物作图,旨在识别心律失常等值线的关键区域。然而,尽管使用了这些系统,仍然存在心律失常不能消除的情况。浅表无创心脏测绘方法似乎是相关的,它使估计手术量和选择必要的技术来消除心律失常成为可能。目的:比较非典型定位室性心律失常介入治疗的效果。本研究包括40例罕见局限性室性心律失常患者。患者被分为两组。第一组21例患者行无创浅表和有创心脏电生理测图。II组19例患者行有创心脏电生理测图。在12个月的随访中,I组心律失常发生率为76%,II组为61%。ⅰ组手术总时间、透视时间、透视剂量均少于ⅱ组。研究结果表明,无创心脏体表测绘方法在非典型定位室性心律失常中是非常有效的。与对照组相比,使用浅表无创测图进行射频消融、介入治疗、透视检查的时间较低。收到2021年7月13日。2021年10月20日修订。2021年12月9日接受。基金资助:本工作由俄罗斯科学基金(项目号19-15-00406)资助。利益冲突:作者声明无利益冲突。作者贡献。研究构想与设计:a . a . Artyukhina, A.Sh。回顾数据收集与分析:E.A. Artyukhina, M.V. Yashkov, E.V. Dedukh, I.A. Taymasova, A.Sh。文章起草:E.A. Artyukhina, M.V. Yashkov文章关键修改:E.A. Artyukhina, M.V. Yashkov, A.Sh。最终批准出版的版本:E.A. Artyukhina, M.V. Yashkov, E.V. Dedukh, I.A. Taymasova, A.Sh。Revishvili
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引用次数: 0
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Patologiya krovoobrashcheniya i kardiokhirurgiya
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