Pub Date : 2023-12-20DOI: 10.23873/2074-0506-2023-15-4-515-528
A. Kostyunin, T. Glushkova, A. Stasev, E. Ovcharenko
Aim. The aim of this review was to analyze publications describing studies focusing on the pathophysiological mechanisms of calcification of bioprosthetic heart valves, and to substantiate new and promising methods of calcification prevention for the implantable medical devices.Material and methods. Databases and electronic libraries such as PubMed, Google Scholar and eLibrary were used for searching relevant articles. Search queries included the following word combinations: “bioprosthetic heart valves”, “structural valve degeneration”, “calcification”, “cyclic loading”, “inflammation”, “proteolysis”, “proteolytic enzymes”, “decellularization”, “anticalcification treatment”. The references in relevant articles were used for the search as well. Preference was given to works published from January 2013 to January 2023.Results. We have considered the key aspects of bioprosthetic heart valves calcification and the main strategies of calcification prevention. Calcification of bioprosthetic heart valves incorporates a complex set of mechanisms that includes, but is not limited to: 1) binding of calcium in chemically stabilized biomaterial by free groups of the preservative; 2) precipitation of calcium on residual donor cells and cell debris; 3) pro-calcifying changes in biological material due to proteolysis, mechanical and oxidative stress; 4) cell-mediated biomineralization. Despite modern advances in biopreservation, such as treatment with chemical agents that prevent the deposition of calcium, the problem of bioprosthetic heart valves calcification still prevails. The cause of it lies in the heterogeneity of the pathophysiological mechanisms behind the mineralization of biomaterial: the currently developed methods of calcification prevention cannot block all ways of bioprosthetic heart valves calcification.Conclusion. Calcification of bioprosthetic heart valves leaflets is a complex process that underlies the main cause of dysfunction of the medical devices. Supposedly, a new innovative approach that involves polymer hydrogel filler in biomaterials can completely prevent its calcification.
{"title":"Modern view on calcification of xenogenic bioprosthetic heart valves and their anti-calcification treatment strategies","authors":"A. Kostyunin, T. Glushkova, A. Stasev, E. Ovcharenko","doi":"10.23873/2074-0506-2023-15-4-515-528","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-515-528","url":null,"abstract":"Aim. The aim of this review was to analyze publications describing studies focusing on the pathophysiological mechanisms of calcification of bioprosthetic heart valves, and to substantiate new and promising methods of calcification prevention for the implantable medical devices.Material and methods. Databases and electronic libraries such as PubMed, Google Scholar and eLibrary were used for searching relevant articles. Search queries included the following word combinations: “bioprosthetic heart valves”, “structural valve degeneration”, “calcification”, “cyclic loading”, “inflammation”, “proteolysis”, “proteolytic enzymes”, “decellularization”, “anticalcification treatment”. The references in relevant articles were used for the search as well. Preference was given to works published from January 2013 to January 2023.Results. We have considered the key aspects of bioprosthetic heart valves calcification and the main strategies of calcification prevention. Calcification of bioprosthetic heart valves incorporates a complex set of mechanisms that includes, but is not limited to: 1) binding of calcium in chemically stabilized biomaterial by free groups of the preservative; 2) precipitation of calcium on residual donor cells and cell debris; 3) pro-calcifying changes in biological material due to proteolysis, mechanical and oxidative stress; 4) cell-mediated biomineralization. Despite modern advances in biopreservation, such as treatment with chemical agents that prevent the deposition of calcium, the problem of bioprosthetic heart valves calcification still prevails. The cause of it lies in the heterogeneity of the pathophysiological mechanisms behind the mineralization of biomaterial: the currently developed methods of calcification prevention cannot block all ways of bioprosthetic heart valves calcification.Conclusion. Calcification of bioprosthetic heart valves leaflets is a complex process that underlies the main cause of dysfunction of the medical devices. Supposedly, a new innovative approach that involves polymer hydrogel filler in biomaterials can completely prevent its calcification.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138953748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-20DOI: 10.23873/2074-0506-2023-15-4-477-487
D. A. Lebedev, Yu.Kh. Dolya, G. E. Savkov, M. A. Godkov, E. Klychnikova, А. P. Shakotko, D. Kosolapov, S. N. Kuznetsov, A. Kvasnikov, Yu.N. Vrabiy, K. Kiselev, V. B. Poluektova, S. Petrikov, K. A. Popugaev
Introduction. COVID-19 causes cytokine storm and acute respiratory distress syndrome, which can lead to severe lung damage and multiple organ dysfunction. Early use of monoclonal antibodies has shown promising results in cytokine storm therapy, but the effects on lung gas exchange function have not yet been studied.Aim. To evaluate the effect of tocilizumab on the dynamics of gas exchange parameters in patients with severe COVID-19. Material and methods. The study included 26 patients in whom gas exchange parameters (PaO2, PaCO2, P/f ratio), blood oxygen saturation (saturation), respiration rate, duration and parameters of high-flow oxygen therapy and noninvasive mechanical ventilation, length of stay in intensive care unit and total hospital length of stay were assessed.Results. Tocilizumab significantly improved oxygenation on the third day (p=0.001) from the time of drug administration.Conclusion. In the presented and analyzed cohort of patients with severe COVID-19 and cytokine storm, the normalization and significant increase of oxygenation parameters (PaO2, p=0.001; P/f ratio, p=0.001) were observed within three days after a single-dose tocilizumab administration in a complex intensive therapy. No significant dynamics in the respiratory support parameters was revealed, nor an effect of this therapy on the duration of the respiratory support or the reduction in the aggressiveness of its parameters was observed within three days after tocilizumab administration (p>0.05).
{"title":"Effect of tocilizumab on pulmonary gas exchange function in patients with severe COVID-19","authors":"D. A. Lebedev, Yu.Kh. Dolya, G. E. Savkov, M. A. Godkov, E. Klychnikova, А. P. Shakotko, D. Kosolapov, S. N. Kuznetsov, A. Kvasnikov, Yu.N. Vrabiy, K. Kiselev, V. B. Poluektova, S. Petrikov, K. A. Popugaev","doi":"10.23873/2074-0506-2023-15-4-477-487","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-477-487","url":null,"abstract":"Introduction. COVID-19 causes cytokine storm and acute respiratory distress syndrome, which can lead to severe lung damage and multiple organ dysfunction. Early use of monoclonal antibodies has shown promising results in cytokine storm therapy, but the effects on lung gas exchange function have not yet been studied.Aim. To evaluate the effect of tocilizumab on the dynamics of gas exchange parameters in patients with severe COVID-19. Material and methods. The study included 26 patients in whom gas exchange parameters (PaO2, PaCO2, P/f ratio), blood oxygen saturation (saturation), respiration rate, duration and parameters of high-flow oxygen therapy and noninvasive mechanical ventilation, length of stay in intensive care unit and total hospital length of stay were assessed.Results. Tocilizumab significantly improved oxygenation on the third day (p=0.001) from the time of drug administration.Conclusion. In the presented and analyzed cohort of patients with severe COVID-19 and cytokine storm, the normalization and significant increase of oxygenation parameters (PaO2, p=0.001; P/f ratio, p=0.001) were observed within three days after a single-dose tocilizumab administration in a complex intensive therapy. No significant dynamics in the respiratory support parameters was revealed, nor an effect of this therapy on the duration of the respiratory support or the reduction in the aggressiveness of its parameters was observed within three days after tocilizumab administration (p>0.05).","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138953959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-20DOI: 10.23873/2074-0506-2023-15-4-529-540
M. Novruzbekov, A. Balkarov, E. Y. Anosova, I. Dmitriev, Y. Anisimov, N. Zhuravel, E. Klychnikova, A. S. Bogdanova, B. I. Yaremin
Background. Organ transplantation is the optimal decision for patients in the end stage of many diseases. Certain conditions are required for the transportation and preservation of a donor organ after explantation, including factors such as temperature, pressure, and preservative solution. All currently available methods of preservation of donor organs are aimed at maximizing the complete preservation of the functional state of the graft from the moment of its removal to implantation and reperfusion in the recipient's body.Aim. The purpose of this review is to provide up-to-date information on the results of the studies performed in order to decide on the preferred method of organ preservation.Material and methods. An analysis of literature sources in English and Russian from 2009 to 2023 on this topic was performed in the databases PubMed, MEDLINE, Google Scholar. The review highlights the results of preclinical (on animal models) and clinical studies, as well as achievements in the field of ex-vivo machine perfusion with an emphasis on machine hypothermic perfusion and modified oxygenated hypothermic machine perfusion, subnormothermic machine perfusion and machine normothermic perfusion.Results. The daily increase in the number of patients in need of organ transplantation delays the timely selection and search for a donor. Organ donation after cardiac death is a promising step in an attempt to overcome the disbalance between the number of patients and organs, but the risk of developing early graft damage increases. The criteria for selecting donors and donor organs are being expanded, as a result, elderly donors and not-optimal grafts are included, but they are less resistant to ischemic damage. In this connection, there is a need for long-term infusion support through machine perfusion.Conclusion. In recent years, research has focused on alternative preservation methods, studying hypothermic, subnormothermic and normothermic machine perfusion. The use of machine perfusion has become the most widespread among kidney transplants and has shown good results. Further development is expected in the field of studying and improving this method of organ preservation, which allows not only transporting, but also improving the functional state of the graft.
{"title":"The role of oxygenation in kidney and liver machine perfusion","authors":"M. Novruzbekov, A. Balkarov, E. Y. Anosova, I. Dmitriev, Y. Anisimov, N. Zhuravel, E. Klychnikova, A. S. Bogdanova, B. I. Yaremin","doi":"10.23873/2074-0506-2023-15-4-529-540","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-529-540","url":null,"abstract":"Background. Organ transplantation is the optimal decision for patients in the end stage of many diseases. Certain conditions are required for the transportation and preservation of a donor organ after explantation, including factors such as temperature, pressure, and preservative solution. All currently available methods of preservation of donor organs are aimed at maximizing the complete preservation of the functional state of the graft from the moment of its removal to implantation and reperfusion in the recipient's body.Aim. The purpose of this review is to provide up-to-date information on the results of the studies performed in order to decide on the preferred method of organ preservation.Material and methods. An analysis of literature sources in English and Russian from 2009 to 2023 on this topic was performed in the databases PubMed, MEDLINE, Google Scholar. The review highlights the results of preclinical (on animal models) and clinical studies, as well as achievements in the field of ex-vivo machine perfusion with an emphasis on machine hypothermic perfusion and modified oxygenated hypothermic machine perfusion, subnormothermic machine perfusion and machine normothermic perfusion.Results. The daily increase in the number of patients in need of organ transplantation delays the timely selection and search for a donor. Organ donation after cardiac death is a promising step in an attempt to overcome the disbalance between the number of patients and organs, but the risk of developing early graft damage increases. The criteria for selecting donors and donor organs are being expanded, as a result, elderly donors and not-optimal grafts are included, but they are less resistant to ischemic damage. In this connection, there is a need for long-term infusion support through machine perfusion.Conclusion. In recent years, research has focused on alternative preservation methods, studying hypothermic, subnormothermic and normothermic machine perfusion. The use of machine perfusion has become the most widespread among kidney transplants and has shown good results. Further development is expected in the field of studying and improving this method of organ preservation, which allows not only transporting, but also improving the functional state of the graft.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138957249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-20DOI: 10.23873/2074-0506-2023-15-4-541-558
S. P. Glyantsev
Aim. The article examines and analyzes the state of the problem of organ transplantation in the USSR in the early 1970s and ways to solve it with the participation of three prominent transplantologists of the Soviet Union – Yu.M. Lopukhin, A.G. Lapchinsky and V.P. Demikhov, as well as some world achievements in this field.Material and methods. Available printed works on the history of Russian and world transplantology in the 1970s, the analysis of which was carried out by historical-genetic and comparative-analytical methods.Results. Developed by Yu.M. Lopukhin together with leading surgeons and immunologists of the country the Program of scientific research on the problem of transplantation of organs and tissues included three main areas: clinical problems of transplantation of organs and body parts (limbs), including ensuring the viability of organs and tissues outside the body, the ways to overcome biological incompatibility, and also the moral and ethical issues of transplantation, and donation issues. It is shown that the methods of overcoming biological incompatibility in organ and tissue allotransplantations, which had been used for many years by A.G. Lapchinsky and V.P. Demikhov (exchange transfusion of blood between organisms of different species, cross circulation between individuals of the same species), no longer corresponded to the state of medical science, which was represented by Yu.M. Lopukhin. However, scientists who had world-class priorities for the duration of survival of experimental animals with a transplanted limb (A.G. Lapchinsky) and an additional heart and lung transplanted into the chest (V.P. Demikhov) could help in the implementation of some provisions of the Lopukhin’s Program. The preservation of organs and tissues before transplantation in a state of suspended animation was studied by A.G. Lapchinsky, and V.P. Demikhov worked at developing the methods for the extracorporeal connection of organs to the body of an intermediate host and using portable artificial hearts to maintain the vital activity of a cadaveric heart before transplantation.Conclusions. Pioneers of experimental transplantology in the USSR A.G. Lapchinsky and V.P. Demikhov, who began their research in the 1940s, still could have solved many issues of transplanting organs and body parts by the 1970s. But in presented in 1971 Program on the problem of organ and tissue transplantation, prepared under the guidance of Yu.M. Lopukhin, the emphasis was placed on immunological studies, while experimental surgeons played a minor role in it.
{"title":"Condition of the problem of organ transplantation in the USSR in 1970–1971 and ways to solve it (Yu.M. Lopukhin, A.G. Lapchinsky, V.P. Demikhov)","authors":"S. P. Glyantsev","doi":"10.23873/2074-0506-2023-15-4-541-558","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-541-558","url":null,"abstract":"Aim. The article examines and analyzes the state of the problem of organ transplantation in the USSR in the early 1970s and ways to solve it with the participation of three prominent transplantologists of the Soviet Union – Yu.M. Lopukhin, A.G. Lapchinsky and V.P. Demikhov, as well as some world achievements in this field.Material and methods. Available printed works on the history of Russian and world transplantology in the 1970s, the analysis of which was carried out by historical-genetic and comparative-analytical methods.Results. Developed by Yu.M. Lopukhin together with leading surgeons and immunologists of the country the Program of scientific research on the problem of transplantation of organs and tissues included three main areas: clinical problems of transplantation of organs and body parts (limbs), including ensuring the viability of organs and tissues outside the body, the ways to overcome biological incompatibility, and also the moral and ethical issues of transplantation, and donation issues. It is shown that the methods of overcoming biological incompatibility in organ and tissue allotransplantations, which had been used for many years by A.G. Lapchinsky and V.P. Demikhov (exchange transfusion of blood between organisms of different species, cross circulation between individuals of the same species), no longer corresponded to the state of medical science, which was represented by Yu.M. Lopukhin. However, scientists who had world-class priorities for the duration of survival of experimental animals with a transplanted limb (A.G. Lapchinsky) and an additional heart and lung transplanted into the chest (V.P. Demikhov) could help in the implementation of some provisions of the Lopukhin’s Program. The preservation of organs and tissues before transplantation in a state of suspended animation was studied by A.G. Lapchinsky, and V.P. Demikhov worked at developing the methods for the extracorporeal connection of organs to the body of an intermediate host and using portable artificial hearts to maintain the vital activity of a cadaveric heart before transplantation.Conclusions. Pioneers of experimental transplantology in the USSR A.G. Lapchinsky and V.P. Demikhov, who began their research in the 1940s, still could have solved many issues of transplanting organs and body parts by the 1970s. But in presented in 1971 Program on the problem of organ and tissue transplantation, prepared under the guidance of Yu.M. Lopukhin, the emphasis was placed on immunological studies, while experimental surgeons played a minor role in it.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138994478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-20DOI: 10.23873/2074-0506-2023-15-4-488-498
T. A. Kuznetsova, I. V. Grandilevskaya, I. Y. Obidin
Introduction. The number of bone marrow transplantations is increasing worldwide. However, the issue of cognitive impairments following this procedure in hematologic malignancies remains poorly investigated.Aim. The aim of this study was to investigate the level and dynamics of memory and attention parameters in oncological patients undergoing hematopoietic stem cell transplantation.Material and methods. The study was conducted in three stages: pre-operation and two post-operation stages, on days 21 and 60, with control points corresponding to medical protocol milestones. The study involved 43 patients aged 18 to 62, including 22 males and 21 females.Results. The study revealed that most memory-related parameters were at low levels, which may be attributed to preoperative chemotherapy, and further decreased cognitive functions throughout the study (p=0.014, p=0.082, statistically significant in both cases). Attention assessment results indicated predominantly normal levels, while attention-switching parameters decreased from the second to the third stage of the study (p=0.33). The affective sphere before bone marrow transplantation was characterized by depressive symptoms at the sub-depressive level and upper bounds of situational anxiety. By the third stage of the study, these variables gradually decreased to normal values (p=0.03, p=0.07).Conclusions. In the context of this study, a decline in cognitive functions, including mediated, short-term, long-term, and mechanical memory, was observed. A similar trend was noted in attention concentration and attention-switching capabilities.
{"title":"Dynamics of cognitive functions in patients with hemoblastosis treated with hematopoietic stem cell transplantation","authors":"T. A. Kuznetsova, I. V. Grandilevskaya, I. Y. Obidin","doi":"10.23873/2074-0506-2023-15-4-488-498","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-488-498","url":null,"abstract":"Introduction. The number of bone marrow transplantations is increasing worldwide. However, the issue of cognitive impairments following this procedure in hematologic malignancies remains poorly investigated.Aim. The aim of this study was to investigate the level and dynamics of memory and attention parameters in oncological patients undergoing hematopoietic stem cell transplantation.Material and methods. The study was conducted in three stages: pre-operation and two post-operation stages, on days 21 and 60, with control points corresponding to medical protocol milestones. The study involved 43 patients aged 18 to 62, including 22 males and 21 females.Results. The study revealed that most memory-related parameters were at low levels, which may be attributed to preoperative chemotherapy, and further decreased cognitive functions throughout the study (p=0.014, p=0.082, statistically significant in both cases). Attention assessment results indicated predominantly normal levels, while attention-switching parameters decreased from the second to the third stage of the study (p=0.33). The affective sphere before bone marrow transplantation was characterized by depressive symptoms at the sub-depressive level and upper bounds of situational anxiety. By the third stage of the study, these variables gradually decreased to normal values (p=0.03, p=0.07).Conclusions. In the context of this study, a decline in cognitive functions, including mediated, short-term, long-term, and mechanical memory, was observed. A similar trend was noted in attention concentration and attention-switching capabilities.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138957776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-20DOI: 10.23873/2074-0506-2023-15-4-507-514
N. A. Muradyan, I. Kuzmina, T. R. Gvindzhiliya, V. M. Balanyan, K. A. Popugaev
Background. The article discusses the features of one of the complications of acute myocardial infarction – cerebral dysfunction, which negatively affects the quality of life of patients, worsens the disease prognosis, increases the hospital length of stay and the risk of death. The presence of cerebral disorders in patients with acute myocardial infarction causes difficulties in the choice of therapeutic tactics, including the decision on myocardial revascularization. The identification of predictive factors for cerebral deficiency in acute myocardial infarction and the development of an algorithm for the management of such patients is an urgent task of today medicine.Aim. To study the features of cerebral dysfunction in patients with myocardial infarction according to contemporary Russian and foreign literature sources. To create an algorithm for the diagnosis and treatment of cerebral dysfunction in patients with acute myocardial infarction.Material and methods. Patients with acute myocardial infarction who developed cerebral dysfunction in the acute period of the disease were examined.Conclusion. Timely diagnosis, antiplatelet therapy, emergency reperfusion therapy in the acute period of myocardial infarction, as well as preventive measures reduce the development of cerebral complications, improve the results of treatment of patients with myocardial infarction, reduce the number of inpatient treatment days, as well as improve the long term prognosis.
{"title":"Cerebral dysfunction in patients with acute myocardial infarction","authors":"N. A. Muradyan, I. Kuzmina, T. R. Gvindzhiliya, V. M. Balanyan, K. A. Popugaev","doi":"10.23873/2074-0506-2023-15-4-507-514","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-507-514","url":null,"abstract":"Background. The article discusses the features of one of the complications of acute myocardial infarction – cerebral dysfunction, which negatively affects the quality of life of patients, worsens the disease prognosis, increases the hospital length of stay and the risk of death. The presence of cerebral disorders in patients with acute myocardial infarction causes difficulties in the choice of therapeutic tactics, including the decision on myocardial revascularization. The identification of predictive factors for cerebral deficiency in acute myocardial infarction and the development of an algorithm for the management of such patients is an urgent task of today medicine.Aim. To study the features of cerebral dysfunction in patients with myocardial infarction according to contemporary Russian and foreign literature sources. To create an algorithm for the diagnosis and treatment of cerebral dysfunction in patients with acute myocardial infarction.Material and methods. Patients with acute myocardial infarction who developed cerebral dysfunction in the acute period of the disease were examined.Conclusion. Timely diagnosis, antiplatelet therapy, emergency reperfusion therapy in the acute period of myocardial infarction, as well as preventive measures reduce the development of cerebral complications, improve the results of treatment of patients with myocardial infarction, reduce the number of inpatient treatment days, as well as improve the long term prognosis.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138956360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-20DOI: 10.23873/2074-0506-2023-15-4-499-506
A. Y. Simonova, K. K. Ilyashenko, M. M. Potskhveriya, T. T. Tkeshelashvili, S. Petrikov
Introduction. In recent years, there has been an increased number of poisoning with drugs that mainly affect the cardiovascular system, including calcium channel blockers. According to foreign literature, insulin therapy is an effective and safe method of treating patients with severe poisoning with calcium channel blockers.Aim. To demonstrate the efficacy of high-dose insulin in severe poisoning with calcium channel blockers.Results. Patient T., 37 years old, took 1000 tablets of nifedipine for suicide 4-6 hours before admission to the hospital. In connection with the development of refractory shock and the ineffectiveness of basic therapy (the intravenous administration of 0.9% sodium chloride solution, calcium chloride (saturated dose), vasopressor/inotropic agents), a decision was made to administer high doses of insulin. After a bolus intravenous injection of insulin, the rate of its intravenous administration was 0.5 U/kg/h and, due to the lack of hemodynamic effect, it was gradually increased in increments of 1–2 U/kg/h at every 15–30 minutes up to a maximum of 8 U/kg/h with constant monitoring of glucose and potassium levels in the blood. As a result, the target hemodynamic parameters were achieved. Then the insulin infusion rate was gradually reduced and, upon achieving hemodynamic stabilization, its administration was stopped 2 days after the start On the 9th day from the moment of hospital admission the patient was transferred from the Intensive Care Unit to the Acute Poisoning Department.Conclusions. The presented case report shows the efficacy and expediency of using the insulin therapy in the developed refractory shock due to severe poisoning with calcium channel blockers.
{"title":"Efficacy of insulin therapy in severe poisoning with calcium channel blockers","authors":"A. Y. Simonova, K. K. Ilyashenko, M. M. Potskhveriya, T. T. Tkeshelashvili, S. Petrikov","doi":"10.23873/2074-0506-2023-15-4-499-506","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-499-506","url":null,"abstract":"Introduction. In recent years, there has been an increased number of poisoning with drugs that mainly affect the cardiovascular system, including calcium channel blockers. According to foreign literature, insulin therapy is an effective and safe method of treating patients with severe poisoning with calcium channel blockers.Aim. To demonstrate the efficacy of high-dose insulin in severe poisoning with calcium channel blockers.Results. Patient T., 37 years old, took 1000 tablets of nifedipine for suicide 4-6 hours before admission to the hospital. In connection with the development of refractory shock and the ineffectiveness of basic therapy (the intravenous administration of 0.9% sodium chloride solution, calcium chloride (saturated dose), vasopressor/inotropic agents), a decision was made to administer high doses of insulin. After a bolus intravenous injection of insulin, the rate of its intravenous administration was 0.5 U/kg/h and, due to the lack of hemodynamic effect, it was gradually increased in increments of 1–2 U/kg/h at every 15–30 minutes up to a maximum of 8 U/kg/h with constant monitoring of glucose and potassium levels in the blood. As a result, the target hemodynamic parameters were achieved. Then the insulin infusion rate was gradually reduced and, upon achieving hemodynamic stabilization, its administration was stopped 2 days after the start On the 9th day from the moment of hospital admission the patient was transferred from the Intensive Care Unit to the Acute Poisoning Department.Conclusions. The presented case report shows the efficacy and expediency of using the insulin therapy in the developed refractory shock due to severe poisoning with calcium channel blockers.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139168783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-19DOI: 10.23873/2074-0506-2023-15-4-439-449
M. Khubutiya, E. V. Shuvalova, L. T. Khamidova, A. A. Ivannikov, A. Balkarov, I. Dmitriev, K. Alidzhanova
Background. Pulmonary hypertension is a common complication of chronic kidney disease, with incidence of up to 50%. Currently, the prognostic significance of non-invasive diagnostic methods for pulmonary hypertension in patients with chronic kidney disease remains relevant.Aim. To determine the significance of transthoracic echocardiography in diagnosing pulmonary hypertension in patients with end-stage chronic kidney disease.Material and methods. The study group consisted of 53 patients with chronic kidney disease stage 5D who were evaluated for kidney transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2022. A control group was represented by 24 healthy volunteers. Transthoracic echocardiography was performed on all patients according to a standard protocol, with determination of left ventricular myocardial strain indices.Results. A statistically significant correlation was found between the left ventricular global longitudinal strain and pulmonary artery systolic pressure r=0.488 (p<0.001), as well as between the left ventricular global circumferential strain and pulmonary artery systolic pressure (r=0.545, p<0.001). Regression analysis showed that an increase in pulmonary artery systolic pressure by 1 mmHg increased the odds of lethal outcome by 13% (Odds ratio: 1.13; 95% Confidence interval: [1.05;1.22], p=0.002).Conclusions. Hemodialysis patients are characterized by the development of pre-capillary pulmonary hypertension, which significantly affects their prognosis. Determination of left ventricular myocardial strain indices based on echocardiography provides additional information on the hemodynamics of the pulmonary circulation without using invasive diagnostic methods.
{"title":"Echocardiographic assessment of left ventricular myocardial strain, as a non-invasive method for diagnosing pulmonary hypertension in patients with end-stage chronic kidney disease","authors":"M. Khubutiya, E. V. Shuvalova, L. T. Khamidova, A. A. Ivannikov, A. Balkarov, I. Dmitriev, K. Alidzhanova","doi":"10.23873/2074-0506-2023-15-4-439-449","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-439-449","url":null,"abstract":"Background. Pulmonary hypertension is a common complication of chronic kidney disease, with incidence of up to 50%. Currently, the prognostic significance of non-invasive diagnostic methods for pulmonary hypertension in patients with chronic kidney disease remains relevant.Aim. To determine the significance of transthoracic echocardiography in diagnosing pulmonary hypertension in patients with end-stage chronic kidney disease.Material and methods. The study group consisted of 53 patients with chronic kidney disease stage 5D who were evaluated for kidney transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2022. A control group was represented by 24 healthy volunteers. Transthoracic echocardiography was performed on all patients according to a standard protocol, with determination of left ventricular myocardial strain indices.Results. A statistically significant correlation was found between the left ventricular global longitudinal strain and pulmonary artery systolic pressure r=0.488 (p<0.001), as well as between the left ventricular global circumferential strain and pulmonary artery systolic pressure (r=0.545, p<0.001). Regression analysis showed that an increase in pulmonary artery systolic pressure by 1 mmHg increased the odds of lethal outcome by 13% (Odds ratio: 1.13; 95% Confidence interval: [1.05;1.22], p=0.002).Conclusions. Hemodialysis patients are characterized by the development of pre-capillary pulmonary hypertension, which significantly affects their prognosis. Determination of left ventricular myocardial strain indices based on echocardiography provides additional information on the hemodynamics of the pulmonary circulation without using invasive diagnostic methods.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138959756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-19DOI: 10.23873/2074-0506-2023-15-4-464-476
A. V. Azarov, M. G. Glezer, A. S. Zhuravlev, I. R. Rafaeli, S. P. Semitko, K. V. Gyulmisaryan, S. A. Kurnosov
Introduction. Therapy of patients with acute ST-elevation myocardial infarction and massive coronary thrombosis (TTG 3) is a far from solved problem of modern medicine, since often in such patients immediate stent implantation is associated with the development of myocardial hypoperfusion, reducing the long-term prognosis of life.Aim. To evaluate short-term and long-term efficacy and safety of delayed and immediate coronary artery stenting techniques in patients with acute ST-elevation myocardial infarction and massive coronary thrombosis.Material and methods. Comparative study in parallel groups, a total of 153 patients with ST-elevation myocardial infarction and massive coronary thrombosis (TTG 3), 75 patients in the delayed coronary artery stenting group, 78 patients in the immediate coronary artery stenting group. In the immediate coronary artery stenting group, percutaneous coronary intervention was performed in one stage with stent implantation, in the delayed coronary artery stenting group; percutaneous coronary intervention was performed in two stages: the first was achieving TIMI-3 blood flow using a minimally invasive mechanical strategy, the second was control coronary angiography 5-6 days and the decision on the implantation of the stent. The primary endpoint is: the rate of achieving optimal myocardial perfusion according to angiography, the secondary combined endpoint is the rate of major adverse cardiovascular events.Results. In the hospital period, optimal reperfusion (TIMI-3 and MBG 2-3) after the primary procedure was achieved in 88% in the delayed coronary artery stenting group and 69.2% of immediate coronary artery stenting with an advantage in the delayed coronary artery stenting group (p=0.005). Of the 75 patients in the delayed coronary artery stenting group, 38 patients (51%) did not receive a stent in the delayed period due to the insignificance of stenosis on the control coronary angiography. There was no significant difference in the incidence of major adverse cardiovascular events between the groups. In the long-term period, the median follow-up period was 47 months. The frequency of major adverse cardiovascular events was 13.3% in the delayed coronary artery stenting group and 23.1% in the immediate coronary artery stenting group, with a trend towards the advantage in the delayed coronary artery stenting group (p=0.1). Overall mortality (9.3% vs. 11.7%), recurrent myocardial infarction (2.6% vs. 5.1%), target vessel revascularization rate (1.3% vs. 6.4%) were without significant benefit. between subgroups.Conclusion. In patients with ST-elevation myocardial infarction and massive coronary thrombosis, the use of delayed coronary artery stenting gives an advantage in achieving myocardial perfusion after the procedure, and demonstrates a tendency to reduce adverse cardiovascular events in the long-term period.
导言。急性ST段抬高型心肌梗死合并大量冠状动脉血栓形成（TTG 3）患者的治疗是现代医学远未解决的问题，因为这类患者立即植入支架往往会导致心肌灌注不足，降低长期预后。评估延迟和立即冠状动脉支架植入技术对急性 ST 段抬高型心肌梗死和大面积冠状动脉血栓形成患者的短期和长期疗效及安全性。平行分组比较研究，共153例ST段抬高型心肌梗死合并大量冠状动脉血栓形成患者（TTG 3），延迟冠状动脉支架植入组75例，即刻冠状动脉支架植入组78例。在即刻冠状动脉支架植入组中，经皮冠状动脉介入治疗在一个阶段内完成，并植入支架；在延迟冠状动脉支架植入组中，经皮冠状动脉介入治疗分两个阶段进行：第一阶段是使用微创机械策略达到 TIMI-3 血流，第二阶段是在 5-6 天内进行冠状动脉造影检查，并决定是否植入支架。主要终点是：根据血管造影达到最佳心肌灌注率，次要综合终点是主要不良心血管事件发生率。在住院期间，延迟冠状动脉支架植入术组和即刻冠状动脉支架植入术组分别有88%和69.2%的患者在初次手术后获得了最佳再灌注（TIMI-3和MBG 2-3），延迟冠状动脉支架植入术组更占优势（P=0.005）。在延迟冠状动脉支架植入组的 75 名患者中，有 38 名患者（51%）因对照冠状动脉造影显示狭窄不明显而未在延迟期接受支架植入。两组患者的主要心血管不良事件发生率无明显差异。长期随访的中位随访期为47个月。延迟冠状动脉支架植入组发生主要不良心血管事件的频率为13.3%，即刻冠状动脉支架植入组为23.1%，延迟冠状动脉支架植入组有优势趋势（P=0.1）。总死亡率（9.3% vs. 11.7%）、复发性心肌梗死（2.6% vs. 5.1%）、靶血管血运重建率（1.3% vs. 6.4%）在亚组间无显著差异。对于ST段抬高型心肌梗死和大量冠状动脉血栓形成的患者，延迟冠状动脉支架植入术在术后实现心肌灌注方面具有优势，并显示出在长期内减少不良心血管事件的趋势。
{"title":"Comparison of outcomes of coronary artery stenting in acute myocardial infarction due to massive coronary thrombosis","authors":"A. V. Azarov, M. G. Glezer, A. S. Zhuravlev, I. R. Rafaeli, S. P. Semitko, K. V. Gyulmisaryan, S. A. Kurnosov","doi":"10.23873/2074-0506-2023-15-4-464-476","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-464-476","url":null,"abstract":"Introduction. Therapy of patients with acute ST-elevation myocardial infarction and massive coronary thrombosis (TTG 3) is a far from solved problem of modern medicine, since often in such patients immediate stent implantation is associated with the development of myocardial hypoperfusion, reducing the long-term prognosis of life.Aim. To evaluate short-term and long-term efficacy and safety of delayed and immediate coronary artery stenting techniques in patients with acute ST-elevation myocardial infarction and massive coronary thrombosis.Material and methods. Comparative study in parallel groups, a total of 153 patients with ST-elevation myocardial infarction and massive coronary thrombosis (TTG 3), 75 patients in the delayed coronary artery stenting group, 78 patients in the immediate coronary artery stenting group. In the immediate coronary artery stenting group, percutaneous coronary intervention was performed in one stage with stent implantation, in the delayed coronary artery stenting group; percutaneous coronary intervention was performed in two stages: the first was achieving TIMI-3 blood flow using a minimally invasive mechanical strategy, the second was control coronary angiography 5-6 days and the decision on the implantation of the stent. The primary endpoint is: the rate of achieving optimal myocardial perfusion according to angiography, the secondary combined endpoint is the rate of major adverse cardiovascular events.Results. In the hospital period, optimal reperfusion (TIMI-3 and MBG 2-3) after the primary procedure was achieved in 88% in the delayed coronary artery stenting group and 69.2% of immediate coronary artery stenting with an advantage in the delayed coronary artery stenting group (p=0.005). Of the 75 patients in the delayed coronary artery stenting group, 38 patients (51%) did not receive a stent in the delayed period due to the insignificance of stenosis on the control coronary angiography. There was no significant difference in the incidence of major adverse cardiovascular events between the groups. In the long-term period, the median follow-up period was 47 months. The frequency of major adverse cardiovascular events was 13.3% in the delayed coronary artery stenting group and 23.1% in the immediate coronary artery stenting group, with a trend towards the advantage in the delayed coronary artery stenting group (p=0.1). Overall mortality (9.3% vs. 11.7%), recurrent myocardial infarction (2.6% vs. 5.1%), target vessel revascularization rate (1.3% vs. 6.4%) were without significant benefit. between subgroups.Conclusion. In patients with ST-elevation myocardial infarction and massive coronary thrombosis, the use of delayed coronary artery stenting gives an advantage in achieving myocardial perfusion after the procedure, and demonstrates a tendency to reduce adverse cardiovascular events in the long-term period.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138960811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-19DOI: 10.23873/2074-0506-2023-15-4-426-438
S. Voskanyan, I. Kolyshev, A. Bashkov, V. I. Artemyev, V. Rudakov, M. Shabalin, M. Popov, A. Sushkov, G. V. Vohmyanin
Background. Adequate restoration of blood flow through the portal vein in the graft is only possible with a clear understanding of its anatomy in the donor.The aim was to describe new and extend current data on the portal vein anatomy in a donor of the right liver lobe, to describe variants and formulate principles of portal reconstruction in right lobe living donor liver transplantation.Material and methods. 306 living donor liver transplantations were performed from 2009 to 2021 in the State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. The vascular anatomy of 518 potential donors was analyzed. Portal vein variants of the anatomy of right lobe graft were assessed.Results. Nine types and 3 subtypes of portal vein branching were evaluated. A, B, C, D, E types match the types described earlier in Nakamura classification. Subtypes B1, B2 и D1 are specifications of types B and D. Types F, G, H, I have been described additionally. The incidence of types and subtypes where reconstruction was made: type A (82%), B (4.6%), B1 (3.9%), B2 (1.3%), C (3.9%), D (3.9%). The incidence of E, G, H, I types among 518 potential donors was 0.4%, 0.6%, 0.2%, 0.4%, respectively. The recipient portal vein complications were detected in 12 cases (3.9%), where 3(25%) were Class 3b according to Clavien-Dindo and 9(75%) of Clavien-Dindo Class 2. There were no correlations between portal vein complications and the method of portal vein reconstruction. (p<0.05). No complications occurred with portal vein in donors.Conclusion. The existing classification of right liver graft portal vein has been updated and detailed. A certain way of reconstruction has been proposed for each portal vein type. Anatomical types in which donation and transplantation are contraindicated have been specified.
{"title":"Blood flow reconstruction in portal vein anatomical variations in right lobe living donor liver transplantation","authors":"S. Voskanyan, I. Kolyshev, A. Bashkov, V. I. Artemyev, V. Rudakov, M. Shabalin, M. Popov, A. Sushkov, G. V. Vohmyanin","doi":"10.23873/2074-0506-2023-15-4-426-438","DOIUrl":"https://doi.org/10.23873/2074-0506-2023-15-4-426-438","url":null,"abstract":"Background. Adequate restoration of blood flow through the portal vein in the graft is only possible with a clear understanding of its anatomy in the donor.The aim was to describe new and extend current data on the portal vein anatomy in a donor of the right liver lobe, to describe variants and formulate principles of portal reconstruction in right lobe living donor liver transplantation.Material and methods. 306 living donor liver transplantations were performed from 2009 to 2021 in the State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. The vascular anatomy of 518 potential donors was analyzed. Portal vein variants of the anatomy of right lobe graft were assessed.Results. Nine types and 3 subtypes of portal vein branching were evaluated. A, B, C, D, E types match the types described earlier in Nakamura classification. Subtypes B1, B2 и D1 are specifications of types B and D. Types F, G, H, I have been described additionally. The incidence of types and subtypes where reconstruction was made: type A (82%), B (4.6%), B1 (3.9%), B2 (1.3%), C (3.9%), D (3.9%). The incidence of E, G, H, I types among 518 potential donors was 0.4%, 0.6%, 0.2%, 0.4%, respectively. The recipient portal vein complications were detected in 12 cases (3.9%), where 3(25%) were Class 3b according to Clavien-Dindo and 9(75%) of Clavien-Dindo Class 2. There were no correlations between portal vein complications and the method of portal vein reconstruction. (p<0.05). No complications occurred with portal vein in donors.Conclusion. The existing classification of right liver graft portal vein has been updated and detailed. A certain way of reconstruction has been proposed for each portal vein type. Anatomical types in which donation and transplantation are contraindicated have been specified.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138962341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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