Pub Date : 2022-03-16DOI: 10.23873/2074-0506-2022-14-1-79-97
A. M. Fayn, A. Vaza, S. Gnetetskiy, K. I. Skuratovskaya, V. B. Bondarev, Yu. A. Bogolyubskiy, R. Titov, A. Sergeev
The main method of surgical treatment of patients with post-traumatic disorders of bone regeneration is the use of bone grafting. Until now, the optimal plastic material has been a bone autograft, which use involves additional trauma to the patient. Alternative materials that are used for grafting have only an osteoconductive effect, of varying effectiveness. To optimize the properties of plastic materials, giving them an osteostimulating effect, they can be used in combination with biologically active substances. A source of biologically active substances can be platelet-rich plasma, platelet lysate and red bone marrow. This literature review includes a description of three main methods to stimulate osteogenesis. The first part examines the mechanism of action of platelet-rich plasma, indications and contraindications for its use, describes the results of treatment when platelet-rich plasma is used to stimulate osteogenesis. Platelet-rich plasma is a product of a human native blood obtained by centrifugation. The output is a high concentration of platelets in a small volume of plasma, which contain growth factors and cytokines that have a direct effect on the regeneration process. Local platelet-rich plasma therapy is performed to stimulate osteogenesis. Autologous platelet-rich plasma with growth factors contained in α-granules of platelets is injected into an allogeneic graft or into a fracture zone. The aim of this article is to summarize the results of treatment using platelet-rich plasma to improve bone regenerative potential in orthopaedics.
{"title":"Available methods to enhance regenerative potential of plastic materials for bone defects replacement in orthopedics. Part 1. Autologous platelet rich plasma","authors":"A. M. Fayn, A. Vaza, S. Gnetetskiy, K. I. Skuratovskaya, V. B. Bondarev, Yu. A. Bogolyubskiy, R. Titov, A. Sergeev","doi":"10.23873/2074-0506-2022-14-1-79-97","DOIUrl":"https://doi.org/10.23873/2074-0506-2022-14-1-79-97","url":null,"abstract":"The main method of surgical treatment of patients with post-traumatic disorders of bone regeneration is the use of bone grafting. Until now, the optimal plastic material has been a bone autograft, which use involves additional trauma to the patient. Alternative materials that are used for grafting have only an osteoconductive effect, of varying effectiveness. To optimize the properties of plastic materials, giving them an osteostimulating effect, they can be used in combination with biologically active substances. A source of biologically active substances can be platelet-rich plasma, platelet lysate and red bone marrow. This literature review includes a description of three main methods to stimulate osteogenesis. The first part examines the mechanism of action of platelet-rich plasma, indications and contraindications for its use, describes the results of treatment when platelet-rich plasma is used to stimulate osteogenesis. Platelet-rich plasma is a product of a human native blood obtained by centrifugation. The output is a high concentration of platelets in a small volume of plasma, which contain growth factors and cytokines that have a direct effect on the regeneration process. Local platelet-rich plasma therapy is performed to stimulate osteogenesis. Autologous platelet-rich plasma with growth factors contained in α-granules of platelets is injected into an allogeneic graft or into a fracture zone. The aim of this article is to summarize the results of treatment using platelet-rich plasma to improve bone regenerative potential in orthopaedics.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80444079","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 : 2022-03-16DOI: 10.23873/2074-0506-2022-14-1-20-33
S. Voskanyan, A. Sushkov, V. Rudakov, D. Svetlakova, M. Popov, A. Pashkov, M. Muktarzhan, A. S. Lukianchikova
Background. The novel coronavirus infection (COVID-19) pandemic has had a significant impact on all areas of health care system, including organ donation and transplantation. Despite this, there were no large Russian studies of COVID-19 course and outcomes in liver transplant recipients.The study purpose was to determine prevalence, clinical course, severity, outcomes of COVID-19, as well as to assess the safety and efficiency of vaccination for disease prevention in liver transplant recipients.Material and methods. 260 recipients (71% of all patients at risk of COVID-19 disease) who underwent liver transplantation at State Research Center – Burnasyan Federal Medical Biophysical Center from May 2010 to September 2021 were included in a single-center cross-sectional study. Data collection was performed during a telephone or face-to-face interview from September 6, 2021 to September 20, 2021. If patients were hospitalized with COVID-19, we also analyzed the results of laboratory and instrumental tests, other medical documentation.Results. By mid-September 2021, the incidence of COVID-19 after liver transplantation was 31% (75 cases in 260 recipients). Asymptomatic course was observed in 11 (15%) patients. Hospitalization was required in 18 (28%) cases. In one case, COVID-19 infection was the cause of death. Mortality and death rate in the study cohort were 1% (1/75) and 0.4% (1/260), respectively. Risk factors that statistically significantly increased the likelihood of infection with SARS-CoV-2 were contact with the patient (OR: 12.9; 95% CI: 6.6 - 25.0) and non-compliance with non-specific prophylaxis measures (OR: 2.0; 95 % CI: 1.1 - 3.7). The recipient's age of 60 years or more significantly increased the risk of severe infection (OR 5.0; 95% CI: 1.3 - 18.7). None of the immunosuppressive therapy regimens significantly increased the risk of severe disease. Tacrolimus monotherapy or in combination with other drugs reduced the risk of severe COVID-19 (OR: 0.2; 95% CI: 0.1 - 0.95). Vaccination against SARS-CoV-2, which was performed in 42 (17%) recipients, did not cause serious adverse events and significantly reduced the risk of COVID-19 disease (OR: 7.2; 95% CI: 1.7 - 31.3). The detection rate of specific IgG antibodies to SARS-CoV-2 was 94% in recipients who had undergone the disease and 45% among those vaccinated (p<0.001). The achieved level of herd immunity against COVID-19 in the analyzed cohort was 48%. Conclusion. Adult liver transplant recipients are not at an excessive risk of COVID-19 disease. Compliance with preventive measures and vaccination can significantly reduce the risks of infection and severe infection. There is no objective evidence that immunosuppressive therapy increases the risk of severe COVID-19 in liver transplant recipients. In the context of the ongoing COVID-19 pandemic, tacrolimus monotherapy may be considered as a safe regimen of maintenance immunosuppression.
{"title":"Clinical course and outcomes of COVID-19 infection in liver transplant recipients: single-center cross-sectional study","authors":"S. Voskanyan, A. Sushkov, V. Rudakov, D. Svetlakova, M. Popov, A. Pashkov, M. Muktarzhan, A. S. Lukianchikova","doi":"10.23873/2074-0506-2022-14-1-20-33","DOIUrl":"https://doi.org/10.23873/2074-0506-2022-14-1-20-33","url":null,"abstract":"Background. The novel coronavirus infection (COVID-19) pandemic has had a significant impact on all areas of health care system, including organ donation and transplantation. Despite this, there were no large Russian studies of COVID-19 course and outcomes in liver transplant recipients.The study purpose was to determine prevalence, clinical course, severity, outcomes of COVID-19, as well as to assess the safety and efficiency of vaccination for disease prevention in liver transplant recipients.Material and methods. 260 recipients (71% of all patients at risk of COVID-19 disease) who underwent liver transplantation at State Research Center – Burnasyan Federal Medical Biophysical Center from May 2010 to September 2021 were included in a single-center cross-sectional study. Data collection was performed during a telephone or face-to-face interview from September 6, 2021 to September 20, 2021. If patients were hospitalized with COVID-19, we also analyzed the results of laboratory and instrumental tests, other medical documentation.Results. By mid-September 2021, the incidence of COVID-19 after liver transplantation was 31% (75 cases in 260 recipients). Asymptomatic course was observed in 11 (15%) patients. Hospitalization was required in 18 (28%) cases. In one case, COVID-19 infection was the cause of death. Mortality and death rate in the study cohort were 1% (1/75) and 0.4% (1/260), respectively. Risk factors that statistically significantly increased the likelihood of infection with SARS-CoV-2 were contact with the patient (OR: 12.9; 95% CI: 6.6 - 25.0) and non-compliance with non-specific prophylaxis measures (OR: 2.0; 95 % CI: 1.1 - 3.7). The recipient's age of 60 years or more significantly increased the risk of severe infection (OR 5.0; 95% CI: 1.3 - 18.7). None of the immunosuppressive therapy regimens significantly increased the risk of severe disease. Tacrolimus monotherapy or in combination with other drugs reduced the risk of severe COVID-19 (OR: 0.2; 95% CI: 0.1 - 0.95). Vaccination against SARS-CoV-2, which was performed in 42 (17%) recipients, did not cause serious adverse events and significantly reduced the risk of COVID-19 disease (OR: 7.2; 95% CI: 1.7 - 31.3). The detection rate of specific IgG antibodies to SARS-CoV-2 was 94% in recipients who had undergone the disease and 45% among those vaccinated (p<0.001). The achieved level of herd immunity against COVID-19 in the analyzed cohort was 48%. Conclusion. Adult liver transplant recipients are not at an excessive risk of COVID-19 disease. Compliance with preventive measures and vaccination can significantly reduce the risks of infection and severe infection. There is no objective evidence that immunosuppressive therapy increases the risk of severe COVID-19 in liver transplant recipients. In the context of the ongoing COVID-19 pandemic, tacrolimus monotherapy may be considered as a safe regimen of maintenance immunosuppression.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87288948","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 : 2022-03-16DOI: 10.23873/2074-0506-2022-14-1-58-67
A. A. Anisimov, E. S. Gilmetdinova, M. A. Mulendeeva, A. Y. Anisimov
Relevance. The United States of America is currently one of the world leaders in organ donation and transplantation. In 2020, donor activity in the United States amounted to 38.0 per 1 million of the population, even exceeding the number in Spain 37.9 per 1 million of the population. In this context, the study of the American system of organ donation and transplantation in order to develop an accessible format for interaction with the population to strategically stimulate the potential of organ donation is of particular interest.Aim. To study the organ donation and transplantation system in Nebraska, United States of America, to develop an accessible format for interaction with the population to strategically stimulate the potential of organ donation in the Republic of Tatarstan.Material and methods. We presented the experience of the international internship «Organ donation and transplant management » at the University of Nebraska Medical Center (USA). We described the peculiarities of the functioning of the American transplant programs, the advantages in the matter of organizing organ and tissue donation.Results. In the USA, with a population of 327 million people, today more than 165 million (51%) people are registered as potential donors. At the end of 2018, in the United States 36,428 transplants of various organs and tissues, or 111.4 per 1 million population, were performed. At the same time, the number of deceased donors was 10,700, the number of living donors – 6,800. At the University of Nebraska Medical Center during the same period, 301 transplants (158.4 per million population) were performed from 68 deceased and 40 living donors. The analysis of the American system of organ donation and transplantation with effective interaction of the state, commercial and non-profit sectors, independent of the National Health System, made it possible to organize in 2020 the first social project in the Republic of Tatarstan on organ donation – "Donate Life Russia".Conclusion. The experience of the Republic of Tatarstan in attracting the non-profit sector to solving problems in the development of the transplant programs, following the example of the United States of America, has high potential in the Russian Federation.
的相关性。美国目前在器官捐赠和移植方面处于世界领先地位。2020年，美国的捐赠活动达到每100万人口38.0人，甚至超过西班牙的每100万人口37.9人。在这种背景下，研究美国的器官捐赠和移植系统，以开发一种与人口互动的可访问格式，以战略性地激发器官捐赠的潜力，是特别有趣的。研究美国内布拉斯加州的器官捐赠和移植系统，制定一种与人口互动的无障碍格式，以战略性地激发鞑靼斯坦共和国器官捐赠的潜力。材料和方法。我们介绍了内布拉斯加大学医学中心(美国)国际实习“器官捐献和移植管理”的经验。我们描述了美国移植项目运作的特点，以及在组织器官和组织捐赠方面的优势。在拥有3.27亿人口的美国，今天有超过1.65亿(51%)的人注册为潜在捐赠者。截至2018年底，美国进行了36428例各种器官和组织移植，即每100万人中有111.4例移植。与此同时，已故捐献者的数量为10700人，生前捐献者的数量为6800人。同一时期内布拉斯加大学医学中心(University of Nebraska Medical Center)在68名死者和40名活体捐赠者身上进行了301例移植手术(每百万人中有158.4例)。通过对美国器官捐赠和移植系统的分析，国家、商业和非营利部门之间的有效互动，独立于国家卫生系统，使鞑靼斯坦共和国在2020年组织了第一个关于器官捐赠的社会项目——“捐赠俄罗斯生命”。鞑靼斯坦共和国以美国为榜样，在吸引非营利部门解决移植方案发展中的问题方面的经验在俄罗斯联邦具有很大的潜力。
{"title":"The first social project to popularize organ donation in Tatarstan based on the experience of the United States of America","authors":"A. A. Anisimov, E. S. Gilmetdinova, M. A. Mulendeeva, A. Y. Anisimov","doi":"10.23873/2074-0506-2022-14-1-58-67","DOIUrl":"https://doi.org/10.23873/2074-0506-2022-14-1-58-67","url":null,"abstract":"Relevance. The United States of America is currently one of the world leaders in organ donation and transplantation. In 2020, donor activity in the United States amounted to 38.0 per 1 million of the population, even exceeding the number in Spain 37.9 per 1 million of the population. In this context, the study of the American system of organ donation and transplantation in order to develop an accessible format for interaction with the population to strategically stimulate the potential of organ donation is of particular interest.Aim. To study the organ donation and transplantation system in Nebraska, United States of America, to develop an accessible format for interaction with the population to strategically stimulate the potential of organ donation in the Republic of Tatarstan.Material and methods. We presented the experience of the international internship «Organ donation and transplant management » at the University of Nebraska Medical Center (USA). We described the peculiarities of the functioning of the American transplant programs, the advantages in the matter of organizing organ and tissue donation.Results. In the USA, with a population of 327 million people, today more than 165 million (51%) people are registered as potential donors. At the end of 2018, in the United States 36,428 transplants of various organs and tissues, or 111.4 per 1 million population, were performed. At the same time, the number of deceased donors was 10,700, the number of living donors – 6,800. At the University of Nebraska Medical Center during the same period, 301 transplants (158.4 per million population) were performed from 68 deceased and 40 living donors. The analysis of the American system of organ donation and transplantation with effective interaction of the state, commercial and non-profit sectors, independent of the National Health System, made it possible to organize in 2020 the first social project in the Republic of Tatarstan on organ donation – \"Donate Life Russia\".Conclusion. The experience of the Republic of Tatarstan in attracting the non-profit sector to solving problems in the development of the transplant programs, following the example of the United States of America, has high potential in the Russian Federation.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88188785","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 : 2022-03-16DOI: 10.23873/2074-0506-2022-14-1-45-57
M. M. Potskhveriya, V. A. Matkevich, Y. Goldfarb, A. Simonova, N. E. Stolbova, I. A. Tyurin, S. Petrikov
Background. The problem of pathologically increased permeability of the intestinal wall is actualized with the accumulation of information about the correlation of this phenomenon with complications of an inflammatory nature and multiple organ failure in critical conditions, including acute poisoning.Aim of study. To assess the effect of the program of enteral correction of homeostasis disorders on intestinal permeability in acute poisoning.Material and methods. 40 patients (67.5% of women and 32.5% of men) admitted at the Intensive Care Unit as part of the Scientific Department of Acute Poisonings and Somatopsychiatric Disorders of the N.V. Sklifosovsky Research Institute for Emergency Medicine were examined, 20 of them (group I) with severe acute oral poisoning with corrosive substances: acetic acid 35.6% and alkali (sodium hydroxide) 64.4 %, as well as 20 patients (group II) with severe acute oral poisoning with psychopharmacological agents. Both groups were divided into two subgroups: I-a and II-a – (10 patients in each), in whom an enteral correction program was used in addition to the standard treatment, and I-b and II-b comparison groups (10 patients in each each) who received only standard therapy.Results. It was found that in all observed patients with severe acute oral poisoning with corrosive substances, as well as psychopharmacological agents, the ratio of lactulose / mannitol concentration in urine as an indicator of intestinal permeability was increased before the start of treatment in relation to its reference value of 3.8-4.9 times.After 5 days, in patients who received the enteral correction program, the lactulose/mannitol ratio decreased by 15.4% in cases of poisoning with corrosive substances, and by 19.8% in cases of poisoning with psychopharmacological agents. At the same time, in patients with poisoning with corrosive substances, who received standard treatment, this parameter decreased by only 1%. Attention was drawn to the fact that in patients with psychopharmacological agents poisoning who received standard therapy, the intestinal permeability index after 5 days did not decrease, but continued to increase and exceeded the initial value by 11.4%.Conclusion. With the help of the enteral correction program, it is possible to reduce the permeability of the intestinal wall in acute poisoning with corrosive substances and psychopharmacological agents.
{"title":"The program of enteral correction of homeostasis disorders and its effect on intestinal permeability in acute poisoning","authors":"M. M. Potskhveriya, V. A. Matkevich, Y. Goldfarb, A. Simonova, N. E. Stolbova, I. A. Tyurin, S. Petrikov","doi":"10.23873/2074-0506-2022-14-1-45-57","DOIUrl":"https://doi.org/10.23873/2074-0506-2022-14-1-45-57","url":null,"abstract":"Background. The problem of pathologically increased permeability of the intestinal wall is actualized with the accumulation of information about the correlation of this phenomenon with complications of an inflammatory nature and multiple organ failure in critical conditions, including acute poisoning.Aim of study. To assess the effect of the program of enteral correction of homeostasis disorders on intestinal permeability in acute poisoning.Material and methods. 40 patients (67.5% of women and 32.5% of men) admitted at the Intensive Care Unit as part of the Scientific Department of Acute Poisonings and Somatopsychiatric Disorders of the N.V. Sklifosovsky Research Institute for Emergency Medicine were examined, 20 of them (group I) with severe acute oral poisoning with corrosive substances: acetic acid 35.6% and alkali (sodium hydroxide) 64.4 %, as well as 20 patients (group II) with severe acute oral poisoning with psychopharmacological agents. Both groups were divided into two subgroups: I-a and II-a – (10 patients in each), in whom an enteral correction program was used in addition to the standard treatment, and I-b and II-b comparison groups (10 patients in each each) who received only standard therapy.Results. It was found that in all observed patients with severe acute oral poisoning with corrosive substances, as well as psychopharmacological agents, the ratio of lactulose / mannitol concentration in urine as an indicator of intestinal permeability was increased before the start of treatment in relation to its reference value of 3.8-4.9 times.After 5 days, in patients who received the enteral correction program, the lactulose/mannitol ratio decreased by 15.4% in cases of poisoning with corrosive substances, and by 19.8% in cases of poisoning with psychopharmacological agents. At the same time, in patients with poisoning with corrosive substances, who received standard treatment, this parameter decreased by only 1%. Attention was drawn to the fact that in patients with psychopharmacological agents poisoning who received standard therapy, the intestinal permeability index after 5 days did not decrease, but continued to increase and exceeded the initial value by 11.4%.Conclusion. With the help of the enteral correction program, it is possible to reduce the permeability of the intestinal wall in acute poisoning with corrosive substances and psychopharmacological agents.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90731320","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 : 2022-03-16DOI: 10.23873/2074-0506-2022-14-1-98-114
S. Glyantsev, E. S. Maksimov, M. Gordeeva
On June 20, 1962, at the N.V. Sklifosovsky Research Institute for Emergency Medicine in Moscow, V.P. Demikhov, a biologist, physiologist, and experimental surgeon transplanted a second, additional heart together with the lung through the left thoracotomy access in the fourth intercostal space into the place of the removed two upper lobes of the left lung into the chest to the dog named Grishka. The second heart was implanted in such a way that arterial blood circulated in it and in the transplanted lung. The donor and recipient were selected according to the blood group match. The immediate postoperative period was uneventful. On day 4, the dog became active. On day 12, the sutures were removed from the skin wound. On day 15, antibiotics (penicillin and streptomycin) were discontinued. During the daily examination, general condition and physical activity were noted, rectal temperature, respiratory rate and contractions of one's own and transplanted heart were measured; electrocardiograms were taken from both hearts. On day 13, Grishka gnawed through the electrode, which helped taking the electrocardiograms from the transplanted heart during the first 2 weeks. As a result, in place of the electrode remaining in the chest, the animal developed a fistula with purulent discharge. For this reason, as well as for coughing and wheezing in the lungs on the left, Grishka was periodically administered antibiotics. After the operation and before the withdrawal from the experiment, the dog was injected with heparin. No other pharmaceuticals were given. The dog led an active lifestyle, ate well, and displayed interest in female dogs. The second heart ceased beating 142 days after the operation, on November 8, 1962. Resuscitation measures were unsuccessful. At autopsy, in the right atrial auricle of the transplanted heart, diffuse transmural hemorrhage and a thrombus from the endocardium were revealed, which blocked the blood flow to the heart. The lower lobe of Grishka's lung was in a state of hepatization. Signs of edema and inflammation were observed in the transplanted lung. There were no blood clots at the sites of vascular anastomoses. There were no visual signs of rejection. The results of histological studies are not known. This article for the first time introduced into scientific circulation an operation protocol, a diary of postoperative management and an autopsy protocol for an animal that had lived with a second, additional heart and a transplanted lung without immunosuppression for 142 days, which has been a unique observation in world transplantology. Despite the long-term survival of the animal, nursing the recipient dog in the postoperative period did not meet the complexity of the operation performed, which allows us to conclude that it was impossible at that time to implement the results obtained in the experiment into clinical heart transplantation in humans.
{"title":"PHENOMENON OF DEMIKHOV. At N.V. Sklifosovsky Institute (1960–1986). Grishka the dog lived with a second, additional heart and transplanted lung without immunosuppression for 142 days (1962)","authors":"S. Glyantsev, E. S. Maksimov, M. Gordeeva","doi":"10.23873/2074-0506-2022-14-1-98-114","DOIUrl":"https://doi.org/10.23873/2074-0506-2022-14-1-98-114","url":null,"abstract":"On June 20, 1962, at the N.V. Sklifosovsky Research Institute for Emergency Medicine in Moscow, V.P. Demikhov, a biologist, physiologist, and experimental surgeon transplanted a second, additional heart together with the lung through the left thoracotomy access in the fourth intercostal space into the place of the removed two upper lobes of the left lung into the chest to the dog named Grishka. The second heart was implanted in such a way that arterial blood circulated in it and in the transplanted lung. The donor and recipient were selected according to the blood group match. The immediate postoperative period was uneventful. On day 4, the dog became active. On day 12, the sutures were removed from the skin wound. On day 15, antibiotics (penicillin and streptomycin) were discontinued. During the daily examination, general condition and physical activity were noted, rectal temperature, respiratory rate and contractions of one's own and transplanted heart were measured; electrocardiograms were taken from both hearts. On day 13, Grishka gnawed through the electrode, which helped taking the electrocardiograms from the transplanted heart during the first 2 weeks. As a result, in place of the electrode remaining in the chest, the animal developed a fistula with purulent discharge. For this reason, as well as for coughing and wheezing in the lungs on the left, Grishka was periodically administered antibiotics. After the operation and before the withdrawal from the experiment, the dog was injected with heparin. No other pharmaceuticals were given. The dog led an active lifestyle, ate well, and displayed interest in female dogs. The second heart ceased beating 142 days after the operation, on November 8, 1962. Resuscitation measures were unsuccessful. At autopsy, in the right atrial auricle of the transplanted heart, diffuse transmural hemorrhage and a thrombus from the endocardium were revealed, which blocked the blood flow to the heart. The lower lobe of Grishka's lung was in a state of hepatization. Signs of edema and inflammation were observed in the transplanted lung. There were no blood clots at the sites of vascular anastomoses. There were no visual signs of rejection. The results of histological studies are not known. This article for the first time introduced into scientific circulation an operation protocol, a diary of postoperative management and an autopsy protocol for an animal that had lived with a second, additional heart and a transplanted lung without immunosuppression for 142 days, which has been a unique observation in world transplantology. Despite the long-term survival of the animal, nursing the recipient dog in the postoperative period did not meet the complexity of the operation performed, which allows us to conclude that it was impossible at that time to implement the results obtained in the experiment into clinical heart transplantation in humans.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86244238","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 : 2022-03-16DOI: 10.23873/2074-0506-2022-14-1-10-19
A. Shabunin, P. Drozdov, O. N. Levina, D. A. Makeev, O. S. Zhuravel, E. Y. Astapovich
Aim. The study aim was to assess the negative dynamics of the hepatic artery resistive index as a reliable predictor of early thrombosis in liver transplant recipients from a postmortem donor, to determine risk factors and to identify a group of patients with an increased risk of this complication.Material and methods. From July 2018 to August 2021, 92 orthotopic liver transplants from a deceased donor were performed at the Surgical Clinic of the City Clinical Hospital n.a. S.P. Botkin. All liver grafts were taken from donors with brain death. Control Doppler ultrasound examination of hepatic blood flow in all patients was performed on days 1, 3, 5, 7, if necessary, daily. The hepatic arteries resistive index was considered normal at values from 0.55-0.79, high at 0.8-0.89, extremely high above 0.9. Depending on the resistive index value on the 1st postoperative day and its further dynamics, we divided the patients into 3 groups. In each group, we analyzed the incidence of hepatic artery thrombosis and assessed the impact of various risk factors on the resistive index elevation on the 1st day after surgery and on its growth during dynamic observation in the early postoperative period.Results. Of 92 liver transplants, in three cases, we recorded hepatic artery thrombosis (3.2%), which was not associated with technical difficulties of arterial reconstruction. No mortality was recorded in all three cases. In patients with a normal or high resistive index on the 1st day, without its increase during dynamic observation, the incidence of arterial thrombosis was 0%. In patients with a normal or high resistive index on the 1st day, and its increase during dynamic observation, as well as in patients with an extremely high resistive index on the 1st day, the incidence of arterial thrombosis was 18.1% and 11.1%, respectively. The risk factors of thrombosis were the age of the recipient over 50 years old in an extremely high resistive index on the 1st postoperative day (p=0.024), and the age of the donor over 50 years old in the growth of the resistive index during follow-up (p=0.04).Conclusion. The lack of positive dynamics in the hepatic artery resistive index reduction may be an additional predictor of arterial thrombosis after liver transplantation. This fact makes it possible to identify a high-risk group of arterial thrombosis, to take additional preventive measures in these patients and to improve the immediate results of treatment in this group of patients.
{"title":"Negative dynamics of the hepatic artery resistive index as a predictor of early arterial thrombosis after deceased donor liver transplantation","authors":"A. Shabunin, P. Drozdov, O. N. Levina, D. A. Makeev, O. S. Zhuravel, E. Y. Astapovich","doi":"10.23873/2074-0506-2022-14-1-10-19","DOIUrl":"https://doi.org/10.23873/2074-0506-2022-14-1-10-19","url":null,"abstract":"Aim. The study aim was to assess the negative dynamics of the hepatic artery resistive index as a reliable predictor of early thrombosis in liver transplant recipients from a postmortem donor, to determine risk factors and to identify a group of patients with an increased risk of this complication.Material and methods. From July 2018 to August 2021, 92 orthotopic liver transplants from a deceased donor were performed at the Surgical Clinic of the City Clinical Hospital n.a. S.P. Botkin. All liver grafts were taken from donors with brain death. Control Doppler ultrasound examination of hepatic blood flow in all patients was performed on days 1, 3, 5, 7, if necessary, daily. The hepatic arteries resistive index was considered normal at values from 0.55-0.79, high at 0.8-0.89, extremely high above 0.9. Depending on the resistive index value on the 1st postoperative day and its further dynamics, we divided the patients into 3 groups. In each group, we analyzed the incidence of hepatic artery thrombosis and assessed the impact of various risk factors on the resistive index elevation on the 1st day after surgery and on its growth during dynamic observation in the early postoperative period.Results. Of 92 liver transplants, in three cases, we recorded hepatic artery thrombosis (3.2%), which was not associated with technical difficulties of arterial reconstruction. No mortality was recorded in all three cases. In patients with a normal or high resistive index on the 1st day, without its increase during dynamic observation, the incidence of arterial thrombosis was 0%. In patients with a normal or high resistive index on the 1st day, and its increase during dynamic observation, as well as in patients with an extremely high resistive index on the 1st day, the incidence of arterial thrombosis was 18.1% and 11.1%, respectively. The risk factors of thrombosis were the age of the recipient over 50 years old in an extremely high resistive index on the 1st postoperative day (p=0.024), and the age of the donor over 50 years old in the growth of the resistive index during follow-up (p=0.04).Conclusion. The lack of positive dynamics in the hepatic artery resistive index reduction may be an additional predictor of arterial thrombosis after liver transplantation. This fact makes it possible to identify a high-risk group of arterial thrombosis, to take additional preventive measures in these patients and to improve the immediate results of treatment in this group of patients.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74992382","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 : 2022-03-16DOI: 10.23873/2074-0506-2022-14-1-34-44
A. B. Sidorenko, Y. I. Zakharov, Y. Moysyuk
Background. Reconstructive surgery for iatrogenic injuries of the bile ducts involves the formation of a biliodigestive anastomosis. The development of anastomotic stricture is the most severe complication of this operation.Aim of the study. To evaluate the immediate and long-term results of treatment and follow-up of patients with iatrogenic injuries of the bile ducts who underwent reconstructive surgery on the bile ducts with additional creation of gastroenteroanastomosis.Material and methods. The study included 26 patients operated on according to the original method in the period 2010-2018.Results. In the study group, complications in the early postoperative period developed in 3 (11.5%) patients. Endoscopic interventions using the formed gastroenteroanastomosis in the long-term period were performed in 7 patients. The results of treatment were followed in 25 (96%) patients. The median follow-up period was 90 months [81.5;110] (42-129). Conclusion. The use of the proposed original technique of reconstructive surgery has demonstrated its effectiveness and safety, with the possibility of dynamic endoscopic control and, if necessary, the treatment of postoperative complications such as cholelithiasis and biliodigestive anastomosis strictures.
{"title":"Method of reconstructive surgery for damaged extrahepatic bile ducts: immediate and long-term results","authors":"A. B. Sidorenko, Y. I. Zakharov, Y. Moysyuk","doi":"10.23873/2074-0506-2022-14-1-34-44","DOIUrl":"https://doi.org/10.23873/2074-0506-2022-14-1-34-44","url":null,"abstract":"Background. Reconstructive surgery for iatrogenic injuries of the bile ducts involves the formation of a biliodigestive anastomosis. The development of anastomotic stricture is the most severe complication of this operation.Aim of the study. To evaluate the immediate and long-term results of treatment and follow-up of patients with iatrogenic injuries of the bile ducts who underwent reconstructive surgery on the bile ducts with additional creation of gastroenteroanastomosis.Material and methods. The study included 26 patients operated on according to the original method in the period 2010-2018.Results. In the study group, complications in the early postoperative period developed in 3 (11.5%) patients. Endoscopic interventions using the formed gastroenteroanastomosis in the long-term period were performed in 7 patients. The results of treatment were followed in 25 (96%) patients. The median follow-up period was 90 months [81.5;110] (42-129). Conclusion. The use of the proposed original technique of reconstructive surgery has demonstrated its effectiveness and safety, with the possibility of dynamic endoscopic control and, if necessary, the treatment of postoperative complications such as cholelithiasis and biliodigestive anastomosis strictures.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79334957","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 : 2021-12-15DOI: 10.23873/2074-0506-2021-13-4-367-381
B. B. Gegenava, S. A. Kurnosov, Y. Moysyuk, N. Vetsheva, A. Ammosov
Introduction. Liver transplantation is considered the most effective treatment for patients with end-stage liver disease. X-ray endovascular interventions show good results in the treatment of vascular complications after transplantation. The timing, indications and choice of treatment methods require clarification.Objective. To evaluate the safety and efficacy of emergency X-ray endovascular interventions for arterial complications in the early period after liver transplantation.Material and methods. In the period from October 2016 by July 2021, 88 liver transplants were performed. The graft was obtained from a posthumous donor in 75 cases, and from a living donor (right lobe of the liver) in 13 cases. Arterial complications were registered in 10 cases: thrombosis of the hepatic artery in 7 (8.0%), constriction in 3 (3.4%); 4 patients underwent retransplantation due to thrombosis. This analysis included 6 patients aged 27 to 51 years, including 4 men and 2 women. In the early postoperative period (0–14 days), according to laboratory parameters, ultrasound Doppler, and computed tomography with a contrast agent, an impairment of the arterial blood supply of the graft was revealed, for which the patients underwent emergency X-ray image-guided surgical endovascular interventions.Results. Restoration of adequate arterial blood supply to the liver graft was achieved in all six patients. At the time of this writing, the graft function and patency of the hepatic artery were preserved at follow-up periods of 6, 11, 12, 22 (in two patients), and 26 months with a median of 17 months. Four patients developed biliary complications that required surgical correction.Conclusion. X-ray image-guided endovascular interventions can be considered effective and relatively safe in the treatment of patients with arterial complications after liver transplantation. The period of graft arterial ischemia should be minimized as much as possible in order to prevent biliary complications.
{"title":"Emergency interventional endovascular treatment for early disorder of arterial blood flow in the liver graft","authors":"B. B. Gegenava, S. A. Kurnosov, Y. Moysyuk, N. Vetsheva, A. Ammosov","doi":"10.23873/2074-0506-2021-13-4-367-381","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-4-367-381","url":null,"abstract":"Introduction. Liver transplantation is considered the most effective treatment for patients with end-stage liver disease. X-ray endovascular interventions show good results in the treatment of vascular complications after transplantation. The timing, indications and choice of treatment methods require clarification.Objective. To evaluate the safety and efficacy of emergency X-ray endovascular interventions for arterial complications in the early period after liver transplantation.Material and methods. In the period from October 2016 by July 2021, 88 liver transplants were performed. The graft was obtained from a posthumous donor in 75 cases, and from a living donor (right lobe of the liver) in 13 cases. Arterial complications were registered in 10 cases: thrombosis of the hepatic artery in 7 (8.0%), constriction in 3 (3.4%); 4 patients underwent retransplantation due to thrombosis. This analysis included 6 patients aged 27 to 51 years, including 4 men and 2 women. In the early postoperative period (0–14 days), according to laboratory parameters, ultrasound Doppler, and computed tomography with a contrast agent, an impairment of the arterial blood supply of the graft was revealed, for which the patients underwent emergency X-ray image-guided surgical endovascular interventions.Results. Restoration of adequate arterial blood supply to the liver graft was achieved in all six patients. At the time of this writing, the graft function and patency of the hepatic artery were preserved at follow-up periods of 6, 11, 12, 22 (in two patients), and 26 months with a median of 17 months. Four patients developed biliary complications that required surgical correction.Conclusion. X-ray image-guided endovascular interventions can be considered effective and relatively safe in the treatment of patients with arterial complications after liver transplantation. The period of graft arterial ischemia should be minimized as much as possible in order to prevent biliary complications.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76737138","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 : 2021-12-15DOI: 10.23873/2074-0506-2021-13-4-398-416
S. Glyantsev
The article has reviewed the advances of Soviet and world Transplantology in the field of heart and other organ transplantation achieved by the end of the 1960s. It is shown that there were several groups of doctors and scientists who worked in the USSR dealing with the problem of experimental organ transplantation and trying to bring this experience into clinic. The group of surgeons and urologists (B.V. Petrovsky, Y.M. Lopukhin, etc.) from the Research Institute of Clinical and Experimental Surgery and the 2nd MOLGMI named after N.I. Pirogov, which had the greatest administrative resources and technical capabilities, was successfully implementing kidney transplantation into clinic. The staff of the Faculty Surgery Department (V.S. Savelyev and others) of the 2nd MOLGMI named after N.I. Pirogov developed experimental approaches to heart and liver transplantation. Surgeons from the Tuberculosis Research Institute (N.I. Gerasimenko and others) were dealing with in lung auto- and homotransplats in experiment. All those studies were conducted in close contact with the Department of Operative Surgery and Topographic Anatomy of the 2nd MOLGMI named after N.I. Pirogov (G.E. Ostroverkhov) and the Research Laboratory for Organ Transplantation established at that Department (Y.M. Lopukhin). The leading position in heart transplantation in the country belonged to the Vishnevsky Institute of Surgery (A.A. Vishnevsky, etc.). Surgeons of the MMA named after S.M. Kirov (I.S. Kolesnikov, etc.) rendered a great assistance to the Institute. Apart from these institutions, the Organ Transplantation Laboratory (headed by V.P. Demikhov) worked at N.V. Sklifosovsky Research Institute for Emergency Medicine; it had gained a huge experimental experience, but had very modest opportunities to purchase equipment and pharmaceuticals, to conduct laboratory and morphological studies, having practically no prospects for introducing the results of its research into clinic. Meanwhile, the world clinical Transplantation continued to develop successfully, which was reflected in the materials of the 2nd International Symposium on Heart Transplantation held in 1969 in Montreal (Canada).
{"title":"Phenomenon of Demikhov. At N.V. Sklifosovsky Institute (1960–1986). V.P. Demikhov and world transplantology in 1968-1969","authors":"S. Glyantsev","doi":"10.23873/2074-0506-2021-13-4-398-416","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-4-398-416","url":null,"abstract":"The article has reviewed the advances of Soviet and world Transplantology in the field of heart and other organ transplantation achieved by the end of the 1960s. It is shown that there were several groups of doctors and scientists who worked in the USSR dealing with the problem of experimental organ transplantation and trying to bring this experience into clinic. The group of surgeons and urologists (B.V. Petrovsky, Y.M. Lopukhin, etc.) from the Research Institute of Clinical and Experimental Surgery and the 2nd MOLGMI named after N.I. Pirogov, which had the greatest administrative resources and technical capabilities, was successfully implementing kidney transplantation into clinic. The staff of the Faculty Surgery Department (V.S. Savelyev and others) of the 2nd MOLGMI named after N.I. Pirogov developed experimental approaches to heart and liver transplantation. Surgeons from the Tuberculosis Research Institute (N.I. Gerasimenko and others) were dealing with in lung auto- and homotransplats in experiment. All those studies were conducted in close contact with the Department of Operative Surgery and Topographic Anatomy of the 2nd MOLGMI named after N.I. Pirogov (G.E. Ostroverkhov) and the Research Laboratory for Organ Transplantation established at that Department (Y.M. Lopukhin). The leading position in heart transplantation in the country belonged to the Vishnevsky Institute of Surgery (A.A. Vishnevsky, etc.). Surgeons of the MMA named after S.M. Kirov (I.S. Kolesnikov, etc.) rendered a great assistance to the Institute. Apart from these institutions, the Organ Transplantation Laboratory (headed by V.P. Demikhov) worked at N.V. Sklifosovsky Research Institute for Emergency Medicine; it had gained a huge experimental experience, but had very modest opportunities to purchase equipment and pharmaceuticals, to conduct laboratory and morphological studies, having practically no prospects for introducing the results of its research into clinic. Meanwhile, the world clinical Transplantation continued to develop successfully, which was reflected in the materials of the 2nd International Symposium on Heart Transplantation held in 1969 in Montreal (Canada).","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84857621","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 : 2021-12-15DOI: 10.23873/2074-0506-2021-13-4-356-366
Yulia Malinovskaya, K. Kokina, Y. Moysyuk, O. Sumtsova
Introduction. Liver transplantation restores patients' physical and social life, and its quality. The prevalence of low physical activity in liver recipients is unknown as well as the impact of late liver allograft dysfunction on it. Liver transplantation enhances patient's return to the usual physical and social activity and improves the quality of life. However, the prevalence of low physical activity among liver recipients and the impact of the late allograft dysfunction on it, which is a risk factor for obesity and cardiovascular diseases, require studying.The aim of the study was to identify whether the late liver allograft dysfunction influences the physical activity of recipients.Material and methods. The study included 87 liver recipients. We measured anthropometric parameters, physical performance (SPPB, LFI, 6-min walk test), mean step count per day. Late liver allograft dysfunction was determined if elevated transaminases and/or cholestatic enzymes or hepatic failure have been diagnosed later than 3 months posttransplant. Activity trackers were provided to assess physical activity.Results. Median age was 54 years [45;61], 33% were men. The median follow-up period was 36 months [16;64]. The median of the average steps count was 5.9 [4.1;8.7] thousand per day. 60.5% of recipients were sedentary and low active, 24.4% were somewhat active, 15.1% were active. In cases of liver allograft dysfunction, the mean step count was significantly lower than in patients with normal liver function: 4.1 thousand [2.6;5.3] versus 6.8 thousand [4.2;9.4], p=0.003, despite no differences in the physical activity test results.Conclusion. In case of a late liver allograft dysfunction, the physical activity can decrease; 60.5% of liver recipients, in the absence of pathological restriction of movement, have a sedentary and low active lifestyle. Activity trackers may allow identifying patients who need additional check-up or physical training.
{"title":"The impact of late liver allograft dysfunction on physical activity of liver transplant recipients","authors":"Yulia Malinovskaya, K. Kokina, Y. Moysyuk, O. Sumtsova","doi":"10.23873/2074-0506-2021-13-4-356-366","DOIUrl":"https://doi.org/10.23873/2074-0506-2021-13-4-356-366","url":null,"abstract":"Introduction. Liver transplantation restores patients' physical and social life, and its quality. The prevalence of low physical activity in liver recipients is unknown as well as the impact of late liver allograft dysfunction on it. Liver transplantation enhances patient's return to the usual physical and social activity and improves the quality of life. However, the prevalence of low physical activity among liver recipients and the impact of the late allograft dysfunction on it, which is a risk factor for obesity and cardiovascular diseases, require studying.The aim of the study was to identify whether the late liver allograft dysfunction influences the physical activity of recipients.Material and methods. The study included 87 liver recipients. We measured anthropometric parameters, physical performance (SPPB, LFI, 6-min walk test), mean step count per day. Late liver allograft dysfunction was determined if elevated transaminases and/or cholestatic enzymes or hepatic failure have been diagnosed later than 3 months posttransplant. Activity trackers were provided to assess physical activity.Results. Median age was 54 years [45;61], 33% were men. The median follow-up period was 36 months [16;64]. The median of the average steps count was 5.9 [4.1;8.7] thousand per day. 60.5% of recipients were sedentary and low active, 24.4% were somewhat active, 15.1% were active. In cases of liver allograft dysfunction, the mean step count was significantly lower than in patients with normal liver function: 4.1 thousand [2.6;5.3] versus 6.8 thousand [4.2;9.4], p=0.003, despite no differences in the physical activity test results.Conclusion. In case of a late liver allograft dysfunction, the physical activity can decrease; 60.5% of liver recipients, in the absence of pathological restriction of movement, have a sedentary and low active lifestyle. Activity trackers may allow identifying patients who need additional check-up or physical training.","PeriodicalId":23229,"journal":{"name":"Transplantologiya. The Russian Journal of Transplantation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89307073","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：