Sovremennye Tehnologii v Medicine最新文献

The aim of the study was to test the use of gaseous nitric oxide added to the extracorporeal membrane oxygenation (ECMO) system for treating critical acute heart failure after cardiac surgery.

Materials and methods: Venoarterial ECMO with addition of nitric oxide into the extracorporeal circuit was used for treating a 52-year-old patient after two-step cardiac surgery for acute dissection of the thoracic aorta and aortic valve insufficiency. After the Bentall-de Bono procedure, a technical error was revealed: that was a non-functioning anastomosis to the right coronary artery, which caused massive ischemic myocardial injury. An emergency myocardial revascularization was performed with the help of the cardiopulmonary bypass converted into ECMO; the patient's condition improved and he was transferred to the ICU.

Results: Considering the sharp decrease in heart contractility and the extremely high level of myocardial damage markers, it was decided to supply nitric oxide (40 ppm) to the ECMO circuit. A positive effect was noted within 8 h from the start of the procedure: the concentration of creatine phosphokinase-MB decreased almost 4 times and the concentration of troponin I decreased twofold. The most pronounced changes were observed by the end of day 1: a significant decrease in the concentration of myocardial damage markers, a decrease in the VIS indicator by 7.5 times; an improvement in the contractile function. Further on, the patient's condition gradually stabilized: the manifestations of acute heart failure and multiple organ failure stopped, and then ECMO was discontinued after 82 h of work. The patient was decannulated and he continued to show stable hemodynamic parameters. He was discharged from the clinic on day 18 after surgery.

Conclusion: For the first time, venoarterial ECMO with supply of gaseous nitric oxide into the extracorporeal circuit was used to support blood circulation after cardiac surgery. This made it possible to ensure the survival of the patient with critical ischemia-reperfusion injury developed after the surgery.

The aim of the study is to assess the gender-related specifics of the COVID-19 course in patients under 55 years of age.

Materials and methods: This pilot single-center continuous retrospective non-randomized study was carried out in the repurposed infectious diseases hospital of the Privolzhsky Research Medical University (Nizhny Novgorod, Russia). The study inclusion criterion was the age of patients (up to 55 years) and confirmed coronavirus infection. In the groups based on gender differences (25 men, average age 44.0±7.8 years and 32 women, average age 41.9±9.1 years), we monitored complications of COVID-19 such as the transfer of patients to the ICU and the volume of lung damage (determined with CT scans).

Results: The course of COVID-19 in male patients younger than 55 was aggravated by concomitant diseases (γ=0.36; p=0.043), among which IHD (γ=1.00; p=0.003) and liver disease (γ=0.58; p=0.007) dominated. Frequency analysis confirmed the high prevalence of coronary artery disease in men (p=0.044). Significant differences between the gender-related groups were noted in the volume of lung lesions: at admission (p=0.050), during hospital treatment (p=0.019), and at discharge (p=0.044). Using the logistic regression method, a relationship was found between the transfer of male patients to ICU and the Krebs index [y= -2.033 + 1.154 male gender + 1.539 Krebs index (χ²=5.68; p=0.059)] and comorbidity [y= -2.836 + 1.081 male gender + 2.052 comorbidity (χ²=7.03; p=0.030)]. The influence of the Krebs index and the male gender on the excess volume of lung lesions was shown [y= -1.962 + 0.575 male gender + 1.915 Krebs index (χ²=7.78; p=0.021)].

Conclusion: In individuals under the age of 55 diagnosed with COVID-19, gender is of significant importance: in men, there is a more pronounced lesion of the lung parenchyma and a more significant change in laboratory parameters. Risk factors for a severe course of COVID-19 in men are coronary artery disease and hepatobiliary disorder. Calculating the Krebs index can be used to assess the risk of disease progression.

The aim of the study was to develop a technology for anti-thrombogenic drug coating of biodegradable porous scaffolds and to evaluate the physicomechanical and hemocompatible properties of functionally active vascular prostheses with and without a drug coating.

Materials and methods: Vascular prostheses from polyhydroxybutyrate/valerate and polycaprolactone with the incorporated vascular endothelial growth factor, the main fibroblast growth factor, and the chemoattractant SDF-1α were made by emulsion electrospinning. Additional surface modification of the prostheses was carried out by forming a hydrogel coating of polyvinylpyrrolidone capable of binding drugs as a result of complexation. Unfractionated heparin and iloprost were used as anti-thrombogenic drugs.

Results: We show that after the modification of vascular prostheses with heparin and iloprost, a 5.8-fold increase in the Young's modulus value was noted, which indicated a greater stiffness of these grafts compared to the unmodified controls. Platelet aggregation on the surface of heparin + iloprost coated vascular prostheses was 3.3 times less than that with the unmodified controls, and 1.8 times less compared to intact platelet-rich plasma. The surface of vascular prostheses with heparin and iloprost was resistant to adhesion of platelets and blood proteins.

Conclusion: Drug (unfractionated heparin and iloprost) coating of the surface of biodegradable prostheses significantly improved the anti-thrombogenic properties of these grafts but contributed to the increased stiffness of the prostheses.

The aim of the study was to identify the organized ventricular fibrillation (VF) activity in the dog heart and characterize its quantitative parameters during prolonged heart perfusion.

Materials and methods: A total of four experiments on isolated dog's hearts perfused with the blood of a supporting dog were performed. Episodes of VF were recorded in the form of an electrogram followed by a spectral analysis by the fast Fourier transform in the range of 0.5-15 Hz. The frequency, spectral power (amplitude), and relative weight (%) of the 1^st, 2^nd, and 3^rd highest amplitude oscillations were determined (frequency - mode; amplitude, relative weight - M±SEM; n=120).

Results: In the perfused dog heart, VF was characterized by an organized activity, as evidenced by the dominant structure of the oscillation frequencies. Oscillations with a frequency of 9-10 Hz (occurring in 1/10 of the 0.5-15 Hz range) represent 42-44% of the spectral power and dominate the structure of the oscillation frequencies. The frequency and spectral power of the dominating oscillations proved to be stable thus indicating that under perfusion, VF did not cause disturbances in the heart organized activity.

Conclusion: Our experimentation with isolated perfused hearts revealed the patterns of VF that could not be revealed in situ under conditions complicated by nerve factors and ischemia in VF. The results of the work are protected with a patent which is applicable for VF diagnosis in implantable defibrillators.

We previously found that the number of CCR6⁺ T-helpers with the phenotype of effector/effector memory T cells increases in the blood of patients with H. pylori-associated peptic ulcer. The mature phenotype and the expression of the chemokine receptor CCR6, which is involved in migration of lymphocytes to the inflamed mucous membrane of the gastrointestinal tract, suggests that these cells are involved in the immune response observed in this clinical condition. To better understand the pathogenetic role of these cells, it is necessary to study their functional activity, specifically, the production of pro-inflammatory cytokines involved in the pathogenesis of the disease. The aim of the study was to evaluate changes in the blood level of pro-inflammatory types of mature CCR6⁺ T-helpers in H. pylori-associated peptic ulcer disease.

Materials and methods: CCR6⁺ T-helpers were isolated from the blood by using immuno-magnetic separation adapted to this study. The number of T-helpers of types 1 and 17 (Th1 and Th17) and cells with mixed properties of Th1 and Th17 (Th1/Th17) was determined by intracellular cytokine assay.

Results: Initially, we planned to activate unseparated peripheral blood mononuclear cells ex vivo and evaluate the number of cytokine producers among mature CCR6⁺ T-helper cells by gating them during the flow cytometry. However, dramatic changes in the phenotype of T-helpers upon activation did not allow us to reliably identify the cells of interest. Subsequently, we used a two-stage immunomagnetic separation procedure to obtain functionally active mature CCR6⁺ T-helpers with a purity of >90%. The quantitative yield of these cells from the blood of patients with gastric and duodenal peptic ulcer associated with H. pylori was 9 times higher than that from the blood of healthy donors. Activation of CCR6⁺ T-helpers purified from blood of ulcer patients revealed an increased content of Th1, Th17, and Th1/Th17. One ml of the patient's blood yielded 18.1 times more CCR6⁺ Th1, 19.4 times more CCR6⁺ Th17, and 21.1 times more CCR6⁺ Th1/Th17 compared with the blood of healthy subjects.

Conclusion: The content of mature CCR6⁺ T-helper cells with pro-inflammatory activity significantly increases in the blood of patients with peptic ulcer associated with H. pylori infection.

The aim of the study is to determine indications for the use of sialoendoscopy in the diagnosis and treatment of sialolithiasis.

Materials and methods: The study involved 115 patients with sialolithiasis, who underwent cone beam computed tomography, ultrasound diagnosis of the salivary glands, and sialoendoscopy, in addition to the standard general clinical examination.

Results: Sialoendoscopy makes it possible to detect a stone, determine its shape, relative size, mobility, and assess the condition of the salivary ducts. It is impossible to obtain this information by other methods, though it is very important for treatment decision making. The design of the sialoscope and its special instruments make it possible to proceed with sialolith extraction immediately after detecting it.

Conclusion: The absolute indication for the use of sialoendoscopy is mobile calculi less than 5 mm in diameter (L1 according to F. Marchal's LSD classification). In case of immobile sialoliths less than 4-8 mm in size, located in the main duct (L2), endoscopy should be used as a method supplementary to ductotomy. When sialoliths are located in the distal parts behind the areas of bending or stricture (L3a and L3b), the use of endoscopy is not indicated.

Intermediate transpedicular fixation, i.e. additional insertion of transpedicular screws into the injured vertebrae, is an improvement to the most popular surgical intervention for spinal injuries, currently gaining widespread use in clinical practice. Unilateral insertion of transpedicular screws into the injured vertebrae allows combining the advantages of intermediate transpedicular fixation with the possibility to perform anterior column support without remounting the transpedicular system. The aim of the study was to use biomechanical computer modeling for evaluating the stability of intermediate transpedicular fixation components, which allow performing anterior column support if necessary.

Materials and methods: DICOM files obtained during CT scan of a patient with intermediate thoracolumbar spine injury and the ANSYS software were used. Stability of the transpedicular system and supportability of the complementary Mesh implant installed with unilateral intermediate transpedicular screws were evaluated using computer modeling based on the finite element method.

Results: The values of stress and displacement fields for spine-hardware systems with various arrangements have been obtained. The maximum loads exceeding bone tissue strength (153-161 MPa) were registered for standard 4-screw system (190 MPa) when modeling the load equivalent for walking and falling from a standing position. The use of the proposed fixation system arrangement supplemented with intermediate screws allows obtaining loads in the spine-hardware system not exceeding these thresholds. Complementary eccentric Mesh implant enhances fixation stability of the transpedicular system with intermediate screws.

Conclusion: The results show the high degree of mechanical stability of the proposed hardware arrangement and its potential efficacy for thoracolumbar transitional vertebra stabilization.

At present, diseases of bones and joints stand third after cardiovascular and oncological pathologies which demands the necessity of searching for new etiological factors and pathogenetical mechanisms of these illnesses. The accumulating data show the association between the impairment of bone tissue development and regeneration and endocrine disruptor impact. Endocrine disruptors are chemical substances, mainly of anthropogenic origin, capable of affecting endocrine system functioning and interfering with organ morphogenesis and physiological functions. The development and regeneration of bone tissues have a complex hormonal regulation and therefore bone tissue cells, osteoblasts, and osteoclasts can be considered as potential targets for endocrine disruptors. Endocrine disruptors have been established to be able to impair calcium metabolism which also contributes to the development of musculoskeletal system pathology. Data on histogenesis of bone tissue and regeneration, calcium metabolism as well as on hormonal regulation of bone growth and remodeling processes are presented in this work. Recent information on the effect of the main endocrine disruptor classes (diethylstilbestrol, organochlorine pesticides, alkylphenols, bisphenol A, dioxins, polychlorinated biphenyls, and phthalic acid esters) on the development and remodeling of bone tissues and calcium metabolism has been summarized. The established physiological and molecular mechanisms of their action have been also considered.

The aim of the investigation was to study the issue of making challenging decisions concerning abandonment or removal of non-infected superfluous leads during lead revisions or cardiac implantable electronic device upgrades.

Materials and methods: From 2010 to 2019, a total of 482 patients who had undergone cardiac implantable electronic device implantation in the past were admitted to hospital for generator replacement or lead revision. In 126 patients, 155 malfunctioning leads were found. Mean age of the patients was 59.2±16.7. Total venous occlusion was found in 10 cases of these patients. All patients were divided into two groups: extracted leads group (n=83) and abandoned leads group (n=43). The main factor which influenced our strategy was the mean age of the lead. In group 1 the mean age of the lead was 6.9±5.6 years. In group 2 it was about 12 years.

Results: Lead extraction was performed by manual traction in 69 (61.7%) leads, by lead locking device in 32 (28.5%) leads, and 11 (9.8%) leads were removed using TightRail rotating dilator sheath. In 1 case of total occlusion of the superior vena cava, we performed a video-assisted thoracoscopic lead extraction at the time of vein occlusion recanalisation and electronic device reimplantation. In abandoned leads group 3 patients had lead-related complications.

Conclusion: Transvenous lead extraction with the mean age of the lead less than 10 years is an effective and safe strategy. Preventive transvenous lead extraction of non-infected leads allows avoiding lead-related complications in the long-term period.

The aim of the study was to conduct a functional analysis of sex-specific age-related changes in DNA methylation.

Materials and methods: The study used a GSE87571 methylation dataset obtained from the blood DNA of 729 individuals aged 14 to 94 using the Illumina Infinium HumanMethylation450K BeadChip (USA). Gene ontology analysis was performed for 3 groups of genes (females, males, and duplicates) using the PANTHER database. The DAVID platform was used to perform KEGG metabolic pathway analysis.

Results: The studies revealed unique for males and females changes in methylation of CpG sites, associated with certain metabolic processes. It was demonstrated that most of the CpG sites, for which methylation changes with age were revealed in both sexes, are associated with the genes responsible for the development and functioning of the nervous system. In males, unique age-related methylation changes affect CpG sites associated with changes in the immune system and lipid metabolism. In females, most CpGs are associated with changes involved in transcription and translation processes. Analysis of biological functions by KEGG revealed that a unique process associated with age-related changes in methylation of the glutamatergic system is typical for males. In females, unique biological processes with age-related changes include genes responsible for the development of diabetes and genes associated with cAMP signaling cascades (KEGG:04024).

Conclusion: Our studies reveal fundamental features of sex-dependent changes in methylation of CpG sites with variance increasing, which may indicate differences in age-related changes.