Hospital thrombolytic therapy of ST-Segment Elevation Myocardial Infarction in regional vascular center

Objective. We have studied some cases of hospital thrombolytic therapy in the regional vascular center. Material and methods. The volume of reperfusion therapy in 2014, including hospital pharmacological therapy, is presented. Results. 436 (67.9%) patients have had reperfusion therapy: percutaneous coronary interventions (PCI) in isolation - 326 (50.8 %), only thrombolytic therapy - 36 (5.6 %), pharmaco-invasive method - 74 (11.5 %). Thrombolytic therapy was performed in 110 (17.1 %) cases, 98 (15.2 %) from them - by ambulance crews. The need for hospital thrombolytic therapy occurred in 12 cases (1.9 %). In 9 cases, the main reason was impossibility to do primary PCI due to the occupancy of the room for angiography. In 8 cases thrombolytic therapy was performed by a recombinant protein containing the amino acid sequence of staphylokinase, and it was effective. All patients have had successful PCI. Conclusions. In conditions of our regional vascular centre, we treated hospital thrombolytic therapy as a forced measure due to simple circumstances (the patient’s refusal of coronary interventions or allergic to contrast) or high occupancy of the angiographic operating room. The results of the administration of Russian thrombolytic agent Forteplaze have left a positive impression. Further accumulation of experience will determine the place of this medication in clinical practice.Цель исследования: анализ случаев госпитальной тромболитической терапии (ТЛТ) в региональном сосудистом центре (РСЦ). Материал и методы: представлены объёмы реперфузионной терапии в 2014 г., в т.ч. фармакологической на госпитальном уровне. Результаты. Реперфузионная терапия проведена 436 (67,9%) больным: чрескожные коронарные вмешательства (ЧКВ) в изолированном виде - 326 (50,8%), только ТЛТ - 36 (5,6%), фармакоинвазивный метод – 74 (11,5%). ТЛТ выполнялась в 110 (17,1 %) случаях, в 98 (15,2%) бригадами скорой медицинской помощи. Потребность в госпитальной ТЛТ возникла в 12 случаях (1,9%). Основная причина - невозможность выполнить первичные ЧКВ в связи с занятостью ангиографической операционной - 9 наблюдений. В 8 случаях ТЛТ проведена рекомбинантным белком, содержащим аминокислотную последовательность стафилокиназы, и была эффективной. Всем больным успешно провели ЧКВ. Выводы: в условиях РСЦ госпитальная ТЛТ нами рассматривается исключительно как вынужденная мера, обусловленная простыми обстоятельствами (отказ пациента от коронарных интервенций или аллергия на контраст) или высокой загруженностью ангиографической операционной. Первые результаты применения российского препарата фортеплазе оставили позитивное впечатление. Дальнейшее накопление опыта определит место этого средства в клинической практике

КЛИНИЧЕСКОЕ ЗНАЧЕНИЕ БАКТЕРИЕМИИ У ПАЦИЕНТОВ ПОСЛЕ КОЛОПРОКТОЛОГИЧЕСКИХ ОПЕРАЦИЙ

A retrospective cohort study was conducted, which included 1,274 patients after coloproctological operations. Bacteremia was diagnosed in 28% of the patients; in 17% of them, it manifested itself as the clinical presentation of sepsis (74%) or severe sepsis (26%). Bacteremia was proven to significantly increase the risk of death and to reduce 28-day survival rate. Проведено ретроспективное, когортное исследование, в которое включено 1 274 пациента после коло­проктологических операций. Бактериемия диагностирована у 28% пациентов, из них в 17% случаев ­проявлялась клиникой сепсиса (74%) или тяжёлого сепсиса (26%). Доказано, что бактериемия достоверно повышает риск летального исхода и снижает показатель 28-дневной выживаемости

Development of a methodology for modeling and optimizing the design of modular Hinged facade systems (HFS) in the Autodesk Revit environment

В данной работе рассматриваются проблемы, связанные с моделированием навесных вентилируемых фасадов и оптимизацией работы с ними в среде Autodesk Revit. Данная работа проведена с целью предложения решения по сокращению трудовых и временных затрат проектирования модульных навесных фасадных систем. Результатом работы является написание инструкции по моделированию НФС по модульной схеме и оценка эффективности проектирования с учетом оптимизации процессов проектирования модульных НФС.This paper discusses the problems associated with modeling hinged ventilated facades and optimizing work with them in the Autodesk Revit environment. This work was carried out in order to propose a solution to reduce the labor and time costs of designing modular hinged facade systems. The result of the work is the writing of instructions for modeling HFS according to a modular scheme and evaluating the effectiveness of design, taking into account the optimization of the design processes of modular HFS

The prevalence of modifiable risk factors for atherosclerosis in patients with myocardial infarction

We have conducted the questionnaire survey of 200 patients with the final diagnosis of acute myocardial infarction. The age of patients ranged from 32 to 65 years, the average age was 50.4±1,4 years old. All the respondents had been living in Chelyabinsk and nearby towns. They have answered some questions relating to the the risk of developing atherosclerosis. The records indicated a high prevalence of chronic stress (72%), hypertension (67.5%), overweight (55%), smoking (49%), high cholesterol (42,5%). Less frequently: physical inactivity (20,5%), hyperglycemia (18.5%), poor nutrition (16,5%). Only 26% of the respondents associated the development of the disease with unhealthy lifestyle. Able-bodied citizens don't have enough information about risk factors of developing atherosclerosis and other diseases of the circulatory system. This fact should be taken into account by health care system (it is necessary to develop the preventive measures)

CLINICAL CASE OF RUSSIAN THROMBOLYTIC AGENT FORTELYZIN® USE IN PATIENTS WITH ACUTE CORONARY ARTERY DISEASE

One of the three clinical examples of hospital thrombolysis using Russian thrombolytic agent recombinant protein comprising an amino acid sequence of staphylokinase is described. The trial was held in Chelyabinsk Regional Vascular Centre of specialized medical care for patients with acute coronary syndromes. Each of the three patients had similar reasons for systemic intravenous thrombolysis: hospitalization with ST-segment elevation myocardial infarction, unavailability of coronary interventions due to the X-ray operating room occupancy, high need for the reperfusion therapy in the setting of significant acute myocardial ischemia. In all the cases the pharmacologic reperfusion with recombinant protein comprising an amino acid sequence of staphylokinase was successful, hereafter percutaneous coronary interventions were performed. There were no complications registered

CLINICAL VALUE OF BACTEREMIA IN PATIENTS AFTER COLOPROCTOLOGICAL OPERATIONS

A retrospective cohort study was conducted, which included 1,274 patients after coloproctological operations. Bacteremia was diagnosed in 28% of the patients; in 17% of them, it manifested itself as the clinical presentation of sepsis (74%) or severe sepsis (26%). Bacteremia was proven to significantly increase the risk of death and to reduce 28-day survival rate

CLINICAL CASE HISTORY OF EPTIFIBATIDE USE DURING CORONARY INTERVENTION IN PATIENT WITH CORONARY FAILURE

Clinical case history of endovascular intervention in infarct related coronary artery with 4 sirolimus-eluting stents implantation and their further thrombosis during early postoperative period is described. Percutaneous coronary intervention was successful after the balanced medication with 2 antiplatelet drugs (acetylsalicylic acid and clopidogrel) and heparin. There were not any reasons for additional prescription of antiplatelet medicine. It seems that one of the main reasons of the stent thrombosis was the extended area of 4 sirolimus-eluting stents implantation into the affected vessel. After the analysis of our clinical case history we propose that for stent thrombosis prevention in multistent (≥4 drugeluting stents) interventions it is necessary to apply additional antiplatelet drug – glycoprotein IIb/IIIa inhibitor eptifibatide.</p

CLINICAL CASE OF RUSSIAN THROMBOLYTIC AGENT FORTELYZIN® USE IN PATIENTS WITH ACUTE CORONARY ARTERY DISEASE

One of the three clinical examples of hospital thrombolysis using Russian thrombolytic agent recombinant protein comprising an amino acid sequence of staphylokinase is described. The trial was held in Chelyabinsk Regional Vascular Centre of specialized medical care for patients with acute coronary syndromes. Each of the three patients had similar reasons for systemic intravenous thrombolysis: hospitalization with ST-segment elevation myocardial infarction, unavailability of coronary interventions due to the X-ray operating room occupancy, high need for the reperfusion therapy in the setting of significant acute myocardial ischemia. In all the cases the pharmacologic reperfusion with recombinant protein comprising an amino acid sequence of staphylokinase was successful, hereafter percutaneous coronary interventions were performed. There were no complications registered.</p

Multipurpose resource inventory in Far East (Economical aspect)

Session 1

Multipurpose resource inventory in Far East - Economical aspects

Mimeograp