FEATURES OF POSTOPERATIVE PERIOD IN PATIENTS AFTER BRAIN REVASCULARIZATION

The aim of the research was to compare incidence of small complications after carotid endarterectomy (CEA) versus carotid artery stenting, as well as to evaluate its application in specific clinical situations. The outcomes of1826 patients who underwent surgery for stenosis of the internal carotid artery (ICA) were analyzed. There were two groups: 1018 patients who underwent CEA and 808 patients who carried the stenting. Age of patients was greater and coronary heart disease, diabetes, chronic obstructive pulmonary disease occurs more often in group with endovascular treatment, and they had rife stroke anamnesis. The mortality rate, uncontrolled hypertension and transient ischemic attacks were similar in early postoperative period. Stroke frequency was higher in patients with carotid artery stenting (35 (4,3 %) versus 27 patients (2,6 %) with CEA (p = 0,02)), and myocardial infarction took place more often after CEA (38 (3,7 %) versus 13 (1,6 %) patients with endovascular treatment (p = 0,008)). There was no statistically significant difference in security between CEA and stenting. However, treatment of carotid stenosis should be chosen according to individual characteristics, including individual anatomy

CEREBRAL REVASCULIZATION IN PATIENTS OF 70 YEARS AND OLDER

The aim of the work was to evaluate the perioperative management of aged patients after elective surgical cerebral revascularization. We analyzed the outcomes of 813 patients of 70 years and older who had surgery for stenosis of the internal carotid artery [ІСА]. There were two groups: 392 patients who had carotid endarterectomy [CEA] and 421 patients who had the stenting. Age of the patients, severity of disease and comorbidity were similar in both groups In aged patients, the incidence of acute disorders of cerebral circulation (stroke] after CEA was significantly lower than the one after stenting (p = 0,04]. Frequency of perioperative myocardial infarction [MI] was 3 times higher in cases with CEA (p = 0,03]. in patients of 70 years and older, CEA shown lower incidence of stroke, however, there is increase of perioperative MI while using this method. Endovascular treatment could be chosen in patients with severe cardiac disease according to atherosclerotic plaques with no risk of embolism. In addition, the individual approach and assessment of social aspect are necessary

Development of a technology for the preparation of a dry nutrient medium for anthrax vaccine production

Currently, submerged cultivation of the Bacillus anthracis STI-1 strain for live anthrax vaccine production requires liquid nutrient media, which have disadvantages of a short shelf life (no more than one month) and a narrow range of storage temperatures (2–8 °С). Dry media, in contrast, have a number of indisputable advantages: such media are transportable and easy to use, have a standard capability to retain properties, and can be stored without preservatives at 2–30 °С for 2–5 years. The aim of this work was to develop a technology for the preparation of a dry nutrient medium for anthrax vaccine production. Materials and methods: The study used the Bacillus anthracis STI-1 vaccine strain and a nutrient medium for its cultivation, containing a 70:30 mixture of an enzymatic digest of casein and a pre-processed corn extract solution. Drying of the nutrient medium was carried out on a spray-drying unit. The authors evaluated physicochemical parameters of experimental medium batches. The shelf life was determined by an accelerated stability study. The dry nutrient medium was used to produce a live anthrax vaccine. Quality attributes of the vaccine were assessed for compliance with regulatory requirements. Results: The authors developed the dry media production technology. According to it, the liquid nutrient medium is fed to the drying unit at a rate of 20–25 dm3/h. The spray air pressure is 0.02 MPa. Temperatures at the drying chamber inlet and outlet are 118–122 °С and 85–90 °С, respectively. The technology was used to obtain 3 experimental batches of the dry medium. The study results demonstrate that the technology is reproducible, and the tested quality attributes of experimental medium batches are consistent with the requirements. According to the accelerated stability study, the shelf life of the dry nutrient medium at 2–30 °С is at least 3 years. Experiments demonstrated the possibility of using the dry nutrient medium for live anthrax vaccine production. Critical quality attributes of the vaccine obtained with the medium met regulatory requirements. Conclusions: The developed technology allows for the production of a standard dry nutrient medium with a prolonged shelf life, which is convenient for live anthrax vaccine production

Возможности КТ-ангиографии нижней брыжеечной артерии при планировании резекций левой половины толстой кишки у пациентов с колоректальным раком

During laparoscopic surgery for colorectal cancer, vascular structures may be incorrectly identified and damaged due to ignorance of the variant anatomy of the inferior mesenteric artery (IMA), lack of tactile sensations, narrowed field of vision, which leads to complications such as massive bleeding and intestinal ischemia. Therefore, the preoperative study of the variant anatomy of the IMA is of paramount importance. Knowing the variant anatomy of the vessels before surgery, you can make an operation plan in advance, which will ensure fast and safe vascular ligation at the required level and lymph dissection.Aim: To develop a classification of IMA variability for practical use in operations for colorectal cancer. Optimize the standard abdominal scanning protocol to improve the accuracy of MSCT and the best visualization of the IMA and its branches.Material and methods. From February 2013 to March 2022, 214 computed tomograms (CT) of abdominal organs with intravenous contrast were analyzed. We studied the variant anatomy of the IMA. The abdominal cavity scanning protocol was optimized using a 100 kV tube voltage, the contrast density of the NBA and its branches was compared using standard and optimized scanning protocols during a retrospective analysis of 105 CT studies of abdominal organs.Results. We proposed the classification of structure of the IMA and its branches. This is especially important when the safe lymph node dissection along the IMA is necessary. I type – several colonic branches derivate from the IMA by independent trunks (54%); II type – all colon branches derivate from the IMA in one point like a “goose paw” (25%); III type – one colon branch departs from the IMA by a single trunk; then it divides into colonic branches (21%).The accuracy of MSCT of the abdominal organs with intravenous contrast, which was determined by comparing the results of studies with intraoperative data, was 97.9%. The sensitivity of the method is 95.8%, the specificity of the method is 100%.The use of a scanning protocol with a tube voltage of 100 kV makes it possible to simplify and speed up the determination of the anatomical type of structure, improve the visualization of the IMA and its branches.Conclusion. CT with 3D-reconstruction of vessels allows the surgeon to perform an extended LND for colorectal cancer with a minimal risk of complications.Во время лапароскопической операции по поводу колоректального рака сосудистые структуры могут быть неправильно идентифицированы и повреждены из-за незнания вариантной анатомии нижней брыжеечной артерии (НБА), отсутствия тактильных ощущений, суженного поля зрения, что приводит к таким осложнениям, как массивное кровотечение и ишемия кишечника. Следовательно, предоперационное изучение вариантной анатомии НБА имеет первостепенное значение. Зная вариантную анатомию сосудов перед операцией, можно заранее составить план операции, что обеспечит быструю и безопасную перевязку сосудов на требуемом уровне и лимфодиссекцию.Цель исследования: разработать классификацию вариабельности НБА для практического применения при операциях по поводу колоректального рака. Оптимизировать стандартный протокол сканирования брюшной полости для повышения точности МСКТ и наилучшей визуализации НБА и ее ветвей.Материал и методы. С февраля 2013 г. по март 2022 г. проанализировано 214 компьютерных томограмм органов брюшной полости с внутривенным контрастированием. Изучили вариантную анатомию НБА. Оптимизировали протокол сканирования органов брюшной полости с использованием напряжения трубки 100 кВ, сравнили плотность контрастирования НБА и ее ветвей при использовании стандартного и оптимизированного протоколов сканирования при ретроспективном анализе 105 КТ-исследований органов брюшной полости.Результат. Нами была предложена классификация строения НБА и ее ветвей. Данная классификация очень важна при выполнении лимфодиссекции вдоль основного ствола НБА. Тип I – несколько толстокишечных ветвей отходили от НБА отдельными стволами (54%); тип II – все толстокишечные ветви отходят от НБА из одной точки в виде “гусиной лапки” (25%); тип III – от НБА отходит единственный ствол, который на своем протяжении делится на толстокишечные ветви (21%).Точность МСКТ органов брюшной полости с внутривенным контрастированием, которая определялась путем сравнения результатов исследований с интраоперационными данными, составила 97,9%, чувствительность метода – 95,8%, специфичность – 100%.Использование протокола сканирования с напряжением трубки 100 кВ позволяет упростить и ускорить определение анатомического типа строения, улучшить визуализацию НБА и ее ветвей.Заключение. КТ с 3D-реконструкцией сосудов позволяет хирургу выполнить расширенную лимфодиссекцию при колоректальном раке с минимальным риском осложнений

Разработка технологии приготовления сухой питательной среды для производства сибиреязвенной вакцины

Currently, submerged cultivation of the Bacillus anthracis STI-1 strain for live anthrax vaccine production requires liquid nutrient media, which have disadvantages of a short shelf life (no more than one month) and a narrow range of storage temperatures (2–8 °С). Dry media, in contrast, have a number of indisputable advantages: such media are transportable and easy to use, have a standard capability to retain properties, and can be stored without preservatives at 2–30 °С for 2–5 years. The aim of this work was to develop a technology for the preparation of a dry nutrient medium for anthrax vaccine production. Materials and methods: The study used the Bacillus anthracis STI-1 vaccine strain and a nutrient medium for its cultivation, containing a 70:30 mixture of an enzymatic digest of casein and a pre-processed corn extract solution. Drying of the nutrient medium was carried out on a spray-drying unit. The authors evaluated physicochemical parameters of experimental medium batches. The shelf life was determined by an accelerated stability study. The dry nutrient medium was used to produce a live anthrax vaccine. Quality attributes of the vaccine were assessed for compliance with regulatory requirements. Results: The authors developed the dry media production technology. According to it, the liquid nutrient medium is fed to the drying unit at a rate of 20–25 dm3/h. The spray air pressure is 0.02 MPa. Temperatures at the drying chamber inlet and outlet are 118–122 °С and 85–90 °С, respectively. The technology was used to obtain 3 experimental batches of the dry medium. The study results demonstrate that the technology is reproducible, and the tested quality attributes of experimental medium batches are consistent with the requirements. According to the accelerated stability study, the shelf life of the dry nutrient medium at 2–30 °С is at least 3 years. Experiments demonstrated the possibility of using the dry nutrient medium for live anthrax vaccine production. Critical quality attributes of the vaccine obtained with the medium met regulatory requirements. Conclusions: The developed technology allows for the production of a standard dry nutrient medium with a prolonged shelf life, which is convenient for live anthrax vaccine production.В настоящее время при производстве вакцины сибиреязвенной живой для глубинного выращивания штамма Bacillus anthracis СТИ-1 используется жидкая питательная среда, недостатками которой являются малый срок годности — не более одного месяца и узкий диапазон температуры ее хранения: от 2 до 8 °С. Сухие питательные среды (ПС) обладают рядом неоспоримых преимуществ: их можно хранить от 2 до 5 лет при температуре от 2 до 30 °С без консервантов; они транспортабельны, удобны в применении и стандартны в сохранении свойств. Цель работы: разработка технологии приготовления сухой ПС для производства сибиреязвенной вакцины. Материалы и методы: в исследованиях использовали вакцинный штамм B. anthracis СТИ-1 и ПС, состоящую из смеси ферментативного гидролизата казеина и раствора обработанного кукурузного экстракта в соотношении 70 и 30%, для культивирования сибиреязвенного микроба. Обезвоживание ПС осуществляли на установке распылительного типа. Экспериментальные серии сухой ПС оценивали по физико-химическим показателям на соответствие требованиям нормативной документации. Срок годности определяли методом «ускоренного старения». С использованием сухой ПС готовили вакцину сибиреязвенную живую и проводили оценку показателей качества препарата на соответствие требованиям нормативной документации. Результаты: разработана технология приготовления сухой ПС (скорость подачи ПС на сушку от 20 до 25 дм3/ч, давление сжатого воздуха в распылителе 0,02 МПа, температура воздуха на входе в сушильную камеру от 118 до 122 °С, температура воздуха на выходе — от 85 до 90 °С). По этой технологии получены 3 серии экспериментальной сухой ПС. Показано, что разработанная технология воспроизводима, а экспериментальные серии сухой ПС по изученным показателям отвечают предъявляемым требованиям. Срок годности сухой ПС, установленный с использованием метода «ускоренного старения», не менее 3 лет при температуре хранения от 2 до 30 °С. Экспериментально подтверждена возможность использования сухой ПС в технологии производства сибиреязвенной вакцины. Приготовленный препарат по основным показателям качества отвечает требованиям нормативной документации. Выводы: разработанная технология позволяет получить сухую ПС стандартную с увеличенным сроком хранения и удобную при использовании в производстве вакцины сибиреязвенной живой

INVESTIGATION OF CO-TRIMOXAZOLE EFFICIENCY USING THE EXPERIMENTAL TUBERCULOSIS MODEL IN MICE CAUSED BY TUBERCULOUS MYCOBACTERIA WITH EXTENSIVE DRUG RESISTANCE

The efficiency of using co-trimoxazole for treatment of mice infected with tuberculous mycobacteria with extensive drug resistance and supposed sensitivity to co-trimoxazole have been investigated.The study of 78 clinical cultures of tuberculous mycobacteria has demonstrated that drug resistance to first line drugs (cases with multiple drug resistance – MDR) can be accompanied by the expansion of polymorphism in the part of drug susceptibility to co-trimoxazole, thus this drug can be used as an additional drug in the treatment of M/XDR tuberculosis patients. Using co-trimoxazole as an additional drug to isoniazid in the model of generalized tuberculosis in mice infected with Beijing strain with XDR reduced the bacterial load of the lungs by 10 times.Detail evaluation of drug susceptibility/resistance of tuberculous mycobacteria to the additional drug of co-trimoxazole and investigation of the interaction of this drug with other agents included into treatment regimens IV and V can form the basis for improvement of treatment regimens for M/XDR tuberculosis patients with specification of doses and frequency of drug in-takes for each specific case

Adding cystatin C to the GRACE scale improves the prediction of bleeding complications in non-invasively treated patients with acute coronary syndrome

Aim. To assess the prognostic performance of the GRACE scale extended by cystatin C levels in the prediction of ischemic and hemorrhagic in-hospital complications among patients with acute coronary syndrome (ACS). Material and methods. In 160 ACS patients, admitted to the Moscow City Clinical Hospital No. 29 and included in the hospital register, blood levels of cystatin C were measured within the first 24 hours from admission. All patients were treated conservatively. The in-hospital risk of mortality and bleeding was assessed. The cut-off level of cystatin C was 1,53 mg/l. Results. High levels of cystatin C, high GRACE scale risk, and their combination were associated with a significant increase in the in-hospital risk of hemorrhagic and ischemic complications. Independent mortality predictors included GRACE levels (odds ratio, OR, 1,05; 95% confidence interval (CI) 1,02-1,08; p=0,002) and cystatin C levels (OR 1,01; 95% CI 1,00-1,02: p=0,025). Major and moderate bleeding complications were independently predicted by fibrinolysis (OR 9,86; 95% CI 1,74-55,20; p=0,01), leukocyte levels (OR 1,34; 95% CI 1,11-1,62: p=0,002), and haemoglobin levels (OR 0,96; 95% CI 0,91-0,99; p=0,043), as well as the combination of high GRACE risk levels and elevated cystatin C levels (OR 11,78; 95% CI 1,95-71,06; p=0,007). Adding cystatin C to the high GRACE risk improved the prognostic specificity by approximately 20% and did not affect the prognostic sensitivity in the prediction of in-hospital risk of major and moderate bleeding complications. Conclusion. The combination of high GRACE risk levels and elevated cystatin C levels was an independent predictor of major and moderate in-hospital bleeding complications, but not in-hospital death. Adding cystatin C to the GRACE scale by approximately 20% increased its specificity for the prediction of in-hospital risk of major and moderate bleeding complications