Случай внутрипортального введения мононуклеарных клеток аутологичного костного мозга и трансплантации печени у пациентки с циррозом

To date, liver transplantation remains the only effective treatment for patients with cirrhosis. Due to lack of other effective, alternative therapeutic methods, the search and development of new treatment technologies is problem number one. The development of cellular technologies is promising for use in clinical practice. Using this observation as an example, the safety and efficacy of cell therapy technology for prolonged stay on the liver transplant waiting list by a patient with cirrhosis is shown. After intraportal injection of autologous bone marrow-derived mononuclear cells, liver cirrhosis stabilized on the CTP and MELD-Na scales for 22 months of observation, which allowed the patient to wait for an organ and successfully undergo liver transplantation.На сегодняшний день единственным эффективным способом лечения пациентов с циррозом является трансплантация печени. В связи с отсутствием других эффективных, альтернативных методов терапии поиск и разработка новых технологий лечения является актуальной проблемой. Развитие клеточных технологий перспективно для использования в клинической практике. На примере данного наблюдения показана безопасность и эффективность технологии клеточной терапии для продленного нахождения пациентки с циррозом в листе ожидания трансплантации печени. После внутрипортального введения мононуклеарных клеток аутологичного костного мозга отмечена стабилизация цирроза печени по шкалам CTP, MELD-Na на протяжении 22 мес. наблюдения, что позволило дождаться донорского органа и успешно выполнить трансплантацию печени

Комбинированное лечение нерезектабельной гилюсной холангиокарциномы с последующей трансплантацией печени

Objective: to demonstrate the experience of unresectable hilar cholangiocarcinoma treatment using neoadjuvant therapy followed by liver transplantation (LT).Materials and methods. From 2017 to 2021, six patients were included in the treatment protocol for unresectable Klatskin tumor followed by liver transplantation at Granov Russian Scientific Center for Radiology and Surgical Technology. The neoadjuvant therapy included endobiliary photodynamic therapy (PDT), as well as regional and systemic chemotherapy. Each method was used at least three times for 4 to 5 months with radiological evaluation and measurement of CA 19-9 levels. Patients were placed on the waiting list when the tumor marker reduced, or when there were no radiological signs of disease progression and there was no acute cholangitis. The recipients underwent laparoscopic abdominal revision for carcinomatosis and assessment of lymph nodes in the hepatoduodenal ligament with urgent morphological examination. Where there was no extrahepatic spread, LT was performed according to the classical technique with paracaval, para-aortic and hepatoduodenal lymphodissection, biliodigestive anastomosis by an isolated Roux loop of small intestine. The operation was performed in three patients, all of them were men aged 40 to 55 years (mean 48). The mean time from the start of treatment to transplantation was 9.3 months (range 6 to 14). Mean CA 19-9 level at the time of intervention was 81.3 IU/mL (8 to 212).Results. In three patients, CA 19-9 levels more than doubled on average over four months despite treatment. According to data from computed tomography RECIST assessment, two of the patients showed disease progression. In one patient, carcinomatosis was detected by diagnostic laparoscopy. In three patients, CA 19-9 levels decreased more than fourfold. Two of these patients were radiologically confirmed to have the disease stabilized, and one had a partial response. One patient died from sepsis three years after transplantation as a result of secondary biliary cirrhosis and biliary abscesses without signs of progression. Two patients are still alive after 6 and 21 months without signs of tumor progression.Conclusion. LT for unresectable Klatskin tumor is effective in controlling the bioactivity of the tumor through the use of neoadjuvant therapyЦель: продемонстрировать опыт лечения нерезектабельной гилюсной холангиокарциномы путем применения неоадъювантной терапии с последующей трансплантацией печени.Материалы и методы. С 2017-го по 2021 г. в ФГБУ «РНЦРХТ им. академика А.М. Гранова» в протокол лечения нерезектабельной опухоли Клацкина с последующей трансплантацией печени было включено 6 пациентов. Неоадъювантное лечение включало эндобилиарную фотодинамическую терапию, регионарную и системную химиотерапию. Каждый метод применялся минимум трижды в течение четырех-пяти месяцев с радиологической оценкой и определением уровня Са19-9. Пациенты вносились в лист ожидания при снижении онкомаркера, отсутствии радиологических признаков прогрессии заболевания и без острого холангита. Реципиентам выполнялась лапароскопическая ревизия брюшной полости на предмет канцероматоза и оценка лимфоузлов печеночнодвенадцатиперстной связки со срочным морфологическим исследованием. При отсутствии внепеченочного распространения производилась трансплантация печени по классической методике с паракавальной, парааортальной и гепатодуоденальной лимфодиссекцией, билиодигестивным анастомозом на отключенной по Ру петле тонкой кишки. Операция выполнена трем пациентам, все из них – мужчины. Возраст колебался от 40 до 55 лет (средний – 48). Среднее время от начала лечения до трансплантации составило 9,3 месяца (от 6 до 14). Средний уровень Са19-9 на момент выполнения вмешательства составил 81,3 МЕ/мл (от 8 до 212).Результаты. У трех пациентов, несмотря на лечение, отмечен рост уровня Са19-9 более чем в два раза в среднем за четыре месяца. У двух из них выявлена прогрессия заболевания согласно данным компьютерной томографии по RECIST. У одного пациента выявлен канцероматоз при диагностической лапароскопии. У трех пациентов Са19-9 снизился более чем в четыре раза. У двух из этих пациентов радиологически подтверждена стабилизация заболевания, у одного – частичный ответ. Один пациент умер через три года после трансплантации от сепсиса в исходе вторичного билиарного цирроза и билиарных абсцессов без признаков прогрессирования. Два пациента живы по настоящее время на протяжении 6 и 21 месяцев без признаков прогрессирования опухоли.Заключение. Трансплантация печени при нерезектабельной опухоли Клацкина эффективна при достижении контроля над биологической активностью опухоли путем применения неоадъювантного лечения

Возможности интервенционной радиологии до и послеортотопической трансплантации печени

Presented the case of a combined approach preparation of 47 years old patient with primary biliary cirrhosis for orthotopic liver transplantation (OLT) and arterial flow  insufficiency correction after surgery. The patient was under waiting list for OLT due  liver cirrhosis progression. The patient underwent Intraportal infusion of autologous bone marrow mononuclear cells (MNC) which is allowed temporary  stabilized the cirrhotic transformation. The transjugular intrahepatic portosystemic  shunt (TIPS) procedure performed due to portal hypertension progression with  episodes of bleeding from the esophageal and gastric varices, that allowed to  receive organ donor and OLT. At 6 months after OLT the patient had clinical signs of  a jaundice caused by splenic artery steal syndrome which was corrected by endovascular intervention: splenic artery trunk embolization.Представлен случай комбинированного подхода в подготовке пациентки 47 лет с первичным билиарным циррозом к ортотопической трансплантации печени (ОТП) и коррекции  артериальной недостаточности после операции. Пациентка находилась в листе ожидания ОТП  ввиду прогрессирующего цирроза печени. Была проведена прямая внутрипортальная инфузия  мононуклеарных клеток аутологичного костного мозга, что позволило на время  стабилизировать цирротическую трансформацию печени. Из-за прогрессирования портальной гипертензии с  возникновением эпизодов кровотечения из варикозных вен пищевода и желудка выполнено  трансъюгулярное внутрипеченочное портосистемное шунтирование (TIPS), которое позволило  дождаться донорского органа и ОТП. Через 6 мес. после ОТП вследствие обкрадывания печени селезеночной артерией у пациентки появились клинические признаки желтухи, которые  были разрешены эндоваскулярно: эмболизацией ствола селезеночной артерии

Клиническая эффективность и безопасность применения ингаляционного простациклина у больных с инфекцией, вызванной SARS-CoV-2 (проспективное сравнительное исследование)

Aim. In this study we evaluated clinical effectiveness and safety of nebulized prostacyclin in patients with Novel Coronavirus Disease (SARS-CoV-2). Materials and methods: We have included 44 male patients with moderate PCR confirmed SARS-CoV-2 infection in this study. Control group consisted of 23 patients treated with nebulized prostacyclin (PGI2). besides standard therapy. We compared intensiveness and duration of infectious intoxication syndrome, duration of fever, cough as well as SpO2 level, complete blood count and chemokine status values. Results: Statistically significant difference in duration of fever, cough, intensiveness and duration of infectious intoxication syndrome were observed. Lymphocyte and platelet counts were significantly higher in control group We have also noticed significantly lower level of proinflammatory mediators and C4-complement component in control group. Only 1 adverse effect associated with inhaled prostacyclin was reported. Conclusion. Nebulized prostacyclin showed therapeutic efficacy and good safety profile in adults with moderate COVID-19.Цель: оценка клинической эффективности и безопасность ингаляционного простациклина у пациентов с новой коронавирусной инфекцией (SARS-CoV-2). Материалы и методы: в исследование были включены 44 пациента мужского пола с подтвержденной новой коронавирусной инфекцией среднетяжелого течения. Опытную группу составили 23 пациента, которым, помимо стандартной терапии, был назначен ингаляционный простациклин (PGI2). Клиническая эффективность илопроста была оценена по длительности и выраженности общеинфекционных синдромов (интоксикации, лихорадки), длительности кашля, уровню насыщения крови кислородом, значениям параметров общеклинического анализа крови, показателю иммунологического статуса пациентов. Результаты: получено статистически значимое снижение длительности лихорадки, продолжительности кашля, выраженности и длительности синдрома общей инфекционной интоксикации в опытной группе. Также отмечено, что у этих пациентов средние значения количества лимфоцитов, тромбоцитов достоверно увеличивалось, а значение СОЭ снижалось. Средние значения провоспалительных цитокинов, хемокинов, а также С4-компонента комплемента были статистически значимо ниже, чем у больных COVID-19 в группе сравнения. Нежелательные реакции, связанные с инга ляционной терапией простациклином, были отмечены в 1 наблюдении. Заключение: показана терапевтическая эффективность и хороший профиль безопасности ингаляционного простациклина у пациентов с COVID-19 средней степени тяжести

Prevalence of chronic cough, its risk factors and population attributable risk in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study

Background: Chronic cough is a common respiratory symptom with an impact on daily activities and quality of life. Global prevalence data are scarce and derive mainly from European and Asian countries and studies with outcomes other than chronic cough. In this study, we aimed to estimate the prevalence of chronic cough across a large number of study sites as well as to identify its main risk factors using a standardized protocol and definition. Methods: We analyzed cross-sectional data from 33,983 adults (≥40 years), recruited between Jan 2, 2003 and Dec 26, 2016, in 41 sites (34 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We estimated the prevalence of chronic cough for each site accounting for sampling design. To identify risk factors, we conducted multivariable logistic regression analysis within each site and then pooled estimates using random-effects meta-analysis. We also calculated the population-attributable risk (PAR) associated with each of the identified risk factors. Findings: The prevalence of chronic cough varied from 3% in India (rural Pune) to 24% in the United States of America (Lexington, KY). Chronic cough was more common among females, both current and passive smokers, those working in a dusty job, those with a history of tuberculosis, those who were obese, those with a low level of education, and those with hypertension or airflow limitation. The most influential risk factors were current smoking and working in a dusty job. Interpretation: Our findings suggested that the prevalence of chronic cough varies widely across sites in different world regions. Cigarette smoking and exposure to dust in the workplace are its major risk factors.info:eu-repo/semantics/publishedVersio

Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Prevalence of chronic cough, its risk factors and population attributable risk in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study

© 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)Background: Chronic cough is a common respiratory symptom with an impact on daily activities and quality of life. Global prevalence data are scarce and derive mainly from European and Asian countries and studies with outcomes other than chronic cough. In this study, we aimed to estimate the prevalence of chronic cough across a large number of study sites as well as to identify its main risk factors using a standardised protocol and definition. Methods: We analysed cross-sectional data from 33,983 adults (≥40 years), recruited between Jan 2, 2003 and Dec 26, 2016, in 41 sites (34 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We estimated the prevalence of chronic cough for each site accounting for sampling design. To identify risk factors, we conducted multivariable logistic regression analysis within each site and then pooled estimates using random-effects meta-analysis. We also calculated the population attributable risk (PAR) associated with each of the identifed risk factors. Findings: The prevalence of chronic cough varied from 3% in India (rural Pune) to 24% in the United States of America (Lexington,KY). Chronic cough was more common among females, both current and passive smokers, those working in a dusty job, those with a history of tuberculosis, those who were obese, those with a low level of education and those with hypertension or airflow limitation. The most influential risk factors were current smoking and working in a dusty job. Interpretation: Our findings suggested that the prevalence of chronic cough varies widely across sites in different world regions. Cigarette smoking and exposure to dust in the workplace are its major risk factors.info:eu-repo/semantics/publishedVersio

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

A case report of successful liver retransplantation in patient with early hepatic artery thrombosis complicated by bile ducts necrosis and sepsis

In this present case report during liver transplantation a patient was developed dissection of hepatic artery (HA) which was noticed after arterial reconstruction step. In one hour after surgery at intervention operating room stent placement of HA was performed. At early postoperative period by hepatic angiography study indicated for a second stent placement of HA, also embolization of splenic artery to treat a steal syndrome. After 2 weeks a patient developed thrombosis of recently placed stents which was required vascular reconstruction of HA by using autovenous graft. The condition complicated by development of a cholangiogenous hepatic abscesses and sepsis despite of all used possible methods of liver graft revascularization. However, used methods of vascular correction, which combined of timely carried out intensive care and antibiotic therapy according microbiology laboratory results allows saving graft function. After treatment of septic complications and patient’s somatic status stabilization and normalization of laboratory results liver retransplantation was performed

Случай успешной ретрансплантации печени у пациента с ранним тромбозом печеночной артерии, осложненным некрозом желчных протоков, сепсисом

In this present case report during liver transplantation a patient was developed dissection of hepatic artery (HA) which was noticed after arterial reconstruction step. In one hour after surgery at intervention operating room stent placement of HA was performed. At early postoperative period by hepatic angiography study indicated for a second stent placement of HA, also embolization of splenic artery to treat a steal syndrome. After 2 weeks a patient developed thrombosis of recently placed stents which was required vascular reconstruction of HA by using autovenous graft. The condition complicated by development of a cholangiogenous hepatic abscesses and sepsis despite of all used possible methods of liver graft revascularization. However, used methods of vascular correction, which combined of timely carried out intensive care and antibiotic therapy according microbiology laboratory results allows saving graft function. After treatment of septic complications and patient’s somatic status stabilization and normalization of laboratory results liver retransplantation was performed. В представленном случае у пациента во время трансплантации печени после завершения этапа артериальной реконструкции выявлен участок диссекции печеночной артерии (ПА). В течение часа в условиях рентгеноперационной произведено стентирование ПА. В раннем послеоперационном периоде при контрольных ангиографических исследованиях выявлены показания к повторному стентированию ПА, а также эмболизации селезеночной артерии с целью устранения синдрома обкрадывания. Через две недели у пациента развился тромбоз ранее установленных стентов, что потребовало аутовенозного протезирования ПА. Несмотря на все примененные способы реваскуляризации, течение заболевания осложнилось формированием холангиогенных абсцессов, развитием сепсиса. Однако использованные методы эндоваскулярной коррекции сосудистых нарушений в сочетании с проведением своевременной интенсивной и антибактериальной терапии согласно результатам микробиологических исследований позволили сохранить удовлетворительно функционирующий трансплантат. После купирования септических осложнений, стабилизации соматического статуса пациента и нормализации клинико-лабораторных показателей успешно выполнена ретрансплантация печени