58 research outputs found
PERSPECTIVES OF THE DEVELOPMENT OF MUCOSAL VACCINES AGAINST DANGEROUS INFECTIONS ON THE BASE OF TRANSGENIC PLANTS
Mucosal vaccines created on the base of transgenic plants reacting with mucosal layers of the intestines and other organs are considered to be the perspective method of the vaccination. These vaccines induce both mucosal and general humoral immunogenicity after the peroral administration. The folding of antigenic proteins synthesizing in plants occurs via eukaryotic type and has advantages before yeast and prokaryotic platforms. This feature results to more adequate synthesis of antibodies against pathogens and to the interaction with effector molecules of complement. Earlier we together with The State Scientific Center βVectorβ, Institute of chemical biology and fundamental medicine SB RAS and Dr R.Hammond from Laboratory of Plant Pathology (Maryland, USA) created two candidate vaccines : one of them against AIDS (HIV-1) and hepatitis B on the base of the chimeric gene TBI-HBS, encoding simultaneously 9 antigenic determinants of HIV-1 and the main surface antigen of hepatitis B (HBsAg). The second candidate vaccine was created against hepatitis B on the base of the genetic construct with the gene preS2-S encoding the synthesis of two subunits of the main surface antigen of hepatitis B and the signal peptide HDEL which directed antigens for the accumulation on ER. Both vaccines were tested on mice and confirmed their immunogenicity as the pronounced antibodies response. Twice vaccinated mice maintained the antibodies response during 11 months after there was little tendency to lowering. It was established that transgenic plants β vaccines (tomato) kept the capability to the synthesis of antigenic determinants in seven seed generations during 7 years. The results of the development of the mucosal vaccine against cervical carcinoma (carcinoma of uterine cervix) evoked by human papillomaviruses of high oncogenic risks were presented in this report. We created the genetic construct consisting of 35S CaMV promoter, Ξ (omega) leader of TMV, the target gene HPV16 L1 and the nos terminator. The target gene HPV16 L1 of the most oncogenic type 16 of human papillomavirus was choosen as the object. Different procedures of the plant transformation were elaborated and the transgenic plants synthesizing the antigenic protein L1 of human papillomavirus of type 16 were obtained. The insertion and the expression of the target gene were controlled by northern blotting, the synthesis of antigenic protein HPV16 L1 was determined by ELISA and western blot. The antigenic protein of HPV16 L1 was synthesized in amount of 20 β 50 ng/mg of total soluble proteins in tomato transgenic plants. The results of the examination of the immunogenicity of the vaccine obtained by means of the peroral immunization of mice were showed in the report. Therefore it was demonstrated the principal opportunity of the creation of mucosal vaccines on the base of transgenic plants against several dangerous diseases
ΠΠ½Π΅ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΠ΅ Π»ΠΎΠ²ΡΡΠΊΠΈ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² (NETs) Π² ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΡΡΠΎΠΌΠ±ΠΎΠ·Π° ΠΈ ΡΡΠΎΠΌΠ±ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ
This article summarizes numerous studies on the relationship of biological processes such as inflammation and thrombosis. The huge role of neutrophils and the extracellular neutrophil traps (NETs) secreted by them has been demonstrated. The discovery of NETs has opened new horizons in the understanding of neutrophil biology and the role of these cells in the body. The use of chromatin in combination with the intracellular proteins, as an effective antimicrobial agent has ancient roots and changes our understanding of chromatin only as a carrier of genetic information. Through NETs, neutrophils can contribute to the development of pathological venous and arterial thrombosis or immunothrombosis, as well as atherosclerosis. NETs release has been shown to be one of the causes of thrombosis in conditions such as sepsis and cancer. The presence of NETs in these diseases and conditions makes it possible to use them or individual components as potential biomarkers. NETs and their components may be attractive as therapeutic targets. Further studies of neutrophils and NETs are needed to develop new approaches to the diagnosis and treatment of inflammatory and thrombotic conditions. Perhaps long-forgotten drugs will find a new area for effective use.Π Π΄Π°Π½Π½ΠΎΠΉ ΡΡΠ°ΡΡΠ΅ ΠΎΠ±ΠΎΠ±ΡΠ΅Π½Ρ ΠΌΠ½ΠΎΠ³ΠΎΡΠΈΡΠ»Π΅Π½Π½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΎ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·ΠΈ ΡΠ°ΠΊΠΈΡ
Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΎΡΠ΅ΡΡΠΎΠ² ΠΊΠ°ΠΊ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΠ΅ ΠΈ ΡΡΠΎΠΌΠ±ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅. ΠΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π½Π° ΠΎΠ³ΡΠΎΠΌΠ½Π°Ρ ΡΠΎΠ»Ρ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»Π»ΠΎΠ² ΠΈ Π²ΡΠ΄Π΅Π»ΡΠ΅ΠΌΡΡ
ΠΈΠΌΠΈ Π²Π½Π΅ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΡ
Π»ΠΎΠ²ΡΡΠ΅ΠΊ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² (Neutrophil Extracellular Traps, NETs). ΠΡΠΊΡΡΡΠΈΠ΅ NETs ΡΠ°ΡΡΠΈΡΠΈΠ»ΠΎ Π³ΠΎΡΠΈΠ·ΠΎΠ½ΡΡ Π² ΠΏΠΎΠ½ΠΈΠΌΠ°Π½ΠΈΠΈ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² ΠΈ ΡΠΎΠ»ΠΈ ΡΡΠΈΡ
ΠΊΠ»Π΅ΡΠΎΠΊ Π² ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ΅. ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ Ρ
ΡΠΎΠΌΠ°ΡΠΈΠ½Π° Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ Π²Π½ΡΡΡΠΈΠΊΠ»Π΅ΡΠΎΡΠ½ΡΠΌΠΈ Π±Π΅Π»ΠΊΠ°ΠΌΠΈ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΡΠΎΡΠΈΠ²ΠΎΠΌΠΈΠΊΡΠΎΠ±Π½ΠΎΠ³ΠΎ ΡΡΠ΅Π΄ΡΡΠ²Π° ΠΈΠΌΠ΅Π΅Ρ Π΄ΡΠ΅Π²Π½ΡΡ ΠΈΡΡΠΎΡΠΈΡ ΠΈ ΠΌΠ΅Π½ΡΠ΅Ρ Π½Π°ΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ ΠΎ Ρ
ΡΠΎΠΌΠ°ΡΠΈΠ½Π΅ ΡΠΎΠ»ΡΠΊΠΎ ΠΊΠ°ΠΊ ΠΎ Π½ΠΎΡΠΈΡΠ΅Π»Π΅ Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠΈ. ΠΠ»Π°Π³ΠΎΠ΄Π°ΡΡ NETs, Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»Ρ ΠΌΠΎΠ³ΡΡ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΠΎΠ²Π°ΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠ³ΠΎ ΠΈ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠΎΠΌΠ±ΠΎΠ·Π° ΠΈΠ»ΠΈ ΠΈΠΌΠΌΡΠ½ΠΎΡΡΠΎΠΌΠ±ΠΎΠ·Π°, Π° ΡΠ°ΠΊΠΆΠ΅ Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ·Π°. ΠΡΡΠ²ΠΎΠ±ΠΎΠΆΠ΄Π΅Π½ΠΈΠ΅ NETs ΡΠ²Π»ΡΠ΅ΡΡΡ, ΠΊΠ°ΠΊ Π±ΡΠ»ΠΎ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΠΎΠ΄Π½ΠΎΠΉ ΠΈΠ· ΠΏΡΠΈΡΠΈΠ½ ΡΡΠΎΠΌΠ±ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΈ ΡΠ°ΠΊΠΈΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΡΡ
ΠΊΠ°ΠΊ ΡΠ΅ΠΏΡΠΈΡ ΠΈ ΡΠ°ΠΊ. ΠΠ°Π»ΠΈΡΠΈΠ΅ NETs ΠΏΡΠΈ ΡΡΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΡ
ΠΈ ΡΠΎΡΡΠΎΡΠ½ΠΈΡΡ
Π΄Π°Π΅Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ ΠΈΡ
ΠΈΠ»ΠΈ ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΠ΅ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΡ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ
Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ². NETs ΠΈ ΠΈΡ
ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΡ ΠΌΠΎΠ³ΡΡ Π±ΡΡΡ ΠΏΡΠΈΠ²Π»Π΅ΠΊΠ°ΡΠ΅Π»ΡΠ½Ρ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠΈΡΠ΅Π½Π΅ΠΉ. ΠΠ°Π»ΡΠ½Π΅ΠΉΡΠΈΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² ΠΈ NETs Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΡ Π΄Π»Ρ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠΈ Π½ΠΎΠ²ΡΡ
ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΠΎΠ² ΠΊ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΈ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΠΉ. ΠΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎ, Π΄Π°Π²Π½ΠΎ Π·Π°Π±ΡΡΡΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ Π½Π°ΠΉΠ΄ΡΡ Π½ΠΎΠ²ΡΡ ΡΡΠ΅ΡΡ Π΄Π»Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ
COVID-19, ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΎΠΊ ΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π²Π½ΡΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΡΠ²Π΅ΡΡΡΠ²Π°Π½ΠΈΡ ΠΊΡΠΎΠ²ΠΈ. Π§Π°ΡΡΡ 2
The article discusses the issues of hemostatic system disorders in patients with COVID-19. Strengthening the coagulopathy characteristic of DIC-syndrome, is a key sign of deterioration and an unfavorable prognosis in COVID-19 patients. Data obtained by Chinese colleagues demonstrates that a significantly increased level of D-dimer is one of the predictors of death. The article also highlights the preliminary recommendations of the International society of Thrombosis and Hemostasis (ISTH, 2020) to identify markers such as D-dimer, prothrombin time and platelet count as significant predictive markers in severe COVID-19 patients. The necessity of anticoagulant therapy in hospitalized patients is justified. The article discusses the features of sepsis in pregnant women. Data from a meta-analysis of 19 studies evaluating pregnancy complications and outcomes in patients with various coronavirus infections are presented. Despite the complicated course of pregnancy, there were no cases of vertical transmission of viral infection. In the pathogenesis of severe COVID-19 complications with the formation of severe acute respiratory distress syndrome, multi-organ dysfunction, super inflammation and cytokine storm play a leading role. In connection with viral sepsis, the article discusses the role of hemophagocytic lymphohistiocytosis as a hyperinflammatory syndrome characterized by fulminant and fatal hypercytokinemia with multiple organ failure, the role of hyperferritinemia in predicting the outcomes of severe sepsis. Groups of patients at high risk of death are discussed, as well as the need for anticoagulant and anti-cytokine therapy in patients with COVID-19.Π ΡΡΠ°ΡΡΠ΅ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ Π²ΠΎΠΏΡΠΎΡΡ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΡΠΈΡΡΠ΅ΠΌΡ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ COVID-19. ΠΠ°ΡΠ°ΡΡΠ°Π½ΠΈΠ΅ ΠΊΠΎΠ°Π³ΡΠ»ΠΎΠΏΠ°ΡΠΈΠΈ, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΉ Π΄Π»Ρ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π²Π½ΡΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΡΠ²Π΅ΡΡΡΠ²Π°Π½ΠΈΡ ΠΊΡΠΎΠ²ΠΈ (ΠΠΠ‘-ΡΠΈΠ½Π΄ΡΠΎΠΌΠ°), β ΠΊΠ»ΡΡΠ΅Π²ΠΎΠΉ ΠΏΡΠΈΠ·Π½Π°ΠΊ ΡΡ
ΡΠ΄ΡΠ΅Π½ΠΈΡ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΈ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ COVID-19. ΠΡΠΈΠ²ΠΎΠ΄ΡΡΡΡ Π΄Π°Π½Π½ΡΠ΅, ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΠ΅ ΠΊΠΈΡΠ°ΠΉΡΠΊΠΈΠΌΠΈ ΠΊΠΎΠ»Π»Π΅Π³Π°ΠΌΠΈ, ΡΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΊΠΎΡΠΎΡΡΠΌ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΠΉ ΡΡΠΎΠ²Π΅Π½Ρ D-Π΄ΠΈΠΌΠ΅ΡΠ° ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ΄Π½ΠΈΠΌ ΠΈΠ· ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠ² ΡΠΌΠ΅ΡΡΠΈ. Π’Π°ΠΊΠΆΠ΅ ΠΎΡΠ²Π΅ΡΠ΅Π½Ρ ΠΏΡΠ΅Π΄Π²Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ ΠΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΡΡΠ²Π° ΡΡΠΎΠΌΠ±ΠΎΠ·Π° ΠΈ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° (International Society on Thrombosis and Haemostasis, ISTH, 2020) ΠΏΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ°ΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ², ΠΊΠ°ΠΊ D-Π΄ΠΈΠΌΠ΅Ρ, ΠΏΡΠΎΡΡΠΎΠΌΠ±ΠΈΠ½ΠΎΠ²ΠΎΠ΅ Π²ΡΠ΅ΠΌΡ ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠΎΠ², Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ Π·Π½Π°ΡΠΈΠΌΡΡ
ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΡ
Π±ΠΎΠ»ΡΠ½ΡΡ
COVID-19. ΠΠ±ΠΎΡΠ½ΠΎΠ²ΡΠ²Π°Π΅ΡΡΡ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π±ΠΎΠ»ΡΠ½ΡΡ
. Π ΡΡΠ°ΡΡΠ΅ ΠΎΠ±ΡΡΠΆΠ΄Π°ΡΡΡΡ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΡΠ΅ΠΏΡΠΈΡΠ° Ρ Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
. ΠΡΠΈΠ²ΠΎΠ΄ΡΡΡΡ Π΄Π°Π½Π½ΡΠ΅ ΠΌΠ΅ΡΠ°Π°Π½Π°Π»ΠΈΠ·Π° 19 ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΡΡ
ΠΎΡΠ΅Π½ΠΊΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΈ ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΡΡΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ ΡΠ°Π·Π»ΠΈΡΠ½ΡΠΌΠΈ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΡΠΌΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡΠΌΠΈ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½Π½ΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΡΡΠΈ, Π½Π΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Π½ΠΈ ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΠ»ΡΡΠ°Ρ Π²Π΅ΡΡΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠ΅ΡΠ΅Π΄Π°ΡΠΈ Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ. Π ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΡΡΠΆΠ΅Π»ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ COVID-19 Ρ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΎΡΡΡΠΎΠ³ΠΎ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠ³ΠΎ Π΄ΠΈΡΡΡΠ΅ΡΡ-ΡΠΈΠ½Π΄ΡΠΎΠΌΠ°, ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ Π²Π΅Π΄ΡΡΡΡ ΡΠΎΠ»Ρ ΠΈΠ³ΡΠ°ΡΡ ΡΡΠΏΠ΅ΡΠ²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΠ΅ ΠΈ ΡΠΈΡΠΎΠΊΠΈΠ½ΠΎΠ²ΡΠΉ ΡΡΠΎΡΠΌ. Π ΡΡΠ°ΡΡΠ΅ Π² ΡΠ²ΡΠ·ΠΈ Ρ Π²ΠΈΡΡΡΠ½ΡΠΌ ΡΠ΅ΠΏΡΠΈΡΠΎΠΌ ΠΎΠ±ΡΡΠΆΠ΄Π°Π΅ΡΡΡ ΡΠΎΠ»Ρ Π³Π΅ΠΌΠΎΡΠ°Π³ΠΎΡΠΈΡΠ°ΡΠ½ΠΎΠ³ΠΎ Π»ΠΈΠΌΡΠΎΠ³ΠΈΡΡΠΈΠΎΡΠΈΡΠΎΠ·Π° ΠΊΠ°ΠΊ Π³ΠΈΠΏΠ΅ΡΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ°, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΠ΅ΠΌΠΎΠ³ΠΎ ΡΡΠ»ΡΠΌΠΈΠ½Π°Π½ΡΠ½ΠΎΠΉ ΠΈ ΡΠ°ΡΠ°Π»ΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠΈΡΠΎΠΊΠΈΠ½Π΅ΠΌΠΈΠ΅ΠΉ Ρ ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ, ΡΠΎΠ»Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅ΡΡΠΈΡΠΈΠ½Π΅ΠΌΠΈΠΈ Π² ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΡΠ΅ΠΏΡΠΈΡΠ°. ΠΠ±ΡΡΠΆΠ΄Π°ΡΡΡΡ Π³ΡΡΠΏΠΏΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ Π»Π΅ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ², Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΠΎΠΉ ΠΈ Π°Π½ΡΠΈΡΠΈΡΠΎΠΊΠΈΠ½ΠΎΠ²ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
COVID-19
Fragmentation and Multifragmentation of 10.6A GeV Gold Nuclei
We present the results of a study performed on the interactions of 10.6A GeV
gold nuclei in nuclear emulsions. In a minimum bias sample of 1311 interac-
tions, 5260 helium nuclei and 2622 heavy fragments were observed as Au projec-
tile fragments. The experimental data are analyzed with particular emphasis of
target separation interactions in emulsions and study of criticalexponents.
Multiplicity distributions of the fast-moving projectile fragments are inves-
tigated. Charged fragment moments, conditional moments as well as two and three
-body asymmetries of the fast moving projectile particles are determined in
terms of the total charge remaining bound in the multiply charged projectile
fragments. Some differences in the average yields of helium nuclei and heavier
fragments are observed, which may be attributed to a target effect. However,
two and three-body asymmetries and conditional moments indicate that the
breakup mechanism of the projectile seems to be independent of target mass. We
looked for evidence of critical point observable in finite nuclei by study the
resulting charged fragments distributions. We have obtained the values for the
critical exponents gamma, beta and tau and compare our results with those at
lower energy experiment (1.0A GeV data). The values suggest that a phase
transition like behavior, is observed.Comment: latex, revtex, 28 pages, 12 figures, 3tables, submitted to Europysics
Journal
Π€Π°ΠΊΡΠΎΡ ΡΠΎΠ½ ΠΠΈΠ»Π»Π΅Π±ΡΠ°Π½Π΄Π° ΠΈ ΠΌΠΈΠ΅Π»ΠΎΠΏΠ΅ΡΠΎΠΊΡΠΈΠ΄Π°Π·Π° ΠΊΠ°ΠΊ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠ΅ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΠΏΡΠΈ ΡΡΠΆΠ΅Π»ΠΎΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠΈ COVID-19
Background. The severe acute respiratory syndrome of the SARS-CoV-2 virus-mediated coronavirus disease 2019 (COVID-19) highlighted the central role of immunothrombosis. Severe endothelial damage with the release of unusually large multimers of von Willebrand factor (vWF) and subsequent consumption of ADAMTS-13 is described during severe COVID-19. The activation of innate immune cells among which neutrophils contribute to the formation of extracellular neutrophil traps (NETs) and to the release of myeloperoxidase (MPO) potentially contributing to the spread of inflammation and microvascular thrombosis. Objective to evaluate the ability of vWF, ADAMTS-13 and MPO to predict in-hospital mortality in severe COVID-19 patients needing mechanical ventilation. Methods. We performed a one-center observational study of 79 severe COVID-19 patients entering intensive care unit for mechanical ventilation, examining vWF, ADAMTS-13 and MPO among other potential predictors for in-hospital death. Results. After multivariate analysis, vWF antigen (vWF:Ag) and MPO antigen (MPO:Ag) were finally the single two parameters which increasing values were independently associated with non-survival; vWF:Ag (U/dL): adjusted OR 3.360, 95% CI 1.5627.228, p = 0.0019; MPO:Ag (ng/ml): adjusted OR 1.062, 95% CI 1.0241.101, p = 0.0011. From these results a simplified mortality score was derived and patients categorized as having a score value higher or lower that the median value of the score: a high score value was associated with a lower cumulative survival rate (p 0.0001), 50% of the cases being dead at day 13 post-hospital admission. Conclusions. In severe COVID-19 necessitating mechanical ventilation, increasing values of MPO activity and of vWF antigen tested at admission are associated with poor survival.ΠΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠ΅. Π’ΡΠΆΠ΅Π»ΡΠΉ ΠΎΡΡΡΡΠΉ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΠΉ ΡΠΈΠ½Π΄ΡΠΎΠΌ, Π·Π°ΠΏΡΡΠΊΠ°Π΅ΠΌΡΠΉ Π²ΠΈΡΡΡΠΎΠΌ SARS-CoV-2, ΠΎΠ±ΠΎΠ·Π½Π°ΡΠΈΠ» ΡΠ΅Π½ΡΡΠ°Π»ΡΠ½ΡΡ ΡΠΎΠ»Ρ Π² ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΠΈΠΌΠΌΡΠ½ΠΎΡΡΠΎΠΌΠ±ΠΎΠ·Π°. ΠΡΠΈ ΡΡΠΆΠ΅Π»ΠΎΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠΈ COVID-19 ΠΎΠΏΠΈΡΠ°Π½ΠΎ ΠΌΠ°ΡΡΠΈΠ²Π½ΠΎΠ΅ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠ΅ ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΡ Ρ Π²ΡΡΠ²ΠΎΠ±ΠΎΠΆΠ΄Π΅Π½ΠΈΠ΅ΠΌ Π±ΠΎΠ»ΡΡΠΎΠ³ΠΎ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΠΌΡΠ»ΡΡΠΈΠΌΠ΅ΡΠΎΠ² ΡΠ°ΠΊΡΠΎΡΠ° ΡΠΎΠ½ ΠΠΈΠ»Π»Π΅Π±ΡΠ°Π½Π΄Π° (vWF) ΠΈ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠΈΠΌ ΠΏΠΎΡΡΠ΅Π±Π»Π΅Π½ΠΈΠ΅ΠΌ ADAMTS-13. ΠΠΊΡΠΈΠ²Π°ΡΠΈΡ ΠΊΠ»Π΅ΡΠΎΠΊ Π²ΡΠΎΠΆΠ΄Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠΌΠΌΡΠ½ΠΈΡΠ΅ΡΠ°, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ², ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΡ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΡΠ½ΡΡ
Π²Π½Π΅ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΡ
Π»ΠΎΠ²ΡΡΠ΅ΠΊ (NETs) ΠΈ Π²ΡΡΠ²ΠΎΠ±ΠΎΠΆΠ΄Π΅Π½ΠΈΡ ΠΌΠΈΠ΅Π»ΠΎΠΏΠ΅ΡΠΎΠΊΡΠΈΠ΄Π°Π·Ρ (ΠΠΠ), ΡΡΠΎ, Π² ΡΠ²ΠΎΡ ΠΎΡΠ΅ΡΠ΅Π΄Ρ, ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΠ΅Ρ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΡ ΠΏΡΠΎΡΠ΅ΡΡΠΎΠ² Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ ΠΈ ΡΡΠΎΠΌΠ±ΠΎΠ·Π° Π² ΠΌΠΈΠΊΡΠΎΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΌ ΡΡΡΠ»Π΅. Π¦Π΅Π»Ρ ΠΎΡΠ΅Π½ΠΈΡΡ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠ΅Π½Π½ΠΎΡΡΡ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ vWF, ADAMTS-13 ΠΈ MΠO Π² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ Π²Π½ΡΡΡΠΈΠ±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ ΡΠΎΡΠΌΠΎΠΉ COVID-19, Π½ΡΠΆΠ΄Π°ΡΡΠΈΡ
ΡΡ Π² ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ
(ΠΠΠ). ΠΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΎΠ΄Π½ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π°ΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Ρ ΡΡΠ°ΡΡΠΈΠ΅ΠΌ 79 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ COVID-19, Π½Π°Ρ
ΠΎΠ΄ΠΈΠ²ΡΠΈΡ
ΡΡ Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π½Π° ΠΠΠ. Π£ Π²ΡΠ΅Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈΡΡ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ vWF, ADAMTS-13 ΠΈ MΠO Π² ΡΡΠ²ΠΎΡΠΎΡΠΊΠ΅ ΠΊΡΠΎΠ²ΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ Π΄ΡΡΠ³ΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΠ΅ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΡ Π²Π½ΡΡΡΠΈΠ±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΡΠ΅ΠΌ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΌΠ½ΠΎΠ³ΠΎΡΠ°ΠΊΡΠΎΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π° Π±ΡΠ»ΠΎ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΡΡΠΎ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ ΡΠ°ΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ², ΠΊΠ°ΠΊ Π°Π½ΡΠΈΠ³Π΅Π½ vWF (vWF:AΠ³) ΠΈ MΠO ΡΠ΅Π»ΠΎΠ²Π΅ΠΊΠ° (MΠO:AΠ³), Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΠΈ Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΠΎ ΡΠ²ΡΠ·Π°Π½ΠΎ Ρ Π²ΡΡΠΎΠΊΠΎΠΉ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡΡ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ; vWF:AΠ³ (ΠΠ/Π΄Π»): ΡΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΠΠ¨ 3,360; 95%-ΠΉ ΠΠ 1,5627,228; Ρ = 0,0019; MΠO:AΠ³ (Π½Π³/ΠΌΠ»): ΡΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΠΠ¨ 1,062; 95%-ΠΉ ΠΠ 1,0241,101; Ρ = 0,0011. ΠΠ° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΠΈΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Π±ΡΠ» ΠΏΠΎΠ»ΡΡΠ΅Π½ ΡΠΏΡΠΎΡΠ΅Π½Π½ΡΠΉ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ, ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»ΠΈ ΠΊΠ»Π°ΡΡΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Ρ ΠΊΠ°ΠΊ ΠΈΠΌΠ΅ΡΡΠΈΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ Π΄Π°Π½Π½ΠΎΠ³ΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ Π²ΡΡΠ΅ ΠΈΠ»ΠΈ Π½ΠΈΠΆΠ΅ ΠΌΠ΅Π΄ΠΈΠ°Π½Π½ΠΎΠ³ΠΎ: Π²ΡΡΠΎΠΊΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ Π±ΡΠ»ΠΎ ΡΠ²ΡΠ·Π°Π½ΠΎ Ρ Π±ΠΎΠ»Π΅Π΅ Π½ΠΈΠ·ΠΊΠΎΠΉ ΠΊΡΠΌΡΠ»ΡΡΠΈΠ²Π½ΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡΡ (p 0,0001), Π² 50% ΡΠ»ΡΡΠ°Π΅Π² ΡΠΌΠ΅ΡΡΡ Π½Π°ΡΡΡΠΏΠ°Π»Π° Π½Π° 13-Π΅ ΡΡΡ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ. ΠΡΠ²ΠΎΠ΄Ρ. ΠΡΠΈ ΡΡΠΆΠ΅Π»ΠΎΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠΈ COVID-19, ΡΡΠ΅Π±ΡΡΡΠ΅ΠΌ ΠΠΠ, ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΠ΅ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ ΠΠΠ ΠΈ vWF Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ ΠΏΠΎΡΡΡΠΏΠ»Π΅Π½ΠΈΡ ΠΊΠΎΡΡΠ΅Π»ΠΈΡΡΡΡ Ρ ΠΏΠ»ΠΎΡ
ΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡΡ
COVID-19, Π½Π°ΡΡΡΠ΅Π½ΠΈΡ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° ΠΈ ΡΠΈΡΠΊ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ
The spread of a new coronavirus infection worldwide since the end of 2019 has becomes a pandemic. Thrombotic complications are the leading cause of death in this disease. After entering the human body, the virus starts a cascade of reactions leading to the development of a cytokine storm, activation of all parts of the hemostasis and complement systems and other changes that result in disturbances in the circulation system with the development of multiple organ failures. Numerous studies have shown that a predictor of a severe course of COVID-19 is a sharp increase of D-dimer concentration in the blood and rise of some other markers of hemostasis activation. Based on the pathogenesis, the developed schemes for the prevention and treatment of COVID-19 severe complications include low molecular weight heparins (LMWH) which are also recommended for an outpatient COVID-19 patient. The prescription of low molecular weight heparin, the duration of their use and doses should be decided on the basis of a risk assessment of factors for each individual patient in combination with laboratory monitoring.Π Π°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΠ΅ Π½ΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΏΠΎ Π²ΡΠ΅ΠΌΡ ΠΌΠΈΡΡ Ρ ΠΊΠΎΠ½ΡΠ° 2019 Π³. ΠΏΡΠ΅Π²ΡΠ°ΡΠΈΠ»ΠΎΡΡ Π² ΠΏΠ°Π½Π΄Π΅ΠΌΠΈΡ. Π’ΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΡΠ²Π»ΡΡΡΡΡ Π²Π΅Π΄ΡΡΠ΅ΠΉ ΠΏΡΠΈΡΠΈΠ½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠΈ ΠΏΡΠΈ ΡΡΠΎΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΈ. ΠΠΎΡΠ»Π΅ ΠΏΠΎΠΏΠ°Π΄Π°Π½ΠΈΡ Π² ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌ ΡΠ΅Π»ΠΎΠ²Π΅ΠΊΠ° Π²ΠΈΡΡΡ Π·Π°ΠΏΡΡΠΊΠ°Π΅Ρ ΠΊΠ°ΡΠΊΠ°Π΄ ΡΠ΅Π°ΠΊΡΠΈΠΉ, ΠΏΡΠΈΠ²ΠΎΠ΄ΡΡΠΈΡ
ΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠΈΡΠΎΠΊΠΈΠ½ΠΎΠ²ΠΎΠ³ΠΎ ΡΡΠΎΡΠΌΠ°, Π°ΠΊΡΠΈΠ²Π°ΡΠΈΠΈ Π²ΡΠ΅Ρ
Π·Π²Π΅Π½ΡΠ΅Π² ΡΠΈΡΡΠ΅ΠΌΡ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° ΠΈ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΌΠ΅Π½ΡΠ°, Π΄ΡΡΠ³ΠΈΠΌ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌ, ΠΏΡΠΈΠ²ΠΎΠ΄ΡΡΠΈΠΌ ΠΊ Π½Π°ΡΡΡΠ΅Π½ΠΈΡΠΌ Π² ΡΠΈΡΡΠ΅ΠΌΠ΅ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Ρ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΠΌ ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½ΡΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ. ΠΠ½ΠΎΠ³ΠΎΡΠΈΡΠ»Π΅Π½Π½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°Π»ΠΈ, ΡΡΠΎ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠΌ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ΅Π·ΠΊΠΎΠ΅ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ D-Π΄ΠΈΠΌΠ΅ΡΠ° Π² ΠΊΡΠΎΠ²ΠΈ ΠΈ Π½Π΅ΠΊΠΎΡΠΎΡΡΡ
Π΄ΡΡΠ³ΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Π°ΠΊΡΠΈΠ²Π°ΡΠΈΠΈ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π°. ΠΡΡ
ΠΎΠ΄Ρ ΠΈΠ· ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π°, ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π½ΡΠ΅ ΡΡ
Π΅ΠΌΡ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡΠΆΠ΅Π»ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ COVID-19 Π²ΠΊΠ»ΡΡΠ°ΡΡ Π½ΠΈΠ·ΠΊΠΎΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΡΠ΅ Π³Π΅ΠΏΠ°ΡΠΈΠ½Ρ, ΠΊΠΎΡΠΎΡΡΠ΅ ΡΠ°ΠΊΠΆΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΡΡ Π΄Π»Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π² Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΡΡ
ΡΡΠ»ΠΎΠ²ΠΈΡΡ
. ΠΠ°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π½ΠΈΠ·ΠΊΠΎΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΡΡ
Π³Π΅ΠΏΠ°ΡΠΈΠ½ΠΎΠ², Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΈΡ
ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΈ Π΄ΠΎΠ·Ρ Π΄ΠΎΠ»ΠΆΠ½Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΡΡΡΡ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΡΠΈΡΠΊΠ° Π΄Π»Ρ ΠΊΠ°ΠΆΠ΄ΠΎΠ³ΠΎ ΠΎΡΠ΄Π΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠΌ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³ΠΎΠΌ
COVID-19 and thrombotic microangiopathy [COVID-19 ΠΈ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΌΠΈΠΊΡΠΎΠ°Π½Π³ΠΈΠΎΠΏΠ°ΡΠΈΡ]
As shown by numerous studies conducted during the pandemic, the severe course of COVID-19 is accompanied by multiple organ failure. Cytokine storm, hypercoagulation, complement hyperactivation and other arms comprise the overall picture of the pathogenesis of the severe disease course. The frequent diagnosis of multiple microvascular thrombosis in lung, heart, and kidneys, as well as the presence of platelet-fibrin thrombi there and signs of terminal organ damage, suggest a possible involvement of thrombotic microangiopathy (TMA) in the development of multiple organ failure. In this regard, it is especially important to timely diagnose TMA and start pathogenetic therapy. These measures can significantly reduce mortality due to the novel disease. Heparins and direct oral anticoagulants are the mainstay for prevention and treatment of venous thromboembolism in patients with COVID-19, but their effectiveness in the presence of TMA is questionable. It has been proven that anticoagulants use in critically ill patients with COVID-19 for prevention of large vessel thrombosis is effective, but their role in the prevention of microthrombosis is not clear. Here we review the currently available information on thrombotic microangiopathy, as well as a review of literature data describing TMA-like conditions in COVID-19, discuss potential pathophysiology of the condition development and proposed therapeutic approaches. Β© Obstetrics, Gynecology and Reproduction 2021
ΠΠ»ΠΈΡΠ½ΠΈΠ΅ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ Π²ΠΈΠ΄ΠΎΠ² Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π½Π° ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ ΠΏΡΠΈ COVID-19
Coronavirus disease 2019 (COVID-19) is a viral infection that, in severe course, leads to the development of a cytokine storm, systemic inflammatory response and coagulopathy. Unlike other sepsis-associated disseminated intravascular coagulopathy, COVID-19 induced coagulopathy is realized mainly in thrombosis. Researchers around the world are currently developing adequate diagnostic, monitoring and anticoagulant therapy approaches to safely and effectively manage patients with severe COVID-19. The need to develop laboratory monitoring is due to the fact that 20% of patients have changes in hemostasis indicators, while in patients with a severe form of the disease, they are present in 100% of cases. In case of deaths from COVID-19, there is an increase in the concentration of D-dimer and fibrinogen degradation products. Thus, the severity of hemostasis disorders has an important prognostic value. Anticoagulant therapy is included in the list of all recommendations as an effective means of reducing mortality from COVID-19. The questions of the recommended groups and doses of anticoagulant drugs are still open. The approach to the choice of an anticoagulant should be based not only on risk factors, characteristics of the course of the disease, anamnesis, but also on the wishes of the patient during long-term therapy at the post-hospital stage.ΠΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½Π°Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ 2019 (COVID-19) Π²ΠΈΡΡΡΠ½Π°Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ, ΠΏΡΠΈ ΡΡΠΆΠ΅Π»ΠΎΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠΈ ΠΏΡΠΈΠ²ΠΎΠ΄ΡΡΠ°Ρ ΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠΈΡΠΎΠΊΠΈΠ½ΠΎΠ²ΠΎΠ³ΠΎ ΡΡΠΎΡΠΌΠ°, ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ³ΠΎ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΡΠ²Π΅ΡΠ°, ΠΊΠΎΠ°Π³ΡΠ»ΠΎΠΏΠ°ΡΠΈΠΈ. Π ΠΎΡΠ»ΠΈΡΠΈΠ΅ ΠΎΡ Π΄ΡΡΠ³ΠΈΡ
ΡΠ΅ΠΏΡΠΈΡ-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΠΉ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π²Π½ΡΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΡΠ²Π΅ΡΡΡΠ²Π°Π½ΠΈΡ (ΠΠΠ‘), ΠΊΠΎΠ²ΠΈΠ΄-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΊΠΎΠ°Π³ΡΠ»ΠΎΠΏΠ°ΡΠΈΡ ΡΠ΅Π°Π»ΠΈΠ·ΡΠ΅ΡΡΡ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ Π² ΡΡΠΎΠΌΠ±ΠΎΠ·Ρ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΠΈ Π²ΠΎ Π²ΡΠ΅ΠΌ ΠΌΠΈΡΠ΅ Π² Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΡΠ°Π·ΡΠ°Π±Π°ΡΡΠ²Π°ΡΡ Π°Π΄Π΅ΠΊΠ²Π°ΡΠ½ΡΠ΅ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ ΠΊ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅, ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³Ρ ΠΈ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π΄Π»Ρ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΠ³ΠΎ ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌΠΈ ΡΠΎΡΠΌΠ°ΠΌΠΈ COVID-19. ΠΠ΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³Π° ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Π° ΡΠ΅ΠΌ, ΡΡΠΎ Ρ 20% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈΠΌΠ΅ΡΡΡΡ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π°, ΠΏΡΠΈ ΡΡΠΎΠΌ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ ΡΠΎΡΠΌΠΎΠΉ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΎΠ½ΠΈ ΠΏΡΠΈΡΡΡΡΡΠ²ΡΡΡ Π² 100% ΡΠ»ΡΡΠ°Π΅Π². ΠΡΠΈ Π»Π΅ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄Π°Ρ
COVID-19 ΠΎΡΠΌΠ΅ΡΠ°Π΅ΡΡΡ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΠ΅ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ D-Π΄ΠΈΠΌΠ΅ΡΠ° ΠΈ ΠΏΡΠΎΠ΄ΡΠΊΡΠΎΠ² Π΄Π΅Π³ΡΠ°Π΄Π°ΡΠΈΠΈ ΡΠΈΠ±ΡΠΈΠ½ΠΎΠ³Π΅Π½Π°. Π’Π°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, ΡΡΠ΅ΠΏΠ΅Π½Ρ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° ΠΈΠΌΠ΅Π΅Ρ Π²Π°ΠΆΠ½ΠΎΠ΅ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅. ΠΠ½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ Π²Π½Π΅ΡΠ΅Π½Π° Π² ΠΏΠ΅ΡΠ΅ΡΠ΅Π½Ρ Π²ΡΠ΅Ρ
ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΉ ΠΊΠ°ΠΊ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΡΡΠ΅Π΄ΡΡΠ²ΠΎ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΠΈ ΠΎΡ COVID-19. ΠΠΎ-ΠΏΡΠ΅ΠΆΠ½Π΅ΠΌΡ ΠΎΡΠΊΡΡΡΡΠΌ ΠΎΡΡΠ°ΡΡΡΡ Π²ΠΎΠΏΡΠΎΡΡ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΠΌΡΡ
Π³ΡΡΠΏΠΏ ΠΈ Π΄ΠΎΠ· Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ². ΠΠΎΠ΄Ρ
ΠΎΠ΄ ΠΊ Π²ΡΠ±ΠΎΡΡ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ° Π΄ΠΎΠ»ΠΆΠ΅Π½ Π±ΡΡΡ ΠΎΡΠ½ΠΎΠ²Π°Π½ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π½Π° ΡΠ°ΠΊΡΠΎΡΠ°Ρ
ΡΠΈΡΠΊΠ°, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΡΡ
ΡΠ΅ΡΠ΅Π½ΠΈΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, Π°Π½Π°ΠΌΠ½Π΅Π·Π°, Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π° ΠΏΠΎΠΆΠ΅Π»Π°Π½ΠΈΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΏΡΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π½Π° ΠΏΠΎΡΡΠ³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΠΎΠΌ ΡΡΠ°ΠΏΠ΅
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