Influence of 5-hydroxymethyluracil on the dynamics of angiogenic growth factors in the perioperative period of surgical myocardial revascularization: results of a randomized trial

Aim. To evaluate the effect of 5-hydroxymethyluracil on the dynamics of angiogenic growth factors in the perioperative period of surgical myocardial revascularization.Material and methods. This prospective, randomized, single-center study included two following groups: experimental group — 25 patients in the perioperative period of coronary artery bypass grafting (5 days before and 14 days after surgery) receiving 5-hydroxymethyluracil (at a dose of 500 mg 3 times a day) in addition to standard therapy; control group — 25 patients receiving standard therapy. The groups were comparable in terms of sex, age, main clinical and functional characteristics and features of surgical intervention. In patients, quantitative indicators of angiogenic growth factors in peripheral blood taken 5 days before and 14 days after surgery were studied by enzyme immunoassay: human vascular endothelial growth factor A (VEGF-A), human hepatocyte growth factor (hHGF), insulin-like factor growth 1 (IGF-1) and basic fibroblast growth factor (bFGF).Results. In the experimental group of patients, while taking 5-hydroxymethyluracil, there was a significant increase in the peripheral blood concentration of following growth factors compared with the control group: VEGF-A by 26,90% (p=0,0246), IGF-1 by 44,89% (p=0,0011), bFGF by 60,0% (p=0,0006). The hHGF concentration also turned out to be higher by 19,90%, but did not reach the level of statistical significance (p=0,2836).Conclusion. The use of 5-hydroxymethyluracil, a representative of pyrimidines, in the perioperative period of surgical myocardial revascularization leads to a significant increase in peripheral blood of such angiogenic growth factors as VEGF-A, IGF-1, and bFGF

Совершенствование оказания медицинской помощи пациентам с ОНМК с применением стандартов JCI. Первые результаты

AIM OF THE STUDY To compare the dynamics of thrombolytic therapy effectiveness in patients with stroke after the reorganization of medical care using JCI standards.MATERIAL AND METHODS In 2022, a new system for routing patients with stroke at the level of the emergency department was introduced in the Emergency Care Hospital; and 976 patients with the diagnosis of brain infarction were treated. The analysis of the results was carried out by comparing the mortality rates from ischemic stroke, the number of thrombolytic therapies and procedures of mechanical methods of revascularization, as well as the indicators “Door-CT”, “DoorNeedle”, “Door-Opening” for 2021 and 10 months of 2022.RESULTS After the introduction of the new routing system for patients with stroke at the emergency department level, there appeared the first positive results. Thus, the mortality rate from brain infarction in 10 months of 2022 decreased by 5.6% compared to 2021. The number of thrombolytic therapies performed increased by 5.2%, and mechanical revascularization procedures by 1.62% over the same period, while the “Door-CT” indicator decreased by 27 minutes, “DoorNeedle” by 22 minutes, “Door-Opening” by 31.6 minutes.CONCLUSIONS The immediate results of the introduction of the new patient routing system at the level of the emergency department have proved successful, primarily due to the significant reduction in the mortality rate of patients with cerebral infarction by 5.6%. However, the process requires further investigation and has application points for further improvement.ЦЕЛЬ ИССЛЕДОВАНИЯ Сравнить динамику эффективности проведения тромболитической терапии у пациентов с острым нарушением мозгового кровообращения (ОНМК) после реорганизации медицинской помощи с применением стандартов JCI.МАТЕРИАЛ И МЕТОДЫ В ГАУЗ РТ «БСМП» в 2022 г. внедрена новая система маршрутизации пациентов с ОНМК на уровне приемного отделения и пролечены 976 пациентов с диагнозом «Инфаркт мозга». Анализ полученных результатов проводили путем сравнения показателей летальности от ишемического инсульта, количества проведенных тромболитических терапий и процедур механических методов реваскуляризации, а также показателей «Дверь–КТ», «Дверь–Игла», «Дверь–Раскрытие» за 2021 г. и 10 месяцев 2022 г.РЕЗУЛЬТАТЫ После внедрения новой системы маршрутизации пациентов с ОНМК на уровне приемного отделения с применением стандартов JCI имеются первые положительные результаты. Так, летальность от инфаркта мозга за 10 месяцев 2022 г. снизилась на 5,6% в сравнении с 2021 г. Количество проведенных тромболитических терапий увеличилось на 5,2%, а процедур механических методов реваскуляризации — на 1,62% за аналогичный период, в то время как показатель «Дверь–КТ» снизился на 27 минут, «Дверь–Игла» — на 22 минуты, а «Дверь–Раскрытие» — на 31,6 минуты.ЗАКЛЮЧЕНИЕ Непосредственные результаты внедрения новой системы маршрутизации пациентов на уровне приемного отделения являются успешными, в первую очередь за счет значимого снижения летальности пациентов с инфарктом мозга на 5,6%. Однако процесс требует дальнейшего исследования и имеет точки приложения для дальнейшего улучшения

Место фиксированной комбинации будесонид / формотерол в лечении хронической обструктивной болезни легких стабильного течения. Заключение совета экспертов Приволжского федерального округа Российской Федерации

Late diagnosis of chronic obstructive pulmonary disease (COPD) at advanced stage, high risk of exacerbations, low compliance of patients, and adverse effects of treatment have been still unresolved problems in the treatment of COPD despite the development of new drugs. The personalized medicine rneeds distinct indications and predictors of efficacy and safety of treatment. Budesonide/formoterol fixed combination is recommended for patients with asthma – COPD overlap syndrome and bronchitis phenotype, blood eosinophilia > 300 cells/mm3, if other causes were excluded, post-bronchodilator forced expiratory volume in 1 second (FEV1) < 50% pred.; and ≥ 2 exacerbations or ≥ 1 hospitalization related to exacerbation during the previous year. Budesonide/formoterol fixed combination is not recommended for regular use in patients with emphysema phenotype of COPD and rare exacerbations (< 2 exacerbations and without hospitalizations in the previous year).Несмотря на появление новых препаратов для лечения пациентов с хронической обструктивной болезнью легких (ХОБЛ), в настоящее время нерешенными проблемами в терапии этого заболевания остаются поздняя диагностика и выявление ХОБЛ уже на стадии тяжело протекающего заболевания, высокий риск обострений, низкая комплаентность пациентов, побочное действие лекарственных средств. Персонализированная медицина требует четких показаний, предикторов эффективности и безопасности лечения. Терапия фиксированной комбинацией будесонид / формотерол рекомендована пациентам с сочетанием бронхиальной астмы (БА) и ХОБЛ; высоким уровнем эозинофилов в периферической крови (> 300 клеток в 1 мкл крови) при исключении других причин (гельминты, лямблии и т. п.) и с постбронходилатационным объемом форсированного выдоха за 1-ю секунду (ОФВ1) < 50 %долж.; бронхитическим фенотипом; ≥ 2 обострениями в предшествующий год; ≥ 1 госпитализацией по поводу обострения в течение 1 года при наличии постбронходилатационного ОФВ1 < 50 %долж. Фиксированная комбинация будесонид / формотерол не рекомендуется к регулярному назначению при эмфизематозном фенотипе ХОБЛ у больных с редкими обострениями (< 2 / без госпитализаций за предшествующий год)

NEURAL NETWORK MODEL FOR DIAGNOSING MYOCARDIAL INFARCTION

Body surface potential mapping (BSPM) is a non-invasive and effective method for diagnosing coronary heart disease (CHD) and acute myocardial infarction (AMI). However, most existing systems of BSPM are unable to create standard diagnostic criteria. Aim. To develop the neural network model (NNM) for diagnosing Q-wave AMI and to assess the model effectiveness. Material and methods. The BSPM method in 90 leads was used in 96 controls, 35 patients with anterior Q-wave AMI, 43 with posterior Q-wave AMI, 14 with inferior Q-wave AMI, and 21 with lateral Q-wave AMI. The input NNM layer was decomposed into five subsets corresponding to horizontal levels of registered signals, using amplitudes of Q, R, S, and T waves and the ST segment. The output layer produced the probability of the norm (controls) and different AMI locations. Results. Exploring the NNM performance in controls and AMI patients, sensitivity of 100% and specificity of 97,4% was observed. Sensitivity reached 100% for anterior Q-wave AMI, 94,4% for posterior Q-wave AMI, 85,7% for inferior Q-wave AMI, and 83,3% for lateral Q-wave AMI. Conclusion. Our data have demonstrated the effectiveness of NNM in AMI diagnostics

TOPICAL DIAGNOSTICS OF SINGLE CORONARY ARTERY OCCLUSION IN ST ELEVATION MYOCARDIAL INFARCTION PATIENTS

In ST elevation myocardial infarction (STEMI) diagnostics, main role is played by electrocardiography (ECG), which makes it to define MI itself as, in many cases, localization of occlusion.Aim. To investigate on the efficacy of topical diagnostics of coronary arteries lesion in STEMI with single vessel disease, by ECG.Material and methods. Totally, 200 STEMI patients (59,9±0,93 лет) included, with single vessel disease. The accuracy of diagnostics evaluated, of the coronary occlusion localization in three coronary arteries and in 2 segments in each of them, by original diagnostical algorithm.Results. An algorithm invented, for diagnostics of multivessel disease of three coronary arteries, that makes it to perform topical diagnostics of the left anterior descending artery (sensitivity 92,2% and specificity 96,5%), of the right coronary artery (92,3% and 95,1%) and, at lesser grade, of the circumflex artery (81,5% and 66,7%), as two sectors in each of them with sensitivity 48,8-66,7% and specificity 60,0-74,5%.Conclusion. In STEMI, an algorithm invented, and the software that calculates risk of occlusion of an exact coronary artery and its segments, as the risk of fatal outcome

O-2-O-2 and O-2-N-2 collision-induced absorption mechanisms unravelled

Contains fulltext : 191179.pdf (Publisher’s version ) (Open Access