ФАКТОРИ ФОРМУВАННЯ БРОНХОЛЕГЕНЕВО ПАТОЛОГІ У ДІТЕЙ РАННЬОГО ВІКУ, КОТРИМ ПРОВОДИЛАСЯ ТРИВАЛА РЕСПІРАТОРНА ТЕРАПІЯ У НЕОНАТАЛЬНОМУ ПЕРІОДІ.

Literature data and own experience of the authors are demonstrated a connection between artificial pulmonary ventilation at the neonatal period and later forming of bronchopulmonary pathology. At the article results of medical supervision of 22 children, suffering from recurrent bronchoobstructive syndrome, are shown. The same children were ventilated atthe neonatal period because of acute pulmonary disorders.В статье представлены литературные данные и собственный опыт авторов, которые доводят, что существует связь между проведенной искусственной вентиляцией легких (ИВЛ) в неонатальном периоде и дальнейшим формированием бронхолёгочной патологии. Показанные результаты наблюдения 22 детей с рецидивным бронхообструктивным синдромом, которым после рождения по поводу острых респираторных нарушений проводилась ИВЛ.У статті представлені літературні дані і власний досвід авторів, які доводять, що існує взаємозв’язок між проведеною штучною вентиляцією легень (ШВЛ) в неонатальному періоді і подальшим формуванням бронхолегенево патологі . Показані результати спостережень 22 дітей, хворих на рецидивуючий бронхообструктивний синдром, яким після народження з приводу гострих респіраторних розладів проводилася ШВЛ

Leptoquark pair production at the Fermilab Tevatron: Signal and backgrounds

We perform a Monte-Carlo simulation of scalar leptoquark pair production at the Tevatron (energy =1.8 TeV and luminosity =100 pb^{-1}) with ISAJET. We also investigate the dominant sources of Standard Model background: Z*jj, ZZ production and heavy quark top-antitop. We find that the top-antitop background is the most important except near the Z pole where the Z*jj background is peaked. We also evaluate the signal-to-background ratio and find a discovery reach of 130 GeV (170 GeV) for a branching ratio of B(LQ-> eq)=0.5 (B=1).Comment: 8 pages, 6 figures, latex (revtex

Scalar and Vector Leptoquark Pair Production at Hadron Colliders: Signal and Backgrounds

We perform a systematic analysis of scalar and vector leptoquark pair production at the Fermilab Tevatron and at the CERN LHC. We evaluate signal expectations and background levels for the processes pp (p ppar) -> 2 jets + e^{+} + e^{-} and 2 jets + e + missing p_T. The Monte Carlo event generator ISAJET is used to simulate the experimental conditions at the current (Sqrt{s}=1.8 TeV, Luminosity=100 pb^{-1}) and upgraded (Luminosity=100 pb^{-1}) Tevatron as well as the LHC (Sqrt{s}=14 TeV, Luminosity=10 fb^{-1}). Depending on the luminosity, and assuming a branching ratio B(LQ -> eq)=0.5, we find a discovery reach up to 170 (255) GeV for scalar leptoquarks at the current (upgraded) Tevatron. Similarly, we find vector leptoquarks to be detectable at masses below 300 (400) GeV depending on the coupling. At the LHC, the discovery reach is enhanced to 1 TeV for scalar leptoquarks and to 1.5 TeV for vectors.Comment: 15 pages (REVTEX), 12 figures, submitted to Phys. Rev.

Прогноз гострого інфаркту міокарда з елевацією сегмента ST залежно від особливостей інтракоронарних тромбів

 Risk stratification among patients with acute ST-segment elevation myocardial infarction (STEMI) is very important. Morphological features of intracoronary thrombus significantly influence the prognosis.Aim. To estimate the prognosis after STEMI treated with primary percutaneous coronary intervention (PCI) depending on the morphological structure of intracoronary thrombi obtained during manual thromboaspiration.Materials and methods. Totally 97 patients with STEMI who underwent primary PCI were included into the study. Morphological structure of intracoronary thrombi obtained by manual thromboaspiration was evaluated in all participants. Further, the different structure of thrombi influence on the risk of developing a composite endpoint was determined, which represented a death, myocardial infarction, revascularization, and angina symptoms onset or worsening. The duration of follow-up was 24 months.Results. In 24 months after primary PCI, the occurrence of the endpoint correlated significantly only with macroscopic signs of intracoronary clots, negatively – with white (r = -0.21, P = 0.05) and red thrombi (r = -0.30, P < 0.01), and positively – with mixed thrombi (r = 0.41, P < 0.001). Using the logistic regression, the factors were revealed which in a case of combined action, may increase the risk of the combined endpoint: old blood clots (V1), the presence of microchannels (V2), peripheral leukocyte infiltration (V3), and gross mixed thrombi (V4). The following model was developed for calculating the probability of these factors influence on the occurrence of cardiovascular events included into the endpoint:Z = 2.37 × V1 + 2.21 × V2 + 1.69 × V3 + 3.24 × V4 - 5.60.The model is reliable (P < 0.0001) with a sensitivity of 83.33 % and a specificity of 88.24 %.Conclusions. Despite the similar clinical manifestations and duration of the disease, intracoronary thrombi that cause STEMI differ significantly. Their morphological characteristics were related to the prognosis. These characteristics may be used for construction of a reliable risk scale that is suitable for clinical practice.  Острый инфаркт миокарда с элевацией сегмента ST (STEMI) – значительная медико-социальная проблема. Очень важна стратификация риска пациентов с данной патологией. Факторы, которые могут существенно ее улучшить, – морфологические особенности интракоронарных тромбов, ставшие причиной STEMI.Цель работы – изучить прогноз STEMI в зависимости от морфологической структуры интракоронарных тромбов, полученных при проведении мануальной тромбоаспирации, как одного из элементов первичного чрескожного коронарного вмешательства.Материалы и методы. В исследование вошли 97 пациентов со STEMI, у которых изучали структуру интракоронарных тромбов. Определяли влияние различной структуры тромбов на риск развития комбинированной конечной точки исследования: смерть, инфаркт миокарда, реваскуляризацию, возникновение или ухудшение симптомов стенокардии. Длительность наблюдения – 24 месяца.Результаты. Обнаружили такие морфологические особенности интракоронарных тромбов: старые тромбы – 48,45 % случаев, их послойная структура – 60,82 %, наличие микроканалов – 39,18 %, периферической инфильтрации нейтрофильными лейкоцитами – 54,54 %. По макроскопическим характеристикам красными были 49,48 % тромбов, смешанными – 43,30 %, белыми – 7,22 %. Через 24 месяца после первичного чрескожного коронарного вмешательства достоверные корреляционные связи обнаружили лишь с макроскопическими признаками интракоронарных тромбов: с белыми (r = -0,21, р = 0,05) и красными (r = -0,30, р < 0,01) – отрицательные связи, со смешанными (r = 0,41, р < 0,001) – положительные. Используя метод логистической регрессии, выделили факторы, которые в случае сочетанного действия влияют на риск развития одного из элементов комбинированной конечной точки: старые тромбы (V1), наличие микроканалов (V2), периферическая инфильтрация лейкоцитами (V3), макроскопически смешанные тромбы (V4). Формула для расчета определения достоверности влияния избранных факторов на возникновение комбинированной конечной точки: Z = 2,37 × V1 + 2,21 × V2 + 1,69 × V3 + 3,24 × V4 - 5,60. Модель достоверна (p < 0,0001) с чувствительностью 83,33 % и специфичностью 88,24 %.Выводы. Интракоронарные тромбы, вызывающие STEMI, существенно отличаются, несмотря на похожие клиническую картину и продолжительность заболевания. Их морфологические характеристики связаны с прогнозом пациентов. Они могут быть использованы для построения достоверной шкалы риска, которая реальна для использования в клинической практике. Гострий інфаркт міокарда з елевацією сегмента ST (STEMI) – складна медико-соціальна проблема. Дуже важлива стратифікація ризику пацієнтів із цією патологією. Факторами, які можуть суттєво її поліпшити, є морфологічні особливості інтракоронарних тромбів, що спричинили STEMI.Мета роботи – вивчити прогноз STEMI залежно від морфологічної структури інтракоронарних тромбів, що отримані під час мануальної тромбоаспірації, як одного з елементів первинного черезшкірного коронарного втручання.Матеріали та методи. У дослідження залучили 97 пацієнтів зі STEMI, в яких вивчали структуру інтракоронарних тромбів, що отримані під час мануальної тромбоаспірації. Визначили вплив різної структури тромбів на ризик розвитку комбінованої кінцевої точки дослідження, що включала смерть, інфаркт міокарда, реваскуляризацію, виникнення чи погіршення симптомів стенокардії. Тривалість спостереження – 24 місяці.Результати. Виявили такі морфологічні особливості інтракоронарних тромбів: старі тромби – 48,45 % випадків, їхня пошарова структура – 60,82 %, наявність мікроканалів – 39,18 %, периферичної інфільтрації нейтрофільними лейкоцитами – 54,54 %. За макроскопічними характеристиками червоними були 49,48 % тромбів, змішаними – 43,30 %, білими – 7,22 %. Через 24 місяці після первинного черезшкірного коронарного втручання вірогідні кореляційні зв’язки виявили тільки з макроскопічними ознаками інтракоронарних тромбів: з білими (r = -0,21, р = 0,05) та червоними (r = -0,30, р < 0,01) – негативні зв’язки, зі змішаними (r = 0,41, р < 0,001) – позитивні. Методом логістичної регресії визначили чинники, що у разі поєднаної дії впливають на ризик розвитку одного з елементів комбінованої кінцевої точки: старі тромби (V1), наявність мікроканалів (V2), периферична інфільтрація лейкоцитами (V3), макроскопічно змішані тромби (V4). Формула для обрахування виявлення вірогідності впливу обраних чинників на виникнення комбінованої кінцевої точки: Z = 2,37 × V1 + 2,21 × V2 + 1,69 × V3 + 3,24 × V4 - 5,60. Модель вірогідна (p < 0,0001) з чутливістю 83,33 % та специфічністю 88,24 %.Висновки. Інтракоронарні тромби, що спричиняють STEMI, суттєво відрізняються, незважаючи на подібні клінічну картину та тривалість захворювання. Їхні морфологічні характеристики пов’язані з прогнозом пацієнтів. Їх можна використовувати для побудови вірогідної шкали ризику, яка є реальною для застосування у клінічній практиці. гострий інфаркт міокарда з елевацією сегмента ST; інтракоронарні тромби; морфологічна структура; прогнозування перебіг

Myocardial Hibernation in Patients with Arterial Hypertension and Ischemic Heart Disease as a Cause of Heart Failure

Introduction. Myocardial hibernation refers to “new ischemic syndromes,” which in recent years have increasingly attracted the attention of cardiologists and cardiac surgeons. Hibernation includes a number of adaptive responses: inhibition of metabolic processes to more complex and lengthy pathophysiological changes that lead to myocardial contractile weakness, and their degeneration of cardiomyocytes and their apoptosis. Aim. To find out the pathophysiological mechanisms of occurrence and ultrastructural signs of cardiomyocyte hibernation in patients with arterial hypertension (AH) and myocardial infarction (MI), as well as the role of hibernation in the occurrence of heart failure (HF). To determine the dependence of segmental disorders of the left ventricular myocardial contractility (hypokinesia, akinesia, dyskinesia) on the presence of hybridized cardiomyocytes and to reveal the duration of their life. Materials and methods. For 36 patients with hypertension and coronary artery disease were examined, were examined the ultrastructure of myocardial biopsy material (n = 10) obtained during coronary artery bypass graft (CABG) and aneurysmectomy, as well as express neoplastic lesions (n​​= 26) in those who died of heart attack. Myocardial biopsies were obtained during the execution of the CABG for angina pectoris (n = 10) or ventriculoplasty in combination with CABG (n = 6). Ultra-structured study of 10 myocardial biopsies during CABG and ventriculoplasty, as well as 26 express-necropsies of the myocardium of those died due to the MI who were ill with hypertension were made. Results. It has been determined that hypertrophy and cardiomyocyte hybridization correlate with the severity of hypertension, MI, besides necrosis, causes stunning, hypertension, apoptosis, and necrosis of cardiomyocytes, mainly in the parainfarction and intact regions of the left venticle. The hepatized cardiomyocytes (irreversibly altered, hybridized cardiomyocytes containing α-glucogens) were first detected. The correlation between the percentage of remodulated cells (from 50.0 to > 75.0%) and the emergence of segmental lesions of the contractility of left ventricle (hypo-, aki-, dyskinesia), which leads to acute and chronic HF was found. Conclusions. Myocardial hibernation is a clinically important syndrome, which is often accompanied, under certain circumstances, by the transient left ventricle dysfunction. It is important to consider it in clinical practice, since hibernation is present in patients with almost all forms of coronary heart disease and requires both medical and surgical treatment

Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines

The NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer provide evidence- and consensus-based recommendations for a multidisciplinary approach for the management of patients with gastric cancer. For patients with resectable locoregional cancer, the guidelines recommend gastrectomy with a D1+ or a modified D2 lymph node dissection (performed by experienced surgeons in high-volume centers). Postoperative chemoradiation is the preferred option after complete gastric resection for patients with T3-T4 tumors and node-positive T1-T2 tumors. Postoperative chemotherapy is included as an option after a modified D2 lymph node dissection for this group of patients. Trastuzumab with chemotherapy is recommended as first-line therapy for patients with HER2-positive advanced or metastatic cancer, confirmed by immunohistochemistry and, if needed, by fluorescence in situ hybridization for IHC 2+

Esophageal and esophagogastric junction cancers, version 1.2015

Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Adenocarcinoma is more common in North America and Western European countries, originating mostly in the lower third of the esophagus, which often involves the esophagogastric junction (EGJ). Recent randomized trials have shown that the addition of preoperative chemoradiation or perioperative chemotherapy to surgery significantly improves survival in patients with resectable cancer. Targeted therapies with trastuzumab and ramucirumab have produced encouraging results in the treatment of advanced or metastatic EGJ adenocarcinomas. Multidisciplinary team management is essential for patients with esophageal and EGJ cancers. This portion of the NCCN Guidelines for Esophageal and EGJ Cancers discusses management of locally advanced adenocarcinoma of the esophagus and EGJ

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks

Serious Asthma Events with Fluticasone plus Salmeterol versus Fluticasone Alone

BACKGROUND: The safe and appropriate use of long-acting beta-agonists (LABAs) for the treatment of asthma has been widely debated. In two large clinical trials, investigators found a potential risk of serious asthma-related events associated with LABAs. This study was designed to evaluate the risk of administering the LABA salmeterol in combination with an inhaled glucocorticoid, fluticasone propionate. METHODS: In this multicenter, randomized, double-blind trial, adolescent and adult patients (age, ≥12 years) with persistent asthma were assigned to receive either fluticasone with salmeterol or fluticasone alone for 26 weeks. All the patients had a history of a severe asthma exacerbation in the year before randomization but not during the previous month. Patients were excluded from the trial if they had a history of life-threatening or unstable asthma. The primary safety end point was the first serious asthma-related event (death, endotracheal intubation, or hospitalization). Noninferiority of fluticasone-salmeterol to fluticasone alone was defined as an upper boundary of the 95% confidence interval for the risk of the primary safety end point of less than 2.0. The efficacy end point was the first severe asthma exacerbation. RESULTS: Of 11,679 patients who were enrolled, 67 had 74 serious asthma-related events, with 36 events in 34 patients in the fluticasone-salmeterol group and 38 events in 33 patients in the fluticasone-only group. The hazard ratio for a serious asthma-related event in the fluticasone-salmeterol group was 1.03 (95% confidence interval [CI], 0.64 to 1.66), and noninferiority was achieved (P=0.003). There were no asthma-related deaths; 2 patients in the fluticasone-only group underwent asthma-related intubation. The risk of a severe asthma exacerbation was 21% lower in the fluticasone-salmeterol group than in the fluticasone-only group (hazard ratio, 0.79; 95% CI, 0.70 to 0.89), with at least one severe asthma exacerbation occurring in 480 of 5834 patients (8%) in the fluticasone-salmeterol group, as compared with 597 of 5845 patients (10%) in the fluticasone-only group (P<0.001). CONCLUSIONS: Patients who received salmeterol in a fixed-dose combination with fluticasone did not have a significantly higher risk of serious asthma-related events than did those who received fluticasone alone. Patients receiving fluticasone-salmeterol had fewer severe asthma exacerbations than did those in the fluticasone-only group