Stage approach in surgical treatment of acute pancreatitis.

The article deals with the problem of diagnosis and treatment of acute pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity with a high risk of complications, the mortality rate of which reaches 5.5%, and in acute pancreatitis it varies within 40-70%. The purpose of this work is to improve the results of surgical treatment of patients with acute pancreatitis. The results of treatment of 112 patients with acute pancreatitis, who were hospitalized in the procedure of ambulance in the Department of Surgery No. 2 of the Bogomolets National Medical University in 2009-2019 period are analyzed. Severe disease course was observed in 83 (74.1%) patients, moderate – in 29 (25.9%) patients. In the early phase of the disease, endoscopic operations were performed in 44 (39.3%) patients, and laparotomy was performed in 12 (10.7%) patients with advanced purulent peritonitis. In the late phase 15 (13.4%) patients underwent laparotomy, necrsequestrectomy, abdominization of the pancreas, drainage of the abdominal cavity and retroperitoneal space, 36 (32.1%) patients were treated with ultrasound-guided puncture treatments. In the case of progression of the disease and ineffective drainage under ultrasound control, 5 (4.5%) patients were treated with retroperitoneoscopically assisted necrsequestrectomy, combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy was performed in 3 (2.7%) patients, and in 2 (1.8%) patients – open laparotomy, abdominization, necrsequestrectomy, drainage of the abdominal cavity and retroperitoneal space. The surgical intervention in the late phase of the disease was 21±4.2 days from the onset of the disease. A stage approach in the treatment of acute pancreatitis was applied to 80 (71.4%) patients in the main group. The comparison group consisted of 32 (28.6%) patients who underwent laparotomy and laparoscopic interventions in the early and late periods of the disease without prior use of endoscopic interventions or drainage operations under ultrasound control. In the main group the length of stay in the hospital was 21,3±4,2 days, in the comparison group – 48.2±5.3 days respectively. In 42 (95.5%) patients who underwent endoscopic surgery, a positive clinical effect, rapid regression of symptoms of acute pancreatitis was achieved. In two (4.5%) patients who underwent endoscopic interventions, the disease progressed with the development of an abscess of the omental pouch, they underwent puncture drainage under ultrasound control. When using puncture drainage operations under ultrasound control in 26 (72.2%) patients, a positive result was achieved, the abscess cavity decreased by 63±6.2% within 7 days. In 10 (27.8%) patients due to the progression of the disease, the following stage of treatment was performed: retroperitoneoscopically assisted necrsequestrectomy (5 (13.9%) patients), combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy (3 (8.3%) patients), and open laparotomy, abdominization, necrosequestrectomy, drainage of the abdominal cavity and retroperitoneal space (2 (5.6%) patients). Complications in the main group developed in two (2.5%) patients, the mortality rate was 2.5% (two patients). In the comparison group, complications developed in 8 (25%) patients, the mortality rate was 18.8% (6 patients). The use of minimally invasive endoscopic interventions, draining surgeries under ultrasound control followed by combined laparoscopic and retroperitoneoscopically assisted necrsequestrectomy or open laparotomy reduces the length of hospital stay of patients from 48.2±5.3 days (comparison group) to 21.3±4.2 days (main group) (p<0.0001, t=28.346) and the number of complications by 22.5% (p=0.0002, χ2=14.104, CI 9.2333-39.7022). The use of a stage approach in the surgical treatment of acute pancreatitis reduces mortality by 16.3% (p=0.0026, χ2 =9.058, CI 4.6571-32.9639)

Клінічна значимість погіршення функції нирок у хворих з гострою декомпенсованою серцевою недостатністю в залежності від змін NGAL і вихідної функції нирок

Aim. To determine the value of the renal function worsening (RFW) depending on NGAL and initial renal dysfunction in so-called “wet and warm” patients with acute decompensated heart failure (ADHF).Materials and methods. The prospective study included 141 patients with ADHF 38–85 years old (mean age 66,4±2,2), successively admitted to cardiologic department of Olexandrivska clinical hospital in Kyiv during 2012–2014, 38 patients had RFW, 67 patients underwent the assessment of NGAL in blood serum using enzymatic immune analysis for D1 and last D.Results. RFW by creatinine was in 38 (27 %) of patients and it was absent in 103 (73 %) of patients. RFW group with the increased NGAL content differed from patients without RFW by the more occurrence of hypertonic disease, diabetes mellitus, ІHD and NYHA IV at admission (all p <0,05). At the analysis of patients with RFW depending on MDRD it was established, that patients with MDRD <60 and RFW were essentially older than patients with MDRD in both groups with MDRD > 60 (р <0,05-0,01).Conclusions. RFW in patients with ADHF is connected with the increased intensity of symptoms only at association with NGAL increase in 48 hours. Patients with RFW without NGAL increased didn’t essentially differ from ones without RFWГостра декомпенсована серцева недостатність (ГДСН) залишається провідною причиною госпіталізації хворих у всьому світі. Є достатньо підстав вважати, що погіршення функції нирок (ПФН) є досить гетерогенним за патофізіологією і прогнозом ускладненням ГДСН та репрезентована декількома фенотипами. Визначення таких патофізіологічно обґрунтованих фенотипів у так званих «вологих і теплих» хворих з ГДСН стало метою даного дослідженн

Хірургічне лікування хворих із флегмоною волосистої частини голови

Хірургічне лікування хворих із флегмоною волосистої частини голов

CARDIOVASCULAR DISEASES AND OBSTRUCTIVE SLEEP APNEA SYNDROME. REVIEW

Background.  Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality among adults worldwide. On another hand, obstructive sleep apnea syndrome (OSAS) is common in patients with CVD, and can worsen the patients prognosis due to late diagnosis.  Aim: to analyze and summarize the published researches about interrelation between CVD and OSAS, its influence on CVD, and the effects of continuous airway pressure (CPAP) treatment of OSAS on CVD in order to pay attention to OSAS potential risks, improve the investigation of this syndrome and management. Materials and methods. Review of scientific literature in the international electronic scientometric databases PubMed, Google Scholar by key words for the period 2008-2023. The search was carried out by two independent authors. 150 sources were selected, 48 English–language articles of which met all the search criteria and  were used for analysis. Results. OSAS is one of the widespread sleep disorders that frequently occurs in patients with CVD, impairs quality of life. Its increases cardiovascular and all-cause mortality and cardiovascular morbidity. OSAS is observed in patients with arterial hypertension in 30-83%, coronary heart disease in 38-65%, stroke in 57-65%, heart failure in 12-55%, heart rhythm disorders - in 20-50%. In addition, the relationship between OSAS and diabetes, metabolic syndrome, insulin resistance, depression, and cognitive impairment has been established. OSAS is often not diagnosed or not diagnosed in time. Thus, there are data that 86-95% OSAS, clinically manifestated, were  missed diagnosis, that  worsens the prognosis of such patients. Conclusions. OSAS is a common sleep breathing disorder in patients with CVD that is often diagnosed late. Most studies have shown that OSAS worsens the CVD course and outcomes. Therefore early diagnosis and timely appropriate treatment reduce morbidity and mortality

Poly(lysine) Dendrimers Form Complexes with siRNA and Provide Its Effcient Uptake by Myeloid Cells: Model Studies for Therapeutic Nucleic Acid Delivery

The disruption of the cellular pathways of protein biosynthesis through the mechanism of RNA interference has been recognized as a tool of great diagnostic and therapeutic significance. However, in order to fully exploit the potential of this phenomenon, efficient and safe carriers capable of overcoming extra-and intracellular barriers and delivering siRNA to the target cells are needed. Recently, attention has focused on the possibility of the application of multifunctional nanoparticles, dendrimers, as potential delivery devices for siRNA. The aim of the present work was to evaluate the formation of dendriplexes using novel poly(lysine) dendrimers (containing lysine and arginine or histidine residues in their structure), and to verify the hypothesis that the use of these polymers may allow an efficient method of siRNA transfer into the cells in vitro to be obtained. The fluorescence polarization studies, as well as zeta potential and hydrodynamic diameter measurements were used to characterize the dendrimer:siRNA complexes. The cytotoxicity of dendrimers and dendriplexes was evaluated with the resazurin-based assay. Using the flow cytometry technique, the efficiency of siRNA transport to the myeloid cells was determined. This approach allowed us to determine the properties and optimal molar ratios of dendrimer:siRNA complexes, as well as to demonstrate that poly(lysine) dendrimers may serve as efficient carriers of genetic material, being much more effective than the commercially available transfection agent Lipofectamine 2000. This outcome provides the basis for further research on the application of poly(lysine) dendrimers as carriers for nucleic acids in the field of gene therapy. © 2020 by the authors

Оптимальні характеристики грунтових теплообмінників для теплонасосних систем опалення

Безродний, М. К. Оптимальні характеристики грунтових теплообмінників для теплонасосних систем опалення = Optimal characteristics of ground heat exchangers for heat pump heating systems / М. К. Безродний, Н. О. Притула // Зб. наук. пр. НУК. – Миколаїв : НУК, 2016. – № 1 (463). – С. 47–55.Анотація. Визначено раціональні співвідношення між характеристиками горизонтального/вертикального ґрунтового теплообмінника (ГТО/ВГТО), таких, як довжина труби одного контуру/глибина свердловини, діаметра труби, швидкості руху теплоносія в нижньому контурі теплонасосної системи (ТНС) в залежності від умов роботи ГТО/ВГТО (інтенсивність відбору теплоти від ґрунту) та ТНС (температури верхнього та нижнього джерела теплоти). Дані характеристики повинні забезпечити оптимальну швидкість теплоносія в нижньому контурі ТНС, що дозволить отримати мінімальні питомі витрати електроенергії на ТНС теплопостачання в цілому.Abstract. The paper considers the determination of the rational correlation between the characteristics of the horizontal/vertical ground heat exchanger (HHE/ VGHE) such as the pipe length of one contour / well depth, pipe diameter, coolant velocity in the lower contour of the heat pumping system (HPS), depending on the conditions of the HHE/VGHE operation (intensity of the heat removal from the soil) and HPS (temperatures of the upper and lower heat source). These characteristics should ensure optimal coolant velocity in the lower HPS contour, which will provide minimum specific electricity consumption for heating consumer in general. As a result of numerical studies based on the analysis of the system of equations of the energy expenditures and heat balance of individual elements of the heat pump system, it was established that there are optimal values of the coolant velocity and corresponding minimum specific costs of external energy for the HPS heating. On the basis of this relationship, the characteristics of the soil heat exchangers were obtained; they ensure minimum total energy costs for the heating HPS. It was determined that for the large well depths the use of small-diameter pipes becomes impractical due to the large hydraulic losses. In turn, the hydraulic losses considerably increase with the depth of the well with large heat flow from soil, which requires the transition to larger tube diameter of the heat exchanger. It was established that with providing the optimal coolant velocity in the lower contour the energy expenditures for the HPS with vertical ground heat exchangers in the entire range of the VGHE parameters do not exceed the value of 0.275. This corresponds to the value of equivalent transformation ratio of the low temperature water HPS heating of at least 3.6 and evidences of sufficient effectiveness of the system.Аннотация. Определено рациональное соотношение между характеристиками горизонтального/вертикального грунтового теплообменника, таких, как длина трубы одного контура/глубина скважины, диаметр трубы, скорость движения теплоносителя в нижнем контуре теплонасосной системы в зависимости от условий работы ГТО/ВГТО (интенсивность отбора теплоты от почвы) и ТНС (температуры верхнего и нижнего источника теплоты). Данные характеристики должны обеспечить оптимальную скорость теплоносителя в нижнем контуре ТНП, что позволит получить минимальные удельные затраты электроэнергии на ТНС теплоснабжения в целом

Why the Orientational Mobility in Arginine and Lysine Spacers of Peptide Dendrimers Designed for Gene Delivery Is Different?

New peptide dendrimer with Lys-2Arg repeating units was recently studied experimentally by NMR (RSC Advances, 2019, 9, 18018) and tested as gene carrier successfully (Int. J. Mol. Sci., 2020, 21, 3138). The unusual slowing down of the orientational mobility of 2Arg spacers in this dendrimer was revealed. It has been suggested that this unexpected behavior is caused by the Arg-Arg pairing effect in water, which leads to entanglements between dendrimer branches. In this paper, we determine the reason for this slowing down using atomistic molecular dynamics simulation of this dendrimer. We present that the structural properties of Lys-2Arg dendrimer are close to those of the Lys-2Lys dendrimer at all temperatures (Polymers, 2020, 12, 1657). However, the orientational mobility of the H-H vector in CH2-N groups of 2Arg spacers in Lys-2Arg dendrimer is significantly slower than the mobility of the same vector in the Lys-2Lys dendrimer. This result is in agreement with the recent NMR experiments for the same systems. We revealed that this difference is not due to the arginine-arginine pairing, but is due to the semiflexibility effect associated with the different contour length from CH2-N group to the end of the side arginine or lysine segment in spacers