СИНТЕЗ И СТРУКТУРА КОМПЛЕКСОВ ХЛОРИДА И БРОМИДА МЕДИ(II) С 4,5-ДИХЛОРИЗОТИАЗОЛ-N-(2-ГИДРОКСИЭТИЛ)-3-КАРБОКСАМИДОМ

Copper(II) chloride and bromide complexes with 4,5-dihlorizotiazol-N-(2-hydroxyethyl)-3-carboxamide (L) with the compositions [CuLHal2 ]n , where Hal = Cl– , Br– , are synthesized. The X-ray analysis revealed that the ligand is coordinated to the copper(II) atoms tridentate by the nitrogen atom of the heterocycle and two exocyclic oxygen atoms to form polymer chains. The copper bromide complex showed a synergistic effect in the compositions of insecticides Kerber and Vitan. Разработаны методики синтеза комплексов галогенидов меди(II) с 4,5-дихлоризотиазол-N-(2-гидрокси- этил)-3-карбоксамидом (L) состава [CuLHal2 ]n , где Hal = Cl– , Br– . Методом рентгеноструктурного анализа установлено, что лиганд координируется к атомам меди(II) тридентатно атомом азота гетероцикла и двумя экзоциклическими атомами кислорода, с образованием полимерных цепочек. Комплекс бромида меди проявил синергический эффект в композициях с инсектицидами Кербер и Витан.

Экстренный экстра-интракраниальный микроанастомоз после каротидной эндартерэктомии, осложненной тромбозом внутренней сонной артерии

We report a case of emergency extra- intracranial microanastomosis in a patient with acute thrombosis of the internal carotid artery, formed on the first day after classical carotid endarterectomy using a temporary by-pass under conditions of contralateral occlusion. The causes of the complication are analyzed. A set of instrumental examinations was demonstrated, including multispiral computed tomography with angiography of the brain and extracranial arteries, as well as multispiral computed tomography with the study of parameters of cerebral perfusion after acetazolamide. The main stages of surgical correction, the dynamics of clinical indicators are presented. The conclusion was made about the effectiveness and safety of the chosen revascularization strategy.Представлен случай экстренного экстра-интракраниального микроанастомоза у пациента с острым тромбозом внутренней сонной артерии, сформировавшимся в первые сутки после классической каротидной эндартерэктомии с применением временного шунта в условиях контралатеральной окклюзии. Разобраны причины осложнения. Продемонстрирован комплекс инструментальных обследований, включающих мультиспиральную компьютерную томографию с ангиографией головного мозга и экстракраниальных артерий, а также мультиспиральную компьютерную томографию с изучением показателей перфузии головного мозга после приема ацетазоламида. Представлены основные этапы оперативной коррекции, динамика клинических показателей. Сделано заключение об эффективности и безопасности выбранной стратегии реваскуляризации

Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

Aim. To analyze the results of thrombectomy in lower-extremity ischemia in patients with coronavirus disease 2019 (COVID-19) and respiratory failure of different severity.Material and methods. This retrospective, cohort, comparative study for the period from May 1, 2020 to March 1, 2022 included 305 patients with acute lower-extremity ischemia and COVID-19. Depending on the type of oxygen support, three groups of patients were formed: group 1 (n=168) — nasal oxygen insufflation; group 2 (n=92) — non-invasive ventilation (NIV); group 3 (n=45) — artificial ventilation (AV). Thrombectomy was carried out according to the standard technique using Fogarty catheters (3F-6F — depending on the vessel size). After the diagnosis was established before and after the start of surgical treatment, all patients received the following therapy: Unfractionated IV heparin infusion at an initial rate of 1000 U/r, adjusted to maintain the activated partial thromboplastin time at 2-3 times the normal value; 2. Oral acetylsalicylic acid 125 mg; 3. Analgesics.Results. Myocardial infarction and ischemic stroke were not detected in the total sample. The highest number of deaths (group 1: 5,3%, n=9; group 2: 72,8%, n=67; group 3: 100%, n=45; p<0,0001), retrombosis (group 1 : 18,4%, n=31; group 2: 69,5%, n=64; group 3: 91,1%, n=41; p<0,0001) and limb amputations (group 1: 9,5%, n=16; group 2: 56,5%, n=52; group 3: 91,1%, n=41; p<0,0001) was recorded in group 3 patients.Conclusion. In patients receiving mechanical ventilation, COVID-19 have more aggressive course, which is expressed in an increase in laboratory para- meters (C-reactive protein, ferritin, interleukin-6, D-dimer), the severity of pneumonia and location of thrombosis in the tibial arteries. Among patients with COVID-19 receiving mechanical ventilation, the greatest number of rethromboses (91,1%), limb amputations (91,1%), and deaths (100%) are noted, which suggests the expediency of abandoning open thrombectomy in favor of anticoagulant/antiplatelet therapy in this cohort of patients. The development of arterial thrombosis in patients with COVID-19 receiving mechanical ventilation is an indicator of a high risk of death. Open thrombectomy in combination with anticoagulant/antiplatelet therapy is most effective in patients on nasal oxygen insufflation or NIV

Многоцентровое исследование по изучению течения резистентной артериальной гипертензии после классической и эверсионной каротидной эндартерэктомии

Aim of study. Analysis of the dynamics of resistant arterial hypertension (RAH) and the spectrum of adverse cardiovascular events in patients after classical carotid endarterectomy (CEE) with preservation of carotid body (CB) and eversion CEE with CB transection.Material and methods. This cohort, comparative, retrospective, open-label study from January 2014 to December 2020 included 761 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA) and RH lasting more than 3 years. Depending on the implemented revascularization strategy, 2 groups were formed: Group 1: 38.0% (n=289) — classical CEE with plasty of the reconstruction zone with a patch (made of diepoxy-treated xenopericardium or synthetic); Group 2: 62% (n=472) — eversion CEE with CB transection. To study the dynamics of systolic blood pressure (SBP) in the preoperative period for 4 days, and in the postoperative period, blood pressure was measured for 10 days (during the period when the patient was in intensive care - according to daily monitoring of blood pressure; in the department - 10 times per day, daily). The average SBP figures for all patients were taken into account when constructing a graph of BP fluctuations.Results. In the postoperative period, the groups were comparable in the frequency of the following events: death (group 1: 0.34% (n=1), group 2: 0.63% (n=3); p=0.98; OR 0.54; 95% CI 0.05–5.21), myocardial infarction (group 1: 0.34% (n=1), group 2: 0.84% (n=4); p=0.71; OR 0, 40; 95% CI 0.04–3.65), ischemic stroke (group 1: 0.34% (n=1), group 2: 1.27% (n=6); p=0.36; OR 0.26; 95% CI 0.03–2.25), hemorrhagic transformation (group 1: 0%, group 2: 0.84% (n=4); p=0.29; OR 0.17; 95% CI 0.009–3.35). However, in terms of the number of all complications (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) presented as a combined endpoint, patients after eversion CEE with CB transection were three times superior to classical surgery (group 1: 1.03% (n=3 ), group 2: 3.60% (n=17); p=0.05; OR 0.28; 95% CI 0.08–0.9).Conclusion. The choice of a revascularization strategy in patients with hemodynamically significant ICA stenosis should be personalized and based on the conclusion of a multidisciplinary consultation, and not only on the preferences of the operating surgeon. In patients with RH, it is more expedient to use classical CEE with plasty of the reconstruction zone with a patch in view of the preservation of the CB during this operation. The intersection of the latter with eversion CEE provokes labile hypertension, progression of RAH and a statistically significant increase in the number of all unfavorable cardiovascular events. Thus, the use of carotid body preserving CEE in patients with RAH confirms the therapeutic mechanism of this manipulation in achieving the target SBP level. Цель. Анализ динамики резистентной артериальной гипертензии (РАГ) и спектра неблагоприятных кардиоваскулярных событий у пациентов после классической каротидной эндартерэктомии (КЭЭ) с сохранением каротидного гломуса (КГ) и эверсионной КЭЭ с отсечением КГ.Материал и методы. В данное когортное сравнительное ретроспективное открытое исследование за период с января 2014 г. по декабрь 2020 г. вошел 761 пациент с гемодинамически значимыми стенозами внутренних сонных артерий (ВСА) и РАГ длительностью более 3 лет. В зависимости от реализованной стратегии реваскуляризации были сформированы две группы: 1-я группа: 38,0% (n=289) — классическая КЭЭ с пластикой зоны реконструкции заплатой (из диэпоксиобработанного ксеноперикарда или синтетическая); 2-я группа: 62% (n=472) — эверсионная КЭЭ с отсечением КГ. Для изучения динамики систолического артериального давления (САД) в дооперационном периоде в течение 4 суток, а в послеоперационном периоде в течение 10 суток измерялось артериальное давление — АД (в период нахождения пациента в реанимации — по данным суточного мониторинга АД; в отделении — 10 раз в сутки ежедневно). Средние цифры САД по всем больным учитывали при построении графика колебания АД.Результаты. В послеоперационном периоде группы оказались сопоставимы по частоте следующих событий: смерть (группа 1: 0,34% (n=1), группа 2: 0,63% (n=3); р=0,98; ОШ 0,54; 95% ДИ 0,05–5,21), инфаркт миокарда (группа 1: 0,34% (n=1), группа 2: 0,84% (n=4); р=0,71; ОШ 0,40; 95% ДИ 0,04–3,65), ишемический инсульт (группа 1: 0,34% (n=1), группа 2: 1,27% (n=6); р=0,36; ОШ 0,26; 95% ДИ 0,03– 2,25), геморрагическая трансформация (группа 1: 0%, группа 2: 0,84% (n=4); р=0,29; ОШ 0,17; 95% ДИ 0,009–3,35). Однако по числу всех осложнений (смерть + инфаркт миокарда + ишемический инсульт + геморрагическая трансформация), представленных в виде комбинированной конечной точки, пациенты после эверсионной КЭЭ с пересечением КГ превосходили классическую операцию в 3 раза (группа 1: 1,03% (n=3), группа 2: 3,60% (n=17); р=0,05; ОШ 0,28; 95% ДИ 0,08–0,9).Заключение. Выбор стратегии реваскуляризации у пациентов с гемодинамически значимым стенозом внутренних сонных артерий должен быть персонифицированным и основываться на заключении мультидисциплинарного консилиума, а не только на предпочтениях оперирующего хирурга. У пациентов с резистентной артериальной гипертензией более целесообразно применение классической каротидной эндартерэктомии с пластикой зоны реконструкции заплатой ввиду сохранения каротидного гломуса во время данной операции. Пересечение последнего при эверсионной каротидной эндартерэктомии провоцирует лабильную артериальную гипертензию, прогрессирование резистентной артериальной гипертензии и статистически значимое возрастание числа всех неблагоприятных кардиоваскулярных событий. Таким образом, применение гломус-сберегающей каротидной эндартерэктомии у пациентов с резистентной артериальной гипертензией подтверждает лечебный механизм данной манипуляции в достижении целевого уровня систолического артериального давления.

Results of different kinds of carotid endarterectomy in patients with and without type 2 diabetes mellitus

BACKGROUND: Type 2 diabetes mellitus (DM) is one of the important markers for the development of adverse cardiovascular events after carotid endarterectomy (CEE). However, studies on this issue are based on small sample of patients and do not take into account the type of surgery as an additional factor of potentially negative impact on the course of the postoperative period.AIM: Analysis of hospital and long-term results of eversion and classical CEE with plastic surgery of the reconstruction zone with a biological patch in patients with type 2 diabetes and without it.MATERIALS AND METHODS: In this multicenter retrospective study from January 2010 to December 2020. included 5731 patients. Depending on the presence / absence of type 2 diabetes and the type of implemented CEE, 4 groups were formed: group 1 — 12.2% (n = 702) — patients with type 2 diabetes and eversion CEE; Group 2 — 55.0% (n = 3153) patients without type 2 diabetes and eversion CEE; Group 3 — 8.5% (n = 484) patients with type 2 diabetes and classical CEE; Group 4 — 24.3% (n = 1392) patients without type 2 diabetes and classical CEE. The duration of postoperative follow-up was 78.6 ± 39.2 months.RESULTS: At the long-term follow-up stage, patients with type 2 diabetes after the classical surgical technique demonstrated the highest rates of all types of complications: death (p <0.0001), MI (p = 0.011), ischemic stroke (p <0.0001), restenosis / occlusion of the ICA (p <0.0001), combined end point (p <0.0001). At the same time, the group of eversion CEE with impaired carbohydrate metabolism took the second position in terms of the prevalence of adverse events. These circumstances demonstrate that patch implantation is accompanied by an increased risk of developing not only myocardial infarction, but also restenosis of the reconstruction zone, as well as the associated ischemic stroke, which was demonstrated by our results.CONCLUSION: Patients with type 2 diabetes and a history of CEE are at increased risk of ischemic stroke at the hospital stage of observation and all unfavorable cardiovascular conditions (death, myocardial infarction, ischemic stroke, restenosis or ICA occlusion in the reconstruction zone) in the long-term postoperative period

Predictors of rethrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy for acute ischemia

Aim. To identify predictors of rethrombosis and death in patients with coronavirus disease (COVID-19) after thrombectomy for acute lower limb ischemia.Material and methods. For the period from April 2020 to January 2022, 189 pa tients with acute arterial lower limb thrombosis and acute lower limb ischemia were included in this study. In all cases, a positive polymerase chain reaction test for SARS-CoV-2 was obtained. According to chest multislice computed tomography, bilateral multisegmental pneumonia was identified as follows: 76 patients — grade 2 (25-50% of lung tissue involvement); 52 patients — grade 3 (50-75%); 61 patients — grade 4 (>75%). Breathing was carried out as follows: in 88 patients — spontaneous; in 42 — with oxygen administration by nasal cannula; 26 — non-invasive ventilation; 33 had artificial ventilation. All acute arterial thromboses developed within the hospital at 4,5±1,5 days after hospitalization. The time between the onset to diagnosis verification was 27,8±5,0 min. The revascularization strategy was established by a multidisciplinary team meeting. The interval between the development of acute ischemia symptoms and surgery was 45,9±6,3 minutes. Thrombectomy was performed according to the standard technique, under local and/or intravenous anesthesia, using 3F-7F Fogarty catheters.Results. Retrombosis developed in 80,4% of cases 6,4±5,1 hours after surgery. In 59,8% of cases, retrombectomy turned out to be ineffective and the patient underwent limb amputation. In 65,6% of patients, a death was established due to multiple organ dysfunction. Among them, limb amputation was performed in 103 patients. Binary logistic regression identified following predictors of retrombosis/ death: age over 70 years (odds ratio (OR), 30,73; 95% confidence interval (CI), 11,52-33,7), obesity (OR, 15,53; 95% CI, 6,41-78,19), diabetes (OR 14,21; 95% CI, 5,86-49,21), vasopressor support (OR 8,55; 95% CI, 4,94-17,93), mechanical ventilation (OR 7,39; 95% CI, 4,81-16,52).Conclusion. Predictors of retrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy are age over 70 years, obesity, diabetes, vasopressor support, and mechanical ventilation

CarotidSCORE.RU — risk stratification for complications after carotid endarterectomy

Aim. To demonstrate the first Russian computer program (carotidscore.ru) for risk stratification of postoperative complications of carotid endarterectomy (CE).Material and methods. The present study is based on the analysis of a multicenter Russian database including 25812 patients after CE operated on from January 1, 2010 to April 1, 2022. The following types of CE were implemented: conventional CE with patch angioplasty — 6814 patients; eversion CE — 18998 patients. Following postoperative complications were assessed during the study: death, stroke, myocardial infarction (MI), composite endpoint (death + stroke + MI).Results. During inhospital postoperative period, 0,18% of participants died, while 0,14% had MI, 0,35% — stroke. The composite endpoint was recorded in 0,68%. For each factor present in patients, a predictive coefficient was estimated. The predictive coefficient was considered as a numerical parameter reflecting the strength of the effect of each factor on the development of postoperative complications. Based on this equation, predictive coefficients were calculated for each factor present in patients in our study. The total contribution of these factors was reflected as a percentage and denoted the risk of postoperative complications with a minimum of 0% and a maximum of 100%. On the basis of obtained calculations, a CarotidSCORE program was created. Its graphical interface is based on the QT framework. It is possible not only to estimate the risk of a complication, but also to save all data about a patient in JSON format. The CarotidSCORE program contains 47 patient parameters, including clinical, demographic, anamnestic and angiographic characteristics. It makes it possible to choose one of the four CE types, which will provide an accurate stratification of the complication risk for each of them.Conclusion. CarotidSCORE (carotidscore.ru) may determine the probability of postoperative complications in patients undergoing CE

Сравнительные результаты экстренной каротидной эндартерэктомии и экстренной каротидной ангиопластики со стентированием в острейшем периоде ишемического инсульта. Результаты многоцентрового исследования

 AIM OF STUDY Study of hospital results of emergency carotid endarterectomy (CEE) and carotid angioplasty with stenting (CAS) in the acute period of acute cerebrovascular accident (ACVA).MATERIAL AND METHODS From January 2008 to August 2020, the study included 615 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA), operated on in the acute period of ischemic stroke (within 3 days from the onset of stroke). Depending on the type of revascularization implemented, all patients were divided into 2 groups: group 1 — CAS (n=312); 2nd group — CEE (n=357). Inclusion criteria were as follows: 1. Mild neurological disorders: NIHSS score 3–8; Modified Rankin Scale score 2 of less; Barthel Scale > 61; 2. Indications for CEE / CAS  according to the current national recommendations; 3. Ischemic focus in the brain not more than 2.5 cm in diameter. Exclusion criteria: 1. Presence of  con-traindications to CEE / CAS. Carotid angioplasty with stenting was performed according to the standard technique; in all cases, distal embolism  protection systems were used. Carot-id endarterectomy was performed  according to the classical and eversion techniques. When the retrograde pressure in the ICA was less than 60% of the systemic pressure, a temporary shunt (TS) was installed. In the postoperative period, all patients underwent multispiral computed tomography (MSCT) of the brain. In the absence of negative dynam-ics in the neurological status, MSCT was performed on the 7th day after the operation, if available, it was performed urgently. The checkpoints were the development of such unfa-vorable cardiovascular events as death, myocardial infarction (MI), stroke / transient is-chemic attack (TIA), “mute” stroke, “mute” hemorrhagic transformations, combinedend-point (death + all strokes / TIA + MI). Strokes were mute if diagnosed according to MSCT, without symptoms.RESULTS In 69% of diabetic patients with anterior myocardial infarction and in 63% of patients with posterolateral MI 12 months after PCI, signs of LV inferiority were revealed in the form of an increase in the indices of end-diastolic and systolic volumes of the LV and low ejection fraction (≤45%). In patients without diabetes, these figures were 18% and 31%, respectively. High concentrations of NT-proBNP on the first day of myocardial infarction after PCI were of the greatest value in the  diagnosis and prognosis of LV UR after 12 months.RESULTS When analyzing hospital complications, significant differences in the frequency of lethal outcome were not obtained (group 1: n=6 (1.92%); group 2: n=8 (2.24%); p=0.98; OR=0.85; 95% CI 0.29–2.49); MI (group 1: n=5 (1.6%); group 2: n=5 (1.4%); p=0.91; OR=1.14; 95% CI 0.32–3.99 ); ACVA (ischemic type) / TIA (group 1: n=5 (1.6%); group 2: n=6 (1.7%); p=0.82; OR=0.95; 95% CI 0.28–3.15), as well as “mute” ACVA (group 1: n=7 (2.2%);  group 2: n=15 (4.2%); p=0.23; OR=0.52; 95% CI 0.21–1.3). However, the vast majority of hemorrhagic transformations (group 1: n=2 (0.64%); group 2:  n=13 (3.6%); p=0.018; OR=0.17; 95% CI 0.03–0.76) and all “mute” hemorrhagic transformations (group 1: n=0; group 2: n=26 (7.3%); p=0.001;  OR=0.02; 95% CI 0.001–0.33) were observed only in the CEE group, which was reflected in the maximum values of the combined end point: group 1: n=22 (7.05%); group 2: n=73 (20.4%); p<0.0001; OR=0.29; 95% CI 0.17–0.48). Thus, in the CEE group, every 5th patient had a complication.CONCLUSION Carotid angioplasty with stenting is the safest method of revascularization for patients in the acute period of ACVA. This is largely due to the reduction in the risk of reperfusion syndrome and the prevention of embolism due to the use of modern protection systems. Carotid  endarterectomy can be performed with comparable efficiency only when a tempo-rary shunt is placed in the internal carotid arteries in the absence of unstable atheroscle-rotic plaque. Цель Изучение госпитальных результатов экстренной каротидной эндартерэктомии (КЭЭ) и каротидной ангиопластики со стентированием (КАС) в острейшем периоде острого нарушения мозгового кровообращения (ОНМК).Материал и методы C января 2008 по август 2020 г. в  исследование вошли 615 пациентов с гемодинамически  значимыми стенозами внутренних сонных артерий (ВСА),  оперированными в острейшем периоде ишемического  инсульта (в течение 3 суток от дебюта ОНМК). В зависимости от реализованного вида реваскуляризации все больные были распределены на две группы: 1-я группа — КАС (n=312); 2-я группа — КЭЭ (n=357). Критериями включения стали: 1. Неврологические нарушения легкой степени: от 3  до 8 баллов по шкале NIHSS; не более 2 баллов по  модификационной шкале Рэнкина; более 61 балла по шкале Бартел; 2. Показания для КЭЭ/КАС согласно действующим  национальным рекомендациям; 3. Ишемический очаг в  головном мозге не более 2,5 см в диаметре.  Критерии  исключения: 1. Наличие противопоказаний к КЭЭ/КАС.  Каротидную ангиопластику со стентированием выполняли по стандартной методике, во всех случаях использовали  системы защиты от дистальной эмболии. Каротидную эндартерэктомию производили по классической и эверсионной методикам. При ретроградном давлении в ВСА  менее 60% от системного устанавливали временный  шунт (ВШ). В послеоперационном периоде всем больным  выполняли мультиспиральную компьютерную томографию  (МСКТ) головного мозга (ГМ). При отсутствии  отрицательной динамики в неврологическом статусе — МСКТ выполняли на 7-е сутки после операции, при наличии  — неотложно. Под контрольными точками понималось  развитие таких неблагоприятных кардиоваскулярных событий, как летальный исход, инфаркт миокарда (ИМ),  ОНМК/транзиторная ишемическая атака (ТИА), «немые» ОНМК, «немые» геморрагические трансформации,  комбинированная конечная точка (смерть + все ОНМК/ ТИА+ИМ). «Немыми» считали инсульты, диагностированные  по данным контрольной МСКТ ГМ, не имеющие  симптоматики.Результаты При анализе госпитальных осложнений  значимые различия не были получены по частоте  летального исхода (группа 1: n=6 (1,92%); группа 2: n=8  (2,24%); р=0,98; ОШ=0,85; 95% ДИ 0,29–2,49); ИМ (группа 1: n=5 (1,6%); группа 2: n=5 (1,4%); р=0,91; ОШ=1,14; 95% ДИ 0,32–3,99); ОНМК (ишемический тип)/ТИА (группа 1: n=5 (1,6%); группа 2: n=6 (1,7%); р=0,82; ОШ=0,95; 95% ДИ 0,28–3,15), а также «немых» ОНМК (группа 1: n=7 (2,2%); группа 2: n=15 (4,2%); р=0,23; ОШ=0,52; 95% ДИ 0,21–1,3). Однако подавляющее большинство геморрагических  трансформаций (группа 1: n=2 (0,64%); группа 2: n=13 (3,6%);  р=0,018; ОШ=0,17; 95% ДИ 0,03–0,76) и все «немые»  геморрагические трансформации (группа 1: n=0; группа 2:  n=26 (7,3%); р=0,001; ОШ=0,02; 95% ДИ 0,001–0,33) были зафиксированы только в группе КЭЭ, что отразилось на  максимальных значениях комбинированной конечной  точки: группа 1: n=22 (7,05%); группа 2: n=73 (20,4%);  р<0,0001; ОШ=0,29; 95% ДИ 0,17–0,48). Таким образом в группе КЭЭ осложнение получил каждый 5-й пациент.Заключение Для больных в острейшем периоде острого нарушения мозгового кровообращения наиболее  безопасным способом реваскуляризации является  каротидная ангиопластика со стентированием. Во многом это обусловлено снижением риска реперфузионного синдрома и профилактикой эмболии благодаря применению современных систем защиты. Каротидная эндартерэктомия может выполняться с сопоставимой эффективностью только при установке временного шунта во  внутренние сонные артерии при условии отсутствия  нестабильной атеросклеротической бляшки.

Streptococcus pneumoniae Serotype 1 Capsular Polysaccharide Induces CD8+CD28− Regulatory T Lymphocytes by TCR Crosslinking

Zwitterionic capsular polysaccharides (ZPS) of commensal bacteria are characterized by having both positive and negative charged substituents on each repeating unit of a highly repetitive structure that has an α-helix configuration. In this paper we look at the immune response of CD8+ T cells to ZPSs. Intraperitoneal application of the ZPS Sp1 from Streptococcus pneumoniae serotype 1 induces CD8+CD28− T cells in the spleen and peritoneal cavity of WT mice. However, chemically modified Sp1 (mSp1) without the positive charge and resembling common negatively charged polysaccharides fails to induce CD8+CD28− T lymphocytes. The Sp1-induced CD8+CD28− T lymphocytes are CD122lowCTLA-4+CD39+. They synthesize IL-10 and TGF-β. The Sp1-induced CD8+CD28− T cells exhibit immunosuppressive properties on CD4+ T cells in vivo and in vitro. Experimental approaches to elucidate the mechanism of CD8+ T cell activation by Sp1 demonstrate in a dimeric MHC class I-Ig model that Sp1 induces CD8+ T cell activation by enhancing crosslinking of TCR. The expansion of CD8+CD28− T cells is independent, of direct antigen-presenting cell/T cell contact and, to the specificity of the T cell receptor (TCR). In CD8+CD28− T cells, Sp1 enhances Zap-70 phosphorylation and increasingly involves NF-κB which ultimately results in protection versus apoptosis and cell death and promotes survival and accumulation of the CD8+CD28− population. This is the first description of a naturally occurring bacterial antigen that is able to induce suppressive CD8+CD28− T lymphocytes in vivo and in vitro. The underlying mechanism of CD8+ T cell activation appears to rely on enhanced TCR crosslinking. The data provides evidence that ZPS of commensal bacteria play an important role in peripheral tolerance mechanisms and the maintenance of the homeostasis of the immune system