The use of neuroaxial blockades in obstetric practice for thrombocytopenia

Thrombocytopenia is the second most frequent hematological complication of pregnancy after anemia. Among all thrombocytopenia during pregnancy, the most common is gestational thrombocytopenia. Gestational thrombocytopenia is not accompanied by coagulation disorders, has a minimal risk of bleeding, for both a mother and her fetus. Nevertheless, according to modern concepts, thrombocytopenia is a contraindication for performing obstetric neuroaxial blockades only on the basis of quantitative count of platelets, without taking into account coagulation status. These contraindications are derived from the general surgery and traumatology practice due to the high risk of developing epidural hematoma, but do not take into account the features, including physiological hypercoagulation, of pregnant patients. Refusal of the patient to perform a neuroaxial blockade during delivery on the basis of only counting the number of platelets often leads to an unreasonable increase in the risk / benefit ratio for both the mother and the fetus. Analysis of the research results indicates a change in attitude towards this problem towards a more loyal approach, taking into account the assessment of the coagulative status of a particular patient

Structural features of Ni-Cr-Si-B materials obtained by different technologies

This study considers the structural features of Ni-Cr-Si-B (Ni - base; 15.1 % Cr; 2 % Si; 2 % B; 0.4 % C) materials obtained by different methods. The self-fluxing coatings were deposited by plasma spraying on the tubes from low carbon steel. Bulk cylinder specimens of 20 mm diameter and 15 mm height were obtained by spark plasma sintering (SPS). The structure and phase composition of these materials were investigated by optical microscopy (OM), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and X-ray diffractometry (XRD). The major phases of coatings and sintered materials are [gamma]-Ni, Ni[3]B, CrB and Cr[7]C[3]. We demonstrate that the particle unmelted in the process of plasma spraying or SPS consist of [gamma]-Ni-NEB eutectic and also CrB and Cr[7]C[3] inclusions. The prolonged exposure of powder to high temperatures as well as slow cooling rates by SPS provide for the growth of the structural components as compared to those of plasma coatings materials. High cooling rates at the plasma spraying by melted particles contribute to the formation of supersaturated solid solution of Cr, Si and Fe in [gamma]-Ni. The structure of the melted particles in sintering material has gradient composition: the core constituted of Ni grains of 10 μm with [gamma]-Ni-Ni[3]B eutectic on the edges. The results of the experiment demonstrate that the sintering material has a smaller microhardness in comparison with plasma coatings (650 and 850 MPa, respectively), but at the same time the material has higher density (porosity less than 1 %) than plasma coatings (porosity about 2.. .3 %)

Возможности тромбоэластографии при оценке безопасности нейроаксиальных блокад при гестационной тромбоцитопении (клиническое исследование)

Gestational thrombocytopenia (GT) is the most common type of thrombocytopenia during pregnancy. Unlike other types of thrombocytopenia, it is not accompanied by dysfunction of the cellular component of hemostasis. Currently, a quantitative decrease in platelets in GT is a contraindication to neuraxial blockades (NAB), which significantly reduces the quality of care in childbirth.The aim of the study is to determine the possibility of safe use of neuraxial blockades in gestational thrombocytopenia. A retrospective prospective study involved 70 patients who were performed delivery, depending on obstetric indications, either conservatively or surgically. The patients were divided into two groups. The main group (group No. 1) included 35 patients with gestational thrombocytopenia. The comparison group (group No. 2) consisted of 35 patients with a platelet content above 150×109/l. A comparative intergroup analysis of indicators of a general blood test, coagulogram, thromboelastography with a test for functional fibrinogen before childbirth and 2 days after delivery. The change in platelet content and its effect on the coagulation status of patients during pregnancy were retrospectively analyzed. A comparative assessment of the volume of blood loss during childbirth and the early postpartum period and the risk of complications of neuraxial blockade in patients with and without gestational thrombocytopenia was carried out.It was found that during gestational thrombocytopenia in the perinatal period, there is no decrease in coagulation potential, assessed by the results of coagulography and thromboelastography at a platelet level above 49×109/l. The investigated indicators of hemostasis did not have significant intergroup differences during pregnancy and childbirth. In the group of patients with gestational thrombocytopenia, the volume of blood loss during labor and the postpartum period did not differ from the group without thrombocytopenia, regardless of the method of delivery. The median blood loss after vaginal delivery in group 1 was 225 ml, in group 2 – 250 ml, with abdominal delivery – 572 ml and 386 ml – respectively. In this study, no complications of neuraxial blockade were observed in any of the groups.The results obtained suggest that in patients with gestational thrombocytopenia, even with a significant decrease in platelet content, it is possible to perform neuraxial blockades during labor, taking into account the clinical picture and the absence of coagulation disorders confirmed by thromboelastography.ВВЕДЕНИЕ Гестационная тромбоцитопения (ГТ) является наиболее распространенным видом тромбоцитопении во время беременности. В отличие от других видов тромбоцитопении она не сопровождается нарушением функции клеточного звена гемостаза. В настоящее время количественное снижение тромбоцитов при ГТ является противопоказанием к проведению нейроаксиальных блокад (НАБ), что значительно снижает качество оказания помощи в родах.ЦЕЛЬ ИССЛЕДОВАНИЯ Определить возможности безопасного применения НАБ при ГТ.МАТЕРИАЛ И МЕТОДЫ В ретроспективно-проспективном исследовании приняли участие 70 пациенток, родоразрешенных в зависимости от акушерских показаний консервативным или оперативным путем. Пациентки были разделены на две группы. В основную группу (группа № 1) вошли 35 пациенток с ГТ. Группу сравнения (группа № 2) составили 35 пациенток с содержанием тромбоцитов в крови выше 150×109/л. Проведен сравнительный межгрупповой анализ показателей общего анализа крови, коагулограммы, тромбоэластографии с выполнением теста на функциональный фибриноген перед родами и через 2 дня после родоразрешения. Ретроспективно проанализированы изменение содержания тромбоцитов и его влияние на коагуляционный статус пациенток в течение беременности. Проведена сравнительная оценка объемов кровопотери в родах и раннем послеродовом периоде и риска развития осложнений НАБ у пациенток с ГТ и без нее. Выявлено, что при ГТ в перинатальном периоде не происходит снижения коагуляционного потенциала, оцениваемого по результатам коагулографии и тромбоэластографии при уровне тромбоцитов выше 49×109/л. Исследованные показатели гемостаза не имели значимых межгрупповых различий в течение беременности и родов. В группе пациенток с ГТ объем кровопотери в родах и послеродовом периоде не отличался от группы без тромбоцитопении независимо от метода родоразрешения. Медиана кровопотери после родов через естественные родовые пути в группе № 1 составила 225 мл, в группе № 2 — 250 мл, при абдоминальном родоразрешении — 572 мл и 386 мл соответственно. В проведенном исследовании не зафиксировано каких-либо осложнений НАБ ни в одной из групп.ЗАКЛЮЧЕНИЕ Полученные результаты позволяют предположить, что у пациенток с ГТ даже при значительном снижении содержания тромбоцитов возможно выполнение НАБ в родах с учетом клинической картины и отсутствия нарушений коагуляции, подтвержденных тромбоэластографией

Features of information dissemination in the visual sensory system depending on the processes of visual perception

The goal of the research is to study the features of visual information distribution depending on the pole of cognitive style: field-dependence/ field-independence (FD/ FID

Retrobulbar blockade during eyeball enucleation surgery in children with retinoblastoma

Retinoblastoma (RB) is a malignant tumor of the embryonic nerve retina.Purpose. To determine the effectiveness of retrobulbar blockade (RbB) with ropivacaine 0.5% for intra- and postoperative analgesia, as well as for the prevention of oculocardial reflex (OCR), postoperative nausea and vomiting (PONV) during enucleation.Material and methods. A prospective randomized controlled clinical trial was performed. Eighty patients aged 0 to 10 years were included, who were randomly assigned to the RbB group (retrobulbar blockade with ropivacaine 0.5% with general anesthesia) (n=40) and the GA control group (general anesthesia) (n=40).Results. There were no complications in the RbB group caused by the methodology. In the intraoperative period, the average dose of fentanyl in the RbB group was 4.7±0.7 μg/kg, which is significantly lower than in the OA group of 10.1±1.9 μg/kg (p<0.05). OCR in the RbB group was observed in 5% of cases versus 100% in the GA group (p=0.002). The average VAS score was 1.8 vs. 3.7 60 minutes after surgery (p<0.001). For the first time 12 hours after surgery, PONV was not observed in the RBB group, and in the control group it was observed in 45% of patients.Conclusion. The study revealed that intraoperative retrobulbar blockade with 0.5% ropivacaine solution in children with RB is effective and safe. Provides stable intraoperative hemodynamics and reduces the need for opioids. Promotes the prevention of OCD and PONV, as well as the improvement of postoperative analgesia during the operation of enucleation of the eyeball i n pediatric

ANALYSIS AND FORECASTING THE DYNAMICS OF ADVERTISING BOTS ACTIVITY

When introducing a new product or service to the market, a manufacturer or retailer is faced with the need to develop a promotion strategy. Taking into account the recent trends in e-commerce and social media marketing, it makes sense to evaluate the possibility of borrowing promotion strategies from producers of abstract, potentially  monetized electronic content. The article considers the activity of advertising bots using the example of the social network Facebook. The paper carries out an autocorrelation analysis of the observation results and reveals the frequency of automated requests to the user by advertising bots. The authors construct an autoregressive model of the dynamics of the activity of advertising bots and verbalize Facebook’s strategy to increase traffic to the  information space controlled by the social network

EFFECT OF FERROTHERAPY ON COURSE OF ISCHEMIC HEART DISEASE ASSOCIATED WITH MILD IRON DEFICIENCY IN MEN

Aim. To assess effect of ferrotherapy on course of ischemic heart disease (IHD) associated with mild iron deficiency anemia (IDA) and latent iron deficiency (ID). Material and methods. 80 male patients, coal miners, aged 51±7.9 years, were observed. 28 patients had angina pectoris associated with the mild IDA, 23 patients experienced myocardial infarction accompanied by the mild IDA and 29 patients had angina with latent ID. Latent ID was defined in case of iron plasma level ≤12 µg/l, IDA was diagnosed in case of hemoglobin level <130 mg/l. The minimal hemoglobin level observed in patients was 107g/l. ICD clinical characteristics were compared before and after 3-week iron-based treatment in individualized doses. Results. Latent ID and mild IDA aggravated angina and increased ectopic myocardial activity in patients with IHD. Iron-based therapy with appropriate nutrition reduced angina attacks frequency, duration and intensity, decreased nitroglycerin consumption and increased exercise tolerance. Conclusion. Normalization of haemoglobin level and iron plasma concentration in the mild IDA as well as normalization of iron plasma concentration in ID in patients with IHD reduces ede-ma and dyspnea, decreases heart rate. These effects are provided due to the treatment with elementary iron in individualized course dose, which improves clinical status and minimizes the adverse reactions

Blood saving possibilities in delivering patients with placenta increta

According to the results of systematic reviews of WHO, maternal mortality associated with massive bleeding almost reached 30% and has no tendency to decrease. Among the causes of massive obstetric hemorrhage, the most challenging ones are uterine hypotension and morbidity adherence placenta. Most severe complication for placentation is placenta increta in the uterine wall. Over the past 50 years, the number of cases with morbidity adherence placenta has increased tenfold. By all indications, this pathology has taken on the character of an epidemic and is one of the main causes for massive blood loss and blood transfusion, as well as peripartum hysterectomy. For surgical hemostasis in this pathology we apply X-ray vascular methods (temporary balloon occlusion of large vessels, vascular embolization), ligation of the iliac, uterine, ovarian arteries, various versions of distal hemostasis, including the use of uterine turnstiles, intrauterine and vaginal cylinders, compression sutures. However, data confirming the advantage of any specified methods are not enough. The risk of massive bleeding is high while using any of these methods. The article analyzes the blood saving methods existing at the present stage and possibility of these methods usage in obstetrics. Besides, we describe efficacy and safety of their use in massive blood loss, including the surgical treatment of morbidity adherence placenta

Выбор анестезиологического пособия при органосохраняющих операциях по поводу врастания плаценты

Abstract Placenta accreta (PAS-disorders) is one of the most serious complications of pregnancy, associated with the risk of massive uterine bleeding, massive hemotransfusion and maternal mortality. Peripartum hysterectomy is a common treatment strategy for patients with placenta accreta. Currently, there is a clear trend of changing surgical tactics in favor of organ-saving operations, but there are no studies devoted to anesthesiological support of such operations.The aim of the study is to substantiate an effective and safe method of anaesthesia in organ-saving operations for placenta accreta spectrum disorders.Materia l and methods The study involved 80 patients with a diagnosis of placenta accreta spectrum disorders, confirmed intraoperatively, who underwent organ-saving operations. The patients were randomized depending on the method of anesthesia into 3 groups: general anesthesia, spinal anesthesia with planned conversion to general after fetal extraction and epidural anesthesia with planned conversion to general also after fetal extraction. The comparison of intraoperative hemodynamics, efficiency of tissue perfusion, efficiency of antinociceptive protection at the stages of surgery was performed. A comparative analysis of the volume of blood loss and blood transfusion, time of patients activation in the postoperative period, severity of pain on the first day after surgery, duration of hospital stay before discharge and comparison of the assessment of the newborn according to Apgar score at first and fifth minute after extraction.Conclusion The study shows that the optimal method of anesthesia in organ-saving operations for placenta accreta spectrum disorders is epidural anesthesia with its planned conversion to general anesthesia with an artificial lung ventilation after fetal extraction. Such an approach to anesthesia allows to maintain stable hemodynamic profile with minimal vasopressor support, sufficient heart performance, providing effective tissue perfusion and a high level of antinociceptive protection at the intraoperative stage and reduce the volume of intraoperative blood loss and hemotransfusion. In the current study there were no differences in neonatal outcomes and duration of hospitalization depending on the method of anesthesia. The advantage of epidural anesthesia with its conversion to general anesthesia was earlier activation after surgery and lower intensity of postoperative pain syndrome.Резюме Врастание плаценты (placenta accreta, PAS-disorders) - одно из наиболее серьезных осложнений беременности, сопряженное с риском массивного маточного кровотечения, массивной гемотрансфузии и материнской смертности. Общепринятой стратегией лечения пациенток с врастанием плаценты является перипартальная гистерэктомия. В настоящее время отмечается отчетливая тенденция изменения хирургической тактики в пользу органосохраняющих операций, но исследований, посвященных анестезиологическому обеспечению таких операций, нет.Цель исследования Обоснование эффективного и безопасного способа анестезиологического пособия при органосохраняющих операциях по поводу врастания плаценты.Материал и методы В исследовании приняли участие 80 пациенток с диагнозом врастания плаценты, который был подтвержден интраоперационно. Всем пациенткам выполнены органосохраняющие операции. В зависимости от способа анестезиологического пособия были сформированы три группы: общей анестезии, субарахноидальной анестезии с плановой конверсией в общую после извлечения плода и эпидуральной анестезии с плановым переходом в общую также после извлечения плода. Выполнено сравнение интраоперационной гемодинамики, показателей эффективности тканевой перфузии, эффективности антиноцицептивной защиты на этапах операции. Проведен сравнительный анализ объемов кровопотери и гемотрансфузии, времени активизации пациенток в послеоперационном периоде, оценки выраженности болевого синдрома в 1-е сутки после операции, длительности пребывания в стационаре до выписки и сравнение оценки новорожденных по шкале Апгар на 1-й и 5-й минутах после извлечения.Зак лючение В исследовании показано, что оптимальным способом анестезиологического пособия при органосохраняющих операциях по поводу врастания плаценты является эпидуральная анестезия с ее плановой конверсией в общую анестезию с искусственной вентиляцией легких после извлечения плода. Подобный подход к анестезии позволяет поддерживать стабильность гемодинамического профиля и минимизировать вазопрессорную поддержку, сохранить достаточную производительность сердца и перфузию тканей. Антиноцицептивный эффект сочетания эпидуральной и общей анестезии был выше как на интраоперационном этапе, так и в послеоперационном периоде. Преимуществом эпидуральной анестезии с ее переходом в общую явилось снижение объемов интраоперационной кровопотери и гемотрансфузии. В проведенном исследовании не выявлено различий в неонатальных исходах и сроках госпитализации в стационаре в зависимости от способа анестезиологического пособия

Assessment of the quality of life in elderly and senile age patients with chronic heart failure

The present study aimed to compare the QOL in patients with heart failure with mid-range ejection fraction (HFmrEF) in different age groups, taking into account gender difference