76 research outputs found
ΠΠ½Π΅ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΠ΅ Π»ΠΎΠ²ΡΡΠΊΠΈ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² (NETs) Π² ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΡΡΠΎΠΌΠ±ΠΎΠ·Π° ΠΈ ΡΡΠΎΠΌΠ±ΠΎΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ
This article summarizes numerous studies on the relationship of biological processes such as inflammation and thrombosis. The huge role of neutrophils and the extracellular neutrophil traps (NETs) secreted by them has been demonstrated. The discovery of NETs has opened new horizons in the understanding of neutrophil biology and the role of these cells in the body. The use of chromatin in combination with the intracellular proteins, as an effective antimicrobial agent has ancient roots and changes our understanding of chromatin only as a carrier of genetic information. Through NETs, neutrophils can contribute to the development of pathological venous and arterial thrombosis or immunothrombosis, as well as atherosclerosis. NETs release has been shown to be one of the causes of thrombosis in conditions such as sepsis and cancer. The presence of NETs in these diseases and conditions makes it possible to use them or individual components as potential biomarkers. NETs and their components may be attractive as therapeutic targets. Further studies of neutrophils and NETs are needed to develop new approaches to the diagnosis and treatment of inflammatory and thrombotic conditions. Perhaps long-forgotten drugs will find a new area for effective use.Π Π΄Π°Π½Π½ΠΎΠΉ ΡΡΠ°ΡΡΠ΅ ΠΎΠ±ΠΎΠ±ΡΠ΅Π½Ρ ΠΌΠ½ΠΎΠ³ΠΎΡΠΈΡΠ»Π΅Π½Π½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΎ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·ΠΈ ΡΠ°ΠΊΠΈΡ
Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΎΡΠ΅ΡΡΠΎΠ² ΠΊΠ°ΠΊ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΠ΅ ΠΈ ΡΡΠΎΠΌΠ±ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅. ΠΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π½Π° ΠΎΠ³ΡΠΎΠΌΠ½Π°Ρ ΡΠΎΠ»Ρ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»Π»ΠΎΠ² ΠΈ Π²ΡΠ΄Π΅Π»ΡΠ΅ΠΌΡΡ
ΠΈΠΌΠΈ Π²Π½Π΅ΠΊΠ»Π΅ΡΠΎΡΠ½ΡΡ
Π»ΠΎΠ²ΡΡΠ΅ΠΊ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² (Neutrophil Extracellular Traps, NETs). ΠΡΠΊΡΡΡΠΈΠ΅ NETs ΡΠ°ΡΡΠΈΡΠΈΠ»ΠΎ Π³ΠΎΡΠΈΠ·ΠΎΠ½ΡΡ Π² ΠΏΠΎΠ½ΠΈΠΌΠ°Π½ΠΈΠΈ Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² ΠΈ ΡΠΎΠ»ΠΈ ΡΡΠΈΡ
ΠΊΠ»Π΅ΡΠΎΠΊ Π² ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ΅. ΠΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ Ρ
ΡΠΎΠΌΠ°ΡΠΈΠ½Π° Π² ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ Ρ Π²Π½ΡΡΡΠΈΠΊΠ»Π΅ΡΠΎΡΠ½ΡΠΌΠΈ Π±Π΅Π»ΠΊΠ°ΠΌΠΈ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΡΠΎΡΠΈΠ²ΠΎΠΌΠΈΠΊΡΠΎΠ±Π½ΠΎΠ³ΠΎ ΡΡΠ΅Π΄ΡΡΠ²Π° ΠΈΠΌΠ΅Π΅Ρ Π΄ΡΠ΅Π²Π½ΡΡ ΠΈΡΡΠΎΡΠΈΡ ΠΈ ΠΌΠ΅Π½ΡΠ΅Ρ Π½Π°ΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ ΠΎ Ρ
ΡΠΎΠΌΠ°ΡΠΈΠ½Π΅ ΡΠΎΠ»ΡΠΊΠΎ ΠΊΠ°ΠΊ ΠΎ Π½ΠΎΡΠΈΡΠ΅Π»Π΅ Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠΈ. ΠΠ»Π°Π³ΠΎΠ΄Π°ΡΡ NETs, Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»Ρ ΠΌΠΎΠ³ΡΡ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΠΎΠ²Π°ΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠ³ΠΎ ΠΈ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠΎΠΌΠ±ΠΎΠ·Π° ΠΈΠ»ΠΈ ΠΈΠΌΠΌΡΠ½ΠΎΡΡΠΎΠΌΠ±ΠΎΠ·Π°, Π° ΡΠ°ΠΊΠΆΠ΅ Π°ΡΠ΅ΡΠΎΡΠΊΠ»Π΅ΡΠΎΠ·Π°. ΠΡΡΠ²ΠΎΠ±ΠΎΠΆΠ΄Π΅Π½ΠΈΠ΅ NETs ΡΠ²Π»ΡΠ΅ΡΡΡ, ΠΊΠ°ΠΊ Π±ΡΠ»ΠΎ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΠΎΠ΄Π½ΠΎΠΉ ΠΈΠ· ΠΏΡΠΈΡΠΈΠ½ ΡΡΠΎΠΌΠ±ΠΎΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠΈ ΡΠ°ΠΊΠΈΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΡΡ
ΠΊΠ°ΠΊ ΡΠ΅ΠΏΡΠΈΡ ΠΈ ΡΠ°ΠΊ. ΠΠ°Π»ΠΈΡΠΈΠ΅ NETs ΠΏΡΠΈ ΡΡΠΈΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΡ
ΠΈ ΡΠΎΡΡΠΎΡΠ½ΠΈΡΡ
Π΄Π°Π΅Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ ΠΈΡ
ΠΈΠ»ΠΈ ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΠ΅ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΡ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ
Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ². NETs ΠΈ ΠΈΡ
ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΡ ΠΌΠΎΠ³ΡΡ Π±ΡΡΡ ΠΏΡΠΈΠ²Π»Π΅ΠΊΠ°ΡΠ΅Π»ΡΠ½Ρ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠΈΡΠ΅Π½Π΅ΠΉ. ΠΠ°Π»ΡΠ½Π΅ΠΉΡΠΈΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΠΎΠ² ΠΈ NETs Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΡ Π΄Π»Ρ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠΈ Π½ΠΎΠ²ΡΡ
ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΠΎΠ² ΠΊ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΈ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΠΉ. ΠΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎ, Π΄Π°Π²Π½ΠΎ Π·Π°Π±ΡΡΡΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ Π½Π°ΠΉΠ΄ΡΡ Π½ΠΎΠ²ΡΡ ΡΡΠ΅ΡΡ Π΄Π»Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ
COVID-19, ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΎΠΊ ΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π²Π½ΡΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΡΠ²Π΅ΡΡΡΠ²Π°Π½ΠΈΡ ΠΊΡΠΎΠ²ΠΈ. Π§Π°ΡΡΡ 2
The article discusses the issues of hemostatic system disorders in patients with COVID-19. Strengthening the coagulopathy characteristic of DIC-syndrome, is a key sign of deterioration and an unfavorable prognosis in COVID-19 patients. Data obtained by Chinese colleagues demonstrates that a significantly increased level of D-dimer is one of the predictors of death. The article also highlights the preliminary recommendations of the International society of Thrombosis and Hemostasis (ISTH, 2020) to identify markers such as D-dimer, prothrombin time and platelet count as significant predictive markers in severe COVID-19 patients. The necessity of anticoagulant therapy in hospitalized patients is justified. The article discusses the features of sepsis in pregnant women. Data from a meta-analysis of 19 studies evaluating pregnancy complications and outcomes in patients with various coronavirus infections are presented. Despite the complicated course of pregnancy, there were no cases of vertical transmission of viral infection. In the pathogenesis of severe COVID-19 complications with the formation of severe acute respiratory distress syndrome, multi-organ dysfunction, super inflammation and cytokine storm play a leading role. In connection with viral sepsis, the article discusses the role of hemophagocytic lymphohistiocytosis as a hyperinflammatory syndrome characterized by fulminant and fatal hypercytokinemia with multiple organ failure, the role of hyperferritinemia in predicting the outcomes of severe sepsis. Groups of patients at high risk of death are discussed, as well as the need for anticoagulant and anti-cytokine therapy in patients with COVID-19.Π ΡΡΠ°ΡΡΠ΅ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ Π²ΠΎΠΏΡΠΎΡΡ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΡΠΈΡΡΠ΅ΠΌΡ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ COVID-19. ΠΠ°ΡΠ°ΡΡΠ°Π½ΠΈΠ΅ ΠΊΠΎΠ°Π³ΡΠ»ΠΎΠΏΠ°ΡΠΈΠΈ, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎΠΉ Π΄Π»Ρ Π΄ΠΈΡΡΠ΅ΠΌΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π²Π½ΡΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΡΠ²Π΅ΡΡΡΠ²Π°Π½ΠΈΡ ΠΊΡΠΎΠ²ΠΈ (ΠΠΠ‘-ΡΠΈΠ½Π΄ΡΠΎΠΌΠ°), β ΠΊΠ»ΡΡΠ΅Π²ΠΎΠΉ ΠΏΡΠΈΠ·Π½Π°ΠΊ ΡΡ
ΡΠ΄ΡΠ΅Π½ΠΈΡ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΈ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ COVID-19. ΠΡΠΈΠ²ΠΎΠ΄ΡΡΡΡ Π΄Π°Π½Π½ΡΠ΅, ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΠ΅ ΠΊΠΈΡΠ°ΠΉΡΠΊΠΈΠΌΠΈ ΠΊΠΎΠ»Π»Π΅Π³Π°ΠΌΠΈ, ΡΠΎΠ³Π»Π°ΡΠ½ΠΎ ΠΊΠΎΡΠΎΡΡΠΌ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΠΉ ΡΡΠΎΠ²Π΅Π½Ρ D-Π΄ΠΈΠΌΠ΅ΡΠ° ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ΄Π½ΠΈΠΌ ΠΈΠ· ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠ² ΡΠΌΠ΅ΡΡΠΈ. Π’Π°ΠΊΠΆΠ΅ ΠΎΡΠ²Π΅ΡΠ΅Π½Ρ ΠΏΡΠ΅Π΄Π²Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ ΠΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΡΡΠ²Π° ΡΡΠΎΠΌΠ±ΠΎΠ·Π° ΠΈ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° (International Society on Thrombosis and Haemostasis, ISTH, 2020) ΠΏΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ°ΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ², ΠΊΠ°ΠΊ D-Π΄ΠΈΠΌΠ΅Ρ, ΠΏΡΠΎΡΡΠΎΠΌΠ±ΠΈΠ½ΠΎΠ²ΠΎΠ΅ Π²ΡΠ΅ΠΌΡ ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠΎΠ², Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ Π·Π½Π°ΡΠΈΠΌΡΡ
ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΡ
Π±ΠΎΠ»ΡΠ½ΡΡ
COVID-19. ΠΠ±ΠΎΡΠ½ΠΎΠ²ΡΠ²Π°Π΅ΡΡΡ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π±ΠΎΠ»ΡΠ½ΡΡ
. Π ΡΡΠ°ΡΡΠ΅ ΠΎΠ±ΡΡΠΆΠ΄Π°ΡΡΡΡ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΡΠ΅ΠΏΡΠΈΡΠ° Ρ Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
. ΠΡΠΈΠ²ΠΎΠ΄ΡΡΡΡ Π΄Π°Π½Π½ΡΠ΅ ΠΌΠ΅ΡΠ°Π°Π½Π°Π»ΠΈΠ·Π° 19 ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π½ΡΡ
ΠΎΡΠ΅Π½ΠΊΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΈ ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΡΡΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ ΡΠ°Π·Π»ΠΈΡΠ½ΡΠΌΠΈ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΡΠΌΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡΠΌΠΈ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½Π½ΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΡΡΠΈ, Π½Π΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Π½ΠΈ ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΠ»ΡΡΠ°Ρ Π²Π΅ΡΡΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΠ΅ΡΠ΅Π΄Π°ΡΠΈ Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ. Π ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π΅ ΡΡΠΆΠ΅Π»ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ COVID-19 Ρ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΎΡΡΡΠΎΠ³ΠΎ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΠΎΠ³ΠΎ Π΄ΠΈΡΡΡΠ΅ΡΡ-ΡΠΈΠ½Π΄ΡΠΎΠΌΠ°, ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ Π²Π΅Π΄ΡΡΡΡ ΡΠΎΠ»Ρ ΠΈΠ³ΡΠ°ΡΡ ΡΡΠΏΠ΅ΡΠ²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΠ΅ ΠΈ ΡΠΈΡΠΎΠΊΠΈΠ½ΠΎΠ²ΡΠΉ ΡΡΠΎΡΠΌ. Π ΡΡΠ°ΡΡΠ΅ Π² ΡΠ²ΡΠ·ΠΈ Ρ Π²ΠΈΡΡΡΠ½ΡΠΌ ΡΠ΅ΠΏΡΠΈΡΠΎΠΌ ΠΎΠ±ΡΡΠΆΠ΄Π°Π΅ΡΡΡ ΡΠΎΠ»Ρ Π³Π΅ΠΌΠΎΡΠ°Π³ΠΎΡΠΈΡΠ°ΡΠ½ΠΎΠ³ΠΎ Π»ΠΈΠΌΡΠΎΠ³ΠΈΡΡΠΈΠΎΡΠΈΡΠΎΠ·Π° ΠΊΠ°ΠΊ Π³ΠΈΠΏΠ΅ΡΠ²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ°, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΠ΅ΠΌΠΎΠ³ΠΎ ΡΡΠ»ΡΠΌΠΈΠ½Π°Π½ΡΠ½ΠΎΠΉ ΠΈ ΡΠ°ΡΠ°Π»ΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠΈΡΠΎΠΊΠΈΠ½Π΅ΠΌΠΈΠ΅ΠΉ Ρ ΠΏΠΎΠ»ΠΈΠΎΡΠ³Π°Π½Π½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ, ΡΠΎΠ»Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅ΡΡΠΈΡΠΈΠ½Π΅ΠΌΠΈΠΈ Π² ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΈΡΡ
ΠΎΠ΄ΠΎΠ² ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΡΠ΅ΠΏΡΠΈΡΠ°. ΠΠ±ΡΡΠΆΠ΄Π°ΡΡΡΡ Π³ΡΡΠΏΠΏΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ Π»Π΅ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΡΡ
ΠΎΠ΄ΠΎΠ², Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΠΎΠΉ ΠΈ Π°Π½ΡΠΈΡΠΈΡΠΎΠΊΠΈΠ½ΠΎΠ²ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
COVID-19
Thrombotic storm, hemostasis disorders and thromboinflammation in COVID-19
The rate of thrombosis and disseminated intravascular coagulation (DIC) has been increasing in COVID-19 patients. Key features related to such condition include minimal or no risk of bleeding, moderate thrombocytopenia, high plasma fibrinogen as well as complement components level in the areas of thrombotic microangiopathy. The clinical picture is not typical for classic DIC. This review systematizes the pathogenetic mechanisms of hypercoagulation in sepsis and its extreme forms in patients with COVID-19. The latter consist of the thrombosis-related immune mechanisms, the complement activation, the macrophage activation syndrome, the formation of antiphospholipid antibodies, the hyperferritinemia, and the dysregulation of the renin-angiotensin system. Taking into consideration the pathogenetic mechanisms, the biomarkers had been identified related to the prognosis of the disease development. Patients with pre-existing cardiovascular disease and other risk factors, including obesity, diabetes, hypertension, and aging pose the peak risk of dying from COVID-19. We also summarize new data on platelet and endothelial dysfunction, immunothrombosis, and, as a result, thrombotic storm as essential components of COVID-19 severe features
Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate
Background: The aim of this prospective study is to evaluate the role in the onset of surgical site infections of bilateral internal thoracic arteries harvesting in patients with decompensated preoperative glycemia. Methods: 81 consecutive patients with uncontrolled diabetes mellitus underwent elective CABG harvesting single or double internal thoracic arteries. Single left ITA was harvested in 41 patients (Group 1, 50.6%), BITAs were harvested in 40 (Group 2, 49.4%). The major clinical end points analyzed in this study were infection rate, type of infection, duration of infection, infection relapse rate and total hospital length of stay. Results: Five patients developed sternal SSI in the perioperative period, 2 in group 1 and 3 in group 2 without significant difference. All sternal SSIs were superficial with no sternal dehiscence. The development of infection from the time of surgery took 18.5 Β± 2.1 and 7.3 Β± 3.0 days for Groups 1 and 2 respectively. The infections were treated with wound irrigation and debridement, and with VAC therapy as well as with antibiotics. The VAC system was removed after a mean of 12.8 Β± 5.1 days, when sterilization was achieved. The overall survival estimate at 1 year was 98.7%. Only BMI was a significant predictor of SSI using multivariate stepwise logistic regression analysis (Odds Ratio: 1.34; 95%Conficdence Interval: 1.02β1.83; p value: 0.04). In the model, the use of BITA was not an independent predictor of SSI. Conclusion: CABG with bilateral pedicled ITAs grafting could be performed safely even in diabetics with poor preoperative glycaemic control
Shiga Toxin and Lipopolysaccharide Induce Platelet-Leukocyte Aggregates and Tissue Factor Release, a Thrombotic Mechanism in Hemolytic Uremic Syndrome
BACKGROUND: Aggregates formed between leukocytes and platelets in the circulation lead to release of tissue factor (TF)-bearing microparticles contributing to a prothrombotic state. As enterohemorrhagic Escherichia coli (EHEC) may cause hemolytic uremic syndrome (HUS), in which microthrombi cause tissue damage, this study investigated whether the interaction between blood cells and EHEC virulence factors Shiga toxin (Stx) and lipopolysaccharide (LPS) led to release of TF. METHODOLOGY/PRINCIPAL FINDINGS: The interaction between Stx or LPS and blood cells induced platelet-leukocyte aggregate formation and tissue factor (TF) release, as detected by flow cytometry in whole blood. O157LPS was more potent than other LPS serotypes. Aggregates formed mainly between monocytes and platelets and less so between neutrophils and platelets. Stimulated blood cells in complex expressed activation markers, and microparticles were released. Microparticles originated mainly from platelets and monocytes and expressed TF. TF-expressing microparticles, and functional TF in plasma, increased when blood cells were simultaneously exposed to the EHEC virulence factors and high shear stress. Stx and LPS in combination had a more pronounced effect on platelet-monocyte aggregate formation, and TF expression on these aggregates, than each virulence factor alone. Whole blood and plasma from HUS patients (n = 4) were analyzed. All patients had an increase in leukocyte-platelet aggregates, mainly between monocytes and platelets, on which TF was expressed during the acute phase of disease. Patients also exhibited an increase in microparticles, mainly originating from platelets and monocytes, bearing surface-bound TF, and functional TF was detected in their plasma. Blood cell aggregates, microparticles, and TF decreased upon recovery. CONCLUSIONS/SIGNIFICANCE: By triggering TF release in the circulation, Stx and LPS can induce a prothrombotic state contributing to the pathogenesis of HUS
Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine .
COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH
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