Long-Term Outcome of High-Risk Percutaneous Coronary Interventions with Extracorporeal Membrane Oxygenation Support for Patients Without Cardiogenic Shock

Percutaneous coronary intervention (PCI) has evolved into the high-risk category in the past 2 decades. Endovascular patients are on average sicker than in the past due to increased age, complex anatomy, reduced global left ventricular systolic function and a greater frequency of surgical refusal. Extracorporeal membrane oxygenation (ECMO) can be taken into account for the management of extremely high-risk PCI without any hemodynamic instability. The rationale for the use of ECMO includes a lower risk of hemodynamic collapse which leads to low perfusion episodes minimization. In the evidence based on ECMO-assisted high-risk PCI, there are no randomized clinical trials but only observational studies and case reports. In this paper, we describe one-year long-term results of ECMO support for PCI in patients without hemodynamic disturbances

Correction of critical hypernatremia in severe burn trauma

Hypernatremia along with septic complications is the most frequent and dangerous complication in patients with severe burn trauma. The intravenous infusion of hypoosmolar solutions is considered to be a common tactic in overcoming critical hypernatremia, although the safety and effectiveness of this approach is questioned. The aim of the work was to clarify the pathogenesis of hypernatremia and define the tactic for its correction in the acute period of severe burn trauma. Material and Methods. The retrospective study included 82 adult patients treated in the ICU of the Burn Trauma Center of Novosibirsk Regional Clinical Hospital between 2015–2018 years. There were patients both with partial thickness burns TBSA >40 % or with full thickness burns TBSA 20 % with or without the thermoinhalation trauma. Results. Hypernatremia (serum Na > 150 mmol/L) usually occurred 4–6 days after a severe burn injury. This complication was detected in 27 % of patients. Cortisol serum levels were at the upper limit of the norm, meantime the serum concentration of aldosterone was significantly increased on 3rd day after trauma. Based on the obtained data, hypernatremia was corrected using enteral rehydration (oral water up to 20–30 ml/kg/day), Spironolactone (200–300 mg/day), intravenous titration of furosemide in small doses (60–100 mg/day). Permanent renal replacement therapy started when a patient›s serum sodium level was greater than 160–163 mmol/L. Conclusion. Significant increase of the serum aldosterone concentration in patients with severe burn trauma was noted by the 3 day, so the use of spironolactone should begin in these terms. Titrated intravenous introduction of furosemide in small doses (60–100 mg/day) allows removing sodium without adverse effects. In addition, the use of additional enteral rehydration is necessary

МЕТОДЫ КАРДИОПРОТЕКЦИИ ПРИ ИНФАРКТЕ МИОКАРДА. СОВРЕМЕННОЕ СОСТОЯНИЕ ВОПРОСА

The most efficient method of restitution of a blood-groove at a myocardial infarction is implantation of a stent in a heart attack the bound artery. Restitution of a blood-groove in a heart attack of the bound artery starts processes of reperfusion damage, thereby increasing a hibernation zone with the subsequent nekrosis of a myocardium. Now several techniques helping to resist efficiently to reperfusion damage of cardiomyocyts are considered. Mechanisms of a pre-conditioning and post-conditioning of a myocardium are actively investigated the last decades, at the same time the common concept of protection of a myocardium is not created. In our opinion pharmacological protection of a myocardium can be considered as the modern technique restoring fabric respirations at the level of mitochondrions.Самым эффективным методом восстановления кровотока при инфаркте миокарда является имплантация стента в инфаркт-связанную артерию. Восстановление кровотока в инфаркт-связанной артерии запускает процессы реперфузионного повреждения, тем самым увеличивая зону гибернации с последующим некротизированием миокарда. В настоящее время рассматриваются несколько методик, помогающих эффективно противостоять реперфузионному повреждению кардиомиоцитов. Механизмы прекондиционирования и посткондиционирования миокарда активно исследуются в последние десятилетия, при этом не сформирована общая концепция защиты миокарда. На наш взгляд фармакологическая защита миокарда может быть рассмотрена как современная методика, восстанавливающая тканевое дыхание на уровне митохондрий

Influence of substituents of the conformation of molecules with two geminal C-SR bonds

1,1-Bis(arylthio)ethanes exist in solutions in the form of conformers with trans-gauche and trans-trans conformations of the C-S-C-S-C chain, while geminal disulfones based on them exist in transgauche and gauche-gauche conformations, with the radicals situated on different sides of the plane of S-C-S. © 1975 Plenum Publishing Corporation

A conformational analysis of o,o'- and m,m'-disubstituted diphenyl disulfides and diselenides based on dipole moments and Kerr constants

Effective conformations have been established for the o,o'- and m,m'-disubstituted diaryl disulfides and diselenides. Angles of aryl group rotation relative to the C-E-E plane have been determined for these compounds. One of the substituents lies inside, and one outside, the C-E-E-C dihedral angle. © 1979 Plenum Publishing Corporation

Stereochemistry of eight-membered heterocycles 1. Conformations of 6-oxo-, and 6,6-dioxodibenzo-[d,g][1.3.2]dioxathiocin-12-ones

6,6-Dioxodibenzol[d,g][1.3.2] dioxathiocin-12-one in solution has the chair conformation; for 6-oxodibenzo [d,g][1.3.2]dioxathiocin-12-one, the axial chair conformation is in equilibrium with one of the flexible forms. © 1983 Plenum Publishing Corporation

Conformation of gem-diphenyl group in six-membered cyclic ethers of acids of sulfur, selenium, and arsenic

1. The sulfate, selenite, chloroarsenite, and bromoarsenite of 2,2-diphenyl-1,3-propanediol have been synthesized. 2. In the molecules of cyclic esters based on 2,2-diphenyl-l,3-propanediol, in the dissolved state, equivalent rotation of the phenyl groups relative to the ring symmetry plane is realized. © 1980 Plenum Publishing Corporation

Thermalization of a nonequilibrium electron-positron-photon plasma

Starting from a nonequilibrium configuration we analyse the essential role of the direct and the inverse binary and triple interactions in reaching an asymptotic thermal equilibrium in a homogeneous isotropic electron-positron-photon plasma. We focus on energies in the range 0.1--10 MeV. We numerically integrate the integro-partial differential relativistic Boltzmann equation with the exact QED collisional integrals taking into account all binary and triple interactions in the plasma. We show that first, when detailed balance is reached for all binary interactions on a timescale $t_{k}\lesssim10^{-14}$sec, photons and electron-positron pairs establish kinetic equilibrium. Successively, when triple interactions fulfill the detailed balance on a timescale $t_{eq}\lesssim10^{-12}$sec, the plasma reaches thermal equilibrium. It is shown that neglecting the inverse triple interactions prevents reaching thermal equilibrium. Our results obtained in the theoretical physics domain also find application in astrophysics and cosmology.Comment: 4 pages, 3 figures, Phys. Rev. Lett., to appea

КАРДИОПРОТЕКЦИЯ У ПАЦИЕНТОВ ОСТРЫМ ИНФАРКТОМ МИОКАРДА С ПОДЪЕМОМ СЕГМЕНТА ST

Aim To evaluate cardioprotective effects of combined intracoronary phosphocreatine and succinic acid administration after primary percutaneous coronary intervention (PCI) in patients with ST elevation acute coronary syndrome who were present within 12 hours of symptom onset.Methods Seven patients with STEMI presenting within 12 hours of onset of symptoms and thrombotic occlusion of the left anterior descending artery were included in the study. Evaluation of efficiency and safety was performed with the recording of major adverse cardiac events, evaluation of the procedure success, and the rate of composite endpoints.Results Six (85.7%) patients after primary PCI showed TIMI grade 3 flow on control coronary angiography. None complications had been reported after intracoronary administration of phosphocreatine and succinic acid. Acquired left ventricular aneurysms were found in two patients in the in-hospital period. One patient was readmitted with acute coronary syndrome without ST-segment elevation. Coronary angiography reported restenosis of the previously implanted stent. No definite increase in the left ventricular ejection fraction had been found in the in-hospital and long-term period.Conclusion There were no evidences on definite increase in myocardial contractility. The obtained results might partially be explained by the median symptom-to-balloon time over 400 minutes.Цель Изучить эффективность сочетанного введения кардиопротекторов экзогенного фосфокреатина и янтарной кислоты после первичного чрескожного коронарного вмешательства (ЧКВ) у пациентов острым коронарным синдромом с подъемом сегмента ST (ОКСпST) давность до 12 часов.Материалы и методы В анализ включено 7 пациентов с диагнозом ОКСпST давностью до 12 часов с тромботической окклюзией передней нисходящей артерией. Оценка эффективности и безопасности проводилась на основании оценки серьезных неблагоприятных кардиоваскулярных событий, успеха процедуры, комбинированных конченых точек.Результаты Скорость кровотока TIMI 3 отмечена у 6 (85,7%) пациентов после первичного ЧКВ на контрольной коронарографии. При интракоронарном введении кардиопротекторов осложнений не отмечено. Во время госпитализации у двоих пациентов отмечается формирование аневризмы левого желудочка. Через 8 месяцев один пациент поступил повторно с диагнозом острый коронарный синдром без подъема сегмента ST, на коронарографии выявлен рестеноз ранее имплантированного стента. В госпитальном и отдаленном периоде не получен явный прирост фракции выброса левого желудочка.Заключение В исследовании, оценивающем эффективность кардиопротекторов, мы не получили явного прироста сократительной способности миокарда. Возможно, это обусловлено средним временем симптом-баллон более 400 минут

Mathematical Modeling of a Solar Arrays Deploying Process at Ground Tests

This paper focuses on the creating of a mathematical model of a solar array deploying process during ground tests. Lagrange equation was used to obtain the math model. The distinctive feature of this mathematical model is the possibility of taking into account the gravity compensation system influence on the construction in the deploying process and the aerodynamic resistance during ground tests