Профилактика, диагностика и лечение тромбоэмболических осложнений в травматологии и ортопедии: методические рекомендации

The guidelines describe modern approaches to the prevention, diagnosis, and treatment of thromboembolic complications in patients with injuries and after musculoskeletal surgery, in accordance with the interdisciplinary draft of the Clinical Guidelines (2022) Deep vein thrombosis of the extremities, which has passed public hearings and is being approved by the Russian Ministry of Health. The guidelines are designed for doctors of various specialties to provide medical care to specialized patients: orthopedic surgeons, anesthesiologists, resuscitators, clinical pharmacologists, health care organizers, medical students, residents, graduate students.В методических рекомендациях описаны современные подходы к профилактике, диагностике и лечению тромбоэмболических осложнений у пациентов с травмами и операциями на опорно-двигательном аппарате в соответствии с междисциплинарным проектом клинических рекомендаций 2022 г. Тромбоз глубоких вен конечностей, прошедшим общественные слушания и находящемся на утверждении в Минздраве России. Методические рекомендации рассчитаны на врачей различных специальностей, оказывающих медицинскую помощь профильным пациентам: травматологов-ортопедов, хирургов, анестезиологов-реаниматологов, клинических фармакологов, организаторов здравоохранения, студентов медицинских вузов, ординаторов, аспирантов

Observation Of Very High Energy Cosmic-ray Families In Emulsion Chambers At High Mountain Altitudes (i)

Characteristics of cosmic-ray hadronic interactions in the 1015 - 1017 eV range are studied by observing a total of 429 cosmic-ray families of visible energy greater than 100 TeV found in emulsion chamber experiments at high mountain altitudes, Chacaltaya (5200 m above sea level) and the Pamirs (4300 m above sea level). Extensive comparisons were made with simulated families based on models so far proposed, concentrating on the relation between the observed family flux and the behaviour of high-energy showers in the families, hadronic and electromagnetic components. It is concluded that there must be global change in characteristics of hadronic interactions at around 1016 eV deviating from thise known in the accelerator energy range, specially in the forwardmost angular region of the collision. A detailed study of a new shower phenomenon of small-pT particle emissions, pT being of the order of 10 MeV/c, is carried out and its relation to the origin of huge "halo" phenomena associated with extremely high energy families is discussed as one of the possibilities. General characteristics of such super-families are surveyed. © 1992.3702365431Borisov, (1981) Nucl. Phys., 191 BBaybrina, (1984) Trudy FIAN 154, p. 1. , [in Russian], Nauka, MoscowLattes, Hadronic interactions of high energy cosmic-ray observed by emulsion chambers (1980) Physics Reports, 65, p. 151Hasegawa, ICR-Report-151-87-5 (1987) presented at FNAL CDF Seminar, , Inst. for Cosmic Ray Research, Univ. of TokyoCHACALTAYA Emulsion Chamber Experiment (1971) Progress of Theoretical Physics Supplement, 47, p. 1Yamashita, Ohsawa, Chinellato, (1984) Proc. 3rd Int. Symp. on Cosmic Rays and Particle Physics, p. 30. , Tokyo, 1984, Inst. for Cosmic Ray Research, Univ. of Tokyo(1984) Proc. 3rd Int. Symp. on Cosmic Rays and Particle Physics, p. 1. , Tokyo, 1984Baradzei, (1984) Proc. 3rd Int. Symp. on Cosmic Rays and Particle Physics, p. 136. , Tokyo, 1984Yamashita, (1985) J. Phys. Soc. Jpn., 54, p. 529Bolisov, (1984) Proc. 3rd Int. Symp. on Cosmic rays and Particle Physics, p. 248. , Tokyo, 1984, Inst. for Cosmic Ray Research, Univ. of TokyoTamada, Tomaszewski, (1988) Proc. 5th Int. Symp. on Very High Energy Cosmic-Ray Interactions, p. 324. , Lodz, 1988, Inst. for Cosmic Ray Research, Univ. of Tokyo, PolandHasegawa, (1989) ICR-Report-197-89-14, , Inst. for Cosmic Ray Research, Univ. of TokyoCHACALTAYA Emulsion Chamber Experiment (1971) Progress of Theoretical Physics Supplement, 47, p. 1Okamoto, Shibata, (1987) Nucl. Instrum. Methods, 257 A, p. 155Zhdanov, (1980) FIAN preprint no. 45, , Lebedev Physical Institute, MoscowSemba, Gross Features of Nuclear Interactions around 1015eV through Observation of Gamma Ray Families (1983) Progress of Theoretical Physics Supplement, 76, p. 111Nikolsky, (1975) Izv. Akad. Nauk. USSR Ser. Fis., 39, p. 1160Burner, Energy spectra of cosmic rays above 1 TeV per nucleon (1990) The Astrophysical Journal, 349, p. 25Takahashi, (1990) 6th Int. Symp. on Very High Energy Cosmic-ray Interactions, , Tarbes, FranceRen, (1988) Phys. Rev., 38 D, p. 1404Alner, The UA5 high energy simulation program (1987) Nuclear Physics B, 291 B, p. 445Bozzo, Measurement of the proton-antiproton total and elastic cross sections at the CERN SPS collider (1984) Physics Letters B, 147 B, p. 392Wrotniak, (1985) Proc. 19th Cosmic-Ray Conf. La Jolla, 1985, 6, p. 56. , NASA Conference Publication, Washington, D.CWrotniak, (1985) Proc. 19th Cosmic-Ray Conf. La Jolla, 1985, 6, p. 328. , NASA Conference Publication, Washington, D.CMukhamedshin, (1984) Trudy FIAN, 154, p. 142. , Nauka, Moscow, [in Russian]Dunaevsky, Pluta, Slavatinsky, (1988) Proc. 5th Int. Symp. on Very High Energy Cosmic-Ray Interactions, p. 143. , Lodz, 1988, Inst. of Physics, Univ. of Lodz, PolandKaidalov, Ter-Martirosyan, (1987) Proc. 20th Int. Cosmic-Ray Conf., Moscow, 1987, 5, p. 141. , Nauka, MoscowShabelsky, (1985) preprints LNPI-1113Shabelsky, (1986) preprints LNPI-1224, , Leningrad [in Russian]Hillas, (1979) Proc. 16th Int. Cosmic-Ray Conf., Kyoto, 6, p. 13. , Inst. for Cosmic Ray Research, Univ. of TokyoBorisov, (1987) Phys. Lett., 190 B, p. 226Hasegawa, Tamada, (1990) 6th Int. Symp. on Very High Energy Cosmic-Ray Interactions, , Tarbes, FranceSemba, Gross Features of Nuclear Interactions around 1015eV through Observation of Gamma Ray Families (1983) Progress of Theoretical Physics Supplement, p. 111Ren, (1988) Phys. Rev., 38 D, p. 1404Dynaevsky, Zimin, (1988) Proc. 5th Int. Symp. on Very High Energy Cosmic-Ray Interaction, p. 93. , Lodz, 1988, Inst. of Physics, Univ. of Lodz, PolandDynaevsky, (1990) Proc. 6th Int. Symp. on Very High Energy Cosmic-Ray Interactions, , Tarbes, France(1989) FIAN preprint no. 208, , Lebedev Physical Institute, Moscow(1990) Proc. 21st Int. Cosmic-Ray Conf., Adelaide, 8, p. 259. , Dept. Physics and Mathematical Physics, Univ. of Adelaide, AustraliaHasegawa, (1990) ICR-Report-216-90-9, , Inst. for Cosmic-Ray Research, Univ. of TokyoTamada, (1990) Proc. 21st Int. Cosmic-Ray Conf., Adelaide, 1990, 8. , Dept. Physics and Mathematical Physics, Univ. of Adelaide, AustraliaTamada, (1990) ICR-Report-216-90-9(1981) Proc. 17th Int. Cosmic-Ray Conf., Paris, 5, p. 291(1990) Proc. Int. Cosmic-Ray Conf., Adelaide, 1990, 8, p. 267. , Dept. Physics and Mathematical Physics, Univ. of Adelaide, Australia(1989) Inst. Nucl. Phys. 89-67/144, , preprint, Inst. Nucl. Phys., Moscow State UnivSmilnova, (1988) Proc. 5th Int. Sym. on Very High Energy Cosmic-Ray Interactions, p. 42. , Lodz, 1988, Inst. of Physics, Univ. of Lodz, PolandGoulianos, (1986) Proc. Workshop of Particle Simulation at High Energies, , University of Wisconsin, Madison, USAIvanenko, (1983) Proc. 18th Int. Cosmic-Ray Conf., Bangalore, 1983, 5, p. 274. , Tata Inst. Fundamental Research, Bombay, IndiaIvanenko, (1984) Proc. Int. Symp. on Cosmic-Rays and Particle Physics, p. 101. , Tokyo, 1984, Inst. for Cosmic Ray Research, Univ. of Tokyo(1988) 5th Int. Symp. on Very High Energy Cosmic-Ray Interactions, p. 180. , Lodz, 1988, Inst. of Physics, Univ. of Lodz, Poland(1990) Proc. 21st Int. Cosmic-Ray Conf., Adelaide, 1990, 8, p. 251. , Dept. Physics and Mathematical Physics, Univ. of Adelaide, Australia(1991) Izv. AN USSR No. 4, , to be publishedNikolsky, Shaulov, Cherdyntseva, (1990) FIAN preprint no. 140, , Lebedev Physical Institute, Moscow, [in Russian](1987) Proc. 20th Int. Cosmic-Ray Conf., Moscow, 1987, 5, p. 326. , Nauka, Mosco

A Study On Hadron-induced Shower Transition In Thick Lead Chambers

Three-dimensional development of cascade shower in lead initiated by high energy proton-Pb and pion-Pb interactions are calculated by full Monte-Carlo simulation assuming simple geometrical model for hadron-nucleus interactions. It is shown that fluctuations in shower development is very large but the extraordinary long penetrating showers observed in the Pamir thick lead chamber experiment can not be explained by simple fluctuations of shower development initiated by ordinary hadron-Pb interactions.523222224Baradzei, L.T., (1992) Nucl. Phys., B370, p. 365Lattes, C.M.G., Fujimoto, Y., Hasegawa, S., (1981) Phys. Rep., 65, p. 151Arisawa, T., (1994) Nucl. Phys., B424, p. 241Tamada, M., (1995) J.Phys. G: Nucl.Part.Phys., 21, p. 1387Alner, G.L., (1987) Nucl.Phys., B291, p. 445Okamoto, M., Shibata, T., (1987) Nucl. Instr. and Meth., A257, p. 15

Регуляторы ангиогенеза при химиоиндуцированной периферической полинейропатии

Background: Chemotherapy-induced peripheral polyneuropathy is a major neurotoxicity of treatment for acute lymphoblastic leukemia (ALL) in children. Pathophysiological mechanisms of the injury of peripheral neural system are not fully investigated; however, some studies have shown the involvement of vascular endothelial growth factors. Aim: To evaluate plasma levels of angiogenic growth factors in children with ALL and to identify their association with the development of vincristine-induced peripheral polyneuropathy. Materials and methods: This single center prospective study included 41 patients with ALL aged 3 to 17 years. All patients were given the ALL-MB 2015 chemotherapy regimen. Depending on the vincristine-induced peripheral polyneuropathy, the patients were divided into two groups: the main group (n = 22) comprised of the patients with neurological signs and symptoms of peripheral neuropathy and the control group (n = 19), those without clinical signs of the peripheral nervous system involvement. The levels of angiogenic growth factors (VEGF-A, VEGF-D, PlGF-1, and PDGF-BB) were measured in plasma by multiparameter immunofluorescent analysis. Results: During 3 months of the follow up the chemotherapy-induced signs of peripheral polyneuropathy developed in 53.6% (n = 22) of the children. In 72.7% (n = 16) of the patients the chemotherapy-induced peripheral polyneuropathy was characterized by a combination of neurologic abnormalities with prevailing motor symptoms. The comparative analysis of plasma angiogenic growth factors in children with ALL depending on the presence or absence of the vincristine-induced peripheral polyneuropathy showed that there was a significant decrease of the VEGF-A in those with chemotherapy-induced peripheral polyneuropathy, compared to those without (Me [Q1; Q3]: 178.20 [138.40; 228.45] and 558.50 [160.10; 650.0], respectively, p 0.017). This parameter had diagnostic sensitivity of 77.7% and specificity of 76.9%. Conclusion: We have shown a high clinical value of plasma vascular endothelial growth factor (VEGF-A) level, which makes it possible to consider it as a significant biological marker of neurotoxicity in vincristine-induced peripheral polyneuropathy.Обоснование. Химиоиндуцированная периферическая полинейропатия относится к основным нейротоксическим осложнениям при лечении острого лимфобластного лейкоза (ОЛЛ) у детей. Патогенетические механизмы повреждения периферической нервной системы до конца не изучены, однако исследования показали участие факторов роста эндотелия сосудов. Цель оценить содержание уровня ангиогенных факторов роста в плазме крови у детей при ОЛЛ и определить их связь с формированием периферической полинейропатии, индуцированной винкристином. Материал и методы. В одноцентровом проспективном исследовании участвовал 41 пациент в возрасте от 3 до 17 лет с ОЛЛ. Все пациенты получали химиотерапию по протоколу ALL-MB 2015. В зависимости от развития периферической полинейропатии, индуцированной винкристином, пациенты были разделены на две группы: в основную (n = 22) вошли больные, имеющие неврологические признаки периферической полинейропатии, в группу сравнения (n = 19) дети без клинических симптомов поражения периферической нервной системы. Методом мультипараметрического иммунофлуоресцентного анализа в плазме крови определяли уровень ангиогенных факторов роста (VEGF-A, VEGF-D, PlGF-1, PDGF-BB). Результаты. В течение 3-месячного периода наблюдения признаки периферической полинейропатии на фоне химиотерапии появились у 53,6% (n = 22) детей. При этом у 72,7% (n = 16) больных химиоиндуцированная периферическая полинейропатия характеризовалась сочетанием неврологических нарушений с преобладанием моторных симптомов. Сравнительный анализ плазменных ангиогенных факторов роста в группах детей с ОЛЛ в зависимости от формирования периферической полинейропатии, индуцированной винкристином, показал, что у больных с химиоиндуцированной периферической полинейропатией в отличие от пациентов, не имеющих данных за поражение периферической нервной системы, установлено статистически значимое снижение фактора роста эндотелия сосудов А (Me [Q1; Q3]: 178,20 [138,40; 228,45] и 558,50 [160,10; 650,0] соответственно, p 0,017). При оценке клинической ценности данного параметра диагностическая чувствительность составила 77,7%, а специфичность 76,9%. Заключение. Нами показана высокая клиническая ценность плазменного фактора роста эндотелия сосудов (VEGF-A), что позволяет рассматривать его как значимый биологический маркер нейротоксичности при периферической полинейропатии, вызванной винкристином