Diabetes mellitus and long-time outcomes of autovenous femoro-popliteal bypass

BACKGROUND: the effect of diabetes mellitus on the long-term patency of autovenous femoro-popliteal bypass has not been definitively determined AIM: to determine the effect of diabetes mellitus on the long-term outcomes of autovenous femoral-popliteal bypass.MATERIALS AND METHODS: the results of treatment of 648 patients who underwent autovenous femoral-popliteal bypass were analyzed. The patients were divided into 2 clinical groups: the first group included 367 patients with diabetes mellitus, the second — 281 patients without the named disease. The groups did not differ significantly in the incidence of concomitant pathology.RESULTS: occlusion of the autovenous conduit within a 5-year period after surgical treatment was observed in 218 patients of the first group (59.4%) and 72 patients of the second group (25.6%) (p <0.01, χ2 = 39.05, RR = 1.78; CI = 1.53–2.12). The average service life of the autovenous femoral-popliteal bypass was 63.49 months in patients of the first group, and 107.46 months in the second. The decompensated course of diabetes mellitus was observed in 203 patients (55.2%). Among patients with decompensated diabetes mellitus, occlusion of the autovenous femoral-popliteal bypass was observed in 95 patients (46.8%), in 104 patients the autovenous conduit was passable (51.2%; p = 0.449, χ2 = 0.57). Decompensated course of diabetes mellitus may contribute to a decrease in the service life of autovenous femoro-popliteal bypass.CONCLUSION: the presence of diabetes mellitus, and especially its decompensated course, can negatively affect the patency of autovenous femoro-popliteal bypass in the long term

Prospects for the measurement of muon-neutrino disappearance at the FNAL-Booster

Neutrino physics is nowadays receiving more and more attention as a possible source of information for the long-standing problem of new physics beyond the Standard Model. The recent measurement of the mixing angle $\theta_{13}$ in the standard mixing oscillation scenario encourages us to pursue the still missing results on leptonic CP violation and absolute neutrino masses. However, puzzling measurements exist that deserve an exhaustive evaluation. The NESSiE Collaboration has been setup to undertake conclusive experiments to clarify the muon-neutrino disappearance measurements at small $L/E$, which will be able to put severe constraints to models with more than the three-standard neutrinos, or even to robustly measure the presence of a new kind of neutrino oscillation for the first time. To this aim the use of the current FNAL-Booster neutrino beam for a Short-Baseline experiment has been carefully evaluated. This proposal refers to the use of magnetic spectrometers at two different sites, Near and Far. Their positions have been extensively studied, together with the possible performances of two OPERA-like spectrometers. The proposal is constrained by availability of existing hardware and a time-schedule compatible with the CERN project for a new more performant neutrino beam, which will nicely extend the physics results achievable at the Booster. The possible FNAL experiment will allow to clarify the current $\nu_{\mu}$ disappearance tension with $\nu_e$ appearance and disappearance at the eV mass scale. Instead, a new CERN neutrino beam would allow a further span in the parameter space together with a refined control of systematics and, more relevant, the measurement of the antineutrino sector, by upgrading the spectrometer with detectors currently under R&D study.Comment: 76 pages, 52 figure

Recovery surgery for extracapsular extension of squamous cell cancer metastasizing to the lymph nodes in the neck

Metastatic neck lymph nodes in massive lesion of their tissue with tumor cells are accompanied by extracapsular extension to the adjacent structures in a number of cases. The greatest problem in clinical oncology is when even extended radical neck dissection fails to completely remove tumor tissue that is macroscopically detectable after surgical resection. In this situation, there is a continued growth of tissue mass that is left on the neck. Thus, the unresectable extracapsular spread of neck lymph node metastases to the adjacent tissues reduces the duration of life in the patients and worsens its quality.The basis for this investigation is clinical observations of patients who have been operated on at the Nizhny Novgorod Regional Clinical Oncology Dispensary (Hospital Two) in the period 2005 to 2016. Histologically, the tumors were squamous cell carcinomas. In this period, there have been 24 Crile operations (radical neck dissection) that are cytoreductive. A primary tumor has been (n = 15) or has not been (n = 9) previously excised. The extracapsular spread of metastatic lymph nodes corresponded to levels IIa, IIb, and III. Cytoreductive cervical lymphadenectomy with the pectoralis musculocutaneous flap covering an unresectable tumor for extracapsular unresectable squamous cell carcinoma metastasizing to the neck lymph nodes should be considered the operation of recovery. This type of surgery is warranted, as tumor mass reduction by eliminating the source of intoxication allows further antitumor treatment (radiotherapy or chemotherapy or their combination) that is contraindicated in patients with tumor lysis in the neck. When the cause of death is the exceedingly continued growth of an unresectable component of radio- and chemoresistant variants of tumor tissue on the neck, the covering of the component with a pectoralis major flap delays a fatal outcome in incurable patients to improve a number of quality-of-life indicators

Myocardial revascularization in patients with acute coronary syndrome in the context of COVID-19 pandemic: a single-center prospective cohort study

Aim. To assess the outcomes of myocardial revascularization (MR) and identify risk factors for early postoperative complications in patients with coronary artery disease (CAD) with acute coronary syndrome (ACS) in the context of coronavirus disease 2019 (COVID-19) pandemic.Material and methods. The study included 769 patients aged 67,0±4,4 years with CAD with ACS in the period from April to October 2020. In an expedited manner, percutaneous transluminal coronary angioplasty (n=699) and on pump coronary artery bypass grafting (CABG) (n=70) were performed. All patients underwent a COVID-19 rapid tests. After MR, the following outcomes were recorded: adverse cardiovascular events and other complications; various surgical interventions; bilateral COVID-19 pneumonia; death. The follow-up period lasted 30 days.Results. During the hospitalization, COVID-19 was detected in 5,3% of patients (n=41). Among them, bilateral multisegmental pneumonia developed in 48,8%. Among infected patients, COVID-19-related mortality in the early postoperative period was 9,8%. The all-cause mortality rate was 0,7%. On pump CABG significantly increases the risk of developing COVID-19 pneumonia (odds ratio (OR), 23,2; 95% confidence interval (CI) 14,2-35,4; p<0,001). After MR, COVID-19 pneumonia was associated with respiratory (OR, 7,6; 95% CI, 4,3-11,5; p=0,001) and heart failure (OR, 4,2; 95% CI, 2,9-8,6; p=0,001), atrial fibrillation (OR, 8,3; 95% CI, 4,1-13,9; p=0,001), as well as with all-cause mortality (OR, 10,3; 95% CI, 5,2-16,7; p=0,005). Recurrent transmural myocardial infarction in patients with CAD was associated with heart failure after MR (OR, 7,1; 95% CI, 2,4-12,6; p=0,012).Conclusion. Conducting on pump CABG in patients with CAD with ACS is the leading trigger for developing COVID-19 pneumonia, which, during hospitalization after MR, was associated not only with respiratory complications, but also with impaired heart function, which significantly increases the death risk in this category of patients

Функциональное состояние кардиореспираторной системы после ортотопической трансплантации сердца с длительной холодовой ишемией трансплантата

Objective: to assess the functional state of the cardiorespiratory system in the long term after orthotopic heart transplantation (HT) with prolonged cold ischemia time. Materials and methods. The results of 60 orthotopic HTs performed at Meshalkin National Medical Research Center were analyzed. A comparison was made of the immediate and long-term outcomes of HTs in the group with cold ischemia time lasting for less than 240 minutes and in those with farther distance between donor and recipient sites with cold ischemia time of 240 minutes or more. In the long-term follow-up after HT, all patients underwent cardiopulmonary exercise testing, body plethysmography, assessment of the diffusing capacity of the lungs, and quality of life assessment. Results. Prolonged cold ischemia showed a negative effect on the early postoperative period – decreased myocardial contractility on postoperative day 1 and longer duration of inotropic support. At the same time, the survival rate and incidence of graft rejection reactions in the early and late post-HT periods in the studied groups did not differ significantly. Peak oxygen consumption in the general group in the long term after HT was 17 (14.7–21.0) mL/kg/min, VE/ VCO2 slope was 30 (29–36) at 100 (90–120) W threshold load power. All the parameters of pulmonary function tests did not differ significantly depending on cold ischemia duration. Quality of life also did not show significant differences depending on the duration of graft ischemia in terms of both physical and psycho-emotional health components of the SF-36 questionnaire. Conclusion. Long-term cold ischemia of the graft did not show any negative impact on the functional state of the cardiorespiratory system and quality of life in the long term after HT. The studied group of recipients was characterized by high efficiency of pulmonary ventilation and gas exchange, as well as high tolerance to physical activity in the long-term post-HT period.Цель. Оценка функционального состояния кардиореспираторной системы в отдаленные сроки после ортотопической трансплантации сердца (ТС) с длительной холодовой ишемией трансплантата. Материалы и методы. Проанализированы результаты 60 ортотопических ТС, выполненных в ФГБУ «НМИЦ им. акад. Е.Н. Мешалкина» Минздрава России. Проведено сравнение непосредственных и отдаленных результатов ТС в группах с холодовой ишемией трансплантата менее 240 минут и при дистанционном изъятии с холодовой ишемией 240 минут и более. В отдаленные сроки после ТС всем пациентам проведено кардиопульмональное нагрузочное тестирование, бодиплетизмография, оценка диффузионной способности легких, оценка качества жизни. Результаты. Длительная холодовая ишемия донорского сердца показала негативное влияние на ранний послеоперационный период ТС в виде снижения сократительной способности миокарда в первые сутки после операции и увеличения длительности инотропной поддержки. При этом выживаемость и частота развития реакций отторжения трансплантата в ранние и отдаленные сроки после ТС в изучаемых группах значимо не различалась. Пиковое потребление кислорода в отдаленные сроки после ТС в общей группе составило 17 (14,7–21,0) мл/мин/кг, VE/VCO2 slope – 30 (29–36) при пороговой мощности нагрузки 100 (90–120) Вт. Все параметры легочных функциональных тестов не имели значимых отличий в зависимости от длительности холодовой ишемии. Качество жизни также не показало значимых различий в зависимости от длительности ишемии трансплантата как по физическому, так и психоэмоциональному компонентам здоровья опросника SF-36. Заключение. Длительная холодовая ишемия трансплантата не показала отрицательного влияния на функциональное состояние кардиореспираторной системы и качество жизни в отдаленные сроки после ТС. Изучаемая группа реципиентов характеризовалась высокой эффективностью легочной вентиляции и газообмена, а также высокой толерантностью к физическим нагрузкам в отдаленные сроки после ТС

A facility to Search for Hidden Particles (SHiP) at the CERN SPS

A new general purpose fixed target facility is proposed at the CERN SPS accelerator which is aimed at exploring the domain of hidden particles and make measurements with tau neutrinos. Hidden particles are predicted by a large number of models beyond the Standard Model. The high intensity of the SPS 400~GeV beam allows probing a wide variety of models containing light long-lived exotic particles with masses below ${\cal O}$(10)~GeV/c$^2$, including very weakly interacting low-energy SUSY states. The experimental programme of the proposed facility is capable of being extended in the future, e.g. to include direct searches for Dark Matter and Lepton Flavour Violation.Comment: Technical Proposa

Metabolic model for laboratory control of anti-ischaemic therapy effectiveness: a case study of nicorandil

Scientific relevance. A key anti-ischaemic mechanism of some medicinal products involves their effects on the metabolism of endothelial vasodilators, particularly the synthesis of nitric oxide from arginine and its precursor citrulline.Aim. The study was aimed to determine whether the plasma time course of guanidine derivatives (arginine precursors) is applicable to laboratory control of anti-ischaemic therapy effectiveness using a single oral dose of nicorandil in patients with coronary heart disease as a case study.Materials and methods. The authors used high-performance liquid chromatography to determine metabolites. Blood samples for analysis were obtained from 30 patients with angina pectoris (Grade II–III, Canadian Cardiovascular Society) and 30 healthy donors. All the study participants received a single oral dose of 20 mg nicorandil after 10 h of fasting.Results. At baseline, patients showed significantly higher plasma citrulline levels than donors. However, the elevated levels decreased to the healthy range after nicorandil administration. Plasma arginine levels in patients showed a statistically significant increase following nicorandil administration. Plasma homoarginine levels in patients remained reduced both before and after dosing. Nicorandil did not influence elevated levels of the endogenous nitric oxide synthase inhibitor (asymmetrical dimethylarginine).Conclusions. In addition to the established mechanisms responsible for altering cell metabolism, nicorandil enhances the contribution of citrulline to arginine resynthesis. It is reasonable to include citrulline and arginine, which are involved in the vasodilator response, in model schemes for laboratory control of the effectiveness of anti-ischaemic therapy

Clinical and functional features and quality of life in depressive disorders in patients undergoing pulmonary thromboendarterectomy

Aim. To conduct a comparative analysis of clinical and functional parameters and quality of life (QoL) in patients with chronic thromboembolic pulmonary hypertension (CTEPH), depending on the presence of a depressive disorder in long-term postoperative period.Material and methods. The study included 182 patients with CTEPH in the long term after surgery. Depending on the Patient Health Questionnaire 9 ( PHQ-9) data, all patients were divided into 2 groups: the 1st group — patients without depressive syndrome in the long-term postoperative period, the 2nd — patients with depressive syndrome. A comparative assessment of the initial clinical and functional characteristics, as well as QoL was carried out using the SF-36 questionnaire in both groups of patients. In patients who had a coronavirus disease 2019 (COVID-19), a comparative assessment using the Post-COVID-19 Functional Status (PCFS) scale was carried out.Results. Clinically relevant depressive syndrome in patients with CTEPH in the long term after surgery was registered in 25,3% of cases. In the 2nd group of patients, prior myocardial infarction (p=0,02), concomitant chronic cerebrovascular disease (p=0,01), as well as moderate and severe post-COVID-19 functional limitations according to the PCFS scale (p=0,004) were significantly more often recorded compared with the 1st group. In the 2nd group of patients, the level of QoL in almost all parameters was significantly lower in comparison with the 1st group (p<0,05). Decreased QoL (score <40) in the 2nd group concerned numerous parameters, including the physical and mental health components. In the 1st group of patients, reduced QoL was observed only in some physical parameters.Conclusion. The group of patients with CTEPH with depressive syndrome in the long-term postoperative period was characterized by a higher incidence of concomitant chronic cerebrovascular disease and a history of myocardial infarction compared with patients without depressive disorders. In the group of patients with depressive disorders, moderate and severe post-COVID-19 functional limitations according to the PCFS scale were more often observed. Depressive disorders in patients with CTEPH in the long-term postoperative period were accompanied by significantly reduced QoL parameters. Patients experienced the greatest difficulties both during normal daily activities and in professional activities

ЭФФЕКТИВНАЯ МЕДИКАМЕНТОЗНАЯ КОРРЕКЦИЯ ОСТРОЙ ПРАВОЖЕЛУДОЧКОВОЙ НЕДОСТАТОЧНОСТИ У РЕЦИПИЕНТА С ПОГРАНИЧНОЙ ЛЕГОЧНОЙ ГИПЕРТЕНЗИЕЙ ПОСЛЕ ОРТОТОПИЧЕСКОЙ ТРАНСПЛАНТАЦИИ СЕРДЦА

Acute right ventricular failure in the early period after orthotopic heart transplantation is a severe complication and can often lead to a fatal outcome. This is especially important in patients with high pulmonary arteries resistance. Drug therapy has shown effectiveness only for the treatment of primary pulmonary hypertension. Patient K., 23 years old with signifi cant pulmonary hypertension (mean pulmonary artery pressure of 60 mm Hg, PVR – 6 Wood units) underwent orthotopic heart transplantation. Acute right ventricular failure occurred at early postoperative period which required multicomponent inotropic support. In order to reduce resistance of the pulmonary circulation the patient received sildenafi l (daily dose 50 mg) in combination with inhaled Ventavis (5 mcg a dose every 3 hours) and receipt of Tracleer (bosentan) (at a dose of 125 mg per day). Complex drug therapy resulted in reduction of right ventricular failure, normalization of biochemical parameters. Invasive pulmonary artery pressure decreased to 30 mm Hg and pulmonary vascular resistance was 1.1 Wood units at the moment of discharge. We also revealed right ventricle end-diastolic volume reduction from 70 ml to 62 ml and ejection fraction of the right ventricle (RV EF) increased from 47,7% to 62% in 2 months. Our clinical observation demonstrates the high effi ciency of acute right heart failure complex therapy including inotropic agents in combination with drugs that reduce the pulmonary vascular resistance.Острая правожелудочковая недостаточность, в ранних сроках после ортотопической трансплантации сердца является грозным осложнением и зачастую может приводить к фатальному исходу. Особенно актуальным это является у пациентов с высоким сопротивлением сосудов малого круга. Препараты для снижения легочного сосудистого сопротивления (ЛСС) показали свою эффективность преимущественно для лечения первичной легочной гипертензии. Больному К. 23 лет с пограничной легочной гипертензией (среднее давление в легочной артерии 60 мм рт. ст., ЛСС – 6 ед. Вуда) выполнена ортотопическая трансплантация сердца. В раннем послеоперационном периоде у пациента развилась острая правожелудочковая недостаточность. Больному проводилась многокомпонентная инотропная поддержка. С целью снижения сопротивления малого круга кровообращения больной получал силденафил (в суточной дозе 50 мг) в сочетании с ингаляциями вентависа (в дозе 5 мкг каждые 3 часа) и приемом траклира (базинтан) (в дозе 125 мг в сутки). На фоне проводимой комплексной терапии отмечалось купирование проявлений правожелудочковой недостаточности, нормализация биохимических показателей. По результатам инвазивного мониторинга давление в легочной артерии снизилось до 30 мм рт. ст., сопротивление малого круга кровообращения к моменту выписки составило 1,1 ед. Вуда. По данным эхокардиографии (ЭхоКГ) выявлено уменьшение конечного диастолического объема правого желудочка КДО ПЖ с 70 до 62 мл и увеличение ФВ ПЖ с 47,7 до 62% через 2 мес. Наше клиническое наблюдение демонстрирует высокую эффективность лечения острой правожелудочковой недостаточности инотропными средствами в сочетании с препаратами, снижающими сопротивление малого круга кровообращения

МАССИВНАЯ ПРОДЛЕННАЯ ПОЛИУРИЯ ПОСЛЕ ТРАНСПЛАНТАЦИИ ПОЧКИ

Clinical case of prolonged massive polyuria in patient after renal transplantation is represented in this article. Polyuria lasted for a forty days after kidney transplantation, the larges amount of urine output was 55 litres per day. Analysis of transplant biopsy revealed acute tubular necrosis, initial arteriolosclerosis and suspected acute rejection. Doppler ultrasound study and perfusion scintigraphy detected no pathology. At first we tried to decrease the volume of infusion and fluid intake. Also we performed pulse therapy with methylprednisolone. However, these efforts were not effective. Using of a large doses of «Minerin» (posterior pituitary antidiuretic factor) allowed to decrease and stabilize the volume of urine output. The patient was discharge from clinic on day 42 after transplantation. В статье представлен клинический случай успешного излечения массивной продленной полиурии у па- циентки после аллотрансплантации трупной почки. Полиурия длилась 40 дней, наибольший объем диу- реза достигал 55 литров в сутки. Анализ биоптата трансплантата выявил признаки острого канальцевого некроза, исходного артериосклероза, выставлено подозрение на острое отторжение.Ультразвуковое ис- следование и перфузионная сцинтиграфия трансплантата патологии не выявили. Исходно выполнялись попытки снижения объема внутривенной инфузии и выпиваемой жидкости, проводилась пульс-терапия метипредом. Однако перечисленные мероприятия оказались неэффективными. Стабилизации состояния удалось достичь лишь назначением больших доз препарата антидиуретического гормона минирина. Па- циентка выписана из клиники через 42 дня после операции в удовлетворительном состоянии с хорошей функцией трансплантата.