Отдаленные результаты хирургического лечения тромбоэмболии легочной артерии (ТЭЛА) методом баллонной ангиопластики (БАП) в сочетании с тромболитической терапией

Introduction. Pulmonary Arterial Thromboembolism (PATE), which is characterised by low prognosis probability and potentially high danger, ranks third in the mortality structure of cardiovascular diseases. The primary method for treating PATE is recanalisation of the pulmonary arteries affected by embolism. Although the destruction of thromboemboli with thrombolytic drugs has proven effective, the right ventricular failure progresses faster in a majority of patients with massive pulmonary embolism. The aim of the present study is to evaluate the long-term results of surgical treatment of PATE by balloon angioplasty in combination with thrombolytic therapy in comparison with isolated systemic thrombolysis.Materials and methods. The treatment of 80 patients with pulmonary embolism was analysed. Depending on the selected treatment approaches, the patients were divided into 2 groups as follows: group 1 — 39 patients, conducted by the BAP LA, in combination with thrombolysis; group 2 — 41 patients who underwent conservative treatment (thrombolysis and subsequent anticoagulation therapy).Results. Despite the small sample and short period of observation, we may note the significantly better results of treatment in group 1 of the study. Positive dynamics of ECG indicators — in particular, pulmonary hypertension, RV KDR, functional class of heart failure NYHA as well as the reduction of right ventricular overload according to the ECG — indicates that the BAP LA method for the surgical treatment of pulmonary embolism, in combination with thrombolytic therapy, is effective and safe.Conclusions. Balloon angioplasty of pulmonary arteries in combination with thrombolytic therapy can significantly reduce the degree of pulmonary hypertension (рχ2 = 0.034), as well as helping to normalise the size of the right ventricle (рχ2 < 0.001) and improvement in functional class of heart failure NYHA (рχ2 = 0.026) in patients with pulmonary embolism compared with patients with isolated thrombolytic therapy.Введение. ТЭЛА характеризуется низкой вероятностью прогноза и потенциально высокой опасностью, занимает третье место в структуре смертности от сердечно-сосудистых заболеваний. Основным методом лечения ТЭЛА является реканализация пораженных эмболией легочных артерий. Несмотря на доказанную эффективность разрушения тромбоэмболов тромболитическими препаратами, у значительной части пациентов с массивной легочной эмболией правожелудочковая недостаточность прогрессирует быстрее. Настоящее исследование посвящено оценке отдаленных результатов хирургического лечения ТЭЛА методом баллонной ангиопластики в сочетании с тромболитической терапией в сравнении с изолированным системным тромболизисом.Материалы и методы. Проведен анализ отдаленных результатов лечения у 80 пациентов с ТЭЛА высокого и промежуточно-высокого риска с 2015 по 2018 г. Пациенты разделены на 2 группы в зависимости от выбранной тактики лечения: 1 группа — 39 пациентов, которым было проведено БАП легочной артерии в сочетании с тромболизисом, 2 группа — 41 пациент, которым проводилось консервативное лечение (тромболизис с последующей антикоагулянтной терапией).Результаты. Несмотря на малую выборку и небольшой срок наблюдения, можно говорить о получении достоверно лучших результатов лечения в 1 группе исследования. Положительная динамика ЭхоКГ показателей, в частности легочной гипертензии, КДР ПЖ, функционального класса сердечной недостаточности по NYHA, а также уменьшение перегрузки правых отделов сердца по данным ЭКГ, указывает на то, что метод хирургического лечения ТЭЛА — БАП ЛА в сочетании с тромболитической терапией — является эффективным и безопасным.Заключение. Баллонная ангиопластика легочных артерий в сочетании с тромболитической терапией является безопасным и эффективным методом лечения пациентов с ТЭЛА, позволяющим значительно снизить степень легочной гипертензии (рχ2 = 0,027), ускорить ремоделирование правого желудочка (рχ2 < 0,001) и улучшить функциональный класс сердечной недостаточности по NYHA (рχ2 = 0,026) по сравнению с группой пациентов с изолированной тромболитической терапией

Long-Term Results of Surgical Treatment of Pulmonary Embolism (PE) by Balloon Angioplasty (BAP) in Combination with Thrombolytic Therapy

Introduction. Pulmonary Arterial Thromboembolism (PATE), which is characterised by low prognosis probability and potentially high danger, ranks third in the mortality structure of cardiovascular diseases. The primary method for treating PATE is recanalisation of the pulmonary arteries affected by embolism. Although the destruction of thromboemboli with thrombolytic drugs has proven effective, the right ventricular failure progresses faster in a majority of patients with massive pulmonary embolism. The aim of the present study is to evaluate the long-term results of surgical treatment of PATE by balloon angioplasty in combination with thrombolytic therapy in comparison with isolated systemic thrombolysis.Materials and methods. The treatment of 80 patients with pulmonary embolism was analysed. Depending on the selected treatment approaches, the patients were divided into 2 groups as follows: group 1 — 39 patients, conducted by the BAP LA, in combination with thrombolysis; group 2 — 41 patients who underwent conservative treatment (thrombolysis and subsequent anticoagulation therapy).Results. Despite the small sample and short period of observation, we may note the significantly better results of treatment in group 1 of the study. Positive dynamics of ECG indicators — in particular, pulmonary hypertension, RV KDR, functional class of heart failure NYHA as well as the reduction of right ventricular overload according to the ECG — indicates that the BAP LA method for the surgical treatment of pulmonary embolism, in combination with thrombolytic therapy, is effective and safe.Conclusions. Balloon angioplasty of pulmonary arteries in combination with thrombolytic therapy can significantly reduce the degree of pulmonary hypertension (рχ2 = 0.034), as well as helping to normalise the size of the right ventricle (рχ2 < 0.001) and improvement in functional class of heart failure NYHA (рχ2 = 0.026) in patients with pulmonary embolism compared with patients with isolated thrombolytic therapy

Crystallization Pathways of FABr-PbBr₂-DMF and FABr-PbBr₂-DMSO Systems: The Comprehensive Picture of Formamidinium-Based Low-Dimensional Perovskite-Related Phases and Intermediate Solvates

In this study, we systematically investigated the phase diversity and crystallization pathways of the FABr excessive regions of two ternary systems of FABr-PbBr2-DMF and FABr-PbBr2-DMSO (where FA+—formamidinium cations, DMF—dimethylformamide and DMSO—dimethyl sulfoxide solvents). In these systems, a new FA3PbBr5 phase with a structure containing chains of vertex-connected PbBr6 octahedra is discovered, and its crystal structure is refined. We experimentally assess fundamental information on differences in the mechanisms of crystallization process in FABr-PbBr2-DMF and FABr-PbBr2-DMSO systems and determine possible pathways of crystallization of hybrid perovskites. We show that intermediate solvate phases are not observed in the system with DMF solvent, while a number of crystalline solvates tend to form in the system with DMSO at various amounts of FABr excess

The last three millions of unequal spring thaws

Evidence from various climate proxies provides us with increasingly reliable proof that only in the past 10 millennia were natural systems more or less as we see them at the present (without considering human impact). Prior to 10,000 years ago, natural systems repeatedly changed under the influence of an unstable climate. This is particularly true over the last one million years. During these times, terrestrial environments were populated by a diversity of large animals that did not survive either the last dramatic climate change or the increasing power of humans. The volume of continental ice covering the land and its impact on the planet’s physiography∗ and vegetation have varied consistently. We can try to imagine extreme conditions: the very cold springtimes of the full glacials∗, and the warm springtimes of the rapid deglaciation phases, with enormous volumes of water feeding terrifying rivers. Most of this story is frozen in the ice cover of Greenland and Antarctica, the deep layers of which have been reached by human coring activities only over the past half century. Shorter cores have been drilled in high-altitude ice caps (e.g., in the Andes) that provide insight into other parts of the planet. The interpretation of the signals locked into the ice cores led to the reconstruction of climatic curves covering approximately the past 800 millennia. In addition, long sediment cores have been recovered from thousands of lakes across the globe and yielded data useful to estimate climatic trends based on pollen* records. In the past one to three million years, the continents and oceans were in roughly their present-day locations. Environmental factors, including tectonics (mountain uplift or closure of ocean gateways), interacted with the overall long-term oscillation in atmospheric carbon-dioxide concentration, which, in turn, influenced vegetation cover and ecosystem composition. Well-established glacial-interglacial∗ cycles impacted biotic dispersal∗ events at mid-to-high latitudes and determined the geographical restriction and expansion of tropical and subtropical (warm-temperate) biomes around the globe. This book chapter constitutes an imaginary field trip, presenting the reader with exemplary records of environments, plants, large mammals, and hominins impacted by cooling and warming phases, glaciations, changes in rainfall patterns, and sea level culminating in the world of today