Серцево-судинні ускладнення у хворих з гострою ішемією кінцівок у ранньому періоді ішемічного інсульту

Aim. To define risks and complications for patients with the sharp ischemia of lower extremities in the sharp period of stroke after reconstructive surgical treatment for the decline of amount of amputations and sharp violations of cerebral circulation of blood postoperative period.Materials and methods. In the period 2015–2019 based on the Department of Acute Diseases of Vessels of the State Institution «ICUS by. VT Zaitsev NAMNU »we operated 31 patients for acute ischemia of the lower extremities during the period of acute ischemic stroke (namely, within 3–4 weeks after the neurological manifestations). The mean age of the patients was 72.9±1.65 years. Among them are 17 women and 14 men. The diagnosis of acute ischemia of the lower extremities was established in 19 patients, the upper – in 12 patients.Results. All patients (31) were operated; the main blood flow was restored. In 28 cases of patients were performed embolectomy, in 3 cases – bypass surgery.Conclusions. Ultrasound examination of the lower extremities should be performed for patients with acute stroke ischemia with paresis to verify acute lower limb ischemia, which allows timely diagnosis of ischemia and reduce the number of amputations in patients with acute lower limb ischemia I-II degree to 0 %, and the risk of stroke to 3.2 %Цель. Определить риски и осложнения у больных с острой ишемией конечностей в остром периоде инсульта после реконструктивного хирургического лечения для снижения количества ампутаций и острых нарушений мозгового кровообращения послеоперационном периоде.Материалы и методы. В период 2015-2019 г.г. на базе отделения острых заболеваний сосудов ГУ «ИОНХ им. В. Т. Зайцева НАМНУ» мы прооперировали 31 больного по поводу острой ишемии нижних конечностей в период острого ишемического инсульта (а именно в течение 3–4 недель от манифестации неврологических проявлений). Средний возраст больных составил 72,9±1,65 лет. Среди них 17 женщин и 14 мужчин. Диагноз острой ишемии нижних конечностей установлен у 19 больных, верхних – у 12 больных.Результаты. Все больные (31) были прооперированы, магистральный кровоток восстановлен. В 28 случаях больных была выполнена эмболэктомия, в 3 случаях - шунтирующие операции.Выводы. Больным с ОНМК с парезом нужно выполнять ультразвуковое исследование нижних конечностей для верификации острой ишемии нижних конечностей, что позволяет своевременно диагностировать ишемию и уменьшить количество ампутаций у больных с острой ишемией нижних конечностей I -II В степени до 0 %, а риски ОНМК до 3,2 %Мета. визначити ризики та ускладнення у хворих з гострою ішемією кінцівок у гострому періоді інсульту після реконструктивного хірургічного лікування для зниження кількості ампутацій та гострих порушень мозкового кровообігу післяопераційному періоді.Матеріали та методи. У період 2015–2019 рр. на базі відділення гострих захворювань судин ДУ «ІЗНХ ім. В. Т. Зайцева НАМНУ» ми оперували 31 хворого з приводу гострої ішемії нижніх кінцівок у період гострого ішемічного інсульту (а саме впродовж 3–4 тижнів від маніфестації неврологічних проявів). Середній вік хворих становив 72,9±1,65 років. Серед них 17 жінок та 14 чоловіків. Діагноз гострої ішемії нижніх кінцівок установлено у 19 хворих, верхніх – у 12 хворих.Результати. Усі хворі (31) були прооперовані, магістральний кровотік відновлений. У 28 випадках була виконана емболектомія, у 3 випадках – шунтуючі операції .Висновки. Хворим з ГПМК з парезом потрібно виконувати ультразвукове дослідження нижніх кінцівок для верифікації гострої ішемії нижніх кінцівок, що дозволяє своєчасно діагностувати ішемію та зменшити кількість ампутацій у хворих з ГІНК I -II В ступеню до 0 %, а ризики ГПМК до 3,2

Prophylaxis of complications in postoperative period in patients, suffering stenosis of carotid arteries

Objective. To analyze the surgical treatment results in patients, suffering carotid arteries stenosis, using endarterectomy in combination with conservative therapy. Materials and methods. Results of treatment were analyzed in 58 patients, suffering hemodynamically significant stenosis of carotid arteries and/or presence of embologenic pluck, in whom from 2017 to 2019 yrs in V. T. Zaytsev Institute of General and Urgent Surgery NAMS of Ukraine, Kharkov intraoperative supportive conservative therapy, taking into account the risk for development of the cerebral ischemia and the reperfusion syndrome, was conducted. There were 52 (89.7%) men and 6 (10.3%) women. Middle age of the patients operated on have constituted (65 ± 15) yrs. Results. Basing on the literature data analyzed as well as on investigation of the thrombocytes aggregation in patients in perioperative period the algorithm of supportive conservative therapy was elaborated: injection of 5000 IU heparin 5 min before the internal carotid artery clamping under the ICT control; injection of Citicoline 1000 mg 5 min before the internal carotid artery clamping to the patients with neurological deficiency in accordance to the neurological test data and with application of a temporary by-pass. In all the patients in postoperative period the complications were absent. Control of the carotid arteries passability and the ischemia zone state on the 14th day was conducted, the carotid arteries stenosis was not revealed. Nonsignificant complications, such as the stressed hematoma, demanding postoperative wound revision and hemostasis performance, were observed in 4 patients. In 2 patients postoperative period was complicated by the hypoglossal nerve paresis because of its squeezing by hematoma. Conclusion. Citicoline injection before the carotid artery clamping in the carotid endarterectomy with a temporary by-pass permits to lower the risk for development of neurological complications, and while development of postoperative reperfusion syndrome –to reduce its signs

Tactics of treatment of varicose disease, complicated by thrombosis, using miniinvasive methods

Objective. To determine the treatment tactics for varicose dilation of veins, complicated by thrombosis of subcutaneous veins and the shin deep veins, using miniinvasive methods. Маterals and methods. The results of treatment in the IGUS named after V. Т. Zaytsev NAMS of Ukraine in 2015 - 2017 yrs of 80 patients, suffering varicothrombophlebitis, were analyzed. The patients were divided into two groups. In Group I 38 patients, suffering varicothrombophlebitis and/or the shin deep vein thrombosis (DVT), were included, who were treated in accordance to the algorithm proposed. In Group II 42 patients with the same pathology were included, to them a standard treatment was conducted. Results. Immediately after the operation in the Group I patients a severe morbidity, connected with the operation technique (DVT, pulmonary thromboembolism, hemorrhage) were absent. Rate of cutaneous neurological disorders in distal parts of the extremities in patients, to whom endovenous laser coagulation was performed, have constituted 5.2%, and in radiofrequency ablation (RFA) – 2.6%. Due to differentiated approach applied for determination of the operative intervention volume for varicose dilation of veins, complicated by varicothrombophlebitis and/or DVTH of the shin, it became possible to perform operative intervention of lesser traumaticity and to achieve good immediate result in majority of the patients. In Group II in 1 patient postoperative period have complicated by DVT. Of the local complications lymphorrhea was observed in 5% patients, and in 2 patients – the extended femoral hematomas. Conclusion. Operative treatment in the RFA volume or endovenous laser coagulation of the stem on the level of reflux with ligature/ablation of perforant veins after conduction of anticoagulant therapy on stage of total recanalization are indicated in patients, suffering thrombosis of the big subcutaneous vein or small subcutaneous vein and deep veins of the shin. In the patients, suffering thrombosis of stem, the deep shin veins after conduction of operative treatment it is mandatory to administer anticoagulant therapy in the treatment dosage during 7 - 14 days, depending on indices of soluble complexes of the fibrin monomers and/or D-dimer

In vitro and in vivo MMP gene expression localisation by In Situ-RT-PCR in cell culture and paraffin embedded human breast cancer cell line xenografts

BACKGROUND: Members of the matrix metalloproteinase (MMP) family of proteases are required for the degradation of the basement membrane and extracellular matrix in both normal and pathological conditions. In vitro, MT1-MMP (MMP-14, membrane type-1-MMP) expression is higher in more invasive human breast cancer (HBC) cell lines, whilst in vivo its expression has been associated with the stroma surrounding breast tumours. MMP-1 (interstitial collagenase) has been associated with MDA-MB-231 invasion in vitro, while MMP-3 (stromelysin-1) has been localised around invasive cells of breast tumours in vivo. As MMPs are not stored intracellularly, the ability to localise their expression to their cells of origin is difficult. METHODS: We utilised the unique in situ-reverse transcription-polymerase chain reaction (IS-RT-PCR) methodology to localise the in vitro and in vivo gene expression of MT1-MMP, MMP-1 and MMP-3 in human breast cancer. In vitro, MMP induction was examined in the MDA-MB-231 and MCF-7 HBC cell lines following exposure to Concanavalin A (Con A). In vivo, we examined their expression in archival paraffin embedded xenografts derived from a range of HBC cell lines of varied invasive and metastatic potential. Mouse xenografts are heterogenous, containing neoplastic human parenchyma with mouse stroma and vasculature and provide a reproducible in vivo model system correlated to the human disease state. RESULTS: In vitro, exposure to Con A increased MT1-MMP gene expression in MDA-MB-231 cells and decreased MT1-MMP gene expression in MCF-7 cells. MMP-1 and MMP-3 gene expression remained unchanged in both cell lines. In vivo, stromal cells recruited into each xenograft demonstrated differences in localised levels of MMP gene expression. Specifically, MDA-MB-231, MDA-MB-435 and Hs578T HBC cell lines are able to influence MMP gene expression in the surrounding stroma. CONCLUSION: We have demonstrated the applicability and sensitivity of IS-RT-PCR for the examination of MMP gene expression both in vitro and in vivo. Induction of MMP gene expression in both the epithelial tumour cells and surrounding stromal cells is associated with increased metastatic potential. Our data demonstrate the contribution of the stroma to epithelial MMP gene expression, and highlight the complexity of the role of MMPs in the stromal-epithelial interactions within breast carcinoma

HER-2 overexpression differentially alters transforming growth factor-β responses in luminal versus mesenchymal human breast cancer cells

INTRODUCTION: Amplification of the HER-2 receptor tyrosine kinase has been implicated in the pathogenesis and aggressive behavior of approximately 25% of invasive human breast cancers. Clinical and experimental evidence suggest that aberrant HER-2 signaling contributes to tumor initiation and disease progression. Transforming growth factor beta (TGF-β) is the dominant factor opposing growth stimulatory factors and early oncogene activation in many tissues, including the mammary gland. Thus, to better understand the mechanisms by which HER-2 overexpression promotes the early stages of breast cancer, we directly assayed the cellular and molecular effects of TGF-β1 on breast cancer cells in the presence or absence of overexpressed HER-2. METHODS: Cell proliferation assays were used to determine the effect of TGF-β on the growth of breast cancer cells with normal or high level expression of HER-2. Affymetrix microarrays combined with Northern and western blot analysis were used to monitor the transcriptional responses to exogenous TGF-β1 in luminal and mesenchymal-like breast cancer cells. The activity of the core TGF-β signaling pathway was assessed using TGF-β1 binding assays, phospho-specific Smad antibodies, immunofluorescent staining of Smad and Smad DNA binding assays. RESULTS: We demonstrate that cells engineered to over-express HER-2 are resistant to the anti-proliferative effect of TGF-β1. HER-2 overexpression profoundly diminishes the transcriptional responses induced by TGF-β in the luminal MCF-7 breast cancer cell line and prevents target gene induction by a novel mechanism that does not involve the abrogation of Smad nuclear accumulation, DNA binding or changes in c-myc repression. Conversely, HER-2 overexpression in the context of the mesenchymal MDA-MB-231 breast cell line potentiated the TGF-β induced pro-invasive and pro-metastatic gene signature. CONCLUSION: HER-2 overexpression promotes the growth and malignancy of mammary epithelial cells, in part, by conferring resistance to the growth inhibitory effects of TGF-β. In contrast, HER-2 and TGF-β signaling pathways can cooperate to promote especially aggressive disease behavior in the context of a highly invasive breast tumor model

Obstacles to the formation of a common electricity market of the Eurasian Economic Union

The current state of the economy and society is influenced by the global integration processes taking place in Eurasia - the creation of the Eurasian Economic Union, which should unite the markets for resources, goods and capital of the member states of the Eurasian Economic Union. One of the aspects of this process is the creation of a unified electricity market, which ensures free flow of electrical energy, free pricing and competition in the power industry. The purpose of this study is to study the degree of readiness of national energy systems for integration and to identify problems that impede the formation of the Common Electricity Market of the Eurasian Economic Union. The methods used were statistical analysis tools, a graphical method, comparisons and descriptions. The study was carried out on the basis of the use of information provided in the open access of the Eurasian Economic Union, national statistical services and energy companies. The authors have identified the main goals and objectives, as well as the requirements and expected results of the creation of the Common Electricity Market. As a result of the analysis of national power systems, a number of problems were identified that impede their convergence, including inconsistencies in the scale of production, various pricing mechanisms and electricity price regulation, differences in the energy balance of the Eurasian Economic Union member states, different levels of electricity prices, and a particular opinion Of the Republic of Belarus to the concept of market formation and the lack of unified borders of Armenia with other participating countries Union. The findings of the study indicate that by the stated date, namely July 1, 2019, the Common Electricity Market will most likely not be created for the reasons stated. To solve the identified problems, the authors propose several tools, one of the most important among them is the mechanism of regulatory and legal regulation of electricity markets at the national and supranational levels. Also, according to the authors, in the integration processes in the framework of the Eurasian Economic Union should consider the world experience of such political and economic associations

TECHNOLOGY OF DYNAMIC DATABASES CREATION WITH THE ENCLOSED STRUCTURES IN MS EXCEL

In work questions of use of spreadsheets MS Excel for dynamic database creation with the enclosed structures are examined