Инфаркт миокарда в послеродовом периоде

The study objective Is to present a clinical observation, describe the diagnostics and treatment of acute transmural myocardial infarction in a patient on the 8th day after childbirthMaterial and methods A 31-year-old patient was hospitalized 3 hours after the onset of the disease on the 8th day after urgent spontaneous delivery at 38-39 weeks of gestation with a clinic of acute myocardial infarction in the intensive care unit. Based on the data of anamnesis, complaints, physical examination, results of instrumental and laboratory examination, the following clinical diagnosis was made: ischemic heart disease: acute transmural myocardial infarction of the anterior wall, septum and apex of the left ventricle; atherosclerosis of the aorta and coronary arteries. On an emergency basis, the patient underwent coronary angiography, pronounced atherosclerotic changes in the coronary arteries were revealed: acute occlusion of the anterior interventricular artery in the middle third, stenosis of the diagonal branch up to 70% in the orifice, stenosis of the circumflex branch up to 70% in the middle third, extended stenosis up to 79% in the middle third of the right coronary artery.Results The patient underwent percutaneous coronary intervention (pci) on a symptom-dependent artery: mechanical recanalization and stenting of the anterior descending artery (ada) by a drug-eluting stent.Conclusion An increase in the incidence of acute coronary syndrome in pregnant women and postpartum women requires the development of an algorithm for additional examination of late reproductive age patients at the stage of pregnancy planning, in case of identification of possible risk factors for the development of cardiovascular diseases — observation of a cardiologist during pregnancy and in the postpartum period.Цель Представить клиническое наблюдение, описать диагностику и лечение острого трансмурального инфаркта миокарда у пациентки на 8-е сутки после родов.Материал и методы Пациентка 31 года, госпитализирована через 3 часа после начала заболевания на 8-е сутки после срочных самопроизвольных родов в 38–39 недель беременности с клиникой острого инфаркта миокарда в палату реанимации и интенсивной терапии. На основании данных анамнеза, жалоб, объективного осмотра, результатов инструментального и лабораторного обследования поставлен клинический диагноз: «Ишемическая болезнь сердца: острый трансмуральный инфаркт миокарда передней стенки, перегородки и верхушки левого желудочка; атеросклероз аорты и коронарных артерий». В экстренном порядке пациентке выполнена коронарография, и выявлены выраженные атеросклеротические изменения коронарных артерий: острая окклюзия передней межжелудочковой ветви в средней трети, стеноз диагональной ветви — до 70% в устье, cтеноз огибающей ветви — до 70% в средней трети, протяженный стеноз — до 79% в средней трети правой коронарной артерии.Результаты Больной было выполнено чрескожное коронарное вмешательство на симптом-зависимой артерии: механическая реканализация и стентирование передней нисходящей артерии стентом с лекарственным покрытием.Заключение Увеличение частоты острого коронарного синдрома у беременных и родильниц требует разработки алгоритма дополнительного обследования пациенток позднего репродуктивного возраста на этапе планирования беременности, а при выявлении факторов риска развития сердечно-сосудистых заболеваний — наблюдения кардиолога во время беременности и в послеродовом периоде

Source apportionment of circum-Arctic atmospheric black carbon from isotopes and modeling

Black carbon (BC) contributes to Arctic climate warming, yet source attributions are inaccurate due to lacking observational constraints and uncertainties in emission inventories. Year-round, isotope-constrained observations reveal strong seasonal variations in BC sources with a consistent and synchronous pattern at all Arctic sites. These sources were dominated by emissions from fossil fuel combustion in the winter and by biomass burning in the summer. The annual mean source of BC to the circum-Arctic was 39 ± 10% from biomass burning. Comparison of transport-model predictions with the observations showed good agreement for BC concentrations, with larger discrepancies for (fossil/biomass burning) sources. The accuracy of simulated BC concentration, but not of origin, points to misallocations of emissions in the emission inventories. The consistency in seasonal source contributions of BC throughout the Arctic provides strong justification for targeted emission reductions to limit the impact of BC on climate warming in the Arctic and beyond

The origin of methane in the East Siberian Arctic Shelf unraveled with triple isotope analysis

The Arctic Ocean, especially the East Siberian Arctic Shelf (ESAS), has been proposed as a significant source of methane that might play an increasingly important role in the future. However, the underlying processes of formation, removal and transport associated with such emissions are to date strongly debated. CH4 concentration and triple isotope composition were analyzed on gas extracted from sediment and water sampled at numerous locations on the shallow ESAS from 2007 to 2013. We find high concentrations (up to 500 µM) of CH4 in the pore water of the partially thawed subsea permafrost of this region. For all sediment cores, both hydrogen and carbon isotope data reveal the predominant occurrence of CH4 that is not of thermogenic origin as it has long been thought, but resultant from microbial CH4 formation. At some locations, meltwater from buried meteoric ice and/or old organic matter preserved in the subsea permafrost were used as substrates. Radiocarbon data demonstrate that the CH4 present in the ESAS sediment is of Pleistocene age or older, but a small contribution of highly 14C-enriched CH4, from unknown origin, prohibits precise age determination for one sediment core and in the water column. Our sediment data suggest that at locations where bubble plumes have been observed, CH4 can escape anaerobic oxidation in the surface sediment

Спектр изменений внутрисуставных структур при гемофилической артропатии по данным магнитно-резонансной томографии

The results of joints's magnetic resonance imaging of 10 patients with severe form of hemophilic artropathy are discussing in this article. The purpose of research was to study the state of soft tissue and bone intraarticulare's structures in present group of patients. The form of bones, condition of an articulate cartilage, the joint’s tendons and ligaments, synovium, presence of an intraarticulate exudate, presence and extent of adjournment haemosiderin, and also signal characteristics of a marrow were estimated.В статье обсуждаются результаты магнитно-резонансной томографии суставов у 10 больных гемофилической артропатией с тяжелой формой заболевания. Исследование проводилось с целью детального изучения состояния мягкотканных и костных внутрисуставных структур у данной группы пациентов. Оценивались форма костей, состояние суставного хряща, сухожильно-связочного аппарата, синовия, определялось наличие внутрисуставного выпота, наличие и протяженность отложения гемосидерина, а также сигнальные характеристики костного мозга

Aberrant Otx2 Expression Enhances Migration and Induces Ectopic Proliferation of Hindbrain Neuronal Progenitor Cells

Dysregulation of Otx2 is a hallmark of the pediatric brain tumor medulloblastoma, yet its functional significance in the establishment of these tumors is unknown. Here we have sought to determine the functional consequences of Otx2 overexpression in the mouse hindbrain to characterize its potential role in medulloblastoma tumorigenesis and identify the cell types responsive to this lineage-specific oncogene. Expression of Otx2 broadly in the mouse hindbrain resulted in the accumulation of proliferative clusters of cells in the cerebellar white matter and dorsal brainstem of postnatal mice. We found that brainstem ectopia were derived from neuronal progenitors of the rhombic lip and that cerebellar ectopia were derived from granule neuron precursors (GNPs) that had migrated inwards from the external granule layer (EGL). These hyperplasias exhibited various characteristics of medulloblastoma precursor cells identified in animal models of Shh or Wnt group tumors, including aberrant localization and altered spatiotemporal control of proliferation. However, ectopia induced by Otx2 differentiated and dispersed as the animals reached adulthood, indicating that factors restricting proliferative lifespan were a limiting factor to full transformation of these cells. These studies implicate a role for Otx2 in altering the dynamics of neuronal progenitor cell proliferation

The Quadruple Squeeze: Defining the safe operating space for freshwater use to achieve a triply green revolution in the Anthropocene

Humanity has entered a new phase of sustainability challenges, the Anthropocene, in which human development has reached a scale where it affects vital planetary processes. Under the pressure from a quadruple squeeze—from population and development pressures, the anthropogenic climate crisis, the anthropogenic ecosystem crisis, and the risk of deleterious tipping points in the Earth system—the degrees of freedom for sustainable human exploitation of planet Earth are severely restrained. It is in this reality that a new green revolution in world food production needs to occur, to attain food security and human development over the coming decades. Global freshwater resources are, and will increasingly be, a fundamental limiting factor in feeding the world. Current water vulnerabilities in the regions in most need of large agricultural productivity improvements are projected to increase under the pressure from global environmental change. The sustainability challenge for world agriculture has to be set within the new global sustainability context. We present new proposed sustainability criteria for world agriculture, where world food production systems are transformed in order to allow humanity to stay within the safe operating space of planetary boundaries. In order to secure global resilience and thereby raise the chances of planet Earth to remain in the current desired state, conducive for human development on the long-term, these planetary boundaries need to be respected. This calls for a triply green revolution, which not only more than doubles food production in many regions of the world, but which also is environmentally sustainable, and invests in the untapped opportunities to use green water in rainfed agriculture as a key source of future productivity enhancement. To achieve such a global transformation of agriculture, there is a need for more innovative options for water interventions at the landscape scale, accounting for both green and blue water, as well as a new focus on cross-scale interactions, feed-backs and risks for unwanted regime shifts in the agro-ecological landscape