Clinical Recommendations of the Northwest Society for Enteral and Parenteral Nutrition, Interregional Association for Emergency Surgery, Russian Gastroenterological Association, Union of Rehabilitation Therapists of Russia and Russian Transplantation Society on Diagnosis and Treatment of Short Bowel Syndrome-Associated Intestinal Failure in Adults

Aim. Current clinical recommendations address the epidemiology, causes, clinical manifestations and pathogenesis of possible immediate and long-term complications, as well as the problematic issues related to treatment and rehabilitation of adult short bowel syndrome patients.Key points. Short bowel syndrome (SBS) is a symptom complex of impaired digestion caused by the reduction of small intestine absorptive surface and manifested by intestinal failure (IF) of various severity (maldigestion and malabsorption) developing into malnutrition and systemic somatogenic disorders. The vital strategic aspects of its treatment are the personalisation of liquid, macro- and micronutrients consumption as well as avoidance of intestinal failure- and parenteral nutrition-associated complications. Various nutritional support regimes and the indications for infusion therapy and maintenance parenteral nutrition are considered in this patient category, also in outpatient settings. To mitigate the dependence on intravenous fluid- and nutrient administration and attain enteral autonomy in SBS-IF patients, the use of recombinant glucagon-like peptide-2 (GLP-2) is justified as exerting a pronounced trophic effect on the epithelial regenerative potential as well as structural and functional adaptation of intestinal mucosa. The SBS-IF patients prescribed with home parenteral nutrition and/or their caregivers should be trained in a special programme that covers the catheter care, preparation of infusion solutions and nutrient mixture container, infusion pump operation as well as the prevention, recognition and management of complications. The main referral indications for small bowel transplantation (SBT) are: fast-progressing cholestatic liver disease-complicated irreversible intestinal failure; thrombosis of two or more central venous conduits used for parenteral nutrition; recurrent catheter-associated bloodstream infection.Conclusion. Current recommendations on diagnosis and treatment as well as the developed criteria of medical aid quality assessment are applicable at different levels of healthcare

EPIDEMIOLOGICAL FEATURES OF BACTERIAL INFECTIONS IN BONE MARROW TRANSPLANT UNITS

The aim of the study was to identify the epidemiological features of bacterial infections in patients and circulation of epidemiologically significant microorganisms in the bone marrow transplant (BMT) units. Materials and methods. The study was conducted in three BMT departments. To identify the epidemiological features of bacterial infections, a prospective observational study was conducted from 01 April 2014 to 31 August 2014 (91 patients) which included active detection of cases of infection and microbiological examination of patients. In order to detect the circulation of epidemiologically significant microorganisms, point prevalence studies (59 patients, 170 environmental samples) were conducted. To study the role of colonization, microbiological monitoring of patients on admission to the department was carried out, and repeated every week before discharge. Swab samples from skin and mucous membrane of the oral cavity and stool sampleswere included in the monitoring. In total, 639 samples from 50 patients were tested. Results. The study revealed a high incidence of infectious complications in BMT patients (100 cases of bacterial infections in 57 patients: sepsis 30.8 per 100 patients, pneumonia 26.4 per 100 patients, urinary tract infections 32.9 per 100 patients, soft tissue infection 9.9 per 100 patients, catheter-associated bloodstream infection 9.9 per 100 patients). Most infections were caused by Gram-negative bacteria, in particular K. pneumoniae. The onset of disease manifestation was preceded by colonization of the patient with these microorganisms. Fatal outcomes were observed from sepsis and pneumonia caused by K. pneumoniae and/or P. aeruginosa. Sepsis and pneumonia were often associated with cytopenia, RR 2.63 [95% CI 1.52–4.57] p = 0.004 and RR 3.97 [95% CI 2.19–7.19] p < 0.001 respectively. In course of observation, the frequency of colonization of patients with microorganisms susceptible to antibiotics decreased, and colonization with resistant pathogens increased. A series of prevalence studies revealed a constant circulation of VRE in the BMT units with a contacttransmission via household objects. Multidrug-resistant gram-negative microorganisms did not have a constant circulation and appeared sporadically against the background of the constant circulation of susceptible strains of these pathogens. Conclusions. Prospective epidemiological surveillance and microbiological monitoring are required in the BMT units. Widespread contamination of household objects in the environment indicates the need to strengthen the hygienic education of patients and visitors as well as disinfection of these facilities. In addition, we recommend introduction of weekly fecal screening cultures to monitor intestinal colonization of patients with MDRO

Risk factor prevalence and target organ damage in working-age men with stress-induced arterial hypertension

Aim. To investigate risk factors (RF) and target organ damage (TOD) prevalence in working-age men with stressinduced arterial hypertension (AH). Material and methods. The study included 100 males, working as machinists and machinist assistants, with blood pressure (BP) above 140/90 mm Hg. Control group included males working as railway assemblers (n=40). General physical, laboratory, and instrumental examinations were performed, including psycho-mental test (PMT). Results. TOD was quite prevalent among normotensive males. Twenty-four hour BP monitoring (BPM) demonstrated the difference in mean BP levels at workplace and during weekend, that confirmed stress-induced AH diagnosis. Psychoemotional stress tests are highly sensitive in stress reactivity assessment among individuals with high professional stress levels. These tests can help in identifying AH risk groups. Conclusion. For early diagnostics and adequate therapy choice in patients with high psychoemotional stress levels, not only RF and TOD control, but also 24-hour BPM at workplace and during weekend, and PMT, are necessary

Right chambers of the heart in children with pulmonary circulation hypervolemia

The ultrasound and angiographic parameters of the right chambers of the heart were analyzed in children with pulmonary arterial hypertension (PAH) associated with congenital heart defects. The investigation was conducted in relation to the functional class (degree) of PAH. Right cardiac remodeling was found to depend to a greater extent on afterload (pulmonary artery systolic pressure and pulmonary vascular resistance); moreover, diastolic dysfunction developed just in moderate (Functional Class II) PAH. It was ascertained that there was a prompter development of PAH with myocardial systolic and diastolic dysfunction in the presence of congenital malformations with arterial hypoxemia

Additive manufacturing of titanium alloys in the biomedical field: processes, properties and applications

The mechanical properties and biocompatibility of titanium alloy medical devices and implants produced by additive manufacturing (AM) technologies - in particular, selective laser melting (SLM), electron beam melting (EBM) and laser metal deposition (LMD) - have been investigated by several researchers demonstrating how these innovative processes are able to fulfil medical requirements for clinical applications. This work reviews the advantages given by these technologies, which include the possibility to create porous complex structures to improve osseointegration and mechanical properties (best match with the modulus of elasticity of local bone), to lower processing costs, to produce custom-made implants according to the data for the patient acquired via computed tomography and to reduce waste