Ultrasound-Guided Vascular Access during Cardiopulmonary Resuscitation

The chapter considers the possibilities for using ultrasound to increase the efficiency and safety of the intravascular access in patients during cardiac arrest, cardiopulmonary resuscitation, and advanced life support. It provides the grounds for the real-time use of ultrasound for ensuring satisfactory central vascular access; the main principles of this methodology and current recommendations are described as well. In addition, the article presents special aspects of visualization of ultrasound vessels in cardiopulmonary resuscitation, as well as puncture and catheterization techniques. It is crucial that resuscitators, who are often at the forefront of patient resuscitation, understand how to properly use this potentially life-saving procedure

A Technique for Absolute Haemostasis

Background. Acute bleeding of parenchymal organs in blunt soft tissue traumas, sharp force injuries, bullet and shrapnel wounds is often life­threatening due to hypoxia combined with haemorrhagic shock. Hypoxia and haemorrhagic shock develop due to a continuous blood outflow from multiple gaping non­contractile blood vessels. A safe and effective organ­preserving surgery in parenchymal haemorrhage has not been developed to date.Materials and methods. A survey of scientific and patent literature has been conducted on techniques for parenchymal bleeding haemostasis based on topical cooling and heating­aided surgical interventions. Sources were mined in the Espacenet, Google Patent, eLibrary, Google Scholar, Web of Science, Scopus and PubMed databases.Results and discussion.An original method for parenchymal bleeding arrest was proposed in Russia at the end of the 20th century. The method is based on a safe transverse organ compression at vascular trunk to provide safe ischemia of the injured organ portion and using topical wound heating to trigger blood clotting. The compression is done with a surgical tool usually used for a gentle gastric or gut constriction. Mechanical  compression is applied at a force that ensures a complete constriction of the organ’s blood vessels arresting blood outflow from gaping vessels of the wound. Local hyperthermia of the wound surface is provided by a solid sterile object application with a smooth and slippery surface at +42–45 °C. Ischaemia and heating of the bleeding part of parenchymal organ are halted in 5–15 min. An adequacy criterion for the method is absolute haemostasis.Conclusion.An immediate arrest of blood supply to the wound surface complemented by heating at +42–45°С untill absolute haemostasis has been shown a sole rapid haemostatic technique effective in all forms of parenchymal haemorrhage. The entire peritoneal surface irrigation with 50% glycerol of pH 7.4 at +37–42 °С is advised to prevent postoperative abdominal adhesions at completion of surgery

SymTC: A Symbiotic Transformer-CNN Net for Instance Segmentation of Lumbar Spine MRI

Intervertebral disc disease, a prevalent ailment, frequently leads to intermittent or persistent low back pain, and diagnosing and assessing of this disease rely on accurate measurement of vertebral bone and intervertebral disc geometries from lumbar MR images. Deep neural network (DNN) models may assist clinicians with more efficient image segmentation of individual instances (disks and vertebrae) of the lumbar spine in an automated way, which is termed as instance image segmentation. In this work, we proposed SymTC, an innovative lumbar spine MR image segmentation model that combines the strengths of Transformer and Convolutional Neural Network (CNN). Specifically, we designed a parallel dual-path architecture to merge CNN layers and Transformer layers, and we integrated a novel position embedding into the self-attention module of Transformer, enhancing the utilization of positional information for more accurate segmentation. To further improves model performance, we introduced a new data augmentation technique to create synthetic yet realistic MR image dataset, named SSMSpine, which is made publicly available. We evaluated our SymTC and the other 15 existing image segmentation models on our private in-house dataset and the public SSMSpine dataset, using two metrics, Dice Similarity Coefficient and 95% Hausdorff Distance. The results show that our SymTC has the best performance for segmenting vertebral bones and intervertebral discs in lumbar spine MR images. The SymTC code and SSMSpine dataset are available at https://github.com/jiasongchen/SymTC

Acquired Aortic Valve Diseases (Current Status of the Problem)

Acquired heart disease – the concept of “acquired heart disease” includes a variety of pathological conditions acquired during the life of the patient. The lion’s share of these diseases are acquired heart defects. The significance of this problem is special for our region, since the incidence of rheumatic diseases and its complications in our Republic is still significant. However, in recent decades, statistical data on acquired defects, especially on aortic heart defects, have changed markedly. Thus, the prevalence of aortic heart disease among the elderly and senile is about 10.7%, significantly increasing for sclerotic lesions of the aortic valve – up to 25–48%. According to Euro Heart Survey on valvular heart disease, damage to the aortic valve was detected in 44.3% of patients with valvular heart disease (33.9% – aortic stenosis, 10.4% – aortic valve insufficiency. At the same time, aortic stenosis in 81.9% and insufficiency – in 50 .3% of patients were of degenerative origin. According to the statistics of our Republic, more than 400 patients with rheumatism per 100 thousand of the population are detected per year, of which, after an appropriate examination, in terms of the population of our Republic, more than 16,000 require surgical correction of acquired heart disease, which confirms the importance of discussing the problem for our healthcare

Синдром Николау: некротическая активность лекарств и способы предотвращения постинъекционных абсцессов (в память о профессоре Ласло Гемзе)

Post-injection abscess, which is the sad finale of Nicolau syndrome, continues to attract the attention of researchers due to the need to clarify the causes of this iatrogenic disease in order to develop effective measures for its prevention. For many years, researchers from all over the world have tried from different perspectives to explain the mechanism of the drugs effect that causes post-injection pain syndrome, infiltration, inflammation, erimatous skin damage, necrosis and abscess (Nicolau syndrome), but to no avail. This has been done only in recent years. There are findings in Russia that show that drugs considered to be of high quality today, in some cases, in addition to specific pharmacological activity, may have necrotic activity of a non-specific nature of action. The findings showed that according to the established pharmaceutical practice and in full compliance with the pharmacopoeia requirements for the quality of medicines, pharmaceutical products produced by different pharmaceutical companies, as well as those included in different series of the same pharmaceutical company, may have different compositions (formulations), contain different ingredients, therefore they may have different physico-chemical properties. In this regard, drugs of different serial numbers and/or different manufacturers, which are considered high-quality today, can be hypertonic solutions, have acidifying or alkalizing activity, have alcohols, aldehydes and heavy metal salts in denaturing concentrations. This is the reason that in some cases drugs have necrotic (cauterizing) activity. In this regard, to prevent Nicolau syndrome, it is proposed to reduce the physico-chemical aggressiveness of drugs. Today, this can be done successfully by diluting them with water for injection 2 to 8 times before injection.Постинъекционный абсцесс, являющийся печальным финалом синдрома Николау, продолжает привлекать внимание исследователей из-за необходимости выяснения причин развития этой ятрогенной болезни для разработки эффективных мер ее профилактики. Многие годы исследователи всего мира с разных сторон пытались объяснить механизм действия лекарств, вызывающих постинъекционный болевой синдром, инфильтрацию, воспаление, эритематозное повреждение кожи, некроз и абсцесс (Nicolau syndrome), но безуспешно. Это удалось сделать лишь в последние годы. В России удалось обнаружить, что лекарства, считающиеся сегодня качественными, в некоторых случаях помимо специфической фармакологической активности могут обладать некротической активностью неспецифического характера действия. Было показано, что по сложившейся фармацевтической практике и в полном соответствии с фармакопейными требованиями, предъявляемыми к качеству лекарств, лекарственные средства, произведенные разными фармацевтическими компаниями, а также входящие в состав разных серий одной фармакомпании, могут иметь разные составы (рецептуры), содержать разные ингредиенты, поэтому могут иметь разные физико-химические свойства. В связи с этим лекарства разных номеров серий и/или разных производителей, считающиеся сегодня качественными, могут являться гипертоническими растворами, обладать закисляющей или защелачивающей активностью, иметь в своем составе спирты, альдегиды и соли тяжелых металлов в денатурирующих концентрациях. Именно это является причиной того, что в некоторых случаях лекарства имеют некротическую (прижигающую) активность. В связи с этим для профилактики синдрома Николау предлагается уменьшать физико-химическую агрессивность лекарств. Сегодня это успешно можно сделать с помощью их разведения водой для инъекции в 2–8 раз перед инъекцией