Functional features of innate immunity in the development of postpericardiotomy syndrome in patients after coronary artery bypass grafting

Objective: to study the functional characteristics of innate immunity in the formation of postpericardial syndrome (PPS) in patients undergoing coronary artery bypass graft ing (CABG).Materials and methods: the study involved 60 people, 40 of them made up the main group of patients with coronary artery disease, which retrospectively aft er 1 month of observation was divided into 2 groups. Group I CABG and PPS, group II CABG without PPS. The control group consisted of 20 patients without IHD. Before surgery, aft er 5, 14 days and 1 month, the expression of toll-like receptors (TLRs) 2, 4, 9, the content of CD16+ and Granzyme B lymphocytes, the HCT test and serum α-defensin were evaluated in blood cells. Statistical analysis of the results of the study was carried out using the program Statistica 12.0 (StatSoft , USA). The difference in mean values between groups was evaluated by the Mann-Whitney test. Statistical signifi cance was considered signifi cant at p ≤ 0.05.Results: when comparing the initial indices of the main groups and the control group, an increase in the expression of TLRs 2, 4, 9 was revealed. An increase in the content of CD16+, as well as an increase in the cytotoxic activity of natural killers and an increase in the production of α-defensin.Conclusions: on the basis of the study, activation of the cellular link of innate immunity, an increase in the cytotoxic potential of natural killers and a signifi cantly high level of α-defensin both before and aft er CABG were revealed, which can play an important role in the development of PPS

New nuclear three-body clusters \phi{NN}

Binding energies of three-body systems of the type \phi+2N are estimated. Due to the strong attraction between \phi-meson and nucleon, suggested in different approaches, bound states can appear in systems like \phi+np (singlet and triplet) and \phi+pp. This indicates the principal possibility of the formation of new nuclear clusters

Опыт внедрения системы контроля антимикробной терапии в многопрофильном стационаре

The article is devoted to the issue of control over antibiotic resistance of the main pathogens causing nosocomial infections and presents the experience of introducing the antimicrobial therapy control system in a general hospital. The special emphasis is put on capabilities of information technologies used as a tool to support decision making about prescription or restriction of antibacterial drugs.В статье, посвященной проблеме сдерживания антибиотикорезистентности основных возбудителей нозокомиальных инфекций, приводится опыт внедрения системы контроля антимикробной терапии в многопрофильном стационаре. Акцент сделан на демонстрации возможностей информационных технологий, применяемых в качестве инструмента поддержки решений по назначению или ограничению использования антибактериальных препаратов

QUALITY OF LIFE ASSESSMENT IN PATIENTS WITH ACUTE CORONARY SYNDROME IN COMBINATION WITH TYPE 2 DIABETES

Purpose: to assess the quality of life in patients with acute coronary syndrome in combination with type 2 diabetes.Materials and methods: interviewed 130 people, matched by age. Assessment of quality of life was assessed with the help ofa questionnaire WHOQOL BREF, which consists of 26 questions evaluating the 4 areas of quality of life: physical, psychological,social and natural environment. Evaluation of the results was performed according to the scale presented in the instructions to thequestionnaire. The grid presents from 0 to 100 and, respectively, the higher the score, the higher the quality of life.Results: patients with acute coronary syndrome without type 2 diabetes and associated with type 2 diabetes, there is a decreaseof quality of life mainly in the physical, psychological and social spheres

ВЕНОАРТЕРИАЛЬНАЯ РАЗНИЦА ПАРЦИАЛЬНОГО НАПРЯЖЕНИЯ УГЛЕКИСЛОГО ГАЗА (ΔPCO2) КАК МАРКЕР ГИПОПЕРФУЗИИ У ПАЦИЕНТОВ, ОПЕРИРУЕМЫХ ЛАПАРОСКОПИЧЕСКИМ СПОСОБОМ ПО ПОВОДУ КОЛОРЕКТАЛЬНОГО РАКА

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The level of VEGF-A in the lacrimal fluid of diabetic retinopathy

The lacrimal fluid was investigated in 56 people (95 eyes) with type II diabetes, of which 11 (11 eyes) with no signs of diabetic retinopathy and 45 patients (84 eyes) suffering from diabetic retinopathy of varying severity. Investigation of VEGF-A (vascular endothelial growth factor A) in stimulated lacrimal fluid revealed its level in all patients. It was significantly higher in patients with diabetic retinopathy compared with data that have been obtained in patients with diabetes, but without signs of diabetic retinopathy. Statistically significant differences in the level of VEGF-A in patients with non-proliferative and proliferative retinopathy of 1-3 stages have not been identified. At the same time in patients with far-advanced retinopathy with marked variations of fatal retina and vitreous body (detachment expressed gliosis), but without evidence of neovascularization of the anterior eye, a significant decrease in the level of vasoproliferative factors has revealed

Целенаправленная поддержка гемодинамики при лапароскопических вмешательствах у пациентов с колоректальным раком

Introduction. The conductance of goal-directed hemodynamic therapy is controversial due to the difficulty in its implementation in routine practice despite the significant number of studies and meta-analyses.Objective. To estimate the efficacy of a modified algorithm of goal-directed hemodynamic management in patients with colorectal cancer who undergo laparoscopic surgery based on non-invasive monitoring of cardiac output.Subjects and methods. A single-centered, randomized trial was conducted. The control group included 75 patients, while the goal-directed therapy (GDT) group included 72 patients. In the control group, hemodynamic management was based on mean arterial pressure and intraabdominal perfusion pressure. In addition, results of fluid responsiveness tests were considered in the GDT group. The suggested protocol efficacy was evaluated on the basis of frequency of critical incidents, shifts in acid-base balance and lactate concentration, infusion volume, vasopressor doses, the incidence of acute kidney injury, and other complications.Results. After anesthesia induction and according to the results of a modified, passive leg raising test, 67.1% of patients were considered responders and received 1250 (1000; 1500) ml of balanced crystalloids before carboxyperitoneum. The infusion differentiation test of hypotension cause was performed in 47 patients of the GDT group, 37% were considered responders, and others received vasopressors and/or inotropes. The use of the GDT protocol led to a decrease in total infusion volume and vasopressor doses. A lower frequency of critical incidents was recorded when the GDT protocol was used. In the GDT group, there were no signs of ischemia and increased frequency of complications (including acute kidney injury).Conclusions. Testing of fluid responsiveness and non-invasive cardiac output monitoring allows for the correction of hemodynamics during surgery. Goal-directed therapy in the intraoperative period allows different approaches to maintaining systemic and intraabdominal perfusion pressure, thus decreasing the total volume of infusion without increasing hypoperfusion risk.Введение. Отношение к целенаправленной поддержке гемодинамики во время анестезии остается противоречивым, несмотря на большое число исследований и метаанализов в этой области, главным образом из-за сложности реализации в рутинной практике.Цель: оценить эффективность модифицированного нами алгоритма целенаправленной поддержки гемодинамики у пациентов при лапароскопических вмешательствах по поводу колоректального рака, предполагающего использование неинвазивного мониторинга сердечного выброса.Материалы и методы. Одноцентровое рандомизированное исследование; 75 пациентов включено в контрольную и 72 в группу целенаправленной терапии (ЦНТ). В контрольной группе поддержку гемодинамики осуществляли с ориентацией на целевые значения среднего артериального и интраабдоминального перфузионного давления. В группе ЦНТ также учитывали результаты тестов на чувствительность пациентов к инфузионной нагрузке. Эффективность тактики оценивали по частоте гемодинамических критических инцидентов, сдвигам кислотно-основного состояния и концентрации лактата в крови, объему инфузии, дозам вазопрессорных препаратов, частоте развития острого почечного повреждения и других осложнений.Результаты. После индукции анестезии по результатам теста с поднятием ног 67,1% пациентов отнесены к категории респондеров, до наложения карбоксиперитонеума им дополнительно перелили 1 250 (1 000; 1 500) мл кристаллоидного раствора. Тест с инфузионной нагрузкой для уточнения причины гипотензии на основном этапе операции выполнен 47 пациентам группы ЦНТ, в 37% случаев способом коррекции выбрано усиление инфузионной терапии, в остальных – дополнение ее препаратами вазопрессорного или инотропного действия. Использование протокола ЦНТ привело к уменьшению суммарного объема инфузий и доз вазопрессорных препаратов. При контроле эффективности и безопасности ЦНТ выявлены снижение частоты развития критических инцидентов со стороны гемодинамики по ходу анестезии, стабильность кислотно-основного состояния, отсутствие нарастания признаков тканевой ишемии и увеличения частоты осложнений, в том числе острого почечного повреждения.Выводы. Проведение тестов чувствительности к волемической нагрузке и использование неинвазивного контроля сердечного выброса позволяют в любой момент операции и анестезии целенаправленно корригировать программу обеспечения гемодинамической стабильности. Целенаправленная поддержка гемодинамики в интраоперационном периоде способствует дифференциации тактики по поддержанию системного и интраабдоминального перфузионного давления, позволяя снизить общий объем интраоперационной инфузионной нагрузки без увеличения риска развития гипоперфузии

The role of glycosaminoglycanes in the development of intimal hyperplasia in the shunting of coronary arteries

The article is devoted to the study of the role of glycosaminoglycans (hyaluronic acid, heparan sulfate derivatives, dermatan sulfate) in the genesis of intimal arterial hyperplasia. It is shown that these substances play important role in the structural reorganization of vessels, including the development of intimal hyperplasia of the arteries. Scientific works on the role of GAG in the genesis of intimal hyperplasia are based on experimental data. The authors draw attention to GAG involvement in cell-intercell nteractions of artery walls, including proliferation, migration, signal transduction of smooth muscle cells, endotheliocytes, platelets. Undoubtedly, attempts to create a 3D shunt with hyaluronate, atorvastatin can be used in the clinic for full and longterm use, which can prevent the development of restenosis of the arteries