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A well-known and dangerous complication of COVID-19 infection is the development of hypercoagulation, which leads to thrombosis of various localization. Therefore, the problem of anticoagulant therapy was widely discussed during the first months of the pandemic and continues to be relevant. At the same time, concomitant cardiac pathology is associated with a more severe course of COVID-19 and higher risks of complications and mortality. Therefore, patients who underwent cardiac surgery require special attention. Individuals with prosthetic metal heart valves must constantly receive anticoagulant therapy, however, the literature describes cases of intracardiac thrombotic complications despite anticoagulation during COVID-19 infection. Currently, there are no randomized studies on this issue, and only individual clinical cases provide this information. The aim of the work was to describe a clinical case of thrombosis at the left ventricular apex during COVID-19 infection in a patient with a prosthetic aortic valve who received adequate warfarin therapy and to compare the tactics of patient management and therapeutic outcomes with other clinical cases. Materials and methods. The patient was followed-up after aortic valve replacement for 2 years. During the visits, a general clinical examination, laboratory examinations - clinical blood test, blood glucose, urea, creatinine, bilirubin, INR, NT-proBNP, echocardiography were performed. Results. The patient with a congenital heart defect, a condition after aortic valve replacement, mitral and tricuspid valve annuloplasty (15.03.2022) due to bicuspid aortic valve, combined aortic defect with predominance of stage III-IV regurgitation; stage III secondary arterial hypertension; chronic heart failure IIA, functional class III, stage C, reduced systolic left ventricular function; a two-chamber pacemaker due to complete AV blockade; paroxysmal atrial flutter presented to a cardiologist with worsening shortness of breath and weakness one month after a moderate COVID-19 infection. The patient received bisoprolol 5 mg, amiodarone 200 mg, spironolactone 50 mg, perindopril 8 mg, warfarin 5 mg, INR was carefully controlled, at presentation - 3.7. Echocardiography revealed a left ventricular apex thrombus, a decrease in left ventricular ejection fraction (LVEF) from 46 % to 38 %. Aspirin 75 mg/day, torasemide 10 mg/day, dapagliflozin 10 mg/day, and metabolic therapy were added to the treatment. After 1 month, the patient's condition improved, no thrombus was detected in the left ventricular cavity, LVEF increased to 46 %. Conclusions. This case demonstrates the problem of careful cardiovascular system state monitoring in patients with prosthetic valves during and after COVID-19, since symptoms of heart cavity or valve thrombosis, worsening heart failure can be mistakenly considered as signs of a viral infection or respiratory failure. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common extrapulmonary complication of the past SARS-CoV-2 infection. According to experts, almost 20% of patients with past COVID-19 have a history of atrial fibrillation and the incidence of new paroxysms of this arrhythmia ranges from 10 to 18%. Referring to the studied patients who experienced COVID-19 more than 6 months ago, the subjective perception of cardiac arrhythmia is the most frequent complaint, reported by approximately two-thirds of patients. The aim of our study was to determine the course of atrial fibrillation in patients after past 2019 coronavirus disease (COVID-19) during a dynamic 6-month follow-up after the initial hospitalization for atrial fibrillation in the specialized department of cardiac arrhythmias of the SI “National Scientific Center” “M.D. Strazhesko Institute of cardiology, clinical and regenerative medicine of the National Academy of Medical Sciences of Ukraine” depending on the clinical and anamnestic, demographic, anthropometric factors, the results of laboratory research methods and the received treatment. 36 patients were included in the study, 27 of them formed the first group, which included patients in whom the course of atrial fibrillation improved against the background of recommended antiarrhythmic treatment after initial hospitalization for AF and past COVID-19, who at the time of hospitalization had a negative PCR test, of which 17 were women and 10 were men, aged 62.38±1.83 years. The second group consisted of 9 patients including 4 women and 5 men, aged 69.88±2.60 years in whom the course of atrial fibrillation neither changed nor worsened. We determined that the number of patients in whom the course of atrial fibrillation improved during the 6-month follow-up was three times greater than those in whom the course of this arrhythmia neither changed nor worsened (75% and 25%, respectively). Patients with a more favorable course of atrial fibrillation were younger (on average by 7.5 years), three times less likely to suffer from diabetes and not often had arterial hypertension of the III stage, than those examined, in whom the course of this arrhythmia did not change or worsen. Systemic inflammation and severity of heart failure significantly worsen the course of AF within 6 months after the hospital stage of treatment. However signs of deterioration of lipid metabolism are characteristic of patients with an unfavorable course of atrial fibrillation during 6 months after hospitalization, which is probably caused by the activation of systemic inflammation in them. The improvement of the prognosis of the examined patients was probably influenced by the appointment of antiarrhythmic drugs, such as: amiodarone, flecainide, beta-blockers, statins – from the "up-stream" therapy drugs. [ABSTRACT FROM AUTHOR]

Among the main causes of recurrent thrombosis in young patients there is paroxysmal nocturnal hemoglobinuria (PNH), a complication of which is Budd-Chiari syndrome (BCS), characterized by thrombosis of the hepatic veins and/or inferior vena cava. Detection of PNH is an extremely important task, because its untimely diagnosis leads to recurrent thrombosis, deterioration of the patient's quality of life, and increased mortality from complications which accompany PNH. The article analyzes a clinical case of PNH in a young patient with recurrent BCS, which illustrates the relevance and timely diagnosis of this disease. As a result of unsuccessful pharmacological treatment and progression of liver insufficiency, the patient had liver transplantation. After surgery and standard post-transplantation therapy the patient's condition improved, but after some time a recurrence of hepatic vein thrombosis was developed. After hematologist consultation and performing flow cytometry, the patient was diagnosed PNH. However, on the background of recurrent hepatic vein thrombosis, immunosuppressive therapy, and the lack of targeted treatment for PNH, multiple organ failure was developed, which led to the patient's death PNG is one of the orphan diseases, which is characterized by a severe, chronic, progressive course and accompanied by the formation of degenerative changes in the body, a decrease in the quality and shortening of the patient's life. Targeted therapy can reduce the risk of thrombosis, red blood cell transfusions and improve the quality of life of patients with PNH. [ABSTRACT FROM AUTHOR]

Актуальность. Одно из самых грозных отдаленных осложнений хирургического лечения проксимального расслоения аорты — аневризма ее не­оперированных отделов. Цель. Сравнительный анализ различных методик хирургического лечения проксимальных расслоений аорты в отношении развития тромбоза ложного канала неоперированных отделов. Методы. Провели простое обсервационное ретроспективное многоцентровое исследование эффективности техники «замороженный хобот слона» в сравнении со стандартным хирургическим вмешательством (косой агрессивный анастомоз или полное протезирование дуги аорты многобраншевым протезом). В анализ включили 101 пациента, которых разделили на группы в зависимости от метода лечения: первая группа — вмешательство на дуге аорты по методике «замороженный хобот слона» (n = 31); вторая группа — реконструкция грудной аорты стандартными методами (группа контроля, n = 70). С учетом ретроспективного характера исследования и неравнозначности групп по отдельным характеристикам производили выравнивание групп методом псевдорандомизации (англ. propensity score matching) для повышения достоверности результатов. Собирали данные пациентов в дооперационном периоде, из протоколов хирургических вмешательств, в послеоперационном и отдаленном периодах (3–6 мес., 1, 2, 3 года после операции). Статистические расчеты проводили в программе RStudio версии 0.99.879 (RStudio, Inc., Бостон, США). Результаты. Отсутствие тромбоза ложного канала на уровне грудного отдела аорты сохранялось после хирургического лечения у половины пациентов из группы контроля (n = 13; 52 %) и не определялось в группе «замороженного хобота слона». Полного тромбоза ложного канала на уровне грудного отдела аорты (уровень установки стент-графта и дистальнее до диафрагмы) удалось добиться более чем у половины больных группы «замороженного хобота слона» и только у 3 (12 %) пациентов из группы контроля. Аневризматическая трансформация неоперированной аорты произошла у 12 (48 %) больных из группы стандартных методов и отсутствовала в группе «замороженного хобота слона». Заключение. Методика «замороженный хобот слона» позволяет снизить частоту аортосвязанных событий до 0 % в течение 3 лет по сравнению со стандартным подходом (32 %, p < 0,005). У пациентов, оперированных по поводу проксимального расслоения аорты с использованием этой техники, в сравнении со стандартными методиками достоверно чаще происходит тромбирование ложного канала аорты в грудном отделе (p = 0,004), достоверно ниже частота аневризматической трансформации или скорости роста аорты в грудном отделе более 5 мм в год в отдаленном периоде (p = 0,016). Поступила в редакцию 15 февраля 2023 г. Исправлена 31 июля 2023 г. Принята к печати 4 августа 2023 г. Финансирование Исследование выполнено в рамках гранта Президента РФ НШ-5096.2022.3 (соглашение от 12.05.2022 г. № 075-15-2022-823). Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: А.М. Чернявский, М.М. Ляшенко Сбор и анализ данных: М.М. Ляшенко, А.А. Шаданов, Д.С. Панфилов, Е.В. Скурихина Статистическая обработка данных: М.М. Ляшенко Написание статьи: М.М. Ляшенко Исправление статьи: А.М. Чернявский, Д.А. Сирота, Б.Н. Козлов Утверждение окончательного варианта статьи: все авторы

Hyperhomocysteinemia is considered a risk factor for many diseases, including thrombosis. Patients with chronic kidney disease often have vascular complications in the form of arterial or venous thrombosis, and it is important to consider the blood homocysteine level as a predictor of thrombophilia. The causes of hyperhomocysteinemia can be both genetic mutations and deficiency of homocysteine metabolism enzymes, as well as deficiency of folic acid, vitamin B12 and, to a lesser extent, deficiency of vitamin B6, which affects methionine metabolism. Given the role of hyperhomocysteinemia as a predictor of cardiovascular events in patients with kidney diseases, in our opinion, the multifactorial nature of increased homocysteine requires further research into some links of its pathogenesis in chronic kidney disease and the development of targeted therapeutic interventions. [ABSTRACT FROM AUTHOR]

Program hemodialysis is the main treatment for patients with terminal chronic kidney disease. To conduct adequate hemodialysis, it is necessary to form a permanent vascular access, as a rule, this is an arteriovenous fistula. One of the main reasons for the cessation of its functioning is the formation of thrombosis. The aim of the study was to identify the causes of thrombosis of arteriovenous fistulas and to choose the optimal method for diagnosis and surgical correction. This study included 20 patients with thrombosis of native arteriovenous fistulas. As a diagnosis, patients underwent ultrasound duplex scanning, histological examination of fistula vein stenoses and anastomoses. All patients underwent surgical correction in the amount of thrombectomy, reconstruction of an arteriovenous fistula, or the formation of a new access.

Цель. Оценить эффективность эндоваскулярной стентовой тромб­эктомии при острой ишемии верхней конечности, обусловленной тромбозами или тромбоэмболиями магистральных артерий верхней конечности. Методы. Оценка эффективности и безопасности методики у 18 пациентов с острой ишемией верхней конечности. Средний возраст 72 (38–93) года, 66,7 % группы — женщины. Артериальная гипертензия у 94,4 % пациентов, подтвержденная фибрилляция предсердий — у 38,9 %. Результаты. Первичный успех методики (полная реваскуляризация по данным ангиографии) составил 83,3 % (15 из 18 наблюдений). Изолированно метод использовали в 15 наблюдениях, в 2 случаях имплантировали саморасширяющиеся стенты, одному пациенту провели селективную тромболитическую терапию. В 3 наблюдениях явления острой ишемии не купировали, в течение госпитализации ампутаций верхней конечности не выполняли, конверсий на открытое вмешательство также не проводили. Умерли в течение госпитализации двое пациентов: в первом случае развился острый инфаркт миокарда, во втором — полиорганная недостаточность в послеоперационном периоде. Заключение. Рассматриваемая техника эндоваскулярной тромбэктомии в комбинации с другими эндоваскулярными методами имеет высокую эффективность и такие преимущества, как малая травматичность, отсутствие необходимости в общей анестезии, точный интра- и послеоперационный контроль проходимости, своевременное выявление эмболов с возможностью их удаления из артерий, сопоставимых в диаметре с доставляющей системой стента (до 1,8 мм). Поступила в редакцию 15 февраля 2023 г. Исправлена 29 марта 2023 г. Принята к печати 6 апреля 2023 г. Информированное согласие Получено информированное согласие пациентов на публикацию и использование медицинских данных в научных целях. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Обзор литературы: А.В. Коротких, И.В. Черникова, В.М. Унгурян, А.Д. Киселев Написание статьи: А.Н. Казанцев, А.Н. Иваненко, Г.А. Соболев Исправление статьи: И.С. Семьин Выполнение операций: А.Н. Иваненко, Г.А. Соболев Утверждение окончательного варианта статьи: все авторы

Background. Acute pancreatitis is an aseptic inflammation of the pancreas with diverse complications and further development of necrosis of the gland, parapancreatic tissue and possible addition of secondary infection. A significant number of biochemical markers that can be predictors of pancreatitis complications are still being researched. However, most of them are expensive and their indicators are increased only in the first 24–48 hours after the onset of the disease, so they are not used in daily clinical routine. The purpose of this study is to evaluate the factors that indicate an elevated risk of necrosis in acute severe pancreatitis. Materials and methods. A retrospective analysis of 80 patients with acute pancreatitis was performed via creation of a multivariate logistic regression model. Results. The dependence of the risk of pancreatic necrosis on the following factor signs was found: lipase at the onset of the disease (cut-off value = 599.6 U/l, area under the receiver operating characteristic curve (АUС) = 0.72 (95% confidence interval (СІ) 0.57–0.88)), severity of the disease, fibrinogen on day 3 of the disease (cut-off value = 9.7, АUС = 0.65 (95% СІ 0.48–0.81)), C-reactive protein (cut-off value = 175.7 mg/L, AUC = 0.70 (95% CI 0.54–0.86)), and intra-abdominal mean capillary perfusion pressure on the first day of the disease (cut-off value ≤ 63.3 mm Hg, АUС = 0.88 (95% СІ 0.77–0.99)). The autopsy results revealed the presence of necrosis and microthrombosis of the pancreas. Conclusions. Factors that may indicate an increased risk of pancreatic necrosis were high levels of lipase, fibrinogen on the third day of the disease, C-reactive protein, decreased intra-abdominal mean capillary perfusion pressure, severity of the disease, and the presence of portosplenomesentric thrombosis. [ABSTRACT FROM AUTHOR]

Snake venom-derived platelet aggregation inhibitors can be promising antiplatelet medications that can allow to avoid the risk of bleeding and treatment resistance, particularly in aspirin-resistant patients. Our study aimed to assess the effectiveness of a platelet aggregation inhibitor derived from Echis multisquamatis snake venom in various settings, including in vitro, in vivo, and ex vivo. Methods. We examined a polypeptide from Echis multisquamatis venom, purified using a recently developed chromatography protocol, across multiple models. This polypeptide was introduced into platelet-rich blood plasma and administered intravenously to rats. The effects on platelet aggregation were assessed using aggregometry, focusing on ADP-induced aggregation. Results and Discussion. Our findings revealed that a concentration of 0.040 mg/ml significantly reduced platelet aggregation in vitro. Remarkably, this dosage also proved effective when administered intravenously in laboratory animals, reaffirming its potential as a robust antiplatelet agent. In the final phase of our study, the polypeptide demonstrated its ability to inhibit platelet aggregation in blood plasma of pregnant woman with aspirin resistance, presenting a promising avenue for innovative treatment approaches in such cases. Conclusion. This study underscores the potential of the Echis multisquamatis venom-derived polypeptide as a promising antiplatelet agent, effective in diverse scenarios, including aspirin resistance. Further research and clinical trials are imperative to fully harness its therapeutic potential. [ABSTRACT FROM AUTHOR]

Thromboembolic diseases are of great clinical concern because of their high prevalence and consequences, which are often fatal. Despite significant progress in the prevention and treatment of thrombotic events, patients remain at risk of life-threatening bleeding episodes and other side effects arising from anticoagulant therapy, so the issue of personalizing prescriptions taking into account the genetic characteristics of patients has become urgent. The purpose of the study is to substantiate the need for patient genotype analysis in order to increase the effectiveness and safety of individual pharmacotherapy. The article has a conceptual nature, therefore the following research methods were chosen: systematization and generalization; analysis and specification; abstract and logical. For the search, we used PubMed, PubMedCentral, Google Scholar, dbSNP, Elsevier, Springer from September 2000 to November 2022. The review included studies written in English and Ukrainian. There were analyzed literature data on two main subclasses of oral antithrombotic agents, including oral anticoagulants and antiplatelet agents, namely warfarin, apixaban, rivaroxaban, and clopidogrel. Prognostically significant for evaluating the effectiveness and safety of anticoagulant use, as well as the most studied in this aspect, are CYP2C9 (rs1799853, rs1057910), CYP2C19 (rs4244285, rs4986893, rs12248560), VKORC1 (rs9923231, rs7294, rs9934438), MDR1 (rs4148738, rs2032582, rs1045642), FGB (rs1800787), PAI-1 (rs1799889) genes. The results of CYP2B6, CYP3A4/5 (rs776746), CYP4F2 (rs2108622) genes analysis indicate a certain influence on the anticoagulants metabolism and require further detailed study. Factors such as age, race, sex, smoking, diet, and other medications are known to influence the effectiveness of antithrombotic therapy, but the most influential factor is genetics, which accounts a significant percentage of interindividual variability. Future research should focus on the study of known and novel genetic variants that influence drug metabolism, as well as the molecular mechanisms that contribute to changes in plasma anticoagulant levels. The article provides a brief overview of action mechanisms, pharmacogenetics, and interactions between drugs and the genes responsible for their metabolism. The results indicate the need for studies of gene variants considered in this review before starting anticoagulant therapy, and attention should also be paid to the possibility of inhibitors and inductors influence on components of the metabolic pathway of anticoagulants and gene expression products that participate in their metabolism. The totality of these measures will ensure an increase in the efficiency and safety of individual pharmacotherapy and allow optimizing the choice and dosage of anticoagulants. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic number of patients suffering from symptoms, decreased work ability and the deterioration in quality of life for several weeks and even months after the onset of the disease is increasing. The aim of the literature review is to search and study the existing literature data regarding the lung impairment features in COVID-19, as well as the morphological and pathophysiological prerequisites for the long-term respiratory disorders in patients who have had this disease. The most common complaints of patients after acute COVID-19 are fatigue, dyspnea, cough and chest discomfort. In these cases restrictive pattern in the pulmonary function test, a reduced gas transfer and persistent changes in computed tomography often in the form of fibrosis are observed, less often in the form of bullousemphysematous changes, bronchiectasis and pleural effusion. The main pathophysiological mechanisms of acute lung impairment in COVID-19 are direct viral toxicity, impaired function of the immune system, hyperinflammatory response, endotheliopathy, microcirculatory disorders and increased blood clotting with small and large vessels thrombosis, which can lead to pneumonia or acute respiratory distress syndrome. After the acute phase of COVID-19 the pathology of the lung can be caused by an immunogenic and hyperinflammatory response, hypercoagulability and lead to pulmonary fibrosis. The possible mechanisms of the pulmonary fibrosis are thrombotic processes, hemosiderosis, necrotic capillaritis, angiogenesis, hypoxia, cytokine storm. Thus abnormal immune response, hyperinflammation, endothelial dysfunction and excessive coagulation not only cause pneumonia or acute respiratory distress syndrome in acute COVID-19, but also may persist for a long time and contribute to pulmonary fibrosis in some patients. The causes of a longer duration and increased severity of the lung impairment in some people compared to others are the subject of current investigations. [ABSTRACT FROM AUTHOR]

Background. Contemporary methods to create primary arteriovenous fistula (AVF) for permanent vascular access (PVA) in haemodialysis continue to improve. The modified Brescia-Cimino operation is considered the main technique of forming native AVF. Various early PVA complications occur in 6–40 % patients entailing repeated surgical interventions.Materials and methods. The study was conducted at the vascular surgery unit of City Clinical Hospital No. 21 of Ufa. All patients had surgery for distal AVF formation in forearm. Native forearm AVF creation was aided by the hydraulic balloon dilation technique prior to forming anastomosis.Results. The PVA survival was 75.0 (n = 30), the median survival time corresponding to estimated time-to-rehospitalisation in at least 50 % patients (n = 30) was 4.0 ± 0.89 (95 % CI: 2.25–5.75) months. Mean time-to-relapse was 6.05 ± 1.15 (95 % CI: 3.8–8.3) months.Discussion. The results obtained suggest the accessory hydraulic balloon dilation method useful prior to forming anastomosis to provide for the vein mechanical expansion, outflow capacity assessment and prevent venous torsion at preparation steps. Preparing a certain vein length (10 cm) with ligation of putative tributaries is also of importance.Conclusion. The accessory technique of hydraulic balloon dilation of recipient vein in primary native AVF creation allows an intraoperative estimation of the vein state to exclude torsion and perform its mechanical dilation prior to forming anastomosis, which reduces the risk of postoperative thromboses.

The article is devoted to the accumulated Russian and world experience in the treatment of COVID-19 as of April 2021. The main methods of diagnosis and treatment are presented, as well as our conclusion on their relevance. The place of cardiovascular pathology in the spectrum of patients with new coronavirus infection is described. An increase in the number of emergency angiosurgical interventions was demonstrated in view of an increase in the number of arterial thrombosis and non-operated hemodynamically significant stenosis of the internal carotid arteries. The necessity of using a new glomus-sparing carotid endarterectomy (CEE) according to A.N. Kazantsev in the treatment of precerebral atherosclerosis. The main measures for the prevention of COVID-19 mediated complications after CEE are listed: 1) intravenous infusion of heparin at a dosage of 1000 IU per hour using an infusion pump after surgery; 2) acetylsalicylic acid 125 mg; 3) application of double drainage. Conclusions were made on a number of unresolved issues.

Актуальность. В 5–10 % случаев почечно-клеточный рак осложняется формированием опухолевого тромба в нижней полой вене, что требует хирургического вмешательства в объеме нефрэктомии с тромбэктомией, которое является по сути единственным методом лечения данной категории пациентов. Операция сопряжена с техническими трудностями и риском интра- и послеоперационных осложнений. Цель. Ретроспективно проанализировать результаты хирургического лечения пациентов, которым была выполнена нефрэктомия с тромбэктомией из нижней полой вены. Представить случай из клинической практики отделения онкологии и продемонстрировать результаты успешного хирургического лечения почечно-клеточного рака. Методы. Провели ретроспективный анализ 28 историй болезни пациентов, которым была выполнена нефрэктомия с тромбэктомией из нижней полой вены в отделении онкологии НМИЦ им. ак. Е.Н. Мешалкина с 2014 г. Результаты. Проанализировали 28 историй болезни с 2014 по 2022 г., средний возраст пациентов — 59 [48; 83] лет, гистологическая форма — светлоклеточный почечно-клеточный рак (n = 26, 92,8 %), нефробластома (n = 2, 7,2 %). У двух (7,2 %) пациентов развилось осложнение в виде интраоперационного кровотечения, одно стало летальным. В 2022 г. в практику внедрили лапароскопическую методику, выполнили 4 операции. Клинический случай. Пациент С. 57 лет госпитализирован в отделение онкологии НМИЦ им. ак. Е.Н. Мешалкина. По данным мультиспиральной компьютерной томографии, образование правой почки с инвазией в жировую капсулу, тромб почечной вены с пролабированием в нижнюю полую вену до 1 см. Диагноз — злокачественное образование правой почки, опухолевый тромб почечной и нижней полой вен, T3bNхMх. Выполнили нефрэктомию справа с тромбэктомией опухолевого тромба из нижней полой вены. По результатам патогистологического исследования, светлоклеточный почечно-клеточный рак правой почки G2 с инвазией в жировую клетчатку, прорастанием почечной вены, T3bN0M0. Послеоперационный период проходил без осложнений, дренаж удалили на 2-е сутки, пациента выписали на 4-е сутки в удовлетворительном состоянии. Заключение. Хирургическое лечение почечно-клеточного рака, осложненного опухолевым тромбозом, целесообразно проводить в многопрофильных стационарах. Хотя венозная инвазия ухудшает прогноз, радикально выполненная операция дает шанс на увеличение продолжительности жизни. Индивидуальный подход к планированию лечения, а также нестандартная хирургическая тактика с привлечением в бригаду онкоуролога и сердечно-сосудистого хирурга позволяют осуществить полноценное лечение, в том числе с лапароскопическим доступом, избежав потенциально фатальных осложнений.

Copyright of ScienceRise: Medical Science is the property of PC TECHNOLOGY CENTER and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

На сегодняшний день имеется большое количество публикаций о гипергомоцистеинемии (Ггц) и роли повышенных концентраций гомоцистеина (Гц) в патологии. Повышенный уровень Гц в плазме крови является фактором риска развития ряда патологических расстройств. В настоящем обзоре основное внимание уделяется роли Ггц у различных групп населения, особенно в условиях риска (беременность, младенчество, старость), а также его значимости в качестве маркера и этиологического фактора заболеваний в этих возрастных группах. Во время беременности уровни Гц были исследованы в связи с повышенным риском неблагоприятных исходов беременности, таких как малый размер для гестационного возраста при рождении, преэклампсия, повторные аборты, низкий вес при рождении или ограничение внутриутробного роста. В педиатрических популяциях уровни Гц важны не только для сердечно -сосудистых, почечных заболеваний и ожирения. Наиболее интересные данные касаются изучения повышенных уровней Гц при расстройствах аутистического спектра, синдроме дефицита внимания и гиперактивности. Наконец, важное внимание уделяется основным патологиям пожилых людей (сердечно -сосудистые и нейродегенеративные заболевания, остеопороз). На метаболизм Гц влияют витамины группы В, которые и были предложены в качестве методов коррекции для снижения уровня Гц. Однако клинические исследования не пришли к единому мнению об эффективности витаминных добавок в отношении снижения уровня Гц и улучшения патологического состояния, особенно у пожилых пациентов с явными патологиями. Следует подчеркнуть важность новых экспериментальных проектов, ориентированных на индивидуальную изменчивость в патогенезе Ггц.

The article deals with a clinical case description of a female patient with toxic encephalopathy against the background of Ph-negative myeloproliferative diseases. The article discusses symptoms and neuroimaging of hepatic encephalopathy developed as a result of a shunt placed after portal vein thrombosis. The issues of etiology and pathogenesis of hepatic encephalopathy, principles of therapy, as well as the unique clinical picture of nervous system damage in this condition are also discussed. Data on the role of manganese in development of toxic encephalopathy, accumulation of paramagnetic substance in the basal ganglia of the brain and development of extrapyramidal symptoms are presented. The pathogenesis of toxic damage to neurons, increase in their sensitivity to hypoxia, and the relationship with the risk of cerebrovascular disorders and development of chronic cerebral ischemia, contributing to reduction of cognitive functions, are described.

Цель. Оценить эффективность профилактики тромботических событий, ассоциированных с использованием сосудистого доступа, в периоперационном периоде у пациентов, подвергнутых кардиохирургическим вмешательствам. Методы. В исследование включены 433 пациента детского и неонатального возраста, поступившие в отделение интенсивной терапии с января по декабрь 2018 г. Всем пациентам проводилась антитромботическая профилактика в виде системной гепаринизации. Результаты. У 36 пациентов (8,31 %) зарегистрированы тромбозы в послеоперационном периоде. Выявленные признаки тромбоза: у 28 пациентов — венозный тромбоз, у 6 — тромбоз системно-легочного анастомоза, у 2 — артериальный тромбоз. У пациентов с зарегистрированными тромбозами летальность была выше, чем в группе без тромбозов (р = 0,01). Заключение. Режим дозирования у пациентов детского и неонатального возраста должен опираться на возраст-ассоциированные нормативы антитромботических препаратов и требует интегрального подхода в оценке эффективности мер профилактической и терапевтической направленности. Поступила в редакцию 25 августа 2020 г. Исправлена 18 декабря 2020 г. Принята к печати 22 декабря 2020 г. Конфликт интересов Автор заявляет об отсутствии конфликта интересов. Финансирование Исследование не имело спонсорской поддержки.

Актуальность. По данным отечественной и мировой литературы, частота венозных тромбоэмболических осложнений в онкологии составляет в среднем 5–7 %, однако некоторые авторы указывают и большую распространенность, вплоть до 20 %. Венозные тромбоэмболии существенно увеличивают риск летального исхода в процессе лечения злокачественных опухолей. Одной из наиболее тромбоопасных локализаций опухолей является полость таза, в т. ч. и новообразования предстательной железы. Несмотря на достижения в области тромбопрофилактики и лабораторного контроля состояния системы гемостаза, данная проблема по-прежнему сохраняет свою актуальность. Цель исследования. Определить показатели теста тромбодинамики, прогностически значимые для риска развития венозных тромбоэмболических осложнений у пациентов со злокачественным новообразованием предстательной железы, перенесших радикальную простатэктомию. Материалы и методы. В исследование были включены 59 пациентов с диагнозом рака предстательной железы, которым предстояло оперативное лечение в объеме радикальной простатэктомии с лимфаденэктомией или без нее. Всем больным в предоперационном периоде проведен сбор анамнеза, определен риск развития венозных тромбоэмболических осложнений по шкале Caprini, выполнены лабораторные тесты (общий анализ, биохимический анализ крови, коагулограмма, уровень D-димеров), проведено ультразвуковое исследование проходимости вен нижних конечностей, тест тромбодинамики в день поступления. Фармакологическая профилактика тромбозов проводилась согласно клиническим рекомендациям American Society of Clinical Oncology. Применялся надропарин кальция, доза подбиралась с учетом массы тела больных. В послеоперационном периоде в трех контрольных точках выполнены стандартные коагуляционные тесты с определением уровня D-димеров и теста тромбодинамики. Ультразвуковой контроль проходимости вен выполнен на 3-и сутки после операции и перед выпиской пациентов (10–14-е сутки после операции). Результаты. Частота тромбозов в раннем послеоперационном периоде в нашем исследовании составила 5 %. При анализе данных теста тромбодинамики при повышении стационарной скорости роста сгустка перед первым введением после операции или на пике действия надропарина кальция на 3-и сутки после операции выше 43 мкм/мин частота развития тромбозов существенно повышалась. Заключение. Показатель стационарной скорости роста сгустка, превышающий значение 43 мкм/мин, ассоциировался с повышенной частотой развития венозных тромбоэмболических осложнений у данной категории больных.

Порушення в системі гемостазу мають серйозний вплив на перебіг захворювання і наявність ускладнень у пацієнтів із коморбідним перебігом ішемічної хвороби серця (ІХС) та цукрового діабету (ЦД) 2 типу. Мета дослідження – оцінити та проаналізувати показники фібринолізу в різних групах пацієнтів з ішемічною хворобою серця та супутнім цукровим діабетом 2 типу залежно від стадії компенсації останнього. Матеріали і методи. В ході дослідження фібринолітичної системи обстежено 52 хворих, яких госпіталізовано в кардіологічне та ендокринологічне відділення Київської клінічної лікарні на залізничному транспорті № 2 з клінічними ознаками ІХС. Пацієнтів поділили на три групи: перша – 27 осіб із ІХС у поєднанні з ЦД 2 типу в стадії субкомпенсації, друга – 14 хворих у стадії компенсації та третя 11 пацієнтів у стадії декомпенсації. Результати досліджень та їх обговорення. Проаналізувавши дані, ми виявили знижений рівень плазміногену при субкомпенсації на 15,5 % (р

Taking into account the increase in the level of cardiovascular diseases in recent decades, the clinician faces the task of attempting to make the fastest possible diagnosis of the pathology at its earliest stages. That is why the aim of our work was to identify the main groups of biological markers, and to separate the role of each of them in the assessment of the risk of development, progression and possible complications of cardiovascular diseases. We have given the main working classification of markers of cardiovascular processes with the allocation of their main types, as well as the basic criteria for the “ideal” biological marker. Finally, an attempt was made to structure biomarkers depending on their molecular mechanisms of pathogenesis in the development of a particular pathology. All these data should help the clinician at the stage of early diagnosis of cardiovascular disease.

The article presents the results of conservative therapy in patients with acute hemorrhoids over a 7-day follow-up period. A prospective, randomized study was based on the evidence base for the efficacy of the micronized purified flavonoid fraction (MPFF) used for the treatment of patients with hemorrhoidal disease. The use of MPFF in patients with acute hemorrhoids showed a statistically significant reduction of pain intensity, analgesics consumption, and intensity of bleeding.

Objective: evaluate the effectiveness of treatment of retinal vein occlusion with the use of “massage” of retinal veins on the experimental model of photoinduced retinal venous occlusive disease.Materials and methods. Studies were carried out on 30 rabbits of the Chinchilla breed (30 eyes) weighing 1.5–2.0 kg. In the first stage of the experiment, for all animals the photoinduced thrombosis were modeled by laser irradiation of its retinal veins for 0.3–0.4 seconds at a density of 200 J/cm2 and a wavelength of 662 nm after the administration of “Photoditazine” at a dose of 2.5 mg/kg weight. In the second stage of the experiment, the animals were divided into the main group and the comparison group, depending on the method of treatment: 15 animals of the main group with “massage” of the retinal vein in the form of 5–7 movements with a silicone tip of the scanner Tano, 15 animals of the comparison group with epiretinal administration of recombinant prourokinase in a dose 500 international units (IU).Results. The formation of a parietal thrombus in the simulation of photoinduced the central retinal vein occlusion in the experiment leads to a slowing of perfusion in the affected vessel by (8.0 ± 2.5) s (according to fluorescence angiography), an increase in the thickness of the central parts of the retina by (70.2 ± 9.7) μm (according to optical coherence tomography), to the appearance of crimp and uneven lumen of the retina veins, extensive plasma and hemorrhages (according to the data of ophthalmoscopy). On the model of retinal veins thrombosis, a new method of treating retinal vein occlusion was tested, which showed significant efficacy. It has been established that the use of “massage” of the affected retinal vein reduces the time of venous perfusion by 1.3 times and 1.45 times accelerates the resorption of the edema of the central parts of the retina compared to enzymatic thrombolysis.Conclusions. “Massage” of the retinal veins is an effective method of treating retinal vein occlusion and is not accompanied by damage to chorioretinal structures during manipulation.

Гепарин-индуцированная тромбоцитопения, или ГИТ, – это осложнение терапии гепарином, вызванное иммунной реакцией организма. Несмотря на то, что терапия гепарином проводится для того, чтобы предотвратить тромботическое событие, образующиеся в ответ на гепарин антитела вызывают активацию тромбоцитов и последующее высвобождение тромбина, что приводит к противоположному результату: увеличению риска венозного и/или артериального тромбоза. Такой парадоксальный ответ на терапию гепарином, называемый ГИТ, – довольно редкое явление. В то же время количество пациентов, получающих гепарин, огромно, поэтому абсолютное число пациентов с ГИТ, по-видимому, одно из самых больших среди всех случаев побочного воздействия лекарственных средств (не считая тромбоцитопении, вызванной химиотерапией), а среди пациентов с медикаментозными иммунными нарушениями клеток крови оно, несомненно, максимально. Своевременная диагностика и переход на альтернативные антикоагулянты негепариновой природы – ключ к предотвращению новых осложнений ГИТ.

Introduction. The study reviewed the experience of surgical treatment of 145 patients in Samara State Clinical Hospital (SSCH) №1 named after N.I. Pirogov, city of Samara, during the period 2013 - 2016, which had 146 reconstructive operations on carotid arteries during acute period of ischemic stroke. Materials and methods. Indications for urgent intervention were 3 groups of clinicalmorphological criteria (analysis groups): 1. Stenosis of the internal carotid artery (ICA) over 55% of lumen with unstable neurological symptoms; stenosis of ICA more than 70% of lumen with stable neurological symptoms; heterogeneous atherosclerotic plaque with tire defect, according to colour duplex ultrasonography of brachiocephalic artery – in 94 patients, 81 of them have undergone everting carotid endarterectomy (CEAE), 13 of them -CEAE with plasty of the autovenous patch. 2. Pathological tortuosity of ICA on the side of symptom-based brain injury in combination with or without stenosis + unstable neurologic symptoms - in 22 patients, 18 of them have undergone everting CEAE in combination with resection of ICA, 4 patients have undergone resection of ICA and elimination of pathologic tortuosity. 3. Thrombotic occlusion of ICA on the side of the stroke, regardless of stability of neurological symptoms - in 29 patients, 17 of them have undergone resection of ICA with plasty of the external carotid artery, 6 patients have undergone thrombendarterectomy from ICA with plasty with the autovenous patch, 6 patients have undergone everting CEAE for thrombotic occlusion of ICA. Results. By the time of discharge from the hospital the regression of neurological symptoms reported for 124 (85%) patients. Early lethality was 3.4%. Conclusions. Thus, the findings allow considering that under conditions of multispeciality hospital, with strict compliance with the selection criteria, the surgical treatment on the brachiocephalic vessel in the acute period of ischemic stroke, has the right to be regarded as one of the most effective treatments for this disease.

The article presents a comparative analysis of the clinical course of pulmonary embolism and the effectiveness of thrombolytic therapy in patients with thrombophilia and in those without identified thrombolytic disorders. The impact of thrombophilia on the incidence of pulmonary embolism and phlebothrombosis was analyzed. The results obtained indicate the presence of thrombophilia in 25.7% of patients with pulmonary embolism. It was found out that thrombosis and embolism in the vena cava filter occurred more frequently in patients with thrombophilia rather than in those with pulmonary embolism of unknown etiology.

Copyright of Travma is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Vein thrombosis in the lower vena cava system is a frequent pathology and makes up to 90-95% of venous thromboses. The venous system thromboses should be viewed as a potential danger of the pulmonary artery thromboembolia development with grave consequences [1]

Venous thrombosis and pulmonary embolism in healthy military are rare. Fighting surgical trauma is the trigger of a cascade of defense reactions of the body and the blood coagulation system, leading to stop bleeding. Hemostatic disorders, shifting the equilibrium toward hypercoagulable state, the emergence of the risk factors associated with the injury, lead to uncontrolled thrombosis with subsequent development of venous thromboembolic complications. We present the case of the left pulmonary artery thromboembolism in 41 year old wounded with a gunshot fracture of the right femur, obtained by blowing an unknown explosive device. Medical assistance was provided in three stages of evacuation. In order to stabilize a femur fracture the external fixation device was used. According coagulogram thrombinemia persisted for more than 30 days. Prevention of thrombosis carried LMWH (Clexane), with 9 days after injury. 31 day angiography was performed computer, identified thrombus by 70% ceiling clearance left pulmonary artery; by ultrasound scanning of the veins of the lower limbs was diagnosed asymptomatic thrombosis of the right iliofemoral. Against the background of complex treatment for 67 hours after the injury occurred recanalization. This case shows that the injured limb wound clinical symptoms of the disease symptoms negate venous thrombosis, which becomes the only manifestation of pulmonary embolism. Prevention of venous thromboembolic events, as well as monitoring of its effectiveness, should be carried out at all stages of the evacuation of the wounded and for the entire period of the presence of risk factors for their development.

Pregnancy and childbirth in women with genetic or acquired thrombophilia is usually associated with a high risk to both thrombotic and obstetric complications and fruit. Unambiguous answer to the question of routine screening for thrombophilia in women with a history of obstetric history does not exist until now. It should be noted that the physiological hypercoagulable inherent pregnant, often for the first time reveals the background congenital and / or acquired disorders of hemostasis, which previously could be asymptomatic. A history of fetal loss syndrome, severe obstetric complications (severe preeclampsia, severe twin-platsentranoy failure, fetal death, premature detachment of the placenta), thromboembolism is an indication for the study of genetic thrombophilia and antiphospholipid syndrome.

Тромбозы и тромбоэмболии являются одной из частых и грозных проблем, встречающихся практически у всех категорий пациентов как в отделениях интенсивной терапии, так и в стационарных отделениях многопрофильной клиники. Целью исследования явился анализ клинических ситуаций, потребовавших применения концентрата антитромбина (АТ) в рамках практики отделений реанимации и интенсивной терапии многопрофильного стационара. Был проведен ретроспективный анализ историй болезни 38 пациентов с приобретенным дефицитом АТ за 2016 г., которым проводилась заместительная терапия. При проведении анализа клинических ситуаций, потребовавших применения концентрата АТ, было выявлено, что наиболее часто необходимость введения препарата АТ возникает у пациентов со злокачественными заболеваниями крови, тромбозами и у пациентов с сепсисом. При этом расчетные методики определения необходимой дозировки не обеспечивают получения оптимального уровня активности АТ, а конечная эффективность антикоагулянтной терапии не зависит от суммарной дозировки вводимого препарата.

The safety of anticoagulant therapy is discussed. Warfarin position in prevention of thrombotic complications is analyzed according to the evidence base medicine approach. Possible hemorrhagic complications of warfarin are described and accompanied with clinical cases. Possibility of renewal of anticoagulant therapy in patients after hemorrhagic complications is discussed.

The review deals with the laboratory assessment of clopidogrel effect in patients with CHD. The article presents the results of major studies that have demonstrated the relationship between the residual platelet reactivity level and drug pharmacogenetics abnormalities causing coronary complications. It discusses proposals of the international expert organizations on the assessment of sensitivity to clopidogrel and possible modifications of antiplatelet treatment.

Despite large number of known risk factors of venous thromboembolism (VTE) in cancer patients existing prediction models do not allow definite identification of cancer patients that have indications for anticoagulant prevention. Besides, heparin and warfarin use for VTE prevention in cancer is accompanied by some problems. New oral anticoagulants (NOAC) are promising drugs for use in oncology practice; however their use is complicated by the lack of data on efficacy and safety in these patients, potential drug interactions and the possibility of unpredictable changes in effect during chemotherapy. Widespread use of NOAC for the prevention and treatment of tumor-associated VTE prior to phase III trials is not recommended. However, the criteria for selection of patients for whom the study of the efficacy and safety of NOAC is a priority can now be developed.

Copyright of International Journal of Endocrinology / Mìžnarodnij Endokrinologìčnij Žurnal is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Thrombosis significantly affects the overall morbidity and mortality among all ages. Since the clinical picture of thrombosis of the sagittal, transverse, sigmoid sinuses often vague, the diagnosis brings certain difficulties. For this, computed tomography of the brain, phlebography is performed. Approximately, in 1/5 cases of stroke the true cause of occurrence is not established. Conducting molecular genetic typing of hemostasis system factors is one of the ways to solve the problem of etiological pathology. This article presents a clinical case of transverse sinus thrombosis in a postpartum patient with a thrombophilic condition. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Endocrinology / Mìžnarodnij Endokrinologìčnij Žurnal is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Nowadays, only few cases of simultaneous cerebral arterial and venous thrombosis were reported. However, there might be high probability of coexisted cerebral arterial and venous changes. It is worthy to study the reasons and frequency of these coexisted vascular changes contributing to the development of clinical pictures. We analyzed 12 cases of simultaneous cerebral and/or neck vascular changes based on vascular images and ultrasonography which were divided into 4 groups: coexistence of simultaneous arterial and venous thrombosis; venous thrombosis with arterial hypoplasia; arterial thrombosis, arteritis or dissections with venous sinus hypoplasia; coexistence of arterial and venous hypoplasia.

In this work comparative evaluation between the degree of the decrease of visual acuity and the data of morphometric research of the macular area (thickness of the central area of retina and the volume of the macular area) with the patients with macular edema developed against the backdrop of thrombosis of top temple branch of the central vein of retina was made. The data received make it possible to And the tactics of the future treatment and prophylaxis therapy of the patients with post-thrombotic retinopathy.

В рамках XIV Всероссийского научного форума «Мать и дитя» состоялся круглый стол с участием ведущих международных и российских экспертов. Темой для обсуждения стала проблема рациональной гормонотерапии.

Copyright of Medicina Neotloznyh Sostoanij is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

According to literature data, patients with community acquired pneumonia (CAP) fall into several groups of unfavorable prognostic factors. Development of thrombotic complications is one of causes of mortality of hospitalized patients. In this case systemic inflammation, which is always present in moderate and severe CAP, is the starting mechanism of formation of disorders in the hemostasis system. The aim of our work was to determine anamnestic, clinical, laboratory and pathologic anatomical features in patients with CAP, taking into account markers of systemic inflammation and coagulogram indices, as well as predicting the occurrence of complications. In the course of the work, a retrospective analysis of 151 medical histories of hospitalized patients with CAP was made. We analyzed anthropometric indicators, complaints at the time of hospitalization, results of physical examination, results of the chest X-ray, clinical and laboratory indicators, microbiological sputum analysis and to assess the possibility of thrombotic complications a RAM scale was used. It was found that late asking for medical help, the presence of mixed infection, underestimation of the severity of condition and severe systemic inflammation increase the risk of lethal outcome in patients with CAP. Considering a high risk of thrombosis in patients with CAP, it is necessary to assess the risk of thrombotic complications with the help of special scales, as well as timely detection and correction of disorders from the hemostasis system. [ABSTRACT FROM AUTHOR]