Hemodynamic Disorders Research Articles

Age dynamics of strain differences in the morphofunctional state of pancreatic beta- and amylin-producing cells in SHR and Wistar rats

Large-scale epidemiological studies have shown that cardiac pathology and progressive atherosclerosis in patients with diabetes mellitus occurred already at the stage of prediabetes. Obesity and insulin resistance affect cardiometabolic health due to pleiotropic effects of insulin. Despite the vast range of research, some aspects remain hidden links in the overall pathogenesis of metabolic and hemodynamic disorders. The aim of the work was to study the morphofunctional state of pancreatic islets (PIs), beta- and amylin-producing cells in male rats of Wistar strain (normotensive) and SHR (with spontaneous development of hypertension) in age dynamics. Materials and methods. The study was carried out using 38 male Wistar rats and SHRs aged 7 and 24 months. Non-invasive blood pressure (BP) detection procedures were done using the BP-2000 Blood Pressure Analysis System. The morphofunctional state of PIs was examined in serial 5-μm thick pancreatic tissue sections. Beta- and amylin-producing cells were detected after histological preprocessing and the use of monoclonal FITC-conjugated antibodies. Image file processing was done via ImageJ software (National Institutes of Health, USA). Levels of glycemia were monitored with a SUPER GLUCOCARD-II glucometer. Results. SHRs were hyperglycemic both at 7 and at 24 months, 8.41 ± 0.15 mmol/l and 8.90 ± 0.14 mmol/l, respectively, with elevated BP, 155 ± 5 / 80 ± 5 mm Hg and 165 ± 5 / 90 ± 5 mm, respectively. Old SHRs developed PI hypertrophy mainly associated with the increased number and percentage of beta-cells, apparently in response to hyperglycemia. Both in the PIs of adult and old SHRs, the number of amylin-producing cells was lower while the content of amylin was higher than those in the age-matched Wistar rats. Conclusions. Male SHRs are characterized by a persistent increase in blood pressure and abnormalities of carbohydrate metabolism already at adult age, one of the manifestations of which is hyperglycemia worsening with age. Chronic hyperglycemia in SHRs due to the higher insulin requirement finds its expression in low content of this hormone in the islets at adult age and decreased its content in beta-cells in old animals.

Risk factors for sternal wound infection after open-heart operations: A systematic review and meta-analysis.

We aimed to quantitatively and systematically elucidate the rationality of the examined variables as independent risk factors for sternal wound infection. We searched databases to screen studies, ascertained the variables to be analysed, extracted the data and applied meta-analysis to each qualified variable. Odds ratios and mean differences were considered to be the effect sizes for binary and continuous variables, respectively. A random-effects model was used for these procedures. The source of heterogeneity was evaluated using a meta-regression. Publication bias was tested by funnel plot and Egger's test, the significant results of which were then calculated using trim and fill analysis. We used a sensitivity analysis and bubble chart to describe their robustness. After screening all variables in the eligible literature, we excluded 55 because only one or no research found them significant after multivariate analysis, leaving 33 variables for synthesis. Two binary variables (age over 65 years, NYHA class >2) and a continuous variable (preoperative stay) were not significant after the meta-analysis. The most robust independent risk factors in our study were diabetes mellitus, obesity, use of bilateral internal thoracic arteries, chronic obstructive pulmonary disease, prolonged surgery time, prolonged ventilation and critical preoperative state, followed by congestive heart failure, atrial fibrillation, renal insufficiency, stroke, peripheral vascular disease and use of an intra-aortic balloon pump. Relatively low-risk factors were emergent/urgent surgery, smoking, myocardial infarction, combined surgery and coronary artery bypass grafting. Sternal wound infection after open-heart surgery is a multifactorial disease. The detected risk factors significantly affected the wound healing process, but some were different in strength. Anything that affects wound healing and antibacterial ability, such as lack of oxygen, local haemodynamic disorders, malnutrition condition and compromised immune system will increase the risk, and this reminds us of comprehensive treatment during the perioperative period.

Clinical findings in patients with vertebrobasilar insufficiency

The vertebrabasilar (VB) system plays an essential role in the circulation of main structures of nervous system. As a part of Circle of Willis, it is responsible for major compensatory abilities of brain circulation in some hemodynamic disorders. On the other hand, some pathological diseases, involving VB system, could be fatal or could lead to severe injuries and functional wastes in the patient. Many variations and anomalies in VB system are common cause of hemodynamic disorders and vascular disease such as atherosclerosis. The good knowledge of variations and anatomy as well, allows us to understand pathophysiology and pathogenesis in those disorders, which in combination with specific clinical symptoms, helps us in making the fast and accurate diagnosis. This is fundamental for starting proper treatment.

Peculiarities of Arteriovenous Prosthesis Functioning in Patients on Hemodialysis

Long-term and proper functioning of vascular access is necessary for renal replacement therapy in patients with chronic kidney disease (CKD). If it is impossible to form an arteriovenous fistula due to a pathologically changed structure of the vascular wall of peripheral arteries and veins, an arteriovenous prosthesis of various locations is implanted to form a permanent vascular access. However, the problem of long-term use of arteriovenous prostheses remains relevant, in particular, due to the prevalence of hemodynamic disorders, such as thrombosis, stenoses, and pseudoaneurysms.
 The aim of the study was a retrospective analysis of hemodynamic disorders and peculiarities of the use of arteriovenous prostheses as permanent vascular access in patients undergoing hemodialysis therapy.
 There were analyzed 586 medical records of inpatients and 103 discharge epicrisis of outpatients of the intensive nephrology department. Out of the 467 primary permanent vascular accesses formed for renal replacement therapy, 391 (83.72%) ones – were native arteriovenous fistulas (AVF) and 76 (16.27%) – were arteriovenous prostheses (AVP).
 It was found that the increase in the frequency of initial uncorrected and corrected primary loss of vascular access for AVF is the greatest during the first year of use and amounts to 35.53% and 26.32% of cases, respectively. Instead, the greatest increase in secondary loss of patency is observed during the first six months of using prostheses, which corresponds to 10.53% of patients. It is worth paying attention to the problem of concomitant pathology, in particular diabetes mellitus, arterial hypertension, calcification disease, which directly affect the state of the vascular wall and the functioning effectiveness of the vascular access. The obtained results indicate the necessity to review and supplement the existing methods of prevention of hemodynamic disorders of AVF during the first 6-12 months of their use in order to improve the quality of patients’ lives.

Comparative assessment of echocardiographic parameters in persons without diagnosed chronic non-communicable diseases depending on body mass index

Aim: To compare the indicators of structural remodeling and intracardiac hemodynamics in people without previously diagnosed chronic non-communicable diseases, depending on body mass index (BMI).Material and Methods. We analyzed the data of 123 people aged 21 to 59 years who did not have chronic non-infectious diseases and did not take any drug therapy that affects the indicators of central and peripheral hemodynamics, as well as lipid, carbohydrate and fat metabolism. All the examined persons were divided depending on the BMI into 2 groups, comparable in sex, but with age differences. The first group consisted of 60 people (75% women) with a BMI < 30 kg/m2, whose median age was 40 years (Q1–Q3: 35–48 years). The second group included 63 subjects (76.1% women) with BMI ≥ 30 kg/m2 at the age of 48.5 years (Q1–Q3: 38–54 years). Structural and functional parameters of the heart were assessed during transthoracic echocardiography, which was performed on the Philips EPIQ CVx 2D ultrasound machine by one specialist.Results. In the group of persons with increased BMI, the average values of the left ventricular relative wall thickness (RWT LV) were higher – 0.37 [0.34; 0.40] versus 0.41 [0.37; 0.47], p = 0.01; left ventricular mass index (LVMI) – 64.0 [53.0; 76.5] g/m2 and 27.0 [23.1; 30.9] g/m2,7 vs. 82.0 [70.0; 92.0] g/m2 and 38.1 [34.5; 46.5] g/m2,7, p = 0.01; epicardial fat (EF) – 5 [4; 6] mm vs. 8 [5; 10] mm, p = 0.01, left ventricular global longitudinal strain (LV GLS) –21.8 [–23.6…–19.7]% vs. –19.2 [–21.2…–18.2] %, p = 0.01. Statistically direct correlations of BMI with LVMI g/m2,7 (ρ = 0.746; p = 0.01), EF (ρ = 0.563; p = 0.01), LV GLS (ρ = 0.418; p = 0 .01), RWT (ρ = 0.438; p = 0.01). With an increase in BMI by 1 kg/m2, one should expect an increase in the thickness of EF by 0.172 mm, longitudinal deformation of the LV by 0.151%, RWT by 0.003, LVMI, g/m2 by 1.200, LVMI g/m2,7 by 1.116.Conclusion. The increase in BMI is associated with changes in structural remodeling and systolic function of the LV. In individuals with increased BMI, to determine structural remodeling and changes in the geometry of the heart chambers, it is necessary to use growth indexing, to determine indicators of GLS LV, to determine the thickness of EF in order to detect intracardiac hemodynamic disorders in the early stages and timely prevention of complications.

СОСТОЯНИЕ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ У НОВОРОЖДЕННЫХ, РОЖДЕННЫХ ОТ МАТЕРЕЙ, ПЕРЕНЕСШИХ ВО ВРЕМЯ БЕРЕМЕННОСТИ НОВУЮ КОРОНАВИРУСНУЮ ИНФЕКЦИЮ

Cardiac manifestations in the acute phase and complications of COVID-19 in children, especially newborns, have not been sufficiently studied as yet. The purpose of this research was to determine the nature of damage to the cardiovascular system (CVS) in newborns from mothers who had a new coronavirus infection at different stages of pregnancy and who were infected after birth. Materials and methods used: a single-center observational comparative study with elements of retrospective analysis. The 3 groups of full-term newborns of 37 each were formed as follows: the main group 1 (A) of newborns from mothers who had a laboratory-confirmed new coronavirus infection in the 1st to 2nd trimesters of pregnancy; the comparison group 2 (B) of newborns with a laboratory-confirmed new coronavirus infection from mothers who had COVID-19 in the peripartum period; and the control group 3 (C) of practically healthy newborns. The frequency of various types of CVS lesions (myocarditis, rhythm and conduction disorders, perinatal CVS lesions) as well as the frequency of occurrence of signs of electrophysiological myocardial instability, hemodynamic disorders and increased levels of cardiac-specific enzymes were assessed. Results: newborns from mothers who suffered a new coronavirus infection during pregnancy are more likely than newborns from physiologically healthy pregnancy and childbirth to develop cardiac problems (heart failure (p=0.025), cardiac arrhythmias (p<0.001), specified congenital anomalies of the cardiac septum (p1-3<0.001), other specified congenital heart anomalies (p1-3=0.032) and other cardiovascular disorders that arose in the perinatal period (p<0.001)), in particular, maladaptive disorders of the cardiovascular system with signs of electrical instability of the myocardium, dilation of the heart cavities and increased levels of cardiac-specific enzymes, which required the exclusion of myocarditis. Conclusion: the identified changes in the cardiovascular system dictate the need for monitoring of newborns from mothers with COVID-19 with dynamic CVS assessment.

Obesity as a risk factor for chronic kidney disease: a contemporary view on the problem. Review

The review article is devoted to an actual clinical problem of participation of obesity in development and progression of chronic kidney disease (CKD). Some pathogenic links due to which a negative renal effect of obesity is mediated including in particular, dyslipidemia (DLP), endothelial dysfunction (ED) of renal vessels, activation of renin‑angiotensin‑aldosterone system (RAAS), arterial hypertension (AH), a production of adipose tissue mediators with renal injuring properties such as leptin, tumor necrosis factor‑α, interleukines 1,6,8 are discussed. The data about the main factors of progression of renal damage associated with obesity included insulin resistance (IR), hyperinsulinemia, DLP, systemic and renal hemodynamic disorders caused by activation of RAAS (AH, intraglomerular hypertension) are given. The role of metabolic syndrome and its components in pathogenesis of CKD as well as a role of diabetes mellitus (DM) frequently combined with obesity in development of diabetic kidney disease (diabetic nephropathy) is generalized. Among adipokines a special attention in the present review is paid for pathogenic role of leptin and adiponektin in obesity with its conditions promoted renal damage. The participation of resistance to leptin in the pathogenesis of CKD through such links as IR, ED, oxidative stress and inflammation is discussed. The role of ED and glomerular hyperfiltration in pathogenesis of microalbuminuria is elucidated. The significance of injury of kidney tubular cell structures so called podocytes in pathogenesis of CKD in obesity is uncovered. The clinical significance of early revealing of renal pathology as well as body weight, glycemia level, arterial blood pressure control and following of healthy mode of life in reduction of risk development of CKD associated with obesity, DM and other metabolic disorders is generalized. It’s emphasized that evaluation of lipid and carbohydrate exchange parameters, serum leptin level, IR indices is considered to be perspective for diagnostics of renal damage in obesity.

Left ventricular diastolic dysfunction and transmitral blood flow parameters in patients after COVID-19

Background. People who previously had COVID-19 infection have an increased risk of developing cardiovascular diseases. Left ventricular diastolic dysfunction is an early marker of the development of cardiac pathology. Its early detection is important for the adequate therapy order and dynamic monitoring of patients. In this regard, it seems relevant to study the effect of a recent COVID-19 infection on the left ventricular diastolic function and transmitral blood flow parameters in apparently healthy individuals without clinical and instrumental signs of cardiovascular pathology. The aim of the study. To assess the changes in the diastolic and systolic function of the left ventricle, its anatomical parameters and transmitral blood flow parameters in two groups of apparently healthy individuals: those who had and those who had not COVID-19 infection. Materials and methods. Transthoracic echocardiography was performed according to the standard technique and its results were analyzed in 66 examined patients who were recognized as apparently healthy according to the results of regular comprehensive clinical and instrumental studies. The first group included 30 individuals who underwent an echocardiographic study before or during the COVID-19 pandemic, but did not have a coronavirus infection; the second group consisted of 36 people who recovered from COVID-19. The indicators of the presence of left ventricular diastolic dysfunction and the transmitral blood flow parameters were assessed. The study was approved at a meeting of the Medical Ethics Committee under the Ministry of Health of the Republic of Karelia and of Petrozavodsk State University (Minutes No. 47 of 01.11.2023). Results. The frequency of the left ventricular diastolic dysfunction did not differ in the first and second groups of patients. Statistically significant differences were recorded in the average flow deceleration time for both early and late filling of the left ventricle in people who had and did not have COVID-19 infection. A change in the phase structure of the transmitral blood flow may be an early manifestation of intracardiac hemodynamic disorders in people who have recovered from COVID-19.

Pathophysiological Changes in Diabetic Vitreous and Retina

The development and progression of Diabetic Retinopathy is the result of a series of biochemical and hemodynamic disorders that cause structural changes in the retina and surrounding tissues. Although the mechanisms underlying these disorders have been studied for a long time, they have not been fully explained. To understand these mechanisms, elucidation of the molecular microenvironment in the vitreous will be instructive. Cytokines triggered by hyperglycemia and hypoxia cause structural changes in vascular, retinal and neuronal structures by biochemical mechanisms. They contribute to inflammatory processes. In this review, we tried to explain the structural and molecular changes in the vitreous and retina in the light of current literature.

The Effect Of Snakebite On Hemodynamic Disorders Of The Heart In Adults And Pregnant Women

A snake bite is a natural defense response from a snake and can be an emergency medical situation. Snakes have a venom consisting of various proteins that can affect the functioning of the human body. The venom structure in snake venom varies between different species of snakes. Knowing the effect of snakebite on hemodynamic disorders of the heart in adults and pregnant women. This study is a Systematic Review that applies the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method, which is a systematic approach that follows appropriate research steps and protocols. The result of this study is the association of Snakebite with Hemodynamic Disorders of the Heart in Adult Patients and Pregnant Women" showing a major focus on heart disorders, infections, muscle and bone necrosis due to poisonous snake bites in developing countries, especially in children. Snake bites can cause immediate cardiovascular effects such as anaphylactic reactions, electrolyte disturbances, to cardiogenic shock and cardiac arrest in severe cases. Effective treatment for osteomyelitis and cardiogenic shock due to snakebites involves extensive surgical debridement and antibiotic therapy tailored to culture results. The duration of therapy varies based on the type of infection, with longer treatments for chronic infections. Adequate debridement is key to successful treatment, and a variety of surgical methods can be used, including open surgery, arthroscopy, or puncture/aspiration and flushing

Функціональний стан фетоплацентарного комплексу у вагітних із HCV-інфекцією

Purpose - to study the functional state of the fetoplacental complex (FPC) during pregnancy in women with hepatitis C virus (HCV infection). Materials and methods. A prospective clinical and statistical analysis of the functional state of the FP during pregnancy in 40 women (main group, MG) with HCV infection was conducted on the basis of the Kyiv City Center of Reproductive and Perinatal Medicine for the period 2020-2021. The control group (CG) consisted of 50 healthy pregnant women. Statistical processing of research results was carried out using standard programs Microsoft Excel 5.0 and Statistica 8.0. Results. The hormonal status of FPK in MG of pregnant women, starting from the 18th week, was characterised by a significant decrease in the secretion of progesterone (PG) (159.314.6 nmol/l in MG versus 205.44.8 nmol/l in CG; p<0.05) and human chorionic gonadotropin (39.24.6 mIU/mL versus 52.85.3 mIU/mL, respectively). Estradiol (E2) levels in MG of pregnant women from the 18th week of pregnancy were significantly lower (26.32.7 nmol/l) than in CG of pregnant women (33.71.4 nmol/l, p<0.05). A synchronous decrease in the level of PG and E2 was observed in the case of threatened abortion against the background of bloody discharge, which indicated clinical manifestations of placental dysfunction (PD). In MG of pregnant women, the level of placental lactogen (PL) at week 18 was almost the same (80.913.2 nmol/l) compared to CG of pregnant women (79.57.1 nmol/l; p>0.05). From the 29th week, the level of E2 in MG of pregnant women is significantly different from CG (25.61.3 nmol/l in MG versus 51.20.7 nmol/l in CG; p<0.05). The most pronounced difference was the level of estriol (E3) and cortisol (Cr) in blood serum relative to CG in MG of pregnant women, which was manifested by a decrease in the level of E3 (up to 86.4±5.2 nmol/l in MG versus 98.42.6 nmol/l in CG; p<0.05) against the background of a simultaneous increase in Cr content (up to 751.118.6 nmol/l in MG versus 625.618.4 nmol/l in CG; p<0.05). Endocrinological disorders also changed before delivery (39-40 weeks): the E2 level decreased (to 45.41.9 nmol/l in MG versus 65.30.6 nmol/l in CG; p<0.05), E3 (up to 28.32.0 nmol/l versus 57.81.8 nmol/l, respectively; p<0.01), PG (up to 499.4±11.6 nmol/l versus 604,216.3 nmol/l, respectively; p<0.05) and PL (up to 201.4±12.4 nmol/l versus 63.418.8 nmol/l, respectively; p<0.05) and the Cr content increased (up to 812.4±16.7 nmol/l versus 651.614.6 nmol/l, respectively; p<0.01). Conclusions. The functional state of the FPC in pregnant women with HCV infection, on the eve of delivery, is characterized by a high level of premature maturation of the placenta, changes in the volume of amniotic fluid, due to which significant hemodynamic and endocrinological subcompensated disorders appear, but in some cases they are decompensated, which causes disorders from the functional state of the fetus and the high frequency of development of fetal growth retardation syndrome in this group of women. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Newborn asphyxia: features of the course of pregnancy and delivery and the structure of the placenta

BACKGROUND: The main cause of early neonatal death is neonatal asphyxia. Asphyxia transferred during childbirth can lead to damage of the brain, respiratory disorders, hemodynamic disorders, and impaired renal function.
 AIM: The aim of the study is to determine the factors predisposing to the birth of a child in a state of asphyxia.
 MATERIALS AND METHODS: A retrospective study was conducted, which included the analysis of medical records of 11,662 women who gave birth at the Perinatal Center of the Saint Petersburg State Pediatric Medical University (level IIIB obstetric institution), whose pregnancy ended in urgent delivery. The main group included patients who gave birth to full-term babies in a state of moderate and severe asphyxia (n = 70), the control group included patients who gave birth to children without asphyxia (n = 11,592).
 RESULTS: Factors predisposing to the birth of a full-term baby in a state of moderate and severe asphyxia were identified, which can be used to develop a system for predicting the birth of a child in a state of asphyxia and a set of preventive measures.
 CONCLUSIONS: More frequent ascending infection of stage II and III makes it necessary to timely identify and treat a bacterial infection in all full-term pregnant women. A prognostic model for the birth of a full-term baby in a state of asphyxia has been constructed. Women at risk should undergo an additional examination at 37 weeks of pregnancy: sowing from the cervical canal for flora and sensitivity to antibacterial drugs to identify pathogenic and opportunistic microflora, childbirth should be carried out under mandatory constant monitoring control.

Experimental and morphological justification of the prevention of wound complications during fixation of the mesh to the abdominal wall tissues with composite

The aim of the study is to justify the prevention of wound complications during fixation of the mesh to abdominal wall tissues with cross-linked polyurethane (CP) composite in experimental animals. Маterials and methods. An experimental study was conducted on 60 male laboratory rats, which were divided into 3 groups. In group I (n = 21), the mesh and wound edges were fixed with CP composite with an antiseptic, in group II (n = 24) – with ligatures, in group III (n = 15) muscle incision was performed and the wound was sutured with ligatures. The animals were observed for 30 days, wound healing and the presence of complications were evaluated. Morphological examination was performed on days 7 and 30. Signs of mesh germination by connective tissue and presence of tissue inflammation around the mesh were evaluated. Results. The observation results showed that in group I, the incidence of complications and the duration of wound healing were lower comparing to groups II and III. In group I, seroma was detected in 1 (5.3 %) animal, in group II – in 7 (33.3 %), in group III – in 3 (23.1 %), infection of the wound in 1 (5.3 %) animal of group I, in 4 (19.1 %) of group II and in 2 (15.4 %) of group III. The term of wound healing in group I was 7 (6; 8) days, in group II – 13 (12; 14), in group III –11 (10; 12) days (p < 0.05). The results of observation were confirmed morphologically, namely, in animals of group I, faster process of mesh germination with collagen fibers and wound healing were revealed, which was confirmed by the predominance of a fibrous component over the cellular one (р < 0.05), and the formation of a connective tissue capsule around the CP with the germination of collagen fibers deep into the capsule. Conclusions. The use of the cross-linked polyurethane composite with an antiseptic to fix the mesh implant to abdominal wall tissues in laboratory animals confirms its higher efficiency compared to traditional ligature fixation, by increasing the fibrous component of connective tissue and reducing the cellular component and hemodynamic disorders in dynamics, by the germination of collagen fibers deep into the capsule in the areas of mesh fixation, reduced occurrence of seroma and duration of wound healing, which justifies its use in clinical practice for prevention of wound complications in allogernioplasty.

Pelvic veins ultrasound changes after surgical correction in patients with pelvic congestion syndrome

Pelvic congestion syndrome is a form of varicose disease, which is considered to be one of the main causes of chronic pelvic pain in women, which is associated with a violation of pelvic veins hemodynamics. Pelvic venous disorders are invisible to clinicians due to the lack of pathognomonic symptoms and manual disease criteria, but it has significant consequences. Today, one of the main diagnostic methods of pelvic venous disorders is a transvaginal US of pelvic veins, including gonadal veins (ovarian veins in women). Thanks to this non-invasive and simple diagnostic method that does not require specific preparation and has no contraindications, we have significant opportunities in diagnosis, as well as in the further evaluation of the postoperative results of surgical correction of pelvic congestion syndrome. The aim of the study was to analyze changes of pelvic veins in patients with pelvic congestion syndrome before and after surgical intervention using the transvaginal US method. Materials and methods. The study included 35 patients which underwent surgical treatment using open surgery and endovascular procedure between April 2019 and February 2022 with pelvic congestion syndrome. All patients underwent transvaginal ultrasound of the pelvic veins before surgery. A control examination was performed after surgical treatment in 4–6 months. The examination was performed on an expert-class ultrasound system “Toshiba Aplio 500” using all international standards for transvaginal examination of pelvic veins to evaluate the changes of illiac, paraovarian, parametrial and ovarian veins from the left side and from the right side in patients with pelvic venous disorders. Conclusions. Transvaginal ultrasound of the pelvic veins can be considered one of the key diagnostic methods, with the help of which it is possible to investigate and evaluate hemodynamic disorders in the veins of the pelvis and pelvic organs in real time. Also, this method can be considered optimal for the control examination of patients who underwent surgical correction of pelvic congestion syndrome.

178 Damage Control Surgery in Severe Ballistic Trauma

Abstract Introduction Severe ballistic lesions are the cause of hemodynamic disorders and early coagulopathy causing a high mortality rate, their management needs to be adapted to each situation. Materials & Methods This retrospective study aims to evaluate the feasibility and outcomes of abbreviated laparotomy and early re-exploration. It includes patients suffering from severe ballistic injuries who had to undergo a Damage Control Surgery (DCS) due to a high severity trauma score. Moreover, morbidity and mortality rates were analysed. Results The sample included 73 male patients with an average age of 31years. Most patients suffered from haemorrhagic shock 74%, respiratory distress 40%, and peritoneal contamination 63%. The severity score was 64. After (DCS), the re-exploration was impossible in certain cases. The mortality rate was 28, 8%. Conclusion Abbreviated laparotomy and DCS are effective practices for stabilizing victims of gunshot and maintaining the function and integrity of the organism.

A comparative assessment of open and laparoscopic techniques in managing congenital diaphragmatic hernias in newborns

Introduction. The authors share their experience in managing congenital diaphragmatic hernias (CDH) in newborns with open and thoracoscopic techniques.Material and methods. From 2012 to 2022, 46 newborns with CDH were admitted to Kuraev Children’s Republican Clinical Hospital in Makhachkala (Russia). 5 children died before surgery, they were excluded from the study. In order to compare outcomes after treatment, all children operated on by the authors were divided into two groups depending on the technique of surgical CDH correction. Newborns from Group 1 (n = 23; 56%) were operated with open access. Newborns from Group 2 (n = 18; 44%) were operated with thoracoscopic access.Results. A comparative evaluation of outcomes after thoracoscopic and open techniques for correcting CDH was made. By the literature, the overall survival rate of children with CDH has increased from 50–60% to 80–90%. The author consider, that it is largely due to the application of extracorporeal membrane oxygenation (ECMO) and nitric oxide to compensate pulmonary hypertension which is the main factor decreasing the postoperative mortality. In this case, physicians prescribed Sildenafil; the survival rate in Group 1 was 48% and in Group 2 – 67%. The authors noted that the mortality rate depended on the size of diaphragm dome defect, on the number of abdominal organs in the pleural cavity. Besides, the place where a child was operated on – in the resuscitation department or not – was also an important factor.Conclusion. Thoracoscopy is a preferred approach for managing CDH because it does not need dissection of a large array of muscles; otherwise, later, in the postoperative period, it can impair the respiratory function. Early postoperative mortality in newborns is caused by hemodynamic disorders, so it is recommended to perform surgical interventions in this group of patients in the resuscitation department. To prevent hemodynamic disorders, it is recommended to install a pleural drainage intraoperatively in all patients with CDH. The authors underline that in their study postoperative course, rate of intraoperative and postoperative complications, as well as mortality rate did not have any statistically significant differences in the compared groups (p0.05). Despite a marked progress in CDH management, large diaphragm defects still is an unsolved problem.

DIFFICULTIES IN THE DIAGNOSIS OF COARCTATION OF THE AORTA IN THE NEWBORN IN THE EARLY NEONATAL PERIOD: ANALYSIS OF CLINICAL CASES

Introduction. The problem of diagnosing coarctation of the aorta in the early neonatal period is still relevant and presents certain difficulties due to the peculiarities of hemodynamic adaptation to extrauterine life.The aim of the study is to evaluate own clinical observations with emphasis on the difficulty in diagnosing coarctation of the aorta in neonates in the early neonatal period and to perform differential diagnosis with coarctation (pseudocoarctation) of the aorta.The study was carried out according to the ethical norms and principles for conducting medical researches involving human subjects.The research was conducted within the framework of the National Development Program of the Department "Quality of life and course of somatic diseases in children under conditions of social stress", implementation period 2023-2025, state registration number: 0123U101768.Results. The article presents two clinical observations: the first case is a newborn with coarctation of the aorta in a non-emergent state during the first days of life in the presence of evictive morphological changes of the descending aorta; the second case is a newborn with clinical signs of hemodynamic disorders with diagnosed hemodynamic pseudocoarctation (kinking) at the stage of hemodynamic adaptation to extrauterine life. Adequate medical support helps to avoid the development of a serious, potentially dynamic hemodynamic situation.Conclusions. Diagnosis of critical coarctation of the aorta in newborns has certain difficulties associated with the peculiarities of hemodynamics in the early neonatal period and the functioning of fetal communication. In order to avoid mistakes in the diagnosis of the emergency of the defect and to perform timely surgical intervention, dynamic monitoring of blood pressure and saturation indicators of the upper and lower extremities, central hemodynamic parameters is necessary. Differential diagnosis of coarctation of the aorta with kinking (pseudocoarctation) of the aorta should be based on the results of dynamic monitoring of pressure gradient in the descending part of the aorta with control of blood pressure and saturation in the four limbs during the neonatal period.

Clinical and laboratory signs of multiple organ dysfunction in newborns with intraamniotic infection: prospective observational study

INTRODUCTION: Assessment of the severity of the condition of newborns with intra-amniotic infection is extremely important for neonatal intensive care. OBJECTIVE: To study signs of multi-organ dysfunction in newborns with intra-amniotic infection. MATERIALS AND METHODS: 165 newborns who are being treated in the NICU were examined. The weight of the children was 1870 (1480–2550) g, the Apgar score at the first minute was 7 (6–7), at the fifth — 8 (7–8) points. Depending on the gestation period, the children were divided into 4 groups: I — 26–29, II — 30–33, III — 34–37 and IV — 38–40 weeks. In groups I–III, children with respiratory distress syndrome and intraamniotic infection prevailed, and in groups IV — with asphyxia. RESULTS: The maximum score on the NEOMOD scale of the ball is typical for children of groups I and IV: 4 (3–5) and 3 (1–4) points, respectively. The number of leukocytes in group IV newborns on the first day of treatment was statistically significantly higher than in groups II and III: 19.6 (8.5–43.7) vs 12.4 (5.8–33.1) and 12.5 (6.4–32.5), respectively (p = 0.003). Вase excess indicators in group I were statistically significantly lower than in group IV: −7.2 vs −4.2 (p < 0.001). The minimum concentration of C-reactive protein was typical for group I children — 1.7 (1.3–2.2) mg/l, which was significant compared to the indicators of other groups (p < 0.001). CONCLUSIONS: The most pronounced multiple organ dysfunction was observed in newborns with a gestation period of 26–29 and 38–40 weeks, which is confirmed by high scores on the NEOMOD scale, an increase in the number of leukocytes and neutrophil index indicators. Hemodynamic disorders in newborns with a gestation period of 26–29 weeks are the main factor determining the severity of the child's condition and the NEOMOD score.

Percutaneous left ventricular assist device as a short-term mechanical circulatory support before heart transplantation in patients with high pre-transplant pulmonary hypertension (series of clinical cases)

Federation In certain categories of patients with end-stage heart failure (HF), short-term mechanical circulatory support (MSC) is successfully used as a mechanical «bridge» to heart transplantation (HTx). In predominantly left-ventricular (LV) dysfunction, the use of isolated coronary artery bypass, especially amidst high pulmonary hypertension (PH), seems to be a more physiological method of short-term MSC.Objective: to present the results of a series of clinical cases of the use of percutaneous left ventricular assist device (pLVAD) before HTx in potential recipients with predominantly LV dysfunction and concomitant high PH.Materials and methods. Three potential heart recipients with predominantly left-sided HF and high pre-transplant PH (pulmonary vascular resistance, PVR, 4.7–6.6 Wood units) who required MSC due to progression of hemodynamic disorders were included in the study. A standard venous extracorporeal membrane oxygenation (ECMO) cannula (26 F) was used for percutaneous left atrial-femoral artery (LA–FA) bypass. The cannula was passed from the transfemoral route through the interatrial septum into the left atrial cavity. A paracorporeal centrifugal pump provided blood injection through a standard arterial ECMO cannula (15 F).Results. pLVAD unloaded the left ventricle effectively (PCWP reduced from 27–32 to 15–20 mmHg), reduced pre-transplant PH (mean pulmonary artery pressure (mPAP) reduced from 45–53 to 28–33 mmHg) and improved systemic hemodynamics (cardiac index (CI) increased from 1.8–1.9 to 2.1–2.6 l/min/m2 and mean arterial pressure (mAP) from 56–59 to 70–75 mmHg). All these created the prerequisites for subsequent successful HTx. Against the background of pLVAD, transpulmonary pressure gradient (TPG) decreased from 15–25 to 13–15 mmHg, and PVR decreased from 4.7–6.6 to 2.7–3.4 Wood units. pLVAD flow rate was 2.9–3.8 L/min or 1.38–1.83 L/min/m2 at 4700–7100 rpm. pLVAD duration ranged from 4 (n = 1) to 7 (n = 2) days. All patients underwent successful HTx.Conclusion. pLVAD is a highly effective method of short-term MSC in potential recipients with predominantly LV dysfunction and concomitant high PH, leading to rapid regression of the dysfunction against the background of left ventricular unloading. This short-term MSC technique can be successfully realized using standard ECMO cannulas and centrifugal pumps of any modification, without requiring additional special equipment.

Changes in cardiac hemodynamic parameters in patients after COVID-19

Aim. To study cardiac hemodynamic disorders in patients 3, 6 and 12 months after coronavirus disease 2019 (COVID-19).Material and methods. Sixty-six patients with bilateral pneumonia (mean age, 36,1 years), treated for COVID-19, underwent echocardiography, Doppler ultrasound of hepatolienal blood flow vessels after 3, 6, 12 months. Patients were divided into groups based on computed tomography (CT) data: group 1 — 21 patients with CT1, group 2 — 25 patients with CT2, group 3 — 20 patients with CT 3-4. In the 3rd group, 60% of patients had excessive weight. IBM SPSS Statistics Version 25.0 was used.Results. Three months after the disease in all groups, there was a impairment of diastolic parameters studied on the tricuspid valve. Patients of the 3rd group had pulmonary hypertension, an increase in splenic vein diameter, and the spleen area. After 6 and 12 months. in all groups, there was an improvement in right ventricular diastolic filling. In group 3, pulmonary artery systolic pressure after 6 months decreased by 6,0 (3,7; 6,5)% (p=0,03), after 1 year by another 8,6 (5,4; 9,1)% (p=0,017). The diameter of the inferior vena cava after 6 months decreased by 4,8 (2,0; 10,2)%, and a year later by another 5,0 (4,4; 6,1)% (p=0,001); the splenic vein diameter decreased after 6 months by 7,3 (3,2; 10,4)% (p=0,005). The left ventricular (LV) global systolic strain reduced after 3, 6 and 12 months.Conclusion. All patients 3 months after COVID-19 had cardiac hemodynamic disorders, which further by 6 and 12 months tend to normalize right ventricular diastolic filling. In patients with CT 3-4, by 12 months after the disease, normalization of pulmonary artery systolic pressure was also noted, a decrease in the diameter of the inferior vena cava and splenic veins, and a decrease in the global LV systolic strain persisted.