Saratov Medical Journal

Comparative assessment of circulatory autonomic regulation in the patients with coronary artery bypass graft or valvular heart disease correction

Anton R. Kiselev, Kristina A. Wulf, Vladimir A. Shvartz, Anatoly S. Karavaev, Ekaterina I. Borovkova, Olga L. Bokeria

Статья научная

The objective of our study was to investigate the features of circulatory autonomic regulation in the patients with a coronary artery bypass graft surgery (CABG) or correction of a valvular heart disease (CVHD). Material and Methods. Our study enrolled 42 patients (including 12 women) aged 63 (57; 67), who underwent CABG; and 36 patients (including 16 women) aged 58 (47; 65), who underwent CVHD. Simultaneous 15-minute recordings of electrocardiograms and photoplethysmograms (PPG) were performed on all patients before and after the surgery. We assessed and analyzed statistical and frequency-related measures of heart rate variability (HRV) and index of synchronization (S) among low-frequency (LF) oscillations in HRV and PPG. Results. The values of most autonomic regulation indices in our study did not have statistically significant differences among the patients with CABG and CVHD at all stages of research. The exception was represented by the heart rate, which was higher before CVHD (p=0.013). Conclusion. In all patients with CABG, the values of HRV and S did not depend on the differences in their clinical statuses or performed cardiac surgical interventions.

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Evaluating biocompatibility of vaterite-mineralized polycaprolactone matrices in subcutaneous implantation tests on white rats

Aleksei N. Ivanov, Mariya O. Kurtukova, Maksim N. Kozadayev, Dariya A. Tyapkina, Sergei V. Kustodov, Mariya S. Savelieva, Irina O. Bugaeva, Bogdan V. Parakhonsky, Elena A. Galashina, Ekaterina V. Gladkova, Igor A. Norkin

Статья научная

Objective: to estimate biocompatibility of matrices manufactured from polycaprolactone (PCL) and mineralized by vaterite (CaCO3) via studying local and systemic manifestations of inflammatory reaction in subcutaneous implantation tests on white rats. Material and Methods. The experiment was conducted on 40 rats divided into four groups of equal sizes: control, comparison (rats with imitation of implantation), negative control (rats with implanted non-biocompatible matrices) and experimental group, comprised of animals with implanted PCL/CaCO3-matrices. Local inflammatory manifestations were analyzed by morphological investigation of implantation area tissues. Systemic inflammatory manifestations were estimated via TNF-α and interleukin-1β (IL-1) concentrations in blood serum by ELISA. Results. The changes in cellular population content demonstrated that, on day 21 after the implantation, the PCL/CaCO3-matrice was evenly colonized by fibroblast cells and afterwards vascularized. Such matrices did not cause intense inflammatory reaction observed in negative control animals. It was accompanied by systemic manifestations, such as statistically significant increase in TNF-α and IL-1 concentrations. Conclusion. Our data confirmed the biocompatibility of PLC/CaCO3-scaffolds, thus experimentally substantiating the potential for their use in tissue engineering.

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Methodology of designing specialized medical information registries

Aleksander S. Fedonnikov, Anna S. Kolesnikova, Yuliya Yu. Rozhkova, Irina V. Kirillova, Leonid V. Bessonov, Vladimir Yu. Ulyanov, Leonid Yu. Kossovich

Статья научная

The objective. Developing information exchange methodology by means of specialized registries among the core healthcare partakers in the course of provisioning medical assistance to traumatology and orthopedic patients. Materials and Methods. We conducted the analysis and systematization of functionality for 31 registers of traumatology- and orthopedics-related medical information from the databases of the Federal Institute of Industrial Property, European Patent Office and developers’ websites. The search depth has been set at 1979 and defined by the date of the earliest discovered information source. Results. The analysis of specialized registries revealed that majority of those (70.9%) were mono-nosologic, hence containing information about the diagnosis and treatment procedures provided at the level of a specific medical institution. We developed the methodology for evaluating the functionality of specialized medical information registries, containing the data on used medical devices, medications, medical technologies, rehabilitation programs, and assessment of medical treatment effectiveness. Such methodology was designed to operate on data from the information systems of major healthcare partakers. Conclusion. The proposed information exchange methodology defined the necessity of integrated, target-oriented registry development. Its implementation would allow increasing the quality of management decisions proposed by healthcare participants.

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Effect of different pancreatic stump closure techniques after distal pancreatectomy on frequency and severity of acute postoperative pancreatitis

Sergei E. Voskanyan, Evgeny V. Naydenov, Igor Yu. Uteshev, Aleksei I. Artemiev

Статья научная

Objective: to study the effect of different pancreatic stump closure techniques and diameter of the main pancreatic duct on frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomy was performed on 126 patients with neoplasms of body and/or tail of the pancreas. Patients were distributed among four groups based upon the pancreatic stump closure technique applied after distal pancreatectomy: group 1 (control) included the patients with isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing by the gastrocolic omentum or hemostatic sponge; group 2 patients underwent isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing with 2-octyl cyanoacrylate biological glue; group 3 patients had their pancreatic stump closure performed with endoscopic linear cutter stapler; group 4 was composed of the patients with external transduodenal transnasal drainage of enlarged (D>3 mm) main pancreatic duct in the pancreatic stump. Results. The occurrence of acute postoperative pancreatitis in the control group amounted to 45.8%, while, in groups 2, 3 and 4, the frequencies were 44.4, 9.7 and 15.0(%), correspondingly. Besides, the control group was characterized by declined occurrence of the moderately severe form of acute postoperative pancreatitis. Use of endoscopic linear cutter stapler and external transduodenal transnasal drainage of the enlarged main pancreatic duct caused lower acute postoperative pancreatitis frequency in the patients with main pancreatic duct in their pancreatic stumps below 5 mm in diameter. Conclusion. Use of proposed pancreatic stump closure techniques after distal pancreatectomy resulted in lower frequencies of occurrence and severity of acute postoperative pancreatitis.

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Complications after different surgical methods for suburethral implantation of polypropylene slings in women with stress urinary incontinence

Igor A. Eizenakh, Olesiya S. Korotkevich, Vadim G. Mozes, Veronika V. Vlasova

Статья научная

Objective: to identify the proportion of complications after suburethral implantation of polypropylene slings in women with stress urinary incontinence based on a seven-year experience. Material and Methods. We conducted the analysis of а seven-year experience in various implantation techniques of suburethral slings in 1260 women with stress urinary incontinence: inside-out and outside-in obturator sling fixation; suprapubic sling fixation and non-trocar mini-sling installment. Results. The highest incidence of complications was observed over the first two years after suburethral sling implantation was performed. Subsequently, the proportion of complications declined progressively to the lower limit values of 7-8% in the course of three last years. An incidence of early surgical complications among various suburethral sling implantation techniques had no statistically significant differences. However, after the suprapubic sling implantation, intraoperative and mesh-associated complications prevailed. Conclusion. Our study confirmed that suburethral sling implantation using suprapubic fixation method was associated with a higher incidence of complications and should have been performed exclusively for the target group of the patients, for whom safer surgical procedures were contraindicated.

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Medicamentous therapy of stable coronary artery disease sensu the guidelines on myocardial revascularization

Olga M. Posnenkova, Ekaterina N. Genkal, Yulia V. Popova, Anton R. Kiselev, Vladimir I. Gridnev

Статья научная

Objective: based on the Russian Federation multicenter registry data, to assess the comprehensiveness of medicamentous therapy in patients with stable coronary artery disease (CAD) from the perspective of 2018 European Society of Cardiology (ESC-2018) recommendations for myocardial revascularization and 2017 American Appropriate Use Criteria (AUC-2017) for the expediency of revascularization. Materials and methods. Anamnestic data of 1531 patients with stable CAD (average age: 61.7 ± 9.8 years; 76% men) were studied. The data source was the Russian Federation multicenter registry of patients with arterial hypertension, CAD, and chronic heart failure. We identified the prescription of optimal medical therapy (OMT) sensu ESC-2018, maximal anti-ischemic therapy (MAT) sensu AUC-2017, and compliance of drug therapy with ESC-2018 and AUC-2017 simultaneously. OMT included at least one anti-ischemic medication + antiplatelet agent + statin + short-acting nitrate + blocker of the renin-angiotensin system in the presence of hypertension, diabetes mellitus, or heart failure. MAT included at least two anti-ischemic pharmaceutical drugs. Compliance with these criteria was determined in the groups of patients who underwent, or did not undergo, myocardial revascularization, as well as among those, for whom invasive treatment was indicated as the first priority, as the second priority, or was not indicated at all, according to ESC-2018 and AUC-2017. Results. Among patients who received solely medicamentous therapy (n=924), OMT was prescribed in 18%, while in the revascularization group (n= 07), in 9% of cases (p <0.001). MAT was also prescribed more often in the conservative therapy group (34%) than in the revascularization group (24%): p = 0.001. OMT sensu ESC-2018 and AUC-2017 in the groups with, or without, intervention was prescribed in 3% vs. 7% of cases, respectively (p <0.001). Conclusion. According to the Russian Federation multicenter registry, medicamentous therapy of stable CAD complies with the provisions of European and American clinical guidelines for myocardial revascularization in a small proportion of patients, regardless of the chosen treatment tactics.

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