[Influence of chronic obstructive pulmonary disease on hospital outcomes of percutaneous coronary interventions in patients with acute coronary syndrome].

AIM: To evaluate the impact of chronic obstructive pulmonary disease (COPD) on hospital outcomes of percutaneous coronary interventions (PCI) in patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: A cohort prospective study of the COPD effect on mortality and coronary microvascular obstruction (CMVO, no-reflow) development after PCI in ACS was carried out. 626 patients admitted in 2019-2020 were included, 418 (67%) - men, 208 (33%) - women. Median age - 63 [56; 70] years. Myocardial infarction with ST elevation identified in 308 patients (49%), CMVO - in 59 (9%) patients (criteria: blood flow <3 grade according to TIMI flow grade; perfusion <2 points according to Myocardial blush grade; ST segment resolution <70%). 13 (2.1%) patients died. Based on the questionnaire "Chronic Airways Diseases, A Guide for Primary Care Physicians, 2005", 2 groups of patients were identified: 197 (31%) with COPD (≥17 points) and 429 (69%) without COPD (<17 points). Groups were compared on unbalanced data (÷2 Pearson, Fisher exact test). The propensity score was calculated, and a two-way logistic regression analysis was performed. The data were balanced by the Kernel "weighting" method, logistic regression analysis was carried out using "weighting" coefficients. Results as odds ratio (OR) and 95% confidence interval. RESULTS: The conducted research allowed us to obtain the following results, depending on the type of analysis: 1) analysis of unbalanced data in patients with COPD: OR death 3.60 (1.16-11.12); p=0.03; OR CMVO 0.65 (0.35-1.22); p=0,18; 2) two-way analysis with propensity score: OR death 3.86 (1.09-13.74); p=0.04; OR CMVO 0.61 (0.31-1.19); p=0.15; 3) regression analysis with "weight" coefficients: OR death 12.49 (2.27-68.84); p=0.004; OR CMVO 0.63 (0.30-1.33); p=0.22. CONCLUSION: The presence of COPD in patients with ACS undergoing PCI increases mortality and does not affect the incidence of CMVO.

Using an Artificial Neural Network to Predict Coronary Microvascular Obstruction (No-Reflow Phenomenon) during Percutaneous Coronary Interventions in Patients with Myocardial Infarction.

The aim of the study was to develop, evaluate, and validate an artificial neural network to predict coronary microvascular obstruction (CMVO) during percutaneous coronary interventions (PCI) in patients with myocardial infarctions (MI) based on the parameters, which are routinely available in an operating room when choosing a surgical approach. Materials and Methods: 5621 patients with MI and emergency PCI were retrospectively selected from the database of the City Clinical Hospital No.13 (Nizhny Novgorod, Russia); among them, there were 3935 men (70%) and 1686 women (30%), their mean age was 61.5±10.8 years. CMVO was recorded in 201 (4%) patients (the blood flow in the infarction-related artery after PCI was less than 3 points according to TIMI flow grade). The following input parameters were assessed: age, gender, past history of coronary artery disease, previous revascularization, presence of ST-segment elevation, a class of acute heart failure, a fact of systemic thrombolytic therapy administration and its effectiveness, symptom-to-balloon time, severity of coronary thrombosis and atherosclerosis, the number of stents and the number of operated coronary arteries. The sampling was divided into a training group (n=4060), a testing group (n=717), and an independent validation group (n=844). Results: We developed an artificial neural network by a fully connected multilayer perception with forward signal propagation and two hidden layers (the area under the ROC curve - 0.69) to predict CMVO based on the subsampling for training and testing. The network model was tested on an independent subsampling (the area under the ROC curve - 0.64, negative predictive value - 97.4%, positive predictive value - 14.6%). Conclusion: The developed artificial neural network enables to use the parameters routinely available in an operating room when choosing a surgical approach and predict CMVO development during PCI in MI patients with accuracy sufficient for practical use.

Antibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review).

Controlling infection is crucial in treating patients with acute pancreatitis (AP). The infectious process in AP often predisposes to subsequent sepsis by damaging not only the pancreas, but retroperitoneal tissues as well. Among other AP-associated factors, are the rapidly developing immune imbalance, the poor penetration of antimicrobial agents into necrotic tissue, and the impossibility of a single surgical debridement. Antibacterial and antifungal therapy for patients with infected necrosis and AP-associated extra-pancreatic infections remains a complex and largely unresolved problem, partially due to the high occurrence of multiresistant pathogens. The preventive use of antimicrobial agents has been discussed in the literature; however, the lack of consistent results makes it difficult to develop a unified strategy and clinical guidelines on this specific issue. Recent meta-analyses provide no conclusive evidence that antibacterial prophylaxis reduces the infection rate, mortality, or the need for surgical treatment in patients with necrotizing pancreatitis. We found only two studies indicating the benefits of using carbapenems for prophylactic purposes and one meta-analysis indicating a reduction in mortality under antibiotic treatment started no later than 72 h after the onset of the attack. Selective bowel decontamination is considered as one of the preventive anti-infection measures, although the available data may not be fully reliable. The main indications for antibacterial therapy in patients with AP are confirmed infected necrosis or extra-pancreatic infection, as well as clinical symptoms of suspected infection. Intra-arterial administration or local treatment with antibiotics can increase the efficacy of antibacterial therapy. No randomized studies on antifungal prophylaxis in AP are available; some reports though recommend using such therapy among patients at high risk of invasive candidiasis.

[Peculiarities of treatment policy for lower-limb phlebothromboses].

Quality of treatment for acute venous thrombosis is determined by adequacy of conservative treatment and optimization of the operative procedure. We analysed the outcomes of management of 1,768 patients presenting with various forms of lower-limb phlebothrombosis. Deep veins were affected in 1,158 (65.5%) cases. Of these, thrombosis of crural veins was revealed in 672 (58%) patients, iliofemoral phlebothrombosis in 486 (42%) subjects. A total of 47 (9.7%) patients were operated on for iliofemoral thrombosis with floating thrombus confirmed by ultrasonic angioscanning. Criteria for floatation were determined. A total of 610 (43.5%) patients were diagnosed as having ascending subcutaneous thrombophlebitis of the femur. Of these, a total of 592 (97%) patients were operated on within 1-48 hours following admission. We propose a methodology of comprehensive conservative treatment with the use of Antistax in a double dose and alternating pneumocompression with elevated pressure in the cuffs.

[First experience of laparoscopic appendectomy in the 150-bed garrison hospital].

The article reflects the results of the first laparoscopic appendectomy experiment which was conducted on the base of 30 person department of the military hospital for 150 patients. The researcher made the statistical analysis of the results of acute appendicitis diagnostic and cure among young men. For the group of patients whit catarrhal form of acute appendicitis separate analysis was committed. It was found out that in the half of cases the clinic and laboratory scheme of acute appendicitis does not differ from the destructive one. These results made the researcher comprehend the necessity of additional ways of diagnostic in the acute appendicitis shady cases. It is also necessary to develop a medicinal and diagnostic algorithm for shady appendicitis in accordance with diagnostic conditions of military hospital for 150 patients.

[Effect of lower limb critical ischaemia on course of wound process and incidence rate of high amputations in pyonecrotic forms of diabetic foot syndrome].

Analysed herein are therapeutic outcomes in a total of 417 patients presenting with pyonecrotic complications of diabetic foot syndrome. The obtained findings suggest an unfavourable course of the wound process and increased risk of high amputations in the presence of lower limb critical ischaemia.

[Clinical characteristics, course and diagnosis of chronic progressive liver diseases in patients with a history of acute viral hepatitis]. / Klinicheskaia kharakteristika, techenie i paspoznavanie khronicheskikh progressiruiushchikh porazhenii pecheni u bol'nykh s nalichiem v anamneze ostrogo virusnogo gepatita.

Based on examination of 144 patients with chronic active hepatitis (CAH) and liver cirrhosis (LC) with a history of acute virus hepatitis (AVH) it was established that chronic progressive liver injuries of virus etiology with and without HB-antigenemia are characterized by the diversity of the clinico-laboratory findings determined by the involvement, in addition to the liver, of many organs and systems. The following variants of chronic AVH were recognized: (1) early development of chronic progressive liver injury due to AVH (40.4% of cases); (2) late occurrence of chronic progressive liver injury after a latent period of varying duration, namely up to 21-30 years and more (59% of cases). Late recognition of CAH and LC in patients with a history of AVH was caused, on the one hand, by a high rate of chronic progressive liver injuries after a long-term period, and on the other hand, by erroneous evaluation of extrahepatic lesions, which were the first symptoms of a chronic condition in many patients. Hepatitis virus B markers were detected in the blood serum of 44.5% of patients with CAH and LC with a history of AVH, mostly in men (55.3%) versus women (34.9%). In view of the difficulties of verifying liver injuries of virus etiology based on the laboratory research methods alone, one should be guided by a clinico-epidemiological approach to a study of CAH and LC etiology.

[Intermediate filaments in the lung macrophages and endothelial cells in chronic alcoholism and suppurative-destructive lung diseases]. / Promezhutochnye filamenty v makrofagakh i éndotelial'nykh kletkakh legkogo u bol'nykh khronicheskim alkogolizmom i gnoino-destruktivnymi zabolevaniiami legkikh.

Accumulation of intermediate filaments in lung macrophages and endotheliocytes has been found in patients with chronic alcoholism and purulent destructive pulmonary diseases. Excess accumulation of cytoskeletal elements reflects cell dystrophy. The authors believe that impairment of macrophage function may favour the lingering of the suppurative process.