Efficiency of an algorithm for the prevention of sternal infection after cardiac surgery in children under 1 year of age: A single-center retrospective study.

Background: Sternal infection is one of the most challenging complications to manage after heart surgery. The aim of our study is to evaluate the effectiveness of a developed algorithm for preventing sternal infection in pediatric patients after surgery for congenital heart disease (CHD). Methods: We conducted a single-center study examining the treatment of 478 children with CHD. Patients were divided into 2 groups, taking into account the application of a developed management algorithm. A multivariate logistic regression analysis was used to identify the factors influencing the development of sternal infection following heart surgery using median sternotomy. Results: A developed algorithm was applied in 308 children. In total, there were 16 cases of sternal infection (3.34 %) across both groups. Deep wound infection developed in 6 patients (1.26 %). Sternal infection developed in 2 children (0.65 %) in the first group (in which the algorithm was applied) and 14 children (8.2 %) in the second group. Deep sternal infection developed in 1 patient in the first group (0.33 %) and in 5 patients in the second group (2.94 %). As a result, perioperative risk factors as postoperative resternotomy (OR 23.315; p < 0.001), delayed sternal closure (OR 9.087; p = 0.003), development of acute renal failure (OR 5.322; p = 0.018) were associated with increased risk of infection and application of the developed algorithm resulted in a significant reduction in risk (OR 0.032; p < 0.001). Conclusion: The suggested method for the prevention of sternal infection has significantly reduced the incidence of sternal infection after cardiac surgery in children less than 1 year of age. In patients with moderate to high risk for surgical site infection, surgeons can enhance wound healing and prevent wound infections with simple, inexpensive, and readily available tools and techniques. Surgical aspects, topical use of antibiotics, prevention of peripheral vasoconstriction, maintenance of normal oxygen delivery rates, and an individual approach to intensive care are essential.

[Possibilities of tissue perfusion assessment in abdominal surgery: integration into the intraoperative system of safety control points]. / Vozmozhnosti otsenki perfuzii tkanei v abdominal'noi khirurgii: integratsiya v sistemu intraoperatsionnykh kontrol'nykh tochek bezopasnosti.

OBJECTIVE: To evaluate the possibility of integrating tissue perfusion assessment techniques (ICG perfusion and imaging photoplethysmography - iPPG) into the system of intraoperative control points of laparoscopic interventions with a reconstructive component. MATERIALS AND METHODS: Quantitative assessment of ICG fluorescence and iPPG were used during 8 laparoscopically assisted interventions: gastrectomy for gastric cancer (total - 2 and distal - 1) and colorectal resections (left-sided colorectal resections - 4 and right hemicolectomy - 1). RESULTS: Four stages are presented for the assessment of tissue perfusion: initial assessment, before intestine transection, before anastomosis formation, and evaluation of anastomosis. From the point of view of the significance of clinical decision-making, the «before intestine transection¼ stage is of great importance, due to the ease of transferring the resection level to the optimal tissue perfusion zone. CONCLUSION: Integration of tissue perfusion assessment techniques into the system of intraoperative checkpoints is possible and promising.

A rare case of diagnosed absent aortic valve and severely hypoplastic pulmonary valve with double outlet right ventricle: A case report.

Agenesis of the aortic and pulmonary valves is a very rare congenital malformation of the semilunar valves. The literature describes no more than thirty cases of such anomaly in combination with congenital heart disease. Most descriptions include aplasia of either the aortic or pulmonic valve. The combination of such defect in both valves has been described in a much smaller number of scientific papers. In this article, we present a clinical case of the treatment of a patient with agenesis of aortic valve and severely hypoplastic pulmonary valve. As a result circulatory arrest occurred immediately after birth, which required the implementation of cardiopulmonary resuscitation. The child was resuscitated and transferred to the intensive care unit for further examination and treatment.

Application of Magnetic Particles for Fast Determination of Immunoreactive Fraction of 68Ga-Labelled VHH Antibodies to PD-L1.

Quantification of the immunoreactive fraction (IRF) of radioactive isotope-labeled antibodies or their fragments is necessary to assess the specific activity of radiopharmaceuticals. Traditionally, cells expressing the target molecules on their surface are used to determine IRF, but such analysis is time-consuming and has difficulties with standardization. The aim of the study was to develop a fast and reliable method for quantitative determination of IRF by 68Ga-labeled VHH antibodies to PD-L1 based on the use of magnetic particles coated with antigen molecules. Materials and Methods: Commercially available magnetic particles coated with protein A have been used in our study. The antigen conjugated with the Fc fragment (PD-L1-Fc) was immobilized on the particles. The IRF value of 68Ga radionuclide-labeled nanobodies (VHH) against PD-L1 (68Ga-VHH-PD-L1) was determined using magnetic particles coated with antigen molecules and cells expressing the antigen on their surface. When VHH antibodies were conjugated to 68Ga radionuclide, protein molecules were modified using bifunctional chelating agents: tetraazacyclododecanetetraacetic acid (DOTA) or deferoxamine (DFO). The magnitude of IRF was defined as the ratio of radioactivity specifically bound to particles or cells to the total radioactivity added to the sample. Results: The specificity of the 68Ga-VHH-PD-L1 radioimmunoconjugate binding to the antigen-coated magnetic particles has been proved. Some special aspects, which should be taken into consideration when using this method, have been established. The comparison of the IRF estimates using the antigen-expressing cells and magnetic particles has not revealed any significant differences in the results obtained in our study. Nevertheless, the presented method based on magnetic particles with immobilized antigen molecules requires only 15 min to determine the radioimmunoconjugate IRF, which is of fundamental importance for the routine assessment of the specificity of radiopharmaceuticals containing short-lived isotopes.

[Analysis of healthcare for patients with cardiovascular diseases in Russian Federation in comparison with the practice of Europe and USA].

The medical community, researchers and healthcare organizers are constantly challenged by comparing key indexes reflecting the effectiveness of cardiovascular care, primarily for the dynamic assessment and implementation of the world's best practices to reduce cardiovascular mortality. The analysis of health care for patients with cardiovascular diseases (CVD) is a complex, multicomponent process, the structure and key tools of which differ from country to country. Using different data sources, methodological and analytical approaches creates certain limitations and barriers to the assessment. In order to update the ideas about the modern coordinate system and tools for assessing cardiovascular care, the authors presented practices for analyzing major indexes in Russia, European countries, and the United States. The review presents sources of statistical data, principles for assessing risk factors, cardiovascular morbidity and mortality, and specific features of monitoring the availability and quality of cardiovascular care.

[Clinical significance of different assesment methods of myocardial fibrosis in patients with hypertrophic cardiomyopathy.]

Objective To evaluate prospects for clinical use of circulating biomarkers for characterizing fibrotic changes in the myocardium of patients with hypertrophic cardiomyopathy (HCMP) with left ventricular (LV) outflow tract obstruction.Materials and Methods This was a prospective study with a 12-month follow-up period. The study included 47 patients (29 females and 18 males) with obstructive HCMP who were selected for septal reduction. Echocardiography (EchoCG), cardiac magnetic resonance imaging (MRI) and measurements of serum C-reactive protein, N-terminal pro-brain natriuretic peptide, and relevant circulating markers of fibrosis (TGF-ß1, MMP-2,-9, TIMP-1, galectin-3, sST2, CITP, PICP, and PIIINP) were performed for all patients. All patients were evaluated at baseline and at 7 days, 6 and 12 months following surgical treatment. Morphometrical analysis of intraoperative biopsy samples was performed for evaluation of the degree of fibrotic changes. Patients received beta-blockers (95.7%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (34%), loop diuretics (68.1%), aldosterone antagonists (34%), and statins (66%).Results Women with HCMP were older and more frequently had additional risk factors (arterial hypertension). Men had a higher risk of sudden cardiac death. Histological study of intraoperative myocardial biopsy samples showed that the area of fibrotic changes was 13.9±6.9%. According to cardiac MRI mean area of delayed contrast enhancement was 8.7±3.3% of LV myocardial mass. No association was established between traditional cardiovascular risk factors and severity of myocardial fibrotic changes or levels of circulating fibrosis markers. Perhaps that was due to the modifying effect of the drug therapy received by HCMP patients. According to EchoCG maximum pressure gradient in the LV outflow tract before the surgical treatment was 88 (55; 192) mm Hg, and interventricular septal thickness was 22 (16; 32) mm. A considerable decrease (p=0.0002) in the LV outflow tract gradient was observed after myectomy in all patients. At the same time, the left ventricular dimension, which tended to decrease in the early postoperative period, returned to baseline values by the 6th month of follow-up.Conclusion The study confirmed the increase in relevant circulating markers of fibrosis in patients with obstructive HCMP. At the same time, no correlation was observed between levels of circulating biomarkers and severity of fibrosis according to data of histology and cardiac MRI, which was probably due to the modifying effect of drug therapy and limited sampling.

Polycyanoacrylate porous material for bone tissue substitution.

A proof of concept study has been conducted for the design of a porous biodegradable material containing nanocapsules and two actives with independent release-bimodal drug-eluting implants. Completely safe synthetic material free from risk of prion and virus contamination was tested in vivo, and a method for controlling the rate of biodegradation of poly-2-cyanoacrylic polymer was developed. Novel perfluorinated 2-cyanoacrylic esters have been applied for the chemical modification of polyethyl-2-cyanoacrlylate copolymers. Internal imide-cycle formation has been used to retard the rate of enzymatic hydrolysis of the 2-cyanoacrylic copolymer main chain.

[First experience of using positron emission tomography with 11C-choline in prostate cancer (PC)].

Introduction into clinical practice of combined positron emission technology and computer tomography (PET/CT) allows in one study to identify structural and functional abnormalities. The study involves 32 patients who underwent PET/CT with "C-choline, including 5 patients with prostate cancer (PC), 3--with chronic prostatitis and 24--with biochemical PC recurrence. PET/CT with 11C-choline has a high diagnostic efficacy in detection of local recurrence and PC metastases in patients with biochemical PC recurrence. The results of visual analysis do not permit to distinguish PC from benign prostate diseases.

[The analysis of the unfavourable outcomes of dental care based on the materials of forensic medical examinations carried out by the Bureau of Forensic Medical Expertise, Moscow Department of Health].

The analysis of the unfavourable outcomes of dental care based on the materials of forensic medical examinations carried out by the Bureau of Forensic Medical Expertise, Moscow Department of Health.

[Production of the recombinant human bone morphogenetic protein-2 in Escherichia coli and testing of its biological activity in vitro and in vivo].

Bone morphogenetic protein-2 (rhBMP-2) represents the osteoinductive protein factor which plays a dominant role in growth and regeneration of a bone tissue. In clinical practice the bone grafting materials on the basis of rhBMP-2 are widely applied; the Russian analogues of similar materials are not produced. The fragment of the bmp2gene coding for a mature protein was cloned in Escherichia coli. The effective overproducing strain of rhBMP-2 was created on a basis of the E. coli BL21 (DE3). The rhBMP-2 production was about 25% of total cell protein. The biologically active dimeric form of rhBMP-2 was obtained by isolation and purification of protein from inclusion bodies with subsequent refolding. The rhBMP-2 sample with more than 80% of the dimeric form was obtained, which is able to interact with specific antibodies to BMP-2. Biological activity of the received rhBMP-2 samples was shown in the in vitro experiments by induction of alkaline phosphatase synthesis in C2C12 and C3H10T1/2 cell cultures. On model of the ectopic osteogenesis it was shown that received rhBMP-2 possesses biological activity in vivo, causing tissue calcification in the place of an injection. The protein activity in vivo depends on way of protein introduction and characteristics of protein sample: rhBMP-2 may be introduced in an acid or basic buffer solution, with or without the carrier. The offered method of rhBMP-2 isolation and purification results in increasing common protein yield as well as the maintenance of biologically active dimeric form in comparison with the analogues described in the literature.

[Radioecological biomonitoring of the radioactive waste long-term storage territories].

Radionuclide release to environment is possible during long-term storage of the low and middle activity radioactive waste on specially equipped territories, which leads to radioactive background increase and to permanent radiation influence to biocenosis. For an ecological situation control in such places it is need to provide a biomonitoring using the method of complex estimation of the morphological changes on whole organism and internal organs levels (presents of tumors, teratogenic effects), the hematological indexes reflected quantifies and qualifies changes in blood, cytogenetic distribution (bone marrow polychromatic erythrocytes with micronuclei) and distributions on molecular level (alterations of DNA structure lead to increase in the DPC level).

[Responsibility of ENT specialists in rendering medical care in present-day social-economic conditions].

The article contains basic legal and standard acts on regulating law in health service, rights and responsibilities of patients and doctors. Knowledge of the regulation raises responsibility of otorhinolaryngologists in rendering medical care and must improve quality of ENT service.

Catalytic enantioselective synthesis of 18F-fluorinated alpha-amino acids under phase-transfer conditions using (S)-NOBIN.

We describe a new method for the asymmetric synthesis of [(18)F]fluorinated aromatic alpha-amino acids (FAA) under phase transfer conditions using achiral glycine derivative NiPBPGly and (S)-NOBIN as a novel substrate/catalyst pair. The key alkylation step proceeds under mild conditions. Substituted [(18)F]fluorobenzylbromides were prepared using nucleophilic [(18)F]fluoride and were used as alkylation agents. Two important FAA, 2-[(18)F]fluoro-L-tyrosine (2-FTYR) and 6-[(18)F]fluoro-L-3,4-dihydroxyphenylalanine (6-FDOPA), were synthesized with an ee of 92 and 96%, respectively. The total synthesis time was 110-120 min and radiochemical yields (d.c.) were 25+/-6% for 2-FTYR and 16+/-5% for 6-FDOPA.

[Forensic medical expert evaluation in connection with civil actions of patients complaining of improper dental care]. / Sudebno-meditsinskaia ékspertiza po grazhdanskim iskam patsientov na nekachestvennoe okazanie stomatologicheskoi pomoshchi.

The authors discuss questions facing forensic medical experts in connection with civil "medical" actions. The questions are classified as common and private. Expert evaluations of correspondence of the scope and quality of dental care are offered as the base for analysis of these problems within the framework of civil legislation. The data evidence efficiency of forensic medical expert evaluations in civil legal procedure and the significance of forensic medical service in the solution of problems of quality and efficiency of medical (including dental) care of the population.

[Attempt at allo-aortal conduits in the correction of congenital heart defects]. / Pervyi opyt ispol'zovaniia alloaortal'nykh konduitov pri korrektsii vrozhdennykh porokov serdtsa.

In the period September 1990 to April 1993, an allo-aortic conduit was used in 16 patients during reconstruction of the right ventricular outflow duct. The patients age ranged from 2 years 8 months to 14 years, their body weight was 11.8 to 26 kg. Seven patients were diagnosed as having pulmonary atresia with ventricular septal defect, 4 had Fallot's tetrad and 5 transposition of great vessels with pulmonary stenosis and ventricular septal defect. The allo-aortic conduit made by the procedure developed at the A. N. Bakulev Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, was used in all cases to reconstruct the right ventricular outflow duct. The allografts were sterilized in a solution containing culture medium RPMI-1640 and mixture of antibiotics. After sterilization, the prostheses were frozen in liquid nitrogen vapours and kept at -150 to -160 degrees C till their clinical application. In the immediate postoperative period, 2 patients died, which amounted to 13%. Two deaths were caused by excessive bleeding, but in one case the implanted conduit wall bled. The residual right ventricle-pulmonary artery gradient was no more than 23 +/- 17 mm Hg. A discharge echocardiographic examination of patients found no valvular dysfunction of the implanted conduits on days 12 to 26 days after surgery. The findings suggest that the allo-aortic conduits prepared at the A. N. Bakulev Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, can be regarded as the prostheses of choice in the surgery of congenital cardiac malformations.

[Prosthesis of the aortic valve by a loose allograft]. / Protezirovanie aortal'nogo klapana beskarkasnym allograftom.

A procedure has been developed to prepare live aortic allografts, which consists in taking a valve early after a donor's death, sterilizing it in antibiotics and freezing it to -190 degrees C in the presence of the cryoprotective agent dimethylsulfoxide. The preservation of valve tissue is evidenced by morphological studies. The first 3 operations for aortic valvular diseases were performed. In two cases, the indication for surgery was infectious endocarditis refractory to antibiotic therapy. Postimplantation complications were not seen. The competence of the allograft was confirmed by intraoperative transesophageal echocardiographical study. The patients examined 4 months postoperation developed no signs of aortic incompetence and infectious endocarditis. Thus, the creation of a bank of live valves allows this prosthesis to be implanted with appropriate indications, one of which is active infectious endocarditis of the aortic valve.