Effectiveness of Bokeria-Boldyrev ACH Solution in Surgerical Treatment of Adult Patients with Obstructive Hypertrophic Cardiomyopathy.

The study examined effectiveness of pharmaco-cold cardioplegia employing solutions of enhanced buffer capacity during surgery of obstructive hypertrophic cardiomyopathy in adult patients (N=51) operated during 2013-2018. In group 1 (N=28), the cardioplegia was performed with HTK (Custodiol) solution, whereas in group 2 (N=23), it was carried out with Bokeria-Boldyrev ACH solution. The mean, minimum, and maximum ages in group 1 were 46, 21, and 64 years, respectively; in group 2 - 42, 14, and 70 years, respectively. In both groups, the patients were subjected to myoectomy of exit pathway in the left ventricle according to Bokeria-Morrow operation and annuloplasty of tricuspid valve accompanied by reconstructive surgery (or replacement) of mitral valve. Atrial fibrillation (if any) was suppressed with cryoablation (-60°Ð¡) of the openings of the right and left pulmonary veins. The surgery was carried out in hypothermic mode at 28°C. The significant intergroup differences were observed in the asystole latent period after the onset of antegrade or retrograde injection of cardioplegic solution. In group 1, the asystole latent periods determined after antegrade or retrograde injection were 53±7 or 170±30 sec, respectively; in group 2 - 32±6 and 97±11 sec (p<0.0001), respectively. The mean times of aortic cross-clumping in groups 1 and 2 were 66±8 and 64±6 min, respectively; the electromechanical action of the heart restored after aortic unclamping in 35±7 and 30±6 sec, respectively. The biochemical and clinical data revealed no significant intergroup differences. Overall, novel Bokeria-Boldyrev ACH cardioplegic solution secured effective protection of the myocardium against intraoperative ischemia in adult patients with obstructive hypertrophic cardiomyopathy and significantly decreased the asystole latent period.

Experimental study of the effects of sodium ion concentrations on the function of the myocardium exposed to cardioplegic ischemia.

A new cardioplegic solution based on three natural dipeptides was developed and introduced at the Laboratory of Cardioplegia, A. N. Bakulev Research Center of Cardiovascular Surgery. The electrolyte composition of the solution corresponded to the category of intracellular cardioplegic solutions. The results of 60 experiments on isolated rat hearts were analyzed for choosing the optimal concentration of sodium ions (35, 60, or 80 mmol/liter). The composition of the studied cardioplegic solutions was selected by ion concentrations in the intra- and extracellular fluid. Earlier and most effective recovery of cardiac function with minimum rhythm and conductivity disorders was observed in the group treated with cardioplegic solution with sodium ion concentration of 60 mmol/liter.

[Immunological indices in gastric cancer].

Immunological indices were assayed in 167 patients with gastric cancer. Tumor growth involved reduction in levels of neutrophil peroxide (p<0.05), CD3+ and CD19+-cells (p<0.05) as well as intensification of apoptosis of lymphocytes (p<0.05). As monocytic and granulocytic phagocytosis (p<0.001) and HLA-DR-expression in monocytes (p<0.001) diminished, and mitogen-induced proliferative activity of mononuclear cells suppressed (p<0.05), total and relative levels of CD8+-cells (p<0.05) and spontaneous proliferative activity of mononuclear cells (p<0.05) in peripheral blood increased. Such changes should not be reganded as expression of immunosuppression alone. Mechanisms of immunological failure inherent in tumor growth need to be investigated further.

[Immunogenetic prognosis and long-term results of surgery for gastric cancer].

A link between HLA allelic variants and long-term results of surgery for gastric tumors was established on the basis of a 10-years follow-up of 112 cancer patients (stage I-II--37.9, III-IV--62.1%; radical surgery--44.6%). HLA class I was studied in a lymphocytotoxic test; HLA class II--gene DRBI specificity using polymerase chain reaction of peripheral blood cell DNA. The control group included healthy subjects living in the city of Novosibirsk (n = 341). High frequency of antigens HLA-B41, -DR1, -DR7 (p < 0.01) co-occurred with HLA-A2, -B12, -B13 and -B18 presence (p < 0.05) in breast cancer patients. Clinical manifestations of cancer were shown to develop in HLA-A1, -B8, -B15, -DR3 and -DR5 carriers at early stages. Tumor development at later stages (III-IV) was associated with HLA-A2, -B12, -B17, -B35, -B41 and -DR7. A link was registered between lethality rate, on the one hand, and HLA-A3, -B22, and, in particular, DR4, on the other, while remission of more than 7-years--with HLA-A11, -B13, -B21 and -DR5. HLA-B22/DR3 phenotype involved worse prognosis in radically-treated patients whereas that of HLA-B8/DR3--a better one.

[Clinical immunogenetics of stomach cancer in Western Siberia]. / Klinicheskaia immunogenetika raka zheludka v zapadnoi Sibiri.

An immunogenetic examination of 86 cases of stomach cancer established a correlation between predisposition and resistance, on the one hand, and the distribution of allele sets of HLA-genes (classes I and II), on the other. The relationship was found to vary according to sex and age. The most significant relationships with respect to predisposition were identified for HLA-B51 (RR = 19.82) alleles and allele combinations of HLA-DRI-DR7 (RR = 25.52) and HLA-A9-DRI (RR = 33.67). High relative risk of stomach cancer was attributed to the absence of relevant alleles in 91 patients included into the group of comparison. Also, combinations of allele sets were identified in healthy subjects which never occur in stomach cancer patients. The results provide a substantiation for developing an automated system of interpreting HLA-typing data which are instrumental in evaluating the patient's predisposition, resistance and prognosis.