Pericardial and Pleural Effusions in Non-ICU Hospitalized Patients with COVID-19-A Retrospective Single-Center Study.

Background: Pericardial and pleural effusions are two complications recently described in patients hospitalized with COVID-19 infections. There are several mechanisms that have been proposed and refer to SARS-CoV-2's capacity to bind to cell surfaces via various receptors and its broad tissue tropism that might cause significant complications. The aim of the present study is to evaluate the incidence of pericardial and pleural effusions during COVID-19 infection as well as to determine the risk factors associated with these complications. Methods: We conducted a retrospective single-center study that included 346 patients admitted to the National Institute of Infectious Disease "Prof. Dr. Matei Bals" (Bucharest, Romania), from 1 January to 25 May 2021, during the third wave of the pandemic. Socio-demographic and anthropometric data were collected for each patient. The patients were evaluated clinically, biologically, and radiologically within 48 h of admission. Patients were divided into 3 groups: (1) patients with pericardial effusions-18; (2) patients with pleural effusions-28; (3) patients without pericardial/pleural effusions-294. Results: After exclusion criteria were applied, 337 patients were analyzed. The median age of the participants was 58.26 ± 14.58 years. More than half of the hospitalized patients had associated respiratory failure (61.5%), of which 2.7% had a critical form of the disease and 58.8% had a severe form. The cumulative percentage for pericardial and pleural effusions for the study group was 12.8% (43 patients out of 337). The prevalence of pericardial effusion was 5.3%, twice more frequent among male respondents. Pleural effusion was identified in 8.3% patients. Most patients had unilateral effusion (17), compared to 11 patients who had bilateral involvement. Based on laboratory results, patients with pericardial and pleural effusions exhibited increased levels of C reactive protein, erythrocyte sedimentation rate, NT proBNP, and a higher value of neutrophil/lymphocyte count ratio. In contrast to patients without pleural and pericardial effusions, those with these symptoms experienced a higher frequency of severe or critical illness and longer hospital stays. Conclusions: Pericardial and pleural effusions can complicate COVID-19 infections. In our study, the prevalence of pericardial and pleural effusions in hospitalized patients was low, being associated with the same comorbidities and a number of clinical and biological parameters.

Mucous non-goblet cells in the small intestine of guinea pigs (Cavia porcellus): a histological and histochemical study.

BACKGROUND: The covering and glandular epithelium of the small intestine in guinea pigs (Cavia porcellus) include some mucus-secreting cells. Goblet cells are specific cells for mucus secretion with a distinctive cup-like appearance due to the accumulation of mucin in the apical pole. The deep crypt secretory (DCS) cells were identified in a limited array of species and only recently were noticed in the large intestine in mice, guinea pigs, humans, monkeys, and pigs. Our study focuses on the microscopical and histochemical features of the DCS cells in the small intestine of guinea pigs. MATERIALS AND METHODS: The samples from the small intestine were collected from five fully grown guinea pigs that were presented to the Hospital of the Faculty of Veterinary Medicine Cluj-Napoca (Romania) with severe lesions resulted from domestic activities. The collected tissue samples underwent fixation in 10% buffered formalin and were later processed by standard paraffin technique. Mucous substances were detected using the Periodic Acid-Schiff and Alcian-Blue histochemical stain methods. RESULTS: The intestinal samples of the guinea pigs assessed had a standard microanatomical structure. As regards the mucous-secreting cells from the small intestine, two cell types were identified, i.e. the goblet cells and DCS cells. DCS cells were only detected in the deep parts of the Lieberkühn glands from the jejunum and ileum, and were different morphologically and histochemically from the regular goblet cells. CONCLUSIONS: Our study managed to describe for the first time in guinea pigs, the existence of DCS cells in the jejunum and ileum of the small intestine, but not in the duodenum.

Loss of Human Capital Caused by Emigration.

Today, the question is often raised about the need to increase investment in human capital, the efficiency of its use, as well as attraction to the regions. Working on the accumulation of human capital, it is necessary to ensure that it does not "leak" from the country; especially for highly skilled workers. The article considers the features of modern migration statistics in Russia. Using the methodology developed by the author, the paper assesses the losses caused by emigration. According to the results of the study, it was found that emigration statistics do not correctly reflect real migration flows. The resulting estimates of the loss of human capital turned out to be quite significant. Taking into account the additional potential losses caused by a possible slowdown in the scientific and technological development of the country, it is necessary to pay close attention to the ongoing processes, the adjustment of economic development programs and migration policy.

[Glycocalyx as a determining factor in development of endothelial venous dysfunction and possibilities of correction thereof]. / Glikokaliks ­ opredeliaiushchii faktor v razvitii éndotelial'noi venoznoi disfunktsii i vozmozhnosti ee korrektsii.

Modern vascular surgery has the data on a substantial role of the endothelium in pathogenesis of vascular diseases. Endothelial dysfunction is associated with a wide range of pathological processes including those in chronic diseases of lower-limb veins. The discovery of the endothelial glycocalyx made it possible to evaluate its role in the development of endothelial dysfunction as a trigger mechanism in impairment of venous blood flow. The understanding of the unifying role of endothelial dysfunction in pathology in various fields of medicine provides a possibility of predicting the development of serious socially significant diseases such as cardiovascular diseases, diabetes mellitus, obstetrical complications, and to correct the conditions associated therewith. The present study was aimed at carrying out a systematic literature review, thus making it possible to evaluate the role of the endothelial glycocalyx in the development of endothelial dysfunction, as well as to determine therapy with sulodexide capable of decreasing the probability of the onset of endothelial dysfunction at the expense of an anti-inflammatory, antithrombotic, and angioprotective effect on the endothelial wall.

Surface-enhanced Raman spectroscopy (SERS) investigations of saliva for oral cancer diagnosis.

Saliva could be an optimal sample for non-invasive cancer detection, as it contains plenty of proteins and metabolites which can reflect the health status of an individual. Moreover, pairing it with high-sensitivity, label-free detection techniques could prove successful for early cancer diagnosis. In this study, we explore the enhancement of salivary characteristic Raman bands by using label-free, ultrasensitive surface-enhanced Raman scattering (SERS) based on gold nanoparticles. SERS maps were acquired from dry samples of saliva supernatant mixed with Au colloidal nanoparticles, which was then pipetted on clean glass slides. The SERS spectra presented a high variability of signal intensities and frequency shifts. However, several reproducible SERS spectra showing well-resolved bands were obtained at certain locations on the maps, where Au nanoparticles clustered together during the air-drying. The healthy and oral cancer saliva could be differentiated using principal components analysis based on several SERS bands assigned mainly to amino acids and proteins. Moreover, thiocyanate Raman modes were detected in saliva samples of both smoking and non-smoking volunteers and cancer patients. The analysis indicated that the cancer group displayed an overall higher level of the 2126 cm-1 band area assigned to C-N stretching vibrations of thiocyanate.

[About redirection of calls of acute medical care service because of emergency conditions in territorial medical organizations].

The article considers the results of functioning of the Surgut station of emergency medical care concerning redirection of calls of acute medical care service because of emergency conditions in territorial medical organizations in 2013-2016. The analysis demonstrated that the redirection of 10% of overall calls resulted in decreasing of day load of emergency medical care team from 15.8 calls in 2013 up to 13.3 calls in 2016. The timely qualified medical care support resulted in increasing of number of successful reanimation activities that testifies the increase of efficiency of emergency medical care service in case of life-threatening conditions.

[Efficacy and safety of micronized purified flavonoid fraction (MPFF) in treatment of venous diseases in geriatric patients]. / Éffektivnost' i bezopasnost' MOFF pri lechenii zabolevanii ven u gerontologicheskikh patsientov.

Analysed herein is the experience with micronized purified flavonoid fraction (MPFF) in treatment of geriatric patients with decompensated forms of chronic venous diseases. A total of 218 geriatric patients were examined and treated. Of these, 132 patients had trophic disorders (C4-C6 class), including 40 patients found to have venous trophic ulcers (VTU). Therapeutic policy consisted in wound cleansing, application of topical antiseptics, hydroalginate dressing, stimulation of regenerative processes by therapy with MPFF at a dose of 1,000 mg daily. The microcirculatory blood flow was examined by means of laser Doppler flowmetry. By the end of a 4-week course of comprehensive treatment, 31 of 40 patients were found to have elevated microcirculation index to 16.9±2.1 perfusion units, suggesting improved perfusion of the lower-limb skin. Venous trophic ulcers completely epithelialized in 9 patients and decreased by half of their initial area in 22 patients. Repeat assessment of cardiac activity showed a decreased functional class of chronic heart failure in 9 of 17 patients with healed VTU. Assessing safety of phlebotrophic therapy revealed neither adverse reactions nor decompensation of accompanying diseases during the whole follow-up period.

[Multicentre observational study of Phlebodia 600 in treatment of patients with CEAP class C0-C3 chronic venous diseases]. / Mnogotsentrovoe nabliudatel'noe issledovanie primeneniia Flebodia 600 u bol'nykh c khronicheskimi zabolevaniiami ven klassov C0-C3 po CEAP.

The purpose of the study was to evaluate efficacy of Diosmin (Phlebodia 600, Innothera, France) in treatment of patients presenting with class C0s-C3 chronic venous diseases (CVD) according to the CEAP classification. Presented herein are the results of a prospective observational study aimed at assessing the outcomes of two-month administration of Phlebodia 600 (600 mg diosmin) in patients suffering from class C0s-C3 CVD according to the CEAP classification. The study comprised a total of 868 patients, including 175 (20.2%) men and 693 (79.8%) women. Of these, 866 patients completed the study according to the protocol. Amongst the 868 followed-up patients, 851 (98.0%) subjects strictly adhered to the physician's prescription and stopped taking the drug without violation of the regimen and dosing of diosmin. The main drug dosage regimen of diosmin was 1 tablet once a day in 851/868 (98.04%) patients. Satisfaction with treatment with diosmin was reported as 'excellent' by 46.7 % of patients (95% CI: 43.3-50.0) and by 49.4% of physicians (95%: CI 46.1-52.7), being rated as 'good' by 45.0% of patients (95 % CI: 41.7-48.4) patients and by 43.6% of physicians (95% CI: 40.3-47.0). The score for the quality of life of patients according to the CIVIQ-20 scale at the first follow-up visit amounted to 45.4±15.4 points (median 43.0 points). At the second follow-up visit, this parameter improved dramatically, dropping to the level of 35.6±11.5 points (median 33.0 points). By the third follow-up visit, the positive dynamics of the parameters preserved continued, averagely amounting to 28.9±8.7 points (median 26.0 points). A decrease in the circumference of the left and right crura (by 0.39±0.74 and by 0.36±0.75 cm, respectively) was observed at the second follow-up visit. The difference of the malleolar measurements between the first and third follow-up visits amounted to 7.2±9.4 mm and 6.6±9.7 mm for the right and left crus, respectively (p<0.001). The number of patients with a reported feeling of heaviness in the legs statistically significantly decreased from 97.6% at the stage of enrollment into the study to 73.0% after 2 months of therapy, that of those with painful sensations from 84.5 to 55.3%, those with complaints of swelling (oedemas) of the lower limbs from 83.9 to 56.8%, with complaints of convulsions from 71.2 to 35.7%, with complaints of sensation of tingling from 63.4 to 34.1%, respectively. Hence, a statistically significant improvement of the patients' condition was observed as early as 30 days after the beginning of treatment. By day 60, the positive effect of the carried out therapy continued to grow. Safety and good tolerance of the drug were noted, which was confirmed by low incidence of undesirable events and high adherence to treatment.

[Compression knitwear VENOTEKS TREND in treatment of patients with chronic venous diseases of the lower limbs]. / Kompressionnyi trikotazh VENOTEKS TREND v lechenii bol'nykh s khronicheskimi zabolevaniiami ven nizhnikh konechnostei.

The authors assessed efficacy and safety of class 2 compression knitwear VENOTEKS TREND used in conservative and injection phlebosclerosing therapy of patients presenting with clinical class C1-C3 chronic venous diseases of the lower limbs. The study included a total of 30 patients. The compliance rate amounted to 92%. It was demonstrated that class 2 compression knitwear Venoteks Trend statistically significantly decreases the degree of subjective symptomatology, is efficient and safe in therapy for oedematous syndrome in the programmes of conservative treatment and after sclerotherapy.

Reaching out: junctions between cardiac telocytes and cardiac stem cells in culture.

Telocytes (TCs) were previously shown by our group to form a tandem with stem/progenitor cells in cardiac stem cell (CSC) niches, fulfilling various roles in cardiac renewal. Among these, the ability to 'nurse' CSCs in situ, both through direct physical contact (junctions) as well as at a distance, by paracrine signalling or through extracellular vesicles containing mRNA. We employed electron microscopy to identify junctions (such as gap or adherens junctions) in a co-culture of cardiac TCs and CSCs. Gap junctions were observed between TCs, which formed networks, however, not between TCs and CSCs. Instead, we show that TCs and CSCs interact in culture forming heterocellular adherens junctions, as well as non-classical junctions such as puncta adherentia and stromal synapses. The stromal synapse formed between TCs and CSCs (both stromal cells) was frequently associated with the presence of electron-dense nanostructures (on average about 15 nm in length) connecting the two opposing membranes. The average width of the synaptic cleft was 30 nm, whereas the average length of the intercellular contact was 5 µm. Recent studies have shown that stem cells fail to adequately engraft and survive in the hostile environment of the injured myocardium, possibly as a result of the absence of the pro-regenerative components of the secretome (paracrine factors) and/or of neighbouring support cells. Herein, we emphasize the similarities between the junctions described in co-culture and the junctions identified between TCs and CSCs in situ. Reproducing a CSC niche in culture may represent a viable alternative to mono-cellular therapies.

[Endoprosthetic repair of the abdominal aorta in patients with infrarenal aneurysm and unfavourable anatomy of its proximal neck].

Analysed herein are immediate and remote results of endoprosthetic repair of the abdominal aorta in patients with unfavourable anatomy of its proximal neck. Group I (Study Group) was composed of 31 patients with unfavourable anatomy of the proximal neck, the control group (Group II) comprised a total of 52 patients with no unfavourable anatomical factors. The criteria of assessment were as follows: technical success, adequate position of the endograft, frequency of the development of various endoleaks, duration of the operation and hospital stay, lethality in the remote period, and necessity of secondary interventions. Technical success of endoprosthetic repair was achieved in 100% of patients in the both groups. An adequate position by the proximal end of the coated portion of the endograft was observed in 27 (87.1%) patients of Group I and in 51 (98.1%) patients of the control group (p=0.08). Secondary postdilatation of the endograft's body in the proximal neck was statistically more often performed in the study group of patients. The duration of the operation and hospital stay in the compared groups had no statistically significant differences. In the remote period, patients with unfavourable morphology of the proximal neck were found to develop type I-A endoleaks into the cavity of the aneurysm. By other evaluated criteria such as the total survival rate, secondary interventions, graft migration, type I-B, II and V endoleaks no statistically significant differences were revealed. It was concluded that endoprosthetic repair of the abdominal aorta in patients with unfavourable anatomy of the proximal neck of the aneurysm is associated with admissible immediate, short- and long-term outcomes. Longer follow up is required in order to more adequately asses the reliability of the obtained findings.

[Magnetic resonance imaging in the diagnosis of secondary vaginal tumor involvement].

OBJECTIVE: To estimate the capabilities of magnetic resonance imaging (MRI) in revealing and estimating the extent of secondary vaginal involvement. MATERIAL AND METHODS. Thirty patients with secondary vaginal tumor involvement underwent contrast-enhanced MRI. Examinations were made using a 1.5 T MRI. The protocol encompassed T2- and T1-weighted, diffusion-weighted, and dynamic contrast-enhanced MRIs. To smooth out vaginal wall rigosity, the examination was made using an intracavitary MR-compatible applicator. RESULTS: Vaginal metastatic involvement was detected in 30 patients with sustained malignancies at various sites. The largest group consisted of 16 (53.3%) patients with uterine corpus metastases. Secondary vaginal involvement was observed in 11(36.7%) patients with cervix uteri cancer, in 2 (6.7%) patients with progressive ovarian cancer, and in 1 (3.3%) patients with rectal cancer. With a significant tumor volume giving rise to thickening of the vaginal wall or its impaired slice differentiation, the portion of an inhomogeneously increased MR signal portion during T2-weighted MRI, which intensively accumulated the paramagnetic in an arterial and venous phase of dynamic contrast-enhanced MRI, was detected. There were no T2-weighted images of a hypointense muscular layer and paravaginal fat streaks during an invasive process. In our investigation, vaginal metastatic tumors which were enclosed by the mucous membrane and evident as shallow erosion, as shown by the data of clinical and histological examinations, had no specific MRI signs in any of the pulse patterns, which is likely to be associated with the resolution of this technique. CONCLUSION: The proposed protocol of comprehensive magnetic reso nance imaging makes it possible to clearly localize a tumor process into the vagina and to determine the volume and pattern of involvement in most patients, including whose who have a history of antitumor treatment.

[TREATMENT OF COLORECTAL CANCER COMPLICATED BY INTESTINAL OBSTRUCTION USING THE METHOD OF <> RECOVERY].

A medical trend which is currently gaining strength includes the complex treatment based on the concept of "fast-track" recovery in oncology. An application of modem high-tech approaches allowed minimizing the terms of treatment, shortening economic costs and getting the highest final results. It provides a high quality treatment. Given method could exclude an interim treatment stages, sufficiently reduces terms of general treatment and rehabilitation of patients and could succeed in high quality of life for the patients in short- and long-term period. The authors present the results of successful clinical surgery of 78 patients using this method in public health.

[First Results of Analysis of Russian Part of the European Register on Cardiac Rehabilitation EuroCaReD (European Cardiac Rehabilitation Database)].

The joint European Registry of patients with cardiovascular diseases participating in cardiac rehabilitation programs (European Cardiac Rehabilitation Database, EuroCaReD) is conducted in collaboration between the ESC and EACPR). It's main goals were to improve the routine use of cardiac rehabilitation, to develop joint standards for cardiac rehabilitation in all European countries and evidence based rehabilitation programs and to monitor any changes. In the EuroCaReD registry participated a total of 44 centers from 13 countries, including 3 centers from Russia, which enrolled 151 patients during 2010-2012. This paper is comparing the baseline demographics, clinical data and risk factors in Russian patients versus the rest of Europe. It was shown that cardiac rehabilitation patients in Russia, as in the whole cohort, are predominantly male. Elderly patients from Russia were 3 times less likely to be referred for rehabilitation than in Europe. Unlike the whole cohort Russian patients were almost never sent to rehabilitation because of heart failure or stable angina. Likewise the whole Europe Russian patients had an average of 3 cardiovascular risk factors before rehabilitation, but with some national differences in their prevalence and severity.

[CLINICAL AND PHARMACOLOGICAL FACTORS INFLUENCING RESISTANCE TO CLOPIDOGREL IN PATIENTS WITH CARDIOVASCULAR DISEASES].

We analysed clinical and pharmacological factors influencing resistance to clopidogrel in 250 patients with cardiovascular diseases during 18 months. It was shown that the risk ofresistance depends on the form of coronary heart disease, carbohydrate metabolism, the AA genotype of CYP2C19*2 and TBS1 genes. The cardiovascular events significantly morefrequently occurred during 12 and 18 months in resistant diabetics and in the patients with an allele lacking the *2/*3 CYP2C9 gene function and AT/TT polymorphism of the thromboxane synthase gene TBS1.

[Conformational states of NADH molecules in hydrated shell under weak electromagnetic irradiation].

The work deals with spectra of capillary waves of water distillate and water solution of NADH and dynamics of NADH under electromagnetic irradiation in the range of millimeters at different space frequencies of surface wave k.

[Effect of original and generic clopidogrel on prognosis in relation to different gene polymorphisms].

AIM: To analyze the influence of clinical and pharmacogenetic factors on the risk of resistance to original or generic clopidogrel and that of cardiovascular events (CVE) during 12 months of follow-up. SUBJECTS AND METHODS: Two hundred and fifty patients admitted to Moscow hospitals in October 2011 to September 2012 were examined. All the patients received clopidogrel. During their stay at hospital, venous blood samples were collected twice (before and 7-10 days after continuous clopidogrel intake). Platelet function was determined by optical aggregometry. A less than 10% reduction in platelet aggregation was taken as a resistance criterion. In addition, CYP2C9 and CYP2C19 gene polymorphisms were investigated. RESULTS: Whether original or generic clopidogrel is used, the level of baseline or post-7-day ADP-induced platelet aggregation (ADP aggregation) fails to affect the risk of its resistance. Evaluation of ADP-induced platelet aggregation in patients with different CYP2C9 and CYP2C19 gene polymorphisms during the administration of original or generic clopidogrel also showed no significant differences in its resistance. During the 12-month follow-up, CVE significantly less frequently occurred as a result of the intake of original versus generic clopidogrel. CONCLUSION: The use of original clopidogrel does not affect the risk of resistance to antiplatelet drugs, but it is associated with the lower incidence of CVE during a year.

[Standard and new regimens of anticoagulation for pulmonary thromboembolism].

The article discusses various options of anticoagulant therapy for pulmonary thromboembolism and the main criteria of medication choice including the use of unfractionated heparin, low-molecular-weight heparins, and rivaroxaban. The data presented are based on the own experience and results of international clinical trials.

[Twelve months results of percutaneous coronary interventions in patients with ischemic heart disease combined with diabetes mellitus using sirolimus and everolimus covered stents].

We included into this study 112 patients with ischemic heart disease (IHD) and concomitant type 2 diabetes mellitus (DM) subjected to percutaneous coronary interventions with stenting. Everolimus and sirolimus eluting stents (EES and SES) were implanted in 54 (group 1) and 58 (group 2) patients, respectively. After 12 months in groups 1 and 2 rates of repeat target lesion revascularizations (TLR) were 5.5 and 8.6% (odds ratio - OR - 0.62, 95% confidence interval - CI - 0.14- 2.74, p = 0.72); acute myocardial infarctions (MI) - 3.7 and 5.2% (OR 0.71, 95% CI 0.11- 4.4, p = 0.94); deaths - 1.85 and 1.7% (OR 1.1, 95% CI 0.1- 17.6, p = 1.0), respectively. There was no significant difference between groups by rate of unfavorable cardiac events (composite of cardiac death, nonfatal MI, and clinically indicated TLR) - 11.1 and 15.5% in groups 1 and 2, respectively (OR 0.68, 95% CI 0.225- 2.059, p = 0.69). Rates of stent thrombosis also did not differ (1.85 and 3.4% in groups 1 and 2, respectively; OR 0.53, 95% CI 0.05- 6.0; p = 0.94). Thus the use of EES and SES in patients with IHD and type-2 DM was equally effective.

[Foix-Alajouanine syndrome, what is it?].

The article contains the description of Foix-Alajouanine syndrome (FAS) from literature. Three our own cases of FAS, which developed in two men and one woman, are presented. An analysis of FAS clinical picture revealed a step-like progression of the disease with a possibility of short-term fluctuation of some focal neurological signs. Five stages of clinical course of FAS were detected. Some peculiar sings of spinal neurovisualization, together with serum and cerebro-spinal fluid (CSF) laboratory examinations, were indicated in FAS. Surgery is first-choice of FAS treatment. Pharmacological treatment with high doses of anticoagulants, together with antiviral therapy (and antibiotics, if necessary), neuroprotectors, antiedematic and symptomatic therapy must be started early. Prevention of thrombotic, trophic and purulent complications is required.