Efficacy of distal haemostasis during caesarean delivery in women with placenta accreta spectrum disorders.

Pregnancies complicated by the placenta praevia are associated with an increased risk of massive obstetric bleeding and high rates of hysterectomy which are often caused by the placenta accreta. The aim of our study was to identify the risk factors for placenta praevia associated with PAS disorders and the efficacy of distal haemostasis during Cesarean delivery. METHODS: This was a cohort study carried out between 2014 and 2020 in 532 women with abnormal placental localization and attachment. The placental attachment spectrum (PAS) disorder diagnosis was confirmed during the surgery and by the histology results in 164/532 participants. Depending on the surgical approach during the Cesarean delivery, patients were divided into three groups. In Group 1 (n = 52), patients underwent bilateral uterine artery ligation. In Group 2 (n = 33), we used the combined compression haemostasis approach including the placement of tourniquets and insertion of an intrauterine balloon for controlled tamponade. In Group 3 (n = 79), we used the combination of surgical haemostasis with the controlled intrauterine tamponade using the vaginal and intrauterine Zhukovsky balloon. RESULTS: PAS was observed in 30.8% of the placenta praevia cases, and in 93.3% was associated with the presence of a uterine scar. Women with the placenta praevia and PAS had a significantly higher number of past deliveries (р = .001). According to the FIGO classification, 53.8% of women with placenta praevia observed during the Cesarean had РА1 and 46.2% PA2. With regards to the PAS disorders observed in 30.8% of patients, 38.4% had PAS3, 34.7% PAS4, 18.3% PAS5 and 8.5% PAS6. The histology analysis showed normal placental attachment in 42.9% of the total number of study participants, placenta accreta in 28.2%, placenta increta in 16.7%, and placenta percreta in 12.2%. In Group 1, we performed the resection of uterine wall with the attached portion of the placenta in 13.5% of women, in Group 2 in 30.3% women, and in Group 3 in 50.6% women. There was a significant 4.8-fold reduction in the number of hysterectomies in Group 3 versus Group 2 (р = .043) and a 4.4-fold reduction in Group 2 versus Group 1 (р = .003). In Group 2, the volume of blood loss was 1.3-fold lower and in Group 3 1.5-fold lower than in Group 1. Conclusion: The techniques of compression distal haemostasis evaluated in this study in women with PAS are efficacious in the reduction of adverse maternal outcomes and should be used more widely in clinical practice.

Analysis of risk factors and predictors of pregnancy loss and strategies for the management of cervical insufficiency in pregnant women at a high risk of preterm birth.

AIM: To identify risk factors and predictors of pregnancy loss and to compare the efficacy of Arabin's pessary with cervical cerclage in women at a high risk of pregnancy loss. MATERIALS AND METHODS: This was a two-center retrospective case-control study that included 240 women at a high risk of preterm delivery. Group I (n = 161) included women who underwent insertion of the Arabin's pessary between 14 and 24 weeks of pregnancy. Group II (n = 79) included women who had undergone circular cervical cerclage during the current pregnancy. All women included in the study received micronized vaginal progesterone at the dose of 200 mg/day until and including 34 weeks of gestation. RESULTS: Threatened pregnancy loss defined as spotting or vaginal bleeding in the first trimester was diagnosed in 29.8% (48/161) of patients in Group I versus 37.9% in Group II (p = .448). Postpartum bleeding occurred in 8.1% (13/161) in women in Group I versus 22.8% in Group II (χ2 = 6.500; p = .011). Our study showed that cervical cerclage was most suitable for patients with history of obstetric complications, cervical length <15 mm, and large isthmic uterine fibroids. The use of the Arabin's pessary reduced the rate of preterm births by 1.7-fold. A cluster analysis demonstrated that predictors of preterm birth in women with a high risk of pregnancy loss included: threatened pregnancy loss associated with chorionic/placental abruption, cervical incompetence, uterine fibroid growth to a large size, history of multiple spontaneous pregnancy losses, cervical tears during past labor, and gestational diabetes diagnosed for the first time during the current pregnancy. CONCLUSIONS: Women with a high risk of pregnancy loss treated with Arabin's pessary or cerclage plus vaginal progesterone had a term delivery rate of 70.4% (169/240). The combined strategy of pregnancy management allowed to markedly reduce the number of preterm births.

PREDICTORS OF FATAL OUTCOME IN PATIENTS WITH HEMORRHAGIC SHOCK IN GASTROINTESTINAL BLEEDING.

This work aimed to reveal the statistically reliable clinical and laboratory markers, which are associated with fatal outcomes in patients with hemorrhagic shock of the III degree on the stage of hospital treatment. It was stated that decrease of body temperature (till 35,9 °C), pH of venous blood (till 7,19) and content of ionized calcium (till 0,32 mmole/l) in venous blood and increase of lactate content (up to 4,1 mmole/l) in venous blood and rise of activated partial thromboplastin time (up to 59 sec) are connected with fatal outcomes.

[Clinical variations of chronic generalized periodontitis, genetic polymorphism and systemic production of inflammatory cytokines].

Carriage of polymorphic alleles of genes of cytokines-interleukines IL-1ß, IL-1RN, TNFα, IL-4 can be a specific feature of chronic periodontitis patients. Genetic tests can be used to predict the course of the disease at its early manifestations. Objective: To establish the relationship of clinical manifestations of periodontal disease, inflammatory cytokines gene polymorphism and systemic levels of cytokine production. Periodontal tissue assessment and cone-beam computed tomography (CBCT) were performed in 150 periodontitis patients. A molecular--genetic testing for the presence of polymorphic alleles of genes IL-1ß -511 C>T and +3953 C>T, IL-1RN (VNTR intron 2), IL-4 (VNTR intron 3), TNFα-308 G>A; content determined IL-1ß, TNFα, IL-4 in peripheral blood was carried out in 150 patients with periodontitis and 150 healthy donors. Based on the analysis of the speed and nature of the supporting bone resorption and clinical manifestations patients are divided in "aggressive", "moderately progressive" and "slowly progressive" periodontits course groups. Disease severity was associated with distribution of genotypes and alleles of polymorphic genes cytokine IL-1RN (VNTR intron 2), TNFα-308 G>A and IL-4 (VNTR intron 3); haplotype IL-1ß-511 TIL-1ß +3953 T/IL-1RN 2R. There was no statistically significant difference in systemic level of IL-1ß, TNFα and IL-4 between periodontitis groups but the donor level of cytokines was 2-4 times less.

[Influence of methanol on the content of NAD(P)H, free amino acids and protein in the cells of Chlamydomonas reinhartdii].

It is known that the addition of methanol to the culture medium stimulates the photosynthetic productivity of some species of microalgae, but its influence on the biochemical composition of the biomass has not been investigated. The aim of the present work is to determine the effect of methanol (50 mM) on the content of free amino acids, soluble proteins and reduced nicotinamide coenzyme NAD(P)H in C. reinhartdii cells. It is shown that in case of illumination of C. reinhardtii methanol raises intracellular content of NAD(P)H four times more efficiently than in the darkness. Total content of free amino acids is increased and their ratio is changed. The concentration of glutamic acid, glutamine, alanine, serine and tyrosine also increases. The concentration of valine and methionine is reduced. Growth of culture with methanol is followed by an increase in the content of intracellular protein by 30% after 20 hours of cultivation. The obtained data indicate that methanol stimulates growth of C. reinhardtii, not only as a result of additional carbon utilization, but also due to improved nitrogen assimilation and the impact on the energy metabolism of cells.

[First experience of application of assist circulation device using biventricular type "excor"].

The frequency of use of assist blood device as the "bridge" to the heart transplantation increased in last years. An assessment of results of first 7 implantations of assist circulation device using biventricular type "Excor" was made. The implantations were performed in Federal Almazov centre of the heart, blood and endocrinology. An observation period after implantation was since 11 till 301 days. The heart transplantation of 4 patients was carried out in different terms after implantation. One of the patients passed away on the fifth day due to the pulmonary embolism. Another patient died on the eleventh day after the implantation because of multiple organ failure against the background of severe chronic cardiac failure. The waiting list of heart transplantation includes 2 patients.

[The first experience with heart transplantation in the Federal Center of the Heart, Blood and Endocrinology named after V. A. Almazov].

At the present time heart transplantation is considered to be the operation of choice in treatment of patients with terminal stage of chronic heart failure. Results of the first 5 heart transplantations made in the Federal Center of the heart, blood and endocrinology named after V. A. Almazov are assessed. There were no perioperational lethality and complications at the hospital stage. An analysis of the long-term results has shown effectiveness of heart transplantations in treatment of severe heart pathology.

[Methanol metabolism in plants].

Methabolism of methanol in plant organisms is considered in the paper. Enzymes of consecutive oxidation of methanol and enzymes responsible for incorporation of carbon from methanol molecule to methyl groups of phospholipids, carboxylic acids and carbohydrates have been described. The peculiarity of plant organisms is in interaction of reactions of methanol transformation with pathways of photorespiration and C1-metabolism and in the capacity to use methanol carbon to form organic matter through photosynthesis. The inclusion of methanol metabolites in anabolic processes occurs at the level of formaldehyde and formiate. As a result, exogenous methanol at low concentrations can stimulate the photosynthetic efficiency of plants.

Synaptic plasticity of the neocortex of white rats with diffuse-focal brain injuries.

Studies on white mongrel rats addressed the reorganization of the synaptoarchitectonics of layer I of the cerebral cortex in diffuse-focal injuries. The experiments used models of acute arrest of the systemic circulation (clinical death) resulting from exposure to mechanical asphyxia for 6 min, clamping of the common carotid arteries for 20 min (ischemia), and imposition of sublethal rotatory trauma by the Noble-Collip method (craniocerebral trauma). Electron microscopy and morphometric analysis showed that reductions in the total number density of synapses were accompanied by changes in the relative and absolute contents of the major types of synaptic apparatuses. There were increases in the numbers of large simple and perforated contacts and synapses with invaginated synaptic membranes, mitochondria, and spine apparatuses. These changes were interpreted as the structural basis for the mechanisms of synaptic plasticity in diffuse-focal brain injuries.

[Synaptic plasticity of neocortex of albino rats in diffuse-focal injuries of the brain].

In an experiment conducted using mature albino rats, the regularities of reorganization of synaptic architectonics of cortical layer I of the brain were studied in the areas of diffuse-focal injuries. The models of acute break of systemic circulation (clinical death) as a result of 6-minute-long mechanical asphyxia, compression of common carotid arteries for 20 min (ischemia) and rotatory sublethal injury according to Noble-Collip method (cranial trauma), were used. Using the methods of electron microscopy and morphometric analysis, it was shown that a reduction in a general numerical density of synapses was accompanied by the changes in relative and absolute numbers of major variants of synaptic organization. The content of large simple and perforated contacts was increased, as well as of synapses with invaginated synaptic membranes, containing mitochonria and spine apparatus. The changes detected are considered as a structural basis for realization of the mechanisms of synaptic plasticity in diffuse-focal injuries of the brain.

[Local sorption-detoxication therapy in combined treatment of acute purulent paraproctitis]. / Mestnaia sorbtsionno-detoksikatsionnaia terapiia v kompleksnom lechenii ostrogo gnoinogo paraproktita.

Efficacy of sorption-detoxication therapy (sorbent SUMS-1) in combined treatment of acute purulent paraproctitis was evaluated. Degree of endotoxication, state of postoperative wound, structural and morphological state of mucosous membrane of the rectum (light, electron microscopy, morphometry of biopsies) were studied. It was found that local use of sorbent increases efficacy of treatment of severe paraproctitis: endotoxicosis eliminates, regional hemo- and lympho-circulation improves, wound regeneration activates.

[Structural changes in dendritic spines of the pyramidal neurons of layer III of the rat sensory-motor cortex during remote postischemic period]. / Strukturnye izmeneniia dendritnykh shipikov piramidnykh neironov sloia III sensomotornoi kory bol'shogo mozga krys v otdalennom postishemicheskom periode.

The combination of Golgi method with the lipid phosphorilate mark Dil (1,1'-dioctadecyl-3,3,3 cents, 3 cents-tetramethyl-indocarbocyanine perchlorate) and confocal laser scanning microscope for demonstration of the structure of dendritic tree and dendritic spines enables exact determination of spatial organization of small dendrites and their spines at significant distances in norm and especially in postischemic period. The regularities of dendritic spine reorganization in layer III pyramidal neurons of the cerebral sensory-motor cortex during 9 months after short-term (10 min) total brain ischemia were established.

Effect of transplantation of embryonic nervous tissue on reorganization of interneuronal relationships after mechanical damage to sensorimotor cortex.

The effect of implanted embryonic nervous tissue on restoration of axonal connections in the cerebral cortex after mechanical injury was studied on albino rats using fluorescent lipophilic probe DiI (1,1'-dioctadecyl-3,3,3',3'-tetramethyl-indocarbocyanine perchlorate) and confocal laser scanning microscope. Implantation of embryonic tissue to damaged area promotes the growth of axons through the transplant to adjacent tissue. The damaged area is impenetrable for axons growing without implantation.

Hypertrophic synapses as a factor of formation of persistent pathological centers in the brain in the late postresuscitation period.

Clinical death was modelled on albino rats. Synapses in the molecular layer of the cerebral sensorimotor cortex were investigated 1, 2, 3, 4, 5, 6, 7, 8, and 9 months postresuscitation. The total density of synapses peaked and the number of hypertrophic and perforated contacts increased 4, 7, and 9 months after resuscitation. The role of increased number of hypertrophic and perforated contacts in the pathogenesis of postresuscitation encephalopathy is discussed.

[Postischemic reorganization of dendritic architectonics of the hippocampal CA3 region in albino rats predisposed to seizures]. / Postishemicheskaia reorganizatsiia dendritoarkhitektoniki sektora CA3 gippokampa belykh krys s vysokoi sudorozhnoi gotovnost'iu mozga.

Total short term ischemia of brain was induced experimentally in albino rats (10 min long clamp of heart vascular bundle). Using Golgi Silver nitrate impregnation geometry of pyramidal neurons dendritic tree was studied in sector of hippocampus in norm, postischemic period (d 1.30 and 90) healthy animals and those predisposed to cramps. Significant reduction of dendrite volume, total length, dendrite territory, parameters of dendrite arborization were shown on the background of stable numerical density of neurons in all animals who survived brain ischemia. The extent of reduction, volume and duration of changes of parameters of dendritic tree geometry was higher in animals predisposed to cramps than in high threshold animals without cramps. Possible mechanisms of postischemic neuron "epileptization" were discussed.

[Regularity of synaptic contacts forming in the molecular layer of the cerebral cortex after brief total brain anoxia]. / Zakonomernosti formoobrazovaniia sinapticheskikh kontaktov v molekuliarnom sloe kory mozzhechka posle kratkovremennoi total'noi anoksii mozga.

By the end of 10 and 90 min long total brain anoxia and on 1st, 3rd, 7th and 30th postanoxic days numerical density of synapses, shape and size of presynaptic dense projections (DP), curvature of synaptic contacts plane in molecular layer of cerebellar cortex were studied in control albino rats. Dependence between shape and extent of alterations of curvature of synaptic contacts and parameters and shape of DS was established. Maximum positive curvature of plane of synaptic contacts corresponded with maximum distance between DP, minimum height and spherical shape of DP. Maximum decline in numerical density of synapses and extent of curvature of synaptic contacts plane were found in zones of irreversible postanoxic damage of Purkinje cells.

[A comparison of the convulsive readiness of the brain, of long-term memory and of learning capacity and their structural equivalents in the postresuscitation period]. / Sopostavlenie urovnia sudorozhnoi gotovnosti mozga, dolgovremennoi pamiati, sposobnosti k obucheniiu i ikh strukturnye ékvivalenty v postreanimatsionnom periode.

Clinical death of asphyxia was modelled in white rat experiments. After resuscitation passive avoidance tests were made to assess audiogenic convulsive readiness of the brain, the ability to learn and long-term memory. The experiments were made for 66 days. Light and electron microscopy studied cyto- and synaptoarchitectonics of the cerebrum sensomotor cortex. Deterioration of learning ability, enhancement of convulsive readiness of the brain and long-term memory were found. Changes in the long-term memory and convulsive readiness of the brain correlate with an increase in the number of large synaptic contacts.