Evaluation of Stromal Vascular Fraction Properties and Histological Changes of Regenerating Tissue during Healing of Radiation-Induced Lesions in the Rectum.

We analyzed the main properties of autologous adipose-derived stromal vascular fraction (SVF) used for the treatment of radiation-induced lesions in the rectum. No statistically significant correlation between the main characteristics of the cell product (cell number, viability) and patient's age or donor area were revealed. The stages and peculiarities of histological changes in the regenerating tissue after injection of autologous adipose tissue cells were analyzed. Morphological changes at the stages of granulation, early and complete epithelialization, and tissue maturation were described.

[Methylation status of line-1 retrotransposon in chromosomal mosaicism during the early stages of human embryonic development].

Early stages of human embryonic development are characterized by spatio-temporal coincidence of events of total epigenetic genome reprogramming and elevated level of mosaic forms of numerical chromosome abnormalities. It is possible that the abnormal reprogramming of various regions of the genome can lead to violations of local epigenetic chromatin organization and gene expression, affecting the correct chromosome segregation during mitosis. In this study, a comparative analysis of the methylation index of LINE-1 retrotransposon, which is largely reflecting the methylation profile of the genome, is performed in placental tissues of spontaneous abortions with complete and mosaic forms of aneuploidy, and with a normal karyotype, as well as in the control group of induced abortions of the first trimester of pregnancy. It was shown that extraembryonic mesoderm and chorionic cytotrophoblast of spontaneous abortions with chromosomal mosaicism are characterized by the highest index of LINE-1 methylation among all groups studied. At the same time excessive hypomethylation of transposable genetic element recorded in spontaneous abortions with normal karyotype. It is suggested that violations of parental genomes demethylation during epigenetic reprogramming at preimplantation stages of development may be associated with an increased frequency of mitotic errors in chromosome segregation, leading to the formation of a mosaic karyotype.

[Hypercoagulation syndrome in multiple myeloma].

AIM: To determine the frequency and pattern of blood clotting disorders in patients with multiple myeloma (MM) and to evaluate the adequacy of preventive anticoagulant or antiaggregant therapy. SUBJECTS AND METHODS: The prospective study conducted at the Department for High-Dose Chemotherapy and Bone Marrow Transplantation, Hematology Research Center, Ministry of Health of the Russian Federation, in March 2012 to May 2013, enrolled 25 patients (13 men and 12 women) aged 29-72 years (median age 54 years) with new-onset MM. The latter was staged using the Durie-Salmon classification: Stages I, II, and III were determined in 2, 10, and 13 patients, respectively. Seven patients were found to have renal dysfunction (which corresponded to Substage B). The hemostasis was evaluated from the results of the following tests: activated partial thromboplastin time (APTT), thrombin time (TT), Xlla-dependent fibrinolysis time, Quick prothrombin index, international normalized ratio (INR), and fibrinogen and D-dimer concentrations. The investigators used new hemostatic techniques, such as thrombin generation test, thromboelastography, as well as thrombodynamics, a novel method to determine the characteristics of spatial clot growth. Induction therapy was performed using the PAD and VCD regimens. Thromboses were prevented by using 24-hour infusion of unfractionated heparin (500 U/hr) or by administering aspirin (100 mg/day). RESULTS: Hypercoagulability was identified in 17 (68%) patients. Eleven (44%) patients had elevated D-dimer concentrations. The level of D-dimer was statistically significantly positively correlated with the endogenous thrombin potential and the amount of beta2-microglobulin. The thrombodynamic technique revealed an inverse relationship between the level of paraprotein and the optimal density of a fibrin clot. A thrombotic episode was seen in one elderly (71-year-old) patient after aspirin discontinuation during long-term immobilization. CONCLUSION: Nearly 50% of the primary patients with MM were ascertained to be more prone to thrombosis. Infusion of unfractionated heparin in a dose of 500 U/hr or administration of aspirin (100 mg/day) was the adequate prevention of thrombotic events.

[The phenomenon of vascular microthrombosis in mucoperichondrium associated with plastic closure of nasal septum perforations].

The objective of the present study was to identify specific hematological features characterizing the pathophysological processes of clinical significance associated with plastic closure of nasal septum perforations. Changes of clinical, biochemical, and coagulation-related blood characteristics developing as a result of the surgical treatment of the patients with ENT pathology were analysed. It was shown that D-dimer is a specific hematological characteristic that reflects the phenomenon of postoperative vascular microthrombosis in mucoperichondrial-periosteal flaps associated with plastic closure of nasal septum perforations. Based on the results of this study, the authors recommend to prescribe low-molecular weight heparins for prophylactic purposes to the patients undergoing plastic closure of nasal septum perforations.

[Correction of metabolic disorders during treatment of alcohol-induced liver injuries in patients with acute alcoholic intoxication].

A total of 103 patients with acute alcoholic intoxication were examined and treated for alcohol-induced hepatic lesions. It was shown that remaxol reduced severity of metabolic disorders associated with hypoxic conditions and active lipid peroxidation and thereby decreased the frequency of alcoholic delirium to 10.8% (n=7) compared with ademetionine (10.8%, n=22). Improvement of metabolism resulted in the reduction of stay in the intensive therapy ward by 5.6+/-0.3 and 7.3+/-0.6 days after remaxol and ademetionine therapy respectively). The total duration of treatment decreased by 9.0+/-0.4 and 11.8+/-1.1 days. The use of remaxol reduced the cost of the treatment by 21.7% compared with ademetionine.

[Cryodestruction in neurosurgery].

The study aimed to work out the method of cryodestruction of brain tumors. 10 patients with neuroepithelial brain tumors were prospectively operated on with the use of cryodestruction. MRI was performed before and after the operation. The operation strated from tumor biopsy under the ultrasound control with further injection of cryoprobe with further destruction. The study demonstrated that ultrasound navigation is an effective means of the cryodestruction control on all stages. The cryodestruction itself is a miniinvasive, easily controlled and effective method, applicable for tumors, located in functionally important regions of the brain, where major surgery could be mutilating.

[A case of favourable outcome of the treatment of extremely severe acute poisoning with methanol].

A case of favourable outcome of the treatment of extremely severe acute poisoning after prolonged exposure to lethal doses of methanol is reported. The complex treatment included urgent and effective elimination of the poison (multiple gastric lavage, hemodialysis), antidote therapy (administration of ethanol), correction of decompensated metabolic acidosis (alkali therapy and infusion therapy with reamberin). These measures had beneficial effect on the clinical course of poisoning and ensured its favourable outcome.

[Experience with outpatient treatment for thromboses and thrombophilias].

AIM: To evaluate the efficiency of diagnosis and treatment of thromboses in patients with thrombophilia in an outpatient setting. SUBJECTS AND METHODS: One hundred and seventy-two patients with different forms of thrombophilic states were examined. One hundred and thirty-two patients were found to have genetic mutations, of them 125 patients had multiple mutations. Thromboses were diagnosed in 130 patients with genetic disorders. RESULTS: The most common laboratory markers of thrombophilias were hyperhomocysteinemia (55%), sticky platelet syndrome (41%), and laboratory findings of antiphospholipid syndrome. Thrombogenic mutations, such as plasminogen activator plasminogen inhibitor-1 (73%), methylene tetrahydrofolate reductase (60%), platelet glycoprotein 1a receptors (50%), and fibrinogen (42%), were most often diagnosed. The efficiency of treatment was shown to largely depend on the duration of an initial thrombotic process. CONCLUSION: Outpatient treatment for thromboses is more economical and comfortable for patients. To avoid hospital admissions, it is necessary to time detect the disease and to start its treatment as soon as possible. The concurrent use of ultrasonography, genetic and laboratory diagnostic methods accelerates the identification and localization of the pathology, which facilitates its treatment and frequently rules out the need for patient hospitalization.

[The use of remaxol in combined intensive therapy of acute mushroom poisoning].

A case of very severe mushroom poisoning is reported. Traditional hepatoprotective therapy with ademethionine, ornithine-aspartate, and essential phospholipids failed to ensure positive dynamics of the hepatic and general functional state. Hepatic insufficiency was complicated by cerebral oedema and swelling, bilateral pneumonia, and acute respiratory distress of mixed genesis. Combined therapy with remaxol and ornithine aspartate produced beneficial effect, resulted in the improvement of the patient's condition and favorable outcome of the life-threatening intoxication.

[Features of clinical way and treatment of old and senile patients with severe poisoning with carbon monoxide and the products of combustion].

The article presents the materials obtained in the course of treatment of 64 patients with severe poisoning with carbon monoxide and the products of combustion. It is established that acute carbon monoxide poisoning and combustion products in elderly and senile age is accompanied by more pronounced metabolic disorders, higher frequency of complications and lethality. Intensive therapy of severe poisoning with carbon monoxide has its own peculiarities. The use of Cytoflavin with antihypoxic purpose can lead to the development of metabolic desynchronization. To correct the hypoxic disorders in elderly and senile patients is more appropriate to use Reamberine, not having a negative effect on the indices of central hemodynamics and effectively reducing the depth of metabolic disorders.

[Characteristics of perioperative period in Xenon-based combined general anaesthesia in neurosurgery].

Neuroprotection could be the aim to use Xenon for general anesthesia. However the experience of Xenon anesthesia in neurosurgery is quite limited. The appraisal of Xenon based anesthesia was accomplished in 12 patients during various brain surgery. Xe in concentration 65% was used to maintenance of anesthesia, other medication was avoided. As a resuIt there were 8 cases of arterial hypertension and 2 cases of superficial hypnotic state. Excitation (n = 3), hyperdynamic reaction (n = 8), PONV (n = 8) were detected in early postoperative period. An analysis of this study suggests a conclusion that studied method of Xenon-based anesthesia is inexpedient for neurosurgery.

[The problem of hemorrhagic syndrome in its treatment with vitamin K antagonists (a review of literature)].

Vitamin K antagonists (warfarin, syncumar, phenylin, etc.) are commonly used to treat and prevent thrombotic diseases. The risk for varying degrees of hemorrhagic syndrome (intracranial hemorrhage in particular) is the most important problem in the use of drugs from this group. The rapid neutralization of the effects of used anticoagulants, which is verified by correcting the international normalized ratio (INR), is required in these cases and when emergency surgical interventions are needed. Transfusions of prothrombin complex concentrates (PCCs) in combination of vitamin K preparations are optimal for this purpose. The reason for the rational use of PCCs to promptly correct INR is the balanced composition of this transfusion medium (a combination of blood coagulation factors and biological anticoagulants). This regimen for emergency correction of INR minimizes the risk of thrombotic events.

[Pharmacologic correction of hypoxia in patients with acute cerebral failure due to acute poisoning with carbon monoxide and combustion products].

The article deals with the materials, which have been received in the process of the examination and treatment of 48 patients with acute severe carbon monoxide and burning products poisonings on fires. It has been registered that the including of citoflavin into the complex program of the intensive therapy of acute severe carbon monoxide and burning products poisonings on fires leads to a decrease of hypoxia and manifestations of acute toxicohypoxic cerebral deficiency, which significantly improves the clinics of acute severe poisonings.

[Pecularities of correction of alcohol affctions of liver in patients with acute ethanol poisoning in the setting of consequence of toxic effect of ethanol].

The aim of this work was to test the usage of infusion of hepatoprotector "remaxol" in intensive therapy of acute ethanol poisoning accompanied with severe alcohol affections of the lever. In the result of the examination and treatment of 130 patients it was established that severe alcohol poisonings registered on alcohol abused patients with toxic hepatopathy, are always accompanied with serious metabolic violations. In the process of a comparative valuation of the using of heptral (ademethionin) and remaxol in the intensive therapy of alcohol poisonings it has been revealed that the using of remaxol led to improvement of the clinic of that poisonings, what had been registered as a decrease of frequency and duration of an alcohol delirium from 33,9% to 10,8%, a decrease of frequency of secondary lung complication from 18,5 to 3,1%, a decrease of a duration of treatment in intensive care unit from 7,3 +/- 0,6 to 5,6 +/- 0,3 and a hospital treatment duration from 11,8 +/- 0,5 to 9,0 +/- 0,3 days. Biochemical investigation has shown that using as heptral, as remaxol led to improvement of lever damages due to alcohol. However remaxol compared with heptral was better in the treatment of metabolic violations.

[Fibrinolysis system in patients with sepsis in state of myelotoxic agranulocytosis].

PURPOSE: Hemostasis disorders are the part of multiple organ failure (mOF) in sepsis. This work objective is to evaluate the system parameters in septic patients. PATIENTS AND METHODS: 55 oncohaematological patients were included in study: 45 with sepsis and 10 patients in control group (no signs of infection). Septic patients were subdivided into septic patients without multiple organ failure, patient with multiple organ failure and patients with septic shock. The C-reactive protein (CRP), procalcitonine (pCT), interleukine-6 (IL-6) serum concentration and fibrinolysis parameters were measured Patients were examined daily during first 5 days, later once a week during 28 days, control group was examined one time. RESULTS: Levels of CRP IL-6 and PCT were raised since 1st day. PCT and IL-6 concentrations were higher in sepsis and MOF group and septic shock group, than in sepsis without MOF group. CRP was raised in all patients. PCT went to normal at 7th day, CRP and IL-6 have started to decrease after 7th day, but both were higher than in control group. T-PA and plasmin inhibitors were comparable to control group and haven't changed significantly. Septic shock patients and patients with MOF have shown a decrease of plasminogen activity. Patients without MOF have shown an initially decreased plasminogen activity, but after 2 days it was similar to control group. PAI-I activity was increased only in septic shock and MOF groups in first days, and was similar to control group in cases of no MOF. Exended XIIa-dependent fibrinolysis time in average was present in all septic patients since 1st day, and extended twice in MOF and septic shock groups. Clot lysis time tended to decrease starting from 8th day, but it was longer than in control group till 28th day. A raised D-dimer concentration compared to control group was present in 75% of patients, but no difference was found among subgroups. A raised D-dimer serum concentration was relevant for prognosis. CONCLUSION: The most sensitive diagnostic test in sepsis is XIIa-dependent fibrinolysis. Plasminogen and PAI-I activity changes are mostly present inpatient with MOF and septic shock. The 28-day survival rate was 60% in MOF and septic shock groups and 95% in no MOF groups. A raised D-dimer concentration was found in 75% of septic patients.

[Pharmacological correction of hypoxia in patients with severe carbon monoxide poisoning].

The article deals with the materials, which have been received in the process of the examination and treatment of 44 patients with acute severe methadone poisonings. It has been revealed, that gravity of these patients' condition depends on the intensity of hypoxia due to breath deficiency because of methadone. The development of hypoxia, in its turn, causes violations of antiradical protection system and intensification of processes of peroxide lipid oxidation. It has been registered that the including of reamberin into the complex program of the intensive therapy of acute severe methadone poisonings leads to a more rapid restoration of antiradical protection system and to a decrease of activity of processes of peroxide lipid oxidation. The correction of hypoxia and free-radical violations led to the improvement of the acute poisonings clinics, what was characterized by a decrease of coma-period duration, duration of treatment with artificial lung ventilation, a decrease of secondary lung complications and a decrease of lethality.

[Comparative evaluation of clinical efficacy of drugs remaxol and ademetionine in patients with acute ethanol poisoning complicated by the toxic damage of the liver].

As a result of survey in process of treatment of 100 patients with severe acute poisoning of ethanol on the background of the toxic damage of the liver set that the severity of poisoning depends on the duration abuse of alcohol (Binge drinking). Inclusion in the intensive care infusion hepatoprotector remaxol compared with ademetionine leads to a faster dynamics of improvement of the patients condition, evaluated by the scale assessing the severity APACHE II. Also found, Use of remaxol can reduce development of complications such is alcoholic delirium on the background of long-term abuse of alcohol in percentage from 31.9% to 16%, as well as reduces the time of stay of patients in the departments of the resuscitation and intensive care unit from 7,3±0,6 to 5,6±0,3 days and duration of treatment of patients in the hospital from 11,8±1,1 to 9,0±0,4 days.

[Pharmacological correction of toxic liver damage in patients with heavy forms of acute ethanol intoxication].

The efficiency of using remaxol and ademethionine in the therapy of patients with heavy acute alcohol intoxication on the background of toxic liver damage has been studied. The administration of remaxol led to improvement of the clinical treatment of alcohol intoxication, which is manifested by a decrease in the rate and duration of delirium tremens (from 33.9 to 10.8%), frequency of secondary lung disorders (from 18.5 to 3.1%), duration of stay in hospital (from 7.3 +/- 0.6 to 5.6 +/- 0.3 days), and total therapy duration (from 11.8 +/- 1.05 to 5.6 +/- 0.3 days). The results of biochemical investigations confirmed that remaxol and ademethionine provide effective treatment of the toxic liver damage. Remaxol decreases the degree of metabolic disorders to a greater extent than does ademethionine.

[Correction of mnestico-intellectual disturbances in the somatogenic phase of acute poisoning with a mixture of psychotropic drugs].

A total of 60 patients suffering acute poisoning with a mixture of psychotropic drugs were available for observation. The study focused on comparative estimation of reintegration of psychic conditions (recovery of consciousness, conceptualization of mnestico-intellectual functions) in these patients. It was shown that intensive therapy of toxic and hypoxic brain lesions with antihypoxic agent cytoflavin results in rapid and effective reintegration of psychic activity including recovery of consciousness and conceptualization of mnestico-intellectual functions.

[Characteristics of the pharmacological treatment of toxic liver damage in patients with an alcohol abused syndrome and an acute severe ethanol poison].

The examination of 130 patients with an alcohol abused syndrome and a severe ethanol poison have revealed that ethanol action are accompanied by significant metabolic disturbances. The comparative evaluation of the inclusion of heptral and remaxol in the treatment has shown that remaxol improves the clinical course of mentioned disorders decreasing the frequency and duration of alcohol delirium. Patients treated with this drug spent less time in acute care and their treatment duration was shorter. Remaxol reduces more effectively the severity of metabolic disorders.