Risk factors of venous thromboembolism after incisional ventral hernia repair.

BACKGROUND: The problem of venous thromboembolic events (VTE) after incisional hernia repair remains relevant. According to the literature the frequency of VTE ranges from 0.2 to 4.2%. The data on risk factors of VTE in this cohort of patients are scarce. Aim of our study is to find frequency and risk factors for VTE development in patients who underwent surgery for incisional ventral hernia. MATERIALS AND METHODS: There were 240 patients enrolled in our retrospective study. We included patients, who were operated for incisional hernia in Saveljev University Surgery Clinic from January 2018 to December 2019. Compression duplex ultrasound of lower extremity veins was performed within median 3 days (min 1 day, max 7 days) after surgery for all participants. The primary endpoint was the occurrence of the VTE event, including deep venous thrombosis (DVT) and pulmonary embolism (PE). RESULTS: VTE was detected in 19 patients, which accounted for 7.9% in analyzed cohort. All patients received standard pharmacological prophylaxis. There were 3 (1.3%) proximal, 16 (6.7%) distal DVT, in one patient (0.4%) distal thrombosis was complicated by symptomatic pulmonary embolism. In multivariate Cox proportional hazard model was found that component separation (HR 3.99, 95% CI 1.14-14.0, p = 0.03), duration of operation in hours (HR 1.67. 95% CI 1.13-2.5, p = 0.011) and body mass index (HR 1.13, 95% CI 1.02-1.2, p = 0.02) were statistically significant risk factors. CONCLUSION: The incidence of postoperative VTE in patients after incisional hernia repair is high with a predominant distal DVT as a thrombotic event. Component separation, duration of operation and body mass index are statistically significant factors of VTE in patients undergoing surgery for incisional hernia.

Prevalence and risk factors for abdominal wall hernia in the general Russian population.

PURPOSE: To find out the prevalence and risk factors for abdominal wall hernias in the general Russian population. METHODS: 783 residents of Kryukovo rural community (Central Russia) of 10 > years were enrolled. Medical history was taken and clinical examination was performed documenting hernia presence. Ultrasound examination was performed in inconclusive situations. We considered residents with hernias at the time of examination, as well as those who had previously undergone hernia repair, to be hernia positive. RESULTS: There were 298 (38%) men and 485 (62%) women (mean age 49.3). Abdominal wall hernias have been found in 20.9% of population. 31.2% of men and 14.6% of women were affected (p < 0.0001). Umbilical hernias was found in 10.2%, groin hernias in 8.3%, incisional in 2.4% of residents. 72% of individuals with hernia reported local pain. 70% had never asked for medical advice before, 30% had undergone hernia repair before. Male gender, age, family history were confirmed as risk factors for any hernia with OR 3.9, 1.03 and 2.7, respectively (p < 0.01). For groin hernias male gender, age, family history and rough labour were confirmed with ORs 9.2, 1.03, 2.9 (p < 0.01) and 2.1 (p < 0.05). Risk factors for umbilical hernias were male gender with OR 2.2 (p < 0.01), age, family history and BMI with ORs 1.02, 1.8 and 1.08 (p < 0.05). CONCLUSIONS: This study is the first to demonstrate prevalence of abdominal wall hernias and its risk factors in Russia. The results confirm that hernias are common in a general population pointing the need for improvement of surgical activity.

Polymorphisms of genes involved in inflammation and blood vessel development influence the risk of varicose veins.

Heredity plays an important role in the etiology of varicose veins (VVs). However, the genetic basis underlying this condition remains poorly understood. Our aim was to replicate top association signals from genome-wide association studies (GWASs) for VVs of lower extremities using 2 independent datasets-our sample of ethnic Russian individuals (709 cases and 278 controls) and a large cohort of British residents from UK Biobank (10 861 cases and 397 594 controls). Associations of polymorphisms rs11121615, rs6712038, rs507666, rs966562, rs7111987, rs6062618, and rs6905288 were validated in the UK Biobank individuals at a Bonferroni-corrected significance level. In Russian cohort, only rs11121615 reached a nominal significance level of P < .05. Results of original GWAS and replication studies were combined by a meta-analysis, and polymorphisms listed above as well as rs111434909 and rs4463578 passed a genome-wide significant threshold. Notably, the majority of these polymorphisms were located within or near genes involved in vascular development and remodeling, and regulation of inflammatory response. Our results confirm the role of these polymorphisms in genetic susceptibility to VVs and indicate the revealed genomic regions as good candidates for further fine-mapping studies and functional analysis. Moreover, our findings implicate inflammation and abnormal vascular architecture in VVs pathogenesis.

Polymorphism of Matrix Metalloproteinases Genes MMP1, MMP2, MMP3, and MMP7 and the Risk of Varicose Veins of Lower Extremities.

We studied the effects of single nucleotide polymorphisms in the promoter regions of matrix metalloproteinase genes rs1799750 (-1607dupG) MMP1, rs243865 (C-1306T) MMP2, rs3025058 (-1171dupA) MMP3, and rs11568818 (A-181G) MMP7 on the risk of varicose vein of the lower extremities in ethnical Russians, residents of the Russian Federation. We genotyped 536 patients with this pathology and 273 healthy participants without history of chronic venous disease. Association was examined using logistic regression analysis. None of the studied polymorphisms showed statistically significant association with the risk of varicose veins of the lower extremities. Our results provide evidence that these polymorphisms are not involved in the pathogenesis of varicose veins and cannot serve as markers of predisposition to this pathology.

Polymorphic Variants rs13155212 (T/C) and rs7704267 (G/C) in the AGGF1 Gene and Risk of Varicose Veins of the Lower Extremities in the Population of Ethnic Russians.

We analyzed associations between single nucleotide polymorphisms (SNP) rs13155212 and rs7704267 in the AGGF1 gene (angiogenic factor with G patch and FHA domains 1) and the risk of risk of varicose veins of the legs in ethnic Russians. Frequencies of alleles, genotypes, and haplotypes were estimated in the sample of patients with this disease (474 patients) and in the control group of participants (478 volunteers) without a history of chronic venous disease. None of the studied polymorphisms was associated with the risk of this pathology. The whole AGGF1 gene sequence lies in a single block of high linkage disequilibrium, and both studied polymorphic variants are representative of all other SNP within this region. From these results, a conclusion was made that AGGF1 gene polymorphism does not affect the risk of varicose veins of the legs in ethnic Russians, or its contribution is low and can be revealed only after analysis of larger cohorts.

Improved Adeno-associated Viral Gene Transfer to Murine Glioma.

Glioblastoma (GBM) is a deadly primary brain tumor. Current treatment, consisting of surgical removal of the tumor mass followed by chemotherapy and/or radiotherapy, does not significantly prolong survival. Gene therapies for GBM are being developed in clinical trials, for example using adenoviral vectors. While adeno-associated virus (AAV) represents an alternative vector system, limited gene transfer to glioma cells has hampered its use. Here, we evaluated newly emerged variants of AAV capsid for gene delivery to murine glioma. We tested a mutant AAV2 capsid devoid of 3 surface-exposed tyrosine residues, AAV2 (Y444-500-730F), and a "shuffed" capsid (ShH19, containing sequences from several serotypes) that had previously been selected for enhanced glial gene delivery. AAV2 (Y-F) and ShH19 showed improved transduction of murine glioma GL261 cells in vitro by 2- to 6-fold, respectively, over AAV2. While AAV2 gene transfer to GL261 cells in established tumors in brains of syngeneic mice was undetectable, intratumoral injection of AAV2 (Y-F) or ShH19 resulted in local transduction of approximately 10% of tumor cells. In addition, gene transfer to neurons adjacent to the tumor was observed, while microglia were rarely transduced. Use of self-complementary vectors further increased transduction of glioma cells. Together, the data demonstrate the potential for improved AAV-based gene therapy for glioma using recently developed capsid variants.

[How real is the prevention of postoperative venous thromboembolic complications].

The article represents the results of the Study "The safety territory of venous thromboembolic complications". 59 surgical hospitals took part in the multi-centered study. The risk assessment of the venous thromboembolic complications and prevention measured were analyzed in 53, 596 patients.

[Lower limb varicose disease in men and women: findings of prospective study SPECTRUM].

AIM: The study was aimed at comparing peculiarities of varicose disease, its complications, treatment policy in men and women. MATERIAL AND METHODS: The prospective observational study SPECTRUM follows up a total of 866 patients with venous chronic disease. Of these, 615 were found to have varicose disease (VD) (486 (79.0%) women and 129 (21.9%) men). The patients' age varied from 12 to 83 years old (mean age 46.1, median 46). The body weight index ranges from 15.7 to 62.0 (average 27.2, median 26.0). The duration of the disease from the moment of being included into the program ranges from 0.1 to 53 years (mean 14.5, median 11, interquartile range from 5 to 20). RESULTS: No differences by age, body mass index were observed. Men consulted the phebologist averagely at earlier stages of the disease onset (after 10.9 years as compared with 15.5 years for women; p=0.00001). The frequency of detecting subjective symptoms does not differ along the majority of the measures, with men less often reporting the development of pain syndrome (45.7 versus 65.2% for women; p=0.0001). The proportion of patients with class C4-C6 amongst men and women does not differ (29.5% and 24.1%, respectively; p=0.211). No differences in the incidence of varicosephlebitis, external bleeding from the venous node were revealed. Men were found to have more often total reflux along the great saphenous vein on the right leg (35.7% as compared with 25.1 % for women; p=0.017) and insufficiency of perforants (72.9% versus 59.7%; p= 0.006). Women were more often found to have isolated varicosity of inflows-confluents. 47.3% of men had not previously attended presented consulted for VD, amongst women the proportion of such cases was considerably lower (28.6%; p = 0.000001). Only 6.0% of women had previously not undergone any treatment for VD. Amongst men the share of previously not treated amounts to 23.3% (p=0.000001). Women were statistically significantly more often prescribed phleboscleroobliteration the inflows confluents. The recommendations of phlebologists on using compression, pharmacotherapy, surgical methods did not differ in men and women. CONCLUSION: The obtained differences are not principal. The course of VD is similar in patients of different gender, which is confirmed by identity of treatment policy.

[Functional venous insufficiency: diagnosis and treatment (literature review) (Part I)].

UNLABELLED: Reviewed herein are the available literature data concerning functional venous insufficiency (phlebopathies). Part I analyses the data on terminology, epidemiology, effect on quality of life, aetiology and pathogenesis, risk factors, as well as possible methods of diagnosis of this pathological condition. METHOD: search in the MEDLINE database by means of the PubMed system.

[Functional venous insufficiency: diagnosis and treatment (review of the literature)].

UNLABELLED: Reviewed herein are the available literature data concerning functional venous insufficiency (phlebopathies). Part I analyses the data on terminology, epidemiology, effect on quality of life, aetiology and pathogenesis, risk factors, as well as possible methods of diagnosis of this pathological condition. METHOD: search in the MEDLINE database by means of the PubMed system.

Some methods for human liquid and solid waste utilization in bioregenerative life-support systems.

Bioregenerative life-support systems (BLSS) are studied for developing the technology for a future biological life-support system for long-term manned space missions. Ways to utilize human liquid and solid wastes to increase the closure degree of BLSS were investigated. First, urine and faeces underwent oxidation by Kudenko's physicochemical method. The products were then used for root nutrition of wheat grown by the soil-like substrate culture method. Two means of eliminating sodium chloride, introduced into the irrigation solution together with the products of urine oxidation, were investigated. The first was based on routine electrodialysis of irrigation water at the end of wheat vegetation. Dialysis eliminated about 50% of Na from the solution. This desalinization was performed for nine vegetations. The second method was new: after wheat cultivation, the irrigation solution and the solution obtained by washing the substrate containing mineral elements not absorbed by the plants were used to grow salt-tolerant Salicornia europaea L. plants (saltwort). The above-ground biomass of this plant can be used as a food, and roots can be added to the soil-like substrate. Four consecutive wheat and Salicornia vegetations were cultivated. As a result of this wheat and Salicornia cultivation process, the soil-like substrate salinization by NaCl were considerably decreased.

Surgical correction of varicose vein disease under micronized diosmin protection (results of the Russian multicenter controlled trial DEFANS).

The paper presents the results of DEFANS trial (Detralex - assessment of efficacy and safety for combined phlebectomy). The study enrolled 245 patients with varicose vein disease, who underwent unilateral combined phlebectomy. The main group (n=200) received micronized diosmin (Detralex, 1000 mg/day) for 2 weeks before and 30 days after the procedure; control group (n=45) did not receive Detralex in pre- and postoperative period. Pain severity by 10-point visual analog scale (VAS), an area of subcutaneous hemorrhage in the zone of femoral great saphenous vein resection (by original 12-point scale) and subjective feelings of limb heaviness and fatigability were evaluated 7, 14 and 30 days after the procedure. Subjective symptoms and the area of subcutaneous hemorrhage were significantly lower in the main group, then in control: 7 days after the procedure VAS score was 2.9 and 3.5, respectively; hemorrhage area - 3.4 and 4.6 points, respectively. The same trend was observed for limb heaviness and fatigability, evidencing the better exercise and orthostatic tolerance among patients of the main group in early postoperative period. Quality of life assessment by CIVIQ failed to reveal statistically significant difference between main and control groups in 4-weeks postoperative follow-up. Micronized diosmin in pre- and postoperative period after plebectomy helps to attenuate pain syndrome, to decrease postoperative haematomas and accelerate their resorption, to increase exercise tolerance in early postoperative period.

[Remote outcomes of endoscopic dissection of crural perforating veins in chronic venous insufficiency].

We studied the long-term results following endoscopic dissection of crural perforating veins (EDCPV) in chronic venous insufficiency. The study comprised a total of 36 patients (41 lower limbs) who had endured the intervention concerned. The term having passed from the time of the operation till the moment of assessing the obtained outcomes varied from I to 10 years. Ultrasonographic angioscanning within the zone of the previous intervention revealed 38 perforating veins on 3.1 of the postoperative lower limbs (75.6 %). Amongst the veins revealed, most frequently encountered were Cockett's perforants (the so-called Cockett II) in the typical place - the lower third along the medial surface of the crus (29 cases). In five cases, perforants were revealed in the middle third of the crus, which located in the close proximity from the edge of the tibia (Cockett III). Perforants on the posterior crural surface were revealed on four extremities. Only 22 veins on 20 lower limbs (48.8%) turned out incompetent. The median access to perform EDPCV was used in 28 cases (68.3%); within the zone of the operative intervention performed we found 24 perforating veins, with 15 of these being incompetent. After EDPCV performed from the posterior or posterior-medial approaches on 13 limbs (317%), we revealed 14 perforating veins (of these, 7 - incompetent). Despite this, the patients regarded the effect obtained as either good or satisfactory in 79% of cases. The obtained findings suggest that thorough diagnosis of perforating reflux and improvement of the technique of endoscopic dissection thereof should be required. Along with it, it is also necessary to attentively examine the problem of the true role of the low vein-venous shunt in the pathogenesis of vein chronic diseases.

[A relapse of lower-limb varicose disease: definition, diagnosis and causes of pathology (review of literature)].

Current trends are towards a permanent growth of the number of patients presenting with a relapse of lower-limb varicose disease (RVD). According to the data of various investigators, from 5 to 80 % of postoperative patients develop RVD. Despite the close attention paid over decades to this problem by phlebologists of all the world over, there is no common interpretation of the notion "relapse of varicose disease". Recommendations on carrying out examination are of too general character and do not take into consideration the necessity of maximal individualization of therapeutic policy. Attention is attracted by a wide variety of the data concerning the causes of RVD with considerable differences as to the percentage ratio thereof. All this results in various readings when assessing the outcomes of different therapeutic methods, as well as hampers development of a unified therapeutic policy. It is necessary to eliminate terminological ambiguity, to be followed by devising a present-day diagnostic and therapeutic policy in RVD. The structure and classification of the causes leading to development of a relapse should also be studied, especially in the light of using novel, including minimally invasive technologies.

[Unadequate ostial ligation of the great saphenous vein as the cause of varicose disease reccurence].

Authors investigated the frequency of varicose disease recurrence after crossectomy, classified clinical types and proposed the tactics of treatment of this group of patients. 258 patients with varicose disease recurrence were examined and operated. In 179 cases (69,4%) there were found differ pathological changes in the place of saphenofemoral junction, which were collected in several groups. Pathological stump of the great saphenous vein was in 155 lower limbs (60,1%). 12 patients (4,7%) had not ligated saphenofemoral junction. And in 12 patients (4,7%) there were found signs of neoangiogenesis. We proposed the scheme of tactical actions in cases of pathological changes in the place of saphenofemoral junction. The absolute indication for surgery is present saphenofemoral junction and trunk of the great saphenous vein. Furthermore, recection of vein's stump is necessary if its length is more 3 cm, that always combined with varicose tranformation of the varicosities. If the linear size of stump is from 1 to 3 cm its resection have to be done only in case of considerable varicosities. In not severe lesions of varicosities it is enough to perform sclerotherapy or mini-phlebectomy of involved vessels. There is not necessary to surgery if the stump is short (less 1 cm). In this case the phlebosclerotherapy or mini-phlebectomy of varicosities are expedient. The method of choice for removal of neoangiogenesis is phlebosclerotherapy. Our results showed that treatment of patients with varicose disease recurrence is in special phlebological centers or vascular departments and improvement of technique of Troyanov-Trendelenburg operation.

[Peculiarities of ultrasonographic anatomy of the small saphenous vein].

The authors studied the prevalence and peculiarities of lesions of the small saphenous vein (SSV), having performed ultrasonographic mapping of this vessel on 223 lower limbs. We revealed three major variants of localization of the SSV's terminal portion. In 36.3 % of cases, the SSV merged with the popliteal vein in the zone from the projection of the knee-join line and not above 7 cm from this level (type I). In 29.6% of cases, the SSV flowed into the femoral vein at a height of 8-20 cm from the knee-joint line (type II). In 31,3 % of cases, the SSV's terminal portion had no direct connection with the deep veins. In the upper third of the femur, the vessel flowed into the confluents of the large saphenous vein, or into the system of the gluteal veins (type III) The largest by the calibre are type I veins. Valvular insufficiency of the SSV was revealed in 16 (7.2 %) cases. The majority of the veins with incompetent valves (12) belonged to type I In the group of 143 veins with the diameter of not more than 0.4 cm at the level of the knee-joint fissure in the standing position, no pathological venous reflux was registered. We also examined the extent of the reflux along the SSV. Only in one case blood shunt to the lower third of the crus was registered. A combination of venous insufficiency of the SSV and the large saphenous vein on the same extremity was revealed only in 2 cases (1.6%). The obtained results give occasion to reconsider certain diagnostic and therapeutic approaches in varicose disease in the SSV's basin.

[Semisynthetic Diosmin (Phlebodia 600) for therapy of lower limb chronic venous insufficiency].

The study was held to assess clinical effectiveness of coaggregated semisynthetic Diosmin (Phlebodia 600) for patients with II-III CEAP classes of chronic venous insufficiency (CVI), caused by lower limb variceal diseases. In 30 cases Phlebodia 600 demonstrated positive effect on CVI symptoms, edematous and convulsive syndromes. The authors conclude that Phlebodia 600 is highly effective and safe for patients with CVI.

[Risk factors of chronic venous insufficiency of the lower extremities and possibilities of its medication in therapeutic practice].

AIM: To verify incidence of risk factors of chronic venous insufficiency (CVI) of the lower limbs and efficacy of outpatient treatment. MATERIALS AND METHODS: A total of 4388 patients were examined by questioning and examination of the lower limbs. 1209 patients with CVI stages C1, C2 and C3 were included in the study. They received recommendations to use elastic compression, topic modalities, physiotherapy. Patients of the study group were given, in addition, detralex for 8 weeks. RESULTS: Characteristic symptoms of CVI were seen in 68% males and 84% females but only 17.5 and 20%, respectively, had complaints. The risk was highest in history of CVI in the patient's mother, sitting or standing job, hard physical labour, obesity and constipation, two or more labours in women. The effect was achieved in the detralex group. CONCLUSION: Many outpatients had symptoms of chronic venous insufficiency but had no complaints. Detralex therapy proved highly effective in outpatient practice.