Predictors of Lethality, Remodeling, and Aorta-Related Events in Different Types of Proximal Aortic Dissection Surgery.

The aim of the study is to analyze predictors of lethality, false lumen thrombosis, enlargement of aortic diameter, and frequency of aorta-related events in the early and remote postoperative periods for various types of proximal aortic dissection surgery using the logistic regression method. Materials and Methods: A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions. Results: The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period.

[Changes in Pulmonary Hemodynamics Resulted From Long-Term Mechanical Heart Support].

Aim      To study the dynamics of right ventricular function and pulmonary hemodynamics in patients with pulmonary hypertension during mechanical circulatory support of the heart.Material and methods  A retrospective analysis was performed for 25 implantations of left ventricular assist device performed in the Meshalkin National Medical Research Center from 2006 through 2021. Mechanical assist devices were implanted in 21 men and 4 women (median age, 37.5 [29; 48] years). All patients had severe, NYHA functional class III-IV chronic heart failure refractory to the optimal drug therapy. Invasive measurements showed that mean pulmonary arterial pressure (MPAP) was 50 [44.5; 60] mm Hg, transpulmonary pressure gradient (TPG) was 16 [14; 19] mm Hg, and calculated pulmonary vascular resistance was 5.4 [4.9; 9] Wood units, which is an absolute contraindication (TPG >15 mm Hg or pulmonary vascular resistance >5 Wood units) for heart transplantation (HT).Results Duration of left ventricular support was from 17 to 948 days. For 12 (48 %) patients, the HT was performed at 180-948 days following the implantation of left ventricular assist device; 3 patients are presently waiting for HT; 10 patients died from various complications, 6 of them died during the hospital stage. Already during the early stage after the implantation of the mechanical assist device, pulmonary hemodynamics significantly improved. Thus, in one week, MPAP decreased from 50 [44.5; 60] mm Hg to 36 [33; 38] mm Hg (р=0.012) whereas pulmonary vascular resistance decreased from 5.4 [4.9; 9] to 2.9 [2.4; 3.6] Wood units (р=0.008). Follow-up showed further improvement of pulmonary hemodynamics; at 1 month, MPAP was 29 [27; 30] mm Hg and by the time of HT, MPAP was 2.0 [24.8; 26.3] mm Hg (р=0.01), i.e., reached a normal level, which made it possible to perform HT. Similar dynamics was observed for other variables that reflected pulmonary hemodynamics.Conclusion      Mechanical support of the heart is able to alleviate manifestations of pulmonary hypertension in most patients with end-stage heart failure. It is necessary to develop an algorithm for identifying the category of patients with a high risk of progression of right ventricular failure.

Hybrid Technologies for Reconstruction of Proximal Aortic Dissection.

The aim of the study is to evaluate the efficacy of various types of hybrid technology in compare to the classical repair of the aortic arch of type I aortic dissection treatment in the in-hospital period. Materials and Methods: A retrospective observational study has been conducted, the results of surgical treatment of 213 patients with DeBakey type I aortic dissection operated on within the period from 2001 to 2017 were compared. Patients were divided into three groups: in group 1, patients undergone a hemiarch type of aortic repair or the total arch replacement (n=121); in group 2, a hemiarch aortic reconstruction and implantation of bare metal stent was performed (n=55); in group 3, a frozen elephant trunk technique was used (n=37). Taking into consideration the retrospective character of the investigation and nonequivalence of the groups by separate characteristics, they were equalized to improve the reliability of the results using the PSM (propensity score matching) pseudorandomization method. As a result, three groups of comparison were formed which were equalized by the PSM method and called PSM 1, 2, and 3. The mortality and complication rate in the in-hospital period, as well as the frequency of false lumen thrombosis development depending on the treatment method, have been analyzed. Results: The mortality rate in the PSM 1 group was 15 patients: group 1 (standard technique) - 10 patients (9%), group 2 (uncoated stents) - 5 patients (11%). A significant difference was found in the number of major bleedings (group 1 - 8%, group 2 - 21%, p=0.031) and cases of bowel ischemia (group 1 - 1%, group 2 - 9%, p=0.028). Complete false lumen thrombosis of the thoracic aorta was observed significantly more often in group 1 than in group 2 (22% vs 5%, p=0.015).In the examined group PSM 2, hospital mortality rate was 4 patients: group 1 - 3 patients (12%), group 3 - 1 patient (3%). No differences between the groups were found in the number of complications. In group 3, complete false lumen thrombosis of the thoracic aorta was observed in 59% of cases, whereas in group 1 it was found only in 4% of patients (p<0.001).In comparison group PSM 3, the mortality was 8 patients: group 2 - 5 patients (11%), group 3 - 3 patients (9%). The number of neurological complications differed significantly: in group 2 - 27%, in group 3 - 6% (p=0.019). Besides, 3% of cases of complete false lumen thrombosis were found in group 2, while there appeared 55% (p<0.001) of such patients in group 3. Conclusion: The comparative analysis showed that the use of bare metal stents and hybrid prostheses demonstrated a comparable low level of in-hospital mortality compared to the standard surgical technique of aortic arch reconstruction. At the same time, the use of the bare metal stents is associated with a higher rate of perioperative complications (bleeding, postoperative bowel ischemia, neurological complications) compared to the standard treatment and repair of the aortic dissection using hybrid prostheses. Complete thrombosis of the false lumen occurred significantly less commonly in case of using bare metal stents than with standard treatment and hybrid prostheses.

Evidence for the First Excited State of

The ^{7}H system was populated in the ^{2}H(^{8}He,^{3}He)^{7}H reaction with a 26 AMeV ^{8}He beam. The ^{7}H missing mass energy spectrum, the ^{3}H energy and angular distributions in the ^{7}H decay frame were reconstructed. The ^{7}H missing mass spectrum shows a peak, which can be interpreted either as unresolved 5/2^{+} and 3/2^{+} doublet or one of these states at 6.5(5) MeV. The data also provide indications of the 1/2^{+} ground state of ^{7}H located at 1.8(5) MeV with quite a low population cross section of ∼25 µb/sr within angular range θ_{c.m.}≃(17°-27°).

Towards the Limits of Existence of Nuclear Structure: Observation and First Spectroscopy of the Isotope

The most remote isotope from the proton dripline (by 4 atomic mass units) has been observed: ^{31}K. It is unbound with respect to three-proton (3p) emission, and its decays have been detected in flight by measuring the trajectories of all decay products using microstrip detectors. The 3p emission processes have been studied by the means of angular correlations of ^{28}S+3p and the respective decay vertices. The energies of the previously unknown ground and excited states of ^{31}K have been determined. This provides its 3p separation energy value S_{3p} of -4.6(2) MeV. Upper half-life limits of 10 ps of the observed ^{31}K states have been derived from distributions of the measured decay vertices.

Observation and Spectroscopy of New Proton-Unbound Isotopes ³°Ar and ²9Cl: An Interplay of Prompt Two-Proton and Sequential Decay.

Previously unknown isotopes (30)Ar and (29)Cl have been identified by measurement of the trajectories of their in-flight decay products (28)S+p+p and (28)S+p, respectively. The analysis of angular correlations of the fragments provided information on decay energies and the structure of the parent states. The ground states of (30)Ar and (29)Cl were found at 2.25(-0.10)(+0.15) and 1.8±0.1 MeV above the two- and one-proton thresholds, respectively. The lowest states in (30)Ar and (29)Cl point to a violation of isobaric symmetry in the structure of these unbound nuclei. The two-proton decay has been identified in a transition region between simultaneous two-proton and sequential proton emissions from the (30)Ar ground state, which is characterized by an interplay of three-body and two-body decay mechanisms. The first hint of a fine structure of the two-proton decay of (30)Ar*(2(+)) has been obtained by detecting two decay branches into the ground and first-excited states of the (28)S fragment.

[Clinical toxicology of the Academy: yesterday, today and tomorrow].

National toxicology school of the Kirov Military Medical Academy, demonstrates the unity of clinical and experimental approaches related to one purpose throughout its history--saving human life and health from exposure to toxic substances of chemical nature. For more than three centuries the russian science of toxicology has been steadily developing, often ahead of the world science. It helped to create the means of protection and develop methods of treatment for chemical lesions. Currently, toxicology departments of military field therapy and military toxicology and medical protection are actively involved in the current study of military medicine, restructuring policy to provide toxicological aid in the Armed Forces, the development and introduction of Innovative methods of diagnosis and treatment of victims of toxicological etiology.

[Peculiarities of occupational esophagogastroduodenal pathology in personnel serving at CW disposal and storage facilities].

In a process of medical care and supervision on staff and military personnel, eliminating the chemical weapons, it was revealed that they are more susceptible to esophagogastroduodenal pathology in comparison with the control group. Moreover, the given pathology has an asymptomatic disease course but associated with high contamination of Helicobacter pylori. Marked inflammation changes, atrophic and fibrosis manifestation and microcirculation dysfunction have been confirmed by histological analysis of gastric mucosa. We supposed that the complex of occupational health risk factors, including possible subliminal toxic influence of eliminated CW components determines this pathological dysfunction. Negative influence of shift work and irregular nutrition rhythm are not excluded. The findings of this research are dictating the necessary of revision of military medical expertise principles and the development of the more effective treatment and prophylactic methods.

Structure of 10He low-lying states uncovered by correlations.

The 0+ ground state of the 10He nucleus produced in the 3H(8He,p)10He reaction was found at about 2.1±0.2 MeV (Γ∼2 MeV) above the three-body ^{8}He+n+n breakup threshold. Angular correlations observed for ^{10}He decay products show prominent interference patterns allowing us to draw conclusions about the structure of low-energy excited states. We interpret the observed correlations as a coherent superposition of a broad 1- state having a maximum at energy 4-6 MeV and a 2+ state above 6 MeV, setting both on top of the 0+ state "tail." This anomalous level ordering indicates that the breakdown of the N=8 shell known in 12Be thus extends also to the ^{10}He system.

[Clinical-laboratory diagnostics of the somatic pathology at the military men occupied on works with toxic chemicals].

The article presents the results of a comprehensive staff survey of the objects of storage and destruction of toxic chemicals. It was established that the structure of morbidity predominated respiratory diseases, cardiovascular system, nervous system and gastrointestinal tract. There are features of development and a current of some somatic diseases.

[Whole-genome amplification by MDA to improve sensitivity of forensic expert examination of chromosomal DNA].

This pilot project has the objective to evaluate the possibility of application of the multiple displacement amplification (MDA) technique to whole-genome amplification with a view to improving sensitivity of molecular-genetic test-systems. Preparations of total cellular DNA were amplified by MDA and analysed to assess conserved specificity of chromosomal DNA and its enhanced template activity in the standard polymerase chain reaction (PCR) for typing allele variants of polymorphous DNA loci. DNA samples before and after MDA showed virtually identical genotypic combinations of alleles. Allele fragments were stably detected at a level of DNA 4-5 times lower than in the standard test. The results of the study indicate that the MDA technique provides a promising tool to improve reliability of forensic- expert examination of chromosomal DNA and imply the necessity to further develop forensic-medical aspects of this method.

Observation of two-proton radioactivity of 19Mg by tracking the decay products.

We have observed the two-proton radioactivity of the previously unknown (19)Mg ground state by tracking the decay products in-flight. For the first time, the trajectories of the 2p-decay products, (17)Ne+p+p, have been measured by using tracking microstrip detectors which allowed us to reconstruct the 2p-decay vertices and fragment correlations. The half-life of (19)Mg deduced from the measured vertex distribution is 4.0(15) ps in the system of (19)Mg. The Q value of the 2p decay of the (19)Mg ground state inferred from the measured p-p-(17)Ne correlations is 0.75(5) MeV.

Observation of excited states in 5H.

The 5H system was produced in the 3H(t,p)5H reaction studied with a 58 MeV tritium beam at small c.m. angles. High statistics data were used to reconstruct the energy and angular correlations between the 5H decay fragments. A broad structure in the 5H missing mass spectrum showing up above 2.5 MeV was identified as a mixture of the 3/2+ and 5/2+ states. The data also present evidence that the 1/2+ ground state of 5H is located at about 2 MeV.

Experimental evidence for the existence of 7H and for a specific structure of 8He.

Experimental search for the superheavy 7H isotope was performed in the reaction p(8He,pp)7H with the 8He beam at 61.3A MeV. The evidence for existence of the 7H state near the t+4n threshold was obtained. In the same experiment, the p(8He,t) reaction populating the ground and excited 2(+) state of 6He was investigated. The obtained results argue on a specific structure of the 8He ground state containing the 6He subsystem in the excited 2(+) state with a large weight.

Superheavy hydrogen (5)H.

Experimental search for (5)H using a secondary beam of (6)He has been performed. The transfer reaction (1)H((6)He,(2)He)(5)H was studied by detecting two protons emitted from the decay of (2)He. A peak consistent with a (5)H resonance at 1.7+/-0.3 MeV above the n+n+t threshold was observed, with a width of 1.9+/-0.4 MeV. The angular distribution of the (1)H((6)He,(2)He)(5)H reaction was measured as well as the energy correlation of the two protons.

[Cholic acid sorption by food fibers]. / Sorbtsiia kholevykh kislot pishchevymi voloknami.

The ability of five kinds of dietary fibers isolated from different plants for binding of bilious acids (BA) in vitro was estimated. The bile was derived from patients with obstructive hepatitis. The examined kinds of dietary fibers have a capacity to absorb BA. This capacity is a little lower than a pharmaceutical preparation bilignin. The studied dietary fibers may be recommended for preventive diets.

[The lysosomal acid phosphatase activity of the peripheral blood neutrophils of women in the dynamics of the menstrual cycle]. / Aktivnost' kisloi fosfatazy lizosom neitrofilov perifericheskoi krovi u zhenshchin v dinamike menstrual'nogo tsikla.

During menstrual cycle of women, the intensity of fluorescence of acid phosphatase (IAF) was registered in lysosomes from peripheral blood neutrophils after staining with Acridin orange. It has been shown that such integral values as criterion of agreement (chi(2)) and information entropy by Shennon (h) are most informative values of IAF. It is suggested that the dynamics of chi-square and h in menstrual cycle reflects changes in enzymatic activity, and is associated with destroying the ovum utilizing the products of its lysis.