[Myocardial revascularization in chronic coronary artery disease. State of art].

The review addresses debatable issues of myocardial revascularization in chronic forms of ischemic heart disease, shows major differences between percutaneous coronary intervention and coronary artery bypass grafting in terms of long-term prognosis, and the dependence of the results on the clinical profile of the disease. The review of current publications demonstrates advantages of open surgery in long-term survival and prevention of adverse outcomes in target groups of patients.

[Surgical treatment of lung injuries and diseases in patients with blunt chest trauma]. / Khirurgicheskoe lechenie povrezhdenii i boleznei legkikh u patsientov s zakrytoi travmoi grudi.

OBJECTIVE: To establish the indications for optimal open lung surgery in patients with severe blunt chest injury. MATERIAL AND METHODS: Hematomas, lung wounds and purulent pulmonary complications were studied in four groups of victims. Causes of injuries included road accidents (n=426), falling and beating (n=387), catatrauma (n=217), squeezing the body with a massive weight (n=46). Majority of victims (n=731, 67.9%) were transferred to the hospital within 1-5 hours after injury; 345 (32.1%) patients were transferred from other hospitals to treat combined injuries of head, chest, abdomen and complications within 1-49 days after injury. RESULTS: Lung surgery was applied in 48 patients. Typical resections and pneumonectomies made up 77.1%. Indications for surgery included lung wounds complicated by pulmonary hemorrhage grade IIa and severe hemothorax, intrapulmonary hematoma ≥6 cm with high risk of bleeding and suppuration, gangrene, gangrenous and purulent abscesses of aspiration genesis, lung cancer first diagnosed in victims. Postoperative mortality was 14.6%. Twelve victims with unrecognized deep lung wounds and pulmonary root rupture were not operated. Thus, 5.6% of victims with severe blunt chest trauma need for open lung surgery.

[Historical view on the pathogenesis and surgical treatment of cervical dystonia]. / Istoriya izucheniya patogeneza i khirurgicheskogo lecheniya tservikal'noi distonii.

In the past few decades, approaches to surgical treatment of dystonia passed through paradigmatic shift. Intradural upper cervical anterior rhizotomy was replaced by selective peripheral denervation with lesser spectrum of side-effects. Such techniques as microvascular decompression of accessory nerve or spinal cord stimulation for cervical dystonia were abandoned due to lack of proven efficacy. Introducing globus pallidus interna (GPi) DBS in 1990's to treat all types of dystonia, including cervical dystonia, was a fundamental factor. With the growing body of knowledge on the pathophysiology of dystonia, GPi DBS appears to be the most expedient, effective and safe method with limited indications to peripheral destructive procedures.

[Molar-incisor hypomineralization among 12-years old children in Arkhangelsk region]. / Moliarno-reztsovaia gipoplaziia u 12-letnikh detei Arkhangel'skoi oblasti.

AIM: To estimate the prevalence of molar incisor hypomineralisation (MIH) across genders and place of residence as well as its association with dental caries among 12-years-old children in Northwest Russia. METHOD: A cross-sectional study included 1233 (653 girls) randomly selected 12-years-old children from 7 urban and 5 rural areas of Arkhangelsk region. MIH and its severity were diagnosed using Weerheijm et al (2003) and Mathu-Muju & Wright (2006) criteria. Dental caries was studied at the D3 level following WHO (2013) recommendations. Prevalence of MIH and caries and means for Decayed-Missing-Filled (DMFT) scores are presented with 95% confidence intervals (CI). Pearson's chi-squared tests and Mann-Whitney tests were used for dichotomous and numerical data, respectively. The study was approved by the Ethical Committee of the Northern State Medical University, Arkhangelsk, Russia. RESULTS: The overall prevalence of MIH was 2.1% (95% CI: 1.44-3.07). The prevalence of mild MIH was 46.2% (95% CI: 28.8-64.5). Average and severe MIH were diagnosed in 26.9% (95% CI: 13.7-46.1) of children each. The prevalence of caries among those with and without MIH was 100% (95% CI: 87.1-100.0) and 74.8% (95% CI: 72.3-77.2), respectively (p=0.003). DMFT values for children with and without MIH were 4.46 (95% CI: 3.20-5.72) and 2.41 (95% CI: 2.28-2.53), respectively (p<0.001). CONCLUSION: Although the prevalence of MIH in Northwest Russia is lower than in most other countries our findings suggest that hypomineralised molars are much more prone to caries.

[The Case of Successful Surgical Treatment of a Patient With Thoracic Endograft Infection in 5 Years After Thoracic Endovascular Aortic Repair].

We present here a case of successful staged treatment of a patient with para-aortic abscess that arose 5 years after thoracic endovascular aortic repair because of thoracic aortic aneurysm. After stabilization of the patient's condition by intensive antibiotic therapy we performed left-subclavian extra-thoracic debranching as the first stage of the surgical treatment. In 2 weeks via median sternotomy and on-pump we removed the infected endograft and performed extraanatomical ascending-to-descending aortic bypass with good postoperative result.

[Infectious complications after endoprosthetic repair of the thoracic aorta]. / Infektsionnye oslozhnenii pri éndoprotezirovanii grudnoi aorty.

Presented herein is a review of publications of foreign authors on the problem of infectious complications after endoprosthetic repair of the thoracic aorta. The problem discussed is of current importance, however in the Russian literature it is covered insufficiently. The article contains the data on frequency, terms and possible causes of the development of complications, also discussing the problems of diagnosis. The authors demonstrate extreme danger of infection of an aortic stent graft, difficulty of early diagnosis and mostly unsatisfactory therapeutic outcomes. Also noted are possible ways of prevention of complications and aimed at improving the results of this extremely severe patient cohort.

[Haemangioma of the left atrium]. / Gemangioma levogo predserdiia.

Presented herein is a clinical case report concerning successful surgical management of a rare variety of a primary tumour of the heart, i. e., a capillary haemangioma of the left atrium, simulating by the contours and localization a myxoma. The final diagnosis was verified only by histological examination. The authors describe difficulties of diagnosis of the disease involved, underlying the necessity of plastic correction for restoration of the normal anatomical configuration of the heart. This is followed by a review of the literature, reflecting a possible course of the disease, problems of diagnosis, and therapeutic policy.

[Pre- and Postsynaptic Mechanisms of the Deprivational Potentiation of Population Responses in Rat Hippocampal CA1 Neurons].

Mechanisms of the deprivational potentiation (DeP) of the population responses in rat hippocampal CA1 neurons after 60-min period of the cessation of rare (0.05 Hz) test stimulation of Schaffer collaterals was investigated in vitro. It has been demonstrated that two independent mechanisms are involved in DeP induction: presynaptic component in initial phase of DeP and postsynaptic one responsible for the long-term phase of DeP. The competitive interference between mechanisms of the long-term phase of DeP and the protein phosphorylation phase of long-term potentiation (LTP) was confirmed. It was shown that not NMDA receptors, but purinergic P2 receptors participate in Ca(2+) -dependent mechanism of induction of the postsynaptic component of DeP. The common curve of dependence of synaptic strength on synaptic use/disuse, including the DeP, long-term depression (LTD) and LTP areas, is presented.

[INTERACTION OF GLUTAMATE AND GABA RECEPTORS IN THE CENTRAL NERVOUS SYSTEM].

The article provides an overview of postsynaptic interaction of GABA and glutamate receptors in central neurons. Co-localization of GABA and glutamate in synapses, structure and function of their receptors and interaction of both ionotropic and metabotropic glutamate and GABA receptors are being discussed.

ATHEROSCLEROSIS OF ABDOMINAL AORTA IN A POPULATION OF THE NORTHERN PART OF EUROPEAN RUSSIA.

Atherosclerosis is a major challenge for public health services throughout the world. It is a systemic degenerative disease affecting all arterial basins and most fiequently occurring in men aged above 40 years. Multifocal lesions are much more typical than isolated lesion of a single basin. Atherosclerosis is a frequent cause of impaired patency of visceral branches of abdominal aorta and is a chronic disorder of visceral circulation manifest as ischemia of abdominal organs. We studied native preparations of abdominal aortafrom residents of the northern part of European Russia using the WHO-recommended visual planimetric method. It was shown that 93.4% of the residents of this region aged above 50 years have abdominal aorta affected by atherosclerosis. Statistical analysis did not reveal signficant differences between the frequency of atherosclerotic lesions in men and women. Most of them had raised aortic lesions. Correlation analysis with the calculation ofpaired Pearson correlation coefficients demonstrated moderate correlation between atherosclerotic lesions of abdominal aorta and the stage of atheromatosis (r=0,42; p = 0,000).

[Endovascular closure of iatrogenic arteriovenous anastomosis of the iliac artery and vein].

The presented herein clinical case report concerns successful endovascular closure of a iatrogenic lesion of the iliac artery and inferior vena cava with formation of a pathological arteriovenous anastomosis manifesting itself by venous thromboembolic syndrome and severe right-ventricular insufficiency.

[Modulation of GABA- and kainate-activated currents by metabotropic receptors in isolated rat cortical neurons].

Whole-cell patch-clamp recordings from isolated neurons from rat prefrontal cortex have been made to study GABAb and mGluR receptor modulation of currents induced by applications of GABA and kainate. The GABAb-receptor antagonist CGP-55845 (5 microM) enhanced the peak by 26 +/- 13% (n = 6) but had no effect on the steady-state of GABA-activated current. Bath application of GABAb-receptor agonist baclofen (50 microM) enhanced the GABAa currents by 9 +/- 2% (n = 8). Kainate-activated currents were not affected by baclofen. Both GABA-activated currents and kainate-activated currents were not affected by trans-ACPD (MGluR agonist). These results suggest that in cortex postsynaptic response of GABAa-receptors can be modulated by GABAb-receptors.

[The key role of calcium in the mechanism of deprivational potentiation of population responses in hippocampal CA1 neurons].

We investigated a role of calcium in the mechanisms of deprivational potentiation (DeP) of the popspikes amplitude of CA1 neurons that was induced in consequence of long (60 min) interruption of rare test stimulation (0.05 Hz) of Schaffer collaterals in rat hippocampal slices. There are two phases of deprivational potentiation that have presumably different genesis: short-term initial "peak" (about 12 min) and long-term "plateau" (more than 1 h). The presence of the membrane permeable Ca2+ chelator (BAPTA-AM) in the solution, or decrease of [Ca2+](out), or depletion of intracellular Ca2+ stores (in the presence of thapsigargin/cyclopiazonic acid) led to reduction of the short-term and to suppression of the long-term phases of DeP. Thus the key role of calcium in the DeP induction mechanisms and participation of two main sources (the extracellular environment and the intracellular Ca2+ stores) was demonstrated.

[Somatic genome variations in vascular tissues and peripheral blood leukocytes in patients with atherosclerosis].

The first data on the existence of multiple genomic rearrangements, such as copy number variation (CNV) and copy neutral loss of heterozygosity, in vascular tissues and peripheral blood leukocytes from patients with atherosclerosis, are presented. Compared to internal mammary arteries and peripheral blood leukocytes, right coronary arteries in the atherosclerotic plaque area presented with a higher CNV length and number of genes located in their vicinity. In each of the patients, 6-16% of CNVs were common to the three types of tissues examined. Therefore, most of the copy number variations in the tissues affected by atherosclerosis (from 68 to 91% in each of the patients) were of somatic origin. The gains in 3p21.31 (CACNA2D2), 7q32.1 (FLNC), 19p13.3 (C19orf29, PIP5K1C), and 21q22.3 (COL6A1) were detected in vascular tissues but not in peripheral blood leukocytes. Moreover, the gain in 7p15.2 (SKAP2), detected in the patients with atherosclerosis, did not overlap with any CNV regions currently reported in The Database of Genomic Variants. The loss of heterozygosity in 12 out of 13 chromosomal regions was copy neutral and covered tumor suppressor genes (SFRP1, CEBPD, RB1CC1, DIRAS3, TUSC3, and ZDHHC2).

[Transcutaneous coronary intervention accompanied by biventricular circulatory support and combined with extracorporeal membranous oxygenation].

In a multiple-vessel lesion of the coronary bed, pronounced accompanying pathology, low ejection fraction of the left ventricle, obesity, previously performed operation of coronary aortic bypass grafting may be causes of refusal from revascularization by means of coronary bypass grafting. A transcutaneous coronary intervention (TCI) in this patient cohort is also associated with the risk of an unfavourable outcome in case of a technically complicated procedure and a large volume of the myocardium supplied with blood by the target arteries. Haemodynamic support of such high-risk TCI by means of intra-aortic balloon contrapulsation or a left-ventricle assist device is associated with a series of shortcomings which are removed by means of a biventricular bypass used in a combination with extracorporeal membranous oxygenation. This article deals with a case report of successful stenting of the unprotected trunk of the left coronary artery and the right coronary artery in the conditions of a mechanical biventricular bypass.

[Effect of the terms of complete revascularization on the outcomes of treatment of patients with st segment elevation myocardial infarction and multivessel coronary artery disease].

The study was aimed at evaluating the results of treating a total of 227 patients presenting with ST segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent primary percutaneous interventions (PCI). The patients were subdivided into three groups: Group One consisted of the patients having endured multivessel stenting (MVS) within the framework of a primary PCI (n=40); Group Two comprised patients having endured stagewise revascularization (SWR) carried out within 60 days after the index event (mean 29.9±19.6 days) (n=39), and Group Three was composed of patients with stagewise revascularization either performed or planned to be performed within the terms exceeding 60 days (mean value 183.4±90.7 days) (n=148). During 12 months significant differences were observed between Group One and Group Three patients, as well as between Group Two and Group Three patients by the frequency of the composite end point (death, myocardial infarction, secondary revascularization of the target vessel (TVR) (p<0.05) and separately by the TVR between Group Two and Three patients (p<0.05). Besides, there was a tendency towards significant differences between Group One and Group Three patients, as well as Group Two and Group Three patients by the development of recurrent MI (p<0.05). By the number of lethal outcomes no statistically significant differences between the groups were observed. Hence, in the cohort of patients with STEMI and MVD who were subjected to primary PCIs, performing of MVS or secondary revascularization within 60 days has advantages as compared with the time period > 60 days by the frequency of the composite end point, TVR and is associated with a tendency towards lower incidence rate of recurrent MI during 12 months of follow up. The strategy of MVS and the secondary SoR within 60 days demonstrated comparable results during 12 months. Performing complete revascularization within the framework of primary PCI or shortly after discharge from the hospital (29.9±19.6 days) is associated with greater availability of the second SoR as compared with that planned for the terms of 183.4±90.7 days.

[Left anterior descending bypass grafting from the anterolateral minitorakotomy].

Current efficient methods of open revascularization in patients with multivessel coronary artery lesions are associated with a certain amount of general and local complications depending on traumatic interventions, bypass, manipulation on the ascending aorta. Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) allows to avoid certain perioperative risk factors and appears to be a promising myocardial revascularization model in isolated lesion of left anterior descending (LAD) and multivessel lesions, applying combines percutaneous intervention (PCI).

Effects of fullerene C60 nanocomposites on human platelet aggregation.

The effects of fullerene C(60) nanocomposites on human platelet aggregation induced by ADP, ristocetin, and collagen were studied. The nanocomposite containing fullerene C(60) in polyvinyl pyrrolidone solution did not change platelet aggregation, while fullerene C(60) in crown ether and Twin-80 solutions inhibited ADP-induced platelet aggregation by 20 and 30%, respectively.

[Summation of GABA- and glutamate-mediated currents in rat cortical neurons].

Whole-cell patch clamp recordings from isolated neurons from rat prefrontal cortex have been made to study the interaction of responses induced by application of GABA and glutamate. Two different pipette solutions were used in this research: the first one was based on CsCl, while the second one was CsF-based. With CsCl-based pipette solution being used, co-application of GABA (200 microM) and glutamate (200 microM) resulted in producing a total current smaller than the sum of the two individual responses. But with CsF-based pipette solution being used, the response to co-application of GABA (200 microM) and glutamate (200 microM) was equal to the sum of the two individual responses. These results suggest that there is a cross-modulation between GABA- and glutamate-mediated responses.

[Multiple aortocoronary bypass without artificial circulation].

Results of 145 surgeries for direct myocardial revascularization without artificial circulation are presented. FC III and IV angina of effort was diagnosed in 80.6% and 13.5% of the patients respectively, acute coronary syndrome in 6.5%, past myocardial infarction in 63.8%. Mean left ventricular ejection fraction (EF) prior to surgery was 48.7 +/- 5.1%; it was below 40% in 28.8% of the patients. Three- and two-vessel coronary disease was documented in 54.7% and 35.3% of the patients respectively; 10% of them presented with the affected anterior interventricular branch, 14% with the stenotic trunk of the left coronary artery. Mean revascularization index increased from 22 to 76. The frequency of complete autoarterial revascularization amounted to 42.7%. Sequential and composite grafts were used in 93 and 257 cases respectively. No patient experienced perioperative myocardial infarction, acute disturbance of cerebral circulation, acute renal or cardiac insufficiency. Immediate postoperative hemorrhage requiring resternotomy developed in 0.9% of the patients, 1.2% with suppurative complications needed additional surgical treatment. It is concluded that myocardial revascularization on a beating heart is an efficacious and reliable method ensuring good results in the immediate and late postoperative period. Its success first and foremost depends on the previously gained experience that permits to operate patients with severe multi-vessel coronary artery disease and various concomitant disorders and thereby correct combined pathological conditions. The available data give reason to consider each patients in need of aortocoronary bypass as a candidate for myocardial revascularization on a beating heart regardless of the character and extent of coronary lesions and anatomical feature of the coronary bed.