Lithium-Modified Sorbent: Effects on Hemostatic Responses In Vitro.

The effects of a lithium-modified sorbent based on aluminum oxide and polydimethylsiloxane (Al2O3@PDMS/Li) and a lithium-free sorbent (Al2O3@PDMS) on some indicators characterizing blood clotting under hemosorption conditions were compared in vitro. Sorbent Al2O3@PDMS/Li had significantly lower reactogenic effect on the blood passed through the column than the sorbent without lithium. This was seen from the degree of platelet reduction (66×109 vs 19×109/liter) as well as a less pronounced hypercoagulation shift in chronometric indicators. In contrast to lithium-free sorbent, Al2O3@PDMS/Li demonstrated the ability to reduce the concentration of fibrinogen. However, this had no impact on the density characteristics of the blood clot assessed by thromboelastometry such as maximum clot firmness, angle and fibrin clot formation time, amplitudes at 10 and 15 min after clotting time, which are known to depend on the quantity of platelets and the concentration of functionally active fibrinogen.

New Carbon-Mineral Sorbent Based on Aluminum Oxide, Polydimethylsiloxane, and Single-Wall Carbon Nanotubes: Assessment of the Effect on Erythrocytes In Vitro.

A comparative study of the effect of a sorbent with nanotubes (Al2O3@ WCNT-PDMS) and a carbon-mineral sorbent (Al2O3@C) on the parameters of human erythrocytes was carried out. Using scanning flow cytometry, the morphological and functional parameters of venous blood erythrocytes as well as drainage blood after its perfusion through columns with sorbents were determined. The compared samples Al2O3@SWCNT-PDMS and Al2O3@C are similar by their effect on the morphological and functional parameters of erythrocytes. The maximum membrane extensibility increased to a greatest extent after contact with Al2O3@C, the amount of hemoglobin in erythrocytes decreased to the greatest extent after perfusion through a column with Al2O3@SWCNT-PDMS sorbent. The scanning flow cytometry is promising for assessing the effect on erythrocytes of new sorption materials intended for blood detoxification. Changes in the parameters of erythrocytes of blood collected in a sterile drainage system for subsequent reinfusion were revealed.

[Treatment of torpid trophic ulcers in patients of the older age group.]

Chronic ulcers or non-healing ulcers are more common in the elderly (20 out of 1 000 people), whose age is closer to 80 years. The application of the principles of regenerative medicine, actively developing, in the treatment of such diseases, is based on the use of both autologous blood derivatives and autologous mononuclear cells. Objective: to evaluate the effectiveness of the use of plasma enriched with platelets in the treatment of torpid ulcers of the lower extremities in patients of the older age group. A prospective, randomized clinical trial was conducted in 80 patients. According to preliminary calculations, it has been shown that the combination of traditional treatment with the introduction of plasma enriched with platelets leads to accelerated healing of ulcers.

[The morphology of the connective tissue matrix and lymphatic bed of the external genitalia in primary massive localized lymphedema]. / Morfologiya soedinitel'notkannogo matriksa i limfaticheskogo rusla naruzhnykh polovykh organov pri pervichnoi massivnoi lokalizovannoi limfedeme.

OBJECTIVE: To identify the structural organization of connective tissue and vascular bed of the external genitalia in primary massive localized lymphedema. To analyze a clinical case of the development of massive localized lymphedema of the external genitalia concurrent with primary lymphedema of the lower limb in a patient with a normal body mass index. MATERIAL AND METHODS: The samples obtained by resection during volume reduction surgery were used to study the morphological features of the lymphatic bed and extracellular matrix of the scrotal skin and testicular dartos versus the samples without pathological changes. Biological samples were processed using standard techniques for histological, immunohistochemical and ultrastructural analyses. Lymphatic vessels were differentiated using the molecular lymphatic endothelial marker Podoplanin. RESULTS: In lymphedema, there was an increase in the thickness of all scrotal skin layers, a decrease in the volumetric lymphatic vessel density, an expansion of the interstitial spaces, and a change in the structure of collagen fibers that were homogenized, loosened, and swollen and did not form a three-dimensional network. The testicular dartos exhibited intermuscular fibrosis, expansion of the interstitial spaces, and perivascular leukocytic infiltration. CONCLUSION: Histological and immunohistochemical analyses revealed changes in the structural organization of the connective tissue matrix and lymphatic bed of the scrotal skin and testicular dartos in long-standing massive localized lymphedema. The feature of the described clinical case was the absence of signs of chronic inflammation and severe diffuse fibrosis in primary scrotal massive localized lymphedema in a patient with a normal body mass index.

[Vaginal approach for the surgical treatment of pelvic organ prolapse].

A review of current literature on the results of surgical treatment of patients with pelvic organ prolapse by vaginal approach is presented in the article. The relevant issues are the safety and efficiency of using mesh implants for the surgical correction of pelvic organ prolapse. Most experts recognize a need for further improvement of vaginal reconstruction techniques using synthetic meshes, however, current restrictions in a number of countries significantly impact on the respective studies. Despite the many scientific works and various publications, to date there is no single concept of the pelvic organ prolapse. It is necessary to conduct multicenter clinical studies in order to further develop clinical guidelines and to determine a place of these operations in the surgical treatment of pelvic organ prolapse.

[First experience with prostate artery embolization for benign prostatic hyperplasia].

This study aimed to evaluate the feasibility of the prostate artery embolization (PAE) in the management of patients with benign prostatic hyperplasia (BPH) in different age groups, depending on the severity of voiding dysfunction, findings of the prostate ultrasound, and the ASA surgical risk. MATERIALS AND METHODS: The study comprised 39 patients with grade II-III BPH. Patients were divided into three groups, depending on the prostate volume and the grade of anesthesia risk. Patients of the group 1 (n=12), group 2 (n=19), and group 3 (n=8) underwent a classical transvesical prostatic adenomectomy (TPA), bipolar transurethral resection (TUR) of the prostate, and PAE, respectively. The treatment outcomes were assessed at 3 and 6 months after the operation. RESULTS: When comparing the outcomes in three groups, a statistically significant difference in the IPSS was found both at 3 and 6 months when comparing TPA and TUR groups (p<0.0001) and PAE and TPA groups (p=0.0003). At 3 and 6 months after surgery, postvoid residual urine volume in the TPA and TUR group did not differ statistically significantly, but in the PAE group, it was significantly higher at 6 months than in the other two groups (p=0.004). CONCLUSION: As a minimally invasive procedure, prostate artery embolization can become an alternative to TUR and one-stage TPA for patients with verified BPH and grade III ASA risk. This treatment modality can be performed in patients of any age and any prostate volume. The age of the patient does not significantly affect the outcomes of TPA, TUR, and PAE. To recommend this treatment modality as a method of choice, further multi-center, randomized trials are warranted involving longer study duration and larger patient groups.

Polymorphism of angiogenesis regulation factor genes (VEGF/VEGFR), and extracellular matrix remodeling genes (MMP/TIMP), and the levels of their products in extracellular tissues of patients with primary and secondary lymphedema.

Cells of various organs and systems perform their functions and intercellular interactions not in an inert environment, but in the microenvironment of tissue fluids. Violations of the normal drainage of tissue fluids accompany lymphedema. An important mechanism of angiogenesis and vasculogenesis regulation in tissue fluids is the production and reception of vascular endothelial growth factors in combination with the regulation of matrix metalloproteinases. The aim of the work was to perform: a comparative analysis of some polymorphisms of vascular endothelial growth factor and their receptors and the genes encoding matrix metalloproteinases in two forms of lymphedema; an analysis of the relationship of these genes' polymorphisms with the levels of vascular endothelial growth factor and matrix metalloproteinases and their inhibitors in serum and affected tissues. Polymorphism of VEGF (rs699947, rs3025039), KDR (rs10020464, rs11133360), NRP2 (rs849530, rs849563, rs16837641), matrix metalloproteinases MMP2 (rs2438650), MMP3 (rs3025058), MMP9 (rs3918242), Timp1 (rs6609533) and their combinations were analyzed by the Restriction Fragment Length Polymorphism method and TaqMan RT-PCR. The serum and tissue fluid levels were determined using the ELISA test system. Changes in the frequency distribution of MMP2 genotypes in primary and MMP3 in secondary lymphedema are shown. Significant frequency differences in NRP2 genotypes were revealed by comparing primary and secondary lymphedema. Features of the distribution of complex genotypes in primary and secondary lymphedema were revealed. The correlation analysis revealed the interdependence of the concentrations of the MMP, TIMP and VEGF products and differences in the structure of the correlation matrices of patients with both forms of lymphedema. It was shown that, in primary lymphedema, genotypes associated with low MMP2 and TIMP2 in serum and tissue fluid are detected, while in secondary lymphedema, other associations of the production levels with combined genetic traits are observed.

[Lymphatic endothelium in certain conditions].

Presented herein is a review of the literature data concerning the structural and functional peculiarities of the endothelium of the lymphatic and blood vessels. The authors consider the current state of the art of the problem regarding dysfunction of lymphatic endothelium dysfunctions developing in various diseases, as well as in the process of ontogenesis, pointing out an important role of impaired processes of lymphangiogenesis, underlying the development of diseases of the lymphatic system. The authors also assess administration of quercetine in treatment for chronic venous insufficiency, followed by suggesting a possible mechanism of its positive action consisting ina decrease in the oedema at early stages of lymphoedema.

[State of the lower-limb lymphatic bed after open and endoscopic exposure of the great saphenous vein during coronary artery bypass grafting].

The article deals with the results of a comparative analysis of the state of the lower-limb lymphatic bed depending on the method of exposing the great saphenous vein (GSV) during the operation of coronary artery bypass grafting (CABA). Pronounced lesions of the lower-limb lymphatic system after surgical aggression provoke the development of complication such as lymphorrhea, lymphocele, and secondary oedema. The chosen objective method of assessment was radionuclide lymphoscintigraphy allowing of dynamically evaluating the alterations in the lymphatic system. We examined a total of 205 patients presenting with coronary artery disease and subjected to CABA. The patients were subdivided into two groups depending on the method used to expose the vein, including 109 patients with endoscopic exposure of the vein and group two consisting of 96 patients undergoing open exposure of the vein. Lymphoscintigraphy was performed in 18 patients with open exposure of the vein and in 23 patients with endoscopic exposure before and after the operation. Analysing the obtained findings revealed that according to the results of lymphoscintigraphy endoscopic exposure of the GSV was accompanied predominantly by an insignificant degree of impairment of the lymphatic drainage in 34.4%, whereas 94.4% were found to have mainly moderate-to-severe impairments. The lymphatic complications rate in the group with open exposure of the GSV was considerably higher which was mainly associated with the development of early oedema confirmed by an increased volume of the lower third of the crus of the operated limb. Radionuclide lymphoscintigraphy may be recommended as a method of early preclinical diagnosis of impairments of lower-limb lymphatic drainage in patients after exposure of the GSV in order to predict the development of clinically significant complications.

[Prevention of complications after surgery in patients with upper limbs' lymphedema].

The results of surgical treatment of patients with the fourth stage of the upper limbs' lymphedema was studied. Of all 170 patients with lymphedema, 16 (9.4%) had the fourth stage of the disease. The debulking procedures were performed in 15 patients (8 had standart operations, 7 - simultaneous rwo-stage operations). Beeing a preliminary stage of the radical surgical excision of lymphoedematously changed tissues, the liposuction allows a more precisional hemostasis for the accurate vessel visualization. It led to the 4,4 times decrease of the postoperative morbidity rate and shortened the time of the operation.

[Morphological changes of lymphatic system in patients with the lymphedema of lower extremities]. / Morfologicheskie izmeneniia limfaticheskoi sistemy u bol'nykh s limfedemoi nizhnikh konechnostei.

Morphological changes in inguinal lymph nodes, lymphatic collector and subcutaneous space were studied up in patients with the lower extremities lymphoedema. While the lower extremities lymphoedema occurs in inguinal lymph nodes the connective tissues spreading in two variants is observed. In the first one fibroblasts and collagen fibres appears in medullar substance (chordae medullaris and medullar sinuses) and in the second the sclerosis process begins from cortical plateau and paracortical zone. It is expedient to include the intraarterial infusion of the xenospleen preparations in complex of treatment of patients with initial stage of the lower extremities lymphoedema, especially in the absence of possibility to proceed with microsurgical intervention and the erysipelas presence in anamnesis.