APPLICATION OF GRAFTSKIN TO ACCELERATE HEALING OF ULCERS IN DIABETIC FOOT SYNDROME.

Diabetic foot syndrome (DFS) is one of the severe and more frequent complications of diabetes. It is characterized by occurrence of chronic purulent necrotic processes (trophic ulcers) on the foot with damage of skin, soft tissues and osteoarticular system due to pathological changes in the peripheral nervous system (diabetic neuropathy) and vascular system (diabetic angiopathy). This study aimed to evaluate the possibility of accelerating of wound healing in DFS by using the dermal equivalent (graftskin) and determine the safety of the method, factors and indications for its application. The research included 60 patients with DFS who were cured at the period from 2013 to 2016 in departments of purulent surgery of Hospital of war veterans and Municipal hospital № 14 of Saint-Petersburg. The patients were divided into 2 groups by random sampling of two comparable groups in age and sex. The patients of main group were treated by standard method and using application of dermal equivalent (DE) on the area of trophic ulcers. The patients of control group had only standard treatment. The DE showed a high efficacy in the main group of patients. The application of DE in complex treatment of patients with DFS stimulated processes of healing and accelerated the rate of epithelization. The application of DE was the most effective in patients with neuropathic form of DFS.

[Perfusion, Metabolism and Regional Myocardial Contractility in Patients With Valvular Heart Disease: a Long-Term Follow-Up After Valve Replacement].

AIM: To perform complex assessment of myocardial perfusion, metabolism, and regional contractility in patients with valvular heart disease (VHD) in remote period after surgical correction of heart defects. MATERIAL AND METHODS: We examined 30 patients with VHD in 1-8 years after heart valve replacement because of mitral (n=13) or aortic (n=17) valve defects of the following etiology: rheumatic heart disease (n=10), degeneration of connective tissue (n=13), infective endocarditis (n=7). For assessment of myocardial perfusion, metabolism, and regional contractility, we used single photon emission computed tomography (SPECT). RESULTS: Myocardium of patients who had undergone surgical correction of heart valve defects was characterized by dominating diffuse sclerotic changes localized mostly in basal segments. Hibernating myocardium was a less frequent finding. There were segments of borderline state with normal parameters of metabolism but slight impairment of perfusion without pronounced disturbances of kinetics. Patients with infectious etiology of valvular defects had combined perfusion and metabolic changes in multiple myocardial segments. Extensive derangements of perfusion and metabolism were characteristic for patients with connective tissue degeneration. CONCLUSION: Signs of cardiac failure caused by disturbances of myocardial perfusion and metabolism in patients with valvular heart disease can persist even after successful correction of valvular defect with normalization of intracardiac hemodynamics.

[ABCG1 transporter gene expression in peripheral blood mononuclear cells of patients with atherosclerosis].

Accumulation of cholesterol in arterial wall macrophages is a main hallmark of atherosclerosis. The ABCG1 transporter mediates cholesterol efflux to high density lipoproteins (HDL) and plays an important role in macrophage foam cell formation. The goal of our study was to investigate the potential role of ABCG1 in atherosclerosis development in humans. ABCG1 gene expression has been examined in leukocytes, monocytes and monocyte-derived macrophages of patients with atherosclerosis and in the control group. Real time PCR and Western blotting were used to determine ABCG1 mRNA and ABCG1 protein levels. Monocyte ABCG1 mRNA level was inversely correlated with the rate of artery occlusion (r = -0.45, P = 0.016). Patients with 100% artery occlusions had decreased monocyte ABCG1 mRNA levels compared to patients who had smaller plaques and controls (P < 0.05). ABCG1 mRNA (P < 0.001) and ABCG1 protein (P < 0.05) levels in macrophages of patients with coronary artery stenosis were significantly reduced compared to the control group. No significant correlation between the ABCG1 gene expression in mononuclear cells and HDL cholesterol concentration has been found. Our study suggests that decrease in the ABCG1 gene expression in macrophages is associated with atherosclerosis.

[Comparative analysis of the early postoperative period in patients with postoperative ventral hernias after different nonstrain hernioplastic techniques application].

The article presents the research of the early postoperative period in 64 patients with postoperative ventral hernias who underwent the operation by two different ways. The method of patch applied on the hernial orifice was used in 30 cases. In these cases prosthesis contacted with hypoderm. The modified way of Toskin-Zhebrovskiy was carried out in 34 patients. In these cases the prosthesis was isolated from hypoderm using the hernia bag flap. It was shown, that the frequency of seromas formation was significantly less in comparison with standard method of nonstrain hernioplasty in early postoperative period. Given method allowed shortening the terms of inpatient treatment on 3 days.

[Individual approach to choosing the exposure time during myocardial perfusion single-photon emission computed tomography].

OBJECTIVE: To assess whether the quality of the results of myocardial perfusion single-photon emission computed tomography (SPECT) may be improved by applying an individual approach to choosing the exposure time of a study. MATERIAL AND METHODS: The results of myocardial perfusion SPECT with the radiotracer (RT) Technetril upon 25-sec (short) and 60-sec (long) exposures in 22 patients with valvular heart disease (VHD) and coronary heart disease (CHD) were retrospectively analyzed. The basis for the comparative assessment of the study results was the number of myocardial impulses (NMI). The reference informative value was taken as a NMI equal to 21,000-77,000. All the patients were divided into two groups: 1) those with a NMI of below 21,000 and 2) those with a NMI of above 21,000. The raw counts of RT and lesion extent were compared in each group during two exposure modes. RESULTS: No statistically significant differences were found between the raw counts of RT in the left ventricular segments upon short and long exposure regardless of NMI. Evaluation of lesion extent revealed differences in sizes and/or location in 14 (63,6%) patient upon various exposures, most (10 patients) of them were from Group I and only 4 patients were from Group 2, these patients having marked myocardial hypertrophy. CONCLUSION: To enhance the informative value of myocardial perfusion SPECT, it is expedient to individually choose exposure time for each patient, being oriented to the time taken to achieve a NMI of at least 21,000, which can be determined by making one planar scintigram in the left anterior oblique projection (LAO 45 degrees).

[ABCA1 mRNA and protein levels in M-CSF-activated macrophages from patients with arterial stenosis].

ABCA1 transporter is one of the key factors defining the level of antiatherogenic HDL in plasma. It is actively involved in the removal of cholesterol from peripheral tissues by reverse cholesterol transport. However, the influence of the level of ABCA1 mRNA and the level of ABCA1 protein 1 in macrophages in atherosclerosis remains unexplored. Using real time PCR we determined ABCA1 mRNA level in macrophages cultured for 5 days with macrophage colony-stimulating factor (M-CSF). ABCA1 mRNA levels in macrophages from patients with arterial stenosis were increased when compared with the control group, P = 0.04. According to a Western blot analysis ABCA1 protein level in macrophages from patients was significantly lower than in the control group, P = 0.01. Our results suggest that the level of ABCA1 mRNA and level of ABCA1 protein in macrophages may be important factors in the development of atherosclerosis.

[Long-term results of using mononuclear fraction of autologous bone marrow cells in complex surgical treatment of patients with heart valve failure].

The article is devoted to long-term results of pilot clinical investigation of using mononuclear fraction of autologous bone marrow cells as an additional procedure to standard surgical treatment of heart valve failure in order to improve local perfusion and contractive ability of the myocardium. The article presents results of an analysis of findings of the examination of 7 living patients within 6 years or 7 years after operation as also data of pathologicoanatomical investigation of three dead patients. The data obtained show the safety and effectiveness of this method of cell therapy in patients with heart valve failure.

[Intracardial transplantation of mononuclear cells of the autologous bone marrow in complex treatment of patients with valvular heart diseases].

The authors present the first clinical experience with intramyocardial transplantation of the mononuclear fraction of cells of the autologous bone marrow in complex surgical treatment of 10 patients with valvular heart disease. The cellular transplantation was fulfilled intraoperatively when making a prosthetic mitral (5 patients) and aortal (5 patients) valves on the open heart under conditions of extracorporeal circulation. Simultaneously direct revascularization of the myocardium (aorto-coronary and mammary-coronary shunts) was performed in 4 patients (1--with a mitral and 3--with aortal heart diseases). An investigation of the results of the examination including ECG, EchoCG and investigation of the myocardium perfusion using one-photon emission computed tomography fulfilled in the early postoperative period and within 6-12 months after operation has shown that the cell cardiomyoplasty with mononuclear fraction of cells of the autologous bone marrow improves the myocardium perfusion, however, in the early postoperative period the appearance of transitory impairments of the heart rate is possible.

[The influence of myocardial perfusion on the course of postoperative period in patients operated on for valvular heart disease].

The interrelation between the course of the early postoperative period and myocardial perfusion was studied in 48 patients. Its condition was determined before surgical correction of the valvular disease by the method of single-photon emission computed tomography with a radiopharmaceutical preparation Technetril. It was found that although all the examined patients had impaired myocardial perfusion, 15 (32%) of them had no clinical symptoms of ischemic syndrome. In patients with marked disturbances of myocardial perfusion the early postoperative period was considerably more severe as compared with the patients having mild disturbances of the myocardial perfusion.

[On teaching surgery at the graduation course of a medical college according to a new curriculum]. / O prepodavanii khirurgii v meditsinskom vuze na vypusknom kurse po novomu uchebnomu planu.

Teaching surgery to students of the medical college represents a complex dynamic process based on the achievements and advantages of domestic medical education. The article presents an analysis of historical aspects of teaching surgery formed under the influence of N.I.Pirogov's ideas and shows the necessity of searching for new forms of organization of teaching surgery at the up-to-date stage of reorganization of higher professional school. Special attention is given to a compulsory preservation of traditional principles of the system of teaching surgery verified by almost two centuries of experience of using it.

[Indices of chronic intravascular hemolysis in patients with different prosthetic heart valves in long-term follow-up]. / Pokazateli khronicheskogo vnutrisosudistogo gemoliza u bol'nykh s razlichnymi konstruktsiiami iskusstvennykh klapanov serdtsa v otdalennye sroki nabliudeniia.

An examination of 153 patients with valve replacement was performed at late stages of (6.8 +/- 0.2) years, in 84 patients the mitral valve replacement (MVR) was fulfilled, in 64--the aortic replacement (AVR) and in 5--two valve replacement were performed. Higher indices of hemolysis were noted in patients with AVR, in cases of two valve replacement and in patients with the paravascular fistula. The lowest indices of hemolysis take place in patients with bileaflet prostheses (MEDING/CarboMedics, St. Jude Medical), especially in patients with AVR. The complications of intravascular hemolysis are: cholelithiasis, anemia, hemosiderosis of the kidneys, sideropenia. The timely diagnosis, treatment and prophylactics are necessary to prevent these complications.

[Possibility of angiogenesis stimulation in ischemia by embryonic human brain tissue (initial experimental results)]. / Vozmozhnost' stimuliatsii angiogeneza pri ishemii preparatom émbrional'noi mozgovoi tkani cheloveka (pervye éksperimental'nye rezul'taty).

The article proves the presence of angiogenic activity of the original specimen of biological genesis obtained from the embryogenic human brain tissue. The investigation was carried out on ischemia models of the rat's myocardium and hind limb.

[Transplantation of embryonic myocardium in animal experiments]. / Transplantatsiia émbrional'nogo miokarda v éksperimente.

The work presents the results of experimental transplantation of a not-divided embryonic myocardium culture into the mesentery of the adult rats' intestine for the terms of about 30 days. The influence of Cimitidine--cardiolen on the development of this culture was investigated. The grafts were shown to be taken and to function well and the use of cardiolen reliably improves the development of the culture.

[Effect of cytomedins on development of organotypic culture of various tissues from the internal organs of rats]. / Vliianie tsitomedinov na razvitie organotipicheskoi kul'tury razlichnykh tkanei vnutrennikh organov krysy.

Some natural peptides, referred to as cytomedines, were isolated from different organs: cortexin and epithalamin (both from the brain), cordialin (heart), hepalin (liver) and thymalin (thymus),--to test their stimulating effects on the growth in organotypic culture of different tissue explants taken from 3 day old rats. It has been found that these peptides exerted their obvious stimulating effects on the growth of the cultured explants, compared to the control, if taken in the respective concentrations: 100, 50, 50, 100 and 5 ng/ml. Thus, these cytomedins can be used in the clinical practice for stimulating reparative processes in the appropriate tissues.

[Rare causes of the dysfunction of mechanical bicuspid heart valves]. / Redkie prichiny disfunktsii mekhanicheskikh dvustvorchatykh klapanov serdtsa.

The authors share the observations from their cardiosurgical practice showing that one of the causes of sudden death or of rapid worsening of the state of patients with implanted bicuspid artificial valves might be their dysfunction resulting both from breakage of the hinged mechanisms of the valve with its dislocation and migration and from the disturbed mobility of the valve cusp due to a thrombus formed in the atrium. The observations show that the "ideal" construction of the valve is to be created.

[Should the presence of coiled blood flow in the left heart ventricle and aorta be taken into consideration when constructing artificial heart valves?]. / Sleduet li uchityvat' nalichie zakruchennogo potoka krovi v levom zheludochke serdtsa i aorte pri konstruirovanii iskusstvennykh klapanov?

The use of an original device developed by the authors which was introduced in the blood flow in experiments in dogs has confirmed the presence of coiled blood flow in different parts of the aorta. The rate, direction and angle of coiling were calculated. The results obtained suggest that the fact of coiling the blood flow should be taken into account when constructing new models of artificial valves of the heart in order to decrease the energy value of the cardiac output, to prevent injury of the formed elements of blood and thrombogenesis.