[First case of thrombolysis with non-immunogenic staphylokinase in a patient with ischemic stroke receiving dabigatran etexilate followed by thrombectomy]. / Pervyi sluchai tromboliticheskoi terapii pri pomoshchi neimmunnogennoi stafilokinazy u patsientki s ishemicheskim insul'tom, poluchayushchei dabigatrana eteksilat, s posleduyushchei trombektomiei.

Currently, five oral anticoagulants have been shown to be effective in preventing recurrent ischemic stroke and/or systemic embolism in patients with non-valvular atrial fibrillation. However, 1.1-2.2% of patients taking oral anticoagulants develop ischemic strokes. The use of oral anticoagulants limits the possibility of systemic thrombolytic therapy, as this is associated with an increased risk of symptomatic hemorrhagic transformation. The exception is cases when, with the help of a specific antagonist, it is possible to neutralize the effect of the anticoagulant in the shortest possible time and achieve normocoagulation. Currently, the Russian Federation allows two drugs for systemic thrombolytic therapy in patients with ischemic stroke in the «therapeutic window¼ up to 4.5 hours from the onset of the disease - recombinant tissue plasminogen activator and non-immunogenic staphylokinase, which showed no less efficacy and safety in the FRIDA study compared to recombinant tissue plasminogen activator. This article describes a clinical case of the first systemic thrombolytic therapy with a non-immunogenic staphylokinase after the use of idarucizumab in a patient taking dabigatran etexilate, followed by thrombectomy.

[Ultrasound in the diagnosis and treatment of abdominal abscesses]. / Ul'trazvukovoe issledovanie v diagnostike i lechenii abstsessov briushnoi polosti.

OBJECTIVE: To improve the results of surgical treatment of abdominal abscesses using ultrasound-assisted drainage. MATERIAL AND METHODS: There were 103 cases of percutaneous ultrasound-assisted drainage of intraperitoneal abscesses for the period from 2012 to 2017. Patients who underwent drainage of intraorganic and retroperitoneal abscesses associated with pancreatic necrosis were excluded from the study. RESULTS: Complete recovery was observed in 101 (98%) out of 103 patients within 10-73 days. CONCLUSION: Ultrasound-assisted drainage is an effective procedure for abscesses. This method has demonstrated high efficiency, availability and safety without need for open approach. This method may be a reliable alternative to open surgery, for example in emergency surgical hospitals.

[Prognostic significance of leukocyte count in the venous blood in the acute stage of cerebral aneurism rupture]. / Prognosticheskaia znachimost' kontsentratsii leikotsitov v venoznoi krovi v ostrom periode razryva tserebral'nykh anevrizm.

AIM: To determine a prognostic role of leukocyte count in the venous blood in the acute stage of cerebral aneurysm (CA) rupture. MATERIAL AND METHODS: Fifty-one patients with CA rupture, aged from 20 to 65 years, hospitalized in the first 72 h over the period from 01.10.12 to 01.02.16 were examined. The severity of disease and anatomical form of hemorrhage was corresponded to III-IV degree on the W. Hunt - R. Hess scale and Fisher scale. All patients underwent surgery. Outcomes after open and endovascular surgeries were similar. RESULTS: Normal leukocyte number in the venous blood at admission was identified in 12 (24%) of patients (on average 7.3±1.4·109/L), leukocytosis in 39 (76%) (14.3±3.1·109/L) (p<0.0001). Leukocyte number in the acute stage of CA rupture was correlated with the frequency and severity of the vessel spasm. In 28 (55%) of patients with ischemic lesions of the brain matter, mean leukocyte number in the first 72 h after hemorrhage was higher by 2-24% (3±4.8·109/L) compared to patients without ischemia (11.9±2.5·109/L) (p=0.06). The level of leukocytes in survivors was lower by 3 - 28% (122±3.4·109/L) compared to patients with fatal outcome and patients with severe neurological deficit after the surgery (14.5±3.9·109/L) (p>0.05). CONCLUSION: The increase in leukocyte number in the venous blood in the first 72 h after CA rupture ≥10,1·109/L is a reliable risk factor of marked vessel spasm. The level of leukocytes in patients with cerebral ischemia and poor prognosis in the first 72h after aneurysmal hemorrhage was higher by 2-28% compared to survivors without neurological impairment or mild neurological deficit.

[Dilated cardiomyopathy as a cause of ischemic stroke]. / Dilatatsionnaya kardiomiopatiya kak prichina ishemicheskogo insul'ta.

Dilated cardiomyopathy (DCMP) is a disease of the myocardium characterized by the dilatation of heart cavities with the development of systolic dysfunction but without a decrease in the thickness of the myocardium. DCMP is a frequent cause of cardioembolic syndrome, in particular cardioembolic ischemic stroke (CES). A case of a patient with DCMP after CES is presented.

[Effect of normobaric hyperoxia on cerebral oxygenation, metabolism and oxidative stress in patients with subarachnoid hemorrhage caused by intracranial aneurysm rupture].

The development of cerebral vasospasm in subarachnoid hemorrhage (SAH) due to cerebral aneurysms rupture results in cerebral circulation disturbances. Application of normobaric hyperoxia can be an effective way for improving of oxygen delivery to injured brain tissues. The purpose of this study was to assess of normobaric hyperoxia influence on intracranial pressure (ICP), cerebral oxygenation and metabolism, oxidative stress and endogenous factors of vascular regulation in II critically ill patients with nontraumatic SAH due to cerebral aneurysms rupture. Increase of FiO2 from 0.3 to 0.5 and 1.0 was accompanied with brain oxygen tension (PbrO2) increase and cerebral extraction ratio for oxygen (O2ER) decrease. Application of normobaric hyperoxia had no effect on ICP, cerebral perfusion pressure, arterial blood pressure and cerebral metabolism. The results obtained from patients with nontraumatic SAH showed an evident increase of oxidative stress which had a significant effect on vascular endothelial function, causing an imbalance in the endogenous regulation of vascular tone. Application of normobaric hyperoxia was not accompanied by an increase of free-radical processes in critically ill patients with nontraumatic SAH due to cerebral aneurysms rupture.

[High-flow extracranial-intracranial (EC-IC) bypass surgery in a patient with giant right cavernous ica aneurysm].

To present the clinical case of successful extracranial-intracranial (EC-IC) high-flow bypass performance. Patient, female, 51 years old, was suffered from giant cavernous aneurysm of right internal carotid artery (ICA), presented with mass effect. The EC-IC high-flow bypass using radial artery was performed between M2 segment of right middle cerebral artery and right external carotid artery. Bypass patency was confirmed by intraoperative dopplerography, postoperative digital subtraction angiography and by ultrasound examination of anasthomosis. Patient was discharged in 3 weeks after operation in satisfactory condition. The EC-IC high-flow bypass is one of effective method for cavernous aneurysm treatment, allowing excluding aneurysm from cerebral blood flow and decreasing its mass effect.

[Role of multicomponent neuromonitoring in the determination of intensive care tactics in a female patient with subarachnoidal hemorrhage due to cerebral arterial aneurysmal rupture].

The paper describes a case of aneurysmal subarachnoidal hemorrhage in a female patient during intensive care involving the whole set of the latest neuromonitoring parameters: intracranial and cerebral perfusion pressure, brain tissue oxygen tension and temperature, as well as a set of biochemical parameters studied by the tissue microdialysis technique. The high diagnostic value of the parameters that cannot be changed by any other neuromonitoring modalities is shown.

[Intracranial pressure, cerebral perfusion and metabolism in acute period of intracranial hemorrhage].

Estimation of the volume of cerebral lesion, reversibility of ischemia and prognosis of the disease determinate management tactics in patients with severe head injuries and non-traumatic intracranial hemorrhages. Data of multimodal neuromonitoring in patients with intracranial hemorrhage in the earlier stages of comatose period were analyzed in this paper. They included incracranial pressure, cerebral perfusion pressure, bulb oxymetry, brain oxygen tension, tissue microdialysis. Typical parameters for different types of neurological outcomes were defined.

Retrospective luminescence dosimetry: development of approaches to application in populated areas downwind of the Chernobyl NPP.

The cumulative absorbed dose in fired-clay bricks collected from ten buildings in the populated contaminated settlement (137Cs, 1,470 kBq m(-2)) of Stary Vishkov, located 175 km downwind of the Chernobyl Nuclear Power Plant (NPP) in the Bryansk administrative region of Russia, was determined using luminescence techniques by five laboratories. At each location, the cumulative dose, after subtraction of the natural background dose, was translated to absorbed dose in air using conversion factors derived from Monte Carlo simulations. The simulations employed source distributions inferred from contemporary soil contamination data and also took into account heterogeneity of fallout deposition. At four locations the cumulative dose at a reference location was calculated, enabling the luminescence determinations to be compared directly with values of cumulative absorbed dose in air obtained using deterministic models. A "local" conversion factor was also derived from the Monte Carlo simulations for locations where the disturbance of soil was significant. Values of the "local" cumulative dose in air calculated using this factor were compared with those predicted using the deterministic models at each sampled location, allowing location factors to be calculated. The methodology developed is generally applicable to populated areas contaminated by radioactive fallout in which brick buildings are found. The sensitivity of the luminescence techniques for bricks from this region of Russia was sufficient to evaluate cumulative absorbed dose in brick due to fallout of less than 20 mGy.

The application of retrospective luminescence dosimetry in areas affected by fallout from the semipalatinsk nuclear test site: an evaluation of potential.

Luminescence retrospective dosimetry techniques have been applied with ceramic bricks to determine the cumulative external gamma dose due to fallout, primarily from the 1949 test, in populated regions lying NE of the Semipalatinsk Nuclear Test Site in Altai, Russia, and the Semipalatinsk region, Kazakhstan. As part of a pilot study, nine settlements were examined, three within the regions of highest predicted dose (Dolon in Kazakshstan; Laptev Log and Leshoz Topolinskiy in Russia) and the remainder of lower predicted dose (Akkol, Bolshaya Vladimrovka, Kanonerka, and Izvestka in Kazakshstan; Rubtsovsk and Kuria in Russia) within the lateral regions of the fallout trace due to the 1949 test. The settlement of Kainar, mainly affected by the 24 September 1951 nuclear test, was also examined. The bricks from this region were found to be generally suitable for use with the luminescence method. Estimates of cumulative absorbed dose in air due to fallout for Dolon and Kanonerka in Kazakshstan and Leshoz Topolinskiy were 475 +/- 110 mGy, 240 +/- 60 mGy, and 230 +/- 70 mGy, respectively. The result obtained in Dolon village is in agreement with published calculated estimates of dose normalized to Cs concentration in soil. At all the other locations (except Kainar) the experimental values of cumulative absorbed dose obtained indicated no significant dose due to fallout that could be detected within a margin of about 25 mGy. The results demonstrate the potential suitability of the luminescence method to map variations in cumulative dose within the relatively narrow corridor of fallout distribution from the 1949 test. Such work is needed to provide the basis for accurate dose reconstruction in settlements since the predominance of short-lived radionuclides in the fallout and a high degree of heterogeneity in the distribution of fallout are problematic for the application of conventional dosimetry techniques.

Comparison of retrospective luminescence dosimetry with computational modeling in two highly contaminated settlements downwind of the Chernobyl NPP.

The cumulative absorbed dose in bricks collected from six buildings in two heavily contaminated settlements (137Cs > 2,000 kBq m(-2)) located downwind of the Chernobyl Nuclear Power Plant was determined using luminescence techniques by six laboratories. The settlements, Vesnianoje in Ukraine and Zaborie in Russia, are located in, respectively, proximal and distal locations relative to the Chernobyl Nuclear Power Plant. The luminescence determinations of cumulative dose in brick, after subtraction of the natural background dose, were translated to absorbed dose in air at a Reference Location using conversion factors derived from Monte Carlo simulations of photon transport. The simulations employed source distributions inferred from contemporary soil contamination data and also took into account heterogeneity of fallout deposition. This translation enables the luminescence determinations to be compared directly with values of cumulative absorbed dose obtained by computational modeling and also other dose reconstruction methods. For each sampled location the cumulative dose was calculated using three deterministic models, two of which are based on the attenuation of dose-rate with migration of radionuclides in soil and the third on historic instrumental gamma dose-rate data. The results of the comparison of the two methods indicate overall agreement within margins of +/-25%. The methodology developed is generally applicable and adaptable to areas contaminated by much lower levels of radioactive fallout in which brick buildings are found.

Elimination of the background signal in tooth enamel samples for EPR-dosimetry by means of physical-chemical treatment.

A method of elimination of the background EPR signal in tooth enamel is proposed. This method implies treatment of enamel powder by highly active reduction reagent hydrazine with subsequent washing out by ethanol-water solution. Such treatment results in reducing both the native background signal (which is assumed to be originated by the organic component) and the mechanical induced EPR signal in enamel. Testing of the efficiency of hydrazine treatment is made for different sizes of enamel powder. It is shown that the optimal results are obtained for a powder fraction of about 100-200 microm. The radiation-induced EPR signal in enamel is practically not changed after treatment by hydrazine.

Possibility of using porcelain samples of high-voltage line insulators for radiation dose reconstruction by EPR spectroscopy.

In electron paramagnetic resonance spectra of irradiated porcelain samples from high-voltage supply line insulators three overlapping single signals were observed. The dependencies of the amplitude of these signals on the microwave power, irradiation dose and the stability in darkness and in natural light were investigated. It was concluded that for dosimetric purposes it is reasonable to use the radiation-induced signal with g = 2.001, which could be ascribed to the E' centres of quartz. The microwave power dependence of the amplitude of this signal is saturated at 1 mW, the dose dependence is saturated at about 60 mGy. A minimal level of dose determination is about 1 Gy, and it is limited mainly by the accuracy of subtraction of the background signal existing in the unirradiated sample. The radiation-induced signal is stable in the darkness, but rapidly faded in natural light, therefore, for dosimetric purposes it is possible to use only insulators covered with dark glaze or ceramic samples from the very interior of the insulators.

Application of EPR retrospective dosimetry for large-scale accidental situation.

Above 3000 tooth enamel samples, collected at population of radioactive contaminated territories after Chernobyl accident, the Chernobyl liquidators, the retired military of high radiation risk and the population of control radiation free territories were investigated by EPR spectroscopy method in order to obtain accumulated individual exposure doses. Results of EPR spectra measurements are stored in data bank; enamel samples are also stored in order to provide the possibility to repeat the measurements in future. Statistical analysis of results has allowed to detect the contribution into EPR signal in tooth enamel due to the action of the natural background radiation, and the radioactive contamination of territory. In general, the average doses of external exposure of the population obtained with EPR spectroscopy of teeth enamel are consistent with results based on other methods of direct and retrospective dosimetry. Essential exceeding of the individual doses above the average level within the population groups was observed for some persons. That gave the possibility to detect the individuals with overexposure, which were included into groups for medical monitoring.

Tooth enamel EPR dosimetry: sources of errors and their correction.

Some of the most important sources of systematic errors in dose determination using tooth enamel EPR spectroscopy and ways of reducing those errors are discussed. Enamel from the outside of the front teeth should not be used for dose determination because of induction of paramagnetic centers by solar light. The accuracy of the method in the low dose range is limited by variation in the shape of the EPR signal of unirradiated enamel, which can be described by an initial intrinsic signal and which varies for different samples with standard deviation of 20-30 mGy. The energy dependence of enamel sensitivity should be taken into account in the form of a correction factor. The value of this factor is estimated at 1.1-1.3 for real radiation fields in radiation contaminated territories. Variation in enamel sensitivity for different samples is shown to be within limits of 10-15% of the average value.

The first international intercomparison of EPR-dosimetry with teeth: first results.

Intercomparison of EPR-dosimetric techniques using tooth enamel had been performed in order to check whether the results produced by different laboratories are consistent and accurate. Participants were supposed to evaluate doses applied to pulverized enamel samples, using routine techniques from their laboratories. The intercomparison has demonstrated a great variety of methods used for dose reconstruction. Peculiarities of experimental approaches are discussed systematically in terms of procedure for recording the EPR-spectra, determination of the amplitude of the radiation induced signal, determination of the dose, and error propagation.

ESR and TL dosimetry systems: comparative measurements for human phantom.

Mixtures of small fragments of tooth enamel as well as thermoluminescence (TL) dosimeters were placed into the tissue-equivalent phantom of the human head with skeleton (approximately at the level of the jaws) and irradiated using 137Cs low dose-rate gamma therapeutic sources ('SELEKTRON' LDR 137Cs). Phantom, samples of teeth and TL detectors were irradiated behind water tank to produce scattered irradiation. The same irradiation with the same geometry was performed in air too. For gamma-spectrometry 137Cs sources with very low activity were used but with the same geometry as therapeutic sources. The absorbed dose in enamel was estimated with the help of ESR spectrometer 'ESP-300 E' (Brucker). The samples of tooth enamel were partially used for preliminary dose evaluation by ESR signal before starting of experiment. TL dosimetry was performed by TL reader model 8800 (HARSHAW) using TL dosimeters calibrated with 137Cs. The paper presents data obtained in comparative aspects.