[Remote results of infrainguinal bypass graft procedures for critical lower limb ischaemia]. / Otdalennye rezul'taty infraingvinal'nykh shuntirovanii pri kriticheskoi ishemii nizhnikh konechnostei.

AIM: The study was aimed at assessing the remote results of infrainguinal reconstructions in patients with critical lower limb ischaemia depending upon the bypass graft material used. PATIENTS AND METHODS: Analysed herein are the results of 237 infrainguinal bypass procedures performed over a 9-year period from January 1st, 2010 to December 31st, 2018. The patients were divided into three groups depending on the level of the distal anastomosis. Each group was then subdivided into subgroups based on the bypass graft material. Group One comprised 40 patients having endured femoral-proximal-popliteal bypass grafting. Group Two was composed of 77 patients after femoral-distal-popliteal bypass graft operations. Group Three included 120 patients after femorotibial bypass graft procedures. The comparative analysis was carried out in the first group between autovenous and synthetic grafts, in the second group - between autovenous, synthetic grafts and xenografts, and in the third group - between autovenous, composite grafts and xenografts. RESULTS: The primary patency rates at 1, 3, and 5 years in the first group amounted to 92, 88, and 73%, in the second group to 68, 60, 45% and in the third group - to 58, 49, and 43%, respectively. The 1-, 3-, and 5-year limb salvage rates in the first group were 100, 100, and 87%, in the second group - 90, 85, 73%; and in the third group - 90, 80, and 79%, respectively. Statistically significant differences were observed only when comparing the femoral-proximal and tibial grafts (p=0.039). Patients' survival at 1, 3, and 5 years in all groups turned out to be approximately similar, amounting in the first group to 92, 84, and 61%, in the second group to 96, 91, 71%, and in the third group to 88, 77, and 69%, respectively (p=0.87). In the first group, there were no significant differences between autovenous and synthetic grafts for any of the parameters studied. In the second group, the synthetic grafts (20%) were significantly inferior by the 5-year patency to autovenous grafts (65%) and xenografts (56%), as well as by the limb salvage rate to autovenous grafts (47 versus 84%). In the third group, the 5-year patency was the worst for the subgroup of composite grafts (15%), with the patency of xenografts being slightly inferior to that of autovenous grafts (33 vs. 55%). CONCLUSION: In patients presenting with critical ischaemia and requiring infrainguinal bypass grafting, as an alternative to an autovein if unavailable may serve synthetic prostheses when shunting to the proximal portion of the popliteal artery, or xenografts when shunting to the distal portion of the popliteal artery or tibial arteries. Despite worse patency, with their help it is possible to achieve regression of critical ischaemia and an acceptable limb salvage rate, which is comparable to the results of autovenous grafts.

[On patterns of human height distributions relative to the specific length of the foot]. / O zakonomernostiakh raspredeleniia znachenii rosta cheloveka dlia konkretnoi dliny stopy.

The purpose of the study is to clarify the patterns of distribution of height measurements relative to a specific length of a foot in humans, in order to use them for more accurate and reliable determination of body length (height). 15,892 people of mixed population (9814 men and 6078 women of 49 nationalities) aged from 20 to 50 years were examined. Their heights and their foot lengths were measured, and the coefficients of the ratios were calculated. A chart was made showing the distribution of body lengths relative to different lengths of the feet, in increments of 10 mm. The nature and density distribution of body lengths for each specific foot length were analyzed. The data revealed that each individual length of the foot corresponds to several values of height with a total spread of up to 24 cm at different frequencies of occurrence, which in fact does not allow to unambiguously determine the length of the body (height) of a person relative to the length of his foot. The maximum concentration of body lengths corresponding to a specific foot length is within the proximity of the average value, while significant deviations in one direction or another are much less common - making an exception in 1-3% of cases. The main density of the distribution of height values (76-86%) relative to foot lengths falls within the range of 10-12 cm. This makes it possible with a high degree of probability to determine height relative to foot length within these limits. The ratios of foot length to height, calculated in various ways, differ from each other. In this regard, the ratio between height and foot length, established by anthropologists and shoe designers/ergonomists - including methods for determining height, based on their calculations - are poorly suited for forensic science and forensic purposes.

[About the anthropometric relationship between the foot length and the height in the newborn infants and adult subjects]. / Ob antropometricheskoi zavisimosti mezhdu dlinoi stopy i rostom u novorozhdennykh detei i vzroslykh.

The objective of the present study was to clarify the relationship between the foot length and the height (body length) in the human subjects for the development of the rationale for the use of this characteristic for the estimation of the probable height of the newborn infants and adults. A total 1293 newborn babies (654 boys and 639 girls) were available for the examination. In addition, a mixed population of 12,141 men and 8213 women at the age ranging from 18 to 60 years and representing 49 ethnic groups were included in the study. We measured the height and the foot length in all the participants of the study and calculated the coefficients of correlation between these parameters. The same aspects of the anthropometric relationship between the height and the foot length were subjected to the analysis. It was shown that all the main characteristics of such dependence revealed in the adults are inherent in the newborn infant too; moreover, they are especially pronounced at birth. The differences were documented only between the relative values of the height to the foot length ratio. It is concluded that such qualitative differences can be accounted for by the fact that soon after the birth of a human being his (her) individual personality traits together with the age and gender as well as other subjective and objective factors begin to influence the above relationship. The coincidence of the height to the foot length ratios in the newborn infants and the adult subjects give evidence that such relationship is intrinsic in the anatomical structure of the human body. Therefore, it can be safely used for determining the height (body length) from the foot length for the purpose of forensic medical and criminalistic expertise.

[Multifactorial Prognostication of Remote Outcomes in Patients With Non-ST Elevation Acute Coronary Syndrome].

AIM: Creation of a mathematical nonlinear regression model for prognostication of 1 year outcomes after non-ST elevation acute coronary syndrome (NSTE ACS) for optimization of rehabilitation, secondary prevention, and personalized approach to treatment. MATERIAL AND METHODS: We included in this study 135 patients with confirmed NSTE ACS (mean age 59.1±6.1 years, 94 men and 41 women) admitted to hospital No 1 in Novosibirsk during 2010. During hospitalization and 1 year after discharge these patients received standard medical therapy. All patients underwent clinical and instrumental examination which included electrocardiography, echocardiography, Holter ECG monitoring. Program of clinical investigation also included determination of levels of inflammatory cytokines and molecular genetic studies. Effect of each of studied parameters on the probability of unfavorable one year prognosis was assessed by methods of correlation and factor analysis. RESULTS: The constructed mathematical model of multifactor prognostication of 1 year unfavorable or favorable outcomes after NSTE ACS included patient's age in years, presence of tachycardia at admission, Killip class >II, life-threatening paroxysmal tachyarrhythmias, as well as serum concentration of high-sensitivity C-reactive protein and CT genotype of a polymorphic variant rs1376251 of TAS2R50 gene. CONCLUSION: The use of the proposed model of multivariate prognostication of 1 year outcomes of NSTE ACS allows to improve the accuracy of events prediction, as it is based on data from Russian patients and takes into account the activity of subclinical inflammation and genotype of the patient. The model is simple to use and allows to personalize secondary prevention, which will facilitate lowering of total cardiovascular risk in these patients.

[Two-year results of infrainguinal reconstructions using autovenous shunts and xenografts]. / Dvukhletnie rezul'taty infraingvinal'nykh rekonstruktsii s ispol'zovaniem autovenoznykh shuntov i ksenoprotezov.

The authors analysed two-year results of inftrainguinal distal arterial reconstructions using xenograft ("kemAngioprosthesis") as compared with an autovein. Ours was a retrospective study including a total of 110 patients who endured 57 femoropopliteal (distal) and 54 femorotibial bypasses by means of both an autovein and a xenograft used as a shunt. The indications for reconstructive operation in the majority of cases was critical ischaemia induced by an atherosclerotic lesion of the femoropoplitealtibial segment corresponding to type D according to the TASC II classification. A xenograft was used only in case when the patient had neither great nor small saphenous vein suitable for use. Xenografts were used in 38 operations. In femoropopliteal (distal) bypasses the primary two-year patency of the xenograft virtually did not differ from that of autovenous shunts (70.1 and 76.5%, respectively). The two-year limb salvage rate for xenografts and autoveins used as shunts amounted to 87.1 and 88.7%, respectively. In For femorotibial bypass grafting, primary 2-year patency of xenografts was considerably worse and amounted to 35.8 versus 73.7% for autovenous shunts. The two-year limb salvage rate did not depend upon the type of the shunt, amounting in both cases to 80.2%. A characteristic complication for using xenografts was aneurysmatic degeneration of the shunts, which was observed in 21% of cases averagely 2 years after surgery. A conclusion was made that using xenografts for infrainguinal bypass operations may be considered as an adequate alternative in case of no autovenous material available.

[MULTIDISCIPLINARY TEAM APPROACH FOR DIABETIC FOOT PATIENTS IN AN OUT-PATIENT CLINIC].

AIM: To assess the effectiveness of multidisciplinary team approach in daily practice of diabetic foot. MATERIALS AND METHODS: 376 diabetic patients (446 ulcers) treated in a diabetic foot department in 2014 were examined. All patients were screened for diabetic peripheral polyneuropathy and blood insufficiency of lower extremities in order to diagnose the type of diabetic foot ulcer: neuropathic or neuroischemic. Patients were treated by a multidisciplinary team. The number of healed ulcers, minor and major amputations was analyzed. RESULTS: 80% of diabetic foot ulcers were neuropathic with normal blood supply, 20% had signs of ischemia. 77.8% of the ulcers healed in the general group during the study period. 13 amputations (2.9%) were done in the study group: 7 minor amputations (1.6%), 2 below the knee (0.4%), and 4 above knee (0.9%). Two patients died from cardiovascular events (0.4%). The comparative analysis of outcomes of neuropathic and neuroischemic ulcers showed that 84% of neuropathic ulcers healed. Minor amputations were done in 1% of the cases, no major amputations were performed. In patients with neuroischemic ulcers, 60% of them healed, minor amputations were made in 3.4% of cases (2.3% below knee, 4.6% above knee). CONCLUSION: The majority of diabetic ulcers in the study group were neuropathic with normal blood supply. The main risk factor of major amputations is ischemia of the affected limb. The multidisciplinary team approach in daily practice of the diabetic foot department of an out-patient clinic is instrumental in healing ulcers and minimizing the risk of major amputations.

[Endovascular interventions on the arteries of the popliteal-tibial segment].

The work was based on the results of studying the potential ability and outcomes of endovascular interventions (balloon angioplasty, stenting) in treatment of patients presenting with occlusive and stenotic lesions of the arteries of the popliteal-tibial segment at the stage of chronic ischaemia of lower limbs, in whom surgical reconstruction was impossible due to the type of the lesion or severity of concomitant pathology. The study was carried out in one hundred and four patients. On a total of 108 extremities involved, we carried out 174 endovascular interventions, including 29 stenting procedures and 145 balloon angioplasties. The following parameters were studied: dynamics of the clinical status, indices of the peripheral blood flow, immediate technical outcome, limb salvage rate, as well as short- and long-term (up to 2 years) patients' survival. It was proved that endovascular treatment of patients presenting with lesions of arteries of the popliteal-tibial segment is an efficient therapeutic method to relieve chronic ischaemia of lower extremities. For patients suffering from critical ischaemia of the lower limbs and diabetic angiopathy, this technique is sometimes the only method of surgical correction of the disordered blood flow. This method makes it possible not only to save the limb involved but also to improve the patient's quality of life.