[Long-term follow-up study of post-COVID-19 patients].

AIM: To evaluate dynamic changes in the lungs, hemostasis system, immune system in different terms after coronavirus pneumonia. MATERIALS AND METHODS: Ventilation-perfusion single-photon emission computed tomography/computed tomography (CT), functional methods of lung investigation, evaluation of hemostasis system, immune status and specific humoral immune response were performed and evaluated in different terms after coronavirus pneumonia. A total of 71 patients were examined according to this protocol. We examined patients with the lesion volume not less than 50% according to chest CT. All patients were divided into 2 groups depending on the distance from the acute stage of coronavirus pneumonia. Group 1 included patients who were examined early (3060 days after hospital discharge), group 2 included patients who were examined later (61180 days after hospital discharge). RESULTS: We obtained gradual regression of pathologically-modified tissue from 67.3% during the inpatient phase to 30.9% during the early period and to 19.7% during the late period of examination, according to CT scan of the chest organs. The same tendency was demonstrated by diffusion capacity of the lungs. Perfusion scintigraphy data showed a decrease in perfusion deficit from 26.012.8% during the early period of examination to 19.46.2% during the late period of examination. On the contrary, ventilatory scintigraphy demonstrates the increase of isotope passage time through the alveolar-capillary membrane over time (from 48.231.3 minutes in the early period to 83.637.2 minutes in the late period). An increase in D-dimer was detected in 24% of patients in the early group. The levels of inflammatory markers, indices of immune status, and specific humoral immune response did not differ in the two described groups. CONCLUSION: The results demonstrate gradual regression of pathological changes caused by coronavirus infection.

AB0 and rhesus blood groups as a risk factor for ARVI COVID-19.

The frequency of AB0 and Rhesus blood groups was studied in 12120 patients with COVID-19, 5180 convalescent plasma donors and 118801 healthy donors from Moscow, Smolensk, Yakutsk, Minsk and Gomel. In infected individuals, the frequency of blood group A was significantly higher than in uninfected individuals (41,54 % and 34,39 % respectively, p<0,05), and the frequency of blood group 0, on the contrary, was significantly lower (27,69 % and 36,71 %, p<0,05). The frequency of blood group A was particularly high among patients who died from ARVI COVID-19 - 45,51 % vs. 34,39 %, p=0,008. In some groups of patients, there was a decrease in the frequency of Rh-negative individuals (2,23 % vs. 8,30 %, p<0,001).

[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

[Severe postoperative intracranial hemorrhagic complications in a neurosurgical patient with von Willebrand disease not diagnosed before surgery (a case report and literature review)]. / Tiazhelye posleoperatsionnye intrakranial'nye gemorragicheskie oslozhneniia u neirokhirurgicheskogo bol'nogo s ne diagnostirovannoi do operatsii bolezn'iu Villebranda (klinicheskoe nabliudenie i obzor literatury).

The article describes a rare clinical case of a patient with previously undiagnosed von Willebrand disease and basal meningioma; an intracranial neurosurgical intervention was complicated by delayed intracranial hematomas, both at the resected tumor site and distantly. The diagnosis of von Willebrand disease was established only after special hematology tests and only after surgery. Despite the use of specific therapy, the patient died due to intracranial hemorrhagic complications in the postoperative period. The paper discusses the problem of preoperative diagnosis of asymptomatic hemostasis disorders in neurosurgical patients and potential ways of its solution.

[EMERGENCY TREATMENT OF BLEEDING IN PATIENTS TAKING WARFARIN].

Anticoagulant therapy with vitamin K antagonists (AVK) is an effective treatment and prevention of thrombosis. One of the major disadvantages of the AVK is a risk for serious bleeding. Prothrombin complex concentrates (PCC), fresh frozen plasma (FFP) and vitamin K1 are available for control of these situations. The experience of special team ofthe Scientific Center for Hematology was the basis for presented retrospective study. Three regimens of warfarin-related bleeding were compared: PCC+ VK for several bleeding, FFP+ VK for different clinical situations and VKfor light bleeding. PCC showed himself as effective and safe hemostatic agent. Transfusions of FFP were sometimes not effective, sometimes led to TACO. Supplementation of vitamin K1 for patients of I and II groups provided more stable control of hemostasis. In III group VK vas effective to stop bleeding. Two impotent sings for conclusion: necessary of laboratory monitoring, TEG first of all; individual balance of hemostasis base of bleeding or thrombotic risks.

[Endogenous heparin-like syndrome: analysis of clinical observations].

One of the reasons for non-surgical bleeding is heparin-like syndrome (HLS), under which is understanded presence of heparin effect in the absence of it's exogenous application. The role of endogenous heparins perform glycosaminoglycans -- biologically active substances. HLS is accompanied by endothelium damage and discussed in the network of the systemic inflammatory response syndrome (SIRS). HLS is described in liver future, sepsis, pregnancy and a number of hemoblastosis. Hypocoagulation effect of endogenous heparin localizates in X coagulation factor. The main method of diagnosis - thromboelastography. The use of a specific heparin antidote - Protamine sulfate has not confirmed clinical efficacy. Priority direction in the therapy of - methods of "shunt hemostasis". In this paper, we present the analysis of observations of 4 patients with developed endogenous HLS. In 2 cases (combination of sepsis with hepatic failure in one patient and initial thrombophilia in other) HLS has been accompanied by massive bleeding (massive hemothoraxc with haemorrhagic shock, a massive intraoperative blood loss). For HLS relief in these cases was used prothrombine complex concentrate (PCC) (in the 1st case), recombinant VIIa factor (in the 2nd case). In other cases, HLS (in a patient with multiple myeloma and childbirth in the postpartum period), haemorrhagic syndrome was not so expressed, the treatment was carried out with FFP transfusion.

[Therapy of acute massive blood loss in a hemophilic patient: case report].

A case is reported of management of massive intraoperative blood loss in a male patient with severe hemophilia. Extirpation of hip pseudotumor with one-stage osteosynthesis with an intramedullary joint-pin in a 43 year old male patient was accompanied with 7.5 l blood loss. The infusion-transfusion therapy (ITT) contained transfusion media about 1/3 of the total volume, fresh-frozen plasma and erythrocyte-containing media were used 1:1. Infusion solutions consisted of balanced polyelectrolytic solutions, hydroxyethylated starches 130/0.4, hyperchaes. Intraoperative normovolemic hemodilution and reinfusion of wound blood were made (CellSaver). ITT target markers were standard hemodynamics control tests. Hemostasis monitoring was conducted with thromboelastography. Complex ITT based on modern principles of clinical transfusiology provided a complete and safe compensation of massive intraoperative blood loss in a patient with severe hemophilia.

[Acute abdominal syndrome in blood system diseases].

AIM: To define an optimal diagnostic and therapeutic algorithm when the acute abdominal syndrome occurs in hematological patients. MATERIALS AND METHODS: The results of 145 emergency surgeries made in 2006-2008 for acute abdominal syndrome were studied in patients with blood system diseases. RESULTS: Clinical manifestations of acute abdominal syndrome emerge in 1-1.4% of all the patients treated at the Hematology Research Center, Russian Academy of Medical Sciences. There is a need for surgery in 0.5-0.7% of all the patients admitted. In this group of patients, annual postoperative mortality is 12-16%. CONCLUSION: The routine algorithm for a diagnostic search in hematological patients with acute abdominal syndrome can lead to both hyperdiagnosis and unwarranted surgery, and incorrect choice of expectant policy as well.

[Thromboelastographic characteristics of different infusion therapy regimens in healthy bone marrow donors].

Infusion solutions are able to change the hemostatic system. Thromboelastography (TEG) is an integral technique to evaluate the hemostatic system. TEG was used to evaluate the effect of three infusion solutions (6% hydroxyexyethyl starch (HES) 200/0.5 - Hemohes; HES 130/0.4 - Voluven; modified gelatin solution - Gelofusin) on the hemostatic system in 36 bone marrow donors (healthy individuals). The solutions were used in combination with crystalloid solutions during a procedure to compensate for intraoperative blood loss. Hemostatic changes were noted by the end of an operation in all groups; however, these were less pronounced when Voluven was administered. Thus, all colloid infusion solutions have varying effects on the hemostatic system, with a tendency toward both hypo- and hypercoagulation. According to TEG, HES 130/0.4 (Voluven) has a minimal effect on the hemostatic system.

[Transfusion-associated lung injury (TRALI): obvious and incomprehensible].

Acute transfusion-associated lung injury (TRALI) is an acute lung injury associated with and develops within 6 hours after the transfusion of components and blood preparations. Today there are no uniform views on the pathogenesis of TRALI. The discussion of immune and non-immune mechanisms is relevant. The key link of the former is that the presence of anti-leukocytic antibodies in a donor or a recipient and their interaction during transfusion with the leukocytes of the recipient or the donor, respectively; that of the latter link is the accumulation of biologically active substances in the transfusion media during storage and their passive administration to the recipient during transfusion. In both cases, the total link is drastic increased pulmonary capillary permeability. The clinical presentation of TRALI is nonspecific and generally similar to that of the adult respiratory distress syndrome and lung injuries of another genesis. It is necessary to make its differential diagnosis with allergic reactions, the transfusion of bacterially contaminated media and mainly with circulatory overload. Specific treatments for transfusion-associated lung injury are unavailable. Diferent variants of respiratory therapy are effective. Prevention of TRALI is mainly based on its immune mechanism. The leading direction of its prevention is to select donors.

[Enhancement of coagulation caused by transfusion of artificial plasma-replacement solutions].

AIM: To investigate hemostasis disorders caused by massive blood transfusions of artificial plasma replacing solutions (PRS). MATERIAL AND METHODS: Two groups of patients were examined: 7 healthy volunteers without blood loss (group 1) and 11 healthy donors of bone marrow with intraoperative blood loss 1-2 l (group 2). Five patients of group 1 received transfusion of 12 ml/kg hydroxyethyl starch (HES) 130/0.4, two patients of group 1 received transfusion of modified gelatine solution (gelofusin). All of them received infusions (1-1.5 l) of crystalloid PRS (1-2 l) and infusion of one of colloid PRS (6-HES, 5--gelofusin). Estimated hemodilution in group 1 was 1.17 +/- 0.01 times, in group 2 it varied from 1.3 to 2.7 times (mean 1.78 +/- 0.4 times). Hemostasis was studied by clot growth rate (for groups 1 and 2), endogenic thrombin potential and parameters of thromboelastography (for group 2) in plasm samples obtained before, 2.24 and 48 hours after infusion of colloid PRS. RESULTS: For both groups spatial clot growth rate 2 hours after hemodilution was high. Then it fell and reached baseline level 48 hours after PRS infusion. Endogenic thrombin potential and thromboelastography data (for group 2) changed by the same pattern. A hypercoagulation effect of gelofusin on parameters of thromboelastography and clot growth rate was higher than of HES 130/04. CONCLUSION: Moderate hemodilution with PRS in vivo causes hypercoagulation which persisted longer than volemic effect of PRS.

Mechanisms of toxic effect of streptozotocin on ß-cells in the islets of langerhans.

Administration of streptozotocin caused selective damage to endocrine ß-cells in rat pancreatic islets, which was related to activation of apoptosis. The cytotoxic effect of streptozotocin was associated not only with DMA damage due to dysfunction of the antioxidant defense system, but also with activation of the caspase cascade and TNF-related apoptosis-inducing ligand.

[Antidiabetic effect of Gymnema sylvestre-based medicinal complex].

The paper deals with the study of the antidiabetic mechanism of action of the medicine "Diabeta". The agent has been found to have a central effect (pancreatotropic one associated with insulin secretion stimulation) and a peripheral one (extrapancreatic effect associated with intestinal carbohydrate malabsorption).

[Structural alterations in pancreatic islets in streptozotocin-induced diabetic rats treated with of bioactive additive on the basis of Gymnema sylvestre].

The structural alterations in pancreatic islets in streptozotocin-induced diabetic rats were studied after the administration of Gymnema sylvestre extract or its composition. Diabetes mellitus was modeled by daily injection of streptozotocin (20 mg/kg for 5 days) and single injection of 0.2 ml of complete Freund's adjuvant, Only the animals with the blood glucose level exceeding 15 mmol/l were included in the experiment. B- and A-endocrinocytes were demonstrated using immunocytochemistry. The proportions of the area of the pancreatic islets, occupied by B- and A-endocrinocytes, as well as the volume fraction of the pancreatic islets within the pancreas, were determined. In the model of streptozotocin-induced diabetes, the part of the total islet area occupied by B-endocrinocytes, was diminished in the pancreatic islets located in all the zones of the gland. Prophylactic administration of Gymnema sylvestre extract or its composition tended to restore the area occupied by B-endocrinocytes in the pancreatic islets. These results indicate the equal potency of the composition and extract of Gymnema sylvestre to induce the regeneration of B-endocrinocytes.

[Hemorheological activity of Gymnemy sylvestre extracts in streptozotocin-induced diabetes].

Extracts of Gymnemy sylvestre (GS) exhibit hemorheological activity. The most pronounced effect was observed for GL extract in 25 wt % concentration, which (i) induced a decrease in the viscosity of blood and washed erythrocyte suspensions in the entire range of shear rates by a factor of 1,3 (ii) reduced the degree of deformability of red blood cells, (iii) increased the degree of osmotic resistance of erythrocytes by 21.3%, (iv) increased the intensity of fluorescence of DSM+ probe in erythrocyte suspensions by a factor of 1.5, and (v) decreased the degree of anisotropy, thus generally improving the viscoelastic properties of the erythrocyte membrane and preventing the thrombocyte aggregation. In this respect, the GS extract activity exceeded that of Tanakan.

Reduction of the linewidths of deep luminescence centers in 28Si reveals fingerprints of the isotope constituents.

Dramatic reductions of the linewidths of well-known deep centers in 28Si reveal "isotopic fingerprints" of the constituents. The approximately 1014 meV Cu center, thought to be either a Cu pair or an isolated Cu, is shown to contain four Cu atoms, and the approximately 780 meV Ag center is shown to contain four Ag. The approximately 944 meV ;{*}Cu center, thought to be a different configuration of a Cu pair, in fact contains three Cu and one Ag, and a new two-Cu two-Ag center is found. The approximately 735 meV center, previously assigned to Fe, actually contains Au and three Cu. This suggests a family of four-atom (Cu, Ag, Au) centers.

Optical detection and ionization of donors in specific electronic and nuclear spin States.

We resolve the remarkably sharp bound exciton transitions of highly enriched 28Si using a single-frequency laser and photoluminescence excitation spectroscopy, as well as photocurrent spectroscopy. Well-resolved doublets in the spectrum of the 31P donor reflect the hyperfine coupling of the electronic and nuclear donor spins. The optical detection of the nuclear spin state, and selective pumping and ionization of donors in specific electronic and nuclear spin states, suggests a number of new possibilities which could be useful for the realization of silicon-based quantum computers.