[Morphological aspects of diaphragm dysfunction in COVID-19-associated pneumonia]. / Morfologicheskie aspekty disfunktsii diafragmy pri COVID-19-assotsiirovannoi pnevmonii.

OBJECTIVE: To assess morphological changes in the diaphragm and phrenic nerve in patients who died from COVID-19. MATERIAL AND METHODS: In a case-control study, an analysis was made of autopsy material of the diaphragm and phrenic nerve of those who died from COVID-19 infection complicated by SARS-CoV-2-associated pneumonia, confirmed in vivo by the presence of SARS-CoV-2 RNA (Group 1, n=12), and those who died with a diagnosis of acute cerebrovascular accident of the ischemic type without parenchymal respiratory failure (Group 2, n=3). RESULTS: The main histopathological features in the diaphragm of the 1st group were the edema of the pericellular spaces of muscle fibers, edema of perivascular spaces, diapedese hemorrhages, plethora in arteriolas, in most veins and capillaries, red blood clots were revealed; in the diaphragmatic nerve - swelling of the perineral space, severe edema around the nerve fibers inside the nerve trunk. In the diaphragm of group 2, edema of pericellular spaces of muscle fibers and edema of perivascular spaces were less pronounced (p<0.001), hemorrhages were not determined; in the diaphragmatic nerve, moderate edema of the perineral space, mild swelling inside the nerve trunk around the nerve fibers was revealed (p<0.001). The glycogen content in the muscle cells of group 1 is significantly lower compared to group 2 (p<0.001). CONCLUSION: The study confirms the characteristic pathological picture of organ damage in COVID-19. However, the leading pathological mechanism of organ damage requires further investigation.

[Infusion prevention of fat globulaemia during total hip arthroplasty]. / Infuzionnaia profilaktika zhirovoi globulemii pri reéndoprotezirovanii tazobedrennogo sustava.

AIM: To assess the effect of the modified infusion therapy regimen on the frequency of development of laboratory and clinical manifestations of fat embolism syndrome in patients after hip replacement. MATERIAL AND METHODS: The study was conducted in 80 patients (70 men and 10 women) who were admitted for planned revision hip arthroplasty. The criteria for not inclusion in the study were the presence of a traumatic brain injury, episodes of acute disturbance of blood supply (stroke) and diabetes mellitus in history. 40 patients of the main group during the operation were administered Gelofuzin and Sterofundin isotonic, and in the first day after the operation Remaxol and Sterofundin isotonic. Using the copy-steam method, a control group (n=40) out of 197 patients was selected by gender and age. In the control group, infusion therapy was carried out using a 0.9% NaCl solution. All patients underwent assessment of fat globulemia, water-electrolyte balance, acid-base status and oxygenation index - before surgery; 2, 24, 48, and 72 hours after the operation, on the third day, mental disorders were assessed using the Addenburg scale (ACE-R) for evaluating cognitive functions. RESULTS: All patients underwent hip joint endoprosthetics. In the group receiving the modified infusion therapy regimen, the results were significantly better, there were no statistically significant changes in the level of electrolytes (p=0.14), episodes of a decrease in the oxygenation index and cognitive dysfunction. In contrast to patients in the control group, where the level of chlorine and sodium was significantly higher, the number of fat globules with a diameter of more than 8 µm, as well as in two patients, the development of postoperative delirium with a decrease in the oxygenation index below 300 was observed. The causal relationship between the number of fat globules with a diameter of more than 8 microns and clinical manifestations of cerebral and pulmonary forms of fat embolism (r-Pirsen = -0.87 and -0.80, respectively). There were no statistically significant changes in platelet count, potassium concentration with indicators of fat globulemia and a scale of cognitive impairment. CONCLUSION: A high correlation of fatty globulemia with the development of respiratory and pulmonary dysfunction after hip replacement was determined. The inclusion of Gelofuzin, Sterofundin isotonic and Remaxol in intensive therapy provides a pronounced emulsifying effect on fat globules appearing in the bloodstream in the first hours after hip replacement, and effective prevention of potentially dangerous fat embolism.

[To the question of laboratory diagnostics of fat droplets.]

This study aims to compare of study of blood plasma for the presence of fat globules using the method of V.A. Cherkasov and the method what we developed in 60 patients with severe combined trauma. The use of the developed method increases the accuracy of qualitative and quantitative analysis by reducing the emulsifying action of the ethyl alcohol of Sudan IV, preventing uneven coloring and destruction of the preparation within 3 minutes after preparation. A classification of fat globules has been developed, capillary-hazardous globules of ≥ 8 µm in size and arterioles-hazardous globules ≥ 50 µm.

[The role of unesterified fatty acids in diagnostic of fat embolism.]

The prospective study of concentration of unesterified fatty acids in patients with severe combined trauma was carried out. In patients with fatty embolism syndrome increasing of concentration of unesterified fatty acids in arterial and venous blood in comparison with reference interval was detected. The increasing of concentration of fatty acids in arterial blood in comparison with venous blood was established. The higher diagnostic significance of arterial venous difference in concentration of unesterified fatty acids in diagnostic of fatty embolism syndrome is established.

[METABOLIC PREVENTION OF FAT EMBOLISM.]

THE AIM: to study the effect of solution with methionine "Remaxol" on metabolic disorders andfat embolism developing in severe combined trauma. MATERIALS AND METHODS: 544 patient with severe skeletal trauma were undergone to a prospective study of dynamics of fat embolism syndrome development depending on the inclusion in the program of infusion therapy drug "Remaxol". The dynamics of lactate, glucose, free fatty acids, globularia and the incidence offat embolism syndrome were analyzed. RESULTS: Corrective action drug with methionine "Remaxol" on hyperglycemia, hyperlactatemia, hyperlipemia and de- crease circulation offat globules, which is reflected in the decrease in the frequency of development offat embolism syndrome was identified. CONCLUSION: One of the proposed mechanisms reduce the risk offat embolism development is assumed restoration of endogenous carnitine synthesis with methionine and transport offree fatty acids in the cell and their subsequent inclusion in metabolic processes.