Postpericardiotomy syndrome (PCTS) is one of the most frequent cardiac surgery complications seen in 9-65% of patients. Despite its widespread occurrence, the mechanisms of the development of PCTS are still understudied. drug. The use of colchicine in cardiac surgery patients is of particular interest. Due to the ability of this drug the colchicine mechanisms of action are able to inhibit the mobilization of the NLRP3 inflammasome assembly, to suppress the activation of caspase-1. As a result, it can prevent the release of proinflammatory cytokines, namely IL-1β and IL-18. There are conflicting data on the effect of colchicine on the PCTS progression within the systemic inflammatory response after cardiac surgery. In this regard, it was important to study the dynamics of serum levels of IL-6, IL-10, IL-1β, and TNFα in patients before coronary artery bypass grafting (T1), 6 hours (T2), and 10 days (T3) after surgery, and to evaluate the effect of colchicine on the development of PCTS. The results of our research showed a significant increase of IL-10 in both groups 6 hours after surgery. However, on the 10th day, the increase in the level of IL-10, compared with the initial values, was higher in the 1st group – 2 times, compared with the 2nd group. In both groups, showed significant increase in serum concentration of IL-6 after 6 h surgery, with a subsequent decrease in the expression at the stage of T3, while the IL-6 levels in the 2nd group was statistically notably higher than T1. The incidence of pleurisy was lower in the group of patients taking colchicine. Only in the 1st group IL-6 levels were directly associated with IL-10. In patients with pleurisy, the level of released IL-10 and TNFα was significantly higher in the 2nd group. There were no significant intergroup differences in serum levels of IL-1β and TNFα, as well as significant changes in IL-1β between the stages of observation. Analysis of TNFα expression revealed significant differences in TNFα content in the 1st group between the T1-T3 and T2-T3 stages. In both groups, multiple positive associations were found between the studied indicators. Thus, data were obtained indicating the antiinflammatory effect of colchicine in cardiac surgery patients. This was clinically expressed in a tendency to a lower incidence of pleurisy, and was accompanied by increased expression of IL-10, which has an antiinflammatory and immunomodulatory effect against the background of the drug in the postoperative period.
Aim. To test the hypothesis that early detection of clinically significant patients with high risk of developing intra-abdominal hypertension in cardiac surgery may be based on an increase in the level of fatty acid-binding protein.Material and Methods. Concentrations of fatty acid-binding protein (I-FABP) were measured in urine samples taken from 82 patients after cardiac surgery with cardiopulmonary bypass. The data were compared with clinical manifestations of the perioperative period, as well as changes in pH and lactate levels in arterial blood.Results. Statistically significant differences were revealed between the study groups in the cases of increased intra-abdominal pressure, duration of ventilation, and the number of cases of intestinal failure. The level of I-FABP increased in the patients of both groups after removal of the aortic clamp in 2 hours, 12 hours, 24 hours after surgery. Conclusions. The I-FABP level can be a valuable marker for early detection of patients with the development intra-abdominal hypertension of after cardiac surgery. The measurement of I-FABP can serve as a guideline not only for the identification of patients with intra-abdominal hypertension, but also for the initiation of therapeutic measures aimed at minimizing further deterioration of intestinal function.
The article describes a clinical case of inhalation therapy with high doses of nitric oxide (NO) in a comorbid patient with a severe course of COVID-19. An air stream containing NO was generated using the PLAZON device. High-dose NO inhalation therapy was administered as a life-saving option due to the lack of effect from treatment delivered in accordance with the current national clinical guidelines for the treatment of COVID-19. The safety and clinical efficacy of the technique was demonstrated.
<p>Acute kidney injury (AKI) and its delayed diagnosis often lead to an increase in the number of patients with chronic kidney disease. There is no denying the importance of studying the pathogenetic mechanisms of AKI, timely predictive identification of patients at high risk of CSA-AKI, as well as the need to search for and improve perioperative strategies to prevent CSA-AKI. The development of new approaches regarding predictive diagnostics of AKI and their widespread introduction into a wide clinical practice will improve the prognosis and survival of these patients.<br />The modern diagnostic continuum of AKI considers risk factors as pre-existing conditions against which adverse factors of the perioperative period are realised. Risk factors for AKI in cardiac surgery are divided into two categories: 1) patient-dependent and 2) operations-associated or modifiable risk factors for the development of AKI, to some extent secondary to iatrogenic effects (adverse factors of the perioperative period). A clear understanding of the significance of these factors regarding the development of AKI in cardiac surgery patients allows us to form risk scales for predicting CSA-AKI in the postoperative period. This review presents the following work, which is a milestone for the predictive diagnosis of AKI in cardiac surgery: model Association of Nephrology and the Association of Anaesthesiologists and Reanimatologists of Russia, the scale EuroSCORE II, the STS Score, Score Mehta, ‘risk index perioperative renal dysfunction/failure’, S. Aronson et al., scale S.Y. Ng et al., model K. Birnie et al.<br />The use of predictive models for the predictive diagnosis of CSA-AKI is an important strategy for identifying high-risk patients. This approach allows active application of preventive strategies regarding AKI in routine clinical practice. It also has distinct advantages regarding conducting cohort clinical studies of new renoprotective technologies. To date, there is no ‘gold standard’ scale for predicting the risk of cardiac AKI. The authors propose consideration of their application as a weighted ‘Solomon’ solution, according to a specific clinical situation.</p><p>Received 10 July 2020. Revised 9 September 2020. Accepted 10 September 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: N.O. Kamenshchikov, Yu.K. Podoksenov, M.L. Diakova<br />Drafting the article: N.O. Kamenshchikov, M.L. Diakova, A.M. Boyko<br />Critical revision of the article: M.L. Diakova, Yu.K. Podoksenov<br />Final approval of the version to be published: N.O. Kamenshchikov, Yu.K. Podoksenov, M.L. Diakova, A.M. Boyko, B.N. Kozlov</p>
Цель. Оценить степень нейронального повреждения и когнитивного статуса в условиях унилатеральной антеградной перфузии головного мозга через брахиоцефальный ствол при хирургической реконструкции грудной аорты. Материал и методы. В исследование включены 144 пациента с аневризмой и расслоением грудной аорты. Больным выполняли реконструктивные вмешательства в условиях искусственного кровообращения, унилатеральной антеградной перфузии головного мозга и циркуляторного ареста. До и после вмешательства проводился анализ когнитивного статуса с использованием МоСА-теста, корректурной пробы, таблиц Шульте. Периоперационно определяли динамику нейрон-специфической енолазы (NSE)-маркера нейронального повреждения. Результаты. Продолжительность искусственного кровообращения составила 155 [115; 201] мин, кардиоплегического ареста-100 [72; 150] мин, унилатеральной перфузии-20 [15; 51] мин, циркуляторного ареста-20 [15; 30] мин. Госпитальная летальность составила 7% (10 случаев). Неврологические осложнения были отмечены в 12 (8%) случаях. У всех пациентов в послеоперационном периоде (в течение 24 ч) отмечалось повышение уровня NSE по сравнению с исходными значениями (3,3 мкг/л и 2,07 мкг/л, соответственно, p=0,0003), но не выходящее за верхнюю границу нормы (9,9 мкг/л). По результатам психометрических тестов, которые проводились при поступлении в стационар и через 2 нед. после операции, не было выявлено отрицательных
Aim. To evaluate manifestations of systemic inflammatory response (SIR) and the effect of the colchicine therapy on SIR severity in patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) with extracorporeal circulation (EC).Material and methods. This study included 100 patients aged 62+6.3 years with stable IHD and multivessel coronary atherosclerosis scheduled for CABG with EC. Patients of group 1 (n=50) were administered with a single dose of colchicine (Colchicum-Dispert) 500 µg 4 hours before surgery followed by 500 µg twice a day for 10 days after surgery. Patients of group 2 (n=50) received a standard treatment, including nonsteroid anti-inflammatory drugs after surgery. Severity of the inflammatory response was evaluated by measuring blood cytokines.Results. In the postoperative period, patient of group 1 showed a tendency toward a lower incidence of pleurisy and heart rhythm disorders in the form of paroxysmal atrial fibrillation (AF) (p=0.18). Levels of the anti-inflammatory cytokines, interleukin-10 (IL-10) and interleukin-6 (IL-6), were significantly increased in both groups at 6 hours after surgery (p<0.05); at the same time, in group 1, IL-10 remained increased also at 10 days after surgery (р=0.0002). No significant time-related changes in the proinflammatory cytokines, tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β), were observed. At 3 days post-CABG, there were significant increases in tissue inhibitors of matrix metalloprotease 1 (TIMP-1) (р<0.0001) and matrix metalloproteinase 9 (MMP-9) (р<0.001); at the same time, patients of group 1 had lower MMP-9 concentrations than patients of group 2 (p<0.05). At 10 days of postoperative period, these values were comparable with the background values. Increases in neopterin compared to preoperative values were found in both groups on days 3 and 10 after surgery (р <0.0001).Conclusion. CABG with EC is associated with the activation of SIR. The colchicine therapy at a dose of 500 µg 4 hours prior to surgery and 500 µg twice a day for 10 days after surgery reduces manifestations of SIR, which is clinically evident as a tendency to reduced incidence of pleurisy and arrhythmias, and does not result in the development of serious complications. The dynamics of matrix metalloproteinases indicates that the colchicine treatment is promising for decreasing the risk of CHF progression and myocardial remodeling in patients with IHD.
<p>Surgical intervention on an ‘open’ heart during cardio-pulmonary bypass is the method of choice for patients with valvular defects, complicated forms of coronary heart disease and combined pathology. The level of perioperative mortality in these interventions range from 2 % to 10 %. Acute kidney injury associated with cardiac surgery is a common and serious complication which dramatically worsens operative prognoses and results. According to several major studies, the incidence of acute renal injury in cardiac surgery is comparable with the incidence of myocardial infarction, with corresponding unsatisfactory outcomes.<br />The introduction of the term ‘acute kidney injury’ into clinical practise, replacing the concept of acute renal failure, occurred relatively recently. This facilitated a universal definition for this condition, and unified the criteria for diagnosis and stratification of acute renal dysfunction severity. The article defines acute kidney injury using RIFLE, AKIN and KDIGO criteria. Acute kidney injury in cardiac surgery dramatically worsens short-term results and long-term outcomes, and thus increases the economic cost of treating patients. According to some reports, in industrialised countries, the health costs associated with acute kidney injury are estimated at $ 1 billion. Acute kidney injury is associated with approximately 300,000 deaths per annum, as well as approximately 300,000 new cases of chronic kidney disease. Cumulative expenses associated with acute renal injury in cardiac surgery are not directly limited to the hospitalisation period, but are often prolonged and/or deferred. These patients require additional financial expenses after discharge from hospital, which once again exemplifies this problem in cardiac surgery.<br />Manifest acute kidney injury in the postoperative period of cardiac surgery leads to an increased number of extrarenal complications, reduced short-and long-term survival rates, increased economic costs in hospitals and prolonged treatment effects in the long-term. The introduction of a single definition of cardiac acute renal injury according to KDIGO criteria into clinical practise will identify patient groups with a high risk of developing this pathology. Similarly, it will also facilitate timely measures to prevent the development of complications in postoperative periods, which will reduce the risk of complications in cardiac patients.</p><p>Received 10 July 2020. Revised 2 September 2020. Accepted 9 September 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: N.O. Kamenshchikov, Y.K. Podoksenov, M.L. Diakova<br />Data collection and analysis: N.O. Kamenshchikov, A.M. Boyko, M.L. Diakova<br />Drafting the article: N.O. Kamenshchikov, M.L. Diakova, A.M. Boyko<br />Critical revision of the article: M.L. Diakova, Y.K. Podoksenov<br />Final approval of the version to be published: N.O. Kamenshchikov, Y.K. Podoksenov, M.L. Diakova, A.M. Boyko, B.N. Kozlov</p>
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