ВведениеОдной из важных задач реаниматологии является определение упруго эластичных свойств эритроцитов при критических состояниях. Эти свойства обеспечи вают эффективность транспорта клеток в системе сосу дов микроциркуляции и оксигенацию тканей. Для ис IntroductionOne of the important problems of reanimatology is determining the elasticity patterns of erythrocytes in crit ical illness. These properties ensure efficient cell transfer in vascular microcirculation and effective tissue oxygenation. Different techniques are used to investigate the deforma Цель исследования. Выработать методику получения изображений нативных клеток в физиологической среде, изме рить локальную жесткость фиксированных мембран эритроцитов в жидкости в опытах in vitro. Материал и методы. Забор крови производили у четырех здоровых доноров в процессе профилактических осмотров. Кровь помещали в микроветты с ЭДТА. Эритроциты фиксировали в среде буферного раствора на подложку с покрытием полилизина. Изображение клеток получали с помощью АСМ NTEGRA Prima, (NT MDT, РФ). Жесткость мембран оценивали с помощью метода атомно силовой спектроскопии. Результаты. Получены значения эффективного модуля Юнга для статистической выборки фиксированных мембран эритроцитов. При действии верапамила на кровь модуль Юнга был равен 528±21кП. При действии на кровь ионов тяжелых металлов средняя локальная жесткость высушенной мембра ны была увеличена до 942±56 на глубине 35 нм. Выводы. Измерения силовых характеристик эритроцитов в жидкости позволяют получать воспроизводимые результаты исследований упруго эластичных свойств мембран. С помощью метода атомной силовой микроскопии и атомно силовой спектроскопии можно анализировать свойства живой клетки в физиологической среде. Ключевые слова: мембраны, нативные клетки, упруго эластичные свойства, атомно сило вая спектроскопия.Objective: to develop a procedure to image native cells in a physiological medium and to measure the local stiffness of fixed red blood cell membranes in liquid in vitro experiments. Material and methods. Blood was taken from 4 healthy donors dur ing prophylactic examinations and placed in EDTA containing Microvette tubes. The red blood cells were fixed in buffer solution onto a polylysine coated substrate. Cell images were obtained using an ACM NTEGRA Prima microscope (NT MDT, the Russian Federation). Membrane stiffness was estimated by atomic force spectroscopy. Results. The values of effective Young's modulus were obtained for a statistical sample of fixed red blood cell membranes. Under the action of ver apamil on blood, Young's modulus was equal to 528±21 kP. Under the action of heavy metal ions on blood, the mean local stiffness of the dried membrane was increased up to 942±56 at a depth of 35 nm. Conclusion. The measurements of the force characteristics of red blood cells in liquid can yield reproducible results of examining the elastic properties of the mem branes. Atomic force microscopy and atomic force spectroscopy can be employed analyze the properties of a live cell in the physiologica...
mental treatment of gastrointestinal bleeding with endoscopic high-frequency welding bipolar electrocoagulation. ABSTRACT. Background. Problem of treatment of gastrointestinal bleeding remains relevant. According to the Center of Medical Statistics of the Ukraine Health Ministry-total mortality of gastrointestinal bleeding in Ukraine is 5, 87%. In 2017, 18968 patients were hospitalized, of which 35, 56% with late hospitalization (> 24 hours). Mortality of gastrointestinal bleeding in Ukraine is 5, 87%, in Kiev-7, 42%. Postoperative mortality in Ukraine is 5,15%, late hospitalization (>24h)-7,86%; in Kyiv-3,33%, late hospitalization-6,32%. Endoscopic hemostasis reduces both general and postoperative mortality 3-4 times. There are a number of methods for endoscopic hemostasis: chemical (Caproferr, Infuzol), injectable (Epinephrine 1:20, Terlipressin), monopolar coagulation, argonoplasmic coagulation, laser coagulation, and clapping. Objective. We have proposed endoscopic high-frequency welding bipolar coagulation with a probe (Patented No. 115147, Application number u201608620 dated 10.04.17), which is carried out through the instrumental channel of the endoscope to the bleeding site. Methods. Welding of the vessel is provided by the high-frequency bipolar apparatus EK-300 M1. In order to evaluate the effectiveness of our method we conducted an experiment on pigs with morphological verification of the vessel's condition. We used two different probes for high-frequency welding bipolar coagulation, connected to the EK-300 M1 for welding bleeding vessel. Results. After coagulation visually we could see that bleeding was stopped in all cases. Morphologically was found that for stopping bleeding of vessels up to 1mm in diameter the most effective is the use of a probe 1 with an exposure time of 15s, for vessels more than 1mm is effective to use a probe 2 with an exposure time of 30s. Conclusion. Taking into account the results of our study and disadvantages of already existing methods, high-frequency welding bipolar electrocoagulation has its own advantages (superficial effect on tissue, good coagulation effect with bleeding vessels 2-3mm and more, can be used in patients with artificial pacemaker), therefore it is new expedient and justified method of endoscopic stopping of bleeding.
A high number of repeat cesarean sections increases a risk of excessive bleeding, uterine atony, hysterectomy. The aim of study was to evaluate the efficacy of medical and technical methods (argon plasma coagulation, tranexamic acid, carbetocin) to prevent complications following repeat cesarean section and to improve the myometrial wound healing, to establish morphological features of uterine scar tissue in case of using argon plasma coagulation of myometrium in the area of the suture during the previous operation. Prospective cohort study of 77 patients who had undergone repeat cesarean section. I group included 37 women who had repeat cesarean section using argon plasma coagulation. Ten minutes before the operation, 15 mg/kg of tranexamic acid was injected intravenously. 100 mcg carbetocin was administered intravenously after cutting the umbilical cord. ІІ group comprised 40 women who had traditional cesarean section using Stark's technique and Joel-Cohen incision. Pathomorphological study of scarred lower uterine segment myometrium was performed. Immunohistochemical staining against CD3, CD34, CD68, vimentin, α-SMA was performed. Results are presented as Mean±SD. Total operative time was significantly shorter in the І group (37,0±2,1 minutes) compared to ІІ (46,1±1,8 minutes) (р<0,05). Volume of blood loss in the І group was 465,7±37,5 ml, and in the ІІ — 547, 7±34,6 ml (p<0.05). Patients of the І group needed analgesic for 18-24 hours, the ІІ group — 36-48 hours after operation. The width of the uterine cavity in group І was 9,8±0,37 mm, in group ІІ — 14,6±0,54 mm (р<0,05). One patient of group І and 9 patients of group ІІ had signs of uterine subinvolution. Length of hospital stay after surgery in group I was 4,7±0,12 days, in ІІ — 6,6±0,28 days. The ultrasound thickness of myometrium in group I and group II is an average of 9,32±0,64 mm and 6,24±0,59 mm, respectively. Pathomorphological data of scarred lower uterine segment myometrium showed that in group I regenerative processes have more favorable course, a tendency to restore the structure of myometrium, while in group II there were processes of disturbed regeneration with the replacement of smooth muscle tissue varying maturity of connective tissue, moderate inflammatory process. So, the use of tranexamic acid, carbetocin and argon plasma coagulation is effective in reducing perioperative blood loss, total operative time, dosage of uterotonic and analgesic medications and postoperative hospital stay in patients giving birth by repeat cesarean section. According to the pathomorphological study, argon plasma coagulation of myometrium in the area of suture increases the value of the reparative processes and promotes the formation of a morphologically complete scar, with the predominance of smooth muscle cells over connective tissue.
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