Comparative Assessment of Original vs. Standard Surgery Techniques in Treatment for Purulent Pyelonephritis

Background. Modern minimally invasive surgical techniques reduce traumatism of operative interventions and aggressive anaesthesia, which accordingly shortens the patient’s hospital stay and rehabilitation period.Aim. An improvement of surgical outcomes in patients with purulent pyelonephritis via introduction of laparoscopic techniques.Materials and methods. Th e study included 80 purulent pyelonephritis patients operated at the Territorial Clinical Hospital during 2006—2018. Th e patients were divided between two cohorts. Cohort 1 included 40 (50 %) patients operated with standard techniques (ST), cohort 2 — 40 (50 %) patients having surgery by an original minimally invasive technique (OT). Kidney decapsulation was found to outcome in parenchymal decompression and blood circulation restore in cortical layer. Intraarterial infusion of alprostadil prevents further spread of purulent-destructive processes in kidney.Results and discussion. In patients with the minimally invasive technique, postoperative period proceeded at no complications. On day 1, the patients reported reduced pain syndrome in the surgical area. Contrasted renal MSCT before and aft er surgery showed the recovery of renal blood flow and significant diminishing of destruction foci in short term. Nephrectomy was not performed as no-indication.Conclusion. The treatment outcomes in 40 patients having the new surgical technique demonstrate its efficacy and applicability in clinical practice.

In Vitro Model for Simulating Drug Delivery during Balloon-Occluded Transarterial Chemoembolization

Background: Balloon-occluded transarterial chemoembolization (B-TACE) has emerged as a safe and effective procedure for patients with liver cancer, which is one of the deadliest types of cancer worldwide. B-TACE consist of the transcatheter intraarterial infusion of chemotherapeutic agents, followed by embolizing particles, and it is performed with a microballoon catheter that temporarily occludes a hepatic artery. B-TACE relies on the blood flow redistribution promoted by the balloon-occlusion. However, flow redistribution phenomenon is not yet well understood. Methods: This study aims to present a simple in vitro model (IVM) where B-TACE can be simulated. Results: By visually analyzing the results of various clinically-realistic experiments, the IVM allows for the understanding of balloon-occlusion-related hemodynamic changes and the importance of the occlusion site. Conclusion: The IVM can be used as an educational tool to help clinicians better understand B-TACE treatments. This IVM could also serve as a base for a more sophisticated IVM to be used as a research tool.

Efficacy of Regional Chemotherapy Approach in Peritoneal Metastatic Gastric Cancer

Peritoneal spread is frequent in gastric cancer (GC) and a palliative condition. After failure to systemic chemotherapy (sCTx) remaining therapeutic options are very limited. We evaluated the feasibility and efficacy of locoregional chemotherapy (RegCTx) in peritoneal metastatic GC. In total, 38 (23 male and 15 female) patients with peritoneal metastatic GC after failure of previous sCTx and unresectable disease were enrolled in this study. Using the hypoxic abdominal stop-flow perfusion, upper abdominal perfusion and intraarterial infusion technique in total 114 cycles with Cisplatin, Adriamycin and Mitomycin C were applied. No significant procedure related toxicity was noticed- especially no Grade 3 or 4 toxicity occurred. With the RegCTx approach a median overall survival of 17.4 months was achieved. Patients who had undergone previously resection of the GC the median overall survival was even better with 23.5 months. RegCTx is a promising, safe and efficient approach in diffuse metastatic GC. The evaluation of RegCTx in the setting of multimodal treatment approach at less advanced stages is also warranted.

Negative Influence of Insufficient Sleep on Endothelial Vasodilator and Fibrinolytic Function in Hypertensive Adults

Insufficient nightly sleep (<7 hour/night) has been linked to the cause of hypertension and is a prevalent, often ignored, comorbidity. We tested the hypotheses that chronic nightly insufficient sleep is associated with lower nitric oxide-mediated endothelium-dependent vasodilation and endothelial tPA (tissue-type plasminogen activator) release in hypertensive adults; and that the insufficient sleep-related reduction in endothelial vasodilator and fibrinolytic function is due to increased oxidative stress. Fifty hypertensive adults were studied: 20 with normal nightly sleep duration (14M/6F; age: 59±2 year; blood pressure: 138/83±1/1 mm Hg; sleep: 7.6±0.1 hour/night) and 30 with short nightly sleep duration (21M/9F; 56±1 year; 138/84±2/1 mm Hg; 5.8±0.1 hour/night). Forearm blood flow (plethysmography) was determined in response to intraarterial infusion of: acetylcholine in the absence and presence of N G -monomethyl-L-arginine and the antioxidant vitamin C; bradykinin in the absence and presence of vitamin C; and sodium nitroprusside. Endothelial release of tPA was determined in response to bradykinin without and with vitamin C. Vasodilation to acetylcholine was significantly lower (≈20%) in the short versus normal sleep adults. N G -monomethyl-L-arginine reduced (≈25%; P <0.05) acetylcholine vasodilation in the normal but not short sleepers. Vitamin C increased (≈35%; P <0.05) acetylcholine vasodilation in short sleepers only. Endothelial tPA release to bradykinin was significantly lower (≈25%) in the short versus normal sleep duration adults. Co-infusion of vitamin C induced greater tPA release in short sleepers. In hypertensive adults, insufficient sleep is associated with reduced nitric oxide–mediated endothelium-dependent vasodilation and endothelial tPA release. These sleep-related abnormalities in endothelial function are due, in part, to oxidative stress.

Biodistribution of Mesenchymal Stromal Cells after Administration in Animal Models and Humans: A Systematic Review

Mesenchymal Stromal Cells (MSCs) are of great interest in cellular therapy. Different routes of administration of MSCs have been described both in pre-clinical and clinical reports. Knowledge about the fate of the administered cells is critical for developing MSC-based therapies. The aim of this review is to describe how MSCs are distributed after injection, using different administration routes in animal models and humans. A literature search was performed in order to consider how MSCs distribute after intravenous, intraarterial, intramuscular, intraarticular and intralesional injection into both animal models and humans. Studies addressing the biodistribution of MSCs in “in vivo” animal models and humans were included. After the search, 109 articles were included in the review. Intravenous administration of MSCs is widely used; it leads to an initial accumulation of cells in the lungs with later redistribution to the liver, spleen and kidneys. Intraarterial infusion bypasses the lungs, so MSCs distribute widely throughout the rest of the body. Intramuscular, intraarticular and intradermal administration lack systemic biodistribution. Injection into various specific organs is also described. Biodistribution of MSCs in animal models and humans appears to be similar and depends on the route of administration. More studies with standardized protocols of MSC administration could be useful in order to make results homogeneous and more comparable.

COVID-19-ASSOCIATED ACUTE LOWER LIMBS ISCHAEMIA IN ELDERLY AND SENILE PATIENTS: TREATMENT PROSPECTS (PRELIMINARY ANNOUNCEMENT)

Summery. The aim — analysis of preliminary experience of treatment of COVID-19-associated acute lower limbs ischemia in elderly and senile patients. Materials and methods. We examined 48 patients (age 60- 84 years). First group — 16 patients with COVID-19-associated acute lower limbs ischemia, second group — 32 patients with chronic limb ischemia without coronavirus infection. . Results and discussion. First group’s patients had extended blood clotting time (more than 13-15 min). Other blood clotting indicators changed slightly. An isoline or a low-amplitude curve was recorded during photoplethysmography. After thrombectomy (6 patients) 3 patients had fatal thrombotic complications (PE, myocardial infarction, stroke), 1 had progressive ischemia. Pharmacotherapy was performed in 10 patients (in 2 patients later than 12 hours from the onset of ischemia). The effectiveness of timely started pharmacotherapy reached 67 %. All patients of group II had arteriosclerosis of the tibial arteries. Blood clotting indicators were normal. A high-amplitude curve was recorded during photoplethysmography. Thus, all elderly and senile patients has arteriosclerosis of the tibial arteries. On this basis, there was a fatal coincidence (coagulopathy, a sharp slowdown in blood flow, endothelial dysfunction) in case of coronavirus infection (COVID-19). Prospects for further developments are the improvement of anticoagulant therapy (for example, the simultaneous use of unfractionated and low molecular weight heparin) and improving of collateral circulation (for example, nerve block and forced intraarterial infusion or lavage). Conclusion. Currently, the effectiveness of thrombectomy in elderly and senile patients with COVID-19-associated acute lower limbs ischemiа is 33 %, the effectiveness of timely started pharmacotherapy Is 67 %.

CFD Simulations of Radioembolization: A Proof-of-Concept Study on the Impact of the Hepatic Artery Tree Truncation

Radioembolization (RE) is a treatment for patients with liver cancer, one of the leading cause of cancer-related deaths worldwide. RE consists of the transcatheter intraarterial infusion of radioactive microspheres, which are injected at the hepatic artery level and are transported in the bloodstream, aiming to target tumors and spare healthy liver parenchyma. In paving the way towards a computer platform that allows for a treatment planning based on computational fluid dynamics (CFD) simulations, the current simulation (model preprocess, model solving, model postprocess) times (of the order of days) make the CFD-based assessment non-viable. One of the approaches to reduce the simulation time includes the reduction in size of the simulated truncated hepatic artery. In this study, we analyze for three patient-specific hepatic arteries the impact of reducing the geometry of the hepatic artery on the simulation time. Results show that geometries can be efficiently shortened without impacting greatly on the microsphere distribution.

Applicability of a single camera-based catheter navigation system using teeth arch as an anatomical landmark for superselective intraarterial infusion in advanced oral cancer treatment

Superselective intraarterial infusion chemoradiotherapy is a modality of oral cancer therapy in which the artery feeding the tumor is catheterized. 3D information about the carotid artery is required to enable the surgeon to judge whether to advance, retract, or rotate the catheter. For this purpose, we proposed and conducted a model experiment to assess a new method of catheterization that applies a tracking system using registration with a monocular camera using the maxillary arch as the anatomical landmark. In this method, the preoperative 3D computer tomography angiographic image of the carotid artery that the catheter will be passed through is overlaid on the 2D video image. The mean TRE was 0.96 ± 0.36 mm and 0.88 ± 0.31 mm and 1.12 ± 0.46 mm when images were registered with the anterior and posterior teeth as the landmarks, respectively; the difference was not significant (p = 0.21). This tracking system that enables markerless registration simply by taking images of the maxillary anterior teeth with a single camera was convenient and effective for catheterization. In this study, we propose the new application of this tracking system and a novel method of catheterization for superselective intraarterial infusion chemoradiotherapy for oral cancer. Graphical abstract

Our experience in using of intravascular recanalization methods for treatment of acute ischemic stroke

Objective ‒ to evaluate results of the introduction of intravascular recanalization in the provision of emergency care to patients with ischemic stroke.Materials and methods. The experience of intraarterial thrombolysis on the example of 25 clinical cases was analysed. In 22 patients was performed selective intra-arterial thrombolysis, in 3 cases ‒ with thrombaspiration. All patients had a severe stroke, ranging from 15 to 25 points NIHSS. Confirmation of the diagnosis was performed according to computed tomography scan), ultrasound of the precerebral and cerebral arteries. Selective cerebral angiography was performed up to 6 hours after the onset of stroke. Patients were infused with 3 ml of recombinant tissue plasminogen activator bolus into the occluded vessel, followed by infusion at a dose of up to 20 ml for 1 hour, in 2 cases ‒ internal carotid artery stenting. Outcomes were assessed according to computed tomography, NIHSS and a modified Rankin scale for 30 days.Results. The combination of methods of intra-arterial thrombolysis and stenting of the internal carotid artery made it possible to minimized the negative consequences with sufficient restoration of the arterial lumen, which was controlled with digital subtraction angiography.Conclusions. Intravascular thrombectomy is the most promising and actively develo-ping area of ​​interventional treatment of ischemic stroke. Indication for selective intraarterial infusion of thrombolytics is the presence of acute cerebral circulatory disorders of the ischemic type in the middle cerebral artery pool when it is impossible to conduct mechanical thrombextraction.