Purpose. Modelling of the interaction of biomechanical systems «aortic root – transcatheter heart valve prosthesis» via finite element method.

Materials and methods. The object of the study used a model of transcatheter aortic valve size 23 mm, contains a self-extracting mesh support frame, with mounted a tubular leaflet apparatus made of porcine pericardium stabilized glutaraldehyde. Modeling of the prosthetic aortic valve implantation was performed in an environment CAE Abaqus/CAE in the three-dimensional aortic root model № 19 size.

Results. As a result of the interaction of the prosthesis and the aortic root has been found that the resulting voltage at the nodes flap apparatus does not exceed the permissible tensile strength: 0.96 MPa against 10.62 MPa, respectively. The individual finite elements of the prosthesis frame showed a slight excess of the tensile strength, but the maximum amount of permanent deformation was not more than 0.4 %.

Conclusion. The work demonstrated the consistency of modeling approach prosthetic implant assembly allowing for the interaction between the support frame and the leaflet apparatus with the aortic root.

Different variants of surgical tactics at suppuration of the vascular prosthesis are described in the review. Basic variants of surgical tactics such as extraanatomic bypass, vascular prosthesis regrafting, appliance of allograft and femoral vein are proposed. Pros and cons of each method are shown. Comparative analysis of the performed techniques was performed. Indications and contraindications for each method are determined. Situations suitable for attempt of conservative treatment of infected prosthesis and regrafting by vascular prosthesis are described. Possible ways of prevention of the vascular prosthesis contamination are described in details. Different approaches to the antibiotics prevention of the infectious complications are listed. Step-by-step development of the prevention methods of the infectious 
complications is carried out.

Search of an ideal polymer for the preparation of the artificial scaffolds is an important goal of vascular tissue engineering. Biofunctionalization of the scaffolds may assist in creation of the bioactive environment at the site of implantation. Combination of biodegradable polymers and growth factors may be an appropriate approach for the directed regeneration of the vascular tissues.

Purpose. To assess tissue reaction to nonwoven scaffolds prepared from poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV)/polycaprolactone (PCL) with vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and stromal-derived growth factor-1α (SDF -1α) implanted into the rat pericardial sac.

Materials and methods. Nonwoven PHBV/PCL scaffolds with and without VEGF, bFGF, and SDF -1α were prepared using electrospinning and implanted into the rat pericardial sac for 2 weeks, 1, 2, and 3 months with the further histological examination.

Results. Implantation of the scaffolds did not cause any inflammatory reaction. We detected an active neoangiogenesis in both PHBV/PCL/VEGF and PHBV/PCL/SDF -1α scaffolds and adjacent tissues at all the time points. Moreover, we observed a considerable cell infiltration and production of extracellular matrix in PHBV/PCL/SDF -1α scaffolds. PHBV/PCL/bFGF scaffolds were colonized by fibroblasts and were surrounded by a connective tissue capsule. Therefore, growth factors retained their bioactivity in the tissues during the whole time of the experiment.

Conclusions. Incorporation of the growth factors into biodegradable polymers is an appropriate approach for the creation of thetissue engineered scaffolds for directed tissue regeneration. VEGF, bFGF, and SDF -1α may be used for the creation of biodegradable vascular graft promoting de novo formation of the vascular tissue after the implantation.

In order to strengthen the state support of national medical science and to improve the effectiveness of the use of scientific and technological potential of federal clinics currently a legal framework is created for medical care delivery within clinical testing of methods of prevention, diagnostics, treatment and rehabilitation. The article considers the problems of medical care organization within clinical testing. It is shown that the priority areas of rulemaking in this sphere are the creation of viable mechanisms for assessment the effectiveness of new technologies as well as the security of medical care provided to patients who are selected and hospitalized to institutions and research centers according to the themes of scientific researches.

Purpose. To study the attitude of the staff to the results of labour within the research and medical activities in the field of cardiovascular diseases.

Materials and methods. According to the original questionnaire continuous method carried out a sociological survey 312 key employees of the Research Institute of complex problems of cardiovascular disease. About the study focused on the subjective assessment of work performance

Main results. It’s found out that most of the employees of the organization are active in the effectiveness assessment of their own labour, labour of their colleagues in the department, as well as labour of the employees in whole organization. Most of the respondents see the prospects of their professional growth and seek the opportunities for advanced professional training. The employees take personally the successes and failures if their department and organization as a whole. A significant proportion of employees who participated in the survey go for a work with positive emotions, consider working in the institution to be prestigious and are proud of their organization.

Conclusions. We identified the strengths and weaknesses of the collective of scientific healthcare organization. The strengths are the facts that the employees are satisfied with the results of their labour and the level of responsibility at work, they are active in effectiveness assessment of their own labour, labour of their colleagues in the department and the organization as a whole, they see the prospects of their professional growth. The weaknesses of the collective are incomplete involvement of the personnel in the work of the whole organization and a low level of their awareness about the working results of other departments, insufficient knowledge of basic indicators for effectiveness assessment of the organization as a whole.

Cardiovascular diseases especially coronary artery disease (CAD) remains the major cause of death both in Russian and in other industrialized countries. The most effective method of CAD treatment is a coronary artery bypass grafting (CABG). Despite the technological improvement of cardiac surgery operations, one of the leading position in postoperative complications are taken by bronchopulmonary complications which lengthen a subject’s hospital stay, increasing treatment cost and mortality rate. A review provides a methodological approach to the preparation of CAD subjects for CABG, as well as proposes the methods aimed at reducing the postoperative respiratory complications.

In this review the literature data of 2010–2015 years were analysed for smoking prevalence and its influence on brain, heart, blood vessels, blood and treatment effects with taking into account of age, gender, genetic factors, duration of smoking. The results of smoking stopping and its biorhytmic aspects were presented too.

Purpose. To compare duration of the prehospital stage of acute myocardial infarction (AMI) in patients with and without myocardial infarction in past medical history and with and without preinfarction syndrome over six years.

Materials and methods. The study was based on 2008 and 2013 data form the information analysis database of the populationbased epidemiology program of the World Health Organization “Register of Acute Myocardial Infarction”. A total of 627 and 840 cases of AMI were analyzed in Tomsk in 2008 and 2013, respectively. The rates of individuals with AMI in past medical history were 170 (27.1 %) in 2008 and 223 (27.7 %) in 2013; the rates of patients with preinfarction syndrome were 382 (60.9 %) in 2008 and 448 (53.3 %) in 2013.

Results. Among patients with and without AMI in past medical history, no significant differences were found in duration of prehospital stages between 2008 and 2015 both for the entire periods and for the temporal components of prehospital stage. Total duration of prehospital stage was longer in patients with preinfarction syndrome compared with those without it. It was true both for the entire prehospital stage duration and for the particular periods except the period of medical delay (physical examination and hospital admission) when the differences were insignificant.

Conclusion. This study showed that AMI in past medical history significantly affected neither prehospital stage duration of index AMI nor promptness of seeking medical help by patients. Our results confirmed literature data suggesting that the presence of preinfarction syndrome contributes to the longer duration of the prehospital stage of AMI because patients get used to their pain and spend more time on making decision to seek medical assistance.

Purpose. To assess the functional state of hemostasis and fibrinolysis in children with cyanotic CHD before and after cardiac surgery, as well as to identify possible causes of hemorrhagic disorders to ensure adequate therapy.

Materials and Methods. Children with cyanotic CHD were enrolled into to groups: Group 1 (n=30) patients received the LPTEGguided therapy and Group 2 (n=30) patients received standard hemostatic therapy.

Results. Hypocoagulation caused by the abnormalities in the clooting phase of hemostasis was found in the study groups in the end of the main stage of cardiac surgery. CTA, TBC, ICD, ICP, MA and CPH significantly decreased compared to the control group. Therefore, haemostatic therapy in Group 1 patients included the transfusion of FF P, whereas in Group 2, in addition to the FF P transfusion, tranexamic acid and etamzilat were used. The amount and rate of blood loss did not differ significantly between the study groups. The rate of bleeding >3 ml/kg/hr during 24 hours in the postoperative day was 6.6 % in Group 1 and 10 % in Group 2.

Conclusion. The approach of differentiated LPTEG-guided therapy allows to reduce the medication load, decrease the bleeding rate by 3.3 %, decrease the ventilation time on 9.4 hours. Moreover, this approach allowed to reduce the duration of inotropic support on 24 hours as well as the ICU stay on 33.6 hours.

In this review, the authors have put forward modern principles of diagnosis and treatment of paraganglioma (chemodectoma) of neck. The analysis of data in the literature revealed that paraganglioma occurs with a frequency of 0.01 % of all cancers of the head and neck. The etiology and pathogenesis of the disease is not completely understood till date. Paraganglioma is often misdiagnosed. The clinical picture is also diverse. Modern methods of diagnosis include CT, MRI with visualization of vessels of the head and neck , as well as traditional methods like ultrasonic diagnostic angiography with the introduction of contrast medium. Radical treatment of paraganglioma includes the surgical method . When malignancy, conservative treatment (chemotherapy and radiotherapy) of paraganglioma are ineffective.

The paper features comparative outcomes of applying different methods of renal replacement therapy for acute renal failure and chronic renal failure in children at the pediatric dialysis unit of the Russian children’s hospital «Zonal perinatal centre» in Novokuznetsk. The use of renal replacement therapy as an optimal method for achieving adequate and effective replacement of kidney function is validated. There are treated 58 children, 37 patients with acute kidney injury and 21 with terminal chronic renal failure. Acute renal failure was prevailed in preschoolers of 1–6 years old children – 24 (64,8 %), the terminal chronic renal failure in school children and teenagers – 16 (76,2 %). The renal replacement therapy used in 5 (13,5 %) patients with septic diseases, and in 6 (16,2 %) patients with poisons diseases. Methods of renal replacement therapy is effectively cleansing of the blood in critically ill patients. This method can reduce the rate of mortality and effectively adjust homeostasis in severe infections, septic diseases, multiple organ dysfunction syndrome and in patients with poisons diseases. Application of peritoneal dialysis allows as effective replacement of renal function in the children with difficulty vascular access.

Purpose. The purpose of this article was a review of contemporary international guidelines for the analysis of the evidence base for bivalirudin use as a medical support of percutaneous coronary intervention (PCI) in patients with different forms of coronary artery disease.

Materials and methods. Based on a review of European and American guidelines for management and revascularization in patients with different forms of coronary artery disease of 2013, 2014 and 2015, the evidence base of bivalirudin use as a medical support for PCI in patients with different forms of coronary artery disease was analyzed.

Results. The current evidence base for anticoagulant PCI support in patients with different forms of coronary artery disease means choosing safe and effective anticoagulant accordance to the profiles of ischemic and hemorrhagic risk. The direct thrombin inhibitor bivalirudin has a short half-life, predictable anticoagulant profile and has indications for use it in any form of coronary artery disease (Stable coronary artery disease, Non-STEMI and STEMI), based on a large number of randomized clinical trials.

Conclusions. There is no doubt that bivalirudin for patients with stable coronary artery disease and heparin-induced thrombocytopenia and for a cohort of patients with a high risk of bleeding complications has benefits and efficacy. Bivalirudin as the anticoagulant support for PCI in non-STEMI patients has the highest class and level of evidence. Class and level of evidence for the use of bivalirudin as PCI support in STEMI patients in 2014 decreased to class IIa, level A however increased risk of acute stent thrombosis associated with the bivalirudin using in this group of patients does not lead to an increased risk of death compared with unfractionated heparin.

In the first part of a review article highlights the key moments of the history of the study of cerebral microcirculation, formation of the basic theories and postulates a gradual improvement of the methods of qualitative and quantitative assessment of brain perfusion parameters in science and medical practice. Presented and discussed in terms of advantages and disadvantages of the current methods of assessing cerebral perfusion: transcranial Doppler (TCD), positron emission tomography (PET), single photon emission computed tomography (SPECT) perfusion computer tomography (PCT) and magnetic resonance tomography (PMRI) techniques. Most of all studies related to the use of radioisotopes or contrast media agents. It is noted that the TCD and perfusion CT and MRI prevail today in radiologic practice of cerebral circulation disturbances diagnostics. In recent years, more research is carried out in relation to clinical trial non-contrast MR technique (ASL), associated with endogenous labeling and registration of cerebral blood flow, which considering the absolute safety in the absence of external contrast makes it attractive for clinical use in the near future is possible. The second part of this article will devoted to a detailed consideration of the issues of diagnostic semiotics different clinical forms of violations of cerebral circulation using CT and MR perfusion study techniques that are by far the most accessible to a wide network of healthcare system. There will discuss the physical basis of blood flow parameters changes of brain tissue on the cards of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT ) and time to peak (TT P) contrast in the «classical» and the «difficult» clinical cases on the basis of the works of the most respected researchers in the field.