The aim of the study was to evaluate the effect of administering tranexamic acid, alone and combined with epidural anesthesia, on postoperative blood loss and donated blood transfusion in patients undergoing corrective scoliosis surgery. Materials and Methods. 160 patients aged 15-18, were assigned to 4 groups in a double-blinded manner to receive one of the two anesthesia techniques: general anesthesia (sevoflurane and fentanil), or general anesthesia (sevoflurane) with an epidural block (thoracic epidural anesthesia with 0.5% ropivacaine and fentanil) and one of the two solutions for antifibrinolytic therapy. These solutions were tranexamic acid (group GT and group ET), and 0.9% saline as placebo (group GP and group EP). Tranexamic acid was administered in groups ET and GT before skin incision-a bolus of 15 mg/kg followed by IV infusion of 2 mg/kg/h up to the end of surgery. For a statistical analysis, we employed non-parametric methods and linear regression. Results. Group GT demonstrated a statistically significant reduction in the volume of intraoperative blood loss by 28.9% as compared with group GP. The groups with epidural anesthesia (EP, ET) demonstrated a statistically significant reduction in the volume of intraoperative blood loss by 43.3 and 21.9%, as compared with the groups without the epidural component in anesthesia (GP and GT). The standalone use of tranexamic acid in patients without epidural anesthesia led to a reduction in their intraoperative blood loss by 28.9%. Epidural anesthesia contributed to the limitation of changes in the biochemical data of hemostasis/fibrinolysis system during surgery. At the same time, hypercoagulation changes dominated in group GP. Hence, groups EP and ET did not require hemotransfusion, while group GT featured a much lower need for it. There were no severe complications in all the groups. The effect of fibrinolysis inhibition was complementary. Conclusion. Tranexamic acid and epidural anesthesia, administered separately or in combination with each other, can be safely and effectively applied to reduce perioperative blood loss and the need for hemotransfusion during corrective surgery for idiopathic scoliosis in adolescents. The combination of the methods produces the biggest blood-saving effect. Still, the standalone use of tranexamic acid in scoliosis surgery is a safe, cheap, and effective method of blood-saving.

OBJECTIVESurgical trauma is known to result in systemic inflammatory changes that can lead to postoperative cognitive dysfunction. In the present study, the authors compared the effects of an epidural anesthesia protocol to those of traditional anesthesia with regard to postoperative inflammatory changes, cellular immunity, and cognitive dysfunction.METHODSForty-eight patients, ages 45–60 years, underwent multilevel thoracolumbar decompression and fusion and were randomly assigned to one of two groups: group 1 (27 patients) had combined epidural and general anesthesia, followed by epidural analgesia for 48 hours after surgery, and group 2 (21 patients) had general anesthesia, followed by traditional opioid pain management after surgery. At multiple time points, data on pain control, cognitive function, cellular immunity, and inflammatory markers were collected.RESULTSGroup 1 patients demonstrated lower pain levels, less systemic inflammation, less cellular immune dysfunction, and less postoperative cognitive dysfunction than group 2 patients.CONCLUSIONSThe use of combined epidural and general anesthesia followed by postoperative epidural analgesia during the first 48 hours after multilevel thoracolumbar decompression and fusion surgery had a significant positive effect on pain management, cellular immune function, systemic inflammation, and postoperative cognitive function.Clinical trial registration no.: 115080510080 (http://rosrid.ru)

The state of the hemostasis system was studied in 9 patients of the middle age group (44 ± 9.94 years) who received thermal trauma on an area of more than 32% (49.4 ± 18.3) of the body surface, accompanied by the development of burn shock. The standard therapy for burn injury was supplemented with HBO sessions. Treatment with hyperbaric oxygen was carried out in pressure chambers BLKS-307, BLKS-307/1. The state of the coagulation, anticoagulant and fibrinolytic links of the hemostasis system, as well as the viscoelastic properties of the blood, were assessed immediately before the HBO session and immediately after it. The total number of comparison pairs was 45. Under the influence of HBO therapy, there was an increase in the activity of antithrombin III (ATIII), protein C (PrS) and a decrease in the viscoelastic properties of blood (p <0.05). Positive deviations in the values of ATIII, Pr C, von Willebrand factor, APTT, prothrombin and thrombin time, fibrinogen, factor XIII, XIIa-dependent fibrinolysis, D-dimers and thromboelastography parameters were revealed. The maximum frequency of their occurrence was recorded for ATIII (95%), the minimum - for the D-dimer (62%). After HBO procedures, undesirable deviations of the hemostatic system parameters were also noted. They were chaotic, were compensated by an increase in the activity of physiological anticoagulants and were not accompanied by complications of a thrombogenic nature. Thus, conducting HBO therapy sessions in the acute period of burn disease increases the activity of physiological anticoagulants and stabilizes the viscoelastic properties of blood. There is a high frequency of occurrence of positive effects of hyperoxia on the components of the hemostasis system. The identification of its undesirable effects indicates the need to monitor the state of the hemostasis system during HBO procedures.

Цель: разработать модель биомедицинского клеточного продукта, согласующуюся со стратегией «гомологичный препарат» на основе протоколов подготовки клеточной составляющей и скаффолда-носителя для доклинических исследований на крупном лабораторном животном (свинье). Материалы и методы. Биомедицинские клеточные продукты-эквиваленты кожи (ЭК) формировали с использованием криопреципитата плазмы крови здоровых доноров и мезенхимальных стволовых клеток (MSCs) жировой ткани человека. Для формирования модельных эквивалентов кожи (мЭК) использовали криопреципитат плазмы крови свиней и MSCs жировой ткани свиней. Наблюдение за состоянием клеток в культуре и в составе эквивалентов проводили с использованием методов светлого поля, фазового контраста (Leica DMI 3000B) и флуоресцентной микроскопии (имиджер Cytation 5; BioTek, USA). Скаффолды эквивалентов тестировали на цитотоксичность (МТТ-тест, метод прямого контакта). Характеристику плотности распределения клеток проводили авторским способом (Пат. № 2675376 РФ). Результаты. Разработан модельный эквивалент кожи (мЭК) для проведения доклинических исследований на крупном лабораторном животном (свинье). В мЭК замещены компоненты, переходящие из алогенных условий в ксеногенные при трансплантации животному. Представлен комплексный подход для подготовки мЭК, включающий забор первичного биоматериала свиньи, выделение и характеристику MSCs жировой ткани, подготовку скаффолда-носителя, соответствующего стратегии «гомологичный препарат». Проведена оценка цитотоксичности скаффолда мЭК. Показано, что мЭК обеспечивает аналогичную эквиваленту кожи (ЭК) механическую поддержку клеток и сопоставимое развитие клеточных событий при культивировании. Вывод. Разработана модель биомедицинского клеточного продукта, согласующаяся со стратегией «гомологичный препарат» для доклинических исследований на крупном лабораторном животном (свинье). Представлен комплексный подход, для разработки модельного эквивалента основанный на протоколах подготовки и тестирования клеточной составляющей, скаффолда-носителя и готового модельного эквивалента.

Clinical guideline contained a summary on the management of hip fractures in the elderly. Presents the key positions, the implementation of which is required in the perioperative period. Special attention is given pain relief, prevention of delirium and management of patients in the postoperative period.