Saint-Petersburg Medico-Social Institute

Nurses may find four modern updates useful for optimal patient care. First, the so-called Rome Criteria for constipation (Rome-IV, 2016) have been significantly revised. Instead of focusing only on the severe stage of constipation (defined as bowel movements “less than 3 times per week”), current guidelines emphasize the earliest stages of constipation. The modern “Frequency Classification of Constipation” identifies three stages: mild (bowel movements 5–6 times per week), moderate (3–4 times per week), and severe (1–2 times per week). The second update reveals an increasing frequency of laxative use depending on the stage of constipation: 13% of patients use laxatives at the mild stage, 30% at the moderate stage, and 64% at the severe stage. The third update concerns the prevalence of anxiety at each stage of constipation: 12% of patients exhibit anxiety at the mild stage, 33% at the moderate stage, and 57% at the severe stage. The fourth update relates to the prevalence of depression among cardiology patients: 12% of patients with mild constipation experience depression, 17% with moderate constipation, and 43% with severe constipation. The last three updates validate the applicability of the frequency classification of constipation and enable nurses to identify the earliest disruptions in the circadian rhythm of the intestines

The article presents a personal observation of the course of pregnancy and childbirth in a patient with spinal muscular atrophy type III. The diagnosis was established at the age of 8 according to clinical data, confirmed by electroneuromyography and the results of a molecular genetic study. During pregnancy planning, a genetic prognosis was made for the birth of a child with SMA in this couple. Pregnancy occurred after further examination of the respiratory system, preparation of the endometrium with gestagen preparations and prevention of thromboembolic complications, proceeded with the phenomena of obstructive sleep apnea, impaired carbohydrate metabolism, cardiac arrhythmias and hypercoagulation. At 37 weeks, she was delivered by caesarean section due to the occurrence of preeclampsia.

Introduction/Purpose Subdural hematomas (SDHs) are among the most common neurosurgical conditions, particularly affecting the elderly. Standard treatment paradigms include surgical evacuation and, more recently, middle meningeal artery embolization (MMAe) to prevent recurrence. These interventions are typically performed as separate procedures by different teams, often under general anesthesia. This fragmented approach introduces inefficiencies, procedural risks, and access barriers—especially for frail or medically complex patients.To address these limitations, we developed the first endovascular system enabling single‐session , fully transvascular treatment of non‐acute SDH. The procedure integrates MMA embolization and catheter‐based subdural evacuation through the same arterial access, obviating the need for craniotomy. A proprietary system of devices allow controlled perforation of the arterial wall and dura, enabling catheter navigation into the subdural space for drainage. Materials and Methods In a prospective, single‐arm, first‐in‐human study (EMBODRAIN), we enrolled 16 consecutive patients with symptomatic non‐acute SDH. Two patients were excluded due to anatomical reasons (diminutive MMA in one case, and MMA emerging from ophthalmic artery in one case). Patients were followed clinically and radiographically for 30 days. Results All fourteen treated patients (mean age 73.6 years; 80% male) underwent successful MMA embolization and transvascular subdural drainage without intraoperative complications or need for surgical backup. SDH volume was reduced by >65% in average. Midline shift improved from 9.7 ± 3.8 mm to 4.2 ± 2.1 mm. Functional status also improved rapidly: Modified Rankin Scale (mRS) scores decreased from a mean of 2.7 to 1.3, and Markwalder Grading Scale scores from 1.9 to 0.7 within 72 hours. There were no hemorrhagic complications, neurologic deteriorations, or radiographic reaccumulations. No patients required ICU admission or anticoagulation reversal. Conclusions This first‐in‐human experience establishes the safety, technical feasibility, and early clinical effectiveness of fully endovascular treatment of non‐acute SDH. The approach provides a streamlined, minimally invasive solution that integrates embolization and hematoma evacuation into a single transvascular session. Beyond SDH, this technology lays the foundation for transvascular neurosurgery —a new paradigm that utilizes endovascular access to treat traditionally non‐vascular intracranial pathologies. Its potential to transform intracranial therapeutics, improve access, and reduce treatment morbidity is significant and warrants further clinical investigation. image FundingSupportResearch : National Institutes of Health (NIH)

Objective : to evaluate the effectiveness of lung preservation in donation after circulatory death (DCD) using a non-perfusion-based preservation method. Materials and methods . The study was conducted on eight healthy male Landrace pigs (weight range: 40–60 kg), divided into three groups based on the preservation solution used: Celsior group (n = 3), lungs preserved using a solution prepared according to the Celsior formulation.; NewSolution group (n = 3), lungs preserved using a custom-formulated solution developed in-house; NaCl group (n = 2), lungs preserved using saline (control group). Results . In the study groups (Celsior and NewSolution), the oxygenation index after reperfusion exceeded 350, while the control group (NaCl) exhibited an oxygenation index of less than 350. Conclusions . The method described for evaluating the effectiveness of new lung preservation solutions is technically simple and cost-effective, as it enables rapid experimentation with a sufficiently large number of observations. While this approach may not address all challenges in experimental transplantology, it provides a practical and efficient tool for preliminary screening of lung preservation strategies.

Background: Primary health care is a basic component of the Russian healthcare system. All relevant national projects and programs are focused on improving primary health care both in outpatient and day stay settings. Furthermore, a strategy to reduce hospital bed capacity by increasing day hospitalizations is considered a promising area for further advancements in healthcare services. The continuous evaluation of the performance of the healthcare system components is necessary to ensure its effective operation. AIM: To review the scientific publications and propose a new terminology for better organizing and evaluating primary health care activities. METHODS: Laws and regulations from the Russian Ministry of Health were thoroughly analyzed, and scientific medical publications regarding the system of primary health care were also reviewed. RESULTS: We have developed and proposed the new concept of “simultaneous day stay interventions” to increase the functional capacity of day hospitals and improve patient satisfaction. This concept facilitated the integration of multiple therapeutic and preventive interventions in day stay settings, which had not been previously performed in combination, thereby increasing the functional capacity of day hospitals and improving patient satisfaction. CONCLUSION: The practical implementation of this concept will contribute to the enhanced effectiveness of day hospitals and treatment outcomes, ensuring a more optimal use of healthcare resources and improved patient satisfaction.

Aim: to justify a differentiated approach to the treatment of obstetric coagulopathic bleeding depending on the nature of hemostasis disorders.Materials and Methods. A prospective cohort study was conducted involving 52 patients with postpartum hemorrhage (PPH) who gave a child birth between 2021 and 2023. Diagnostics and treatment of coagulopathy was carried out according to the algorithm using thromboelastometry (TEM) parameters. Patients were divided into 3 groups depending on blood loss volume: group 1 (n = 19) – blood loss up to 1499 ml; group 2 (n = 14) – blood loss from 1500 to 1999 ml; group 3 (n = 19) – blood loss 2000 ml and more. The following hemostasis parameters were determined: platelet count, prothrombin index, activated partial thromboplastin time (APTT), Claus fibrinogen level, international normalized ratio, and TEM parameters, including clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), and maximum clot firmness at 10 minutes (A10) on the EXTEM channels (a test in which recombinant tissue factor is used to activate the extrinsic coagulation pathway), FIBTEM (a test in which platelet activity is suppressed by cytochalasin D, which allows detecting fibrinogen deficiency or qualitative disturbances in fibrin polymerization), and INTEM (a test in which ellagic acid is used as a contact activator of the intrinsic coagulation pathway). Blood samples were collected before administration of blood components and products, tranexamic acid.Results. Statistically significant differences were found for the fibrinogen level, MCF and A10 parameters on the FIBTEM channel depending on blood loss volume (p < 0.05), indicating a decrease in the quality of fibrin clot upon with increasing blood loss. Highly tight direct relationships were found between the fibrinogen, MCF and A10 values, demonstrating that with a decrease in the fibrinogen level at the time of bleeding by 1.0 g/L, a decrease in MCF by 3.802 mm (the resulting model explains 64.3 % of the observed variance), and A10 by 3.497 mm (the resulting model explains 64.1 % of the observed variance) should be expected. All patients whose blood loss volume reached 2000 ml and more were administered cryoprecipitate, the differences in the parameters were statistically significant between group 3 vs. group 1 and group 2 (p < 0.001). TEM parameters CT and CFT on the INTEM channel also correlated with blood loss volume and had a significant direct correlation between noticeable tightness (according to the Chaddock scale) between APTT and CT (ρ = 0.612; p < 0.001) as well as moderate tightness between APTT and CFT (rxy = 0.44; p = 0.017). The need for transfusion of fresh frozen plasma (FFP) and prothrombin complex concentrates (PCСs) arose with APTT more than 35 seconds in 77 % of cases (among all patients), with the CT parameter more than 260 seconds – in 63 % of cases and CFT more than 110 sec – in 63 % of cases, respectively; the differences in the indicators are significant while compared with those of patients requiring no introduction of FFP and PPC (p < 0.05). Based on controlled transfusion protocol, in group 1, in 57.9 % of cases it was possible apply no transfusion therapy; the differences in indicators are significant while comparing group 2 and group 3 (p < 0.05).Conclusion. The use of the TEM method in the diagnostics of hemostasis disorders with PPH allowed for the differential and short-term application of pathogenetically justified therapy with blood components and preparations only in cases where it was required.

The study was conducted using the MDCK renal epithelial cell line with sodium dithionite at a concentration of 5 mM to create hypoxic conditions. The parameters of cellular metabolism (including the value of mitochondrial membrane potential, the state of mitochondrial NADH and FAD, the content of Ca2+ and Mg2+ and the pH level in the cytosol, the rate of glucose absorption by cells, and cell death) were assessed by means of confocal and wide-field fluorescence microscopy. The concentration of dissolved oxygen was established using the polarographic method with a Clark electrode. It was demonstrated that the use of sodium dithionite allows modeling acute hypoxia in vitro with a rapid decrease in the oxygen concentration in the cell incubation medium, which resulted in a change in mitochondrial function and the apoptosis progression. At that, sodium fumarate reduces the level of cell death, which is associated not with the restoration of the ATP-producing ability of mitochondria, but rather with an increase in the contribution of alternative sources of high-energy compounds. At the cellular level, using an optimized hypoxia model, the study revealed the mechanism of the protective role of sodium fumarate, which explained the antihypoxant effectiveness in assisted ischemia of organs and tissues.

2025