Introduction: Natriuretic peptide-guided therapy has not proven to be more sufficiently effective than usual care (UC) in patients with heart failure (HF). Soluble ST2 (sST2) has a number of advantages over natriuretic peptides. Hypothesis: sST2-guided therapy (sST2-GT) will be more effective than UC in patients with HFrEF. Methods: The prospective study included 76 patients (pts) with HFrEF, who were hospitalized due to acute decompensated HF. Pts with sST2 levels ≥ 37.8 ng/ml at the time of discharge constituted the high-risk cohort and were randomized into 2 groups: 19 pts in the sST2-GT and 18 patients in the UC. 39 pts with sST2 < 37.8 ng/ml and NT-proBNP < 1700 pg/ml were included in the low-risk cohort. The duration of the active treatment period was 6 months with monthly visits for therapy correction, the total follow-up period was up to 1 year. Therapy was carried out in accordance with clinical recommendations. In the sST2-GT group, therapy was also adjusted taking into account the concentration of sST2. The goal in this group was to reduce sST2 concentration by more than 30% or to less than 30 ng/ml. Measurement of sST2 (ASPECT-PLUS) concentration, echocardiography and registration combined endpoints (CEP) (HF decompensation (HFD) or cardiovascular mortality) were identified in all groups after 6 and 12 months. Results: Pts therapy in both high-risk groups was comparable, but pts in the sST2-GT group had a greater number of study clinic visits (7.1±2.3 vs 5.6±1.6 (p=0.024) compared with UC group. Pts sST2 concentration decreased in both high-risk groups, with the study goal achieved in 68,4% of pts in sST-GT group. Fewer CEP were registered In sST2-GT group pts compared to the UC group (for 6 months - 5 (0.26 / pt) vs 15 (0.83 / pt), p = 0.029 and 9 (0.47/pt) vs 22 (1.22/pt), p=0.035 over the entire follow-up) and it was practically similar low-risk cohort (0.46/patient). Fewer HFD were registered in the sST2-GT group compared to the UC group (for 6 months 4 (0.21 /pt) vs 13 (0.72 /pt), p < 0.001 and 8 (0.42/pt) vs 19 (1.06/pt), p<0.001 over entire follow-up), which was similar the low-risk group (0,31/pt). LV EF increased only in the sST2-GT group (from 29.2±6.2 up to 36.1±8.8, p=0.003 for 6 months). Conclusions: sST2-GT in high-risk pts with HFrEF is more effective than UC.

Goal: This paper aims to identify optimal transplantation methods for correcting soft tissue defects of the face and mandible based on our medical records and study of up-to-date research literature. Materials and methods: The analysis of standard transplantation procedures was carried out, as well as research of patients charts with extensive defects of the lower jaw at the department of maxillofacial surgery of a Moscow oncological hospital. There was a comparative analysis of the following most popular methods of correction of soft tissue defects of the face and lower jaw: Trapezoidal flap Filatov and H.D. Gillies stem grafting Deltopectoral flap Thoracodorsal flap Temporal parietal flap - Lexer and Esser method Results: Plastic surgery with complex grafts on the neurovascular pedicle is used in the surgical treatment of injuries and diseases of the mandible, which are accompanied by deep defects in the soft tissues of the face and bones of the mandible. The most optimal methods for restoring the anatomical integrity of the mandible, which is necessary for adaptation of the patient in society, and restoration of speech and chewing functions have been identified. Conclusion: Nowadays, the most common and effective methods in the world of eliminating mandibular defects by transplantation are considered to be Lexer’s method (temporal parietal flap), transplantation of the delto-pectoral flap, as well as thoracodorsal on feeding pedicle. The clinical researches conducted in the Moscow Oncological Hospital confirmed generally successful outcomes without complications.

Introduction . In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time. Materials and methods . In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients). Results . Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months. Conclusion . The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Background: Venous thromboembolism (VTE) with the prevalence of pulmonary microcirculatory thrombosis is considered a common complication of novel coronavirus disease (COVID-19) that develops despite anticoagulation. Methods: The clinical course of the disease and the autopsy findings of seven deceased patients with verified COVID-19 were analyzed. The chest computed tomography (CT) scan was routinely performed while CT pulmonary angiography and a duplex ultrasound scan (DUS) of the lower limbs were used in cases of suspected VTE. The VTE prophylaxis was administered to all patients with intermediate or therapeutic doses of low-molecular-weight heparin. The histological examination of the lung tissue and other organs was performed with particular attention paid to the pulmonary vasculature. Results: Venous thromboembolism, including deep vein thrombosis in one patient and pulmonary artery thrombosis in two patients, was confirmed by imaging tests despite anticoagulation. Systemic thrombolysis was performed in two patients with putative and confirmed pulmonary embolism. An autopsy revealed the signs of acute respiratory distress syndrome in all seven patients. Abnormalities of lung vessels were found in all cases and were represented by dystrophy and necrosis in the endothelium and muscle fibers, and by infiltration by plasmatic cells, neutrophils, and lymphocytes. Multiple clots of variable maturity were observed. All those changes developed despite anticoagulation and were preserved after systemic thrombolysis. Conclusion: Inflammatory and prothrombotic changes in the arterial wall in parallel with the lack of lung perfusion may cause diffuse arterial thrombosis in the lungs. This background may be responsible for the low response to systemic anticoagulation and thrombolysis in severe forms of COVID-19.

At present, it is widely recognized that machine perfusion allows for a decreased rate of delayed function of the renal graft and of the risk of liver graft early dysfunction. The aim of the review is to present the actual changes of the donor pool related to prevailing numbers of donors by expanded criteria, to determine the prospects of expanding of the available donor pool based on their selection, as well as development of functional rehabilitation and modification at tissue, cell and molecular levels with the help of perfusion technologies. The article presents the state-of-the art view on the mechanisms of ischemic-reperfusion injury of donor organs, delineates the trends in the maintenance of their viability, and gives the literature data on the role and outlook of perfusion methods in organ transplantation. The authors provide the rationale for a comprehensive systemic approach to the assessment of the functional status of a donor organ with any baseline parameters and discuss a number of theoretical provisions on the implementation of a personalized perfusion approach to ensure the availability of transplantation care.

The article presents the stage results of treatment of patients with out-of-hospital cardiac arrest, who was admitted to ED of the University Clinic. The main obstacle for ECMO-CPR remains a long time of CPR by pre-hospital services. The possibility of using ECMO for conditioning of potential donors by emergency physicians is considered.

Organs’ shortage remains the main limiting problem for accessibility of organ transplantation. There is the growing interest among transplant society for use organs obtained from «uncontrolled» donors after cardiac death (uDCDs), or, asystolic donors. But the warm ischemic time is critical factor for wide accepting of practice of transplantation such kind of organs. The article presents the first case of successful clinical organ transplants from the donor with out-of-hospital irreversible cardiac arrest obtained with help of life support devices.

The article presents the stage results of treatment of patients with out-of-hospital cardiac arrest, who was admitted to ED of the University Clinic. The main obstacle for ECMO-CPR remains a long time of CPR by pre-hospital services. The possibility of using ECMO for conditioning of potential donors by emergency physicians is considered.

To date ethical aspects of the use of perfusion technologies in organ donation are the subject of active discussions. The transplant community and the general public faced a return of the researchers' attention to the "initially classic" form of donation – donation of organs for transplant from deceased donors after irreversible cardiac arrest. The vulnerability of the concept of brain death is now clear due to its "industrial failure" to satisfy the request for organ transplants from medical and patient communities against the backdrop of constantly evolving types of emergency neurosurgical and neurological care, and the emerging "secondary deficit" of deceased organ donors. Thus, new ethical issues were formulated in the context of the implementation of perfusion technologies as a method of resuscitation of donor organs in the body of a deceased person and/or in the body of an intensive care patient with a sudden cardiac arrest. They are: “If it is possible to resuscitate a person?”; “What are roles and place of new technologies in the specter of resuscitation procedure?”; “When it is the precise moment to connect perfusion device?”; “Who should have the permission to connect the perfusion devices?”; “How death of a patient on an ongoing ECMO, LVAD, TAH can be verified and recorded?”. Answers to all these and many other questions yet have to be found by medical community. We presume, that the most difficult issue from the ethical and socio-humanitarian point of view is the use of ECMO-CPR in the case of ineffective CPR, where further it is necessary to carry out measures to ascertain the patient's death on the ongoing ECMO. From 2009 to the present we have carried out 35 procedures of perfusion of potential donors with 60 minutes after death record of the patient. In Russian Federation, there is a "presumed of consent". The design of this study, the protocols for perfusion, the organization procurement and the transplant procedures were approved by the Scientific Board and the Ethics Committee of the Saint Petersburg State Research Institute for Emergency (Decision 7/0615/09) and authorized for clinical application The Federal Advisory Service of the Ministry of Health of the Russian Federation (Resolution N2010/299). All donation and perfusion procedures were approved by local Ethics Committees and Institutional Review. Petersburg. According to our experience in perfusion protocols application, the most ethically approved record of patient death (potential donor) on the ongoing ECMO is the standard procedure for detecting "brain death" with the mandatory performance of cerebral angiography, and obtaining consent of the relatives for the procedure. However, this issue requires detailed consideration and discussion by the medical community. The thesis has been prepared with the financial support of the Russian Science Foundation, Project No. 17-18-01444.

Utilization of kidneys from extended criteria donors leads to an increase in average warm ischemia time (WIT), which is associated with larger degrees of ischemia-reperfusion injury (IRI). Kidney resuscitation by extracorporeal perfusion in situ allows up to 60 minutes of asystole after the circulatory death. Molecular studies of kidney grafts from human donors with critically expanded WIT are warranted. Transcriptomes of two human kidneys from two different donors were profiled after 35-45 minutes of WIT and after 120 minutes of normothermic perfusion and compared. Baseline gene expression patterns in ischemic grafts display substantial intrinsic differences. IRI does not lead to substantial change in overall transcription landscape but activates a highly connected protein network with hubs centered on Jun/Fos/ATF transcription factors and HSP1A/HSPA5 heat shock proteins. This response is regulated by positive feedback. IRI networks are enriched in soluble proteins and biofluids assayable substances, thus, indicating feasibility of the longitudinal, minimally invasive assessment in vivo. Mapping of IRI related molecules in ischemic and reperfused kidneys provides a rationale for possible organ conditioning during machine assisted ex vivo normothermic perfusion. A study of natural diversity of the transcriptional landscapes in presumably normal, transplantation-suitable human organs is warranted.

A hardware and software system for donor liver perfusion is described. Both standard and adaptive algorithms for perfusion control in the process of liver function restoration are described. The adaptive algorithm is based on a mathematical model of machine perfusion. It provides complete perfusion and allows blood cell injuries that often accompany the standard perfusion procedure to be avoided.

The article presents a review of modern approach to the application of extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in patients with cardiac arrest, discuss main include and exclude criteria for the patients.