16 research outputs found
Prejudices that Destroy the Law
No full textРукопись поступила в редакцию: 20.07.2022. Принята к публикации: 01.08.2022.Received: 20.07.2022. Accepted: 1.08.2022.Рассматривается статья М. А. Краснова «Аксиомы, разрушающие право», посвященная решению Европейского суда по правам человека (ЕСПЧ) по делу о правомерности отказа российских властей в регистрации брачных отношений трем однополым парам. М. А. Краснов обосновывает свою критику данного решения новой аксиоматикой, т. е. некоторыми принимаемыми без доказательства постулатами, из которых, по его мнению, исходит ЕСПЧ. В данной статье показывается, что такой аксиоматики в постановлении суда не наблюдается ни в открытом — прямом, текстуально выраженном — виде, ни в скрытом, косвенно извлекаемом из решения значении. Напротив, Суд доказывает свои исходные посылки приглашением властей России обосновать вред, который может, по их мнению, возникнуть в случае введения в стране юридического института однополых союзов, а также призывает найти справедливый баланс между общественными интересами и интересами заявителей. При этом Суд не настаивает на непопулярном в общественном мнении страны решении о признании однополых браков в России. В статье предлагается отыскать общие основания для поиска компромиссов сторонников и противников однополых союзов: в качестве таковых предлагаются известные правовые аксиомы равноправия, уважения человеческого достоинства и обосновывается, что реальный вред правовым началам в стране наносится имеющимися общественными предрассудками, а не новыми аксиомами, которые к тому же еще и не удалось отыскать в решении ЕСПЧ.The review considers the article “Axioms that destroy the law,” dedicated to the decision of the European Court of Human Rights (ECHR) in the case of the legality of the refusal of the Russian authorities to register marriage between three same-sex couples. The author of the peer-reviewed article justifies his criticism of this decision with new axiomatics, that is, some postulates taken without proof, from which, in his opinion, the ECHR proceeds. The proposed review shows that such axiomatics in the Ruling of the Court are not observed either in an open — direct, textually expressed — form, or in a hidden, indirectly meaning extracted from the decision. On the contrary, the Court proves its original premises by inviting the Russian authorities to substantiate the harm that, in their opinion, might arise if a legal institute of same-sex unions were introduced in the country, and also calls for finding a fair balance between the public interests and the interests of the applicants. At the same time, the Court does not insist on the decision of the authorities unpopular in the country’s public opinion on the recognition of same-sex marriages in Russia. The review proposes finding common grounds for compromises between supporters and opponents of same-sex unions: as such, the author offers well-known legal axioms of equality, respect for human dignity. He also justifi es that real harm to legal principles in the country is caused by existing public prejudices, and not by new axioms, which, moreover, have not been found in the decision of the ECHR yet
EFFECTS OF ENDOVASCULAR INTERVENTION VS. THROMBOLYSIS ON INTRACARDIAC HEMODYNAMICS AND LEFT VENTRICULAR REMODELLING IN ACUTE MYOCARDIAL INFARCTION
No full textAim. To assess the dynamics of myocardial contractility, geometry, and diastolic function in patients with acute myocardial infarction (AMI) after endovascular intervention vs. thrombolysis. Material and methods. In total, 60 patients (mean age 48,9±2 years) with AMI and ST segment elevation (STEMI) were examined within the first 6 hours from the AMI onset. All participants were divided into three groups: Group I – 22 patients with primary stenting; Group II – 22 patients with the stenting within 24 hours after successful thrombolysis; and Group III – 16 patients with effective thrombolysis and no endovascular intervention. At Day 1 and 7, all participants underwent Doppler echocardiography with the assessment of left ventricular (LV) diastolic function, LV size and volume parameters, total and segmental myocardial contractility (biplane Simpson’s method). Results. According to the comparative analysis results, LV volume parameters did not deteriorate substantially only in Group I. By Day 7, Group III demonstrated a restrictive type of LV diastolic dysfunction, persistent reduction of ejection fraction, and more pronounced disturbances of local LV contractility, compared to Groups I and II. Conclusion. In STEMI patients, primary stenting of the infarct-related artery more effectively prevents early pathological LV remodelling, compared to successful thrombolysis or post-thrombolysis endovascular intervention
Immediate and Medium-Term (6 Months) Results of BVS Absorb Biodegradable Coronary Scaffolds Installation in Patients with Chronic Forms of Coronary Artery Disease
No full textAim of study To evaluate the immediate and medium-term (6 months) results of BVS Absorb biodegradable stents implantation in patients with chronic forms of coronary artery disease, taking into account their location in coronary vessels, morphological nature of the initial lesion of the coronary arteries and technical features of implantation as well.Material and methods From June 2014 to December 2015, 199 biodegradable stents (Absorb Bioresorbable Vascular Scaffold — BVS; Abbott Vascular, CA, USA) were routinely installed in 114 patients treated at the Interventional Cardioangiology Center of I.M. Sechenov First Moscow State Medical University. The analysis of the obtained results was carried out depending on the type of coronary artery lesion, the length and diameter of the stents, and the details of the angioplasty procedure. To characterize the type of coronary artery lesion, the ACC/AHA classification was used: type A vascular lesion (95 coronary segments); type B vascular disease (68 coronary segments); type C vascular disease (36 coronary segments). The ultimate goal of the study was to study the frequency of thrombosis and in-stent stenosis of stented coronary arteries.Results The immediate success of scaffold implantation was 98.2%. Complications in the early hospital period were 1.8% (acute stent thrombosis was observed in 2 cases on the first day after implantation). In the medium-term (~6 months), 102 patients (89.5%) with 172 previously placed stents underwent comparison selective coronary angiography. The rest of the patients with stents refused to undergo coronary angiography due to good health and underwent a telephone survey.The satisfactory result of stenting in the medium-term (6 months) was a completely preserved lumen of the stented area, or with less than 50% stenosis of this place, which comprised 94.3%. The frequency of in-stent stenosis (narrowing of the lumen of the stented area by 50% or more) was 5.7%. In-stent stenosis was detected in groups of patients with type B and C lesions, respectively, in 4% and 1.7%. In the group with type A coronary artery disease, in-stent stenosis was not detected in the medium-term period.Conclusion The immediate and medium-term results of stenting with the biodegradable BVS Absorb stent were successful in the vast majority of cases (94.3%). Only in 2 cases (1.8%), acute thrombosis of the stent was observed immediately after stenting
Strategy of delayed intervention without stent implantation in myocardial infarction with ST segment elevation caused by massive thrombosis of the infarct-related artery
No full textAim. TIntroduction. To evaluate in-hospital angiographic and five-year posthospital clinical outcomes of percutaneous intervention strategy without stent implantation with immediate coronary artery stenting technique in STEMI patients with massive coronary thrombosis.Material and methods. The study enrolled 116 patients with primary STEMI myocardial infarction with the signs of massive thrombosis in the lumen of the main epicardial coronary artery with TIMI thrombus grade greater than 3 after antegrade blood flow restoration. In the 1st group of delayed intervention at the primary stage the blood flow was restored by small diameter balloon inflation and/ or manual vacuum thrombus aspiration until stable TIMI grade 3 blood flow was achieved, at control CAG on day 5-6 in 36 people the stent was not implanted due to insignificance of infarct-related coronary artery stenosis (stenosis less than 50% according to QCA). Immediate stent implantation was performed in 78 patients (group 2). The primary endpoint was the incidence of adverse cardiovascular events, including total mortality, recurrent myocardial infarction, repeated revascularization of the infarct-responsive artery. Secondary endpoint: frequency of achieving optimal myocardial perfusion as measured by angiography – TIMI blood flow and Myocardial Blush Grade.Results. The median follow-up period was 47 months. The incidence of the primary end point (MACE) was 15,8% in group 1 and 23,1% in group 2, with no statistically significant difference (p=0,408). Overall mortality (10,5% and 11,7%), the rate of repeat myocardial infarction (2,6% and 5,1%), and the rate of repeat target vessel revascularization (2,6% and 6,4%) were without significant advantage between subgroups. Optimal reperfusion (TIMI-3 and Myocardial Blush Grade 2-3 after primary procedure was achieved in significantly (p=0,02) more patients in group 1 (89%) than in group 2 (69,2%) ST segment resolution ≥70% after intervention was achieved in 87% of cases in group 1 and in 64,1% of cases in group 2 (p=0,011).Conclusion. In STEMI patients with massive coronary thrombosis, the method of delayed percutaneous intervention increases the rate of achieving optimal blood flow and allows avoiding stent implantation in the infarct-related artery in 50% of cases as compared to the method of immediate stenting. Both methods have comparable hospital and five-year clinical risks
Comparison of outcomes of coronary artery stenting in acute myocardial infarction due to massive coronary thrombosis
No full textIntroduction. Therapy of patients with acute ST-elevation myocardial infarction and massive coronary thrombosis (TTG 3) is a far from solved problem of modern medicine, since often in such patients immediate stent implantation is associated with the development of myocardial hypoperfusion, reducing the long-term prognosis of life.Aim. To evaluate short-term and long-term efficacy and safety of delayed and immediate coronary artery stenting techniques in patients with acute ST-elevation myocardial infarction and massive coronary thrombosis.Material and methods. Comparative study in parallel groups, a total of 153 patients with ST-elevation myocardial infarction and massive coronary thrombosis (TTG 3), 75 patients in the delayed coronary artery stenting group, 78 patients in the immediate coronary artery stenting group. In the immediate coronary artery stenting group, percutaneous coronary intervention was performed in one stage with stent implantation, in the delayed coronary artery stenting group; percutaneous coronary intervention was performed in two stages: the first was achieving TIMI-3 blood flow using a minimally invasive mechanical strategy, the second was control coronary angiography 5-6 days and the decision on the implantation of the stent. The primary endpoint is: the rate of achieving optimal myocardial perfusion according to angiography, the secondary combined endpoint is the rate of major adverse cardiovascular events.Results. In the hospital period, optimal reperfusion (TIMI-3 and MBG 2-3) after the primary procedure was achieved in 88% in the delayed coronary artery stenting group and 69.2% of immediate coronary artery stenting with an advantage in the delayed coronary artery stenting group (p=0.005). Of the 75 patients in the delayed coronary artery stenting group, 38 patients (51%) did not receive a stent in the delayed period due to the insignificance of stenosis on the control coronary angiography. There was no significant difference in the incidence of major adverse cardiovascular events between the groups. In the long-term period, the median follow-up period was 47 months. The frequency of major adverse cardiovascular events was 13.3% in the delayed coronary artery stenting group and 23.1% in the immediate coronary artery stenting group, with a trend towards the advantage in the delayed coronary artery stenting group (p=0.1). Overall mortality (9.3% vs. 11.7%), recurrent myocardial infarction (2.6% vs. 5.1%), target vessel revascularization rate (1.3% vs. 6.4%) were without significant benefit. between subgroups.Conclusion. In patients with ST-elevation myocardial infarction and massive coronary thrombosis, the use of delayed coronary artery stenting gives an advantage in achieving myocardial perfusion after the procedure, and demonstrates a tendency to reduce adverse cardiovascular events in the long-term period
The Problem of Same-Gender Marriages as One of the Many Challenges of a Developing Society to Modern Culture (A Culturological Epilogue)
No full textРукопись поступила в редакцию: 25.07.2022. Принята к публикации: 01.08.2022.Received: 25.07.2022. Accepted: 1.08.2022.Статья является послесловием к опубликованным в данном номере «Койнона» статьям правоведов М. А. Краснова и А. П. Семитко. Опираясь на материал этих статей, автор предлагает культурологическое видение проблемы однополых браков. С его точки зрения, главное противоречие жизни современного человечества — это порожденное масштабными всесторонними радикальными изменениями социокультурного мира противоречие между прошлым и возникающим сегодня будущим. Между старым опытом, воплощенным в традициях, нормах, ценностях, ментальных матрицах и привычках культуры, — и новым, сегодня совершаемым опытом, радикально отличающимся от прошлого, формирующим новые представления, ценности, способы деятельности и человеческих отношений. Этот новый опыт несет еще не виданные перспективы обществу и человеку, но он же рождает и новую, пока не освоенную сложность, неопределенность будущего, часто непонятные и даже непредсказуемые риски и угрозы. Радикальная эволюция современного человечества, таким образом, каждый день рождает новые сложные вызовы обществу, культуре, человеку. Проблема однополых браков в указанном контексте оказывается одним из вызовов, рожденных ускоренной эволюцией и порожденным ею противоречием прошлого и будущего. Важное звено концепции статьи — констатация рожденного ускоренным развитием амбивалентного значения культурного прошлого. Оно воспринимается и реально работает, с одной стороны, как не соответствующее и потому не нужное настоящему и будущему, как препятствие развитию общества и человека, а с другой — в условиях неопределенности перспектив и рисков во многом непредсказуемой радикальной эволюции — оно же получает новую ценность как резервуар проверенного жизнью опыта (даже не всегда осознаваемого), как важный фактор самосохранения общества в его антрпологической и социальной специфике, в его закономерных, проверенных на практике отношениях с природой. С этой точки зрения автор оценивает как заслуживающую внимательного отношения, полезную для нахождения оптимального решения сложной проблемы однополых браков умеренно консервативную позицию М. А. Краснова, чья апелляция к традиционным иудеохристианским морально-нравственным истокам права и на этой основе критическое отношение к однополым бракам взывает к спокойному взвешенному анализу их возможных последствий, пока практически неясных. Отвечая на этот имплицитный призыв Краснова и, с другой стороны, на верный антитезис А. П. Семитко об исторической изменчивости морально-нравственных оснований права, автор обозначает самую проблемную зону однополых семей: социализацию детей, в течение всей предыдущей истории человечества осуществлявшуюся разнополыми парами, чьи особенности и различия во многом определили воспроизводство фундаментальной антропологической специфики человека и человеческого рода. Поэтому и появление однополых родителей не может не быть антропологически существенно. Но как именно, об этом пока нет надежной информации. В итоге автор выделяет три важнейших аспекта вызова рассматривавшейся проблемы: вызов, требующий тщательного всестороннего анализа опыта однополых семей по социализации детей, адекватного постижения проблемы в ее сложности; вызов, требующий объединения усилий сторонников разных взглядов и подходов к проблеме и подлинного диалога между ними, цивилизованной дискуссии; вызов, требующий практического культуротворчества: нахождения и реализации способа оптимального решения проблемы в гармоническом единстве интересов личностей и общества.This paper is an afterword to the articles by legal scholars M. A. Krasnov and A. P. Semitko published in this volume of Koinon. Based on the materials from these works, the author suggests a culturological vision of same-sex marriage problem. In his view, the main controversy of contemporary man’s life is the controversy between the past and the today-emerging future originated from large-scale comprehensive radical changes in the sociocultural world; between the old experience embedded in the traditions, norms, mental matrices, habits of culture and a new, currently gained experience that differs radically from the past and that forms new notions, values, modes of activities and human relationships. This new experience brings about yet-unseen perspectives for society and the individual but it also gives birth to a novel, yet-unutilized complexity, uncertainty of a future, often incomprehensible and even unpredictable risks and threats. The radical revolution of today’s mankind, thus, creates new complex challenges to society, man, culture on a daily basis. The problem of same-sex marriages in the given context appears to be one of the challenges generated by an accelerated evolution and the contradiction between the past and the future produced by it. An essential link of the paper’s concept is the reporting of an ambivalent significance of the cultural past generated by the accelerated development. On the one hand, it is perceived and works as inconsistent and therefore unnecessary for the present and the future, as an obstacle to the development of society and the individual. On the other, in the context of uncertain prospects and risks of largely unpredictable radical evolution, it acquires a new value as a reservoir of the life-tested experience, as an essential factor of society’s self-preservation in its anthropological and social specificity, in its regular, proven-in-practice relations with nature. From this point of view, the author treats a moderately conservative stance of M. A. Krasnov whose appeal to the Judeo-Christian moral origins of law, and, based on this, a critical attitude to same-gender marriage calls for a calm, balanced analysis of their possible consequences that are currently unclear, as worthy of careful consideration and useful in finding the best solution to the complex problem of same-sex marriages. Responding to this implicit call of Krasnov and, on the other hand, to the right antithesis of A. P. Semitko about the historical changeability of moral foundations of law, the author defines the most problematic zone of same-sex families: the socialization of children which, throughout all the preceding history, has been implemented by different-sex couples whose specific features and distinctions have largely determined the reproduction of the fundamental anthropological specificity of mankind and human race. That is why the emergence of same-sex parents cannot help being anthropologically essential. But there is a lack of reliable information about how exactly it is. Eventually, the author identifies three most significant aspects of the challenge posed by the problem under consideration: the challenge that requires thorough, comprehensive analysis of the experience obtained by same–gender families in the socialization of children; the challenge that requires joint efforts of proponents of different views and approaches to the problem and genuine dialogue between them, civilized discussion; the challenge that requires practical culture-making: finding and implementing a way to optimally solve the problem in a harmonious unity of the interests of individuals and society
НЕИНВАЗИВНАЯ ОЦЕНКА ФРАКЦИОННОГО РЕЗЕРВА КРОВОТОКА У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА ПО ДАННЫМ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ: ПЕРВЫЕ РЕЗУЛЬТАТЫ КЛИНИЧЕСКОГО ПРИМЕНЕНИЯ. СРАВНЕНИЕ С ДАННЫМИ ИНВАЗИВНОГО ИЗМЕРЕНИЯ
No full textObjectives: to determine the diagnostic performance of non-invasive FFR derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFRCT) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD).Methods. Prospective study included 16 patients ((m/f – 13/3 mean age 47.8 ± 2.3 years) with CAD and coronary stenosis 40–75% lumen reduction. Coronary CTA was performed prior to ICA with invasive FFR measurement. FFRCT was calculated and interpreted in a blinded fashion by an independent Core Laboratory (HeartFlow, USA). Results were compared to invasively measured FFR, with ischemia defined as FFRCT or FFR ≤ 0.80.Results. The area under the receiver operating characteristic curve (95% CI) for FFCT was 0.90. Per-vessel sensitivity and specificity to identify myocardial ischemia were 91% and 89% for FFRCT.Conclusion. FFRCT provides high diagnostic accuracy, and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. Цель исследования: оценить диагностическую значимость неинвазивного измерения фракционного резерва кровотока (FFR) по данным МСКТ-коронарографии (FFRCT) в определении значимых стенозов коронарных артерий у пациентов с ишемической болезнью сердца (ИБС).Материал и методы. В проспективное исследование было включено 16 пациентов (м/ж – 13/3, средний возраст 47,8 ± 2,3 года) с ИБС и стенозами коронарных артерий 40–75% просвета артерии. Вначале пациентам выполняли КТ-ангиографию, затем – инвазивную коронарографию с измерением FFR. Измерение FFRCT проводили слепым методом независимой лабораторией Core Laboratory (HeartFlow, США). Результаты FFRCT были сопоставлены с инвазивным измерением FFR. Пороговое значение значимости стеноза определялось как FFR и FFRCT ≤ 0,80.Результаты. Площадь под ROC-кривой (AUC) (95% CI) для FFRCT составила 0,9. Чувствительность и специфичность в определении гемодинамически значимых стенозов для FFRCT составили 91 и 79% соответственно.Выводы. FFRCT представляет собой инновационный метод, демонстрирующий высокую диагностическую значимость для выявления или исключения поражения коронарных артерий, вызывающих ишемию
Ultrasound-assisted intravascular therapy: history and future perspectives of development. A review
No full textThe first use of ultrasound in treating vascular disorders dates back to 1976. Since then, numerous original studies have been published, offering various concepts of its use. Many technical solutions have been developed and used with variable success, some of which have been developed in modern medicine. This article discusses the development of ultrasound therapeutic technologies in treating vascular disorders. The history of methods is described, available data on promising future areas are presented, and information on existing methods and devices is given
THE RESULTS OF DELAYED ENDOVASCULAR INTERVENTION IN ST ELEVATION ACUTE MYOCARDIAL INFARCTION DUE TO THROMBOTIC OCCLUSION OF CORONARY ARTERY
No full textEventual role of myocardial muscular «bridges» in the pathogenesis of acute coronary syndrome
No full textAim of the study was to investigate the role of myocardial muscular «bridges» (MMB) in the pathogenesis of acute coronary syndrome (ACS). Material and methods. The study comprised of 27 patents with ACS: 21 (77,8 %) with diagnosed unstable angina pectoris (UA) and 6 (22,2 %) with acute anterior myocardial infarction with ST elevation (STEMI). Results. All patients with STEMI had positive qualitative troponin test. The serum level of creatine phosphokinase (CPK) was 857.7 ± 495.5 U/l, the CPK MB level was 46.5 ± 42.4 U/l. The patients’ age varied from 32 to 68 years (on average, 52.4 ± 4.6 years). Selective coronary angiography (CAG) revealed systolic functional obstruction of the LAD with vessel’s lumen recovery to the norm during diastole in all 27 patients, which is typical for MMB. In all cases with UA, the clinical aggravation was associated with ECG signs of transitory or permanent myocardial hypoxia in the territory supplied by the LAD, while the patients with STEMI had ECG, biochemical and EchoCG signs of myocardial damage and kinetics disturbances in the left ventricular areas supplied by the LAD. All patients underwent intravascular instrumental investigation. During in-hospital stage all patients received conservative therapy including β-adrenergic receptors or CA-channels blockers; ACE inhibitors; disaggregants. Upon 12 months all patients underwent repeated outpatient examination. In all cases, the conducted therapy resulted in the improvement of the patients’ condition. Conclusion. This study allows concluding that MMB play an essential role in the pathogenesis of ACS, including STEMI
