Convenient transfers of the Moscow metro. Liver transplant surgery: preparation, conduct, where and how to do Where to do a transplant
All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.
The kidneys are a paired organ of our body that performs the function of removing toxins. If the kidney function is impaired, the organism is poisoned and the person dies. A little over 15-20 years ago, patients with end-stage renal failure were doomed.
The kidney is a very complex functioning structure, and its functions can be replaced either with very complex equipment (which cannot be simply put in your pocket and carried with you), or by replacing it with a healthy organ.
Now such patients live for many years thanks to a developed network of dialysis centers, as well as an increase in the number of kidney transplants.
Hemodialysis (artificial kidney) is a good invention that allows you to prolong the life of a patient with end-stage renal failure. But such a patient is “tied” to a dialysis center. He cannot go anywhere for more than one day. Skipping even one dialysis session can lead to death.
And there are more and more patients with chronic renal failure every year.
Therefore, the issue of kidney transplantation is so relevant.
Story
The kidney was the first organ to be transplanted, first in experiment and then in practice. The first experiments on the engraftment of a foreign kidney were carried out on animals at the beginning of the 20th century.
The first successful human-to-human kidney transplant was in 1954. US surgeon Joseph Murray transplanted the kidney of his own brother to an incurable patient. The patient lived with the transplanted kidney for nine years. This period is considered the beginning of the era of transplantation. By the same time, the necessary studies on tissue compatibility and the need to suppress the immune response in patients with a transplanted organ had accumulated. Without this, transplantation would be doomed.
Important milestones in the development of transplantology:
- Discovery of new cytotoxic drugs.
- Widespread introduction of hemodialysis and peritoneal dialysis.
- Discovery of new preservative solutions.
- Opening the role of HLA-DR compatibility.
Kidney transplant in the modern world
Currently, kidney transplantation is a fairly common operation, it makes up half the volume of all transplantation. About 30,000 such operations are performed annually in the world. The five-year survival rate is 80%.
It has been proven that kidney transplantation not only significantly improves the quality of life of a patient with CRF, but also increases its duration (compared to chronic hemodialysis).
However, the number of those in need of a kidney transplant is many times greater than the number of operations performed. Of course, this is due to the lack of donor organs.
The transplant operation itself is only one of the stages of treatment. After it, an equally difficult and responsible stage begins - life with a transplanted kidney, which requires constant lifelong medication in order to prevent rejection of the transplanted organ.
Who needs a kidney transplant
There is only one indication for a kidney transplant - the final stage of renal failure, that is, the stage when both kidneys (or for some reason the only kidney) do not cope with the function of purifying the blood.
The amount of nitrogenous wastes that are toxic to all organs is increasing in the body. This state without intervention inevitably leads to death. No medication can slow down the progression of kidney failure.
What diseases most often lead to kidney failure?
- Chronic glomerulonephritis.
- Chronic pyelonephritis.
- Nephropathy in diabetes mellitus.
- congenital pathology.
- Polycystic.
- Urolithiasis disease.
- Injuries.
- Tumors.
Kidney transplantation is indicated primarily for children, since it is rather difficult for them to carry out hemodialysis.
Preparatory stage
If a disappointing diagnosis is made and a decision is made on the need for a transplant, the patient is assigned a whole range of examinations in order to only put him on the waiting list.
It is necessary to exclude, first of all, absolute contraindications for kidney transplantation:
- Malignant neoplasms.
- active tuberculosis.
- Active hepatitis or AIDS.
- Severe diseases of the heart and blood vessels.
- Chronic lung disease with respiratory failure.
- Addiction.
- Mental illness.
- All diseases with a life expectancy of no more than two years.
To exclude these diseases, appropriate examinations are carried out:
- Blood and urine tests.
- Biochemical detailed analysis.
- Blood for markers of infectious diseases.
- X-ray examination of the lungs.
- Study of lung function.
- Ultrasound of the abdominal organs.
- Fibrogastroscopy.
- A functional study of the heart, if abnormalities are detected, coronary angiography can be prescribed.
The procedure for typing histocompatibility according to the HLA system is carried out.
If an organ transplant from a deceased donor is expected, the patient is put on a waiting list and waits in line until a donor organ suitable for him according to the results of typing appears. The kidney should also be suitable for age and size. The wait is quite long, on average, needy patients wait 1.5-2 years for a kidney. A kidney transplant to a child, if a suitable organ is available, is carried out in the first place.
What needs to be done while the operation is expected:
- The patient should be on adequate hemodialysis.
- It is necessary to examine for latent infections (bacteria culture of feces, urine, sputum) and their treatment.
- Sanitation of the oral cavity.
- Otolaryngologist examination.
- Examination by a gynecologist.
- Make all necessary vaccinations against infectious diseases.
- Maximum correction of the treatment of chronic diseases, selection of insulin therapy to ensure adequate compensation for diabetes mellitus.
- If necessary, surgical treatment of coronary artery disease (myocardial revascularization surgery) is possible.
- If the inflammatory bacterial process in diseased kidneys does not lend itself to conservative treatment, bilateral nephrectomy is possible.
- It is necessary to apply for a quota for a free operation to the regional Ministry of Health.
A call for a kidney transplant from the transplant center can be received at any time (for this, as many contact phone numbers as possible are left in the center). Therefore, you should always be ready for a call for an operation, and when you receive a call, try to arrive at the center as soon as possible together with your escort. After receiving a message about the upcoming operation, you must refrain from eating and eating.
Kidney transplant from a living donor
Waiting for a suitable donor is a long process. The kidney is taken mainly from people who died in disasters, in which brain death has been recorded.
Currently, living donor kidney transplantation is becoming more and more common all over the world. This transplant has a number of proven benefits:
- Transplantation from a living donor (even unrelated) gives a higher survival rate and a longer life expectancy.
- Long wait times are excluded.
- The planned nature of the intervention.
- The possibility of a more thorough preliminary examination of the donor.
- The period of cold ischemia is reduced.
- Possibility of kidney transplantation prior to hemodialysis, which also gives fewer complications.
In Russia, a kidney transplant is allowed only from a close relative. A donor can be a person who is in a genetic relationship with the patient, aged 18 to 65, who has given voluntary consent to the removal of the kidney.
The donor undergoes a thorough examination. He should not have any serious somatic and mental diseases, arterial hypertension. Particular attention is paid to the study of the state of the kidneys, to exclude latent pathology. Since the donor will have to live the rest of his life with one kidney, doctors must be sure that it is functioning normally.
Description of the operation itself
There are two methods for this operation:
- Orthotopic.
- Heterotopic.
Orthotopic transplantation is a kidney transplant to the place where it is usually located. That is, the diseased kidney is removed, and a donor one is placed in its place, the renal vessels are sutured with the renal vessels of the recipient. Orthotopic transplantation is rarely used, as it has many negative aspects.
Heterotopic transplant
- this is the suturing of the kidney in an atypical place for it in the iliac region of the small pelvis. In this case, the vessels of the donor kidney are sutured with the iliac vessels of the patient: the renal artery - with the iliac artery, the renal vein - with the iliac vein. Only after the restoration of blood flow in the kidney, create a path for the outflow of urine. The ureter is sewn into the bladder.
Such an operation is technically easier, access to the vessels of the iliac region is easier, they are larger than the kidney ones.
The operation is performed under general anesthesia, the duration of the operation is 3-4 hours. When transplanting a cadaveric organ, time is a decisive factor, so preoperative preparation is carried out on an emergency basis.
When transplanting from a living donor, nephrectomy and transplantation operations are carried out almost simultaneously, planned in advance, which allows both the donor and the recipient to be more thoroughly prepared.
After completion of all stages, drainage tubes are left in the surgical field and the wound is sutured.
Early postoperative period
After the operation, the patient will be in the intensive care unit for several days under close monitoring.
The transplanted kidney begins to function in full on the 5-7th day, until this time hemodialysis sessions are performed.
Nutrition for the first days is carried out parenterally, that is, by infusion of various nutrient solutions intravenously. Broad-spectrum antibiotics are prescribed, and drugs that suppress the body's immune response are prescribed from the first days (the basic immunosuppressant is Cyclosporine A).
Doctors are allowed to get up and walk for 2-3 days.
Discharge from the hospital with a successful outcome is possible in 3-4 weeks. All this time, doctors monitor the functioning of the transplanted kidney: daily blood and urine tests, creatinine, urea, electrolytes. A radioisotope examination is prescribed, as well as vascular dopplerography to assess blood flow. Sometimes a kidney biopsy is needed.
Possible early postoperative complications:
- Failure of vascular anastomoses with the development of bleeding or the formation of retroperitoneal hematomas.
- Infectious complications in the form of suppuration of the surgical wound or generalization of latent infection against the background of immunosuppressive therapy.
- Acute rejection reaction.
- Thrombosis or thrombophlebitis of the iliac vessels or deep veins of the leg.
Life with a transplanted kidney
If the operation was successful, the kidney began to function and the threat of postoperative complications has passed, the patient is discharged home.
The quality of life of such patients improves, many return to work, women are able to give birth to children. Patients with a transplanted kidney live for 15-20 years, then the question of a new transplant may arise.
The main problem in transplantology is the risk of transplant rejection, which can occur at any time after surgery. A donor kidney, even taken from a close relative, is perceived by the body as a foreign body. Our immune system, designed to get rid of foreign bodies, produces antibodies to foreign proteins. As a result of the interaction of antibodies with antigens, organ necrosis occurs.
The main signs of donor kidney rejection:
- Temperature rise.
- Pain in the area of the transplanted kidney
- Decreased diuresis or complete cessation of urination.
- Changes in analyzes characteristic of acute renal failure.
To suppress the immune response after transplantation of any organ (not just the kidney), special drugs are prescribed - immunosuppressants.
Major immunosuppressants, used today:
- Corticosteroids.
- Cyclosporine (sandimun).
- Tacrolimus.
- Sirolimus.
- Everolimus.
- Simulect.
- Zenopax.
- Atgam.
Usually, a combination of several immunosuppressants acting on various parts of the immune response is prescribed. There are two modes of immunosuppression:
- Induction (within 8-12 weeks after transplantation), involving the maximum dose of drugs.
- Supportive (for the rest of your life).
Immunosuppressive therapy has its own side effects, which the patient is warned about in advance: the development of drug-induced hepatitis, leukopenia, diabetes mellitus, obesity, osteoporosis, peptic ulcers, arterial hypertension is possible. It also increases susceptibility to infections.
What factors influence graft survival and life expectancy?
- Immunological compatibility of the donor and recipient. The more positions match in tissue typing, the less likely it is to be rejected. The most favorable donors are identical twins, followed by siblings, then parents, then more distant relatives, then a living unrelated donor. And in the last place - a cadaveric organ.
- Center effect. Means a set of experience and conditions existing in each particular center. The difference in the results of organ survival in different centers reaches 20%.
- Duration of cold ischemia of the donor organ. There is evidence that this factor is more important than histocompatibility.
- Age (risk increases).
- The quality of preparation and rehabilitation at the time of surgery.
- Concomitant extrarenal diseases.
According to patients who have undergone kidney transplantation: despite all the hardships of preparation, expectations, the severity of the operation itself and the subsequent constant treatment with heavy drugs, all these torments pay off with a sense of freedom. A person feels full, not tied to a hemodialysis machine.
Where is a kidney transplant done and how much does it cost
Kidney transplantation is a high-tech medical care; quotas are allocated from the federal budget for each region to perform it free of charge for patients in need.
However, there are not enough quotas for all those in need. Many decide on a paid operation. The average cost of a kidney transplant is $20,000. It should be noted that the sale of organs in our country is prohibited. This is the price of the operation itself, regardless of which organ will be transplanted - from a relative or from a corpse.
There are more places where a kidney is transplanted in Russia than centers for transplanting other organs.
AT Moscow Kidney transplants are performed by:
- Research Institute of Transplantology and Research Institute of Rosmedtekhnologii.
- RRC of Surgery, Russian Academy of Medical Sciences.
- Scientific Center of the Union of Artists Bakuleva RAMS.
- National Medical and Surgical Center. Pirogov.
- Russian Children's Clinical Hospital of Roszdrav.
- Oncological Scientific Center of the Russian Academy of Medical Sciences.
- Main military clinical hospital named after Burdenko.
- Russian VMA them. Kirov.
There are several federal kidney transplant centers in St. Petersburg:
- GMU them. Academician Pavlov.
- Federal State Institution "Central Research X-Ray Radiological Institute".
There are also kidney transplant departments in almost all major cities: Novosibirsk, Nizhny Novgorod, Samara, Krasnoyarsk, Khabarovsk, Yekaterinburg, Irkutsk and others. The address of the nearest kidney transplant center can be obtained from the regional Ministry of Health, where you can also try to get a quota for a free transplant.
Video: kidney transplant - medical animation
Video: related kidney transplant
Schedule of the Moscow metro and transitions.
The Moscow Metro operates at the entrance of passengers, as a rule, from 5:30 in the morning until 1:00 at night.
More specifically, for stations, this can be clarified on the official website of the Moscow metro - www mosmetro ru
A slightly different work schedule for the monorail line of the Moscow metro. The line opens for passenger entry at 7:00 am.
Some stations have different entry times.
For example, people are allowed to enter the Vykhino station after one in the morning, since the last train from the opposite end station (Planernaya) only departs at this time. During the time when the last train from Planernaya reaches Vykhino, several more will pass.
Crossings are open until 1:00 am at all stations. This is official information.
As they say on the website, the train schedule is 99.98% fulfilled.
If you are late and do not have time for the transition before one in the morning, it can still be done, but on foot, since the escalators turn off at one in the morning.
You just have to walk up or down the steps of the stopped escalator.
Which ticket to buy if you plan to stay for several days in Moscow? -
But the most important thing is information about when the last train departs from different stations and metro lines, including the Circle Line.
As a rule, at 01:03 the last train leaves the terminal stations. So, for example, the last train from Planernaya station on the Tagansko-Krasnopresnenskaya line leaves at 01:03. Accordingly, it arrives at Vykhino station at approximately 01:52, and at Zhulebino at 02:00; the last train from the Mitino station leaves a little later - at 1:04; from the station "Alexandrovsky Sad" towards the station "Mezhdunarodnaya" even later - at 1:08). Late passengers still have a chance to reach their destination.
For example, if you need to know when the last train will arrive at a certain station of the radial line (for example, in the direction from Barrikadnaya towards Zhulebino), you need to count the number of stops from Planernaya station to Barrikadnaya (8 pieces) and calculate the total travel time for these stations (in in this example, it is 22 minutes). In total, if the train leaves from Planernaya at 1:03, then it will be at Barrikadnaya at about 01:25. This is the deadline when you can catch the last train towards Zhulebino. On average, from the city center to the outskirts, the last trains of the radial lines pass the central stations around 01:20-01:40.
At a little over one in the morning (at about 01:10), all the trains definitely go in different directions, but after 01:15 it’s no longer worth the risk and go with transfers. Especially if the line is short (like Kalininskaya).
For example, if you decide to travel along the Circle Line from one station to another at a late hour, you can miscalculate, because trains sometimes go only to a certain station, or the train interval is increased. Sometimes you can expect a train up to 10 minutes and miss the last one, following one of the directions. If the train goes to a certain station, this is announced in advance when boarding.
In order to be guaranteed to get on the subway, it is advisable to try to catch the transition before 01:15.
All escalators work at the exit from the metro.
On average, train intervals are 2.5-4 minutes (at night they are longer - the maximum interval can reach 10 minutes - for example, at night on weekends).
To find out the travel time from one station to another, you need to open the Moscow Metro scheme - mosmetro ru, select the desired direction, move the arrow to the desired station and click. A dark blue circle will appear. Then you need to click on another desired station. The time of movement on this segment will appear automatically.
The best travel route will also be shown.
From September 2013 for regular and forced night passengers using the services public transport, new opportunities are provided - night traffic routes have appeared -
On the trolleybus number B at night you can ride along the Garden Ring, and on the bus number H1 - from Sheremetyevo to Leninsky Prospekt, with a bus interval of 30 minutes.
Let's say you missed the transition from the Circle Line to the Radial Line. Don't panic. Go outside, try to get to the Garden Ring. Look for a stop on route number B. It runs around the clock, with an interval of 15 minutes. Bus number B runs at night, not a trolleybus. Are you driving along Garden Ring to the desired station (direction). For example, you missed the transition from Krasnopresnenskaya to Barrikadnaya towards the center to get to Vykhino. Take "B" to Taganskaya, and save a lot on taxis. If you go on Friday evening or on weekends, then by trolleybus number 63 you can easily reach Vykhino.
Tram number 3 will take you to Chertanovo at night, and trolleybus number 15 will take you from VDNKh to Luzhniki.
The wholesale market of Moscow, where you can dress cheaply -
- for beginner travelers;
- for those who first encountered a transit flight;
- for those who are worried that they may not have enough time for a transplant;
What type of transplant do I have?
The first thing to find out when faced with a transit flight is what type of transfer you will have.
Transits are different. For example, you may have single ticket when the entire flight (including transfers) is served by one airline. This is the most convenient option, since the carrier in this case is responsible for delivering the passenger to the destination. And if, say, a flight was delayed in the first segment and you missed the second segment, then you will be required to be put on another aircraft of the same company. If the transfer time exceeds 8 hours, some carriers (for example, Emirates and Qatar Airways) provide passengers with a place in the hotel. Luggage will also be checked in and delivered to the end point of the route. Additionally, you do not need to register with such a ticket.
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Another option is the so-called "code-sharing" when you buy a single ticket from one carrier, but fly part of the way with a partner airline. In this case, you will also be checked in with luggage to your destination and a transfer will be arranged for you. The only difference is that, in case of unforeseen situations (damage / loss of luggage, etc.), all claims must be submitted to the partner company. Note: For this type of travel, the name of the additional carrier may not appear on the ticket.
There is also such a thing as interline agreement- an agreement between airlines in which one carrier recognizes the tickets of another. That is, one company can sell you tickets to another. The bottom line is that this method allows you to buy a single ticket for more favorable price than if you were buying several separate ones. Often there are special fares on these flights.
Important! Tickets of this type always indicate all carrier companies. Your luggage will also be checked in before the end of the flight, but you need to ask for this separately. Sometimes you need to get a ticket for the next leg of the journey when changing - this is also worth keeping in mind.
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Well, the last option is a few separate tickets. Many consider it the most inconvenient, since in this case you will have to pick up and re-register your luggage at the transfer point, as well as re-check in for the next leg of the route. If you miss your flight, you will most likely need to buy new ticket. And the price of such a combined flight is often higher than in other cases. Therefore, if you still decide to fly this way, make sure that you have enough time for a transfer (it makes sense to play it safe and fly out of the transfer point the next day).
But what to do with low-cost airlines? Let's make it clear right away - in principle, low-cost airlines do not have transfers. Itineraries offered to you by aggregator sites, including TripMyDream, are routes that consist of two or more separate flights. Therefore, in the case of low-cost flights, the entire responsibility for the safety of luggage, and your arrival at your destination, is solely on you.
Transit visa. When is it needed?
We warn you right away - this point must be clarified even before buying tickets. Generally, a transit visa is not needed if your next flight departs from the same airport and terminal you arrived at and if you do not need to collect luggage. Then you just wait for the next plane in the transit area of the airport, without going through immigration control.
But, when it comes to a transplant in the UK, be on the lookout. Very often, travelers, tempted by the low price, buy flights with a transfer in London. For example, Ryanair always has a lot of flight offers to different cities in Europe at the most low prices with transfers in Stansted or Luton, and then they are simply not allowed on the flight due to lack of transit visa.
But a transit visa is issued if:
- You are flying with a transfer and you need to change the airport.
- When transferring, you need to change the terminal, and for this you need to go to the city (the departure terminal is located in another area, for example).
- You need to make two or more transfers in the Schengen area. In this case, a transit visa is issued at the embassy of the first country.
- Your transplant will take place in the UK (assuming it lasts 24-48 hours). Then you need to apply for a Visitor in transit Visa in advance. But if the transfer lasts more than 48 hours, you will need a regular Transit Visa.
- You are flying on two different tickets (say, from to and from London to). Then you need a visa to get your luggage and check in for the next flight.
Important! Some countries (for example, and) require a transit visa even just to be at the airport in the transit zone.
Luggage is a different story, since it is received after passing through migration control. Therefore, make sure that your suitcases are checked in until the end of the trip, and you yourself have the right to stay in the transfer country without a visa.
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Another important nuance concerns the transfer zones themselves. First, they are not available at all airports. Secondly, they do not always work 24/7, if you arrive late in the evening and depart in the morning, and the airport does not work at night, you will have to take care of a place to spend the night and arrange Schengen transit in advance. This is the most inconvenient option, so think over your plan of action in advance so that you don’t huddle on a bench later.
I arrived at the transfer airport. What's next?
If you are flying with a transfer for the first time, then the main rule is to keep calm and carry on. Do not be nervous, your gate and plane will not go anywhere and you will calmly fly further, do not even doubt it!
So, you have arrived at the transfer point. What's next? Firstly, your tickets and documents should always be with you in order to check the data in them at any time (flight departure time, gate, terminal, etc.) with the airport information board and present them without delay before boarding.
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If you are flying on a single ticket, upon arrival at the transfer airport, follow the signs marked "Transfer" / "Transit" - you will easily find them transit zone where you will wait for the next flight. Immediately find your flight on the information board and specify the departure time, gate number and other information (sometimes it can change). We also advise you to immediately find your gate in order to know where you will have to go for a landing, and only then go for a walk around the airport.
Please note that if you are flying to one of the Schengen countries, you will need to passport control immediately upon arrival. Those who fly with two separate tickets will have to go through a similar procedure, since in this case you are not included in the category of transit passengers. Upon arrival, you will need to collect your luggage, proceed to the check-in counters (the signs will help you!) and re-check in by rechecking your luggage.
Stop. Can you pick up your luggage or deliver it?
It depends on the type of ticket. If it's a single ticket, then you can check in your luggage to your final destination and not worry about it at all. But if you need to change the airport during a transfer, then you may need to pick up and check in your luggage again, even if you have a single ticket. Therefore, be sure to check this at the baggage check-in.
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Long transfer. Things to do?
If your transplant takes 3-4 hours at most, you can safely skip this step. But it happens that it takes quite a long time to wait for the next flight. If it is possible to go to the city and the airport itself is not so far from it, go for a walk. the best way you can't pass the time. Make a plan in advance with a list of places you want to see and calculate how long it will take you to get from the airport to the city and back, plus the time spent in the city, and add another half an hour to be sure. For sure!
Dear guests of the capital! And also Muscovites (it turned out that many Muscovites are also not aware. Yes, I myself discovered this not so long ago). That there are a lot of nightmarish, long and tedious transitions from branch to branch in the Moscow metro, especially in the center, I think everyone knows this. For some reason, the St. Petersburg residents especially complained to me: as far as I understand, most of the transitions there are arranged according to the same principle as we have at Kitay-Gorod. But not everyone knows that sometimes this problem can be easily bypassed, you just need to know where and how. The fact is that the branches of the Moscow metro usually intersect at an acute angle. And transitions from branch to branch in most cases are an escalator, and more often a simple staircase in the center of the hall. Going up or down the stairs is a great pleasure, especially if a crowd of people is rushing up there with you, and you have sore legs, a bag on wheels or just a heavy backpack! - you find yourself in a more or less long corridor leading to the center of the hall of the neighboring station. At the same time - attention, know-how! - both of these stations very often have a common ground lobby. And the escalators leading up (this is where there will almost certainly be an escalator!), go out to the common room, as a rule, even before the turnstiles. That is, instead of climbing up and down stairs and walking along long narrow corridors in a crowd of people, you can simply go to the end of the hall, go up the escalator, go down the other way, and now you are at the right station. At the same time, this possibility is almost not advertised anywhere. The signs say: the exit to the city is at the end of the hall, the transition to the station such and such is in the center of the hall. Stomp, dear, up the stairs.
The most striking example is Paveletskaya. The transition from "Paveletskaya" - ring to "Paveletskaya" - radial - seems to be the longest in Moscow. Plus tight steep stairs - the trademark of the "green" branch. But I haven't used it for several years. The escalator at the end of the hall leads to a round lobby, there is literally ten steps away - the second escalator, and that's it. There is only one exit to the city, you won't get lost, two exits to the radial one, and the transition to the one that is not to the station. At the same time, on the radial, a sign hangs by the escalator on purpose: "Transition to the Circle Line in the center of the hall." Yeah thanks. I know.
Or the transition "Turgenevskaya" - "Chistye Prudy". The corridor is shorter than on Paveletskaya, but uphill. The same: exit to the city (it is there alone at both stations), from the escalator from Turgenevskaya - to the left, from " Chistye Prudy”, respectively - to the right, the escalator down.
"Teatralnaya" - "Okhotny Ryad". Here it is more difficult. There are two exits to the city on Okhotny Ryad, and each time you have to remember again which one you can use to go to Teatralnaya. It seems to be on the one to the Bolshoi Theater, but it will be necessary to check. And the “Teatralnaya” station is generally a very confusing station, it’s easy to get lost there - but, again, if you use the right escalator, you won’t have to climb stairs and wander through the transitions. In short, the path is proven, but needs to be clarified.
There is, they say, the same transition from the "Teatralnaya" to the "Revolution Square", but I have never been there.
"Pushkinskaya" - "Tverskaya" - in principle, the transition there is quite convenient, but if you crowbars climb the stairs, AND YOU HAVE A TRAVEL PASS WITH UNLIMITED TRIPS, or you do not mind spending an extra trip, you can go up the escalator, and immediately go back and go down the escalator to the desired station. As for the travel card, it is important, because, having gone upstairs, you will find yourself behind the turnstiles. It makes sense if you, for example, have a heavy bulky load that you are reluctant to carry up the stairs.
"Pushkinskaya" - "Chekhovskaya" - the second transition is officially marked, but it cannot be said that it is much more convenient than the other: both there are stairs and corridors. Unless it is more convenient for you personally to go at the end of the platform, and not in the center of the hall.
"Komsomolskaya" ring-radial - in principle, this can also be done, there the escalators lead to one hall, but it does not make sense: there are a lot of stairs and passages on the way to the escalators. It makes sense only if the official transition is packed to capacity: at the exit, the stairs and corridors are wider. But at the exit, the crowd is usually thicker, after all, there are three stations.
"Library named after Lenin", transition to "Alexander Garden" and "Arbatskaya" - two official transitions, but it is more convenient to use the one at the end of the hall. There is a wide staircase and a short passage, and in the center of the hall there is a staircase and a long narrow corridor leading to the same passage. It's best not to go there during peak hours.
That's all I remember for now. I propose to supplement, systematize, and, perhaps, lay it out somewhere, if this has not already been done. I haven't found it yet.
Hair transplantation is a procedure during which genetically healthy hair is transferred from donor areas to areas of the head that are prone to baldness. As a rule, the sides of the head and the back of the head become donor areas. When transplanting hair, one of the methods is used - surgical or non-surgical. Now more and more popular and widespread is the non-surgical method, in which the follicles of genetically resistant hair are combined.What does a hair transplant include
Hair transplantation by the surgical method involves the transfer of donor skin strips (grafts) to problem areas of the head. The method is ineffective, after such a transplant, scars remain forever on the donor area, and it is simply impossible to achieve natural hair density in this way.A partially non-surgical method consists in sutureless transplantation of grafts, which are subsequently transferred to the problem area of the head. In this case, the incisions are much smaller, but noticeable scars still remain on the donor area. The method also does not allow you to get the natural thickness of the hair.
The non-surgical method involves the union of 3 or more hairs, which are transplanted by the hands of a specialist to the problem area and are planted to the nearby roots of healthy hair. The nerve endings are not affected, the procedure is painless and leaves no traces behind. The effect persists for a long time. The method allows you to achieve natural hair density.
