Arterial hypertension (AH) is currently considered as the main risk factor for the development of atherosclerosis of the epicardial arteries, contributing to the formation of not only structural, but also functional changes in the coronary vessels, including at the level of microcirculation.

Aim: To assess the influence of coronary microvascular dysfunction (CMD) of hypertensive origin on the functional significance of stenoses of the main coronary arteries according to measurements of fractional flow reserve (FFR), as well as to analyze the mechanisms of CMD formation in patients with coronary heart disease in combination with hypertension. The FFR measurement method is considered as a standard for making decisions about myocardial revascularization, which can increase the effectiveness of the intervention. However, the results available to date are still ambiguous, as evidenced by the results of numerous meta-analyses presented in the work. Equally important is the assessment of the independent unfavorable prognostic value of CMD, which makes it urgent to develop new targeted treatment methods that reduce the severity of these disorders.

The development of novel strategies for diagnosing, treating, and preventing cardiovascular diseases (CVDs) linked to metabolic syndrome and obesity presents a significant challenge for the scientific community. There is a pressing need to identify effective compounds that target the underlying pathogenic mechanisms of these disorders. Increasing knowledge about the pathogenesis of CVDs has highlighted the crucial role of perivascular adipose tissue (PVAT) in maintaining cardiovascular homeostasis. PVAT is a metabolically active endocrine organ that plays a key role in regulating blood vessel tone, endothelial function, and the growth and proliferation of vascular smooth muscle cells. However, in metabolic disorders, there is a disruption in the functional activity of PVAT cellular components and an imbalance in the production of vasoactive substances, leading to the development and progression of CVDs. This review systematically examines the morphofunctional changes in PVAT associated with metabolic syndrome and obesity, emphasizes the dysfunction of PVAT as a key pathogenetic factor in cardiovascular disease, and evaluates the potential of hydrogen sulfide (H2S) produced by PVAT as a promising vasoregulatory agent based on existing data.

Aim: To study the state of cardiac tissue homeostasis in the process of ontogenesis in prematurity in the light of modern fundamental knowledge on the biology of cardiac stem cells, the structure of cardiomyocytes, paracrine regulation mechanisms and other pathogenetic mechanisms affecting the growth, development and remodeling of the cardiovascular system in childhood and in follow-up.

Literature search strategy. A search for studies and analytical literature reviews was conducted in databases Cochrane library, MEDLINE, Google Academy, PubMed and other databases mainly from the beginning of 2018 to December 2023. Publications/ studies reflecting various aspects of the physiology of the infant heart in premature infants (clinical and experimental aspects) were independently selected for inclusion. Preference was given to randomized controlled trials.

Results. Based on modern concepts of pre- and post-implantation (postnatal) development and growth of the infant heart, the analysis of the processes of postnatal growth and development of the heart of children born healthy full-term and premature with spontaneous natural conception is given. The analysis of the main pathogenetic mechanisms influencing the processes of growth and development of the child’s heart in the intrauterine and postnatal period is carried out.

Conclusion. Experimental and clinical data reasonably require a conscious revision of the fundamental theoretical postulates about the regenerative capabilities of the myocardium in various periods of childhood, including the clinical group of premature babies, and practical guidelines for pregnancy management with the threat of abortion and infertility (preimplantation measures using assisted reproductive technologies), combined/intensive (including, respiratory) therapy in the neonatal period, longterm outpatient follow-up of children and adults born prematurely with low, very low and extremely low body weight in order to prevent, screen and treat potential effects on the health of the cardiovascular system throughout life. The information provided is very useful for a wide range of readers – biologists, embryologists, reproductive doctors, obstetricians, gynecologists, neonatologists, pediatricians, internists, cardiologists, surgeons.

Macroencapsulation of cells allows to isolate the donor biomaterial from the influence of the recipient’s organism. The degree of isolation can vary from mechanical isolation of donor cells within the implantation site to complete immune isolation of the transplanted biological material. The diffusion chamber was the first device used for macroencapsulation. The initial stage of research of this technique was aimed at expanding the range of cell and tissue implantation in allogenic and xenogenic models and clarifying the mechanisms underlying the graft rejection reaction. Later the design of the diffusion chamber underwent a number of changes that determined the modern application of the macroencapsulation method. The derivative of the diffusion chamber – the engineering chamber in complex with the arterio-venous shunt is used as a tissue modeling tool for creation of soft tissue flaps of different composition with the axial type of blood supply. An alternative design of the flow chamber allows the formation of soft tissue flaps on intact vessels. The engineering chamber is also used for growing various types of tissues and organ fragments (cardiac transverse striated muscle tissue, lymphoid tissue, fragments of liver, thymus, pancreas). A separate direction in studying the range of practical applications of the diffusion chamber is the development and testing of methods of transplantation of pancreatic islet cells into animals when creating allo- and xenogeneic experimental models for the treatment of diabetes mellitus. Some devices are already undergoing clinical trials and are available as a product for experimental studies.

Introduction. In order to prevent thrombotic complications after endovascular closure of patent foramen ovale (PFO), dual antiplatelet therapy (DAPT) is prescribed with a switch to acetylsalicylic acid monotherapy. These drugs increase the risk of bleeding, while early withdrawal of therapy can lead to recurrent ischemic stroke (IS) and transient ischemic attack (TIA). The effective and safe duration of DAPT has not been accurately established due to the small evidence base.

Aim. To compare the efficacy and safety of long-term and shortened antiplatelet therapy (AAT) in patients undergoing endovascular closure of PFO.

Material and Methods. 239 patients who underwent endovascular closure of PFO were included in the study. Clinical and anamnestic characteristics of the sample: 140 (58.58%) women, mean age 43.00 [35.00; 52.00] years, 173 (72.38%) patients had an IS and 66 (27.62%) TIA. Patients were taking APT according to two regimens. Prolonged in duration included DAPT (clopidogrel + acetylsalicylic acid) for 6 months with a switch to acetylsalicylic acid monotherapy for up to 5 years. Shortened duration included DAPT and acetylsalicylic acid monotherapy for up to 6 months. Patients were followed up for 38.23 [22.20; 48.67] months and were divided into 2 groups. The first group included 145 (60.70%) patients with prolonged duration of DAPT and the second group included 94 (39.30%) patients who were receiving DAPT according to the shortened duration regimen.

Results. There were no differences between the groups of patients with prolonged and shortened duration of DAPT in terms of clinical and anamnestic and intraoperative characteristics, complication rate, early postoperative period and long-term follow-up. The pvalue ˃ 0.05 for all comparison parameters. The duration of follow-up for the group with prolonged DAPT duration was 38.65 [23.14; 48.43] months, 110 (75.86%) patients received clopidogrel for 6 months, acetylsalicylic acid for 60 months. During follow-up, there were 6 (4.35%) bleeding events, including 1 (0.72%) major bleeding event, 1 (0.72%) IS, and 1 (0.72%) TIA. The duration of follow-up for the group with shortened DAPT duration was 35.70 [21.43; 51.67] months (p = 0.4088). A total of 74 (78.72%) patients were received clopidogrel for 6 months (p = 0.8970), and 68 (72.34%) discontinued acetylsalicylic acid therapy 6 months after endovascular closure of the PFO. There was 1 (1.18%) minor bleeding and 1 (1.18%) IS during follow-up (p ˃ 0.05).

Conclusion. Prolonged duration and shortened to 6 months APT have comparable efficacy in preventing thrombotic complications after endovascular closure of the PFO. Administration of APT may risk of bleeding, the likelihood of which increases with the duration of treatment. The decision on the duration of APT should be made individually based on the risk of thrombosis and bleeding.

In aortic valve (AV) replacement surgery in patients with a narrow annulus fibrosus (AF), the likelihood of prosthesis-patient mismatch (PPM) is high. PPM, in turn, significantly affects the hemodynamic and functional capabilities of AV, morbidity and mortality in the postoperative period. The “gold standard” for the treatment of AV diseases is prosthetics with mechanical and biological prostheses. However, there are alternative methods, such as neocuspidalization of AV according to the S. Ozaki (AVNeo) method.

Aim: To compare the immediate and medium-term results of AV prosthetics using the S. Ozaki (AVNeo) technique and AV prosthetics with a biological prosthesis in patients with a small aortic annulus.

Material and Methods: A retrospective multicenter study of 309 patients with a narrow fibrous ring of the aortic valve (FR AV) who underwent surgery between February 2010 and December 2021 was conducted. Inclusion criteria: prosthetics of AV, FR AV = 21 mm, age 18 years and older. Exclusion criteria: left ventricle ejection fraction ≤ 40%, repeated interventions, mini-stop. 153 patients underwent Aveo and 156 patients underwent AV prosthetics using biological prostheses. After “pseudorandomization” (propensity score matching), 92 patients were selected: 46 patients in the AVNeo group and 46 patients in the biological prosthesis group. The primary endpoint was hospital mortality. Postoperative complications, transvalvular gradients, and medium-term outcomes (three-year overall survival and freedom from surgery on AV) were evaluated as secondary endpoints.

Results. There was no statistically significant difference in the duration of surgery (275.9 ± 34.2 min in the AVNeo group and 285.8 ± 37 min in the bioprosthesis group, p < 0.4), artificial circulation (98 min in the AVNeo group and 115 min in the bioprosthesis group, p < 0.3), aortic compression (80 min in the AVNeo group and 93 min in the bioprosthesis group, p < 0.7). Hospital mortality among the studied patients did not differ: in the AVNeo group – 2 (4.3%) and 1 (2.2%) in the bioprosthesis group, p = 1.0. There were no significant differences in postoperative complications: wound surface infection (3 (6.5%) in the AVNeo group and 1 (2.2%) in the bioprosthesis group, p = 0.617), acute kidney injury (1 (2.2%) in the AVNeo group and 0 in the bioprosthesis group, p = 1.0), stroke ( 1 (2.2%) in the AVNeo group and 2 (4.3%) in the bioprosthesis group, p = 1.0), resternotomy for bleeding (0 in the AVNeo group and 2 (4.3%) in the bioprosthesis group, p = 0.495). Permanent pacemaker implantation was not required by any patient. There was also no statistically significant difference in the three-year overall survival and re–operation, in the AVNeo group it was 83% and 92.5% in the bioprosthesis group, p = 0.23; three-year freedom from re-operation was 96.4% in the AVNeo group and 97.1% in the bioprosthesis group, p = 0.27. However, peak and average gradients were statistically less after AVNeo surgery. The peak and average gradients after AVNeo were 12 and 6 mmHg, after prosthetics 32 and 20 mmHg, p < 0.001.

Conclusions: There was no statistically significant difference in hospital mortality, postoperative complications, and three-year survival and re-operation. The values of the peak and average pressure gradient at discharge differed statistically significantly in favor of the AVNeo group.

Aim: To evaluate the features of coronary artery disease (CAD) in patients in the Far North and determination of the potential impact of extreme climatic factors on the development of coronary atherosclerosis. 

Material and Methods. Using the “Register of performed coronary angiography operations”, 5,679 patients with coronary artery disease were selected, who underwent coronary angiography at the Tyumen Cardiology Research Center. The main study group consisted of 2,590 patients permanently residing in the YamaloNenets Autonomous Okrug and 3,089 patients residing in the South of the Tyumen Region. 

Results. Patients with permanent residence in the Yamalo-Nenets Autonomous Okrug were on average younger (53.20 ± 7.49 versus 56.79 ± 8.34 years, p < 0.001), men were more common among them. In the extreme North there were more smokers (40.7 vs. 32.0%, p < 0.001) and alcohol users (19.7 vs.15.0%, p < 0.001), and more frequent myocardial infarction in anamnesis (57.1 vs. 48.2%, p < 0.001). At the same time, in patients permanently residing in the South of the Tyumen Region, a burdened hereditary history of CAD was more often determined, and the frequency of arterial hypertension and dyslipidemia was higher. In groups balanced by baseline clinical and demographic characteristics, including CAD risk factors, patients from the Yamal-Nenets Autonomous Okrug had more frequent lesions of the three main coronary arteries: anterior descending artery (42 vs. 35%, p < 0.001), circumflex artery (25 vs. 23%, p = 0.038) and right coronary artery (42 vs. 38%, p = 0.007). It should be noted that in balanced groups in patients permanently residing in the Far North, occlusive lesions of the coronary arteries were statistically significantly more likely to be determined (54 vs. 47%, p < 0.001). Also, between the compared groups, statistically significant differences were found in the type of left ventricle (LV) myocardial remodeling, but these differences were not determined in the balanced groups. Also, in the group of patients permanently residing in the Far North, there was a trend towards a decrease in the LV ejection fraction (53.6 ± 8.6% vs. 54.2 ± 8.7, p = 0.074).

Conclusion. In patients with verified coronary artery disease living in the Far North, a more frequent and pronounced atherosclerotic lesion of the coronary bed is determined. These pathological changes are probably due to the complex impact of unfavorable natural and climatic environmental factors.

Background. Despite the high prevalence of iron deficiency (ID) in heart failure with preserved ejection fraction (HFpEF), relationship between iron status indicators with the presence of the disease and parameters of diastolic function and myocardial strain have been insufficiently studied.

Aim: To evaluate association of iron status indicators with the disease and parameters of diastolic function and myocardial strain in HFpEF patients.

Material and Methods. According to diastolic stress test (DST) 67 patients with EF > 50% (65.8 ± 5.5 years) were divided into 2 groups: Gr.1 with HFpEF (n = 41), Gr.2 without HFpEF (n = 26). Parameters of diastolic function, left atrial reservoir strain (LASr), global longitudinal strain (GLS), diastolic reserve as per DST, serum iron (Fe), ferritin, iron transferrin saturation coefficient (ITSC) , hemoglobin (Hb), N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), creatinine, estimated glomerular filtration rate (eGFR) were assessed. Spearman method was used to study the relationships between iron status indicators and parameters of diastolic function, LASr, GLS; the cut-off point for ITSC was found by ROC analysis; factors associated with HFpEF were assessed via regression analysis.

Results. In group 1, FCII (NYHA) was revealed more frequent with trends to greater prevalence in women, obesity, higher values of peak E, NT-proBNP, CRP > 3.0 mg/ml, lower values of E/e΄, LASr, Hb, ITSC. As per DST, differences between groups in all variables related elevation left ventricular filling pressure were registered; supreme load and heart rate were lowest in Gr1. Anemia was detected in 6 (9%) patients: 5 (12.2%) vs 1 (3.8%), respectively, p = 0.238; Iron deficiency in 27(40.3%): 18 (43.9%) vs 9 (34.6%), p = 0.157. Correlations were defined between Fe and ITSC with supreme load with DST and diastolic function parameters, but not with LASr and GLS. New cut-off point for ITSC = 29.2% (AUC = 0.699, p = 0.009; sensitivity = 71%, specificity = 69%) associated with HFpEF risk (OR 5.029 95% CI 1.575–16.055; p = 0.006) was revealed.

Conclusion: Regardless of HFpEF, ID prevailed in patients aged over 60 years old, which determined the necessity of its screening study for the purpose of timely correction. Association between ITSC reduction less than 29.2% and the disease presence was found: risk of having HFpEF concurrently increased by five times. Interactions were registered between Fe and ITSC with supreme load and diastolic function parameters, but not with LASr and GLS. Higher incidence of CRP > 3.0 mg/ml with HFpEF confirmed pro-inflammatory status of the disease.

Introduction. T-regulatory (T-reg) lymphocytes as the main modulators of immunity, present in ectopic adipose tissue focuses, may be involved in the pathogenesis of atherosclerosis. Currently there is a lack of data regarding T-reg lymphocyte counts, particularly in epicardial (EAT) and thymic adipose tissue (TAT) in patients with coronary atherosclerosis.

Aim: To study the contents of FoxP3+ T-regulatory lymphocytes of peripheral blood, epicardial and thymic adipose tissue in patients with coronary atherosclerosis.

Materials and Methods. The study included a total of 26 cardiosurgical profile patients with coronary atherosclerosis. Patients were divided into two groups via Gensini Score (GS): first group with severe coronary atherosclerosis (GS > 26.5; n = 15) and second group without severe coronary atherosclerosis (GS ≤ 26.5; n = 11). In all patients, the levels of FoxP3 nuclear translocation and the relative content of CD4+CD25^hiFoxP3 and CD4+CD25^loFoxP3 T-reg lymphocytes in peripheral blood, epicardial, thymic, and subcutaneous adipose tissue (SAT) were determined by flow cytometry with imaging.

Results. The group of patients with severe coronary atherosclerosis was characterised by a statistically significant higher median of relative content of CD4+CD25^hiFoxP3 T-lymphocytes (12.0 (6.5; 17.4) vs. 6.82 (3.32; 12.4) %; p = 0.031) and statistically significant lower median of nuclear translocation level of FoxP3 in CD4+CD25^hiFoxP3 T-lymphocytes in TAT (30.82 (18.50; 40.80) vs. 51.91 (25.9; 71.00) %; p = 0.048). Statistically significant correlations between FoxP3 T-reg lymphocyte parameters in different adipose depots and lipid spectrum markers (TC, HDL-C) were found. There were inverse correlations found between EAT and TAT, in particular, between the relative contents of T-reg lymphocytes and of the FoxP3 nuclear translocation level.

Conclusion. Patients with severe coronary atherosclerosis (GS > 26.5 points) were characterised by an increased relative content of CD4+CD25^hiFoxP3 T-lymphocytes in thymic adipose tissue and a decreased level of FoxP3 nuclear translocation in this cell subpopulation compared to patients with moderate atherosclerosis (GS ≤ 26.5 points). Identified correlations between relative content of T-reg lymphocytes and the level of FoxP3 nuclear translocation in thymic and epicardial adipose tissues suggest potential existence of T-reg lymphocyte recirculation in-between these ectopic adipose depots.

Aim: To assess the diagnostic value of lung tissue density maps based on computed tomography (CT) in patients in the intensive care unit of a multidisciplinary hospital.

Material and Methods. 78 patients in the intensive care unit were examined. Patients underwent CT scans of the chest with an assessment of lung tissue density maps. Age: 47 ± 5,8 years, 45 (57.7%) men, 33 (42.3%) women. CT scan was performed on GE EVOLUTION EVO device, 64 sections, with a voltage from 80 to 120 kV (depending on the patient’s physique), with an assessment of the lung tissue density maps. Data processing was carried out using descriptive statistics and sample comparison methods using nonparametric criteria.

Results. For analyzing lung tissue density map data, a summary quantitative criterion was calculated: interstitial changes (%) + consolidation process (%) + lack of aeration (%). Despite the fact that 53 patients had no changes in the lung tissue according to CT scan of the chest, in 25 (47.2%) of them, according to the lung tissue density map, quantitative criterion ranged from 14% to 25%, the qualitative density image was characterized by inhomogeneity pattern of the lung parenchyma in the posterior-basal, central segments. In 25 (32.1%) patients out of 78, according to CT of the chest, stages II (n = 19) and III (n = 6) of acute respiratory distress syndrome (ARDS) were established. According to the data of lung tissue density maps, in 14 (73.6%) patients out of 19 people, it was noted that the qualitative image was characterized by pronounced diffuse inhomogeneity of the lung parenchyma. Quantitative indicators of lung tissue density maps in acute lung injury (ALI) were more than 26%, which correlated with negative clinical laboratory dynamics.

Conclusions. 1. To obtain the results of lung tissue density maps on CT scans in patients with ALI, it is necessary to evaluate the total amount criterion: interstitial changes (%) + consolidation process (%) + lack of aeration.

1. Summation quantitative indicators from 14% to 25% corresponded to negative clinical symptoms (shortness of breath, cyanosis, tachypnea), a decrease in partial oxygen pressure in arterial blood (p < 0.05).
2. An increase in the percentage of the summation quantitative indicators of lung tissue density maps was accompanied by negative laboratory dynamics (increased pCO₂, decreased pO₂, increased blood lactate).
3. With a cumulative quantitative indicator of lung tissue density maps of more than 26%, the frequency of CT signs damage of the lung tissue increases, indicating a previously unfavorable course of ALI.

One of the basic principles of treatment of tuberculosis patients is the appointment of treatment taking into account the drug resistance of Mycobacterium tuberculosis (MBT). However, during treatment, it may be necessary to change the intake regimen when new data on drug resistance become available. The search for ways to choose the optimal treatment method seems relevant.

Aim: To analyze the prescribed regimens and the reason for their correction in newly identified patients before verifying the diagnosis of tuberculosis.

Material and Methods. The following methods were used to detect MBT: luminescent microscopy, molecular genetic methods and seeding on liquid and solid media. Tests for drug sensitivity were conducted in parallel. The study group consisted of patients with established bacterial excretion (n = 79), whose diagnosis was confirmed by cultural methods. A retrospective method was used in the analysis.

Results. At the beginning of treatment with bacterioscopy and polymerase chain reaction methods MBT was detected in 65/79 (82.2%) cases, the remaining 14 cases were detected only by culture methods. Forced change of the therapy regimen during treatment after receiving the results was in 25/79 (31.6%) cases, of which 1/25 (4%) with isoniazid resistance, 7/25 (28%) with multidrug-resistant tuberculosis, 17/25 (68%) with the pre-extensive drug resistance regimen. The latter was prescribed only after receiving results of tests for drug sensitivity on liquid and solid media after 1–3 months. The multidrug-resistant tuberculosis treatment regimen decreased after receiving data on resistance to fluoroquinolones in accordance with the seeding data, but the largest number of patients still remained on this regimen – 41/79 (51.9%). Among these patients a change in chemotherapy regimen from multidrug-resistant tuberculosis to pre-extensive drug resistance during the intensive phase of treatment occurred in 17/25 (68%).

Conclusion. When prescribing a regimen, it is recommended to assess the risk of changing the regimen and, if there are predictors, apply a chemotherapy regimen before treatment.

Rationale. As the precursors of macrophages, monocytes play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Traditionally, classical (CD14⁺⁺CD16^–), intermediate (CD14⁺⁺CD16⁺) and non-classical (CD14⁺CD16⁺⁺) subpopulations of monocytes are distinguished, which differ in their functional characteristics.

Aim: To study the relative amount of circulating subpopulations of monocytes in patients with COPD and to identify their possible relationship with pulmonary function and humoral inflammatory markers.

Methodology and Research Methods. The study enrolled 47 patients with COPD, predominantly GOLD II-III, and 25 individuals without bronchial obstruction (control group). Monocyte subpopulations were determined by flow cytometry. Plasma cytokine concentrations were measured using a multiplex assay on a flow cytometer. Pulmonary function was assessed by spirometry.

Results. A reduced number of non-classical monocytes was observed in COPD patients as compared to the control group (10.5 (6.7–15.1)% vs. 14.4 (8.3–18.4)%, p = 0.04). Higher content of classical monocytes was associated with a more pronounced decrease in bronchial patency (FEV₁ ρ = –0.37, p = 0.007), while intermediate monocytes were characterized by a direct relationship with FEV₁ (ρ = 0.42, p = 0.003). The number of non-classical monocytes in the main group had an inverse correlation with cytokine concentrations (IL-4 ρ = –0.30, p = 0.04; IL-2 ρ = –0.36, p = 0.01; IL-1β ρ = –0.35, p = 0.02; TNF-α ρ = –0.47, p < 0.001; IL-17A ρ = –0.34, p = 0.02; IL-6 ρ = –0.32, p = 0.03; IL-10 ρ = –0.34, p = 0.02; IFN-γ ρ = – 0.35, p = 0.01; IL-12p70 ρ = –0.30, p = 0.04; IL-8 ρ = –0.40, p = 0.004).

Conclusion. The obtained results indicate a deficiency of non-classical monocytes in COPD patients, which may contribute to systemic inflammatory response, while classical forms of monocytes may be involved in the formation of bronchial obstruction.

Introduction. Optimal therapeutic tactics for diabetic peripheral neuropathy (DPN) can reduce the risk of complications and improve the quality of life of patients with diabetes mellitus (DM).

Aim: To evaluate the effectiveness of various approaches to the treatment of DPN.

Materials and Methods. 67 patients were examined (36 men and 31 women, mean age 59.4 ± 9.7 years), duration of diabetes was at least 7 years. Patients underwent general clinical examinations, neurological examination and diagnosis of DPN with assessment of pain, tactile and vibration sensitivity. All patients underwent ultrasound of the peroneal nerve (PN): the structure and cross-sectional area (CSA) were assessed (≤ 11 mm² was taken as the norm). Patients with symptoms of PN compression received mini-invasive treatment by perineural administration of 20 mg methylprednisolone under ultrasound control.

Results. Clinical manifestations of DPN were identified in 33 (49.3%) cases. Changes in ultrasound PN occurred in 62 (92.5%) patients. 29 patients with echographic changes in PN and asymptomatic DPN received α-lipolic acid and benfotiamine: the CSA of the PN before treatment was 13,2 ± 2,4 mm², after 6 months –10,4 ± 1,6 mm²; the proportion of people with CSA PN ≥ 12 mm² before treatment was 82,7%, after 6 months –27,6% (all p < 0.05). 19 patients with symptoms of DPN, but without signs of compression of the MBN, received additional drugs and techniques. The average pain intensity before treatment was 4,93 ± 1,07, after 6 months –2,47 ± 0,61; CSA PN before treatment –17,3 ± 3,8 mm², after 6 months –13,2 ± 2,2 (all р < 0,017). 14 patients with PN compression underwent mini-invasive treatment under ultrasound control. In the first 24–48 hours after manipulation, in all cases there was a moderate increase in local manifestations of compression. Then the pain intensity decreased (5.74 ± 1.19 points – before manipulation, 3.18 ± 0.97 – after 6 months, р < 0,0125), CSA decreased (22.4 ± 4.3 mm² – to 15.3 ± 3.6 mm² – after 6 months, р < 0,0125) and echographic characteristics improved.

Conclusions. Ultrasound of the nerves can be a valuable method for the early diagnosis of DPN and a tool for choosing treatment tactics. The use of pathogenetic pharmacotherapy alone or in combination with other drugs was associated with satisfactory tolerability, favorable clinical and ultrasound dynamics. The use of mini-invasive treatment with perineural administration of drugs for compartment syndrome was characterized by a positive effect on compression symptoms and ultrasound characteristics of the nerve.

Introduction. Currently, it is relevant to develop new diagnostic criteria for assessing the condition of the deep femoral artery (DFA), in order to determine the possibilities of its use in various hybrid reconstructions for critical lower limb ischemia.

Aim: To determine the indications for isolated profundoplasty as the final stage of proximal hybrid reconstruction using the method of intraoperative luminescence spectroscopy.

Material and Methods. The prospective open-label non-randomized pilot study included 64 people operated at City Clinical Hospital No. 29 with a clinical diagnosis of “Obliterating atherosclerosis of the arteries of the lower extremities. Stenosis of the external iliac artery. Steno-occlusive lesion of the common femoral/superficial femoral artery. Stenosis of the deep femoral artery of the thigh. Chronic arterial ischemia of the III st.”, in the volume of proximal hybrid reconstruction, including isolated profundoplasty. The first group (n = 28) consisted of patients who had stenosis or occlusion of the mouth of the deep femoral artery, the second group (n = 20) – had diffuse lesion of the deep femoral artery, the third group (n = 16) – had a distal type of lesion of this artery. The first stage of the hybrid operation was stenting of the external iliac artery. The choice of further intraoperative tactics occurred as a result of an assessment of the anatomy and severity of the lesion of the deep femoral artery, by measuring the ankle-shoulder and hip-popliteal indices. All patients underwent intravascular luminescent spectroscopy intraoperatively using our technique to determine the luminescent compensation coefficient (CI). The follow-up period was 3 months. The end point of the study was thrombosis of the reconstruction zone. The SPSS 17.0 software was used for statistical data processing when comparing study groups.

Results. When comparing the obtained CI, a direct strong correlation was noted with a preoperatively determined hip-popliteal index (r = 0.76; at p < 0.005). When assessing the interval of the hip-popliteal index from 0.3 to 0.4; 4 patients with thrombotic complications in the early postoperative period and 3 patients with no thrombotic complications were evaluated. When correlating CI in these categories of respondents, the statistically significant differences in indicators were established: CI (without complications) = 0.46 (0.43; 0.50); CI (complicated) = 0.59 (0.58; 0.60); with p < 0.05. When studying preoperative deep femoropopliteal index in representatives of study groups 1 and 2 who had GPI in the range from 0.4 to 0.5, but differed in the outcomes of the late postoperative period, the statistical significance of differences in indicators was noted: Cl (without complications) = 0.44 (0.43; 0.46); Cl (complicated) = 0.61 (0.60; 0.62); at p < 0.05.

Conclusion. Intravascular luminescence spectroscopy is an important method of clarifying the intraoperative feasibility of performing isolated profundoplasty in addition to preoperative assessment of the degree of the hip-popliteal index.

Bilateral asymmetry in the function of the semicircular canals underlies dizziness and vestibular balance disorders. According to the traditional view, otolith dysfunction does not have a significant effect on the clinical picture in individuals with peripheral vestibular disorders. In recent years, interest in studying the contribution of vestibular function to the control of posture and movements has increased. However, we have not identified any studies addressing the reactivity of otolith organs in vestibular balance disorders in the available literature.

Aim: To study bilateral otolith reactions in patients with vestibular balance disorders using the method of cervical vestibular evoked myogenic potentials (cVEMP) in patients with episodic and chronic vestibular disorders.

Material and Methods. A clinical examination was carried out in 63 patients complaining of dizziness and balance problems. They were hospitalized on an emergency and planned basis in the neurological departments of the clinics of the Siberian State Medical University and the Medical and Sanitary Unit No 2 in Tomsk. From the total group, 28 patients (8 men and 20 women aged from 22 to 84 years) were selected for assessment of vestibular function; the average age was 63.87 ± 11.52 years and 57.2 ± 18.5 years for men and women respectively. They had chronic and episodic vestibular dysfunction unrelated to acute or progressive neurological disease and inflammatory pathology of the inner ear.

Results. 27 patients (96.4%) complained of dizziness. Systemic dizziness, characterized by a feeling of objects rotating around the subject, was detected in 29.63% of patients; non-systemic dizziness, including a feeling of “failing” – in 81.48%. Both types of complaints appeared in 10.71% of those examined, which made it possible to identify 2 groups of patients: Group A – with chronic vestibular disorders (7 patients) and Group B – with episodic vestibular disorders (21 patients). During the study of the groups of patients, differences were found in the amplitudes of cVEMP latency P13 and the coefficient of vestibular asymmetry between Groups A and B, as well as the absence of a difference in amplitudes in Group A and the presence of a difference in Group B on the right.

Conclusion. Despite the fact that patients presented with predominantly one complaint of dizziness, clinical and instrumental tests of vestibular dysfunction showed the presence of damage to both the semicircular canals and otolithic organs; asymmetry of vestibular reflexes and/or bilateral damage to the vestibular organs. The results of the study allow us to consider the cVEMP method as one of the methods for objectively assessing the condition of the otolithic apparatus in patients with impaired vestibular function. In this regard, it is recommended to use this method in routine neurological practice.

The course and prognosis of chronic heart failure (CHF) are associated with the activation of inflammatory cascades, the severity of which is genetically determined.

Aim: To analyze adverse cardiovascular events in patients with chronic heart failure over 5 years depending on the rs1143634 polymorphism of the interleukin-1β gene.

Material and Methods. Clinical signs were studied, genotyping was carried out at the polymorphic locus rs1143634 of the IL-1β gene in patients with CHF of ischemic origin (n = 445, average age 66.4 ± 10.4 years). Information on patient outcomes over 5 years was obtained by telephone interview with endpoints: all-cause death, cardiovascular death, fatal and non-fatal cardiovascular events formed a composite endpoint. Time to event was analyzed using the Kaplan-Meier method; hazard ratio – Cox regression. Statistical processing was carried out in the Jamovi, R 4.3.1 programs.

Results and conclusions. The occurrence of genotypes of the rs1143634 polymorphism of the IL-1β gene in patients with CHF and the genetic control group did not differ and was commensurate with the theoretically expected Hardy–Weinberg equilibrium. Carriers of the TT genotype were characterized by a high level of inflammation and the development of myocardial infarction at a young age. In patients with CHF of the TT genotype, the risk of death from all causes is 2.85 times higher, achieving the combined endpoint is 3.3 times higher, fatal cerebral stroke is 17.1 times higher compared to CC, 14.9 times higher than compared to ST genotype. In patients with CHF and chronic kidney disease of the TT genotype, the risk of death from cerebral stroke is 29.33 times higher than the CC genotype, and 29.12 times higher for the CT genotype. In patients with CHF in combination with diabetes mellitus, the frequency of hospitalizations due to cardiac decompensation in the TT genotype is higher than in the CC and CT genotypes (χ₂ = 6.33, p = 0.042).

chronic heart failure; rs1143634 polymorphism of the IL-1β gene; prognosis; cardiovascular complications

Introduction. Every year in Russia, the number of people who have undergone cardiac surgery exceeds 600 thousand. Among them, anemia occurs in 30-70% of cases, and cognitive dysfunction is noted in 20–80% of cases. Anemia increases the risk of death 4-fold within a year, 5-fold the risk of stent thrombosis, 1.3–fold the risk of recurrence of acute coronary syndrome and 2-fold the risk of bleeding, worsens the quality of life, cognitive status and compliance. Unresolved problems of managing medical care for specialized patients are associated with insufficient coupling of components of clinical and sociopsychological interaction, taking into account modifiable risk factors, and irrational use of limited industry resources distributed according to the quota mechanism. Patient-centered digital systems contribute to improving the quality of life of patients, optimizing the use of healthcare resources.

Aim: To evaluate the parameters of the quality of medical care and clinical prognosis in patients who underwent myocardial revascularization, taking into account an expanded range of modifiable risk factors, including anemia, cognitive dysfunction and depression, using a developed digital intelligent data collection system.

Material and Methods. A prospective cohort study of 300 adult patients who underwent myocardial revascularization is planned for 12 months in 3 groups (depending on the consent and technical feasibility of using a digital information system (CIS): 1 group will undergo questionnaires and cognitive behavioral training online through CIS; 2 group will undergo only questionnaires through CIS; 3 group will not use CIS. There are 2 face-to-face visits to the doctor (6 and 12 months), at which the following groups of endpoints will be evaluated: clinical outcomes; parameters of the quality of medical care and rehabilitation; patient-reported experience indicator (PREM). Validated and authored self-questionnaires will be used.

Introduction. Atrial septal defects (ASD) are one of the most common congenital heart defects, accounting for about 10–15% of all congenital heart defects. Currently, endovascular treatments for ASD are considered the method of choice in most patients with secondary ASD. ASD occluders, after fixation on the atrial septum, close the shunt, eliminating the intercameral communication. However, these devices increase the stiffness of the septum, limit its mobility and presumably disrupt the mechanical function of the left atrium (LA).

Aim: To study the effect of surgical and endovascular correction on the size, shape and function of the left atrium and left ventricle in children.

Material and Methods. We retrospectively studied sequential echocardiograms of patients who underwent endovascular and surgical treatment of ASD in the period from 2006 to 2016 at the cardiology center in Tomsk, Russia. 756 patients with ASD were examined, 564 of them before and after endovascular closure and 192 after surgical correction. The duration of follow-up ranged from 1 day to 10 years, with an average of 3.6 years in the group receiving hardware treatment and 4.2 years in the group undergoing surgery. The control group consisted of 3393 healthy patients of the same age group. Echocardiographic images were obtained using an iE33 ultrasound scanner, Philips Ultrasound. Standard echo indicators of heart sizes and volumes were evaluated, including taking into account the body surface area and deviations of the studied parameters as a percentage of the predicted norm.

Results. 15 days after ASD closure, both groups showed a significant increase in the volume of the left ventricle and a decrease in the right chambers. During follow-up in the group receiving the devices, left atrial shape index (LASI) was significantly reduced, while in patients undergoing surgery, there was no significant increase in LASI. A change in the shape of the left atrium and a decrease in its volume were combined with a change in the effort in the left atrium (LAEF), determined by the Manning method.

Discussion. The study showed that both endovascular and surgical methods are effective in correcting ASD and lead to favorable results with respect to left atrial function. However, there is still uncertainty about the long-term effects after implanted devices used in endovascular procedures. Although these devices offer a minimally invasive solution, there is a problem associated with increased stiffness and limited mobility of the partition. Such changes can potentially alter the normal dynamics of atrial filling and contraction, affecting the overall function of the left atrium over time.

Conclusion. Endovascular correction of ASD in 35% of children was accompanied by a change in the shape of the left atrium a decrease in sphericity and an increase in ellipsoid. Changes in the shape of the left atrium persisted in 22% of patients after transcatheter correction in the long term. These changes were not accompanied by any disorders of contractility and volume of the heart chambers. In the group of children after surgical correction of ASD, the contractility and volume of the heart chambers did not significantly differ from those in the device group.

Rationale. Doxorubicin is a chemotherapeutic antibiotic from the anthracycline class that has cumulative and dose-dependent cardiotoxic effects. The cardiotoxic properties of doxorubicin are manifested in characteristic pathologies of the heart and its microenvironment. Doxorubicin also exhibits genotoxic properties and is often used to model acute genotoxic effects in small laboratory animal models.

Aim: To evaluate chronic low-dose exposure to doxorubicin in a Wistar rat model using cytogenetic methods and electron microscopy.

Material and Methods. The study included two groups of 10 male Wistar rats: an experimental group (weekly doxorubicin in the tail vein 2 mg/kg for 4 weeks) and a control group (0.9% NaCl). A micronucleus test was used to evaluate genotoxic effects. Visualization of the myocardial structure was carried out using scanning electron microscopy in back-scattered electrons on an electron microscope.

Results. The analysis showed a significant difference between the control (0.8%) and experimental groups (3.2%) in the level of polychrome erythrocytes with a micronucleus. It was found that rats from the experimental group were characterized by a significant decrease in the number of polychromatic red blood cells compared to the control group. In the experimental group, pronounced heterogeneity of the morphological structure of the myocardium was noted. Electron micrographs of hepatocytes from rats treated with doxorubicin showed degenerative changes in the structure of liver cells.

Conclusion. The results of our study provide insight into the subacute effect of a small dose of doxorubicin on the heart, liver and hematopoietic system of normolipidemic Wistar rats. We have proposed mechanisms of interaction between important organs and systems of the body exposed to doxorubicin against the background of a general pathological condition. In the future, the nature of the toxic effects of lower and optimal doses of the mutagen in the context of subchronic cumulative exposure should be determined.

Introduction. Alzheimer’s disease is a terminal form of dementia, the treatment of which is a significant medical problem, which requires the development of new drugs to correct this condition. Antioxidants may be one of such promising groups.

Aim: To assess the antioxidant properties of monocarbonyl analogues of curcumin in the conditions of experimental Alzheimer’s disease.

Material and Methods. Alzheimer’s disease was modeled in Wistar rats of both genders by injection A_ß1-42 aggregates into the CA1 part of the hippocampus of animals. The analyzed compounds are (1E, 4E)-1.5-bis (3,4,5-trimethoxyphenyl) penta1,4-diene-3-one and (1E, 4E)-1.5-bis (2,4,6-trimethoxyphenyl) penta-1,4-diene-3-one at a dose of 20 mg/kg orally and the reference donepezil at a dose of 50 mg / kg, orally was administered for 30 days from the moment of surgery. After this time, changes in the activity of endogenous antioxidant defense enzymes: superoxide dismutase, glutathione peroxidase and catalase were evaluated in rats in hippocampal tissue, and changes in the concentration of mitochondrial hydrogen peroxide and active products reacting with 2-thiobarbituric acid were also determined.

Results. During the study, it was shown that the use of the analyzed compounds and the reference contributed to an increase in the activity of antioxidant enzymes in hippocampal tissue in rats. At the same time, in animals (both sexes) treated by (1E, 4E)-1.5-bis (3,4,5-trimethoxyphenyl) penta-1,4-diene-3-one and (1E, 4E)-1.5-bis (2,4,6-trimethoxyphenyl) penta-1,4-diene-3-one, the activity of superoxide dismutase was higher (p < 0.05), than in animals treated by donepezil. Also, administration of the analyzed substances, a decrease in the concentration of mitochondrial hydrogen peroxide and active products reacting with 2-thiobarbituric acid was found, which was significantly (p < 0.05) lower when donepezil were administered.

Conclusion. The study showed that the monocarbonyl analogues of curcumin have an antioxidant effect in the conditions of experimental Alzheimer’s disease, while surpassing the reference donepezil. Based on the obtained data, it is reasonable to assume the relevance of further studies analyzing monocarbonyl curcuminoids as a remedies of pathogenetic therapy of Alzheimer’s disease.

Current recommendations for the primary prevention of chemotherapy cardiotoxicity are based on stratification of the risk of cardiovascular complications before anticancer treatment is initiated. The proposed cardiotoxicity risk scores take into account the presence of existing cardiovascular diseases, but do not take into account the therapy used for these diseases. Two clinical cases of patients with tumor diseases are presented. One patient had a high risk of cardiotoxicity, but even before the detection of a tumor process, he received a β-blocker, an angiotensin receptor blocker and a statin as a treatment strategy for coronary heart disease, which are recommended for the primary prevention of cardiovascular complications of chemotherapy. In this patient, development of cardiac dysfunction during ongoing antitumor treatment was not detected. In contrast, the second patient had a low risk of cardiotoxicity and was not given cardioprotective primary prophylaxis while on chemotherapy. However, this patient developed signs of severe cardiac dysfunction. It is possible that treatment of existing cardiovascular pathology with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers and statins significantly reduce the risk of cardiotoxicity, which must be taken into account stratifying the risk of cardiotoxicity. Accordingly, it seems necessary to further improve the scales for assessing the risk of cardiotoxicity.

Introduction. At the end of December 2019 the World Health Organization (WHO) announced cases of pneumonia of unknown etiology. Soon, the disease received the official name “New coronavirus infection” (COVID-19), and the etiological agent was named the SARS-CoV-2 virus, characterized by rapid spread, high variability and diverse epidemic manifestations in various territories.

Aim: To identify the epidemiological features of the spread of COVID-19 in the Tomsk region in the first year of the pandemic.

Material and Methods. A descriptive epidemiological study was conducted in the Tomsk region in 2020. Information on COVID-19 cases was analyzed according to the federal register of persons with COVID-19, federal statistical observation form N 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”. The assessment of the obtained data was carried out using the method of retrospective epidemiological analysis with subsequent statistical processing.

Results. In connection with the threat of importation and spread of COVID-19 on the territory of Tomsk region, the order of the Administration of Tomsk region on January 31, 2020 approved the Plan of organizational sanitary and anti-epidemic (preventive) measures to prevent the importation and spread of a new coronavirus infection caused by 2019-nCoV. The first year of the COVID-19 pandemic was characterized by a wave-like course and significant fluctuations in morbidity during its different periods. Clinical manifestations of COVID-19 were registered in 91.2% of the diseased. The composition of patients was characterized by the prevalence of women (56.8%) compared to men (43.2%). The population mortality rate due to COVID-19 was 0.9%. In general, 74.3% of patients with COVID-19 received medical care in outpatient conditions. The capacity of the bed fund by the end of the first year of the pandemic in Tomsk region reached 2810 beds. The maximum coverage of population testing for SARS-CoV-2 identification was observed in the 46–47 calendar week, which corresponded to the maximum rise in COVID-19 morbidity among the total population.

Conclusion. In the first year of the COVID-19 pandemic in Tomsk region, the following epidemiologic features can be distinguished: absence of seasonality; prevalence of patients with clinical manifestations of COVID-19 in the structure of the diseased; prevalence of patients requiring medical care in outpatient settings; involvement of patients aged 50–64 years in the epidemic process to a greater extent; prevalence of men aged 65 years and older among those who died due to COVID-19.

Background. The study using numerical modeling of functional properties (conductive, distributive, pillar) of digital models of 4 types of bifurcations of the intraorgan arterial vasculature is a valuable tool to find its morphometric reference and subsequently the criterion of normality.

Aim: To establish the functional properties of different types of splenic arterial bifurcations through their numerical modeling based on morphometry results.

Material and Methods. Modelling was carried out on the basis of previously obtained morphometric characteristics of different types of splenic arterial bifurcations: type 1, the diameter of the parent (proximal) segment (D) is not equal to the diameters of the larger (dmax) and smaller (dmin) subsidiary branches (distal segments) D ≠ dmax ≠ dmin; type 2, D = dmax, D ≠ dmin; type 3, D ≠ dmax, dmin = dmax; type 4, D = dmax = dmin. The ANSYS Student computer software was used to calculate the values of splenic arterial bifurcation indices characterizing the conductive and support functions, and the Vasculograph computer software was used to calculate the distribution function.

Results. It was found that the value of the bifurcation parameter of splenic arterial bifurcations of different types characterizing: 1) conductive function decreases in the order of type 1 complete asymmetry, type 2 lateral asymmetry, type 4 complete symmetry and type 3 unilateral symmetry; 2) the distributive function decreases in the direction of type 1 complete asymmetry, type 2 lateral asymmetry, type 3 unilateral symmetry, and type 4 complete symmetry 3) the pilar function decreases in the direction of type 1 complete asymmetry, type 2 lateral asymmetry, type 3 unilateral symmetry, and type 4 complete symmetry.

Conclusion. The obtained results indicate that different types of splenic arterial bifurcations are oriented to fulfil heterogeneous functions. This should be taken into account when seeking a reference and subsequently a morphometric criterion of splenic vasculature norm, which can be used for radial diagnostics.