Showing papers in "Sibirskij žurnal kliničeskoj i èksperimentalʹnoj mediciny in 2022"

Subpopulation composition and prooxidant activity of visceral adipose tissue cells in patients with metabolic syndrome

Abstract: Purpose. The aim of the study was to investigate the subpopulation composition and prooxidant activity of adipose tissue cells in the big omentum of patients with metabolic syndrome.Material and Methods. A fragment of white adipose tissue obtained from the greater omentum during planned endoscopic cholecystectomy in 37 female patients aged 48 (34; 65) years was used as a material for the study. The main group was represented by patients with metabolic syndrome (n = 31) diagnosed according to current recommendations for management of patients with metabolic syndrome. Six patients without signs of metabolic syndrome, comparable with the main group in terms of age and gender, made up the comparison group. The subpopulation composition of the adipose tissue cells in the greater omentum was determined by immunohistochemical analysis. The content of reactive oxygen species in the isolated cell pools of adipocytes and mesenchymal stromal cells was identified using flow cytometry.Results. Comparison of the mean values in the groups showed a statistically significant prevalence in patients with metabolic syndrome only in the level of cells expressing CD68 (macrophage marker) on their surface (p < 0.05). Correlation analysis allowed to detect a positive relationship between morphometric indicators determining the severity of infiltrative changes of adipose tissue (the number of infiltrates) and the relative number of cells presenting CD3 (r = 0.357, p < 0.05), CD36 (r = 0.575, p < 0.05), and CD68 (r = 0.374, p < 0.05) on their surface, respectively. A comparative analysis of the level of reactive oxygen species in adipose tissue cells showed statistically significantly (p < 0.05) higher values of reactive oxygen species in patients with metabolic syndrome compared with the control group both in adipocytes and in mesenchymal stromal cells.Conclusion. The presence of a positive correlation between the relative numbers of cells presenting CD3, CD36, and CD68 markers and the morphometric parameters reflecting the severity of infiltrative manifestations suggested that the mentioned cell lymphocyte and macrophage populations were involved in the development of infiltration in the adipose tissue in metabolic syndrome. The pro-inflammatory phenotype of adipose tissue in metabolic syndrome was characterized not only by a number of morphological features, but also by enhanced prooxidant activity of the adipocytes and mesenchymal stromal cells.

Cholesterol and its biological significance. Atherosclerosis. Statin therapy (Part 1)

Abstract: Despite the profound development of the theory explaining atherosclerosis pathogenesis, many questions still remain open. Modern ideas about the nature of atherosclerotic lesions in the vascular wall are largely based on the results of N.N. Anichkov’s research where hypercholesterolemia is considered the key point. Numerous theories of atherosclerosis have been proposed to date. However, the lipid-infiltrative idea, established over 100 years ago, remains dominant, and, despite the involved controversies, this concept lays the foundation for the therapeutic and preventive measures in cardiovascular diseases.Aim. The purpose of this review is to remind the reader of the biological significance of cholesterol, which performs essential vital functions in the body; to discuss some controversial points of view and contradictory facts regarding the etiological role of hypercholesterolemia in atherogenesis, which call into question the appropriateness of using blood cholesterol content as an indicator of disease severity and the possibility to assess the treatment effectiveness based on cholesterol level dynamics.

Perinatal observation of large congenital pial arteriovenous fistula before and after surgery: A case report

Abstract: Pial arteriovenous fistula (PAVF) is an extremely rare type of intracranial vascular congenital anomalies. The presented clinical case is a unique example of intrauterine diagnosis of PAVF using fetal MRI at 30 weeks of gestation, which allowed successful surgical treatment in the early neonatal period. The case demonstrates the capabilities of fetal MRI in the diagnosis of PAVF and estimation of accompanying brain changes, which are fully consistent with the results of postnatal cerebral angiography. Based on neuroimaging data, endovascular embolization of the fistula with detachable microcoils was successfully performed on the 2nd day of the child’s life. A good neurologic outcome of the surgery was stated. Taking into account the known unfavorable outcome of PAVF in the case of untimely surgical treatment, this observation demonstrates the need to use fetal MRI for prenatal differential diagnosis of vascular malformations in order to reduce the risk of possible complications and mortality in the early neonatal period.

Pilot study of changes in the level of piRNA in plasma and serum in women at different stages of physiological pregnancy

Abstract: Aim. To study changes in the level of piRNA in plasma and serum of pregnant women at different stages of gestation.Material and Methods. A total of 42 samples of plasma and blood serum were obtained from seven women with physiological singleton pregnancy without obstetric and gynecological pathology. The study was carried out at three time points corresponding to 8–13, 18–25, and 30–35 weeks of pregnancy, respectively. To assess the spectrum and levels of piRNA by the NGS method, whole genome sequencing of small RNAs was carried out. Sequencing data analysis was performed using the GeneGlobe Data Analysis Center web application. Differential expression was assessed using the DESeq2 R package.Results and Discussion. The piRNA contents among all small RNAs were 2.29%, 2.61%, and 4.16% in plasma and 7.29%, 7.02%, and 10.82% in serum during the first, second, and third trimesters, respectively. The contents of the following piRNAs increased in blood plasma from the first to the third trimester: piR 000765, piR 020326, piR 019825, piR 020497, piR 015026, piR 001312, and piR 017716. The study showed that the levels of piR 000765, piR 020326, piR 019825, piR 015026, piR 020497, piR 001312, piR 017716, and piR 004153 were significantly higher in serum compared with the corresponding values in plasma whereas the content of only one molecule, piR 018849, was higher in plasma.Conclusion. This pilot work created a basis for understanding the processes of piRNA expression in plasma and serum of pregnant women and can become the foundation for the search for biomarkers of various complications in pregnancy.

Tension-type headache and hypertension phenotype: Myth or reality

Abstract: Objective. This review article provides an analysis of studies focusing on the problem of comorbid tension-type headache (TTH) and hypertension (HT).Key Points. A combination of headache and HT is common in clinical practice. The analysis of studies showed that 53.7% of hypertensive patients present with complaints of headache, and 30.7% of headache patients have HT in the anamnesis. The prevalence of HT is 1.9 times higher in TTH patients than in those with migraine. The results demonstrate the presence of two separate, but highly comorbid nosologies (HT and TTH) among study participants included in the review. Evaluation of research methodology showed that the discrepancies in the results may be explained by the diff erences in design and sample characteristics (degree and profi le of HT; duration of HT and TTH). Patients with mild HT do not have direct associations between headache and increased blood pressure. Blood pressure values do not diff er during, before, and after TTH paroxysm. HT is less prevalent in patients with episodic TTH compared with that in patients with chronic TTH.Conclusion. The analysis of available studies suggests that TTH + HT phenotype is a frequent condition, but its real prevalence rates require further studies.

Some molecular genetic risk factors for myocardial fi brosis (Literature review)

Abstract: Myocardial fi brosis is a multifactorial process, which predisposes to a number of cellular and molecular factors, the level of which is determined genetically. This review discusses some genetic variants that are directly related to the development of cardiac fi brosis and open up prospects for scientifi c research on assessing the risk of heart failure in various cardiovascular pathologies.

The problem of association between obstructive sleep apnea and atrial fibrillation in cardiology practice

Abstract: The problem of association between obstructive sleep apnea syndrome (OSAS) and cardiac pathology, namely, atrial fibrillation (AF) is quite relevant and multifaceted. This review presents the epidemiological aspects of OSAS and AF, discusses the main concepts of atrial arrhythmogenesis in OSAS, and describes the capabilities of diagnostic tools for searching for OSAS in the context of routine cardiological practice.

The problem of association between obstructive sleep apnea and atrial fi brillation in cardiology practice

Abstract: The problem of association between obstructive sleep apnea syndrome (OSAS) and cardiac pathology, namely, atrial fi brillation (AF) is quite relevant and multifaceted. This review presents the epidemiological aspects of OSAS and AF, discusses the main concepts of atrial arrhythmogenesis in OSAS, and describes the capabilities of diagnostic tools for searching for OSAS in the context of routine cardiological practice.

Gender-specifi c differences in ascending aortic surgery

Abstract: Introduction. According to recent data, thoracic aortic surgery have reduced morbidity and mortality, however, women are at increased postoperative risk of adverse outcomes. Our aim was to evaluate and compare early outcomes in male and female patients undergoing ascending aortic replacement.Methods. A total of 88 patients, consisting of 54 men (61.4%) and 34 women (38.6%) underwent ascending aortic surgery for non-syndromic aneurysms from January 2013 to December 2021. We analyzed clinical outcomes between males and females.Results. According to computed tomographic angiography, preoperative normalized aortic diameters were significantly larger in females (2.9 [2.7; 3.2] cm/m2) vs. (2.5 [2.3; 2.6] cm/m2, p < 0.001) in males, without differences in absolute values (51 [49; 53] mm vs. 52 [50; 53] mm, p = 0.356). There were no significant differences in neurological, cardiac, pulmonary, and renal complications in both groups in the early postoperative period. In-hospital mortality was 1.9% and 5.9% (p = 0.307) in male and female patients, respectively.Conclusions. Ascending aortic surgery for aneurysms below 5.5 cm threshold has tolerable early outcomes both in men and women.

Correlation between the features of β1 and β3 integrin expression and lymphangitic metastatic spread in nonspecific invasive breast carcinoma based on tumor morphological heterogeneity

Abstract: Objective. To study β1 and β3 integrin expression in nonspecific invasive breast carcinoma and to find the associations with parameters of tumor morphological heterogeneity and lymphatic dissemination.Material and Methods. Study group comprised 107 patients with breast cancer. Histological type of tumor corresponded to invasive carcinoma of a nonspecific type (invasive ductal carcinoma) in 100% of cases. Patients did not receive any preoperative treatment. In each case, we performed morphological examination of samples of primary tumor and axillary lymph nodes obtained at the surgical stage of treatment (radical mastectomy or sectoral resection of mammary gland with axillary lymphadenectomy). The parameters of β1 and β3 integrin expression in primary tumor tissue were assessed by immunohistochemistry.Results. The study demonstrated that an increase in the degree of malignancy of breast carcinoma was associated with a decrease in the incidence of positive expression of β1 integrin as well as with an increase in the incidence of positive expression of β3 integrin. Metastases in lymph nodes were significantly less frequently detected in the presence of positive expression of β1 integrin in the alveolar and solid structures compared with the cases of absent expression of the marker in similar structures (48%; χ2 = 3.5; p = 0.05 and 48%; χ2 = 4.8; p = 0.02, respectively). Lymphogenic metastasis were detected significantly more often in cases with positive expression of β3 integrin in discrete groups of cells compared with the cases where the expression of study marker in the described structures was absent (47 and 23%, respectively; χ2 = 5.1; p = 0.02).Conclusion. The results of work showed the presence of relationships between the morphological heterogeneity of the tumor and the parameters of β1 and β3 integrin expression in the parenchymal structures of the neoplasm. The study showed the association of described parameters with the frequency of lymphatic dissemination in patients with breast cancer. Obtained data expand and support previously known evidence and suggest the possibility of assessing the markers as potential prognostic factors predicting the course of cancer.

The system for assessing liver function according to magnetic resonance imaging with gadoxetic acid

Abstract: Purpose. To develop a system for assessing liver function in patients with liver cirrhosis according to magnetic resonance imaging (MRI) with gadoxetic acid.Material and Methods. Data from studies of 74 patients who underwent abdominal MRI with intravenous gadoxetic acid (GA) enhancement were analyzed. For statistical analysis of the data, two groups were formed: group 1 (n = 22) comprised patients with unchanged liver parenchyma, normal liver function, and benign tumors; group 2 (n = 52) comprised patients with liver cirrhosis, with the presence of regenerative and/or dysplastic nodes, and hepatocellular carcinoma (HCC). The following quantitative parameters were studied to assess liver function in patients of two groups: relative enhancement (RE), contrast enhancement index (CEI), liver/skeletal muscle (SM) index, liver/spleen index, liver/kidney index, analysis of histograms (AH), and liver function imaging scale (FLIS).Results. The criteria for a functional deficiency of liver function based on calculated data of contrast agent transport and accumulation were a decrease in FLIS total score to 4 and below, RE values below 0.85, and CEI values below 1.38 with sensitivity and specificity of 100 and 75%, the values of liver/SM and liver/kidney indices below 0.350, liver/spleen index below 0.750 with sensitivity and specificity of 100 and 81%, respectively, in patients with cirrhosis.Conclusion. The developed system for assessing liver function using FLIS, intensity matching analysis (IMA), and AH according to MRI with GC in comparison with METAVIR allowed for liver function assessment in patients with cirrhosis with a sensitivity and specificity of 100% and 80%, respectively.

A clinical case of successful simultaneous percutaneous coronary intervention and endovascular mitral valve repair “edge-to-edge” with the MitraClip G4 device

Abstract: Mitral regurgitation is one of the prevalent entities among valvular defects in the adult population. In approximately half of the patients, the etiology of this defect is directly related to obstructive coronary artery disease. As a rule, the high perioperative risk in such patients is the main reason for the refusal to perform traditional open interventions. According to the available literature, the first experience of successful simultaneous percutaneous coronary intervention and transcatheter mitral valve repair “edge-to-edge” with the MitraClip G4 device is presented in a 77-year-old patient with severe mitral regurgitation who had previously suffered myocardial infarction and paroxysmal atrial fibrillation. The advantages of such an approach to treatment are demonstrated, and the need for its further study for systemic implementation is actualized.

Magnetic resonance imaging-derived portrait of cardiac patients in one specialized cardiovascular center during COVID-19 pandemic

Abstract: Purpose. The objective of the study was to elucidate the impact of COVID-19 pandemic on cardiac magnetic resonance imaging (CMR)-derived portrait of a patient in one specialized cardiovascular center.Material and Methods. The study comprised 987 patients who underwent CMR with paramagnetic contrast enhancement in cardiovascular center from 01.01.2019 to 01.06.2022. Data were obtained from electronic medical records stored in the electronic module keeping track of instrumental studies. Data contained information on type and characteristics of protocol, referring department, clinical and demographic patient characteristics, and diagnosis. Gender, age, type of visit (ambulatory, in-hospital), instrumental data, and unstructured text were analyzed. Contrast-enhanced CMR was performed according to standard method using 1.5-Tesla MRI system Vantage Titan 1.5T (Toshiba Medical Systems) with ECG-synchronization.Results. Proportion of CMR among all MRI studies increased during the study period. Maximum number of cardiac diseases was detected in 2021. Incidence of fibrosis-dystrophic myocardial changes increased from 67.17% in 2019 to 84.14% in 2022 potentially due to the past cardiac inflammation. Patient numbers in each age group peaked in 2021, and the highest incidence rate was observed in the group of 60-69-year-old patients with high risk for severe COVID-19 course and complications. In 2020, the incidence of acute myocarditis significantly decreased to 10% in men and 13% in women and then gradually increased in 2021. The rate of ambulatory visits significantly increased in 2020, but returned to the pre-pandemic level in 2021.Conclusion. COVID-19 pandemic increased the need for CMR. Patients with history of COVID-19 had persistent and newly occurring symptoms of myocardial damage suggesting chronic cardiac involvement. Regional myocardial fibrosis was the main COVID-19-associated presentation on contrast-enhanced CMR. Continuous follow-up of patients is required to assess their risk for the left ventricular remodeling.

Drug-induced liver injury after high-dose methylprednisolone: Clinical case

Abstract: We present a clinical case of acute hepatitis confirmed by liver biopsy. A 24-year-old patient underwent pulse therapy with methylprednisolone due to the onset of multiple sclerosis. The liver enzyme values were within the normal range 15 days later. Blood tests revealed the development of cytolysis syndrome during an unrelated medical examination two months later. Obvious causes of hepatitis were excluded, and liver biopsy was performed to verify the diagnosis. The biopsy showed a picture of acute hepatitis with high histological activity and development of submassive necrosis. The situation was interpreted as drug-induced liver injury after pulse therapy with methylprednisolone. Oral prednisone therapy was prescribed, and the inflammation and liver injury were reverted. The presented clinical case highlights the importance of follow-up of patients receiving high doses of methylprednisolone.

Features of erythrocyte membranes beta-adrenoreactivity in patients with resistant hypertension and type 2 diabetes mellitus

Abstract: Introduction. Patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM) are characterized by sympathetic hyperactivity. A promising method for the assessment is a measurement of erythrocyte membrane beta-adrenergic reactivity (β-ARM). However, little is known about β-ARM in patients with RHTN and T2DM.Purpose. To investigate the properties of β-ARM of erythrocytes in patients with RHTN and T2DM in relation to clinical, laboratory, and instrumental data.Material and Methods. The cross-sectional study comprised 38 patients with RHTN combined with T2DM with mean age of 62.1 ± 7 years (25 women (65.8%)), 24-hour systolic/diastolic blood pressure (24-BP) (SBP/DBP) of 160.3 ± 14.2/90.8 ± 10.5 mm Hg, and glycated hemoglobin (HbA1c) of 7.2 ± 1.4%. The comparison group comprised 24 patients with RHTN without T2DM, which did not significantly differ in sex and age. General clinical examinations, measurements 24-BP and office blood pressure, β-ARM, HbA1c, 24-hour urine, echocardiography, and 24-hour electrocardiography with the assessment of heart rate variability (HRV) with low-frequency (LF) and high-frequency (HF) components were performed in all patients.Research Results. In both groups, β-ARM was significantly higher than the normal value corresponding to 20 conventional units (CU): 45.9 ± 21.9 and 41.3 ± 18.9 for patients with RHTN+T2DM and RHTN without T2DM, respectively, p = 0.39. The incidence of increase in β-ARM was comparable: 82% in RHTN with T2DM patients and 88% in RHTN without T2DM patients, χ2 = 0.38, p = 0.537. The β-ARM values correlated with duration of hypertension (R = 0.31), SBP-24 variability (R = 0.36), LF (R = 0.60), and HF (R = –0.53)) values according to HRV, 24-hour urine volume (R = –0.32), left ventricular parameters (ejection fraction (R = 0.42), ventricular efficiency (R = –0.36), arterioventricular coupling (R = –0.40)), duration of T2DM (R = –0.45), and HbA1c level (R = –0.55).Conclusions. RHTN patients were characterized by a high frequency of β-ARM increase, whether or not T2DM was present, although a long and severe course of T2DM was associated with lower values of this indicator. According to the data from instrumental studies, β-ARM in patients with RHTN and T2DM was quantitatively related to the markers of sympathetic activity, which correlated with the duration of hypertension and parameters of renal and left ventricular functional status.

A clinical case of transapical aortic valve implantation for low-gradient stenosis in a comorbid patient with COVID-19-associated pneumonia

Abstract: Aortic stenosis is the leading entity in the structure of valvular pathology in adult population with the frequency ranging from 2 to 4% in the general population. The distinct features of this defect include slow progression and frequent lack of correlation between the severity of stenosis according to clinical and instrumental data. The article presents the case of successful transcatheter aortic valve implantation by transapical access in a 71-year-old patient with symptomatic low-flow, low-gradient aortic stenosis, heart failure with preserved left ventricular ejection fraction, a history of coronary artery bypass grafting, severe concomitant pathology, and recent moderate COVID-19 coronavirus infection. The complexity of management of elderly patients with combined pathology is updated, and a multidisciplinary approach to clinical decision-making in a high-risk clinical situation is demonstrated.

Ceramides: correlation with cardiovascular risk factors

Abstract: Despite the successes achieved, cardiovascular disease (CVD) remains the leading cause of death worldwide. With the help of traditional risk factors, it is not always possible to identify all patients with a high probability of developing cardiovascular events (CVЕ); therefore, the problem of finding new CVD biomarkers still remains relevant. Previous studies have shown the important role of excessive synthesis of ceramides in the development of obesity, insulin resistance (IR), type 2 diabetes mellitus (DM2), and liver steatosis. It is considered that ceramides are able to modulate signaling pathways involved in the regulation of glucose metabolism, triglyceride synthesis, development of apoptosis, fibrosis, and atherosclerosis. Given the wide range of metabolic effects, the study of ceramides is promising for identifying patients at high risk of CVD, as well as improving existing treatment and diagnostic strategies. This review article considers the role of ceramides in the development of atherosclerosis, the correlation with traditional risk factors, and the possibility of using them as new risk factors for early diagnosis of CVD.

Determining the time of maximum risk of death and associated factors in patients with COVID-19 in the hospital and after discharge

Abstract: Due to the rather specific course of COVID-19, the question of what day after the start of hospitalization should be expected to be the maximum risk of death in patients both during hospitalization and after discharge is relevant. Aim. The aim of the study was to determine the time of maximum risk of death during hospitalization of patients with COVID-19 as well as after their discharge from the hospital. Methodology and Research Methods. A total of 2,410 patients hospitalized with a diagnosis of COVID-19 were retrospectively studied. Inhospital 28-day mortality rate was 131 patients, and 28-day mortality rate after discharge from the hospital was 9. The accelerated failure time model (AFT) was used to determine the time of maximum risk of death in patients with COVID-19 after hospitalization as well as after discharge from the hospital during the period up to 28 days. Results. Without taking into account the influence of pathological values of other risk factors, lethal outcomes in patients occurred on days 9-11 after admission to hospital. Age over 60 years and the elevated levels of D-dimer, glucose, urea, creatinine, AST, and C-reactive protein were the risk factors (p < 0.01) that shortened the time to death, except for total protein, which lengthened this period. The maximum risk of death in patients after discharge from the hospital occurred on days 13-25, and an increase in creatinine and a decrease in INR were associated with a shorter time to death. Conclusion. The periods of maximum risk of death as well as the factors affecting these periods in patients with COVID-19 were determined for both hospital stay (days 9-11) and time after discharge from hospital (days 13-25).

Review of potential predictors of anthracycline-induced cardiotoxicity from the position of disease pathogenesis

Abstract: Cardiotoxicity of anthracycline chemotherapy drugs is one of the main interdisciplinary problems in the research area of cardio-oncology. As is known, the high antitumor effi cacy of anthracycline antibiotics is signifi cantly leveled by the development of disabling and lethal heart lesions. However, the pathogenesis of toxic heart disease, as well as diagnostic criteria and markers of anthracycline-induced cardiomyopathy are not fully understood. The article provides a detailed review of potential markers of anthracycline cardiotoxicity from the position of disease pathogenesis. The scheme of pathogenetic development of anthracycline-induced cardiomyopathy is proposed in this article. The main methods of diagnostics of toxic damage of the heart that are currently used in clinical researches of domestic and foreign scientists are reviewed.

Ethical problems of genetic testing for hereditary cardiovascular diseases

Abstract: Data on the features of genetic counseling and predictive testing in patients with hereditary cardiovascular diseases are presented in the review. The ethical problems of genomic testing especially in regard to secondary (incidental) fi ndings, cascade screening, examination of children and adolescents, and postmortem genetic testing are discussed. Particular attention is paid to the psychosocial impact of genetic testing.

Imaging of early vasogenic edema in hyperperfusion zones of venous ischemic stroke

Abstract: Aim. The aim of the study was to investigate the features of cerebral edema in cases of venous ischemic stroke with cerebral venous sinus thrombosis.Material and Methods. The study included 33 patients with venous stroke as a result of cerebral venous sinus thrombosis. Comparison group comprised 33 patients with arterial ischemic stroke. The control group included 33 individuals. Neuroimaging included native computed tomography (CT) of the brain at admission and at days 5–7, perfusion CT (MSCT 64) within the first 40 minutes of admission to the hospital, and magnetic resonance imaging (MRI) of the brain (1.5T) within the first 24–48 hours of the disease.Results and Discussion. The relationships were found between the early intercellular edema development according to diffusion MRI and a signal inversion on diffusion-weighted imaging (DWI) (a decrease in the perifocal zone against the background of a high signal of cytotoxic edema), an increase in the signal with the average upper limit of apparent diffusion coefficient (ADC) range (0.82 ± 0.05) * 10-3 mm2 /s differing only from the central zone, and moderate plethora of perifocal zones (with an increase in rCBV and rCBF by 27–28%) according to perfusion CT. These phenomena could be unfavorable factors for the development of edema and probable hemorrhage (in 27% of cases in venous stroke versus 9% in arterial stroke), but were accompanied by a more favorable clinical outcome of venous stroke (improvement in 66% of cases with a complete regression of neurological deficit in 25% versus 57% without complete regression of symptoms in arterial) with a lower incidence of necrosis/infarction (in 50% of cases versus ¾ of cases of ischemic stroke). The presence of a significant correlation between the parameters of lesion area and the relative values of CT-based perfusion and MRI-based diffusion (r = 0.44; p < 0.05) suggested that the early vasogenic edema and hyperemia were the elements of a pathophysiological mechanism for the development of cerebral venous ischemia, which, unlike arterial ischemia, is secondary in nature, associated with mechanical arterial vasoconstriction due to intercellular edema.Conclusion. Probably, vasogenic edema in most cases of venous stroke, developing almost simultaneously with cytotoxic edema, does not reach the peak of pathological changes and stop in development at the stage of ionic edema with a functional impairment of permeability of the anatomically intact blood-brain barrier when it can reverse. The progressive development of vasogenic edema is a factor for the deepening of ischemia to necrosis/infarction and secondary hemorrhagic transformation.

Repeated prosthetics of the ascending aorta and aortic arch with a homograft for prosthesis infection and ruptured aorta after Bentalla de Bono operation

Abstract: Prosthetic vascular graft infection is a formidable complication after cardiac surgery. Until now, the question on the tactics of managing such patients remains open, as well as the timing of each of the treatment methods such as conservative antibiotic therapy and surgery. In addition, the choice of a method of surgical treatment in itself poses new questions for specialists in regard to what methods to adhere to including prosthesis-preserving technique, prosthesis explantation and its replacement with a synthetic or biological graft, and the use of omentum to cover the infected bed. We present a case of treating a patient with an infected synthetic valve-containing conduit after Bentall de Bono operation and aortic rupture with the formation of false aneurysms. Attention is drawn to the prolonged clinical patient condition manifesting with fever, and the lack of data suggesting an infectious process according to positron-emission tomography and blood cultures. We chose a homograft of the ascending aortic and aortic arch with aortic valve as a conduit. It is also of interest that cultures of infectious prosthesis and aortic valve did not reveal any infectious agent. Aggressive antibiotic therapy in combination with surgical replacement of the infected prosthesis with a cryoprepared allograft allowed for successful treatment of patient without complications.

Interdisciplinary approach to revealing cardiac pathology in TB patients during the COVID-19 pandemic

Abstract: The tuberculosis (TB) dispensary patients are often diagnosed with cardiac diseases, but the regulatory documents associated with TB care refer to the procedures and standards of examination and treatment of TB patients or patients with suspected TB while the management of associated chronic diseases is carried out in other medical institutions. There is lack of continuity between doctors of diff erent specialties. Patients face organizational problems of accessibility and quality of medical care. The creation of Department of Medical and Social Care and Rehabilitation in TB dispensary with therapeutic profi le specialists became especially urgent in the period of coronavirus pandemic.Aim. The aim of the study was to estimate the expediency and eff ectiveness of Department of Medical and Social Care and Rehabilitation in detection and treatment of comorbid cardiac pathology in patients of TB dispensary during coronavirus (COVID-19) pandemic.Material and Methods. All patients of the St. Petersburg TB dispensary No. 5 were examined according to specially developed algorithm to detect and treat the cardiac pathology comorbid with TB. Results. Cardiac diseases comorbid with tuberculosis were detected using an integrated multidisciplinary approach to examination of TB patients during the pandemic of coronavirus infection. Examination, consultation, and necessary treatment were carried out directly in TB dispensary allowing to avoid disease exacerbations and complications during the entire period of monitoring.Conclusion. The establishment of Department of Medical and Social Care and Rehabilitation in TB dispensary No. 5 showed the relevance and timeliness of this measure. The coronavirus genesis of some cardiac diseases required to revise the management tactics of aff ected tuberculosis patients.

Type 2 myocardial infarction: Diagnostic features in real clinical practice

Abstract: Purpose. To determine the incidence of type 2 myocardial infarction (MI) diagnosis (according to the Fourth Universal Defi nition) and the features of patient management in real clinical practice.Material and Methods. A retrospective study was performed by analyzing the case histories of 153 patients diagnosed with acute coronary syndrome (ACS). Inclusion criteria were the presence of ACS at admission followed by a confi rmed diagnosis of MI during the hospital period according to the Fourth Universal Defi nition of MI and the age of patients > 18 years. Patients with severe comorbidities aff ecting the immediate prognosis and/or being an alternative to the diagnosis of MI were not included in the study.Results. The study showed that emergency coronary angiography was performed in 151 patients (98.7%). A decrease in the renal fi ltration function in the presence of chronic kidney disease was a contraindication to this study found in 1.3% of cases; 12 (8%) patients did not have coronary artery disease or had stenoses of less than 50%; these patients comprised the group of patients with type 2 MI. While analyzing the results of examination in patients with type 2 MI, ST segment elevation was detected in seven patients (58.4%) according to electrocardiography; ST segment depression was observed in one patient (8.3%); complete left bundle-branch block was found also in 1 case (8.3%), three individuals (25%) did not have any changes in the position of ST segment, but had a negative T wave. Analysis of possible etiological factors in the development of type 2 MI showed the presence of sinus tachycardia in two patients (16.7%), severe sinus bradycardia in one patient (8.3%), fl utter paroxysm and atrial fi brillation with tachysystole throughout the ventricles in two patients (16.7%), and history of atrial fi brillation in one patient (8.3%).Conclusion. Type 2 MI was diagnosed in 8% of patients with ACS with and without ST segment elevation where cardiac arrhythmias including sinus arrhythmias may be the potential etiological factors. Limited capabilities of assessing the stability of atherosclerotic plaque in the coronary artery including that in the presence of plaque thrombosis represent a signifi cant negative factor for establishing diagnosis in routine clinical practice.

Patterns of sleep disorders after a new coronavirus infection COVID-19

Abstract: Background. Sleep disorders have a negative impact on many aspects of life. COVID-19 exacerbates this problem in the context of the post-COVID syndrome where sleep disorder is one of the common complaints. Objective. We aimed to assess the frequency of sleep disorders after COVID-19 and the presence of associations between post-COVID sleep disorders and the severity of COVID-19. Material and methods. A cross-sectional study was carried out in Novosibirsk. It included 115 people aged 26 to 74 years (an average age of 54.22 ± 12.48 years) after recovery from COVID-19, which occurred two to eleven months before. Patients underwent questionnaire survey (Spiegel sleep score questionnaire, HADS Anxiety and Depression Scale, International Restless Legs Syndrome (RLS) Severity Scale), examination by a somnologist, and screening night computer pulse oximetry. If an index of desaturations was more than five per hour, we performed overnight somnography by WAtch PAT 200 or polysomnography. Patients were divided into groups depending on the presence of sleep disorders, COVID-19 severity, and their age. Statistical analysis included a descriptive analysis. Odds ratio was assessed by determining the risk measure for dichotomous variables in the contingency table. Results. RLS was the most common post-COVID sleep disorder ( n = 63, 75%). However, primary insomnia was diagnosed only in patients with moderate-to-severe course of COVID-19 ( n = 3, 9%). There were 40 patients with post-COVID sleep disorder; they had significantly lower sleep time on workdays (7.00 [6.00; 7.50] vs. 7.50 [6.50; 8.00] hours, p = 0.021) and significantly higher mean HADS depression score (5.00 [3.00; 7.00] vs. 3.00 [1.00; 6.00] points, p = 0.006) compared with the corresponding parameters in patients without deterioration of sleep quality. The chance of reduced sleep quality was 11.6 times higher after moderate-to-severe COVID-19 infection than that after mild infection only in patients aged 26-59 years (95% confidence interval 1.42–94.32, p = 0.007). Conclusion. The chance of worsening sleep quality was significantly higher after a moderate-to-severe COVID-19 infection than after mild infection in 26-59-year-old old patients. At the same time, RLS was the most common post-COVID sleep disorder according to our study. Given the importance of sleep disorders, working-age patients after moderate-to-severe COVID-19 infection require active monitoring by doctors in order to timely correct emerging complaints.

Hypertrophic cardiomyopathy: A modern view on the diagnosis and management of patients (review)

Abstract: Hypertrophic cardiomyopathy (HCM) is a genetically determined disease with a high prevalence and manifestation at the age of 30–40 years. Currently available most effective treatments are extended myectomy and Morrow septal myectomy. However, the frequent occurrence of postoperative complications and restrictions to the use of these methods in certain groups of patients provides rationale for the improvement of the existing treatment methods and search for new pharmacological approaches. One of the most promising areas of conservative therapy is the study of a specific small-molecule allosteric inhibitor of myosinadenosine triphosphatase (mavacamten). Clinical studies of the efficacy and safety of this drug continue to this day, and if they are successfully completed, the drug may be included in the pharmacotherapy protocol for HCM.

Patterns of sleep disorders after a new coronavirus infection COVID-19

Abstract: Background. Sleep disorders have a negative impact on many aspects of life. COVID-19 exacerbates this problem in the context of the post-COVID syndrome where sleep disorder is one of the common complaints.Objective. We aimed to assess the frequency of sleep disorders after COVID-19 and the presence of associations between post-COVID sleep disorders and the severity of COVID-19.Material and methods. A cross-sectional study was carried out in Novosibirsk. It included 115 people aged 26 to 74 years (an average age of 54.22 ± 12.48 years) after recovery from COVID-19, which occurred two to eleven months before. Patients underwent questionnaire survey (Spiegel sleep score questionnaire, HADS Anxiety and Depression Scale, International Restless Legs Syndrome (RLS) Severity Scale), examination by a somnologist, and screening night computer pulse oximetry. If an index of desaturations was more than five per hour, we performed overnight somnography by WAtch PAT 200 or polysomnography. Patients were divided into groups depending on the presence of sleep disorders, COVID-19 severity, and their age. Statistical analysis included a descriptive analysis. Odds ratio was assessed by determining the risk measure for dichotomous variables in the contingency table.Results. RLS was the most common post-COVID sleep disorder (n = 63, 75%). However, primary insomnia was diagnosed only in patients with moderate-to-severe course of COVID-19 (n = 3, 9%). There were 40 patients with post-COVID sleep disorder; they had significantly lower sleep time on workdays (7.00 [6.00; 7.50] vs. 7.50 [6.50; 8.00] hours, p = 0.021) and significantly higher mean HADS depression score (5.00 [3.00; 7.00] vs. 3.00 [1.00; 6.00] points, p = 0.006) compared with the corresponding parameters in patients without deterioration of sleep quality. The chance of reduced sleep quality was 11.6 times higher after moderate-to-severe COVID-19 infection than that after mild infection only in patients aged 26-59 years (95% confidence interval 1.42–94.32, p = 0.007).Conclusion. The chance of worsening sleep quality was significantly higher after a moderate-to-severe COVID-19 infection than after mild infection in 26-59-year-old old patients. At the same time, RLS was the most common post-COVID sleep disorder according to our study. Given the importance of sleep disorders, working-age patients after moderate-to-severe COVID-19 infection require active monitoring by doctors in order to timely correct emerging complaints.

Clinical application of T1-myocardial mapping: Review of literature and first experience of clinical application

Abstract: The present review summarizes the data of modern studies on the capabilities of non-invasive evaluation of myocardial tissue, which is widely used in clinical practice for diagnosis of various nosologies. The quantitative assessment of myocardial fibrosis via T1 mapping and extracellular volume fraction can replace myocardial punch biopsy. The paper presents the data of quantitative measurements that help to assess the morphological changes in the hearts of professional athletes and the dynamics of exercise-induced myocardial remodeling.

Expression of oxidative stress markers in native heart valves obtained from patients with infective endocarditis

Abstract: Aim. To evaluate the contribution of SOD1, CAT, PXDN1, NOS3, EDN1, VCAM, ICAM, PECAM, SELE and SELP genes to the pathogenesis of infective endocarditis in patients undergoing cardiac surgery.Material and Methods. We studied 25 native heart valves obtained from patients with infective endocarditis and 13 native heart valves obtained from patients with other valvular pathology. The expression of SOD1, CAT, PXDN1, NOS3, EDN1, VCAM, ICAM, PECAM, SELE and SELP genes was determined by qPCR. Immunofluorescent staining was performed using specific primary antibodies to nitrotyrosine.Results. Native heart valves obtained from infective endocarditis patients were characterized by the decreased expression of genes involved in the processes of oxidative stress and genes encoding cell adhesion molecules. Immunofluorescence staining showed that the heart valves obtained from infective endocarditis patients had lower nitrotyrosine staining compared to the control suggesting the decreased oxidative stress.

Ceramides: correlation with cardiovascular risk factors

Abstract: Despite the successes achieved, cardiovascular disease (CVD) remains the leading cause of death worldwide. With the help of traditional risk factors, it is not always possible to identify all patients with a high probability of developing cardiovascular events (CVЕ); therefore, the problem of finding new CVD biomarkers still remains relevant. Previous studies have shown the important role of excessive synthesis of ceramides in the development of obesity, insulin resistance (IR), type 2 diabetes mellitus (DM2), and liver steatosis. It is considered that ceramides are able to modulate signaling pathways involved in the regulation of glucose metabolism, triglyceride synthesis, development of apoptosis, fibrosis, and atherosclerosis. Given the wide range of metabolic effects, the study of ceramides is promising for identifying patients at high risk of CVD, as well as improving existing treatment and diagnostic strategies. This review article considers the role of ceramides in the development of atherosclerosis, the correlation with traditional risk factors, and the possibility of using them as new risk factors for early diagnosis of CVD.