Aim. To evaluate the morphological and functional parameters of the myocardium in patients with coronary artery disease (CAD) and concurrent overt primary hypothyroidism, as well as to identify possible relationships between these parameters and levels of thyroid hormones.

Methods. 344 patients with CAD who had verified classes 1-3 stable angina pectoris using the clinical guidelines were recruited in a study [6]. 100 patients with CAD and concurrent primary hypothyroidism were enrolled in the study group. 244 patients with CAD were enrolled in the comparison group. Severity of stenosis in one- and/ or two- and/or three-vessel disease were measured in all patients. A comparative assessment of biochemical parameters and echocardiography was performed. A single-stage cross-sectional comparative analysis of the studied parameters was performed. The presence of any relationships of thyroid hormones with morphological and functional parameters of the myocardium were determined. The correlation analysis reported the relationships between diastolic dysfunction, left ventricular ejection fraction and thyroid-stimulating hormone levels in patients with CAD and concurrent hypothyroidism.

Results. Statistically significant differences in lipid profile, glucose levels, glycated hemoglobin, and glomerular filtration rate were found. Three-vessel disease prevailed in both groups, but the prevalence of three-vessel disease was higher in the study group (CAD and hypothyroidism) than in the comparison group (p<0.01). Echocardiography assessment reported the differences in the levels of E/a (p = 0.02), E/E` (p = 0.001), and LVEF (p = 0.001) between the study groups.

Conclusion. Patients with coronary artery disease and concurrent overt primary hypothyroidism demonstrated worse dyslipidemia parameters, glycemic indicators and impaired glomerular filtration rate. Three-vessel disease prevailed among patients enrolled in the study. The relationship between TSH and myocardial morphological and functional parameters was determined. Obtained data can be used for assessing the prognosis in this group of patients.

Specialized quantitative MRI techniques allow identifying structural changes in individual muscles in inflammatory myopathies.

Aim. To evaluate the role of T2 mapping MRI and to evaluate specific changes in T2 relaxation time in patients with inflammatory myopathies at different stages of the disease process.

Methods. T2 mapping technique for assessing structural changes in muscle tissues was optimized for the Philips “Ingenia” 3.0T MR scanner. T2 relaxation (T2rt) time of the thigh and lower leg muscles (muscule rectus femoris, m. vastus lateralis, m. adductor magnus, m. soleus, m. tibialis anterior, medial and lateral head of m. gastrocnemius) was assessed in the control group (n = 9) and the study group (n = 6). Patients recruited in the study group suffered from dermatomyositis and polymyositis of various severity.

Results. The following values of T2rt were obtained in the control group: m.rectus femoris – 78.2±6.9 ms, m.vastus lateralis – 79.5±4.8 ms, m.adductor magnus – 77.1±4.4 ms, m. soleus – 92.9±4.3 ms, m. tibialis anterior – 89.4±1.3 ms, m.gastrocnemius medial head – 93.7±2.4 ms, m.gastrocnemius lateral head – 92.9±3.5 ms. Patients with polymyositis and dermatomyositis showed an increase in the signal intensity on STIR and PD-SPAIR in the structure of m.soleus, m. gastrocmenius, m.rectus femoris, as well as a significant increase in T2rt of 40–49% (p<0.01). T2rt values did not differ in patients with polymyositis who received drug therapy and had clinical remission. Patients with dermatomyositis who had laboratory remission along with the deterioration reported an increase in T2rt in the structure of long spine muscles, m. rectus femoris and m. vastus lateralis equal to 15–25% (p<0.05). However, none significant changes in the signal characteristics on STIR and PDSPAIR were reported.

Conclusion. The sensitivity of the reported technique in the detection of sub-acute swelling of muscle tissue in the absence of significant changes in signal characteristics on routine MR sequences had been shown. 

We performed a correlation analysis between primer parameters and qPCR efficiency/coefficient of determination in two independent samples from in vitro functional experiments.

Primer parameters do not define qPCR efficiency and coefficient of determination significantly if primers are designed according to the optimised PRIMER-BLAST settings.

Aim. To find the correlation between the primer parameters, efficiency, and coefficient of determination (R2 ) in quantitative polymerase chain reaction (qPCR) conditions.

Methods. Upon RNA isolation from primary human coronary artery endothelial cells, we performed reverse transcription-qPCR (RT-qPCR) utilising SYBR Green chemistry to measure the expression of the following genes: IL1B, IL6, CXCL8, IL12A, IL23A, PECAM1, VWF, KDR, FAPA, ACTA2, SMTN, VIM, COL4A1, MMP2, SNAI2, TWIST1, ZEB1, SCARF1, CD36, LDLR, VLDLR, VCAM1, ICAM1, SELE, SELP, CDH5, IL1R1, IL1R2, TNFRSF1A, TNFRSF1B, NOS3, PXDN. Primers were designed employing Primer-BLAST software using optimised settings. For the correlation analysis, Spearman's rank correlation coefficient was applied (GraphPad Prism).

Results. Coefficient of determination correlated with the primer pair rating by Beacon Designer, amplicon melting temperature, and GC content in the reverse primer. Reaction efficiency did not correlate with the Beacon Designer rating, yet being associated with length and GC content of the reverse primer. Abovementioned correlation coefficients ranged from 0.4 to 0.5 or from -0.4 to -0.5 indicative of moderate positive or negative correlation. Other parameters did not affect reaction efficiency and coefficient of determination. Conclusion Primer parameters do not define qPCR efficiency and coefficient of determination significantly if primers are designed according to the optimised PRIMER-BLAST settings. 

This review summarizes the core principles of immediate and early rehabilitation with aerobic exercises of various intensity in patients following cardiac surgery.

One of the main principles of cardiac rehabilitation is early mobilization of patients after cardiac surgery with the subsequent expansion of physical activity modes. The optimal time for commencing early rehabilitation and its intensity in patients who have undergone cardiac surgery remain controversial. In addition, cardiac rehabilitation programs for elderly patients and those with severe with comorbidities have not been studied yet. This review presents the results of the recent meta-analyzes and studies, focusing on the efficacy and safety of immediate and early aerobic exercise as a core component of rehabilitation in different cohorts of patients, who have undergone cardiac surgery.

The factors contributing to the development of cardiac arrhythmias in obstructive sleep apnea syndrome and the main methods of treating this syndrome have been analyzed and summarized.

The review discusses the relationships of obstructive sleep apnea syndrome (OSAS) with various types of heart rhythm disorders. Pathogenetic factors of obstructive sleep apnea syndrome leading to the development of cardiac arrhythmias, current treatment strategies and their impact on heart rhythm disorders are summarized.

Lung ultrasound is an integral part of echocardiography in emergency conditions. The method allows determining the clinical status of the patient and remains an important differential diagnostic method for examining patients in intensive care units.

The second part of the article is devoted to echocardiography as part of the differential diagnosis of dyspnea syndrome. Lung ultrasound for differentiation of interstitial pulmonary syndrome, the role of echocardiography in the diagnosis of pulmonary thromboembolism and verification of valvular pathology are described.

A new concept was adopted by the Fourth Universal Definition of MI Expert Consensus Document in 2018 – periprocedural myocardial injury after cardiac- and noncardiac interventions, which is distinct from myocardial infarction.

It is difficult to diagnose a heart attack and myocardial damage after noncardiac surgery.

Postoperative myocardial injury increases mortality and worsens the long-term prognosis and quality of treatment.

The quality of surgical care is determined by surgical techniques and the course of the postoperative period. Although complications often negate the results of brilliantly performed surgery, many of them would happen irrespective of surgeon`s actions. The development of complications determining the outcome of treatment can be associated with cardiac pathology. Cardiac complications may develop due to existing comorbidities, hemodynamic instability during surgery, cardiotoxic effect of drugs, etc. In 40% of cases, the risk of cardiac death after noncardiac surgery is associated with the development of perioperative myocardial infarction or myocardial injury. Myocardial infarction is the most demonstrative complication, although it is difficult to diagnose in the perioperative period in case of asymptomatic course. The link between postoperative myocardial infarction and lethality is beyond doubt. Adopted in 2018, the Fourth Universal Definition of MI Expert Consensus Document introduced a new concept of periprocedural myocardial injury after cardiac- and noncardiac interventions, which are distinct from myocardial infarction. Myocardial injury requires laboratory tests to be diagnosed. However, myocardial injury itself affects postoperative mortality and significantly worsens the long-term prognosis and quality of treatment. This article reports the features of the etiopathogenetic mechanisms of cardiac complications during surgical care, as well as the multifactorial genesis of myocardial injury. The analysis of modern scientific literature on the diagnosis of myocardial damage is given. The need for early diagnosis of myocardial damage to create optimal management tactics for patients undergoing noncardiac interventions is demonstrated.

The article discusses the adverse arrhythmogenic effects of an antitumor drug – doxorubicin.

Doxorubicin has a significant effect on the action potentials and ion currents of cardiomyocytes, the dynamics of intracellular calcium concentration.

Oncological diseases are the leading causes of death and disability of the population, causing extremely high socio-economic damage. Among the many currently available drugs for the treatment of cancer, an important place is taken by the anthracycline antibiotic – doxorubicin. However, adverse concomitant effects on several organs and systems of the human body, in particular on the cardiovascular system, do not allow the full use of the high potential of doxorubicin`s antitumor effectiveness. Cardiotoxicity of doxorubicin is manifested in the form of electrocardiographic abnormalities and arrhythmias, degenerative cardiomyopathy and chronic heart failure. The authors consider the following arrhythmogenic effects of doxorubicin: the mechanisms of influence of doxorubicin on electrocardiographic parameters, the action potential of cardiomyocytes, cardiac ion currents and the dynamics of intracellular calcium concentration. The study and assessment of specific pathophysiological mechanisms of arrhythmogenic effects of doxorubicin is necessary for the development and justified use of cardioprotective measures.

The lymphatic drainage system of the brain is assumed to consist of the lymphatic system and a network of meningeal lymphatic vessels. This system supports brain homeostasis, participates in immune surveillance and presents a new therapeutic target in the treatment of neurological disorders.

The article analyzes and systematizes data on the brain lymphatic drainage system. The key components of this system are considered: recently described meningeal lymphatic vessels and their relationship with the glymphatic system, which provides perfusion of the central nervous system with cerebrospinal and interstitial fluids. The lymphatic drainage system helps to maintain water and ion balances of the interstitial fluid and to remove metabolic waste products, assists in reabsorption of macromolecules. Disorders in its work play a crucial role in age-related changes in the brain, the pathogenesis of neurovascular and neurodegenerative diseases, as well as injuries and brain tumors. The review also presents the results of human studies concerning the presence, anatomy and structure of meningeal lymphatic vessels and the glymphatic system. The discovery of the brain lymphatic drainage system has not only changed our understanding of cerebrospinal fluid circulation, but also contributed to understanding the pathology and mechanisms of neurodegenerative diseases.

Distant-learning methods combined with the generally accepted methods of e-learning increase the involvement of medical students in the educational process.

Aim. To describe interactive learning as a core component of distance education.

Methods. We selected free educational tools and online services to support our distance learning.

Results. The third-year students successfully completed the course using the selected methods. 81.9% of respondents preferred the uploaded educational material in the VKontakte social network. 75% of the respondents liked the interactive intermediate tests. 62.5% of respondents were satisfied with the resource book uploaded for them.

Conclusion. The proposed tools support the use of the electronic educational environment and increase students’ involvement in the learning process.

For the first time the possibility of ultrasound diagnostics of stylocarotid, hyoid-carotid, thyroid-carotid and stylo-jugular syndromes is shown in patients with impaired cerebral circulation.

The necessity of reconstruction of bone-cartilage transitional structures with standard MR/CT angiography is justified.

Abnormal structures of the styloid process such as elongation or curvature, the hyoid bone or thyroid cartilage, often in combination with ossification of the stylohyoid or stylomandibular ligaments can cause compression of the internal carotid artery with the formation of dissection, intramural hematoma, stenosis, occlusions and aneurysms. Additionally, symptoms of impaired cerebral circulation start to develop in these patients. Extravasal compression by the styloid process and/or the transverse process of the first cervical vertebra can reduce the blood flow in the internal jugular vein. But only standard vascular imaging is performed in cases of cerebral circulatory disorders, without reconstruction of adjacent bone and cartilage structures. Therefore, there is insufficient data on compression lesions of the neck vessels. Moreover, there is lack of data on ultrasound imaging of vascular Eagle syndrome. The article presents authors` experience of ultrasound diagnostics of this pathology in combination with clinical, angiographic and CT nuances. 

Several aspects of diagnostic radiology are considered, particularly concerning the occurrence of stroke and cerebral hyperperfusion after carotid and coronary artery revascularization.

Hypoperfusion is the main subject of concern for neurologists and neuroradiologists in the clinical practice, even though hyperperfusion also has an important clinical and prognostic value. Acute pathological hyperperfusion after carotid endarterectomy and venous stroke following cerebral venous sinus thrombosis with a two- or three-fold increase in regional cerebral blood flow have a high risk of hemorrhage. A more favorable condition is benign hyperperfusion with moderate (up to 30%) plethora. It develops during venous stroke as element of the pathogenesis of brain tissue injury after secondary ischemia. Often patients who have undergone the simultaneous carotid and coronary surgery or CABG in the early postoperative period showed signs of neurological deterioration in the form of moderate postischemic hyperperfusion. Timely diagnosis can prevent severe cerebral complications during cerebral venous sinus thrombosis or postoperative adverse events in patients with coronary and carotid artery injuries. CT perfusion is the fastest and most adapted tool for emergency diagnostics, whereas SPECT provides a non-invasive assessment of perfusion and brain tissue metabolism with less radiation and fewer negative effects, such as allergic reactions.