Highlights

In recent years, congenital heart defects (CHD) have remained the most prevalent diseases in young children. Opinions on the health of children who have undergone cardiac surgery vary: for example, there are data in the literature indicating that speech disorders following cardiac surgery are present in 56% of cases, whereas cognitive disorders are present in 21% of cases.

Aim. To study the level of development of receptive and expressive language in primary schoolchildren with septal congenital heart defects before surgical correction.

Methods. The prospective study of children (n = 90) with septal congenital heart defects (atrium septal defect, n = 75; ventricle septal defect n = 15) before surgical correction was conducted at the Scientific Research Institute of Complex Issues of Cardiovascular Diseases (Kemerovo). The anamnesis, clinical symptoms, hemodynamics and the level of speech development (receptive and expressive language) were studied.

Results. In children with septal heart defects, speech disorders were noted in 82% of cases: 56% of children had common speech disorders, 26% had delayed speech development. Expressive language skills of these children can be often characterized by delayed development, which manifests in the form of articulation disorder, difficulties with grammar syntax and morphology, and pronunciation disorders. There were no statistically significant differences between the level of expressive language and the type of CHD (p = 0.125).

Conclusion. Even in the absence of intracardiac hemodynamic disorders in children with septal CHD, detected neurodevelopmental delays at the preoperative period necessitates the implementation of the interdisciplinary approach in the management of children with such pathology.

Highlights

According to a single-center comparative registry study, patients with myocardial infarction and new coronavirus infection can be characterized by a higher frequency and severity of hyperglycemia, as well as acute heart failure (alveolar pulmonary edema) upon admission to the hospital against with severe comorbidity (due to type 2 diabetes mellitus and a previous stroke). Type 2 diabetes mellitus can be considered a disease that makes a significant contribution to a more unfavorable course of myocardial infarction against the background of a new coronavirus infection, as well as presumably to the structure of long-term adverse outcomes in this group of patients.

Abstract

Aim. To comparatively analyze the period of inpatient care in patients with myocardial infarction (MI) complicated by the novel coronavirus infection (COVID-19).

Methods. The retrospective single-center register study involved 591 patients with MI. Of them 399 (67.5%) were men, and 192 (32.5%) were women, the mean age was 64.5 (58.0; 72.0) years. Taking into account the verified COVID-19, two groups of patients were formed. The first group included 478 (80.9%) patients with isolated MI, the second group included 113 (19.1%) patients with MI and COVID-19. A comparative assessment of demographic, clinical and anamnestic characteristics, the results of laboratory and instrumental tests and the frequency of adverse events during hospitalization in both groups was carried out. Moreover, the data of patients with a fatal outcome were analyzed as well.

Results. Patients with MI and COVID-19 were characterized by a higher frequency of prior revascularizations (23.9 vs. 12.7, p = 0.025), including coronary artery bypass grafting (7.1 vs. 2.9%, p = 0.049), stenting (16.8 vs. 9.8%, p = 0.034), and bleeding (9.8 vs. 2.7%, p = 0.002). Patients with MI and COVID-19 presented with a higher level of hyperglycemia (7.7 (6.0; 11.4) versus 6.0 (5.2; 8.0) mmol/L, p<0.001) and a comparable prevalence of type 2 diabetes mellitus. During the period of index hospitalization, patients with COVID-19 developed pulmonary edema 1.8 times more often, despite the fact that the incidence of acute heart failure ≥ class II according to Killip was 1.7 times higher in the group with isolated MI. Among all patients with MI, fatal outcome was registered in 89 (18.6%) cases, with the comparable frequency in the groups – 14.6 and 18.6%, respectively. At the same time, patients with MI and COVID-19 who died during hospitalization were characterized by a higher frequency of type 2 diabetes mellitus (3.6 times) and a prior stroke (3.7 times). The most common cause of fatal outcomes was pulmonary edema, which developed 2.3 times more often in patients with MI and COVID-19 than in patients with isolated MI.

Conclusion. There were no significant clinical differences between patients with MI and COVID-19 and patients with isolated MI, except for higher glycemia levels. A similar pattern has been discovered for in-hospital mortality. At the same time, the frequency of type 2 diabetes mellitus, prior stroke and pulmonary edema was higher in deceased patients with COVID-19.

Highlights

The article is focused on one of the most urgent modern issues – the peculiarities of the diagnosis of pathological aging. Due to the absence of a “gold standard” of detection of frailty, attempts to assess its prevalence among the population of different age groups present fragmented and controversial data. In this study, for the first time, the prevalence of frailty in patients with multivessel coronary artery disease, characterized by extremely pronounced clinical complexity, was analyzed using six different diagnostic approaches, allowing us to obtain data on the sensitivity and specificity of these instruments.

Abstract

Aim. To study the prevalence of pre-frailty and frailty in patients with multivessel coronary artery disease.

Methods. The study included 387 patients with multivessel coronary artery disease scheduled for coronary artery bypass grafting. To detect pre-frailty and frailty, we have used various diagnostic approaches, such as the screening questionnaire “Age is not a drawback”, a multi-stage diagnostic framework based on the clinical recommendations on frailty developed by the “Russian Association of Gerontologists and Geriatricians” in 2020, the questionnaire “PRISMA-7”, the clinical frailty scale, the criteria of the Fried frailty phenotype, and the modified 5-item frailty index (mFI-5).

Results. The median age was 65 [59; 69] years, men were the majority (73.1%). Taking into account six diagnostic approaches, the prevalence of frailty in patients with multivessel coronary artery disease varied from 19.1% to 71.6%, the prevalence of pre-frailty varied from 15% to 58.2%. A high number of patients with frailty was detected using a multi-stage diagnostic framework based on the on the clinical recommendations on frailty developed by the “Russian Association of Gerontologists and Geriatricians” (46.8%), the clinical frailty scale (44.5%), the criteria of the Fried frailty phenotype (42.4%) and mFI-5 (71.6%), the lowest number of patients with frailty was detected using the questionnaire “PRISMA-7” (22.5%). The clinical frailty scale showed a higher level of sensitivity and specificity (67.8% and 80%, respectively) regarding the detection of pre-frailty, whereas a multi-stage diagnostic framework had a higher level of sensitivity and specificity (65.2% and 76.8%, respectively) regarding the detection of frailty.

Conclusions. The results of the study revealed a high prevalence of pre-frailty (15–58.2%) and frailty (19.1–71.6%) in patients with multivessel coronary artery disease, taking into account several diagnostic approaches. The clinical frailty scale and a multi-stage diagnostic framework based on the recommendations showed the highest sensitivity and specificity regarding the detection of frailty (clinical frailty scale – 67.8% and 80%, respectively; a multi-stage diagnostic framework – 65.2% and 76.8%, respectively).

Highlights

In the physical rehabilitation of patients after coronary artery bypass surgery (CABG), special attention has recently been paid to respiratory rehabilitation. The article presents the results of studies demonstrating that a course of respiratory coordination training was associated with a decrease in the incidence of hydrothorax, improved blood oxygen saturation, increased exercise tolerance and muscle strength by reducing diaphragm dysfunction and increasing respiratory muscle strength in patients in the postoperative period.

Abstract

Aim. To analyze the clinical effectiveness of a new method of breathing exercises developed for improving breathing control in complex early rehabilitation of patients who underwent CABG.

Methods. The study involved 73 patients with coronary artery disease (CAD) who underwent CABG at the Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” (Kemerovo, Russia) in 2021. During the inpatient rehabilitation, patients were randomized into two groups comparable in anamnestic and baseline clinical and functional indicators: the experimental group (38 patients) had individual breathing exercises as a part of respiratory gymnastics (with different types of exercises), and the control group (35 patients) underwent conventional exercise training.

Results. Initially, there were no statistically significant differences between the groups. After 14 days the number of patients in the main group with signs of hydrothorax was significantly lower compared with the control group: 7 (18.4%) vs 11 (31.4%), respectively, p = 0.001. The ultrasound examination of the pleural space revealed the same pattern - hydrothorax was less pronounced in the main group compared with the control group: 0.9 [0.5; 1.5] vs 1.7 [0.6; 2.5] mL, p = 0.049. Analysis of oxygen saturation (SpO₂,%), reflecting the functional status of the oxygen transport system, showed higher blood oxygen saturation rates in the main group compared with the control group: 98 [96; 99] vs 95.2[94; 97]%, p = 0.04, respectively. At the same time, the exercise tolerance (ET) estimated with bicycle ergometry was comparable at baseline in both groups, and at the end of the inpatient rehabilitation ET in the main group was significantly higher than in the control group with conventional exercise training: 74. 9 [50; 100] vs 55.1[25; 75] W, p = 0.005, respectively.

Conclusion. Respiratory gymnastics facilitates cardiac and respiratory rehabilitation mainly by improving the coordination of respiratory muscles and preparing them for respiratory gymnastics within short period of early inpatient rehabilitation.

Highlights

We estimated theta current sources density changes in patients who received cognitive multitasking training in the early postoperative period of cardiac surgery.

Patients with cognitive multitasking training had a significantly lower theta current source density (t<–3.89; p<0.002) before surgery compared to baseline. The strongest differences were localized in Brodmann areas 7, 19 and 31 which related to the structures of the parieto-occipital lobes of the brain, cuneus and precuneus.

Abstract

Aim. The effect of cognitive recovery techniques on brain activity remains a significant issue in modern health care. The aim of this study was to estimate theta current sources density changes using standardized low resolution electromagnetic tomography – sLORETA – (standardized low resolution brain electromagnetic tomography) in patients who have received cognitive multitasking training (CMT) in the postoperative period of coronary artery bypass grafting (CABG).

Methods. The study included 30 patients aged between 45 and 75 years who underwent routine CABG. Clinical and neurophysiological examinations were carried out 2–3 days before surgery and 11–12 days after CABG. The cognitive training started 3–4 days after CABG and lasted until discharge and consisted of a motor task - a keypress in response to an object appearing on the screen and three consecutive cognitive tasks (counting backwards, verbal fluency and unusual use of an ordinary object).

Results. Patients with CMT had lower theta current source density (t<–3.89; p<0.002) before CABG as compared to postoperative data, the most significant differences were noted in parieto-occipital lobes of the brain, cuneus and precuneus (Brodmann areas 7, 19 and 31).

Conclusion. The results of our research contribute to a better understanding of the pathogenetic mechanisms underlying postoperative cognitive impairments in cardiac surgery patients.

Highlights

Interactive therapy (stimulation) of the brain has a significant potential, especially if it includes not only medical, but neurophysiological and psychological modalities. An integrated approach is required to provide complete readaptation to new life conditions and to decrease the percentage of disabilities in post-stroke patients.

Abstract:

Aim. The article is devoted to the psychological support in neurorehabilitation of patients with acute disorders of cerebral circulation. Interactive therapy (stimulation) of the brain is a new generation of neurofeedback characterized by a radical change in the “targets” of cognitive (adaptive, volitional) influence. These targets are specific cerebral structures and neural networks, the reconstruction of which leads to the restoration of physiological functions and behavioral (psychological) metamorphoses.

Methods. The study involved 18 patients diagnosed with ischemic stroke with hemiparesis of 2 points in the hand (early recovery period). All patients received rehabilitation treatment at the clinic of the Federal Research Center for Fundamental and Translational Medicine. The rehabilitation program for patients from the main group (n = 11) was supplemented with a course of interactive brain stimulation in an MRI scanner. Functional magnetic resonance imaging (fMRI) in the biofeedback contour uses a natural intravascular tracer, a blood oxygen level dependent (BOLD) signal, as feedback. Thus, the subject included into an “interactive brain” circuit is learning to modulate and modify his cerebral networks creating the new ones, or “awakening” pre-existing ones in order to improve (or reform) his mental, sensory and/or motor functions. The subject being placed in a tomograph for a long time to learn new reparative skills is in a significant need of constant (sustainable) psychological support at all stages of the neurorehabilitation.

Results. A course of interactive therapy contributed to a radical improvement in motor functions, confidence in movements, and an increase in working capacity. The analysis of fMRI data over time showed that activation of the accessory motor cortex and cerebellum on the ipsilateral side at the beginning is replaced by bilateral expansion of activity zones in the cerebellum and premotor cortex by the end of the course of interactive therapy. It also was established that the result of a stroke is a deep transformation of the intrapersonal relationships of patients. At the same time, rehabilitation has significant potential, especially if it includes not only medical, but also neurophysiological and psychological modalities. The dynamics of learning in terms of fMRI mapping should be successfully synchronized with the kinetics of psychological metrics and success scales, the influence of which, as a rule, remains beyond the scope of clinical studies.

Conclusion. This study was carried out in line with the search for a self-referential psychological accompaniment that optimizes the recovery, the study of temporal and spatial correspondence between the interactive dynamics of fMRI and specific clinical symptoms.

Highlights

The study showed differences in the expression of a number of genes in atherosclerotic plaques of different types in patients with coronary atherosclerosis. The obtained data can become the basis for the development of test systems in order to determine the dynamics of the atherosclerotic process and detect signs of destabilization of the atherosclerotic plaque as early as possible.

Aim. To study the differential expression of genes encoding molecules associated with the etiopathogenesis of atherosclerosis by the method of genome-wide RNA sequencing in stable atherosclerotic plaque of fibrous type and unstable atherosclerotic plaque of dystopic-necrotic type.

Methods. The study was performed on samples of atherosclerotic plaques of patients with coronary atherosclerosis without acute coronary syndrome with stable angina pectoris of functional class II–IV (FC) at the age of 45-65 years. Tissue sampling of atherosclerotic plaques was performed intraoperatively in the presence of indications. Genome-wide RNA sequencing was performed using Illumina’s TruSeq RNA Sample Preparation Kit (Illumina, USA).

Results. An increase in the level of gene expression in stable atherosclerotic plaques was noted for A2M, ADAMTS13, CSF3, CX3CL1, CXCL1, FGF2, GDF15, ICAM1, IL1A, IL1B, IL6, IL10, PDGFA, PTX3. There was an eightfold statistically significant increase in the level of CFD, CXCL16, FABP4, FLT3, IFNG, IL7, IL15, SELL, TGFA, THBD, TNNT1, VCAM1 and VEGFA gene expression (p<0,001) in unstable atherosclerotic plaques of dystrophic-necrotic type.

Conclusion. The study showed differences in the expression of a number of genes in atherosclerotic plaques of different types in patients with coronary atherosclerosis. The obtained data can become the basis for the development of test systems in order to determine the dynamics of the atherosclerotic process and detect signs of destabilization of the atherosclerotic plaque as early as possible.

Highlights

Adhesion formation is a classic complication of any surgical intervention, which reduces the quality of life of patients and carries the risk of fatal complications during repeated surgery. Moreover, there is an issue of postoperative wound infection. Currently, there are no effective anti-adhesive agents with antibacterial activity in the arsenal of surgeons.

Aim. To justify and develop biodegradable anti-adhesive membranes with antibacterial activity.

Methods. The membranes were made by electrospinning using a composition of biodegradable polymers: polylactide-co-glycolide copolymer (50:50) Mm 20–30 KDa and ε-caprolactonone. The antibiotic Tigacil was added to the polymer solution to impart antibacterial properties to the membrane. The surface structure of the membranes was evaluated using a scanning electron microscope. Physical, mechanical and hemocompatibility properties were studied. The antibacterial activity of the membranes was evaluated after manufacturing, sterilization and storage for 24 months.

Results. The inclusion of Tigacil in the membrane composition contributed to a decrease in fiber thickness by almost 4 times, while the packing of fibers became denser, which affected the increase in the strength of the modified membranes. Samples of membranes before and after the inclusion of Tigacil have no negative effect on erythrocytes The obtained results confirm the antibacterial activity of membranes against Staphylococcus aureus and Klebsiella pneumoniae, as well as the preservation of these properties after sterilization and during 2 years of storage.

Conclusion. The inclusion of Tigacil in the polymer composition makes it possible to create biodegradable anti-adhesive membranes with antibacterial activity, which is maintained for two years after the manufacture. The inclusion of Tigacil in the polymer fiber composition does not adversely affect the initial properties of the membrane.

Highlights

The incorporation of multi-walled carbon nanotubes into the structure of the poly(styrene-block-isobutylene-block-styrene) polymer matrix leads to an increase in the tensile strength and Young's modulus of the nanocomposites. The resulting nanocomposites retain high biocompatibility and can be used as elements of implanted cardiovascular products.

Abstract

Aim. To synthesize and modify poly(styrene-block-isobutylene-block-styrene) (SIBS) with two types of multi-walled carbon nanotubes (MWCNTs) in different concentrations to improve its mechanical properties.

Methods. SIBS was synthesized by controlled cationic polymerization. Polymer nanocomposites were prepared using ultrasonic dispersion followed by casting films from a polymer solution. The resulting nanocomposite films were subjected to mechanical tests under uniaxial tensile conditions. Tensile strength, elastic-strain properties, and plastic deformation under cyclic loading were assessed. The structure of the nanocomposites was analyzed by scanning electron microscopy. The hydrophilicity of the surface of the materials was studied by measuring the contact angle with water. The cytotoxicity of the resulting polymer films was assessed by the viability and metabolic activity of endothelial cells cultured on the surface of the nanocomposites.

Results. Polymer nanocomposites with a uniform distribution of MWCNTs in the polymer matrix were obtained. SIBS films modified with 1% MWCNTs with a diameter of 50–90 nm showed an increase in tensile strength by 16.4% compared to SIBS polymer. Increasing the concentration of MWCNTs to 8% led to a decrease in the strength of polymer materials by 19,6%. The inclusion of nanoparticles into the polymer matrix significantly increased the Young's modulus of the studied polymers with a MWCNT content above 4%. With an increase in the content of MWCNTs in the nanocomposites, an increase in hydrophilicity was also observed, while the cytotoxicity of the samples towards endothelial cells was not noted.

Conclusion. Nanocomposites based on SIBS and MWCNTs, due to their high strength and biocompatibility, can become a promising material for the development of various medical products, in particular prosthetic heart valves.

Highlights

• The presented numerical model of the bioprosthesis support frame for sutureless fixation needs to be optimized to reduce the amplitude of the von Mises stresses.
• The presented setup of numerical modeling has been validated using the study of commercial analogs.

Abstract

Aim. To assess the stress-strain state of three computer models of TAVI prosthesis support frames during crimping and shaping to the delivery configuration.

Methods. The study included three models of stent-like support frames for balloon-expandable devices, which are intended to serve as a foundation for the subsequent development of a domestic aortic valve prosthesis: two models of commercial bioprostheses and one experimental. The objects were evaluated numerically under the conditions of stress-strain state that arises in the stent support frames, simulating two loads: crimping and shaping to the delivery configuration. The study was conducted using the numerical modeling complex Abaqus/CAE (“Dassault Systemes”, France). The key indicators for evaluation were the von Mises stress, as a strength criterion, and its distribution over the frame; the presence and proportion of elastic recoil.

Results. It was shown that all samples are capable of reaching the required diameter without excessive material. A quantitative investigation of the Von Mises stress showed that commercial models display amplitudes below the material`s strength limit (892.4 and 916.8 MPa), whereas the proprietary model exceeds this limit, reaching 991.4 MPa, requiring geometry optimization. Shaping to the delivery configuration indicates that all models provide safe expansion up to 26 mm, with a Von Mises stress level in the range of 882.4–914.1 MPa, which is below the strength limit of the cobalt-chrome alloy. Moreover, we have noted heterogeneous stress distribution, with concentration in the lamella junction areas.

Conclusion. Thus, it has been demonstrated that numerical modeling and the finite element method can be effectively applied to assess the stress-strain state of sutureless prostheses. Geometry optimization and further development of this project – the development of a Russian minimally invasive aortic valve prosthetic system, may contribute towards increasing the accessibility of this treatment method.

Highlights

The article describes the features of remodeling of polyurethane matrices during long-term implantation into the vascular bed of sheep. The results indicate high biocompatibility of polyurethane and resistance to bioresorption. The obtained data are significant for the development of medical products for cardiovascular surgery, in particular, biodegradable vascular prostheses.

Abstract

Aim. To evaluate the features of polyurethane remodeling in a long-term experiment on a large animal model.

Methods. Matrices made of 12% polyurethane solution in chloroform were manufactured by electrospinning at the Nanon-01A nanofiber electrospinning system (MIC, Japan). Matrix samples in the form of patches were implanted into the carotid arteries of sheep (n = 3) for a period of 6 months. The patency of vessels with implanted matrices was assessed after 2, 4 and 6 months using a portable hand-carried color Doppler - M7 Premium Ultrasound Machine (Mindray, China). The structure of the matrix surface before and after implantation was studied using an S-3400N scanning electron microscope (Hitachi, Japan). Histological examination of the explanted samples was carried out using an AXIO Imager A1 microscope (Carl Zeiss, Oberkochen, Germany) with previous staining of matrix sections with hematoxylin-eosin, Van Gieson and alizarin red C. Data processing was performed using the Statistica 6.0 software.

Results. After 2, 4 and 6 months of implantation of polyurethane matrices into the carotid artery of sheep, complete patency of the carotid arteries was revealed. Macroscopically, after 6 months of implantation, the matrix completely resembled the carotid artery wall due to the full consolidation of the matrix with the artery wall and remodeling. Layers of newly formed vascular tissue – neointima and neoadventitia – were formed on the basis of the matrix. Histological examination revealed the structural integrity of the matrix without signs of inflammation and calcification both in the matrix structure and adjacent tissues.

Conclusion. The biological inertia of polyurethane matrices with signs of remodeling was noted, which indicates a high biocompatibility of the material. Resistance to bioresorption and the ability to keep the frame of the product for a long time allows us to consider polyurethane as a suitable material for the formation of anti-aneurysmal protection of biodegradable vascular prostheses.

Highlights

The article focuses on a new polyurethane-based material that has been developed and tested in vitro. This highly porous material with satisfactory physical and mechanical, hemocompatibility and matrix properties, obtained by using an electrospinning method, is suitable for the fabrication of cardiovascular products.

Abstract

Aim. To manufacture a polyurethane-based tissue engineered matrix and study its physical and mechanical characteristics, hemocompatibility and matrix properties in comparison with decellularized xenopericardium and sheep carotid artery.

Methods. Matrices based on polyurethane were produced by electrospinning. The surface structure was studied by scanning electron microscopy, the physical and mechanical characteristics were studied using a Zwick/Roell Universal testing machine, hemocompatibility was studied according to ISO 10993-4-2020, and the matrix properties of the material were studied in a cell experiment with Ea.hy 926.

Results. The structure of the 12% polyurethane matrix was represented by a fibrous network with interpenetrating pores. The physical and mechanical characteristics of polyurethane matrices corresponded to the parameters of the carotid artery of sheep more than xenopericardium. Polyurethane had optimal hemocompatibility: hemolysis of erythrocytes did not exceed 0.52%, platelet aggregation corresponded to the aggregation of platelet-rich plasma – 80%. Platelet adhesion to the surface of the polyurethane matrix is statistically significantly lower than adhesion to the xenopericardium (p = 0.0041). Cell adhesion, viability and metabolic activity of Ea.hy 926 cultured on the surface of polyurethane matrices were higher relative to xenopericardium: cell density was 236.3 [198.5; 264.6] cells/mm² (p = 0.458), viability 19.0 [16.0; 25.0] % (p = 0.0145).

Conclusion. Physical and mechanical characteristics, hemocompatibility and matrix properties of polyurethane confirmed its suitability for potential use for the needs of cardiovascular surgery.

Highlights

An analysis of the medical and demographic situation in the Russian Federation during the covid years (2020–2021) showed that the mortality rate in the studied population increased by 39.1%, the primary morbidity rate – by 26.3%, the incidence of COVID-19 increased by 135.6% and amounted to 10,304.1. The results of the study should be taken into account in the development of management decisions on the health of the elderly population at the federal, regional and municipal levels, as well as for planning dispensary work and preventive care for this population.

Aim. To conduct an analysis of medical and demographic indicators and mortality rate in the population older than working age to develop management solutions regarding the health of older adults in the context of pension reforms.

Methods. The study analyzed statistical data from the Federal State Statistics Service and the Central Scientific Research Institute of Public Health of the Russian Ministry of Health for period from 2012 to 2021.

Results. The mortality rate in the population older than working age in the Russian Federation in 2021 amounted to 5 102.3‰_oo. In the federal districts, the fluctuations in indicators were 1.3-fold: from 4 091.6‰_oo in the North Caucasian Federal District to 5 374.6 in the Siberian Federal District. In the constituent entities of the Russian Federation, the difference between indicators was significant (2.9-fold): from 2 066.6‰_oo in the Republic of Ingushetia to 5 974.6 in the Novgorod region. In 2021, the primary morbidity rate in the population older than working age in the Russian Federation was 66 183.5, in the Federal District the difference between indicators was 1.25-fold, the highest values ​​were noted in the Siberian Federal District – 73 257.0‰_oo, the lowest in the Central Federal District – 58 462.2. In other constituent entities of the Russian Federation, the difference was significant as well (2.3-fold): the Oryol region showed 91 162.7‰_oo, in the Kursk region - 39 282.9. In 2021, the following diseases had high morbidity rate in the Russian Federation: respiratory diseases – 21 391.3‰_oo (32.3%), COVID-19 – 10 304.1 (15.6%), injury, poisoning and certain other consequences of external causes – 6 528.1‰_oo (9.9%), and diseases of the circulatory system amounted to 6 191.7‰_oo (9.4%). Regarding this class of diseases, the highest morbidity rates were associated with high blood pressure – 29.9%, cerebrovascular diseases – 28.4%, and hypertension– 25.4%. In federal subjects of the Russian Federation, the difference in the incidence of COVID-19 in the studied population was almost 6-fold in 2021: from 3463.4‰_oo in the Chechen Republic to 20 481.6‰_oo in the Altai Republic, indicating the ambiguity of COVID-19. During the year of the analysis (2020–2021), the mortality rates in the studied population increased from 4 408.1 to 5 102.9‰oo (by 39.1%), the primary incidence increased from 57 041.4 to 60 183.5‰_oo (by 26. 3%), the incidence of COVID-19 increased from 4 373.9 to 10 304.1 COVID-19 (by 135.6%).

Conclusion. The results of the study should be taken into account at the federal, regional and municipal levels during planning dispensary and preventive work for the health protection of the older generation.

Highlights

We have conducted the analysis of work processes in medical organizations of the Kemerovo region – Kuzbass providing cardiovascular care in the period 2021–2022. The results revealed key issues regarding personnel and organizational and methodological support of their work, and management of patients with high cardiovascular risk. Moreover, we have analyzed the availability of medical care for patients with cardiovascular diseases in the Kemerovo region – Kuzbass.

Aim. To evaluate organizational solutions aimed to increase the availability of medical care for patients with cardiovascular diseases in the Kemerovo region – Kuzbass.

Methods. The study involved analytical, statistical and direct observation methods for the analysis. Statistical data from Federal statistical survey forms based on the Federal State Statistics Service Order No. 985 dated 12/27/2022 (dated 10/27/2023) “On approval of Federal statistical survey forms with instructions on how to fill them out for organizations by the Ministry of Health of the Russian Federation of federal statistical observation in healthcare” (Form № 30 (annual), all-Russian classifier of management documentation code 0609362, Form N 14 (annual), all-Russian classifier of management documentation code 0609348), database on the provision of medical care, other relevant data from the Federal State Statistics Service, statistical data of the Central Research Institute of the Ministry of Health of the Russian Federation for the period from 2019–2022, and the results of an expert assessments of specialized Federal centers were studied.

Results. In comparison with 2021, taking into account insufficient staffing of 59.5%, the number of cardiologists in the Kemerovo region decreased slightly. At the same time, there is a slight downward trend in the number of cardiologists with higher qualification, the percentage of doctors with higher qualification has decreased to 46.7% (of the total number of cardiologists). Regarding this profession, the availability of a doctor per 10,000 adults decreased by 10%, in 2022 the regional indicator was 19.8% lower than the national average, and 12% lower than the average for the Siberian Federal District. In the study period, some indicators displayed negative trends, indicating the presence of issues in medical organizations in the Kemerovo region, namely: the number of surgeries for acquired heart diseases decreased by 13.8%. The number of coronary artery bypass grafting surgeries decreased by 9.3%, per 1 million people in the region, this indicator remains 14% lower than the national value. The number of surgical procedures for rhythm disorders per 1 million population also 1.3% lower than the national value. The problem areas identified in the course of this study related to staffing, management of patients with high cardiovascular risk, organizational and methodological support for the work processes in medical organizations, served as the basis for the justification of the made organizational decisions.

Conclusion. Organizational decisions taken in 2022 positively affected the availability of medical care for residents of the Kemerovo region – Kuzbass due to implementation of a systematic approach to cardiovascular risk management, with an emphasis on identifying patients at high-risk through additional diagnostic methods, the widespread introduction of remote medical care for the population and, as a result, an increase in the number of provided medical care procedures.

Highlights

The results of the study revealed a recent increase in the mortality of the rural population in the Siberian Federal District, and in Russia in general, which required a separate study to identify its causes. Thus, new management solutions should be developed to improve the resource capacity of the healthcare system in the context of the COVID-19 pandemic.

Abstract

Background. Currently, the main strategic goals include increasing life expectancy, reducing mortality rates of the country`s population and improving medical and demographic indicators. This task is becoming especially relevant in rural areas.

Aim. To analyze changes in public health indicators of the rural population in the context of the COVID-19 pandemic using the Siberian Federal District data.

Methods. The research methods that were used in this study are as follows: statistical and comparative analysis, and generalization on the basis of prior experience. For the analysis the statistical data and reports from the Ministry of Health of Russia, Federal State Statistics Service, and the Siberian Federal District were selected.

Results. The analysis of demographic indicators in the Siberian Federal District for the period from 2018 to 2021 showed higher mortality rates compared to the national average, especially in the Altai Territory (1.2 times higher). In 2020 the overall incidence in rural areas both in the Russian Federation as a whole and in the Siberian Federal District decreased for almost all types of diseases (respiratory diseases -2.4%, digestive diseases -13.4%, diseases of the circulatory system -5.3%, infectious and parasitic diseases -11.8%, malignancies -5.3%, injuries and poisoning -5.2%) compared to 2019, whereas there was a growth of the indicator in 2021 in the district being 14% higher than in the Russian Federation. The incidence rate of new coronavirus infection (COVID-19) and life expectancy at birth in the rural population are given, but it should be noted that although the incidence rate of COVID-19 in 2021 in the Omsk region was lower than the national average, mortality from this disease remains the highest in the Siberian Federal District and it exceeded the national average by 1.4 times. To assess the availability of medical care in rural areas, the indicators of the availability of medical personnel and hospital beds were analyzed, showing a steady downward trend.

Conclusion. The results of this study make it possible to identify new directions and initiatives for the development of management strategies to improve the resource capacity of the healthcare system at the federal and regional levels.

Highlights

The review presents up-to-date data on the contribution of type 2 diabetes mellitus to the development and progression of heart failure. The review highlights the key mechanisms of the pathogenesis of heart failure associated with changes in the energy metabolism of cardiomyocytes.

Abstract

Type 2 diabetes mellitus is one of the main risk factors that significantly worsen the prognosis of heart failure and increases the probability of fatal cardiovascular events. The development of heart failure in diabetic patients involves a great number of risk factors for the rapid progression of atherosclerosis, as well as numerous combinations of neurohumoral, molecular and histological changes not associated with atherogenesis, which interconnection results in cardiovascular complications and heart failure decompensation. This review discusses the key mechanisms underlying development of heart failure in type 2 diabetes mellitus, in particular, special attention is paid to cardiomyocyte energy metabolism, cardiomyocyte death, and the significance of epigenetic factors in progression of chronic heart failure.

Highlights

The article describes the main pathogenetic aspects of atherogenesis and focuses on the role of low-intensity inflammation in this process. Moreover, the article presents data on the possibilities of predicting cardiovascular outcomes in patients using a number of pro-inflammatory markers, and on the effectiveness of anti-inflammatory therapy in this cohort of patients.

Abstract

Chronic low-intensity inflammation is currently considered one of the most significant risk factors for cardiovascular disease. The initiation and progression of atherosclerosis are associated with an inflammatory response to endothelial damage, accompanied by an increase in number of pro-inflammatory markers blood circulation. The atherogenic effect of the main risk factors for atherosclerosis, such as hypertension, smoking, increased dietary fat intake, physical inactivity and obesity, as well as psychological and emotional factors and sleep disturbance, is mostly carried out through these mechanisms. In addition, proinflammatory cytokines blood levels increase is associated with sympathetic tone level increase under these risk factors influence.

The article describes the relevant atherogenesis mechanisms and the results of large clinical trials studying the relationship between inflammatory activity, assessed by the levels of various pro-inflammatory markers, and the risk of cardiovascular complications. Data regarding the use of anti-inflammatory drugs such as canakinumab, anakinra, tocilizumab, colchicine to treat patients with coronary artery disease are given. The efficacy of nano-immunotherapy, when powerful anti-inflammatory agents are target delivered to atherosclerotic plaques using nanoparticles, is considered, as well as the anti-inflammatory effect of renal denervation due to the sympatholytic activity of this procedure.

Highlights

The article presents a review of the literature and the results of endovascular correction of multiple atrial septal defects, methods of occluder implantation. Indications for transcatheter closure and possible complications of the procedure are given.

Abstract

Over the past few decades, the treatment strategy for the second atrial septal defect has changed significantly. Due to the improvement of device technology and procedural techniques, transcatheter closure of atrial septal defects is currently considered to be the method of choice in most patients with secondary types of defects. The latest generation devices provide a simple and safe implantation. The use of biocompatible occluder materials contributes to endothelization and reduction of traumatization of nearby structures. Most of the currently available devices demonstrate excellent efficiency and comparable results with their own advantages and disadvantages. In addition to improving the properties and performance of the device, there was a clear improvement in the procedural technique because of numerous experiments with closing of the device. A difficult problem for an endovascular surgeon is the procedure for closing multiple defects, due to their shapes, locations on the septum, the lack of a sufficient amount of tissue edge on the septum, as well as difficulties with choosing the type of device, their number and relative location.

Highlights

• Immune processes and mechanisms underlying bioprosthetic heart valve degeneration and rejection of allografts and xenografts are similar.
• Manufacturers and surgeons can implement effective approaches to prevent immune rejection in the process of production and implantation of prosthetic heart valves in order to delay the process of structural valve degeneration.

Abstract

Bioprosthetic heart valves (BHV) are characterized by low thrombogenicity, thus circumventing the need for long‐term anticoagulation. However, BHV lifespan is limited to 10–15 years because its tissue components are subject to degeneration. Recent research data indicate that immune responses forming the basis of humoral and cellular rejection of allografts and xenografts play a major role in the development of structural valve degeneration (SVD). This review summarizes up-to-date data on immune processes involved in SVD pathogenesis. Moreover, the latest achievements in the development of strategies to reduce the immunogenicity of BHV, such as data on immune compatibility of allogeneic material and the process of deriving low immunogenic biomaterial from genetically modified animals, decellularization of BHV, and the ways of slowing the process of degeneration are analyzed.

On April 15, 2023, a meeting of the Council of Experts was held in Kemerovo on key issues of providing medical care to patients with chronic heart failure in the subjects of the Siberian and Far Eastern Federal Districts.