Highlights

Acquired valvular heart disease (AVHD) is a widespread pathology that remains one of the leading causes of cardiac mortality and disability in the population. The article presents an analysis of the changes in the “portrait” of patients undergoing surgical treatment of AVHD.

Aim. To assess changes from baseline characteristics of patients with acquired mitral valve disease before the implantation of a bioprosthetic heart valve.

Methods. The study included 600 patients admitted in 2000–2020 and undergoing surgical treatment of AVHD using bioprosthesis produced domestically at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo). The patients` portrait was assessed retrospectively, comorbidities, type and etiology of AVHD in 2000–2010 and 2011–2020 were evaluated. 

Results. The main changes in the “portrait” of patients with AVHD over the past decade are as follows: “aging” of recipients of bioprosthetic heart valves (median age went up from 52 [46; 58] to 68 [64; 71] years (p < 0.001)), an increase in the number of people with ischemic mitral insufficiency by 7.4 times, concomitant coronary artery disease by 4.4 times, and cerebral atherosclerosis by 3.7 times (p < 0.001).

Conclusions. The results of the analysis highlight the changes in the “portrait” of patients undergoing surgical treatment of AVHD. Taking into account all of the above-mentioned, it is necessary to develop patient-oriented approaches to management of patients undergoing surgical treatment of acquired valvular heart disease.

Highlights

Obesity and depression are a growing global public health problem affecting people of all ages and socioeconomic status. They are independently among the major risk factors for cardiovascular disease. In terms of biological mechanisms, genetic risk factors have been proposed as a potential factor associated with the comorbidity of depression and obesity. Significant correlations were found between the A/A rs9939609 genotype of the FTO gene and both depression and overweight/obesity compared to non-depressed and normal weight A/T+T/T genotypes in young individuals. Our findings will provide a useful starting point for understanding the biological mechanism involved in the association between obesity and depression in the population.

Abstract

Aim. To analyze the relationship between the rs9939609 T>A genotypes of the FTO gene, depression and overweight/obesity as risk factors for cardiovascular diseases among young people aged 25–34 residing in Novosibirsk.

Methods. The population-based study included Novosibirsk residents aged 25–34, the study was conducted in 2013–2016 within the framework of the research topic FWNR-2024-0002. 975 people (43.7% men, Caucasians) were screened, the response rate was 71%. Demographic and social data and anthropometry were collected. All study participants took the “MONICA-MOPSY” psychosocial questionnaire. Genotyping of the FTO gene polymorphism was carried out at the Research Institute of Therapeutic Microbiology and Microbiology, a branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk.

Results. The distribution of the A/A rs9939609 genotype of the FTO gene was higher in both the overweight (36.8%) and obese (45.6%) groups compared to the normal BMI group (17.5%). The distribution of the T/T genotypes was higher in the normal BMI group (51.6%) compared to the overweight (32%) and obese (16.4%) groups. The average BMI (body mass index) values were higher among carriers of the A/A genotype (30.4 ± 7.4 kg/m²) compared to carriers of the A/T (26.4 ± 5.2 kg/m²) and T/T (25.2 ± 5.2 kg/m²) genotypes (p < 0.001). The average depression scores were higher among carriers of the A/A genotype 4.4 ± 2.6, compared to carriers of the A/T genotype 3.1 ± 2.2 and T/T 2.9 ± 2.0 (p < 0.001). Carriage of the A/A genotype of the FTO gene was a predictor of both depression (OR = 3.267; 95% CI 1.770–6.030; p < 0.001) and overweight/obesity (OR = 2.208; 95% CI 1.228–9.777; p < 0.001) compared to carriers of the A/T+T/T genotypes without depression and with normal body weight.

Conclusion. The results established the role of the A/A rs9939609 polymorphism of the FTO gene in the comorbidity of depression and obesity.

Highlights

The review presents the analysis of long-term outcomes of implantation of the most common types of conduits in children. Predictors of the development of dysfunction and infective endocarditis are presented.

Aim. To analyze the function of the available types of conduits in pediatric group of patients who underwent right ventricular outflow tract (RVOT) reconstruction.

Methods. The retrospective study included patients between 0 and 18 years old who underwent RVOT reconstruction using conduits between 2000 and 2017. Clinical records and imaging data were analyzed.

Results. A total of 400 patients underwent implantation of 495 conduits including glutaraldehyde (GA)-treated bovine jugular vein (contegra) (n = 181); GA-treated xenopericardial conduit (BioLAB) (n = 84); diepoxyde (DE)-treated xenopericardial conduit with porcine aortic root (AB-composite) (n = 65); DE-treated xenopericardial conduit (Pilon) (n = 32) and cryopreserved pulmonary homograft (n = 135). Primary implantation was made in 383 cases (77.3%) and conduit reimplantation was made in 112 cases (22.5%). Median follow-up was 79.9 (42.6; 110.7) months. Redo surgery with conduit replacement was made in 41 (8.5%) cases, of these, 6 (2.1%) conduits were replaced due to thrombosis, endocarditis was diagnosed in 14 patients (4.8%), there were no statistical differences between the groups. Younger age was associated with high risk of early dysfunction (OR 0.97; 95% CI 0.96–0.99, p = 0.03). Multivariate analysis revealed that the type of conduit was not a risk factor (OR 0,86; 95% CI 0,64–1,15; p = 0,64). Severe calcification was the main predictor of conduit-associated mortality (OR 0.02; 95% CI 0.002–0.34; p = 0.005).

Conclusion. Incidence of reintervention due to conduit dysfunction is still high in pediatric group and is not associated with type of conduit. All types of available conduits showed comparable rates of dysfunction. Risk of developing conduit-associated infective endocarditis also does not depend on the type of implanted graft.

Highlights

• The review presents a retrospective analysis of data of patients who underwent combined coronary artery bypass grafting and mitral valve repair/replacement.
• The authors comparatively assessed outcomes of off-pump coronary artery bypass grafting (OPCABG) and on-pump CABG (ONCABG) in patients with combined valvular pathology.

Abstract

Aim. To evaluate the benefits of off-pump coronary artery bypass grafting (OPCABG) in patients with coronary artery disease and concomitant mitral valve (MV) regurgitation.

Methods. The study included 50 patients with coronary artery disease and concomitant MV disease who underwent simultaneous CABG and correction of MV regurgitation. Patients were divided into 2 groups: group 1 (n = 26) included patiens with on-pump CABG (ONCABG), group 2 (n = 24) included patiens with OPCABG.

Results. In the OPCABG group there was shorter aortic cross-clamping time (85,5 [71,25; 105,25] vs 119 [99,25; 132,25] min, compared with the ONCABG group, p < 0,05), shorter duration of CPB (136,5 [119,25; 158,5] vs 168,5 [142,75; 186,25] min, p < 0,05), and overall duration of the operation (292,5 [252,5; 360] vs 340 [287,5; 385] min, respectively, p = 0,15). Moreover, in this group there was a lower need for transfusion of blood and its components: freshly frozen plasma (2 [2; 3] vs 3 [3; 3], p < 0,05), RBC mass (2 [1; 2] vs 2 [2; 2],  respectively, p = 0,4),  and  lower number of bed-days during hospital stay (20 [13,5; 26,25] vs 23,5 [17,5; 26] days, p < 0,05).

Conclusions. Off-pump CABG in patients with combined valvular pathology is a safe and reproducible technique that provides shorter aortic cross-clamping time, on-pump time and operation duration. The need for blood transfusion and the length of hospital stay are reduced as well.

Highlights

Reconstructive interventions on the arteries of the lower extremities remain an extremely common type of treatment for arteriosclerosis obliterans. Research in this area will help determine the indications for implantation of understudied but effective vascular xenografts, which have a number of significant advantages over other types of prostheses and surgical treatment methods.

Abstract

Aim. To analyze in-hospital outcomes of femoropopliteal bypass grafting above and below the knee joint gap using the “KemAngioprotez” vascular xenograft.

Methods. The retrospective study included 115 patients undergoing infrainguinal arterial reconstructions (femoral segment) using the “KemAngioprotez” epoxy-treated vascular xenograft (CJSC NeoKor, Kemerovo) for chronic arterial occlusive disease of the lower extremities from 2012 to 2022.

Results. 7 patients (6.1%) suffered thrombosis in vascular xenograft, including 2 cases (20%) with the point of formation of the distal anastomosis below the knee joint gap, 5 cases (4.8%) – above the gap (p = 0.113). Of the analyzed predictors of 30-day thrombosis and other complications in this period, the number of functioning arteries of the leg and the type of antiplatelet therapy were statistically significant. There were no fatal outcomes. 3 patients (2.6%) undergone repeated arterial reconstruction to restore peripheral blood flow. 2 patients (1.7%) with coronary artery disease and a history of myocardial infarction suffered perioperative myocardial infarction. 12 patients (10.4%) had lymphorrhea. 6 (5.2%) patients had postoperative wound diastasis; 2 (1.7%) patients had marginal necrosis.

Conclusion. In-hospital outcomes of infrainguinal revascularization of the lower extremities using the “KemAngioprotez” epoxy-treated vascular xenograft are comparable with bypass with autologous veins. This may be due to the satisfactory implantation properties of the vascular xenograft. Further multicenter prospective randomized studies are required to study the main limitation of the use of vascular prosthesis according to the literature – the tendency towards degeneration.

Highlights

Ventricular septal defect is the most common congenital heart defect requiring open-heart surgery. The epoxy-treated patch made from xeno-pericardium used to correct this defect was assessed from the standpoint of efficacy, safety, thrombogenicity and degree of calcification

Annotation

Aim. To assess long-term outcomes of ventricular septal defect closure using epoxy-treated xeno-pericardial “KemPeriplas-Neo” patch in children.

Methods. This retrospective study included 42 patients aged 16 months to 18 years, diagnosed with ventricular septal defect (VSD, membranous and muscular) and undergoing VSD closure. The study did not include patients with congenital heart defects (CHD) and congenital and acquired valvular heart diseases. In the long-term follow-up, VSD patch closure (including pseudoaneurysms, fibrosis, recanalization of VSD and recurrence, macrocalcification) was assessed using postoperative transthoracic echocardiography (TTE).

Results. Mean age of patients at the time of surgery was 67.4 ± 53.4 months (range 16–216 months), and at the time of the study 178.2 ± 35.9 months (range 101–243 months). The mean follow-up period was 111.5 ± 18.5 months (range 70.0–147 months). According to TTE results, there were no complications after procedure. Valve function after surgical closure of VSD was satisfactory. Reoperations were not required, and there were no cases of acute stoke and myocardial infarction in the follow-up period. Moreover, there were no in-hospital deaths and no long-term fatal outcomes.

Conclusion. The data obtained indicate the safety and effectiveness of conducting ventricular septal defect closure using epoxy-treated xeno-pericardial “KemPeriplas-Neo” patch. The VSD patch did not disturb the movement of the interventricular septum, and it did not negatively affect the adjacent areas, including the aorta. However, it is necessary to increase the number of patients and conduct a comparative analysis with other types of patches (synthetic, glutaraldehyde–treated) for a more detailed study of the VSD patch efficacy.

Highlights

The article presents the results of the analysis of age and gender characteristics of patients, epidemiological and clinical features of the course of the new coronavirus infection, and appropriate patient care strategies in the Kemerovo region – Kuzbass in 2020–2022 according to the Federal Registry of COVID-19 patients.

Annotation

Aim. To analyze age and gender characteristics of patients, epidemiological and clinical features of the course of the new coronavirus infection (NCI, COVID-19), and the aspects of patient care strategies for this cohort of patients in the Kemerovo region – Kuzbass in 2020–2022 using the data from the Federal Registry of COVID-19 patients.

Methods. The object of the study was the Federal Registry of COVID-19 patients (for the Kemerovo region – Kuzbass). The data was presented in the format of data as of January 10, 2023 and in dynamics – from June 14, 2020 to December 31, 2022. The subject of the retrospective study included: age and gender of patients, prevalence and morbidity associated with COVID-19, mortality from NCI, type of medical care/treatment and its absence (outpatient, inpatient, including treatment in the intensive care unit (ICU)), severity of NCI (mild, moderate, severe, extremely severe), etc. The unit of analysis was the adult population (18 years and older) permanently residing in the Kemerovo region – Kuzbass and included in the Federal Registry of COVID-19 patients with U07.1 and U07.2 ICD-10-CM codes.

Results. The authors analyzed the data of 345,588 patients diagnosed with NCI. The median age was 53.2 (38.7; 66.0) years. The majority of participants were female (61%), the number of males was much lower (39%). The prevalence of the disease in 2020 was 2,593.1 cases per 100 thousand population of Kuzbass, in 2021 it was 6,764.5 cases, in 2022 it was 7,468.8 cases in the analyzed age group. The majority cases were people with mild (78.3%) and less often moderate severity (16.8%) of the disease. The authors noted that the cases with severe (2.9%) and extremely severe (2.0%) course were detected with the same frequency. The majority of patients were undergoing outpatient treatment (75.9%), a quarter of patients (23.7%) were undergoing inpatient treatment, 0.4% of patients refused treatment. The median duration of outpatient treatment was 11 (7.0; 15.0) days, inpatient treatment lasted 10.0 (7.0; 14.0) bed-days. The inpatients were 16.7 years older than the outpatients. In the ICU, 7,025 patients received treatment during the analyzed period, which accounted for 2% of all patients aged≥ 18 years and 8.6% of those who were hospitalized. 75.1% of patients treated in the ICU needed mechanical ventilation. During the analyzed period, 3.9% of the patients with NCI included in the analysis died. Mortality from NCI in 2020 amounted to 124.6 cases per 100 thousand population, in 2021 – 392.5 cases, in 2022 – 136 cases. The median age of the deceased persons was 72 (64.4; 81.8) years, the deceased women were 3.6 years older than men.

Conclusion. The study made it possible to systematize data on gender and age characteristics of patients, epidemiological and clinical features of the course of NCI, as well as aspects of medical care for this cohort of patients in the Kemerovo region – Kuzbass in 2020-2022 according to the Federal Registry of COVID-19 patients. The results obtained can be used for rational allocation of healthcare resources.

Highlights

Coated stents or stent-grafts are widely used in endovascular surgery to close arterial perforations, dissections and aneurysms, as well as in stenting of arteries with loose atherosclerotic plaques in order to reduce the risk of emboli and strokes. The material of stent coating is of great importance in the prevention of early thrombosis and restenosis of stent grafts. Biodegradable polymers have an advantage over non-biodegradable polymers because they do not remain in the patient's tissues for a long period of time and do not cause chronic inflammation. The study of the dynamics and biodegradation characteristics of polymer coating can provide information about its suitability and safety in the stent graft.

Annotation 

Aim. To screen potentially suitable polymers for stent-graft coating with the following assessment of biocompatibility and biodegradation dynamics in an in vivo experiment.

Methods. The coating was applied on the stent by electrospinning from a solution of polymers: Polycaprolactone (PCL); polydioxanone (PDO); polylactide-co-caprolactone (P(LA/CL)) with lactide: caprolactone ratio – 70:30; polylactide-co-glycolide (PLGA) with lactide: glycolide ratio – 50:50. Chloroform (CHCl3) and 1,1,1,1,3,3,3,3,3-hexafluoro-2-propanol (HFP) were used as a solvent. Gore-Tex polymer membrane made of polytetrafluoroethylene (ePTFE) was used as control. In order to evaluate biocompatibility and biodegradation dynamics in vivo, the studied polymeric samples were implanted subcutaneously in male Wistar rats for periods of 7 and 14 days, 1, 2, 3 and 6 months. After explantation all samples were studied histologically.

Results. 14 days after implantation a moderate inflammatory reaction developed on all polymer specimens. The PTFE material was separated from the surrounding tissues by a thin ordered fibrous capsule, confirming its satisfactory biocompatible properties. The porous structure of PCL membranes was filled by fibroblasts and the specimens were tightly integrated into the surrounding tissues. P(LA/CL) degrades with the formation of large fragments. The composite polymer P(LA/CL)/PDO degraded to form small fragments that are tightly integrated with the fibrous capsule. PLGA membranes showed high rates of degradation - membrane fragments were detected 3 months after implantation, after 6 months the samples were completely degraded.

Conclusion. The results of biocompatibility and biodegradation assessment in vivo indicate that the most promising polymers for stent-graft creation are PCL, PLGA and composite polymer P(LA/CL)/PDO. In order to finalize the choice of polymer, it is necessary to conduct further studies to assess the biocompatibility and degradation of polymer coating during implantation of stent-grafts into the arterial bed of large laboratory animals.

Highlights

Following the development of an effective small-diameter tissue engineered vascular grafts, we have conducted preclinical tests of the new product on a primate model. 6 months after implantation, the patency of vascular grafts was 83.3%, there were no signs of aneurysm formation and pronounced inflammation. Remodeling of vascular grafts was accompanied by the formation of a neointima lined with endothelium and neoadventitia, whereas the integrity of the polymer frame remained high.

Annotation

Aim. To conduct preclinical tests of the small-diameter tissue engineered vascular grafts on a primate model with subsequent assessment of patency and remodeling.

Methods. We created vascular grafts using a polymer composition of polycaprolactone and polyurethane with proangiogenic factors by emulsion electrospinning. On the inner surface, we formed a hydrogel coating consisting of iloprost and heparin. The obtained grafts were implanted into the femoral artery of adult male baboons for 6 months. After 5 days, 1, 3 and 6 months of implantation we performed ultrasound examination to assess patency. Moreover, we performed stereomicroscopy, scanning immunofluorescence staining of explanted samples. Statistical data processing was carried out using the GraphPad Prism 8 software.

Results. The patency of vascular grafts after 6 months of implantation was 83.3%. The examinations of the samples confirmed the absence of aneurysms and stenoses during the entire follow-up period. Upon inspection, we noted that the explanted grafts were surrounded by a thin vascularized connective tissue capsule. 6 months after implantation, the polymer scaffolds of the grafts did not have pronounced bioresorption. We observed a neointima with a thickness of 192.9 (138.4; 258.1) microns, a neoadventitia with a thickness of 233.2 (188.1; 510.4) microns and a continuous endothelial monolayer on the lumen side in all patent grafts.

Conclusion. The grafts retained patency in 83.3% of cases 6 months after implantation into the femoral arteries of baboons. Moreover, all patent grafts showed the formation of neointima and neoadventitia with a functionally active endothelial monolayer. There were no signs of concomitant inflammation, calcification or aneurysms.

Highlights

Practitioners regularly encounter unexplained (false-positive) causes and mechanisms of increased concentrations of cardiac troponins. One of the most significant and common causes of false increases in cardiac troponin levels are heterophile antibodies. There are no articles in domestic and foreign databases that systematize in detail information about the prevalence, mechanisms of increase and ways to combat this cause of false-positive increase in cardiac troponin concentration, which was the purpose of this manuscript.

Annotation

According to traditional concepts, cardiospecific troponins (cTnT and cTnI) are the most important laboratory biomarkers with high diagnostic value in myocardial infarction (MI). The development of new generations of methods for determining cTnT and cTnI, also called high- and ultra-sensitive methods, has expanded the diagnostic capabilities of cardiac troponins in relation to other diseases in which myocardial tissue is involved in the pathological process, thereby carrying additional prognostic value. Given the wide scope for use of cTnT and cTnI, which is not limited to the diagnosis of MI, there is an urgent need to carefully identify all factors that can in any significant way affect or distort the result of laboratory testing of blood serum for cTnT and cTnI. Among all known factors affecting the concentration of cTnT and cTnI, heterophile antibodies are the most significant in terms of the degree of change (increase) in serum levels. In this review, we will consider the main causes of the formation of heterophile antibodies, the mechanisms of their influence on the concentration of cTnT and cTnI, as well as methods for detecting and combating heterophile antibodies.

Highlights

The frequency of Dressler syndrome decreased sharply from 20 to less than 5% with the introduction of early reperfusion into clinical practice. Relapses of Dressler’s post-infarction syndrome are quite common. The review presents current literature data on the etiology and pathogenesis, diagnostic methods and various approaches to the treatment of Dressler syndrome, including the effectiveness of colchicine and reports on the use of immunoglobulins.

Annotation

The development of Dressler syndrome relapses within 1 year after the first occurrence of the event, despite the decrease in the frequency of the disease, emphasizes the relevance of the problem under consideration. Dressler syndrome is based on autoimmune genesis. Echocardiography is the “gold standard” of instrumental diagnostics and the most sensitive imaging method for suspected Dressler syndrome, but in some cases magnetic resonance imaging may be effective. There is currently no single treatment regimen for autoimmune pericarditis. Most literature sources indicate the most frequent use of nonsteroidal anti-inflammatory drugs, glucocorticosteroids and colchicine. The article highlights the literature data on etiology, modern views on pathogenesis, current methods of diagnosis of Dressler syndrome and various approaches to treatment tactics and drug selection. The following resources were used: eLIBRARY.ru, PubMed. The keywords were as follows: “Dressler syndrome”, “postinfarction syndrome”, “postpericardiotomy syndrome”, “myocardial infarction”. The articles published primarily in the last 5 years (2017-2022) were preferred.

Highlights

• Methods for modeling heart failure in rats are classified into models requiring surgical intervention, toxic, genetic and autoimmune models, models based on the effects of physical factors, the use of special dietary regimens.
• It is impossible to single out a single ideal model, since the development of heart failure is a multifactorial process, it is preferable to use a combination of several methods.
• The correctness of the choice of the model and its compliance with the tasks of future research must be confirmed by combining several diagnostic methods for verifying myocardial fibrosis - laboratory, histological, instrumental.

Annotation

Detailed study of the mechanisms of heart failure and its main pathogenetic factor, myocardial fibrosis, is required for developing new effective treatment strategies. The choice of an appropriate model is key for a reliable experimental study. The aim of the review is to systematize current data on methods for modeling heart failure in rats. The main advantages of these animals are high genetic, biochemical and physiological similarity with humans, ease of breeding, availability of maintenance, small size, while allowing for surgery. This article classifies the currently available rat models of heart failure, discusses their pathophysiological basis, timing of the formation of heart failure, clinical features, advantages and disadvantages of each experimental model. The authors have paid particular attention to methods developed by domestic scientists. Methods for assessing the developed myocardial fibrosis and the influence of drugs on its formation are considered. The study of heart failure requires reliable animal models to assess biochemical, functional, morphological changes in damaged myocardium, and controlled testing of new drugs. Should the necessity arise, specialists should use several methods simultaneously, whereas the choice of treatment strategy depends on the aim of the study.

Highlights

This review presents a clinical case of a patient with a rare combination of two life-threatening pathologies whose treatment required high-tech surgery. The effectiveness of a multidisciplinary approach to treatment has been demonstrated.

Annotation

Aortic stenosis (AS) is the most common heart disease in elderly patients requiring treatment. Malignant neoplasms of the kidneys account for about 3% of all cancers in the Russian Federation, and the formation of tumor thrombi in the renal and inferior vena cava occurs in 4–10% of patients with this pathology. Given the prevalence of aortic stenosis and renal cell carcinoma (RCC), the number of patients with a combination of these two conditions keeps increasing and they are recommended to undergo surgical treatment at multidisciplinary clinical centers. Transcatheter aortic valve implantation (TAVI) and radical nephrectomy with intracorporeal thrombectomy using the DaVinci Si robotic surgical system may be a preferred approach for the treatment of critical AS and RCC for this category of patients.

At the multidisciplinary clinical center a patient with dysfunctional bioprosthetic aortic valve implanted in 2010 and NYHA class 3 heart failure with history of endovascular treatment of coronary artery disease, peripheral arterial disease and carotid endarterectomy and concomitant renal cell carcinoma with tumor thrombosis of the renal vein received surgical treatment in 2 stages: TAVI – the first stage, and robot-assisted right-sided nephrectomy and thrombectomy from the renal vein – the second stage. The patient was discharged from the Center on the 7^th day after TAVI and on the 6^th day after surgery for renal cancer. Six months after the procedure, there was a decrease in the functional class of heart failure, satisfactory function of the transcatheter aortic valve bioprosthesis, decrease in the size of the left ventricle, decrease in the brain natriuretic peptide, and the absence of cancer progression.

Highlights

• The severity of liver steatosis is inversely correlated with the echogenicity of carotid atherosclerotic plaques in middle-aged patients with carotid atherosclerosis.
• Hepatorenal index is an ultrasound marker of hypoechoic carotid atherosclerotic plaques.
• The inclusion of liver steatosis in cardiovascular risk stratification systems can potentially improve the prediction of adverse cardiovascular events.

Annotation

Aim. To study the relationship between hepatorenal index (HRI) and echogenicity of carotid atherosclerotic plaques (CAP).

Methods. The study included patients with CVD risk factors. The patients' age ranged from 40 to 64 years. The ultrasound study of the brachiocephalic arteries was carried out in standard modes. Echogenicity of CAP in carotid arteries was assessed by GSM-analysis. HRI was defined as the ratio of the median gray scale of the liver to the median gray scale of the kidney. Severity of hepatic steatosis was determined by semiquantitative method using Hamaguchi scale.

Results. 139 patients underwent examination according to a unified protocol. Among those patients 104 were selected for the analysis. Assessing the relationship between echogenicity of carotid CAPs, Hamaguchi scale score and HRI, we have found inverse statistically significant correlations. The median GSM of CAP in the study group was 57,0 (39,7; 80,0) conventional units. In order to determine the potential diagnostic value of Hamaguchi scale and HRI for detecting CAPs with lower than median echogenicity for the given group of patients, we performed ROC analysis. According to logistic regression analysis adjusted for sex, age, obesity, and abdominal obesity, an increase in HRI greater than 1,34 was associated with increased odds ratio of carotid CAPs with GSM < 57 conventional units (less than 50^th percentile) by a factor of 2,66 (95% CI 1,09–6,45; p = 0,031), whereas the increase associated with CAPs with GSM < 39,7 conventional units (less than 25^th  percentile) was 2,95-fold (95% CI 1,08–8,08; p = 0,035).

Conclusion. The severity of hepatic steatosis as assessed by the Hamaguchi scale and HRI was inversely correlated with the echogenicity of carotid CAPs in middle-aged patients with carotid atherosclerosis. An increase in HRI > 1,34 with 65,8% probability predicted the presence of carotid CAPs with a GSM of less than 57. Odds ratio of carotid CAPs with GSM < 57 conventional units (less than the 50^th percentile) and GSM < 39,7 (less than 25^th percentile) with HRI values > 1,34 were 2,66 and 2,95, respectively, after adjustment for intervening factors.

Highlights

Acute perioperative myocardial injury develops in 38.5% of patients with non – small cell lung cancer and is associated with the ThRCRI major cardiac events risk index, preoperative hemoglobin level and postoperative heart rate.

Aim. To determine the incidence and predictors of acute myocardial injury after surgical treatment of patients with non – small cell lung cancer (NSCLC).

Methods. The study included 104 men aged 63.0 [58–67] years who underwent lung resection for NSCLC. Blood levels of cardiac troponin I (cTnI) were determined before and 24 and 48 hours after surgery. Myocardial injury after noncardiac surgery (MINS) was diagnosed when postoperative cTnI increased > 99^th percentile of the upper reference limit. Two patients with elevated cTnI of non-ischemic origin were excluded from the analysis. In groups with and without MINS, clinical parameters were compared and their relationships with the MINS development were assessed using univariate regression. Multivariate logistic regression analysis was performed to identify independent MINS predictors. ROC curves were constructed and threshold values of quantitative variables associated with the study outcome were determined.

Results. MINS was diagnosed in 40 patients (38.5%). In 36 of them, the cTnI increase was asymptomatic. Among patients with MINS, in contrast to the group without MINS, the share of pneumonectomy, heart rate (HR) after surgery and the cardiac events risk index ThRCRI were higher, as well as hemoglobin level before surgery was lower. Using multiple logistic regression, a combination of factors that provides the greatest accuracy in predicting MINS was identified: ThRCRI index ≥ 1 (adjusted odds ratio (OR) 5.85, 95% confidence interval [1.41–24.28]), hemoglobin before surgery (OR 0.68 [0.5–0.91] for every 10 g/L), HR after surgery (OR 1.99 [1.26–3.13] for every 10 min^–1). Threshold levels were established for hemoglobin before surgery (135 g/L), below which the OR for MINS was 2.54 [1.12–5.75], and postoperative HR (88 min^–1), above which the OR for MINS was 2.64 [1.16–5.99].

Conclusion. The incidence of acute myocardial injury after NSCLC surgery is 38.5%. In 90% of cases the MINS was asymptomatic. A mathematical model was created and following independent predictors of MINS were established: ThRCRI index ≥ 1, hemoglobin level before and heart rate after the surgery. At a threshold hemoglobin value < 135 g/L and HR>88 min^–1, the risk of MINS increases significantly.

Highlights

• There is an independent correlation between the cardio-ankle vascular index and the presence of atherosclerotic plaques in the carotid arteries in the working-age male population.
• In the presence of atherosclerotic plaques cardio-ankle vascular index values are higher at any age.
• The chances of detecting atherosclerotic plaques depended on the values of the cardio-ankle vascular index at a relatively young age. At an older age detection of atherosclerotic plaques did not depend on the index as much.
• The value of the cardio-ankle vascular index ≥ 6.9 is associated with a 7-fold increase in the chances of detecting atherosclerotic plaques in men aged 35-44 years.

Aim. To study age-specific relationship between the cardio-ankle vascular index (CAVI) and the presence of carotid atherosclerotic plaques (CAP) in the general population.

Methods. The study included 1 380 people from representative sample of general population (participants of the ESSE-RF study), aged 25–64 years, who underwent cardiac screening, volumetric sphygmography, and carotid ultrasonography. Correlation, linear and logistic regression analyzes were used to analyze relationships.

Results. The odds of detecting CAP depended significantly on CAVI in men and women: OR = 2.51 and 1.83 (both p < 0.001). After adjustment for age, systolic blood pressure and body mass index, the correlation was present in men only: OR = 1.30 (p = 0.017). The association was greatest at the age of 35–44 years, declined thereafter and was not observed after 55 years. CAVI​​ ≥ 6.9 was associated with a 7-fold increase in the odds of detecting CAP in men aged 35–44 years. Regardless of gender, CAVI values were high in case of ​CAP presence (both p < 0.001). After adjustments, the association remained only in men (p = 0.007). Dependence of CAVI on CAP presence did not vary significantly with age.

Conclusion. Study results revealed an independent correlation between CAVI and carotid plaques in the male population. CAP and high CAVI were present at any age. The chances of detecting CAP depended mostly on CAVI at a relatively young age (35–44 years). At an older age detection of CAP did not depend on CAVI as much. The data obtained indicate the possible contribution of vascular stiffness to development of early atherosclerosis.

Highlights

The main surgical interventions for aortic valve pathology at the aortic root site are aortic valve replacement and redo replacement. The Ozaki procedure emerged in the last decade; it involves replacement of the aortic valve using autologous pericardium. Despite the fact that many centers perform the Ozaki procedure frequently, there are few studies on the comparative evaluation of its efficacy. This necessitated the present study, which compares three groups of patients operated on using different techniques.

Aim. To compare the short- and medium-term results of the Ozaki procedure and aortic valve replacements using mechanical and biological valves.

Methods. The retrospective study included 189 patients operated on for aortic malformation at the Cardiac Surgery Department of Sechenov University from 2017 to 2022. Three groups of patients were formed: patients undergoing Ozaki procedure were included in the Ozaki group (70 patients), patients undergoing aortic valve replacement using mechanical prosthesis were included in the Mechanical valve group (62 patients), and patients undergoing aortic valve replacement using biological prosthesis were included in the Biovalve group (57 patients). The Ozaki procedure was performed in case the diameter of the aortic annulus was ≤ 25 mm. All mid-term outcomes were assessed after at least 6 months (mean follow up period was 20 months). The primary end points were mean and peak aortic valve gradient, 30-day mortality in the short-term postoperative period, and midterm mortality (≥ 6 months).

Results. The mean gradient in the Ozaki, Biovalve, and Mechanical valve groups were 10.67 ± 7.15, 15.94 ± 21, and 17.87 ± 7.52 mm Hg. The peak gradient in the Ozaki group decreased from 81.7 ± 32.5 to 21.01 ± 13.22 mm Hg (in the in-hospital setting). 6 months after surgery, the peak gradient values were 18.98 ± 16.17 mm Hg. The in-hospital mortality rates in the Ozaki, Mechanical valve and Biovalve groups were 2.86, 5.26, and 6.45%, respectively. The overall mid-term mortality in three groups was 6/189, 3.17% (95% CI: 1.5–6.07), p = 0.172.

Conclusion. In the short- and mid-term period, Ozaki procedure is superior to aortic valve replacement techniques in terms of aortic valve pressure gradient and comparable in terms of mortality.

Highlights

• A fundamental distinguishing feature of normal endothelial cell morphotypes from pathological ones is their preserved orientation along the direction of blood flow in the absence of cytoplasmic or membrane defects.
• The main characteristics of dysfunctional endothelial cells include a spherical shape (indicating a loss of cellular orientation along the direction of blood flow), the presence of large vacuoles within the cell, cytoplasmic vacuolization, impaired plasma membrane integrity, reduced contrast between the nucleus and cytoplasm, and partial detachment of the endothelial cell from the basement membrane.
• The condition of organelles (mitochondria, Golgi complex, and endoplasmic reticulum) and impaired basement membrane integrity are not sensitive or specific markers of dysfunctional endothelium compared to the aforementioned features

Aim. To analyze the electron microscopic features of normal and dysfunctional endothelium using the descending aorta of rats (characterized by laminar blood flow).

Methods. The study was conducted on 5 male Wistar rats (age ≈ 6 months, body weight ≈ 500 g). The extracted aortas were chemically fixed in 2.5% glutaraldehyde, post-fixed in 1% osmium tetroxide solution with 1.5% potassium ferrocyanide, incubated with 1% thiocarbohydrazide, stained in 2% aqueous osmium tetroxide solution, contrasted in 1% phosphotungstic acid, stained with 2% gadolinium triacetate, dehydrated in ascending concentrations of ethanol, isopropanol, and acetone, embedded in a mixture of acetone and epoxy resin, and then in pure Araldite 502 epoxy resin, followed by its polymerization. After grinding and polishing, the aorta samples were contrasted with lead citrate, coated with carbon, and visualized using backscattered scanning electron microscopy.

Results. Electron microscopic analysis identified three main morphotypes of normal endothelial cells: 1) elongated shape along the direction of blood flow and an elongated nucleus; semicircular shape with an oval, round, kidney-shaped, or polymorphic nucleus with a less pronounced but clearly visible orientation along the direction of blood flow; 3) large nucleus with an even less pronounced but visible orientation along the direction of blood flow. The basement membrane of normal endothelial cells often contained various defects. Dysfunctional endothelium also exhibited several morphotypes, characterized by different combinations of the following features: spherical shape and loss of cell orientation along the direction of blood flow, presence of large vacuoles within the cell, cytoplasmic vacuolization, disruption of plasma membrane integrity, reduced contrast between the nucleus and cytoplasm, and partial detachment of the endothelial cell from the basement membrane. However, pronounced changes in the structure of organelles or the adjacent basement membrane were often not observed in dysfunctional endothelial cells.

Conclusion. The preservation of orientation along the direction of blood flow indicates a normal phenotype of endothelial cells in the absence of other signs of dysfunctional endothelium (vacuoles within the cytoplasm, cytoplasmic vacuolization, disruption of plasma membrane integrity, reduced contrast between the nucleus and cytoplasm, and partial detachment of the endothelial cell from the basement membrane).

Highlights

• Non-contrast computed tomography (CT) scan is a promising modality for opportunistic screening of abdominal aortic aneurysm (AAA).
• Automation of opportunistic screening of AAA according to CT data is a promising use of artificial intelligence (AI) technologies.
• The development of AI algorithms for opportunistic screening of AAA based on CT data is currently limited due to the high labor costs in preparing datasets for AI training and testing.

Annotation

Abdominal aortic aneurysm is a cardiovascular disease characterized by a latent progression and adverse prognosis. Timely diagnosis reduces surgical risks and postoperative complications. Diagnostic imaging methods used to detect and evaluate this disease, particularly in targeted and opportunistic screening, are reviewed. The prospects of automation using artificial intelligence technologies for opportunistic screening are explored, moreover, they have already proven to be effective tools for optimizing radiology reports in several fields. This review highlights, however, relatively poor development of artificial intelligence algorithms for opportunistic screening of abdominal aortic aneurysms on native non-contrast abdominal CT studies. Possible reasons for this phenomenon and potential ways of development of this subject area are investigated.

Highlights

Stroke is one of the leading causes of death and disability worldwide. Minimizing the consequences of the disease and potentiating the restoration of functionally significant areas of the brain is an important task of neurorehabilitation. At the same time, the search for effective rehabilitation strategies continues, taking into account the expansion of knowledge in the field of neuroplasticity based on the progress of neuroimaging capabilities in studying the mechanisms of post-stroke structural and functional reorganization of the brain.

Abstract

Neuroplasticity of the human brain is characterized by the ability to change its organization as a result of adaptation to external or internal stimuli. Local brain lesions, for example during a stroke, lead to functional and cognitive impairments of the brain, which is manifested by neurological deficits. Existing neuroimaging methods allow us to study both morpho-anatomical and functional brain rearrangements. Post-stroke rehabilitation methods, along with the possibilities of visualizing the processes of neuroplasticity of brain, make it possible to evaluate the effectiveness of the measures taken and the patient's recovery. In this review, we aimed to conduct a retrospective analysis of studies on the mechanisms of neuroplasticity of brain and their relationship to recent advances in neurorehabilitation using the example of ischemic stroke. Timely and adequate use of rehabilitation practices in the post-stroke period is necessary for the most effective recovery of the patient while optimizing economic costs.