Highlights

Arterial hypertension often develops in women during the perimenopausal period, accompanied by a decrease in estrogen levels and metabolic disorders. It is important to take into account traditional risk factors such as obesity, family history of hypertension and dyslipidemia, and other characteristics of the female body associated with hormonal changes to effectively prevent hypertension in these women. Further study of new risk factors specific to the female population will help improve preventive measures and treatment of hypertension.

Abstract

Aim. To study the prevalence of cardiovascular disease risk factors in women aged 40-50 years, and to evaluate their influence on the development of arterial hypertension (AH).

Methods. The study analyzed the medical records of 47 women aged 40 to 50 years who consulted a cardiologist. Patients' complaints were assessed using the Greene climacteric scale, whereas the history of AH and personal medical history, physical examination and laboratory data obtained before the examination were used for analysis.

Results. Patients were divided in two groups according to the presence of confirmed АH: the group of patients with AH (n=12), mean age was 45.19 ± 2.86 years; and the group of patients with normal blood pressure (BP, n =35), mean age was 45.30 ± 3.09 years. Age differences between the groups were not significant. 58.3% of patients with AH and 22.8% of patients with normal BP (p = 0.045) suffered from headaches, 83.3% of women with AH and 11.4% of women without AH (p < 0.001) were obese. Family history of AH was more prevalent in the group with AH 75.0% compared with the group with normal BP 34.2% (p < 0.001). 58.3% of patients with AH and 22.6% of patients without AH (p < 0.001) presented with dyslipidemia. Factors such as preterm labour, smoking, excessive salt intake and glycaemic level were not statistically different between groups.

Conclusion. The results of the study with a small sample of patients show that for perimenopausal women the most significant factors associated with arterial hypertension are a family history of hypertension, and the need to control body weight and lipidogram parameters. These aspects require attention during the development of preventive measures. Further research on new risk factors associated with female sex is needed to determine their applicability to the Russian population.

Highlights

The article shows the positive role of consulting a cardiologist and the prospects of using multispiral computed tomography of the coronary arteries to assess the cardiological risk in patients with cancer before the upcoming surgery.

Abstract

Aim. To study the possibilities of using multispiral computed tomography (MSCT) of coronary arteries with the following determination of the calcium index for additional risk assessment and risk restratification in patients with cancer before the upcoming surgical intervention.

Methods. The pilot study included 26 patients (median age was 68.6 years, 69% men, 31% women) with malignant neoplasms undergoing additional examination and risk stratification before the high-risk surgery. All patients were examined by a cardiologist who assessed the perioperative cardiovascular risk during noncardiac surgery. Moreover, patients underwent the assessment of the pre-test probability (PTP) and the clinical probability of obstructive coronary artery disease (CAD). After that, all patients underwent MSCT of the coronary arteries with determination of the calcium index (50%) or MSCT of the coronary arteries with contrast (50%). In order to establish the severity of the coronary lesion, patients underwent selective coronary angiography (SCA). The randomization of patients was performed taking into account the limitations of contrast-enhanced coronary artery MSCT.

Results. When assessing the clinical symptoms of angina pectoris, patients were more likely to have atypical and non-anginal pain (in 38% of cases, respectively) than typical anginal pain (only in 27% of patients). At the same time, the median PTP of obstructive CAD was 24%, which corresponded to a high risk of obstructive CAD. An additional assessment of the clinical probability of CAD classified 61% of patients as a group with a very high probability of obstructive CAD. According to the results of the examination, one patient (4%) with high coronary calcium and 2 patients (8%) with hemodynamically significant stenosis were referred for SCA. Of these, all (100%) patients had significant coronary artery stenosis > 70%. According to the results of the angiographic examination, preventive coronary artery stenting was indicated in two cases, and conservative tactics were chosen in one case.

Conclusion. The results of this study highlight the prospects of using MSCT of coronary arteries to assess the cardiological risk in patients with cancer before the upcoming surgery. Such diagnostic and therapeutic tactic may minimize the number of perioperative cardiac complications.

Highlights

Beta-adrenoreactivity of erythrocyte membranes (beta-ARM) is an indirect indicator of the activity of the sympathoadrenal system and can act as a marker of the severity of heart failure. In patients with chronic coronary artery disease, higher beta-ARM values are associated with a lower left ventricular ejection fraction. Beta-ARM is elevated in people who have suffered a prior myocardial infarction.

Abstract

Aim. To assess the relationship between erythrocyte membrane beta-adrenoreactivity (beta-ARM) and the level of catecholamines in the blood with the functional state of the myocardium in patients with chronic heart failure (CHF) of ischemic origin.

Methods. The study included 116 patients with chronic ischemic heart disease, of which 56.9% of patients had postinfarction cardiosclerosis (PICS). In the sample, functional class (FC) I CHF was present in 10.3% of patients, FC II in 56.0% of patients, and FC III in 33.6% of patients. Based on echocardiography data, CHF with preserved left ventricular ejection fraction (LVEF≥50%) was detected in 78.4% of patients, in 7.8% of patients with reduced LVEF<40%, and in 13.8% of patients with mid‐range LVEF 40–49%. The levels of adrenaline and norepinephrine in the blood plasma were determined using the ELISA kits. Beta-ARM was assessed using the Beta-ARM-Agate kit in accordance with the manufacturer's protocol.

Results. The study sample revealed an inverse relationship between beta-ARM and LVEF (r = –0.318, p = 0.001), as well as a direct correlation with the LV sphericity index (r = 0.331, p = 0.001). An inverse linear relationship was found between the LVEF and the level of adrenaline (r = –0.287, p = 0.010) and norepinephrine (r = –0.418, p < 0.001). Patients with PICS had higher values of beta-ARM (29.7% (19.2; 39.1) vs 21.4% (14.8; 26.7), p = 0.004) and norepinephrine (30.5% (24.3; 41.8) vs 26.9% (19.6; 30.1), p = 0.042) compared with patients without PICS. Groups with different CHF FCs had comparable levels of catecholamines, but differed in beta-ARM (p = 0.029): 22.8% (19.5; 29.2) with FC I, 21.4% (14.8; 28.4) with FC II, 30.1% (19.4; 40.1) with FC III. There was a tendency towards differences in beta-ARM between groups in LVEF (p = 0.053).

Conclusion. Thus, the results of the study revealed an association between beta-ARM and norepinephrine levels with systolic myocardial dysfunction. Higher values of beta-ARM and norepinephrine correlate with lower LVEF and indicate an unfavorable course of heart failure.

Highlights

This review presents the latest available literature data on cognitive and speech characteristics of children with congenital heart defects (CHD), and describes the findings regarding the formation of the grammatical structure of speech in adolescent children with congenital heart defects.

Aim. To assess the development of the grammatical structure of speech in adolescents undergoing surgery for congenital heart defects.

Methods. The prospective study of the formation of grammatical structure of speech included 37 adolescent children in the early postoperative period after radical surgical treatment of septal heart defects at the Research Institute for Complex Issues of Cardiovascular Diseases.

Results. The grammatical structure of speech in adolescents aged 13–16 years with septal congenital heart disease after surgical intervention is not sufficiently formed, the greatest difficulties are associated with changing the form of words. The lowest average score was obtained when performing the task of selecting the appropriate preposition in a sentence (average score – 6.70) and when verifying errors in sentences (average score – 4.97). The highest success rate occurred in the tasks consisting of repeating read sentences and completing unfinished sentences (average scores 10.7 and 13.10, respectively).

Conclusion. For adolescents after surgical correction of CHD to be able to freely chose profession and properly socialize, it is necessary to take into account postoperative results with an assessment of clinical and hemodynamic characteristics, and the quality of life, including neurocognitive status.

Highlights

The effectiveness of cognitive rehabilitation in reducing the incidence of early postoperative cognitive dysfunction in patients who have undergone coronary artery bypass grafting has been demonstrated for the first time by optimizing neurodynamics and memory parameters.

Abstract

Aim. To study the effectiveness of cognitive training (CT) using a combination of simple visual-motor reactions with a set of arithmetic and verbal tasks to reduce the frequency of early postoperative cognitive dysfunction (POCD) in patients who underwent coronary artery bypass grafting (CABG), and to evaluate the dynamics of the neurovascular unit markers (NVU).

Methods. The prospective randomized study included 81 patients: group with CT (n = 43) and the comparison group without CT (n = 38). All patients underwent general clinical, laboratory and instrumental examinations as well as extended neuropsychological examination and determination of concentrations in the plasma of peripheral blood of NVU markers.

Results. Patients who underwent CT with a combination of vision-motor task and cognitive components in the early post-operative period of CABG showed better psychomotor and executive functions (faster reaction time, a smaller number of errors and missed signals), as well as attention (more processed symbols in the 4th minute of Burdon’s test) compared to patients without training. The patients with CT also had a decrease in the concentration of S100β protein in peripheral blood at 11–12 days after CABG and a tendency towards higher the concentration of BDNF. The comparison group had an increase in the concentration of S100β protein at 1^st day after surgery and maintained an elevated level until 11–12 days after CABG.

Conclusion. Thus, the cognitive rehabilitation as the combinations of simple visual-motor reactions with a set of arithmetic and verbal tasks in the early postoperative period of CABG contributed to a decrease in the incidence of early POCD and the maintenance of the cognitive status of patients to a greater extent due to the optimization of the activity of the neurodynamic and short-term memory domains. The decrease in the concentration of S100β protein in the peripheral blood at 11–12 days after CABG and the tendency towards higher concentration of BDNF, observed in patients with CT in comparison to patients without CT, may indicate NVU reorganization.

Highlights

For the first time it was demonstrated that changes in the neurophysiological parameters and markers of the neurovascular unit in cardiac surgery patients under the influence of multitask training in a three-dimensional environment result in optimization of the attention and short-term memory domains, the absence of significant dynamics of low-frequency theta activity and a pronounced activation of BDNF synthesis in contrast to patients without training.

Abstract

Aim. To study the changes in a complex index of cognitive status in the neurodynamic, attention and short-term memory domains, electroencephalogram (EEG) indices and neurovascular unit (NVU) markers in cardiac surgery patients under the influence of multitask training in a three-dimensional environment.

Methods. The prospective randomized study included 100 patients who were divided into two groups using the envelope method: 47 patients underwent a course of multitask training in a three-dimensional environment and 53 patients received no training. In addition to a standard clinical examination, all patients underwent an extended study of cognitive status, EEG parameters, and NVU markers in peripheral blood.

Results. The complex indicators of attention and short-term memory improved at 11–12 days after CABG compared to preoperative values, but only in patients who underwent training. There were no significant changes in complex indicators of cognitive domains in patients without training. Analysis of the EEG total power revealed that theta 1 rhythm indicators did not statistically differ from preoperative values in patients who underwent training. In the group without training, the increase in theta activity (theta1 and theta2) was significant, as was beta 1–2 activity. The dynamics of changes in the BDNF indicator demonstrated that in patients with training, who had an increase in BDNF concentrations in the peripheral blood on the 1^st day after CABG, there was no development of early POCD at 11–12 days after cardiac surgery.

Conclusion. The multitask trainings in a three-dimensional environment contributed to a decrease in the incidence of POCD at the end of the in-hospital stage of CABG due to optimization of the activity of the attention and short-term memory domains. The positive effect of the training was the absence of significant dynamics of low-frequency theta activity and a more pronounced activation of BDNF compared to patients without training, which may indicate a reorganization of brain activity and NVU, but this effect requires confirmation in further studies.

Highlights

• The review is devoted to the analysis of baseline and in-hospital outcomes of patients with hypertrophic cardiomyopathy after alcohol septal ablation.
• The results showed that efficacy and safety of alcohol septal ablation in the treatment of patients with hypertrophic cardiomyopathy is comparable to surgical myectomy of the left ventricular outflow tract.

Aim. To analyze cases of patients undergoing alcohol septal ablation (ASA) at the Research Institute, assessing patients' baseline status, perioperative data and in-hospital outcomes, and to prove that efficacy and safety of ASA in the treatment of patients with hypertrophic cardiomyopathy (HCM) is comparable to surgical myectomy of the left ventricular outflow tract (LVOT) taking into account the available literature data.

Materials and Methods. The study included 25 patients with HCM and LVOT obstruction who underwent ASA at the Research Institute for Complex Issues of Cardiovascular Diseases between 2018 and September 2022. The feasibility of the procedure was based on echocardiographic (LVOT obstruction with peak gradient ≥ 50 mm Hg) and angiographic data (absence of coronary bed lesions, and presence of septal branches with diameter of at least 2 mm). The intervention was performed only in case of a “positive” balloon test, i.e. peak gradient decrease by 30% or more compared to baseline during balloon inflation in the target septal branch.

Results. We considered the decrease of LVOT peak gradient by more than 50% compared to baseline to be a success criterion of the procedure. In in-hospital setting there were no endpoints (death, stroke, blockage of left anterior descending artery, permanent pacemaker implantation), and temporary cardiac pacing was required only in 2 cases (8%) due to transient AV blockade. The echocardiography showed that the peak LVOT pressure gradient was 35 [10; 87] mmHg on the 1^st day, and 20 [8; 75] mmHg on the 5^th day.

Conclusion. The findings and the experience of other clinics proved that ASA can be used in the treatment of patients with HCM and is comparable to surgical myectomy in terms of efficacy. However, patient selection for ASA should be thorough and include clinical and demographic indicators, and echocardiography and angiography data.

Highlights

• The morphofunctional conduit-artery system as a surgical connection between the bypass graft and the coronary artery exists in two forms – arterio-arterial and venous-arterial continuum.
• Coronary artery bypass grafting with autogenous arterial grafts shows the most effective results, this technique relies on the use of patient`s arteries as bypass grafts.
• The studied interactome of the endothelium of two connected vessels in the arterio-arterial continuum provides a fundamental justification of the high efficiency of this type of bypass.

Abstract

Background. Alterations in conduits and coronary arteries, which lead to the unacceptable frequency of major adverse cardiovascular events after coronary artery bypass graft surgery, are often determined by endothelial dysfunction. This pathological process may be less pronounced when using autogenous arterial grafts, since the connection of one artery to another is associated with a large number of similar categories of proteome and transcriptome of endothelial cells (EC) of these vessels. At the same time, it remains unclear what constitutes the interactome of this compound, which is based on the interaction of differentially expressed genes and proteins that reflect the structural and functional heterogeneity of various ECs and can influence the biological congruence of the arterio-arterial continuum.

Aim. To characterize an interactome of human coronary artery ECs (HCAEC) and human internal thoracic artery ECs (HITAEC) for biological congruence of arterio-arterial continuum assessment.

Methods. The study involved commercial culture of human primary HCAEC and HITAEC. Physiological expression was evaluated by transcriptomic and proteomic profiling using RNA sequencing and ultra-high performance liquid chromatography-mass spectrometry, respectively. Bioinformatics analysis of transcriptomic and proteomic data was conducted using the Gene Ontology, Reactome, UniProtKB, and KEGG databases. Interactome was analyzed and characterized during modeling in silico.

Results. Most of the protein-protein and gene-gene interaction categories in HCAEC and HITAEC were responsible for the structural and functional maintenance of the endothelial monolayer and basement membrane. This was expressed in such categories as intercellular junctions (tight, anchor, focal, gap junctions, cell junction assembly, cell-substrate junction), cell adhesion (cell and intercellular adhesion and its regulation) and matrix (cell-matrix junction, cell-matrix contact). Moreover, such interactions have been associated with vascular formation (vascular morphogenesis and development, angiogenesis, regulation of angiogenesis, sprouting angiogenesis, VEGF signaling pathway, regulation of VEGF production, transcription and translation of pre-NOTCH, NOTCH signaling), EC proliferation (development, differentiation and migration of EC), formation of elastic fibers (molecules associated with elastic fibers, formation of elastic fibers, assembly of elastic fibers), NO biosynthesis and its regulation (stimulation of NO guanylate cyclase, NO-mediated signal transduction, regulation of the NOS biosynthesis process, regulation of NOS activity).

Conclusions. Datasets associated with interactions between differentially expressed proteins and genes of HCAEC and HITAEC are characterized by significant enrichment of arterial homeostasis pathways due to heterogenic cells` coherent structural and functional effects upon contact and synergetic impact on endothelial phenotype, which could possibly be keeping the biological congruence of arterio-arterial continuum in the morphofunctional conduit-artery system for a long time period and thus determine high effectiveness of coronary artery bypass grafting with autogenous arterial grafts.  

Highlights

The selective δ₂-opioid receptor agonist deltorphin II increases cardiac tolerance to reperfusion by activating guanylyl cyclase, stimulating cGMP synthesis, activating sarcK_ATP channel, and blocking MPT pore.

Aim. To evaluate the role of NO-synthase, guanylyl cyclase, cGMP, MPT pore in the infarct-limiting effect of deltorphin II in the model of ischemia and reperfusion of the rat heart.

Methods. Coronary artery occlusion (45 min) and reperfusion (2 h) were performed in rats anesthetized with chloralose. The selective δ₂-opioid receptor agonist deltorphin II was administered intravenously at a dose of 120 µg/kg 5 min before reperfusion. The NO synthase inhibitor L-NAME, the guanylyl cyclase inhibitor ODQ, and the MPT pore blocker atractyloside were administered intravenously 10 min before reperfusion. The cAMP and cGMP levels were measured in myocardial tissue.

Results. Deltorphin II causes a decrease in infarct size by about 50%. L-NAME did not affect the cardioprotective effect of deltorphin. Atractyloside and ODQ completely abolished the infarct-reducing effect of deltorphin. Deltorphin II caused an increase in the cGMP level in the myocardium, but did not affect the cAMP level.

Conclusion. Analysis and generalization of obtained data and the results of previous studies indicate that the infarct-limiting effect of deltorphin II is associated with activation of δ₂-opioid receptors located in cardiomyocytes, followed by activation of heme oxygenase-1, an increase in CO production, stimulation of guanylyl cyclase, and activation of protein kinase G. The putative end-effectors are MPT pore and sarcK_ATP channel. In turn, NO synthase is not involved in signal transduction from δ₂-OR to the MPT pore and sarcK_ATP channel.

Highlights

• Doxorubicin is an anthracycline–type antibiotic used to treat certain forms of cancer, the use of which is associated with the development of a number of complications in the cardiovascular system.
• In vitro and in vivo experiments using primary endothelial cells of the coronary and internal thoracic arteries and normolipidemic Wistar rats have shown that exposure to doxorubicin leads to a change in the gene expression profile of endothelial cells, indicating a minor disruption of key links in the pathogenesis of endothelial dysfunction.

Abstract

Aim. To assess the expression profile of endothelial dysfunction marker genes in endothelial cells exposed to doxorubicin in in vitro and in vivo experiments. 

Method. The study included commercial cultures of primary human coronary and internal thoracic artery endothelial cells exposed to 2 μg/mL doxorubicin for 24 hours, and normolipidemic Wistar rats, which were injected with 2 μg/kg of body weight doxorubicin into the tail vein for four weeks. Endothelial dysfunction was assessed by measuring the expression of VCAM1, ICAM1, SELE, SELP, IL6, CXCL8, CCL2, CXCL1, MIF, VWF, SERPINE1, PLAU, PLAT, KLF2, KLF4, NFE2L2, NOS3, SNAI1, SNAI2, TWIST1, ZEB1, CDH5 and CDH2 genes in endothelial cell lysate and in endothelial monolayer washed from rat descending aorta using quantitative polymerase chain reaction.

Results. 2 μg/mL doxorubicin exposure is associated with upregulation of IL6, CXCL8 and CCL2 genes in both HCAEC and HITAEC, and downregulation of PECAM, MIF and NOS3 genes in HCAEC. The mRNA level of transcription factors ZEB1, VE-cadherin (CDH5) and CXCL1 was lower compared to the control in both cell lines. The assessment of gene expression in the endothelial lysate of aorta explanted from Wistar rats showed increased expression of the Ccl2 gene and the decreased expression of the Klf2, Plau, Nos3, Cdh2, Serpine and Vwf genes in the experimental group compared to the control.

Conclusion. In vitro and in vivo experiments using primary coronary and internal mammary artery endothelial cells and normolipidemic Wistar rats showed that doxorubicin exposure leads to some changes in the gene expression profile of endothelial cells, indicating minor disruption of key links in the pathogenesis of endothelial dysfunction.

Highlights

Formation of adhesions after chest surgery remains an unresolved issue. The use of biodegradable anti-adhesion membranes with anti-inflammatory activity can reduce the risk of adhesion. Preclinical assessment of the developed membranes in a large laboratory animal model is a mandatory step in the development of a medical device.

Aim. To conduct a preclinical evaluation of the effectiveness of an anti-adhesive biodegradable membrane with anti-inflammatory activity in a large laboratory animal model (sheep).

Methods. A composition of biodegradable polymers was used to manufacture the membranes: polylactide-co-glycolide copolymer (50:50) Mm 20–30 kDa and polylactide-co-glycolide (85:15). The polymers were dissolved in 1,1,1,3,3,3-hexafluoroisopropanol. To impart anti-inflammatory properties to the membrane, dexamethasone (DM) was added to the membrane composition at a final concentration of 1 mg DM/1 ml of polymer solution. The membranes were manufactured by electrospinning. The anti-adhesion efficiency of the membranes was assessed on an animal model (sheep) during implantation into the chest cavity.

Results. In the control group of animals, a massive adhesive process was noted. In the experimental group, six animals (66.6%) had no adhesions at all, two animals (22.2%) had weak adhesion of the lung and pericardium in the area of ​​membrane fixation with suture material, and one animal (11.1%) had moderate adhesion of the pericardium to the surface of the chest cavity.

Conclusion. The developed biodegradable membranes have demonstrated satisfactory anti-adhesive activity (88.8%). The implantation experience showed that it is better to use a membrane 30% larger in size than necessary to properly close the wound.

Highlights

The study results revealed gender differences in reactions to psycho-emotional stress in young healthy people, showing that women had higher levels of muscle tension, while men had higher levels of skin conduction. This highlights the importance of taking gender differences into account when assessing stress reactivity and developing stress resilience programs. The data obtained can be used to create an optimal battery of physiological parameters for assessing the dynamics of stress tolerance and developing biofeedback programs for stress management.

Abstract

Aim. To study gender-specific reactions to psycho-emotional stress in young healthy individuals, emphasizing the physiological parameters of the cardiovascular system.

Methods. The study included 47 students of Kemerovo State Medical University aged 18 to 32 years. The participants were divided into male (n = 14) and female (n = 33) groups. Psychophysiological diagnostics was performed using the BOSLAB complex: an electromyogram, an electrocardiogram, body temperature, respiration, a galvanic skin reaction and a photoplethysmogram were obtained. The stress testing protocol included cognitive tasks and rest phases.

Results. When exposed to stress tests, there was a statistically significant increase in heart rate (HR) and a shortening of the R-R intervals (p < 0.001), as well as an increase in the duration of the respiratory cycle (p = 0.029) and a decrease in the frequency of the respiratory mode (p < 0.001). Gender differences were manifested in higher levels of muscle tension in women (p < 0.001) and higher skin conduction in men (p = 0.033).

Conclusion. In young healthy individuals, mental stress causes activation of the sympathoadrenal system, which manifests itself in changes in heart rate and respiratory parameters. Gender differences in stress responses are expressed in differences in muscle tension and skin conduction. This data can be useful for the development of stress tolerance and stress training programs.

Highlights

The article shows the positive impact of measures aimed at the improvement of human resources in primary care on the availability of high-tech medical care for patients with circulatory diseases for the population of small territories, and analyzes the effectiveness of the conducted educational and organizational activities for medical personnel. The findings allowed us to identify targets for improvement of knowledge among primary health care workers, which is a basic value in the development of staff potential of employees at the municipal level.

Aim. To assess the effectiveness of measures of improving human resources in primary health care, aimed at enhancement of the quality of selection and availability of HTMC for patients with diseases of the circulatory system.

Methods. The study was carried by employees of the Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” (hereinafter referred to as the Research Institute of Cardiovascular Diseases) at the State Budgetary Healthcare Institution “Guryevsk District Hospital”. The subject of the study is the level of training of primary care medical workers in terms of diagnostics, treatment and routing of patients with diseases of the circulatory system. The methods used in the present study included analytical, statistical, sociological. The object of the study – physicians and paramedics of medical organization. Time period of the study: 01.07.2023–29.12.2023.

Results. Increase in the level of knowledge among primary health care workers on topical issues of identification and selection of patients for open surgery for cardiovascular diseases, as well as the implementation of organizational measures aimed at the improvement of working conditions, affect the availability of specialized care, including HTMC. In 2023 compared to 2022, there was a 37% (p = 0,001) increase (p = 0,001) in the number of telemedicine consultations made to select patients for HTМС, a 65% (p = 0.001) increase (p = 0,001) in the number of diagnostic CAGs, and a 69% (p = 0,001) increase (p = 0,001) in the number of planned HTМС technologies performed.

Conclusion. The analysis of performance indicators in the study period indicates the impact of educational and organizational activities, including telemedicine consultations, on improving the level of knowledge among medical workers, which is an important condition for the improvement of human resource potential and contributes to improving the accessibility of HTMC in diseases of the circulatory system to the population of small territories. The presented experience can be replicated for at any medical organization.

Highlights

Silk fibroin is resistant to early degradation, focal calcification, adsorbs albumin, and does not cause pronounced local and systemic inflammation during subcutaneous implantation in rats, which is comparable and even superior in properties to bovine pericardium used in vascular surgery.

Aim. To study the hydrolytic degradation of silk fibroin (SF), to evaluate in a comparative aspect the surface adsorption of proteins by matrices from SF and bovine pericardium (BP), calcification of biomaterials, as well as their biocompatibility, the dynamics of biodegradation and systemic inflammation after subcutaneous implantation in rats.

Methods. Matrices from SF were made by electrospinning. The BP flap was used as a comparison material. The loss of SF mass and the change in pH of the incubation solution during its hydrolytic degradation in vitro were studied at periods of 1, 3, 6, and 12 months. The surface adsorption of albumin and fibrinogen by matrices was assessed in vitro. Samples of SF and BP were implanted subcutaneously in rats for periods of 7, 14, 30, and 60 days. After explantation of the matrices, a histological examination of the samples was performed and their calcification was assessed. The levels of interleukins 6 and 8, tumor necrosis factor-α, and monocyte chemotactic protein-1 were studied in the blood serum of rats using the enzyme immunoassay method.

Results. Hydrolytic degradation of SF in vitro resulted in a 6% loss of the matrix mass and was accompanied by a decrease in the pH of the incubation solution to 6.56. Twice as much albumin and six times as much fibrinogen were adsorbed on the SF surface than on the BP surface. Signs of SF biodegradation and a thin connective tissue capsule around the matrix appeared after 30 days of subcutaneous implantation in rats. No pronounced inflammation or calcification of SF were detected. Subcutaneous implantation of BP was accompanied by the formation of a pronounced connective tissue capsule around the sample after 60 days, fraying, and degradation of the material. Localized foci of calcification were not detected at any time point of subcutaneous implantation. The content of proinflammatory cytokines in the blood serum of rats after subcutaneous implantation of SF and BP decreased by day 60 of the study without statistically significant intergroup differences.

Conclusion. Due to its resistance to premature degradation and calcification, increased surface adsorption of albumin, optimal biocompatibility and the absence of pronounced peri-implantation and systemic inflammation, SF is comparable and also has a number of advantages compared to BP used in vascular surgery.

Highlights

The article reports on the progress in the development of a method for producing porous nonwoven material based on silk fibroin, and the following study of its structural, physical, and mechanical properties. The findings indicate that the obtained material is similar in its characteristics to the native artery thus proving that silk fibroin has a high potential in vascular tissue engineering.

Abstract

Background. Natural polymer – silk fibroin, obtained from silkworm cocoons, is a promising biomaterial. Tissue engineering has allowed us to obtain 3D-scaffolds based on silk fibroin for cardiovascular surgery.

Aim. To make a porous matrix based on regenerated silk fibroin (SF) and to study its characteristics in vitro.

Methods.  Silk was refined in an alkaline solution with further dissolution in LiBr, dialysis and freeze drying to obtain sponges. Matrices based on 15%, 18% and 20% SF in hexafluoroisopropanol were manufactured by electrospinning. By incubation in ethanol, methanol or isopropanol the β-sheet of SF was made water-insoluble. The structure of the matrix surface and the cross-section were studied by scanning electron microscopy. Physical and mechanical characteristics were evaluated using a universal bursting strength tester.

Results. The optimal electrospinning parameters for 15% solution were as follows: needle 22 G; tip to collector 15 cm; voltage 20 kV; solution feed rate 1.0 mL/h; rotational speed of 200 rpm; humidity 65% and room temperature 23 °C. The obtained matrix had “flat fibers” with a width of 4.84 (4.20; 5.47) microns and a small number of shallow pores with a diameter of 8.65 (5.01; 11.13) microns. The walls of the matrix consisted of fibers with a diameter of 11.70 (10.04; 13.90) microns with a large number of pores with a diameter of 4.89 (4.46; 6.05) microns. Incubation of samples in 70% ethanol allowed us to form a non-water-soluble form of the SF matrix that has physical and mechanical characteristics comparable to sheep carotid arteries.

Conclusion. We have developed a porous 3D matrix based on 15% silk fibroin with satisfactory structural, physical and mechanical characteristics. It is necessary to further conduct in vitro studies to fully understand the characteristics of the manufactured material for further testing on in vivo models.

Highlights

The review presents modern available data on the epidemiology, etiology, pathogenesis, and risk factors for sudden cardiac death.

Abstract

Russia remains one of the leading countries regarding high mortality from cardiovascular diseases. Sudden cardiac death is an urgent and significant issue in modern medicine, it is associated with a high prevalence of cardiovascular diseases and a large number of sudden cardiac deaths in the overall mortality rate from cardiovascular pathologies. Middle-aged (working-age) men are predominately at risk, thus making sudden cardiac death a socio-economic issue as well. At the same time, the issue of detecting predisposition to sudden cardiac death remains unresolved and urgent, since a large number of people who passed away due to sudden cardiac death were not diagnosed with cardiovascular disease. The review is devoted to modern research and current ideas about the epidemiology, etiology, pathogenesis and risk factors for sudden cardiac death.

Highlights

It is important to implement programs to improve prevention, awareness, and control of arterial hypertension. The levels of hypertension control vary depending on populations and time periods. This review presents an assessment of the variation in awareness, treatment, and control of hypertension in modern populations around the world.

Abstract

High blood pressure (BP) is a major risk factor in the development of premature death and disability throughout the world. We conducted an analytical review of the medical research publications for the period 2005–2023, which assessed the prevalence, awareness, treatment and control of hypertension (HT) in various populations in the contemporary period. For literature search we used electronic databases of Google Academy (https://scholar.google.ru/), PubMed (https://pubmed.ncbi.nlm.nih.gov), eLIBRARY.ru (https://www.elibrary), and the data from international and Russian journals dedicated to cardiology and internal medicine. The results of the analysis showed significant geographical variations in the HT prevalence (from < 20% to > 60%); predominantly high rates of HT awareness and treatment in developed countries (up to > 80%) with low relevant indicators in underdeveloped countries, for example, in Sub-Saharan African regions (below 15–20%). The level of hypertension control varies from < 10% to > 60%. The assessment of adherence to the guidelines for CVD prevention, is most consistently reported by the series of EUROASPIRE I–V, NHANES, NCD Risk factor Collaboration, ESSE-RF studies. Despite the availability of modern guidelines for the management of HT and existence of effective and safe antihypertensive drugs, the control of HT is very difficult. According to generalized data, about 50% of hypertensive patients do not achieve target BP levels. Recent trends demonstrate that a dual approach to reducing HT through primary prevention and improved treatment and control is achievable not only in high-income countries, but also in middle- and low-income settings. Accordingly, the implementation of coordinated programs to improve the prevention, detection, education, treatment and control of hypertension is warranted and important worldwide.

Highlights

• Studying circulating microRNAs in vascular cognitive disorders significantly contributes towards understanding the molecular mechanisms of development and progression of these disorders.
• Studying microRNAs allows us to identify new biomarkers that can be used to diagnose, predict the course of the disease and determine the effectiveness of treatment.

Abstract

Vascular cognitive disorders (VCD) are one of the most common forms of non-psychotic mental disorders with a variable phenotype and rate of progression, transformation into vascular dementia. VCD develops due to existing cardiovascular diseases (CVD), which highlights the importance of an interdisciplinary approach to diagnosis and treatment of these diseases. The study of new mechanisms of the development of VCD can help in finding the key to the development of innovative diagnostic methods and personalized treatment approaches. In recent years, the role of non-coding ribonucleic acids (RNA) has been actively studied, while the greatest interest of researchers and clinicians is focused on studying the role of microRNAs (miR). The aim of this review was to search, generalize and systematize preclinical and clinical studies on the role of circulating miR as molecular biomarkers of the development and progression of VCD. The authors searched for publications in the following databases PubMed, Springer, Web of Science, ClinicalKey, Scopus, Oxford Press, Cochrane, e-Library using keywords and their combinations. The publications published in 2013–2023 were analyzed, including original clinical studies of VCD and vascular dementia. The findings of this review show that miR-409-3p, miR-502-3p, miR-486-5p and miR-451a can be considered as promising molecular biomarkers of VCD. However, the role of other microRNAs is debatable and needs further study. In the future, it will be possible to consider previously studied circulating microRNAs with high specificity and sensitivity to VCD and vascular dementia as prognostic molecular biomarkers (predictors) of the risk of their development and severity in patients with CVD.

Based on the analysis of the results of preclinical and clinical studies, the authors present the most sensitive and specific microRNAs associated with the development and rapid progression of VCD in people with cerebrovascular and cardiovascular diseases. Moreover, microRNAs have been demonstrated to facilitate the differential diagnosis of VCD and cognitive disorders in Alzheimer's disease and Parkinson's disease.

Highlights

The development of new valve devices (SAPIEN, Myval) with a large size range has significantly expanded the possibilities of endovascular treatment of pulmonary valve dysfunction. It became possible to treat pulmonary regurgitation in patients with obstructive right ventricular outflow tract and in patients with transannular patch repair of pulmonary trunk and right ventricular outflow tract enlargement. Based on the analysis of literature data, this work examines modern valve design features, indications, methods and techniques of their implantation, as well as clinical results.

Abstract

The paper analyzes the effectiveness and safety of endovascular transcatheter pulmonary valve replacement using balloon-expandable devices. The authors conducted a review of the literature on this topic, studied the available clinical trial data and case reports, and analyzed the main technical aspects of the replacement procedure. The study results helped to assess the effectiveness of the procedure, indications and complications associated with its use. It can be concluded that endovascular transcatheter pulmonary valve replacement using balloon-expandable devices is a promising alternative treatment method for certain patients with heart defects. However, further research is needed to optimize the technique and improve the results of the procedure.

Highlights

Left atrial appendage resection is a safe and effective method of excluding the appendage from the systemic circulation, it reduces the number of cerebral ischemic events and increases the effectiveness of atrial fibrillation treatment.

Abstract

According to a number of studies, left atrial appendage can be the source of atrial fibrillation. Moreover, in atrial tachyarrhythmias, the appendage is the main source of thrombosis that causes cerebral ischemic events. In an attempt to solve these two issues, specialists developed various devices to exclude the left atrial appendage from the systemic circulation and attempted to ablate the arrhythmogenic area. The aim of this review is to analyze current literature data on the abovementioned issues and our own experience of left atrial appendage resection during thoracoscopic pulmonary vein ablation in patients with persistent atrial fibrillation.

Highlights

Cardiovascular surgery with cardiopulmonary bypass for congenital heart defects in children is associated with the issue of organ protection that impacts the outcome and subsequent rehabilitation process. The literature review highlights the need to improve cardiopulmonary bypass-associated adverse effects in cardiovascular interventions in different patient populations.

Article 

Pathological effects of cardiopulmonary bypass (CPB), which is necessary for most surgeries in children and adults with congenital heart defects, remains an unresolved issue. The functional immaturity of the circulatory system and endogenous mechanisms of organ protection in children necessitates intraoperative protection of the organs affected by CPB. The severity of the effects of extracorporeal circuits can lead to an increase in comorbidity and mortality in patients who have undergone CPB. The relevance of the study lies in the fact that most organ protection strategies adopted in adults are inapplicable in children. The search for Russian and English publications (up to 7 years old) was performed using the following databases: Web of Science, PubMed, E-library. The keywords for the search were: nitric oxide, cardiopulmonary bypass, congenital heart defects, organ protection. Literature analysis results revealed the potential for further research on the inhaled nitric oxide for organ protection during cardiac surgery, and the feasibility of its perioperative administration. The nitric oxide is a promising method of organ protection in cardiac surgery with CPB. Moreover, scientific data highlight the importance of the organ protection during CPB in order to ensure successful outcome of the intervention. However, further research on inhaled nitric oxide effects is necessary.

Highlights

• Neutrophil extracellular traps (NETs) take a predominant part in the reaction of the macroorganism to damage of any etiology and make a significant contribution during the pathological process. However, in many chronic diseases and urgent conditions, NETs and NETosis negatively affect the patient's condition, worsening the prognosis of the outcome.
• The development and application of extracorporeal therapies can help break the vicious circle of NETosis and stabilize the general condition of a critical patient.

Abstract

The role of neutrophils in the immune response has been studied quite well. However, there are mechanisms of neutrophil response that can significantly worsen the patient's condition, thus requiring additional study. Such mechanisms include neutrophil extracellular traps (NETs), the physiological and pathophysiological role of which has recently been of great interest. In particular, the use of cardiopulmonary bypass (CPB) may be one of the mechanisms of neutrophil activation and excessive NETs–NETosis formation. NETosis negatively affects the outcome of the disease due to the aggravation of multiple organ dysfunction syndrome (MODS) and sepsis. The methods of diagnosis and treatment for NETosis in patients in critical condition have not been sufficiently studied. Nevertheless, recently scientists developed and clinically tested devices for extracorporeal removal of NETs, which are of great scientific and practical interest, since the effectiveness of NETs sorption has not been studied yet.

Highlights

With the recent advancement in cardiopulmonary bypass techniques in pediatric cardiac surgery, the issue of organ protection during surgery is becoming more urgent, in particular cerebral protection is turning into one of the most important parts of patient management. The aim of this literature review is to determine the role of near-infrared spectroscopy among a variety of techniques for monitoring cerebral function.

Abstract

Near-infrared spectroscopy evaluates regional tissue perfusion and oxygenation of brain tissues during cardiac surgery with cardiopulmonary bypass (CPB). Data on the correlation of laboratory markers of cerebral injury and indicators of cerebral oximetry in children make it possible to create effective strategies of cerebral protection and prevention of postoperative cognitive dysfunction as part of a comprehensive intraoperative assessment of the patient's condition. The aim of the article was to analyze the effectiveness of the near-infrared spectroscopy in cerebral protection during surgical correction of congenital heart defects with CPB in children. The search for Russian and English publications (up to 10 years old) was performed using the following databases: Web of Science, PubMed, E-library. The keywords for the search were: “organ protection”, “congenital heart defects”, “children”, “cardiopulmonary bypass”, “near-infrared spectroscopy”. Publications that did not meet the specified criteria were excluded from the analysis. The findings substantiate the use of near-infrared spectroscopy to assess cerebral perfusion for the purpose of cerebral protection in children with congenital heart defects. The effectiveness of cerebral oximetry in various types of cardiac surgery with CPB in children has been shown. Near-infrared spectroscopy is a routine technique for assessing cerebral perfusion for the prevention of cerebral injury during cardiac surgery with CPB. The data presented in the review demonstrate the relationship between laboratory markers of cerebral injury and indicators of intraoperative cerebral oximetry using near-infrared spectroscopy in children during cardiac surgery with CPB. Further research is needed to explore the prospects of the described method of cerebral protection.

Highlights

The article presents an analysis of works on systemic inflammatory response that occurs during cardiac surgery, as well as research data on promising pharmacological strategies and the results of experimental research aimed at reducing the inflammatory response. Moreover, the authors proposed technological solutions to reduce the release of cytokines during cardiopulmonary bypass.

Abstract

The increase in the number of surgical revascularization procedures is one of the many reasons for the study of predictors of poor long-term prognosis after coronary artery bypass grafting (CABG). Recently, the issues associated with systemic inflammatory response have become even more urgent since cytokines play an important role in critical conditions. The aim of this work was to analyze the available data on the role of cytokines in CABG. The article presents research data reflecting the importance of studying the changes in tumor necrosis α (TNFα) and interleukins (IL), and the analysis of data on the impact of the types of circulatory assist devices on changes in cytokine concentration. The authors evaluated the possible pharmacological strategies to reduce the systemic inflammatory response, and obtained data on the possibility of using methylprednisolone, colchicine, and pentoxifylline in cardiac surgery patients to reduce the levels of pro-inflammatory cytokines. Experimental studies on the use of adenosine and monoclonal anti-TNFα antibodies seem promising due to a decrease in myocardial and lung injury. Numerous studies in this area confirm the need to develop methods for effective reduction of the inflammatory response after surgical myocardial revascularization.

Highlights

This review describes a rare clinical case of hypertrophic cardiomyopathy in a teenager with LEOPARD syndrome.

Abstract

Hypertrophic cardiomyopathy (HCM) is a genetically determined cardiac disease which can be caused by nearly 1500 genetic mutations, encoding proteins of the cardiac sarcomere and some non-sacromeric proteins. There is a number of hereditary metabolic disorders and diseases which can imitate phenotype and clinical picture of HCM. Abnormalities with systemic symptoms are usually identified as a syndrome, including hypertrophic myocardium signs. Such abnormalities are regarded to the RASopathies, a group of phenotypically similar genetic syndromes. Nowadays RASopathies include 1-type neurofibromatosis, Noonan syndrome, LEOPARD syndrome, Costello syndrome, Legius syndrome, cardiofaciocutaneous syndrome, and capillary malformation-arteriovenous malformation syndrome.

Highlights

The article aims to expand the understanding of septal defects in children with congenital heart defects, emphasizing their frequency and variety of clinical manifestations, and to describe radical corrections of hearts defects, which, despite their routine nature, can be accompanied by severe complications.

Abstract

Septal defects in children with congenital heart disease (CHD) occur frequently: atrial and interventricular septal defects are quite common, either in isolation or as a part of other complex heart defects. In many cardiac surgical centers, surgical correction of septal defects is considered a “routine” operation; such patients usually do not have complications before, during, or after surgical intervention. Despite the seemingly commonplace nature of the procedure, there are some severe complications such as “stone heart” syndrome. Stone heart syndrome or ischemic myocardial contracture is a condition caused by impaired blood supply to the myocardium, resulting in impairment of energy metabolism in cardiomyocytes and the development of ischemic contracture. The article presents a clinical case of a child undergoing a radical correction of CHD complicated by fatal ischemic myocardial contracture.

Highlights

Cardiopulmonary bypass that is necessary for the surgical correction of congenital heart defects in children can induce systemic inflammation and lead to organ failure. Renal replacement therapy for acute renal injury after heart surgery in children is an effective method of kidney function substitution in the postoperative period comparable to peritoneal dialysis widely used in this category of patients. This case report presents a successful patient recovery after incorporation of this technique into the surgical treatment.

Abstract

The use of cardiopulmonary bypass during surgical correction of congenital heart defects in children can significantly damage the child's organism, which is widely reported in medical field. This negative impact is associated with morphofunctional immaturity of child's organs and caused by using extracorporeal circuits. The aim of this article is to demonstrate the use of renal replacement therapy for kidney injury in the postoperative period of correction of congenital heart disease in a child aged 52 days with transposition of the great vessels. The child's condition was stabilized as a result of surgical intervention and the use of renal replacement therapy to treat the complications of acute kidney injury. The patient was transferred to a specialized Cardiac Surgery Department, where they successfully finished rehabilitation.

Highlights

The article presents proposals for improving primary health care for the coal industry workers by creating specialist outpatient clinics, integrating medical organizations at all levels, and incorporating an interdepartmental approach for various ministries and departments to preserve the health of the able-bodied population.

Aim. To develop a promising model for organizing health services for coal industry employees in the Kuzbass (using the Kemerovo region – Kuzbass data).

Methods. The object of the study is the organization of primary health care (PHC) for coal industry employees. The subject of the study are the coal industry employees. The analytical method and content analysis of domestic and foreign literature and regulatory documents regarding the organization of primary health care for employees (federal laws of the Russian Federation, regulatory documents of the Ministry of Healthcare, Ministry of Labor and Social Protection of the Russian Federation and Kemerovo region-Kuzbass) were used in this review.

Results. The new model of the organization of PHC for coal industry employees has three levels of interdepartmental interaction. The first level involves new specialized outpatient clinics for the working population that should be created within territorial polyclinics as the main link in the provision of primary health care with the support from enterprises and the occupational pathology service providers of the region. The second level involves the identification of cardiovascular risk factors, diagnosis of cardiovascular diseases, and developing personal preventive measures for patients. The third level of the model is managerial, it aims to develop preventive programs to negate occupational-related adverse factors and implement them at personal, workplace and interdepartmental levels.

Conclusion. The interdepartmental approach involving all participants of the process will be able to achieve the target parameters by improving the PHC model for the working population. The developed model will shorten the wait times, simplify document management, ensuring continuity, monitoring of cardiovascular risk factors, outpatient management of patients with premorbid disorders, and interdepartmental responsibility for outcomes.