Biomarkers of heart failure: current state of problem

There is constant increase in patients with heart failure every year worldwide. Early diagnosis and prediction of deterioration could upgrade management of patients and slow down the progression of heart failure.The brain natriuretic peptide precursor (NT-proBNP) is considered to be the universal biomarker, although it has several limitations. The search of ideal biomarker is directed into molecular biology and genetics. Microribonucleic acids (microRNAs) regulate different processes in human body, present myocardial specificity, and plasma stability. It has been proven in different trials that diagnostic and prognostic level of microRNAs is equal to NT-proBNP. Potential opportunities of the method are not only diagnosis but therapeutic targets for heart failure

José María Vargas (1786–1854): medical doctor and the first dean of the central univeristy of Venezuela

José María Vargas (1786–1854) was a multifaceted personality: Venezuelan politician, medical doctor and scientist. In 1827 he became the first dean of the Central University of Caracas. As a professional doctor, he made significant contribution to the teaching of medicine, his educational work encompassed many fields such as human anatomy, surgery, chemistry, etc. In 1827 he founded the Medical Society of Caracas. He served as president of Venezuela from 1835 to 1836. From 1839 to 1852 he was the president of the Directorate General of Education and created its first Code of Public Instruction for Universities and Academies. He carried out plenty of different medical researches and wrote many important books and papers.

West nile fever case in neurological practice

West Nile fever is a zoonotic arbovirus mosquito- and tick-borne infection, which occurs in humans in the form of an acute febrile illness with symptoms of general intoxication, in severe cases – with the central nervous system damage. West Nile virus belongs to the Flaviviridae family.After the start of Russians’ mass tourism to tropical and subtropical regions, number of cases of the disease in Russia has increased, especially in the south, where the virus is more viable. The infection mainly affects birds but also people and many mammals (bats, cats, dogs, skunks, squirrels, rabbits, etc.), which become infected after the bite of a mosquito of the genus Culex (Culex pipiens) carrying the disease, ixodid or argas mite. A clinical case of hemorrhagic stroke caused by West Nile fever is presented in the article.

Ultrasonic diagnostics of vascular complications after laser procedures

A clinical case of treatment of rosacea with a high-intensity laser at different stages, performed under control of high-resolution ultrasound (HRU), is presented. According to clinical guidelines, patients in the erythematous stage of rosacea (stage I) undergo selective coagulation of superficial vessels with a neodymium laser. Diagnosis and determination of the severity of the disease are carried out based on the presence of primary and secondary elements of the rash. There are no criteria for ultrasound assessment of the skin and its vascularization in patients with rosacea. During ultrasound examination after 4 laser procedures in B-mode, the dermis is heterogeneous due to hypoechoic papillary and hyperechoic reticular layers, without signs of infiltrative changes, in the color Doppler mapping mode there is a pronounced vascularization of the papillary dermis in the area of interest, represented by multiple vessels in contrast to single vascular structures seen on ultrasound after two laser treatments. According to the results of ultrasound examination, a more severe degree of the disease was diagnosed, which served as the basis for prescribing therapy with systemic retinoids. Clinical observation demonstrates the capabilities of ultrasound in planning laser procedures in order to reduce the risk of complications, their early diagnosis and monitoring of treatment if they occur.

Comparative analysis of local stimulation methods of reparative osteogenesis

Objective To determine the ratio of the main growth factors when using various methods of local stimulation of reparative osteogenesis.Material and methods The study consisted of two parts: in the first part a comparative analysis of the content of growth factors by ELISA was carried out (PDGF – platelet derived growth factor, TGF – transforming growth factor, VEGF – vascular endothelial growth factor, IGF – insulin-like growth factor, BMP6 and BMP7 – morphogenetic proteins 6 and 7), capable of stimulating reparative osteogenesis in blood plasma, plateletrich plasma, red bone marrow and bone autoregenerate. The second part presented the results of approbation of the autoregenerate obtained according to the original method in the framework of an acute experiment on animals.Results The most important cytokines affecting the process of reparative osteogenesis are fibroblast growth factor – FGF1 and bone morphogenetic protein 7 – BMP7. Based on the results of a comparative enzymelinked immunosorbent assay, it has been established that the autoregenerate, obtained by the original method, and a bone marrow aspirate concentrate have the highest osteogenic potential.Conclusion Autoregenerate is an effective and promising means of local stimulation of reparative osteogenesis, and its transplantation is a simple and highly effective procedure.

Evaluation of the idiopathic scoliosis of varying severity treatment effectiveness with transpedicular systems

Introduction Significant success has been achieved in the development of new methods of treatment and rehabilitation of patients with idiopathic scoliosis, however, in many aspects of this problem there is no unambiguous approach to the choice of a correction method, assessment of treatment results.Objective To study the results of treatment of patients with idiopathic scoliosis according to X-ray and MSCT data, as well as according to the questionnaire – the SRS-30, depending on the degrees of the deformity, the type of scoliosis.Material and methods The study is retrospective, single center. Evidence level – IV. In 300 patients with idiopathic scoliosis of varying severity at the age from 10 to 50 years, the immediate and long-term results of elimination of spinal deformity by the method of internal transpedicular fixation were studied. In the study we used polypositional radiography, multislice computed tomography (MSCT) and questionnaire SRS-30.Results In patients with spinal deformity up to 60 ° a year after surgery, no loss of correction was found. After elimination of the deformity at 60–90 °, loss of correction up to 2 ° was observed in 3.6% of patients. In patients with deformity greater than 90 °, the average postoperative progression of scoliotic deformity was 3.5 ± 0.7 °. When examining patients after 2–5 years, there was no loss of correction in the group with initial spinal deformity up to 60 ° and in the group from 60–90 °. In patients with deformity greater than 90 °, the postoperative progression of scoliotic deformity in persons over 25 years old was 4.5 ± 0.6 °, which is associated with degenerative changes in the spine.Conclusion The study of immediate and long-term results showed that 1 year after treatment, 94% of patients rated the treatment result as excellent and good, in 6% – as satisfactory. All patients noted a positive effect of the cosmetic and functional results of treatment, while 56% believed that they looked “better” than before surgery (4 points), 44% rated the effect at 5 points and noted that they looked “much better”. Long-term results were studied in 50 patients 10 years after surgery.

Gender differences in the structure of the cerebrospinal fluid system of pre-school children

Relevance Investigation of the cerebrospinal fluid system of children of different ages, especially pre-school and school periods of childhood, becomes essential, since the further development of the brain and its proper functioning depends on the way it functions. Considering the MRI indications of the elements of the cerebrospinal fluid system of children is important for the development of neurology and neurosurgery, it is necessary to consider gender differences in the brain size and structure.Objective To study the sex differences in the structure of the cerebrospinal fluid system in seven-year-old children.Material and Methods For the study, archival data on the sizes of the lateral ventricles of the brain of 120 children aged 7 (60 boys and 60 girls) were involved, in particular: 1) the length of the anterior horn; 2) the width of the anterior horn; 3) the length of the central part; 4) the width of the central part; 5) the length of the posterior horn; 6) the width of the posterior horn; 7) the length of the lower horn; 8) the anteroposterior size; 9) the distance between the anterior horns; 10) the distance between the posterior horns; 11) the length of the third ventricle; 12) the height of the third ventricle; 13) the length of the aqueduct; 14) the length of the fourth ventricle; 15) the height of the fourth ventricle. The studies were carried out using the method of magnetic resonance imaging. Quantitative indicators were assessed for compliance with the normal distribution using the KolmogorovSmirnov test. The accumulation, correction, systematization of the initial information were carried out in Microsoft Excel 2016. Statistical analysis was carried out using the Statistica 10.0 software (StatSoft Inc., USA). The results were considered statistically significant at p < 0.05.Results The data obtained in the study of the cerebrospinal fluid system in children during their pre-school period of childhood are indicators of the norm and can be used for diagnostic studies in the departments of radiation diagnostics. The bilateral asymmetry of the lateral ventricles of the brain in pre-school children, discovered during the work, is of crucial clinical significance. The morphometric indicators of the elements of the cerebrospinal fluid system should be considered by specialists in the study of brain neuroplasticity.Conclusion Analysis of the obtained in vivo encephalometric data indicates the presence of sexual variability of the brain and parameters of the structures of the cerebrospinal fluid.

The role of intravascular methods of examination of coronary arteries in the selection of patients with diffuse and multivessel lesions for myocardial revascularization

Objective Assessment of the role of intravascular imaging methods in choosing the surgical strategy of myocardial revascularization.Material and Methods The study included 62 patients with diffuse and multivessel coronary artery disease, who underwent percutaneous coronary infervention (PCI) using intravascular imaging methods. Measurement of fractional flow reserve (FFR) in diffusely altered arteries was performed under conditions of maximum hyperemia, sequentially between stenoses, using the sensor, starting from the distal segment. Initially, the most distal hemodynamically significant stenosis was stented. Then, a repeated measurement of FFR was performed, and the issue of the need for stenting of other stenoses was solved. The results of stenting, as well as determination of the area of stent implantation were carried out by the method of optical coherence tomography (OCT).Results After FFR measurement the number of arteries with hemodynamically significant stenoses decreased by 24.7% (from 93 to 70). It was also noted that in patients with two-vessel lesions, the average number of such stenoses decreased from 2.95 ± 0.65 to 1.82 ± 0.88, and in patients with three-vessel lesions – from 2.96 ± 0.6 to 2.24 ± 0.76 respectively (p = 0.0024). Complete (functionally adequate according to FFR measurements) myocardial revascularization was achieved in 88.7% of patients. The second-generation drug eluting stents were implanted in 82 (47.1%) patients, and the third generation stents – in 92 (52.9%) patients. At the same time, the success rate of recanalization of occlusions was 100%. Overall, optimal stent implantation was achieved in all patients. Major cardiovascular complications were observed in 1 (1.6%) patient, which required additional interventions.Conclusion Complex use of intravascular imaging methods (OCT and FFR measurements) allows a differentiated approach to the assessment of each stenosis of the affected artery in patients with diffuse and multivessel coronary lesions, to achieve a high frequency of complete myocardial revascularization, as well as to reduce the number of unnecessary interventions and intraoperative complications.

Detection of symptom-related coronary arteries in patients with coronary artery disease using real-time three-dimensional stress echocardiography with adenosine triphosphate

Aim 1) To develop normative values of global and regional left ventricular longitudinal deformation (LVLD) during real time three-dimensional stress echocardiography with adenosine triphosphate (ATP) and utilization of automated function imaging technology (4D Stress-Echo + LVLD with ATP); 2) to compare the effectiveness of detection of symptom-related coronary arteries during 4D Stress-Echo with ATP using: a) traditional visual assessment of regional myocardial contractility and b) step-by-step analysis of segmental LVLD.Material and Methods 15 healthy subjects and 32 patients with coronary artery disease (CAD) were examined after coronary angiography. All individuals underwent 4D Stress-Echo + LVLD with ATP (Vivid E95, General Electric).Results The normative values of global LVLD at three stages of the pharmacological stress-test (before, during and after ATP infusion) were –19.5 (95% CI: -20.4 – -19.0), –21.6 (95% CI: -22.8 – -20.4) and –19.5 (95% CI: -20.3 – -18.6), respectively; the values of LVLD in each of the 17 segments of left ventricular myocardium in healthy subjects were also determined. In patients with CAD visual control of contractility during stress test revealed dynamic decrease in local thickening of the myocardium, appearance of new zones of contractility disorders and expansion of previously noted in 31.2% of cases, while analysis of deformation detected the appearance of new zones of deformation disturbances and expansion of previously found – in 68.7% (р = 0.0055). Stress-induced worsening of myocardial deformation during ATP infusion in the zones of blood supply of left anterior descending coronary artery, circumflex artery and right coronary artery (with presence of hemodynamically significant stenoses and occlusions detected during coronary angiography) were found in 28.0, 77.7 and 65.2% respectively (р1-3 = 0.0194; р1-2 = 0.0019; р2-3 = 0.2864).Conclusion The normal values of global and segmental LVLD for each stage of 4D Stress-Echo + LVLD with ATP were determined. 4D Stress-Echo + LVLD with ATP can significantly increase the effectiveness of symptom-related coronary arteries identification in patients with CAD in comparison with traditional Stress-Echo with visual assessment of local myocardial contractility.

Surgical treatment of thromboembolia in the heart right atrium in pregnant women

Two clinical cases of surgical treatment of cardiac right-chamber thromboembolism in pregnant women are described. Thromboembolism was diagnosed during a routine examination. In the first clinical case, considering the late pregnancy, a thromboembolectomy was performed under artificial circulation after surgical delivery.In the second case, thrombus removal from the right atrium was performed on a working heart, without interruption of pregnancy. The surgical and postsurgical period proceeded without any specific features and the patients were discharged from the hospital without any complications. These clinical cases show that it is possible to remove thrombus from the right heart chambers without the use of extracorporeal circulation, which is also safe for the mother and the fetus.