Background. Adverse left ventricular remodeling (ALVR) after ST-segment elevation myocardial infarction (STEMI) is associated with the high risk of complications. Objective. Identification of laboratory parameters, structural and functional characteristics of arteries associated with ALVR after STEMI and revascularization. Design and methods. 141 patients were included. On days 7–9, after 24–48 weeks, an examination was performed. The endpoints were recorded for 192 weeks. Results. 125 patients were followed up, who were divided into groups: 1st “ALVR” — 63 patients with an increase in end-diastolic volume index by > 20 % and/ or end-systolic volume index by > 15 %; 2nd group “Without ALVR” — 62 people. After 48 weeks, in the 1st group, in patients with glomerular filtration rate (eGFR) < 90 ml/min/1.73 m², the indicator increased by 12.2 %; in individuals with an initial eGFR ≥ 90 ml/min/1.73 m², it decreased by 18.7 %. In patients without ALVR and initial eGFR < 90 ml/min/1.73 m², the indicator increased by 6.2 %. Only in group 2, positive dynamics of endothelial function indicators was revealed. The odds ratio of adverse events in group 1 was 2.8 [1.3–6.1] compared with group 2 (p = 0.007). Conclusion. The development of ALVR after MI in the medium term was characterized by a deterioration in the filtration capacity of the kidneys and persistent endothelial dysfunction over 48 weeks, a high incidence of adverse events over 192 weeks.

Background. Stenotic lesions of cerebral arteries of atherosclerotic genesis predispose to the development of cognitive disorders; carotid stenosis plays a special role in these disorders. The severity of cognitive dysfunction after correction of carotid stenosis is an important consideration. Objective. To determine the dynamics of cognitive functions in patients with carotid artery stenosis before and after carotid endarterectomy, as well as risk factors for cognitive disorders. Design and Methods. The study was based on the observations of 73 patients with carotid stenosis who underwent eversion carotid endarterectomy (CEA). All patients underwent neuropsychological testing including the Mini-Cog test. The first group included 29 patients who scored 2–3 points on the Mini-Cog test. The second group consisted of 44 patients who scored 4–5 points. Results. The most significant impact on cognitive disorders in patients with carotid stenosis is caused by grade III hypertension (OR = 12.8; CI 3.97–41.2). Type 2 diabetes mellitus has no less influence on the development of cognitive impairment (OR = 8.13; CI 2.3–28.7). Other risk factors include post-infarction cardiosclerosis, which also predisposes to cognitive impairment (OR = 6.88; CI 0.73-65.02). Conclusion. Carotid endarterectomy in patients with carotid stenosis is associated with a positive dynamic regarding cognitive dysfunction. The main risk factors for cognitive disorders after surgery are grade III arterial hypertension and diabetes mellitus.

Background. The relevance of real-world data is promising for prognosis, as it represents the entire spectrum of patients with their individual characteristics, including comorbidities, which are often not included in clinical studies. The application of machine learning methods has the potential to enhance the prognostic value; the availability of a substantial amount of data allows to perform cross-validation and confirm results. Objective. To identify clinically relevant laboratory and angiographic markers that are associated with an unfavourable out-come in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Design and methods. A total of 2348 medical records of patients diagnosed with acute coronary syndrome were analyzed. Factors evaluated included the disease course, risk factors and comorbidity, as well as laboratory and instrumental investigations. A logistic regression model was developed using a cross-validation approach. Results. The analysis revealed a number of risk factors for unfavourable course of NSTE-ACS, including angiographic factors (such as left main coronary artery stenosis or chronic coronary artery occlusion) and laboratory factors (haemoglobin level, MPV, monocyte count and SII index). A prognostic model was developed to assess the risk of in-hospital mortality, demonstrating optimal accuracy, sensitivity and specificity. Conclusion. The data obtained support the prognostic value of indicators derived from routine clinical examination in prediction of in-hospital mortality in patients with NSTE-ACS.

Background. One of the types of disorders in the hemostasis system is gestational thrombophilia. Therefore, it is important to understand the etiopathogenesis of this pathological condition, including the contribution of hereditary factors. Objective. To analyze the association of 8 genetic variants of the hemostasis system genes in women with gestational thrombophilia. Materials and methods. The study included 311 women aged 20 to 38 years outside pregnancy, who had at least 1 previous pregnancy with complicated obstetric and gynecological history, and gestational venous thrombosis of various localizations was detected during gestation, and 225 women in the control group. The genotypes of the selected genetic variants were studied by real-time PCR. Results. A positive association was found for 4 genetic variants: 20210 G>A of the F2 gene (GA + AA) (OR = 11.03 (95 % CI: 2.60–46.81), P < 0.001); 1691G>A of the F5 gene (GA + AA) (OR = 6.02 (95 % CI: 2.52–14.38), P < 0.001); -455 G>A of the FGB gene (AA) (OR = 5.65 (95 % CI: 3.05–10.45), P < 0.001) and -675 5G>4G of the PAI-1 gene (4G/4G) (OR = 2.28 (95 % CI: 1.54–3.39), P < 0.001). Conclusion. Thus, we established an association of 4 genetic variants of the genes of plasma hemostasis factors with a hereditary predisposition to AGA in women against the background of the development of gestational venous thrombosis.

The article describes a clinical case of a child with a common cardiac problem — Wolff-Parkinson-White syndrome (WPW), which often debuts with attacks of achycardie paroxystique AV-receveuse (PAVRT) already in utero and recurs in the postnatal period. It is a well-known fact that fetal tachyarrhythmias can cause not only non-immune hydrops as a symptom of heart failure, but also cause antenatal fetal death. The anatomical and physiological basis of Wolff-Parkinson-White syndrome are additional atrioventricular connections, which can conduct impulses from the atria to the ventricles, causing their pre-excitation. We present a clinical observation of a child with an intermittent type of WPW syndrome. The attacks manifested in utero. However, after the early neonatal period, paroxysms of tachycardia did not bother the patient for a long time. At an older age, the method of choice is RFA, after which attacks of PAVRT most often do not recur. This clinical case demonstrates the need for dynamic observation of patients with fetal tachycardia detected in utero, since attacks can recur at any age. The role of parents in recognizing the clinical manifestations of an attack of paroxysmal tachycardia for timely termination of the paroxysm is also important.

Polycystic Ovary Syndrome (PCOS) — frequent endocrine disease of women of the reproductive period, the prevalence of which ranges from 13 % to 25 %. PCOS is a disease with reproductive and metabolic disorders. This article will discuss innovations in the diagnosis and treatment of PCOS.

An innovation in diagnosis is the determination of AMH levels > 4.7 ng/ml (specificity 92 %, sensitivity 89 %) when ultrasound is unavailable, the refinement of ultrasound markers — ≥ 20 follicles or ovarian volume ≥ 10 ml in adults, and the focus on hyperandrogenism with priority for determining free testosterone, taking into account ethnic characteristics.

In the treatment of PCOS, the emphasis remains on lifestyle modification and on combating obesity. 150–300 minutes of physical activity per week is recommended. Among the pharmacological drugs, metformin, COCs and antiandrogens retain their positions, but there are more and more mentions of inositol isoforms that are recommended for use as experimental therapy. Inositols (myo- and D-chiroinositol in a ratio of 40:1) demonstrate effectiveness in improving ovulation (OR 1.8), reducing free testosterone (15–20 %), and moderately reducing insulin resistance (HOMA-IR -0.8). However, their application requires further research for standardization.

Modern diagnosis of PCOS has become more flexible due to the inclusion of AMH, and therapy combines traditional (COCs, metformin) and promising methods (inositols, aGPP-1). Inositols, despite the limited evidence base, occupy an important place in the treatment, especially for metabolic and reproductive disorders.

The currently existing methods for assessing fetal brain oxygenation are indirect and lead either to underestimation of the clinical situation or, conversely, to excessive obstetric interventions. During hypoxia, the amount of paramagnetic deoxyhemoglobin in tissues increases, so it reduces the T2* relaxation time. This phenomenon opens up the possibility of using T2* as a specific diagnostic marker of brain hypoxia during fetal MRI. This review is devoted to the study of the capabilities of the T2* magnetic resonance relaxometry method in the diagnosis of hypoxic conditions of the fetal brain. The currently available data on T2* of various fetal brain structures and their changes in various pathological conditions are presented. According to the data from the studies presented in this review, T2* relaxation time of fetal brain tissue decreases with gestational age, which is associated with both a physiological decrease in brain oxygenation, especially in the third trimester, and with the natural maturation of tissue during fetal development. Also, a number of studies have observed a noticeable decrease in T2* relaxation time of the fetal brain under various hypoxic conditions.

Fetal MRI is technically challenging due to the small size of the brain, unpredictable fetal movements, and also a number of maternal factors. All researchers indicate a decrease of T2* in the presence of hypoxia. In the review various methods for quickly obtaining and processing T2*-weighted images that are resistant to chaotic fetal movements are considered. The presented material can be used for further development of quantitative T2* relaxometry in prenatal diagnostics.

Background. Insomnia is one of the most common sleep disorders. Cerebral hyperarousal is considered to be the main component in the pathogenesis of insomnia detected at all levels in patients with chronic insomnia. The search for mechanisms of hyperarousal is underway in order to apply target therapy to correct insomnia disorder. Objective. The objective of this study was to determine features of glucose metabolism and cerebral perfusion in adult patients with insomnia using fluorodeoxyglucose F18 and 13N-ammonia. Design and methods. The sample included 58 people — 41 patients with chronic insomnia and 17 volunteers without sleep disorders. Objective assessment of sleep was performed using full polysomnography. PET/CT with the following radiopharmaceuticals was used as a neuroimaging technique: 18F-fluorodeoxyglucose to assess brain metabolism and 13N-ammonium to assess brain perfusion and indirectly evaluate the activity of the glutamatergic system. Results. A decrease in glucose metabolism was found in the left prefrontal medial cortex and in the right inferior parietal lobe. Brain perfusion was higher in the right and left prefrontal cortex, anterior cingulate cortex, right parietal lobe, and right and left sensorimotor cortex. Conclusions. The results of this study demonstrate the objective nature of sleep disturbances and changes in brain metabolism and its perfusion in patients with complaints of insomnia, which may be related to sleep deprivation and constitute a manifestation of hyperarousal.

The relevance of the work is to distinguish a mechanism of the therapeutic effect of low-volume hemoperfusion (LVH) — searching for an active metabolite that determine the effects of LVH, and new methods for their detection. The aim of the study was to quantify the electrophoretic mobility of the protein fraction in blood plasma in the dynamics of contact with the SKT-6A HF carbon sorbent in vitro. Materials and methods. The Kapel-105M capillary electrophoresis system was used. Bovine serum albumin (BSA) was used as a standard model solution of the protein fraction. The study was carried out on blood plasma samples from healthy donors in the dynamics of contact with the SKT-6A HF carbon sorbent. Blood samples were taken before the experiment and after 5 and 10 min. Six experiments were carried out. The specialized software “Elforan” was used to collect and process the data. Statistical data processing using RStudio software. Results. The maximum values of the concentration of the protein fraction were observed in samples of 5 min of blood contact with the carbon sorbent SCT-6A HF in vitro. Conclusion. The study will make it possible to decipher composition of the protein fraction of blood plasma, as well as to expand the understanding of the mechanisms of the therapeutic action of the MTF procedure.