Objective. To evaluate the association of polymorphic genetic variants PON1 (Q192R /rs662) and CETP (Taq1B/rs708272) with cardiovascular risk in T2DM patients resident in Saint-Petersburg, Russia. Design and methods. 386 patients with T2DM, 299 women and 87 men, mean age 59,3 ± 0,3 years, and 199 healthy controls were examined. Genotyping was performed by polymerase chain reaction followed by restriction analysis. Results. B1B1 genotype of CETP was associated with increased risk of stroke in T2DM patients (OR=1.85; 95% CI 1.07-3.21). RR genotype of PON1 was associated with increased risk of T2DM with stroke (OR=2,98; 95% CI 1,01-8,84). Conclusion. Polymorphic variants of CETP (Taq1B/rs708272) and PON1 (Q192R/rs662) contribute to the cardiovascular risk in T2DM.

Ascending aortic aneurysm is a dangerous disease ranking 15^th place among all causes of sudden death. The social significance of this disease and its almost complete asymptomatic character before life-threatening complications occur determine importance of its early detection and timely treatment. This review joins the most discussed recent theories of the formation of an ascending aortic aneurysm. The own data of the Federal Almazov North-West Medical Research Centre are also presented. Multidisciplinary approach of management and research of ascending aortic aneurysms is used in the Almazov Centre since 2006.

Aortic stenosis (AS) remains one of the most common valvular heart diseases despite the improvement of diagnostic techniques and changing therapeutic approaches. Unfortunately, the only radical treatment of AS nowadays is aortic valve replacement. The main reason for the lack of effective drug therapy that could affect the progression of AS are gaps in the understanding of the pathogenic mechanisms of aortic stenosis formation. This review combines the most discussed possible mechanisms of aortic valve calcification in recent years. Also it contains the results of our studies at the Federal Almazov North-West Medical Research Centre since 2010, allowing to estimate the contribution of different links of the pathogenesis to the development of aortic valve calcification.

Objective. To draw the attention of the medical community to receive unexpectedly gelatinous fibrin clot centrifugate blood serum after the psycho-emotional stress (PEN) in individuals with normal blood pressure and in patients with arterial hypertension (AH). This is a possible risk factor for sudden death in the stress. Materials and methods. 22 normotensive men and 28 men with hypertension (mean age 57 and 58 ± 3 years in both groups) underwent PEN, which all subjects answered the rise of blood pressure (BP), heart rate, an increase diuresis. Determine the size of clot in blood serum centrifugate, hematocrit, fibrinogen before and after PEN. Before the beginning of PEN and after the blood sampling was carried out of the vein (10,0 ml), without physical and chemical exposure. After centrifugation of blood for 10 minutes, determined the quantity of blood serum, and the size of a gelatinous clot. Identification of additional clot was performed using light-optical studies with stains after Gimz and Adams. Electrophoresis of serum obtained before and after the PEN on agar-agar into proteins. Results. After PEN in the centrifugation blood serum appeared colorless gelatinous clot size 18,5 ± 16 mm in normotensives and 26,5 ± 15 mm in patients with hypertension, the quantity of blood serum decreased by 87,5 % (p < 0,05) in normotensives and by 81,8 % in those with hypertension. Conclusions. At PEN in the subjects decreases the quantity of blood serum centrifugation and appears colorless, gelatinous clot containing fibrin, positive for tryptophan. Probably at PEN changing physical and colloidal properties of blood, which may contribute to thrombosis and to be independent risk factors for sudden death in the stress.

Objective. The aim of present study was to identify transthyretin amyloidosis (ATTR amyloidosis) in a selected cohort of patients with chronic heart failure (CHF) and establish the mutations spectrum of the transthyretin gene. Methods and Results. 257 patients with CHF have been examined. Clinical examination, immunochemical staining and genetic analysis were performed. Mutations V30M, H90N, N98N, G6S and deletion (del9) in the TTR gene have been detected. Conclusion. In the studied cohort of patients with heart failure found a relatively high frequency of mutations of the transthyretin gene. We assume that it is important to improve the diagnostics of TTR-related familial amyloidosis in Russia.

Ischemic conditioning has been applied before or after an ischemic insult to the myocardium and has taken the form of local induction of ischemia or ischemia of distant tissues. The aim of this article is to review the up-to-date information in physiological mechanism of ischemic conditioning and experimental evidences of it cardioprotective effects. Additionally, the review discusses the results of recent clinical trials of different types of ischemic preconditioning.

We investigated the Bcl-2 protein expression in neurons of layers II, III, and V of the cerebral cortex of rats at an early and lasting reperfusion period after a 10-minute complete global cerebral ischemia and after application of ischemic postconditioning (IPostC). Reversible global brain ischemia leads to a shortage of morphologically unaltered neurons in layers II and III of the cortex in which increases in the late reperfusion period and is accompanied by a decrease in the level Bcl-2 protein expression in the cytoplasm of neurons unchanged. IPostC, applied as three episodes of ischemia-reperfusion lasting 15/15 seconds contributed to significant increase in the number of morphologically unchanged neurons in layers II, III, and V of the cortex and to an increase Bcl- 2 protein expression in cytoplasm of morphologically unchanged neurons of these layers. In the layer of in the early reperfusion period, there were no changes in the number of morphologically unchanged neurons, but they found a decrease in the level of Bcl-2 protein expression, which increased after application of IPostC. The obtained results allow to conclude, that the implementation of the neuroprotective effect of IPostC for layers II, III, and V of the cortex during global ischemia-reperfusion brain in rats, is implemented through a mechanism leading to increased Bcl-2 protein expression.

Background. Metabolic syndrome (MS) is closely associated with the development of diseases of the cardiovascular system, one of the causes of which are changes in the hormonal system, including adenylyl cyclase signaling system (ACSS), which is sensitive to agonists of adrenergic receptors (AR) and the other hormones and plays a key role in the regulation of myocardial function. However, the functional state of the myocardial ACSS in MS is currently poorly understood. Objective. The aim of the work was to study the hormone sensitivity of ACSS in the myocardium of rats with MS and the influence of metformin (MF) and intranasally administered insulin (I-I) treatment on it. Design and methods. The MS in rats was caused by two-month consumption of 30% sucrose solution and diet enriched by saturated fat. The treatment of the MS-rats with MF (200 mg/kg/day) and I-I (0.5 IU/rat/day) was performed for 5 weeks. Results. The MF and I-I treatment of MS-rats led to restoration of glucose tolerance, insulin sensitivity and lipid metabolism. In the myocardium of MS-rats the adenylyl cyclase (AC) stimulating effects of ß1/ß2-AR agonists, relaxin and glucagon-like peptide-1 were decreased, the relationship between ß1/ß2- and ß3-AR was shifted to ß3-AR, and the inhibitory effect of 2-chloro-N⁶-cyclopentyl adenosine, an agonist of A₁-adenosine receptors, was reduced. The treatment with MF and, to a lesser extent, with I-I restored the hormonal regulation of AC in the myocardium. Conclusion. Thus, in the myocardium of MS-rats the hormonal sensitivity of ACSS was impaired, and the MF and I-I treatment led to its complete or partial restoration, which is one of the mechanisms of cardioprotective effect of these drugs.

Background. Getting gunshot wounds of the head make special group of wounds of a skull and a brain that is caused by their anatomo-physiological features. Wounds of this area are characterized by the high specific weight of arterial and venous bleeding, infectious complications and a lethality. Objective. To show a case of successful surgical treatment of the patient with defect of a skull after a getting gunshot wound with damage of the superior sagittal sinus. Design and methods: the case of plasticity of difficult defect of bones of the arch of the skull, received as a result of a getting gunshot wound with the damage of the superior sagittal sinus split by a bone rag with good cosmetic effect and functional effect is presented. Results and conclusion: the satisfactory provision of an autobone graft is confirmed with data of postoperative CT researches, restoration of passability of the superior sagittal sinus is verified by the MR venography.

The paper discusses the possible role of vitamin D in the progression of osteoarthritis (OA). Emphasis is placed on the role of vitamin D in a change in the architectonics of the articulate cartilage, inflammatory mediators, etc. These information may be of importance for elaborating new approaches to OA to the preventive maintenance of the progression.

The article describes phases of birth and development, current state and prospects of post-graduate education at this institute.

Objective. To assess perioperative dynamics of cerebral autoregulation (CA) in patients with brain arteriovenous malformation (AVM) after endovascular interventions. Methods. The radicality of AVM embolization (Hystoacryl or Onyx) was evaluated in 47 patients by cerebral angiography and blood flow velocity index (FVI) in precerebral arteries with a Vivid E (USA) ultrasound scanner. We monitored blood flow velocity (BFV) in basal cerebral arteries with Multi Dop X (DWL, Germany) and blood pressure (BP) with CNAP (Austria). CA was assessed with cuff test (autoregulation index - ARI) and phase-shift (PS) between spontaneous oscillations of BP and BFV within the range of Mayer’s waves (0.08 - 0,12 Hz). Results. Pre-operative values of ARI and PS were 1,8 ± 0,7 and 0,3 ± 0,2 rad, respectively. Total FVI prior to embolization was 254 ± 336 ml/min, after embolization - 952 ± 305 ml/min (p<0,005). In 15 cases with total embolization significant (p<0,005) increase of rate of CA (ARI: 6,0 ± 1,1, PS: 0,9 ± 0,1 rad) was noted. In other two cases with total embolization, CA didn’t change significantly after operation. In 14 cases with subtotal embolization postoperative ARI and PS were 3,6 ± 0,5 and 0,7 ± 0,1 rad, respectively (p<0,05), and in cases with partial elimination were 2,1 ± 0,6 and 0,4 ± 0,1 rad (p>0,05). Conclusion. CA assessment could be used for detection of its real impairment in perinidal area of AVM during the staged endovascular treatment and for prognostication of postoperative complications.

Objective. To analyze the thromboembolic complications of endovascular neurosurgical operations and the results of their treatment. Materials and Methods: During the period from 2010 to 2014 in the Department of Vascular Surgery of the brain endovascular interventions performed in 2415 patients, 28 (1,16 %) of them developed thromboembolic complications. In order to restore patency of cerebral arteries of 22 patients underwent selective intra-arterial injection of the Actilyse drug, with thrombolysis supplemented by mechanical disruption of the thrombus. 6 patients performed trombekstraktsiya with intracranial self-expanding stent «Solitaire ™ FR Revascularization Device». Results. Complete recanalization was achieved in 25 (89,2 %) of the 28 cases acute thrombosis of intracranial arteries arising during endovascular surgery, in 3 cases there was a partial recanalization. Retromboz artery in one day was detected in 2 patients undergoing aneurysm embolization coils with stent-assistend. Both patients showed a lack of inhibition of platelet aggregation during treatment with dual antiplatelet therapy. There was not Hemorrhagic complications of fibrinolytic therapy. Conclusions. During the endovascular interventions to reduce the risk of thromboembolic complications requires careful preoperative preparation of the patient, assessment of the blood coagulation system and sensitivity to antiplatelet agents. Application of trombekstraktor and thrombolytic therapy to restore patency of intracranial arteries is effective (recanalization was achieved in 89,2 % of cases).