Objective. Comparative evaluation of the efficacy, safety and cost-effectiveness of electrical cardioversion in patients with persistent form of atrial fibrillation in outpatient and hospital treatment.

Design and Methods. The study involved 140 patients with persistent form of atrial fibrillation in accordance with the inclusion / exclusion criteria: electrical cardioversion was performed on an outpatient basis in 108 patients , 32 patients received electrical cardioversion(ECV) on hospital treatment. All patients had ECG, which was performed at admission and 10 days after ECV. All patients were prospectively monitoring for long-term efficacy and safety of antiarrhythmic therapy. Results of the study were processed by methods of variation statistics. Cost-effectiveness analysis was calculated taking into account the factor of «cost / benefit».

Results and conclusions.  The  efficacy  and  safety  of  ECV  in  outpatient  are  no  different  from  the  ECV  in hospital. Performing ECV in outpatient conditions is 6 times cheaper than in the hospital.

Maturity onset diabetes of the young or MODY is one of the monogenic forms of inherited diabetes, caused by genetic abnormalities in beta cells. Soft manifestation and overlapping clinical symptoms of MODY with common types of diabetes often lead to difficulties in diagnosis. One of the main criteria of correct MODY diagnosis is identification of causative mutations in MODY-related genes. Correct MODY diagnosis enable to apply more specific treatment strategies and identify unobvious cases of the disease by testing relatives of the patients. Circulating microRNAs are promising candidates for early diagnostic biomarkers of the disease. The review focuses on current literature data about MODY-associated microRNA types and their levels in diverse body fluids, which help to identify asymptomatic patients with different MODY types. 

Today two main approaches are in the focus of neurobiological studies of brain recovery after a stroke. The first is concerned with the infusion of stem cells in damaged brain. The second approach is directed at the stimulation of endogenous reparative processes, in particular, adult neurogenesis. This review considers alterations of adult neurogenesis caused by cerebral ischemia and possible pathways of its regulation. Numerous studies performed on animals have shown that adult neurogenesis is mostly increased after cerebral ischemia. Increased proliferation of neural stem cells and migration of newborn cells towards to infarct zone make adult neurogenesis a potential target for brain recovery. However, the most part of newborn neurons die before reaching maturity. Besides, an increase of neurogenesis in pathological conditions is mainly due to recruitment of new stem cells, but not due to an additional precursor-cells division that results in an overall decline of the regeneration capacity. Thus, the endogenous reparative mechanisms are not sufficient, and the search for new targets to promote proliferation, survival, and maturation of new neurons after a stroke is needed. Neurotransmitter systems, growth factors, and anti-inflammatory drugs are considered as potential regulators of post-ischemic neurogenesis. Besides, recent studies showed direct reprogramming of astcrocytes to neurons after brain damage.

The objective of this work is comparative clinical analysis of the visual aura in patients with migraine with aura and symptomatic occipital epilepsy which is based on our own data and literature review.

Design and methods. We have analyzed the published data and have given the results of our study. The study is based on clinical observation of 2 groups of patients: 99 patients with migraine and 155 patients with epilepsy. We have used clinical-neurological  method  and  interviewing. 

Results.  It  was  detected  the  frequency  of  migraine  with  aura-17% and occipital epilepsy -3.2%. The characteristics of the visual aura in migraine and epilepsy were showed. Conclusion. Sometimes differential diagnosis of occipital epilepsy from migraine with aura can be difficult, especially when there is no tonic or clonic motor manifestations. However, visual aura of migraine is different from aura in occipital epilepsy by visual images, dynamics and distribution of visual phenomena in the field of view, the duration of the aura and the time of occurrence of the subsequent headache. 

Background. Congenital cystic adenomatoid malformation (CCAM) and pulmonary sequestration (PS) occupy significant place in the structure of congenital malformations of lung. These defects subject to surgical correction in many cases. Diagnostic algorithm, age and volume of operation are discussed. General terms of the development of these malformations, occurring picture of combination of histological changes corresponding PS and CCAM, suggest a single origin of these defects. The propensity to infection and the development of inflammatory complications and malignancy define a common approach to the surgical treatment of these conditions.

Objective. Improve the results of treatment of children with CCAM and PS and analyze the experience for the period of 6 years in Federal Almazov North-West Medical Research Centre. Design and methods. 61 patients with CCAM and PS were treated. Patients underwent surgery with good and excellent immediate and long-term results.

Conclusions. Delivery in pregnant women with suspected or established diagnosis of lung malformation should be performed in a specialized perinatal centers with surgical and intensive care unit for newborns and experience in treating these patients. In the postnatal period necessary to carry out X-ray and CT scan with contrast, these types of surveys should also be used in all cases available according to the prenatal ultrasound of the suspected malformation of the lung. The optimal time for surgery — the first month of life.

Inhibition of renal functional activity in children happens at an early age in proportion to stage of obstructive uropathy and activity of inflammation. Echographic and doppler scanning meet clinical and pathogenetic stages of development of chronic obstructive pyelonephritis. On Doppler sonography renal arterial blood flow velocity increase significantly along the whole length of renal blood stream in children on active stage of chronic pyelonephritis (p<0,05). Maximum systolic velocity in comparison with ultimate diastolic velocity increases in a greater degree. It determines elevation of peripheric resistance. At zero interstitial inflammation and low-grade obstructive uropathy, there has been mean value of resistance index (0,64+-0,03). It characterizes appropriate vascular tone. On B-scan sonography of patients with arteriolosclerotic kidney, renal reduction, irregular margins of renal, absence of cortico-medullary differentiation, diffuse irregular change of renal parenchyma with heterogenic hyperechogenicity, medium dilatation of renal collecting system are diagnosed significantly (p<0,001). On Doppler sonography for stage of decompensation there has been marked decline of blood flow velocity at all levels of renal blood stream, for some cases — absence of parenchyma blood circulation.

Main role of development of chronic obstructive pyelonephritis in children belongs to renal blood failure. Their degree detects clinical and pathogenetic stages of disease. At the compensated stage blood flow velocity increase in proportion to activity of inflammation. Subcompensated stage is characterized vasospasm. Hypoperfusion is principal rate for stage of decompensation. Criterions of prediction of outcomes of chronic renal disease are change of thickness of renal parenchyma, maximum systolic velocity and ultimate diastolic velocity, resistance index. Pathogenetic mechanism of staging of renal circulatory failure is basis for principles research on renal dysfunction.

5-days-old girl 1.6 kg. has underwent successful surgical repair for transposition of the great arteries.

Along with the functional, morphological methods at the forefront in evaluating the effectiveness of impacts that weaken the severity of irreversible ischemic damage to the myocardium. Histological examination using hematoxylin-eosin and classical connective tissue staining — are routine methods in the assessment of myocardial remodeling after infarction. However, due to the limited use criteria for macroscopic evaluation, the possibility of these methods are not fully disclosed.

This article describes the main approaches to the evaluation of macroscopic parameters of the scar size and heart remodeling, a comparative analysis of known criteria for morphometric evaluation of the native heart and the hearts with advanced of post-infarction chronic heart failure.

For assessment of scar size used parameters such as percentage (%) of scar area with respect to left ventricle area, scar length in % of epiand endocardial ventricular circumference, left ventricular wall thickness in the scar area. Intensity of remodeling was assessed by measuring the thickness of the interventricular septum, calculating of the LV dilation index (%) with and without consideration the LV wall thickness and index of hypertrophy.

Comparative analysis of the informativeness of different parameters can be recommended for morphometric assessment of the transmural scar size and LVremodeling, scar length as a percentage of epiand endocardial circumference of the LV, LV dilatation index (%) excluding the thickness of the ventricular wall and hypertrophy index as the main criteria for assessment.

Aim of the study was an analysis of plasminogen (PG) dynamics and of content/activity of its activators, urokinase (uPA) and tissue (tPA) ones, as well as of their type 1 inhibitor (PAI-1) in experimental liver metastasis.

Material and methods. The study included 44 white outbred male rats. Levels and activity of uPA, tPA and PAI-1 were identified in liver tissue by the ELISA method, and PG content was studied by spectrophotometry.

Results. Practically all indices reduced in the liver prior to metastases formation (uPА activity was unchanged). In metastases, while PG level was high, activity of its activators and PAI-1 was higher and their levels — lower than in parametastatic area. Metastases which further metastasize were characterized by a higher tPA and PAI-1 activity with their lower reduction; parametastatic area of such metastases showed the maximal PG increase, higher content/activity of uPA and tPA and lower PAI-1 level with its higher activity.

Conclusions. The study confirmed the fact that plasminogen activation system is involved in metastatic process and identified some characteristics of liver metastases.