Objective: to evaluate the effectiveness of complex treatment of patients with diabetic foot syndrome in the conditions of one health centre per one hospitalization.

Design and methods: from January to October 2017 at the research Department of vascular and interventional surgery Almazov National Medical Research Centre, adhering to a multidisciplinary approach, treated 28 patients with ischemic and neuroischemic diabetic foot syndrome. 24 of them had diabetic ulcers. The average ABI amounted to 0.44 (0.2 to 0.9). The treatment took place in three stages. The irst phase consisted in the examination and preparation of patients for vascular revascularization in the Department of endocrinology of the Centre. Examination for signiicant comorbidities, correction of glycemic proile, compensation for other late complications of diabetes and relief of systemic inlammation were performed. In the second phase the patients were in the Department of vascular and hybrid surgery where the performed reconstruction of the lower limb arteries. After revascularization, patients continued treatment at the Department of endocrinology of the Centre, which was corrected of treatment of diabetes, was performed sanation of ulcers and plastic surgery of the foot. Estimated change in the severity of pain, the dynamics of the healing of ulcers, the prospect of saving the limb.

Results and discussion: to assess the level and distribution of vascular lesions in the prehospital phase was performed by CT-A or digital angiography of lower limb arteries. In most cases, was detected distal form of atherosclerosis with a primary lesion of the popliteal-tibial segment. Endovascular treatment was performed 23 (82%) patients, 4 (14%) underwent open intervention. In one case, was applied a hybrid approach. All endovascular and hybrid operations were performed in a hybrid operating room under local anesthesia. In the early postoperative period in 79 % of patients achieved clinical improvement in the relief of symptoms of critical limb ischemia, rest pain, positive dynamics of the healing of trophic ulcers. Seven patients (25%) underwent extended necrectomy within the foot with the plastic of local tissues. In the long term (from 3 to 8 months) of observations one death due to myocardial infarction, amputations were not. 85% of patients had complete or partial healing of the ulcer.

Conclusion: complex multidisciplinary treatment of patients with diabetic foot syndrome in the conditions of one medical centre promotes an individual approach to each patient and improves the quality of medical care.

Background. The study of the genetic phenotypes of CHF and the search for markers associated with the outcome of the disease may contribute to a better understanding of the pathophysiology of CHF and to target the therapeutic effects.

Objective. To research the relationship between clinical, instrumental and genetic factors, including polymorphic variants of the genes HSPB7 (rs1739843), FRMD4B (rs6787362), rs10519210 of the locus 15q22 and MADD (rs10838692, rs2290149) with the survival of patients with postinfarction cardiosclerosis and CHF. Design and methods. The study included 506 men aged 55.4 ± 13.5 years with MI transferred more than 3 months ago. The main group consisted of 260 patients with HF-rEF (CHF I-IV FC, with LVEF (Simpson) <40%), reference group – 246 patients without CHF clinic with LVEF (Simpson)> 55%. The control group consisted of 257 healthy donors, comparable in sex and age. Prospective observation was performed by telephone contact.

Results. Allele T and TT genotype polymorphic variant rs2290149 of the MADD gene were associated with the development of IHD and postinfaction cardiosclerosis (p1,2 <0,005). The highest occurrence of the T allele of both polymorphic variants rs2290149 and rs10838692 of the MADD gene was observed in patients with HFrEF (p1,2 <0,0001). CC genotype of polymorphisms (rs2290149, rs10838692) of the MADD gene is associated with a protective effect against IHD with postinfaction cardiosclerosis and, possibly, arterial hypertension, occurring in ≥68% of patients and acting as a competing pathological towards coronary artery disease. The CC genotype of the polymorphic variant rs1739843 of the HSPB7 gene was associated with a lower 3-year mortality in patients with IHD, regardless of LVEF and clinical manifestations of CHF (p <0.05).

Conclusion. The findings confirm the need for further genetic analysis of a broader population of CHF patients with ischemic etiology.

The aim of the study was to evaluate the contribution of psychoemotional factor in arrhythmogenesis in patients with idiopathic ventricular arrhythmias (VA) on the basis of analysis of the results of various mental stress-tests (MT).

Material and methods. 66 patients with idiopathic VA and anxiety neurotic disorders (AND) were included in the study after careful examination. MT were performed all patients according to the study protocol.

Results. According the data of statistical analysis there were not stasistically significant differences in the baseline levels of hemodynamic parameters in the perid of rest between MT. Thus, the sequence of the test does not affect its result. According comparative analysis there were statistically significant differences between MT only in the hemodynamic parameters changes and not in the change of VA. Comparative analysis between men and women in the changes of hemodynamic parameters and VA during the MT did not reveal gender differences.

The conclusion. Use of MT allows to evaluate the contribution of psyhoemotional factor in the genesis of VA in patients with idiopathic arrhythmia and AND. MT should be included in the algorithm for examining patients with VA because of the different effects of psychoemotional and physical stress, like a trigger, on the ventricular ectopic focus.

The clinical experience of performing ventriculoatrial shunting in children with hydrocephalus of tumor etiology in the Department of Neurosurgery of Children Almazov National Medical Research Centre is presented. Intraoperative and postoperative echocardiographic monitoring is suggested as the main method of monitoring the distal (atrial) catheter of the shunting system.

Background. Gemistocytic astrocytomas (GA) are a variant of diffuse astrocytomas GII (WHO, 2016), which is characterized by a shorter overall survival of patients than diffuse astrocytoma. The role of vascular endothelial growth factor (VEGF) gene expression and its association with the index of proliferative activity (Ki-67) in GA has not been studied

Objective. To estimate the correlation of VEGF gene expression on Ki-67 in GA.

Design and methods. A retrospective and prospective analysis of morphological and molecular-genetic features of tumors was performed on 9 patients with the diagnosis of GA. Patients over 18 years of age with supratentorial tumor localization were included in the study. The patients were aged from 27 to 37 years, the median age was 32 years. There were 4 men. Fragments of tumor tissue obtained during surgery were subjected to histological, immunohistochemical (Ki-67 and GFAP) and molecular genetic studies. By real-time PCR method was used to determine the level of the VEGF gene expression and the presence of a mutation in IDH1/IDH2 genes. Histological diagnosis was made in accordance with the classification of tumors of the CNS WHO (2016) and the AFIP atlas (2007).

Results. The tumor most often affected several lobes of the brain (44,4%). The first clinical manifestations of the disease in the vast majority of cases were epileptic and hypertensive syndromes (55,6%). For the proliferative activity index Ki-67 >5% (71,4% of cases) the moderate proliferation of vascular endothelium was noted in 85,7% of cases and the middle/high level of VEGF gene expression (except one case). In patients with low Ki-67 (≤5%), the low level of the VEGF gene expression was determined in 100% cases, the proliferation of the vascular endothelium was absent.

Conclusion. High Ki-67 (>5%), the proliferation of the vascular endothelium, middle/high level of VEGF gene expression are typical attributes of anaplastic astrocytomas. That’s why some GA have features of astrocytomas GIII.

The modern doctrine of treating ischemic heart disease (IHD) is aimed to choose a method, which maximizes the effectiveness and safety for patients. Currently there are three approaches for treatment of stable IHD: optimal medical therapy, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Each approach has own indications and contraindications, based on international recommendations. Separate controversial group of patients are the elderly and senile patients. Limited physical activity, comorbidities, high complications risk in post-PCI double antiplatelet therapy and after CABG, requires strongly individualized approach and proved treatment method. Surgery is possible only after myocardial ischemia is proved by noninvasive imaging methods, assessment of fractional flow reserve (FFR) or its alternative – instant wave-free ratio (iFR) during the coronary angiography. Determination of hemodynamically significant stenosis helps interventional cardiologists to avoid unreasonable revascularization and PCI-related complications.