Thromboembolic complications is a frequent cause of acute cardiovascular events, disability and mortality. Among the factors that increase their risk in the female population using of medications, containing sex hormones is of high significance. In oral contraceptives the main — contraceptive activity belongs to gestagen, while estrogen performs an auxiliary function of menstrual cycle control. In medications used for therapy during menopause the main active substance is estrogen. Progestin provides prevention of endometrial hyperplasia. Despite the intensive search for optimal effective and safe schemes of combined hormonal drugs, the risk of thrombotic complications in patients using them both for therapeutic purposes and as contraception remains high. The article provides clinical observations illustrating the administration of hormonal therapy to women is reasonable to be discussed and agreed with cardiologists and/or general practitioners, and the patients would be informed about possible cardiovascular complications of such therapy for an adequate selfcontrol.

Background. Diet and nutrition can favorably modulate arterial function during vascular aging, and therefore the search for their relationship is important.

Objective. To study the relationship between eating behavior and markers of early vascular aging in patients with prehypertension and arterial hypertension.

Design and methods. The respondents from the population sample of the epidemiological observational study ESSE-RF were questioned. 477 questionnaires were selected for further analysis of the respondents’ eating habits and the prevalence of early vascular aging among them. Inclusion criteria were age over 40 years to assess the risk of developing cardiovascular complications using the SCORE and ASCORE scales; lack of criteria for high and very high risk on the SCORE scale. A standard questionnaire was used, developed on the basis of adapted and validated international methods, with 12 modules. In the answers of the respondents, the amount and frequency of consumption of table salt, sugar, animal fats, meat and processed meat products, vegetables and fruits, poultry and fish were analyzed. The estimated vascular age of all respondents was assessed using the ASCORE scale.

Results. In total, the responses on eating behavior were analyzed in 295 women and 182 men aged 40 to 65 years; the estimated vascular age (ASCORE) was 55.5 ± 9.6 years. For respondents with healthy vascular aging, compared to respondents with premature vascular aging, significantly less salt (57.2% versus 70.6%), sausages (44.1% versus 27%) and higher consumption of poultry meat are typical (44.1% versus 13.9%), dairy products (73.6% versus 41.4%) and fresh vegetables / fruits (88.2% versus 58%). The group of people with healthy vascular aging showed a higher level of daily consumption of sweets (55.9% versus 30.5%).

Conclusion. Based on the results of a questionnaire survey of the population sample, it can be assumed that there is a connection between the peculiarities of the food pattern and vascular aging. Express assessment of eating behavior and calculation of vascular age can be used in outpatient practice for preventive counseling.

Background. Carotid endarterectomy is an effective and safe operation aimed at treating patients with hemo-dynamically significant stenosis of the carotid arteries, the outcomes of which are well studied, and the permissible levels of postoperative complications are presented in the current recommendations. Nevertheless, the issues related to the incidence of cardiovascular accidents in different age groups of patients have not been sufficiently studied.

Objective. Analysis of hospital outcomes of carotid endarterectomy in different age groups. Design and methods. The study included 1416 patients who were operated on for stenotic lesions of the internal carotid arteries. According to the WHO classification, patients were divided into groups depending on age: up to 44 years — young age (n = 76); 45-59 years old — average age (n = 291); 60-74 — old age (n = 835); over 75 years old — old age (n = 214). The compensatory capabilities of cerebral blood flow were assessed by invasive measurement of the retrograde pressure in the internal carotid artery. The endpoints were death, myocardial infarction, acute cerebrovascular accident, transient ischemic attack, hemorrhagic complications, cranial nerve damage, combined endpoint.

Results. There were no significant differences in the incidence of all cardiovascular events. In the group of young patients, no lethal outcomes, myocardial infarction, acute cerebrovascular accident, or transient ischemic attack were recorded. All deaths were caused by the development of ischemic stroke as a result of distal embolization. In cases of non-fatal acute disorders of cerebral circulation, transient ischemic attacks in 1 patient of the 60-74 year group, the catastrophe developed against the background of thrombosis of the internal carotid arteries. In other 3 cases, on the background of the development of hyperperfusion syndrome. In 1 patient of the 60-74 year group, hemorrhagic transformation of the old ischemic focus with the development of intracerebral hematoma was recorded. There was also no significant intergroup difference in the incidence of hemorrhagic complications. The total number of all cardiovascular events in each group and the sample as a whole did not exceed one and a half percent, which corresponded to the standards described in the current recommendations.

Conclusion. There was no statistically significant difference in the development of adverse cardiovascular events depending on the patient’s age.

Background. Diving experience and the influence of factors of professional activity lead to the development of cardiovascular pathology and the study of the state of the cardiovascular system of divers is one of the urgent problems of modern medicine.

Objective. The aim of the study was to determine hereditarily structural and functional features of the cardiovascular system representatives of extreme professions of the Navy and differentiate them from the influence of some factors. Design and methods. Surveyed 81 military personnel at the age of 21-44 years. The surveyed were represented by three groups, which did not differ significantly in age. In the first group (n = 31) included the deep-sea divers, the second group (n = 28) was introduced by the technical operators of deep-sea vehicles and third (n = 22) group consisted of officers of the Navy, which were not factors of diving work and the specific factors of deep-sea resources. Used regulated and special methods for the study of the cardiovascular system, which was estimated depending on the polymorphic gene variants of matrix metalloproteinase 1 (MMP-1) gene and collagen type 1 (COL1A1) gene.

Results. Statistically significant differences in the distribution of polymorphic variants of the MMP-1 and COL1A1 genes from the specialists of the Navy of the surveyed groups, the distribution of genotypes and analysis in the future was conducted on the combined group. Fifteen groups of indicators (clusters) were identified that change unidirectionally depending on the polymorphic variants of the MMP-1 gene and the COL1A1 gene. Identified favorable and unfavorable combination of polymorphic gene variants of the gene MMP-1 and the gene COL1A1.

Conclusion. The resistive characteristics of the cardiovascular system respond to the conditions of professional activity, including those of specialists in extreme specialties of the Navy. Basic resiliently-elastic properties of the cardiovascular system are associated with polymorphic variants of the MMP-1 and COL1A1 genes involved in the synthesis and degradation of collagen; however, to determine the specific role of each under the influence of extreme occupational factors, larger studies are required.

Background. Magnetic resonance imaging (MRI) is a highly informative method for the diagnosis of various types of temporomandibular joint dysfunction (TMJ), which makes its use an integral component in choosing a treatment algorithm and evaluating its effectiveness.

Objective. Determine the value of MRI in the diagnosis, planning and effectiveness of conservative treatment of patients with various types of ventral dislocation of the intra-articular disk TMJ.

Design and methods. We analyzed the results of clinical and instrumental studies at the stages of planning, treatment and evaluating the effectiveness of conservative therapy in dynamics in 62 patients with complaints of pain in the joint area, difficulty opening the mouth and joint noise. Results. In patients from the dynamic observation group with complete ventral dislocation of the disc identified prior to treatment, conservative treatment underwent positive dynamics of clinical manifestations and the absence or negative dynamics of MRI results. In patients with partial ventral dislocation of the disk, there was a positive dynamic of both clinical manifestations and MR images after conservative treatment.

Conclusion. MRI is a fundamental method in the complex diagnosis of various types of ventral dislocation of the disk, the use of which in certain cases allows us to predict the ineffectiveness of conservative therapy and becomes a decisive factor in the appointment of invasive treatment methods.

The gold standard for diagnosing injuries in polytrauma is computed tomography (CT) of the whole body. This method of radiation diagnostics allows to quickly and non-invasively obtain high-resolution images for an accurate assessment of all trauma-related injuries.

To date, there are different opinions on the optimal algorithm for conducting and evaluating CT in patients with polytrauma, but a unified standard of research methods for this category of patients has not been developed.

This article presents the experience of various domestic and foreign hospitals providing medical care to patients with various types of combined and multiple injuries, as well as describes methodological recommendations for performing and analyzing CT of the whole body in patients with polytrauma, obtained on the basis of our own practical experience. In the article, we also reflected the peculiarities of the interpretation of the resulting traumatic injuries in the native, arterial, venous and delayed phases of scanning; clinical examples of CT studies in patients with polytrauma are given. We noted the particular importance of postprocessing processing of images obtained during CT examination. Here, we recommend performing CT of the whole body in polytrauma with the use of multiphase intravenous bolus contrasting, which allows a more detailed assessment of the changes in internal organs and soft tissues and diagnoses the presence and nature of bleeding. Comprehensive and detailed evaluation of CT images obtained in patients with polytrauma is aimed at helping clinical specialists choose the best treatment method, prioritizing and predicting patient management in each case.

Background. Multiple pregnancy has increased risks for complications. The incidence of fetal anomalies in multiple pregnancies is also significantly higher than in single pregnancies. The syndrome of death of one fetus in multiple pregnancies is often combined with an increase in perinatal morbidity and mortality of second fetuses.

Objective. To investigate and categorize the range of the surviving fetal brain damage by prenatal magnetic resonance imaging in case of single intrauterine fetal death of monochorionic twin. Design and methods. Seventeen patients with a monochorionic multiple pregnancy which complicated by single intrauterine fetal demise were included in retrospective study. All cotwins underwent ultrasound neurosonography and magnetic resonance imaging.

Results. The were no structural pathological changes in 8 cases (47,1 %), while 4 (23,5 %) had only isolated moderate ventriculomegaly. In 5 cases (29,4 %) surviving fetuses from monochorionic diam-niotic twins had structural and morphological brain abnormalities.

Conclusion. Brain injuries of the surviving co-twin after single intrauterine fetal demise in monochorionic pregnancy are mostly ischemic and manifest as periventricular leukomalacia in combination with ventriculomegaly.

Background. Despite the functional multiplicity and complexity of TNF- α effects, its role in the central nervous system in the development of various pathological conditions of the body is still poorly understood.

Objective. Analyzing the dynamics of TNF- α and its receptors in the brain of urokinase (uPA-) gene-knockout mice with malignant growth in presence of chronic neurogenic pain (CNP).

Design and methods. The study included male and female mice of two strains: C57BL/6 (n = 80) and C57BL/6-PlautmI.IBug-ThisPlau6FDhu/ GFDhu (n = 56). A CNP model was created in animals of the main groups by the bilateral sciatic nerve ligation; 2 weeks after it, B16/F10 melanoma was transplanted under the skin of the back. The comparison group — sham operated animals with transplanted melanoma. Control groups — sham operated animals and animals with CNP. On day 21 of the melanoma growth, the mice were decapitated, and levels of TNF- α, sTNF- α R1 and sTNF- α R2 were determined in the cerebral tissues by ELISA.

Results. High levels of TNF- α (by 5.6 times) and low TNF- α R1 (by 2.1 times) were registered in the brain of uPA- males, while no changes were registered in females. Under the influence of CNP, brain levels of TNF- α became similar in male and female mice; TNF- α levels in uPA- mice were twice higher than in animals with the normal genome. The CNP stimulating effect on the malignant process in uPA- mice was based: in females — on an increase in the cerebral concentration of TNF- α R2 (by 1.7 times, p<0.05), in males — on TNF- α reduction (by 2.2 times).

Conclusion. The specificity of the fibrinolytic status of mice determines the course of subcutaneously transplanted melanoma in presence of pain, and one of the mechanisms of this phenomenon involves a change in the functioning of the brain TNF- α system, depending on the animal gender.

Procedures using iodine-containing X-ray contrast agents pose a risk to kidney function, especially in patients with pre-existing renal dysfunction. Contrast-induced nephropathy is the third most common cause of acute kidney injury, and in high-risk groups the incidence of contrast-induced nephropathy may approach 20-30 %. Therefore, assessing and reducing the risk of contrast-induced nephropathy remains a very important issue. There is no treatment for contrast-induced nephropathy in the world, so the main focus is on its prevention. This methodological article describes in detail the definition, methodology for assessing the risks of development and diagnosis of contrast-induced acute kidney injury. The main aspects of prevention of contrast-induced acute kidney injury during angiographic studies and interventions using X-ray contrast agents are also considered. Particular attention is paid to hydration, as the main method of hydration of contrast-induced acute kidney injury, taking into account the somatic status of the patient.