Coronary heart disease still underlies high morbidity and mortality in people of working age. Thus, today one of the most important tasks facing clinical cardiology is the search for new molecular genetic predictors of coronary artery disease associated with the unfavorable course of this disease and the development of complications. In the present review, we analyzed the available data on the mechanisms of vitamin D interrelation with the development of immune inflammation in patients with coronary heart disease. The role of vitamin D and its receptor in cardiovascular diseases and in the development of coronary heart disease, in particular, is considered.
Recent studies showed that vitamin D deficiency is a new risk factor for the development of atherosclerosis and immune inflammation. Immune damage of the vascular wall increases the risk of acute coronary syndrome, especially in patients with a predisposition to atherothrombosis. Vitamin D has a multilevel effect on immune inflammation mechanisms by restoring the balance in the system of pro- and anti-inflammatory cytokines. The protective effects of vitamin D on immune inflammation in the vascular wall are realized through vitamin D receptors. The present work re-viewed the studies describing possible mechanisms of immune inflammation regulation by vitamin D and its receptor and activation of immune inflammation in patients with vitamin D deficiency. Further studies of mechanisms of influence of vitamin D receptor on the suppression of immune inflammation are needed.

Background. Until now, the issue of surgical treatment staging in patients with aortic pathology coexisting with coronary artery disease and atherosclerosis of the peripheral arteries remains controversial because of features of each clinical situation and association with the risk of periprocedural life-threatening complications (ruptured aortic aneurysm, myocardial infarction, stroke).
Objective. Present a clinical case of successful treatment of a patient with an abdominal aortic aneurysm, clinically significant lesions of the coronary and carotid arteries.
Design and methods. Diagnosis was carried out using computed tomography of the aorta with intravenous contrast. Instrumental examination included electrocardiography, echocardiography (EchoCG), ultrasound dopplerography of the BCA. Coronary angiography with BCA angiography was also performed.
Results. Clinical diagnosis is an ischemic heart disease, angina pectoris III FC, chronic heart failure II FC and atherosclerosis of the aorta. Aneurysm of the abdominal aorta (diameter 96 mm), stenosing atherosclerosis of the BCA, PVCA stenosis 80 % and occlusion of the LVCA were observed. Patient had hypertension stage III and risk of CVE 4. Firstly, the patient was underwent stenting of the right internal carotid artery, than coronary artery bypass grafting and on the last stage he was performed — endovascular aotric repair. There were no complications in the perioperative period.
Conclusions. Endovascular repair of abdominal aotric aneurysm is an effective method of treating patients with comorbid conditions. However, it is possible the development of fatal cardiovascular complications in patients with combined atherosclerotic lesions of brachiocephalic and coronary arteries that is why they are required a multidisciplinary approach for choosing a safe treatment strategy.

Background. Endovascular occlusion of the left atrial appendage (LAA) using the Watchman device may be considered an adequate alternative to oral anticoagulant (OAC) administration in high-risk patients.
Objective. To describe our experience with Watchman endovascular occlusion of the left atrial appendage in a city hospital setting in terms of feasibility and safety, as well as assess the short-term efficacy of this procedure.
Design and methods. The study included patients who underwent implantation of the Watchman occlusion device from January 2016 to November 2020. The effectiveness of the procedure was defined as the ability to implant the Watchman without maintaining residual current, safety was defined as the occurrence of nosocomial and 45-day events including stroke, pericardial effusion, major bleeding, and device migration.
Results. The study included 22 patients: 10 men and 12 women, who underwent implantation of the Watchman occluding device in the LAA. The indication for implantation was a history of gastrointestinal bleeding in 15 patients, cerebral hemorrhage in 3 patients and low compliance to therapy in 4 patients. The success rate of the procedure was 95.7 %. According to control transesophageal echocardiography, after 45 days LAA was excluded from the bloodstream in 21 of 22 patients.
Conclusion. Despite the higher complication rate of occlusion of the LAA compared to drug treatment, the overall mortality from any cause in patients with the implanted Watchman was lower.

Background. After breast cancer treatment, up to 90 % of patients suffer from various neurological and mental disorders, such as vertebrobasilar insufficiency, chronic pain syndrome, anxiety and depression. These disorders can cause structural changes in the white matter tracts of the brain, which can be detected using diffusion tensor magnetic resonance imaging (DT-MRI).
Objective. To evaluate structural changes in the white matter tracts of the brain in patients with post-mastectomy syndrome using DT-MRI.
Design and methods. The study was carried out on a tomograph with a magnetic field induction force of 3.0 T. 46 patients with neurological disorders in the long-term postoperative period (more than 6 months) after radical mastectomy, chemotherapeutic and/or radiation treatment for breast cancer were examined.
Results. According to the results of an intergroup statistical analysis, all 46 patients with post-mastectomy syndrome had differences in quantitative fractional anisotropy in the white matter tracts of the brain compared with the control group (p < 0.01).
Conclusion. The use of DT-MRI in patients with post-mastectomy syndrome makes it possible to identify changes in the white matter tracts of the brain that correlate with neurological disorders and a decrease in the quality of life in this cohort of patients. The results obtained indicate the need to improve treatment and rehabilitation approaches in patients receiving treatment for breast cancer.

Background. The state of the aorta is a key factor in the prognosis of the patient’s life, since the distension of the ascending aorta in systole determines the blood supply to the myocardium in diastole. Paramagnetic contrast-enhanced MRI provides a reliable assessment of pathological neoangiogenesis, however, in fact, studies of the aorta are performed descriptively, without calculating mechanical strength and extensibility. Objective. To develop and clinically test on the patients with atherosclerotic lesions and myocarditis a method for quantitative assessment of extensibility and mechanical elasticity of the aortic wall.
Design and methods. Were examined 12 patients with acute myocardial infarction with ST segment elevation, as a control group 11 patients without clinical and instrumental signs of atherosclerosis of large arteries and aorta. All underwent MRI of the chest and heart with paramagnetic contrast enhancement (PMCE) and ECG synchronization. The indices of aortic distensibility, distensibility normalized to pulse BP, Young’s modulus of the aortic wall, systolic distension of the ascending aorta (mL), index of strengthening of the aortic wall in PMCE were calculated.
Results. Ascending aortic distensibility decreased in patients with myocarditis and acute infarction. Young’s modulus and distensibility of the ascending aorta significantly correlated with the value of the aortic wall enhancement index in PMCE. Myocardial damage in acute infarction and myocarditis was noted with a decrease in systolic expansion of the ascending aorta below 10 ml due to its reduced elasticity.
Conclusion. There is a relationship between pathological accumulation of a paramagnet in the wall of the ascending aorta, a decrease in its elasticity, a decrease in the volume of systolic aortic dilation, and the development of hypoperfusion myocardial damage. Magnetic resonance elastometry of the aortic wall makes it possible to assess violations of aortic distensibility and predict the development of ischemic damage in the myocardium of the left ventricle.

Community-acquired pneumonia remains an urgent problem in modern pediatrics. Taking into account the variety of pathogens of community-acquired pneumonia, an important task is to identify the etiology of this disease rapidly. Early diagnostics is able to increase the effectiveness of treatment and exclude the irrational prescription of antibacterial drugs or the formation of resistable microflora. Traditional methods of etiotropic diagnostics do not always meet such criteria as timeliness, minimal invasiveness, and simplicity of reproduction. Meeting these requirements is especially important in pediatric practice due to the difficulty of venous access, collection of spontaneous or induced sputum and negative childhood denial reaction to invasive manipulation. Recently, active efforts have been made to identify the early markers con-firming the etiology of pulmonary inflammation, while the criteria for timeliness and non-invasiveness are met by methods for determining pathogen antigens in accessible media such as saliva and urine.
Considering the fact that Streptococcus pneumoniae remains one of the main causative agents of pneumonia, its testing is of great practical importance. This article presents an overview of modern methods of etiotropic diagnosis of community-acquired pneumonia and the results of our own study of the effectiveness of detecting pneumococcal antigens in urine using express tests. Attention is focused on the use of minimally invasive methods for identifying the pathogen in practical pulmonology. Evaluation of the effectiveness of rapid testing was carried out in comparison with the results of bacterial sputum culture for pneumococcus. The analysis of the obtained results showed the high sensitivity and specificity of the Alere Binax Now test when checking the etiology of community-acquired pneumonia in children.