Introduction. The elimination of critical ischemia in patients with diabetes mellitus requires a delicate approach due to the high risk of complications. The purpose of this study is to analyze the results of revascularization in patients with critical ischemia associated with type 2 diabetes mellitus. Materials and methods. The study involved 135 patients who underwent reconstructive interventions for peripheral arterial disease. Of these, 48 patients suffered from diabetes mellitus, and in 87 patients no disorders of carbohydrate metabolism were registered. The results of surgical interventions were prospectively assessed during the first 30 days after surgery and retrospectively analyzed. Endpoints: primary — reconstructionrelated complications; secondary — major amputations. Adverse events assessed included bleeding, surgicalsite infection, myocardial infarction, stroke, and thrombosis. Results and discussion. Patients with diabetes are more likely to experience adverse effects (52.1 % vs 40.2 %, respectively). In addition, they have more severe postoperative complications. A major role is played by impaired collateral circulation in patients with diabetes mellitus, as well as the presence of concomitant pathologies. Conclusion. At the stage of critical ischemia, the number of dangerous complications after reconstructive surgery increases in people with diabetes mellitus. Against the background of critical ischemia in diabetes mellitus and without it, it is necessary to choose the best option for reconstructive care, taking into account the Archi index, in order to reduce the invasiveness of surgical intervention.

Background. Iron deficiency (ID) is a common issue among patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), negatively impacting their exercise tolerance. Identifying latent iron deficiency in these groups is challenging due to the influence of chronic inflammation on interpreting iron metabolism markers. The L- and H-subunits of ferritin are promising candidates for assessing iron deficiency. Objective is to evaluate the possibilities of using ferritin subunits in the differential diagnosis of absolute and functional (against the background of inflammation) iron deficiency in patients with variants of precapillary pulmonary hypertension. Methods. Study involved 20 PAH and 47 CTEPH patients undergoing echocardiography, right heart catheterization, 6-minute walk tests, and lab assessments of heart failure, inflammation, and iron metabolism. Results. Moderate correlations were found between serum ferritin (SF) and its subunits with MCP-1, which indicates the role of inflammation in changing ferritin levels. The increase in SF in the CTEH group is due to the L- and H-subunits. The study also showed correlations of both ferritin subunits with markers of iron deficiency, such as TSAT and sTfRF, but there were no differences in the ratio of subunits at absolute and functional ID. Conclusion. Findings provide insights into SF/subunit correlations with inflammation/iron markers in PAH/CTEPH, though their utility for differential diagnosis remains limited. The results of the study are important for understanding the mechanisms of iron deficiency in PAH and CTEPH.

Coronary artery disease (CAD) remains the leading cause of death worldwide. While invasive coronary angiography is the gold standard for lumen visualization, it falls short in morphological assessment of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) offers a non-invasive alternative, enabling detailed analysis of coronary artery anatomy and structural plaque characteristics crucial for determining instability and rupture risk. Modern computed tomography (CT) technologies, including dynamic CT perfusion and CT-fractional flow reserve (FFRCT), further enhance CCTA by providing functional assessment of coronary atherosclerosis. Current clinical guidelines position CCTA as a primary non-invasive method for CAD verification, particularly for patients with suspected stable CAD and intermediate pre-test probability. This comprehensive review elucidates the contemporary diagnostic capabilities of CCTA, including its role in assessing anatomical severity and plaque morphology. It details the standardized CAD-RADS reporting system, discusses the utility of FFRCT and CT perfusion for functional stenosis evaluation, and addresses technical limitations and their mitigation. The article emphasizes CCTA’s growing importance in personalized medicine and optimizing patient management pathways.

A case report is presented of a successful hybrid treatment using combined open and endovascular techniques in a patient who developed a giant saccular aortic arch aneurysm during the late period following surgical correction of aortic coarctation in childhood. The young male patient complained of a heavy sensation in the left chest. Multislice CT (MSCT) revealed a large saccular aneurysm of the aortic arch, with a maximum diameter of 9 x 9 cm, extending to the origin of the left subclavian artery. Elective treatment included left carotid–subclavian bypass using a synthetic graft, simultaneous implantation of a stent graft in the Z1 zone of the aortic arch, intraoperative fenestration of the endograft at the left common carotid artery ostium, and subsequent stenting of the carotid origin. Intraoperative fluoroscopy with CT navigation achieved optimal outcomes: adequate perfusion through all brachiocephalic vessels, absence of endoleaks, and reduced contrast exposure. The postoperative course was uneventful, with the patient mobilized on day one and discharged in stable condition on day seven. Twelve-month follow-up MSCT demonstrated complete aneurysm thrombosis and stable stentgraft patency. This case illustrates that hybrid minimally invasive approaches complemented by CT-guided navigation may significantly enhance the safety and efficacy of treating complex aortic arch aneurysms in patients with prior vascular corrections.

Introduction. According to modern concepts, the development of contrast-induced acute kidneys injury after endovascular interventions can negatively affect the results of treatment and can also increase the mortality level. Objective. To evaluate the incidence of contrast-induced acute kidney injury and its impact on treatment results of patients after endovascular replacement of the breast department aorta. Materials and methods. The study included 107 patients who underwent endovascular thoracic aortic replacement. Patients were divided into two groups: the first group with contrast induced acute kidney injury patients and the second group where patients were without any renal damages. Every patient was assessed for age, comorbid status, serum creatinine level and glomerular filtration rate (before intervention, after 24, 48, 72 hours and before discharge). The risk of developing CI-AKI was assessed using the R. Mehran scale. Results. Of all the selected patients, CI-AKI was diagnosed in 20 (18.7 %). The amount of patients with concomitant chronic obstructive pulmonary disease (p = 0.04), post-infarction cardiosclerosis (p = 0.05), chronic heart failure (p = 0.02), ejection fraction left ventricle less than 40 % (p = 0.016) and kidney diseases (p = 0.002) in the first group was significantly more than in the second group. According to the results of multivariate regression analysis of independent risk factors for the development of contrast-induced kidney damage were the patient’s age (OR 1.076; 95 % CI [1.00–1.15]; p = 0.0049) and the volume of used contrast used liquid (OR 1.019; 95 % CI [1.01–1.03]; p = 0.001). Conclusion. Despite the high incidence of contrast-induced acute injury kidneys after endoprosthetics of the thoracic aorta the postoperative period for patients can be evaluated as favorable. The patient’s age and contrast volume are the risk factors for the development of the postoperation complications.

Background. Liposomal drug delivery systems are increasingly used in clinical practice due to their ability to improve the pharmacokinetic profile and reduce the systemic toxicity of drugs. Quinacrine is a promising drug with proven cardioprotective and antiviral activity, however, its use is limited by side effects. The development of a liposomal form of quinacrine (QLPS) can overcome these limitations and increase the efficiency of targeted delivery. Objective. To study the physicochemical properties of synthesized liposomal quinacrine with different concentrations of phospholipids, the kinetics of the release of the active substance and biodistribution in vivo. Design and method. Commercially available reagents were used: phospholipids, cholesterol, vitamin E. The physicochemical characteristics of liposomes (hydrodynamic diameter, polydispersity, zeta potential) were stud ied using the coordination light scattering method. The morphology of liposomes was studied using transmission electron microscopy. The biodistribution study was carried out on laboratory mice using in vivo fluorescence imaging. Results. In the course of the work, the physicochemical characteristics of liposomes were studied, two samples with different concentrations of phospholipids were compared, their release profile and biodistribution were described. Conclusion. The developed liposomal quinacrine has optimal physicochemical characteristics. The obtained data on the active substance release profiles and the features of biodistribution in vivo are the basis for the further development of effective and safe drugs on this platform.

The placenta is a critical link between the maternal and fetal bodies and is therefore a central organ to be studied in the context of fetal programming of the metabolic syndrome. Obesity causes placental dysfunction through various mechanisms, including impaired expression of fatty acid transporter genes, esterification en zymes and lipid deposition. The resulting lipotoxic environment, by increasing proinflammatory markers in maternal plasma and placenta, activating placental inflammatory signaling, and upregulating proinflammatory genes, determines intraplacental functional abnormalities and programs long-term metabolic disorders in the fetus. Abnormalities in placental amino acid transport and mitochondrial dysfunction are observed. Evidence of increased placental reactive oxygen species (ROS) levels, protein nitrosylation, altered cytokine concentrations, and increased lipid peroxidation with subsequent endothelial dysfunction of the placental vascular network is recorded. Studies on hormone levels in placental tissues and fetal cord blood in obese women demonstrate various metabolic shifts. Of particular interest is the consideration of sexual dimorphism in the context of fetal programming, showing a cascade of differences in the genetic, metabolic, and inflammatory profile depending on the sex of the fetus. These changes represent mechanisms contributing to placental dysfunction and program ming of obesity and metabolic diseases in the fetus. However, many aspects of placental dysfunction in maternal obesity require further investigation.

Background. Membrane-associated heat shock protein Hsp70 (mHsp70) is selectively expressed in tu mor, but not in normal cells. The mHsp70 functions are not fully understood. Objective: to study the role of mHsp70 in glioblastoma cell migration. Design and methods. mHsp70-positive rat glioma C6 and human glioblastoma U251 and T98G cell lines were used. Each cell line was sorted into two subpopulations: with high (mHsp70+) and low (mHsp70-) protein expression. The contribution of mHsp70 to migration was as sessed using a wound-healing assay, manual single-cell tracking, and the Transwell analysis. We also exam ined the effect of Hsp70 inhibitors PES and JG-98 on cell motility. To identify potential protein partners of mHsp70 that regulate cell motility, proteomic analysis of lipid rafts of T98G cells was performed. Results. mHsp70+ subpopulations have a higher mean speed (according to manual tracking) and lead to complete wound healing in a shorter period of time compared to mHsp70-. The use of PES and JG-98 inhibitors helps to reduce the speed of movement, as well as the number of invasive cells, with the greatest effect observed for mHsp70+ subpopulations. Proteomic analysis of T98G cells lipid rafts revealed a relationship between mHsp70 and proteins involved in cytoskeleton and extracellular matrix remodeling, adhesion and migration. Conclusion. mHsp70 is involved in glioblastoma cell migration and can be used as a target for malignant neoplasm therapy.

Background. Psychogenic non-epileptic seizures (PNES) are common in pharmacoresistant epilepsy (PRE), especially in neurosurgical patients. Objective. To assess the epidemiology and classify variants of PNES in neurosurgical patients with PRE. Design and Methods. A single-centre uncontrolled open observational study was conducted (2017–2023) at Polenov Neurosurgical Institute within the framework of state assignment No. 123021000127-7. An epidemiological analysis was performed and a classification of PNES was developed. The study was approved by the LEC (protocol No.: 2304-22 of 18/04/2022). Descriptive statistics were used (SPSS 29.0.10; p = 0.05). Results. The study included 369 neurosurgical patients with PRE (cohort 1); PNES were identified in 29 patients (cohort 2). The PNES rate was 8 %. Preoperative PNES occurred in 5.4 % of cohort 1 and 70 % of cohort 2; postoperative PNES — in 2.4 % and 30 %, respectively. The proposed PNES classification includes four variants: isolated PNES, PNES during epilepsy remission, comorbidity of seizures and PNES, and de novo PNES. Conclusion. Psychogenic non-epileptic seizures are reported in about one in thirteen neurosurgical patients with pharmacoresistant epilepsy. De novo psychogenic non-epileptic seizures as psychopathological complications after surgery occur in 2.8 % of patients with epilepsy. The classification of psychogenic non-epileptic seizures includes 4 variants of the combination with epilepsy. The practical applica tion of the data on the epidemiology of psychogenic non-epileptic seizures in pharmacoresistant epilepsy will help to avoid irrational use of antiepileptic drugs and surgical treatment methods.