I.P. Pavlov Russian Medical Biological Herald

INTRODUCTION: The binary in-stent restenosis (ISR) still remains the main factor limiting the effectiveness of percutaneous coronary intervention in the long-term period. Histologically, ISR is defined as neointimal hyperplasia leading to hemodynamically significant narrowing of the arterial lumen. Patients with coronary artery (CA) restenosis represent a particularly challenging group for endovascular treatment.

AIM: To compare effectiveness and safety of the endovascular correction of coronary in-stent restenosis using second- and third-generation stent systems and balloon angioplasty with a drug-coated balloon catheter.

MATERIALS AND METHODS: The study retrospectively included 62 patients with recurrent ISR after the previous endovascular correction. The patients underwent treatment with re-stenting in Saint George Clinic of Thoracic and Cardiovascular Surgery of the National Pirogov Medical Surgical Center in 2016–2023 with use of second- and third-generation drug-eluting stents — cobalt (cobalt alloy) systems with zotarolimus, cobalt-chromium stent systems with sirolimus and zotarolimus, platinum-chromium stent systems with everolimus with biodegradable drug coating. Balloon angioplasty was performed using paclitaxel-coated balloon catheters. The primary endpoint of the study was the target lesion failure (TLF) of CA. The secondary endpoint was major adverse cardiovascular events (MACE).

RESULTS: The TLF rate was 15.6% vs. 13.3% and 28.1% vs. 46.7% in the groups with use of a drug-eluting stent and balloon angioplasty at 1- and 2-year follow-up, respectively (p = 0.30). MACE was recorded in 18.8% vs. 16.7% and 37.5% vs. 56.7% of cases in the groups with use of a drug-eluting stent and balloon angioplasty at 1- and 2-year follow-up, respectively (p = 0.25). The dispersion analysis of predictors of TFL risks identified three factors showing a reliable correlation with the probability for TFL by the second follow-up year in both groups: (1) recurrence of binary ISR (hazard ratio (HR) 2.21; 95% confidence interval (CI) 0.95–4.01; p = 0.03)) in 365 days after the third stage of the percutaneous coronary intervention; (2) length of coronary restenotic lesion (per every 10 mm) (HR 1.25; 95% CI 0.99–1.40; p = 0.002); (3) occlusive restenosis (HR 4.16; 95% CI 0.43–26.96; p = 0.04).

CONCLUSIONS: The implantation of a second- and third-generation drug-eluting stent and balloon angioplasty with use of a drug-coated catheter are comparable in the effectiveness and safety in correcting the recurrent ISR, however, restenting is associated with a lower probability for developing TFL and adverse events.

INTRODUCTION: Employees of the Department of Ophthalmology of Bashkir State Medical University, jointly with engineers of the Department of Microsurgical Equipment of Optimedservice, have developed a new method of adaptive control of infusion during phacoemulsification (PE) permitting to control the infusion flow depending on the changes in the rate of aspiration and infusion flows characteristic of a certain hydrodynamic situation, and also on the vacuum level in the aspiration line. An important aspect of safety of the new method is histological and electron microscopic examination of rabbits’ cornea in different periods after experimental PE.

AIM: To evaluate histological and electron microscopic features of the rabbits’ cornea after experimental PE using a new method of adaptive control of infusion.

MATERIALS AND METHODS: The experiment was conducted on 15 eyes of Chinchilla rabbits using a new method of adaptive control of infusion on the basis of Optimed Profi surgical system (Optimedservice, Russia). Histological and electron microscopic examinations of the cornea were performed on the 1^st, 7^th and 30^th day after surgery.

RESULTS: On the 1^st day after surgery, according to the study data, signs of moderate edema of the corneal stroma with mild separation of collagen fiber bundles were observed. In the cell cytoplasm, signs of dystrophic processes in the epithelial cells were noticeable in the form of vacuoles of different sizes. On the 7^th day after surgery, signs of alteration in the rabbits’ cornea reduced. In 30^th days after surgery, based on the data of histological and electron microscopic examinations, the cornea fully corresponded to norm.

CONCLUSION: The identified histological and electron microscopic alterations considerably diminish on the 7^th day after surgery, and on the 30^th day the ultrastructure of the cornea corresponds to the norm.

INTRODUCTION: A wide spread of infection caused by SARS-CoV-2 coronavirus (Severe Acute Respiratory Syndrome-related coronavirus 2 associated with a severe acute respiratory syndrome) in the population, high risks of infection in pregnant women and the lack of understanding of the mechanisms of invasion of the agent into the placenta and its effect on the perinatal outcomes, dictate the need for targeted investigation of the morphofunctional features of placentas of puerperia’s who have suffered this infection.

AIM: To identify pathomorphological alterations in placentas in a mild, moderate and severe course of the new coronavirus infection in women during pregnancy.

MATERIALS AND METHODS: A morphological survey research of 63 placentas of women who have suffered SARS-CoV-2 infection during pregnancy was conducted. The material was divided into groups with mild (n = 16), moderate (n = 35) and severe (n = 12) course of the disease. The control group included 25 placentas from women with physiological pregnancy. After standard fixation and histological preparation of the material, the tissue sections of 4 µm to 5 µm thickness were stained with hematoxylin and eosin.

RESULTS: It has been established that the new coronavirus infection runs with general pathological alterations in the placentas. In a mild course of the infectious process, inflammation in the basal (12.5%) and parietal (25.0%) decidual membrane, disorders in maternal (6.3%) and fetal (6.3%) hemocirculation were diagnosed. A moderate course of the disease was characterized by predominance of placentas with impaired differentiation of chorionic villi by dissociation type (74.3%, p = 0.0001) and of mononuclear deciduitis (57.1%, p = 0.008). In a severe course of SARS-CoV-2 infection, abnormalities in the form of placenta (58.3%, p = 0.004) and in the attachment of the umbilicus (58.3%, p = 0.03), villous infarctions (33.3%, p = 0.05), thrombosis in the maternal (63.7%, p = 0.005) and fetal (57.3%, p = 0.005) parts of vascular bed were noted.

CONCLUSION: Thus, the mild course of SARS-CoV-2 infection is characterized by chronic inflammation in the structural components of the placenta, the moderate course — by the dissociated development of cotyledons, the severe course — by disorders in hemocirculation in the form of infarctions and thrombosis.

INTRODUCTION: The study of vascular stiffness is a method of assessing the risk of cardiovascular diseases. One of methods of assessing arterial stiffness is theсardio-ankle vascular index (CAVI), which reflects the extent of structural lesion of vessels. This index has prospects in application for studying vascular stiffness in senile individuals with chronic heart failure (CHF) to identify new predictors of the cardiovascular risk.

AIM: To study the parameters of vascular stiffness (cardio-vascular and ankle-brachial indices) in senile patients (75–89 years) with CHF using the volume sphygmography method.

MATERIALS AND METHODS: The study included 120 patients (87 women and 33 men) with CHF of senile age (mean age 81.3 ± 4.2 years). In all patients, the electrocardiography and sphygmography data were analyzed with assessment of the CAVI and ankle-brachial index.

RESULTS: In patients with IV functional class (FC) CHF, the highest CAVI was found on the right exceeding the parameters of II FC CHF and III FC CHF groups by 0.57 and 1.02 units, respectively (p < 0.05). The CAVI on the left in patients with IV FC CHF was higher in comparison with II FC CHF and III FC CHF groups by 0.47 and 0.6 units, respectively. There were also identified correlation relationships of vascular stiffness with the age of patients, functional class of chronic heart failure and echocardiographic parameters: left ventricle ejection fraction, left ventricle end-diastolic diameter, left-ventricle end-systolic diameter (p < 0.05).

CONCLUSION: The cardio-ankle vascular index can be used to assess vascular stiffness in senile patients with CHF and can help determine the risk of cardiovascular diseases. Further studies are needed on a larger sample of patients.

INTRODUCTION: A promising direction that has recently emerged in morphology is investigation of the arterial bed of various human organs as fractal or quasi-fractal systems. Conceptual models have been developed permitting a quantitative description of the vascular bed features. This approach will help to create a morphometric standard of the intraorgan blood flow, which will be useful in objective diagnosis of probable deviations from the normal structure.

AIM: To identify the morphometric features of various types of bifurcations of the splenic intraorgan arterial bed in individuals of different gender and age.

MATERIALS AND METHODS: The characteristics of the splenic intraorgan arterial bed have been studied in 67 individuals who died suddenly and from accidental causes at the age of 21 to 60 years. The arterial bed was represented as connected graphs with vertices corresponding to the bifurcation points of arteries, and edges to the arterial segments. The diameter and length of an arterial segment were measured on corrosion preparations. Based on the morphometry data, the following parameters were determined: generation number, division level, form factor FF1, branching factor ƞ and asymmetry factor γ. Statistical analysis was carried out using the R language.

RESULTS: The total number of examined arterial bifurcations was 6,840. The examined bifurcations were located at 20 division levels and presented 8 generations. In the structure of the vascular bed, bifurcations of neutral kind (0) predominated with the relative quantity 51%. The least numerous was type 2 bifurcations — 9%. The intermediate position was taken by open (1) bifurcations accounting for about 40% in the vascular bed structure.

CONCLUSIONS: The intraorgan arterial bed of the spleen is a quasi-fractal system consisting of three types of bifurcations — open, neutral and closed. A relative number of different types of bifurcations differs depending on gender and age and is also related to the generation number and division level.

INTRODUCTION: Endometriosis is a chronic, hormone-dependent, progressive and recurrent disease characterized by the existence of tissue outside the uterine cavity, similar to endometrium in the morphological and functional properties. This disease is gaining increasing medical and social significance due to its severe clinical manifestations and recurrent course, as well as a negative impact on the quality of life and working capacity of women. The incidence of abdominal wall endometriosis (AWE) that is referred to extragenital localization, is 0.3% to 3.5%. In most cases, it develops after cesarean section, less often after other gynecological operations (hysterectomy, removal of endometrioid ovarian cysts). Its recognition presents certain difficulties due to the necessity of differential diagnosis with postoperative hernias, ligature abscesses, hematomas and use of additional imaging methods. In this context, of interest is to study the clinical and history data, localization and management tactics for female patients with the anterior abdominal wall endometriosis.

AIM: Investigation of clinical presentation, diagnosis, treatment of one of the rarest and least studied forms of extragenital localization of endometriosis — AWE — and improvement of management tactics for patients with this pathology.

MATERIALS AND METHODS: A clinical analysis of AWE cases with several variants of its invasion was carried out in 7 female patients.

RESULTS: The age of the patients ranged from 27 to 39 years (median — 33 years). All the seven patients had a past cesarean section; the period after surgical delivery ranged from 3 to 7 years. Six patients reported pain in the area of the postoperative scar associated with the menstrual cycle, 1 noted the presence of a palpable formation of the anterior abdominal wall. During surgical treatment, excision of endometrioid infiltrates located in the area of the postoperative scar was performed, followed by histological verification.

CONCLUSION: Taking into account the relative rarity of AWE, the difficulty of its early identification, the need for differential diagnosis using additional examination methods, greater awareness of this disease is required among doctors of related specialties. Diagnostic alertness is especially relevant for patients with a history of surgical delivery if they have a formation in the area of a postoperative scar and a cyclic pain symptom in its projection.

INTRODUCTION: Chronic constipation is one of the most pressing problems in the contemporary coloproctology, which is observed in 14%–16% of the population of developed countries. The causes of chronic constipation widely vary from functional to organic. Pathogenesis of this syndrome is based on peristalsis disorders.

AIM: Analysis and systematization of the relevant literature data on pathogenetic mechanisms of disorders in peristalsis in chronic constipation.

Peristalsis is controlled by the influence of the sympathetic and parasympathetic divisions of the autonomic nervous system on the enteric nervous system. The latter, in turn, is regulated by a complex interaction of nerve cells (afferent, motor, mechanosensitive neurons, interneurons, glial cells) with auxiliary cells (enterochromaffin, interstitial, mast cells, fibroblasts, immune cells, endothelium). The intercellular relations provide homeostasis of ions, hormones and neurotransmitters.

CONCLUSION: A disorder in any of the numerous regulatory mechanisms can lead to chronic constipation, and understanding of many-sided pathways of the pathogenesis of the disease will permit to justify and apply the best treatment methods.

INTRODUCTION: A novel coronavirus (severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2)) emerged in December 2019 and rapidly spread over the world having provoked a pandemic of respiratory disease. This highly pathogenic virus can attack the lung tissue and derange gas exchange leading to acute respiratory distress syndrome and systemic hypoxia. Hypoxic conditions trigger activation of adaptation mechanisms including hypoxia-inducible factor-1á (HIF-1á) which is involved in the regulation of the key processes, e. g, proliferation and metabolism of cells and angiogenesis. Besides, the level of HIF-1á expression is associated with the intensity of the immune response of an organism including that of the innate immunity mediating inflammatory reaction. Therefore, understanding the peculiarities of the mechanisms underlying the pathogenesis of this disease is of great importance for effective therapy of coronavirus disease 2019 (COVID-19).

AIM: Analysis of the current data on HIF-1á and its effect on the pathogenesis and progression of COVID-19.

The analysis of the relevant domestic and international literature sources was performed in the following sections: HIF-1á as a key factor of adaptation to hypoxia, targets for HIF-1á in the aspect of the pathogenesis of COVID-19, disorders in HIF-1á-mediated adaptation to hypoxia as an element of the pathogenesis of hyperactivation of the immune cells.

CONCLUSION: HIF-1á prevents penetration of SARS-CoV-2 virus into a cell and primarily acts as the main regulator of the proinflammatory activity at the inflammation site surrounded by hypoxia. In the conditions of the deranged metabolic flexibility, a high level of HIF-1á evokes an excessive inflammatory response of the immune cells. A high HIF-1á level in cells of the inflammation focus is associated with enhanced production of the factors of angiogenesis mediating vascular permeability and capillary leakage process. This is accompanied by tissue damage and organ failure. At the same time, HIF-1á can mediate the anti-inflammatory effect through activation of adenosine receptor-dependent pathway, which is considered as a probable protection of cells and organs against damage by hyperactive immune cells.

INTRODUCTION: One of the important problems of modern rehabilitation is loss of the results achieved at different stages of rehabilitation because of interruption of the recovery processes and absence of home-based rehabilitation after discharge from a medical center. The maximal effect after rehabilitation can be achieved only on condition that an integrated continuous approach is provided including distant format through use of modern digital devices and technologies to ensure the double feedback between the patient and the doctor. In this context, telemedicine acquires special significance. Teleneurorehabilitation (TNR) is a field of telemedicine ensuring accessibility and continuity of rehabilitation care to patients living in geographically remote areas.

AIM: Reporting of brief information on the possibilities of using TNR technologies in neurologic disorders and diseases.

The review includes general concepts of TNR: conditions of realization range of technical means, principles and types of remote rehabilitation interventions. Brief information is given on the possibilities of using remote technologies in motor and cognitive disorders. The effectiveness of TNR and barriers to its implementation are considered.

CONCLUSION: A large number of studies prove the technical feasibility of TNR, however, the development and maintenance of a viable model of remote rehabilitation care integrated into the existing health care system requires scientific justification of the effectiveness and economic benefits of specific technologies in specific forms of neurologic pathology. The creation of an evidence base will permit to realize the potential of TNR and make the remote form of rehabilitation a new standard of medical care not only in the era of the pandemic of a new coronavirus infection, but also after the pandemic.