Vol 14, No 3 (2023)

Background: Patients with heart failure with preserved ejection fraction account for more than half of all hospitalizations because of heart failure. On the other hand, atrial fibrillation and heart failure are quite often diagnosed together and one disease influences the development of the other. Timely and accurate diagnosis of heart failure with preserved ejection fraction is the basis for effective treatment of this category of patients. In 2019, the HFA-PEFF algorithm of diagnosis heart failure with preserved ejection fraction (including patients with atrial fibrillation) was proposed. However, the algorithm implies cardiac catheterization in patients at intermediate risk, which involves certain difficulties and cannot be used in routine practice. As an alternative to cardiac catheterization in the diagnosis of heart failure with preserved ejection fraction, we proposed a noninvasive diagnostic method — cardiopulmonary test. However, the value of cardiopulmonary test technique has not been conclusively studied, especially in patients with a combination of chronic heart failure and atrial fibrillation. Aim: The aim of the study was to evaluate the role of the cardiopulmonary test in the diagnosis of heart failure with preserved ejection fraction in patients with atrial fibrillation. Methods: 138 patients with atrial fibrillation were included in our study. Using HFA-PEFF algorithm (algorithm for diagnosis of heart failure with preserved left ventricular ejection fraction) all patients were initially divided into 3 groups: low probability of heart failure — 23 patients, intermediate probability — 96 and high probability — 19 patients. The stress-test allowed to precisely assess of patients at intermediate risk and finally form the groups: Group 1 without heart failure, 85 patients (61.6%); Group 2 patients with heart failure and preserved ejection fraction, 53 patients (38.4%). The next diagnostic stage was cardiopulmonary test. Results: During cardiopulmonary test, the anaerobic exercise threshold was 6.8 and 4.85 METs for the first and second groups, respectively (p <0.001), reflecting lower exercise tolerance in the second group of patients. Analysis of variance (ANOVA) demonstrated a statistically significant increase in pro-BNP levels with a decrease in peak VO₂ (p <0.001). Also, analysis of variance demonstrated a significant statistical difference with respect to systolic pulmonary artery pressure in the subgroups with severely, moderately reduced oxygen consumption and in the group with normal peak VO₂ (p=0.01). ROC analysis determined a peak VO₂ of 20 ml/kg/min, above which the HFA-PEFF algorithm was unlikely to detect heart failure (AUC 0.73; confidence interval 0.65–0.82; p=0.043; sensitivity 85%; specificity 51%). Conclusion: The cardiopulmonary test is a reliable instrumental non-invasive method in the diagnosis of heart failure with preserved ejection fraction.

Background: Transarterial chemoembolization (TACE) is coming into use in the treatment of liver tumors, with drug-eluting microspheres as one of the technique variations. However, at the moment there are no systematic studies that would answer the questions: what is the role of the method in the treatment regimen for patients with primary and metastatic liver tumor and at what stage should it be used? Aim: to evaluate the effectiveness of transarterial chemoembolization with drug-eluting microspheres for the treatment of metastatic and primary malignant liver tumors at different stages of the disease. Methods: We performed а retrospective observational uncontrolled study of 65 patients with liver metastases (Group 1), and 10 patients with primary malignant liver tumors (Group 2), who underwent 102 operations of transarterial chemoembolization with drug-eluting microspheres. To plan transarterial chemoembolization and evaluate its effectiveness, computed tomography and magnetic resonance imaging were used every 8–9 weeks during the treatment. Results: After two transarterial chemoembolization controls, Group 1 included 51 responders (79%) and 14 non-responders (21%). Among the responders by the 16th week there was a decrease in the volume of the tumor mass in the liver from 12.4 [4.7; 24.6] to 5.2 cm³ [2; 15.5] for colorectal cancer, from 26 [18; 35] to 19 cm³ [13; 25] for neuroendocrine cancer, from 12 [4; 20] to 4 cm³ [0.6; 9] for adenocarcinomas of different localizations. There was no progression in Group 2, while, by week 16, there was a decrease in the tumor volume from 142 [51; 206] to 68 cm³ [23; 185] for hepatocellular carcinoma, from 465 [330; 600] to 187 cm³ [137;237] for intrahepatic cholangiocarcinoma. With repeated transarterial chemoembolization, a decrease in the volume of the tumor mass was also noted, while the time without progression decreased from 303 [170; 369] to 180 [105; 225] days in Group 1, from 266 [200; 367] to 120 [62; 215] days in Group 2. Conclusions: Transarterial chemoembolization with drug-eluting microspheres is an effective treatment for primary and metastatic liver tumors. It should be considered as a palliative therapy, which allows achieving a good antitumor response at different stages of cancer.

Ischemic stroke is a global medical problem and one of the leading causes of death or disability worldwide. The main approach of ischemic stroke therapy in the most acute period, which can prevent or minimize the development of a neurological deficit, is the restoration of the blood flow in the ischemic brain tissue using enzymatic thrombolysis or endovascular thromboextraction. When the therapeutic window is missed, the modulation of the acute inflammatory response may play an important role in determining the fate of neurons in the penumbra. The key players in this process are T-regulatory cells (Tregs) — an immunosuppressive population of CD4+ T-cells with the CD4+, CD25+ CD127^low, FoxP3+ phenotype. Despite the existing reports that Tregs (or certain Treg subpopulations) can exacerbate microcirculatory disorders in the ischemic tissue, many stadies convincingly suggest the positive role of Tregs in ischemic stroke. Resident CD69+ Tregs found in the normal mammalian brain have neuroprotective activity, produce IL-10 and other anti-inflammatory cytokines, control astrogliosis, and downregulate cytotoxic subpopulations of T cells and microglia. Systemic administration of Treg in stroke is accompained by a decrease in the volume of cerebral infarction and decreased levels of secondary neuronal death. Thus, the methods allowing Treg activation and expansion ex vivo open up several new avenues for the immunocorrection not only in systemic and autoimmune diseases, but, potentially, in the neuroprotective therapy for ischemic stroke. The relationship between Treg, inflammation, and cerebrovascular pathology is of particular interest in the case of ischemic stroke and COVID-19 as a comorbidity. It has been demonstrated that systemic inflammation caused by SARS-CoV-2 infection leads to a significant suppression of Treg, which is accompanied by an increased risk for the development of ischemic stroke and other neurological complications. Overall, the information summarized herein about the possible therapeutic potential of Treg in cerebrovascular pathology may be of practical interest not only for researchers, but also for clinicians.

Thyroid cancer is the 9th most common cancer in the world. The five-year survival rate for this disease is over 98%. However, in some patients there are cases of rapidly progressive treatment-resistant cancer that cannot be differed from poor-invasive cancer by routine methods. Liquid biopsy could be one of the methods to solve this problem. This procedure consists in the analysis of tumor derivatives (in particular, circulating DNA) in body fluids. The analysis of “hotspot” mutations and patterns of epigenetic regulation, which are usual for neoplasms with a certain genotype, is used to identify the tumor component in the total mass of circulating DNA. The increase of circulating tumor DNA in the plasma is observed several months ahead of the characteristic signs at MR images of patients, and also surpasses conventional biomarkers such as calcitonin in medullary thyroid carcinoma. In addition, a possibility of minimally invasive determination of the tumor genotype by analyzing circulating DNA is important to select the optimal chemotherapy. This review discusses the current advances in the analysis of circulating tumor DNA in thyroid cancers such as papillary, follicular, medullary, and anaplastic carcinomas.

The COVID-19 pandemic, caused by the SARS-CoV-2 RNA-virus, has a significant impact not only on the people’s lifestyle and health, but on the global economy, as well. According to the epidemiological data, the highest level of the sickness rate in Russian Federation was in January-February of 2022, while the death rate was 1.9%. The numerous studies on the COVID-19 pathogenesis allowed improving the approaches to the development of efficient clinical strategies. However, a number of important issues regarding the clinical applications of new and repurposed drugs on the market still remain unresolved. It is a well-known fact that the most effective way of preventing the immune system from developing the hyperactive reaction known as a cytokine storm is prescribing the etiotropic therapy as fast as possible. Etiotropic drugs are divided into three large groups: those preventing the virus from penetrating the cell, those affecting the replication-transcriptional complex and the last but not the least group is the drugs with the direct or indirect cytotoxic effect. This review introduces some important data regarding the etiotropic treatment methods for the new coronavirus disease.

Background: Axenfeld–Rieger syndrome is a genetically heterogeneous group of morphogenesis disorders associated with abnormal development of the anterior segment of the eye, teeth, the organ of hearing, and abdominal region. Сongenital glaucoma, which is refractory to standard methods of treatment due to pronounced changes in the structures of the anterior segment of the eyeball and other comorbidities, is frequent manifestation of this syndrome. There are several methods for treating glaucoma in patients with Axenfeld–Rieger syndrome: sinus trabeculectomy, implantation of drainage devices and transscleral cyclocoagulation. Сlinical case description: A patient with congenital glaucoma associated with Axenfeld–Rieger syndrome underwent sinus trabeculectomy with posterior scleral trepanation in the right eye and valve drainage implantation in the left eye at the S. Fyodorov Eye Microsurgery Federal State Institution, Moscow due to the intraocular pressure decompensation. In the postoperative period, an encapsulated cyst around the body of the drainage was detected, and then a revision of the operation area was performed. After the anti-glaucoma operations, the intraocular pressure compensation was achieved in the follow-up period up to 9 months. Conclusion: Depending on the degree of the changes in the anterior chamber angle structures, sinus trabeculectomy or valve drainage implantation are the methods of choice for the surgical treatment aimed at the intraocular pressure compensation and visual function preservation in patients with Axenfeld-Rieger syndrome.