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The aim of the study was to evaluate the antimicrobial effect of single and repeated nitric oxide (NO) exposure on the major pathogens of nosocomial pneumonia isolated from the sputum of cardiac surgery patients.Materials and Methods. A 24-hour culture of microorganisms from pan-resistant isolates of Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae from the sputum of inpatient cardiac surgery patients with nosocomial pneumonia, as well as strains of P. aeruginosa and E. coli from the American Type Culture Collection (ATCC), were exposed to 200 ppm NO (experimental sample) or medical air (control sample) in a sealed chamber for 30 minutes. After a single or 4 repeated gas exposure at 4 h intervals, Petri dishes were placed in a thermostat at 37°C and the results were evaluated at 24 and 48 h or at 12, 24, 36 and 48 h, respectively. Grown colonies were counted using an automated colony counter and recorded as CFU/mL.Results. No growth of clinical isolates of P. aeruginosa and E. coli was observed 24 and 48 h after a single exposure to NO. Growth of A. baumannii was lower compared to controls at 24 h but continued at 48 h. No effect of a single exposure to 200 ppm NO on other microorganisms was observed. After 4 exposures to NO, the growth of ATCC E. coli was not detected, the growth of other experimental strains was significantly lower compared to the control (P

This study aims to determine the effectiveness of administering 80 ppm nitric oxide in reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental perfusion. Twenty-four sheep were randomized into four groups: two groups received 80 ppm NO conditioning with 90 min of cardiopulmonary bypass (CPB + NO) or 90 min of CPB and hypothermic circulatory arrest (CPB + CA + NO), while two groups received sham protocols (CPB and CPB + CA). Kidney injury was assessed using laboratory (neutrophil gelatinase-associated lipocalin, an acute kidney injury biomarker) and morphological methods (morphometric histological changes in kidney biopsy specimens). A kidney biopsy was performed 60 min after weaning from mechanical perfusion. NO did not increase the concentrations of inhaled NO2 and methemoglobin significantly. The NO-conditioning groups showed less severe kidney injury and mitochondrial dysfunction, with statistical significance in the CPB + NO group and reduced tumor necrosis factor-α expression as a trigger of apoptosis and necroptosis in renal tissue in the CPB + CA + NO group compared to the CPB + CA group. The severity of mitochondrial dysfunction in renal tissue was insignificantly lower in the NO-conditioning groups. We conclude that NO administration is safe and effective at reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental CPB.

Microvascular obstruction (MVO) of coronary arteries promotes an increase in mortality and major adverse cardiac events in patients with acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI). Intramyocardial hemorrhage (IMH) is observed in 41–50% of patients with ST-segment elevation myocardial infarction and PCI. The occurrence of IMH is accompanied by inflammation. There is evidence that microthrombi are not involved in the development of MVO. The appearance of MVO is associated with infarct size, the duration of ischemia of the heart, and myocardial edema. However, there is no conclusive evidence that myocardial edema plays an important role in the development of MVO. There is evidence that platelets, inflammation, Ca2+overload, neuropeptide Y, and endothelin-1 could be involved in the pathogenesis of MVO. The role of endothelial cell damage in MVO formation remains unclear in patients with AMI and PCI. It is unclear whether nitric oxide production is reduced in patients with MVO. Only indirect evidence on the involvement of inflammation in the development of MVO has been obtained. The role of reactive oxygen species (ROS) in the pathogenesis of MVO is not studied. The role of necroptosis and pyroptosis in the pathogenesis of MVO in patients with AMI and PCI is also not studied. The significance of the balance of thromboxane A2, vasopressin, angiotensin II, and prostacyclin in the formation of MVO is currently unknown. Conclusive evidence regarding the role of coronary artery spasm in the development of MVhasn’t been established. Correlation analysis of the neuropeptide Y, endothelin-1 levels and the MVO size in patients with AMI and PCI has not previously been performed. It is unclear whether epinephrine aggravates reperfusion necrosis of cardiomyocytes. Dual antiplatelet therapy improves the efficacy of PCI in prevention of MVO. It is unknown whether epinephrine or L-type Ca2+ channel blockers result in the long-term improvement of coronary blood flow in patients with MVO.

Objective: We aimed to assess feasibility and functional correlates of left atrial volume index (LAVI) changes during exercise stress echocardiography (ESE). Methods: ESE on a bike or treadmill was performed in 363 patients with heart failure with preserved ejection fraction (HFpEF, n = 173), reduced ejection fraction (HFrEF, n = 59), or hypertrophic cardiomyopathy (HCM, n = 131). The LAVI stress-rest increase ≥6.8 ml/m2 was defined as dilation. Results: LAVI measurements were feasible in 100%. LAVI did not change in HFrEF being at rest 32 (25-45) vs at stress 36 (24-54) ml/m2, P = NS and in HCM at rest 35 (26-48) vs at stress 38 (28-48) ml/m2, P = NS, whereas it decreased in HFpEF from 30 (24-40) to 29 (21-37) ml/m2 at stress, P = 0.007. LA dilation occurred in 107 (30%) patients (27% with treadmill vs 33% with bike ESE, P = NS): 26 with HFpEF (15%), 26 with HFrEF (44%), and 55 with HCM (42%) with P 14 at rest with odds ratio (OR) 4.4, LVEF

Objective. The aim of the study is to modernize the design of the exhaust system of gas turbine engines (GTE) in order to reduce aerodynamic losses using numerical methods (CFD methods) for simulating the flow of exhaust gases.Method. The directions of modernization were chosen by considering the pattern of the flow of exhaust gases (separated flow zones and vortex flows) in the exhaust system during numerical modeling (Computational Fluid Dynamics). The modernization of the exhaust system consists in profiling the axial diffuser and changing the design of the gas collector.Result. The profiling of the axial diffuser was performed using numerical simulation methods. The design of the gas collector was changed based on the technical solution proposed by V.B. Yavkin. Numerical simulation of the flow of exhaust gases in the modernized exhaust device was performed. To evaluate the results of modernization in numerical models of the modernized design and prototype, the values of aerodynamic losses at the outlet of the axial diffuser and gas collector were determined.Conclusion. CFD modeling made it possible to obtain data on the structure of the exhaust gas flow in the upgraded exhaust system, to see the pattern of the distribution of velocities and pressures. The results of the numerical experiment showed a decrease in pressure losses in the exhaust system by 11% relative to the prototype.

Aim. To reveal the association between disorders of myocardial blood flow and reserve, according to dynamic single photon emission computed tomography (SPECT), with risk factors for cardiovascular diseases (CVD) in patients with nonobstructive coronary artery disease (CAD).Material and methods. The study included patients with suspected stable nonobstructive (

The review summarizes and analyzes the results of domestic and major foreign studies of recent years concerning gender characteristics of the epidemiology and development mechanisms of metabolic syndrome and urolithiasis as an associated disease. A deep understanding of gender aspects in the pathogenesis of these pathologies can form the basis for development of high-quality diagnostic algorithms and pathogenetically grounded approaches to treatment.

The aim was to investigate the association of monocyte heterogeneity and presence of circulating endothelial cells with the severity of coronary atherosclerosis in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). We recruited 62 patients with CAD, including 22 patients with DM2. The severity of atherosclerosis was evaluated using Gensini Score. Numbers of classical (CD14++CD16–), intermediate (CD14++CD16+), and non-classical (CD14+CD16++) monocyte subsets; circulating endothelial progenitor cells; and the presence of circulating endothelial cells were evaluated. Counts and frequencies of intermediate monocytes, but not glycaemia parameters, were associated with the severity of atherosclerosis in diabetic CAD patients (rs = 0.689; p = 0.001 and rs = 0.632; p = 0.002, respectively). Frequency of Tie2+ cells was lower in classical than in non-classical monocytes in CAD patients (p = 0.007), while in patients with association of CAD and T2DM, differences between Tie2+ monocytes subsets disappeared (p = 0.080). Circulating endothelial cells were determined in 100% of CAD+T2DM patients, and counts of CD14++CD16+ monocytes and concentration of TGF-β predicted the presence of circulating endothelial cells (sensitivity 92.3%; specificity 90.9%; AUC = 0.930). Thus, intermediate monocytes represent one of the key determinants of the appearance of circulating endothelial cells in all the patients with CAD, but are associated with the severity of atherosclerosis only in patients with association of CAD and T2DM.

Acute myocardial infarction (AMI) remains the leading cause of mortality in the world, highlighting an urgent need for the development of novel, more effective approaches for the treatment of AMI. Remote postconditioning (RPost) of the heart could be a useful approach. It was demonstrated that RPost triggers infarct size reduction, improves contractile function of the heart in reperfusion, mitigates apoptosis, and stimulates autophagy in animals with coronary artery occlusion and reperfusion. Endogenous opioid peptides and adenosine could be involved in RPost. It was found that kinases and NO-synthase participate in RPost. KATP channels, MPT pore, and STAT3 could be hypothetical end-effectors of RPost. Metabolic syndrome and old age abolish the cardioprotective effect of RPost in rats. The data on the efficacy of RPost in clinical practice are inconsistent. These data are discussed in the review.

Introduction. Nowadays, the tactics of removing stones from the kidneys and the ureteropelvic junction are widely covered and described in detail in modern guidelines. Determination of one or another treatment way depends on stone specific features and patient`s constitutional peculiarities. However, usage of percutaneous or retrograde access only does not always allow achieving a good result. In sophisticated cases, such as a large-size branchy renal stone, a “penetrated” stone in the ureter’s upper third, or some patient`s anatomic peculiarities, search for new ways to remove such stones with integrating accesses.Purpose of the study. To evaluate the removal efficiency of kidney stones and ureteropelvic junction by a combination of retrograde and percutaneous lithotripsy using electrical impulse energy. Materials and methods. In 2014-2019 in Siberian State Medical University Clinics (Tomsk, Russia), the integrated retrograde and percutaneous lithotripsy was applied in 26 cases to patients that had differently positioned kidneys’ and ureteropelvic junction stones. The treatment was based on the usage of the electro-impulse lithotriptor Urolith-105M (Lithotech Medical, Israel, MedLine LLP, Russia). In some cases, the laser lithotriptor Calculase II (Karl Storz, Germany) was also engaged. Result. The patients were aged from 25 to 76 (women - 69.2%). The calculus average size was 19.5 mm (varying from 5 to 51 mm). The calculus average density was 1229 HU (from 510 to 1720 HU). The operation average duration was 131 minutes (from 40 to 280 minutes). The incidence of complications was 3.84%. The complete calculus destruction occurred in 92.3% of cases. The overall response rate in re-operations reached up 100%.Conclusion. Integration of antegrade and retrograde accesses with use of the electro-impulse energy in removing complex stones from ureteropelvic junctions and kidneys proved to be an efficient method of treatment and demonstrated great results. Furthermore, this option of the single-step access to the stones is the only one possible in some cases when the extracorporeal lithotripsy is contraindicated, application of upfront surgery is quite risky, or endoscopic methods as an antegrade/retrograde mono-access are not effective .

Introduction. There remains a need to introduce new methods of treating kidney stones, given the increasing incidence of urolithiasis. Considering the proven efficacy and safety of retrograde electro-pulse lithotripsy, its use in the treatment of stones in the ureter, kidney and bladder, the need to expand the scope of this method is substantiated. Namely, the use in the treatment of kidney stones and the ureteropelvic junction with percutaneous approach.Purpose of the study. Assessment of the destruction effectiveness of kidney stones using an electro-pulse lithotripsy apparatus through antegrade (percutaneous) approach.Materials and methods. 229 percutaneous nephrolithotripsies were performed in patients with different locations of kidney stones in Siberian State Medical University Clinics (Tomsk, Russia) period from 2014 to 2019. We used the Urolit-105M electro-pulse lithotripter (Lithotech Medical, Israel, MedLine LLC, Russia) or the Calculase II laser lithotripter in some cases (Storz, Germany).Results. Patients were aged from 24 to 81 (women - 59.8%). The stones average size was 22 mm (from 10 to 73 mm). The stones average density was 1051.1 HU (from 360 to 1720 HU). The operation average duration was 122.3 minutes (from 40 to 300 minutes). The incidence of complications was 14.3%. The complete stones destruction occurred in 76% cases and that in combination with the laser went up to 89.95%. The overall response rate in redo operations reached 98.2%.Conclusion. Application of the electro-pulse method of kidney stone destruction with the percutaneous approach is makes a great effect, which is much higher when the stones is treated by the laser energy. Furthermore, combing with flexible endoscopes enables to apply the electro-pulse lithotripsy antegradely in hard-to-reach spots of the kidney cavitary system with no extra access to be provided. The method also enables to fight efficiently with the ureter upper part stones, also in combination with the retrograde approach to the stones.

Background. The attention of many researchers is focused on studying the role of adipokines secreted by subcutaneous, visceral, epicardial, and perivascular adipose tissues in the pathogenesis of diseases of the cardiovascular system. At the same time, adipose tissue of retrosternal localization remains out of research focus. This pool of fat cells is formed at the site of the thymic involution and has a significant volume. However, their functional activity and participation in the development of cardiovascular pathology remain unexplored.Aim. To study the morphological characteristics of adipocytes of the retrosternal adipose tissue (RSAT) and their production of adipokines in comparison with epicardial (EAT) and subcutaneous adipose tissue (SCAT) and to investigate their relationships with arterial stiffness parameters in patients who underwent coronary artery bypass grafting.Materials and methods. The study included 17 patients (12 men/5 women aged 40–70 years) with the diagnosed coronary artery disease (CAD) who underwent coronary artery bypass grafting (CABG). Each patient underwent measurement of carotid-femoral pulse wave velocity (PWV) and aortic augmentation index (AIx) with the oscillometric device. Isolated adipocytes were obtained enzymatically from explants of SCAT, EAT and RSAT during coronary artery bypass grafting. The adipocytes were analyzed under the microscope at 200x magnification. The release of adiponectin, leptin and insulin was studied in the adipocyte supernatant after 1 hour incubation using ELISA.Results. It was found that adipocytes of the RSAT are smaller than adipocytes of SCAT: 83.96 ± 2.21 vs 98.62 ± 2.67 μm (p = 0.00002), respectively, and comparable in size to adipocytes of EAT: 86.65 ± 1.33 μm. The release of adiponectin by adipocytes of the RSAT turned out to be comparable to the production of this adipokine in SCAT and EAT, however, adipocytes of the RSAT produce less leptin than SCAT and EAT: 0.26 (0.19; 0.27) ng/l vs 0.37 (0.28; 0.55) (р = 0.01) and vs 0.32 (0.28; 0.44) (р = 0.006) ng/ml, respectively. Furthermore, RSAT produce less insulin than SCAT and EAT: 1.56 (1.03; 2.08) vs 1.70 (0.99; 2.18) ng/ml, (р = 0.0022) and 1.76 (1.16; 2.40) ng/ml (р = 0.006), respectively.A positive correlation was found between the secretion of leptin by adipocytes of the RSAT and the AIx (rs = 0.52, p = 0.046). An inverse relationship was found between insulin secretion by retrosternal adipocytes and PWV rs = –0.55, p = 0.035). There was no relationship between the size of the retrosternal adipocyte or hypertrophy of the thymic adipocytes (more than 100 μm) and the production of leptin and insulin and arterial stiffness parameters. Conclusions. The data of our pilot study show that adipocyte hypertrophy of the retrosternal AT is not a significant marker of adipokine production disturbance. The observed relationships suggest that an increase in leptin production and reduced insulin secretion by retrosternal AT may contribute to the formation of adipokine-related arterial stiffness. Based on the data obtained, it can be assumed that adipokines produced by the retrosternal AT can participate in the formation of arterial stiffness in patients with coronary artery disease.

The aim of the study was to compare the morphological features of epicardial adipose tissue (EAT) adipocyte with the circulating inflammatory biomarkers and parameters of extracellular matrix remodeling in patients with coronary artery disease (CAD). We recruited 42 patients with CAD (m/f 28/14) who were scheduled for coronary artery bypass graft surgery (CABG). EAT adipocytes were obtained by the enzymatic method from intraoperative adipose tissue samples. Concentrations of secreted and lipoprotein-associated phospholipase A2 (sPLA2 and LpPLA2), TNF-α, IL-1β, IL-6, IL-10, high-sensitive C-reactive protein (hsCRP), metalloproteinase-9 (MMP-9), MMP-2, C-terminal cross-linking telopeptide of type I collagen (CTX-I), and tissue inhibitor of metalloproteinase 1 (TIMP-1) were measured in blood serum. Patients were divided into two groups: group 1—with mean EAT adipocytes’ size ≤ 87.32 μm; group 2—with mean EAT adipocytes’ size > 87.32 μm. Patients of group 2 had higher concentrations of triglycerides, hsCRP, TNF-α, and sPLA2 and a lower concentration of CTX-I. A multiple logistic regression model was created (RN2 = 0.43, p = 0.0013). Concentrations of TNF-α, sPLA2 and CTX-I appeared to be independent determinants of the EAT adipocyte hypertrophy. ROC analysis revealed the 78% accuracy, 71% sensitivity, and 85% specificity of the model, AUC = 0.82. According to our results, chronic low-grade inflammation and extracellular matrix remodeling are closely associated with the development of hypertrophy of EAT adipocytes, with serum concentrations of TNF-α, sPLA2 and CTX-I being the key predictors, describing the variability of epicardial adipocytes’ size.

Aim. To assess the role of global and selected scintigraphic scores of myocardial perfusion, blood flow and reserve in the anatomical and functional significance of coronary artery (CA) stenosis.Material and methods. The double-blind comparative study included 23 patients (mean age 61,2±6,8 years, 12 (52%) women, 11 (48%) men). All patients underwent stress dynamic single-photon emission computed tomography (SPECT) with adenosine triphosphate (ATP) (140 µg/kg/min in 6 minutes). Myocardial perfusion disorders were assessed by a semi-quantitative method, the total Summed Stress Score (SSS), the Summed Rest Score (SRS), and the Summed Difference Score (SDS) were determined. Global (g) and regional (r) myocardial perfusion (MP) were evaluated; myocardial perfusion reserve (MPR) was calculated as the ratio of MP at stress and at rest. Coronary angiography (CAG) was performed within 1 week after SPECT, the amount of CA narrowing was evaluated by diameter. Stenoses >50% were considered anatomically significant. The assessment of the fractional flow reserve (FFR) was performed by the ratio of the mean intracoronary pressure at the CA ostia to the pressure distal to the stenosis at the ATP infusion peak. FFR ≤0,80 was considered a sign of hemodynamically significant stenosis. Results. Neither regional nor global scintigraphic scores reflecting myocardial perfusion showed statistical significance as markers of CA stenosis >50%. Among perfusion markers, only SSSg (>4) showed good sensitivity and specificity in the diagnosis of hemodynamically significant (FFR ≤0,80) stenoses (AUC 0,76; p=0,002; sensitivity 81,8%, specificity 83,3%). The following regional flow scores allowed identification of hemodynamically significant CA: stress MPr ≤0,54 ml/min/g (AUC 0,8; p=0,0003; sensitivity 57%, specificity 92%) and MPR ≤1,5 (AUC 0,86; p< 0,0001; sensitivity 71,4%, specificity 92,8%).Conclusion. It is proved that global and regional scintigraphic scores of MP and MPR are sensitive and specific markers of hemodynamically significant (FFR ≤0,80) coronary stenosis. It can be more useful for localization diagnosis of the lesion than standard SPECT.

Purpose. This work investigates the relations between the production of reactive oxygen species (ROS) by epicardial adipose tissue (EAT) adipocytes and parameters of glucose/insulin metabolism, circulating adipokines levels, and severity of coronary atherosclerosis in patients with coronary artery disease (CAD); establishing significant determinants describing changes in ROS EAT in this category of patients. Material and methods. This study included 19 patients (14 men and 5 women, 53–72 y.o., 6 patients with diabetes mellitus type 2; 5 patients with prediabetes), with CAD, who underwent coronary artery bypass graft surgery. EAT adipocytes were isolated by the enzymatic method from intraoperative explants obtained during coronary artery bypass grafting. The size of EAT adipocytes and ROS level were determined. Results. The production of ROS by EAT adipocytes demonstrated a direct correlation with the level of postprandial glycemia (rs = 0.62, p < 0.05), and an inverse correlation with serum adiponectin (rs = −0.50, p = 0.026), but not with general and abdominal obesity, EAT thickness, and dyslipidemia. Regression analysis demonstrated that the increase in ROS of EAT adipocytes occurs due to the interaction of the following factors: postprandial glycemia (β = 0.95), postprandial insulin (β = 0.24), and reduced serum adiponectin (β = −0.20). EAT adipocytes in patients with diabetes and prediabetes manifested higher ROS production than in patients with normoglycemia. Although there was no correlation between the production of ROS by EAT adipocytes and Gensini score in the total group of patients, higher rates of oxidative stress were observed in EAT adipocytes from patients with a Gensini score greater than median Gensini score values (≥70.55 points, Gr.B), compared to patients with less severe coronary atherosclerosis (Conclusions. Our data have demonstrated for the first time that systemic impairments of glucose/insulin metabolism and a decrease in serum adiponectin are significant independent determinants of oxidative stress intensity in EAT adipocytes in patients with severe coronary atherosclerosis. The possible input of the interplay between oxidative stress in EAT adipocytes and metabolic disturbances to the severity of coronary atherosclerosis requires further investigation.

Diabetes mellitus type 2 is one of the most important non-infectious diseases in the modern world, being an important risk factor of cardiovascular disorders. Changes in left ventricular myocardial diastolic function are observed in diabetic patients independently from other comorbidities. Etiology of the heart failure during diabetes mellitus type 2 is multifactorial, exhibiting cellular, molecular and metabolic aspects. However, its pathophysiological mechanisms are not completely understood. The aim of this study was to evaluate numbers of inflammatory T lymphocytes, i.e., T helper type 1 (Th1) and T helper type 17 (Th17) cells, and FoxP3+T regulatory lymphocytes, depending on the functional state of the heart assessed by two-dimensional echocardiography in patients with arterial hypertension and diabetes mellitus type 2. A total of twenty-five patients with a combination of arterial hypertension and diabetes mellitus type 2, and 14 patients with arterial hypertension without carbohydrate disturbances were recruited to a cross-ectional case-control study. All the patients underwent echocardiography with transthoracic access at the M-mode, B-mode and Doppler mode of imaging. We evaluated numbers of Th1 and Th17 lymphocytes by intracellular production of IL-17 and IFNγ by CD4+ lymphocytes, respectively. The numbers of FoxP3+T regulatory lymphocytes were estimated by expression of CD25 and FoxP3 transcription factor. A flow cytometry approach was used in both cases. We revealed some correlations between the numbers of Th17 lymphocytes, FoxP3+T regulatory lymphocytes and functional parameters of myocardium in patients with diabetes mellitus type 2, which were absent in patientswithout carbohydrate impairments. The numbers of FoxP3+T egulatory lymphocytes, Treg/Th17 lymphocyte ratio, and mean fluorescence intensity of IL-17 for Th17 cells was lower in patients with diabetes mellitus and diastolic dysfunction compared to the patients with diabetes free of diastolic dysfunction. Association of diastolic dysfunction with diabetes mellitus type 2 was accompanied by increase of IFNγ+Th1 lymphocyte numbers and concentrations of IL-10, IFNγ and TNFα in serum as compared to the patients with diastolic dysfunction in the absence of carbohydrate metabolism disturbances. The diabetic patients with diastolic dysfunction were characterized by hyperinsulinemia, hyperglycemia, higher index of insulin resistance, increase of waist circumference and visceral adiposity index when compared to the patients with diastolic dysfunction without diabetes. Visceral obesity and decrease of insulin sensitivity may be regarded as pathogenetically significant factors for the development of immune regulatory imbalance and diastolic dysfunction in the patients with diabetes mellitus type 2.

Abstract Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module (http://se2020.altervista.org). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p

Syndrome of abnormal originating of the left coronary artery from pulmonary artery (ALCAPA), or Bland-White-Garland syndrome, is an inborn heart defect of atypical coronary arteries branching. In most cases this anomaly is revealed in infancy or adolescence. Opinions exist, that the anomaly is much more prevalent than it is diagnosed. Even more, it might be a cause of myocardial infarction and sudden death of 1st year newborns. In the article, a clinical case presented of first time revealed ALCAPA in 64 year old woman.