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The growing number of COVID-19 cases puts pressure on healthcare services and public institutions worldwide. The pandemic has brought much uncertainty to the global economy and the situation in general. Forecasting methods and modeling techniques are important tools for governments to manage critical situations caused by pandemics, which have negative impact on public health. The main purpose of this study is to obtain short-term forecasts of disease epidemiology that could be useful for policymakers and public institutions to make necessary short-term decisions. To evaluate the effectiveness of the proposed attention-based method combining certain data mining algorithms and the classical ARIMA model for short-term forecasts, data on the spread of the COVID-19 virus in Lithuania is used, the forecasts of epidemic dynamics were examined, and the results were presented in the study. Nevertheless, the approach presented might be applied to any country and other pandemic situations. The COVID-19 outbreak started at different times in different countries, hence some countries have a longer history of the disease with more historical data than others. The paper proposes a novel approach to data registration and machine learning-based analysis using data from attention-based countries for forecast validation to predict trends of the spread of COVID-19 and assess risks. © 2021 Tech Science Press. All rights reserved.

Актуальність. Частота травми периферійних нервів становить 0,3–0,5 на 10 000 населення, 60–75 % з яких супроводжуються інвалідизацією хворого. Найперспективнішим шляхом вирішення проблеми відновлення периферичних нервів є тканинна інженерія з використанням біополімерів і стовбурових клітин, зокрема мультипотентних стовбурових клітин-похідних нервового гребеня (МСК-ПНГ). Мета: дослідити відновлення функції сідничного нерва з використанням засобів тканинної інженерії після його повного перетину в експерименті. Матеріали та методи. Сформовано 4 експериментальні групи: група 1 — перетин сідничного нерва (невротомія) та негайна автонейропластика (n = 14); група 2 — невротомія та негайна пластика колагеновою трубкою, заповненою фібриновим гелем (n = 15); група 3 — невротомія та негайна пластика колагеновою трубкою, заповненою фібриновим гелем з вмістом МСК-ПНГ (n = 16); група 4 — несправжньооперовані тварини (n = 7). Результати. У групах 1 і 3 спостерігали динаміку SFI, що характеризувалася двофазністю. Перша фаза включала практично лінійне зростання показника від значення у –70 на 7-му добу спостереження до –35 станом на кінець 4-го тижня спостереження. Друга фаза тривала протягом 6–7-го та 5–7-го тижня у групі 1 та 3 відповідно і характеризувалася відсутністю змін показника. Для групи 2 характерним була наявність фази відсутності приросту показника протягом 2-го тижня спостереження. У подальшому, протягом 3–4-го тижня виявляли вірогідне збільшення показника (р < 0,01; W-критерій Уїлкоксона), стабілізацію (протягом 5–6-го тижня), вірогідне збільшення показника протягом 7-го тижня (р = 0,036 порівняно зі значенням станом на 5-й тиждень спостереження; W-критерій Уїлкоксона). Протягом усього періоду спостереження між значеннями SFI груп 1 та 3 вірогідних відмінностей не виявлено (р > 0,05; U-тест Манна — Уїтні). Статистично значущі відмінності (р < 0,05; U-тест Манна — Уїтні) між показниками групи 1 та 2, а також групи 2 та 3 на користь груп 1 і 3 відповідно виявляли починаючи з 14-ї доби й до кінця експерименту. При порівнянні з результатами тестування тварин групи 4 показники груп 1, 2 і 3 виявилися вірогідно (р < 0,05; U-тест Манна — Уїтні) меншими протягом усього періоду експерименту. Висновки. Пластика дефекту периферичного нерва трубчатим імплантатом NeuraGenTM, заповненим фібриновим гелем із вмістом стовбурових клітин-похідних нервового гребеня, з точки зору відновлення стану м’язово-суглобового апарату паретичної кінцівки еквівалентне класичній автонейропластиці. Тривалість періоду регенераційного росту волокон травмованого нерва до моменту ініціації відновлення функції паретичної кінцівки суттєво залежить від тканинного оточення у зоні травматичного дефекту. Тривалість активного відновлення функції паретичної кінцівки за відтвореного варіанту травми обмежена першим місяцем, не залежить від специфіки тканинних процесів у зоні пластики дефекту нерва.

It is generally recognized that an elite athlete's status is a multifactorial phenotype depending on many environmental and genetic factors. Variations in the sequence of nucleotides in deoxyribonucleic acid (DNA), in particular, single-nucleotide variants (SNVs) act as key internal factors associated with achieving high results in sports. The determination of specific individuals' genetic characteristics allows us to identify athletes who have the greatest genetically determined potential for certain sports that require speed, strength or endurance manifestation. Of course, peculiarities of the structure and function of skeletal muscles are among the most important characteristics in sports results context, in sports associated with the development of power / strength or endurance phenotypes. The composition and function of skeletal muscles are controlled by many different genes, and their SNVs can serve as strength or endurance athletes' status biomarkers. (1) Background: to conduct a thematic review of candidate genes studies and their single-nucleotide variants (SNVs) associated with the functioning of skeletal muscles in athletes. (2) Methods: A search for articles for the period from 2010 to 2020 was conducted in the databases SCOPUS, Web of Science, Google Calendar, Clinical keys, PubMed, e-LIBRARY using keywords and their combinations; (3) Conclusions: The identification of genetic biomarkers associated with muscular system regulation can help neurologists, sports doctors and coaches in developing personalized strategies for selecting children, adolescents and young adults for endurance, strength and speed sports (for example, running short, medium or long distances). Such a personalized approach will increase sports performance and reduce the risk of sports injuries of the musculoskeletal system.

Актуальность. Травмы опорно-двигательного аппарата, даже незначительные, могут сопровождаться повреждением периферических нервов и приводить к частичной или полной потере функции конечностей. Количество таких пациентов с каждым годом растет в связи с увеличением количества техногенных травм и сложных сочетанных повреждений опорно-двигательного аппарата. Бурная урбанизация приводит к росту общего нейротравматизма в среднем на 2 % в год. В структуре травм опорно-двигательного аппарата повреждения периферических нервов составляют от 1,5 до 6 %, из них 90 % — верхней конечности. Во время военных действий этот показатель составляет 12 % и наблюдается у 2,8–5 % пациентов с политравмой. Цель: исследовать ранние результаты восстановления седалищного нерва крысы с использованием тканево-инженерного подхода после его полного пересечения в эксперименте. Материалы и методы. Сформированы 4 экспериментальные группы: группа 1 — пересечение седалищного нерва (невротомия) и немедленная аутонейропластика (n = 14); группа 2 — невротомия и немедленная пластика коллагеновой трубкой, заполненной фибриновым гелем (n = 15); группа 3 — невротомия и немедленная пластика коллагеновой трубкой, заполненной фибриновым гелем с содержанием мультипотентных стволовых клеток — производных нервного гребня (n = 16); группа 4 — ложнооперированные животные (n = 7). На 30-е сутки половину животных из каждой группы (1-я — n = 7, 2-я — n = 7, 3-я — n = 7, 4-я — n = 3) выводили из эксперимента путем тракции за клювовидный конец и для светооптической микроскопии гистологический материал (седалищный нерв оперирован различными видами тканево-инженерных подходов, указанными выше) фиксировали в течение суток в 10% растворе нейтрального формалина, промывали образцы, обезвоживали в серии спиртов, заключали их в парафин и получали срезы толщиной 5 мкм на микротоме. Затем срезы депарафинизировали в ксилоле и импрегнировали азотнокислым серебром по методу Бильшовского, что позволяет визуализировать структурные элементы периферической нервной системы. Результаты. После пересечения седалищного нерва и аутонейропластики в имплантированном в зону повреждения тканево-инженерном проводнике на 30-е сутки на фоне усиленного разрастания волокнистой соединительной ткани наблюдалось формирование коротких тяжей нервных волокон, а также упорядочение их размещения. Кроме того, в регенерате формировались тонкие перемычки между участками нервных волокон, что приводило к образованию непрерывной связи между регенерирующими тяжами нервных волокон на разных уровнях зоны повреждения седалищного нерва. При применении полого коллагенового проводника, заполненного фибриновым гелем для замещения дефекта седалищного нерва, на 30-е сутки отмечалось формирование незначительного количества тонких, хаотично расположенных нервных волокон и слабо выраженное формирование волокнистой соединительной ткани. При использовании тканево-инженерного проводника в этот же временной период происходило значительное разрастание нервных волокон, их гипертрофия и образование разветвлений нервных волокон, ориентированных в разных направлениях. Также при применении инженерного проводника отмечено более слабое формирование волокнистой соединительной ткани по сравнению с первой и второй экспериментальными группами. Выводы. В результате проведенного исследования установлено, что наибольшее сходство с архитектоникой седалищного нерва интактных животных имеет регенерат нервных волокон, образующийся при применении аутонейропластики. В этом регенерате образовывались участки нервных волокон, которые по своей архитектонике наиболее близко соответствовали нервным волокнам в нативном седалищном нерве. Кроме того, в области повреждения формировались тонкие отростки, связывающие участки регенерирующих нервных волокон на разных уровнях. При этом наблюдалось усиленное разрастание волокнистой соединительной ткани. Наиболее выражено формирование нервных волокон, а именно гипертрофия нервных волокон и значительное их разветвление с формированием сетки, выявлено при применении тканево-инженерного проводника. При этом в тканево-инженерном проводнике на фоне гипертрофии регенерирующих волокон отмечено слабое формирование волокнистой соединительной ткани. Следовательно, для определения преимуществ одного из двух тканево-инженерных подходов, использованных для регенерации седалищного нерва, необходимо провести изучение результата процесса регенерации в более поздней временной точке.

Aim.We aimed to assess safety and effectiveness of class III antiarrhythmic drug Refralon for conversion of atrial fibrillation (AFib) and flutter (AFl) in post-registration trial and to compare data of primary center (National medical research center in cardiology) with data of other hospitals.Material and Methods. We performed retrospective cohort study in 727 patients (451 enrolled in primary center and 276 enrolled in other hospitals) admitted between June 24, 2014 and June 24, 2019. Refralon was administered for conversion of AFib and AFl in intense care units in escalating doses (10-30 micrograms/kg) intravenously.Results.Conversion of AFib and AFl into sinus rhythm was achieved in 53,6% after administration of 10 mcg/kg dose, in 73% after administration of 20 mcg/kg dose and in 91,6% after administration of Refralon in dose up to 30 mcg/kg. No mortality and no major adverse cardiac events registered in our study. Asystole >3.0 sec observed in 5% (35 of 727) of patients): in 5% (24 of 451) of patients enrolled in primary center and in 4% (11 of 276) of patients enrolled in other hospitals; 95% confidence interval (CI) [-0.09; 0.113]. Asystole> 5.0 s observed in 1.7% of patients who further required non-urgent implantation of a permanent pacemaker due to manifestations of sinus node dysfunction. Cardiac conduction disturbances (exclusively sinus bradycardia) were registered in 7% (53 of 727) patients: in 8% (37 of 451) of patients enrolled in primary center and in 6% (17 of 276) of patients enrolled in other hospitals; 95% CI: [-0.1; 0.15]. Only 0.14% of patients had symptomatic sinus bradycardia that resolved after atropine injection. Ventricular arrhythmias (exclusively Torsade de pointes tachycardia in excessive QT interval prolongation) were registered in 1.7% (12 of 727) patients: in 2% (9 of 451) of patients in primary center and in 1% (3 of 276) of patients of other hospitals; 95% CI: [-0.06; 0.08]. QTc interval prolongation to values >500 ms documented in 19% (138 of 727) of patients: in 21% (95 of 451) of patients in primary center and in 16% (43 of 276) of patients in other hospitals; 95% CI: [-0.13; 0.24].Conclusion:In post-registration multicenter trial Refralon demonstrated good safety profile in conversion of AFib and AFl. Potential risk of TdP tachycardia mandates precautions with the use of the drug. In other hospitals Refralon did not demonstrate lower safety than in primary medical center.

Pancreatic pleural fistula is one of the rare and difficulty verifying complication of chronic pancreatitis. We present a rare medical case of a patient with chronic pancreatitis complicated by pancreatic pleural fistula with the formationof multiple lung abscesses. At the same time, the success of the treatment of the patient was due to the staged treatment and the participation of a multidisciplinary team of specialists.

The clinical presentation of cardioneurosis is heterogeneous and includes anxiety-phobic, cenestalgic, and depressive symptoms. General practitioners, who most often see this category of patients, usually recommend to take «sedatives». Modern antidepressant, i. e. selective serotonin reuptake inhibitor, escitalopram demonstrated high efficiency and good tolerability in patients with cardoneurosis (neurocirculatory dystonia).

Проблема лечения тяжелых пневмоний, в том числе и вирусных (вирусно-бактериальных), сохраняет свою высокую актуальность и требует внедрения алгоритма клинико-диагностических мероприятий для обеспечения адекватной лечебной тактики в данной нозологической группе. В статье рассмотрен клинический случай интенсивной терапии пациента с внегоспитальной двусторонней полисегментарной пневмонией.

Aim. Analysis of quantitative and qualitative parameters of dyspnea in patients with the fibrotic phenotype of interstitial lung disease associated with coronary artery disease. Material and methods. We examined 49 patients. Among those were 9 patients with idiopathic pulmonary fibrosis, 25 patients with chronic variant of hypersensitive pneumonitis, and 14 patients with nonspecific interstitial pneumonia. The main group consisted of 25 patients with interstitial lung diseases and coronary heart disease; comparison group consisted of 24 patients without ischemic heart disease. Clinical symptoms, questionnaire results, and instrumental study data were analyzed. Results and discussion. Patients with coronary heart disease experienced increased dyspnea earlier (after 3,21 days) than patients without it (after 7,18 days; p

In the modern world, the incidence of chronic obstructive bronchitis in adolescents remains quite high. Due to the high incidence of chronic obstructive bronchitis in adolescents, there remains an urgent need for medical science to improve the rehabilitation of this contingent of patients. The aim of the work is to assess the rehabilitation possibilities of yoga exercises in adolescents suffering from chronic obstructive bronchitis. The study was carried out on 46 adolescents aged 14-15 years old, suffering from uncomplicated chronic obstructive bronchitis for a long time in a state of unstable remission. The control group included 22 clinically healthy adolescents of the same age. For those surveyed with chronic bronchitis, there was a decrease in lung volumes and the size of the lumen of the bronchi of any diameter. This naturally reduced the functional capabilities of the respiratory system in adolescents. Regular yogic exercises provided in adolescents with bronchitis a pronounced positive dynamics of their well-being and adaptive capabilities of the respiratory system. Systematic yoga exercises optimized the functional capabilities of the entire respiratory system in adolescents with chronic obstructive bronchitis and significantly increased their resistance to hypoxia.

Rationale: The development of eukaryote genome engineering tools based on CRISPR-Cas programmable bacterial nucleases systems opens wide horizons for gene therapies, human disease cell modeling, as well as investigation into manifestation of disease phenotypes and visualization of cellular processes. The safety and approximation of experiments both at the cellular and organismal levels depend on the accuracy of introducing double-stranded breaks into the target DNA regions. The search for new variants of more accurate CRISPR-Cas nucleases and evaluation of their ability to hydrolyze nucleosome DNA in vivo is considered a critical task for the development of the genome engineering technologies.Aim: To analyze the activity of the programmable nuclease AsCpf1 (Cas12a), with low level of off-target activity, in the human genome loci that are safe for the introduction of transgenic constructs (“safe harbor”) and to compare its efficiency with that of the widely used SpCas9 nuclease in HEK293 cells.Materials and methods: We performed the bioinformatics analysis of the association between target regions with nucleosomes and other proteins in the safe harbor loci AAVS1 and GSH-Ch1 and the transcriptionally inactive gene MYBPC3 (cardiac myosin binding protein 3) based on ATAC-seq data for the HEK293FT cells obtained from the NCBI SRA database. Plasmids encoding SpCas9 and AsCpf1 nucleases and guide RNA to the target regions were constructed and transfected into the HEK293FT cells. Events in the target regions of the HEK293FT cell genome were studied in the sequenograms with the TIDE algorithm.Results: The results of the ATAC-seq experiments for HEK293FT cells have shown that the AAVS1 locus can be referred as open chromatin with a low nucleosome density, while the GSH-Ch1 locus can be attributed to closed chromatin. In HEK293FT cells, the cardiac MYBPC3 gene has intermediate chromatin density. Assessment of the efficiency of introducing breaks into the studied HEK293FT cell chromatin loci by nucleases has shown that SpCas9 is able to cope with chromatin of any nucleosome density, while AsCpf1 can effectively introduce DNA breaks only at loci with open chromatin, such as AAVS1 and MYBPC3. Editing events occur at a very low rate at the GSH-Ch1 locus with a high nucleosome density.Conclusion: We have found low efficiency of the AsCpf1 nuclease in the genomic safe harbor locus GSH-Ch1, which is characterized by a high nucleosome density. When planning an experiment on AsCpf1 nuclease genome editing, the epigenetic chromatin landscape and the nucleosome density should be considered, as well as chromatin opening substances should be used.

У статті знайшли відображення найбільш важливі наукові відомості про значення йоду в біологічній природі, його участь у різноманітних біологічних процесах, в утворенні тиреоїдних гормонів та реалізації їх ефектів на рівні різних органів і клітин, що пояснюють виникнення йодозалежних захворювань. Значна увага в статті приділяється ролі йоду в синтезі тиреоїдних гормонів при вагітності та з’ясуванню причин підвищеної потреби в цьому елементі при даному стані. Проведений аналіз результатів багаторічних епідеміологічних досліджень, спрямованих на вивчення йодного забезпечення вагітних у різних регіонах України, співробітниками відділу епідеміології ендокринних захворювань ДУ «Інститут ендокринології та обміну речовин ім. В.П. Комісаренка НАМН України». Значна кількість цих досліджень виконана за підтримки МОЗ України, Дитячого фонду ЮНІСЕФ в Україні, а також центру СDC в Атланті (США), який протягом понад 15 років здійснював контроль за якістю досліджень одного з найважливіших показників йодного статусу населення України — йодурії. Стаття підготовлена як науковий інформаційний матеріал для ендокринологів, акушерів-гінекологів, гігієністів, сімейних лікарів, громадськості, МОЗ України у зв’язку з необхідністю законодавчого вирішення проблеми профілактики йодозалежних захворювань в Україні.

Aim of study. Comprehensive assessment of clinical and hemodynamic results of surgical treatment of high- and intermediate-high risk of pulmonary embolism in a group of patients who underwent spinal surgery.Materials and methods. The analysis of the results of open surgical treatment of pulmonary embolism in high- and intermediate-high-risk patients after neurosurgical operations on the spine in the period from 2013 through 2019. The study group included 5 patients. The average age of patients was 59.74±3.42 years. The Wells index was 9.2±2.4. The Pesi index of the studied patients was in the range of 100–126, which allowed them to be classified as a high-risk group of 30-day mortality (class IV). Clinical manifestations of pulmonary embolism developed on average by 5.8±1.08 days after the initial neurosurgical intervention. The calculated pressure in the pulmonary artery was 56.6±8.22 mm Hg. In all cases, surgical intervention was performed for emergency indications, in conditions of artificial blood circulation, without aortic compression during the main stage of the operation.Results. The 30-day survival rate of patients was 100%. Among non-lethal postoperative complications, acute cardiovascular failure and hepatic-renal failure prevailed, which were levelled by the time the patients were transferred to a cardiac hospital. In 1 patient, the early postoperative period was complicated by the development of exudative pericarditis with cardiac tamponade, which required a finger revision of the anterior mediastinum, its drainage for 2 days. In all cases, there was an improvement in the condition of patients, in the form of increased tolerance to physical activity. The estimated pressure in the pulmonary artery at the time of discharge was 24.69±8.03 mm Hg.Conclusions. Surgical treatment of acute pulmonary embolism of high- and intermediate-high risk of early death in a group of patients with a neurosurgical profile is a highly effective and reliable method with great prospects for application.

Stereotactic body radiation therapy currently occupies its place in the complex treatment of cancer patients with liver metastases. It is assumed that certain groups of patients with breast cancer can benefit from the use of this method, which can be converted into improved overall survival and survival rates without signs of progression of the process. Purpose of the study was to evaluate the efficacy and tolerability of stereotactic radiotherapy in patients with breast cancer metastases in the liver. We have analyzed the results of using stereotactic radiotherapy in 25 breast cancer patients with 43 liver metastases. The treatment was carried out in 3 fractions with a fraction dose of 10-15 Gy and a total dose of 30-45 Gy. Growth of the irradiated lesions was recorded only in 1 case out of 43 metastases (2,3%) and 25 (4%) patients. 1-, 3- and 5-year overall survival rates from the moment of stereotactic radiotherapy were 82,9%, 62% and 38,7%, respectively. Long-term post-radiation adverse events were observed in 8% of cases and did not have a significant effect on the quality of life and the possibility of antitumor treatment. So stereotactic radiotherapy can be recommended as a relatively safe and highly effective method of elimination of breast cancer liver metastases. Taking into account the high achieved local control, further studies on dose escalation in this group of patients are not required.

This article provides basic information about the automated system Monitron developed at the Research Center "Tonnelnaya assotsiatsiya" and "Sigma Tau" as well as integrated systems for measuring vibrations and the stress-strain state of structures. This article also presents application of Monitron in a sometypical tunneling facilities.

OBJECTIVE To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. MATERIALS AND METHODS Retrospective multicentral comparative study. Group "Combo" was presented by patients with the mentioned combined pathology (n=15). Group "Standart" (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: https://youtu.be/fAfYJDvGzsU. RESULTS Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+/-3,8 vs 15,9+/-4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for "Combo" & "Standart" respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. CONCLUSION conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.

Introduction. Modern aspects of the diagnostics and treatment of interstitial lung diseases are closely connected with the comorbidity, which is based on the study of the associations between cardiovascular diseases and interstitial lung diseases. Material and Methods. The study included 65 patients with non-specific interstitial pneumonia, 78 patients with hypersensitive pneumonitis, and 68 patients with lung sarcoidosis. Results. An association between the character of morphological alterations in the lung tissue and clinical-functional disorders was established. More expressed fibrous and interstitial alterations corresponded to more intense respiratory symptoms and more severe disturbances of ventilation and diffuse parameters of the lungs. There was a tendency in the dilation of right and left compartments of the heart in the group of patients with interstitial lung diseases associated with cardiovascular diseases.

The placenta is a unique organ that provides a normal functioning of foetus during the period of intrauterine development. However, in spite of its importance, the placenta remains poorly studied. Answers to the questions about immune interactions in the placenta can explain the development of many pregnancy complications. This paper studied age-related features of immunocompetent cell markers expression in the human placenta in normal and pathological conditions (type 2 diabetes mellitus, T2DМ). We examined villous chorion samples obtained from 80 patients: 40 subjects with type 2 diabetes mellitus and 40 control subjects. Each of the groups was further divided into the subgroups of primiparas and multiparas, as well as into age subgroups (births before and after 28 years). We selected CD68 (macrophage marker), CD20 (B-lymphocyte marker) and CD57 (NK-cell marker) as molecules of interest. The research revealed differences in the expression of immunocompetent cell markers between the group of patients with T2DМ and the control group as well as age-related differences in the expression of these markers within the groups. In addition, we were able to study the morphofunctional state of the placentas. It is known that signalling molecules produced by immune cells play a key role in the pathological processes that can take place during pregnancy. The results obtained indicate a high epidemiological and scientific importance of inflammatory markers in assessing the gestation course and the possible development of somatic pathology in newborns, especially in women aged 28 or older. For citation: Makarenko S.V., Drobintseva A.O., Medvedev D.S., Bode I.I., Andreev A.E., Shumilkin V.R., Polyakova V.O. Morphofunctional features of Immunocompetent Cells in the human Placenta from Patients with Type 2 Diabetes Mellitus. Journal of Medical and Biological Research, 2021, vol. 9, no. 2, pp. 153–162. DOI: 10.37482/2687-1491-Z053

Aim.We aimed to assess safety and effectiveness of class III antiarrhythmic drug Refralon for conversion of atrial fibrillation (AFib) and flutter (AFl) in post-registration trial and to compare data of primary center (National medical research center in cardiology) with data of other hospitals.Material and Methods. We performed retrospective cohort study in 727 patients (451 enrolled in primary center and 276 enrolled in other hospitals) admitted between June 24, 2014 and June 24, 2019. Refralon was administered for conversion of AFib and AFl in intense care units in escalating doses (10-30 mcg/kg) intravenously. Primary endpoints: restoration of sinus rhythm (SR) within 24 hours after the start of infusion of the study drug in a total dose of up to 30 pg / kg; registration of SR on an electrocardiogram (ECG) 24 hours after the start of the study drug infusion. Secondary endpoints: restoration of SR after infusion of the study drug at a dose of 10 pg / kg; restoration of SR after infusion of the studied drug in a total dose of up to 20 pg / kg; no recurrence of AFib/AFl after restoration of AFl within 24 hours of observation after the start of the study drug infusion.Results.Conversion to SR was achieved in 53,6% (391 of 727) after administration of 10 mcg/kg dose, in 73% (531 of 727) after administration of 20 mcg/kg dose and in 91,6% (666 of 727) after administration in dose up to 30 mcg/kg. SR was restored in 89% (402 of 451) of patients in primary center, and in 96% (264 of 276) of patients in other hospitals; 95% confidence interval (CI): (-0,1;-0,03). SR preserved 24 hours after conversion in 98% (650 of 666) successfully converted patients. In primary center SR preserved in 97% (390 of 402) successfully converted patients. In other hospitals - in 98,5% (260 of 264) successfully converted patients. 95 CI: (-0,09;0,06).Conclusion:In post-registration multicenter trial Refralon demonstrated high effectiveness in conversion of AFib and AFl to SR. In other hospitals Refralon did not demonstrate lower effectiveness than in primary medical center.

This paper formulates and substantiates the list of topical problems of thermal physics in relation to hazardous production facilities that constantly arise and require prompt solutions at a metallurgical enterprise. Many problems can be successfully solved using optoelectronic equipment, such as a thermal imager. Thermal imager allows to scan the entire object completely without contact. Topical tasks that can be solved with the help of a thermal imager: monitoring and evaluation of the probability of trouble-free operation of the steel ladle lining during its heating, wear resistance of the converter during oxygen purging of the metal melt, spills of the metal melt from the converter, damage of the exit edges of the nozzles of gas-air burners, determination of the surface temperature of the walls of various furnaces, etc. In the converter, electric steel-making and other workshops, with the help of a measuring thermal imager or pyrometer, it is possible to monitor heat leaks from the production premises, to obtain the distribution of the local heat transfer coefficient on various parts of the thermal surface. It is also possible to predict the temperature condition in emergency situations, confirm the requirements for the thermal mode of the operated object, identify and control ingots and billets with regard to their grain size and uniformity in the ingot cross-section, etc. Paper presents the examples of thermograms obtained both for the steel ladle and for other objects. Formulated list and experimentally confirmed solutions of thermal problems clearly show that with the help of a thermal imager it is possible to quickly, efficiently, and reliably solve the complex problems of heat exchange and heat transfer in the subdivisions of a metallurgical enterprise.

In connection with the use of the SPZO-M modernized system for prestressing the NPP containment, it became necessary to determine the effect of loads inside the containment wall on the stress-strain state of the containment. Because of the particularities of the technology used to install the reinforcing elements, where the ducts are filled with grout under pressure up to 1 MPa, there is a possibility of cracking at the construction stage of the structure. Calculations established that on simultaneous injection of the middle and outer or inner channels the maximum principal stresses in the thinnest zones between the crossing channels reach the tensile strength of concrete 2 MPa. For this reason, it is recommended that simultaneous injection of these channels should be excluded. On prestressing and long-term operation, tensile stresses act in the radial reinforcement that can cause cracks to appear in the containment wall. On using the SPZO-M system, the radial stresses in the rod reinforcement increased by 19.4% compared to SPN-1000. Measures are proposed to limit cracking in the containment body.

The aim of the study was to analyze the outcomes of surgical treatment for pulmonary embolism in the group of patients previously operated on for varicose vein disease of the lower extremities.

Relevance. Data on the efficacy of endocrine and chemotherapy regimens in patients with hormone-resistant metastatic breast cancer (mBC) after progression with CDK4/6 inhibitors are limited; the search for an effective therapy regimen in this clinical situation is an urgent task of clinical oncology. Aim. Evaluate the efficacy and safety of eribulin therapy in patients with HR+/HER2- mBC after progression with CDK4/6 inhibitors; compare the results of the Russian study and the EMPOWER observational study in the USA. Materials and methods. The Russian observational study included 54 patients (pts) with HR+/HER2- mBC, who were treated with eribulin after CDK4/6 inhibitors in 24 Russian Cancer hospitals. The median age of pts was 56 years; 75.9% of them had recurrent BC, 24.1% de novo BC stage IV; 51.9% of pts had progression with CDK4/6 inhibitors in the first 6 months of therapy (primary endocrine resistance); 48.1% of patients had progression in the period from 6 to 38 months; 89.1% had visceral site of metastases (liver MTS 65.5%, lung MTS 52.8%, brain MTS in 7.5%). Eribulin was used after anthracyclines and taxanes in 94.4% of cases. The efficacy and safety of eribulin therapy in patients with HR+/HER2- mBC after progression with CDK4/6 inhibitors was studied, as well as subgroup analysis according to age, sites of metastasis, and previously treatment options. Results. Eribulin was prescribed in the standard regimen of 1.4 mg/m2 on days 1 and 8, the interval between cycles was 21 days, the number cyclys of chemotherapy was 144 (median 8, the mean number of cycles 10.5). With a median follow-up of 11.5 months (from 3 to 36 months), 30 patients (55.6%) continue therapy with eribulin at present; therapy was cancelled in 24 patients due to progression in 22 (40.7%) cases, and due to intolerable toxicity in 2 (3.7%) patients. The maximum response to eribulin therapy included partial response (in 11 cases, 24.4%), stable disease (in 30 cases, 66.7%) and progression in 4 (8.9%) patients. Median PFS with eribulin therapy was 10.0 months; the 6-month, 1-year, and 2-year PFS were 79.5%, 44.8% and 26.5%, respectively. Eribulin therapy was equally effective in different subgroups (p0.05) and did not depend on the age of patients, the previously received treatment, the presence of visceral MTS and liver damage. The best response to chemotherapy with eribulin was observed in lung metastases: median PFS 24 months vs 9.1 months, p=0.056. The safety profile was favorable; adverse events were registered in 34.5% of patients, which required dose adjustment in 18.5% of cases. With a median follow-up of 11.5 months, 92.6% of patients remain alive. Conclusion. Eribulin has demonstrated high efficacy and favorable safety profile in hormone-resistant HER2- mBC in patients with progression when receiving CDK4/6 inhibitor.

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Relevance. The reason for the study was our histological specimen with intrapulpal dye injection from the monograph "Anesthesia in Endodontics". Outside the pulp chamber, in the root canal, the ink is diffusely distributed throughout the vessels. There was a hypothesis about the vascular nature of intrapulpal injection.Aim. Тo prove vascular mechanism intrapulpal injection.Materials and methods. A randomized prospective pilot study was performed in 15 patients (9 men, 6 women) with 15 teeth vital pulpectomy. Traditional anesthesia conducted articaine 4% with epinephrine 1:100 000. When accessed in the pulpintroduced drop the same anesthetic. Heart rate was determined after 30 seconds for 3 minutes pulse oximeter MD 300.Results. There was expressed vascular reaction to intrapulpal introduction anesthetic with epinephrine. It has resulted in a sharp increase in pulse rate by an average of 11.3 beats /min, return to the original level after 3 minutes. Conclusions. Based on the results obtained, we assume the vascular-venous nature of intrapulpal anesthesia.

The utilization of waste from coal and petroleum extraction and processing is of critical importance today. Classical disposal methods, such as incineration or burial, are ineffective and environmentally harmful. The present work shows that the environmental impact of such waste may be reduced if it is used in fuels based on water suspensions. Mixtures containing oil slurries, filter cake from coking coal, and sawdust are considered. The concentration of sulfur and nitrogen oxides formed in combustion is determined. Various characteristics of the emissions from the fuels containing the waste are determined. The combustion of fuels containing these components in different proportions may decrease anthropogenic SO2 and NOx emissions by 4–48% and 16–39%, respectively.

The current composition of horsefly species in Pskov Province and their associations with different biotopes in the province and in the whole of Northwest of European Russia are analyzed. A zoning system of the hydrolandscapes of Pskov Province with regard to the factors affecting the distribution of horsefly species is proposed for the first time.

During the examination of post-COVID patients, a direct and indirect negative effect of COVID-19 on the nervous system is found. Among the mediated subjectively significant stress factors of the pandemic, a potential long-term threat to life, prolonged quarantine measures with selfisolation, lack of stable immunity, restriction of access to medical services, etc. are of particular importance. An increased frequency of depression (up to 53.5%), anxiety (up to 50.9%), and mixed anxiety/depressive disorders were reported during the pandemic. Psychopharmacotherapy in patients with COVID-19 should include drugs not only with minimally expressed undesirable effects and adverse drug interactions but also with the presence of additional therapeutic procognitive and somatotropic properties, similar to those identified in the antidepressant fluvoxamine.

Selenium is an important micronutrient that is essential for the functioning of the human body. Being a component of the active center of several antioxidant enzymes selenium prevents cell injury by free radicals. Decline in selenium-containing enzymes results in progression of oxidative stress and chronic inflammation, which are considered as possible causes for the development of many cardiovascular diseases. This review focuses on mechanisms for prevention of myocardial and vascular injury through the adequate selenium supply to the body. The importance of monitoring and correction of the selenium status in appropriate patients is underlined.

THE AIM OF THE RESEARCH: to reveal the relationship of various markers of calcium metabolism (osteopontin (OPN), parathyroid hormone-related protein (PTHrP), vitamin D, parathyroid hormone (PTH)) on the course of urolithiasis (Urolithiasis) in patients with calcium oxalate nephrolithiasis. Materials and methods 100 people were examined, the following groups were included: group 1 - patients with calcium oxalate primary nephrolithiasis (n=41), group 2 - with calcium oxalate recurrent nephrolithiasis (n=39). Group 3 included conditionally healthy volunteers (n=20). The studies were carried out by the immunoenzymometric ELIZA and biochemical methods using appropriate test systems. Results in patients with recurrent nephrolithiasis, the serum PTHrP level is 54.6 (25.4-78.2) pg / ml, which is 3.7 times higher than in conventionally healthy individuals; the level of osteopontin is more than 1.5 times higher and amounts to 1.820 (0.991-2.212) pg / ml. In the group of primary nephrolithiasis, the level of PTHrP is 2-2.5 times higher than in conventionally healthy people. In patients with primary nephrolithiasis, the blood calcium level does not correlate with the level of PTHrP in the blood (r=- 0.0173, p> 0.05), as in the group with recurrent nephrolithiasis (r=0.0223, p>0.05). Discussion in patients with recurrent nephrolithiasis in the preoperative period, the serum levels of osteopontin and PTHrP in the blood serum were higher than in patients who were first diagnosed with urolithiasis, the data obtained can be used as a criterion for predicting the risk of recurrence of urolithiasis in the postoperative period. The blood calcium level does not have a statistically significant relationship with PTHrP, which allows us to assume that PTHrP has other mechanisms of influence on the development of urolithiasis, given the data obtained that the PTHrP level in patients with primary and recurrent nephrolithiasis is higher than in conditionally healthy people. Conclusion Determination of the level of PTHrP and osteopontin in patients with urolithiasis allows predicting the risk of recurrence of urolithiasis at the stage of primary calcium oxalate nephrolithiasis. Determination of the level of PTHrP makes it possible to predict the risks of developing urolithiasis in conventionally healthy individuals, which can be used for targeted prevention of an unfavorable course of urolithiasis by prescribing timely adequate rational therapy and correcting the patients diet. At the same time, no correlation was found between the level of PTHrP and the level of blood calcium in patients with calcium oxalate nephrolithiasis; therefore, further studies of the role of this protein in the pathogenesis of urolithiasis are needed.

The issue of complications of fistuloplasty of vesicovaginal fistulas (VVF) remains extremely relevant both for modern surgeons and for patients. Optimization of morphological characteristics by local interstitial application of Platelet-Rich Plasma (PRP) can positively affect the results of surgical treatment of VVF. PURPOSE OF THE STUDY to conduct a comparative assessment of the morphological parameters of parafistulous tissues before and after local interstitial application of PRP. MATERIALS AND METHODS Study included 52 patients who underwent fistuloplasty. Group I included 30 women who were treated according to the standard method. Group II included 22 patients who underwent PRP therapy prior to surgery. All patients underwent an excisional biopsy of the VVF edges. After performing an excisional biopsy, Group II patients received 9-10 parafistulic injections of activated PRP with a frequency of one every seven days for five weeks before fistuloplasty. Repeated biopsy of the VVF edges was performed in Group II patients immediately before fistuloplasty. For histological study, tissue sections were stained with hematoxylin and eosin according to standard technology. RESULTS Primary biopsy revealed keratinization disorders in eight (37 percent) patients from Group II, and after PRP therapy in four (18 percent) patients (p>0.05). In all patients of Group II, after PRP therapy, the epithelial layer had a normal histological structure (p

Objective To evaluate the results of extracorporeal shockwave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment of calcium oxalate nephrolithiasis, as well as the damaging effects on renal function, taking into account the dynamics of blood cystatin C and urine beta2-microglobulin.Material and Methods Of 94 patients with calcium oxalate nephrolithiasis aged 23–78 included in the study, 42 patients were classified as having undergone ESWL (group I) and 52 patients as having undergone RIRS (group II). Group II patients were then stratified into subset 2A (n = 32) as having undergone RIRS through rigid ureteroscope and subset 2B (n = 20) as having undergone RIRS through flexible ureteroscope. We performed plain urography and nephrosonography at 24–48 hours postoperatively and unenhanced computed tomography 4–6 weeks after surgery. We measured concentrations of serum cystatin C and urinary beta2-microglobulin as a marker for kidney damage. In group I, samples of peripheral blood andurine were taken before and after the first, third sessions and 30 days after the last ESWL session. In group II, samples were analyzed before surgery, on the first and 30th postoperative days.Results The average size of calculi in the group with RIRS was 16.91 ± 2.79 mm, in the group with ESWL 12.31 ± 2.27 mm. The need for reoperation after RIRS was 19.2%, which was lower than after ESWL. Stone-free effect (no stones, or residual stones less than 3 mm) was observed in 95% of cases in patients with RIRS, and in 78% with ESWL. Group I patients demonstrated an increase in the blood leukocytes total number more often than subsets 2A (rigid RIRS) and 2B (flexible RIRS) patients. Leukocyturia was also a more common complication in group I. In the RIRS group, there was no statistically significant change in the level of blood cystatin C and urine beta2-microglobulin, on the contrary, a moderate increase in the endogenous marker of cystatin C was noted after one ESWL session. The increase in urine beta2-microglobulin levels in patients after the first and third ESWL sessions was significantly higher than after RIRS.Conclusion Flexible RIRS may be suggested as the preferred procedure for patients requiring additional protection of renal function in the treatment of renal stones less than 20 mm. ESWL of stones less than 20 mm can be used as an alternative treatment, since it is characterized by a rather long period of stone eradication from the urinary tract, a high frequency of residual calculi after the procedure, and also has a damaging effect on the renal tissue.

Objective: study the duration of establishment of functional stability to non-specific stress in wrestlers.Materials and Methods. Nineteen athletes in martial arts, mid-age 23 ± 3 years of age, participated in the study. The qualification level of the subjects ranged from first sport grade to Master of Sport. A series of sports training was organized within 4 weeks. Each train consisted of a smooth-running load of 40 minutes at a speed corresponding to the anaerobic exchange threshold (AET). The indicators of the duration of reaching the AET level by heart rate (HR), the power of the low frequency and high frequency component of the spectrum were analyzed.Results. The effect of urgent adaptation, in the form of an extension of the duration the heart rate on the anaerobic threshold level from 29 to 32 mines and the increase in the regulation of vegetative nervous system by increasing the total power of the spectrum observed on the third day of the training cycle. From the third to ninth days of the study, fatigue occurs, as can be seen from the lowering of the anaerobic threshold time to 21 minutes, as well as the lowering of the high-frequency part of the vegetative nervous system regulatory spectrum. The emergency adaptation ends by 9 days of observation, after four high-intensity exercises, which manifests itself in stabilizing the regulation of the heart rate, vegetative nervous system goes from a reflex level to a lower one — a humeral metabolic level. The time to reach the HR in the aerobic threshold will stabilize at 21–23 minutes.Conclusions. Functional stability to the non-specific aerobic load in the wrestlers emerged by the twentyseventh day of the study after ten highly intensive aerobic exercises, which confirmed by the results of the time dynamics of the tine of HR in aerobic threshold and analysis of spectrum results of HRV.

Review of scientific literature on the evidence of the relationship between palm oil (PO) and its components on human health, on the mechanisms of cholesterol control and risks for development of cardiovascular diseases. Natural interest in PO increased when it became evident that its physical properties make PO a natural substitute for partially hydrogenated vegetable oils containing trans fatty acids which have adverse effect on the human health. PO contains both saturated and unsaturated fats which makes it comparable with other vegetable oils, like olive, sunflower or soybean oils. Comparison with other vegetable oils did not show significant differences in of LDL, HDL or total cholesterol levels. Comparison of diets rich in PO with diets rich in trans fatty acids shows improvement of lipid profiles in groups with PO and serves as basis for replacement of trans fatty acids in food with PO and its fractions. In addition to fatty acids content, PO contains several phytonutrients including 4 forms of tocopherols and tocotrienols, carotenoids, sterols, and some others. Most of these compounds are considered beneficial for human health, mainly on account of their antioxidant activity. It is concluded that PO is safe component of food, when we pay attention to the rather high content of saturated fats in it.

Right ventricle (RV) dysfunction is an independent predictor of patient survival in heart failure (HF). However, the mechanisms of RV progression towards failing are not well understood. We studied cellular mechanisms of RV remodelling in a rat model of left ventricle myocardial infarction (MI)-caused HF. RV myocytes from HF rats show significant cellular hypertrophy accompanied with a disruption of transverse-axial tubular network and surface flattening. Functionally these cells exhibit higher contractility with lower Ca2+ transients. The structural changes in HF RV myocytes correlate with more frequent spontaneous Ca2+ release activity than in control RV myocytes. This is accompanied by hyperactivated L-type Ca2+ channels (LTCCs) located specifically in the T-tubules of HF RV myocytes. The increased open probability of tubular LTCCs and Ca2+ sparks activation is linked to protein kinase A-mediated channel phosphorylation that occurs locally in T-tubules. Thus, our approach revealed that alterations in RV myocytes in heart failure are specifically localized in microdomains. Our findings may indicate the development of compensatory, though potentially arrhythmogenic, RV remodelling in the setting of LV failure. These data will foster better understanding of mechanisms of heart failure and it could promote an optimized treatment of patients.

The results of examination and treatment of a patient with a combination of accelerated idioventricular rhythm and atrial conduction disorder, which made it difficult to interpret the Holter monitoring data, are presented.

The aim of the study was to evaluate the immediate results of treatment of high-risk PE developed against the background of COVID-19, and to analyze the features of the clinical course. Material and methods. The study is based on the experience of treatment applied to three patients with pulmonary embolism (PE) that developed against the background of COVID-19. The group under consideration is represented by males. The average age was 41 ± 3.1 years old. Verification of the primary diagnosis of COVID-19 was based on positive results of polymerase chain reaction, supplemented by the results of computed tomography. The formation of high-risk PE was noted on the 5th–7th day from the moment of hospitalization. There was also a decrease in SO2 below 85%, РаО2 — below 76 mm Hg, Borg index > 8, which required non-invasive high-flow ventilation. Catheterization of the right chambers of the heart with a Swan–Ganz catheter revealed an increase in systolic pressure in the right ventricle to 57 ± 1.2 mm Hg, and diastolic pressure to 13 ± 0.34 mm Hg. Pulmonary hypertension increased up to 70 mm Hg. Changes in the biochemical analysis of blood consisted in increasing the level of troponin I to 0.65 ± 0.14 ng/ml, С reactive protein — to 5.42 ± 2.1 mg/l, and creatine phosphokinase — to 324 ± 23.1 units. An increase in the D-dimer level was observed (0.68 ± 0.11 mg/l). Systemic thrombolysis actilyse was performed in all the cases. Results. Positive clinical dynamics was observed up to 15 hours after thrombolytic therapy. The level of SO2 came back to the initial values and was in the range 93–96% and RaO2 — from 86–92 mm Hg by the end of the first day after the intervention. The average pressure gradient in the pulmonary artery was 32 ± 4.12 mm Hg at the time of discharge, and at the peak — 44 ± 5.3 mm Hg.

Pulmonary hypertension is a complex disorder characterized by pulmonary vascular remodeling and right ventricular hypertrophy, leading to right heart failure. The mechanisms underlying this process are not well understood. We hypothesize that the structural remodeling occurring in the cardiomyocytes of the right ventricle affects the cytosolic Ca 2+ handling leading to arrhythmias. After 12 days of monocrotaline-induced pulmonary hypertension in rats, epicardial mapping showed electrical remodeling in both ventricles. In myocytes isolated from the hypertensive rats, a combination of high-speed camera and confocal line-scan documented a prolongation of Ca 2+ transients along with a higher local Ca 2+ -release activity. These Ca 2+ transients were less synchronous than in controls, likely due to disorganized transverse-axial tubular system. In fact, following pulmonary hypertension, hypertrophied right ventricular myocytes showed significantly reduced number of transverse tubules and increased number of axial tubules; however, Stimulation Emission Depletion microscopy demonstrated that the colocalization of L-type Ca 2+ channels and RyR2 (ryanodine receptor 2) remained unchanged. Finally, Stimulation Emission Depletion microscopy and super-resolution scanning patch-clamp analysis uncovered a decrease in the density of active L-type Ca 2+ channels in right ventricular myocytes with an elevated open probability of the T-tubule anchored channels. This may represent a general mechanism of how nanoscale structural changes at the early stage of pulmonary hypertension impact on the development of the end stage failing phenotype in the right ventricle.

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is one of the high-potential non-pharmacological methods for migraine treatment. The purpose of this study is to define the neuroimaging markers associated with rTMS therapy in patients with migraine based on data from functional MRI (fMRI).Materials and MethodsA total of 19 patients with episodic migraine without aura underwent a 5-day course of rTMS of the fronto-temporo-parietal junction bilaterally, at 10 Hz frequency and 60% of motor threshold response of 900 pulses. Resting-state functional MRI (1.5 T) and a battery of tests were carried out for each patient to clarify their diagnosis, qualitative and quantitative characteristics of pain, and associated affective symptoms. Changes in functional connectivity (FC) in the brain's neural networks before and after the treatment were identified through independent components analysis.ResultsOver the course of therapy, we observed an increase in FC of the default mode network within it, with pain system components and with structures of the visual network. We also noted a decrease in FC of the salience network with sensorimotor and visual networks, as well as an increase in FC of the visual network. Besides, we identified 5 patients who did not have a positive response to one rTMS course after the first week of treatment according to the clinical scales results, presumably because of an increasing trend of depressive symptoms and neuroimaging criteria for depressive disorder.ConclusionsOur results show that a 5-day course of rTMS significantly alters the connectivity of brain networks associated with pain and antinociceptive brain systems in about 70% of cases, which may shed light on the neural mechanisms underlying migraine treatment with rTMS.

Злокачественный нейролептический синдром является потенциально опасным осложнением при проведении нейролептической терапии, требующим своевременной диагностики, основанной на исключении других причин гипертермии, и специфических лабораторных исследований. Тактика лечения данного состояния принципиально отличается от тактики ведения больных с другой патологией, сопровождающейся гипертермией. В статье представлен клинический случай успешной и своевременной диагностики и лечения данного состояния.

Aim. То carry out a comparative assessment of the change in the pain threshold (in terms of electroodontometry), the X-ray width of the root canal in the apex area and the nature of the pain sensation of the central incisors in children aged 6.5-15 years.Materials and methods. We examined 280 teeth in 280 children from 6.5 to 15 years old (central incisors). Patients are divided by age into 5 groups: 1 - 6.5-7 years old; 2 - 7-8 years old; 3 - 9-10 years old; 4 - 11-12 years old; 5 - 13-15 years old. The patients underwent electroodontometry (EOM), to measure the sensitivity threshold of the studied tooth, the subjective sensations with EOM were assessed, and the width of the apical part of the root canal was determined, according to the data of intraoral sighting radiography.Results. The study studied the process of teething and formation of teeth in dynamics from 6.5 to 15 years in 5 age groups. Changes in electrodontometry (EOM) are significant from 140.38 цА (4.5 years) to 24.38 цА (15 years) - average data. The relationship between age and the width of the root canal in the area of the apex, which is also characterized by a gradual narrowing, has been traced. Pulp pain with EOM becomes clearer and more short-lived with age. The correlation between age and pain threshold is less pronounced (41%) than between age and apical canal width (72%). Conclusions. The main role in the sensitivity of the tooth is played by the A-delta and C nerve fibers of the pulp. The phenomenon of a decrease in the pain sensitivity threshold of permanent teeth during electrodontometry in the process of root formation due to the reaction of C-fibers was established.

Computed tomography coronary angiography (CTCA) is a non-invasive, powerful image processing technique for assessing coronary artery disease. The aim of the paper is to evaluate the diagnostic role of CTCA using optimal scanning parameters and to investigate the effect of low kilovoltage CTCA on the qualitative and quantitative image parameters and radiation dose in overweight and obese patients. Consolidation of knowledge in medicine and image processing was used to achieve the aim, and performance was evaluated in a clinical setting. Elevated body mass index is one of the factors causing increased radiation dose to patients. This study examined the feasibility of 80-kV and 100-kV CTCA in overweight and obese adult patients, comparing radiation doses and image quality versus standardized 100-kV protocols in the group of overweight patients and 120-kV CTCA in the group of obese patients. Qualitative and quantitative image parameters were determined in proximal and distal segments of the coronary arteries. Quantitative assessment was determined by the contrast-to-noise ratio and signal-to-noise ratio. The results of the study showed that in overweight and obese patients, the low dose protocol affords radiation dose reduction of 35% and 41%, respectively. Image quality was found to be diagnostically acceptable in all cases.