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Objective We investigated the association between the pattern and duration of pelvic venous reflux (PVR) and pelvic pain severity in patients with pelvic varicose veins (PVVs). Methods The present retrospective study included 600 female patients with PVVs. Of the 600 patients, 453 had had PVVs and pelvic congestion syndrome (group 1) and 147 had had an asymptomatic disease course (group 2). Pelvic venous pain (PVP) was assessed using a visual analog scale. All the patients had undergone duplex ultrasound of the left and right renal veins, external, internal, and common iliac veins, and parametrial, uterine, gonadal, and vulvar veins (PV, UV, GV, and VV, respectively), with an assessment of their patency and diameter and the presence and duration of reflux. Reflux in the pelvic veins was considered pathologic if it lasted for >1 second. Results In group 1, PVR type I (1-2 seconds), II (3-5 seconds), and III (>5 seconds or spontaneous reflux in the absence of a loading test) was found in 31%, 58%, and 11% of the patients, respectively. Moderate and severe reflux (types II and III) was associated with severe PVP (mean score, 8.3 ± 0.5) in 69% of the group 1 patients. A combination of reflux in the GV, PV, UV, and internal iliac vein was associated with severe PVP (mean score, 8.1 ± 0.3) in 51% of these patients. A combination of reflux in the PVs, UVs, and VVs was associated with moderate pain (mean score, 5.3 ± 0.2) in 49.2% of group 1. In group 2, PVR type I, II, and III was present in 95%, 4%, and 1% of the patients, respectively, and was observed in the PV only in patients with type I; in the GVs, PVs, UVs, and internal iliac veins in those with type II; and in the PVs and GVs in the patients with type III reflux. Reflux in the GVs and UVs was significantly more prevalent in group 1 than in group 2 (GVs, 51% vs 6%; P = .0001; UVs, 57% vs 7%; P = .0001). A combination of reflux in the GVs and UVs was a predictor of severe PVVs (odds ratio, 19.7; 95% confidence interval, 11.3-34.6). Conclusions In patients with PVVs, the presence and severity of pelvic pain will be determined by the type of PVR and its distribution in the pelvic veins. The combination of moderate to severe reflux (types II and III) in the PVs, UVs, and GVs was a predictor of severe PVP. Patients with asymptomatic PVVs were characterized by mild reflux (type I) in the PVs, with rare involvement of the GVs and UVs.

Objective Compression stockings and bandages are widely used after invasive treatment of varicose veins. The goals of compression after venous interventions are to reduce pain, bruising, and ecchymosis. Nevertheless, patients often report discomfort with the compression. To make postprocedural compression more tolerable, foot-sparing bandages were tested in a randomized clinical trial of noninferiority. Methods A total of 187 patients were randomized to use class II foot-sparing compression sleeves for the full leg or class II stockings after radiofrequency ablation with concomitant phlebectomy. The primary endpoint was the quality of life, measured using the Chronic Venous Disease Quality of Life Questionnaire 20-item scale 30 days after intervention. The secondary endpoints were pain in the leg and discomfort related to the compression garment, which were assessed using the visual analog scale (VAS) at 2, 7, 14, and 30 days. Results The global index score of the questionnaire was 66.1 and 70.6 and 83.8 and 87.7 for the sleeve and stocking groups before and 30 days after intervention, respectively (P = .542 and P = .150, respectively). The VAS for pain score in the operated leg was slightly higher in the sleeve group the day after the intervention (score, 2.1 vs 1.6; P = .03). At 7, 14, and 30 days, the VAS for pain scores did not differ significantly (score, 0.7 vs 0.5; 0.5 vs 0.3; and 0.1 vs 0.1, respectively; P = NS for all). The VAS for discomfort score was not significantly different statistically in the study group at 2 days (sleeve, 1.9; vs stocking, 1.4; P = .08) but was higher after 7 days (sleeve, 0.9; vs stocking, 0.6; P = .008). No difference in discomfort was found between the study and control groups at 14 or 30 days (sleeve, 0.6; vs stocking, 0.4; and sleeve, 0.4; vs stocking, 0.4, respectively; P = NS for both). Conclusions Quality of life after thermal ablation with phlebectomy improved equivalently in patients who had used class II compression sleeves for full legs and those who had used class II compression stockings. Pain and discomfort were slightly higher in the sleeve group.

Долгое время единственным эффективным способом хирургического лечения варикозной болезни нижних конечностей считалось полное удаление ствола подкожной вены. Со временем помимо модификаций удаления вен с помощью зондов появились также эндовенозные термические методы облитерации, однако общим во всех этих методиках оставалось полное иссечение\облитерация несостоятельного сегмента ствола. Данная концепция начала претерпевать изменения только после появления и развития дуплексного ультразвукового сканирования сосудов, благодаря которому появилась возможность более глубокой оценки гемодинамики венозной системы и, как следствие, определения дальнейшего необходимого способа лечения отдельно взятого пациента. Именно благодаря подробному изучению венозной гемодинамики в 1988 г. французский ангиолог Клод Франчески предложил метод амбулаторной консервативной гемодинамической коррекции венозной недостаточности (Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire), ставший известным в мире как метод CHIVA. Данный способ подразумевает устранение столба гидростатического давления в вене, устранение механизма рециркуляции крови, сохранение механизма re-entry и удаление притоков, не имеющих связи с точкой re-entry. В результате выполнения CHIVA происходит восстановление нормального физиологического тока крови путем устранения рефлюкса из глубокой вены в поверхностную и сохранения дренажа из поверхностных вен в глубокие. В представленном обзоре подробно рассматриваются достоинства и недостатки метода CHIVA, а также проведен сравнительный анализ методики с другими существующими на данный момент способами лечения варикозной болезни.

During the COVD-19 pandemic, some pediatric patients in many countries around the world experienced a syndrome resembling a severe Kawasaki disease (KD), often accompanied by shock Due to the incomplete signs of the classic KD in the era before the present pandemic, in many publications from European countries and the United States, this condition was called «multisystem inflammatory syndrome in children - MIS-C» or «hyperinflammatory shock» or «Kawasaki-like syndrome» This syndrome with a new coronavirus infection is characterized by refractory fever, frequent gastrointestinal symptoms, heart damage (including coronary dilation in some patients, and acute left ventricular failure in the majority), increased ESR and CRP levels, neutrophilia, extremely high troponin levels, increased ferritin, AST, ALT, lactate dehydrogenase, creatine phosphate kinase, interleukin-6 and interleukin-10, coagulopathy with an increase in D-dimer and fibrinogen, thrombocytopenia, sometimes procalcitonin increase The manifestations of a cytokine storm may meet the criteria for secondary hemophagocytic syndrome The mechanism of myocardial damage remains unclear Treatment with high-dose intravenous immunoglobulin is effective, and in the presence of signs of hemophagocytic syndrome, dexamethasone or methylprednisolone Further research is needed to understand the pathogenesis, resemblance and differences of this syndrome with classic KD, understanding of heart injuiry and early recognition for the need of urgent care В ходе пандемии COVD-19 у части пациентов детского возраста во многих странах мира отмечен синдром, напоминающий тяжелый вариант болезни Кавасаки (БК), часто сопровождаемый шоком Ввиду неполного его соответствия классической БК в эру до настоящей пандемии во многих публикациях из европейских стран и США это состояние получило название «мультисистемный воспалительный синдром», либо «гипервоспалительный шок», либо «Кавасаки-подобный синдром» Для данного синдрома при новой коронавирусной инфекции характерны рефрактерная лихорадка, частые гастроинтестинальные симптомы, поражение сердца (включая коронарную дилатацию у части больных и острую левожелудочковую недостаточность у большинства), повышение уровня СОЭ и СРБ, нейтрофилез, экстремально высокий уровень тропонина, рост ферритина, АСТ, АЛТ, лактатдегидрогеназы, креатинфосфаткиназы, интерлейкина-6 и интерлейкина-10, коагулопатия с увеличением Д-димера и фибриногена, тромбоцитопения, иногда рост прокальцитонина Проявления цитокинового шторма могут отвечать критериям вторичного гемофагоцитарного синдрома (ГФС) Механизм поражения миокарда остается неясным Эффективно лечение высокодозным внутривенным иммуноглобулином, при наличии признаков ГФС - дексаметазоном либо метилпреднизолоном Дальнейшие исследования необходимы для понимания патогенеза, сходства и различия данного синдрома с классической БК, механизма поражения сердца, раннего распознавания для оказания ургентной помощи

Purpose The aim of the study was to assess the inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE) in tertiary care. Methods We performed a retrospective analysis of database of a tertiary hospital in 2016–2017. All the records of patients admitted for VTE or diagnosed with VTE being hospitalized for other reasons were extracted. The data collected were number of patients, who received IVCF, indications to filter insertion, PE and death rate after procedure, frequency of IVCF occlusion. Results 2399 patients with VTE were admitted to hospital. 442 (18,4%) of them received IVCF (239 in 2016 and 203 in 2017). Retrievable models were used in most cases (98,8%). In 119 (5,0%) patients cava filters were used due to contraindications for anticoagulation, while in 184 (7,7%) patients’ anticoagulation was not effective and thrombosis progression was registered. 101 (4,2%) patients received IVCF due to high PE risk (length of floating thrombus ≥7 cm, in proximal location), high pulmonary hypertension was indication to IVCF insertion in 38 (1,6%) patients with deep vein thrombosis (DVT) in combination with pulmonary embolism (PE). Overall mortality rate after IVCF insertion was 5 (0,2%). No fatal PE was registered. IVCF occlusion during hospitalization occurred in 116 (4,8%) cases. Only 29 (1,2%) of patients were admitted back for IVCF removal. Conclusions Every one in five patients with proximal DVT and/or PE receives IVCF in a routine practice in tertiary hospital. The most common indications for IVCF implantation were inability for anticoagulation or anticoagulation failure. Removal rate of retrievable cava filters is low.

У статті представлено результати дослідження впливу комплексного методу лікування гіперестезії твердих тканин зубів у дітей 12 років. Мета дослідження – вивчити ефективність застосування комплексного методу лікування гіперестезії зубів у дітей 12 років. Матеріали і методи. У дослідженнях взяли участь 44 дитини віком 12 років із гіперестезією зубів ІІ ступеня тяжкості. Дітей, залежно від методу лікування, поділили на 2 групи. До групи порівняння ввійшли 23 дитини 12 років обох статей, яким застосовували стандартну схему лікування гіперестезії. До основної групи увійшли 23 дитини віком 12 років обох статей. До початку лікування їм проводили санацію та професійну гігієну ротової порожнини. У дітей основної групи застосовували комплексний метод лікування, який ми розробили. У дітей кожної групи визначали індекси розповсюдження гіперестезії зубів та інтенсивності гіперестезії зубів. Для визначення електрозбудливості пульпи зубів із гіперчутливістю ми використовували апарат «PulpTester-P». Результати досліджень та їх обговорення. У результаті проведених досліджень ми встановили достовірне зниження індексу розповсюдження гіперестезії зубів у дітей основної групи та групи порівняння після проведеного курсу лікування, але цей індекс у дітей основної групи через півроку був в 9,31 раза менше, ніж показник групи порівняння. Показники індексу інтенсивності гіперестезії зубів через 6 місяців, рік та півтора року засвідчують пролонгований ефект після застосування запропонованого нами методу лікування. Висновки. Використання комплексного методу лікування дозволяє зменшити прояви гіперестезії зубів у дітей, що підтверджується показниками індексів розповсюдження, інтенсивності гіперестезії зубів та показниками електроодонтометрії. У дітей, яким використовували розроблений метод лікування гіперчутливості зубів, зменшувалась кількість рецидивів захворювання.

The preparation of formaldehyde gas mixtures required for metrological assurance of air pollution control is an urgent task. Methods for the preparation of gas mixtures of formaldehyde for metrological purposes are considered. The 2 μmol/mol-level gas mixtures of formaldehyde in nitrogen have been obtained by a dynamic-gravimetric method with the depolymerization of trioxane vapor. The efficiency of the trioxane conversion process was experimentally studied. The sources of uncertainty are analyzed in detail. The reference gas mixtures obtained were used for the formaldehyde mole fraction measurements during the CCQM-K90 key comparison. The relative expanded uncertainty of the measurement U = 3.3% was achieved, confi rmed by the comparison results.

Objectives. To study the interaction of polymorphic markers for matrix metalloproteinases (MMP) and chronic stress on formation of stroke on the background of hypertensive disease. Materials and methods. A total of 830 patients were studied: 303 patients with ischemic stroke on the background of hypertensive disease and 527 patients with hypertensive disease without stroke. SNP for metalloproteinases were studied using the real-time polymerase chain reaction. The functional significance and influences of polymorphic loci on gene expression were studied using the HaploReg (v4.1) (http://archive.broadinstitute.org) and GTEx-portal (http://gtexportal.org) services. Results and conclusions. An association was found between the GG rs11568818 genotype of the MMP7 gene and a high risk of developing stroke in patients experiencing regular stress (odds ratio (OR) 1.71). The 5A allele and the 5A/5A genotype of rs3025058 of the MMP3 gene had protective effects on development of stroke in people without histories of chronic stress (OR 0.73 and OR 0.60, respectively). The SNP studied here were located in the histone protein H3K4me1 and H3K4me3 region, which is hypersensitive to DNase 1 and binds regulatory proteins and transcription factors, while the polymorphic rs11568818 locus is linked with the level of expression of the MMP7 gene.

The purpose of this work was to study the contents of calcitonin gene-related peptide (CGRP) and substance P (SP) in the blood plasma of patients with pelvic varicose veins. Thirty women with pelvic varicosities and a reflux blood flow were investigated using duplex ultrasonography. Group 1 included 18 patients with clinical signs of the pelvic congestion syndrome (PCS), including venous pelvic pain (VPP). Group 2 consisted of 12 patients with pelvic varicosities with no clinical signs of PCS. Group 1. The score of VPP intensity ranged from 4 to 8; the mean score being 4.84 0.43. The CGRP level in the studied group ranged from 0.39 to 1.01 ng/mL; the SP level ranged from 0.005 to 1.33 ng/mL. Group 2. The CGRP values were 0.15-0.32 ng/mL, and the SP range was 0.003-0.3 ng/mL. In this group, the levels of the studied peptides were 3-5 times lower than those for the patients with VPP. Group 3. The mean CGRP values were 0.06 0.003 ng/mL, and the mean SP values were 0.03 0.001 ng/mL. These values were considered as the reference parameters; a statistical analysis was performed for them. The correlation analysis revealed a strong relationship between the CGRP and VPP levels (r = 0.82) and a medium correlation between the SP level and pelvic pain in Group 1. The CGRP and SP levels in blood plasma highly correlate with the presence of pelvic venous pain.

The aim of the study was to assess the efficacy and safety of ART regimens that included different doses of the drug 6НР with the reception of QD, in comparison with the scheme of ART, containing, PhAZT, to select the daily dose 6НР in conducting phase III clinical trials.Patients and methods. 125 patients were randomized to 25 people in 4 groups, depending on the daily dose of the drug 6НР (600, 800, 1000, 1200 mg), and in the comparison group (phosphazide). For a daily dose of the drug 6НР the study was blind. All patients, in addition to the studied drugs were receiving 3TC and EFV. The effectiveness of ART regimens was assessed by the proportion of patients with HIV RNA Results. The use of ART scheme, which included 6НР + 3TС + EFV, was highly effective regardless of the daily dose of the drug 6НР, and is comparable to the effectiveness of the comparison mode (PhAZT+3TC+EFV). More than 95.5% of patients receiving 600 mg and 800 mg of the drug 6НР QD, after 24 weeks of therapy, the level of HIV RNA was < 50 copies/ml (in the comparison group – 87.5%). In patients of all groups there was a significant increase in the median CD4+lymphocytes. The maximum result of increasing the median CD4 + lymphocyte count (164 cells/µl) was observed in patients receiving the drug 6НР – 600 mg/day. All the studied modes was safe because of the 24-week study made up 94% of the patients receiving 6НР, and 96% of receiving PhAZT. Only 1 patient (1%) receiving the maximum daily dose 6НР (1200 mg), marked AES possibly related to study medication, and which led to the cancellation of the treatment.Conclusions. The effectiveness and safety of all modes of ART did not depend on the daily dose of the drug 6НР and was comparable to the comparison scheme, which included PhAZT. The maximum virological and immunological response after 24 weeks of therapy was achieved in patients receiving the drug 6НР at a dose of 600 mg QD in the ART scheme. The drug 6HP is recommended for phase III study in a daily dose of 600 mg in the ART.

Objective. To evaluate the incidence of post-embolization syndrome (PES) and the effect of venoactive therapy on its development, severity, and duration after endovascular embolization of gonadal veins (EEGV) with coils in patients with pelvic congestion syndrome (PCS). Materials and Methods. We analyzed the outcomes of EEGV with coils in 70 female patients who received (n = 38, group 1) or did not receive (n = 32, group 2) treatment with a venoactive drug (VAD) before and after the procedure. Assessments of the EEGV efficacy and for possible signs of PES were done on days 1, 5, 10, 15, 20, and 30 after the intervention. All patients underwent transvaginal and transabdominal duplex ultrasound scanning (DUS) after EEGV. In addition, patients with PES were examined using the computed tomography of the pelvic veins in the postprocedural period. Results. Technical success of EEGV was achieved in 100% of patients. Pelvic venous pain (PVP) reduction after EEGV was observed in 77.1% of patients. The PES was diagnosed in 18.6% of cases (10.5% in group 1 vs. 28.1% in group 2, p &gt, 0.05). In three patients of group 1, the protrusion of coils was suspected and eventually verified during the resection of the left gonadal vein with coils. The group 1 patients had less severe post-embolization pain (6.2 ± 0.4 vs. 7.8 ± 0.3 scores in group 2, p = 0.009) and three times shorter duration of PES (5.0 ± 1.2 vs. 16.2 ± 2.7 days, p = 0.003). No significant differences in the diameters of gonadal veins, side of embolization, and number of coils were revealed between patients with and without PES. The rate of parametrium vein thrombosis was found to be significantly higher in patients with PES than in those without PES (30.7% vs. 18.5%, respectively, p &lt, 0.05). Conclusion. The PES is a frequent complication of EEGV with coils and occurs in 18.6% of patients. Venoactive treatment does not effect the incidence of this complication but reduces the PES severity and duration.

The aim of the study was to compare the efficacy and safety of ART regimens, which included TDF or PhAZT, in patients with HIV infection who had not received treatment previously. Patients. The study included 85 adult patients with HIV infection. Group 1 consisted of 60 patients who received TDF/FTC + EFV. The second group included 25 patients who received PhAZT + 3TC + EFV. The study was not randomized, comparative, patient groups were similar in terms of the main indicators. The efficacy and safety of the treatment was assessed during the first 24 weeks of therapy. Results. After 24 weeks of therapy, 74,5% of patients in Group 1 and 87,5% of patients in Group 2 had less than 50 copies/ml of HIV RNA (MITT analysis). The increase in the median CD4 + lymphocytes after 24 weeks of treatment was 143 and 135 cells/μl, respectively. Most of the AE (including all AE that caused change or cancellation of the treatment regimen) were associated with the use of EFV. In 22,4% of patients receiving TDF, transient proteinuria was noted, and in 17,2% – deviation of blood creatinine level deviation of mild severity. The safest drugs included PhAZT, FTC and 3TC. The most frequent AE associated with the use of PhAZT, there was a slight decrease in hemoglobin and red blood cell count. Conclusion. The study conducted in the conditions close to real clinical practice showed that both first-line ART regimens, including TDF or Phosphazide in addition to 3TC (FTC) and EFV antiretroviral drugs, were highly effective and safe during the first 24 weeks of treatment. PhAZT is a drug of choice in the schemes of ART of the first line in the presence of contraindications to the prescription of TDF and/or ABC.

Aim. The generalization of the modern data on the influence of comorbidities on cardiac remodeling and heart dysfunction in chronic heart failure (CHF) with preserved ejection fraction (EF). The objectives of the study included the analysis of the pathogenesis of CHF with preserved ejection fraction. Material and methods. Analyzed all Russian and English literature, submitted to the search engines. Results. Analysis of scientific literature showed that the increase in systemic vascular inflammation, endothelial dysfunction and oxidative stress lead to reduced bioavailability of nitric oxide , which leads to increased stiffness of the left ventricle and adverse remodeling of the heart in CHF with preserved ejection fraction. Comorbidities such as overweight /obesity, diabetes, hypertension, chronic obstructive pulmonary disease, anaemia and chronic renal dysfunction leads to coronary remodeling in microvascular endothelial inflammation. The negative contribution is also made by demographic factors such as older age and female gender. In the present review substantiates the crucial role of comorbidities in the pathophysiology of CHF with preserved ejection fraction. Conclusion. Summarizing the analysis of literature sources, devoted to the pathogenesis of CHF with comorbidity, the findings that, in addition to diastolic dysfunction of the left ventricle, there are other patofiziologiia mechanisms: the violation of backup functions, the violation of jeludochno-blood relationship, the energy deficit of the myocardium, pulmonary hypertension, chronotropic imbalance, inflammation, oxidative stress and endothelial dysfunction. With CHF with preserved ejection fraction comorbidities contribute to systemic inflammation which causes oxidative stress in the coronary microvascular endothelium. This reduces the bioavailability of nitric oxide in the myocardium and leads to reduced activity of protein kinase G in cardiomyocytes, which therefore become stiff and hypertrophied. In addition, with increasing age and postmenopausal hormonal changes may lead to additional structural and functional changes.

The guidelines for treatment of patients with HIV infection developed in the United States (DHHS) and the European Union (EACS) are the most globally recognised. They are used in the development of many national guidelines, including those in Russia. The guidelines of the European Union and the United States are specific in that they are characterized by high scientific validity and target countries with high income per capita. In the process of the guidelines evolution, they tended to update the recommended drugs with more efficient, safe and easy to use medications; they expanded the list of indications for antiretroviral therapy to the extent that it was recommended to all HIV patients regardless of clinical manifestations and the level of CD4 cells. The article also analyzes the changes that the guidelines underwent over the past 6 years. There are recent versions of the guidelines.

New esters of N-benzoyl-3-phenoxyphenylcarboxamide acid and N-benzoyl-N′-4-bromophenyl-3-phenoxybenzamidine were synthesized. Some of the synthesized compounds were shown to inhibit the activity of dipeptidyl peptidase-4 and nonenzymatic glycosylation of proteins and manifested antiplatelet and antioxidant properties. The compounds tested did not display the antagonistic effect toward angiotensin II type 1 receptor, did not influence the activity of glycogen phosphorylase and had very little ability to break cross-links of the glycated proteins. The derivatives with the biological activity of two types were found, which can serve as basic molecules in the search for new drug products.

This review presents modern information on the anatomy of pelvic veins, mechanisms of development of pelvic congestion syndrome (PCS) and venous pelvic pain (VPP), methods for verifying the venous nature of pelvic pain, as well as opportunities of various surgical interventions on the gonadal veins in treatment of PCS and relief of its most severe symptom, VPP. A comparative analysis of resection and embolization treatment methods and their effects on VPP, as well as rates of postprocedural complications, was carried out. The issues of elimination of specific compression syndromes causing occurrence of VPP, by using open, endoscopic and endovascular techniques are addressed.

The results of observation of 17 patients aged 2 monthsto 16 years with acute and fulminant myocarditis(FM) were analyzed. Patients were observed in the period 2013-2016. Diagnostics used clinical data, laboratory and instrumental studies. Of 17 patients, acute myocarditis was diagnosed in 14 children, fulminant in 3. Therapy included, first of all, measures for the treatment of heart failure – diuretics (furosemide, verospiron, triampur), angiotensin converting enzyme (ACE) inhibitors (captopril), beta-blockers, digoxin inotropic agents. Intravenous human immunoglobulin was administered at a dose of 1-2 g/kg/course in 5 of 17 (29.4%) patients. When the pathogen was verified, specific antiviral therapy (acyclovir, ganciclovir, cymevene) was administered in a standard mode. Immunosuppressive therapy (prednisolone, delagil) was prescribed for two of them. Nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac) was obtained in children with acute myocarditis duration of over 2 weeks (13 children) prior to 2016. Nonsteroidal antiinflammatory drugs were not administered to hemodynamically unstable patients, regardless of the time period of observation. Overall, 16 out of 17 (94.4%) patients recovered with apparent regression of signs of myocarditis on the background of treatment – the symptoms of acute heart failure and cardiogenic shock were treated, and then manifestations of chronic congestive heart failure gradually decreased. 1 (5,6%) child with fulminant myocarditis died. After 6 months to 3 years, 14 children were observed. Follow-up within 6 months to 3 years showed that the diameter of the left ventricle normalized in 10 out of 14 (71.4%). Two out of 14 children (14.3%) formed postmyocardial dilated cardiomyopathy.

To assess position of mesh endoprosthesis in retroperitoneal space after TARR hernioplasty using ultrasound in early and long-term postoperative period.There were 30 patients with inguinal hernias after TARR procedure. Standard technology of laparoscopic transabdominal preperitoneal hernioplasty was used in all patients. In all cases, a large-pore monofilament polypropylene mesh 10x15 cm was used. Control examination and ultrasound of the mesh implant were performed the next day, in 1, 3, 6, 12 months after surgery. Correct position of the implant was determined by its placement at the level of pubic bone with complete overlap of posterior wall of the inguinal canal and inner ring.US-image of the implant is present in two geometric forms - linear and sinusoid. The shape of prosthesis varies depending on postoperative period and the use of fixing elements. Thus, sinusoidal shape of prosthesis was observed in patients without fixation of prosthesis the next day and in 1 month after TARR. Geometry of the implant acquired the form of a straight line after 3 months and became almost a straight line in 12 months after surgery. Linear shape of prosthesis in early postoperative period was found after intraoperative fixation of endoprosthesis. Sinusoidal shape is noted after 3 months. Ultrasonic pattern of endoprosthesis looked as a thin hyperechoic band with thickness of 1.2-3.9 mm. Mean thickness of prosthesis was 2.2±0.1 mm the next day after surgery, 2.8±0.2 mm after 1 month and 1.6±0.05 mm after 12 months.Geometry of synthetic implants after TARR hernioplasty undergoes significant changes and depends on duration of postoperative period and fixation of the prosthesis.Цель исследования - оценка положения сетчатого эндопротеза в ретроперитонеальном пространстве после трансабдоминальной преперитонеальной герниопластики с помощью ультразвукового метода в ближайшем и отдаленном послеоперационном периоде. Материал и методы. Обследованы 30 пациентов после выполнения стандартной лапароскопической трансабдоминальной преперитонеальной герниопластики по поводу паховой грыжи. Во всех случаях в качестве герниопротеза использовали крупнопористую монофиламентную полипропиленовую сетку размером 10×15 см. Контрольные осмотры и УЗИ сетчатого имплантата выполняли на следующий день и через 1, 3, 6, 12 мес после операции. Критериями правильного положения имплантата рассматривали его визуализацию на уровне лонной кости с полным перекрытием задней стенки пахового канала и его внутреннего кольца. Результаты и обсуждение. Изображение имплантата при УЗИ имеет 2 геометрические формы - линейную и синусоидную. Форма протеза изменяется в зависимости от срока послеоперационного периода и применения фиксирующих элементов. Так, у пациентов без фиксации эндопротеза в 1-е сутки и через 1 мес после трансабдоминальной преперитонеальной герниопластики он имеет синусоидную форму, а с 3-го месяца начинает приобретать вид прямой линии, к 12-му месяцу имплантат имеет форму практически полностью прямой линии. У пациентов, которым выполнена фиксация эндопротеза, в ближайшем послеоперационном периоде протез имеет линейную форму, а с 3-го месяца начинает приобретать синусоидную форму. В ходе УЗИ эндопротез выглядел в виде тонкой гиперэхогенной полосы, толщина которой варьировала от 1,2 до 3,9 мм. В первые сутки после операции толщина протеза составляет в среднем 2,2±0,1 мм, через 1 мес после операции толщина увеличивается до 2,8±0,2 мм, затем отмечается уменьшение толщины до 1,6±0,05 мм к 12-му месяцу наблюдений. Заключение. Геометрическая характеристика синтетических имплантатов, используемых при выполнении трансабдоминальной преперитонеальной герниопластики, претерпевает значительные изменения, которые зависят от сроков послеоперационного периода, а также от наличия либо отсутствия фиксации протеза.

Mechanisms of the development of pain in chronic venous diseases (CVD), including pelvic congestion syndrome (PCS), are understudied. The existing hypotheses of the occurrence of venous pelvic pain (VVP) do not allow to answer the question why some patients have no pain syndrome while others have very pronounced pain despite the same morphofunctional changes in the pelvic veins. This review presents current hypotheses of the VPP development, data on some vasoactive neuropeptides (endothelin, calcitonin gene-related peptide, and substance P), their role in the modulation of vascular tone and sensation of pain, possible association between neurogenic inflammation and VPP and provides a rationale for studying the activity of these neurotransmitters in the treatment of PCS and pelvic pain.Механизмы формирования боли при хронических заболеваниях вен, включая синдром тазового венозного полнокровия, до конца не изучены. Имеющиеся гипотезы возникновения венозной тазовой боли не позволяют ответить на вопрос, почему у ряда больных с синдромом тазового венозного полнокровия отсутствует болевой синдром, а у других значительно выражен при одинаковых морфофункциональных изменениях в тазовых венах. В обзоре представлены современные гипотезы формирования венозной тазовой боли, сведения о некоторых вазоактивных нейропептидах (эндотелин, кальцитонин-ген-родственный пептид, субстанция Р), их роли в регуляции сосудистого тонуса и болевых ощущений, возможной связи нейрогенного воспаления и венозной тазовой боли, обосновано потенциальное значение изучения активности указанных нейротрансмиттеров в лечении синдрома тазового венозного полнокровия и тазовой боли.

To study the interaction of polymorphic markers of matrix metalloproteinases (MMP) and chronic stress in the development of stroke associated with hypertension. MATERIAL AND METHODS: A total of 830 patients, including 303 patients with ischemic stroke associated with essential hypertension (EH) and 527 patients with EH without stroke, were examined. The study of metalloproteinases SNP was carried out using real-time PCR. The functional significance and influence of polymorphic loci on gene expression was studied using of HaploReg (v4.1) (http://archive.broadinstitute.org) and GTEx-portal (http://www.gtexportal.org). RESULTS AND CONCLUSION: An association of the genotype GG (rs11568818) of MMP7 with a high risk of stroke in patients exposed to regular stress (OR=1.71) was observed. It was found that allele 5A and genotype 5A/5A (rs3025058) of MMP3 had a protective effect on the development of stroke in patients without regular stress in the anamnesis (OR=0.73 and OR=0.60, respectively). Those SNPs are localized in the region of histone proteins H3K4me1 and H3K4me3, in the region of hypersensitivity to DNase-1, in the region of binding of regulatory proteins and transcription factors. The polymorphic locus rs11568818 is associated with the expression level of MMP7.Цель исследования. Изучить взаимодействие полиморфных маркеров матриксных металлопротеиназ (ММР) и хронического стресса при формировании инсульта на фоне гипертонической болезни. Материал и методы. Проведено обследование 830 пациентов: 303 больных с ишемическим инсультом на фоне гипертонической болезни и 527 больных с гипертонической болезнью без инсульта. Исследование SNP металлопротеиназ осуществляли методом полимеразной цепной реакции в режиме реального времени. Функциональное значение и влияние полиморфных локусов на экспрессию генов изучали с помощью сервисов HaploReg (v4.1) (http://archive.broadinstitute.org) и GTEx-portal (http://www.gtexportal.org). Результаты и заключение. Установлена ассоциация генотипа GG rs11568818 гена MМР7 с высоким риском развития инсульта у пациентов, подверженных регулярному стрессу (отношение шансов - ОШ 1,71). Выявлено, что аллель 5А и генотип 5А/5А rs3025058 гена ММР3 оказывают протективное влияние при развитии инсульта у лиц, не имеющих хронического стресса в анамнезе (OШ 0,73 и OШ 0,60 соответственно). Изученные SNP локализованы в регионе белков-гистонов H3K4me1 и H3K4me3, гиперчувствительности к ДНКазе-1, связывания регуляторных белков и факторов транскрипции, а полиморфный локус rs11568818 связан с уровнем экспрессии гена MМР7.

Chronic glomerulonephritis (CGN) is one of the most severe kidney diseases. Genes of vascular reactivity are thought to play an important role in development and progression of CGN. In this study, we analyzed association of genes of vascular homeostasis with hypertension and renal survival of CGN patients. The study sample included 238 patients with CGN and 304 healthy subjects of population control. Ten polymorphisms of ten genes of vascular homeostasis were genotyped through polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP) analysis and TaqMan assays. Association of the genotypes with renal survival was analyzed by the Kaplan-Meier estimator. Genotypes 311SC and 311SS of the PON2 gene, (-1166)AC and (-1166)CC of the AGTR1 gene, (+46)AA of the ADRB2 gene, and 198KK and 198KN of the EDN1 gene were associated with decreased rate of renal survival of the patients. Polymorphisms S311C PON2, (-1166)A/C AGTR1, (+46)G/A ADRB2, and K198N EDN1 were associated with the accelerated decline in kidney function in the CGN patients.