Filtering in Stochastic Systems: Analysis for the case of continuous observations with memory of arbitrary multiplicity

We consider stochastic systems with continuous time over observations with memory in the presence of an anomalous noise. The paper is devoted to analysis of some properties of an optimal unbiased in mean-square sense filter. In the case of anomalous noises action in the observation channel with memory, we have proved insensitivity of the filter to inaccurate knowledge of the matrix of anomalous noise intensity and its equivalence to a truncated filter constructed only over non-anomalous components of an observation vector

Peripheral arterial disease and indicators of low-grade inflammation in patients with coronary artery disease and type 2 diabetes mellitus

BACKGROUND: The study of low-grade inflammation in patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular diseases is a pressing problem. A deeper understanding of the cascade of inflammatory reactions, possibly mediating the severe atherosclerotic lesions of various vascular pools in patients with diabetes, has the potential to introduce more sophisticated diagnostic and therapeutic approaches into practice. AIM: To study the interrelation of low-grade inflammation and atherosclerosis of peripheral arteries in patients with coronary artery disease (CAD) and T2DM. MATERIALS AND METHODS: The study included 137 patients (77 men and 60 women) with CAD. The average age of patients was 62.0 (57.066.0) years. The first group included 67 patients with CAD and T2DM, and the second group included 70 patients with CAD. Low-grade inflammation was assessed by the levels of high-sensitivity C-reactive protein, interleukin (IL)-1, IL-6, IL-8, IL-10 and TNF-. All patients underwent duplex scanning of carotid arteries and lower extremity arteries (LEAs). RESULTS: Patients with CAD and T2DM showed significantly greater values of stenosis of carotid arteries and LEAs. Direct correlation was revealed between markers of inflammation and the degree of stenosis of the femoral and tibial arteries, as well as the intima-media thickness of the carotid and femoral arteries. In the group of patients with T2DM, the value of IL-1 was 2.04 (0.982.52) pg/mL, which was significantly less than 2.43 (1.843.19) pg/mL for patients in the second group (p = 0.010). The values of IL-6 were also significantly lower in the first group of patients, at 1.84 (0.734.41) pg/mL vs. 3.73 (2.2710.2) pg/mL in the first and second groups, respectively (p = 0.008). The dose of metformin was inversely correlated with the level of IL-6 (r = 0.314, p = 0.003). CONCLUSIONS: Patients with CAD and T2DM compared with patients without diabetes had significantly greater values of stenosis of peripheral arteries. The levels of IL-1 and IL-6 in the group of patients with CAD and T2DM were significantly lower in comparison with patients without diabetes. The dose of metformin was inversely correlated with the level of IL-6

Ultrasound Atherosclerosis Burden Score as a tool for predicting adverse cardiovascular events in patients with various cardiovascular risks aged 40-64 years

Aim. To investigate the prognostic significance of the Atherosclerosis Burden Score (ABS) in relation to the development of major adverse cardiovascular events in patients of different cardiovascular risks (CVR) aged 40 to 64 years.Material and methods. Men and women aged 40 to 64 years were included in the study. All the patients underwent duplex scanning of the carotid arteries and lower limb arteries. The total ABS was calculated by assessing the presence of plaque in the carotid and femoral bifurcations on both sides. The combined endpoint was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or peripheral artery revascularization.Results. The study included 232 patients who met the inclusion criteria, with a median age of 55,0 years. Very high CVR was established in 94 (40,5%) patients, while high CVR — in 48 (20,7%) patients, and low and intermediate CVR — in 90 (38,8%) patients. The follow-up period lasted 23,6 (15,5; 51,2) months, providing 632,6 patient-years of follow-up. Events within composite endpoint occurred in 28 (12,1%) patients. Increased cumulative risk of adverse cardiovascular events was observed for ABS ≥2, with a significant increase in relative risk (RR) for ABS ≥3. According to Cox regression analysis, ABS 3 was associated with a 3,71-fold (95% CI 1,18-11,6; p=0,025) increase in the RR of adverse cardiovascular events after adjustment for sex, age, baseline CVR, obesity, smoking, diabetes, CAD, a history of myocardial revascularization, type 2 diabetes, drug therapy, and levels of non-high density lipoprotein cholesterol, highly sensitive C-reactive protein, and glomerular filtration rate.Conclusion. In patients of various CVR aged 40-64 years, an ABS ≥3 was associated with a 3,71-fold (95% CI, 1,18-11,6; p=0,025) increase in relative risk of adverse cardiovascular events after adjusting for potential confounders, including sex, age, baseline CVR, CAD, and type 2 diabetes

CARDIAC ARRHYTHMIAS IN CERTAIN INTERNAL DISEASES (review)

Heart rhythm disorders are considered as changes in the normal frequency, regularity, and source of depolarization of the heart, as well as impulse conduction disorders. Cardiac arrhythmias can be caused by numerous reasons, as well as their combination. The review presents current data on the frequency, risk stratification and prognostic value of cardiac arrhythmias in patients with various internal diseases. The data on the increased risk of atrial fibrillation in gastroesophageal reflux disease, gastric diseases and inflammatory bowel diseases are presented. The spectrum of the most common arrhythmias in patients with chronic obstructive pulmonary disease and asthma, as well as thyroid diseases, diabetes mellitus and acromegaly is considered. The options for cardiac arrhythmias associated with the use of chemotherapeutic drugs in the treatment of hemoblastosis are considered separately. Modern ideas about the mechanisms of development of arrhythmias in various internal diseases are discussed. In most cases, cardiac arrhythmias are associated with both the direct effect of the underlying disease on the cardiovascular system and the systemic reactions that occur. However, to date, the question remains to what extent the myocardial state that precedes the underlying disease plays a role in the occurrence of cardiac arrhythmias. The significance of various congenital and genetic factors has not been clarified. These questions are essential for everyday clinical practice and require detailed scientific study

The FINDRISC scale as a risk assessment tool for liver fibrosis in patients with nonalcoholic fatty liver disease

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, which includes changes from hepatic steatosis and nonalcoholic steatohepatitis to fibrosis and cirrhosis. Attempts to find noninvasive markers of liver fibrosis have led to a variety of scales, diagnostic algorithms, and imaging techniques. Individual studies have analyzed the relationship between the FINDRISC scale and hepatic steatosis and concluded that this questionnaire can be used as part of population screening to identify individuals at risk for hepatic steatosis. However, our review of the literature did not reveal any clinical studies on the use and effectiveness of the FINDRISC in liver fibrosis screening.AIM: To evaluate diagnostic value of FINDRISC for liver fibrosis detection.MATERIALS AND METHODS: The study enrolled patients aged 40–60 years from unorganized outpatient population. The sample of patients was formed randomly according to the inclusion and noninclusion criteria. All patients were assessed with standard anthropometric parameters. The FINDRISC questionnaire was used. All patients underwent transabdominal ultrasound examination of the liver and transient liver elastometry. The degree of steatosis was evaluated using Hamaguchi ultrasound scale. RESULTS: The study included 100 patients. An increased risk of type 2 DM (≥7 points) was detected in 68% of patients using the FINDRISC scale. Liver steatosis was diagnosed in 41% of patients. Median values of hepatic elastic modulus by transient elastometry were 4.50 (4.00; 5.25) kPa. At the same time, liver elasticity modulus values ≥5.9 kPa were registered in 11 (11.0%) patients. When analyzing the array of sensitivity and specificity values using the ROC-curve, it was found that for the FINDRISC scale the maximum LR+ and the minimum LRvalues were observed when the number of points on the indicated scale exceeded 10. At this cutoff, the FINDRISC scale had a sensitivity of 81.8% and specificity of 61.8% for detecting liver fibrosis (liver modulus of elasticity ≥5.9 kPa). The scale was of good diagnostic value (AUC 0.699; 95% CI 0.530–0.815).CONCLUSION: In an unorganized sample of patients aged 40–60 years the FINDRISC can serve as a diagnostic tool for liver fibrosis and steatosis. Sum of FINDRISC scores >10 allowed to diagnose liver fibrosis (liver elastic modulus ≥5.9kPa) with sensitivity 81.8% and specificity 61.8%. The probability of absence of hepatic fibrosis with FINDRISC scale values <10 was 96.5%

Features of the upper gastrointestinal tract mucous membrane state in patients with atherosclerosis of the mesenteric arteries

Aim. To evaluate the clinical and endoscopic features of diseases of the upper gastrointestinal tract (GIT) in patients with atherosclerosis of the mesenteric arteries (MA). Materials and methods. The study included 48 patients with atherosclerosis of MA and 43 patients without atherosclerosis of MA, who were hospitalized in the department of vascular surgery of the Chelyabinsk Regional Clinical Hospital in the period from 2019 to 2021. All patients underwent multispiral computed tomoangiography of the visceral and lower limb arteries, esophagogastroduodenoscopy. Results. Assessment of lesions of the upper gastrointestinal tract revealed a higher incidence of erosive and ulcerative gastroduodenopathies among patients with atherosclerosis of MA (60.4%), compared with patients without atherosclerosis MA (39.5%); p=0.047. Signs of severe atrophy according to the data of histological examination were statistically significantly more frequent among patients with atherosclerosis of MA (29.2 and 11.6%; p=0.031). According to the results of logistic regression, the following predictors of erosions and ulcers of the upper gastrointestinal tract were revealed: the severity of stenosis of the superior mesenteric artery (SMA) is more than 35%, the body mass index (BMI) is less than 25.9 and the total score on the HADS scale is more than 6.5 points for depression (p=0.008). Conclusion. Erosive-ulcerative gastroduodenopathies and atrophy of the gastric mucosa are significantly more common in the group of patients with MA atherosclerosis. The main risk factors for erosions and ulcers of the upper gastrointestinal tract in patients with MA atherosclerosis are: the severity of SMA stenosis is more than 35%, a decrease in BMI is less than 25.9 and an increase in the HADS score is more than 6.5 points

Relationships between serum HMGB1 concentration and subpopulation composition of circulating monocytes in patients with subclinical atherosclerosis

Chronic non-infectious inflammation of low intensity is the most important mechanism of development and progression in atherosclerosis. Under the conditions of persistent non-resolving inflammation observed in the vascular wall and atherosclerotic plaque (ASB), permanent tissue damage occurs, thus leading to increased formation of endogenous danger-associated molecular patterns (DAMPs). The non-histone chromosomal protein HMGB1 may be regarded as a prototypical DAMPs. HMGB1 acts as a DAMP if entering the extracellular space, causing inflammation by its binding to pattern-recognizing receptors (TLR2, TLR4, RAGE, CD36, etc.). A number of clinical studies have revealed higher HMGB1 levels in the blood of patients with coronary heart disease and atherosclerotic disease of the lower limb arteries, as well as its interrelations with the burden of coronary artery atherosclerosis. Currently, the mechanisms of HMGB1-mediated atherosclerosis progression are studied only fragmentary. The aim of our study was to investigate relationships between the serum HMGB1 level and subsets of circulating monocyte subpopulations in patients with subclinical atherosclerosis.The study enrolled patients aged 40-64 years with subclinical atherosclerosis of peripheral arteries. Serum HMGB1 concentration was determined using enzyme immunoassay kits (Human HMGB1/HMG-1 ELISA Kit, NBP2-62766, Novus Biologicals, USA). The serum HMGB1 threshold was 18.75 pg/ml, whereas the measurement range was 31.25 to 2000 pg/ml. Phenotyping of the blood monocyte subpopulations was performed by flow cytometry using Navios 6/2 device (Beckman Coulter, USA).An increase in serum HMGB1 concentration was associated with decreased number of classical M2 monocytes, and an increase in intermediate and M1 monocytes. Moreover, an increase in HMGB1 concentration was associated with higher numbers of classical, intermediate, and non-classical monocytes expressing CD36 and TLR2. Increased HMGB1 concentration (from Q1 to Q4) correlated with higher numbers of classical (p = 0.001) and intermediate monocytes (p = 0.006) but not with non-classical phenotypes (p = 0.147). Upon increase of HMGB1 concentration (Q1 to Q4), we have found an increase in the number of classical (p < 0.0001), intermediate (p < 0.0001), and non-classical (p < 0.0001), CD36-expressing monocytes. An increased number of intermediate (p = 0.022; p1, 4 = 0.034) and non-classical, TLR2-expressing monocytes was also revealed (p = 0.002; p1, 4 = 0.035). By mean of correlation analysis, IL-1β concentrations showed direct correlation with the number of M1 monocytes (r = 0.268; p = 0.035) and inverse relation with the number of M2 monocytes (r = -0.376; p = 0.003).Increased serum HMGB1 concentration in patients with subclinical atherosclerosis was associated with decreased numbers of classical and M2 monocytes, as well as higher numbers of intermediate and M1 monocytes, like as with increased contents of intermediate and non-classical monocytes expressing CD36 and TLR2. IL-1β levels directly correlated with HMGB1 concentration and the number of Mi-monocytes

Interactions between immunosuppressor neutrophiles, innate and adaptive immunity indexes in the patients with subclinical atherosclerosis

The last fifteen years have been marked by rapid progress in the study of neutrophils. The discovery of transcriptional plasticity of neutrophils, their phenotypic and functional heterogeneity contributed to launching active interdisciplinary studies on the role of neutrophils in various chronic inflammatory diseases. Increased systemic circulation of immunosuppressive neutrophils can be observed not only in sepsis, but also in chronic systemic inflammation, which, along with disorders of lipid metabolism, is the major mechanism of atherosclerosis development and progression. Monocytes, dendritic cells, Tlymphocytes and neutrophils are key participants and modulators of inflammation in atherosclerosis. Potential significance of immunosuppressive neutrophils in atherogenesis and regulation of inflammatory response in atherosclerosis has not been currently established. However, taking into account their possible effects upon T lymphocytes and innate immunity cells, the study of immunosuppressive neutrophils seems promising in the context of atherosclerosis and atherosclerotic cardiovascular diseases. The purpose of this study was to evaluate relationship between the numbers of circulating immunosuppressive neutrophils and subpopulations of T cells and monocytes in the patients with subclinical atherosclerosis. The study enrolled patients aged 40-64 years with subclinical atherosclerosis of peripheral arteries. Subpopulations of neutrophils, lymphocytes and monocytes were phenotyped by flow cytometry using “Navios 6/2” (Beckman Coulter). 133 patients, 65 (48.8%) males and 68 (51.2%) females were included into the study. Correlation analysis showed that increased number of circulating CD16hiCD11bloCD62Lbr neutrophils was associated with increased number of regulatory T lymphocytes. The patients with subclinical atherosclerosis and absolute numbers of circulating immunosuppressive neutrophils within the first quartile (<136 cells/μL) had a statistically significantly lower number of regulatory T lymphocytes compared with patients in the 2-4 quartiles. An increase in immunosuppressive neutrophils was associated with decreased number of classical monocytes expressing TLR4 (r = -0.335; p = 0.004), and a decrease in TLR2 surface expression intensity (r = -0.268; p = 0.023) on the non-classical monocytes. In patients with subclinical atherosclerosis of 40-64 years old, an increase in immunosuppressive CD16hiCD11bloCD62Lbr neutrophils was associated with increase in regulatory T lymphocytes and nonclassical monocytes, as well as decrease in classic monocytes expressing TLR4, and lower intensity of TLR2 expression on the non-classical monocytes

Research of hemodynamic in visceral branches of the abdominal aorta in patients with nonalcoholic fatty liver disease

Aim. Rate particular regional hemodynamics in unpaired visceral branches of the abdominal aorta in patients with nonalcoholic fatty liver disease (NAFLD), depending on the severity of liver fibrosis, established by circumstantial laboratory markers. Materials and Methods. The study included 53 patients of both sexes, older than 50 years. The first group consisted of 17 people with NAFLD and liver fibrosis, established by Forns - index and the value of more than 6.9. The second group included 36 people with the value Forns - index less than 6.9. The examination included the study of clinical and anamnestic parameters, evaluation of laboratory parameters, instrumental examination of the gastrointestinal tract. Biochemical parameters of the study completed hyperlipidemia. All patients underwent transabdominal duplex scanning unpaired visceral branches of the abdominal aorta, will allow to estimate blood flow velocity parameters and calculate the shear rate. Results. Patients in both groups were matched for age and sex. When analyzing the structure of comorbid diseases of the digestive tract in patients with hepatic fibrosis in NAFLD, the most frequently detected Chronic Biliary pancreatitis. The study of lipid metabolism, showed significantly lower cholesterol levels in patients with NAFLD and Forns index of more than 6.9, with a peak performance speed of blood flow and shear rate in the splenic artery were significantly lower in this group of patients. Conclusion. Patients with nonalcoholic fatty liver disease and hepatic fibrosis, established by indirect laboratory markers (Forns-index) did not differ in age and gender composition and comorbid diseases from patients without liver fibrosis. The low shear rate in the splenic artery in patients with hepatic fibrosis steatosis suggests developing a violation of local splanchnic hemodynamics in the pool against the backdrop of liver fibrosis and can then be used as one of the proxy indicators that reflect morphological changes in the liver.Цель. Оценить особенности региональной гемодинамики в непарных висцеральных ветвях брюшной аорты у пациентов с неалкогольной жировой болезнью печени (НАЖБП) в зависимости от выраженности фиброза печени. Материалы и методы. В исследование включены 53 пациента обоего пола старше 50 лет. Первую группу составляли 17 человек с НАЖБП и фиброзом печени, установленным по Forns - индексу и значением более 6,9. Во вторую группу вошли 36 человек со значением Forns - индекс менее 6,9. Обследование включало изучение клинико-анамнестических параметров, оценку лабораторных показателей, инструментальное исследование желудочно-кишечного тракта. Биохимическое исследование дополнено изучением параметров липидемии. Всем пациентам выполнено трансабдоминальное дуплексное сканирование непарных висцеральных ветвей брюшной аорты, позволившее оценить скоростные параметры кровотока и рассчитать скорости сдвига. Результаты. Больные обеих групп были сопоставимы по полу и возрасту. При анализе структуры коморбидной патологии пищеварительного тракта у пациентов, страдающих фиброзом печени на фоне НАЖБП, наиболее часто выявлялся хронический билиарнозависимый панкреатит. Исследование липидного обмена, выявило достоверно более низкий уровень холестерина у пациентов с НАЖБП и индексом Forns более 6,9. При этом показатели пиковой скорости кровотока и скорость сдвига в селезеночной артерии были достоверно ниже у данной группы пациентов. Выводы. Пациенты с неалкогольной жировой болезнью печени и фиброзом печени, установленным по косвенному лабораторному маркеру (Forns-индекс), не отличались по возрастно-гендерному составу и коморбидным заболеваниям от пациентов без фиброза печени. Низкая скорость сдвига в селезеночной артерии у пациентов с фиброзом печени на фоне жирового гепатоза свидетельствует о развивающемся нарушении локальной гемодинамики в спланхническом бассейне на фоне фиброза печени и может в дальнейшем использоваться как один из косвенных показателей, отражающих морфологические изменения в печени

Evaluation of hemostasis and severity of atherosclerosis in the peripheral arteries depending on the presence of insulin resistance

Aim. Research of peripheral arterial atherosclerosis and condition of inflammation and hemostasis in addiction of insulin resistance measured with TG / HDL-C ratio. Materials and Methods. In the research were included 50 patients of both sexes 30-75 years old. First group consisted of 21 persons with TG I HDL-C >3. The second group included 29 persons with TG / HDL-C 3 values of C-reactive protein were authentically high: 4,03+3,16 and 2,81+3,72 in first and second groups accordingly (p=0,033). Members of first group had lower activity of antithrombin III: 97,6+19,6 in first group, 110,4+11,0 in second one (p=0,009). In group of patients with insulin resistance platelet aggregation inducted by adrenaline and A D P 10 mcm was authentically low (p3 had higher percent of artery stenosis of femoropopliteal segment than patients of the second group (47,7+35,9% and 10,7±17,5%, p=0,01). Conclusion. Patients with the indirect marker TG / HDL-C>3 had low activity of antithrombin III and high level of C-reactive protein. Patients with insulin resistance had changes of platelet link of hemostasis characterized with high sensitivity to aggregation inductors and with low aggregation activity measured by light transmission. Patients of first group had more valuable peripheral arterial atherosclerosis of low extremities mainly in femoropopliteal segment.Цель. Изучение особенностей атеросклеротического поражения периферических артерий, состояния воспаления и гемостаза в зависимости от инсулинорезистентности, оцениваемой по величине коэффициента ТГ7ХСЛВП. Материалы и методы. В исследование включены 50 пациентов обоего пола 30-75 лет. Первую группу составляли 21 человек с ТГ/ХСЛВП >3. Во вторую группу вошли 29 человек с ТГ/ХСЛВП 3 значения С-реактивного белка были достоверно выше - 4,03+3,16 и 2,81 ±3,72, в первой и второй группах соответсвенно (р=0,033). Лица первой группы имели более низкую активность антитромбина III - 97,6+19,6 в первой группе, 110,4+11,0 - во второй (р=0,009). В группе больных с инсулинорезистентностью агрегация тромбоцитов, индуцируемая адреналином и А Д Ф 10 мкМ, была достоверно ниже (р3 имели достоверно больший процент стенозирования артерий бедренно-подколенного сегмента в сравнении с пациентами второй группы (47,7+35,9% и 10,7+17,5%, р=0,01). Выводы. Пациенты со значениями косвенного маркера инсулинорезистентности ТГ/ХСЛВП >3 имели достоверно меньшую активность антитромбина III и больший уровень С-реактивного белка. Изменения тромбоцитарного звена гемостаза у этих больных характеризовалось повышенной сенситивностью к индукторам агрегации и меньшей агрегационной активности, оцениваемой по светопропусканию. Больные первой группы имели более значительное атеросклеротическое поражение артерий нижних конечностей