Summary of updates to the 2021 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure

The article provides a summary of the 2021 European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure (CHF). The most significant changes for general practitioners, internists and primary care cardiologists, from our point of view, regards etiology, terminology, as well as algorithms for diagnosing and treating CHF in accordance with phenotypes, new indications to a number of drugs, in particular sodium-glucose cotransporter type 2 inhibitors (dapagliflozin and empagliflozin) with assignment of class I recommended therapy and vericiguat. The article discusses the diagnostic criteria for different heart failure phenotypes, the potential of treating patients with heart failure mildly reduced and preserved ejection fraction

Assessment of the risks of changes in brachiocephalic vessels according to ultrasound examination of patients with obstructive sleep apnea

Introduction. In the medical literature, there is not enough work on the impact of obstructive sleep apnea (OSA) on the development of atherosclerosis of the brachiocephalic arteries and venous dysgemenia. For the purpose of early diagnosis of vascular complications, further study of extracranial vessels in patients with OSA is necessary.Aim. To study the chances of changes in brachiocephalic vessels by ultrasound examination in patients with obstructive sleep apnea.Materials and methods. A survey was carried out of 88 patients. The results of anthropompetry, polysomnography and ultrasound examination of brachiocephalic vessels were evaluated.Results and discussion. New data were obtained on the severity of macroangiopathy, an increase in the peak systolic blood flow velocity in the internal jugular veins, and an increase in the diameters of the vertebral veins in patients with sleep apnea. It was also found that in patients with OSA, the chances of having a wide diameter of the common carotid artery (CCA) on both sides and the internal carotid artery on the left are more than 3 times higher, the probability of thickening of the intima-media complex in the area of the CCA and its bifurcation is more than on the left 3.5 times and the chances of macroangiopathy are 3 times higher in comparison with the examined patients without apnea.Conclusion. Timely assessment of the entire spectrum of pathological changes in the brachiocephalic vessels in patients with OSA will make it possible to diagnose early signs of atherosclerotic lesions of the arteries, venous dysfunction at the extracranial level

Heart failure and atrial fibrillation: updates and perspectives

The article discusses modern approaches and features of management, as well as predicting the risk of complications in patients with cardiac arrhythmias, in particular, atrial fibrillation, and the potential of using conservative and interventional treatment methods for heart failure (HF), taking into account updates and achievements in clinical practice. Epidemiological data, algorithms for managing patients with HF and atrial fibrillation, prevention of thromboembolic events, results of studies comparing the effectiveness of different strategies for atrial fibrillation treatment, catheter ablation compared with drug therapy in patients with HF are presented

Acute mitral chodae rupture in the early postcovid in heavy physical active men. Case series

The opinion that COVID-19 is a greater threat only to the elderly people has changed over the past year. Experience has been accumulated in the development of complications of varying severity in young patients who had optimal health indicators before infection. The consequences of myocarditis are most dangerous, especially in athletes and military personnel. We present a series of clinical cases of spontaneous mitral valve chordae rupture in highly trained middle-aged men in the early post-COVID period. In all cases, the infection proceeded subclinically; SARS-CoV-2 was verified only by analysis for IgM. 1–2 weeks after infection, against the background of a routine training process, patients felt pain in the heart area, which was underestimated. Patients presented for help at 2 and 10 weeks with complaints of reduced endurance and shortness of breath. Echocardiography revealed rupture of one of the chords of the anterior part of the mitral valve against the background of signs of myocarditis with the development of valvular insufficiency of the 1st degree. By the time of treatment, the pathology of other laboratory data and ECG was not observed. The control after 6 months showed in 1 patient a focus of myocardial fibrosis according to MRI, a minimal increase in NT-proBNP, a decrease in exercise tolerance, in 2 patients there was no visible fibrosis, normal NT-proBNP and complete restoration of exercise tolerance, but a decrease in local myocardial deformation according to echocardiography

Комплекс «Экзокисть-2» в реабилитации верхней конечности при детском церебральном параличе с использованием неинвазивного интерфейса «мозг-компьютер»

Improving the function of the upper limb in cerebral palsy is one of the main tasks of rehabilitation treatment and socialization of the patient.The purpose of the study was to evaluate the effectiveness of the “Exo hand-2” complex with the non-invasive interface “brain-computer” for correcting the motor function of the upper limb in cerebral palsy.The study involved 50 male and female with cerebral palsy (main group n = 30, control group n = 20) aged 12–18 years old. The level of motor activity according to the criteria of classification of large motor functions (GMFCS) was not more than III. All patients received a standard course of spa rehabilitation for 21 days. Patients of the main group were additionally rehabilitated using the “Exo hand-2” complex with the non-invasive interface “brain-computer”. As a result of treatment in the main group, spasticity in the paretic hand on the Modified Ashworth Scale decreased from 3 (2; 3) to 2 (1; 2) points (p <0.002); according to Tardieu, spasticity decreased from the level of 3 (2; 3) to 2 (1; 2) (p <0.002). Half of the patients had paretic arm muscle strength in the Medical Research Counsil Weakness Scale sums core from 2.3 (2; 3) to 3 (2; 3) points after treatment (p = 0.002); assessment of household skills on the Modified Franchay Scale showed an improvement from 37 (22.75; 63.75) to 45 (30; 72.75) points after therapy.Улучшение функции верхней конечности при детском церебральном параличе – одна из главных задач реабилитационного лечения и социализации пациента.Цель исследования – оценить эффективность комплекса «Экзокисть-2» с неинвазивным интерфейсом «мозг-компьютер» для коррекции двигательной функции верхней конечности при детском церебральном параличе.В исследование включены 50 детей с детским церебральним параличом (основная группа – 30, группа контроля – 20) мужского и женского пола в возрасте 12–18 лет с уровнем двигательной активности по критериям классификации больших моторных функций (GMFCS) не больше III. Всем пациентам в течение 21 дня проводили стандартный курс санаторно-курортной реабилитации. Пациентам основной группы дополнительно проводили реабилитацию с использованием комплекса «Экзокисть-2» с неинвазивным интерфейсом «мозг-компьютер». В основной группе спастичность в мышцах паретичной кисти по модифицированной шкале спастичности Эшворта уменьшилась с 3 (2; 3) до 2 (1; 2) баллов (p <0,002), по шкаде Тардье – с уровня 3 (2; 3) до 2 (1; 2) (p <0,002). У половины пациентов сила мышц паретичной руки по шкале оценки силы мышц Британского совета медицинских исследований выросла с 2,3 (2; 3) до 3 (2; 3) баллов (p = 0,002). Оценка бытовых навыков по модифицированной шкале Френчай показала улучшение с 37 (22,75; 63,75) до 45 (30; 72,75) баллов после терапии

Real-Time Measurement of F-Actin Remodelling during Exocytosis Using Lifeact-EGFP Transgenic Animals

F-actin remodelling is essential for a wide variety of cell processes. It is important in exocytosis, where F-actin coats fusing exocytic granules. The purpose of these F-actin coats is unknown. They may be important in stabilizing the fused granules, they may play a contractile role and promote expulsion of granule content and finally may be important in endocytosis. To elucidate these functions of F-actin remodelling requires a reliable method to visualize F-actin dynamics in living cells. The recent development of Lifeact-EGFP transgenic animals offers such an opportunity. Here, we studied the characteristics of exocytosis in pancreatic acinar cells obtained from the Lifeact-EGFP transgenic mice. We show that the time-course of agonist-evoked exocytic events and the kinetics of each single exocytic event are the same for wild type and Lifeact-EGFP transgenic animals. We conclude that Lifeact-EGFP animals are a good model to study of exocytosis and reveal that F-actin coating is dependent on the de novo synthesis of F-actin and that development of actin polymerization occurs simultaneously in all regions of the granule. Our insights using the Lifeact-EGFP mice demonstrate that F-actin coating occurs after granule fusion and is a granule-wide event

Evaluation of the impact of unhealthy nutrition on the intestinal microbiota, mitochondrial function and the formation of multiple organ metabolic syndrome, ways of correction

BACKGROUND: The problem of metabolic syndrome is considered a demographic catastrophe. According to WHO experts,«by 2025, the prevalence of metabolic syndrome (MS) in the world will amount to more than 300 million people, and in the next 25 years it is expected to increase by 50%.» The pathophysiological mechanisms of MS formation and the role of unhealthy diet on the development of intestinal dysbiosis, mitochondrial insufficiency remain unclear.AIM: To study the effect of unhealthy diet on the state of the intestinal microbiota and the development of metabolicmitochondrial insufficiency in the formation of a multi-organ metabolic syndrome, evaluation of ways of correction.MATERIALS AND METHODS: Clinical picture assessment, anthropometric data (body mass index), laboratory results (glucose, cholesterol and fractions) were carried out in patients with MS, triglycerides, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, lipid peroxidation indicators: malondialdehyde, diene conjugates, schiff bases, hydroperoxides, catalase, superoxide dismutase, succinate dehydrogenase (ASDH), α-glycerophosphate dehydrogenase (α-AGFDH). Hemorheological parameters were evaluated by the apparent viscosity of blood, the yield strength, the aggregation coefficient of erythrocytes and platelets. The microbiota and microbiome of the intestine were evaluated by species, strain composition and the level of metabolites-propionic, butyric, acetic acid, lipopolysaccharides, peptidoglycans. A questionnaire was conducted to study the nature of nutrition.RESULTS: The study included 128 patients with MS and 25 healthy individuals. According to medical outpatient records from anamnesis, questioning of each patient, complaints and clinical picture, 26.2% of patients had type 2 diabetes, 3.74% of men had erectile dysfunction, 7.5% of women had polycystic ovaries, 15.1% had night apnea syndrome, 8.7% hyperuricemic syndrome, 96.5% of patients had metabolic fatty liver steatosis. According to the results of the survey, it was revealed that 99.8% of patients adhered to an unhealthy and unbalanced, high-calorie diet, 46.4% of patients had a low level of physical activity, 48.7% had an average. The revealed disorders of lipid, carbohydrate metabolism, microbiota and intestinal microbiome were associated with increased lipid peroxidation, decreased levels of antioxidant defense enzymes, indicators reflecting mitochondrial function against the background of hemorheological disorders.CONCLUSION: In multi-organ MS, unhealthy diet can be considered as a targeted risk factor triggering pathophysiological mechanisms at the level of the intestinal microbiota, followed by a cascade of metabolic disorders in the form of activation of lipid peroxidation with inhibition of antioxidant defense enzymes, the development of multi-organ mitochondrial insufficiency and the development of latent hemorheological syndrome. The revealed metabolic complex obviously constitutes a multiorgan morphological cluster underlying the development of multi-organ metabolic syndrome. Based on the identified disorders, pathogenetically justified correction of MS should include a balanced diet with mitochondrial protective therapy

Возможности реабилитации детей с синдромом ДЦП с применением роботизированных устройств и биологической обратной связи

This article overviews and systemizes published data on the ways of implementing different methods of biofeedback, robotic devices, and brain-computer interfaces (BCI) for rehabilitation of children with cerebral palsy (CP).Aim. To survey implementation practices and clinical outcomes of rehabilitation technologies and possible neurophysiological mechanisms underlying their efficacy in patients with CP. We searched PubMed, Web of Science and eLIBRARY.ru databases for relevant publications using specified keywords.Results. The analysis of relevant literature has shown that robotic technologies and BCIs with biofeedback based on electroencephalography and electromyography parameters are rapidly developing and implemented for the rehabilitation of children with CP. The first evidence of effectiveness for such methods and approaches has been found. However, there is a lack of fully developed conventional standards for the use of such rehabilitation methods and protocols in children. Control groups comprising of children with CP are often absent in such studies. In many cases, the variations of neurophysiological and neurochemical parameters before and after a course of rehabilitation are not evaluated. Having such data would help clarify physiological mechanisms underlying effective rehabilitation of motor functions and then design more adequate rehabilitation procedures and medication protocols.Обзор литературы посвящен систематизации имеющихся данных о применении методики биологической обратной связи, роботизированных устройств и интерфейсов «мозг – компьютер» в реабилитации детей с синдромом детского церебрального паралича (ДЦП).Цель – изучить опыт применения, клиническую эффективность реабилитационных технологий у пациентов с ДЦП и возможные нейрофизиологические механизмы, лежащие в их основе. Поиск по ключевым словам (дети, ДЦП, биологическая обратная связь, роботизированные устройства, интерфейс «мозг – компьютер», экзоскелеты) был проведен с использованием баз научной литературы Pubmed, Web of Science,  eLIBRARY.ru.Результаты. Проведенный анализ данных литературы показывает, что в настоящее время в реабилитации детей с синдромом ДЦП активно развивается применение роботизированных устройств и интерфейсов «мозг – компьютер» с биологической обратной связью по параметрам электроэнцефалограммы и электромиограммы. Получены первые доказательства эффективности указанных методов и подходов. В то же время не полностью разработаны стандарты использования таких методов в реабилитационной практике и протоколы работы с детьми. Не всегда создавались контрольные группы из детей с ДЦП. Во многих исследованиях не оценивалась динамика нейрофизиологических и нейрохимических показателей до и после курса реабилитации. Такие данные позволили бы уточнить физиологические механизмы восстановления моторных функций и более корректно подходить к назначению реабилитационных процедур и медикаментозного лечения

Сhronic kidney disease complications in patients with type 1 diabetes mellitus after simultaneous pancreas-kidney transplantation – potential role of oxidative stress and glycation end products

BACKGROUND: Normoglycaemia in patients with diabetes mellitus type 1 (T1DM) after simultaneous pancreas-kidney transplantation (SPKT) is very interesting in regards to chronic kidney disease (CKD) complications dynamics depending of posttransplantation period and possible targets of potential treatment from the point of view “metabolic memory” AIM: To evaluate the relationship between oxidative stress indicators and advanced glycation end products and complications of end-stage renal disease (ESRD) in patients with T1DM аnd a long-term history of diabetes decompensation, who reached stable euglycemia after SPKT. MATERIALS AND METHODS: The study included 20 patients with compensation of carbohydrate metabolism after SPKT performed from November 2011 to September 2018. Assessment included examination of complications of ESRD (arterial hypertension, dyslipidemia, anemia, mineral and bone disorder) and analysis of "metabolic memory" markers: 3-nitrothyrosine (3-NT), superoxide dismutase (SOD), advanced glycation end products (AGE) and AGE receptor (RAGE). We performed follow-up examination of patients included in the early postoperative period (1st day/week) in 6-12 months after SPKT. RESULTS: All patients with DM1 duration for 22 [19; 28] years, diabetic nephropathy (DN) 8 [6; 14] years and duration of renal replacement therapy (dialysis) for 3 [1.5; 4] years reached euglycemia (HbA1c 5,5 [5,1; 5,8] %; С-peptide 3,2 [2,45; 3,63] ng/ml) after 6 month of surgical treatment. Despite of stable graft function (estimated glomerular filtration rate (eGFR) CKD-EPI 84 [69; 95] ml/min/1.73m2) 35% of patients still needed antihypertensive therapy, 40% needed treatment with recombinant human erythropoietin (RHuEPO) and 15% – ferrotherapy. With vitamin D deficiency, observed in 80% of cases (13.3 [9.3; 18.5] ng/ml), 55% of patients had secondary hyperparathyroidism, 45% – osteoporosis. The results of the correlation analysis revealed the association of the state of ESRD target organs with the studied "metabolic memory" markers: oxidative stress and AGE-RAGE system. CONCLUSIONS: SPKT as the way to achieve compensation of carbohydrate metabolism and uremia does not provide regress of diabetes and complications of ESRD. Analysis of "metabolic memory" markers indicate their direct contribution to the persistence of metabolic consequences of diabetic nephropathy (DN). Found trends need more long-lasting observation and enlargement of study groups

Клинический случай синдрома Кернса–Сейра: диагностика, тактика лечения

The article outlines the current knowledge of the etiology, pathogenesis, clinical features and diagnostic criteria of one of the forms of mitochondrial encephalomyopathy – the Kearns–Sayre syndrome. The observation of a patient with an incomplete case of the Kearns–Sayre syndrome is presented. The complexity of diagnosis and the range of differential diagnostic search as well as approaches to treatment with the use of neurotrophic factors are widely discussed in the research.В статье изложены современные представления об этиологии, патогенезе, клинических особенностях и диагностических критериях одной из форм митохондриальной патологии – синдроме Кернса–Сейра. Представлено наблюдение пациента с неполным вариантом синдрома Кернса–Сейра. Обсуждаются сложности диагностики и круг дифференциально-диагностического поиска, подходы к лечению с применением нейротрофических факторов