Comprehensive physical rehabilitation of patients with heart failure: impact on clinical and functional status and analysis of problems related to the enrollment

Aim. To evaluate functional, clinical and psychological status of patients with class II-III heart failure, who underwent comprehensive cardiac rehabilitation program.Material and methods. Patients of both sexes with class II-III heart failure who met the inclusion criteria, did not have the exclusion criteria, and signed informed consent were included. The training process consisted of a 4-week respiratory muscle (RM) training using the THRESHOLD® IMT breathing trainer followed by a 12-week moderate intensity aerobic exercise (AE). AE were conducted under the supervision of an instructor 3 times a week for 40 minutes. RM training was carried out by patients at home on their own 5-7 times a week. Minnesota Living With Heart Failure Questionnaire (MLwHFQ.23) was used to assess quality of life. In addition, we applied Hospital Anxiety and Depression Scale (HADS). The evaluation was performed before the start of the study (visit 1), after 4 weeks of respiratory training (visit 2) and at the end of 16 weeks of AE (visit 3). The baseline characteristics of patients who were screened and not enrolled in the study were compared with those who participated in training.Results. A total of 102 patients were included in the study (passed the first visit). Subsequently, for various reasons, including due to the pandemic, 82 patients refused to participate in the study. Only 20 patients participated in RM training for 4 weeks followed by a 12-week cycle of moderate-intensity AR (median age, 67,0 (58,7-74,3) years; men, 70%; Δ peak oxygen uptake (VO2peak) (1-2) =1,1, p=0,3863; ΔVO2 peak (1-3) =2,3 ml/kg/min, p=0,139. During 16-week training, we revealed an increase in expiratory muscle strength (EMS) (ΔEMS =10 cmH2O (p=0,037), six-minute walk test (6MWT) (Δ6MTX=60 meters, p=0,005), and SHOKS score (p=0,0117), as well as improvement in anxiety and depression symptoms (ΔHADS =-2 points, p=0,0346). Patients who refused to be included in the study were older, had lower blood pressure, and had a worse quality of life. The groups did not differ significantly in other clinical, functional and laboratory parameters.Conclusion. Patients’ motivation to exercise was associated with younger age and better subjective health perception and did not depend on objective status. In patients undergoing a comprehensive rehabilitation program, there was a significant change in RM strength, as well as an increase in 6MWT distance, clinical and psychological status already at the stage of respiratory training. This trend continued at the AE stage as well

Диагностика кистозной эндокринной опухоли поджелудочной железы. Дифференциальные возможности применения лучевых методов (клиническое наблюдение)

Nonfunctioning neuroendocrine tumors (NFET) account for up to 33% of the neuroendocrine tumors of the pancreas, ranging from 1 to20 cmin diameter and showing a higher malignancy rate, up to 90%. The clinical presentation of nonfunctioning neuroendocrine tumors is nonspecific. These tumors, in fact, are predominantly characterized by an expansive growth pattern; therefore, they are clinically silent until adjacent viscera and structures are involved. This makes it difficult to diagnose NFET at an early stage. Correct diagnosis is typically delayed by several years. About 15% of pancreatic NFET are cystic and difficult to differentiation from other cystic pancreatic lesions. In such cases, the important role played by hypervascular rim in the arterial phase image. Literature review and case report оf diagnostics and treatment of Neuroendocrine Tumor with cystic transformation are presented in the article. Нефункционирующие нейроэндокринные опухоли (NFET) составляют до 33% от нейроэндокринных опухолей поджелудочной железы, диаметром от 1 до20 см, с коэффициентом злокачественности до 90%. Клинические проявления нефункционирующей нейроэндокринной опухоли неспецифичны либо могут отсутствовать вовсе. Эти опухоли характеризуются экспансивным характером роста, поэтому они могут себя никак не проявлять до вовлечения прилегающих внутренних органов и структур. Это значительно затрудняет диагностику на ранней стадии, в связи с чем постановка диагноза запаздывает на несколько лет. Около 15% панкреатических NFET имеют полость, что затрудняет дифференциальную диагностику с другими кистозными поражениями поджелудочной железы. В таких случаях патогномоничным признаком является наличие гиперваскулярного ободка в артериальную фазу контрастирования. В статье представлены обзор литературы и собственное клиническое наблюдение диагностики и лечения нейроэндокринной опухоли поджелудочной железы с кистозной трансформацией структуры.

TFOS European Ambassador meeting: Unmet needs and future scientific and clinical solutions for ocular surface diseases

The mission of the Tear Film & Ocular Surface Society (TFOS) is to advance the research, literacy, and educational aspects of the scientific field of the tear film and ocular surface. Fundamental to fulfilling this mission is the TFOS Global Ambassador program. TFOS Ambassadors are dynamic and proactive experts, who help promote TFOS initiatives, such as presenting the conclusions and recommendations of the recent TFOS DEWS II™, throughout the world. They also identify unmet needs, and propose future clinical and scientific solutions, for management of ocular surface diseases in their countries. This meeting report addresses such needs and solutions for 25 European countries, as detailed in the TFOS European Ambassador meeting in Rome, Italy, in September 2019

Сосудистые кальцинаты молочной железы как проявление системного атеросклероза

Cardiovascular diseases (CVD) are socially significant diseases and one of the main causes of death among women. There are no effective and uniform screening methods to prevent the prevalence and mortality of CVD. Breast artery calcifications may be one of the available tools for CVD risk stratification. The pathogenesis of calcification of the middle vessel wall, known as Mönckeberg's arteriosclerosis, is different from the pathogenesis of coronary atherosclerosis that coronary arteries. However, research data supports a correlation between breast artery calcifications and risk factors for CVD. These factors include coronary atherosclerosis, detected by CT-coronarography.Purpose. To assess the prevalence of breast arterial calcification and to determine the association with cardiovascular risk factors, coronary artery calcification, atherosclerosis of brachiocephalic arteries and visceral branches of the abdominal aorta.Material and methods. 21 patients were hospitalized in the cardiology department. The patients underwent digital mammography to detect breast arterial calcifications. All patients also underwent CT coronary angiography with angiography of the abdominal aorta.Results. The use of the Wilcoxon-Mann-Whitney W-test with an abnormal distribution showed a correlation between the breast arterial calcifications and the calcium index (p = 0.0028), coronary artery stenosis (p = 0.040), calcification of the thoracic aorta wall (p = 0.035) and stenosis of the visceral branches of the abdominal aorta (p = 0.037).Conclusions. The breast arterial calcifications correlates with a more frequent detection of calcifications in the walls of the coronary arteries and a higher calcium index.Сердечно-сосудистые заболевания (ССЗ) относятся к социально значимым заболеваниям и являются одной из основных причин смертности среди женщин. Отсутствие эффективных и унифицированных методов скрининга препятствует уменьшению заболеваемости и распространенности ССЗ и смертности от них. Сосудистые кальцинаты в молочной железе могут стать одним из доступных инструментов страти фикации риска ССЗ. Патогенез кальциноза средней оболочки артерий, известный как артериокальциноз Менкеберга, отличается от патогенеза атеросклероза интимы, возникающего в коронарных артериях. Тем не менее исследования подтверждают корреляцию между сосудистыми кальцинатами в молочной железе и факторами риска ССЗ. К таким факторам относится атеросклероз коронарных артерий, выявляемый с помощью КТ-коронарографии.Цель работы: изучение связи сосудистых кальцинатов в молочной железе с факторами риска сердечно-сосудистых заболеваний, атеросклерозом коронарных артерий, брахиоцефальных артерий и висцеральных ветвей брюшной аорты.Материал и методы. 21 пациентка, находящаяся на стационарном лечении в отделении кардиологии, была обследована на наличие сосудистых кальцинатов в молочных железах с помощью цифровой маммографии. Также всем пациенткам была выполнена КТ-коронарография с ангиографией брюшной аорты.Результаты. Применение W-критерия Уилкоксона–Манна–Уитни при ненормальном распределении показало взаимосвязь между наличием сосудистых кальцинатов в молочной железе и кальциевым индексом (р = 0,0028), стенозами коронарных артерий (р = 0,040), кальцинозом стенки грудной аорты (р = 0,035) и стенозами висцеральных ветвей брюшной аорты (р = 0,037).Заключение. Наличие кальцинатов в стенках сосудов молочных желез коррелирует с более частым выявлением кальцинатов в стенках коронарных артерий и более высоким кальциевым индексом

TFOS European ambassador meeting:Unmet needs and future scientific and clinical solutions for ocular surface diseases

The mission of the Tear Film & Ocular Surface Society (TFOS) is to advance the research, literacy, and educational aspects of the scientific field of the tear film and ocular surface. Fundamental to fulfilling this mission is the TFOS Global Ambassador program. TFOS Ambassadors are dynamic and proactive experts, who help promote TFOS initiatives, such as presenting the conclusions and recommendations of the recent TFOS DEWS II™, throughout the world. They also identify unmet needs, and propose future clinical and scientific solutions, for management of ocular surface diseases in their countries. This meeting report addresses such needs and solutions for 25 European countries, as detailed in the TFOS European Ambassador meeting in Rome, Italy, in September 2019

Diseases and abnormalities of the nipple-areolar complex: a case report series

The nippleareolar complex is a specific anatomical and histological structure. Normal structure and pathological process variabilities and the complexity of diagnostic imaging cause difficulties for radiologists and physicians. Breast magnetic resonance imaging is highly sensitive for structural features and nipple-areolar complex cancer detection. Magnetic resonance imaging is a useful diagnostic tool when mammography and ultrasound findings are inconclusive. It allows visualization of the retroareolar region, suitable for the diagnosis of papillomas, adenomas, Pagets disease, ductal carcinoma in situ, and invasive ductal carcinoma. This is a case report on identifying the pathology and anomalies of the nipple-areolar complex, which may benefit radiologists, gynecologists, and residents

Silk route to the acceptance and re-implementation of bacteriophage therapy.

This multidisciplinary expert panel opinion on bacteriophage therapy has been written in the context of a society that is confronted with an ever-increasing number of antibiotic resistant bacteria. To avoid the return to a pre-antibiotic era, alternative treatments are urgently needed. The authors aim to contribute to the opinion formation of relevant stakeholders on how to potentially develop an infrastructure and legislation that paves the way for the acceptance and re-implementation of bacteriophage therapy