Risk factors for heart failure in patients with COVID-19

Aim. To establish risk factors for heart failure (HF) in patients with coronavirus disease 2019 (COVID-19).Material and methods. Medical records of 151 patients treated in an infectious disease hospital from November 3, 2020 to February 2, 2021 with a confirmed diagnosis of COVID-19 were retrospectively selected. The collection of clinical, history and laboratory data were carried out by analyzing electronic medical records. We analyzed information on age, sex, body mass index, smoking, and comorbidities. Following laboratory studies were analyzed: complete blood count, biochemical blood tests, coagulation profile, acute phase proteins (C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH)), procalcitonin. The diagnosis of HF was confirmed by clinical performance, echocardiography, and elevated levels of the N-terminal pro-brain natriuretic peptide (NT-proBNP). The risk of HF was taken as the endpoint of the study.Results. The studied sample of patients was divided into two groups depending on HF: the 1st group included 46 patients with HF, the 2nd group — 105 patients without HF. The median age was 66,2 (50-92) years (women, 91 (60,3%)). Laboratory indicators, such as the levels of CRP, LDH, procalcitonin, creatinine, bilirubin, differed significantly from each other, and the median values were higher in patients with HF. The neutrophil-to-lymphocyte ratio (NLR) showed significant intergroup differences: in the group of patients with HF, the median was 4,97% vs 3,62% (p=0,011) in the group of patients without HF. There were following most significant predictors increasing the HF risk: age ≥66 years (odds ratio, 8,038, p<0,001), procalcitonin level, which increases the HF risk in patients by 3,8 times (p><0,001), NLR ≥4,11% (p=0,010), thrombocytopenia ≤220×109/l (p=0,010), history of chronic kidney disease (CKD) (p=0,018). Conclusion. The following predictors of HF were established: age ≥66 years, procalcitonin ≥0,09 ng/ml, NLR ≥4,11%, thrombocytopenia ≤220×109/l, history of CKD, LDH ≥685 U/l and creatinine ≥102 µmol/l, international normalized ratio ≥1,19, QTc interval ≥407,5 ms, bilirubin ≤10,7 µmol/l. It is worth noting that the best accuracy values are demonstrated by the Random Forest algorithm (88,5% on the validation set), but the mathematical model of the neural network turned out to be the most sensitive (90,0% on the validation set). Keywords: novel coronavirus infection, heart failure, prognosis>˂0,001), procalcitonin level, which increases the HF risk in patients by 3,8 times (p˂0,001), NLR ≥4,11% (p=0,010), thrombocytopenia ≤220×109/l (p=0,010), history of chronic kidney disease (CKD) (p=0,018).Conclusion. The following predictors of HF were established: age ≥66 years, procalcitonin ≥0,09 ng/ml, NLR ≥4,11%, thrombocytopenia ≤220×109/l, history of CKD, LDH ≥685 U/l and creatinine ≥102 µmol/l, international normalized ratio ≥1,19, QTc interval ≥407,5 ms, bilirubin ≤10,7 µmol/l. It is worth noting that the best accuracy values are demonstrated by the Random Forest algorithm (88,5% on the validation set), but the mathematical model of the neural network turned out to be the most sensitive (90,0% on the validation set)

Initial/boundary-value problems of tumor growth within a host tissue

This paper concerns multiphase models of tumor growth in interaction with a surrounding tissue, taking into account also the interplay with diffusible nutrients feeding the cells. Models specialize in nonlinear systems of possibly degenerate parabolic equations, which include phenomenological terms related to specific cell functions. The paper discusses general modeling guidelines for such terms, as well as for initial and boundary conditions, aiming at both biological consistency and mathematical robustness of the resulting problems. Particularly, it addresses some qualitative properties such as a priori nonnegativity, boundedness, and uniqueness of the solutions. Existence of the solutions is studied in the one-dimensional time-independent case.Comment: 30 pages, 5 figure

Возможности и ограничения магнитно-резонансной томографии в определении эффективности генно-инженерной биологической терапии при анкилозирующем спондилите

Extensive use of magnetic resonance imaging (MRI) in clinical practice revolutionized our understanding of the pathogenesis of axis spondyloarthritis (aSpA) and treatment approaches. The use of MRI to diagnose non-radiographic aSpA is well established. At the same time, the possibility of its use for follow-up and treatment assessment is actively discussed.Objective: To present comparative analysis of clinical and laboratory data, reflecting the activity of the disease, and analysis of MRI results in patients with ankylosing spondylitis (AS) receiving biological disease modifying anti-rheumatic drugs therapy (bDMARDs).Patients and methods. The study included 39 patients with AS, mainly men (74.3%), 24 patients (61.5%) had late and 15 (38.5%) – advanced stage of the disease. The average age was 41.0 [34.0; 48.0] years. All patients were administered bDNARDs; inhibitors of the tumor necrosis factor α or inhibitors of interleukin 17 were drug of choice. The median of treatment duration was 1.5 [1.0; 4,5] year. All patients had sacroiliac (SI) and spinal MRI. The activity of the disease was estimated using BASDAI and ASDAS-CRP/ESR indexes, functional disorders – using the BASFI questionnaire. Results and discussion. There was no significant difference in disease activity between patients with osteitis in the SI/spine or without it: BASDAI – 4.7 [2.7; 5,5] and 4.2 [2.9; 8,1], respectively (p=0.533); ASDAS-ESR – 2.6 [2.2; 3,0] and 2.6 [2.2; 3,2], respectively (p=0.725); ASDAS-CRP – 2.5 [2.1; 3,4] and 3.1 [2.8; 3.9], respectively (p=0.172). There was no significant difference in the number of osteitis foci between group of patients who have achieved the therapeutic target (ASDAS < 2.1) and those who have not (ASDAS ≥2.1) – 1.0 [0.0; 3.5] and 1.0 [1.0; 4.0], respectively, (p=0.376), and no difference in amount of inflammatory changes – 1.0 [0.2; 1.7] and 0.1 [0.0; 1,1] cm3, respectively (p=0.124). Conclusion. The data suggests a limited MRI informative value as a method for managing the efficacy of bDMARDs treatment in patients with the advanced / late stage of the AS.Широкое внедрение в клиническую практику магнитно-резонансной томографии (МРТ) стало революционным шагом в понимании патогенеза аксиального спондилоартрита (аксСпА) и тактики ведения этих больных. Общепризнанным является использование МРТ для диагностики нерентгенологического аксСпА. В то же время возможность ее применения для контроля эффективности проводимой терапии активно обсуждается.Цель исследования – сравнительный анализ клинико-лабораторных данных, отражающих активность заболевания, и результатов МРТ у больных анкилозирующим спондилитом (АС), получающих генно-инженерную биологическую терапию (ГИБТ).Пациенты и методы. В исследование включено 39 больных АС, преимущественно мужчин (74,3%), из которых 24 (61,5%) имели позднюю и 15 (38,5%) – развернутую стадию заболевания. Средний возраст больных составил 41,0 [34,0; 48,0] год. Все пациенты получали ГИБТ, препаратами выбора были ингибиторы фактора некроза опухоли α или ингибиторы интерлейкина 17. Медиана длительности лечения достигала 1,5 [1,0; 4,5] года. Всем пациентам проводилась МРТ крестцово-подвздошных суставов (КПС) и позвоночника. Активность болезни оценивалась с помощью индексов BASDAI и ASDAS-СРБ/СОЭ, функциональные нарушения – с использованием опросника BASFI.Результаты и обсуждение. Группы больных с наличием остеита в КПС/позвоночнике и без него по уровню активности заболевания статистически значимо не различались: BASDAI – 4,7 [2,7; 5,5] и 4,2 [2,9; 8,1] соответственно (р=0,533); ASDAS-СОЭ – 2,6 [2,2; 3,0] и 2,6 [2,2; 3,2] соответственно (р=0,725); ASDAS-СРБ – 2,5 [2,1; 3,4] и 3,1 [2,8; 3,9] соответственно (р=0,172). Группы пациентов, достигших (ASDAS < 2,1) и не достигших (ASDAS ≥2,1) цели терапии, статистически значимо не различались ни по числу очагов остеита: 1,0 [0,0; 3,5] и 1,0 [1,0; 4,0] соответственно (р=0,376), ни по объему воспалительных изменений: 1,0 [0,2; 1,7] и 0,1 [0,0; 1,1] см3 соответственно (р=0,124).Заключение. Полученные данные свидетельствуют об ограниченной информативности МРТ как метода контроля эффективности ГИБТ у больных с развернутой/поздней стадией АС

Центральная инспираторная активность и сила дыхательных мышц после перенесенного COVID-19

The respiratory pump that provides pulmonary ventilation includes the respiratory center, peripheral nervous system, chest and respiratory muscles.The aim of this study was to evaluate the activity of the respiratory center and the respiratory muscles strength after COVID-19 (COronaVIrus Disease 2019).Methods. The observational retrospective cross-sectional study included 74 post-COVID-19 patients (56 (76%) men, median age – 48 years). Spirometry, body plethysmography, measurement of lung diffusing capacity (DLCO), maximal inspiratory and expiratory pressures (MIP and MEP), and airway occlusion pressure after 0.1 sec (P0.1) were performed. In addition, dyspnea was assessed in 31 patients using the mMRC scale and muscle strength was assessed in 27 of those patients using MRC Weakness scale.Results. The median time from the COVID-19 onset to pulmonary function tests (PFTs) was 120 days. The total sample was divided into 2 subgroups: 1 – P0.1 ≤ 0.15 kPa (norm), 2 – > 0.15 kPa. The lung volumes, airway resistance, MIP, and MEP were within normal values in most patients, whereas DLCO was reduced in 59% of cases in both the total sample and the subgroups. Mild dyspnea and a slight decrease in muscle strength were also detected. Statistically significant differences between the subgroups were found in the lung volumes (lower) and airway resistance (higher) in subgroup 2. Correlation analysis revealed moderate negative correlations between P0.1 and ventilation parameters.Conclusion. Measurement of P0.1 is a simple and non-invasive method for assessing pulmonary function. In our study, an increase in P0.1 was detected in 45% of post-COVID-19 cases, possibly due to impaired pulmonary mechanics despite the preserved pulmonary ventilation as well as normal MIP and MEP values.Составляющими «дыхательного насоса», обеспечивающего легочную вентиляцию, являются дыхательный центр, периферическая нервная система, грудная клетка и дыхательные мышцы.Целью настоящего исследования явилось изучение активности дыхательного центра и силы дыхательных мышц после COVID-19 (COronaVIrus Disease 2019).Материалы и методы. В обсервационном ретроспективном поперечном исследовании принимали участие пациенты (n = 74: 56 (76 %) мужчин; средний возраст – 48 лет), перенесшие COVID-19. У пациентов проводились спирометрия, бодиплетизмография, измерение диффузионной способности легких (ДСЛ), параметров максимального респираторного давления на вдохе (MIP) и выдохе (MEP), окклюзионного ротового давления (ОРД) в первые 0,1 с вдоха (Р0.1). Оценивалась степень одышки по шкале одышки (Modified Medical Research Council Dyspnea Scale – mMRC) (n = 31), у 27 из них – сила мышц по шкале силы мышц (Medical Research Council Weakness Scale – MRCw).Результаты. Медиана срока проведения функциональных исследований системы дыхания от начала COVID-19 составила 120 дней. Пациенты общей группы были распределены в 2 подгруппы: 1-я – лица с ОРД Р0.1 ≤ 0,15 кПа (норма), у больных 2-й подгруппы Р0.1 составило > 0,15 кПа. Легочные объемы, бронхиальное сопротивление, показатели MIP и MEP в среднем по группе составляли пределы нормальных значений у большинства пациентов, тогда как ДСЛ была снижена в 59 % случаев, отмечались одышка легкой степени и незначительное снижение силы мышц. Статистически значимые различия между подгруппами выявлены по параметрам легочных объемов (более низкие – у пациентов 2-й подгруппы) и бронхиальному сопротивлению (более высокие – у пациентов 2-й подгруппы). По данным корреляционного анализа установлено наличие умеренных обратных связей между Р0.1 и легочными объемами.Заключение. Измерение ОРД является простым, неинвазивным методом оценки функционального состояния системы дыхания. Увеличение Р0.1 после перенесенного COVID-19 выявлено у 45 % пациентов, что может быть обусловлено нарушением механических свойств аппарата вентиляции при сохранении параметров легочной вентиляции, а также показателей MIP и MEP в пределах нормальных значений

Severe plastic deformation for producing superfunctional ultrafine-grained and heterostructured materials: An interdisciplinary review

Ultrafine-grained and heterostructured materials are currently of high interest due to their superior mechanical and functional properties. Severe plastic deformation (SPD) is one of the most effective methods to produce such materials with unique microstructure-property relationships. In this review paper, after summarizing the recent progress in developing various SPD methods for processing bulk, surface and powder of materials, the main structural and microstructural features of SPD-processed materials are explained including lattice defects, grain boundaries and phase transformations. The properties and potential applications of SPD-processed materials are then reviewed in detail including tensile properties, creep, superplasticity, hydrogen embrittlement resistance, electrical conductivity, magnetic properties, optical properties, solar energy harvesting, photocatalysis, electrocatalysis, hydrolysis, hydrogen storage, hydrogen production, CO2 conversion, corrosion resistance and biocompatibility. It is shown that achieving such properties is not limited to pure metals and conventional metallic alloys, and a wide range of materials are currently processed by SPD, including high-entropy alloys, glasses, semiconductors, ceramics and polymers. It is particularly emphasized that SPD has moved from a simple metal processing tool to a powerful means for the discovery and synthesis of new superfunctional metallic and nonmetallic materials. The article ends by declaring that the borders of SPD have been extended from materials science and it has become an interdisciplinary tool to address scientific questions such as the mechanisms of geological and astronomical phenomena and the origin of life