This article is a literature review aimed at consideration of the ways to increase the effective use of laboratory biomarkers in the context of biopsychosocial approach in patients with atherosclerosis of brachiocephalic arteries. Laboratory markers are a valuable diagnostic tool to evaluate atherosclerotic plaque progression and assess treatment effectiveness. However, according to up to date guidelines only few biomarkers are recommended to routine use in stroke patients. Hence, their analysis does not provide enough information to satisfy diagnostic and therapeutic needs. The parameters of general lipid profile can not serve as a reliable predictor of stroke risk, so we need to find biomarkers more significantly associated with progression of atherosclerosis, atherosclerotic plaque destabilization and stroke risk. Many studies on novel laboratory markers of atherosclerosis (lipoprotein-associated phospholipase A2, high sensitive C reactive protein, lipoprotein (a), pregnancy-associated plasma protein A and asymmetric dimethylarginine) have been performed in the recent years. However, these biomarkers are not included in the guidelines for stroke evaluation due to the lack of sufficient evidence. The published data are very contradictory. History of previous disease, individual characteristics of the patient, lifestyle, vitality, psycho-emotional background and social environment may all have a significant impact on atherosclerosis development and progression due to their influence on molecular mechanisms. Increased use of biopsychosocial approach that takes into account these features will result in better understanding of biochemical processes in patients with atherosclerosis and will contribute to identification of new targets for drug and non-drug treatment. This will provide much more accurate results and more efficient use of laboratory biomarkers in patients with high risk of stroke during their diagnostic evaluation and treatment.

Aim: to compare the evaluation of health components in the ICF categories in patients with acute stroke in the first stage of rehabilitation by the rehabilitation multidisciplinary team for the «new» and «classic» models of rehabilitation. Methods. The project is registered in the ClinicalTrials.gov register under the title: «The Pilot Project Development of the MEdical Rehabilitation System in Russian Federation (DOME)». The design of the study was consecutive. In the 1st phase doctors worked according to the traditional «classic» scheme of rehabilitation (n = 130). In the second phase, medical organizations worked on a «new» model implementing a problem-oriented multidisciplinary approach (n=130) and using a rehabilitation diagnosis in the ICF categories, which was installed using the ICF-reader software. The study analyzed the quantitative and qualitative characteristics of rehabilitation diagnoses. Results and discussion. The total number of identified problems in the rehabilitation diagnosis decreased (p<0.001) in a «new» model group. This was achieved due to reduction of the domains of function and structure (p<0.001). More attention was paid to the aspects of activity; accordingly, the number of activity domains (activity and participation) and environmental factors increased (p<0.001) in a «new» model group. The members of rehabilitation team learn from each other, which is characterized by a better vision of the problems of activity (activity and participation) with an increase in the duration of the rehabilitation team work (p<0.001). Conclusions. The introduction of the ICF to form a diagnosis results in better recognition of the patient's problems. In addition, it facilitates the elaboration of rehabilitation goals and objectives. Implementation of the multidisciplinary principle of the team and the use of the program «ICF-reader» leads to a reduction in working time in the rehabilitation process.

Purpose of the study: to analyze thee influence of vasoactive drugs in combination treatment in women with chronic pelvic pain syndrome (CPPS). Methods. 177 women with CPPS were examined. The average age was from 18 to 84 years (32.6±9.3). The duration of the disease ranged from 6 months to 6 years (an average of 2.7±0.9 years). To study the microcirculation of the bladder, the original technique of intravesical high-frequency ultrasonic dopplerography was used. An assessment of the intensity of the pain syndrome and urination disorders was carried out using the PUF questionnaire, and an evaluation of the psychoemotional status using the depression scale of A.T. Back. Results. After the examination, all patients with CPPS (n=177) were divided into 2 groups. In the 1st group (n=88) patients got standard therapy in the form of instillations of the bladder and suppositories with nonsteroidal anti-inflammatory drug. In the 2nd group (n=89), the patients received therapy in combination with a vasoactive drug (pentoxifylline in a dose 200 mg per day), 10 days. Analysis of the results of intravesical dopplerography of the bladder revealed differences in the state of microcirculation in women with CPPS, depending on the treatment regimen. The parameters of the microcirculatory bed have significantly improved at the arterial and capillary levels in patients with CPPS who got combined therapy with vasoactive drugs. The conducted therapy led to a significant decrease in the severity of the symptoms, which was confirmed with the questionnaire «Scale of Pelvic Pain Symptoms, Mandatory, Frequent Urination» and evaluation of the psychoemotional state according to the depression scale of A.T. Back. Conclusion. Insufficient effectiveness of standard CPPS therapy is caused in particular by altered blood flow in the bladder in this category of patients. Therefore, it is advisable to include vasoactive drugs in combination therapy of CPPS in women.

Since 2010 the National project aimed at reducing cardiovascular mortality has been implemented in Tver region. Since 2014 the region has accepted the 3-stage medical rehabilitation model according to the order of the Ministry of Healthcare of the Russian Federation No. 1705 (on Medical Rehabilitation). To streamline patient routing, the Ministry of Healthcare of Tver region issued guidelines on routing patients with acute disorders of cerebral circulation. In the Regional Clinical Treatment and Rehabilitation Center, a call center has been established to coordinate primary and secondary prophylaxis of patients with acute disorders of cerebral circulation and their routing.

Introduction. The large-scale studies on adult patients with congenital heart disease (CHD) demonstrated high prevalence of thrombocytopenia, especially in patients with Eisenmenger syndrome (sEis). The exact reasons for the decline of platelet count in adults with CHD are currently unknown. Objective: to determine the prevalence of thrombocytopenia in a representative group of adult patients with CHD and explore the possible causes of thrombocytopenia. Methods. A retrospective study of 17 pregnant women with CHD was carried out. All women were admitted for delivery to Federal Almazov North-West Medical Research Centre. Data are presented as median (25th, 75th percentile) and as M±σ for parametric variables. Results. The median age was 26 (21; 28) years. The average period of gestation at the time of admission was 31 (28; 34) weeks. 12 (70.6 %) patients had sEis. At the time of admission PAPsys was 88 (82; 98) mm Hg, SpO₂ - 92 (85; 95)%. In whole group the platelet count median was 105 (62; 164) 10⁹/L, while in 12 (71%) women platelet count was less than 150 10⁹/L. There was a significant difference between patients with sEis and women without right-to-left shunt in platelet count: 99 (73; 105) and 162 (138; 166) 10⁹/L, respectively, p<0.001. Mean platelet volume (MPV) in patients with sEis was higher than in women without right-to-left shunt: 12.2±2.4 fl and 10.6±1.6 fl, respectively, p=0.003. Furthermore, a significant negative correlation (r=-0.52) was found between platelet count and MPV. Three patients with sEis died after cesarean section. Thus, the mortality in the entire group was 17.6%, and among women with sEis - 25%. Conclusions. Reduced platelet count is typical for adult patients with sEis. Right-to-left blood shunting with lung bypass and reduced thrombopoiesis in the pulmonary capillary bed are the main causes of thrombocytopenia.

Introduction. Better understanding of the pathogenesis of hemophilic arthropathy is crucial for prevention of irreversible injury to joints in patients with hemophilia. Research objective - to define a role of altered regulation of microcirculation in formation of joint injury in patients with hemophilia. Methods. The changes in knee and ankle joints in 82 patients with hemophilia were investigated by means of ultrasound and X-ray. Microcirculation was evaluated using computer infrared thermography and laser doppler flowmetry in joints of 44 patients and 46 healthy individuals. Results. Increased temperature and perfusion (M) are major risk factors of hemarthrosis development (RR=1.86 and RR=1.26) and are characteristic of joints with hemorrhages developing more often than 1 time per month. Increase in these indexes in joints without hemarthrosis in the anamnesis is a sign of a latent inflammation. Both decrease in the index of shunting (IS) and increase in a vibration amplitude of perfusion in the endothelial range (Amax E) are characteristic of joints with a recurrence of hemarthrosis more often than 3 times a month. Decrease in indexes of M and Amax E with concomitant increase in PSh demonstrate low risk of hemarthrosis. Conclusions. Changes of microcirculation in joints represent an important factor in the pathogenesis of hemophilic arthropathy development in the patients with variable risk of a recurrence of a hemarthrosis. Joint inflammation leads to endothelial dysfunction with poor vasospasm, to increase in Amax E and M that is a new diagnostic sign of a latent inflammation in joints. Decrease of PSh promotes recurrence of hemarthrosis because of strengthening of an imbuing of tissues of joint blood. Preservation of endothelium-mediated vasoconstriction, decrease in the neurogenic tone, increase in shunting of blood are characteristic features of hemophilic arthropathy in patients with infrequent recurrence of hemarthrosis.

The analysis of long-term results of diagnosis and treatment in 1057 patients with embologenic phlebothrombosis in the inferior vena cava, including pregnant women (n=69) and postpartum women (n=33). Of particular interest is the study of genetic disorders of hemostasis that contribute to thrombosis in pregnant and postpartum women, thereby threatening the life of both mother and child. Observations of such patients within 5, 10, 15 or more years have confirmed a sufficient efficiency of that program of prevention and treatment of life-threatening situations developed by the authors, including the correction of genetic disorders of hemostasis, which led to the preservation of life and the safe delivery of all monitored patients in this group.

Introduction and aim. Chest lymphadenopathy is unspecific syndrome found in various diseases. The aim of the study was to give an overview of chest lymph outflow pathways and methods of chest lymphadenopathy imaging. Methods. 60 literature sources were analyzed: 28 in Russian and 32 in international journals. Various radiological methods of chest lymphadenopathy were analyzed as well. Results. A definition of lymphadenopathy, brief description of the chest lymphatic drainage pathways anatomy and modern classification of thoracic lymph nodes are provided in this article. Modern imaging methods of lymphatic drainage and thoracic lymph nodes in lymphadenopathy syndrome are presented: the traditional x-ray techniques, ultrasound, computed tomography, magnetic resonance imaging, SPECT, PET/CT. Conclusion. A problem of chest lymph outflow pathway studying and a problem of chest lymphadenopathy is significant and awaits further investigation. Optimal methods of chest lymphadenopathy imaging are anatomical (CT, US) and functional (SPECT, PET/CT).

Objective. To study the relationship between the intensity of thrombin formation, estimated by thrombin generation test (TGT) in platelet poor plasma, and myocardial contractility in patients with coronary artery disease (CAD) before and after percutaneous coronary intervention (PCI). Methods. The study included 75 patients with coronary artery disease aged between 40 to 75 years, who underwent primary PCI (10 patients) or elective (65 patients) procedure, as well as 35 individuals matched for age and sex with no clinical signs of CAD. We investigated the venous blood obtained before and after 6 and 12 months following PCI. In the same period, stress echocardiography was performed. The intensity of thrombin formation was assessed using a TGT, formed in platelet poor plasma and the modified reaction mixture by adding human recombinant thrombomodulin (rh-TM) to assess the degree of activation of the protein C system. Results. The association between stress echocardiography parameters characterizing myocardial contractile capacity (ejection fraction (EF) of the left ventricle and a wall motion abnormalities (WMAs)) and TGT parameters, reflecting the intensity (ETP and the Peak) of the thrombin formation rate (V), was identified to be more expressed in patients undergoing primary PCI. The presence of the reverse correlation between EF and WMAs and the percentage reduction of V, ETP and Peak after the addition of rh-TM, as well as a significant association of the EF and WMAs with TGT indicators staged with rh-TM demonstrates the role of protein C system in the changes of myocardial contractility. The intensity of thrombin generation was also associated with hypertension. Conclusion. It was determined that TGT parameters were strongly associated with stress echocardiography parameters. The changes in thrombin generation rate were most closely associated with left ventricular ejection fraction, index of wall motion abnormalities and arterial hypertension, including hypertensive reaction to physical activity.

This article describes the case of a possible rare complication of sildenafil citrate use - central retinal vein occlusion. Sildenafil citrate influences on regional and systemic hemodynamics. The role of predisposing factors (arterial hypertension, hyperhomocysteinemia) and provoking factors (physical exercise, visiting sauna and a double dose of the potency regulator) is discussed. Combination of provoking factors including use of sildenafil citrate has resulted in acute decrease in regional perfusion pressure with the development of central retinal vein occlusion.

Introduction. Potential mechanisms of cell therapy benefit in myocardial ischemia include direct differentiation of stem cells into myocardial cells, stimulation of angiogenesis and differentiation of resident stem cells by paracrine factors secreted by autologous or allogeneic stem cells after intramyocardial injection. Dissection of the exact role of these mechanisms in the net effect of cell therapy can be aided by use of stem cell mircoencapsulation. Purpose. This work was aimed at: (i) evaluation of mesenchymal stem cells (MSC) viability and function after encapsulation in vitro and (ii) in vivo safety assessment of microencapsulated mesenchymal stem cells after intramyocardial transplantation. Methods. In order to encapsulate MSC from the rat bone marrow, the magneto-mechanical encapsulator was used. Sodium alginate in combination with a variety of coordinating agents (2.2 % BaCl₂, 1.2 % BaCl₂, and 1.5 % CaCl₂ was used as polymer for capsule formation. Stability assessment of capsules was made by incubation in phosphate buffer. The viability of encapsulated cells was evaluated in vitro by fluorescent staining by LIVE/DEAD Kit. Safety assessment of the intramyocardial transplantation of microencapsulated MSC was made in male Wistar rats weighing 225±25 g. Severity of systemic inflammation was assessed by leukocyte count in peripheral blood. Morphological and functional parameters of the heart were evaluated by echocardiography 5 days after transplantation. Results. In the result of this study standardized capsules were designed. The average diameter of the capsules was 225±25 μm. Capsule stabilization in 2.2 % barium chloride solution resulted in best stability (CaCl₂: swelling - 1 day, complete destruction - 5 days; BaCl₂: swelling - 14 days, complete destruction - more than 21 days), and viability of encapsulated cells (CaCl₂: after 30 min - 48±4 %, after 5 days - 18±2 %; BaCl₂: after 30 min - 63±6 %, after 5 days - 71±5 %). Intramyocardial injection of microcapsules had no effect on leukocyte count and morphofunctional parameters of the heart in comparison with control solution. Conclusion. The technique of MSC microencapsulation was designed with subsequent intramyocardial transplantation. Microencapsulation of MSC can be used to assess the role of paracrine factors in the mechanism of action of cell therapy on myocardial remodeling. Microencapsulation technique can also be used to protect stem cells from the effects of the host immune system and increase their survival early after intramyocardial transplantation.

Introduction. The outcome of ischemia is depending on a condition of microcirculatory bed. The important factor in development of cerebral ischemia is regulation of microvascular function, influencing both perfusion and oxygenation of cerebral tissue. The aim of the current study was to examine the time course of micirculatory changes in rat cerebral cortex, as well as to assess the changes in oscillatory components of myogenic, neurogenic and endothelial levels of cortical microvessel tone within 21 days after ischemia. Methods. Transient global cerebral ischemia was induced in anesthetized Wistar rats by clamping of both common carotid arteries for 12 min with simultaneous controlled hypotension to 45±3 mm Hg, followed by blood reinfusion and recovering from anesthesia. Five different groups of rats were re-anesthetized at 1 hour and 2, 7, 14 or 21 days after ischemia and subjected to studies using continuous wavelet transform analysis of laser Doppler flowmetry. Results. In the first 7 days of the post-ischemic period, peripheral resistance was reduced in the cerebral cortex, which was associated with domination of nutritive blood flow. By 14th day after ischemia it resulted in the blood stagnation connected with development of endothelial dysfunction. From 14th to 21st day post-ischemia, the increase of shunt blood flow was noted. It was possibly a consequence of blood shunting processes happening in a cerebral cortex bypassing a nutritive level that prevents microcirculation from congestion. Conclusions. It is established that transient global cerebral ischemia results in significant changes of microcirculation in cerebral cortex lasting at least 3 weeks after ischemia. Initial dominant nutritive blood flow is probably due to blood congestion because of endothelial dysfunction. Three weeks post-ischemia, it is followed by increase in shunt blood flow that can prevent blood congestion in microcirculatory vascular bed.

Transport of respiratory gases and the entire spectrum of substances for the metabolism of cells is carried out by coordinated work of circulation and blood. The review considers the main theoretical and experimental studies on microcirculation and hemorheology with an emphasis on the mechanisms of their interrelation and on the influence of individual hemorheological characteristics on the regulation of microvascular tissue perfusion. The analysis of the leading microrheological characteristics of erythrocytes - deformability is performed, the signal molecular mechanisms associated with the change of this cell parameter are shown. Data on the role of erythrocytes in the regulation of arteriolar tonus and functional density of capillaries are given. The mechanism of this regulation by exocytosis with erythrocytes adenosine triphosphate (ATP) and its stimulation of nitric oxide synthesis by endothelial cells is discussed. The review performed a comprehensive analysis of the participation of major hemorheological characteristics in the regulation of microvascular perfusion, including the role of the optimal viscosity of whole blood and the viscosity of plasma for effective tissue perfusion and oxygenation.