Despite the fact that the phenomenon of unrecovered coronary blood flow (no-reflow) has long been known, there is still no unanimous opinion about the predictors and, accordingly, the risk groups for its occurrence. This prevents predicting the further course of the disease and investigating the effectiveness of therapeutic and surgical methods for preventing the consequences of reperfusion in patients with ST-segment elevation myocardial infarction, which in turn worsens the postoperative and long-term prognosis in this group of patients. We used the search engines E-library, Google Scholar and Pubmed to search for studies on this issue. The article presents and analyzes research data covering the predictors of the no-reflow phenomenon. The difficulties in identifying them are also described, the issue of a diagnostic approach ans sampling for research is raised. A review of studies dedicated to the identification of predictors of the no-reflow phenomenon using optical coherence tomography and intravascular ultrasound is given.

The literature review presents data on features of microcirculation in patients with psoriatic arthritis (PsA). The immune inflammation underlying PsA leads to increased permeability of the vascular wall, deposition of the immune complexes in it, a decreased capillary blood flow, and vascular sensitivity to sympathetic stimulation. In combination with impaired blood rheology during inflammation, these changes have a significant effect on the state of the microvasculature. Increased vascular permeability and a damaged connection between the endothelium and the extracellular matrix in PsA cause the formation of the capillaries with a pathological structure. Microscopic examination of the synovial membrane of patients with PsA shows vascular tortuosity, branching, and elongation. The duration, activity of articular inflammation, as well as severity of psoriasis are associated with the degree of microcirculatory disorders in PsA. The pathomorphological changes in the vessels of patients with PsA are detected not only in the articular tissues but also in the skin, which indicates dysregulation of angiogenesis in general. The mechanisms of the formation of new vessels with a pathological structure are not fully understood. However, most likely, an imbalance of the factors of angiogenesis and antiangiogenesis plays an important role. There is growing evidence that vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-beta) and platelet growth factor (PDGF) are involved in the pathogenesis of PsA. At the moment, the issue of early diagnosis of PsA remains relevant, especially in cases with minor skin changes and rheumatoid-like joint lesions. Information on microcirculation obtained by capillaroscopy, video capillaroscopy, and fluorescence microscopy provides additional opportunities for a differential diagnosis of PsA, a determination of activity, and a prognosis of the disease.

The aim of the study was to assess the clinical and genetic factors associated with the risk of recurrent ischemic events in patients with stable stenocardia (SS). Materials and methods. A total of 100 patients with SS were examined and followed-up for 15.3±8.3 months. The patients were divided into subgroups (SG): SG1 (n=51) – persons without events, SG2 (n=49) persons with recurrent ischemic events (hospitalization due to the development of pain syndrome, re-stenting due to stent restenosis, myocardial infarction, cerebral infarction and death from cardiovascular causes), SGB (n=11) – persons with «major» recurrent ischemic events (re-stenting due to stent restenosis, myocardial infarction, cerebral infarction and death from cardiovascular causes) , SGG (n=89) – persons without «major» events. The obtained survey data (general clinical, aggregometry, polymor  phism of genes of platelet fibrinogen receptor ITGB3 (T1565C), platelet collagen receptor ITGA2 (C807T), ADP platelet receptor P2RY12, H1/H2 (T744C)) were analyzed using the STATISTICA 10.0 software. Results. In SG2, men predominated (χ² =9.2; p<0.01), past MI was more common (χ² =4.8; p<0.05), more stents were implanted (2.4±1.9 versus 1.7±1.1, p<0.05), TRAP-test values were higher (p<0.05) compared to SG1. In SGB, greater number of stents were implanted (3.1±2.2 versus 1.61±1.57, p<0.05), the carriage of the TC genotype of the ITGB3 gene was more common, (p<0.05), a combination of gene mutations ITGB3 and P2RY12 was more common, (p<0.05) compared to SGG. A logistic regression equation was constructed, including the presence of diabetes mellitus, the number of platelets in the blood test, the ASPI-test values, the carriage of the 1565C allele of the ITGB3 gene, the number of stents implanted, which makes it possible to determine the likelihood of developing «major» recurrent ischemic events with a cut-off threshold LP₀=0.0965, with sensitivity – 81.82 %, specificity – 78.48 %, overall accuracy – 78.89 %. Conclusions. The factors associated with the development of recurrent ischemic events are: male sex, previous MI, a greater number of implanted stents, and high TRAP-test values. The factors associated with the development of recurrent «major» ischemic events are: a greater number of implanted stents, carriage of the TC genotype of the ITGB3 gene, carriage of a combination of mutations of the H1/H2 polymorphic locus of the P2RY12 gene and the T1565C polymorphic locus of the ITGB3 gene, diabetes mellitus, the number of platelets in blood test, ASPI-test values.

Introduction. Cardiac surgeries using cardiopylmonary bypass (CB) have been successfully performed for more than 60 years, but at present it is necessary to further study the changes in tissue hemodynamics during interventions to minimize possible iatrogenic complications. One of these tissues available for direct observation of the vessels of the microvasculature is the retina. Aim – to study the structural and functional state of the retina in patients who underwent cardiac surgery with the use of CB, and to identify potential factors that negatively affect the retinal blood flow. Materials and methods. The clinical study involved 10 patients (20 eyes). All patients before cardiac surgery using CB and 10–14 days after it underwent visometry, perimetry, non-contact tonometry, biomicroscopy, reverse binocular ophthalmoscopy, fundus photography, optical coherence tomography of the retina of the macular region and optic nerve head with determination of the thickness of the layer of ganglion cell and the layer of nerve fibers. To carry out CB, pharmaco-cold cardioplegia was performed with the Custodiol solution using unified surgical and anesthetic tactics. CB was performed on a device with disposable membrane oxygenators (Strockert, Germany) under normothermic conditions, blood circulation was provided with non-pulsating blood flow with a volumetric flow rate of 2.4–2.8 L/min/m² at an initial dose of heparin of 300 U/kg. Results. The studies revealed a correlation between changes in the histoarchitectonics of the retina and the level of mean arterial pressure (MAP). So, in 30 % of patients, the appearance of ischemic foci along the vascular arcades was found. In 10 % of patients, a decrease in the thickness of the ganglion layer and the layer of retinal nerve fibers was reported as a result of impaired blood circulation in the vessels supplying the optic nerve. Conclusion. Increase in MAP up to 90 mm Hg and above and fluctuations in its level of more than 20 mm Hg (p<0.05) during cardiac surgery under cardiopulmonary bypass in 67 % of cases is accompanied by transient disturbance of regional blood circulation at the level of vessels of the microvasculature of the retina with the appearance of ischemic foci in the retinal tissue. In this regard, it is necessary to carefully monitor the MAP parameters during the cardiopulmonary bypass to prevent circulatory disorders in various organs and tissues of the body.

Introduction. The participation of soluble leptin receptor (SLR) in the formation of hyperleptinemia and leptin resistance in patients with coronary artery disease (CAD) in combination with obesity is discussed. Aim. Study of the role of SLR in the pathogenesis of ischemic heart disease. Materials and methods. A cohort study of 744 patients was performed: 465 patients with CAD (56 years old, Q1=44; Q3=62), 270 patients without CAD (52 years old, Q1=44; Q3=56). Methods: EchoCG, heart computed tomography, coronary angiography. In the blood serum, the lipids, glucose, creatinine, uric acid, and c-reactive protein were assessed using a highly sensitive method (HF-CRP). Concentrations of SLR, leptin (LN), adiponectin (total and high molecular weight), fatty acid binding protein-4 (FABP-4) tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), serum insulin were determined by enzyme immunoassay. Results. The level of SLR in blood serum in men and women with CAD is lower than in men without CAD (p <0.001). In CAD patients, obesity was associated with a low SLR level in the blood serum and a high free LN index. At a serum SLR concentration of <7.5ng/ml in men with CAD, the incidence of obesity was higher simultaneously with signs of visceral obesity of the heart, the presence of atherosclerotic plaques in the common carotid arteries, high glycaemic levels, insulin, IL-6, and LN in serum, serum LN/adiponectin ratio and a high HOMA-IR index. Diabetes mellitus, visceral obesity, high levels of hs-CRP, TNF-α, FABP-4, serum insulin, and HOMA-IR index were more often detected in women with coronary artery disease with SLR <10.2 ng/ml. In men and women with CAD, there were no differences in SLR concentration depending on the extent of coronary atherosclerosis. Conclusion. An increase in the free LN index indicates the disruption of connections in the leptin-receptor system and reflects the mechanisms of compensation for overcoming the resistance of peripheral tissues to leptin, which is confirmed by a noticeable negative relationship between the levels of SLR and leptin in the serum of men with coronary artery disease. A low concentration of SLR in patients with CAD is associated with obesity, pro-atherogenic and pro-inflammatory markers of cardiovascular diseases.

Introduction. The state of the blood flow within the capillaries and close blood vessels is highly important in practice for the revealing of pathogenetic mechanisms of both systemic and local circulatory disorders. Aim of the study was to define the parameters of microcirculation and the level of blood flow fluctuations (flux) in the distal segments of upper and lower limbs (in fingers of hands and toes of feet) in children of 6–7 years old; and to describe the possible differences in the mechanisms of blood flow modulation in boys and girls. Materials and methods. Skin microcirculation was assessed in middle fingers of hands and great toes of feet in children of 6-7 years old (14 girls and 7 boys in prone position) by means of laser doppler flowmetry. Results. The ranges for parameters of microcirculation (PM) for distal segments of upper and lower limbs in children of mentioned age group were defined, also it was shown that the PM are significantly lower in the lower limbs comparing to those of the upper limbs (both in groups of girls and boys). Asymmetry of PM in the feet was not found; the features of right hand-left hand asymmetry for PM in girls and boys are described. The analysis of modulation of blood flow fluctuations (fluxmotions) of different frequencies showed the profound role of vasomotor (myogenic) rhythm for regulation of microcirculation. Conclusion. Increased neurogenic influences on the modulation of fluxmotions in girls of 6-7 years old may be an evidence of the ongoing development of the mechanisms of blood flow regulation, particularly the association with the growth rate of girls is possible.

Osteoarthritis is a common disease of the musculoskeletal system, the cause of pain, loss of joint function and, as a consequence, a factor in the disability of the population. The treatment strategy for patients with gonarthrosis is not fully defined, especially in patients with stage 1–2. One of the treatment options for such patients is transcatheter embolization of the hypervascular network of the popliteal arteries. The article presents a series of clinical cases of embolization of the popliteal artery branches. Retrograde percutaneous puncture and catheterization of the target femoral artery were performed under local anesthesia. Then, selective angiography of the popliteal artery was performed to identify the hypervascular vasculature of the knee joint. After revealing the target artery along the interventional guidewire, selective catheterization of the artery of the hypervascular vascular network was performed using a microcatheter. Transcatheter arterial embolization of the hypervascular vascular network in osteoarthritis of various origins and localization can be successfully applied as an alternative treatment if conservative therapy is ineffective and if there are contraindications to surgical treatment. It should be noted that further randomized multicenter studies and meta-analyzes are needed to introduce this treatment method into everyday clinical practice.

Introduction. Pregnancy development following unfavorable conditions could facilitate disorders of nitric oxide (NO) production during offspring’s postnatal life and «program» offspring’s cardiovascular diseases. Investigation of particular features and mechanisms of nitric oxide synthesis and action disorders following prenatal stress will promote expansion of considerations about pathogenesis of different cardiovascular diseases and propose new approaches to their prevention and management.The aim of the investigation is to assess the nature of nitric oxide synthesis and action in mature rats whose mothers were exposed to chronic «unpredictable» stress during pregnancy. Materials and methods. Pregnant rats were subdivided into the «control» and «stress» groups (in 20 animals). The rats from the «stress» group were exposed to multiple different stressors at various intervals, such as 1-day famine; 20-min. immobilization in the water at room temperature; 1-day contact with cats’ excrements. In the blood serum of 3-mo offspring (n=96, including «control» males – 24, «control» females – 26, «stress» males – 22, «stress» females – 24) concentration of the stable products of NO degradation – nitrates/nitrites (NO₃^–/NO₂^–), endothelial (eNOS) and inducible (iNOS) isoforms of the NO-synthase, inhibitor of NO-synthase asymmetric dimethylargininne (ADMA), cyclic guanosine monophosphate (cGMP), lipid peroxidation products – diene conjugates (DC) and malonic dialdehyde (MDA) and C-reactive protein (^hsCRP) was detected. Results. The decrease of eNOS and cGMP concentration (by 12.9 and 31.9 %, respectively), increase of iNOS, ^hsCRP and ADMA concentration (by 49.9, 20.3 и 63.1 %, respectively) without statistically significant fluctuation in the NO₃^–/NO₂^– level and accumulation of DC and MDA by 21.1 % and 1.5 times in a prenatally stressed male rats’ blood serum were found (as compared with «control» male rats). In a blood serum of female rats, whose mothers were exposed to chronic «unpredictable» stress during pregnancy, a tendency to eNOS concentration decreasing, and increase of iNOS by 30.6 %, ^hsCRP by 23.9 % and MDA by 2.3 times without statistically significant changes in cGMP, ADMA, NO₃^–/NO₂^–, and DC concentration were detected (as compared with «control» female rats). Conclusion. Identified changes of the nitric oxide system synthesis and action in the prenatally stressed male rats could argue the high risk of their cardiovascular system lesion.

Introduction. Ozone is a physiological factor that can change hemoglobin oxygen affinity and the formation of gaseous transmitters (NO, H₂S). The aim is to study the effect of ozone with gaseous transmitters donors on oxygen-dependent processes in the blood under hypoxic conditions in vitro. Materials and methods. Blood samples were divided into 6 groups of 3 ml each. Groups 2, 4, 5, 6 were pretreated with a deoxygenating gas mixture (5.5 % CO₂; 94.5 % N₂). In groups 3, 4, 5, 6, ozonized isotonic sodium chloride solution (with an ozone concentration of 6 mg/l) was added, and in groups 5 and 6, the donors of gas transmitters nitroglycerin and sodium hydrosulfide, respectively, were additionally introduced. Results. Pre-deoxygenation reduces the effect of ozone on oxygen transport in the blood. Nitroglycerin prevents this effect. The action of ozone under hypoxic conditions leads to an increase of content of NO₃^-/NO₂^- and H₂S, and combination with nitroglycerin and sodium hydrosulfide increase these parameters. Deoxygenation due to ozone reduces parameters of lipid peroxidation (malonic dialdehyde, diene conjugates), retinol and α-tocopherol, and the same result in the nitroglycerin group. Conclusion. Under hypoxic conditions, a decrease in the effect of ozone on oxygen-dependent processes is reported. Nitroglycerin reduces its manifestation, while sodium hydrosulfide does not have a similar effect.

Introduction. Pulmonary vasoconstriction is one of factors of hypoxic pulmonary hypertension (HPH). The progression of this disease depends on the degree of hypoxiа and seх. The aim of this study was to investigate the reactivity of isolated pulmonary vessels of male and female rats with HPH to vasoactive factors. Materials and methods. The experiments were on male and female of Wistar rats 190–200 g, which were gonadectomized. All animals were divided into 4 groups. One group of males and female rats was kept in a vivarium (21 % О₂ ). To simulate HPH, other rats were exposed to hypobaric hypoxia for 10 hours a day at an oxygen content in the inhaled air equal to 13 % (pP O₂ 103.7 mmHg) or 10 % (pP O₂ 78,2 mmHg), or 8 % (pP O₂ 63,5 mmHg) as compared to its content at 21 % (pP О₂ 159 mmHg). After that, a third-order pulmonary vessel was perfused at a constant flow rate with vasoconstrictors and vasodilators. The reaction was recorded by the change in perfusion pressure. Results. In females with HРН 10 %O₂ , constricting response to serotonin were greater than in males. In normotensive males, the dilatory response to sodium nitroprusside (NP) was less than in female. Exposure to hypoxia induced an increase in NP responses. Conclusion. Increased reactivity of pulmonary vessels to serotonin is a factor of pathogenesis of HPH in females, in contrast to males. Increased reactivity to NO donor in males exposed to hypoxia сan be used for a pharmacological target for HPH.