The article analyzes scientific publications on the possibilities of echocardiographic examination in the acute period of COVID-19 and after the recovery of the new coronavirus infection. The use of echocardiography in the assessment of right ventricular dysfunction and pulmonary hypertension, left ventricular dysfunction, in acute coronary syndromes, in the diagnosis of effusion in the pericardial cavity, in the diagnosis of infectious endocarditis, as well as in post-COVID syndrome is reviewed. The prevalence of echocardiographic signs of heart damage and possible mechanisms of cardiac pathology are considered. It has been shown that echocardiographic analysis in patients with COVID-19 provides important information about the systolic and diastolic function of the left and right ventricles, myocardial remodeling, regional wall kinetics, the presence of effusion in the pericardial cavity, as well as valvular pathology in the context of possible infectious endocarditis. An analysis of the literature sources indicates the prognostic value of the myocardial strain of the right and left ventricles, assessed using the speckle tracking echocardiographic technique, especially in people with severe COVID-19. Echocardiography data can be useful in the diagnosis of such cardiovascular complications of the new coronavirus infection as acute coronary syndromes, heart failure, pericarditis, and infectious endocarditis. Echocardiography results are of diagnostic value both in the acute period and in people who have suffered from COVID-19, especially with the development of post-COVID syndrome. The authors concluded that long-term follow-up with echocardiographic monitoring of people who have suffered a new coronavirus infection is important, with the mandatory inclusion of systolic myocardial strain analysis of the left and right ventricles in the echocardiography protocol.

The structure of combat surgical pathology due to modern defeat factors of modern weapons used in armed conflicts of recent times is characterized by a high frequency of injuries of blood vessels of the lower extremities, which is often accompanied by massive bleeding and/or acute limb ischemia (ALI). A review of scientific literature devoted to the types of surgical methods for the treatment of acute limb ischemia is presented. The issues of neoangiogenesis regulation in tissues are considered, the possibilities of application of genetically engineered technologies of angiogenesis stimulation in patients with chronic lower limb ischemia are presented. The results of experimental and clinical studies in this direction are presented. A promising concept of the possibility of application of genetically engineered complexes of VEGF-dependent angiogenesis stimulation based on cyclic plasmid DNA of this growth factor is substantiated. The review included data from relevant articles describing methods of angiogenesis stimulation in ischemia, as well as the structure and nature of limb arterial injuries published in the period of January 2013 and January 2023 and presented in PubMed, ScienceDirect, and eLibrary databases. Currently, surgical treatment of the wounded with the injuries of the main arteries of the extremities does not always allow to achieve the optimal result. The key to accelerated restoration of the injured limb arteries may be the understanding of the processes of angiogenesis stimulation and development of new techniques of adjuvant therapeutic stimulation of angiogenesis in this category of patients. In the long term, this will lead to a decrease in disability and improved outcomes of treatment of modern surgical trauma. Taking into account numerous literature sources, publications of our colleagues, we can conclude that the techniques of therapeutic stimulation of angiogenesis in patients with the injury of the main arteries of the limb are promising and effective. However, further study of angiogenesis mechanisms in this type of injuries is required, as well as expansion of indications for its application.

Acute myocardial infarction (AMI) is one of the main reasons of death and disability worldwide. The pathophysiological changes such as microvascular obstruction (MVO), cardiac microvascular injury (CMI), and intramyocardial haemorrhage (IMH) play an essential role in its development. IMH is associated with larger infarct size and contractile dysfunction. IMH precedes the occurrence of adverse remodeling. IMH is accompanied by inflammation. Experimental studies demonstrate that the appearance of IMH occurs after recanalization of the infarct-related artery and its size depends on the duration of ischemia. IMH is accompanied by contractile dysfunction and adverse remodeling of the heart. The most likely cause of IMH is CMI. CMI is accompanied by an increase in the myocardial and plasma proinflammatory cytokine levels and also the downregulation of tight junction proteins in cardiac vascular endothelial cells. However, there is no convincing evidence that proinflammatory cytokines trigger CMI. An increase in the proinflammatory cytokine and CMI can be two independent processes. In this review, we analyse clinical and experimental data on intramyocardial haemorrhage and cardiac microvascular injury during cardiac ischaemia/reperfusion.

Introduction. Stenting of bifurcation lesions of the coronary arteries is a pressing issue in interventional cardiology that requires constant adaptation to modern technical advances and patient needs. Optimized treatment methods should take into account morphological features, the potential for plaque formation in the main vessel and in the side branch; ensure long-term efficacy and a low risk of restenosis in the distant period. Objective. To evaluate the immediate results of surgical treatment of bifurcation lesions of the coronary arteries using a modified provisional stenting technique. Materials and methods. In three groups of patients with bifurcation lesions of the coronary arteries, provisional stenting was performed using classical generally accepted techniques (side branch dilation with proximal optimization in the first group and kissing dilation with proximal optimization in the second) and a modified technique i. e. local post-dilation of the stent cell with proximal optimization was used in the third group. After the surgery, we performed OCT control, analyzed in-hospital complications and the following parameters: stenosis of the main and side branches (OCT MB and SB, %); diameter of the main branch (mm); malposition of stent struts (%). Results. When comparing the frequency of major adverse cardiovascular events (MACE), angiographic success in MB and SB, MB predilation, transition to a two-stent technique, as well as the number of stents and guidewires used during the intervention, no statistically significant differences were found in the compared groups. However, when using the modified technique, there was a tendency to reduce the time of X-ray radiation (p=0.37) and the number of balloon catheters used (p=0.55), as well as a decrease in the percentage of malpositioned struts (p=0.31) according to the results of OCT control in comparison with classical techniques. Conclusion. The proposed modified technique of provisional stenting of bifurcation lesions of the coronary arteries is comparable in efficiency and applicability with classical, generally accepted methods of provisional stenting, and also demonstrates ease of implementation and safety in the medium term. The technique demonstrates better geometry of the stented section of neobifurcation; it allows to reduce the risk of thrombosis in the early postoperative period due to complete and optimal adhesion of the stent to the artery.

Introduction. Heart rate variability (HRV) due to rhythmically occurring processes exhibits stable cyclical fluctuations, which are now widely recorded in long-term heart rate monitoring technologies. It seems interesting whether it is possible to use HRV data obtained by Holter monitoring (HM) of ECG to assess the non-modifiable individual state of cardiac reactivity. Aim. Search for evidence of the presence, under standard conditions of human behavior, of a stable pattern of heart rate variability throughout the day, caused by a set of stable reflections, individually formed during the process of ontogenesis. Materials and methods. The study included 20 practically healthy male subjects of a semi-closed group aged 18–19 years, who underwent daily HM ECG. The subjects were divided into 2 groups with the same average heart rate (HR) per day (n=10): group 1 – subjects with high HRV and group 2 – subjects with low HRV. The studied HRV parameters were analyzed twice with an interval of 4 years between studies. Results. Despite similar 24-hour mean RR interval values between groups, significant differences in HRV parameters persisted both at baseline and study end. HRV indices (SDNN, SDANN, rMSSD, pNN50) remained consistently higher in Group 1 (p < 0.01). Intragroup HRV parameters showed no statistically significant temporal variations: SDNN (p₁=0.06, p₂=0.11),  SDANN (p₁=0.06, p₂=0.17), rMSSD (p₁=0.06, p₂=0.07), and pNN50 (p₁=0.14, p₂=0.09), suggesting the existence of persistent HRV patterns over time. The general study population (n=20) demonstrated significant reduction in total HRV power (p <0.05) during the 50-month observation period, while maintaining stable heart rate values and LF/HF ratio (1.4–1.5, p=0.08). These findings exclude autonomic balance alterations as the cause of HRV decline. Conclusions. The obtained results indicate the existence of a stable HRV pattern along with a decrease in the reactivity of the system over time due to changes in the functional state of the vascular receptor field.

Introduction. Our earlier studies have shown the negative effect of smoking and the positive effect of smoking cessation on the «classic» parameters of the microcirculatory bed (MCB). In this new study in young outpatients, we decided, in addition to the «classic» microcirculatory (MC) parameters analyzed earlier, to propose «new» ones and test their diagnostic significance, which was the purpose of this study. Materials and methods. We examined 171 outpatients (20–44 years old) with hypertension (HT) stages I/II. All were divided into 3 groups: Group 1 – those who stopped smoking (n=55), Group 2 – smokers (n=66), Group 3 – never smokers (n=50). The duration of HT in those who had stopped smoking was 3.0 (1.0; 7.0) years, in smokers – 3.0 (1.5; 10.0) years, in never smokers – 6.5 (2.0; 10.0) years. MC was studied by direct biomicroscopy of bulbar conjunctival vessels. The following «classic» parameters were assessed: the average diameter of arterioles, venules, capillaries, arteriole-venule ratio (AVR), the number of capillaries per 1 mm² of conjunctival surface, and «new» ones: the total number of arteriole-venule pairs (AVP), the number of normal and narrow AVPs, and the percentage of AVPs with low AVR. Results. The total number of AVPs was the lowest in the group of smokers (24 pairs), the highest in those who never smoked (30 pairs), and intermediate in the group of those who quit smoking (27 pairs). The number of narrow AVPs and the percentage of narrow AVPs were statistically significantly higher in the group of smokers (18 pairs and 66.7 %, respectively (p < 0.05 compared to non-smokers (13 pairs and 52.4 %, respectively, for the number of narrow AVPs and the percentage of narrow AVPs) and those who quit smoking (10 pairs and 48.6 %, respectively)), no significant differences were found between the latter. Conclusion. The diagnostic significance of «new» MC parameters is shown: the total number of AVPs, the number of normal and narrow AVPs and the percentage of narrow AVPs demonstrating an increase in total peripheral vascular resistance (TPVR) in patients with HT regardless of smoking status and the additional negative impact of smoking on resistive vessels.

Introduction. The effect of chronic stress on the digestive tract is an urgent issue of physiology and pathology. The aim is to study the features of histostructure, morphometric characteristics and the level of total water in the wall of the small intestine in a Wistar rat when modeling chronic predatory stress. Materials and methods. The study was conducted on 60 male Wistar rats weighing 220–370 g, divided into control and experimental groups of 30 rats each. In animals of the experimental group, chronic predatory stress was simulated by exposure to the smell of urine of predator (cat) for 10 days according to the method of V. E. Zeilikman et al. (2021). To determine the total water level, fragments of the small intestine were weighed on electronic scales before and after drying in a thermostat to a constant weight (dry residue) at a temperature of +55 °C. Histological preparations were prepared according to the standard procedure. Sections with thickness of 8 and 12 μm were stained with hematoxylin and eosin, and morphometric examination of intestinal villi and crypts was performed. Digital data were processed by methods of variational statistics. Results. When exposed to chronic stress, the rats of the experimental group showed an increase in the thickness of intestinal villi by 1.286± 0.026 times and the transverse size of the crypts by 1.128±0.268 times, which was associated with venous fullness and lymphostasis, which were accompanied by edema and swelling of the mucous membrane of the small intestine with deformation of the crypts. An increase in the total water level in the small intestine confirmed the detected changes. Conclusion. Under conditions of chronic predatory stress, stress-induced changes with morphometric and histostructural transformations develop in the small intestine of rats, which are characteristic of exudative enteropathy.

Introduction. There are increasing reports of adverse effects of the SARS-CoV-2 virus (COVID-19) on the bone system, especially in the maxillofacial region. Purpose. To demonstrate the possibilities of complex radiology diagnostics by multispiral computed tomography (MSCT) and positron emission computed tomography (PET/CT) methods, to show the peculiarities of radial semiotics of the maxillofacial osteomyelitis in a patient with rhinocerebral mucormycosis developed after coronavirus infection on the background of Burkitt’s lymphoma. Materials and methods. The article presents a clinical case of patient K., 41 y.o., with complaints of a defect in the region of the upper jaw after coronavirus infection, on the background of which rhinocerebral mucormycosis developed. From the patient’s history, it is known that the patient was diagnosed with Burkitt’s lymphoma in 2020, and the upper jaw was resected in 2021 with simultaneous plasty with local tissues. A comprehensive clinical and radiological examination was performed to assess the activity of the underlying disease and the dynamics of the patient’s condition at various stages of treatment. After repeated surgery in March 2022, the patient underwent MSCT in order to assess the condition of the facial skeleton. Results. Based on a comprehensive examination data, the final diagnosis was made, and the radiation semiotics of osteonecrosis of the maxillofacial region in a patient with Burkitt’s lymphoma combined with rhinocerebral mucormycosis that developed against the background of coronavirus infection was described. The most informative method for diagnosing osteonecrosis of the bones of the facial skeleton is MSCT of the maxillofacial region, which provides comprehensive information on the localization and prevalence of the lesion, which determines further treatment tactics for the patient, taking into account the identified changes. Conclusion. The literature increasingly concludes that there is a positive causal relationship between COVID-19 and the development of osteonecrosis of the maxillofacial region. In the presented clinical case, MSCT was used to diagnose osteonecrosis of the maxillofacial region, which developed against the background of a coronavirus infection, and PET/CT was used to assess the prevalence of osteonecrosis of the maxillofacial region and the activity of Burkitt’s lymphoma.

Introduction. A significant number of publications devoted to anatomical variation of the main arteries of the shoulder use the results of pathoanatomical observations or retrospective analysis data. The description of rare variants of the development of the main arteries is an urgent task that allows to develop and improve surgical treatment methods taking into account the individual characteristics of patients. Aim. to provide a detailed description of the identified variant of the development of the arteries of the right upper limb. To compare the hemodynamic features with the patient’s second limb and the results obtained during the examination of the control group. Materials and methods. A clinical case of an unusual variant of the development of the arteries of the upper limb is described. The Dopplerography data were compared with the results of an examination of 50 relatively healthy patients of both sexes aged 32 to 85 years. Statistical analysis was performed using IBM SPSS Statistics 20. Results. A 46-year-old woman was diagnosed with a split of the axillary artery in the upper third of the shoulder into two arterial trunks. Their diameter was 2.3 mm, they passed through the medial intermuscular groove of the shoulder and then continued independently into the radial and ulnar arteries. When assessing the blood supply to the palmar arches, signs of arterial blood flow are determined. During the Allen test, the dominant role of the ulnar artery in the blood supply to the hand was noted. Discussion. The results obtained in the female patient with an unusual variant of the development of the arteries of the upper extremity suggest a tendency to increase the resistance indices and peak blood flow velocity in comparison with the data of the control group. In general, the study revealed no signs of significant hemodynamic changes. Conclusions. The results obtained suggest a tendency towards an increase in resistance indices and peak blood flow velocity. The presented case indicates that timely detection of hemodynamic disorders allows to actively use bypass surgery methods to restore or improve the developed changes in blood supply, and to choose the optimal level for reconstructive intervention.

The production of powerful vasoconstrictors (endoperoxides, endothelins) and cytokines such as tumor necrosis factor alpha (TNF-α) that suppress nitric oxide (NO) synthesis play a key role in the development of endothelial dysfunction, which leads to disruption of vasorelaxation processes. To date, sufficient data have been accumulated showing that the development of endothelial dysfunction, caused, in particular, by quantitative and qualitative disruption of lipid homeostasis, is of paramount importance in the progression of systemic vascular pathology. The effect of oxidized low-density lipoproteins (oxy-LDL) on the vascular wall initiates the development of endothelial insufficiency and the formation of an atherosclerotic plaque. Oxy-LDL also mediates vasoconstriction of coronary vessels by reducing eNOS, inhibiting NO and increasing endothelin production. The development of hyperlipidemia initiates a proliferative response of endothelial cells with subsequent changes in their functional activity and expression of proteins of the “proinflammatory endothelial phenotype” that play an important role in regulating the local inflammatory process. At the same time, hyperexpression of cell adhesion molecules VCAM-1, ICAM-1 and E-selectin is a decisive step in increasing the adhesive activity of monocytes and their migration into the vascular wall. An important link in the formation of endothelial dysfunction in hyperlipidemia, according to many authors, is a change in the amount and activity of endothelial nitric oxide synthase (eNOS) and, as a consequence, a violation of NO production by the endothelium.