Objective: to identify predictors of an unfavorable course of the wound process in the postoperative period in patients with purulent-necrotic complications (PNC) of neuropathic and neuroischemic forms of diabetic foot syndrome (DFS). 

Materials and methods. A comparative analysis of anamnestic, clinical, laboratory, and microbiological parameters of 40 patients with PNC of DFS, divided into 2 statistically homogeneous opposition groups of 20 patients each. Studies were conducted at the time of admission of patients to the hospital and 3-5 days after surgical treatment. In patients of the 1 (main) group with an unfavorable course of the wound process in the postoperative period, there was a need for repeated surgical interventions, and in patients of the 2 (compared) group, wound healing occurred after a single radical surgical aid. 

Results. Preoperative biomarkers of unfavorable course of wound process in patients with PNC of DFS were: age less than 60 years, treatment with insulin before admission, the lesion of the foot tissue of 4-5 degree (according to Wagner), the persistence of pulsation at a. dorsalis pedis, contamination of the wound by Pseudomonas aeruginosa or Staphylococcus aureus with gram-negative bacteria, resistance of the wound microflora to cephalosporins. In the postoperative period on the 3-5 days the patients of the main group significantly more often developed the following signs: hyperthermia >37.5°C, hypoalbuminemia <35 g/l, hyperglycemia >10 mmol/l and local signs of inflammation in the affected foot area, such as pain, edema, hyperemia, inconsistency of sutures, wet necrosis and purulent discharge from the wound, as well as detection of P. aeruginosa or enterobacteria. 

Conclusion. The identified biomarkers can be used to develop a model for predicting the unfavorable course of the wound process in the postoperative period in patients with PNC of neuropathic and neuroischemic forms of DFS which, in turn, will allow optimizing surgical tactics and timely adjusting the conservative therapy regimen.

Objective. The aim of the study is the evaluation of endothelial functional activity and immune status in systemic and local blood flow in atherosclerotic lesions of the aorto-iliac segment after open and endovascular interventions and establishing the relationship with the lesion class. 

Materials and methods. The study included 190 patients with lesions of the aorto-iliac segment. Depending on the type of surgical intervention, patients were divided into two groups: group I (n=97) - patients who underwent aorto-femoral bypass surgery, group II (n=93) - patients who underwent TRANS-balloon angioplasty with stenting of the iliac arteries. 

Results. Violations of the functional state of the endothelium and the immune status in the systemic and local blood flow, which do not correlate with the TASC II lesion class (TransAtlantic Inter-Society Consensus II), were revealed. There were differences in the factors of endothelial damage (in patients of group II before surgery, the level of homocysteine in the systemic blood flow, oxidized low-density lipoproteins in the systemic and local blood flow), hemostatic form of endothelial dysfunction (in group I, inhibitor of tissue plasminogen activator type I (PAI-1) in the systemic and tissue plasminogen activator (t-PA) in the local blood flow) and apoptosis (higher in group I in the systemic and local blood flow). During revascularization of the aorto-iliac segment, there were violations of the hemostatic form of endothelial dysfunction in group II with an increase in PAI-1 by 14.8% (p<0.001) in the systemic blood flow and by 1.9 times (p<0.001) in the revascularized arterial segment compared to group I. In group II after revascularization was significantly higher the immunoglobulins (Ig) class A in system and the circulating immune complexes, interleukins 1 (IL-1) in local blood flow and lower levels of IgM, interleukins 6 (IL-6), IL-1 in system and IgA, IgM, IL-6 in local blood flow compared with I group. 

Conclusion. The study of the features of the functional state of the endothelium and the immune status will optimize the management strategies of patients after various types of revascularization interventions on the aorto-iliac segment.

The review presents the key provisions of the recommendations of the Russian society of cardiology and the guidelines of the European society of cardiology for the diagnosis and treatment of atrial fibrillation (AF), updated in 2020. The recommendations clearly state the requirements for atrial fibrillation diagnosis verification, and propose an approach to the formation of a complex characteristic of the disease in four positions, which is designated as 4S-AF (Stroke risk, Symptom severity, Severity of AF burden, Substrate severity). The authors analyzed the strategy "CC To ABC" (Confirm AF, Characterize AF, Treat AF: the ABC pathway) proposed by European experts, the issues of modern terminology and requirements for verifying the diagnosis of AF, complex characteristics of the disease and stratification of the risk of stroke and bleeding, a new ABC approach in the treatment of AF, where A is anticoagulant prevention of thromboembolic complications, B is the control of symptoms of the disease and C is the detection and treatment of comorbid pathology. The General principles that have changed in comparison with the previous versions of guidelines of 2016 on the initiation and tactics of anticoagulant therapy, pharmacological and non-drug cardioversion, catheter ablation in patients with AF, affecting the prognosis and outcomes in patients with AF, are outlined. It is emphasized that the pattern of atrial fibrillation (first diagnosed, paroxysmal, persistent, long-term persistent, permanent) should not determine the indications for anticoagulant prevention. The solution to this issue is determined by the level of risk according to the CHA2DS2-VASc scale. The introduction of the considered methods of diagnosis and treatment of AF into clinical practice will optimize the burden on the health care system and reduce the costs associated with the burden of AF.

The cause of mortality in the Russian Federation in half of cases is still cardiovascular diseases (CVD), the most prognostically unfavorable variant of which is certainly acute myocardial infarction (AMI). At the same time, there is a steady tendency to increase the frequency of myocardial infarction in women of working age. The frequency and severity of AMI in women is underestimated by many researchers, and the prognostic factors of an unfavorable outcome in comparison of female and male individuals are not determined. Objective. The aim of the study was to compare the immediate prognosis and outcome of AMI in women and men, and to identify possible factors leading to an unfavorable outcome. Materials and methods. The analysis of medical cases and pathoanatomical reports of 196 patients who died from AMI within a 5-year period, among whom there were 107 women (average age 72.1±7.2 years) and 89 men (average age 65.4±11.1 years). The authors compared the case, clinical features of the disease, complications, the presence of comorbidities, the depth and localization of AMI, and the direct causes of deaths. Results. In groups comparable in age, the mortality rate in women over 60 years was 1.6 times higher than that in men. Somewhat more often, women died in this case, whose MI began with a typical pain syndrome or an asthmatic variant of it. Concomitant pathology in women who died from MI was significantly more common than in men: arterial hypertension, diabetes mellitus (1.5 times) and obesity (6.5 times). The unfavorable prognostic factors in MI in men can be the previous stroke. Conclusion. The immediate prognosis of mortality in AMI in women is more unfavorable than in men. The immediate causes of death in women compared to men were more often cardiogenic shock, myocardial ruptures and pulmonary embolism, and in men - acute cardiovascular failure and ventricular fibrillation.

Objective. To determine the comparative effectiveness of atorvastatin and rosuvastatin in relation to individual biochemical and functional markers of vascular wall remodeling in patients with arterial hypertension of high cardiovascular risk. 

Materials and methods. The study included 140 patients with stage II of arterial hypertension (AH), II-III degree of severity with the duration of the disease from 5 to 12 years, who, against the background of antihypertensive therapy (enalapril 20-40 mg/day, indapamide retard 1.5 mg, metoprolol 100-150 mg/days) received atorvastatin 20 mg/day for 1 year, subsequently it was replaced by rosuvastatin 10, 20, 40 mg / day. The dose regimen was determined by achieving the target level of cholesterol (CS) and low density lipoprotein cholesterol (LDL-C). 

Results. Taking atorvastatin for 1 year was accompanied by a decrease in the value of the cardio-ankle vascular index (CAVI) by 14.4%, the augmentation index (AI) - by 10.3%. The replacement of atorvastatin with rosuvastatin was accompanied by a further decrease in the R-CAVI value: by 10.8% (20 mg/day) and 14.4% (40 mg/day). The use of atorvastatin for 1 year was accompanied by a decrease in both C-reactive protein (CRP) (by 26.0%) and osteopontin (OP) (by 22.8%). A further decrease in the concentration of CRP by 18 months of rosuvastatin therapy is recorded when using mean and high doses (20-40 mg/day). Differences in the severity of changes in CRP level between the groups were significant (p<0.05). The level of OP in comparison with the beginning of rosuvastatin decreased by 32.9%. Differences in the degree of reduction of OP when taking rosuvastatin between the groups were significant (P<0.05). 

Conclusion. Rosuvastatin in various dosage regimens with long-term use in patients with arterial hypertension with a high vascular risk reduces the content of CRP and OP in blood, reduces the CAVI and the AI, and is more effective than 20 mg atorvastatin a day.

The aim is to examine the effectiveness of preoperative skin biopsy method to determine indications for preventive endoprosthesis implantation of the anterior abdominal wall based on structural features of connective tissue. 

Materials and methods. The study included 17 patients who had been planned to undergo a scheduled surgery such as video laparoscopic cholecystectomy. The histological material was collected with DERMO PUNCH biopsy needles in an outpatient clinic. Using polarized light microscopy we inspected histological slices coloured with Sirius red. After that we analyzed histological sections including the ratio of collagen fibers, the density of connective tissue and the number of interfibrous spaces. 

Results. All the studied features of connective tissue dysplasia had been registered among 18% of patients; significant differences (p ≤0.05) had been identified among other 24% of patients. In patients with identified signs of connective tissue dysplasia, an increase in type III collagen fibers and a decrease in type I fibers were revealed, which directly resulted in a decrease in their ratio. In addition, this category of patients noted a decrease in the density of connective tissue and a significant number of interfibrous spaces. 

Conclusion. Skin biopsy is a safe and informative method to reveal patients with predisposition to the formation of hernias of the anterior abdominal wall based on structural features of connective tissue and to determine indications for preventive endoprosthetic implantation. This method will reduce the frequency of postoperative ventral hernias, so the effectiveness of the treatment will definitely increase.

Changes in psychological status undoubtedly have a great impact on the development and course of myocardial infarction (MI). 

Objective - to study changes in the psychological status in women with acute myocardial infarction (AMI) in comparison with male patients and the reflection of these changes on the quality of life. 

Materials and methods. A single-stage observational study was performed in the city hospitals of Tver. 120 women with AMI aged 36-74 years and 50 men with AMI aged 37-72 were examined. The main group (women with AMI) was divided into two subgroups: the first - patients under 60 years of age, the second - 60 years and older. The study of psychological characteristics of the individual was carried out using the abbreviated multifactor questionnaire for personality research (the so called “Mini-Mult” or “SMOL”), the personality questionnaire of the Bekhterev Institute (the so called “LOBI”), and the methodology for assessing the quality of life of a patient (QOL) according to V.P. Zaitsev. 

Results. In women aged 60 years and older, an increase in the profile of pitches on all scales was detected. The most noticeable increase in indicators was observed on the scales of the neurotic triad (1st, 2nd, and 3rd) and the 6th Mini-Mult scale. Analysis of the LOBI test revealed that the level of anxiety, hypochondriac, sensitive, neurasthenic, dysphoric and melancholic types of attitude to the disease prevailed in women, with the greatest severity of changes in the group of women under 60 years of age. In the block of interpsychic orientation, the most significant increase was in the sensitive type of attitude to the disease, which prevailed in both groups of women compared to men. The total indicator of "quality of life" was reduced in all the examined groups, and this decrease was most pronounced in older women. 

Conclusion. Women with AMI have more pronounced changes in their personal and emotional status than men. This is manifested in an increase in hypochondriac, depressive, emotionally labile symptoms; anxiety, hypochondriac, neurasthenic types of response to the disease and a decrease in the "quality of life".

Objective. The article provides information on how to improve the forecast of the early postoperative period by additional individualization of anesthetic management of patients during emergency surgical interventions on the gallbladder using artificial neural network technologies. 

Materials and methods. The course of combined anesthesia and the features of the postoperative period were analyzed in 92 patients with an endoscopic cholecystectomy performed for urgent indications. The prediction of the variant of the postoperative stage of hospitalization was realized using the analysis of the significance of 20 different-modal variables selected for the description of patients using fuzzy logic technologies. The possibility of changing the forecast to a more favorable one was achieved on the basis of the developed algorithm for evaluating the results of training neural networks on the Neuro Pro 0.2 neuroimitator. 

Results. According to the generally accepted criteria, all patients had endoscopic cholecystectomy and anesthesia wit out complications. At the postoperative stage, 2 groups of persons were identified - with the expected short hospitalization (72 cases - 6.7±2.1 days) and with the clinic, which led to its reliable prolongation (20 cases - 12.2±3.5 days). It has been shown that the use of a neural network approach makes it possible with a confidence of more than 80% to assume cases with a high probability of postoperative disorders and in half of such patients to improve the prognosis within the framework of neural network technology and the developed algorithm for selecting the severity of the selected 5 variable factors related to the method of conducting anesthesia. 

Conclusion. Neural network technology makes it possible to predict cases with individual “unpredictable” responses to surgical trauma. Assessing the significance of the factors used and varying their severity create the basis for the individualization of anesthetic management of patients, prevention of postoperative reactions and a reduction in the period of hospitalization.

Objective: to conduct a comparative analysis of age-related morphometric characteristics of the corpus callosum (callosometry) in elderly and senile age based on magnetic resonance imaging data. 

Materials and methods. The analysis of the results of a morphometric study of the corpus callosum of 97 people of both sexes (46 men and 51 women) who underwent a brain study in the Department of Radiation Diagnostics in the period 2019-2020 was carried out. Depending on the age, the subjects were divided into two groups. Group I included 52 elderly people (61-72 years old), and group II included 45 senile people (76-87 years old). All patients had no history of diseases and injuries of the Central and peripheral nervous system, as well as alcohol and drug dependence, but the predominance of the right hand (right-handed) was noted. All of them gave their consent to the magnetic resonance imaging examination, which was carried out only according to the indications. We determined the thickness of the genu, the thickness of the splenium, length and height of the corpus callosum, as well as its depth - anterior, superior and posterior. 

Results. When comparing the parameters of length and height of the corpus callosum, as well as all three parameters of depth, established in elderly and senile ages, statistically reliable age differences in the indices do not exist (p>0.05), but there is a tendency to reduce all their linear sizes from elderly to old age. When comparing the studied linear dimensions of the structural components of the corpus callosum (the thickness of the genu and the splenium) in elderly and senile ages, statistically significant differences in parameters were found with their predominance in the elderly (p<0.001).