Long-term observations of body composition values are used in extended clinical settings: in case of fat mass reduction, during observations after GIT resection, among patients with cardiovascular and renal insufficiency, etc. In case of long-term observations, an important element of the analysis is to assess the impact of age and sex variability as compared to the effect of treatment or disease development. An objective of this study is to develop a tool for two-dimensional visualizations, which allows to assess whether a patient's trend data can be explained only with the factor of age and sex dependence of body composition values and to which extent. In his paper, the data of 1,083,275 bioimpedance analyses conducted at health centers of Russia in 2010-2015 involving patients who were 5 to 80 years of age were used. Visualization of age and sex trends of BIA onedimensional value medians allows to discover special points. The trends look more flattened in elder patients. Visualization of age and sex trends of two-dimensional modes depicts more obvious trends but clinical judgements can be made with direct reference to dynamic variations in the patient's values. The difficulty is eliminated if age and sex trend is added to the 2D BIA result sheet. In case of significant projection of current change vector on the opposite or perpendicular direction in relation to the vector of age and sex changes it can be assumed that the events in the human body were affected extrinsically: the effect could be therapeutic or caused by some disease factors or something else.

Background: There is paucity of data in the available medical literature regarding the parameters of the volumetric perfusion of pancreas grafts. Methods: From 5 February 2016 to 23 December 2021, we performed perfusion computed tomography in 41 patients at different times after simultaneous pancreas and kidney transplantation. The study group consisted of 18 men (44%) and 23 women (56%) with a long history of type 1 diabetes mellitus complicated by terminal chronic renal failure. The results of the perfusion computed tomography of the pancreas graft were studied, and the effects of post-transplantation timing and graft revascularization peculiarities on volumetric perfusion parameters were evaluated. Results: The median arterial blood flow, arterial blood volume, and permeability of the pancreas graft were 115.1 [99.7;130.3] mL/100 mL/min, 46.7 [37.4;56.9] mL/min, and 8.6 [4.1;11.4] mL/100 mL/min, respectively. No statistically significant differences in the averaged perfusion values were found in the head, body, and tail of the pancreas graft. The post-transplantation timing and the number of arteries involved in graft revascularization did not have a significant effect on the volumetric perfusion of the graft. Conclusion: The volumetric perfusion results of the pancreas graft correspond to those obtained in the study of pancreatic perfusion in healthy participants.

The practical application of the bioimpedance analysis of human body composition (BIA) technology began four decades ago. The first two-dimensional representation of the dependence of one bioimpedance parameter on another was proposed in 1994 in the work of Piccoli et al. This representation is referred to as bioimpedance vector analysis (BIVA). The position of the point in BIVA coordinates has an unambiguous relationship with values of the phase angle (PA), as BIVA coordinates can be used for calculating PA. In this case, the two-dimensional BIVA graph can be supplemented with values of the phase angle ranges, thus forming a pseudo-three-dimensional representation. Continuing with the BIVA logic, you can use other pairs of BIA parameters to build two-dimensional representations (and in some cases, pseudo-three-dimensional), including body composition parameters. This technology can be referred to as the two-dimensional bioimpedance analysis of the human body composition (2D BIA or BIVA HBC - bioimpedance vector analysis of human body composition). The informativeness of BIVA reports and BIVA HBC reports, in the case when the values deposited along the axes are clinically related, will increase. Nevertheless, the practice of using various BIA techniques indicates that from 6 to 10 parameters are used to obtain a complete picture of the processes of changing body composition. In terms of BIVA HBC, it is 3–5 visual representations, and with the partial use of BIVA HBC+ technology (with the introduction of the third parameter), in the monitoring window, you can limit yourself to tracking 2–4 forms of visual representation of body composition parameters.

We evaluated the vaccine properties of a novel attenuated strain of M. tuberculosis BN (Mtb BN) and its impact on the gut microbiota in inbred female mice in comparison with a virulent strain Mtb H37Rv and a vaccine strain BCG. The Mtb BN strain demonstrated the highest anti-tuberculosis vaccine effect in I/St mice highly susceptible to tuberculosis infection and the same effect as BCG in mice of the recombinant strain B6.I-100 and in β2 microglobulin gene knockout mice. No adverse effects of the new Mtb BN strain on the gut microbiota of BALB/c mice were revealed. The virulent strain Mtb H37Rv and the vaccine strain BCG decreased the main indicators of normocenosis (Bifidobacterium spp., Bifidobacterium animalis subsp. lactis, Akkermansia, and Erysipelotrichaceae) and led to disappearance of Clostridium perfingens, E. coli, Pseudomonas spp., which contributed to reduction of species diversity and the development of dysbiosis.

Мазаев А.П., Молодцов М.С., Щелыкалина С.П. Магнитно-резонансная ангиография у детей с ишемическим инсультом. Детские болезни сердца и сосудов. 2023; 20 (1): 23–32. DOI: 10.24022/1810-0686-2023-20-1-23-32 HTML

The purpose of the study was to evaluate the possibilities of MRI in determining the stage of hemorrhagic stroke (HS) depending on structural and perifocal changes in children. Materials and methods. The study included 46 patients (including 19 boys and 27 girls) aged from the 29th day of life to 18 years, with a clinical picture of cerebrovascular accident and the presence of HS in the brain substance (BS) during an MRI study. For statistical analysis, patients were divided into two groups: group 1 – patients examined in the first 48 hours from the onset of neurological symptoms (21 people), group 2 – after 48 hours (26 people). Comparison in two groups was carried out according to MR signs: the presence of perifocal cytotoxic edema, the presence of perifocal hemorrhagic impregnation, the presence of a cytoplasmic rim. Intergroup comparisons on a qualitative basis were carried out using Fisher's exact test. Results. As a result of the study, differential diagnostic criteria for the stages of HS in children were determined by analyzing the MRI semiotics of hematoma in combination with the symptom complex of perifocal changes (CPC) in the form of perifocal cytotoxic edema, perifocal hemorrhagic impregnation and cytoplasmic rim. Statistically significant differences in the frequency of occurrence of signs of perifocal cytotoxic edema and perifocal hemorrhagic impregnation in the groups were found. The presence of perifocal cytotoxic edema was statistically significant (p = 0.027) more common in group 1 (47% (n = 10), 95% CI 26–69) than in group 2 (16% (n = 4), 95% CI 5–36). The presence of perifocal hemorrhagic soaking was statistically significantly (p = 0.003) more common in group 1 (81% (n = 17), 95% CI 57–93) than in group 2 (36% (n = 9), 95% CI 18–57). In addition, a statistically significant (p = 0.005) difference was found in the incidence of CPC, which was observed in group 1 (28% (n = 6), CI 12–52) and was not observed in group 2 (0%, (n = 0), 95% CI 0–17). Conclusions. The use of T2, T1, FLAIR, SWI and DWI modes (b = 1000) in combination with ADC in the protocol of MRI examination of children is mandatory, and only a comparison of the characteristics of the MR signal from a hematoma in combination with an analysis of perifocal changes allows us to differentiate the stage of hemorrhage. HS in the acute and early subacute stages has a similar MRI semiotics, therefore, it is necessary to assess the complex of perifocal changes, which allows to differentiate these stages, as it is determined in patients examined in the first 48 hours (p < 0.05) and is not observed after two days. SWI analysis makes it possible to differentiate the late subacute stage of hematoma from chronic due to different characteristics of the MR signal, and also allows you to establish the presence of perifocal hemorrhagic impregnation, which contributes to the differential diagnosis of hemorrhage in the early stages of the pathological process.

Simultaneous pancreas–kidney transplantation (SPKT) can improve long-term patient survival and restore endogenous insulin secretion in recipients with type 1 diabetes (T1D). There are currently few data on glucose fluctuations assessed by continuous glucose monitoring (CGM) after SPKT. Aim: to evaluate CGM-derived time in range (TIR) and glucose variability (GV) in patients with T1D and functioning pancreatic grafts after SPKT. Fifty-four CGM recordings from 43 patients, 15 men and 28 women, aged 34 (31; 39) years were analyzed. Time since SKPT was up to 1 year (group 1, n = 13), from 1 to 5 years (group 2, n = 15), and from 5 to 12 years (group 3, n = 26). TIR (3.9–10 mmol/L), Time Above Range (TAR), Time Below Range (TBR), and GV parameters were estimated. There were no differences in mean glucose (5.5 [5.1; 6.2], 5.9 [5.4; 6.2], and 5.9 [5.6; 6.7] mmol/L), TIR (97.6 [92.8–99.1], 97.2 [93.2; 99.1], and 97.5 [93.4; 99]%); TAR (0, 1.8 [1.3; 3.7], and 2.5 [2; 5]%), TBR (5 [3.3; 12.7], 4.1 [2.2; 10.1], and 3.5 [1.3; 6.5]%) and GV parameters between three groups (all p > 0.05). Thus, recipients with functioning pancreatic grafts demonstrate remarkably high TIR and low GV after SPKT.

Introduction: Simultaneous pancreas-kidney transplantation (SPKT) is the best medical option to achieve stable euglycemia and insulin independence in patients with type 1 diabetes mellitus and end-stage renal disease. The outcomes of SPKT in one transplant center with the largest number of pancreas transplantations in Russia are presented. Methods: The retrospective analysis of 79 SPKT performed at our transplant center from January 2008 to December 2021 was made. Besides, the impact of significant factors that affect the outcomes of SPKT was done. Intra-abdominal pancreas transplantation with duodenoejunoanastomosis was performed in 18 recipients (22.8%). Retroperitoneal pancreas transplantation was performed in 61 patients (77.2%), exocrine drainage was maid via duodenoduodenoanastomosis in 50 patients (63.3%) and via duodenojejunoanastomosis in 11 patients (13.9%). In 69 patients (87.3%) vascular reconstruction with a Y-shaped graft was used, in 9 cases (11.4%) the pancreas graft with isolated splenic artery blood supply was used and the pancreas graft with triple blood supply (gastroduodenal, superior mesenteric and splenic arteries) was used in 1 recipient (1.3%). Results: Rates of immunological and surgical complications were 25.3% and 43.4%, respectively. The rate of non-vascular complications was significantly higher than the rate of vascular complications (77.5% vs. 22.5%; p<0.001). 1-, 5- and 10-year uncensored and death-censored survival rates were 83.4%, 79.8%, 72.6% and 88.2%, 86.1%, 83.7% for kidney graft and 75.7%, 70.8%, 61.7% and 82.9%, 79.2%, 71.0% for pancreas graft. 1-, 5- and 10-year patient survival rate was 84.6%, 82.9% and 78.0%, respectively. The factors that significantly affected the pancreas graft survival were duration of renal replacement therapy (p=0.001), Clavien IIIb surgical complications (p=0.046), reoperations (p=0.001) and kidney graft failure (p<0.0001). The factors that significantly affected the patient graft survival were duration of renal replacement therapy (p=0.007), diabetes mellitus duration (p=0.006), Clavien IIIb (p=0.016) and IVa (p=0.03) surgical complications, reoperations (p<0.001), kidney and pancreas graft failure (p<0.001). Conclusion: The results of SPKTx at the N.V. Sklifosovsky Research Institute for Emergency Medicine are comparable to those in most transplant centers.

The article presents data on preliminary studies aimed at developing a technology for prognosis of orthostatic instability of astronauts and volunteers under the action of unfavorable factors of space flight and carrying out preventive measures, particularly, during rotation on a short-radius centrifuge, functional orthostatic tests, and for patients with orthostatic instability. The technology proposed for the prediction of the development of syncope states is based on monitoring changes in the electrical resistance of regions of the human body.

Aim. The paper aims to test bioimpedance analysis for quantitative assessment of post-operative lower limb edema and knee joint effusion after knee surgery. Materials and methods: the pa-per contains a description of 15 clinical cases of the examination of highly skilled athletes by means of the ABC-02 "MEDASS" metabolic analyzer. Before and at certain time points after the surgery, all athletes were examined with a four-channel and a two-channel system. Edema severity was assessed with an ana-lysis of free fluid in body segments at a frequency of 5 kHz. Then, the local resistance of the knee joint area was assessed using the authors' method. Five athletes underwent a study of local resistance before and after evacuation of the fluid from the knee joint, with the amount of the fluid being recorded. All obtained data were processed with the "MEDASS" ABC 045 and "MEDASS" ABC 026 software. Results. Segmental bioimpedance analysis showed a regular decrease in the resistance of the limb after surgery with a gradual equalization of parameters between the limbs over the rehabilitation period. Measurement of local resis-tance of the knee joint area revealed a noticeable increase of 3-26% in segment resistance after the evacua-tion of 25-30 ml of fluid. Conclusion: The bioimpedance analysis can be used in clinical practice to quan-the dynamics of postoperative edema and the severity of synovitis after knee surgery.

Introduction. Nowadays, there are few studies concerning assessment of the clinical significance of determining the level of pretransplant and de novo anti-HLA antibodies in patients after simultaneous pancreas-kidney transplantation.Aim. The study of the incidence, timing of formation and specificity of pretransplant and de novo anti-HLA antibodies in patients after simultaneous pancreas-kidney transplantation.Material and methods. We conducted a prospective and retrospective research to study the incidence, timing of formation and specificity of pretransplant and de novo anti-HLA antibodies in 55 patients after simultaneous pancreas-kidney transplantation performed at the N.V. Sklifosovsky Research Institute for Emergency Medicine from 2008 to 2022.Results. There were 4 patients with preformed anti-HLA antibodies (7%). The formation of de novo anti-HLA antibodies after simultaneous pancreas-kidney transplantation was observed in 17 patients (31%). There were 5 patients with antiHLA class I, 3 patients with anti-HLA class II, 3 patients with anti-HLA class I and II, 5 patients with anti-MICA and 1 patient with both classes of anti-HLA and anti-MICA. The formation of de novo anti-HLA antibodies significantly increased the incidence of acute rejection (47% compared with 13%, p=0.014).Conclusion. The frequency of pretransplant and de novo anti-HLA antibody detection in the recipients at our Center is comparable to published data from other transplant centers. We obtained evidence that the formation of de novo antiHLA antibodies increases the incidence of acute rejection after simultaneous pancreas-kidney transplantation.

The aim of this study was the development and implementation of algorithms for computer analysis of medical images to quantify the asphericity of the area of radiopharmaceutical accumulation in a primary tumor, as well as to study the prognostic significance of asphericity as a predictor of an adverse outcome in patients with neuroblastoma. This retrospective study included 142 primary patients (69 boys, 73 girls, median age 22.5 months, range 1-198 months) with newly diagnosed neuroblastoma. All patients underwent full-body scintigraphy with 123I. Cox regression analysis, ROC analysis, and Kaplan-Meier analysis with a log-rank test in assessing event-free survival were used to assess the predictive value of asphericity. The median follow-up period was 18 months (range 7 to 78 months; 17 patients had disease progression / relapse, 10 patients died). The asphericity of the accumulation area in univariate Cox regression analysis is a significant pre- dictor of poor outcome (p = 0.035; hazard ratio (HR) = 1.106 [1.007; 1.215] for an increase of one unit). The optimal cut-off point for the asphericity parameter in the ROC analysis was chosen equal to 28.4%, predictor sensitivity: 77.8% (95% CI: 65%; 92%), specificity: 65.1% (95% CI: 52%; 75%). According to the results of the log-rank test, statistically significant differences were obtained: in patients with high asphericity (more than 28.4%) and low asphericity, the mean event-free survival rate was 42.9 (95% CI: 38.9%; 46.8%) and 56.6 (95% CI: 48.3%; 64.8%) months, respectively (p = 0.044). For the first time in the Russian Federation, a method for assessing the asphericity of neuroblastoma has been developed and implemented in software. In this study, the asphericity of the radiopharmaceutical accumulation area in the primary tumor, assessed prior to treatment initiation, identified children with a high and low risk of progression / relapse and death, with a sensitivity of 77.8% and a specificity of 65.1%.

To diagnose and dynamically monitor patients with diseases accompanied by changes in body composition, data from a number of hardware analytical methods are required. Non-invasive, without radiation and chemical loads, fast and patientfriendly bioimpedance analysis of body composition comprehensively solves the problem of obtaining quantitative estimates of all components of body composition at the same time. This article discusses the terminology features of bioimpedance analysis of body composition and the most common mistakes in the use of terms. In the Russian-speaking medical environment, you can often find the use of a number of inaccurate terms related to bioimpedance analysis of the human body composition. At the same time, the terminology of bioimpedance analysis of human body composition in English-language publications has long been established. The article presents the Russian and English terms of bioimpedance analysis of the human body composition with corresponding abbreviations, as well as the hierarchy of the terms body composition components, body composition parameters, parameters of bioimpedance analysis of body composition and bioimpedance parameters. The most developed areas of application of bioimpedance analysis in medical practice are discussed: assessment of nutrition and dynamic observations of changes in body composition, assessment of the body mineral mass, assessment of the body hydration parameters, assessment of blood supply to tissues and organs, including in the monitoring mode, assessment of the asymmetry of paired organs and limbs, assessment of pre-start readiness, physical development and the level of fitness of the athletes muscular system.

Objective. To estimate frequency of overweight, obesity, high blood pressure and hypercholesterolemia in children and adolescents – visitors of health centers. Material and methods. In a cross-sectional retrospective study there were analyzed different data: height, weight, arterial pressure, total cholesterol level in blood samples of 70.001 children (36.097 boys) aged 6–17 years from 17 regions of Russia. Overweight and obesity were determined by the WHO`s diagnostic criteria, z-score tables of body mass index, taking into account gender and age. Hypercholesterolemia was diagnosed as total cholesterol level > 5,2 mmol/l, high blood pressure as systolic and/or diastolic blood pressure > 95‰ of blood pressure curve in the population with the corresponding age, gender and height. Results. Frequency of overweight, obesity, high blood pressure and hypercholesterolemia were 18.2%, 6.9%, 5.2% and 3.0% in boys and 15.9%, 5.3%, 4.8% and 4.1% in girls. Frequency of hypercholesterolemia exceeded standard values in 17 regions of Russian Federation (3.5%), in Perm Territory (18.8%), Chuvash Republic (6.9%) and Vladimir Region (8.5%). The maximum frequency of overweight and obesity was observed in the Perm Territory – 39.1% and 17.1%. Frequency of high blood pressure exceeded average values in 17 regions of Russian Federation (4.9%) twice – in Voronezh Region (10.6%) and three times in Khanty-Mansyisk–Yugra Region (15.2%). Conclusion. This data confirm the necessity of prevention intensification of cardiovascular disease, life-style modification and food habits in those regions of Russia with high frequency of cardiovascular risk factors in children and adolescents.

Specialists are interested in using bioimpedance technology to assess the rate of metabolic processes and body composition; thus, this study aimed to determine the possibilities of the clinical application of the phase angle, which is a parameter that is specific for the bioimpedance method to obtain body composition information. In nutrition assessment, the phase angle is used as an indirect characteristic of the protein fraction of the body and the rate of metabolic processes. In the early 2000s, low values of the phase angle in diseased catabolic orientation were shown to assess the survival rate whereas high values assess the muscular system fitness in athletes and other individuals who regularly experience physical exertion. Systematic reviews and Meta-analyzes of subsequent years have summarized the evidence based on these provisions and identified several new applications for sarcopenia, anorexia, and renal failure. Therefore, all the reviews presented in this study confirm that higher phase angle values correspond to a better state of the body and that phase angle can dynamically change in an individual patient. This feature of the parameter requires a detailed understanding of the variability of values depending on measurement conditions. The phase angle is recognized as a convenient diagnostic tool and a convenient parameter for screening examinations. At high values, it reflects the degree of muscular system fitness, and at low values, the severity of catabolic disorders due to existing diseases or immobilization.

Introduction. The total number of pancreas transplantations performed in Russia by the end of 2019 had been 176. There are no detailed reports on the number and results of pancreas transplantation in Russia with analysis of factors that significantly affect outcomes.Material and methods. This article presents a retrospective analysis of 60 pancreas transplantation results, which had been performed from January 2008 to July 2019 at the N.V. Sklifosovsky Research Institute for Emergency Medicine. In addition, the assessment of factors that significantly affect the outcomes of pancreas transplantations was performed.Results. 17 intra-abdominal pancreas transplantations with duodenoejunoanastomosis and 43 retroperitoneal pancreas transplantations with interduodenal anastomosis were performed. In 52 patients, the pancreas graft after vascular reconstruction with a Y-shaped vascular prosthesis was used; in other 8 patients, the pancreas graft with isolated blood flow through the splenic artery was used. The rates of immunological and surgical complications were 23.3% and 56.7%, respectively. In-hospital and 1-year recipient, kidney and pancreas graft survival rates were 88.3%, 86.4%, 83.3% and 86.6%, 84.8%, and 81.7%, respectively. The factors that significantly affected the outcomes of pancreas transplantation were the conversion of the dialysis therapy modality, the development of parapancreatic infection, repeated open surgical interventions, surgical complications of IIIb-IVa severity grades by Clavien-Dindo Classification, some features of basic and induction immunosuppressive therapy.Conclusion. The results of pancreas transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine are comparable to the outcomes of pancreas transplantation in most world transplant centers.

The analysis of the differences in the spirometry estimation using different predicted values systems (Clement R.F., ECSC-1993, Knudson R.J, and GLI2012) have been made. The predicted values for volume indicators (FVC and FEV1) calculated using the GLI-2012 system were higher than those of the first three systems, while the flow indicators (FEF25-75 and MEF75), on the contrary, were lower. This difference has led to a different assessment of deviation of normal when using different predicted values systems. This is especially true when the values are near the evaluated areas borders.

The purpose of our study was to obtain ranges of basic parameters of body composition in physiologically occurring pregnancy in women without obesity at different gestation periods. To achieve this goal, a prospective cohort study of 195 women from 7 to 40 weeks of gestation living in the Yaroslavl region was conducted. All subjects underwent a standard clinical examination in accordance with the Order of the Ministry of health of the Russian Federation dated November 1, 2012. N 572N and bioimpedance analysis of body composition using the analyzer for evaluating the balance of water sectors of the body with the software ABC-01 «MEDAS». Normative data on the resistance of biological tissues were obtained, as well as the main parameters of body composition at different gestation periods were calculated. Dynamic observation during the entire pregnancy and analysis of the birth history were performed. The obtained data will allow us to analyze the peculiarities of adaptation of a woman's body to pregnancy, as well as to identify pathological changes in the body composition in the early stages of gestation, which can be predictors of the development of obstetric pathology in later pregnancy.