Objective: To study the diagnostic efficiency (DE) of sonographic signs in differentiation of inflammatory bowel disease (IBD) and functional bowel disorder (FBD) in children and to develop an optimal mathematical model for differential diagnosis of IBD and FBD using comprehensive assessment of sonographic signs.Material and methods: We examined 79 children with and without clinical signs of large-bowel disease. All the children underwent bowel ultrasonography with strain elastography. We also determined the level of fecal calprotectin (FC). The FC level > 120 μg/g was a cutoff value to differentiate IBD from FBD.Results: We determined the DE of sonographic signs in verification of IBD and FBD: large-bowel wall thickening (DE, 87%; P < .0001), large-bowel wall stratification (DE, 93.1%; P < .0001), enlarged mesenteric lymph nodes (DE, 53.4%; P=.591), interloop ascites (DE, 98.3%; P < .0001), Color Doppler findings in the large-bowel wall (DE, 98.3%; P < .0001), strain elastography findings in the large-bowel wall (DE, 96.5%; P < .0001). We developed an optimal model for differentiation of FBD and IBD using the analysis of sonographic signs (DE, 98.7%).Conclusions: The sonographic signs (large-bowel wall thickening, large-bowel wall stratification, interloop ascites, color Doppler findings in the large-bowel wall, stiffness found on strain elastography) can be effectively used for differential diagnosis of FBD and IBD in children. The developed mathematical model enables to reliably differentiate children with FBD and IBD.

The presented literature review allows us to understand and supplement the existing ideas about the pathogenesis of coronary calcification and aortic valve calcification at the stage of formation of these changes. To study in detail the participation of the most studied immunocompetent cells of innate immunity, such as macrophages, dendritic and mast cells, neutrophils, natural killers in calcification of arteries and aortic valve, their functional role in the progression of this process. The review also presents gaps and missing data present in the study of these cell populations, the replenishment of which will contribute to the development of targeted therapy for the calcification process.The search for literature sources was conducted in the following databases: Scopus, web of Science, MedLine, The Cochrane Library, RSCI, Springer, Science Direct — taking into account the year of publication (no more than 10 years), language of publication (English/Russian), availability of full-text publications and access to them.

Aim 1) To develop normative values of global and regional left ventricular longitudinal deformation (LVLD) during real time three-dimensional stress echocardiography with adenosine triphosphate (ATP) and utilization of automated function imaging technology (4D Stress-Echo + LVLD with ATP); 2) to compare the effectiveness of detection of symptom-related coronary arteries during 4D Stress-Echo with ATP using: a) traditional visual assessment of regional myocardial contractility and b) step-by-step analysis of segmental LVLD.Material and Methods 15 healthy subjects and 32 patients with coronary artery disease (CAD) were examined after coronary angiography. All individuals underwent 4D Stress-Echo + LVLD with ATP (Vivid E95, General Electric).Results The normative values of global LVLD at three stages of the pharmacological stress-test (before, during and after ATP infusion) were –19.5 (95% CI: -20.4 – -19.0), –21.6 (95% CI: -22.8 – -20.4) and –19.5 (95% CI: -20.3 – -18.6), respectively; the values of LVLD in each of the 17 segments of left ventricular myocardium in healthy subjects were also determined. In patients with CAD visual control of contractility during stress test revealed dynamic decrease in local thickening of the myocardium, appearance of new zones of contractility disorders and expansion of previously noted in 31.2% of cases, while analysis of deformation detected the appearance of new zones of deformation disturbances and expansion of previously found – in 68.7% (р = 0.0055). Stress-induced worsening of myocardial deformation during ATP infusion in the zones of blood supply of left anterior descending coronary artery, circumflex artery and right coronary artery (with presence of hemodynamically significant stenoses and occlusions detected during coronary angiography) were found in 28.0, 77.7 and 65.2% respectively (р1-3 = 0.0194; р1-2 = 0.0019; р2-3 = 0.2864).Conclusion The normal values of global and segmental LVLD for each stage of 4D Stress-Echo + LVLD with ATP were determined. 4D Stress-Echo + LVLD with ATP can significantly increase the effectiveness of symptom-related coronary arteries identification in patients with CAD in comparison with traditional Stress-Echo with visual assessment of local myocardial contractility.

В настоящей работе проведена оценка диагностической значимости пяти показателей, определяемых при ультразвуковом исследовании (УЗИ) толстого кишечника с применением эластографии, в выявлении воспалительных заболеваний кишечника (ВЗК). УЗИ толстого кишечника проведено у 79 детей. Установлено, что значительное усиление кровотока в брыжейке и кишечной стенке при цветном допплеровском картировании, межпетлевой асцит, «жесткая стенка» толстой кишки при компрессионной эластографии и ее утолщение более 3 мм указывают на наличие ВЗК у детей. Показано, что признак увеличения мезентериальных лимфатических узлов является малоинформативным в диагностике ВЗК. Полученные данные могут быть использованы в работе врачей-гастроэнтерологов для раннего выявления ВЗК у детей.

Objective. Submaximal myocardial hyperemia is known not to be achieved in 16–18% of cases during cardiac stress tests and monotonic intracubital administration of adenosine triphosphate (ATP) at a dose of 140–160 μg/kg/min. The authors set a task to elaborate a new algorithm for stress echocardiography (SEchoCG) with ATP, providing for the possibility of a stepwise increase in the dosage of the drug, as well as to test it in healthy individuals and patients with coronary heart disease (CHD). Material and methods. The authors elaborated a new algorithm for SEchoCG on the basis of an analysis of the main science databases and their first own experience in using ATP during SEchoCG. The key provisions of the new algorithm were: (a) the exercise test consisted of 3 stages (EchoCG data should be recorded before, during, and 5 minutes after ATP infusion); (b) the criterion for achieving submaximal myocardial hyperemia during ATP administration is a systolic blood pressure (SBP) reduction of 5 and more mm Hg; (c) EchoCG was usually recorded at Stage 2 of the test 3 minutes after the start of ATP administration and with a decline in SBP; (d) the initial dose of ATP administration was 140 μg/kg/min; if SBP did not decrease at 3 minutes of the drug administration, the dosage should be first increased up to 175 μg/kg/ min at 1 minute; if there was no effect, the dosage should be increased up to 210 μg/kg/min at another 2–3 minutes. The algorithm was tested in 9 healthy volunteers, and in 26 patients with CHD. Results. Testing the new algorithm showed that all cases achieved submaximal myocardial hyperemia. SBP decreased below 90 mm Hg in 2 patients; 1 patient developed second-degree atrioventricular block; however, a simple decrease in the ATP infusion rate within 30 sec leveled this symptomatology. The SEchoCG data acceptable for the subsequent analysis of myocardial contractility and deformation could be recorded in all the examinees. Conclusion. The new algorithm for SEchoCG with ATP is effective in recording EchoCG findings. To have a final decision on the safety and information value of a new stress test protocol, it may be recommended to further test those in larger groups of patients during SEchoCG and in the use of other imaging procedures to assess myocardial contractility and perfusion.

PURPOSETo: 1) optimize algorithm of stress echocardiography (s-Echo) with intravenous adenosine triphosphate (ATP) infusion taking into account pharmacokinetics and pharmacodynamics of ATP in human body, 2) test new algorithm in patients with coronary and other heart diseases.MATERIALS AND METHODSIn order to determine spectrum of factors influencing the results of stress test with ATP we inspected main scientific data bases and found 48 publications on ATP application for diagnostic purposes. Analysis of these publications allowed us to optimize algorithm of ATP s-Echo. Optimized algorithm was tested on 26 subjects, who underwent ATP 4D strain-stress-echocardiography of the left ventricle.RESULTS AND DISCUSSIONOptimized algorithm has three stages: registration of Echo data sets before, at the time of ATP infusion, and after 5 min of ATP infusion termination. Registration of Echo parameters at the second stage must begin not earlier than 3 min after the onset of ATP infusion and only in the presence of signs of coronary vasodilation. We think that the main indirect criterion of submaximal coronary vasodilation is 5 mm Hg or more decrease in systolic blood pressure (SBP), but not below SBP level of 90 mm Hg. Initial dose of ATP is 140 µg/kg/min. If after 2 min of infusion SBP do not diminish we increase the infusion rate at first to 175 and then to 210 µg/kg/min. While testing new algorithm in all cases we have achieved criteria of effective vasodilation. Mean SBP decrease was 16.4±13.7 mm Hg, heart rate increase - 12.7±8.1 bpm. In all patients we obtained interpretable 4D LV Echo data sets for visual analysis of local contractility and automatic strain analysis.CONCLUSIONOptimization of ATP s-Echo algorithm was performed. Safety and efficacy of optimized algorythm for registration of echo data was demonstrated. New ATP infusion algorithm can also be recommended for testing with other cardiac imaging modalities in evaluation of myocardial perfusion and contractility (SPECT, CT, MRI, PET).

In a group of 32 patients with combined ischemic heart disease (IHD) and arterial hypertension (AH) we studied dynamics of parameters of blood pressure and ECG 24-hour monitoring, as well as ultrasound structural and functional parameters of left and right ventricles during 3-month therapy with fixed dose combination of perindopril arginine (10.0 mg) and amlodipine (5.0 mg). The obtained results demonstrated significant positive effect of this combination on the geometry, structure and diastolic function of both left and right ventricles, as well as confirmed its high antiischemic and antihypertensive effects.

Endothelial dysfunction (ED) triggers vascular complications in many diseases, including diabetes mellitus. Currently existing methods for detection of ED do not ensure early diagnostics of the pathological process. We examined 168 men with type 2 diabetes mellitus. ED was studied by ultrasound assessment of arterial vasoreactivity of the brachial artery and determination of biochemical ED markers. Based on manifestations of reactive hyperemia, the patients were divided into groups according to the presence or absence of ED. It was shown that 23.2%of the patients exhibiting normal endothelium-dependent vasodilation in response to the reactive hyperemia test had s.582 + 353_379del polymorphism of the endothelial nitric oxide synthase gene. We also demonstrated that the time till maximum vasodilatation in these patients was 33.3% longer, on the average, than in men who did not have such polymorphism. The slowdown of the maximum response of endothelium-dependent vasodilation was associated with increased levels of ED proteomic markers VCAM-1 and ICAM-1 in 27% and 22.9% of the cases respectively. Thus, we showed for the first time that the time till maximum vasodilation is a more reliable marker of ED than the difference between the diameters of the brachial artery during reactive hyperemia test expressed in percentage.

Aim. To assess clinical significance of the novel ultrasound and biochemical markers of endothelial dysfunction (ED) in men with 2 type diabetes (DM2).Material and methods. Totally, 200 males studied, with DM2, of those 112 selected (mean age 51,7±6,7 y.) with normal vascular reactivity by Celermajer D. (1994). function of endothelium was assessed by ultrasound study of arterial vessel reactivity of brachial artery (BA) during the test with reactive hyperaemia and proteomic markers of ED — nitric oxide, endothelial nitric oxide synthase type 3 (NOS3), adhesion molecules ICAM-1, VCAM-1, p-selectin, e-selectin, resistin, osteoprotegerin, immune-enzyme assay. Patients were selected to 2 groups by presence or absence of polymorphism с.582+353_379del gene eNOS3.Results. Regardless the absence of ED signs by standard test with reactive hyperaemia, patients with deletion of 27 pair of nucleotides in 4 intron of non-coding area of eNOS3 gene had increased concentrations of adhesion molecules VCAM-1 by 27% and ICAM-1 by 22,9%, as the decrease of eNOS3 by 55,7%, that followed by slowed maximum vasodilation of BA during the test, comparing to the males not having this polymorphism. The significant positive correlations found of the time of maximum vasodilation development with proteomic markers of ED ICAM-1 and VCAM-1.Conclusion. For the first time, a complex of parameters established — time to maximum BA dilation with increased concentration of proteomic markers ICAM-1, VCAM-1 and decrease of eNOS3 that points on the role of ED earlier than BA diameter changes during the reactive hyperaemia test.

The current literature is lacking sufficient coverage of the relationship between erectile dysfunction (ED) and diabetes mellitus (DM), and age-related hypogonadism. At the same time, the mutual impact of cardiovascular and endocrine systems on men erectile function and the resulting damage of male sexual organs are being studied and debated. This prospective, randomized, simple comparative study examined the erectile function of 131 men with type 2 DM and age-related hypogonadism, tested the effects of DM on serum testosterone, formed an idea of possible relationship between DM, severity of ED and testosterone levels, degree of endothelial dysfunction and the involvement of the testicles. The study results showed the impact of testosterone level on the compensation of DM and frequency of ED. Correlations were observed between testosterone levels, peak systolic velocity of blood flow in the of capsular arteries of testes and testicular size. The interrelation between testicular size, reduction of testicular blood flow, and DM-related endothelial dysfunction and variability of serum testosterone levels was found. The findings suggest the need for revising existing reference ranges for serum testosterone upward to 15 nmol/L.

We have shown previously that reflected high intensity motion signals (RIMS) can be used for detection of left ventricular (LV) diastolic dysfunction (DD). It is also well known, that left atrial (LA) dimension can be used as a marker of DD. In this study we decided to analyze the diagnostic role of new echocardiographic morphofunctional diastolic index (MFDI) in differentiation of normal filling of LV from pseudonormal and restrictive. MFDI includes LA dimension and velocity of early diastolic component ea of RIMS (MFDI = LA/ea). 343 healthy subjects and patients with various cardiac pathology underwent dopplerechocardiographic exam. According to the criteria of "Don" classification scheme 155 subjects had signs of normal LV filling (N) and 55 of pseudonormal and restrictive filling (PN + R). LA dimension was performed in standard manner. RIMS were registered by conventional pulsed wave Doppler from apical 4chamber view, when the sample volume was positioned between the tips of mitral leaflets. The velocity of early diastolic component of RIMS was measured. After calculation of MFDI mean values of this index in two groups (N and PN + R) were compared. The cutoff value of MFDI for differentiation of patients with N and PN + R was determined. Mean value of MFDI in subjects with normal filling was 1.38+0.33 and in patients with pseudonormal and restrictive filling 2.43+0.43; p<0.0001. The cutoff value of MFDI > 2.0 separated subjects with normal LV filling from subjects with pseudonormal and restrictive filling with sensitivity 89.1% and specificity 97.4%. Keywords—Dopplerechocardiography, diastolic dysfunction, left atrium, reflected high intensity motion signals.

Артериальная гипертензия АГ приводит к развитию структурно-функциональных изменений сосудистой системы головного мозга - гипертонической ангиопатии. Гипертоническая ангиопатия - это сложный и многообразный комплекс, структурные изменения в котором представлены гипертрофией мышечной оболочки, гиперэластозом, миоэластофиброзом, а в последующем и пролиферацией соединительно-тканных элементов Однако по-прежнему неясно, какова роль эндотелиальной дисфункции в нарушениях регуляции мозгового кровотока (МК) у больных АГ с наличием церебральных осложнений и не являются ли нарушения в системе ауторегуляции МК результатом только структурных изменений сосудистой стенки. Для лечения больных АГ рекомендуется использование следующих основных групп лекарственных препаратов: b-адреноблокаторы, ингибиторы АПФ, антагонисты рецепторов ангиотензина II, диуретики, антагонисты кальция и агонисты имидазолиновых рецепторов. Однако не все гипотензивные препараты идеально подходят для лечения больных АГ, осложненной цереброваскулярной патологией (ЦВП). Проблема усугубляется еще тем, что отсутствуют четкие рекомендации по лечению данной категории больных. Тиазидоподобный диуретик Арифон ретард в крупных исследованиях показал способность к снижению риска церебральных осложнений при АГ, однако свойства препарата далеко не ограничиваются только гипотензивным действием и полностью не изучены. Интересны исследования, в которых выявлены свойства индапамида восстанавливать функцию эндотелия (ФЭ) и блокировать кальциевые каналы, способствуя вазодилатации. Цель исследования: изучить роль дисфункции эндотелия в патогенезе ЦВП, а также эффективность ретардной формы тиазидоподобного диуретика Арифона для коррекции нарушенной регуляции МК у больных АГ, осложненной ЦВП.