Cardiovascular disease (CVD) is a leading cause of morbidity and mortality. An important task in cardiology is the search and study of new biomarkers. Scientific interest is actively focused on the study of interleukin-11 (IL-11). The purpose of the literature review was to analyze experimental and clinical studies devoted to the study of IL-11 as a diagnostic and prognostic marker in CVD. Material and methods. The article provides an overview of current publications. An analysis of literature sources was carried out, including all relevant publications in the databases PubMed, RSCI, MedLine, Google Scholar, Science Direct. Results. In endothelial cells, IL-11 primarily promotes angiogenesis, thereby exerting a beneficial effect on coronary heart disease. IL-11 also promotes vascular remodeling by inducing smooth muscle cell transformation and fibroblast activation. IL-11 may be involved in the onset and progression of pulmonary hypertension through the JAK/STAT3 pathway and aortic dissection processes through the non-classical ERK pathway. Conclusion. The presented literature review indicates the potentially important diagnostic and prognostic value of IL-11 assessment. Regulating the concentration and expression of IL-11 may be a promising strategy for the treatment of CVD.

Heart failure is an important medical, social and economic problem around the world. In recent years, a number of diagnostic and prognostic biological markers of blood in cardiovascular diseases have been studied. Identification of new biological markers, analysis of their pathophysiological aspects and changes in concentration under the influence of various treatment options, allow us to understand many pathogenetic features of the development and course of heart failure. In recent decades, natriuretic peptides have been introduced into clinical practice, which are widely used as reliable markers for diagnostic and prognostic assessment. Growth differentiation factor-15 is a cytokine belonging to the family of transforming growth factors, the activity of which is significantly increased under stress and inflammation. In patients with chronic heart failure, the concentration of this marker is associated with an increased risk of overall mortality and adverse cardiovascular events; in patients with heart failure with preserved left ventricular ejection fraction, the use of the marker showed prognostic and diagnostic significance. Data from the Framingham Heart Study showed that growth differentiation factor-15 was the only marker in multivariate analysis that showed a statistically significant association with all adverse cardiovascular events. Eight studies showed that overexpression of growth differentiation factor-15 was associated with an increased risk of mortality in patients with heart failure. It was shown that growth differentiation factor-15 as a prognostic marker in patients with acute heart failure is not inferior to the brain natriuretic peptide precursor. To confirm the value of this marker in blood in patients with heart failure, it is necessary to conduct extensive prospective randomized clinical trials.

One of the possible adverse events of cervical cancer arising both as a result of the progression of the disease and as a result of the treatment, leading to a significant decrease in the quality of life, is the development of genital fistulas. This review presents current information on diagnostic approaches, and treatment options for fistulas caused by cervical cancer. The peculiarities of fistulas that have arisen after radiation therapy and surgical treatment are highlighted.

Heart failure (HF) remains a serious problem in Russian and world health care due to the growing morbidity and mortality from complications of heart failure, despite the development and implementation of programs for the early detection and treatment of heart failure in asymptomatic patients. Currently, a large number of new biological markers have been studied that could serve as a laboratory tool for diagnosing and predicting the course of heart failure, but only brain natriuretic peptides have found application in real clinical practice. Renalase is a recently discovered cytokine that is synthesized by the kidneys and released into the blood. To date, seven subtypes of renalase have been found, each of which plays a different physiological role in the human body. Renalase is usually positioned as a signaling molecule that activates cytoprotective intracellular signals, leading to a decrease in blood pressure and protection of the heart muscle. The concentration of renalase freely circulating in the bloodstream of an adult is approximately 3–5 ng / ml. Currently, the level of renalase is determined by the enzyme immunoassay with a detection range of 3.12 to 200 ng / ml, while the minimum detectable concentration of the marker is less than 1.38 ng / ml. The presence of missense polymorphism of renalase is associated with myocardial dysfunction. Data from animal and human studies have shown that renalase plays a key role in the metabolism of catecholamines and in cardioprotective processes. Studies have shown the contribution of renalase to the occurrence of cardiovascular diseases: ischemic heart disease, arterial hypertension, diabetes mellitus, and aortic stenosis. Moreover, detailed protocols of multicenter prospective studies have demonstrated that functional polymorphism of the renalase gene was associated with myocardial hypertrophy in patients with aortic stenosis, hypertension, metabolic syndrome, unstable angina pectoris and stable forms of coronary artery disease, as well as in patients receiving renal replacement therapy. Based on these data and further studies, renalase has been proposed as a predictive biomarker of ischemia in patients with coronary microvascular dysfunction, as well as a predictor of clinically significant progression of chronic kidney disease in patients with cardiovascular diseases.Our review presents data on the role of renalase in heart failure. Further study of the structure and function of renalase, as well as future clinical studies, will allow determining the diagnostic, prognostic and, possibly, therapeutic significance of this biological marker in HF and other cardiovascular diseases.

Introduction. Currently, the search and study of new biological markers that can help early diagnosis of heart failure, serve as a laboratory tool for assessing the effectiveness of therapy, be a predictive marker of possible adverse clinical outcomes and a significant criterion for risk stratification is very relevant. While cardiospecific markers, including natriuretic peptides, their precursors, and highly sensitive troponins, are widely used in clinical practice, the need to use other markers does not have sufficient evidence. aspect of a biological marker of heart failure.Gamma-glutamyl transpeptidase is an enzyme localized on the outer side of cell membranes and involved in the metabolism of glutathione and cysteine. This enzyme is a dimeric glycoprotein (68 kDa), consisting of 2 subunits – a large and a small (46 and 22 kDa). Gamma-glutamyl transpeptidase is encoded by a multigene family consisting of at least 7 different genes located on chromosome 22; however, only 1 of these genes is involved in the formation of a functional enzyme. Gamma-glutamyl transpeptidase was found in all cells except erythrocytes. There is a significant variability in enzyme activity, which is especially high in tissues with a secretory and absorptive function, such as the kidneys, biliary tract, intestines, and epididymis.Purpose of the review is to present an overview of current publications devoted to the study of γ-glutamyl transpeptidase in the aspect of a biological marker of heart failure.Materials and methods. The analysis of literature sources (foreign and domestic articles) was carried out in the databases: PubMed, RSCI, MedLine, Google Scholar, Science Direct. The search was performed according to the following keywords: biological markers, heart failure, γ-glutamyl transpeptidase, biological markers, heart failure, γ-glutamyl transpeptidase.Results. In addition to its clinical use as a test for liver disease, biliary tract disease, and alcohol abuse, γ-glutamyl transpeptidase is of great interest because of its association with cardiovascular disease, diabetes, metabolic syndrome, and cancer. In the literature available to us, we found a small number of works devoted to the study of γ-glutamyl transpeptidase in patients with heart failure. In the review, we have presented data from experimental and clinical studies indicating a clear link between γ-glutamyl transpeptidase and heart failure. The pathogenetic mechanism of the possible relationship between γ-glutamyl transpeptidase and heart failure is not completely clear. The localization of this enzyme in tissues with a transport function has led to the assumption that it is involved in the transport of amino acids through the γ-glutamyl cycle.Conclusion. Further deeper understanding of the structure and function of the enzyme is needed, as well as future clinical studies to determine the diagnostic, prognostic and possibly therapeutic significance of this biological marker.

In recent decades, significant progress has been made in the study of cardiovascular biological markers. The introduction into clinical practice of studying the concentration of natriuretic peptides used as markers for the diagnostic and prognostic assessment of patients with chronic heart failure became the crucial event. At present, the assessment of the values concerning the ventricular natriuretic peptide and its N-terminal precursor is the gold standard in laboratory diagnosis of heart failure and predicting its course. However, there are limitations due to the influence of several factors on their indicators, the ambiguity of threshold values and rather low information content in heart failure with preserved ejection fraction. Even a special sub-study of the large-scale PROTECT protocol could not identify an ideal single biomarker among 48 different markers for prognostic evaluation of patients with acute heart failure. All this determines the need for further search for highly sensitive and more specific markers. This review is devoted to the study of the possibility of using heart-type fatty acid binding protein (H-FABP) as a diagnostic and prognostic biomarker in heart failure. To date, one of the possible applications of H-FABP may be in the diagnosis of the early stages of heart ischemia and inflammation. KEYWORDS: heart failure, biological marker, left ventricular ejection fraction, Heart-type fatty acid binding protein, troponin, natriuretic peptides. FOR CITATION: Aliyeva A.M., Baykova I.E., Reznik E.V. et al. Heart-type fatty acid binding protein: the promising biological marker in heart failure. Russian Medical Inquiry. 2022;6(1):5–11 (in Russ.). DOI: 10.32364/2587-6821-2022-6-1-5-11.

Novel biological markers, such as fibrosis marker galectin-3, peptide hormone adrenomedullin, soluble ST2, chemokine CX3CL1, surrogate marker of vasopressin, and others, are every year one step closer to being introduced into health practice. Over the past decades, significant progress has been made in the study of cardiovascular biomarkers. A key moment was the introduction of deter mining the concentration of natriuretic peptides used as markers for the diagnostic and prognostic evaluation of patients with heart failure. Currently, in order to search for novel markers for early diagnosis and risk stratification, studies have been conducted on the analysis of promising inflammatory marker tenascin-C (TNC) in cardiovascular patients. Data have been obtained that allow us to consider TNC as a tool for risk stratification and assessment of cardiovascular disease prognosis. The combination of TNC with other biological markers, in particular brain natriuretic peptide, may improve prognostic power. Nevertheless, serial testing to assess the prognosis and effectiveness of ongoing treatment, including in the conditions of a multimarker model, requires further research.

Inflammation is a universal response of a living organism to various damaging factors and is aimed at restoring tissue integrity and minimizing cell death. Proinflammatory cytokines, in particular interleukins, are active participants in the inflammatory response. In patients with heart failure, inflammatory reactions lead to damage to cardiomyocytes, their apoptosis and activation of neurohumoral systems, which contribute to the initiation of myocardial hibernation and mechanisms of its remodeling. The purpose of this review is to consider IL-1 as a diagnostic and prognostic marker in heart failure, as well as the effect of treatment with a recombinant form of IL-1R on the course of the disease.

The aim of this study was to analyze currently available information on the risks of fistulas in patients with cervical cancer after radiation therapy and possible treatment options.This review includes data from Russian and foreign articles devoted to this problem. It covers the frequency of fistulas of after radiation therapy in cervical cancer patients, as well as some treatment methods.Attempts to change the approaches to radiation therapy for advanced cervical cancer were unsuccessful; therefore, patients with cervical cancer will be at high risk of developing fistulas in the next few years. Different treatments for fistulas demonstrate contradictory results and dictate the need for a tailored-approach in such cases. The development of new surgical methods for the correction of vesicovaginal and rectovaginal fistulas is still highly relevant.

The diagnosis and treatment of systemic amyloidosis remains a significant clinical problem for physicians of various specialties. Infectious complications and sepsis account for up to 8% of deaths in amyloidosis patients. This clinical case describes the development of an initially asymptomatic monoclonal gammopathy of unclear significance into systemic AL-amyloidosis, which was complicated by the formation of a renal carbuncle after the first cycles of chemotherapy. There was a significant discrepancy between the severity of the patient’s overall clinical state and changes in laboratory parameters. There were no objective factors for the ascending spread of urinary tract infection or hematogenous dissemination from other foci, so a primary bacteremia was assumed.

This review aims to provide up-to-date information on the factors associated with an increased risk of vaginal fistula in women with cervical cancer, as well as on methods of their prevention and treatment. It includes data on various types of vaginal fistulas in cervical cancer patients and risk factors for their development, according to foreign and Russian research articles published over the last 20 years. Cervical cancer is one of the most challenging oncological diseases in the Russian Federation, because it is detected at stage III–IV in more than 30 % of women. Such a high incidence of cervical cancer and the need for radiotherapy determine high risk of fistulas, which significantly impairs the quality of life. Thus, identification of factors associated with vaginal fistulas, as well as methods of their prevention and treatment remains a highly relevant task for the Russian healthcare system.

Background. The parasternal lymphatic collector is an important pathway of the lymph drainage from the breast in breast cancer patients. Evaluation of parasternal lymph nodes is not available during physical examination. To date, no algorithm for diagnostic imaging of the parasternal lymphatic pathway has been developed. The presence of metastases in parasternal lymph nodes upstages the breast cancer patient to a minimum of clinical stage III disease.Case description. We present the case of breast cancer progression in a 40-year-old woman. The patient received treatment for triple-negative stage IIA breast cancer (Т2N0M0) in 2018. In August, 2019, 18-FDG PET /CT images revealed a solitary metastasis in the parasternal lymph node. Ultrasound images also showed the same lymph node assessed by PET -CT and the additional parasternal lymph node metastasis. A fine-needle aspiration biopsy of both lymph nodes confirmed the specific involvement of the parasternal lymph nodes.Conclusion. Ultrasound scans are used to assess the axillary, subclavian and supraclavicular lymphatic collectors, but there is little evidence in the literature on the use of ultrasound in the assessment of parasternal lymph nodes. Our clinical case shows the feasibility of using ultrasound in assessing the status of the parasternal of lymph nodes, as well as the feasibility of performing fine-needle aspiration biopsy by ultrasound navigation.

Radiotherapy is one of the radical treatment options used in patients with prostate cancer (PC). Many studies of combined radiotherapy (CRT) for PC have demonstrated good results in respect of response to treatment; however, the sequence of CRT steps and optimal interval between them have not been determined so far. Few randomized studies have been conducted in order to confirm the advantages of brachytherapy at the first or second step or determine the most effective interval between the contact and external beam RT. Therefore, it appears reasonable to evaluate different CRT techniques.Purpose. The goal of the study was to evaluate the outcomes of PC treatment depending on the sequence of CRT steps and the interval between them.Materials and methods. 53 patients with PC received 125I radiation therapy in combination with long-term hormone therapy (HT). Median follow-up was 38 months. Patients’ age varied from 54 to 81 years. All patients were in a high-risk group according to the D’Amico Risk Classification System. The patients were allocated to two groups: in Group 1, brachytherapy was used as the first step (n=31); in Group 2, it was applied after external beam therapy (EBT). The interval between the CRT steps could be less than 4 weeks (n=6), 4 – 7 weeks (n=17) and more than 8 weeks (n=30). Standard fractionation EBT with a total dose of 46 Gy using the VMAT technique was conducted. 125I prostate implants were inserted to reach a total dose of 110 Gy. Neoadjuvant (2 – 4 months) and adjuvant (not less than 24 months) regimens of HT were applied.Results. Five (9.4 %) patients had disease progression; two of them experienced only biochemical recurrence; distant metastases were diagnosed in three patients. Median time to disease progression was 29.9 months. One patient with a biochemical relapse died of acute myocardial infarction (1.9 %). Median five-year disease-free survival was 84.5±11.7 % in Group 1 and 83.5±9.1 (p=0.73) in Group 2. There were no significant differences in the incidence of toxicity depending on the sequence of CRT steps.Conclusion. EBT using 125I radiation sources in combination with long-term hormone therapy is an effective and safe treatment option for high-risk PC patients. No significant increase in the incidence of disease progression was observed when the interval between the CRT steps was increased to more than 8 weeks. Changes in the sequence of CRT steps do not affect response to treatment or incidence of radiation-related complications.

Background. until now, only a few reports have been available on clinical management of breast cancer patients with metastases to the contralateral axillary lymph nodes. Breast cancer is traditionally considered to affect ipsilateral lymph nodes. However, there are many reports describing cases with contralateral axillary lymph node metastasis. Case presentation. We report a case of cancer in the right breast with contralateral axillary lymph node metastasis (Т2N1М1). Histological examination revealed invasive ductal G2 carcinoma with angiolymphatic invasion. No mutations in the BRca1, BRca2, cHEK2, and NBs1 genes were detected. the patient received complex treatment. Literature review. a PubMed search was conducted using the systematic review filter to identify articles describing cases with contralateral axillary lymph node metastasis. contralateral axillary lymph node metastasis, especially after surgery or radiotherapy, should be considered not only as hematogeneous metastasis but also as lymphagenous metastasis. survival of these patients is more comparable to that observed in patients with locally-advanced cancer than to that observed in patients with distant metastases. Conclusion. Early detection and management of contralateral axillary lymph node metastasis in breast cancer patients remains a debatable topic. Factors affecting disease prognosis have not been identified yet. Further studies concerning staging of contralateral axillary lymph node metastasis are needed.

We present the very rare clinical case of a 54-year-old man who was diagnosed on CT and MRI with a mixed cystic-soft tissue pancreatic lesion with septa and calcification, looking like a malignant tumor of pancreas. The preoperative diagnosis was uncertain because of unclear features of the mass. This tumor from the body and tail of pancreas was excised by means of laparotomy. The final diagnosis of a complicated hydatid cyst was confirmed on morphological examination.

One of the main issues in the treatment of multicentric breast cancer (BC) is to choose the type of surgery (paying attention to the tendency to reduce the volume of surgical interventions). Many studies have demonstrated an adverse effect of this form of BC on long‑term survival outcomes (increased risk of recurrence, decreased overall survival rates, etc.). However, none of the studies examined the effect of surgery extent on the quality of life of these patients.Objective. To assess the effect of the surgery type on the quality of life of patients with multicentric BC.Materials and methods. 190 patients were included in the study. The median follow‑up was 72 (7–116) months. Age ranged from 27 to 76 years. The majority of patients (150 women, 78.9 %) had luminal HER2‑negative tumors, while «aggressive» (HER2‑overexpressing, triple negative) subtypes were detected in 40 (21.1 %) of them. 134 patients underwent radical mastectomy (40 of which also had immediate breast reconstruction), 56 received breast‑conserving surgery. Statistically significant differences were not observed among stages III and I–II BC (p = 0.125). The quality of life was assessed with the use of EORTC QLQ-C30 and EORTC QLQ-BR23 scales at ≥ 12 months after performing surgical treatment.Results. The quality of life was assessed depending on the type of surgical intervention. The patients after breastconserving surgery and immediate breast reconstruction demonstrated a significant advantage, primarily in the general perception of one's own health (p < 0.05) and emotional status (p < 0.05). Also, there were no significant differences in quality of life between the groups of patients after breast‑ conserving surgery and immediate breast reconstruction.Conclusion. Due to the increase in the life expectancy of breast cancer patients, the issues of maintaining a high quality of life are becoming increasingly important. From this point of view, performing breast‑ conserving and reconstructive surgeries is preferable for patients with multicentric BC.

Radiotherapy is one of the radical treatment options used in patients with prostate cancer (PC). Many studies of combined radiotherapy (CRT) for PC have demonstrated good results in respect of response to treatment; however, the sequence of CRT steps and optimal interval between them have not been determined so far. Few randomized studies have been conducted in order to confirm the advantages of brachytherapy at the first or second step or determine the most effective interval between the contact and external beam RT. Therefore, it appears reasonable to evaluate different CRT techniques. Purpose . The goal of the study was to evaluate the outcomes of PC treatment depending on the sequence of CRT steps and the interval between them. Materials and methods . 53 patients with PC received 125 I radiation therapy in combination with long-term hormone therapy (HT). Median follow-up was 38 months. Patients’ age varied from 54 to 81 years. All patients were in a high-risk group according to the D’Amico Risk Classification System. The patients were allocated to two groups: in Group 1, brachytherapy was used as the first step (n=31); in Group 2, it was applied after external beam therapy (EBT). The interval between the CRT steps could be less than 4 weeks (n=6), 4 – 7 weeks (n=17) and more than 8 weeks (n=30). Standard fractionation EBT with a total dose of 46 Gy using the VMAT technique was conducted. 125 I prostate implants were inserted to reach a total dose of 110 Gy. Neoadjuvant (2 – 4 months) and adjuvant (not less than 24 months) regimens of HT were applied. Results . Five (9.4 %) patients had disease progression; two of them experienced only biochemical recurrence; distant metastases were diagnosed in three patients. Median time to disease progression was 29.9 months. One patient with a biochemical relapse died of acute myocardial infarction (1.9 %). Median five-year disease-free survival was 84.5±11.7 % in Group 1 and 83.5±9.1 (p=0.73) in Group 2. There were no significant differences in the incidence of toxicity depending on the sequence of CRT steps. Conclusion . EBT using 125 I radiation sources in combination with long-term hormone therapy is an effective and safe treatment option for high-risk PC patients. No significant increase in the incidence of disease progression was observed when the interval between the CRT steps was increased to more than 8 weeks. Changes in the sequence of CRT steps do not affect response to treatment or incidence of radiation-related complications.

Введение: внутрибрюшинная (в/б) химиотерапия у больных раком яичников (РЯ) в 1 линии лечения показала позитивные результаты в трех рандомизированных исследованиях.Однако данный метод до сих пор не является рутинным в клинической практике.Материалы и методы: нами было проведено исследование 2 фазы по изучению 1 линии химиотерапии с в/б введениями, в которое включались больные РЯ с Ic -IV стадиями после первичной оптимальной циторедукции.Интраперитонеальные порт-системы устанавливались интраоперационно или лапароскопическим методом.Пациенты получали режим химиотерапии: паклитаксел 135 мг/м 2 в/в в 1-й день, цисплатин 75 мг/м 2 в/б во 2-й день и паклитаксел 60 мг/м 2 в/б в 8-й день, всего 6 курсов. А.С. Тюляндина, В

Objective. To evaluate efficacy and safety of FOLFIRINOX regimen as induction therapy in borderline resectable and unresectable pancreatic cancer. Materials and methods. A prospective study included patients with borderline resectable and unresectable pancreatic cancer without distant metastases. Patients received up to 6 courses of induction chemotherapy with FOLFIRINOX regimen (oxaliplatin 85 mg/m2 i. v., irinotecan 180 mg/m2 i. v., calcium folinate 400 mg/m2 i. v., 5‑fluorouracil 400 mg/m2 i. v. bolus and 2 400 mg/m2 i. v. 46‑hours infusion) repeated every 14 days. Patients underwent surgery when radiologic signs of resectability were achieved. Maintenance chemotherapy was prescribed to the patients in cases of unresectability preservation. The primary endpoint was 1‑year progression-free survival. Results of the study. The study included 32 patients. The median follow-up was 7.0 months. The one-year progression-free survival was 55.3%. The one-year overall survival of patients in this study was 83.2%. Eight patients (25%) underwent surgery after induction therapy, and in 7 of them it was possible to perform R0 resection. The main manifestations of 3–4 grade toxicity were neutropenia (46.9%), diarrhea (12.5%), and elevation of hepatic transaminases (12.5%). Conclusions. The FOLFIRINOX regimen showed high potential as induction chemotherapy in pancreatic cancer. The use of this regimen is possible only in patients with good performance status due to its high toxicity.