[A rare variant in the TTR gene (p.E112K) is associated with systemic amyloidosis and a new symptom - skin hyperemia in response to ethanol intake: family segregation analysis, literature review, and a clinical case. Case report]

Transthyretin amyloidosis (ATTR-amyloidosis) is a systemic disorder associated with extracellular deposition in the tissues and organs of amyloid fibrils, transthyretin-containing insoluble protein-polysaccharide complexes. The change in transthyretin conformation, leading to its destabilization and amyloidogenicity, can be acquired (wild type, ATTRwt) and hereditary due to mutations in the TTR gene (variant, ATTRv) [1, 2]. Hereditary ATTR-amyloidosis has an earlier onset and greater phenotypic diversity. The age of the manifestation, the predominant phenotype, and the prognosis are often determined by the genetic variant. To date, more than 140 variants in the TTR gene have been identified; however, most of them are described in single patients and do not have clear evidence of pathogenicity. The prospects of a new pathogenetic treatment of ATTR-amyloidosis [3], especially effective in the early stages of the disease, increases the relevance of timely diagnosis, which is challenging due to physicians' lack of awareness. This article presents a clinical case of ATTRv-amyloidosis associated with a rare pathogenic variant in the TTR gene and a newly described skin symptom. This article is a literature review.

Genetic landscape in Russian patients with familial left ventricular noncompaction

Background

Left ventricular noncompaction (LVNC) cardiomyopathy is a disorder that can be complicated by heart failure, arrhythmias, thromboembolism, and sudden cardiac death. The aim of this study is to clarify the genetic landscape of LVNC in a large cohort of well-phenotyped Russian patients with LVNC, including 48 families (n=214).

Methods

All index patients underwent clinical examination and genetic analysis, as well as family members who agreed to participate in the clinical study and/or in the genetic testing. The genetic testing included next generation sequencing and genetic classification according to ACMG guidelines.

Results

A total of 55 alleles of 54 pathogenic and likely pathogenic variants in 24 genes were identified, with the largest number in the MYH7 and TTN genes. A significant proportion of variants -8 of 54 (14.8%) -have not been described earlier in other populations and may be specific to LVNC patients in Russia. In LVNC patients, the presence of each subsequent variant is associated with increased odds of having more severe LVNC subtypes than isolated LVNC with preserved ejection fraction. The corresponding odds ratio is 2.77 (1.37 -7.37; p <0.001) per variant after adjustment for sex, age, and family.

Conclusion

Overall, the genetic analysis of LVNC patients, accompanied by cardiomyopathy-related family history analysis, resulted in a high diagnostic yield of 89.6%. These results suggest that genetic screening should be applied to the diagnosis and prognosis of LVNC patients.

Proactive anti-inflammatory therapy in the advanced stages of a new coronavirus infection. Main results of the inpatient phase of the COLORIT study (Colchicin vs. Ruxolitinib and secukinumab in an open, prospective, randomized trial in patients with novel coronavirus infection COVID-19)

Aim      To evaluate clinical efficacy of the proactive anti-inflammatory therapy in patients hospitalized for COVID-19 with pneumonia and a risk of "cytokine storm".Material and methods  The COLORIT study was a comparative study with randomization into 4 groups: colchicine (n=21) 1 mg for the first 3 days followed by 0.5 mg/day through day 12 or discharge from the hospital; secukinumab 300 mg/day, s.c., as a single dose (n=20); ruxolitinib 5 mg, twice a day (n=10); and a control group with no anti-inflammatory therapy (n=22). The effect was evaluated after 12±2 days of inpatient treatment or upon discharge, what comes first. For ethical reasons, completely randomized recruitment to the control group was not possible. Thus, for data analysis, 17 patients who did not receive any anti-inflammatory therapy for various reasons not related with inclusion into the study were added to the control group of 5 randomized patients. Inclusion criteria: presence of coronavirus pneumonia (positive PCR test for SARS-CoV-2 RNA or specific clinical presentation of pneumonia; IDC-10 codes U07.1 and U07.2); C-reactive protein (CRP) concentration &gt;60 mg/l or its threefold increase from baseline; at least 2 of 4 symptoms (fever &gt;37.5 °C, persistent cough, shortness of breath with inspiratory rate &gt;20 per min or blood saturation with oxygen &lt;94 % by the 7th-9th day of disease. The study primary endpoint was changes in COVID Clinical Condition Scale (CCS-COVID) score. The secondary endpoints were the dynamics of CRP and changes in the area of lung lesion according to data of computed tomography (CT) of the lungs from the date of randomization to 12±2 days.Results All three drugs significantly reduced inflammation, improved the clinical course of the disease, and decreased the disease severity as evaluated by the CCS score: in the ruxolitinib group, by 5.5 (p=0.004); in the secukinumab group, by 4 (p=0.096); in the colchicine group, by 4 (p=0.017), and in the control group, by 2 (р=0.329). In all three groups, the CCS-COVID score was 2-3 by the end of observation period, which corresponded to a mild process, while in the control group, the score was 7 (р=0.005). Time-related changes in CRP were significant in all three anti-inflammatory treatment groups with no statistical difference between the groups. By the end of the study, changes in CT of the lungs were nonsignificant.Conclusion      In severe СOVID-19 with a risk of "cytokine storm", the proactive therapy with ruxolitinib, colchicine, and secukinumab significantly reduces the inflammation severity, prevents the disease progression, and results in clinical improvement.

Existing and Emerging Approaches to Risk Assessment in Patients with Ascending Thoracic Aortic Dilatation

Ascending thoracic aortic aneurysm is a life-threatening disease, which is difficult to detect prior to the occurrence of a catastrophe. Epidemiology patterns of ascending thoracic aortic dilations/aneurysms remain understudied, whereas the risk assessment of it may be improved. The electronic databases PubMed/Medline 1966–2022, Web of Science 1975–2022, Scopus 1975–2022, and RSCI 1994–2022 were searched. The current guidelines recommend a purely aortic diameter-based assessment of the thoracic aortic aneurysm risk, but over 80% of the ascending aorta dissections occur at a size that is lower than the recommended threshold of 55 mm. Moreover, a 55 mm diameter criterion could exclude a vast majority (up to 99%) of the patients from preventive surgery. The authors review several visualization-based and alternative approaches which are proposed to better predict the risk of dissection in patients with borderline dilated thoracic aorta. The imaging-based assessments of the biomechanical aortic properties, the Young’s elastic modulus, the Windkessel function, compliance, distensibility, wall shear stress, pulse wave velocity, and some other parameters have been proposed to improve the risk assessment in patients with ascending thoracic aortic aneurysm. While the authors do not argue for shifting the diameter threshold to the left, they emphasize the need for more personalized solutions that integrate the imaging data with the patient’s genotypes and phenotypes in this heterogeneous pathology.

Predictive potential of ACE phenotyping in extrapulmonary sarcoidosis

Elevated ACE expression in tissues (reflected by blood ACE levels) is associated with increased risk of cardiovascular diseases and is also a marker for granulomatous diseases. We developed a new approach for characterization of ACE status in the blood—ACE phenotyping and established normal values of ACE levels 50–150% of control pooled plasma. ACE phenotyping was performed in citrated plasma of 120 patients with known interstitial lung diseases. In the 1st set of 100 patients we found 22 patients with ACE levels > 150%; ACE phenotyping also objectively identified the presence of ACE inhibitors in the plasma of 15 patients. After excluding these patients and patient with ACE mutation that increases ACE shedding, 17 patients were identified as a suspicious for systemic sarcoidosis based on elevation of blood ACE (> 150% of mean). A new parameter that we have established–ACE immunoreactivity (with mAb 9B9)—allowed us to detect 22 patients with decreased values (< 80%) of this parameter, which may indicate the presence of ACE in the blood that originates from macrophages/dendritic cells of granulomas. In the remaining 20 patients, this new parameter (mAbs binding/activity ratio) was calculated using 3 mAbs (9B9, 3A5 and i1A8—having overlapping epitopes), and 8 patients were identified as having decreases in this parameter, thus increasing dramatically the sensitivity for detection of patients with systemic sarcoidosis. Whole body PET scan confirmed extrapulmonary granulomas in some patients with lower immunoreactivity towards anti-ACE mAbs. ACE phenotyping has novel potential to noninvasively detect patients with systemic sarcoidosis.

Regional pericarditis following uncomplicated catheter ablation procedure: a case report

Background

Acute post-ablation pericarditis is the most common complication of epicardial ablation of ventricular arrhythmias, while regional pericarditis following an initially uneventful endocardial catheter ablation (CA) procedure is a rare and elusive diagnosis.

Case summary

We report a case of a 66-year-old Russian female who developed chest pain accompanied by electrocardiogram (ECG) changes—biphasic T waves in V1–V4 leads after an initially uncomplicated premature ventricular complex CA procedure. After examination and investigations, including transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT), she was diagnosed with regional pericarditis, which occurred even though the ablation was uneventful with the limited number of radiofrequency applications. Furthermore, the diagnosis was difficult due to normal body temperature and the absence of pericardial effusion and myocardial abnormalities on TTE, findings that are not characteristic of pericarditis. The patient’s last office visit was in 6 months after the procedure. Neither patient had any complaintsnor there were any changes on ECG and TTE.

Discussion

Regional post-ablation pericarditis is a relatively rare type of post-cardiac injury syndrome (PCIS). The varying severity of the PCIS clinical course makes the diagnosis of post-ablation pericarditis initially difficult, especially in patients undergoing an uneventful CA procedure. Non-invasive imaging modalities as CMR and CCT should be considered initially in elusive cases of PCIS.

Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries

Aim. To analyze diagnostic performance of cardiovascular magnetic resonance (CMR) in patients, presented with myocardial infarction with nonobstructed coronary arteries (MINOCA). Materials ant methods. 46 consecutives patients presented with myocardial infarction without evidence of obstructive coronary disease on angiography between January, 1 2018 and October 1, 2019 were included in the study. All patients underwent CMR within 10 days after admission. MRI was performed on 1.5 T Magnetic Resonance Imaging (MRI) using comprehensive protocol (T2-images, Cine-CMR, late gadolinium enhancement (LGE)). Results. CMR revealed myocardial infarction (MI) pattern in 14 patients (30.4%), myocarditis in 12 (26.1%), hypertrophic cardiomyopathy in 6 (13.1%). In 14 patients (30.4%) no LGE was observed. Notably in 2 patients without LGE features of takotsubo syndrome were noted. Mean age was significantly lower in patients with MI versus patient with non-ischemic causes of MINOCA (56.112.3 vs 64.612.8; p=0.04). ST elevation at admission frequency didnt differ between MI and non-ischemic patients (35.7% vs 25.0%; p=0.76). However MI patients had significantly increased troponin level, 0.87 [0.22; 1.85] vs 0.22 [0.07; 0.38]; p=0.008. CMR allowed to establish the prcised clinical diagnosis in 73.9% of the cases. Conclusion. Clinical data doesnt allow to differentiate ischemic or non-ischemic causes of MINOCA. However, CMR establish the correct diagnosis in most cases.

Familial left ventricular noncompaction: phenotypes and clinical course. Results of the multicenter registry

Aim. To analyze and demonstrate various phenotypes in patients with familial left ventricular noncompaction (LVNC). Materials and methods. In 2013 was created a multicenter registry of LVNC patients. On its basis 30 families with a familial LVNC were selected. Results. 30 LVNC families were selected from the register. From a total of 115 people (probands and relatives) in 71 (61.7%) LVNC was diagnosed (30 probands and 41 relatives with non-compact myocardial criteria). The most common type of remodeling in patients was the dilated type (DT) (n=30), the isolated LVNC with preserved ejection fraction (EF) was slightly less common (n=23), and the hypertrophic type (GT) was detected in 8 patients. 4 patients were diagnosed with the isolated LVNC with a reduced EF. 3 patients were with a combination of non-compact myocardium with congenital heart disease and with a combination of DT and GT (DT+GT). During the analysis of cases a combination of different phenotypes in the same family was observed. The largest number of families was diagnosed with a combination of DT and the isolated LVNC with preserved EF. The development of cardiovascular complications was associated with DT. Conclusion. Family cases of LVNC had different types of myocardial remodeling and variants of clinical course. In one family a combination of different types of left ventricular remodeling is possible. DT is associated with the most severe clinical manifestations. The clinical picture of the isolated LVNC with preserved EF, is the most favorable, but in rare cases, serious clinical manifestations were observed.

Proactive anti-inflammatory therapy with colchicine in the treatment of advanced stages of new coronavirus infection. The first results of the COLORIT study

Actuality The course of the novel coronavirus disease (COVID-19) is unpredictable. It manifests in some cases as increasing inflammation to even the onset of a cytokine storm and irreversible progression of acute respiratory syndrome, which is associated with the risk of death in patients. Thus, proactive anti-inflammatory therapy remains an open serious question in patients with COVID-19 and pneumonia, who still have signs of inflammation on days 7-9 of the disease: elevated C-reactive protein (CRP)&gt;60 mg/dL and at least two of the four clinical signs: fever &gt;37.5°C; persistent cough; dyspnea (RR &gt;20 brpm) and/or reduced oxygen blood saturation &lt;94% when breathing atmospheric air. We designed the randomized trial: COLchicine versus Ruxolitinib and Secukinumab in Open-label Prospective Randomized Trial in Patients with COVID-19 (COLORIT). We present here data comparing patients who received colchicine with those who did not receive specific anti-inflammatory therapy. Results of the comparison of colchicine, ruxolitinib, and secukinumab will be presented later.Objective Compare efficacy and safety of colchicine compared to the management of patients with COVID-19 without specific anti-inflammatory therapy.Material and Methods Initially, 20 people were expected to be randomized in the control group. However, enrollment to the control group was discontinued subsequently after the inclusion of 5 patients due to the risk of severe deterioration in the absence of anti-inflammatory treatment. Therefore, 17 patients, who had not received anti-inflammatory therapy when treated in the MSU Medical Research and Educational Center before the study, were also included in the control group. The effects were assessed on day 12 after the inclusion or at discharge if it occurred earlier than on day 12. The primary endpoint was the changes in the SHOCS-COVID score, which includes the assessment of the patient's clinical condition, CT score of the lung tissue damage, the severity of systemic inflammation (CRP changes), and the risk of thrombotic complications (D-dimer) [1].Results The median SHOCS score decreased from 8 to 2 (p = 0.017), i.e., from moderate to mild degree, in the colchicine group. The change in the SHOCS-COVID score was minimal and statistically insignificant in the control group. In patients with COVID-19 treated with colchicine, the CRP levels decreased rapidly and normalized (from 99.4 to 4.2 mg/dL, p&lt;0.001). In the control group, the CRP levels decreased moderately and statistically insignificantly and achieved 22.8 mg/dL by the end of the follow-up period, which was still more than four times higher than normal. The most informative criterion for inflammation lymphocyte-to-C-reactive protein ratio (LCR) increased in the colchicine group by 393 versus 54 in the control group (p = 0.003). After treatment, it was 60.8 in the control group, which was less than 100 considered safe in terms of systemic inflammation progression. The difference from 427 in the colchicine group was highly significant (p = 0.003).The marked and rapid decrease in the inflammation factors was accompanied in the colchicine group by the reduced need for oxygen support from 14 (66.7%) to 2 (9.5%). In the control group, the number of patients without anti-inflammatory therapy requiring oxygen support remained unchanged at 50%. There was a trend to shorter hospital stays in the group of specific anti-inflammatory therapy up to 13 days compared to 17.5 days in the control group (p = 0.079). Moreover, two patients died in the control group, and there were no fatal cases in the colchicine group. In the colchicine group, one patient had deep vein thrombosis with D-dimer elevated to 5.99 µg/mL, which resolved before discharge.Conclusions Colchicine 1 mg for 1-3 days followed by 0.5 mg/day for 14 days is effective as a proactive anti-inflammatory therapy in hospitalized patients with COVID-19 and viral pneumonia. The management of such patients without proactive anti-inflammatory therapy is likely to be unreasonable and may worsen the course of COVID-19. However, the findings should be treated with caution, given the small size of the trial.

[Results of Open-Label non-Randomized Comparative Clinical Trial: "BromhexIne and Spironolactone for CoronаvirUs Infection requiring hospiTalization (BISCUIT)]

Introduction The aim of this study was to assess the efficacy and safety of a combination of bromhexine at a dose of 8 mg 4 times a day and spironolactone 50 mg per day in patients with mild and moderate COVID 19.Material and methods It was an open, prospective comparative non-randomized study. 103 patients were included (33 in the bromhexine and spironolactone group and 70 in the control group). All patients had a confirmed 2019 novel coronavirus infection (COVID 19) based on a positive polymerase chain reaction (PCR) for SARS-CoV-2 virus RNA and/or a typical pattern of viral pneumonia on multispiral computed tomography. The severity of lung damage was limited to stage I-II, the level of CRP should not exceed 60 mg / dL and SO2 in the air within 92-98%. The duration of treatment is 10 days.Results The decrease in scores on the SHOKS-COVID scale, which, in addition to assessing the clinical status, the dynamics of CRP (a marker of inflammation), D-dimer (a marker of thrombus formation), and the degree of lung damage on CT (primary endpoint) was statistically significant in both groups and differences between them was not identified. Analysis for the group as a whole revealed a statistically significant reduction in hospitalization time from 10.4 to 9.0 days (by 1.5 days, p=0.033) and fever time from 6.5 to 3.9 days (by 2.5 days, p&lt;0.001). Given the incomplete balance of the groups, the main analysis included 66 patients who were match with using propensity score matching. In matched patients, temperature normalization in the bromhexine/spironolactone group occurred 2 days faster than in the control group (p=0.008). Virus elimination by the 10th day was recorded in all patients in the bromhexine/spironolactone group; the control group viremia continued in 23.3% (p=0.077). The number of patients who had a positive PCR to the SARS-CoV-2 virus on the 10th day of hospitalization or longer (≥10 days) hospitalization in the control group was 20/21 (95.2%), and in the group with bromhexine /spironolactone -14/24 (58.3%), p=0.012. The odds ratio of having a positive PCR or more than ten days of hospitalization was 0.07 (95% CI: 0.008 - 0.61, p=0.0161) with bromhexine and spironolactone versus controls. No side effects were reported in the study group.Conclusion The combination of bromhexine with spironolactone appeared effective in treating a new coronavirus infection by achieving a faster normalization of the clinical condition, lowering the temperature one and a half times faster, and reducing explanatory combine endpoint the viral load or long duration of hospitalization (≥ 10 days).

[Proactive anti-inflammatory and anticoagulant therapy in the treatment of advanced stages of novel coronavirus infection (COVID-19). Case Series and Study Design: COLchicine versus ruxolitinib and secukinumab in open prospective randomIzed trial (COLORIT)]

The article is devoted to the treatment of the new coronavirus infection (COVID-19) in the advanced stages of the disease. The types of response of the immune system to the viral load of SARS-CoV-2 with the start of the inflammation process are considered. The situation is analyzed in detail in which the growing autoimmune inflammation (up to the development of a "cytokine storm") affects not only the pulmonary parenchyma, but also the endothelium of the small vessels of the lungs. Simultaneous damage to the alveoli and microthrombosis of the pulmonary vessels are accompanied by a progressive impairment of gas exchange, the development of acute respiratory distress syndrome, the treatment of which, even with the use of invasive ventilation, is ineffective and does not really change the prognosis of patients with COVID-19. In order to interrupt the pathological process at the earliest stages of the disease, the necessity of proactive anti-inflammatory therapy in combination with active anticoagulation treatment is substantiated. The results of the first randomized studies on the use of inhibitors of pro-inflammatory cytokines and chemokines (interleukin-6 (tocilizumab), interleukin-17 (secukinumab), Janus kinase blockers, through which the signal is transmitted to cells (ruxolitinib)), which have potential in the early treatment of COVID- 19. The use of a well-known anti-inflammatory drug colchicine (which is used for gout treatment) in patients with COVID-19 is considered. The design of the original COLORIT comparative study on the use of colchicine, ruxolitinib and secukinumab in the treatment of COVID-19 is presented. Clinical series presented, illustrated early anti-inflammatory therapy together with anticoagulants in patients with COVID-19 and the dangers associated with refusing to initiate such therapy on time.

Neural Correlates of Group Versus Individual Problem Solving Revealed by fMRI

Group problem solving is a prototypical complex collective intellectual activity. Psychological research provides compelling evidence that problem solving in groups is both qualitatively and quantitatively different from doing so alone. However, the question of whether individual and collective problem solving involve the same neural substrate has not yet been addressed, mainly due to methodological limitations. In the current study, functional magnetic resonance imaging was performed to compare brain activation when participants solved Raven-like matrix problems in a small group and individually. In the group condition, the participant in the scanner was able to discuss the problem with other team members using a special communication device. In the individual condition, the participant was required to think aloud while solving the problem in the silent presence of the other team members. Greater activation was found in several brain regions during group problem solving, including the medial prefrontal cortex; lateral parietal, cingulate, precuneus and retrosplenial cortices; frontal and temporal poles. These areas have been identified as potential components of the so-called "social brain" on the basis of research using offline judgments of material related to socializing. Therefore, this study demonstrated the actual involvement of these regions in real-time social interactions, such as group problem solving. However, further connectivity analysis revealed that the social brain components are co-activated, but do not increase their coupling during cooperation as would be suggested for a holistic network. We suggest that the social mode of the brain may be described instead as a re-configuration of connectivity between basic networks, and we found decreased connectivity between the language and salience networks in the group compared to the individual condition. A control experiment showed that the findings from the main experiment cannot be entirely accounted for by discourse comprehension. Thus, the study demonstrates affordances provided by the presented new technique for neuroimaging the "group mind," implementing the single-brain version of the second-person neuroscience approach.

[Combination therapy at an early stage of the novel coronavirus infection (COVID-19). Case series and design of the clinical trial "BromhexIne and Spironolactone for CoronаvirUs Infection requiring hospiTalization (BISCUIT)"]

The article focuses on effective treatment of the novel coronavirus infection (COVID-19) at early stages and substantiates the requirement for antiviral therapy and for decreasing the viral load to prevent the infection progression. The absence of a specific antiviral therapy for the SARS-CoV-2 virus is stated. The authors analyzed results of early randomized studies using lopinavir/ritonavir, remdesivir, and favipiravir in COVID-19 and their potential for the treatment of novel coronavirus infection. Among the drugs blocking the virus entry into cells, the greatest attention was paid to the antimalaria drugs, chloroquine and hydroxychloroquine. The article addresses in detail ineffectiveness and potential danger of hydroxychloroquine, which demonstrated neither a decrease in the time of clinical recovery nor any improvement of prognosis for patients with COVID-19. The major objective was substantiating a possible use of bromhexine, a mucolytic and anticough drug, which can inhibit transmembrane serin protease 2 required for entry of the SARS-CoV-2 virus into cells. Spironolactone may have a similar feature. Due to its antiandrogenic effects, spironolactone can inhibit X-chromosome-related synthesis of ACE-2 receptors and activation of transmembrane serin protease 2. In addition to slowing the virus entry into cells, spironolactone decreases severity of fibrosis in different organs, including the lungs. The major part of the article addresses clinical examples of managing patients with COVID-19 at the University Clinic of the Medical Research and Educational Centre of the M. V. Lomonosov Moscow State University, including successful treatment with schemes containing bromhexine and spironolactone. In conclusion, the authors described the design of a randomized, prospective BISCUIT study performed at the University Clinic of the M. V. Lomonosov Moscow State University with an objective of evaluating the efficacy of this scheme.

Modulation of Intrinsic Brain Connectivity by Implicit Electroencephalographic Neurofeedback

Despite the increasing popularity of neurofeedback, its mechanisms of action are still poorly understood. This study aims to describe the processes underlying implicit electroencephalographic neurofeedback. Fifty-two healthy volunteers were randomly assigned to a single session of infra-low frequency neurofeedback or sham neurofeedback, with electrodes over the right middle temporal gyrus and the right inferior parietal lobule. They observed a moving rocket, the speed of which was modulated by the waveform derived from a band-limited infra-low frequency filter. Immediately before and after the session, the participants underwent a resting-state fMRI. Network-based statistical analysis was applied, comparing post- vs. pre-session and real vs. sham neurofeedback conditions. As a result, two phenomena were observed. First, we described a brain circuit related to the implicit neurofeedback process itself, consisting of the lateral occipital cortex, right dorsolateral prefrontal cortex, left orbitofrontal cortex, right ventral striatum, and bilateral dorsal striatum. Second, we found increased connectivity between key regions of the salience, language, and visual networks, which is indicative of integration in sensory processing. Thus, it appears that a single session of implicit infra-low frequency electroencephalographic neurofeedback leads to significant changes in intrinsic brain connectivity.

[Steroid pulse -therapy in patients With coronAvirus Pneumonia (COVID-19), sYstemic inFlammation And Risk of vEnous thRombosis and thromboembolism (WAYFARER Study)]

Introduction Coronavirus pneumonia not only severely affects the lung tissue but is also associated with systemic autoimmune inflammation, rapid overactivation of cytokines and chemokines known as "cytokine storm", and a high risk of thrombosis and thromboembolism. Since there is no specific therapy for this new coronavirus infection (COVID-19), searching for an effective and safe anti-inflammatory therapy is critical.Materials and methods This study evaluated efficacy and safety of pulse therapy with high doses of glucocorticosteroids (GCS), methylprednisolone 1,000 mg for 3 days plus dexamethasone 8 mg for another 3-5 days, in 17 patients with severe coronavirus pneumonia as a part of retrospective comparative analysis (17 patients in control group). The study primary endpoint was the aggregate dynamics of patients' condition as evaluated by an original CCS-COVID scale, which included, in addition to the clinical status, assessments of changes in the inflammation marker, C-reactive protein (CRP); the thrombus formation marker, D-dimer; and the extent of lung injury evaluated by computed tomography (CT). Patients had signs of lung injury (53.2 % and 25.6 %), increases in CRP 27 and 19 times, and a more than doubled level of D-dimer (to 1.41 µg/ml and 1.15 µg/ml) in the active therapy and the control groups, respectively. The GCS treatment group had a more severe condition at baseline.Results The GCS pulse therapy proved effective and significantly decreased the CCS-COVID scores. Median score difference was 5.00 compared to the control group (р=0.011). Shortness of breath considerably decreased; oxygen saturation increased, and the NEWS-2 clinical status scale scores decreased. In the GCS group, concentration of CRP significantly decreased from 134 mg/dl to 41.8 mg/dl (р=0.009) but at the same time, D-dimer level significantly increased from 1.41 µg/ml to 1.98 µg/ml (р=0.044). In the control group, the changes were nonsignificant. The dynamics of lung injury by CT was better in the treatment group but the difference did not reach a statistical significance (р=0.062). Following the GCS treatment, neutrophilia increased (р=0.0001) with persisting lymphopenia, and the neutrophil/lymphocyte (N/L) ratio, a marker of chronic inflammation, increased 2.5 times (р=0.006). The changes in the N/L ratio and D-dimer were found to correlate in the GCS pulse therapy group (r =0.49, p=0.04), which underlined the relationship of chronic autoimmune inflammation with thrombus formation in COVID-19. No significant changes were observed in the control group. In result, four patients developed venous thromboembolic complications (two of them had pulmonary artery thromboembolism) after the GCS pulse therapy despite the concomitant antiplatelet treatment at therapeutic doses. Recovery was slower in the hormone treatment group (median stay in the hospital was 26 days vs 18 days in the control group, р=0.001).Conclusion Pulse therapy with high doses of GCS exerted a rapid anti-inflammatory effect but at the same time, increased the N/L ratio and the D-dimer level, which increased the risk of thromboembolism.

Morphologically proved ANCA positive Loeffler's pancarditis: medical and surgical treatment

Loeffler's endocarditis remains is a very rare disease, develops due to eosinophilic inflammation predominantly of the endocardium with an outcome in fibrosis and massive thrombus formation and. He is generally characterized by an unfavorable prognosis. Clinical case of a 42-year-old patient with Loeffler endocarditis is presented. The development of the disease was preceded by a polyvalent allergy, mild dry eye syndrome and pansinusitis with a single eosinophilia of blood up to 16%. The reason for the hospitalization was the appearance of biventricular heart failure. During the previous year, the level of blood eosinophils remained normal, a threefold increase in the level of eosinophilic cationic protein was observed once. A 20-fold increase in the pANCA level, a 2.5-fold increase in the level of antibodies to DNA, an antibody to the nuclei of cardiomyocytes 1:160 were detected. The diagnosis was made on the basis of electrocardiography data (low QRS voltage, atrial hypertrophy), echocardiography, multispiral computed tomography and magnetic resonance imaging of the heart (thickening and delayed contrasting of the endocardium, massive thrombosis of the left ventricular apex with obliteration of its cavity, encapsulated fluid in the pericardium with compression of the right ventricle). Systolic dysfunction, severe signs of restriction and arrhythmias were absent. Trombectomy, tricuspid valve plasty, pericardial resection, suturing of an open oval window were performed. Signs of active inflammation with single eosinophils, vasculitis, perimuscular sclerosis, endocardial sclerosis were detected in morphological and immunohistochemical studies of endo-, myo-, pericardium. Viral genome was not found. The therapy with methylprednisolone 24 mg/day, azathioprine 75 mg/day was started. Six months after the operation, the symptoms of heart failure are completely absent, the thrombosis did not recur.

[Possibilities of Computed Tomography of the Heart in Risk Stratification and Determination of Optimal Strategy of Primary Prevention of Cardiovascular Complications of Atherosclerosis]

Modern strategies of primary prevention of cardiovascular complications of atherosclerotic etiology are presented in this article: traditional approach based on assessment of risk of development of complication and coming to replace it concept of prevention based on direct application of results of prospective clinical studies. The article contains detailed presentation of new opportunities of computer tomography of the heart allowing to substantially elevate precision of assessment of risk of cardiovascular complications of atherosclerotic etiology. Main attention is paid to the coronary artery calcification index, which determination substantially simpli- fies decision making relative to strategy of primary prevention in clinical practice.

Noncompaction cardiomyopathy is caused by a novel in-frame desmin (DES) deletion mutation within the 1A coiled-coil rod segment leading to a severe filament assembly defect

Mutations in DES, encoding desmin protein, are associated with different kinds of skeletal and/or cardiac myopathies. However, it is unknown, whether DES mutations are associated with left ventricular hypertrabeculation (LVHT). Here, we performed a clinical examination and subsequent genetic analysis in a family, with two individuals presenting LVHT with conduction disease and skeletal myopathy. The genetic analysis revealed a novel small in-frame deletion within the DES gene, p.Q113_L115del, affecting the α-helical rod domain. Immunohistochemistry analysis of explanted myocardial tissue from the index patient revealed an abnormal cytoplasmic accumulation of desmin and a degraded sarcomeric structure. Cell transfection experiments with wild-type and mutant desmin verified the cytoplasmic aggregation and accumulation of mutant desmin. Cotransfection experiments were performed to model the heterozygous state of the patients and revealed a dominant negative effect of the mutant desmin on filament assembly. DES:p.Q113_L115del is classified as a pathogenic mutation associated with dilated cardiomyopathy with prominent LVHT.

Constrictive pericarditis in a patient with inherited factor VII deficiency

Constrictive pericarditis (CP) is the final stage of a chronic inflammatory process characterized by fibrous thickening and calcification of the pericardium that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure. We present a clinical case of CP in a patient with rare inherited bleeding disorder - factor VII deficiency. Heart failure due to CP was suspected based on clinical symptoms, results of ultrasonic and radiological investigations. The diagnosis was verified by the results of cardiac magnetic resonance imaging. Pericardectomy was performed resulting in significant improvement in the patient's condition.

[Dual energy computed tomography in diagnosis of urolithiasis: a new method for determining the chemical composition of urinary stones]

The "gold standard" for the diagnosis and evaluation of urinary stones is native computed tomography, which allows determining stone localization and size of with high accuracy. However, this imaging technique has limited diagnostic usefulness in determining the stone chemical composition. The newly introduced method of dual-energy computed tomography, based on obtaining images at two different energy levels is highly effective in determining the composition of urinary stones. The review outlines the principles and methods of performing dual-energy computed tomography using various scanners. The authors analyze the results of using this method for diagnosing urolithiasis, determining the stone chemical composition and point out the limitations and difficulties encountered in its application.

[Myocardial Crypt of the Left Ventricle Combined With Barlows syndrome]

Myocardial crypts were initially described in patients with hypertrophic cardiomyopathy. Modern diagnostic data show that this structural abnormality can be found in patients with other diseases, or might represent the variant of normal heart development in healthy individuals. The prognostic significance of this finding is uncertain. In this publication we present a clinical case of the combination of myocardial crypt and Barlows syndrome.

[THE ROLE OF PREOPERATIVE BREAST MAGNETIC RESONANCE IMAGING IN PLANNING OF OPTIMUM SURGICAL TREATMENT FOR BREAST CANCER PATIENTS]

Breast cancer represents a global healthcare problem. In spite of all advances in treatment regimens for breast cancer, mortality from the disease stays high in countries where population based screening has not yet been introduced. On the other hand, there is a significant decrease in mortality from breast cancer in those countries where treatment is applied in an early phase of the disease, as a result of regular, population-based screening with mammography. Although mammography is the gold standard in diagnosing breast cancer in its early stage, it has limitations in detecting breast cancer sufficiently early in the dense portion of the breast. This calls for using the multimodality approach also for screening. In addition, the high frequency of multifocal and diffuse breast cancers calls for the need to describe the true extent of the disease preoperatively. The best modality to accomplish this goal is the use of magnetic resonance imaging of the breast (MRI). This report describes the role of breast MRI in the preoperative workup of the different subtypes of breast cancer.

[Professional standards and unsolved issues of vocational training of radiologists]

This article describes the main statements of the Professional standards of radiologists, statements regarding vocational radiologists training, included in the Orders of the Ministry of Health of the Russian Federation and the educational standards in the specialty "Radiology', approved by the Ministry of Education and Science of the Russian Federation.

[The foreign experience with the application of the modern radiodiagnostic methods for the estimation of prescription of death coming and time of infliction of injury]

We undertook the analysis of the foreign publications concerning the application of the modern radiodiagnostic methods (including MSCT- and MRI-visualization) with reference to the solution of the traditional problems facing forensic medical expertise, such as the estimation of prescription of death coming and time of infliction of injury in the dead bodies. Both advantages and disadvantages of postmortem visualization of the corpses of adult subjects are discussed taking into consideration the period of time that elapsed between the death and the onset of the study as well as the character of the injuries. It was shown that the examination of the corpses using the up-to-date methods of radiodiagnostics prior to autopsy makes it possible for morphologists, jointly with radiologists, to identify, to see in the new light, and to evaluate the number of charges in the dead body, such as the alteration of the blood cell sedimentation rate, the formation of postmortem hypostases in the internal organs, the hardening of the walls of aorta and major blood vessels, right heart dilatation, gradual smoothing of the borderline between grey and white matter of the brain. Virtual autopsy can be useful , even for the study of such long-term processes in the corpses as putrefaction, saponification, mummification, and peat tanning. Moreover, this technique may be instrumental in the elucidation of the specific features of topographic-anatomical relationships between individual 'tissues and organs, detection of the concealed lesions, and a variety of pathological changes. Postmortem visualization allows for the quantitative evaluation of the severity of these transformations and the preliminary estimation of prescription of death coming. Also, radiodiagnostic methods can be employed to reliably visualize and measure various hemorrhagic events (from the density of such ones as liquid and clotted blood) in the tissues surrounding the fractures, in body cavities, and internal organs as well as to establish the facts of inter-vital aspiration of blood, alimentary masses, liquid and solid foreign bodies penetrating into the upper sections of the respiratory and gastrointestinal tracts as the consequence f an injury. It is concluded that the postmortem visualization techniques employed to estimate prescription of death coming and time of infliction of injury as well as other complicated problems facing forensic medical expertize need the further scientifically based development.

[Comparative survey of radiation doses to patients in computed tomography in a federal hospital]

OBJECTIVE

to analyze radiation exposure due to computed tomography (CT) of brain, chest, abdomen and pelvis in a large multi-field federal hospital and feasibility of low-dose CT-examinations.

MATERIAL AND METHODS

Retrospective analysis was performed using data from electronic patient records and PACS from a single multi-field hospital. Data were obtained from 1626 records of patients (794 men, 832 women; age range 17-93) scanned with 3 MDCT during one year. CT-examinations of good quality were selected, volumetric CT dose index (CTDI) and dose-length product (DLP) were collected for each of them. The effective doses (ED) were calculated using the normalized coefficients according to Russian Guidance. RESULTS. Number and structure of CT-examinations for the years 2012-2014 in a multi-field hospital were analyzed. The mean effective dose (M ± m) values with/without contrast medium (respectively), according to anatomical areas were as follows: brain--2.34 ± 0.03/3, 52 ± 0.23, chest--4.83 ± 0.11/11.02 ± 0.82, abdomen-pelvis--9.81 ± 0.40/36.6 ± 1.17, chest-abdomen-pelvis - 12.41 ± 0.79/35.63 ± 1.81 mSv. CONCLUSION. Results of this study give an example of CT dose values and distribution in a multi-field hospital. They are compa- rable with reference levels published of other authors. This expe- rience should be expanded for creation of CT national reference values and for co-operation with international initiatives (EUROSAFE projects).

[Magnetic resonance imaging of the liver and spleen in the diagnosis of storage diseases]

Storage diseases (thesaurismoses, storage reticuloses) are the common name of a large group of hyperplastic non-leukemic diseases characterized by congenital or acquired metabolic disturbances and abnormal accumulation of metabolic products in blood and/or cells of different organs and by hyperplasia of mononuclear phagocyte elements in the liver, spleen, bone marrow, lymph nodes, and other organs, which makes the diseases systemic. Among the imaging techniques for diffuse liver diseases, ultrasonography and X-ray computed tomography are most commonly used for their diagnosis and follow-up. Magnetic resonance imaging (MRI) has the highest sensitivity and specificity in diagnosing liver diseases. The paper considers the current MRI procedures that are used to diagnose storage diseases and to quantify found changes. For Gaucher's disease, the potentials of novel techniques, such as MR spectroscopy, diffusion-weighted imaging (DWI), and chemical shift imaging (Dickson's method) for the estimation of revealed changes, are described. For hemochromatosis, the contribution of T2 WI to the quantification of iron overload in the liver parenchyma is depicted, which is an alternative invasive procedure in its determination. Incorporation of MRI into the examination algorithm for patients with storage diseases will be able to improve the detection of these rare diseases and to monitor the efficiency of performed therapy.

[Role of multislice computed tomography in the differential diagnosis of right iliac tumors and inflammatory diseases]

OBJECTIVE

To determine the capabilities of multislice computed tomography (MSCT) in the differential diagnosis of tumors and inflammatory diseases of the cecum, appendix, and ascending colon.

MATERIAL AND METHODS

The investigation analyzed the complete data of medical records and the results of diagnosis in the patients admitted in 2009 to 2013 to the Treatment and Rehabilitation Center for right iliac pains. The results of MSCT were compared with those of histological verification.

RESULTS

The sensitivity and specificity of MSCT for diagnosing right iliac tumors were 97.6 and 97.8%, respectively. Those of MSCT for diagnosing right iliac inflammatory diseases were 95.1 and 97.3%, respectively. The investigation showed that the accuracy of MSCT for diagnosing right iliac tumors and inflammatory diseases was 94.1%.

CONCLUSION

MSCT is the method of choice in the diagnosis and differential diagnosis of right iliac tumors and inflammatory diseases.

[HEALTH PREDICTION INDICES OBTAINED WITH LOW-DOSE COMPUTER TOMOGRAPHY SCANS]

Purpose of the investigation was to make prognostic estimations of reductions in somatic morbidity and temporal disability, and tumor pathology using low-dose computer tomography (CT) scans and to compare with standard protocols. Mean effective radiation doses were determined based on the results of 1627 diagnostic CT investigations made in 2012-2014 at the Treatment and Rehabilitation Center of the Russian Ministry of Health. Low-dose CT scans of the head and thoracic, abdominal and small pelvis organs were obtained on a GE Discovery CT750 HD, and with the help of the ASIR and MBIR algorithms of iterative reconstruction. In comparison with a standard dose, a single CT scan with a dose reduced by 10-12 mSv predicts a decrease in total morbidity by 0.84-5.52% and temporal disability by 0.55-1.65% per 100 employees over a year; total risk of tumors and genetic effects reduced in 5 to 10 times, which may be equal to 40-90 cases per 100,000 of 30 y.o. males.

[Structured radiology reports]

The paper reviews the problem of using structured radiology reports. Their salient features are as follows: to work out a protocol in accordance with some pattern, to divide it into subheadings arranged consecutively and logically and broken down by main anatomical structures, types of disease, and study, and to use standardized terminology. The RSNA proposed RadLex system is the most known example of structured reports. The experience in using these protocols has shown that the latter may improve the clearness and informative value of roentgenologists' opinions and alleviate their understanding by physicians of other specialties. However, the systems of writing the structured radiology reports have a number of constraints for the time being, which interfere with their wide clinical introduction. Nonetheless, their use is substantially increasing in the years ahead.

[Capabilities of computed tomography to evaluate polymorphic changes in destructive pancreatitis]

OBJECTIVE

To determine whether the lower-density pancreatic parenchymal areas detected by a computed tomography (CT) study in patients with acute pancreatitis correspond to the necrotic portions of the gland or whether these changes may be reversal.

MATERIAL AND METHODS

The investigation covered 25 patients who had undergone or dynamic CT studies made at different time intervals. Two independent investigators with 4 and 19 years of experience retrospectively analyzed the results of both CT studies. Target estimation was made of the extent (volume) of and CT density changes in the hypodense areas of the gland parenchyma.

RESULTS

Seven (28%) of the 25 patients were noted to have higher CT density in the areas that had decreased density during primary CT studies (more than a 30 HU increase was rated as significant). There was a statistically significant difference between the patient groups when comparing the extent of hypodense areas and the difference in CT density (t-test, p = 0.006); Mann-Whitney U-test, p = 0.01 for extent difference and t-test, p = 0.00; Mann-Whitney U-test, p = 0.00 for CT density difference. There was also a correlation between the extent of hypodense areas and the difference in their CT density (Pearson: r = -0.533, p = 0.006; Spearman: r = -0.636, p = 0.001).

CONCLUSION

The results of our investigation may suggest that the lower-density pancreatic parenchymal areas cannot always correspond to necrotic changes and may be reversible.

[Cardiac magnetic resonance imaging in the diagnosis of acute myocarditis: a clinical case and a review of literature]

The clinical manifestations of myocarditis are extremely variable and it may commonly manifest as acute myocardial infarction. The diagnosis of acute myocarditis is frequently empiric and substantiated by the clinical picture of the disease, ECG changes, elevated enzyme levels, and the lack of any data on coronary heart disease. Until recently, endomyocardial biopsy has been considered to be the most accurate diagnostic method. However, endomyocardial biopsy has a low sensitivity and is associated with the high risk of complications. This paper describes a clinical case of a patient with cardialgias occurring after acute respiratory viral disease, with ST segment elevation, and higher levels of cardiospecific enzymes. The diagnosis of myocarditis was verified by contrast-enhanced cardiac magnetic resonance imaging.

[Diagnostic efficiency of multidetector computed tomography in patients with tongue cancer]

OBJECTIVE

To determine the capacities of multidetector computed tomography (MDCT) to diagnose tongue cancer.

MATERIAL AND METHODS

Intravenous bolus contrast-enhanced MDCT was performed in 40 patients with tongue cancer diagnosed during complex clinical and instrumental examination. In all cases, the tumor had a structure of squamous cell carcinoma of varying grades. The results of MSCT were compared with the data of surgery and cytological and histological examinations. Tongue tumor accumulation of a contrast agent was qualitatively analyzed.

RESULTS

In 38 (85%) patients, the tongue tumor actively accumulated the contrast agent and was clearly differentiated in the presence of unaffected portions of the tongue and other adjacent anatomical structures, such as mouth floor, oropharynx, and larynx. Only in two cases, the tumor failed to significantly accumulate the contrast agent, which was associated with that there were massive decay areas in its structure. The sensitivity, specificity, and accuracy of MDCT in the diagnosis of tongue cancer were 95, 80, and 87.5%, respectively. MDCT could reliably differentiate changes in tongue cancer from non-tumor diseases. The result of constructing the curve of diagnostic errors became the following values: the area under the curve was 0.875 and the P-value (Asymptotic Sig.) was 0.0001.

CONCLUSION

Intravenous bolus contrast-enhanced MDCT has a high diagnostic efficiency in identifying tongue cancer. The technique can establish the location of a tumor and to reveal the extent of the process to the nearby organs.

[Comparison of low- and high-concentration (270 and 320 mg I/ml) iso-osmolar iodinated contrast media in coronary CT angiography: a randomized prospective single-center blinded study]

OBJECTIVE

To compare the image quality at coronary multidetector computed tomography (MDCT) using low-dose and low-iodine protocol study in comparison with the standard protocol.

MATERIAL AND METHODS

In study included 60 patients undergoing coronary computed tomography angiography. All examinations were performed with 64-row MDCT using prospective ECG-gating and ASIR 40%. 30 patients were examined using a low-concentration (Iodixanol, 270 mg I/ml) iodinated contrast medium and low tube voltage (80 kV) (group 1), 30 patients--using of high-concentration (Iodixanol, 320 mg I/ml) iodinated contrast medium and standard tube voltage (120 kV) (group 2). Image quality of coronary arteries was evaluated using a four-point grading scale, images were randomised. Intra-arterial density was measured for the proximal and distal segments of left anterior descending artery (LAD) and right coronary artery (RCA).

RESULTS

Age, heart rate, BMI and scan parameters were not statistically different between the two groups. Analysis of coronaries visualization revealed the same image quality for group 1 and group 2 (image quality scores were 1.28 ± 0.28 vs. 1.34 ± 0.29, p = 0.4). There was no significant difference between mean enhancement values in the distal segments of RCA and LAD for the two groups. Intraarterial density for proximal LAD and proximal RCA for the nazpyara, umepamuenas group 2 were significantly lower (p < 0.05) than those values for the group 1. Conclusion. Theuse of low-dose and low-iodine protocol can be beneficial for patient safety and or image quality ithout loss of diag- stic information.

[Capabilities of magnetic resonance imaging to diagnose infiltrating pelvic endometriosis]

Deep infiltrating endometriosis is a disease in reproductive-aged women, resulting in varying chronic pelvic pains and infertility, which requires surgical treatment. Objective--to determine the capabilities of magnetic resonance imaging (MRI) to diagnose pelvic endometriosis and to elaborate an optimal scanning protocol if this disease is suspected. Small pelvic MRI has a high accuracy in the diagnosis of endometriosis and can visualize most endometrioid implants, including those that are located under adhesions and in the subperitoneal regions. Just the same, a radiodiagnostician should not forget that MRI is of low informative value in identifying bowel endometriosis. Hence, when diagnosing deep infiltrating endometriosis, MRI should be complemented with transvaginal ultrasonography to detect endometrioid implants on the bowel walls as the informative value in this aspect is above.

[Radiology report: past, present and future]

The analysis of literature data showed that the creation and implementation of a new form of radiology reports into clinical practice is an actual problem of modern medicine. Although imaging modalities have undergone dramatic evolution over the past century, radiology reporting has remained largely static, in both content and structure. In recent years the necessity to create a structured reporting is widely discussed in the literature. A universal format of radiology report hasn't been found yet. The standard of reporting system is absent, a wide variety of styles in radiology reporting currently exists. The challenging goal is improvement of existing protocols and creation of a new form of radiology reports--the protocols of the future.

[Clinical use of proton magnetic resonance spectroscopy in brain tumors and adjacent tissues]

Magnetic resonance spectroscopy (MRS) is a noninvasive technique to measure the concentration of chemical substances, which estimates biochemical changes in health and different diseases in vivo. The technique opens up a wide range of possibilities for both primary diagnosis and evaluation of the efficiency of further treatment--medical or surgical one. This review of literature is dedicated to proton MRS used in different tumors of the brain, its tunics, and adjacent nerves. It contains and systematizes data related to the problems of primary diagnosis, differential diagnosis, and evaluation of the efficiency of treatment for tumors and gives references to both basic researches in this area and recent investigations.

[Use of multislice spiral computed tomography to diagnose and control pulmonary complications in intensive care unit patients after neurosurgical interventions]

OBJECTIVE

To perform a multifactorial analysis of the association of the development of complications in neurologic intensive care unit patients in the early (on days 1-3) postoperative period and with surgical conditions, mechanical ventilation parameters, and risk factors.

SUBJECT AND METHODS

The results of multislice spiral computed tomography (MSCT) of the chest and brain were analyzed in 80 patients (34 men and 46 women; mean age, 52 +/- 13 years).

RESULTS

In the study patient group, the incidence of pulmonary edema and pneumonia was not found to depend on the type of neurosurgical intervention and that of an inhaled anesthetic. There was a significant (p < 0.05) relationship of the development of pulmonary edema to anesthesia duration exceeding 6 hours and an increase in the risk of lung pathology in the presence of extrapulmonary complications in patients with high body mass index.

CONCLUSION

Some pulmonary complications in neurosurgical patients are potentially preventable. Early postoperative chest MSCT in neurosurgical patients is essential to timely diagnose lung pathology.

[The normal anatomy of the tongue and adjacent organs according to the data of computed tomography and magnetic resonance imaging]

The paper presents the normal anatomy of the tongue and adjacent organs according to the data of computed tomography (CT) and magnetic resonance imaging (MRI). Tomographic diagnostic techniques have been proved to be of highly diagnostic value in assessing the anatomy of the tongue and adjacent organs. The authors describe the advantages of CT and MRI over standard clinical and instrumental examination in assessing the anatomic features of the lingual area.

[Use of dual-energy computed tomographic angiopulmonography in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary artery thromboendarterectomy]

OBJECTIVE

To estimate the contribution of dual-energy computed tomographic (CT angiopulmonography t o a diagnostic algorithm in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and its role in the evaluation of postoperative changes.

MATERIAL AND METHODS

CT angiopulmonography was performed on the 64-slice Discovery HD 750 system (GE Healthcare) using the dual-energy scanning mode (140 and 80 kV). The examination results in patients with CTEPH were analyzed.

RESULTS

All the patients were found to have typical CT signs of CTEPH: abnormal contrast enhancement of the pulmonary arteries, their dilatation and tortuosity; signs of right cardiac overload: right ventricular dilatation and/or hypertrophy, bronchial artery dilatation, decreased peripheral vascular pattern, mosaic pulmonary perfusion, and wedge-shaped perfusion defects on the iodine maps. Mosaic pulmonary perfusion areas were also found in all the patients. Perfusion defects were more clearly visualized when dual-energy CT by constructing iodine perfusion maps was used. Analyzing the perfusion maps in 6 patients operated on revealed a 20-50% reduction in perfusion deficit.

CONCLUSION

Information on the vascular bed and pulmonary perfusion may be obtained in patients with CTEPH within one investigation, which is important to plan surgical treatment. Construction of iodine pulmonary perfusion maps allows evaluation of perfusion recovery after artery thromboendarterectomy.

[Diagnostic value of magnetic resonance imaging in the differential diagnosis of acoustic neuroma and meningiomas of the cerebellopontine angle]

OBJECTIVE

To estimate the diagnostic value of differential diagnostic criteria for acoustic neuromas and meningiomas of the cerebellopontine angle in the use of standard magnetic resonance imaging (MRI) modes.

SUBJECT AND METHODS

The study enrolled 39 patients aged 54 +/- 8 years who had histologically verified acoustic neuromas (n=26) and meningiomas (n=13) of the cerebellopontine angle. MRI scans were compared in the outline and location of a tumor and its signal intensity and uniformity. The quantitative standardized coefficient of tumor signal intensity values was calculated by dividing of the latter by those of cerebrospinal fluid in the lateral ventricles and pons cerebelli.

RESULTS

The acoustic neuromas and meningiomas of the cerebellopontine angle exhibited differences in indicators, such as a wide base, the rate of penetration into the internal acoustic meatus, and heterogeneous contrast enhancement on T2-weighted images (T2-WI). The adjacent meninges were different in contrast. Neuromas were hyperintense to the pons varolii on T2-WI and had a low standardized coefficient of cerebrospinal fluid (1.73 +/- 0.3) and the pons (0.73 +/- 0.09) on T1-weighted images (T1-WI). Meningiomas were isointense to the pons varolii on T2-WI had a higher standardized coefficient of cerebrospinal fluid (2.23 +/- 0.36) and the pons (0.86 +/- 0.08) on T1-WI. ROC analysis determined the boundary values for the coefficients with the highest specificity.

Magnetization and spin gap in two-dimensional organic ferrimagnet BIPNNBNO

A magnetization process in the two-dimensional ferrimagnet BIPNNBNO is analyzed. The compound consists of ferrimagnetic (1,1/2) chains coupled by two sorts of antiferromagnetic interaction. Whereas the behavior of the magnetization curve in higher magnetic fields can be understood within a process for the separate ferrimagnetic chain, the appearance of the singlet plateau at lower fields is an example of non-Lieb-Mattis type ferrimagnetism. By using the exact diagonalization technique for finite clusters of size 4 × 6, 4 × 8 and 4 × 10 we show that the interchain frustration coupling plays an essential role in stabilization of the singlet phase. These results are complemented by an analysis of four cylindrically coupled ferrimagnetic (1,1/2) chains via an Abelian bosonization technique and an effective theory based on the XXZ spin-1/2 Heisenberg model when the interchain interactions are sufficiently weak/strong, respectively.

[Endometrial cancer: preoperative staging. The informative value of ultrasound study versus magnetic resonance imaging]

OBJECTIVE

to prospectively study and compare the capacities of magnetic resonance imaging (MRI) and ultrasound study (USS) in the preoperative assessment of the extent of endometrial cancer.

SUBJECTS AND METHODS

The study covered 50 patients with FIGO stages IA-IIIA endometrial cancer. A week before surgery, all the patients underwent small pelvic MRI and USS. The results of MRI and USS were compared with the data of a postoperative histological study.

RESULTS

The diagnostic value of MRI in preoperatively assessing the local extent of endometrial cancer was 82%, including its sensitivity, specificity, and accuracy; the prognostic value of a positive result and a negative one was as much as 94 and 56%, respectively. The accuracy, sensitivity, and specificity of USS were 70, 72, and 64%, respectively. Its prognostic value of a positive result and a negative one was 84 and 47%, respectively.

CONCLUSION

In this study, MRI versus USS showed a higher diagnostic efficiency in the preoperative staging in patients with endometrial cancer. The former promotes the optimization of assessment of the local extent of the tumor, including the depth of myometrial invasion and the spread into the cervix uteri, which affects the algorithm and policy of treatment for endometrial cancer.

[Radial diagnosis MRT and MSCT in assessing the outcomes of surgical correction for complicated congenital heart defects: discordant atrioventricular connections with double outlet right ventricle]

Discordant atrioventricular connection with double outlet right ventricle is a rare complicated congenital heart defect (CHD) requiring accurate diagnosis and appropriate correction. Magnetic resonance imaging (MRI) and multiple spiral computed tomography (MSCT) were used to assess long-term outcomes of the «classical» repair of the double outlet right ventricle in a patient presenting with discordant atrioventricular connection. Using a modified segmental approach provided all necessary anatomical evidence concerning the condition of the heart, major vessels, and an extracardiac pulmonary valve-containing conduit. MSCT made it possible to evaluate the degree of calcinosis and stenosis of the conduit and to visualize the coronary arteries. MRI was employed to assess the pressure gradient at the level of stenosis of the conduit, the relationship between the pulmonary and systemic circulation, transvalvular regurgitation, and ventricular contractility. Comprehensive use of present-day tomographic methods of imaging made it possible to obtain complete anatomical and functional information about the condition of the heart, vessels, extracardiac vascular transplant, as well as to reveal complications and determine the indications for a repeat operative intervention.

[Possibilities of decreasing radiation load during MSRT coronarography: using adaptive statistic iterative reconstruction]

AIM

To assess the effective dose of irradiation and quality of the obtained images while using the algorithm of adaptive statistical iterative reconstruction (ASIR).

MATERIAL AND METHODS

A total of 57 patients were examined using by means of computed tomography (CT), coronarography in the mode of retrospective synchronization. In 27 patients we used the filtered algorithm of filtered back projection (FBP) in the postprocessing treatment, in 30 patients - underwent ASIR algorithm. In all patients we measured the level of contrast, noise and signal/noise ratio (SNRs).

RESULTS

There were no significant difference by the level of contrast, noise and SNRs in the two groups of patients. The effective dose of using ASIR was less by 45,9% than while using FBP (8,7 [3,5] mZv and 16,1 [1,4] mZv, respectively, p < 0,0001).

CONCLUSION

Using 40% of ASIR while performing CT coronarography makes it possible to considerably decrease the effective dose of irradiation of patients without loosing los of diagnostic information.

[Successful treatment of massive thrombosis of the vena cava inferior with nephrotic syndrome and chronic bilateral pulmonary artery thromboembolism in a patient with genetic thrombophilia]

A case is reported of a 23-year-old male patient who developed, after severe blunt injury of the lumbar region, massive thrombosis of the vena cava inferior (VCI), both renal veins, bilateral pulmonary artery thromboembolism (PATE), nephrotic syndrome (NS). In spite of anticoagulant therapy, the condition of the patient progressively aggravated for 1.5 year: thrombosis involved the ileac and femoral arteries on the right, thrombus floated in the right atrium with PATE recurrent episodes, pulmonary hypertension reached 120 mm Hg with formation of decompensated cor pulmnonale, proteinuria and hypoalbuminemia deteriorated, anasarca edema developed Multigenic thrombophilia was diagnosed (1 homozygous and 5 heterozygous mutations). A radical one-stage operation was successful: thromboectomy from the VCI, right ileac and left renal veins, thrombendarterectomy from the pulmonary arteries, suture of the interatrial septum defect, installation of cava-filter After the operation pulmonary pressure lowered to 40-45 mm Hg, right heart volume normalized, immunosuppressive therapy with prednisolone and cyclosporine led to nephropathy remission. The discussion covers mechanisms and factors (including genetic) of thrombosis progression, correlations between intravascular thrombosis, NS and chronic glomerulonephritis (possible NS development due to bilateral thrombosis of the renal veins and nephropathy role in thrombosis progression), approaches to conservative and surgical treatment of such patients. Global experience in conduction of pulmonary thrombendarterectomy and thrombectomy from VCI is reviewed (one-stage operations were not described earlier).