Purpose — to study the effi cacy and safety of transesophageal atrial stimulation in combination with intravenous administration of amiodarone in comparison with pharmacological or device cardioversion in patients with typical atrial fl utter (AF).

Material and methods. 129 patients with a typical paroxysmal or persistent AF were examined. The average patients age was 57.87 ± 7.43 years. The eff ectiveness and safety of pharmacological cardioversion with amiodarone iv, electrical cardioversion, transesophageal atrial stimulation, combined, if necessary, with intravenous amiodarone were compared.

Conclusion. Statistically signifi cant diff erences were not found in the frequency of sinus rhythm achievement for diff erent types of a typical AF classical conservative treatment. The amiodarone addition during transesophageal atrial stimulation leads to a signifi cant increasing in the effi cacy in comparison with pharmacological cardioversion (p = 0.0380).

Introduction. Highly sensitive tests to determine the level of cardiac troponin in the blood are currently recommended and have a number of advantages. For the purpose of timely diagnosis and identifi cation of patients with a high risk of adverse outcomes of acute coronary syndrome, attempts are made to take a comprehensive approach using several biological markers.

The purpose of the study. To study the prognostic signifi cance of the determination of highly sensitive troponin (highly sensitive cardiac troponin — hs-cTn) in the complex with natriuretic peptide (NT-proBNP) in assessing the outcomes of acute coronary syndrome (ACS).

Material and methods. The analysis of the possibility of using a complex of biological markers in patients with ACS (n = 120), urgently hospitalized in the State Budgetary Institution of Health Nizhny Novgorod region «Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko. Comparison Group for Existing Patients IHD (n = 37), hospitalized in the cardiology department of the State Budgetary Institution of Health Nizhny Novgorod region «Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko». Observation period showed 42–72 months (from February 2014 to August 2016). Patients underwent a general clinical examination, determination of the level of troponin I (cTnI), hs-cTnI, NT-proBNP, electrocardiogram (ECG), echocardiography, coronary angiography. Using statistical analysis, the prognostic value of the complex of biological markers in ACS was evaluated. The analysis of the obtained material was carried out using the application programs IBM SPSS Statistics for Mac, version 26.0 (IBM Corporation, www.ibm.com (2019), Microsoft Offi ce Excel for Mac (2016), Prism 8 for macOS, version 8.4.2 (464), April 7, 2020 (1994–2020 GraphPad Software, LLC).

Results. A prognostic model of the immediate outcomes of ACS (hospital and up to 12 months) was constructed, which includes the concentration of hs-cTnI (quantitative), the value of NT-proBNP (qualitative), ST segment elevation, and multi-vessel lesion, hyperglycemia. It is shown that the value of the integral index «PROGNOSIS FOR ACS+5» ≥ 0.5926 is associated with a high risk of poor prognosis in ACS for 12 months, and the index value < 0.5926 indicates a low risk of an adverse forecast.

Conclusion. The results of the study indicate the high importance of the prognostic model in assessing the outcomes of acute coronary syndrome (ACS) for 12 months.

According to recent WHO estimates, chronic HBV infection is one of the leading causes of death and disability in patients with infectious diseases. From 780 thousand to 1 million deaths are annually recorded in the world as a result of cirrhosis of the liver and hepatocellular carcinoma. Pathogenetic features of the course and outcomes of chronic hepatitis B are determined by the immunological, genetic factors of the host, as well as the molecular biological structure of the virus.

The aim of the pilot study was to study the polymorphic loci of the cytokine genes SMAD 7 (rs4939827), TNFα (rs1800620), IL-10 (rs1800896), IL-4 (rs2243250) and the degree of structural changes in the liver based on the non-invasive Fibrotest technique in patients with chronic hepatitis B as part of a search for possible predictors of predisposition to the rapid progression of liver fi brosis.

Material and methods. The pilot study included 41 patients with chronic hepatitis B. Assessment of morphological changes (stage of fi brosis) was carried out by the method of non-invasive diagnosis of Fibrotest, which is an alternative to puncture biopsy of the liver.

Results. It has been suggested that homozygous SS alleles IL-4 (rs2243250), GG TNFα (rs1800620), SS SMAD family member 7 (rs4939827) have a protective eff ect on the course of chronic hepatitis B, as these variants of allelic polymorphism of cytokine genes were found mainly in patients with CHB with a degree of fi brosis F0-F1. The heterozygous genotypes CT IL-4 (rs2243250) and GA TNFα (rs1800620), the mutant homozygous TT genotype SMAD family member 7 (rs4939827) have a profi brotic eff ect on the course of chronic hepatitis B, as they are found mainly in patients with chronic hepatitis B with degree of fi brosis F3.

Discussion. The established relationship between the liver fi brosis stage according to the METAVIR scale and the polymorphism of the cytokine genes SMAD 7 (rs4939827), TNFα (rs1800620) and IL-4 (rs2243250) made it possible to create a prognostic scale for assessing the individual risk of rapid progression of liver fi brosis. The proposed scale, due to a comprehensive assessment of the polymorphism of cytokine gene alleles and the stage of liver fi brosis using the METAVIR scale, makes it possible to carry out an individual assessment of the risk of progression of chronic hepatitis and, possibly, draw up a personalized treatment plan for the patient. Coding of the studied polymorphisms and subsequent counting can be automated, which does not require signifi cant fi nancial investments.

Objective — to study the morphometric characteristics of the brain in patients with type 1 diabetes mellitus (DM) receiving insulin therapy in diff erent modes, taking into account the variability of glycemia.

Material and methods. 120 patients with type 1 diabetes, living in Tomsk and the Tomsk Region, were examined. All patients were divided into 2 groups: group 1 — patients receiving insulin in the base-bolus regimen of multiple insulin injections (MII), group 2 — using pump insulin therapy by continuous subcutaneous infusion of insulin using a wearable dispenser (CSII). Patients took this therapy for at least 6 months before inclusion in the study. All patients underwent a general clinical examination, testing of cognitive functions using the Montreal scale (MoCA test), continuous monitoring of blood glycemia (CMG) using iPro™ 2 Professional Continuous Glucose Monitoring (Medtronic, USA), FreeStyle Libre (Abbot, USA) in for 14 days, standard magnetic resonance imaging (MRI) on a 1.5 Tesla apparatus in axial, sagittal and coronal projections using T2, TE, T1, and using programs that suppress the signal of free water. We processed the results of MRI using Free Surfer (USA) and recon-all segmentation algorithm. Statistical analysis was performed using the R-system software package.

Results. It was found that in both groups with type 1 diabetes there was a decrease in cognitive functions. It has been shown that CSII is associated with the best completion of the MoCA test. In addition, it has been reported that more frequent episodes of diabetic ketoacidosis and increased glycated hemoglobin (HbA1c) are the main causes of cognitive impairment in this group of patients. Changes in the morphometric parameters of the brain are interconnected with glycemic variability.

Conclusion. In patients with type 1 diabetes, cognitive impairment associated with acute and chronic hyperglycemia was verifi ed. Morphometric features of brain changes are more dependent on glycemic variability. CSII helps improve cognitive function.