[Vasoprotective Effects of Prolonged Therapy With Perindopril A in Patients with Hypertension Including Concomitant Type 2 Diabetes Mellitus].

Objective Investigate the dynamics of morphological and functional markers of vascular remodeling in patients with arterial hypertension (AH), including those with concomitant type 2 diabetes mellitus (DM2), during 12-month administration of perindopril A.Material and Methods The study included patients with grade I-II AH, with and without DM2 (30 and 32 patients, respectively), who underwent outpatient correction of initially ineffective antihypertensive therapy and administration of perindopril A, 10 mg/day. Morphological and functional parameters of vascular remodeling were evaluated in all patients at baseline and at 12 months using photoplethysmography. Stiffness index (SI) and phase shift (PS) were measured in large vessels. Reflection index (RI) and occlusion index (OI) were measured in microvessels. Computed nailfold videocapillaroscopy was used to determine capillary density (CD) at rest (CDr), CD during venous occlusion test (CDvo), and CD during reactive hyperemia test (CDrh). Data are medians [interquartile range].Results After 12-month administration of perindopril A, the morphological and functional parameters of vascular remodeling in AH patients without DM2 significantly improved at all vascular levels. SI decreased to 9.25 [7.8; 10.93 ] m/s and PS increased to 7.4 [5.6; 9.05] ms. In microvasculature, a statistically significant reduction was observed in RI, 31 [27; 36.5]%, and an increase was observed in OI, which characterizes endothelium function, 1.75 [1.68; 1.9]. Capillary CDr significantly increased to 40.5 [34.93; 46] cap/mm2, as did CDvo and CDrh. At the same time, in the group of patients with AH and DM2, a significant improvement was observed for the large vessels. SI decreased to 9.8 [9.08; 10.58] m/s, and PS increased to 6.95 [5.13; 10.08]. The RI index, reflecting the structural condition of arterioles, significantly decreased to 34 [25.9; 45.53]%, and the OI index, characterizing endothelial function, did not change significantly, 1.4 [1.3; 1.6]. Capillary CDr significantly increased to 31.55 [27.68; 34.7 ] cap/mm2; however, CDvo and CDrh did not change significantly. Renal function improved in both groups.Conclusion Both groups demonstrated improvement of morphological parameters at all levels of the arterial bed. However, patients with AH and concomitant DM2 showed no improvement of the endothelial function of arterioles and capillaries compared to improvement in AH patients without DM2. This reflected the more severe endothelial dysfunction present in AH patients with DM2.

[Circulating Neuregulin-1 and Chronic Heart Failure with Preserved Ejection].

Chronic heart failure (CHF) with preserved ejection fraction (CHFpEF) is an unsolved, socially relevant challenge since it is associated with a high level of morbidity and mortality. Early markers for this pathology are unavailable, and therapeutic approaches are undeveloped. This necessitates extensive studying the mechanisms of CHFpEF to identify therapeutic targets. According to current notions, systemic inflammation and endothelial dysfunction play an important role in the pathogenesis of CHFpEF. These processes induce the development of myocardial fibrosis and impairment of cardiomyocyte relaxation, thereby resulting in diastolic dysfunction and increased left ventricular (LV) filling pressure. Neuregulin-1 (NRG-1) is a paracrine growth factor and a natural agonist of ErbB receptor family synthesized in the endothelium of coronary microvessels. The NRG-1 / ErbB4 system of the heart is activated at early stages of CHFpEF to enhance the cardiomyocyte resistance to oxidative stress. Preclinical and clinical (phases II and III) studies have shown that the recombinant NRG-1 therapy results in improvement of myocardial contractility and in LV reverse remodeling. Results of recent studies suggest possible anti-inflammatory and antifibrotic effects of NRG-1, which warrants studying the activity of this system in patients with CHFpEF.

[Duodenopancreatectomy for pancreatic tumors - pros and cons]. / Duodenopankreatéktomiia pri opukholiakh podzheludochnoi zhelezy - PRO ET CONTRA.

AIM: To optimize surgical treatment of multiple and advanced pancreatic tumors. MATERIAL AND METHODS: There were 852 patients with various pancreatic tumors for the period 2011 - September 2019. Duodenopancreatectomy (DPE) was performed in 18 patients. Locally advanced ductal adenocarcinoma was diagnosed in 10 patients, acinar cell carcinoma - in 1 patient, multiple neuroendocrine tumors - in 4 cases, intraductal papillary mucinous tumor - in 2 patients, multiple metastases of renal cell carcinoma - in 1 patient. This procedure was avoided in 9 patients who underwent alternative operations: pancreatoduodenectomy (PDE) with pancreatic body resection for intraductal papillary mucinous tumor - 5 cases, two-stage (2) and one-stage (1) distal pancreatectomy and PDE for multiple neuroendocrine tumors - 2 patients, simultaneous pancreatic head resection and distal pancreatectomy for multiple metastases of renal cell carcinoma - 1 patient. RESULTS: Postoperative complications occurred in 14 patients after DPE (77.8%) and in 5 patients after alternative operations (55.5%). Alternative procedures in patients with neuroendocrine tumors, intraductal papillary mucinous tumors and metastases of renal cell carcinoma ensured radical surgical treatment. These patients did not need for insulin replacement therapy and enzyme drugs. CONCLUSION: Strict adherence to oncological canons and differentiated approach in patients with multiple neuroendocrine tumors, metastases of renal cell carcinoma and intraductal papillary mucinous tumors are essential to avoid DPE in some cases in favor of alternative operations.