[Role and importance of forensic medical re-examination of defects in health care delivery]. / Rol' i znachenie povtornoi sudebno-meditsinskoi ekspertizy defektov okazaniya meditsinskoi pomoshchi.

Article is devoted to the problem of production and legal evaluation of repeated commission (complex) forensic medical examinations based on materials of «medical¼ practices, related to facts of health care delivery adverse outcomes, in criminal and civil proceedings. Reasons of re-examination assignment, theoretical and applied aspects of this procedural institute in evidence in cases of iatrogenic crimes and unqualified health care delivery were considered. The authors pay particular attention to deficiency of legal base and practical approaches to the re-examination assignment and its results' evaluation, and suggest ways to improve the forensic medical and law enforcement activity in this category of cases. The examples from practice, illustrating the content and nature of the re-examination's problem in «medical¼ cases, were given, the ways to improve the quality of expert work and judicial practice were emphasized, and measures, that will improve the situation in short term, were identified.

[Molecular and Cellular Aspects of the Endothelial-Mesenchymal Transition in Cardiovascular Diseases].

Endothelial cells (ECs), which form the inner surface of the blood vessels, contact the blood, withstand mechanical pressure, and demonstrate heterogeneous reactions to exogenous and endogenous stimuli. ECs have unique properties in accordance with their niches and play an important role in regulating vascular homeostasis. Endothelial cells may undergo a dynamic phenotypic switch in terms of its heterogeneity, which may lead to endothelial dysfunction and a number of associated pathologies. Endothelial-mesenchymal transition (EndMT) is one of the possible molecular and cellular mechanisms of this kind. EndMT is characterized by phenotypic changes in ECs through which endothelial cells acquire new properties, i.e., start producing mesenchymal markers such as alpha-SMA and vimentin, change morphology, and become able to migrate. EndMT is a complex biological process that can be induced by inflammation, hypoxia, or oxidative stress and be involved in pathogenesis of cardiovascular disease. This review describes the key markers, inhibitors, and inducers of endothelial-mesenchymal transition and overall state-of-the-art of EndMT in cardiovascular diseases.

[Endoleaks in endovacular infrarenal abdominal aortic aneurysm repair. (Part II)]. / Endoliki pri endovaskulyarnom protezirovanii infrarenal'nykh anevrizm bryushnoi aorty. (Chast' II).

Searching for literature data was performed in the PubMed, Scopus and eLIBRARY databases. In the second part, we considered modern classifications of endoleaks type 3, 4 and 5 after endovascular infrarenal abdominal aortic aneurysm repair, etiology, risk factors, classification of endoleaks. Modern data on effectiveness of their treatment by various methods are presented.

[Endoleaks in endovacular treatment of infrareneral abdominal aortic aneurysm (part I)]. / Endoliki pri endovaskulyarnom protezirovanii infrarenal'noi anevrizmy bryushnoi aorty (chast' I).

We analyzed the PubMed, Scopus databases and the eLIBRARY electronic library regarding appropriate literature data. In the first part, modern classifications of endoleaks type 1 and 2 after stenting of infrarenal aortic aneurysm are considered. We described causes, risk factors and effectiveness of various treatment options.

[Changes in deep femoral artery topography during open revascularization of the lower limbs]. / K voprosu ob izmenenii topografii ust'ya glubokoi arterii bedra pri otkrytykh revaskulyariziruyushchikh vmeshatel'stvakh.

OBJECTIVE: To study topographic changes of femoral triangle arteries during open revascularization of the lower limbs. MATERIAL AND METHODS: A retrospective study included 30 men aged 59.6±3 years with atherosclerotic femoropopliteal occlusion and chronic lower limb ischemia IIb-III stage according to the Pokrovsky-Fontaine classification. All patients underwent open reconstructive interventions. Ten patients underwent above-knee femoropopliteal replacement with a synthetic prosthesis, 10 patients - above-knee femoropopliteal bypass with a synthetic prosthesis, 7 patients - above-knee femoropopliteal bypass with autologous vein, 3 patients - below-knee femoropopliteal bypass with autologous vein. Control group consisted of 30 healthy mean aged 60±2 years. Ultrasound was carried out using the Esaote My Lab Alfa scanner (3-12 MHz linear transducer and 3-5 MHz convex transducer). RESULTS: In healthy volunteers, deep femoral artery always arose from common femoral artery under the angle ≤30° in all cases (20° - 93.3% of cases, 30° - 6.7% of cases). In patients with previous surgical treatment, angle of deep femoral artery varied from 35 to 80°. After femoropopliteal bypass grafting with autologous vein, angle of deep femoral artery varied from 35 to 45° (35° - 8 patients, 40° - 1 patient, 45° - 1 patient). After femoropopliteal bypass grafting with a synthetic prosthesis, angle of deep femoral artery increased up to 40-50° (40° - 2 patients, 50° - 8 patients). In case of previous femoropopliteal replacement with a synthetic prosthesis, angle of deep femoral artery increased up to 70-80° (70° - 7 patients, 75° - 2 patients, 80° - 1 patient). CONCLUSION: Normally, angle of deep femoral artery does not exceed 30°. Open reconstructive surgery on femoropopliteal arteries increases this value from 30° to 80°. Minimal changes are observed after femoropopliteal bypass grafting with autologous vein.

Apoptosis and Cell Proliferation Markers in Inflammatory-Fibroproliferative Diseases of the Vessel Wall (Review).

Apoptosis is the main feature of inflammatory-fibroproliferative disorders of the vessel wall. Studies in animal models have shown that smooth muscle cells (SMCs) cultured from endarterectomy specimens from the affected area proliferate more slowly and display higher apoptotic indices than SMCs derived from the normal vessel wall. Apoptotic cells were found in the destabilized atherosclerotic plaques, as well as in the samples with restenosis of the reconstruction area. Injury to the vessel wall causes two waves of apoptosis. The first wave is the rapid apoptosis in the media that occurs within a few hours after injury and leads to a marked reduction in the number of vascular wall cells. The second wave of apoptosis occurs much later (from several days to weeks) and is limited by the SMCs within the developing neointima. Up to 14% of the neointimal SMCs undergo apoptosis 20 days after balloon angioplasty. Ligation of the external carotid artery in a rabbit model led to a marked decrease in blood flow in the common carotid artery, which correlated with the increased apoptosis of endothelial cells and SMCs. Angioplasty-induced death of SMCs is regulated by a redox-sensitive signaling pathway, and topical administration of antioxidants can minimize vascular cell loss. On the whole, studies show that apoptosis is prevalent in vascular lesions, controlling the viability of both inflammatory and vascular cells, determining the cellular composition of the vessel wall. The main markers of apoptosis (Fas, Fas ligand, p53, Bcl-2, Bax) and cell proliferation (toll receptor) have been considered in the current review.

Effect of Nitinol on Metabolic and Coagulation Activity of Endothelial Cells Culture.

We studied the effect of nitinol, the most prevalent material for endovascular stents, on metabolic and coagulation activity of a primary culture of human umbilical vein endothelial cells (HUVEC). Metabolic activity was evaluated using MTS-test and by the level of stable NO metabolites in the conditioned medium, coagulation activity was assessed by activity of von Willebrand factor (vWF) and levels of plasminogen activator inhibitor-1 (PAI-1) and soluble endothelial protein C receptors (sEPCR). Exposure to nitinol reduced metabolic activity of the cell culture by 11.1% in comparison with the control (p<0.001). Although absolute activity of vWF and absolute level of sEPCR were elevated, incubation with nitinol did not lead to a statistically significant elevation of these parameters in comparison with the control, which can indicate the absence of substantial hypercoagulation effects of nitinol.

Expression of Apoptotic Markers Bcl-2 and Bax in the Vascular Wall.

The aim of the study was to assess the levels of Всl-2 and Bax proteins in the vascular wall and their correlation with serum cholesterol in patients with stage III-IV atherosclerosis obliterans of lower limb arteries. Materials and Methods: The study included 32 patients with stage III-IV atherosclerosis obliterans of the lower limb. Samples of intraoperative material (all three layers of the vascular wall) including an atherosclerotic plaque (AP) were taken during primary open surgery on major leg arteries. As a control, we used samples of the arterial wall without visible signs of atherosclerosis. Based on AP ultrasonography, the patients were divided into two groups: with APs of mixed echogenicity and with hyperechoic (calcified) AP. The vascular samples were crushed and homogenized for further measurements of Всl-2 and Bax proteins; in a separate setup, cholesterol in blood serum was measured. Results: In patients without atherosclerotic changes, the level of the anti-apoptotic protein Bcl-2 in the arterial wall was 1.25 ng/mg, and that of the pro-apoptotic protein Bax - 4.7 ng/mg. In the case of APs of mixed echogenicity, the expression of Bcl-2 was 1.8 ng/mg (p=0.143) and that of Bax - 5.1 ng/mg (p=0.834), with no significant differences from AP-free vascular wall samples. In the arterial wall containing a heterogeneous calcified AP, the expression of Bcl-2 was 0.9 ng/mg (p=0.143), In contrast, the level of Bax was 6.8 ng/mg, which showed its significant increase as compared with the non-AP controls (p=0.02). In the cases with predominantly hyperechoic AP, the expression of Bcl-2 was significantly lower (p=0.036), and that of Bax - significantly higher (p=0.036) in comparison with AP of mixed echogenicity. In patients with hyperechoic AP, we found a negative correlation between the Bax and Bcl-2 values ( r=-0.315) and a positive correlation between the Bax expression and serum cholesterol (r=0.617). Conclusion: In arterial walls with hyperechoic (calcified) APs, the expression of anti-apoptotic protein Bcl-2 is reduced, and that of pro-apoptotic protein Bax is increased, which indicates the apoptosis activation in advanced atherosclerotic lesions. In patients with such APs, elevated cholesterol levels directly correlate with the increased expression of pro-apoptotic Bax protein (r=0.617).

[Markers of the course of obliterating atherosclerosis of lower limb arteries]. / Markery techeniia obliteriruiushchego ateroskleroza arterii nizhnikh konechnostei.

AIM: The purpose of the study was to determine the level of substances damaging the vascular endothelium, as well as to assess their effect on the functional state of the endothelium and the course of obliterating atherosclerosis of lower limb arteries. PATIENTS AND METHODS: The study included a total of 112 people, subdivided into three groups: those with an unfavourable course of obliterating atherosclerosis of lower limbs arteries (n=48) - group 1, patients with obliterating atherosclerosis of lower limbs arteries with a conventionally favourable course (n=48) - group 2, and apparently healthy volunteers (n=16). In all subjects, the following parameters were analysed: stable metabolites of nitric oxide II, endothelin-1, homocysteine and basal insulin. RESULTS: The level of stable nitric oxide metabolites (p<0.001 as compared with group 1; p<0.045 compared with group 2) was lower in the groups of patients with obliterating atherosclerosis of lower limb arteries (88.5±7.3 µmol/L in group 1; 161.5±8.6 µmol/L in group 2) as compared with healthy volunteers (226.0±28.6 µmol/L). In its turn, the level of nitric oxide was statistically significantly lower (p<0.001) in group 1 patients as compared with those of group 2. The level of endothelin-1 turned out to be higher (p<0.001) in group 1 (2.1±0.1 ng/ml) as compared with group 2 (1.6±0.1 ng/ml). Comparing group 1 patients with healthy volunteers (1.4±0.1 ng/ml), the level of endothelin-1 had also higher values (p<0.001). The level of endothelin-1 did not differ (p=0.270) as compared with group 2 and healthy volunteers. Comparing the homocysteine level in patients of the examined groups (20.7±0.8 µmol/L in group 1 patients and 18.1±0.6 µmol/L in group 2 patients) with healthy volunteers (13.0±0.4 µmol/L) demonstrated an increase in the parameters (p<0.001). The level of homocysteine turned out to be higher in group 1 patients than in those of group 2 (p<0.001). The level of basal insulin turned out to be significantly higher in the studied groups of patients with obliterating atherosclerosis of lower limb arteries (24.9±4.6 mIU/L in group 1; 8.0±0.7 mIU/L in group 2) than in healthy volunteers (5.1±0.5 mIU/L). Statistically significant (p<0.001) hyperinsulinemia was observed in group 1 as compared with group 2. CONCLUSION: Hyperhomocysteinemia and hyperinsulinemia are predictors of an unfavourable course of the disease. In a high level of these parameters, one may predict an unfavourable course of obliterating atherosclerosis of lower limb arteries.

[Clinical anatomy of deep femoral vessels in the area of femoral triangle]. / Klinicheskaia anatomiia glubokikh sosudov bedra oblasti bedrennogo treugol'nika.

AIM: The purpose of this study was to specify the anatomy of the deep femoral artery and deep femoral vein within the femoral triangle. MATERIAL AND METHODS: The study was based on the data of anatomical dissection of vessels in the area of the upper third of the femur (20 specimens ) and ultrasonographic duplex angioscanning of patients undergoing routine examination of the vascular system (40 patients, 50 lower extremities). Ultrasonography was performed using linear and convex transducers (frequency 3-13 and 3-5 MHz). RESULTS: In the majority of cases, the deep femoral artery originated from the common femoral artery: in 100% of cases in anatomical dissection and in 98% according to the findings of ultrasound duplex angioscanning. Two trunks of the deep femoral artery were revealed in 14% of cases. The findings of ultrasound duplex angioscanning and those of anatomical dissection demonstrated a high origin of the deep femoral artery in 8% and 10% of cases, respectively. In the majority of cases, the deep femoral artery originated from the posterior surface of the common femoral artery: in 46% of cases on ultrasound duplex angioscanning and in 60% of cases in anatomical dissection; along the posterior lateral surface: in 36% according to the data of ultrasound duplex angioscanning and in 40% on dissection. The origin of the deep femoral artery from the medial surface of the common femoral artery was encountered in 8% cases and in 6% of cases was associated with formation of an atypical saphenofemoral junction. One patient was found to have the origin of one of the trunks of the deep femoral artery from the anterior surface of the common femoral artery. Two trunks of the deep femoral vein were revealed in 84% of cases. The proximal trunk flowed into the femoral vein from the lateral surface immediately beneath the ostium of the deep femoral artery, and the distal trunk - 1-1.5 cm lower from the posterior medial side of the femoral vein. CONCLUSION: The knowledge of variant anatomy of deep femoral vessels is very important for decreasing the risk of iatrogenic lesions during surgical manipulations and false-negative results of diagnostic manipulations. If possible, it is always necessary to preoperatively assess variant anatomy of deep femoral vessels (real-time assessment of topography of vessels by means of ultrasound duplex angioscanning, preoperative marking of vessels).

[Anatomy of foot perforator veins in surgery of varicose veins]. / Anatomiya perforantnykh ven stopy v khirurgii varikoznoi bolezni.

OBJECTIVE: To clarify the role of clinical anatomy of foot and ankle perforator veins (PV) in surgical treatment of varicose vein disease. MATERIAL AND METHODS: Anatomy of foot and ankle PV was assessed in 50 amputated lower extremities by anatomical dissection. RESULTS: There were 4-6 PVs at the medial surface of the foot. These veins connected medial marginal vein and vv. plantaris medialis (VPM). There were 2-3 PVs at the lateral surface of the foot. These veins connected lateral marginal vein and vv. plantaris lateralis (VPL). All PVs on the lateral surface of the foot constitute the neurovascular bundles. PVs flowing into vv. dorsalis pedis are localized on the medial surface of the medial marginal vein at the level of the ankle base. In most cases, we found an arterial branch nearby at the subfascial level. In anterior part of the plantar surface of the foot, we distinguished 4-5 small PVs (~1 mm) flowing into vv. digitales plantares through the commissural orifices of the aponeurosis. There were 6-9 vessels (~1 mm) along the fascial aponeurotic septa. These vessels connected superficial plantar venous network and plantar veins. Small arterial branch was found almost in all cases near these veins. Noteworthy is the area where the plantar veins lie on the quadratus plantae and are covered by a leaf of deep plantar fascia. This anatomy is similar to topography of posterior tibial veins. CONCLUSION: Foot perforator veins constitute the neurovascular bundles as a rule. Plantar vein topography and their relationship with PV confirm an existence of muscular-venous pump of the foot.

[Study of gene expression in patients with peripheral artery disease]. / Izuchenie ékspressii genov u patsientov s zabolevaniiami perifericheskikh arterii.

Currently, there are no widely used available techniques for reliable prognosis of the onset and course of peripheral artery disease. Working out of optimal test systems including genetic ones for assessment of risks for the development of the disease, its progression or development of complications in patients with peripheral atherosclerosis is an important mission of modern medicine. This article deals with a promising technique of genetic studies in patients with peripheral artery disease, i. e., study of gene expression. Also provided herein is a literature review devoted to the main techniques used for the analysis of the profile of gene expression. This is followed by evaluating the possibility of using DNA chips, as well as describing the state of the art and unsolved problems of studying gene expression in patients with peripheral artery disease.

[The place of arterial allograft in reconstructive surgery of the main arteries of the lower extremities]. / Mesto arterial'nykh allograftov v rekonstruktivnoi khirurgii magistral'nykh arterii nizhnikh konechnostei.

Critical limb ischemia, especially in the absence of autologous vein, prosthetic and native vascular infections are isolated diseases for which there currently doesn't have best surgical treatment. Vascular allografts may be the treatment of choice for these patients. In this analysis, we tried to reflect the directions of development of vascular allotransplantation, global trends related to indications for their use, methods of conservation, degradation and endothelial dysfunction. At the present time there doesn't have meta-analyzes on the efficiency of using arterial allografts or other options for implantation (synthetic graft, xenografts) for critical limb ischemia and graft and native infections. Now it is wrong to recommend using them always. Further studies of their performance are necessary. In addition, development of graft control techniques is also needed when rejection develops. Currently, there are no special diagnostic markers, the assessment of which could save patients with immune-mediated dilatation and dysfunction of allografts.

[Duration of treatment with phlebotonics in patients with chronic venous disease]. / Dlitel'nost' flebotropnoi terapii u patsientov s khronicheskimi zabolevaniiami ven.

Lower extremity chronic venous disease is a highly prevalent vascular pathology. Progression of the disease exerts a negative impact on the patients' quality of life and imposes a large economic burden on the healthcare systems. Conventional methods of conservative treatment of chronic venous disease include wearing compression knitwear and pharmacological therapy. Although highly effective, compression therapy appears to be associated with lower compliance due to difficulties putting on and taking off the compression stockings. Therefore, the majority of patients prefer pharmacological therapy with phlebotonic drugs. There are many phlebotropic agents possessing particular indications and recommendations regarding the duration of administration. This article presents a review of the available literature addressing the problems related to prescription of pharmacotherapy to patients with lower limb chronic venous disease, also describing the results of published clinical studies evaluating efficacy and safety of phlebotropic drugs, as well as those concerning the duration of the course administration of drugs depending on the severity of the disease, invasive nature of a surgical intervention performed, or sclerotherapy. Besides, analysed is the role of phleboactive agents in correction of pathophysiological mechanisms of the development and progression of venous disease. This is followed by a review of clinical trials studying the influence of phlebotonics on such links of pathogenesis as leukocyte activation, vein-specific inflammation, endothelial dysfunction, and activation of proteolytic enzymes promoting destruction of the extracellular matrix. Based on the above data, proposed herein are appropriate approaches to determining the duration of the courses of phlebotropic therapy with due regard for the patients' status, underlying once again the importance and necessity of a personalized approach to selection of the optimal duration of venotonic therapy.

[The order of the investigators as an object of study in conducting forensic medical examinations according to «medical¼ cases]. / Postanovleniya sledovatelei kak ob"ekt issledovaniya pri provedenii sudebno-meditsinskikh ekspertiz po materialam «vrachebnykh del¼.

The article is devoted to the problem of studying the orders of investigators on the appointment of forensic examinations in «medical¼ cases. The results of own research of the content of orders in the aspect of their filling with the circumstances of the case and the data necessary for the rational interaction of experts with the investigation team at the organizational stage of the examination are presented. The ways of improving the methods of carrying out examinations of this type in order to reduce the number of repeated and additional examinations, as well as interrogations of experts, and reduce the burden on state forensic institutions are proposed.

[Successful treatment of an aortoduodenal fistula after operation on the abdominal portion of the aorta]. / Uspeshnoe lechenie aorto-duodenal'noi fistuly posle operatsii na briushnom otdele aorty.

Gastrointestinal haemorrhage is a common cause of emergency admission of patients to surgical hospitals. Within the structure of nosological entities, not unreasonably referred to the rarest causes of gastrointestinal bleeding is the formation of an aortointestinal fistula whose early diagnosis is of paramount importance. The clinical picture may be different but it is mostly represented by gastrointestinal haemorrhage. The incidence of gastrointestinal fistulas following a surgical intervention ranges from 0.6 to 2.3%. Unless timely diagnosed and with incorrect therapeutic decision-making, the mortality rate amounts to 90%. In this article we present a clinical case report regarding successful treatment of a patient presenting with a secondary aortoduodenal fistula occurring 5 years after previously performed aortofemoral bypass grafting and complicated by relapsing intestinal bleeding and acute ischaemia of the right lower extremity.

[Recirculation syndrome in hemodialysis patients]. / Prichiny sindroma retsirkuliatsii pri programmnom gemodialize.

OBJECTIVE: To study the causes of recirculation syndrome and optimize surgical correction. MATERIAL AND METHODS: There were 2329 procedures of formation and restoration of permanent vascular access in 2109 patients for the period from 1998 to 2018. Recirculation syndrome occurred in 66 (3.1%) patients. Instrumental diagnosis of the causes of recirculation syndrome included Doppler ultrasound of permanent vascular access (100%) and angiography in accordance with indications. All patients were divided into 4 groups. The first group included 39 (59.1%) patients with native arteriovenous fistula. The second group included 12 (18.2%) patients with high arteriovenous fistula (between the brachial artery and the cephalic vein). The third group included 10 (15.1%) patients with major vein transposition. Synthetic prosthesis to create an arteriovenous fistula was used in the fourth group (n=5, 7.6%). RESULTS: In the first group, recirculation syndrome was caused by the presence of a large branch in close proximity to the arteriovenous anastomosis, its combination with significant stenosis of the anastomosis, hypoplasia of the outflow pathways of the fistulous vein. In the second group, the reasons were subclavian vein stenosis and dilated tributaries of the saphenous veins. In the third group, the main cause of recirculation syndrome was major vein stenosis in the upper third of the shoulder. In the fourth group, recirculation syndrome was caused by stenosis of the prosthetic-venous anastomosis. CONCLUSION: Recirculation syndrome in hemodialysis patients is usually caused by malfunction of permanent vascular access. Ultrasound or angiography may be successfully used to diagnose dysfunction. Effective treatment of this problem implies surgical or endovascular correction of permanent vascular access.

[Clinical study of efficacy and safety of Aducil in patients with chronic lower limb ischaemia]. / Klinicheskoe issledovanie éffektivnosti i bezopasnosti Adutsila pri khronicheskoi ishemii nizhnikh konechnostei.

AIM: The study was aimed at assessing efficacy and safety of treatment with Aducil® (cilostazol) compared with Trental® 400 in patients with moderate-to-severe intermittent claudication due to peripheral atherosclerosis. PATIENTS AND METHODS: The study included a total of one hundred and forty-five 36-to-75-year-old patients. The participants were distributed into 2 groups according to the inclusion/exclusion criteria in a 2 to 1 proportion: patients in group 1 received Aducil® 100 mg BID, in group 2 - Trental® 400 TID for 12 weeks. 142 subjects completed the protocol. RESULTS: Analysis of the effectiveness of treatment according to the primary criterion showed a better effectiveness of Aducil® as compared with Trental® 400. Subjects who received Aducil® had a higher increase in the absolute maximum walking distance after 12 weeks of treatment as compared with those taking Trental® 400: 126±110 m versus 45±39 m, respectively (р<0.001). Subjects who received Aducil® had a statistically significant improvement in quality of life parameters such as physical and mental health components according to the SF-36 questionnaire after 12 weeks of treatment (р≤0.01). Subjects in Aducil® group had better quality of life with an increase from 34 to 40 points according to the physical component score, while patients in Trental® 400 group demonstrated minor positive changes (from 35 to 37 points); mean mental component score increased from 45 to 48 points in Aducil® group as compared with an increase from 45 to 47 points in Trental® 400 group. While self-reported physical health status was similar between the groups at baseline, subjects in Aducil® group reported better physical functioning after treatment (р=0.016). Two adverse events were registered in two subjects in Aducil® group. CONCLUSION: Analysis of the study endpoints demonstrated that Aducil® had better treatment effectiveness in patients with chronic lower limb ischemia stage IIB according to the classification of A.V. Pokrovsky-Fontaine as compared with Trental® 400, while the safety profile and drug tolerance were similar between the two.

[Current aspects of performing treadmill test in patients with peripheral artery disease]. / Sovremennye aspekty provedeniia tredmil testa u patsientov s zabolevaniiami perifericheskikh arterii.

The protocols of performing treadmill tests (TMT) in patients presenting with peripheral artery disease have over the last decades undergone significant changes, with the alterations concerning not only the speed and time values of the load, but also the parameters measured. Currently, there is no unified generally accepted method of TMT, hence the need for an optimal protocol for carrying out this type of examination, which would help obtain reliable results in assessment of everyday life functional activity of patients and efficacy of various methods of treatment for peripheral atherosclerosis. The choice of an optimal methodology of performing a TMT in patients with intermittent claudication is extremely important because studying the haemodynamic parameters alone not always clearly reflect functional peculiarities of the course of the disease, since they depend not only on the presence of arterial stenoses or occlusions, but also on the activity of oxidative enzymes, endothelial and mitochondrial dysfunction, taking therapeutic agents, concomitant pathology and a series of other factors. The article is a review of the related literature contained in such databases as the Medline, PubMed, Russian Science Citation Index (RSCI) and Scopus and concerning TMT in patients with peripheral artery disease. The authors summarized the information from a total of 63 literature sources over the period from the 1970s to 2018.

[Effect of genetic polymorphisms on functioning of a permanent vascular access in patients on dialysis]. / Vliianie geneticheskikh polimorfizmov na funktsionirovanie postoiannogo sosudistogo dostupa u patsientov na dialize.

Thromboses and stenoses of permanent vascular access appear to be a serious hazard for patients with end-stage kidney disease on programmed haemodialysis. Relapses of these pathological conditions are the cause of repeated hospitalization, secondary surgical interventions and may eventually lead to impossibility of carrying out procedures of haemodialysis. Often, vascular access dysfunction occurs for no apparent reason, thus underlying the importance of studies aimed at revealing additional factors of intravascular thrombogenesis and neointimal formation in a vascular access, including the works dedicated to studying genetic predictors of the development of the above-mentioned complications. The authors examined herein the role of polymorphisms of the genes of endothelin-1 (END-1), nitric oxide synthase-3 (NOS-3), angiotensinogen-2 (AGT-2), angiotensinogen-1 (AGT-1), angiotensinogen 2 receptor type 1 (AGTR1), mitochondrial superoxide dismutase-2 (SOD-2), catalase (CAT) superoxide dismutase-1 (SOD-1) and angiotensin converting enzyme (ACE) in the functional state of permanent vascular access in patients on dialysis. The obtained results demonstrated direct cause-and-effect relationships between polymorphisms lys-198 asn in the END-1 gene, C60T, T58C in the SOD-2 gene and the function of vascular access. The presence of END-1 gene lys-198 asn polymorphism in a homozygous state (allele 1) was associated with a high risk of an unsatisfactory condition of permanent vascular access (p=0.019).