Using an Artificial Neural Network to Predict Coronary Microvascular Obstruction (No-Reflow Phenomenon) during Percutaneous Coronary Interventions in Patients with Myocardial Infarction.

The aim of the study was to develop, evaluate, and validate an artificial neural network to predict coronary microvascular obstruction (CMVO) during percutaneous coronary interventions (PCI) in patients with myocardial infarctions (MI) based on the parameters, which are routinely available in an operating room when choosing a surgical approach. Materials and Methods: 5621 patients with MI and emergency PCI were retrospectively selected from the database of the City Clinical Hospital No.13 (Nizhny Novgorod, Russia); among them, there were 3935 men (70%) and 1686 women (30%), their mean age was 61.5±10.8 years. CMVO was recorded in 201 (4%) patients (the blood flow in the infarction-related artery after PCI was less than 3 points according to TIMI flow grade). The following input parameters were assessed: age, gender, past history of coronary artery disease, previous revascularization, presence of ST-segment elevation, a class of acute heart failure, a fact of systemic thrombolytic therapy administration and its effectiveness, symptom-to-balloon time, severity of coronary thrombosis and atherosclerosis, the number of stents and the number of operated coronary arteries. The sampling was divided into a training group (n=4060), a testing group (n=717), and an independent validation group (n=844). Results: We developed an artificial neural network by a fully connected multilayer perception with forward signal propagation and two hidden layers (the area under the ROC curve - 0.69) to predict CMVO based on the subsampling for training and testing. The network model was tested on an independent subsampling (the area under the ROC curve - 0.64, negative predictive value - 97.4%, positive predictive value - 14.6%). Conclusion: The developed artificial neural network enables to use the parameters routinely available in an operating room when choosing a surgical approach and predict CMVO development during PCI in MI patients with accuracy sufficient for practical use.

[Revascularization of the myocardium and kidneys in patients with combined atherosclerotic lesions of coronary and renal arteries].

The study included a total of 109 patients presenting with combined atherosclerotic lesions of coronary and renal arteries. Depending on severity of angina pectoris, the patients were subdivided into two groups. Group One consisted of patients subjected to revascularization of the myocardium and kidneys, and Group Two comprised those with a dominating clinical picture of vasorenal hypertension syndrome and undergoing surgery on renal arteries alone. Combined revascularizations were carried out in 31 patients. Of these, five underwent single-stage endovascular interventions on coronary and renal arteries. Isolated interventions were performed in 78 patients. Selectivity of revascularisations of vascular basins was determined first of all by the degree of coronary impairments, arterial hypertension, and the presence of chronic renal failure. No cases of hospital lethality were registered. The 10-year survival rate after renal revascularization amounted to 80.1%, after combined operations to 90.9%. In the immediate postoperative period improvement following isolated renal revascularization was achieved in 62 (86.1%) patients, after isolated coronary artery bypass grafting and combined operation - in all patients. The long-term outcomes turned out to be better after combined operations (80.0%) as compared to those after isolated operations on renal arteries (70.3%).

[Optical introscopy is a new diagnostic technique in reproductive medicine].

The WHO classification's concept "infertility of unclear genesis" is due to a number of circumstances. On the one hand, this is a preponderance of the subtle forms of diseases, which are a cause of female infertility, including the subclinical forms of small pelvic inflammatory diseases (SPID). On the other hand, this is an imperfection of existing diagnostic methods. Laparoscopy considered to be the gold standard demonstrates a not very high efficiency in diagnosing SPID because of its low sensitivity. In practice, laparoscopic diagnosis of SPID is combined with ultrasound study, computed tomography, and magnetic resonance tomography. This paper proposes to use optical coherent tomography (OCT) in addition to laparoscopy. OCT makes it possible to noninvasively in real time obtain information on the internal structure of biological tissues with a resolution of 10-15 pm at a depth of at least 2 mm. Removable endoscopic probes make OCT compatible with standard endoscopic studies. The use of OCT during laparoscopy yielded optical images of the internal structure of the fallopian tube wall in different conditions: unaltered fallopian tubes; an acute inflammatory process with pronounced changes; minimal manifestations of fallopian tube inflammatory changes. Based on the comparative analysis of OCT data and histological findings, the authors elaborated OCT criteria for health and disease. A blind test indicated the high diagnostic efficacy of the technique. The additional processing of images makes it possible to objectify the data and to automate the optical introscopic technique proposed by the authors.

[Successful endovascular treatment for a false aneurysm of the hepatic artery using a stent-graft (a remote follow-up case report)].

Presented herein is a clinical case report concerning a female patient diagnosed with a pseudoaneurysm of the hepatic artery, chronic panel eatitis, and a pancreatic cyst. The woman was subjected to intravascular treatment consisting in reconstruction of the hepatic artery at the site of the origin of the aneurysmal neck with a stent graft.

[Optic coherent tomography: a new high-resolution technology of visualization of tissue structures. Communication II. Optical images of benign and malignant entities]. / Opticheskaia kogerentnaia tomografiia -- novaia vysokorazreshaiushchaia tekhnologiia vizualizatsii struktury tkanei. Soobshchenie II. Opticheskie izobrazheniia dobrokachestvennykh i zlokachestvennykh sostoianii.

This is the second communication of a series of publications on Russian studies in the field of optical coherent tomography (OCT), the newest noninvasive highly resolving technology of visualization of the structure of biological tissues. By using the investing tissues as an example, this paper demonstrates the universal types of changes in their optical properties. Optimal images permit differentiate benign and malignant processes with a high degree of diagnostic accuracy. Diverse benign processes occurring in the epithelium are detected on the OCT images as changes in its height, the scattering properties and stroke of a basilar membrane. The absence of any structure on the image is the main OCT criterion for malignancy. The diagnostic efficiency of OCT is high in recognizing neoplasia of various mucous membranes: the sensitivity of the technique is 77-98%; its specificity and diagnostic accuracy are 71-96 and 81-87%, respectively.

[Optic coherent tomography: a new high-resolution technology of visualization of tissue structures. Part 1. Principle of the technique. Objects of OCT applications and technical decisions for their study]. / Opticheskaia kogerentnaia tomografiia--novaia vysokorazreshaiushchaia tekhnologiia vizualizatsii struktury tkanei. Soobshchenie 1. Printsip metoda. Ob"ekty prilozheniia OKT i tekhnicheskie resheniia dlia ikh issledovaniia.

The authors present a series of three papers dedicated to studies made in Russia in the field of optic coherent tomography (OCT), the latest noninvasive high-resolution technology of visualization of the structure of biological tissues. A group of medical specialists of different disciplines has been examined over 2,000 patients for 8 years of the use of an original class of the Russian OCT devices developed at the Institute of Applied Physics, Russian Academy of Sciences, and awarded a RF State Prize in the field of science and technology in 1999. The first paper discusses the basic aspects of OCT, the objects of study, and technical decisions for the clinical application of the technique. The paper shows a place of OCT, whose resolving capacity is close to the cellular level (approximately 10-15 microns), among classical methods for imaging biological tissues. The optical images of different types of normal tissues and the method of their identification are demonstrated. It has been found that different optical properties of investing tissues and dentin permit their tomographic differentiation by showing their regular bedded structure. The tomographic pattern of investing tissues is affected by their specific features, such as the type of the lining epithelium, its keratosic processes, and the architecture of the basilar membrane.

Safety and efficacy of interventional occlusion of patent ductus arteriosus with detachable coils: a multicentre experience.

UNLABELLED: In order to define the safety and efficacy of Cook detachable coils for interventional closure of patent ductus arteriosus, we performed a retrospective analysis of all patients who underwent cardiac catheterization in seven centres for intended interventional occlusion of patent arterial duct. From January 1995 until March 1998, cardiac catheterization for intended interventional occlusion of patent arterial duct was performed in 317 consecutive children. Successful placement of at least one coil was achieved in 282 children (89%). The mean diameter of the ductus in children treated with Cook detachable coils was 1.65 mm, mean fluoroscopy time was 10.7 min. Occlusion rates were 62% 10 min after the procedure, 82% at the time of discharge, 91% at 4 months and 95% at late follow-up (2 years). In children with a ductus diameter of < or = 2.5 mm the rate of successful coil deployment was 94% with a 98% occlusion rate at late follow-up. Complications occurred in 11 procedures (3.5%) including haemolysis (3 patients), embolization of a coil to the pulmonary artery (7 patients, 2.3%) and inability to release a coil (1 patient). CONCLUSION: In our opinion, Cook detachable coils are safe and effective especially in the treatment of persistent ductus arteriosus with a diameter < or = 2.5 mm. Due to the low costs these coils appear to be superior to other devices in this subgroup of patients.

[Ultrasonic diagnosis of subpleural parietal formations of the lung]. / Ul'trazvukovaia diagnostika subplevral'nykh pristenochnykh obrazovanii legkikh.

The article generalizes experiences with ultrasonic scanning of the chest in patients with subpleural parietal formations of the lungs of inflammatory and tumorous etiology. The technique of the investigation and criteria of the assessment of the pathological focus are described. The normal echoscopic picture of the chest was determined. The ultrasonic images of the abscesses were compared with those of the peripheral lung carcinoma. The echoscopic pictures typical of each disease were revealed.

[Arterial factors in the mechanism of penile erection]. / Arterial'nye faktory v mekhanizme érektsii polovogo chlena.

Hemodynamic study of the penis in diagnosis of erectile impotence is thought essential because many investigators have obtained evidence for involvement of vascular affections in the mechanisms of somatogenic erectile disturbances in 70-80% of the cases. The authors have assessed arterial and venous phases of penile hemodynamics in healthy males at rest and erection (28 subjects aged 24-56) and in 37 patients with functional sex disturbances aged 21-43. It was found that erection is maintained not only in participation of deep penile arteries, but also dorsal ones. This is also confirmed by synchronous changes in a.a. dorsalis et profunda penis circulation in response to sexual stimulation. However, more expanded network of arteriovenous anastomoses in the system of dorsal arteries makes hemodynamic changes in the course of erection less pronounced than in deep penile arteries. No hemodynamic alterations in the system of common iliac arteries during erection confirmed autonomic pattern of the processes running in penile vascular system.

[Ways of improving the diagnosis and prognosis in vasorenal hypertension]. / Puti uluchsheniia diagnostiki i prognozirovaniia vazorenal'noi gipertenzil.

Atherosclerosis, aorto-arteritis and fibromuscular dysplasia are the most common causes of vasorenal hypertension. Determination of plasma renin activity is a valuable diagnostic test at early stages of vasorenal hypertension. HLA studies demonstrated significantly elevated antigens B8 and B12 in patients with essential hypertension, and antigen A9 in patients with affected renal arteries. These findings may expand the possibilities of differential diagnosis for the selection of patients, eligible for angiographic investigation. A less than three-years duration of the disease in the presence of high plasma renin activity is a favorable prognostic criterion.

[Importance of the angiographic methods of diagnosing left ventricular postinfarct aneurysms in the choice of surgical treatment]. / Znachenie angiograficheskikh metodov diagnostiki postinfarktnykh anevrizm levogo zheludochka v vybore khirurgicheskogo lecheniia.

Complete clinical and X-ray examination including catheterization of the heart cavities and selective coronarography was conducted in 116 patients suffering from postinfarction aneurysm of the heart. In 97.4% of cases the aneurysm of the heart was localized in the basin of the anterior interventricular branch of the left coronary artery. The size of the aneurysm was determined by the extent of affection of the coronary channel expresses as an overall value. Particular attention was focused on the study of the functional potentialities of the intact port of the left-ventricular myocardium. It is concluded that it is expedient to perform the operation for aortocoronary shunting to the affected arteries supplying blood to the part of the left-ventricular myocardium which is not involved in the aneurysm, so as to improve the function of the left ventricle after resection of the aneurysm.

[Modification of Souns' method of selective coronary angiography]. / Modifikatsiia metoda selektivnoi koronarografii po Sounsu.

A new modification of the method of selective coronarography after Souns is offered, which differs by the site of introduction of the catheter and by its form, which is more convenient as to the approach through the axillary artery and a U-shaped bend of the working tip of the catheter which makes the method more reliable and shortens the time of the procedure.