Application of Artificial Intelligence to Assess the Risks of Simultaneous Operations for Patients with Concomitant Atherosclerotic Damage of Coronary and Carotid Arteries.

The aim of the study is to assess the possibility of using artificial intelligence to determine the most significant predictors of the operative correction outcomes for patients with damaged coronary and carotid arteries. Materials and Methods: The retrospective study of the simultaneous (or single-stage) surgical intervention results has been carried out in patients with combined atherosclerotic damage of the coronary bed and cerebral arteries (n=42), which was severe and extensive. The parameters which may be predictors of the cardiovascular risk were analyzed using the TADA program. Ten models were built for program learning. The model with 92% predictive accuracy appeared to be the most successful. Results: Simultaneous correction resulted in the absence of 30-day coronary complications in all patients. With respect to the cerebral vascular territory, acute ischemic stroke developed in 2 patients. The lethality rate was 2.4%, the fatal outcome was caused by postoperative gastrointestinal bleeding.The TADA program model considered the following parameters to be the most significant predictors: internal carotid artery cross-clamping time in minutes (51.24%); damage to the left coronary artery stem (30.42%); diastolic AP (18.28%). If cross-clamping of the internal carotid artery lasts for less than 18 min, complications are not likely to occur, while they are practically inevitable if the time exceeds 46 min. The probability of complications grows nonlinearly with the increase of the extent of the left coronary artery stem injury. A high diastolic AP never virtually coincides with the presence of complications, nor does the low one. The highest probability of complications is at the values from 70 to 80 mm Hg.In patients with a triple vessel injury of the coronary arteries, a representative picture of a nonsignificant feature is observed. Conclusion: Application of artificial intelligence for determining risk predictors for patients with concurrent atherosclerotic damage of the coronary and carotid arteries is an effective method for prognosticating the risks of simultaneous interventions.

[Surgical treatment of rupture of the anterior wall of the left ventricle in the apical region with the formation of a false aneurysm in the acute stage of myocardial infarction].

One of the most dangerous complications of acute myocardial infarction (MI) is external or internal left ventricular rupture. Despite multiple studies on early diagnostics and algorithms for routing of patients with complicated MI, mortality in this patient group remains extremely high. Presently available publications on the tactics of managing patients with cardiac rupture are very scarce, and expectancies of surgical treatment are questionable. The provided clinical example demonstrates effectiveness of early open-heart surgical intervention, which supports the requirement for aggressive tactics for patients with cardiac rupture.

[Clinical pharmacology of agents affecting the tonus of the lower esophageal sphincter]. / K klinicheskoi farmakologii sredstv, vliiaiushchikh na tonus nizhnego sfinktera pishchevoda.

The effect of pharmacological drugs indicated for specific diseases on the lower esophageal sphincter, was studied in 195 patients. Pentagastrin increased the sphincter tone, secretin when used in peptic ulcer, did not influence the tone. Unlike atropine, a therapeutic course with pirenzepine (gastrozepin) for patients with peptic ulcer did not lower the tone of the lower esophageal sphincter. Diazepam significantly decreased indices of the sphincter tone. In the treatment of CHD patients with corinfar, a calcium antagonist, the sphincter tone was on a moderate but statistically significant decrease. Aminophylline in patients with chronic bronchitis made no effect on this index. The ratio of the sphincter tone stimulated with metoclopramide to its basal values was higher in the patients with initially lowered indices as compared to the patients in whom the initial tone was within normal.