Journal of Clinical Practice

Background: Atherosclerotic stenosis of the carotid arteries is one of the main reasons of stroke, of transient ischemic attacks, of developing cognitive disorders and of incapacitating the population. The key indication to invasive treatment for this disease is the degree of stenosis in the carotid artery, due to which the most important problem in the diagnostics is the maximally precise evaluation of the stenosis degree. The duplex scanning of the carotid arteries is a safe, non-invasive and relatively inexpensive visualization method, which is the first line of diagnostics. The precision of measuring the stenosis and the occlusion of the carotid artery, according to the ultrasound examination data, varies from 70% to 90%. At the same time, the degree of stenosis, measured using various methods, does not always match. AIM: to compare the data obtained by duplex scanning of the brachiocephalic arteries and by other instrumental diagnostics methods in terms of the precision of measuring the percentage of stenosis in the carotid arteries, as well as to analyze the reasons of discrepancies between the obtained data. METHODS: The research is based on the retrospective analysis of case history data from the patients hospitalized to the Vascular Surgery Department of the Federal State Budgetary Institution «Federal Scientific and Clinical Center» under the Russian Federal Medical-Biological Agency during the period from 01.05.2023 until 20.05.2024. The obligatory inclusion criteria for the analysis were the presence of the main disease of the I65 group according to the ICD-10 and undergoing at least one of the examination types within the settings of the FSBI «Federal Scientific and Clinical Center» under the Russian Federal Medical-Biological Agency (duplex scanning, computed tomographic angiography, transcatheter X-ray contrast angiography). The statistical processing was done using the Statistica software pack version 10.0 (StatSoft). RESULTS: The conducted research has shown that there is no complete matching between the data from the transcatheter X-ray contrast angiography, the computed tomographic angiography and the duplex scanning. The analysis of the reasons of discrepancies when measuring the degree of stenosis in the orifices of the internal carotid arteries from the results of duplex scanning and computed tomographic angiography has allowed for isolating three main groups: the human factor (operator-dependent, 30.4%), the anatomic factor (23.2%) and the differences in descriptions (46.4%). CONCLUSION: Upon examining the patients, it is necessary to strictly follow the algorithm of diagnosing the stenoses of the carotid arteries, beginning from the duplex scanning of the extracranial segments of brachiocephalic arteries as the most accessible and highly informative method. Computed tomographic angiography of this vascular segment is required for selecting the patients for surgical treatment, for it is necessary to keep in mind the potential risk of developing the contrasted nephropathy and the risks of radiation exposure. A properly done ultrasound examination allows for not only decreasing the number of discrepancies between these two diagnostic methods, but also to avoid the necessity of conducting such an invasive radio-contrasting method as angiography.

Background: The compilation of a neuroanatomic atlas based on a large sample is essentially a fundamental research work, but compiling a digital atlas during the epoch of wide usage of radiodiagnostics methods in the clinical and experimental practice along with using the artificial intelligence systems brings a significant applied relevance to the research. Rats are the main species of laboratory animals, in which the studies of modeling the ischemic stroke, of testing the cerebroprotective drugs and of developing new strategies of regenerative therapy of stroke consequences are carried out. At the present moment, there is no available and comprehensive digital atlas of the arterial blood supply of the rat brain, while single research works are based on small groups of animals and their histological description. Within this context, it is deemed very interesting and important to take the first step in addressing this issue. AIM: to compile an atlas of blood supply zones within the intracranial branches of the internal carotid artery in the settings of experimentally induced occlusion of the medial cerebral artery. METHODS: The archived data were used from the magnetic resonance imaging scans in rats with modeling the transient occlusion of the medial cerebral artery with a monofilament (n=243). The system of automatic brain segmentation based on artificial intelligence was used for objective mapping of the cerebral infarction area, the obtained data were added to a single coordinate space, unified and analyzed for highlighting the arterial blood supply zones. RESULTS: A digital atlas of the arterial circulation was compiled based on the intravitam data of high-resolution magnetic resonance imaging with an isotropic voxel. CONCLUSION: The compiled atlas may be used for increasing the quality of modeling the cerebral infarction by means of transient occlusion of the medial cerebral artery with a monofilament and it allows for using the additional objective parameters in the evaluation of the treatment effects in cases of experimentally induced ischemic stroke. The methodology developed by us is applicable for high-performance retrospective analysis of the neurovisualization data from the ischemic stroke patients, obtained within a framework of the implementation of the Vascular Medicine Program in the Russian Federation.

BACKGROUND: The detection of bone tissue erosions in cases of rheumatoid arthritis has a fundamental importance for the purpose of defining the treatment strategy and it indicates the unfavorable outcomes. It is recognized that the sensitivity of X-ray in detecting the bone tissue erosions is lower comparing to the ultrasound examination, especially at the early stages of the disease. The application of non-invasive and safe methods for the diagnostics of rheumatoid arthritis opens new possibilities for successful treatment. AIM: to compare and to evaluate the results of ultrasound and radiological detection of destructive changes in the joints of the hands and feet in rheumatoid arthritis patients. METHODS: The research included 76 patients with an established diagnosis of rheumatoid arthritis. Radiography and ultrasound examination of the joints in the hands and feet were carried out at the moment of enrollment into the research and later on in 1 and 4 years. RESULTS: The findings included a slight degree of correlation between the two absolute values — the number of joints with erosions according to the data from the ultrasound examination and according to the radiology examination findings. The rate of progression of the erosive changes was more pronounced in the data from ultrasound examination comparing to the radiology findings: from 0.5 [0; 1] to 2.5 [0; 6.0] (p=0.001) and from 0 [0; 1] to 0 [0; 3] (p=0.001), respectively. When evaluating the comparability of the two methods used for detecting the erosive changes in the joints of the hands and feet at each observation point by means of using the Bland–Altman method, it was shown that the results from both methods partially reach the outside of the margins of two standard deviations, which indicates the low degree of agreement between them. The mean difference between the measurements was -0.38 (95% CI -0.63…-0.13) before treatment, -1.15 (95% CI -1.5…-0.79) at the follow-up point of 12 months and -1.52 (95% CI -2.32…-0.73) in 4 years, which indicates the presence of systematic deviations. No correlation was detected between the difference in the number of joints with erosions and the mean number of joints with erosions according to the ultrasound examination and according to the radiography findings. CONCLUSION: Ultrasound examination and radiography are not equivalent methods of detecting erosions in rheumatoid arthritis, however, ultrasound examination helps detecting early progression of the process, which is a key to successful therapy of rheumatoid arthritis.

Selective dorsal rhizotomy is one of the methods used for surgical correction of spasticity in the muscles of the lower limbs with high level of evidence among the patients with cerebral palsy. At the same time, the long-term positive results after surgery can be achieved only when combining surgical treatment with rehabilitation activities. The provided literature review contains a historic reference on the development of the technology along with the current data on the efficiency of surgical intervention with the analyzed research results in terms of the methods and the specific features of rehabilitation among the patients with the diagnosis of cerebral palsy after selective dorsal rhizotomy. Just like other treatment methods, selective dorsal rhizotomy does not exclude the probability of developing complications, but the individual approach during the course of combined, long-term and intensive rehabilitation, as well as following the clinical protocols, can minimize these risks. Stable improvement of motor functions, as well as an increase in the quality of life among patients after selective dorsal rhizotomy and combined rehabilitation courses, confirm the efficiency and the perspectivity of this method.

Magnetic resonance imaging (MRI) of the heart has proven itself as an important tool for the evaluation of myocardial perfusion and for the diagnostics of myocardial ischemia. Due to its high spatial resolution and absence of X-ray radiation, MRI of the heart allows for precise diagnosing subendocardial ischemia without any adverse effects, which makes it a valuable method for detecting the ischemic heart disease. Recent advances in cardiac MRI and in post-processing have allowed for moving from qualitative to quantitative evaluation of the stress perfusion cardiac MRI, which has significantly increased the objectiveness and the precision of diagnostics. Quantitative evaluation of myocardial perfusion using the MRI provides a possibility of objective evaluation of myocardial ischemia, which can contribute to improved detection of coronary microvascular dysfunctions. The integration of quantitative perfusion MRI with other methods, such as the kinematic MRI, the delayed increase of gadolinium levels and the Т1/Т2-mapping, allows for deeper understanding the pathophysiology and improving the prediction of outcomes for various cardio-vascular diseases. The review addresses modern research works on cardiac MRI with regard to diagnostics and predicting of ischemic heart disease, coronary microvascular dysfunctions or non-ischemic cardiomyopathy, focusing on the quantitative approach in the evaluation of myocardial perfusion and its potential use in clinical practice.

Background: Arranging the laboratory tests for the patients presenting with suspected ischemic stroke, represents an important task for medical organizations. Further treatment tactics may depend on the results of such tests, due to which, it is necessary to assure its high quality at all the stages of laboratory diagnostics. aim: An optimization of the pre-analytical and analytical stages of laboratory testing for the admitted patients, shortening the testing turnaround time (TAT) along with drawing up the organizational decisions together with the clinicists and the quality control department. Methods: The analysis and the rehearsal of the logistical aspects of all the processes related to the hospitalization of acute ischemic stroke patients were arranged by means of organizing the in-house drills and the time tracking of the operations at the admission ward and at the express-laboratory. Results: After performing the in-house timed drills, a number of problems was revealed, both at the admission ward and at the express-laboratory, solving of which has allowed for optimizing the working processes, facilitating the pre-analytical stage and shortening the time of issuing the results. An in-house directive was issued on providing medical aid to the stroke patients, standard operations procedures were drafted and additional adjustments were introduced into the laboratory and medical information systems. The analysis of the regulatory basis has provided a possibility for specificating a number of immunohematological tests for stroke patients and shortening the costs of reagents and expendable materials. Conclusion: For the decreasing the total ТАТ down to 20 minutes for the purpose conforming the quality criteria, it is necessary to shorten the time of pre-analytical and analytical stages. Each medical organization is recommended to arrange the time tracking of all the processes of stroke patient admission for detecting the most time-intensive activities.

BACKGROUND: Acute macular neuroretinopathy is a rare disease of the central retinal zone. CLINICAL CASES DESCRIPTION: The first clinical case represents a male patient aged 47 years with the complaints of a decreased vision acuity and developing a spot in the vision fields of the left eye. He was treated at the ophthalmology clinic due to acute central serous chorioretinopathy with no effect. At the moment of examination, his vision acuity in the left eye was 1.0, with the anterior segment showing no abnormalities, the ophthalmoscopy has not revealed any changes. According to the data from the optical coherence tomography of the macular zone, the findings included the changes in the reflectivity at the level of the external plexiform and the external nuclear layers. The diagnosis set was «Acute macular neuroretinopathy in the left eye», the recommendations included dynamic follow-up. The second description is a case of female patient aged 39 years, undergoing dynamic checkups due to the operated squamous carcinoma in the lower orbital wall on the right side and in the maxilla, s/p radiation therapy. The patient had no vision-related complaints, but the ophthalmoscopy of the right eye (at the macular zone para- and perifoveally) has revealed three «cotton-wool-like» exudates. According to the data from the optical coherence tomography, in the right eye, there were foci of hyperreflectivity at the level of the neural layer of retinal fibers along with the corresponding «cotton-wool-like» exudates, as well as juxtafoveally at the level of the external nuclear layer, which is characteristic for acute macular neuroretinopathy. CONCLUSION: The first clinical case shows the importance of multimodal diagnostics in cases of complaints of a decreased vision acuity and spots in the vision fields, despite the high acuity of central vision. The second clinical case demonstrates that radiation therapy, conducted in the areas adjacent to the eyeball, is capable of resulting in an impaired circulation in the capillary plexuses of the retina, including the superficial vascular complex and in the deep capillary plexus with the development of ischemic retinal manifestations.