Presence Of Inflammatory Changes Research Articles

Evaluation of symbiotic relationships of oral microorganisms and their effect on the development of inflammatory changes of the oral mucosa in the complete absence of teeth

Introduction. By fixing on the exposed surfaces of complete removable dentures and oral soft tissues, bacteria form a biofilm, thereby increasing their overall virulence and resistance. The microorganisms that make up the biofilm are often in a symbiotic relationship, which allows them to increase their pathogenic potential and cause the development of denture stomatitis. Accordingly, when a particular strain is present in the oral cavity, the risks of symbiosis are significantly increased. The aim of the study was to evaluate the effect of symbiotic relationships of oral bacteria on the development of inflammatory changes in the oral cavity in the absence of teeth. Materials and methods. Two groups of patients belonging to the elderly age according to WHO systematization (60–74 years) with complete absence of teeth (K08.1) were formed, differing in the presence of clinical manifestations of inflammation (82 men and 49 women). Biological material sampled from the oral cavity of patients was studied using the culture method and RT-PCR. To quantify the interaction between members of the microbiocenosis, we used the Jaccard similarity coefficient. Results. Coagulase-negative and coagulase-positive staphylococci, Neisseria, Candida spp., Enterobacterales and F. nucleatum were more frequently found in patients with complete absence of teeth. Expressed symbiotic relations between microorganisms of the Enterobacterales order, Lactobacillus, Neisseria and Corynebacterium genera, as well as S. salivarius, C. albicans, F. nucleatum were established. The nature of these relations depended on the presence of inflammatory changes in the oral mucosa and, in turn, influenced the development of the latter. Thus, in the absence of inflammation, Corynebacterium, Lactobacillus and S. salivarius showed stable synergism. In case of inflammation, the association between these bacteria was accompanied by the introduction of F. nucleatum and displacement of S. salivarius. Conclusion. Thus, conditionally pathogenic microorganisms, forming microbial associations with multidirectional symbiotic relations increase their virulence, which allows them to occupy free niches in the oral cavity and subsequently trigger the development of pathological process of inflammatory character of prosthetic bed tissues.

Визначення предикторів стійких порушень серцевого ритму у військовослужбовців із тяжким перебігом міокардиту

The aim – to study heart rhythm and conduction disturbances in different localization and distribution of myocardial lesions in combatants with severe myocarditis based on the results of a 6-month follow-up.Materials and methods. 46 male military personnel with a severe course of acute myocarditis (AM) with a reduced ejection fraction (EF) of the left ventricle (LV) (≤ 40 %) with an average age of (35,1±2,4) years were examined. Examinations were carried out in the 1st month after the onset of symptoms of myocarditis and after 6 months of observation. The diagnosis of myocarditis and the severe course of the disease were established on the basis of the Recommendations for the diagnosis and treatment of myocarditis of the All-Ukrainian Association of Cardiologists of Ukraine. All patients underwent for 24-hour ECG monitoring with analysis of the frequency and spectrum of rhythm and conduction disturbances and cardiac magnetic resonance (CMR) imaging with contrast analysis of the topography of the lesion and counting the number of LV segments affected by inflammatory changes and LV segments with the presence of late gadolinium enhancement (LGE).Results and discussion. When comparing the results of heart MRI with the data of daily ECG monitoring, a clear association of the presence of frequent ventricular extrasystoles (VE) and paroxysms of non-sustained ventricular tachycardia (NSVT) with the localization of LGE in the interventricular septum (IS) was established – among patients with LGE lesions at the onset of AM more than in a third (37.0 %) had frequent VE, and NSVT paroxysms, which increase the risk of developing life-threatening ventricular arrhythmias, were detected in 25,9 % of cases. After 6 months of observation in the presence of LGE in the IS, the frequency of detection of frequent VE and NSVT paroxysms was also significantly higher compared to other localization of the lesion and amounted to 20,0 and 13,3 %, respectively. With the help of correlation analysis, an associative relationship was revealed between the presence of LGE in the IS and the presence of frequent VE and NSVT paroxysms in the debut of myocarditis – r=0.73 (р<0.01) and r=0.66 (р<0,01) respectively, and also after 6 months of observation – r=0.65 (р<0.01) and r=0.59 (р<0.05), respectively. According to the results of the multivariate regression analysis, predictors of frequent VE persistence after 6 months were: LVEF ≤30 %; LV end-diastolic volume index ≥105 ml/m2; presence of inflammatory changes in ≥5.0 LV segments; presence of LGE in ≥4.0 LV segments and its presence in the IS, determined in the 1st month from the onset of the disease. The predictors NSVT paroxysms persistence after 6 months were the same factors with the exception of LV EF, and, according to the value of the β coefficient (β=1.302; p<0.001), the most significant contribution was the presence of LGE in the IS.Conclusions. In combatants with severe myocarditis, the presence of late gadolinium enhancement in the interventricular septum is an additional risk factor for the persistence of frequent ventricular extrasystoles and paroxysms of non-sustained ventricular tachycardia during 6 months, while the presence of late gadolinium enhancement in the posterior and lateral walls of the left ventricle has no reliable relationship with the presence of rhythm and conduction disorders. On the basis of multivariate regression analysis, predictors of frequent ventricular extrasystoles and paroxysms of non-sustained ventricular tachycardia persistence were established in combatants with myocarditis.

Kappa index in the diagnostic work-up of autoimmune encephalitis

BackgroundThe presence of inflammatory changes in the cerebrospinal fluid (CSF), including immunoglobulin intrathecal synthesis (IS), can support the diagnosis of autoimmune encephalitis (AE) and allow prompt treatment. The main aim of our study was to calculate the Kappa index as a marker of IS, in patients with AE. MethodsCharts of patients undergoing a diagnostic work-up for suspected AE between 2009 and 2023 were reviewed and the Graus criteria applied. CSF and serum kappa free light chains were determined using the Freelite assay (The Binding Site Group) and the turbidimetric Optilite analyzer. ResultsWe identified 34 patients with “definite” AE (9 anti-NMDAR AE and 25 limbic AE) and nine patients with “possible” AE. Five patients (15%) with definite AE had pleocytosis and twelve (34%) showed CSF-restricted oligoclonal bands (OCB) at isoelectric focusing. The Kappa index was >6 in 29.4% and > 3 in 50% of the definite AE patients. It was elevated (>3) in 36.4% of patients with definite AE who resulted negative to OCB testing and was the only altered parameter suggestive of an ongoing inflammatory process in the CNS in three definite AE patients with otherwise normal CSF findings (i.e. normal cell count and protein levels, no OCBs). In the possible AE group, one patient had a Kappa index >3 in the absence of OCB. ConclusionsThe Kappa index could be useful, as a more sensitive marker of IS and as a supportive marker of neuroinflammation, in the diagnostic work-up of suspected AE.

Diagnostic and prognostic markers of morphofunctional heart state impairment and long-term persistence of heart failure in patients with myocarditis

The problem of myocarditis, has gained special relevance in recent years, therefore, the search for new diagnostic and prognostic markers of the disease unfavorable course is expedient for the timely appointment of optimal drug therapy, strengthening of regimen measures and adequate monitoring of the patient’s clinical condition. The purpose of the study: to establish laboratory and instrumental markers of morphofunctional heart state impairment and to develop a mathematical model for early prediction of long-term heart failure persistence in patients with myocarditis. We included 80 patients with acute myocarditis with a severe course and reduced left ventricular ejection fraction (LVEF) – ≤40 %. Assessment of laboratory and instrumental indicators was carried out in the 1st month from the onset of symptoms, after 6 and after 12 months of observation. All patients underwent for immunological studies, 24-hour ECG monitoring, echocardiography with speckle-tracking and cardiac magnetic resonance imaging. After 12 months of follow-up frequency of adverse cardiovascular events (ACE) was assessed. Statistical processing included Student’s t-test for comparison of mean values, binary logistic regression and ROC analysis, discriminant analysis. A set of morphofunctional instrumental indicators determined during the 1st month from the onset of myocarditis, which can serve as predictors of cardiovascular events during the next 12 months, was established: left ventricular ejection fraction ≤30 %; indicator of longitudinal global strain ≤7.0 %; the presence of paroxysms of non-sustained ventricular tachycardia; the presence of inflammatory changes in ≥6 segments and delayed contrast enhancement in ≥5 segments of the left ventricle. A mathematical model has been created, with the help of which it is possible to predict the adverse course of the disease with long-term (at least 12 months) persistence of heart failure already within the 1st month from the onset of myocarditis.

Порівняльна клінічна характеристика застосування цифрових і аналогових відбитків на якість непрямих реставрацій у пацієнтів із дефектами твердих тканин жувальних зубів у різні терміни спостереження

Introduction. Diseases of the hard tissues of the teeth are recognized as one of the most common dental diseases. These are mainly dental caries, congenital defects, fractures, fluorosis or acid erosion. Production of indirect restorations, which require taking impressions of the jaws, is one of the most common methods of restoring the hard tissues of the tooth when they are significantly destroyed. In today’s era of growing interest in digital dentistry, researchers are still undecided as to whether a digital impression provides the same accuracy as a conventional impression for making indirect restorations. Goal. To conduct a comparative characterization of the use of digital and analog impressions on the quality of indirect restorations in patients with defects of the hard tissues of chewing teeth at different follow-up periods. Research material and methods. The research involved 58 patients aged 25-60 years who applied to the Department of Stomatology of the P. L. Shupyk National Healthcare University of Ukraine for the purpose of orthopedic treatment of 79 defects of the hard tissues of the lateral teeth with destruction of 50-60% of their occlusal surface. In the course of orthopedic rehabilitation, patients were made indirect restorations - ceramic inlays using E. MAX Press material (Ivoclar Vivadent, Liechtenstein, Germany). The research group was further divided into 2 subgroups depending on the method of obtaining the impression. Subgroup A included patients who underwent digital scanning of a one-stage two-phase silicone impression, and subgroup B included patients who underwent impression removal using an intraoral digital impression system (TRIOS®, 3shape). The degree of destruction of the occlusal surface of chewing teeth and the choice of indirect restoration was carried out using the index of destruction of the occlusal surface of chewing teeth for I and II class according to Black (IROPZ). The clinical quality of indirect restorations was evaluated 1 week after the installation of the restoration and at long-term periods (12, 24, 36 months) using visual-instrumental control and according to the recommendations of the revised FDI criteria for the evaluation of direct and indirect dental restorations (2023). The presence of inflammatory changes in periodontal tissues was determined using the gingivitis index, the presence of dental plaque was determined using the OHI-S index (Green-Vermillion, 1964), the gingival sulcus bleeding index (SVI) was determined according to the Miihlemann and Son method before indirect restorations, during 1 week, 12 month and 24 month visits after cementation. Conclusion. Dental restorations made using digital impressions showed similar marginal discrepancy as restorations made using traditional impression methods (P>0.05). Lateral masticatory restorations fabricated by intraoral scanning using CAD/ CAM technology have acceptable results in terms of periodontal tissue condition, color, contour, marginal adaptation, and occlusion. Although both direct and indirect digitization have been shown to be equally effective, digital impressions have shown advantages in patient acceptance of the procedure. They take less time for both the doctor and the patient and facilitate the digital workflow. No significant difference was found between conventional and digital displays in the accuracy of the 3D data sets. Key words: defects of hard dental tissues, indirect restorations, digital and traditional impression, inflammatory changes in periodontal tissues, marginal adaptation.

On the issue of the etiology of acute inflammatory pathology of the pharynx in children

To compare the microbiota of the oropharynx in healthy children and children with acute tonsillitis and pharyngitis. The study included two groups of patients (139 people) aged from 1 year to 17 years inclusive. The main group consisted of children with acute tonsillitis and acute pharyngitis (111 patients, average age 7±4 years), the control group consisted of 28 healthy children (average age 7±6 years) without signs of upper respiratory tract infection. All patients were examined and material was taken from the mucous membrane of the posterior pharyngeal wall and palatine tonsils, the samples obtained were subjected to bacteriological examination to isolate a pure culture and identify bacterial microorganisms and virological examination by polymerase chain reaction in order to isolate a number of typical respiratory viruses and herpes viruses. It was found that viral-bacterial associations predominate (66.7%) in patients with acute tonsillitis and pharyngitis (32% in healthy volunteers). The detection rates of typical respiratory viruses and herpes viruses in patients with acute tonsillitis and pharyngitis are comparable (44% and 40.5%, respectively). Streptococcus pyogenes (beta-hemolytic streptococcus group A, 6.3%), as well as Streptococcus pneumoniae, Moraxella catarrhalis, Klebsiella pneumoniae and Pseudomonas aeruginosa were detected only in patients with acute tonsillitis. Other microorganisms were isolated both in healthy patients and in children with acute tonsillitis and pharyngitis, but in the presence of inflammatory changes in the pharynx, the concentration of microorganisms was slightly higher than in a healthy state, which is especially significant for Staphylococcus aureus. In patients without signs of inflammation, typical respiratory viruses (rhinovirus, 14%) and herpes viruses (with a predominance of type 6 herpes virus - 28%) were also found in a percentage comparable to that of patients with acute tonsillitis and pharyngitis. The etiology of acute tonsillitis and pharyngitis in children is dominated by viral-bacterial associations, while rhinovirus (34%) and herpes virus type 6 (28%) are among the viruses. The detection rate of Streptococcus pyogenes in patients with acute tonsillitis was 6.3%. Typical respiratory viruses and herpes viruses can be found on the mucous membrane of the oropharynx and outside the phenomena of inflammation. This once again proves the importance of comparing the clinical manifestations observed in a patient and data on the structure of the microbiota of a particular locus, including to address the need for systemic or local antimicrobial therapy.

Correlation Between Serum Magnesium & Zinc with Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) In Patients with Metabolic Syndrome

Metabolic syndrome (MS) increases cardiovascular disease and death risk. Many studies have found a link between vascular inflammation and metabolic disorders. Discovering unique and specific blood-based indicators for vascular inflammation, particularly in metabolic syndrome related to obesity, such as (lipoprotein-associated phospholipase A2) and Lp-PLA2, could provide valuable assistance in identifying individuals at an elevated risk for cardiovascular incidents. Lp-PLA2 has been implicated in metabolic dysregulation, playing a crucial role in the onset of microvascular dysfunction and the exacerbation of oxidative stress. Lp-PLA2 is essential in the pathogenesis of atherosclerosis and may be used as a biomarker to predict future cardiovascular events. The study comprised 200 participants categorized into two groups: individuals diagnosed with MS (Metabolic Syndrome) (Test, n = 100) and those without MS (controls, n = 100). The serum activity levels of hs-CRP and Lp-PLA2 were measured and subsequently analysed for correlation with micronutrients (magnesium (Mg) and zinc (Zn)) and lipoprotein markers (Ox LDL, Apo-A1, and Apo-B). The study showed a significant correlation between Lp-PLA2 and the Mg level of patients with MS, whereas Hs-CRP did not exhibit a significant correlation. The test population did not exhibit a noteworthy elevation in oxidized LDL level, despite the presence of inflammatory changes as indicated by the level of Lp-PLA2. A significant correlation was observed between the Zn level in patients with MS and Lp-PLA2, whereas Ox LDL did not exhibit a significant correlation. The current study revealed a significant link between Mg and Zn and CVD risk in the Kerala population. The study found elevated levels of LpPLA2, an emerging biomarker for cardiovascular risk, in people with MS

Coherence of the electroencephalogram and peripheral markers of nerve tissue damage in depressive disorders

To evaluate the coherence parameters of the electroencephalogram and the level of peripheral markers of nerve tissue damage in patients with depressive disorders. Thirty patients with a diagnosis from a cluster of mood disorders: affective disorder within a single depressive episode and recurrent depressive disorder were examined. A control group consisted of 30 healthy individuals, comparable in sex and age to the main group. The bioelectric activity of the brain was recorded and analyzed with the calculation of the averaged coefficients of intra- and interhemispheric coherence. The concentration of calcium-binding protein S100b, the main protein of myelin MBP and glial fibrillar acid protein GFAP was determined in blood sera by solid-phase enzyme immunoassay. Patients with depressive disorders showed signi cantly lower coefficients of interhemispheric coherence of alpha (p=0.003), beta (p=0.042) and theta rhythms (p=0.041), as well as intrahemispheric coherence of alpha rhythm in the left (p=0.016) and right hemispheres (p=0.026), beta rhythm in the right hemisphere (p=0.034) compared to the control group. Patients with depressive disorders showed a higher concentration of MBP compared to the control group (p=0.008). Additionally, we identified statistically significant correlations between EEG coherence coefficients and serum markers in patients with depressive disorders. The results clearly confirm the presence of inflammatory changes in the brain in patients with depression, which is reflected in structural and functional changes.

Advanced cross-sectional imaging of cerebral aneurysms.

While the rupture rate of cerebral aneurysms is only 1% per year, ruptured aneurysms are associated with significant morbidity and mortality, while aneurysm treatments have their own associated risk of morbidity and mortality. Conventional markers for aneurysm rupture include patient-specific and aneurysm-specific characteristics, with the development of scoring systems to better assess rupture risk. These scores, however, rely heavily on aneurysm size, and their accuracy in assessing risk in smaller aneurysms is limited. While the individual risk of rupture of small aneurysms is low, due to their sheer number, the largest proportion of ruptured aneurysms are small aneurysms. Conventional imaging techniques are valuable in characterizing aneurysm morphology; however, advanced imaging techniques assessing the presence of inflammatory changes within the aneurysm wall, hemodynamic characteristics of blood flow within aneurysm sacs, and imaging visualization of irregular aneurysm wall motion have been used to further determine aneurysm instability that otherwise cannot be characterized by conventional imaging techniques. The current manuscript reviews conventional imaging techniques and their value and limitations in cerebral aneurysm characterization, and evaluates the applications, value and limitations of advanced aneurysm imaging and post-processing techniques including intracranial vessel wall MRA, 4D-flow, 4D-CTA, and computational fluid dynamic simulations.

Kappa index in patients with autoimmune encephalitis

The diagnosis of autoimmune encephalitis (AE) can be complex and is supported by the presence of inflammatory changes in the cerebrospinal fluid (CSF), including intrathecal immunoglobulin synthesis (IS). Aim was to calculate the kappa index (CSF/serum kappa free light chain-KFLC-divided by CSF/serum albumin ratio), as a marker of IS, in patients with a diagnosis of AE or possible AE according to the Graus criteria.

Prognostic model for determining the probability of congenital pneumonia in full-term newborns

According to the data of the World Health Organization, pneumonia is one of the leading causes of death in children under five years of age. Objective: to develop a prognostic model to determine the factors associated with the development of congenital pneumonia in full-term newborns. A comprehensive survey of 116 full-term newborns who were in the pediatric Department for newborn children and the Maternity Physiological Department of the State Institution “Republican Scientific and Practical Center “Mother and Child” in the period from 2017 to 2019 was conducted. The study group consisted of 53 healthy full-term newborns with congenital pneumonia, born at the gestational age of 39.50 ± 0.69 weeks, body weight 3337.50 ± 354.42 g and a body length of 52.20 ± 2.13 cm. The control group consisted of 63 healthy full-term babies born at gestational age of 39.30 ± 0.63 weeks, body weight 3417.30 ± 253.82 g and a body length of 52.50 ± 1.57 cm. The survey revealed the most significant factors associated with the development of congenital pneumonia in full-term newborns: from the obstetric-gynecological and somatic history of the mother’s life — spontaneous miscarriage; from the complications of pregnancy — chronic intrauterine fetal hypoxia; the placenta study determined the presence of inflammatory changes in the placenta; clinical manifestations within the first 72 hours of life included respiratory failure. Based on the data obtained, a model with sensitivity equal to 92.5 %, specifi­city 92.1 % and an area under ROC-curve (AUC) 0.94 ± 0.054, p < 0.001 (95% CI 0.90–0.99). Using a prognostic model, thre­shold values were calculated: for spontaneous miscarriage — 0.810; chronic intrauterine fetal hypoxia — 0.289; inflammatory changes in the placenta — 0.565; the presence of respiratory failure — 0.928, which at threshold values ≥ 0.56 ROC-curve allows identify a high risk group for the development of congenital pneumonia among full-term newborns.

Osteoarthritis of the hand: clinical and ultrasound parallels

Osteoarthritis of the hand: clinical and ultrasound parallels

Adapting MRI as a clinical outcome measure for a facioscapulohumeral muscular dystrophy trial of prednisone and tacrolimus: case report

BackgroundFacioscapulohumeral muscular dystrophy (FSHD) is a patchy and slowly progressive disease of skeletal muscle. MRI short tau inversion recovery (STIR) sequences of patient muscles often show increased hyperintensity that is hypothesized to be associated with inflammation. This is supported by the presence of inflammatory changes on biopsies of STIR-positive muscles. We hypothesized that the STIR positivity would normalize with targeted immunosuppressive therapy.Case presentation45-year-old male with FSHD type 1 was treated with 12 weeks of immunosuppressive therapy, tacrolimus and prednisone. Tacrolimus was treated to a goal serum trough of > 5 ng/mL and prednisone was tapered every month. Quantitative strength exam, functional outcome measures, and muscle MRI were performed at baseline, week 6, and week 12. The patient reported subjective worsening as reflected in quantitative strength exam. The MRI STIR signal was slightly increased from 0.02 to 0.03 of total muscle; while the T1 fat fraction was stable. Functional outcome measures also were stable.ConclusionsImmunosuppressive therapy in refractive autoimmune myopathy in other contexts has been shown to reverse STIR signal hyperintensity, however this treatment did not reverse STIR signal in this patient with FSHD. In fact, STIR signal slightly increased throughout the treatment period. This is the first study of using MRI STIR and T1 fat fraction to follow treatment effect in FSHD. We find that STIR might not be a dynamic marker for suppressing inflammation in FSHD.

INTESTINAL LESIONS OCCURRING IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE AFTER SUFFERING THE COVID-19 INFECTION

The aim: To investigate the effectiveness of determining the activity of faecal calprotectin for detecting colonic lesions in patients with nonalcoholic fatty liver disease who have had a COVID-19 acute respiratory infection. Materials and methods: The study included 46 patients with non-alcoholic fatty liver disease NAFLD at the stage of outpatient observation after suffering a COVID-19 acute respiratory infection. Results: One of the main clinical signs indicating intestinal lesions among the COVID-19-infected patients with NAFLD at the time of admission to hospital was diarrhea (identified in 43.5% of cases during the patients’ examination), as well as bloating and pain in the colon (identified in 26.1% and 32.6% of cases during the patients’ examination, respectively). The analysis of the data obtained indicates a slight increase in the level of faecal calprotectin among NAFLD patients infected with COVID-19 during hospital treatment, and in this regard the indicators did not exceed the reference values. A more pronounced deviation from the norm was observed 2 months after hospital treatment, namely, its increase to 101.6 ± 2.5 μg / L. Conclusions: A frequent clinical manifestation of intestinal lesions among NAFLD patients infected with COVID-19 is defaecation disorder, which at the beginning of the disease is more often manifested through alternating diarrhea (up to 43.5%) and constipation (32.6% of the examined patients). NAFLD patients infected with the COVID-19 virus are diagnosed with an intensified activity of faecal calprotectin and α1-antitrypsin in the blood serum and faeces, as well as the clearance, and this indicates the presence of inflammatory changes in the colon, which requires conducting further research of these patients’ cases.

Clinical effectiveness of catheter treatment for atrial fibrillation depending on the dynamics of histological changes in the myocardium

Background. Atrial fibrillation (AF) is combined with an inflammatory process that occurs in the myocardium. Diagnosis of histological changes, including inflammatory changes, in the myocardium is a complex task in the field of modern medicine. The only reliable way of determining the inflammatory changes in the myocardium is endomyocardial biopsy (EMB). As per our literature review, there are no data on the effect of histological changes in the myocardium on the efficacy of interventional treatment for AF. Moreover, assessing the dynamics of EMB results allows us to approach the treatment of patients in greater detail, thereby lowering the risk of the development and progression of serious cardiac pathologies, particularly AF.Aim. To study the effectiveness of catheter treatment for ‘idiopathic’ AF, depending on the dynamics of histological changes in the myocardium.Methods. We enrolled 48 patients with an ‘idiopathic’ form of AF; the median patient age was 39.0 y (33.5–48.0 y). Of these, 42 (87.5 %) were men and 6 (12.5 %) were women. The median duration of arrhythmic history was 4.0 y (2.0–7.0 y). All the patients underwent radiofrequency isolation of the pulmonary veins (Rcil) and EMB from the right ventricle. Histological tests, using the criteria of Cristina Basso, and immunohistochemical (IHC) tests were performed to determine the antigens of the following viruses: herpes simplex virus (HSV) types 1, 2 and 6, enterovirus (EV), Epstein-Barr, adenovirus and parvovirus (PV). After 6 mon, EMB, histological and IHC studies were repeated. Depending on the clinical form of AF, the patients are divided into the following three groups: group 1—paroxysmal form [21 (43.7 %) patients], group 2—persistent [13 (27.1 %) patients], group 3—long-term persistent [14 (29.2 %) patients]. Based on the results of the observation and evaluation of effectiveness, all the groups were divided into the following three subgroups: a—absence of AF during 12 mon of observation, b—early arrhythmia recurrences were registered during the first 3 mon of observation, c—presence of late arrhythmia recurrence after 3 mon of observation.Results. According to the histological criteria for active lymphocytic myocarditis identified in the subgroups, there were 5 patients (35.7 %) in 1a, 2 (50 %) in 1b, 6 (75 %) in 2a, 2 (66,7 %) in 2b, 7 (70 %) in 3a, 2 (66.7 %) in 3b, and 1 (100 %) in 3c. The rest of the patients showed signs of lymphocytic infiltration. After 6 mon, only in group 2a, there was a significant reduction in the number of patients with active lymphocytic myocarditis (p < 0.05). All the patients showed fibrotic changes and expression of HSV 6 and EV antigens of varying severity; this persisted till after 6 mon. The overall effectiveness of the surgical treatment was 66.7 % for paroxysmal, 61.5 % for persistent and 71.4 % for long-term persistent forms of AF during 12 mon of follow-up.Conclusion. Patients with ‘idiopathic’ AF show inflammatory changes in the myocardium, and 48.7 % met the criteria for myocarditis. All the patients showed the expression of viral antigens and the development of fibrosis that met the criteria for post-inflammatory changes. A repeat study that was conducted after 6 mon showed no significant dynamics of inflammatory and fibrotic changes. Despite the presence of inflammatory changes in the myocardium, the effectiveness of catheter treatment was 66.7 % for paroxysmal, 61.5 % for persistent and 71.4 % for long-term persistent forms of AF. Received 29 April 2020. Revised 1 June 2020. Accepted 3 June 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: A.E. Shelemekhov, R.E. BatalovData collection and analysis: A.E. Shelemekhov, Yu.V. Rogovskaya, S.Yu. Usenkov, E.A. Archakov, M.S. Rebenkova Drafting the article: A.E. ShelemekhovStatistical analysis: A.E. Shelemekhov, A.M. GusakovaCritical revision of the article: R.E. Batalov, Yu.V. Rogovskaya, A.M. GusakovaFinal approval of the version to be published: A.E. Shelemehov, R.E. Batalov, Yu.V. Rogovskaya, S.Yu. Usenkov, E.A. Archakov, A.M. Gusakova, M.S. Rebenkova

An investigation into the factors predicting acute appendicitis and perforated appendicitis.

To investigate the factors predicting acute appendicitis (AAp) and perforated AAp in patients who underwent surgery with a preliminary diagnosis of AAp. Between May 2009 and December 2018, 1316 patients underwent appendectomy with a presumed diagnosis of AAp. To investigate the factors predicting AAp, patients were divided into two groups considering the histopathological presence of inflammatory changes in the appendix: AAp positive (AAp group; n=1043) and AAp negative (Non-AAp group; n=273). Also, to investigate the factors predicting appendiceal perforation, patients with AAp were divided into two groups considering the presence of perforation: non-perforated AAp (n=850) and perforated AAp (n=193). ROC curve analysis was used to identify optimum cut-off values of quantitative variables. The groups were compared using univariate analysis methods and parameters with a p≤ 0.20 were taken into a multivariate logistic regression model. Multivariate analysis method related to factors predicting AAp showed that gender (male; p=0.034; OR=1.4), WBC (≥10.900; p=0.022; OR=1.5), MPV (≥29.1; p=0.006; OR=1.6), TBil (≥0.61; p=0.034; OR=1.4), CRP (≥0.725; p=0.002; OR=1.7), NLR (≥5.13; p=0.034; OR=1.5), PNR (<24.04; p=0.001; OR=1.9) and US findings (AAp+; p<0.001; OR=2.9) were independent factors for predicting AAp. Multivariate analysis method related to factors predicting appendiceal perforation showed that age (≥32 years; p<0.001; OR=2.5), TBil (≥0.67; p=0.046; OR=1.5), CRP (≥3.75; p<0.001; OR=3.0) and NLR (≥5.69; p=0.006; OR=1.8) were independent factors for predicting perforated AAp. We believe that predicting both AAp and perforation will help the clinician evaluate patients who applied to the emergency unit with presumed diagnosis AAp. This approach will also contribute to reducing the negative appendectomy and perforation rates.

Three Tesla 3D High-Resolution Vessel Wall MRI of the Orbit may Differentiate Arteritic From Nonarteritic Anterior Ischemic Optic Neuropathy.

Anterior ischemic optic neuropathy (AION) is the most common cause of acute optic neuropathy in older patients. Distinguishing between arteritic AION (A-AION) and nonarteritic (NA-AION) is paramount for improved patient management. The aim of this study was to evaluate 3-dimensional high-resolution vessel wall (HR-VW) magnetic resonance imaging (MRI) at 3 T to discriminate A-AION from NA-AION. This prospective single-center study was approved by a national research ethics board and included 27 patients (17 A-AION and 10 NA-AION) with 36 AIONs from December 2014 to August 2017 who underwent 3 T HR-VW MRI. Two radiologists blinded to clinical data individually analyzed the imaging separately and in random order. Discrepancies were resolved by consensus with a third neuroradiologist. The primary diagnostic criterion was the presence of inflammatory changes of the ophthalmic artery. Secondary diagnostic criteria included the presence of an enhancement of the optic nerve or its sheath, the optic disc, or inflammatory changes of posterior ciliary or extracranial arteries. A Fisher exact test was used to compare A-AION from NA-AION patients. Inflammatory changes of the ophthalmic artery were present in all patients with A-AION but in none of NA-AION (P < 0.0001). Its sensitivity, specificity, positive predictive value, and negative predictive value were 100%. Inflammatory changes of posterior ciliary arteries were significantly more likely in A-AOIN (82% vs 0%, P < 0.0001). Interreader and intrareader agreements were almost perfect (κ = 0.82-1). High-resolution vessel wall MRI seems highly accurate when distinguishing A-AION from NA-AION and might be useful to improve patient management.

Modern morphological characteristics of alcoholic, non-alcoholic and toxic steatohepatitis

Objective: to characterize the pathological features of alcoholic, non-alcoholic and toxic steatohepatitis (SН) for use in forensic-histological diagnostics.Material and methods. By histological (G), histochemical (HC) and immunohistochemical (IHC) methods we studied changes in 239 liver biopsy samples of 450 deceased patients with alcoholic, non-alcoholic, toxic SH and hepatic steatosis.Results. Chronic alcoholic, non-alcoholic and toxic SG is characterized by zonal steatosis of hepatocytes; the presence of steatonecrosis and apoptosis of hepatocytes, ballooning hepatocytes, hepatocytes with Mallory-Denk bodies, lesions of lobular necrosis and sinusoidal steatopeliosis, portal-lobular infiltrates of leukocytes, lymphocytes and macrophages; moderate perisinusoidal infiltration of CD68 + by macrophages, plasma cells, CD4 + and CD8 + T‑lymphocytes; as well as perisinusoidal-pericellular or portal-Z1-3perisinusoidal fibrosis of the liver. It differs from simple steatosis and acute toxic-drug hepatic steatosis by the presence of inflammatory changes and liver fibrosis.Conclusions. Despite certain microscopic differences between alcoholic, non-alcoholic and toxic SG for their differential diagnosis, the expert-histologist requires clinical and laboratory data of patients and the results of forensic chemical studies of the deceased patients.

Predictors of unfavorable course of acute myocarditis with reduced left ventricular ejection fraction

Early prediction of myocarditis clinical course still remains one of the actual tasks of cardiological science, which has a significant practical value. The purpose of the study was to determine the predictors of unfavorable course of myocarditis with reduced ejection fraction (EF) of the left ventricle (LV) on the basis of follow-up during 24 months. The study included 90 patients with acute myocarditis and reduced LV EF, who were examined in the first month after the disease onset, after 6, 12 and 24 months of follow-up. All patients underwent for echocardiography, Holter monitoring of the electrocardiogram and cardiac magnetic resonance imaging. Statistical processing of the results was performed using the Excel XP software (Місrosoft Office, USA) and Statistica for Windows v. 6.0 (Statsoft, USA). It was found that restoration of cardiac contractility in patients with myocarditis and reduced LV EF began with an increase in the index of LV longitudinal global systolic strain, which occurred 6 months after the debut of the disease and was associated with a decrease in the number of LV segments affected by the inflammatory process, and a significant increase of LV EF and a decrease of LV end-diastolic volume were observed only 1 year after the disease onset. The predictors of cardiovascular events in patients with acute myocarditis during the next 24 months from the onset of the disease, were detected in the 1st month from the debut of the disease and included following pathological changes: value of the LV EF ≤ 30%; reduction of LV longitudinal global systolic strain ≤ 7.0%; evidence of non-sustained ventricular tachycardia, presence of inflammatory changes in ≥6 LV segments, presence of delayed enhancement in ≥ 5 LV segments. Prospects for further research are the creation of registries of patients with myocarditis on the basis of multicenter clinical trial results on a large number of patients surveyed in order to improve diagnosis, prediction of clinical course and identification of early diagnostic markers of cardiovascular events and quantitative risk assessment of their development.

Diagnostic accuracy of laboratory and ultrasound findings in patients with a non-visualized appendix

Ultrasound (US) and laboratory testing are initial diagnostic tests for acute appendicitis. A diagnostic dilemma develops when the appendix is not visualized on US. Objective: To determine if specific US findings and/or laboratory results predict acute appendicitis when the appendix is not visualized. Methods: A prospective study was conducted on children (birth-18 yrs) presenting to the pediatric emergency department with suspected acute appendicitis who underwent right lower quadrant US.Children with previous appendectomy, US at another facility, or eloped were excluded. US findings analyzed: inflammatory changes, right lower quadrant and lower abdominal fluid, tenderness during US exam and lymph nodes. Diagnoses were confirmed via surgical pathology. Results 1252 subjects were enrolled, 60.8% (762) had appendix visualized and 39.1% (490) did not. In children where the appendix was not seen, 6.7% [33] were diagnosed with appendicitis. Among patients with a non-visualized appendix, the likelihood of appendicitis was significantly greater if: inflammatory changes in the RLQ (OR 18.0, 95% CI 4.5–72.1), CRP >0.5 mg/dL (OR 2.64, 95% CI 1.0–6.8), or WBC > 10 (OR 4.36, 95% CI 1.66–11.58). Duration of abdominal pain >3 days was significantly less likely associated with appendicitis in this model (OR 0.34, 95% CI 0.003–0.395). Combined, the absence inflammatory changes, CRP < 0.5 mg/dL, WBC < 10, and pain, ≤3 days had a NPV of 94.0%. Conclusion When the appendix is not visualized on US, predictors for appendicitis include the presence of inflammatory changes in the RLQ, an elevated WBC/CRP and abdominal pain <3 days.