The article continues a series of articles on the interpretation of the latest national recommendations on spirometry. Examples of spirogram interpretation in adults and children are considered, such spirogram variants as dysanapsis, PRISM, etc. are given. The difference in clinical conclusions when using different systems of predicted values and different approaches to assessment (as a percentage of the predicted value and by the z-criterion) is reflected.

The lecture is devoted to ultrasound examination of the heart in premature newborns. The lecture highlights the features of premature infants in the neonatal period. The issues re-lated to ultrasound diagnostics of persistent pulmonary hypertension of newborns and the functional state of the right ventricle are reflected. The role of ultrasound in the assessment of transient posthypoxic myocardial ischemia is shown. The criteria for ultrasound diagno-sis of a hemodynamically significant functioning arterial duct in premature newborns are presented.

Ultrasound imaging is one of the modern methods for detecting atherosclerotic vascular lesions.

Goal. To evaluate the relationship between wall thickness, shear stress, and blood flow turbulence in atherosclerosis of the internal carotid artery.

Research materials and methods. 32 healthy men and women aged 29 to 44 years (average age 32±2.1 years) and with internal carotid artery stenosis of less than 50% in 48 patients aged 43 to 64 years (average age 51±3.1 years) were examined. All studies were performed at rest on a Mindray Resona 7 ultrasound machine (China) equipped with a linear sensor (3–11 MHz) with Vflow software. The wall thickness, systolic blood flow velocity (Vs) before and after stenosis, wall shear stress (WSS) by vector analysis, and blood flow turbulence before and after stenosis were calculated. The change in the direction of the voltage vector during the cardiac cycle was described using the oscillation index (OSI). The intragroup correlation coefficient was calculated for measuring arterial tension, wall thickness, and blood flow turbulence.

Results. The results of examination of patients with less than 50% internal carotid artery stenosis were analyzed. The thickness of the internal carotid artery wall and the percentage of plaque stenosis were assessed. The average arterial wall thickness ranged from 0.8 to 2.1 mm, the average value was 1.4±0.4 mm. Blood flow turbulence in stenosis after narrowing was almost 6 times higher than normal (P<0.01). The shear stress of the wall correlated with vascular wall thickness (r= 0.55) and blood flow turbulence (r=0.42).

Conclusion. With internal carotid artery stenosis < 50%, the wall shear stress was higher than normal. The narrowing is accompanied by turbulence of blood flow in both the distal and proximal sections. An increase in the wall thickness of the internal carotid artery leads to a decrease in tension in the area of stenosis by more than 1.6 times compared with the norm. At the same time, the oscillation index in stenosis is increased by 8 times compared to the norm. The registration of wall shear stress using vector flow mapping is a new and promising direction for assessing pathology and assessing the initial form of vascular narrowing.

A limited opportunity of results definition of physiotherapeutic correction vasomotor function at patients with an arterial hypertension represents an obvious problem of medical rehabilitation.

Material and methods. The 92 patients with an arterial hypertension were examined. Con-ducted the bicycle-stressful research at patients of the first group (n=48) was complemented with Doppler measurement of renal artery blood-groove in a with calculation of peak speed and vas-cular resistance (Vps-RA and RI-RA), and at patients of the second group (n=44) the similar measurements were taken in an middle cerebral artery (Vps-MCA and RI-MCA).

Results. The load increase in Vps-RA by 68% [62–70] accompanied with increase in RI-RA for 20% [17–21] was initially observed, after treatment the load speed of kidney perfusion increased up to 72% [70–77], and the resistance decreased to 16% [10–14]. Cerebral blood circulation was characterized by orthostatic decrease in Vps-MCA by 22% [16–23] with the small load growth by 28% [26–30] accompanied with increase in RI-MCA by 30% [18–23]. After complex physical therapy the orthostatic Vps-MCA decrease was 12% [10–15], exercise increased to 34% [30-38], and RI-MCA increased only by 18% [16–24]. Placebo-therapeutic distinctions were statistically significate (р<0,005).

Conclusion. Stressful Doppler-angiographic researches of aortic-renal and hemisphere blood circulation sensitively reflect efficiency of physiotherapeutic correction of system intra organ and brain vasomotor function. Use of the compact equipment and the simplified measurements, allow to integrate technologies into work of institutions of medical rehabilitation.

Introduction. The aim of the study is to assess the risk of arterio-arterial embolism in patients with cerebral circulatory disorders with stenosis of the internal carotid arteries (ICA) of various degrees, depending on the characteristics of atherosclerotic plaque (ASB), its risk level according to the Plaque-RADS classification.

Materials and methods. The study included 47 patients with symptomatic ICA stenosis (39 men and 8 women aged 61±11 years). All patients underwent duplex scanning of the brachiocephalic arteries, magnetic resonance or computed tomography of the brain and transcranial Doppler monitoring in the mode of embolodetection. Based on the ultrasound data, ASB was classified according to the Plaque-RADS classification.

Results. The relationship between the registration of microembolism and the ASB category according to the Plaque-RADS classification was revealed. The greatest embologenicity was shown by ASBS belonging to categories IV a, IV b, IV c. A smaller number of microemboli were isolated by plaques of the RADS category II.

Conclusions. Plaque embologicity depends not only on the degree of plaque-induced stenosis, but also, to a large extent, on the structure of the ASB.

Objective. To assess the incidence of hypertensive response of arterial pressure (BP) to exercise (HRE) during stress echocardiography (SE) in patients with known or suspected coronary artery disease and the effect of HRE on the results of ABCDE-SE.

Materials and methods. The single-center study included 193 patients who underwent ABCDE-SE (evaluation of wall motion abnormalities, B-lines, contractile reserve (CR), coronary, chronotropic) with traditional assessment of BP response. The incidence of HRE during SE and the relationship of HRe with positive SE results were studied.

Results. The prevalence of HRE was 36.3% (70 patients). Patients with HRE more often had low exercise tolerance (p=0.013); coronary artery blood flow velocity at rest and under load, CR value were higher in patients with HRE (p=0.009, p=0.008 and p=0.002). Among patients with HRE CR decrease was less common than among patients with adequate BP response: 45 (64.3%) versus 99 (80.5%) (p=0.013).

Conclusion. Excessive BP increase during SE may be a limiting feature leading to premature termination of testing, which means worse exercise tolerance compared to normotensive patients. There is a relationship between BP response to load and ABCDE-SE results, in particular the effect of peak BP on CR. The relationship between BP response to load and SE steps, as well as its prognostic significance, require further study.

The article presents the results of clinical and ultrasound examination of the subcutaneous veins of the lower extremities of 165 patients, including 20 healthy volunteers, 100 patients with chronic venous insufficiency (CVI) in stages C3–C4a and 45 patients with trophic ulcers (stage C6) according to the CEAP classification of 2020. The focus was on measuring the internal lumens of the large (LSV) and small subcutaneous veins (SSV) on the affected and conditionally healthy lower extremities. Conditionally healthy lower limb is a limb without clinical and ultrasound signs of CVI in the presence of these signs on the diseased opposite limb. Mean diameters of LSV and SSV in patients with CVI (classes C3–C4a and C6 according to the CEAP 2020 classification) significantly exceeded those of healthy volunteers (p < 0.01): LSV at C6 – 8.1 ± 1.5 mm, at C3–C4a – 6.8 ± 1.6 mm, in healthy volunteers – 3.3 ± 0.4 mm. On conditionally healthy limbs of patients with signs of CVI on the second lower limb, the internal dimensions of the SSV were significantly larger than in healthy volunteers, which indicates a systemic nature of the disease even in the absence of clinical manifestations. The frequency of conditionally healthy limbs decreased from 84% at stages C3–C4a to 42% at stage C6 according to the CEAP classification of 2020, which indicates the progression of the pathology. The results of the study show the commonality of pathophysiological processes in the venous walls of both lower extremities in CVI. That is why dynamic ultrasound control of subcutaneous veins of conditionally healthy limbs is advisable in patients with signs of CVI on a sick lower limb both before and after surgery.

Aortic systolic blood pressure (aoSBP) is a strong predictor of target organ damage. Arterial stiffness, assessed by pulse wave velocity (PWV), is an independent predictor of future cardiovascular events in adults. Non-invasive assessment of aoSBP and PWV can be performed using brachial oscillometry (BO) during ambulatory blood pressure monitoring (ABPM). The aim of the study was to evaluate 24-hour aoSBP and PWV profiles obtained by BO during ABPM in adolescents with masked hypertension (MH).

Materials and methods. A simple non-interventional study of 103 adolescents (56 boys) aged 13–17 years (mean age 14.6±1.7 years) assessed 24-hour aoSBP and PWV profiles using BO. The MH group included 30 adolescents (16 boys), while the control group consisted of 73 normotensive adolescents (40 boys).

Results and discussion. Adolescents with MH had significantly higher mean 24-hour aoSBP compared to those with normal blood pressure (119.06±4.52 mmHg vs 102.23±7.36 mmHg, p=0.001). The degree of nocturnal aoSBP dipping was significantly lower in MH adolescents (9.6±5.8% vs 11.57±3.71%, p=0.04). Mean 24-hour PWV did not differ between groups (8.93±1.77 m/s vs 8.62±2.18 m/s, p=0.49), but nocturnal PWV dipping was significantly reduced in MH adolescents (7.22±9.49% vs 11.89±6.8%, p=0.006).

Conclusion. The results demonstrated that adolescents with MH have distinct 24-hour aoSBP and PWV profiles compared to normotensive adolescents, characterized by higher aoSBP values and impaired nocturnal dipping of both aoSBP and PWV.

The concept of formation of the summary electroencephalogram is proposed, based on the hypothesis of the existence of three different, but interconnected mechanisms of bioelectrical activity generation: dendritic integration processes, processes of change in the level of constant potential, impulse activity of cortical neurons. The interaction of sources of different nature underlies the activity recorded on the summary EEG. With the dominance of the thalamocortical system, rhythmic activity is recorded, the frequency of which depends on the functional state of the central nervous system. Discharge forms of activity on the EEG reflect the hypersynchronous impulse activity of a large pool of cortical neurons. The basis of the slow-wave activity of the delta range are dysmetabolic processes, on the one hand, suppressing the thalamocortical mechanism, on the other, causing pronounced changes in the constant potential. The proposed concept is aimed not only at explaining the diversity of EEG phenomenology, but also opens up opportunities for finding new methods of EEG analysis based on an understanding of physiological mechanisms.