Objective. To evaluate changes in the shear stress of the internal carotid artery (ICA) wall after carotid endarterectomy (CEAE) in the remote postoperative period. Material and methods of the study. 26 patients (65±2.9 years old) with ICA pathology were examined before surgery, with an average degree of stenosis of 80.4±3.3% (64–95%). According to echogenicity, the distribution of plaques was as follows: predominantly hypoechoic – 12, hyperechoic – 10, and isoechoic – 4. After carotid endarterectomy (CEAE) in the hospital period, satisfactory echolocation allowed for the examination of 19 patients (61.6±2.7 years). In the long-term period, 12 patients (63.1±2.0 years) were examined 6–14 months later. The study was conducted using a Mindray Resona 7 ultrasound scanner (China) and a linear sensor (2.5–9 MHz) in V-flow mode. Systolic blood f low velocity (Vs), wall shear stress (WSS), and blood flow turbulence were assessed using vector analysis before and after stenosis. The change in the direction of the WSS vector during the cardiac cycle was described using the Oscillatory Shear Index (OSI). The intra-group correlation coefficient was calculated for the measurement of wall stress and shear. Results. Before surgery, ICA stenosis is characterized by changes in WSS in different parts of the artery and increased blood flow turbulence. The adequacy of the CAEA operation was assessed based on the dynamics of changes in blood flow velocity and the ratio of wall shear stress to the proximal and distal vessels. In the long-term postoperative period, the direction and velocity of the flow vectors approach normal values, which serves as one of the hemodynamic indicators of the adequacy of surgical correction of ICA stenosis. Conclusion. The criteria for adequate correction were the normalization of intravascular blood flow, wall shear stress, and oscillation index, as well as the reduction of blood flow turbulence. The registration of wall shear stress using V-flow in patients with cerebrovascular diseases represents a new approach for evaluating the results of surgical treatment.

Echocardiographic (EchoCG) assessment of LV DF remains a complex difficult task. The application of the algorithm proposed by current guidelines (ASE/EACVI, 2016), which involves the assessment of transmitral flow, tissue Doppler myocardial velocities, LA maximum volume index, LAVI, and tricuspid regurgitation (TR) velocity, leads to the fact that the presence and severity of LV diastolic dysfunction (DDF) remain uncertain in a significant proportion of patients. The maximum LAVI index is certainly a marker of the duration and severity of LV DDF, but it cannot serve as the only parameter for diagnosing early phases of LV DDF, before the formation of LA remodeling. Left atrial (LA) function assessment is an important part of the left ventricular (LV) diastolic dysfunction (DF) the assessment and heart failure with preserved ejection fraction. Since the main function of the LA is to modulate LV filling, it is logical that at the earliest stages of LV DDF, LA functional changes first appear. LA function testing may be useful not only for diagnosing LV DDF, but also for assessing its severity and monitoring treatment effectiveness. In this review the evolution of approaches to assessing LV DF, as well as the key role of LA parameters in assessing LV DDF are considered.

Introduction. Nerve conduction study (NCS) is the main component of instrumental diagnostics of ulnar neuropathy at the elbow (UNE). In recent years, ultrasound (US) examination has become increasingly important, allowing the identification of the site of compression, dynamic examination, and assessment of the structures surrounding the nerve. Aim. To compare the results of NCS and US in patients with clinical signs of UNE. Materials and methods. The NCS and US data were analyzed in 93 patients with clinical signs of mild (86 patients) and moderate (7 patients) UNE. Standard NCS studies and US of the ulnar nerve were analyzed. Results. Electrophysiological changes corresponding to UNE were detected in 48 (51.5%) examined patients, ultrasound changes in 50 (54%). The groups with positive and negative NCS and US results did not differ in the main anthropometric characteristics and disease duration. When the left ulnar nerve is involved, nerve conduction study and ultrasoun are often positive; the presence of m. anconeus epitrochlearis in the retroepicondylar groove is often accompanied by negative nerve conduction study results. The ulnar nerve CSA is characterized by an inverse correlation with the amplitude of the ulnar nerve sensory response, motor nerve conduction velocity at the elbow and compound muscle action potential amplitude recorded from abductor digiti minimi muscle. The maximum ulnar nerve CSA at the elbow differs in patients with different UNE severity (p = 0.0001). Conclusions. In the group of patients, which was characterized by a predominance of patients with mild cubital tunnel syndrome, NCS and ultrasound results are highly consistent. The identified factorial interactions indicate the need for a comprehensive approach to diagnosing ulnar nerve lesions, taking into account the lateralization of the process and the specific anatomical features.

The quadricuspid aortic valve (QAV) is a rare congenital heart anomaly that can remain asymptomatic for a long time. Modern non-invasive imaging methods significantly shift the timing of diagnosis and allow for the identification of such patients at earlier stages and their adequate monitoring.

According to Russian clinical COPD guidelines (2024), 101 bronchial asthma (BA) patients were diagnosed with a possible BA and COPD overlap (32.7%). The main clinical and functional characteristics were compared in patients with BA without (BA group) and with COPD overlap (BA+COPD group). Against the background of a higher rate of pack-years indicator, severe asthma with more pronounced bronchial obstruction and reduced SpO2 levels was more common in BA+COPD group. According to the results of 6MWT in BA+COPD group, we revealed a more pronounced impairment of physical performance against the background of a more significant decrease in all main characteristics of blood oxygenation before, during and after 6MWT combined with high levels of desaturation-distance ratio (DDR) and the need for additional O2 flow during physical activity (O2-GAP index). The potential diagnostic regression model included: age, the factor of the severe asthma presence, the factor of the lack of complete control of bronchial asthma according to GINA, the DDR value, the dynamics of dyspnea as a result of 6MWT, average blood oxygenation after 6MWT, FEV1 , FVC and pack-years indicator. Three independent factors were included in the final model to accurately determine the probability of a combination of bronchial asthma and COPD: DDR, FEV1 , and pack-years indicator. The developed model has characteristics: AUC=0,88 (p<0.001), the sensitivity is 75.0%, specificity is 90.6%. The BA and COPD overlap was highly probable with the diagnostic threshold of the model ≥0.481.

Background. Determination of the QRS axis (axQRS) plays a significant role in electrocardiograms’ (ECG) interpretation. Although multiple techniques have been introduced for estimating of axQRS, the frequency of their use by practicing physicians unknown. The study aimed to explore the frequency of usage of different axQRS assessment methods and evaluate physicians’ attitudes toward the accuracy of automatic axQRS determinations. Materials and methods. A web-based questionnaire was administered via Yandex Forms between June 24th and July 6th, 2025. Respondents included functional diagnostics physicians and cardiologists invited through specialized groups on the Telegram messenger. The obtained data underwent statistical analysis using R software. Key Findings. Analysis of 689 completed questionnaires indicated that the most common approach for axQRS estimation is the visual approximation method, which is favored by the majority of surveyed physicians (56%). Only 10% of respondents reported relying exclusively on precise table-based or calculator-assisted calculations. According to the consensus view of most participants, an acceptable level of accuracy for axQRS determination lies within approximately ±8 degrees. A substantial proportion of doctors expressed overall satisfaction with the accuracy of automated axQRS evaluations. Conclusion. The visual method has emerged as the preferred choice among physicians owing to its ease and practicality. Published evidence supports its high concordance with more exact computational approaches for determining axQRS position. Furthermore, many physicians find the outcomes provided by automated axQRS calculations satisfactory. The visual method for determining axQRS positions in Gertsch – Mueller-Leisse variant is described and recommended for practical use.

The world's first neurosurgical institute was established in Leningrad in 1926 and now bears the name Polenov Russian Research Neurosurgical Institute (branch of the Almazov National Medical Research Center). Neurophysiology has been one of the main areas of scientific research since the Institute was set up. An original scientific school was formed, with A.D. Speransky and A.V. Lebedinsky at its origins. From the very beginning, neurosurgery was formed in an inseparable alliance with intraoperative neurophysiology, whose history dates back to the use of electrophysiological techniques in peripheral nervous system surgery. The established clinical and physiological direction allowed the institute to take one of the leading positions in fundamental and clinical neurophysiology in the 1930s and 1940s. The team's scientific activities were characterized by the mutual penetration of neurosurgery and neurophysiology research.