UDC 616.13‑004.6‑02:577.112.85]-038:616.12‑008.331.1(048.8)

Introduction. Elevated lipoprotein(a) has emerged as an important determinant of cardiovascular risk because of its roles in atherosclerotic disease, vascular inflammation, endothelial dysfunction, arterial stiffening, and vascular calcification. Increasing evidence suggests that the clinical significance of Lp(a) extends beyond atherosclerosis, as higher concentrations have also been linked to vascular remodeling and adverse cardiovascular outcomes in patients with arterial hypertension.

Aim. To evaluate the current scientific evidence on the role of lipoprotein(a) in vascular remodeling and its effects on endothelial function, arterial stiffness, and cardiovascular risk among patients with arterial hypertension.

Materials and methods. The MEDLINE database via PubMed was searched for articles published between 2016 and 2026 using a predefined set of keywords. The search yielded 86 articles, which were initially screened and assessed based on their titles and abstracts. After evaluating relevance, we selected 56 articles for detailed assessment. Finally, 31 articles were included in the review.

Results. Elevated Lp(a) concentrations are linked to multiple mechanisms that drive vascular remodeling and cardiovascular injury. A substantial part of Lp(a)'s pathogenic activity is attributed to oxidized phospholipids, which contribute to endothelial dysfunction, vascular inflammation, extracellular matrix remodeling, fibrosis, and vascular calcification. Research indicates associations between elevated Lp(a) levels and increased pulse pressure, reduced nocturnal blood pressure decline, arterial stiffness, vascular calcification, and hypertensive target-organ damage. These findings suggest that elevated Lp(a) may influence the development of a less favorable vascular profile in arterial hypertension and contribute to cardiovascular risk beyond that explained by traditional lipid markers. The development of RNA-based therapeutic approaches, including antisense oligonucleotides and small interfering RNA agents, has enabled substantial reductions in circulating Lp(a) levels and may provide new opportunities for individualized cardiovascular risk management.

Conclusions. Elevated lipoprotein(a) levels should be regarded as an important genetically determined factor in vascular remodeling and cardiovascular risk in patients with arterial hypertension. Increased lipoprotein(a) concentrations contribute to endothelial dysfunction, vascular inflammation, arterial stiffness, vascular fibrosis, and calcification through multiple mechanisms, predominantly mediated by oxidized phospholipids.

ABSTRACT A 16-year-old male (ASA II, BMI 31) underwent reconstructive osteoplasty with insertion of a polymethylmethacrylate (PMMA) spacer. Shortly after cement application, he developed sudden hypotension, tachycardia, and decreased end-tidal CO₂, consistent with Grade II BCIS. Supportive management with fluids, ketamine, and norepinephrine stabilized the patient. Postoperatively, he experienced recurrent hypotension, acute kidney injury, and elevated liver enzymes and creatine kinase. Intensive care treatment resulted in recovery, and he was discharged from the ICU on day five. Bone cement implantation syndrome, though exceptionally uncommon in pediatric patients, may develop during orthopedic procedures involving polymethylmethacrylate. Early recognition, continuous anesthetic vigilance, and timely multidisciplinary intervention are crucial to reduce morbidity and improve perioperative outcomes.

KEY WORDS: bone cements, anesthesia, hypotension, acute kidney injury, vasopressors, creatine kinase

Aim: To determine the significance of growth factors (TGF-β1 and CTGF) in the development and progression of diabetic retinopathy (DR) in carriers of different genotypes of the TGFB1 rs1800470 polymorphism in type 2 diabetes mellitus (T2DM).

Materials and Methods: 102 individuals with T2DM and DR were examined, who were divided into 3 groups: 1st – with non-proliferative DR (NPDR, 35 individuals), 2nd – with preproliferative (PPDR, 34 individuals) and 3rd – with proliferative (PDR,33 individuals); 61 individuals were included in the control group. The patients underwent standard ophthalmological examinations. Determination of TGF-β1 in blood serum and intraocular fluid (IOF) and CTGF in IOP was performed by enzyme-linked immunosorbent assay (Invitrogen Thermo Fisher Sci., USA). Alleles rs1800470 (T869C) were determined by polymerase chain reaction (TaqMan Mutation Detection Assays Life-Technology test system, USA). For statistical studies, the MedStat and MedCalc v.15.1 software packages (MedCalc Software bvba) were used.

Results: Rs1800470 A/Acarriers had worse visual acuity (p=0.016) and higher central retinal thickness and volume (p<0.001) compared to G/G carriers. In DR the content of TGF-β1 in the blood and IOF and CTGF in IOF significantly exceeded that in controls (by 1.5-5.2 times; p<0.05). The highest content of both factors in DR compared to controls was determined in G/Aand A/Ars1800470 carriers. By stages of DR, a significant increase in the content of TGF-β1 in the blood and IOF and CTGF in IOF was established with maximum values in PDR. A higher content of both factors was established in G/Aand A/Acarriers compared to G/Gcarriers. In PDR, the blood content of TGF-β1 in A/A carriers was 1.2 times higher (p<0.05) than in G/Gcarriers. The increase in CTGF content in the IOF when comparing NPDR and PPDR was characteristic only for A/A carriers compared to G/Aand G/Gcarriers (1.2-1.5 times; p<0.05). In PDR, the content of this factor was equally high in G/Aand A/Acarriers compared to G/Grs1800470 carriers (1.3 times; p<0.05).

Conclusions: Thus, the content of both TGF-β1 and CTGF was higher in carriers of the G/Aand A/Agenotypes compared with the ancestral G/Ggenotype. Therefore, the clinically worse course of DR in carriers of the SNP rs1800470 of the TGFB1gene could be associated with a higher concentration of TGF-β1 and CTGF in the IOF of such patients.

УДК : 613.84:616.89:616.132-089]-06

Aim. To establish the features of the dynamics of TDR in patients with coronary artery disease before and after CABG surgery, depending on age, the presence of the smoking factor and its cessation during the rehabilitation treatment.
Materials and Methods. 122 patients with chronic coronary artery disease aged 40 to 83 years (mean age 62.39±0.65 years) with indications for CABG were examined. Patients were divided into two groups by age: the first (I) group included 45 patients<60 years, and the second group included 77 patients ≥ 60 years. Patients in each age subgroup were divided into subgroups by smoking factor. Subgroups IA (n=28, mean age 55.21±0.91) and IIA (n=18, mean age 65.0±0.77) were formed from patients-smokers; IB (n=17, mean age 55.17±1.26) and IIB (n=59, mean age 67.08±0.61) were from patients who had never smoked. To verify the manifestations of anxiety and depression, we used the screening method of the survey using the hospital scale HADS (The Hospital Anxiety and Depression Scale) before CABG and after 12 months of rehabilitation treatment. Results and Discussion. At the beginning of the study, the mean levels of anxiety (7.77±0.45 (I) and 7.57±0.29 (II)) and depression (7.64±0.47 (I) and 7.42±0.31 (II)) in the age groups did not differ significantly, however, smoking patients of the younger age category had significantly higher levels of anxiety (8.64±0.66 (IA) vs. 6.29±0.58 (IB), p<0.05) and depression (8.44±0.67 (IA) vs. 6.32±0.57 (IB), p<0.05), compared to non-smokers of the same age category. In the same subgroup, a significantly higher proportion of  individuals with clinical symptoms of TDR (mostly subclinically expressed) was recorded: for anxiety, 64.29% (IA) versus 47.06% (IB), p<0.05; for depression, 78.57%
(IA) versus 47.06% (IB), p<0.05. At the same time, the absence of symptoms of anxiety and depression was mainly
recorded in non-smoking patients (IB): anxiety - 41.18% (IB), p<0.05, depression - 47.06%, p<0.05 (IB), p<0.05. At
the same time, among smoking patients, symptoms of anxiety were absent 1.6 times less often (25.00% (IA)), depression  3.3 times (14.29% (IA)). After 12 months of rehabilitation treatment after CABG, positive dynamics were observed in all groups: the average levels of anxiety and depression were statistically significantly reduced: the average level of anxiety- by 20.43% to 6.33±0.50 (I) and by 25.97% to 5.83±0.24 points (II); depression - by 43.7% to 4.90±0.53 (I) and 37.82% to 5.06±0.32 (II). The most pronounced decrease in the level of anxiety and depression was found in the IA subgroup - that is, among patients of the younger age group who gave up smoking and did not resume this habit within 12 months. The proportion of patients without symptoms of anxiety increased approximately twice in the subgroup IIA (up to 72.22%) and 3.3 times in the subgroup IA (up to 82.14%), and the proportion of individuals without clinical signs of depression increased among them by 5-6 times: up to 85.71% in IA and up to 83.33% in IIA subgroups. In subgroups of patients who have never smoked (IB, IIB), a positive dynamics of an increase in the proportion of individuals without symptoms of anxiety and depression was
also noted, but it turned out to be less significant.
Conclusions. Compared with non-smokers, among smoking patients with indications for CABG, especially those younger than 60 years, the highest levels of anxiety (p<0.05) and depression (p<0.05) are recorded, and the largest
proportions of individuals with their subclinical and clinically pronounced manifestations (more than 70-80%).
The most significant positive dynamics in terms of reducing the average levels of TDR indicators and the proportion of individuals with their clinical manifestations are recorded in subgroups of patients who have quit smoking and have not smoked during 12 months of rehabilitation treatment after CABG. The smoking factor may exacerbate TDR in patients with coronary artery disease, while smoking cessation is accompanied by a more intensive improvement in their psychological state.

УДК : 616.12-008.331.-02:616.441-06:616.132-008.64-036.11]-079.4

The paper presents the results of a study of circadian arterial blood pressure (ABP) profile in patients with
Acute Coronary Syndrome (ACS) and their association with thyroid-stimulating hormone (TSH) levels.
Aim. To conduct a comparative analysis of circadian BP monitoring (CBPM) indicators in patients with ACS and
their association with the TSH level.
Materials and Methods. The study includes 125 patients with ACS aged 36 to 81 (mean age - 60.98± 0.81 years
old). The patients were divided into two groups according to thyroid function. Group one (I) included 51 individuals (40.8%) - hypothyroid patients (TSH level>4μIU/ml), mean age - 62.51±1.18 years old; Group II included 74 individuals (59.2%) - euthyroid patients (TSH level 0.4 4μIU/ml), mean age - 59.93±1.08 years old. The serum
free thyroxine (FT4) levels were within the normal rangein both groups. In the general group, the proportion of
individuals with unstable angina (UA) was 28.8%, and with myocardial infarction (MI) - 71.2%. In particular,
in Group I, the proportion of individuals with UA was 23.53%, and with MI - 76.47%; in Group II, the
proportion of individuals with UA was 32.43%, and with MI - 67.57%, p>0,05 between Groups I and II. The
circadian BP monitoring was carried out using the Biomed ÂÀÒ41-2 device after stabilization of the patient's
condition (on the second day of hospital admission). The following indicators have been determined: systolic BP
(SBP) - daytime, nighttime, and average daily (24 hours) (SBPd, SBPn, and SBPav); diastolic BP (DBPd, DBPn,
and DBPav); pulse BP (PBPd, PBPn, and PBPav); time index (TI) for SBPd, SBPn, and SBPav (SBPd TI, SBPn
TI, and SBPav TI) and DBP (DBPd TI, DBPn TI, and DBPav TI); variability of SBPd, SBPn, and SBPav (SBPd
var, SBPn var, and SBPav var) and DBP (DBPd var, DBPn var, and DBPav var); average daily index for SBP (SBP
AvDI) and DBP (DBP AvDI); average daily heart rate (HRav). To study thyroid function in patients enrolled, TSH
and FT4 levels were determined by chemiluminescent immunoassay method on the ARCHITECT iSystem analyzer
using reagent kits for the quantitative determination of TSH (ARCHITECT TSH) and FT4 (ARCHITECT Free T4).
Results and Discussion. The comparison of the CBPM results in both groups of patients with ACS shows
significantly higher mean nighttime (SBPn and DBPn) levels in Group I patients compared to Group II patients:
SBPn - by 6.27% (125.44±2.98 mm Hg (I) versus 117.58±2.26 (II), p<0,05), DBPn - by 6.15% (73.65±1.91
mm Hg (I) versus 69.12±1.62 (II), p<0,05), in the absence of a significant between-group difference between the
mean levels of respective daytime and average daily indicators. Mean DBPn TI value also turned out to be
significantly higher in Group I patients compared to Group II patients - by 33.69% (42.47±4.60% (I) versus
28.16±3.60% (II), p<0.01). Significant difference was detected between mean SBP AvDI and DBP AvDI
indicators in hypothyroid patients (I) versus respective indicators in euthyroid patients (II): SBP AvDI (I) 2.52±1.25% versus SBP AvDI (II) 5.99±0.98, p<0.05; and DBP AvDI (I) 4.69±1.38% versus DBP AvDI (II) 8.88±1.32, p<0.05.
Conclusions. 1. Mean nighttime BP indicator (SBPn, DBPn, and DBPn TI) levels were significantly higher in
the Group of hypothyroid patients with ACS, compared to euthyroid patients. In addition, the proportion of
patients whose mean nighttime SBP and DBP levels exceeded the permissible values (SBPn<120, DBPn<70
mm Hg) was significantly higher in the Group of hypothyroid patients (I) compared to the Group of
euthyroid patients (II). 2. Every third hypothyroid patient (I) (SBP AvDI: 37.25% and DBP AvDI: 31.37%) had a
night-peaker circadian BP profile, characterized by nighttime BP increase instead of reduction, which suggests an extremely unfavorable prognosis. The findings may signal an additional adverse effect of thyroid dysfunction on arterial tone and, accordingly, BP regulation, which brings about a high risk of complications of ACS.