Introduction: Actuality to deeply understand the underlying mechanisms in the aneurysm wall launching the progression and potentially rupture may be helpful to optimize the clinical decision making process among patients with unruptured cranial aneurysms (totally fast 18 million in Europe), especially asymptomatic with low score according to specific scales such as PHASES und UIATS.

Aim of the study was to gather and analyze the current relevant scientific achievements describing the pathophysiology of inflammatory remodeling of aneu rysm wall resulting in the degeneration und poor clinical outcome.

Material and methods: 529 patients with unruptured saccular intracranial aneurysms are being observed and treated during 2013-2023. 19.1% have already been operated (98% endovascular, 2% transcranial approach). Among them 19.8% had multiple, 4.95% – mirror intracranial aneurysms. Primarily we used PHASES and in the last years UIATS Score to estimate and individualize the risk of aneurysm rupture. We conducted also the literature review using the PubMed service.

Results and discussion: Our findings correlate with literature data confirming the thickening of aneurysm wall, myointimal hyperplasia und hypocellularity with accelerated collagen breakdown. The high wall shear stress activates pro-inflammatory signaling thorough macrophage chemoattractant protein 1 (MCP1) promoting the smooth muscle cell proliferation being thus a promising target for drug therapy. This process increases the aneurysm wall permeability, which can be detected using the dynamic contrast-enhanced MR perfusion.

Conclusions: The detection of biochemical markers of aneurysm wall remodeling with modern radiological correlates looks promising to improve the early diagnosis, treatment and prevention of rupture of the cerebral aneurysms.

УДК 616.12–005.8:616.12–008.318]–089.6–089.168.1–06–038

Гострий коронарний синдром, зокрема гострий інфаркт міокарда з елевацією сегмента ST (ST-elevation myocardial infarction – STEMI), доволі часто супроводжується появою аритмій. Такі пацієнти мають гірший прогноз у порівнянні з хворими з синусовим ритмом. Мета. З’ясувати характер аритмій у пацієнтів зі STEMI за наявності різних чинників ризику впродовж першої доби після реперфузії міокарда шляхом первинного черезшкірного вінцевого втручання. Матеріяли й методи. У дослідження залучено 50 хворих віком від 45 до 83 років (середній вік – 63,4±9,6 р.; чоловіків – 70,97%, жінок – 29,03%), яким упродовж 24 годин після стентування інфарктпов’язаної вінцевої артерії проведено добовий моніторинг електрокардіограми (ЕКГ), із застосовуванням 7-канального реєстратора ЕКГ Solvaig 06000.7. Фактичний матеріал опрацьовано з допомогою пакетів прикладних програм Microsoft Excel 2022, Statistica 10. Результати. Серед порушень ритму переважали передчасні серцеві скорочення – суправентрикулярні та шлуночкові. У пацієнтів з артеріальною гіпертензією та осіб з перенесеним COVID-19 екстрасистоли виникали у вигляді пар, триплетів, бігемінії, тригемінії; поряд з цим, реєструвались шлуночкові екстрасистоли «R на T», а також епізоди суправентрикулярної та нестійкої шлуночкової тахікардій. Висновки. У хворих із гострим інфарктом міокарда з елевацією сегмента ST впродовж першої доби після первинного черезшкірного вінцевого втручання із стентуванням інфарктпов’язаної вінцевої артерії доволі часто виникають як надшлуночкові, так і шлуночкові передчасні скорочення, а також епізоди суправентрикулярної та нестійкої шлуночкової тахікардій, що є свідченням електричної нестабільності міокарда. Характер порушень ритму за  наявності артеріальної гіпертензії, а також перенесеного COVID-19 прогностично несприятливіший і вказує на вищий ризик виникнення в цих осіб загрозливих для життя аритмій.

Introduction. Acute coronary syndrome, in particular acute ST-elevation myocardial infarction (STEMI), is often accompanied by complex, often hemodynamically significant arrhythmias and conduction disorders. Such patients have a worse prognosis compared to patients with sinus rhythm. Arrhythmias in patients with STEMI are facilitated by the presence of comorbidities such as arterial hypertension, diabetes mellitus, obesity, and COVID-19.

The aim of the study. To elucidate the nature of arrhythmias in patients with acute ST-elevation myocardial infarction for the presence of various risk factors during the first day after myocardial reperfusion by primary percutaneous coronary intervention.

Materials and methods. The study involved 50 patients aged 45 to 83 years (average age – 63,4±9,6 years; men – 70,97%, women – 29,03%), who were treated from 2021 to 2023 at the cardiology and reperfusion therapy department of the center for heart and vasculars of the «Hospital of Saint Panteleimon» Municipal non-profit enterprise «First Territorial Medical Union of Lviv» and the infarction department of the Municipal non-commercial enterprise of the Lviv Regional Council «Lviv Regional Clinical Cardiological Center». The patients included in the study underwent daily electrocardiogram (ECG) monitoring for 24 hours after stenting of the infarct-related coronary artery, using a 7-channel ECG recorder of the Ukrainian manufacturer Solvaig 06000.7 and with computer processing of the recording using the DiaCard2 software. The factual material was developed using modern application software packages (Microsoft Excel 2022, Statistica 10). Results. It was found that among supraventricular rhythm disturbances, premature contractions were the most common, the average number of which per patient was significantly higher in the presence of obesity and was quite high in patients who had COVID-19 and also had hypertension. In coronavirus infection and hypertension cases, extrasystoles were often in the form of pairs, triplets, bigemia, and trigemia; paroxysms of supraventricular tachycardia were also recorded in these patients. Among the ventricular arrhythmias, premature cardiac contractions were also the most frequent, significantly more often recorded in patients with hypertension and in patients who had experienced COVID-19; only in these patients, were extrasystoles presented in the form of pairs, triplets, bigeminy, trigeminy, runs of extra beats, «R to T», which are currently considered as harbingers of life-threatening ventricular arrhythmias. In the presence of hypertension and COVID-19, episodes of unstable ventricular tachycardia were also observed.
Conclusions. In patients with STEMI, both supraventricular and ventricular premature contractions and episodes of supraventricular and unstable ventricular tachycardia are quite common during the first day after primary percutaneous coronary intervention with infarct-related coronary artery stenting, which is evidence of electrical instability of the myocardium. The nature of rhythm disturbances in the presence of hypertension and also COVID-19 is prognostically unfavorable and indicates a higher risk of life-threatening arrhythmias in these patients. Thus, myocardial revascularization only in combination with optimal medical treatment can prevent the occurrence of adverse cardiovascular events in patients with STEMI. Prospects for further research: determination of the predictive value of detected arrhythmias for the occurrence of cardiovascular events in the early and long-term post-infarction period.

УДК 615.28:616.33-006.6

Резюме. З’ясування ще у 1980-х рр. певних позитивних результатів передопераційної (неоад’ювантної)  хіміотерапії (НХТ) при раку грудної залози (принаймні можливості зменшити розміри пухлини) стимулювало дослідження ролі такого лікування і при інших типах пухлин, зокрема при раку шлунка. У цьому огляді літератури ми зосередимось на таких питаннях: 1) потенційні переваги та ризики неоад’ювантної  терапії раку шлунка; 2) етапи дослідження цієї проблеми; 3) показання до НХТ при раку шлунка; 4) кількість циклів НХТ; 5) оптимальний час між НХТ і операцією; 6) роль лімфаденектомії після НХТ; 7) предиктивні маркери; 8) практичні поради щодо застосування схеми FLOT.

UDC 616.33-006-092-089-033.2: 617.55-006]-07

Peritoneal metastases are commonly associated with gastric cancer (GC) recurrence after radical treatment. Thus, patients at a high risk of peritoneal relapse require adjuvant intraperitoneal chemotherapy during the ini tial treatment. Along with clinical and morphological predictors of peritoneal relapse, another approach in surgi cal oncology is proving to be promising today. It refers to the prediction of the risk of developing metachronous peritoneal metastases in various molecular types of GC.

OBJECTIVE — to study the risk of peritoneal relapse in patients with the genomically stable type of GC in com parison to its other molecular types.

MATERIALS AND METHODS

. 37 patients with GC were enrolled into the study and evaluated after the radical treat ment. 19 (51.4 %) patients formed a subgroup with peritoneal relapse and 18 patients (48.6 %) were included into a subgroup without metachronous carcinomatosis in the long term. All patients underwent immunohisto chemical study for the E-cadherin (CDH1 gene) expression in a gastric tumor. The genomically stable molecular type was identified on the basis of the aberrant E-cadherin (CDH1-mutated) tumor phenotype detection.

RESULTS

. There was a statistically significant difference (p = 0.022,  2= 5.22) in the degree of aberrant E-cadherin expression in subgroups of patients with and without peritoneal relapse — 68.4 and 33.3 %, respectively. Hence, it was noted that the genomically stable molecular type had a significant influence on the risk of peritoneal recur rence: the 2-year peritoneal relapse-free survival of GC patients with E-cadherin of aberrant type was 31.6 %, and in GC patients with wild-type E-cadherin expression — 71.4 % (p = 0.022). The 2-year overall survival of GC patients with aberrant type E-cadherin expression was 36.8 %, whereas in GC patients with E-cadherin of the wild type — 77.8 % (p = 0.003).

CONCLUSIONS. The study found that the genomically stable molecular type of GC may serve as a predictive factor associated with an increased probability of peritoneal relapse, as well as a prognostic factor due to its negative impact on patient prognosis. The genomically stable molecular type of GC may be used as a tool for forming a cohort of patients with indications for adjuvant intraperitoneal therapy.

Background. Non-alcoholic fatty liver disease (NAFLD) is a pressing issue in modern society. While excess circulating glucose and insulin resistance contribute to its pathogenesis, the diagnosis poses particular challenges. The purpose of the study was to identify new additional non-invasive diagnostic markers of NAFLD and the risk of developing comorbid diseases in these patients. Materials and methods. The study involved 64 men aged 39 to 62 years: 35 patients were diagnosed with non-alcoholic fatty liver disease according to EASL-EASD-EASO guidelines, 29 patients comprised the control group. The results of complete blood count, biochemical blood tests, and abdominal ultrasound were evaluated in both groups. Results. Patients with NAFLD had significantly higher body weight and body mass index, higher glucose, HOMA-IR, total cholesterol, triglycerides, low-density lipoproteins, atherogenic index, alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, and aspartate aminotransferase. Additional non-invasive markers of NAFLD were high body mass index, HOMA-IR, total cholesterol, triglycerides, low-density lipoproteins, atherogenic index, and alanine aminotransferase, which may also indicate future risks of type 2 diabetes and hypertension. Conclusions. Among patients with NAFLD within three years, hypertension occurred in 22.2 % of cases and type 2 diabetes in 20.0 %, which is higher than in patients without NAFLD (8.7 and 4.3 %, respectively). We found that at the time of initial examination, patients with NAFLD had higher body weight and body mass index, as well as higher glucose, HOMA-IR, total cholesterol, triglycerides, low-density lipoproteins, atherogenic index, alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, and aspartate aminotransferase. From these metrics, we identified high body mass index, HOMA-IR, total cholesterol, triglycerides, low-density lipoproteins, atherogenic index, alkaline phosphatase as potential non-invasive risk markers for NAFLD. This highlights the importance of studying them for the early diagnosis of type 2 diabetes and hypertension, which could improve the treatment of this cohort of patients in the future.