Artificial Intelligence (AI) has been the subject of particular interest in the field of radiology in recent years. Experts believe that the development and implementation of AI technologies will improve diagnostic accuracy, speed up the acquisition of objective information, reduce its variability, and optimize the workflow of diagnostic departments of medical institutions. Over the years, AI has evolved from simple rule-based systems to sophisticated deep-learning algorithms capable of analysing medical images with high accuracy.

Despite some progress, the use of AI in medical imaging is still limited. There are many challenges that need to be overcome before it can be widely adopted in clinical practice. For example, training AI algorithms require large amounts of high quality annotated data, and such data is not yet available for the bulk of pathology and any of the imaging techniques. This article looks at the possibilities of AI and some of the current challenges associated with the application of AI in neuroimaging.

Purpose. To moderate computed tomography angiography (CTA) of the heart scanning protocol in children with dilated cardiomyopathy and low left ventricle ejection fraction (LVEF) for optimal visualization of the heart and its major vessels.

Materials and methods. We examined 38 patients aged from 9 months to 17 years, undergoing treatment at the cardiology department in the of the Rehabilitation Clinic for Children of the Almazov National Medical Research Centre. Firstly, all patients were performed echocardiography (Echo). Echo data evaluated LVEF. The patients were selected based on the clinical diagnosis, the LVEF index, the patient’s height (or the length of the scan area). 2 groups of patients with DCM (with low LVEF) were formed - younger and older patients; for each group was formed a control group of patients with normal LVEF values. All patients underwent CTA on a 128-sliced computed tomograph Ingenuity Elite (Philips, Netherlands) after a bolus intravenous contrast medium injection.

Results. There was revealed a relationship between the start time of the scan and the LVEF, the patient’s height. For patients with low LVEF were created study protocols, where scan start time offset was set as: for the group 1 in the early arterial phase +3c, in the late arterial phase +5c, in the venous phase +15c; for the group 2 in the early arterial phase +5c, in the late arterial phase +5c, in the venous phase +29c.

Conclusion. The moderated scanning protocol presents good contrast enhancement by chambers of the heart and its major vessels. It is necessary for an assessment of the anatomy and pathological changes. The identified criteria (LVEF, patient height) should be considered for CTA of the heart in children with dilated cardiomyopathy.

Objective. The aim of study: to investigate the functional changes in the thalamus, amygdala, and hippocampal region using functional MRI at rest and determine their clinical significance in various types of MS.

Materials and methods. 68 patients with a diagnosis of multiple sclerosis (MS) were examined: 40 patients with a relapsing-remitting MS (RRMS) in remission and 28 patients with secondary progressive MS without signs of activity and progression (SPMS). The control group consisted of 10 healthy people of the appropriate age and gender without neurological and somatic diseases. All patients and controls underwent MRI of the brain on a Siemens Tim Trio tomograph with a magnetic field induction of 3.0 TL, using contrast enhancement, T1 gradient echo protocols, REST-BOLD, and subsequent processing of the data obtained using CONN 19с software.

Results and conclusion. In the course of the study, various patterns of changes in functional connections were found: in patients with RRMS, there is a decrease in the intensity of connections of the thalamus with other brain structures and a decrease in their number. In patients with RRMS, a greater number and intensity of connections within the thalamus and other structures of the brain were detected compared to SPMS. In patients with RRMS, there is a significant decrease in the connectivity parameters of the hippocampal formation, which is expressed on the left, and in the case of the amygdala complex – on the right, this is manifested in a total decrease in the intensity of connections with other brain structures and a decrease in their number. Thus, the method of functional MRI at rest makes an additional contribution to the understanding of neurodegenerative processes in various phenotypes of multiple sclerosis.

The presented literature review is devoted to the assessment of the brain connectivity using specialized magnetic resonance imaging (MRI) techniques — resting state functional MRI and MR tractography, and the possibilities of their use in the rehabilitation of patients with multiple sclerosis (MS).

MS is the leading cause of non-traumatic neurological disability in young adult patients in the Russian Federation, and its prevalence continues to grow steadily. The use of complex neurorehabilitation is the basis to improve the better functional outcome of patients suffering from this disease.

At the same time, in clinical practice, the evaluation of the effectiveness of rehabilitation results is carried out purely on the basis of clinical scales. Resting state functional magnetic resonance imaging (rs-fMRI) makes it possible to identify connections between various functionally related regions of the brain without any external stimulation, as well as to assess the state of the connectome in dynamics.

This review article discusses the main directions of modern methods of neurorehabilitation, assesses impairments in the DTI and rs-fMRI measurments in patients with multiple sclerosis compared with healthy volunteers, as well as changes in these parameters over time after the use of various neurorehabilitation methods aimed at restoring motor and cognitive functions.

The article is devoted to one of the manifestations of post-mastectomy syndrome - cerebrovascular disorders that develop in patients after radical treatment of breast cancer. The literature review considers the pathogenetic aspects of cerebrovascular disorders, clinical manifestations, methods of diagnosis and treatment of this pathology.

The current pandemic caused by the SARS-Cov-2 virus has significantly influenced the emergence of new injectable vaccines that provide a predominantly specific IgG response. However, it is generally accepted that protection against pathogens at the mucosal surface, which is the first barrier to viral entry, is predominantly dependent on the IgA response. It is now widely accepted that the use of genetically modified microorganisms, including probiotics, allows the oral or nasal mucosal delivery of therapeutic molecules, inducing an immune response in the mucous membranes. Probiotic strains are well studied for safety for the organism and are able to remain viable after passing through the gastric barrier, improve intraepithelial connections, and can generate a number of surface expressed molecules that enhance the effectiveness of vaccination.

Recombinant probiotic microorganisms capable of producing vaccine antigens by inserting specific DNA fragments into their genome are one of the potential platforms that can be used to develop an appropriate vaccine containing a specific antigen for rapid response to viral mutations. Here, we demonstrate the construction of a novel SARS-Cov-2 vaccine candidate employing the gene fragment of S1 SARS-Cov-2 gene. According to the available data on new variants of SARS-Cov-2 mutations, three amino acid substitutions were made in the chosen sequence. This DNA fragment was inserted in frame into major pili protein gene within d2 domain of enterococcal operon encoding for pili.

Introduction. The problem of the spread of antibiotic resistance among pathogens of nosocomial infections is becoming increasingly important. In order to improve microbiological monitoring, it is advisable to use methods that allow you to quickly determine the largest number of antibiotic resistance determinants. In this regard, it seems relevant to develop PCR test systems for detecting antibiotic resistance genes, in particular, for screening hospitalized patients and identifying cases of nosocomial infection.

Purpose. Develop a panel of primers for detection of antibiotic resistance genes using PCR with real-time visualization of results.

Materials and methods. For the design of specific primers and probes, reference sequences from the databases of the National Center for Biotechnology Information (NCBI) were used. Primer selection and specificity assessment were performed using the NCBI PrimerBlast and Primer3 programs. Primers for PCR amplification of a number of antibiotic resistance genes were tested on strains of Klebsiella pneumoniae. These strains were isolated from the clinical material of intensive care patients with COVID-19 and whole genome sequencing of the strains was carried out with a detailed assessment of the resistome, virulome. The results of whole genome sequencing and multiplex real-time PCR were compared.

Results. We have developed a set of primers for the detection of antibiotic resistance genes, including carbapenemase, using real-time multiplex PCR.

Conclusion. The developed panel of primers can be used to screen Klebsiella pneumoniae isolates for the presence of resistance genes; further expansion of the spectrum of detected genes and testing of the panel on clinical material is required.

Spondyloarthritis (SpA) is a group of chronic inflammatory diseases of the musculoskeletal system involving of the axial skeleton and extra-articular manifestations such as inflammatory bowel diseases. Some violations of the intestinal microbiome often occur during the course of spondyloarthritis. Also, intestinal dysbiosis can be enhanced by ongoing therapy. The aim of the study was to evaluate the effectiveness of combined therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and autoprobiotics supplementation.

SpA patients treated with NSAID were divided into two groups: group A which took autoprobiotic based on indigenous culture of Enterococcus faecium, and group S which took only Supra medium, which is the basis used for making of autoprobiotic. Reducing of pain intensity, dyspeptic phenomena were observed to a greater extent in group A compared to group S. PCRRT testing revealed no significant changes in intestinal microbiocenosis in patients with SpA, except of a decrease in the Lactobacillus population, which was restored only in group A. A feature of the changes in group S was a decrease in the total bacterial mass, amounts of Bacteroides, Faecalibacterium, Enterobacter and expansion of Methanobrevibacter population. The tendency to restore the quantitative content of Lactobacillus, correlating with a decrease of IL-10 concentration, was found only in group A.

In our study the effectiveness of enterococcal auprobiotic supplementation as an element of complex therapy of patient suffering from SpA has been proven. The use of an autoprobiotic leads to a decrease in the severity of the symptoms of the disease, the leveling of dyspeptic symptoms and microbiota disorders.

Volatilome is a collection of all volatile compounds, both organic and inorganic, the source of which is the object under study. Unlike the metabolome, which includes only compounds of endogenous origin, the concept of volatilome includes substances of both endogenous and exogenous origin. Exhaled air volatilome contains thousands of metabolites and volatile organic compounds (VOCs), which are formed both in the respiratory tract and in the systems of internal organs and tissues. The study of the chemical composition of human exhalation can provide clinically useful information about the state of human health, while the studies are non-invasive and safe for the patient. The instrumental methods used in the study of human volatilome make it possible to online examine large numbers of patients. All this contributes to a high interest on the part of the medical community in the study of human exhaled air volatilome and suggests that the methods of these research methods have a high potential for implementation in clinical practice.

Objective  Evaluate the effectiveness of the multidisciplinary specialists team in Almazov National Medical Research Centrе to the treatment of patients with the neuroischemic form of diabetic foot syndrome in a multi-field hospital.

Materials and methods We made retrospective analysis of the multidisciplinary approach to the treatment of patients with a neuroischemic form of diabetic foot syndrome who were hospitalized to Almazov National Medical Research Centrе during the period from January 2018 to July 2020 (inclusively). The patients were treated in the clinic of the Almazov National Medical Research Centrе during one hospitalization period. The investigation includes patients over 18 years old with a diabetes mellitus who were performed revascularization at the vascular surgery clinic Almazov National Medical Research Centrе. Patients with a secondary diabetes mellitus, immunosuppressive therapy were excluded from the study. 51 patients with neuroischemic form of diabetic foot syndrome were specifically selected for analysis. We gathered all information about them till August 2022. So, the period of observation was from 2 years 8 months (32 months) to 4 years 8 months (56 months). The mediana time was 44 months (3.67 years). All inclusive patients had a diabetic ulcer on the foot. The outcomes of this study were the healing or non-healing of diabetic foot ulcers, major amputation or death (from all causes).

Results Successful healing of ulcers or postoperative wounds at the time of contact with the patient or his relatives, was with 45 patients (88.3 %). In more than half of the patients (56.86 %) healing of ulcers and wounds was occurred in the 3 months after operation.70.59 % (n = 36) patients were performed orthopedic organ-preserving reconstructions on the feet in the hospital. 6 patients (11.7 %) were performed initially revascularization according to the “less affected pathway” principle which didn’t heal the ulcers in the postoperative period and leaded to repeated surgery to restore blood flow according to the angiosomal principle. For 9 patients (17.64 %) it was required to perform repeated orthopedic intervention on the foot during the current hospitalization. The causes of complications were: stent thrombosis (n=3), intimal dissections (n = 2) and distal embolism (n = 1). The reasons for repeated orthopedic surgery were marginal necrosis in the postoperative wounds. Optimal revascularization wasn’t achieved with 10 (19.6 %) patients. Despite this in 4 (7.84 %) cases ulcers was healed. In two cases, 3.92 % (n = 2) suboptimal revascularization was associated with the lack of technical possibility in revascularization of the lower leg arteries with satisfactory revascularization of the femoral-popliteal segment. Indirect revascularization with no effect was performed in 4 cases (7.84 %). 6 major amputations (11.7 %) were performed during the observation period, 1 major amputation during the current hospitalization and 5 in the long-term period. The Kaplan-Mayer three-year survival rate was 80 %.

Conclusion The analysis of the results of a multidisciplinary approach to the treatment of patients with diabetic foot syndrome demonstrated an improvement in the preservation of the limbs, reduced of bone-plastic reconstructions, reduсtion of hospitalization time and improving the lives of patients.

Acute mesenteric ischemia (AMI) is a rare vascular disease characterized by a high mortality rate with untimely diagnosis and treatment. The overall incidence is low, estimated at 0.09–0.2 % of all hospital admissions to emergency departments. One of the causes of acute mesenteric ischemia is acute arterial thrombosis, which is most common in the elderly.

The problem of early diagnosis of acute mesenteric thrombosis is still relevant due to a non-specific clinical features. Computed tomography angiography (CT angiography) of the abdominal aorta and its branches is characterized by high sensitivity (85–98 %) and specificity (91–100 %). Computed tomography angiography is the gold standard for the diagnosis of acute mesenteric ischemia.

The article discusses the use of computed tomography angiography (CT angiography) for visualization of acute mesenteric thrombosis.

Introduction. The aim of the paper is demonstrating the possibilities of CT angiography in newborns with suspected combinations of a congenital heart defect and pulmonary malformations.

Materials and methods. The article presents a clinical case of a rare constellation of horseshoe lung with hypoplastic left heart syndrome, right lung hypoplasia and intralobar pulmonary sequestration of the right lung.

Results. Contrast-enhanced computed tomography is mandatory in visualization of rare complex congenital heart and bronchovascular anomaly.

Discussion. Horseshoe lung is a rare congenital anomaly of childhood in which the caudal and basal segments of the lungs are joined together anterior to the aorta and behind the left ventricle. This anomaly was described for the first time by Spenser in 1962. Horseshoe lung is often associated with unilateral lung hypoplasia, most commonly involving the right lung, and can occur in conjunction with scimitar syndrome, which includes hypoplasia of the right lung, abnormal right pulmonary venous return, and abnormal arterial supply to the right lung.

Conclusion. Presented case report demonstrates current postnatal examination possibilities (CT, angiography) in the diagnostics of a rare congenital heart and bronchovascular anomaly — hyperplastic left heart, intralobar pulmonary sequestration of the right lung, anomalous venous return, anomalous hepatic venous drainage. The incidence of this disorder is approximately 1–3 per 100 000 births.