Aim. To assess an efficacy of continuous glucose monitoring system (CGMS) combined with insulin pump therapy for perioperative glycemic control after coronary artery bypass grafting (CABG).
Design. Prospective comparative study.
Materials and methods. We used CGMS for 72 hours in 105 patients with coronary artery disease including 52 ones with diabetes mellitus type 2 (DM2). Patients with DM2 were divided into 2 subgroups: insulin pump therapy (subgroup 1) and bolus intravenous insulin according to in-hospital protocol (subgroup 2). We analyzed pro-inflammatory markers, adipokines and incidence of postoperative complications in one hour, 12 hours, 7 days and 1 year after CABG.
Results. Insulin pump therapy ensured target glycemia in most cases (62.5%) while bolus intravenous insulin injection was followed by normal glucose level in 21.4% of patients (p = 0.003). Insulin pump therapy significantly decreased highly sensitive C-reactive protein after 12 hours (p = 0.0001), RANTES after 7 days (p = 0.035). In patients on insulin pump therapy the leptin level after 7 days was significantly lower than in the subgroup 2 (p = 0.039). There was a negative relationship between the leptin level after 7 days and the use of CGMS combined with insulin pump therapy (r = –0.73; p = 0.025). In patients on insulin pump therapy the adiponectin level after 1 year was significantly higher than in the subgroup 2 (p = 0.028). Insulin pump therapy decreased the incidence of postpericardiotomy syndrome (p = 0.03) and the period of hospitalization (p = 0.007), but there was no significant difference in the rate of complications in the long-term period.
Conclusion. CGMS combined with insulin pump therapy is safe and effective for perioperative glycemic control, as well as decrease of the incidence of postpericardiotomy syndrome.

Aim. To analyze the prevalence and anatomic-topographic features of myocardial bridges (MBs) and evaluate their role in the development of cardiovascular complications.
Design. А retrospective study.
Materials and methods. The study was conducted in two stages. In the first stage, to assess the prevalence and anatomic-topographic features of MBs, was retrospectively analyzed a registry of 883 coronary computed tomographic angiography (CCTA) results performed at the S.M. Kirov Military Medical Academy from 2011 to 2021. From the remaining 811 results after the initial review, 117 CCTA with MBs were selected and subjected to further detailed study. In 6 cases the CCTA was supplemented with stress-CT myocardial perfusion. In the second stage, a retrospective analysis of medical histories of 20 patients with MBs who were treated at the S.M. Kirov Military Medical Academy from 2017 to 2021 was performed for assessment the clinical significance of MBs and their role in the development of cardiovascular complications.
Results. According to CCTA MBs were visualized in 14.4% of cases, in the left anterior descending artery (LAD) they were diagnosed in 84.6% of them with predominant localization in the middle segment — 94.9%. The mean length of the MBs in the LAD was 23 [17; 31] mm, depth — 1 [1; 2] mm. Atherosclerotic lesion according to classification of Coronary Artery Disease Reporting and Data System (CAD-RADS) of the LAD was detected in 58.6% of cases, of which in the proximal segment — 84.5%. According to stress-CT myocardial perfusion in asymptomatic patients, hypoperfusion was detected in 3 (50%) cases in the segments of the left ventricle, the blood supply of which comes from the LAD and its branches. Among 20 patients with dyslipidemia was detected in 80% of patients with MBs, stable angina was diagnosed in 5 (25%) cases, unstable angina and myocardial infarction — 3 (15%) patients in each cases. The assessment of the lipid spectrum revealed the elevations of total cholesterol to 5.47 ± 1.25 mmol/l and low-density lipoprotein to 3.52 ± 1.04 mmol/l, other fractions remained within normal values. In addition, various heart arrhythmias and conduction disorders were detected by 24-hour electrocardiography monitoring in patients with MBs, including supraventricular and ventricular extrasystoles, supraventricular and ventricular tachycardia, A-V blockade, atrial fibrillation and flutter and pauses greater than 2.5 seconds.
Conclusion. The study confirmed the predominant character of MBs localization in the LAD and its middle segment. In addition, frequent atherosclerotic lesion of proximal segments of LAD by CAD-RADS classification was detected. The presence of association of MBs with symptoms of myocardial ischemia, dyslipidemia, as well as various arrhythmias requires searching of new approaches to early visualization of MBs, especially in the group of asymptomatic patients, in order to diagnose the pathology on time and prevent cardiovascular complications associated with it.

Aim. To summarize the contemporary literature data on the clinical and pathogenic correlations between atrial fibrillation (AF) and myocardial infarction (MI).
Key points. AF is one of the most common and clinically significant arrhythmias. In patients with MI, this type of arrhythmia is recorded for the first time in 6 % to 21 % of cases. The review discusses the incidence of AF in patients with various forms of coronary heart disease, mechanisms of arrhythmogenesis, and the ways to predict poor outcomes in a group of patients with AF who had a history of MI.
Conclusion. The mechanisms of AF development in patients with MI need better understanding. AF impact on the short-term and long-term prognosis for patients with MI should be studied better, and modern tools for the classification of poor outcome risks should be developed.

Aim. To assess the clinical and functional status of the cardiovascular system in military aged men in Berdsk (Novosibirsk Region).
Design. Observational analytical cohort study.
Materials and methods. We observed 184 young men (18–27 years old) who were referred by medical examining boards of the recruitment offices to the Berdsk Central City Hospital. The study analysed the incidence of minor heart anomalies, various rhythm and conductivity disorders, and cardiovascular risk factors. We measured mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) upon admission and following 24-hour monitoring, with the evaluation of the outpatient antihypertensive therapy. Echocardiography, Holter monitoring, electrocardiography were performed as well.
Results. The risk factor assessment demonstrated smoking in 92 (50%) subjects, low physical activity — in 112 (60.9%) subjects, poor daily regimen and diet — in 130 (70.6%) subjects, not enough sleep — in 40 (21.7%) subjects, hereditary arterial hypertension — in 80 (43.5%) subjects. 141 (76.6%) persons had subjective symptoms. 103 (56%) conscripts had minor heart anomalies: mitral valve prolapse — 45 (24.5%) subjects, supplemental chord of the left ventricle — 49 (26.6%) subjects, while a combination of these heart anomalies was observed in 40 (21.7%) subjects. Besides, 9 (4.9 %) subjects had a functional foramen oval. Mean systolic BP upon admission was 162.0 ± mm Hg, diastolic BP — 91.2 ± mm Hg. 24-hour BP monitoring demonstrated daily mean SBP of 156 mm Hg, DBP — 86 mm Hg. Grade I AH was diagnosed in 80 (43.5%) conscripts, grade II AH — in 56 (30.4%), grade III AH — in 3 (1.6%). Antihypertensive therapy was prescribed to 65 (35.3%) young men, while symptomatic treatment — to 30 (16.3%) young men.
Conclusion. Military aged men demonstrated high incidence of arterial hypertension in some risk factors, mostly genetic predisposition, sleep disorders, poor labour and rest regimen, physical inactivity. Minor heart anomalies are not uncommon. This population needs comprehensive modifiable risk factor programs, including body weight correction, smoking cessation, lipid-lowering diet, and increased physical activity.

Aim. To review the literature on topical issues of possible complications of the use of androgenic anabolic steroids (AAS) from the cardiovascular system and the role of abuse of AAS in increasing individual cardiovascular risk.
Key points. The article reflects the historical stages of the application of AAS. The main pathophysiological mechanisms of the development of undesirable effects from the cardiovascular system have been established. Potential strategies for reducing the risk of side effects and complications from the circulatory system are proposed.
Conclusion. There is a trend of steadily increasing consumption of AAS in the absence of medical recommendations and control, which creates significant prerequisites for increasing cardiovascular risk in people engaged in recreational physical activity who do not fall into the field of preventive cardiology.

Aim. To identify the most significant factors contributing to the development of abdominal obesity (AO) in young and middle-aged residents of St. Petersburg.
Design. A single-stage study conducted according to the “case — control” type.
Materials and methods. We examined 966 employees of various institutions of the city of St. Petersburg who underwent a dispensary examination in 2008–2009. Of these, 503 patients (366 women and 137 men) with AO were included in the study, whose diagnosis was established according to anthropometric studies (measurements of waist circumference, WC). The comparison group consisted of 50 people (38 women and 12 men) without AO, comparable in age and gender with patients with AO.
Results. 82.7% of people aged 30 to 39 years were obese, 91.3% of patients aged 40–49 years and 97.9% of participants aged 50–55 years, the prevalence of obesity increased with age (p < 0.01). Patients with AO were significantly more likely than participants in the comparison group to eat easily digestible carbohydrates (268 (53.3%) and 12 (24%), respectively, p < 0.001) and fats (248 (49.3%) and 11 (22%), respectively, p < 0.001). Among patients with AO, those who ate 1–2 times a day or, conversely, 6 or more times a day had body weight (p < 0.001) and body mass index (BMI) (p < 0.01) significantly higher than those examined who ate 4 times a day. When comparing BMI and WC in AO patients with different birth weights, it was found that AO patients whose birth weight was more than 4 kg had higher BMI and WC values. 482 (95.8 %) patients with abdominal obesity (AO) had low physical activity — less than 210 minutes weekly; 21 (4.2 %) patients with AO — at least 210 minutes weekly (р < 0.001). Almost all the examined patients without AO had higher education 49 (98%), while among patients with AO — only 297 (59%), p < 0.001. The analysis of the income level structure revealed that the income level of individuals with AO is slightly lower than in the group without AO.
Conclusion. The prevalence of AO among residents of St. Petersburg aged 30–55 years is 52.1%. We have created a model based on the calculation of the logistic regression equation to assess the risk of AO development. The most significant parameters influencing its formation are highlighted: the level of education, age, type of nutrition, number of meals per day, birth weight, gender, income level, physical activity.

Aim. To evaluate the effect of a hypoglycemic drug from the group of glucagon-like peptide-1 agonists on epicardial fat thickness in patients with type 2 diabetes mellitus and obesity.
Design. Open pilot study.
Materials and methods. The study included 30 patients (12 women and 18 men) with type 2 diabetes mellitus and obesity of varying severity. 2 patients had a history of myocardial infarction, 20 patients had arterial hypertension of varying severity. To current therapy with oral hypoglycemic agents Dulaglutide was added with drugs for intensification at a dose of 1.5 mg once a week. At baseline and one year later, along with routine laboratory parameters, we assessed the level of glycated hemoglobin, C-reactive protein, anthropometric indicators (body weight, body mass index, waist circumference), echocardiography with determination of epicardial fat thickness, and bioimpedance measurements.
Results. After 12 months of therapy, patients showed a significant decrease in the level of glycated hemoglobin by 0.95% (0.63–1.29%; p < 0.05). Improved performance of carbohydrate metabolism was accompanied by a statistically significant decrease in body weight by 0.96% (0.83–1.1%; p < 0.005), epicardial fat thickness by 0.89 cm (0.08–1.00 cm; p < 0.001) and the amount of adipose tissue according to bioimpedance measurements by 0.88 kg (0.29–0.98 kg; p < 0.05).
Conclusion. Intensification therapy with the GLP-1 receptor agonist dulaglutide led to a significant improvement in carbohydrate metabolism and a decrease in the amount of fat, both total and epicardial, which could potentially reduce the risk of developing cardiovascular events in patients with type 2 diabetes and obesity.

Aim. To assess the risk factors for thrombosis in patients with osteoporosis-induced diabetes mellitus.
Key points. Osteoporosis is a common multifactorial disease with a high risk of venous thromboembolic complications (VTEС). This is due to the main pathology — diabetes mellitus, the use of medications for the prevention and treatment of osteoporosis. The main pathogenetic patterns of VTEС development in patients with diabetoporosis are considered. These include hemostasis disorders, the calcification or calcification of blood vessels, drug inducers, age-related estrogen deficiency, etc.
Conclusion. Patients with diabetes mellitus, mainly type 2, on the background of obesity, older age and with osteoporosis have an increased risk of developing VTEС. Thorough examination of patients with thrombosis risk factors and dynamic monitoring of them, individualization and personification of approaches to the treatment of osteoporosis are advisable.

Aim. To describe a clinical case of a patient with diabetes mellitus in the outcome of chronic calcific pancreatitis.
Key points. Chronic pancreatitis is a multifaceted disease complicating a great number of body systems work. Currently, the problem of post-pancreatitis diabetes mellitus is receiving more and more attention precisely because simultaneous decrease of the endo- and exocrine functions of the pancreas without timely correction is accompanied by concomitant metabolic disorders that lead to different complaints, hiding the underlying cause. In addition to the familiar to endocrinologists’ problem of correcting hyperglycemia, there is also the problem of exocrine pancreatic insufficiency and vitamin-mineral-protein deficiency. Our patient’s dysfunction of the pancreas was reflected in the appearance of secondary hyperparathyroidism with the formation of osteoporosis, decreased growth, and a pathological fracture. The presented clinical case demonstrates the variety and scale of complications that develop in a patient with chronic calculous pancreatitis.
Conclusion. Careful history taking and a comprehensive examination of a patient with a long story of chronic alcoholic pancreatitis should contribute to the timely diagnosis and correction of diseases that develop due to a progressive loss of endo- and exocrine pancreatic function.

Aim. To consider the problem of diagnosing nodular goiter.
Key points. This article analyses the data of the world literature on the problems of various stages of diagnostics of nodular goiter. The data illustrating the recurrence of multinodular goiter with concomitant undiagnosed adenoma of parathyroid gland are presented, the difficulties of diagnosis even at the stage of histological examination in the postoperative period are described.
Conclusion. Despite a large list of diagnostic possibilities and a very good study of this problem, the difficulties at the stage of diagnosis remain, requiring the introduction of a comprehensive personalised approach using modern diagnostic technologies.