In this paper, we compare common Unet architectures with upgrade version Unet++ for segmentation of the the left ventricular (LV) endocardial boundaries on ultrasound images, which were obtained by ultrasound studies of the heart. The key difference of Unet++ from Unet is the improved skip connections between encoder and decoder by adding convolution blocks. Such implementation allows us to transfer information from encoder to decoder with avoiding to loss of small details of the ultrasound image. It is very important to detect internal boundaries accuratly. We evaluated Unet++ in comparison Unet and wide Unet. The Dice coefficient for the LV segmentation with Unet++ is 91.20%. This result of Unet++ for the LV area segmentation outperforms Unet and wide Unet architectures.

Nowadays ultrasound studies of the heart, also called echocardiography (EchoCG), are widespread in modern cardiology. One of the most important steps in estimating the health of the heart is the tracking and segmentation of the left ventricular (LV) endocardial border from EchoCG, which is used for measuring the ejection fraction and assessing the regional wall motion [1]. The disadvantage of these methods is the necessity to apply image processing manually or in a semi-automatic mode, which requires special knowledge and skills. As a result, the issue of an automatic tracking and segmentation of the LV on EchoCG-images is an actual and practical problem. The capabilities of the fully trained model of the convolutional neural network Unet for automatic identification of the LV region are explored in this paper. The obtained accuracy of LV segmentation is up to 92.3%, which suggests the expediency of using Unet for automatic identification of the LV endocardial border on ultrasound images.

Background. Information on the incidence of cervical intraepithelial neoplasia (CIN) is relevant for planning and evaluating the effectiveness of medical care at the stage of secondary prevention of cervical cancer. Aim. To analyze the incidence of CIN and benign diseases of the cervix: erosion and ectropion, leukoplakia, polyp, according to medical organizations in Yekaterinburg in 2013–2019. Materials and methods. A descriptive epidemiological study of the incidence of cervical pathology in the population of women in Yekaterinburg in 2013–2019 was conducted. The forms of Federal Statistical Observation No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization”, in terms of erosion and ectropion, and data from the city’s women’s consultations on the number of cases of CIN, leukoplakia and cervical polyp were examined. Information on the number of female population of the city from Sverdlovskstat was used. Results. The primary incidence of CIN increased throughout the follow-up period. The indicator increased by 1.7 times compared to 2013 (p 0.001) in 2016, it had a maximum value in 2019 – 215.5 per 100 thousand women and was 3.2 times more than in 2013 (p 0.001). The dynamics of the primary incidence of other types of cervical pathology: ectropion, leukoplakia and cervical polyp, was characterized by the absence of significant changes (p 0.05) in 2013–2019. The increase in the overall incidence of CIN was registered from 2014 to 2019 in comparison with 2013 (p 0.001). The indicator of the overall incidence of CIN in 2019 was 2.1 times higher than in 2013 (p 0.001). Conclusions. The growth of primary and total incidence of CIN in the population of Yekaterinburg women noted since the beginning of the XXI century continued in 2013–2019. The primary incidence rate of CIN had the maximum value in 2019. The increase in the incidence of CIN is associated with the natural spread of the disease, accessibility and improvement in the quality of medical care.

Aim. To determine quantitative criteria for assessing the therapeutic benefits and the most informative time frames after cardiac resynchronization therapy (CRT) to assess its long-term effectiveness (1, 2, 3 years of follow-up) based on retrospective analysis. To assess the CRT effectiveness, parameters of left ventricular (LV) reverse remodeling and signs characterizing the clinical CRT response were considered.Material and methods. This single-center, retrospective, non-randomized study included data from 278 patients with implanted CRT devices. Quantitative criteria for assessing CRT effectiveness were determined using a two-step cluster analysis of patients 1, 2, and 3 years after CRT by LV reverse remodeling parameters.Results. In the dataset with satisfactory division accuracy, after the first year, two clusters were identified, which are conventionally named as “non-responders” and “responders”. Two and three years after therapy, patients were classified into three clusters: “non-responders”, “responders” and “super-responders”. For the obtained clusters, we found cutoff values for LV reverse remodeling parameters, which can be used as criteria for response to therapy.The study identified the most informative time frames for assessing the postoperative CRT effectiveness 1, 2, 3 years after the surgery. At the same time, the clinical response to therapy is manifested earlier in comparison with the reverse LV remodeling.Despite the high divisibility of patients into responders and non-responders, predictive models of CRT effectiveness created using the available data from standard diagnostic protocols for heart failure patients have insufficient accuracy to be used for making decisions on therapy appropriateness. This circumstance indicates the need to receive additional data to improve the forecasting quality.Conclusion. The study revealed a period for assessing the clinical response and changes in LV reverse remodeling after CRT surgery, which is important for the optimal choice of postoperative therapy. It has been shown that in most cases, one year after surgery is sufficient to assess the clinical response, and the process of LV reverse remodeling can last up to two years on average.When assessing the CRT effectiveness by reverse remodeling, along with a change in LV end-systolic volume (ESV), it is necessary to take into account LV end-diastolic volume (EDV) changes. The change in LV ejection fraction showed a significantly lower value among the analyzed parameters in assessing the CRT effectiveness. Based on the cluster classification of patients, a dividing rule was established for responders and non-responders in the first and second years after surgery with an accuracy of 97%: a decrease in LV ESV and EDV by 9% or more compared to preoperative values.

Epidemiological studies consistently have suggested an association between low birth weight and increased rate of cardiovascular morbidity and mortality in adult life. Preterm birth, as one of the leading causes of the low birth weight, is associated with cardiovascular remodeling which consists of changes in heart chambers geometry and contraction-relaxation mode, ventricular hypertrophy, arterial wall structure and density changes. Several types of preterm birth are discussed: prematurity, associated with placental insufficiency and fetal growth restriction, preterm leaking of amniotic fluid, and twin pregnancy. DNA methylation process under the influence of epigenetic factors of the intrauterine and early postnatal development is suggested as a one of the main mechanism of cardiovascular remodeling in preterm infants. The other mechanisms of cardiovascular remodeling are discussed in terms of the modern intrauterine programming concept. The early diagnostics and prevention of cardiovascular diseases in preterm born children are discussed. The treatment during prenatal and early postnatal periods as well as prevention of the remodeling causes could diminish and even reverse the development of the negative cardiovascular events and diseases in later life according to the so called concept of one thousand days opportunities window.