The aim of this study was to evaluate the performance of screening for small-for-gestational age newborns at first trimester using the algorithm proposed by the Fetal Medicine Foundation. This was an observational follow-up cohort study on 2 500 patients who were seen at the outpatient clinic for their pregnancy in 2015-2017 and who opted to have screening for chromosomal abnormalities and small-forgestational age preterm neonates at 11⁺¹-13⁺⁶ weeks’ gestation ultrasound scan. The inclusion criterion was singleton pregnancy with a live fetus at the time the screening was performed. The exclusion criteria were multiple pregnancy, fetal structural and chromosomal abnormalities. The individual risk for small-for-gestational age preterm newborn was calculated by the algorithm that combines maternal factors, mean arterial pressure, pregnancy-associated plasma protein-A, and uterine artery pulsatility index with the help of Astraia Software (version 2.8, 3.0) (Germany). The main outcome measure was small-for-gestational age that defined as birthweight below the 10th percentile according to the sex-specific actual-age growth charts for preterm and term infants used in Russian Federation. We excluded 447 cases because of loss to follow-up (n = 265), fetal abnormalities (n = 159), and miscarriages before 22 weeks (n = 23), leaving for the final analysis 2 053 patients. 137 (6.7%) neonates were small-forgestational age, including 37 (1.8%) cases of small-for-gestational age preterm neonates and 100 (4.9%) cases of small-for-gestational age term neonates. The use of the screening algorithm for small-for-gestational age preterm newborns in Russian population achieved a good diagnostic efficacy (area under curve (AUC) - 0.836, 95% confidence interval (CI) - 0.819-0.852) (P < 0,001) with optimal cut-off ≤ 1 : 162 that provided sensitivity of 83.8% with false positive rate of 23.1%. In cases of small-for-gestational age term neonates 1^st trimester screening didn’t achieve an acceptable diagnostic efficacy (AUC - 0.650, 95% CI - 0.633-0.675). Taking into account good performance of screening for small-forgestational age preterm newborns, patients screening-positive for small-for-gestational age preterm newborn can be classified as high risk group in cust omizing antenatal care, justifying the need for increased surveillance.

The article presents the detailed data of the modern standardized criteria of fetal growth restriction developed in 2016 by leading world experts and recommended for use in daily clinical practice and for research. The international principles, protocols and algorithms for follow-up, timing and method of delivery for fetal growth restriction cases developed on the basis of evidence-based multicenter European studies have been provided.

The article presents the case of diagnosis and treatment of rare heart pathology - the left atrial appendage aneurysm with atrial appendage thrombosis in 51 years old female. This patient had the cardiac arrhythmias for 9 years (paroxysmal atrial fibrillation) and ischemic stroke (3 years ago) at the past medical history. She sought for the medical attention to the Lipetsk Regional Clinical Hospital (Lipetsk) with the complaints of arrhythmias, frequent headaches, intermittent dizziness, general weakness, a rare heart area stabbing pain without any correlations with physical activity, low effort tolerance. The additional lesion was revealed with the transthoracic echocardiography. The diagnosis was confirmed with the transesophageal echocardiography. The ECG and daily monitoring of the ECG registered the sinus rhythm with rare supraventricular extrasystoles. The anticoagulant, antiarrhythmic, hypolipidemic, and antihypertensive therapy was carried out. The patient was consulted by the mobile team of cardiac surgeons from the A.N. Bakulev National Medical Research Center of Cardiovascular Surgery (Moscow), and the surgical tactics of treatment was chosen (the surgical treatment was performed in this organization later). The Holter ECG monitoring, which were registered the atrial fibrillation throughout the recording twice, and the repeat instrumental examination were performed before the surgical treatment. Because of the left atrial appendage volume about 213 ml (CT), the revealed aneurysm can be considered as giant. Cryomodification of Cox Maze III (left atrial appendage aneurysm resection in the conditions of cardiopulmonary bypass, hypothermia, and cold cardioplegia) was performed. The pericardial effusion (separation of the pericardial layers behind the posterolateral wall of the left ventricle up to 1 cm with transthoracic echocardiography) was detected in the early postoperative period. Heart rhythm was atrial fibrillation. At the follow up period (1.5 months after surgery) the atrial fibrillation was preserved, the volume of the pericardial effusion was the same. The patient noted the good general condition, the reducing of fatigue, and subjective absence of arrhythmia feeling. The presented clinical case clearly shows the potential of transesophageal echocardiography in the left atrial appendage aneurysm detection.

Ulnar nerves of 200 upper extremities were studied in 100 neurologically healthy children aged 0-17 years. All children were divided into 5 age groups (1^st - 0-4 years old, 2^nd - 5-7 years old, 3^rd - 8-10 years old, 4^th - 11-13 years old, 5^th - 14-17 years old). The methodology of ulnar nerve ultrasound examination was detailly described with anatomical landmarks indication. Ultrasound patterns of ulnar nerve and quantitative parameters were shown according to the age. The cross-sectional area (with transverse scanning) of nerves and it’s thickness (with longitudinal scanning) were measured at three locations: at the border of the middle and lower third of the shoulder (I), at the middle third of the cubital channel (II), at the border of the upper and middle third of the forearm (III). There were no changes of ultrasound images with increase of the children’s age. Intraneural vascularization was not identified. There were no significant differences (P > 0.05) of ulnar nerve cross-sectional area and thickness between right and left arms at all levels within all age groups. Significant differences (P < 0.05) of the cross-sectional area were found between locations I and II, I and III in all age groups. Between locations II and III differences in all age groups were insignificant (P > 0.05). The values of locations II and III cross-sectional area obtained in each age group were integrated in the combined distal level. Significant differences (P < 0.05) were found for all intergroup comparisons (except for the 4^th and 5^th groups). The 4^th and 5^th groups were integrated in the combined older group. It was the same for the thickness of ulnar nerve. A significant (P < 0.05) positive correlation was found between the values of ulnar nerve cross-sectional area and the age of children at two locations (at the proximal level r_S = 0.74, at the combined distal level r_S = 0.72). All of the above can be used in everyday practice for the interpretation of ulnar nerve ultrasound results in children of different age groups.