bluuebunny/crossref_metadata_2025 huggingface dataset:
First, We Do Harm: Obtaining Informed Consent for Surgical Procedures
Authors: Tribble Curt , Julliard Walker
Published: October 2019

Although many believe that the phrase “First, do no harm” was part of the Hippocratic Oath, in fact it was not. This phrase, often written in Latin (“Primum non Nocere”), seems to have first appeared in medical writing in the 17th century. However, it is obvious that many therapeutic interventions do cause at least some harm with hopes of benefitting patients in the long run. This balancing of initial harm in hope of eventual benefit is never more apparent than in the case of invasive procedures, though other examples abound, such as the administration of chemotherapy. The ethical concept of nonmaleficence, which traces its origins to the concept of primum non nocere, accurately acknowledges the concept of the need to strive to do more good than harm. Thus, it is apparent that, in a surgical operation, the surgeon is proposing to cause harm, initially, to the patient in hopes of creating an outcome that results in more good than harm. Therefore, the process of obtaining consent from the patient for a surgical operation acknowledges the fact that harm will, in fact, be inflicted on that patient, with the hope that, on balance, this harm will result in a greater overall good for the patient. It is for this reason that the modern concepts of informed consent have developed.
Efficiency of a Constrained Linear Genomic Selection Index To Predict the Net Genetic Merit in Plants
Authors: Cerón-Rojas J Jesus , Crossa Jose
Published: October 2019

The constrained linear genomic selection index (CLGSI) is a linear combination of genomic estimated breeding values useful for predicting the net genetic merit, which in turn is a linear combination of true unobservable breeding values of the traits weighted by their respective economic values. The CLGSI is the most general genomic index and allows imposing constraints on the expected genetic gain per trait to make some traits change their mean values based on a predetermined level, while the rest of them remain without restrictions. In addition, it includes the unconstrained linear genomic index as a particular case. Using two real datasets and simulated data for seven selection cycles, we compared the theoretical results of the CLGSI with the theoretical results of the constrained linear phenotypic selection index (CLPSI). The criteria used to compare CLGSI vs. CLPSI efficiency were the estimated expected genetic gain per trait values, the selection response, and the interval between selection cycles. The results indicated that because the interval between selection cycles is shorter for the CLGSI than for the CLPSI, CLGSI is more efficient than CLPSI per unit of time, but its efficiency could be lower per selection cycle. Thus, CLGSI is a good option for performing genomic selection when there are genotyped candidates for selection.
Fractura mandibular parasinfisiaria y condilar intracapsular en paciente pediátrico manejado con placas reabsorbibles: reporte de un caso
Authors: Díaz Príncipe Fernando Ernesto , González Rebattú y González Mauricio , Nieto Mungía Ana María , Muñoz Torres Carlos Enrique
Published: October 2019

La fractura mandibular es uno de los tipos más comunes en el trauma maxilofacial pediátrico. El principal objetivo del manejo de fracturas, es la restauración de forma y función del hueso. Las fracturas incompletas son más comunes, debido a la elasticidad del hueso; por lo que, usualmente el tratamiento de fracturas en niños es conservador. Debido al progreso en materiales de reparación ósea y la mejora tecnológica, actualmente la proporción de niños tratados con reducción abierta y fijación interna (RAFI) ha aumentado; siendo el uso de miniplacas y minitornillos el tratamiento gold estándar para fijación semirrígida craneomaxilofacial. Una alternativa son los materiales reabsorbibles, lo cuales no requieren retiro y van degradándose gradualmente, ventaja considerable en el manejo de fracturas mandibulares en niños. Presentamos el caso de un paciente de 6 años, quién sufrió una fractura mandibular parasinfisiaria y condilar por caída de escaleras. Al examen se evidencia limitación de apertura bucal, dolor moderado a la palpación; se solicitaron exámenes imagenológicos donde se evidencia trazo de fractura parasinfisiaria y trazo a nivel intracapsular de cóndilo izquierdo, estas fracturas fueron manejadas con placas reabsorbibles y tratamiento conservador, respectivamente. El resultado fue óptimo.
Modelo de ficha clínica ortodóntica en pacientes con fisura labio palatina
Authors: Leiva Noemi , Fuentes Vanessa , Ayala Francisca , Stange Carolina
Published: October 2019

La ficha clínica es un documento médico legal que permite el registro de la información de un paciente y su problema de salud. En la Unidad de Malformaciones Craneofaciales de la Universidad de Chile, se ha utilizado por 33 años un modelo único de ficha clínica dental utilizado específicamente para la atención ortodóntica en pacientes con fisura labio palatina. El objetivo de este trabajo, es exponer una ficha clínica ortodóntica utilizada con finalidades tanto de documento clínico y docencia.
Incremento de la viabilidad, producción de especies reactivas de oxígeno, IL-1 y TNF-α en células mononucleares de sangre periférica humana tratadas con fucoidan de Lessonia trabeculata
Authors: Colona‐Vallejos Erasmo H. , Alzamora‐Gonzales Libertad , Chávez Pérez Jorge A. , Apumayta Suárez Eder V. , Chang Avila Iliana
Published: October 2019

Las algas pardas constituyen una fuente de alto contenido de polisacáridos como los fucoidanos que poseen importantes propiedades inmunomoduladoras. El objetivo fue determinar la viabilidad de células mononucleares de sangre periférica humana (CMSPh), producción de óxido nítrico (NO), especies reactivas de oxígeno (ROS) y de las citoquinas proinflamatorias IL-1α, IL-6, TNF-α e IFN-γ en cultivos tratados con fucoidan de Lessonia trabeculata. Se empleó fucoidan de Lessonia trabeculata proveniente de la bahía San Nicolás de Marcona-Ica. Las CMSPh se aislaron empleando Ficoll-Hypaque, se distribuyeron a una concentración de 1x105 células/pocillo en medio RPMI-1640 completo y se trataron con diferentes concentraciones de fucoidan durante 24 y 48 h. La actividad citotóxica se determinó por la reducción de MTT, la producción de NO por la reacción de Griess y las ROS por la reducción del NBT. La producción de citoquinas se cuantificó por ELISA. El fucoidan de L. trabeculata estimuló la proliferación de CMSPh y produjo el incremento de ROS a concentraciones de 100-2000 μg/mL respecto al control (p<0.001), la reacción para nitritos resultó negativa. El fucoidan incrementó la producción de IL-1α y TNF-α a concentraciones de 100 y 10 μg/mL respectivamente, mientras que la producción de IL-6 e IFN-γ no mostró diferencias significativas. Se concluye que el fucoidan de L. trabeculata estimula la proliferación de CMSPh, producción de especies reactivas de oxígeno y las citoquinas proinflamatorias IL-1α y TNF-α que poseen importantes propiedades inmunomoduladoras.
GPU Parallelization Nested Decomposition Method for Solving Large Linear Systems in Reservoir Numerical Simulation
Authors: Shi Xin , Di Yuan
Published: October 2019

This paper designs a highly parallel Nested Factorization (NF) to solve large linear equations generated in reservoir numerical simulation problems. The NF method is a traditional linear solution preprocessing method for reservoir numerical simulation problems, and has regained attention in recent years due to its potential to extend to parallel architectures such as GPUs (Graphics Processor Units). The parallel algorithm of this paper is based on the MPNF (Massively Parallel Nested Factorization) framework proposed by Appleya (Appleyard, Appleyard, Wakefield, & Desitter, 2011). The MPNF algorithm designed in this paper focuses on its efficient implementation on the GPU parallel architecture. Its features include: using a custom matrix structure to achieve merge access, improving access bottlenecks and improving the efficiency of the SpMV algorithm. It is also applicable to the two-stage preprocessing method CPR. (Constrain Pressure Residual) pressure solution and global preprocessing stage; the MPNF method is extended to the solution of 2.5-dimensional unstructured grid problem. The parallel algorithm in this paper has been integrated into the reservoir numerical simulator. For the SPE10 (million grid, highly heterogeneous) standard example, the GPU-based parallel NF algorithm is in the structured grid model and the equivalent 2.5-dimensional non- On the structured grid model, compared with the serial version of the NF method, the acceleration ratios of 19.8 and 17.0 times were obtained respectively; compared with the mainstream serial solution method, the efficiency was also improved by 2 to 3 times.
Virtual Display System of Geological Body Based on Key Algorithms of Three-dimensional Modelling
Authors: Feng Wei
Published: October 2019

In order to study the virtual display system of geological body, the key algorithm of three-dimensional modelling is used to analyze it, and the virtual display scheme of geological body is realized. Three-dimensional modelling of geological bodies is a frontier field of current geoscience research, and also a hot issue in computer science. Its research can complement and improve the theoretical basis of virtual reality technology and expand its application fields. Geological body three-dimensional modelling software can meet the needs of geoscientists to study geological problems more effectively from three-dimensional space, and has considerable practical value. In the network environment, users' information needs are diversified and individualized, and special attention is paid to the breadth, novelty and timeliness of information. Faced with massive information resources, the information users need is a drop in the ocean in the huge and disorderly network information space. Users need to spend a lot of time and energy to find valuable information in all kinds of uniform systems. Traditional system information services can no longer help users effectively get rid of information overload and information lost. Therefore, the concept of personalized service system has become a hot spot of people' s attention as soon as it is put forward. In recent years, personalized systems have emerged in endlessly. In the early stage of formulation and implementation of personalized service strategy, the existing personalized service generally lacks the attention to context information such as user' s environment. There are weak links in personalization and intellectualization of service, which damages user experience. Therefore, Shepard algorithm and Kriging algorithm of three-dimensional modelling are used to study the virtual display system of geological bodies. The results show that these two key algorithms play a very important role in the research process of geological virtual display system, and also provide a new idea for further research on the popularization of geological knowledge.
Effects of L1/L2 Captioned TV Programs on Students’ Vocabulary Learning and Comprehension
Authors: Wang Yangting
Published: October 2019

This study investigated the effects of different types of captions on English as a Foreign Language Learners’ (EFL) vocabulary learning and comprehension. Eighty students in a Chinese university participated. Students were divided into four groups with two classes of freshmen, one class of juniors, and one class of graduate students. Each group watched four video clips with four caption conditions: L1 Chinese, L2 English, dual (L1 and L2), and no captions. The order and caption conditions were counterbalanced. The purpose of the study was to find which caption condition is more effective for EFL learners. Four by four mixed ANOVAs were used to compare the differences among the four conditions and groups. Results indicated that students’ performances were statistically significantly different across captions and class levels. In general, students in L1, L2, and dual captions statistically outperformed the no caption condition in vocabulary and comprehension. Results of the effects of L1, L2, and dual captions on vocabulary learning and comprehension were mixed. The pedagogical implications of using authentic TV series and multimedia captions were discussed.
Effects of Japanese University Students’ Characteristics on the Use of an Online English Course and TOEIC Scores
Authors: Ozawa Shinya
Published: October 2019

The effective use of Information and Communication Technology (ICT) can have positive effects on the development of learners’ English abilities. To what degree it is effective is partly determined by learners’ characteristics in ICT use. However, these characteristics have not yet been sufficiently discussed in Japan. This study, then, explored how the characteristics of Japanese EFL university students related to their actual use of an online English course and whether it led to the development of their English abilities. In the survey, 130 Japanese university students were asked to self-evaluate their attitudes toward computer-assisted language learning (CALL) and the use of technology in an out-of-classroom situation. As a result, it became clear that most of the students were not confident in using the technology and did not use it actively outside the classroom. Cluster analysis was employed with a focus on individual differences, revealing that the time students actually spent on the course and their high evaluations of the effectiveness of CALL did not necessarily predict development of English abilities. It was suggested that individual differences should be carefully considered in adopting online English courses effectively in higher education institutions.
Relação entre o Marketing de Relacionamento e a Fidelização de Clientes: um estudo no setor bancário
Authors: Rezende Gracielle Antunes Cangussú , Almeida Geciane Silva , Loriato Hannah Nicchio , Pelissari Anderson Soncini
Published: October 2019

O marketing de relacionamento tem se destacado nos últimos anos como um importante diferencial para as empresas que querem manter os seus clientes fiéis, mesmo em mercados com grande concorrência. A presente pesquisa teve como objetivo identificar a relação entre os principais construtos do marketing de relacionamento e a fidelização de clientes em instituições financeiras. Em termos teóricos, esse estudo fundamentou-se no marketing de relacionamento, satisfação do cliente, qualidade do serviço, valor percebido, confiança e fidelização do cliente. Trata-se de um estudo de natureza quantitativa. Para levantamento dos dados foi realizada uma survey, com a aplicação de 418 questionários respondidos por clientes de diferentes instituições financeiras, mediante a técnica snowball sampling ou amostragem em bola de neve. Os dados coletados foram analisados por meio do programa SPSS Statistical 22 (Statistical Package for Social Sciences), ferramenta que possibilitou a análise da estatística descritiva e multivariada dos dados. Os resultados revelaram relações positivas e significativas entre os constructos do marketing de relacionamento: satisfação, qualidade, valor percebido e confiança, e a fidelização de clientes em instituições financeiras. Desta forma, os resultados indicam que as instituições financeiras, ao desenvolverem suas estratégias de marketing, poderão considerar tais variáveis no planejamento das suas ações, para assim desenvolver relacionamentos mais duradouros com seus clientes.
Optimal Determination of Space Objects Orbit by Angular Measurements of Ground-Based Optoelectronic Stations
Authors: Mironov Vyacheslav , Mironov Yuri , Khegay Dmitry
Published: October 2019

The successful solution of practical cosmonautics problems is largely achieved by contemporary advances in measurement and computing technology, as well as by improvements in methods of primary and secondary processing of trajectory measurements. Therefore, in long-range programs of space exploration and space technology development, much attention is paid to improving existing and developing new algorithmic and technical means of navigation support for flights of space objects with the purpose to expand capabilities and increasing the efficiency of autonomous navigation systems of spacecraft, as well as ground-based and perspective orbital systems of space monitoring. Currently, active work is underway to modernize and develop promising complexes of specialized optoelectronic devices for monitoring near-Earth space based on angular measurements. The article considers the application of the variational approach for solving problems of statistical estimation of the trajectory parameters of the orbital object by angular measurements, which were carried out by ground-based optoelectronic means that are part of the modern space control system. Models and algorithms for determining estimates of orbital parameters that implement the variational version of the maximum likelihood method are presented, as well as the results of test calculations related to iterative solution of the two-point boundary value problem of variational estimation. The main purpose of the numerical calculations  is a study of convergence of the proposed estimation algorithm, as well as the impact of measurement errors on the displacement of the obtained estimates relative to their exact values. The simulation results, presented in the article, correspond to the conditions of the orbital motion of METEOR PRIRODA spacecraft and were obtained using the ephemeris data of the NORAD catalog in TLE-elements.
Compliance as the major effectiveness determinant in preventive acetylsalicylic acid therapy
Authors: Rafalskiy V. V. , Baglikov A. N.
Published: October 2019

Acetylsalicylic acid (ASA) treatment of patients with cardiovascular disease (CVD) is one of the most effective methods for CVD event prevention. In a substantial proportion of the patients, however, long-term preventive ASA treatment compliance is low (44-71%). Low compliance is associated with reduced antiplatelet effects of ASA and a 2-3-fold increase in the risk of myocardial infarction (MI), ischemic stroke (IS), and other cardiovascular events. ASA therapy compliance could be improved by achieving better collaboration between doctors and patients, while educating patients and explaining the importance of following the doctors’ advice. In addition, enteric-coated ASA forms could play an important role in improving treatment tolerability and, therefore, increasing compliance. Other potentially effective measures include the use of modern packaging (calendar blisters) and information technologies (telephone communication, MGMM).
Stem cells in the treatment of patients with coronary heart disease. Part I
Authors: Zhukova N. S. , Staroverov I. I.
Published: October 2019

Heart failure (HF) is one of the leading death causes in patients with myocardial infarction (MI). The modern methods of reperfusion MI therapy, such as thrombolysis, surgery and balloon revascularization, even when performed early, could fail to prevent the development of large myocardial damage zones, followed by HF. Therefore, the researches have been searching for the methods which improve functional status of damaged myocardium. This review is focused on stem cell therapy, a method aimed at cardiac function restoration. The results of experimental and clinical studies on stem cell therapy in coronary heart disease are presented. Various types of stem cells, used for cellular cardiomyoplasty, are characterised. The methods of cell transplantation into myocardium and potential adverse effects of stem cell therapy are discussed.
Clinical and functional manifestations of hypervolemia in patients with arterial hypertension
Authors: Poselyugina O. B. , Nilova S. A. , Volkov V. S. , Hakhed Al Galban
Published: October 2019

Aim.To identify clinical and functional manifestations of hypervolemia in patients with arterial hypertension (AH).Material and methods.In total, 440 patients with Stage I-II AH were examined, including assessment of salt taste sensitivity threshold (STST), 24-hour urinary Na excretion, and NaCl excretion. In addition, 24-hour blood pressure monitoring (BPM), echocardiography (EchoCG), and psychological status assessment (SMOL, MOS SF-36) were performed.Results.In 50,5% of AH patients, daily salt intake (assessed by 24-hour NaCl excretion) was ≥16,8 g, due to adding salt to food, as well as to reduced STST. Higher salt intake was associated with more advanced clinical and functional AH manifestations. Indirect markers of hypervolemia in AH patients included higher salt intake, low effectiveness of standard antihypertensive therapy (AHT), disturbed circadian BP rhythm with inadequate nighttime BP reduction, and EchoCG signs of left ventricular volume overload.Conclusion.Complex examination of AH patients helps to identify individuals with clinical and functional manifestations of hypervolemia.
Aspirin resistance in patients with acute coronary syndrome. Part 2
Authors: Frolova N. S. , Shakhnovich R. M. , Kaznacheeva E. M. , Sirotkina O. V. , Dobrovolskyi A. B.
Published: October 2019

Aim.In patients with acute coronary syndrome (ACS), to investigate the prevalence of aspirin resistance, its clinical features, prognostic effects, and potential correction.Material and methods.The study included 100 ACS patients receiving aspirin. Aspirin resistance was diagnosed if at Day 7 of aspirin therapy, the level of platelet aggregation (PLA) with arachidonic acid was ≥20%. In addition, a thromboxane A2 (ТхА2) metabolite – 11-dehydro-thromboxane B2 (11DHTxB2), as well as inflammation markers and genetic polymorphisms (sub-unit IIIa – Leu33Pro and cyclooxygenase-2 (COG) genes) were studied.Results.Aspirin resistance was diagnosed in 11% of ACS patients, receiving aspirin in a standard dose of 100 mg/d. The majority of aspirin-resistant patients had ACS with ST segment elevation (STE-ACS). In all aspirin-resistant ndividuals, the resistance was pharmacokinetic. The level of 11DHTxB2, increased at baseline in ACS patients and especially in those with STE-ACS, was reduced during aspirin therapy. The combination of high PLA and high 11DHTxB2 levels was typically associated with true aspirin resistance. In patients with metabolite levels >438 ng/ mmol creatinine, prognosis was significantly worse than in those with lower levels of this parameter. In aspirinresistant patients, the levels of interleukin-6 (IL-6), IL-10, and C-reactive protein (CRP) at baseline and throughout the study were significantly higher than in aspirin-sensitive subjects. There was no significant association between aspirin resistance and Leu33Pro or А842G polymorphisms, while А842G polymorphism was more common in aspirin-resistant patients.Conclusion.In aspirin-resistant patients, the level of ТхА2 metabolite is increased (true resistance). In ACS individuals with high levels of 11DHTxB2, the prognosis was worse. Aspirin resistance could be linked to inflammation activation. There was no consistent association between aspirin resistance and studied genetic polymorphisms.
Cardiac arrhythmia prevalence in postmenopausal women
Authors: Izmozherova N. V. , Andreev A. N. , Gavrilova E. I. , Popov A. A. , Fominykh M. I. , Kozulina E. V. , Safyannik E. A.
Published: October 2019

Aim.To study the prevalence and features of cardiac arrhythmias (CA) in postmenopausal women, as well as to investigate the CA association with carbohydrate metabolism disturbances.Material and methods.This cross-sectional study included 210 postmenopausal women (median age 57 years; age range 54,0-61,0 years). Median menopause duration was 7,9 years (3,0-12,0 years). The examination included Holter ECG monitoring, clinical evaluation, measurement of blood pressure, body mass index, waist and hips circumference the levels of glucose, insulin, lipids, Mg, Ca, uric acid, brain natriuretic peptide, and thyrotropin.Results.CA were registered in 99,5% of the participants, including ischemia (17,1%), supraventricular extrasystolia (88,1%), ventricular extrasystolia (VE; 53,8%), high-grade VE (HGVE; 21,5%), SV tachycardia paroxysms (19%), atrial fibrillation (2,3%), V tachycardia paroxysms (1,4%), asystolic periods (0,9%), sino-atrial and atrioventricular blocks (9,1%), bundle branch blocks (3,3%), sinus tachycardia (50,9%), and sinus bradycardia (23,8%). In postmenopausal women with disturbed carbohydrate metabolism, CA prevalence was higher for VE (1,9 times), HGVE (2,4 times), and polytopic VE (2,5 times). VE prevalence was higher in women with abdominal obesity and chronic pancreatitis. In addition, CA odds were higher in postmenopausal women with coronary heart disease (CHD; 2,75 times), chronic heart failure (CHF; 2,6 times), and acute cardiovascular events such as myocardial infarction or stroke (3,3 times).Conclusion.CA and ischemia prevalence was high in postmenopausal women, 21,5% of whom had high potential risk of sudden death. Increased odds of ventricular arrhythmias among postmenopausal women were associated with carbohydrate metabolism disturbances, CHD, CHF.
Pharmacokinetics and pharmacodynamics of a β-adrenoblocker bisoprolol: from mechanisms of action to clinical features
Authors: Ostroumova O. D. , Smolyarchuk E. A.
Published: October 2019

The authors discuss the action mechanisms of β-adrenoblockers (β-AB), as well as pharmacokinetics, pharmacodynamics, and drug interaction of a highly selective β-AB bisoprolol. The paper presents the data on bisoprolol effectiveness and safety in arterial hypertension, coronary heart disease, chronic heart failure, and their combination with other diseases.
Early left ventricular remodelling criteria and antihypertensive therapy effectiveness
Authors: Kirichenko L. L. , Struchkov P. V. , Poltanova M. B.
Published: October 2019

Aim.To identify the criteria of early left ventricular (LV) remodelling; to assess the baseline structure and function of left and right cardiac chambers, as well as their dynamics during adequate antihypertensive therapy (AHT), in patients with Stage 2 arterial hypertension (AH).Material and methods.In total, the study included 79 individuals: 35 patients with Stage 2 AH and 44 healthy volunteers. All participants underwent echocardiography (EchoCG), with the assessment of standard structural and functional remodelling parameters, as well as the original linear parameters “a”, “b”, and “c”, proposed by the authors. Twenty five AH patients were re-examined 1,5 years after the start of adequate AHT.Results.Even early stages of AH are characterised by left and right ventricular dysfunction, as a manifestation of complex heart reaction to pressure overload. Simple, accessible EchoCG criteria, specifically, linear parameters of LV geometry “a”, “b”, and “c”, have been proposed to assess LV remodelling at earlier stages, compared to traditional parameters and spherical index. Adequate AHT resulted in improvement of left and right heart structure and function, with geometric parameters “a” and “b” being the most sensitive criteria.

Conclusion.In AH patients, the proposed linear parameters could be used as diagnostic criteria for earlyLV remodelling, as well as indicators of AHT effectiveness, considering their higher sensitivity, compared to traditional EchoCG parameters.
Modern views on amlodipine and new S-amlodipine medications
Authors: Leonova M. V.
Published: October 2019

The review presents the latest evidence on the calcium antagonist amlodipine, summarizing its mechanisms of action, its pleiotropic, endothelial function-related effects, and its anti-atherogenic activity. Amlodipine suppresses the proliferation of vascular smooth myocytes and extracellular matrix and improves endothelial vasodilatation, despite the absence of L-type calcium channels in these cells. This mechanism is related to an increase in endothelial nitric oxide (NO) release. The results of experimental studies on the role of S and R amlodipine isomers in its hemodynamic and pleiotropic activity are presented. While S-amlodipine is a pharmacologically active blocker of L-type calcium channels, R-amlodipine increases endothelial NO release. New medications have been developed, based on S-amlodipine. It has been shown that S-amlodipine 5 mg/d is bioequivalent to amlodipine 10 mg/d. The pharmacodynamics analysis demonstrated that S-amlodipine 5 mg/d and amlodipine 10 mg/d did not differ significantly in terms of mean levels of systolic and diastolic blood pressure, or mean heart rate. S-amlodipine was better tolerated and characterised by a lower incidence of peripheral edema than amlodipine. However, the effects of S-amlodipine on hard end-points should be investigated in the long-term prospective studies.
Refractory post-infarction myocardial ischemia: treatment potential
Authors: Ryabov V. V. , Oyunarov E. O. , Markov V. A.
Published: October 2019

The treatment of recurrent, refractory post-infarction myocardial ischemia remains an unresolved clinical problem. Aggressive pharmaceutical therapy has limited effectiveness, while percutaneous coronary intervention or coronary artery bypass graft surgery are not possible in these patients, due to various reasons. Currently, alternative methods for refractory angina treatment are being developed for patients with chronic stable angina. The potential of these methods in patients with acute coronary syndrome should be investigated in the future studies.
Perspectives of impaired glucose tolerance management in patients with metabolic syndrome
Authors: Ivanov K. P. , Mychka V. B. , Zhernakova Yu. V. , Tishina E. V. , Tolstov S. N. , Masenko V. P. , Chazova I. E.
Published: October 2019

Aim. To assess the effectiveness of vildagliptin, its effects on visceral obesity (VO), carbohydrate and lipid metabolism parameters, and circadian profile (CP) of blood pressure (BP) in patients with metabolic syndrome (MS), Stage I arterial hypertension (AH), and impaired glucose tolerance (IGT). Material and methods. The study included 30 patients, aged 18-60 years (16 men and 14 women). All patients had IGT, VO, and Stage I AH. Previously prescribed antihypertensive therapy (AHT) was not modified after the start of the study. In all participants, carbohydrate and lipid metabolism parameters, BP CP, and body weight were measured at baseline and after 24 weeks of vildagliptin treatment. Results. Vildagliptin therapy was associated with a significant reduction in body weight, waist circumference, postprandial and fasting glucose levels, the levels of total cholesterol and low-density lipoprotein cholesterol, as well as with a sustained reduction in systolic and diastolic BP levels. Conclusion. Vildagliptin therapy resulted in weight reduction, improved carbohydrate and lipid profiles, and target BP achievement, without inducing hypoglycemia episodes.
C-reactive protein and sociodemographic parameters in Moscow residents aged 55 years and older
Authors: Shalnova S. A. , Zhukova V. A. , Metelskaya V. A. , Deev A. D. , Khudyakov M. B. , Aleksandri A. L. , Balanova Yu. A. , Kapustina A. V. , Konstantinov V. V. , Kukushkin S. K. , Lel’chuk I. N. , Platonova E. V. , Shkolnikova M. A.
Published: October 2019

Aim.High-sensitive C-reactive protein (hsCRP) is currently regarded as an important marker of cardiovascular disease (CVD). The aim of the study was to assess the population characteristics of hsCRP in the sample of Moscow residents aged 55 years and older.Material and methods.The analysis included 1851 people (response rate 65 %), who participated in the SAHR (Stress, Aging, and Health in Russia) study.Results.The hsCRP levels were similar in men and women, with the right-skewed distribution. The hsCRP values ranged from 0,5 to 69,5 mg/dl in men (median 1,5 mg/l), and from 0,5 to 75 mg/l in women (median 1,5 mg/l). The mean hsCRP levels were slightly higher in men than in women (3,4±0,19 vs. 3,1±0,15, respectively;р=0,36). Overall, there was no marked age-related dynamics of hsCRP levels in men or women. The prevalence of high hsCRP levels (>3 mg/l) non-significantly increased from 31,2 % in the youngest age group to 36,2 % in those aged 75 years and older. Acute inflammation (hsCRP levels >10 mg/l) was registered in 85 participants (4,5 %), including 42 men and 43 women. After adjustment for age and gender, the lower education level remained a significant predictor of hsCRP elevation.Conclusion.No clear associations between hsCRP and age or gender were observed. However, participants with university and secondary education had significantly lower hsCRP concentrations, compared to their peers with education level lower than secondary.
Should psychosocial factors be taken into account when developing and implementing population-level preventive programmes?
Authors: Britov A. N. , Eliseeva N. A. , Deev A. D. , Miroshnik E. V.
Published: October 2019

Aim. To assess social status and selected psychological characteristics in organised urban populations from 5 Russian regions; to compare the results with the prevalence of traditional risk factors (RFs) and chronic disease. Material and methods. In 2009-2010, representative samples of organised populations from 5 Russian cities were examined (total n=2227, 1336 women and 891 men). The questionnaires assessed socioeconomic status (SES), as well as somatic and psychological health. The assessed psychological parameters included Lifestyle Index (LI), psychological resilience mechanisms (PRM), social adaptation, sanogenic reflection, Eysenck phychoticism scale, personal moral potential, emotional burnout syndrome, Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). The examination included the measurement of blood pressure, heart rate, waist circumference, and hips circumference. Results. The proportion of higher-educated people ranged from 82% in Nalchik to 29,3% in Omsk. Low self-rated wealth levels were highly prevalent (from 10,4-13% to 40,4%). Arterial hypertension was registered in 1,29% and 1,64% of men and women aged 25-34 years. In people aged 65-74 years, the respective figures were 60% and 75,8%. Obesity (body mass index ≥30 kg/m2) was registered in over 50% of the participants from all social groups. Negative (pathological) levels of LI significantly correlated with the majority of somatic diseases (р<0,001) and psychological disorders (р<0,007). In women, negative PRM were significantly more prevalent than in men (р<0,007). In those aged under 50 years, the prevalence of negative PRM was lower (up to 28%) than in those aged 50-60 years (37,8%), or 60-75 years (57,7%) (р<0,001). Conclusion. The development and implementation of population-level preventive programmes should take into account not only morbidity levels and traditional RFs, but also psychosocial features of the respective population groups.
Essential arterial hypertension in women, or female arterial hypertension?
Authors: Podzolkov V. I. , Bragina A. E.
Published: October 2019

The paper discusses specific features of arterial hypertension (AH) in women: age-related aspects of AH incidence, pathogenetic and clinical AH variants, and optimal pharmacotherapy approaches.
ACE inhibitor effects of brachial artery structure and function in patients with arterial hypertension
Authors: Melnikova L. V.
Published: October 2019

Aim. To investigate the effects of an angiotensin-converting enzyme (ACE) inhibitor fosinopril on the structural and functional parameters of brachial arteries (BA) in patients with essential arterial hypertension (EAH). Material and methods. The study included 32 EAH patients: 15 men and 17 women aged 27-59 years (mean age 45,6±11,7 years). BA ultrasound and echocardiography (EchoCG) were performed with the use of the Vivid 7 Dimension device (USA). The following parameters of BA remodelling were analysed: intima-media thickness (IMT), lumen diameter (D), and wall-to-lumen (W/L) ratio. BA endotheliumdependent vasodilatation (EDVD) was assessed in the reactive hyperemia test. Central hemodynamic parameters were also assessed. Results. In EAH patients, the six-month fosinopril treatment was associated with BA IMT reduction, but not with substantial intraluminal diameter changes, or increased endothelium-dependent vasodilatation. Conclusion. Among EAH patients, an ACE inhibitor fosinopril demonstrated a marked improvement in BA structural and functional parameters.
Long-term treatment with sulfhydryl angiotensin-converting enzyme inhibition reduces carotid intima-media thickening and improves the nitric oxide/oxidative stress pathways in newly diagnosed patients with mild to moderate primary hypertension
Authors: Napoli C. , Bruzzese G. , Ignarro L. J. , Crimi E. , De Nigris F. , Williams-Ignarro S. , Libardi S. , Sommese L. , Fiorito C. , Mancini F. P. , Cacciatore F. , Liguori A.
Published: October 2019

Aim. Sulfhydryl angiotensin-converting enzyme (ACE) inhibitors exert antiatherosclerotic effects in preclinical models and antioxidant effects in patients. However, whether ACE inhibitors have any clinically significant antiatherogenic effects remains still debated. Objectives. In mildly hypertensive patients, we evaluated the effect of the sulfhydryl ACE inhibitor zofenopril in comparison with the carboxylic ACE inhibitor enalapril on carotid atherosclerosis (intima-media thickness [IMT] and vascular lumen diameter) and systemic oxidative stress (nitrite/nitrate, asymmetrical dimethyl-L-arginine, and isoprostanes). Material and methods. In 2001, we started a small prospective randomized clinical trial on 48 newly diagnosed mildly hypertensive patients with no additional risk factors for atherosclerosis (eg, hyperlipidemia, smoke habit, familiar history of atherosclerosisrelated diseases or diabetes). Patients were randomly assigned either to the enalapril (20 mg/d, n = 24) or the zofenopril group (30 mg/d, n = 24); the planned duration of the trial was 5 years. Carotid IMT and vascular lumen diameter were determined by ultrasonography for all patients at baseline and at 1, 3, and 5 years. Furthermore, nitrite/nitrate, asymmetrical dimethyl-L-arginine, and isoprostane levels were measured. Results. In our conditions, IMT of the right and left common carotid arteries was similar at baseline in both groups (P = NS). Intima-media thickness measurements until 5 years revealed a significant reduction in the zofenopril group but not in the enalapril group (P b .05 vs enalapril-treated group). This effect was coupled with a favorable nitric oxide/oxidative stress profile in the zofenopril group. Conclusion. Long-term treatment with the sulfhydryl ACE inhibitor zofenopril besides its blood pressure–lowering effects may slow the progression of IMT of the carotid artery in newly diagnosed mildly hypertensive patients. (Am Heart J 2008;156:1154.e1-1154.e8.)
Conceptual basis of preventive counselling in patients with chronic non-communicable diseases and their risk factors
Authors: Kalinina A. M.
Published: October 2019

The paper presents the results of an analytical study on the complex problem of preventive counselling in patients with multifactorial chronic non-communicable diseases (CNCD). Based on the extensive experience of the author and the major external sources of evidence, the conceptual principles of preventive counselling are presented for people with CNCD or CNCD risk factors (RFs), according to individual personality traits and behavioural specifics. The key requirements for the development of preventive counselling algorithms focusing on major behavioural RFs are identified, which opens a new perspective in the CNCD prevention.
Hypobarotherapy and cardiovascular risk factor correction in women in early postmenopause
Authors: Kshnyaseva S. K. , Konstantinova O. D. , Tin’kov A. N.
Published: October 2019

Aim. To assess the role of hypobarotherapy in the correction of cardiovascular disease (CVD) risk factors (RF) among women in early postmenopause. Material and methods. The hypobaric hypoxia adaptation method (Ural-1 barochamber, 22 daily three-hour sessions; simulated altitude 3500 m, or 460 mm Hg) was used for the metabolic syndrome treatment in 56 women (mean age 53,6±3,1 years) in early postmenopause. Results. The treatment-induced decrease reached 53,5% for modified menopausal index; 6,1% for body mass; 13,4% and 7,3% for systolic and diastolic blood pressure; 19,5% for cholesterol; 21,3% for glucose; and 20,2% for insulin. Systolic and diastolic left ventricular function parameters also improved. Conclusion. Hypobarotherapy was an effective method for the CVD RF correction among women in early postmenopause.
Adding cystatin C to the GRACE scale improves the prediction of bleeding complications in non-invasively treated patients with acute coronary syndrome
Authors: Kharchenko M. S. , Erlikh A. D. , Kosenkov E. I. , Masenko V. P. , Gratsianskyi N. A.
Published: October 2019

Aim. To assess the prognostic performance of the GRACE scale extended by cystatin C levels in the prediction of ischemic and hemorrhagic in-hospital complications among patients with acute coronary syndrome (ACS). Material and methods. In 160 ACS patients, admitted to the Moscow City Clinical Hospital No. 29 and included in the hospital register, blood levels of cystatin C were measured within the first 24 hours from admission. All patients were treated conservatively. The in-hospital risk of mortality and bleeding was assessed. The cut-off level of cystatin C was 1,53 mg/l. Results. High levels of cystatin C, high GRACE scale risk, and their combination were associated with a significant increase in the in-hospital risk of hemorrhagic and ischemic complications. Independent mortality predictors included GRACE levels (odds ratio, OR, 1,05; 95% confidence interval (CI) 1,02-1,08; p=0,002) and cystatin C levels (OR 1,01; 95% CI 1,00-1,02: p=0,025). Major and moderate bleeding complications were independently predicted by fibrinolysis (OR 9,86; 95% CI 1,74-55,20; p=0,01), leukocyte levels (OR 1,34; 95% CI 1,11-1,62: p=0,002), and haemoglobin levels (OR 0,96; 95% CI 0,91-0,99; p=0,043), as well as the combination of high GRACE risk levels and elevated cystatin C levels (OR 11,78; 95% CI 1,95-71,06; p=0,007). Adding cystatin C to the high GRACE risk improved the prognostic specificity by approximately 20% and did not affect the prognostic sensitivity in the prediction of in-hospital risk of major and moderate bleeding complications. Conclusion. The combination of high GRACE risk levels and elevated cystatin C levels was an independent predictor of major and moderate in-hospital bleeding complications, but not in-hospital death. Adding cystatin C to the GRACE scale by approximately 20% increased its specificity for the prediction of in-hospital risk of major and moderate bleeding complications.
Modern treatment strategies in patients with vascular comorbidity Part 1. Correcting tissue energy deficiency
Authors: Rumyantseva S. A. , Oganov R. G. , Silina E. V. , Stupin V. A. , Bolevich S. B. , Svishcheva S. P. , Orlova A. S. , Komarov A. N. , Orlov V. A. , Abroskina O. V. , Eliseev E. V. , Sokhova O. A. , Bogatyreva M. D.
Published: October 2019

The first paper of the series on the treatment of patients with vascular comorbidity (VC) is focused on the role and therapeutic potential of the correction of free radical processes (FRP) as pathogenetic factors of multifocal vascular pathology. Aim. To analyse the effects of VC on the incidence and outcomes of cerebral stroke (S), in order to create therapeutic algorithms of FRP correction. Material and methods. This prospective study included 634 S patients. The following factors were analysed: pre-stroke disability due to various VC variants; VC effects on the clinical course, as well as in-hospital and post-discharge outcomes; and FRP specifics in various VC variants. Results. VC was registered in 97% of S patients; in 45,3%, it resulted in pre-stroke disability. FRP parameters, reflecting the progression of tissue energy deficiency, differed significantly in patients with coronary heart disease, myocardial infarction, atrial fibrillation, and diabetes mellitus. Based on these findings, the therapeutic algorithms for effective energy deficiency correction have been created. Conclusion. The analysis of pre- and post-stroke disability and prevention of repeat events in cardiovascular patients has demonstrated the need for a more active implementation of modern multidisciplinary preventive programs.
Antiplatelet drug resistance in patients with coronary heart disease
Authors: Sulimov V. A. , Moroz E. V.
Published: October 2019

Coronary angioplasty is an important component of coronary heart disease (CHD) management. There is a substantial evidence of the need for dual antiaggregant therapy (clopidogrel and aspirin) in this clinical group, both before and after the intervention. The development of thrombotic complications during antiaggregant therapy suggests the antiplatelet drug resistance. The prevalence of this condition varies from 5% to 45% for aspirin, and from 20% to 45% for clopidogrel, depending on the assessment method and the specific clinical group. For dual antiplatelet therapy, the resistance prevalence is 6-8%. Presently, the gold standard method of the platelet functional activity assessment is optical aggregometry. To assess the resistance to aspirin, arachidonic acid is used as an aggregation inductor, with the calculation of absolute aggregation levels. To assess the resistance to clopidogrel, ADP is used as an aggregation inductor, and the relative aggregation parameters are calculated. The development of aspirin resistance is influenced by biological, clinical, and genetic factors. The clopidogrel resistance is associated with certain medications, hyperglycemia, atherosclerosis, and CYP2C19*2 gene polymorphism. Identification of the patients resistant to antiplatelet drugs enables the clinicians to adjust the antiplatelet treatment reasonably early and to reduce the risk of cardiovascular events. The possible methods of overcoming antiplatelet drug resistance are to double the loading and maintenance doses of clopidogrel and to use new agents.
How to avoid statin hepatotoxicity in patients with obesity and liver disease? Focus on the combination of ursodeoxycholic acid and atorvastatin
Authors: Korneeva O. N. , Drapkina O. M.
Published: October 2019

Obese patients demonstrate the combination of dyslipidemia (DLP) and elevated transaminase levels, as a manifestation of non-alcohol fatty liver disease (NAFLD). Therefore, statins should be administered with care in this clinical group. In the real-world clinical practice, obese patients with high cardiovascular risk and concomitant NAFLD often receive low, inadequately effective doses of statins, due to the fear of their adverse effects on the hepatic function. An alternative method of DLP treatment is a combination of statins with ursodeoxycholic acid (UDCA). The need for a long-term combination treatment with statins and UDCA stresses the importance of the problem of drug interaction and the mechanisms of drug metabolism. Even high doses of atorvastatin are safe and well tolerated. The most severe adverse effects – myopathy and rhabdomyolysis – are very rare. Currently, there is no available evidence of adverse clinical effects of the combination of UDCA and atorvastatin. Presented results emphasise the need for a wider use of new therapeutic strategies in patients with DLP, obesity, and NAFLD. The combination of UDCA and statins is safe and effective. It facilitates not only the achievement of target lipid levels, but also the improvement in the hepatic function.