bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of modern methods for
intravascular visualization of coronary arteries in diagnostics and treatment of coronary heart disease in the employees of the Russian
Railways joint stock company related to train movements.
Authors: Shugushev Z. Kh. , Prishchep Olga A. , Maksimkin D. A. , Faibushevich A. G. , Veretenik G. I.
Published: November 2020

The aim of this study was to show the importance of modern non X-ray diagnostic techniques of coronary arteries for diagnosis and treatment of CHD. Material and methods. 110 patients, who took part in the study, were divided into two groups according to their coronarography: group 1 - patients with intermediate coronary stenosis (n = 80) and group 2 - patients with normal coronary arteries (n = 30). All patients of group1 underwent FFR measurement in the magistral arteries. On the base of FFR value the second group was conventionally divided into two subgroups: Ia (47.5% patients) - with a positive FFR value (≤0,8), in which the lesion was considered functionally significant and responsible for ischemia, and Ib (52.5% patients) - with a negative FFR value (>0,8). In the case of positive FFR value patients underwent IVUS-guided PCI. Results. Survival index free of MACE and readmissions was not significantly different in the group II and subgroup Ib and were 100 and 95.2%, respectively (p > 0.05). A comparison of this index in the subgroups Ia and Ib was no significantly different (97.3% and 95.2%, respectively, p > 0.05). The rate of restenosis in the Ia subgroup, which required re-intervention, was 2.7%, which corresponds to the data in the literature. Late stent thrombosis was not revealed. Conclusions. Survival index free of MACE and readmissions is not different in the long-term period in the study groups.
Clinical aspects of the use of etanercept in treatment of rheumatoid arthritis.
Authors: Shesternya Pavel A. , Petrova M. M. , Gritsenko O. D.
Published: November 2020

Background. Maintaining of a favourable response of tumour necrosis factor inhibitors is one of the most challenging to rheumatologist. Only limited data have been published addressing this field. The aim of our study was investigate efficacy of etanercept (ETN) and evaluate maintaining response after ETN discontinuation in patients who have achieved remission or low disease activity (REM/LDA) of rheumatoid arthritis (RA). Methods. Patients with high disease activity (n = 29) received ETN 50 mg injection and methotrexate 10-20 mg once weekly were included in analysis. Frequency of REM/LDA scoring by DAS 28-joint counts and C-reactive protein level (DAS28-CRP), changes from baseline in DAS28-CRP, Health Assessment Questionnaire (HAQ), global assessment of disease activity by patient and provider (PtGA and PrGA) were evaluated. We assessed persistent of achieved REM/LDA after the ETN discontinued. Results. We saw fast decreasing of active flare already after first month: HAQ (1.4 ± 0.6 vs 2.0 ± 0.6, p = 0.048), PtGA (49.5 ± 17.9 vs 75.6 ± 14.9, p = 0.016) and PrGA (46.6 ± 14.7 vs 77.0 ± 12.3, p = 0.014). DAS28-CRP changes from baseline become significant after second month (3.9 ± 1.1 vs 6.2 ± 0.6, р = 0.005). After 6 months 82.6% patients had DAS28-CRP < 3.2 and 41.4% patients had HAQ < 0.5. Maintenance of REM/LDA lasted 3 month after ETN discontinuation. Conclusion. ETN+MTX is very effective combination in treat to target strategy of RA treatment. In patients who have achieved REM/LDA maintained stable condition during three months after ETN withdrawn. It might be consider in a number of patients in case of accidental or necessary treatment interruption.
Radiological features of pulmonary tuberculosis depending on
the gene polymorphism of HLA-DRB1.
Authors: Stepanova N. A. , Kantemirova B. I. , Galimzyanov Kh. M.
Published: November 2020

Aim. To study radiological features of pulmonary tuberculosis according to the polymorphism of the gene HLA-DRB1. Materials and methods. Radiologically examined 73 newly diagnosed patients with different clinical forms of pulmonary tuberculosis and genotyped for HLA-DRB1 by PCR-MSSR. Results. The analysis of associations specificities gene HLA-DRB1* depending on the x-ray picture of the disease. It is found that the specificity (*04, *11, *13, *14 and *16 gene HLA- DRB1 *) positively associated with the amount of a specific process for more than three segments and destruction of lung tissue. Genotypes with 01*, 07*, 08*, 10*, 12*, 15* and 16* specificities HLA- DRB1* lesion volume were less than three segments, with a predominance of productive inflammation of the lung tissue. Conclusions. X-ray picture of the 60.3% of patients with newly diagnosed pulmonary tuberculosis characterized by common (equity, polysegmental) lesions of the lung tissue. The obtained results of the study of gene polymorphism immune response HLA- DRB1*, show some specificity, in particular *04, *11, *13 and *16 alleles of HLA-DRB1*, possibly responsible for massive infiltration and destruction of lung tissue.
Intestinal microbiota: its role in pathogenesis of arterial hypertension
Authors: Aitbaev K. A. , Murkamilov Ilkham Torobekovich
Published: November 2020

The review presents data on the relationship of intestinal microbiota and the development of arterial hypertension. Mechanisms through which intestinal dysbiosis may contribute to the development of this disease are reviewed. Results of studies on modulation of intestinal microbiota in patients with arterial hypertension with the use of probiotics and antibiotics are presented. It is concluded that the development of innovative dietary strategies ensuring restoration of the balance in the intestinal microbiota will allow to effectively control and treat arterial hypertension.
Differential approach to the evaluation of right ventricular systolic function by pulsed wave Doppler ultrasound
Authors: Mirzoyan Ekaterina Sergeevna , Nelasov N. Yu. , Babaev M. V. , Volkov G. P. , Shumarin K. A.
Published: November 2020

A method for diagnostics of systolic function of the right ventricle of the heart in patients with cardiovascular disease is proposed. Its application expands possibilities for detecting disorders of the discharge RVfunction using a conventional pulsed wave Doppler ultrasonography.
A case of familial disease of pulmonary and hepatic echinococcosis (Echinococcus granulosus)
Authors: Tsvetkova Olga A. , Voronkova O. O. , Ovchinnikova D. V.
Published: November 2020

Echinococcus granulosus still remains a widespread disease. Moreover, there is a large number of patients in whom it is diagnosed rather late because its clinical presentation can be unspecific and symptoms vary. We report a familial case of the disease. Its specific feature was the onset with the bilateral pulmonary process and late involvement of the liver. This excluded other pulmonary diseases, such as pneumonia, tuberculosis or cancer.
Proinflammatory cytokines and signaling pathways in
peripheral blood mononuclear cells in patients with coronary artery disease
Authors: Logatkina A. V. , Nikiforov V. S. , Bondar’ S. S. , Terekhov I. V.
Published: November 2020

Aim. To determine content of mononuclear ells (MNC) in peripheral blood of patients with coronary heart disease (CHD) and factors responsible for their functional state and cytokine production. Materials and methods. Concentration of proteinkinases JNK1/2, ERK1/2, MAPK38, AKT1, JAK2, FAK, AMPK, p70S6K, STAT3, STAT5B and STAT6 was determined in MNC lysate by immune-enzyme assay. Interleukin 1β, 2, 4 and y-interferon levels were measured in blood sera. Results. In patients with angina of effort and unstable angina, the JNK level was 59,8% and 53,1% higher than the normal one respectively (р=0,013) and (р=0,012). The level of the nuclear transcription factor was 26,9% (р=0,015) and 27,9% (р=0,017), JAK2 31,5% (р=0,022) and 48,6% (р=0,018), STAT3 49,6% (р=0,025) and 55,3% (р=0,02), STAT5B 21,5% (р=0,018) and 30,2% (р=0,011) lower. These changes were associated with a 13,1% (р=0,047) and 51,4% (р=0,019) rise in the STAT6 level, 30,1% (р=0,025) and 79,4% (р=0,003) FAK level, 7,6% (р=0,09) and 15,2% (р=0,039) АКТ1 level, 65,3 (р=0,02) and 76,2% (р=0,017) p70S6K level. Conclusion. Results of the study suggest persistent pro-inflammatory activation of whole blood cells in CHD patients due to enhanced levels of IL-1 and IL-2, components of the MAPK/SAPK signal pathway in MNC and decreased STAT3 level determining cell sensitivity to IL-10. The elevated intracellular level of ERK and JNK us responsible for high responsiveness of MNC to pro-inflammatory cytokines.
The prevalence of respiratory symptoms among residents of
the Russian Far North
Authors: Andronov S. V. , Lobanov A. A. , Popov A. I. , Emelyanov A. V.
Published: November 2020

Aim: to study the frequency of respiratory symptoms among the reindeer herders of the Yamal region in the Far North of Russia. We conducted a cross-sectional study of the occurrence of respiratory symptoms among 500 subjects of the tundra Nenets population (28.1% of the adult Nenets population in the district), of which 38.3% were men and 61.7% women (average age 40.1 years). All patients were matched for age and occupation. Medical examination was carried out by a pulmonologist with the use of the GARD questionnaire (WHO, 2004) and spirometry. Spirometry was performed with a SpiroUSB device (UK) according to a unified standard and the criteria of ATS/ERS 2005. The frequency of respiratory symptoms among the tundra population was estimated at 71.8%. Cough with expectoration and dyspnea were found in 22.8% of the respondents. 70.0% of the examined subjects worked in the cold, 33% were exposed to the open flame at home, and 34.4% smoked. Respiratory symptoms developed in 16.3% of those working in the cold and in 37% exposed to open fire. The combination of such complaints as cough and sputum production occurred in smokers twice as frequently as in non-smokers (54.1%) (p<0.01).The combination of such complaints as cough and sputum production was twice as likely note in his those who smoked (54.1% vs 20.2%) (p<0.01). The combination of these problems dyspnea was three times more common in the smokers (23,3%vs 7,3%) (p<0.001). At presence at patients of such a factor as work in the cold and the absence of other only 16.3% of them have respiratory symptoms. When using at home the open flame and the absence of other factors leading up 37.0% of the individuals with symptoms of chronic bronchitis. Cough, sputum and dyspnea are formed only among 26.3% of the smokers face when smoking is the only risk factor. If the surveyed residents of all three negative factors respiratory symptoms met at 62.1%. Disorders of respiratory function according to spirometry were not observed in none of the study participants. Respiratory symptoms developed in 62.1% of the subjects exposed to all three risk factors. External respiration indices remain normal in all he examine subjects. It is concluded that residents of the Far North frequently suffer respiratory symptoms without disorders in the external respiratory function. In most cases they associated with three factors (work in the cold, exposure to open fire at home, and smoking). Compensatory stimulation of lung functions may create additional difficulties for diagnostics of bronchial obstruction.
The influence of correction of vitamin D deficiency on the formation of the stable virological
response during therapy of genotype-1 chronic hepatitis C with PEGylated interferon-alpha-2 and ribavirin
Authors: Kukhareva E. I. , Ogurtsov P. P.
Published: November 2020

Aim. To study effects of correction of vitamin D deficiency on the outcome of antiviral therapy (AVT) with PEGylated interferon alpha 2 (peg-IFN-α-2) and Ribavirin (RBV) in patients with genotype -1 chronic hepatitis C (CHC-1). Materials and methods. The study included 90 patients with primary HCV-1 and deficiency of vitamin D. In all patients of them, insulin resistance (HOMA-IR), body mass index (BMI), viral load, vitamin D levels, stage of liver fibrosis and polymorphism of the IL-28B gene were evaluated. Antiviral therapy included PEG-IFN-α-2 and RBV in combination with water-soluble vitamin D at a dose of 2000 mg/day. 55 patients were assigned to HCV-1 (study group). 35 patients with CHC-1 (control group) were given only PEG-IFN-α-2 + RBV. Results. Vitamin D level was inversely correlated with HOMA-IR, BMI (R = -0,5; R = -0,5; R = -0,4; respectively, p <0.05, Spearman) and inverse relationship between the level of vitamin D (25-Oh), BMI and HOMA-IR (β for BMI=-0,433 (95% CI -1,863;-0,697, p<0.001), HOMA-IR=-0,252 (95% Cl -1,873;-0,229, p=0,013) was documented based on the multiple regression analysis. In the study group, sustained virological response (SVR) was achieved in 74.5% of the patient compared with 42.9% in the control group; OR SVR in patients of the study group was 6.8 (95% Cl 2,90-16.09, p=0.002). SVR was reached in 66.7% and 22.2% patients of the study group with BMI>25 kg/m2 and controls respectively. OR SVR in patients with BMI over 25 kg/m2 who received cholecalciferol at AVT was 7.0 (95% Cl 1.66-29,23, p=0.01, Fisher test). In the patients with HOMA-IR>2.0, the frequency of SVR in the study qnd control groups was 66.7% and 37.5% respectively; OR SVR in patients with HOMA-IR>2.0 receiving colecalciferol at AVT was 3.3 (95% Cl 1.1-9.9, p=0.03, Fisher's exact test). In the study group a statistically significant decrease of HOMA-IR (p<0.001, Wilcoxon test) and undesirable effects of antiviral therapy (р<0,05) was documented. Conclusions. The addition of colecalciferol at a daily dose of 2000 IU to PEG-IFN-alpha-2+RBV therapy is safe and significantly increases the efficiency of AVT from 40.0 up to 74.5% (p=0.002), improves OR SVR up to 7.0 (95% Cl 1.66-29,23, p=0.01) in patients with BMI >25 kg/m2 and up to 3.3 (95% Cl 1.1-9.9, p=0.03) in patients with HOMA-IR>2; it significantly reduces HOMA-IR (p<0,0001) and the frequency of adverse effects (p<0.05).
Primary (hereditary) hemochromatosis
Authors: Tsimmerman Yakov S.
Published: November 2020

The author proposes definition of primary (hereditary) hemochromatosis, discusses terminological problems, the prevalence of the disease in different countries, modern concepts of iron metabolism, etiology, pathogensis and clinical picture of primary hemochromatosis, its classification, diagnostics and treatment.
Vegetative regulation and endothelial dysfunction in patients with metabolic
syndrome
Authors: Smirnova E. N. , Loran Evgeniya A. , Shulkina S. G.
Published: November 2020

Special attention is given to MS bearing in mind its high prevalence in the general population (up to 14-24 %) which is twice the prevalence of diabetes. The study included 50 patients with MS at the age of 25 to 61 years. The group of comparison contained 16 healthy individuals aged 45,3±2,3 years. To evaluate the response of microvascular tone, the wavelet analysis of fluctuations of skin temperature during limb cooling was used. Vascular endothelial growth factor (VEGF) served as a biochemical marker of endothelial dysfunction. Heart rate variability was evaluated in all patients. It was shown that patients with MS were significantly different in terms of all metabolic parameters; their VEGF levels were much higher than in the comparison group. Disturbances of vasodilation identified in the functional cold test in patients with MS confirm the relationship between abnormal vascular reactivity and endothelial dysfunction markers. The cardiointervalographic examination of MS patients revealed typical manifestations of autonomous cardiac neuropathy.
A. Diagnostic and prognostic value of detection of the N-terminal fragment of brain
natriuretic peptide in type 2 diabetes mellitus
Authors: Verbovoy A. F. , Barabanova Natal’ya A.
Published: November 2020

Detction of chronic heart failure at the stage of reversible changes can prevent the development of cardiovascular complications, reduce morbidity and mortality in patients with type 2 diabetes mellitus. The aim of our study was to explore the level of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) and to evaluate the possibility of using this marker in diagnostics of chronic heart failure in patients with type 2 diabetes. The study included 60 patients with type 2 diabetes and concomitant chronic heart failure. All patients underwent echocardiography, blood glucose and glycated hemoglobin, creatinine, and NT-proBNP measurement. All patients with diabetes mellitus were shown to have elevated NT-proBNP levels in comparison with the control group. We established negative correlation of this parameter with the left ventricular ejection fraction and inverse correlation between NT-proBNP and blood glucose. The study confirmed the value of NT-proBNP measurement for diagnostics of CHF but demonstrated low specificity of this test for the assessment of severity (functional class) of CHF in patients with type 2 diabetes.
Assessment of clinical status and characteristics of patients with chronic heart
failure and concomitant chronic obstructive pulmonary disease
Authors: Vatutin N. T. , Smyrnova Anna S. , Gasendich E. S.
Published: November 2020

Pathology of cardiovascular and respiratory systems still dominants in the structure of morbidity and mortality of the population. Comorbidity of these conditions is characterized by the phenomenon of mutual complications and a significantly worsened prognosis in these patients. Purpose of study. Evaluation of the clinical status and the efficiency of treatment of patients with chronic heart failure (CHF) and concomitant chronic obstructive pulmonary disease (COPD). Material and methods. The study included 102 patients (58 men and 44 women, mean age 65.7 ± 4.5 years). Based on the results of spirometry, the patients were divided into 2 groups: the main group included 54 patients suffering from CHF in conjunction with COPD, the control group included 48 patients with CHF without bronchopulmonary pathology. All patients underwent the Six Minute Walk Test (SMWT); severity of dyspnea was measured by the Borg scale. Results. Patients with comorbid disorders had a higher functional class (FC) of CHF and a more pronounced decrease in exercise tolerance accompanied by a greater degree of dyspnea. They more frequently used diuretics and less frequently β-blockers. Conclusion. The combination of CHF and COPD is associated with a higher CHF FC which negatively affects the clinical status of patients and is accompanied by more frequent use of diuretics and rare intake of β-blockers.
Stomach diseases unrelated to Helicobacter pylori infection: current state of the problem
Authors: Svistunov A. A. , Osadchuk Michael A.
Published: November 2020

The review deals with basic etiological and pathogenetic mechanisms of stomach diseases unrelated to H. pylori infection. Special attention is given to the clinical picture and prognosis of this pathology, its fundamental differences from H. pylori-associated stomach diseases. The authors emphasize the importance and relevance of studying the problem of stomach diseases unrelated to H. pylori infection and its increasing role in the structure of digestive tract diseases.
Predictors of progression of atrial fibrillation in patients with congestive
heart failure
Authors: Podzolkov V. I. , Tarzimanova A. I. , Mohammadi L.
Published: November 2020

An appreciable progress has recently been achieved in the study of the nature of atrial fibrillation (AF), from its early asymptomatic stages to irreversible arrhythmia. There are data on the risk factors of AF in the literature, but predictors of progressive arrhythmia remain to be elucidated. This study was aimed to identify predictors of AF progression in patients with congestive heart failure (CHF). Material and methods. The study involved 64 patients aged 59-82 (mean 69,4±3,9) followed up prospectively from September 2010 till June 2016 (observations of mean duration 60±3 mo included regular telephone interviews (each 3 mo) and annual general clinical examination with laboratory and instrumental studies. Continuous or persisting AF served as the criterion for progressive arrhythmia. Results. Cardiovascular complications and progressive arrhythmia were documented in 23 (36%) and 38 (59%) patients respectively during the 60±3 mo observation period. The multifactorial analysis revealed the significant influence of a decrease of left ventricular ejection function (EF) to below 40% and a rise in the plasma level of brain natriuretic peptide (Nt-proBNP) to more than 903 pg/ml on the risk of development of arrhythmia. Conclusion. Independent predictors of arrhythmia in patients with CHF and persistent AF are a decrease in left ventricular ejection function (EF) to below 40% (1,2, 95% CI 0,9-1,5) and a rise in the plasma Nt-proBNP level to more than 903 pg/ml (OR 1,3, 95% , CI+1,1-2,9). Such a rise predicts transition of arrhythmia into continuous form with sensitivity 92,1% and specificity 84,6%.
The theory of dysbiosis (dysbacteriosis)
Authors: Tsimmerman Yakov S.
Published: November 2020

This review article presents definitions of intestinal dysbiosis, main characteristic of normal gastro-intestinal biocenosis, classification of eubiocenosis, data on mucosal and luminal microflora, its functions and their regulation, peculiarities of colon and small intestinal dysbiosis, its classification, criteria for virulence of opportunistic microflora. Debatable terminological issues are considered. Modern methods of diagnostics of colon and small intestinal dysbiosis are described with reference to its clinical manifestations, such as antibiotic-associated diarrhea and pseudomembraneous colitis. New hypotheses of microflora phylogenetic core and symbiotic digestion are discussed with special reference to their rationale and prospects of further studies.
Diffuse toxic goiter
Authors: Pashentseva Anna V. , Verbovoy A. F.
Published: November 2020

Diffuse toxic goiter is one of the commonest diseases of the thyroid. In the present article, etiology and pathogenesis of this disease are considered. Modern approaches to its diagnostics and treatment are described.
The relationship between vitamin D levels and plasma renin activity in
patients with arterial hypertension
Authors: Yankovskaya Lyudmila V. , Snezhitskiy V. A. , Novogran V. I.
Published: November 2020

The aim of the study was to evaluate plasma renin activity (PRA) and its relationship with the level of 25-hydroxyvitamin D (25 (OH) D) in the blood in patients with stage II arterial hypertension (AH). We examined 228 patients (186 women and 42 men, mean age 52,4 ± 7,6 years). They were divided into two groups, one (n = 51) with optimal vitamin D levels (25 (OH) D ≥30 ng/ml), the other (n = 177) with D-hypovitaminosis (25 (OH) D <30 ng/ml). In this group, PRA (0,88 [0,61, 1,80] ng/ml/h) and the level of parathyroid hormone (38.6 [26.3; 52.1] pg/ ml) were higher (p <0,05), than in the former group (0,56 [0,38; 1,09] ng/ml/h and 29.8 [21.6; 44.1] pg/ml respectively). In group 2, the nitrate/nitrite level (18,57 ± 6,56 µmol/l) and blood calcium (2,34 ± 0,15 mmol/l) were lower (p <0.05) than in group 1 (21,57 ± 6,92 µmol/l and 2.40 ± 0.18 mmol/l respectively). No significant differences in results of echocardiography between the groups was apparent. We documented negative correlation between PRA and serum 25(OH)D level. PRA showed weak negative correlation with endothelium-dependent vasodilation (R = -0,15; p = 0,05); this relationship became even more evident (R = -0,24; p = 0.007) in patients with D-hypovitaminosis but was insignificant in those having the optimal level of vitamin D. It suggests the influence of vitamin D on vascular endothelial function and PRA interaction with endothelium. PRA shows positive correlation with the left ventricular wall thickness, left ventricular myocardial mass and negative correlation with the left ventricular ejection fraction, both being more pronounced in patients with D-hypovitaminosis and reflecting the influence of PRA on the structural and functional state of the myocardium.
Bioabsorbable vascular endoproteases for the treatment of patients with coronary heart disease and type 2 diabetes mellitus
Authors: Shugushev Z. Kh. , Maksimkin Daniil A. , Vorob’eva Yu. S. , Chepurnoy A. G. , Veretnik G. I. , Faibushevich A. G.
Published: November 2020

Aim. To evaluate efficiency of endovascular intervention in patients with type 2 diabetes mellitus with the use of bioabsorbable vascular endoproteases and everolimus-coated stents. Material and methods. A total of 143 patients were initially selected for the study of whom 125 were randomized into 2 groups, one including 57 patients with implanted bioabsorbable vascular endoproteases, the other comprised of 68 patients treated with the use of everolimus-coated stents. Inclusion criteria: primary lesion of coronary arteries, stable angina of effort (II-III FC), myocardial ischemia (>10%) confirmed in functional tests, compensated and subcompensated DM2, stenosis of middle and distal segments of the main coronary arteries (≥70%) diagnosed by digital angiography. Exclusion criteria: the target artery not more than 4 mm in diameter, acute coronary syndrome, excess vascular tortuosity, marked calcinosis of coronary arteries, bifurcation lesion, left coronary trunk lesion, history of myocardial revascularization. Criteria for the assessment of immediate outcomes: frequency of major cardiovascular events (death, myocardial infarction, emergency secondary intervention). Criteria for the assessment of long-term outcomes: frequency of major cardiovascular events (death, myocardial infarction, secondary intervention), frequency of in-scaffold/in-stent restenosis or stent thrombosis. Results of biobsorbable scaffold implantation were controlled using optical coherence tomography in the end of surgery and during 12 month during follow-up. Results. A total of 63 bioabsorbable vascular endoprostheses and 102 everolimus-coated stents were implanted to patients of groups 1 and 2 respectively. Mean diameter of the endoprostheses was 2.88±0.06 and 2.68±0.12 mm respectively (р>0,05). The intervention was regarded as technically successful in 100% cases. The overall frequency of major cardiovascular complications during hospitalization in patients of groups 1 and 2 was 3.5 and 2.94% respectively. Long-term outcomes could be estimated in 41 patients of group 1 and 52 ones in group 2. All patients survived for 12 months. The frequency of non-fatal MI was 4.9 and 3.8% in groups 1 and 2 respectively (р>0,05), the cause being progression of atherosclerosis in other arteries. Frequency of in-stent restenosis was 2.4 and 1.9% (р>0,05). Cases of late stent thrombosis were absent whereas coherence tomography revealed severe intravascular volume depletion to 0.14±0.19 and 0.12±0,23 mm in groups 1 and 2 respectively (р>0,05). Conclusion. Bioabsorbable endoprostheses implanted to patients with coronary heart disease and type 2 diabetes mellitus and stenosis of middle and distal segments of the main coronary arteries within 12 months after surgery proved as efficient and safe as everolimus-coated stents.
Stable angina pectoris: choice of therapeutic tactics.
Authors: Kirichenko Andrey A.
Published: November 2020

In everyday practice, the basic principles of diagnosis and treatment of stable ischemic heart disease, set out in the clinical recommendations, are often not observed. For successful treatment of angina, first of all, it is necessary to verify the diagnosis. The diagnosis of stable angina pectoris can be considered sufficiently justified, provided the characteristic chest pain and documentary evidence of transient myocardial ischemia by stress tests. The patient should be evaluated as a whole, taking into account all existing diseases, since concomitant diseases can directly or indirectly exacerbate the course of coronary heart disease, and sometimes be the main cause of angina. In such cases, treatment of concomitant diseases has a pronounced positive effect on the course of angina pectoris. It is advisable to assess the magnitude of the coronary reserve, the severity and prevalence of transient myocardial ischemia, its impact on hemodynamics and, based on the analysis of these indicators, to identify patients with high or low risk of myocardial infarction. Revascularization brings a clear prognostic benefit only in subgroups at high risk.
Relationship of the liver fibrous formation processes and cardiosclerosis in patients with stable coronary heart disease combined with non-alcoholic fatty liver disease.
Authors: Vakalyuk Irina I. , Virstyuk N. G.
Published: November 2020

Aim of the study was to determine the features of myocardial remodeling in patients with postinfarction cardiosclerosis combined with non-alcoholic fatty liver disease (NAFLD) and identify the dependence of the liver fibrogenesis processes and cardiosclerosis depending on the liver fibrosis stage. Material and methods. The study included 300 patients with postinfarction cardiosclerosis with and without NAFLD. Patients with NAFLD were divided depending on the liver fibrosis stage. Among them patients with non-alcoholic steatosis and non-alcoholic steatohepatitis (NASH) were observed. General clinical examination, electrocardiography, coronary angiography, echocardiography, elastography, assessment of the liver functional state, serum type IV collagen were conducted. Results. Formation of pathological myocardial remodeling types dependent on the fibrosis liver stage and grew along with the progression of NAFLD (р<0.05). Analysis of the elastography results showed a significant increase of the liver stiffness in all patients (р<0.05). The greatest value of shear wave velocity was observed in patients with severe fibrosis of the liver parenchyma of F4 stage (р<0.05). The level of type IV collagen increased according to the stages of liver fibrosis progression and was the highest in patients with NASH of IVB and VB groups (p<0.05). The direct correlation relationships between stage of fibrosis, level of type IV collagen and myocardial left ventricle mass index in patients with coronary heart disease and NAFLD were revealed. Conclusions. Intensity of fibrotic changes in the liver and myocardium depends on the NAFLD progression and fibrosis stage, and the presence of direct correlative relationship between the liver parenchyma stiffness, level of type IV collagen and myocardial left ventricle mass index indicates mutual aggravating influence of the coronary heart disease and NAFLD on the course of one another, which generally promotes activation of fibrogenesis in liver and myocardium.
Affective disorders on the
background of hypothyroidism.
Authors: Budnevskiy A. V. , Kutashov V. A. , Priputnevich D. N. , Kravchenko A. Ya. , Fes'kova Anna A.
Published: November 2020

Introduction. Affective disorders are the most common psychopathological symptoms of hypothyroidism. Hypothyroidism greatly reduces the effectiveness of antidepressants and replacement L-thyroxine therapy is not enough to eliminate the anxiety and depressive disorders in hypothyroidism. Aim. The purpose of the research is study of psychosomatic and somatopsychical relationships in hypothyroidism and depression. Material and methods. Four hundred and six patients (78 men and 328 women) with affective disorders aged 51,3 ± 4,7 years were examined. The concentration of thyroid-stimulating hormone (TSH), thyroxine (T4), cortisol, adrenocorticotropic hormone (ACTH) in the blood, urinary excretion of norepinephrine and epinephrine was determined. Severity of depression was estimated by the Hamilton Depression Rating Scale (HDRS), alexithymia level - by the Toronto alexithymia scale (TAS-26). Results. In euthyroid patients TSH level was 2,7 ± 0,13 mU/l, in hypothyroid - 14,1 ± 1,21 mU / l (p<0.001), T4 level was 14,4 ± 1,36 and 7.1±1.16 pmol/l, respectively (p<0.001). Depressive disorders were revealed in 374 patients (92.1%), other affective disorders - in 32 patients (7.9%). Hypothyroid patients had more pronounced depression by the Hamilton Rating Scale for Depression and a higher average score by TAS-26 as compared to euthyroid patients (17,8 ± 2,1 vs 15,3 ± 1,9 points, p=0.001and 79,9 ± 4,6 vs. 71,1 ± 4,4 points; p<0.001 respectively). TSH level has a direct correlation with severity of depression (R=0,62; р<0,001). Severe depression was observed in hypothyroid patients more often than in euthyroid patients (9.5% vs. 5.0%; р=0,029). Patients with affective disorders and hypothyroidism have a higher cortisol level and lower ACTH level than euthyroid patients (503±12.1 vs. 420±10.9 nmol/l; р<0.001 and 12.9±3.07 vs. 15.3±3.4; р<0.001 respectively). Urinary excretion of epinephrine and norepinephrine in hypothyroid patients was higher than that in euthyroid patients: 37,8 ± 2,18 vs. 31,1 ± 2,06 nmol (p<0.001) and 39,2 ± 2,14 vs. 33,4 ± 2,1 nmol (p<0.001), respectively. Conclusions. Prevalence of hypothyroidism among patients with affective disorders is higher than in the general population. The severity of the depression has a direct correlation with TSH. Activity of the sympathetic division of the autonomic nervous system is higher in patients with hypothyroidism than in patients with euthyroidism.
Lung damage in drug addicts who inject drugs parenterally.
Authors: Klester Elena B. , Babushkin I. E. , Proskurin S. N. , Klester K. V.
Published: November 2020

Objective. Тo study the characteristics of lung disease at parenteral drug users. Materials and methods. 69 patients - parenteral drug users were under direct observation, all were diagnosed with pneumonia on admission: 17 (24,6%) with non-severe (<3 points on the CURB-65); 52 (75.4%) with severe pneumonia, 14 (26,9%) patients were initially hospitalized in the ICU. Results. The average age was 32.8±6.9 years, males - 53 (76,8%). HIV infection was verified in 59 (85.5%) patients (11 women and 48 men). Polydrug use was defined in 31 (44.9%), desomorphine and heroin - in 27 (39,2%), amphetamine - in 11 (15.9%) patients. Experience of drug addiction ranged from 7 months to 20 years. 64 patients had viral hepatitis (В, С, В+С), 18 (26,1%) patients - respiratory tuberculosis, 24 (34,8%) - infective endocarditis (IE). HIV-infection of the II (7 patients) and III (10 patients) stage was verified in all patients with non-severe pneumonia (SIRS - 2,3±1,0). 21 patients were diagnosed severe pneumonia (scores by SOFA - 15,7 ±7,6; by APACHE II - 26,6 ±11,9). Septic pulmonary embolism (SPE) was diagnosed in 22 patients, with signs of acute thrombophlebitis of the proximal veins and typical clinic-radiological data. HIV infection of the IV stage (CD4+ <200 cells/μl, copies of HIV RNA >100,000 per ml), leukopenia and Pneumocystis pneumonia were diagnosed in 9 patients. Conclusion. Lung damage at parenteral drug users may manifest by clinic of community acquired non-severe pneumonia, severe pneumonia, including sepsis-associated, septic pulmonary embolism, secondary manifestations of HIV infection. When the diagnosis: The type of drug, the injection site, the presence of impurities of talc, a significant number of HIV-infected patients, patients with hepatitis, tuberculosis, heart failure should be considered at diagnostics.
Additional clinical and instrumental laboratory markers of the main pathogenetic variants of ischemic stroke.
Authors: Kulesh A. A. , Golosova Y. A. , Syromyatnikova L. I. , Shestakov V. V.
Published: November 2020

Atherothrombotic stroke (ATI), cardioembolic stroke (CEI) and lacunar stroke (LI) are the main pathogenetic variants of ischemic stroke and differ not only in the final mechanism of formation of the ischemic focus, but also in the systemic disorders underlying them. Material and methods. 384 patients were examined in acute ischemic stroke using standard methods. All patients were evaluated for total cardiovascular risk with the use of scales ASCORE, CHA2DS2-VASc, Essen and the scale of recurrent stroke . Results. ATI was diagnosed in 268 (70%) patients, 70 (18%) patients, 46 (12%) patients. The highest rate on the scale of relapse of stroke is typical for patients with CEI, the lowest - for patients with LI. Patients with ATI had a high score on THE ascore scale. The highest rate on the scale CHA2DS2-VASc was observed in patients with CEI, the lowest - in patients with LI. Other indicators informative for differentiation of the studied types of AI are age, gender, Smoking, congestive heart failure, lipid profile, presence and size of cerebral infarction on computer tomogram on admission, involvement of vertebrobasilar pool, hemorrhagic transformation of the lesion, the thickness of the intima - media, degree of stenosis of internal carotid arteries, stenosis of intracranial arteries, cardiac ejection fraction, time from stroke to admission to hospital, hemiplegia, neglect syndrome, speech disorder, as well as neurological deficit on the NIHSS scale. Discussion. Patients with studied pathogenetic variants of ischemic stroke differed in severity and representation of cardiovascular risk factors, clinical picture and outcome of the disease, which confirms the point of view of phenotypic independence of ATI, KEI and LEE, probably due to genetic features.
Melatonin and myocardial infarction: use for diagnosis and treatment.
Authors: Budnevskiy A. V. , Ovsyannikov Evgenyi S. , Shkatova Y. S. , Rezova N. V.
Published: November 2020

The article is a literature review, where the results of experimental and clinical researches on the cardioprotective effects of melatonin in myocardial infarction and myocardial reperfusion injury are presented, and also possible use of melatonin as a predictor of adverse events in patients with myocardial infarction is being discussed. We searched the PubMed database for studies in English and Russian languages, which were published between 2000 and 2016.
Proton magnetic-resonance spectroscopy in diagnosis of cognitive dysfunction in patients with type 1 diabetes mellitus.
Authors: Samoylova Y. G. , Rotkank Maria A. , Zhukova N. G. , Matveeva M. V. , Tolmachev I. V.
Published: November 2020

The problem of cognitive dysfunction is currently of interest to doctors of various specialties, since this complication is accompanied by many systemic diseases that involve the central nervous system in the pathological process. However the diagnosis of such violations is given insufficient attention due to the lack of objective methods of verification of this diagnosis. The article presents modern ideas on the possibilities of proton magnetic resonance spectroscopy (1H-MPC) in the diagnosis of cognitive dysfunction in patients with type 1 diabetes mellitus. The role of both hypoglycemia and hyperglycemia in the formation of cognitive dysfunction is considered. The relationship between the state of carbohydrate metabolism and the disorders detected by 1H-MPC is shown.
Epidemiological characteristic of pulmonary pneumonia and its prevention in military servicing through the military service under call.
Authors: Borovkov E. Yu. , Kuchkasov P. V. , Parfenov S. A. , Tuchin I. A. , Ippolitova A. A. , Kovalenko A. L. , Shagvaliev A. G.
Published: November 2020

Community-acquired pneumonia is a disease of great military epidemiological importance to Armed Forces, especially among military conscripts due to fast spread of the disease, high morbidity rates, complication risks and significant productivity losses. System approach to prevention activities for community-acquired pneumonia allow to lower morbidity among military conscripts. There are two problems being solved using system approach which includes personnel vaccination (with pneumovax 23 vaccine). Firstly, activity of the epidemiological process is reduced which not only lowers morbidity rates but also improves course of the disease which is represented by decrease in percentage of severe cases and complications. Secondly, infection resistance among military conscripts increases. There is probability that this effect is caused by prophylactic use of Cycloferon - immunomodulator with wide activity spectrum.
Cardiovascular comorbid conditions and risk of stroke and systemic thromboembolism in chronic
obstructive pulmonary disease.
Authors: Kochetova E. V.
Published: November 2020

The aim of this study was to study the cardiovascular comorbidity in patients with chronic obstructive pulmonary disease (COPD), as well as the assessment of the risk of stroke and systemic thromboembolism on the scale CHA2DS2-VASc in patients with COPD with atrial fibrillation. Material and methods. 224 patients with COPD were examined, who had a long history of smoking (smoker's index 240 and smoking experience 40 packs/years). Research of function of external breath was studied with multimodular installation of type «Master-Lab/Jaeger». The Charlson index was used in the evaluation of comorbidity. An analysis of the risk of thromboembolic complications in patients with COPD with atrial fibrillation was performed on a scale of CHA2DS2-VASc. Results: Atrial fibrillation was noted in 10.7% ofpatients with COPD. The risk of stroke and system thromboembolism on the scale CHA2DS2-Е4Рс in COPD patients with atrial fibrillation was 3.27 ± 1.55 points in patients with COPD 2 st, and 3.0 ± 1.04 in patients with COPD 3 st. The correlation coefficient between the risk of stroke and system thromboembolism on the scale CHA2DS2-Е4Рс and the Charlson comorbidity index was 0.89, p <0,005.
Interrelation of a gene polymorphism of vascular endothelial growth factor VEGF -634G/C
(rs 2010963) with a functional condition of kidneys at patients with different phenotypes of an obesity.
Authors: Shulkina S. G. , Smirnova E. N.
Published: November 2020

Objective. To study interrelation of a polymorphism genes VEGF- 634G/C with a functional condition of kidneys at patients with different phenotypes of an obesity. Materials and methods. The research included 170 people aged from 25 up to 55 years (90 patients with an obesity, metabolic disturbances and AG "the complicated obesity", 50 - with an obesity without metabolic disturbances "metabolic healthy obesity", 30 people with AG without an obesity), 50 healthy respondents without obesity. Clinical-biochemical indicators, the VEGF level in blood and urine, MAU, collagen IV, a polymorphism of a gene VEGF -634G/C were investigated. Results. In the CO group it is established higher VEGF levels in a blood and urine, MAU, collagen IV In the CO and AG groups without an obesity there was a prevalence minor an allele C (р =0,028; QR=1,89) and (р=0,04; QR=1,83) unlike control. The adverse homozygote CC met in a group ofpersons with high MAU (%=6,9; р=0,01). The association polymorphism of a gene VEGF - 634G/C with the SBP (р=0,014), GFR (р=0,014), MAU (р=0,031), collagen IV (р =0,032), and with high levels VEGF (р <0,001) was established. Conclusions. Distribution of genotypes of the region genes of VEGF- 634G/C taped association of a carriage allele C with AG and the complicated obesity. In groups of patients with an obesity MAU level was associated with a homozygote CC. In groups with obesity and AG of the VEGF level in urine becomes perceptible, at conservation of the MAU and GFR normal values.
Complicated management of patients with systemic lupus erythematosus.
Authors: Seredavkina N. V. , Reshetnyak T. M. , Nasonov E. L.
Published: November 2020

Systemic lupus erythematosus (SLE) - chronic systemic disease, which associates with genetic defects of immunoregulatory processes and leads to uncontrolled production of antibodies to native cells and its elements with autoimmune inflammation development. There is a case report of human intravenous immunoglobulin use in lupus patient with the multiple resistances to antirheumatic drugs and many adverse reactions of the therapy.
A comparison of the data computed tomographic angiography and
echocardiography with classic electrocardiographic signs of pulmonary embolism the low risk of death.
Authors: Tyurin V. P. , Kartasheva E. D. , Pronin A. G. , Valova O. A.
Published: November 2020

A study of the correlation of the ECG symptoms to echocardiographic and CT-angiographic of the symptoms of overload of the right heart in 87 patients with pulmonary embolism (PE) is not a high risk of death. All patients were hospitalized on the first day of development of pulmonary embolism. 35.6% of patients had ECG symptoms overload right heart: deep teeth S and Q negative T in V-V, signs of blockade of right bundle branch block. Most of these patients had occlusion of the lobar artery. And in patients without ECG symptoms ofpulmonary embolism were more often obstruction of the segmental arteries (p<0,01). ECG symptoms overload right heart was with the obstruction of two or more of the lobar artery or more than ten segmental arteries. Most patients with pulmonary embolism with ECG signs of overload of right departments of heart, source of embolism was veins of femoral-popliteal segment, and pulmonary embolism in patients without ECG symptoms source was sureline vein (p=0,03). A high correlation between ECG symptoms and amount of damage to the pulmonary system in CT-angiographic, ECG and EchoCG symptoms overload right heart. The same high correlation between the ECG signs of overload of the right heart and clinical symptoms: shortness of breath and presyncopal states.
Hydrothorax in liver disease: pathogenesis, diagnosis, treatment.
Authors: Garbuzenko D. V.
Published: November 2020

The review discusses the current understanding of the pathogenesis, diagnostic methods and principles of treatment of hepatic hydrothorax. To search for scientific articles, we used PubMed database, Google Scholar search system, Cochrane systematic reviews, and reference lists. The corresponding objectives of the review of the publication were selectedfor the periodfrom 1994 to 2016 by the terms: «cirrhosis of the liver», «portal hypertension», «hepatic hydrothorax», «pathogenesis», «diagnosis», «treatment». Inclusion criteria were limited to uncomplicated hydrothorax in patients with liver cirrhosis. Analysis of the literature data showed that, despite the success of modern Hepatology, the presence of hepatic hydrothorax is associated with poor prognosis and high mortality. The majority ofpatients suffering from it are candidates for orthotopic liver transplantation. In normal clinical practice, the key to successful management of such patients may be stratification of the risk of adverse outcome and the definition of individual treatment tactics. Pathogenetically sound approach to the choice of pharmacotherapy, as well as the optimization of minimally invasive treatments will improve the quality of life and increase the survival of this category ofpatients.