bluuebunny/crossref_metadata_2025 huggingface dataset:
Adolescent Mothers’ Life Trajectory: What is Dimming Their Futures?
Authors: Riggs Laramie Nicole
Published: July 2020

For years, researchers contended that early pregnancy was the primary determinant for poor life outcomes for adolescent mothers (Hayes, 1987, as cited in SmithBattle 2007, p 410). More recently, the flaws in these assumptions have surfaced as theories such as the general systems theory on human behavior are gaining traction. This states that from the individual level (social interactions, cultural beliefs and values, degree of self-efficacy) to the environmental level (family, peer groups, societal norms, social class, economic status, racism), the widening disparity along one’s developmental life course reveals outcomes unique to a person and their experiences (Coie et al., 1993, pp 1014, 1016). The intertwined nature of these systems, each of which will be discussed in further sections, have altered the direction of research concerning sources of poor life outcomes commonly attributed to adolescent motherhood.
Numerical analysis of the effect of the design of axial-flow pump cannula tip on stagnation and recirculation zones in the left ventricle
Authors: Nosov M. S. , Itkin G. P. , Zaiko V. M. , Malgichev V. A.
Published: July 2020

Objective: to analyze the inflow cannula of an implantable axial-flow blood pump for a long-term left ventricular assist system in order to minimize thromboembolic complications. Materials and methods. Hemodynamics was considered for 4 different designs of the inflow cannula, from 0 mm to 25 mm long. Areas at the base of the cannula received the most attention. Analysis was performed using the OpenFOAM software. Results. It was revealed that sizes of stagnation and recirculation zones directly depended on the length of the cannula when placed in the left ventricle. Accordingly, longer cannula increases the risk of thrombosis. Conclusion. The design of an inflow cannula determines the likelihood of thrombosis in the cannula. Longer inflow cannula increases stagnation and recirculation zones. This provides a basis for a search for other possible modifications.
First experience in implantation of a mechanical circulatory support device based on a disk-type pump: an acute experiment
Authors: Zhulkov M. O. , Golovin A. M. , Golovina E. O. , Grenaderov A. S. , Fomichev A. V. , Alsov S. A. , Chernyavsky A. M.
Published: July 2020

Objective: to carry out the implantation of an artificial left ventricle of the heart based on a disk-type pump in an acute experiment on a large mammal (mini-pig). Materials and methods. To test the surgical technique of implantation and assess the biocompatibility of the apparatus for mechanical support of blood circulation based on a viscous friction pump, an acute experiment was conducted on an animal. A large mammal (mini-pig weighing 90 kg) was used as an experimental model. The implantation of the pump was performed extracorporeally according to the scheme «the apex of the left ventricle – the descending thoracic aorta». During the experiment, invasive blood pressure, central venous pressure, cardiac arrhythmias, body temperature, blood gas composition, activated coagulation time were monitored. Under the control of transesophageal echocardiography, the pump operation mode was set with parameters – speed 2400–2600, productivity 4 ± 0.5 l/min, average IAD – 70–80 mm Hg. Results. In the course of the experiment, the fundamental possibility of using the developed disk-type pump as a device for supporting blood circulation was proved. For 4 hours, the pump provided adequate hemodynamic parameters with an average productivity of 4 ± 0.5 l/min and 2500 rpm. After 4 hours of operation of the pump in the conditions of inactivated heparin (AST – 114 sec), no blood clots were found between the pump disks. Conclusion The hemodynamics feature of the disk pump allows you to develop sufficient performance parameters to ensure adequate blood circulation. The mechanism of action of the «boundary layer» minimizes the risk of blood clots in the pump cavity. However, the topographic and anatomical features of the pig’s body do not allow experiments with a long observation period.
Hydrodynamic performance of a novel suturelessprosthetic aortic valve
Authors: Klyshnikov K. Yu. , Ovcharenko E. A. , Kudryavtseva Yu. A. , Barbarash L. S.
Published: July 2020

The aimof the study was an in vitro hydrodynamic study of the developed prosthetic heart valve of the second generation, designed to carry out an implantation using «valve-in-valve» method.Material and methods.Prototypes of the developed prosthesis were studied under simulated physiological conditions of the heart using a Vivitro Labs pulse duplicator (Canada) in a comparative aspect with «UniLine» clinical commercial aortic valve bioprosthesis (Russia). Samples were tested by simulating sutureless implantation procedure.Results. The developed valves showed satisfactory hydrodynamic characteristics – for all cases of «implantation» from the position of the average trans-prosthetic gradient (6.1–11.1 mm Hg) and the effective orifice area (1.60–1.81 cm2 ). The analysis of the regurgitation fraction allowed us to determine the optimal sizes for implantation using «valvein-valve» method, which subsequently will form the basis of sizing guidelines for size selection. A qualitative analysis of the leaflet’s work demonstrated the presence of slight asymmetry for a number of prostheses – in case of mismatch of sizes when simulating «valve-in-valve» procedure.Conclusion. The tests demonstrate the viability of the developed design from the standpoint of hydrodynamic efficiency and determines the basic rules of selecting a prosthesis for reimplantation relative to the primary valve.
Robot-assisted kidney transplantation. First experience
Authors: Shchekaturov S. V. , Semeniakin I. V. , Zokoev A. K. , Makhmudov T. B. , Poghosyan R. R.
Published: July 2020

Kidney transplantation is the preferred renal replacement therapy for patients with end-stage renal disease. Traditional surgical approaches consisting of vascular and urinary outflow reconstruction during kidney transplant have been sufficiently studied and standardized. However, surgical techniques are still evolving. The objective of this clinical report is to focus the attention of kidney transplant surgeons and specialists on the currently trending robot-assisted kidney transplantation (RAKT) as a minimally invasive procedure for surgical treatment of patients with end-stage renal disease. In our first experience, good primary graft function was achieved. This shows that RAKT is a surgical option. With considerable number of surgeries and experience, RAKT outcomes would be improved significantly.
Kidney transplantation using complement inhibitor in a patient suffering from atypical hemolytic-uremic syndrome associated with factor H antibodies: successful prevention of recurrence of the underlying disease
Authors: Prokopenko E. I. , Pasov S. A. , Vatazin A. V. , Tsalman A. Ya. , Pankratenko T. E. , Generalova G. A.
Published: July 2020

Atypical hemolytic-uremic syndrome (aHUS) is an extremely rare complement-mediated disease that belongs to the group of thrombotic microangiopathies (TMA). It often reoccurs after kidney transplantation (KT). Previously, KT was considered contraindicated in both children and adults with aHUS due to high (up to 50% and above) incidence of early graft loss associated with post-transplant recurrent TMA. Introduction of specific complement inhibitor therapy into clinical practice has improved outcomes in patients with aHUS and has significantly reduced the risk of post-transplant recurrence of underlying disease. We describe the clinical observation of a 20-year-old female patient with aHUS associated with antibodies to factor H, a major regulator of complement activation. The patient underwent KT and eculizumab was used for prophylactic purposes. In the postoperative period, the patient developed ureteral necrosis that required reconstructive surgery, followed by graft pyelonephritis. Despite postoperative complications, which were highly likely to trigger uncontrolled complement activation, TMA recurrence was avoided due to early treatment of the complications and prophylactic use of complement inhibitor therapy.
Clinical trials for cellular therapy products: conclusions reached by foreign regulatory bodies
Authors: Melnikova E. V. , Merkulova O. V. , Merkulov V. A.
Published: July 2020

Currently, the problem of adopting viable human cell-based drugs – biomedical cell products (BCPs) – in medical practice in the Russian Federation includes, among others, lack of experience in clinical trials for such drugs and insufficient expert assessment under the national state registration procedure. In global practice, by the beginning of 2020, there were over 30 cellular therapy products (human cellular- and tissue-based products) known to have undergone clinical trials for sales licenses from regulatory bodies in the United States, European Union, Japan, and South Korea. Most cellular therapy products are intended for treatment of severe orphan diseases and lifethreatening conditions that currently cannot be treated by traditional drugs or methods. The aim of this study is to analyze the global experience in clinical trials for cellular therapy products and also to examine conclusions reached by regulatory authorities with regards to issuance of sales licenses for the products. Particular attention was paid to clinical trials that subsequently led to granting of sales license (state registration). In reviewing such trials, we also focused on the types and number of clinical trials, the number of patients involved in the clinical trials, conclusions made by expert regulatory agencies on the efficacy, safety and risk/benefit ratio. Most of the products were approved for use based on uncontrolled phase II clinical trials. In the clinical trial, apart from the historical group and the placebo-controlled group, there was also a control group that received nothing. The number of patients in most clinical trials was limited, especially for drugs intended for treatment of rare genetic diseases, as well as drugs approved for use in Japan.
Use of peroxiredoxin for preconditioning of heterotopic heart transplantation in a rat
Authors: Grudinin N. V. , Bogdanov V. K. , Sharapov M. G. , Bunenkov N. S. , Mozheiko N. P. , Goncharov R. G. , Fesenko E. E. , Novoselov V. I.
Published: July 2020

Peroxiredoxin 6 (Prdx6) is an antioxidant enzyme in the human body that performs a number of important functions in the cell. Prdx6 restores a wide range of peroxide substrates, thus playing a leading role in maintaining redox homeostasis in mammalian cells. In addition to peroxidase activity, Prdx6 has an activity of phospholipase A2, thus taking part in membrane phospholipid metabolism. Due to its peroxidase and phospholipase activity, Prdx6 participates in intracellular and intercellular signal transmission, thereby facilitating the initiation of regenerative processes in the cell, suppression of apoptosis and activation of cell proliferation. Given the functions performed, Prdx6 can effectively deal with oxidative stress caused by various factors, including ischemia-reperfusion injury. On an animal model of rat heterotopic heart transplantation, we showed the cardioprotective potential of exogenous recombinant Prdx6, introduced before transplantation and subsequent reperfusion injury of the heart. It has been demonstrated that exogenous Prdx6 effectively alleviates the severity of ischemia-reperfusion injury of the heart by 2–3 times, providing normalization of its structural and functional state during heterotopic transplantation. The use of recombinant Prdx6 can be an effective approach in preventing/alleviating ischemia-reperfusion injury of the heart, as well as in maintaining an isolated heart during transplantation.
Monitoring tacrolimus whole blood concentrations
Authors: Gichkun O. E.
Published: July 2020

Tacrolimus (TAC) is the primary drug for most immunosuppressive therapy regimens. It has a narrow therapeutic index, meaning that insufficient dose can lead to graft and tissue rejection, while overdose can lead to increased risk of infections, toxicity, and cancerous tumors in organ transplant recipients. TAC belongs to a group of calcineurin inhibitors inhibiting T-cell activation. The use of TAC requires regular clinical observation of recipients and laboratory monitoring of the drug concentrations in the blood. This is to ensure correct dosage of the drug and to limit the potential risk of harmful side effects. The review presents data on some clinical, genetic factors affecting the bioavailability and concentration of TAC in the blood. We also present data on the methodological aspects of TAC laboratory control.
Guidelines on improving health care quality in transplantation services in the federal subjects of Russia
Authors: Gautier S. V. , Khomyakov S. M.
Published: July 2020

Objective: to provide guidelines on how to improve the quality of health care in transplantation services for Russian regions; the recommendations were prepared by the Shumakov National Medical Research Center of Transplantology and Artificial Organs (Shumakov Center) based on field trips made by Shumakov Center from 2018 to 2019 in order to assess the status and development prospects of organ donation and organ transplantation in various regions of the Russian Federation. Materials and methods. Based on the over 40 field trips made by the Center, analytical reports, as well as recommendations were prepared by the Ministry of Health of Russia for regional health authorities and transplant centers. Guidelines were selected from these recommendations to address the most significant and common gaps and errors inherent in organ donation and organ transplantation in the regions. On the basis of the analytical reports, guidelines for the roadmap (plan) for organ donation and transplantation in the region were prepared. Results. A methodological framework for solving a wide range of managerial challenges on organ donation and organ transplantation is proposed for heads and experts at healthcare institutions and medical organizations. Conclusion. Organ donation and organ transplantation should be developed for the regions using the roadmap (plan) prepared and approved by the regional health authority. This approach brings stability and consistency to the development process, creates a resource base for development, and provides coordination and oversight.
A five-year liver transplant experience in Rostov Oblast
Authors: Korobka V. L. , Kostrykin M. Yu. , Pak E. S. , Dabliz R. O. , Kotov O. V. , Shapovalov A. M.
Published: July 2020

Objective: to reflect on a 5-year experience in liver transplant surgery at the Rostov Regional Clinical Hospital. Materials and methods. Liver transplant was performed in Rostov Oblast in July 2015 for the first time. There were 52 liver transplant surgeries performed in the region by the end of February 2020. Cirrhosis due to viral hepatitis is the leading indication for liver transplantation in 33.3% of patients. The average age of recipients was 43.5 ± 15.8 years. Male recipients accounted for 59.6% of cases. Nine recipients got liver transplants from blood relatives, while 43 recipients received an organ from post-mortem donors. For two patients, liver graft was obtained by splitting the liver into two lobes using the in situ split technique. Results. The average duration of surgery was 5.14 ± 1.92 hours. Blood loss during surgery did not exceed 1400 ml. Up to 93% of lost blood was recovered using the reinfusion system. The need for red blood cell transfusion was observed in 48.1% of cases. Fresh frozen plasma was transfused in all cases. Early postoperative complications were observed in 15 patients (29.4%), and some of them had several complications simultaneously. Biliary and vascular complications, which were eliminated by minimally invasive methods and open surgeries, had a significant influence on liver transplant outcome. In-hospital mortality was 5.6%. The causes of death were intra-abdominal bleeding (1), portal vein thrombosis (1) and biliary sepsis (1). Four more people died in the long term after being discharged from hospital: lung cancer (1), graft rejection (1) and fungal sepsis (2). Conclusion. Liver transplant outcome depends on the skills and experience of the specialists implementing this program. Post-transplant in-hospital and long-term mortality depends on the presence and nature of complications, and on the possibility of early treatment.
Comparative analysis of induction immunosuppressive therapy protocols in renal transplant recipients (retrospective review)
Authors: Galeev Sh. R. , Galeev R. Kh. , Khasanova M. I. , Gautier S. V.
Published: July 2020

Objective: to evaluate the clinical efficacy and outcomes of kidney transplants performed using an alternative immunosuppressive therapy protocol that is based on double induction. Materials and methods. We examined 296 cases of kidney transplants performed in 295 patients between January 1, 2004 and December 31, 2018. Based on induction immunosuppressive therapy regimen, the patients were divided into two groups. Group 1 included patients who underwent transplantation from January 1, 2004 to June 30, 2013 and who used the standard induction immunosuppression protocol. Group 2 included patients who did transplant surgeries between the period January 7, 2013 and December 31, 2018 and who received the “double” induction protocol being analyzed. The method of dividing patients into these groups is associated with routine implementation of the analyzed protocol at the transplantation center since July 1, 2013. Results. Graft and recipient survival rates at all follow-up periods were higher in the group of patients who received the “double” induction immunosuppressive protocol than in the standard group. The studied protocol provides initially better and more stable graft function than in standard therapy. This is especially valuable in centers experiencing difficulties in assessing pre-transplant immunological risk. The graft and recipient survival rates achieved by the analyzed protocol are more pronounced in deceaseddonor kidney transplantation. Conclusion. Positive results obtained from retrospective analysis of the protocol under study justify a prospective randomized study.
Prevalence and risk factors of post-kidney transplant hyperparathyroidism: a single-center study
Authors: Vetchinnikova O. N. , Ivanova M. Yu.
Published: July 2020

Objective:to assess the prevalence of hyperparathyroidism (HPT) and the factors affecting its development in kidney transplant recipients.Materials and methods. The single-center observational cohort study included 97 kidney transplant recipients – 40 men, 57 women, age 50 ± 9 years. Inclusion criteria: more than 12 months of post-transplant period, 3 months of stable renal transplant function. Non-inclusion criterion: therapy with vitamin D, with its alternatives or with cinacalcet. Dialysis ranged from 0 to 132 months (median 18); 46% of patients had pre-operative secondary HPT. A comprehensive laboratory study included evaluation of serum concentrations of parathyroid hormone (PTH), 25-OH vitamin D, calcium, phosphorus, magnesium, total alkaline phosphatase (ALP) activity, albumin, creatinine and daily proteinuria. At the dialysis stage, the target PTH range of 130–585 pg/ ml was used, in the post-transplant period – ≤130 pg/ml. Glomerular filtration rate (eGFR) was calculated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula.Results.Patients were divided into two groups based on PTH threshold level (130 pg/ml): the first with HPT (PTH >130 pg/ml, median 203), the second without HPT (PTH ≤130 pg/ml, median 101). Both groups were comparable in terms of gender, age, primary renal disease, dialysis modality, post-transplant follow-up, and immunosuppressive therapy regimen. In group 1 and group 2 recipients, dialysis therapy, pre-transplant median PTH level, incidence of reoperation and incidence of immediate renal graft function were 30 (14; 50) and 14 (6; 28) months (p = 0.004), 681 (538; 858) and 310 (182; 556) pg/ml (p < 0.001), 17% and 2% (p = 0.028), 51% and 80% (p = 0.005), respectively. At the time of the study, 72% of group 1 recipients had eGFR <60 ml/min, versus 36% of group 2 (p >< 0.001). Among HPT biochemical parameters, there were differences for ionized serum calcium (1.32 ± 0.07 versus 1.29 ± 0.04 mmol/l, p = 0.017) and ALP activity (113 ± 61 versus 75 ± 19 u/l, p = 0.021). Serum vitamin D in both groups reduced in equal measures – 14 ± 4 and 15 ± 6 ng/ml.Conclusion.Persistent HPT in the long-term post-transplant period reaches 48.5%. Risk factors for its development included dialysis for more than 18 months, pre-operative secondary HPT, repeated kidney transplantation, delayed graft function, and eGFR <60 ml/min.
Electrokinetic, oxidative and aggregation properties of red blood cells in the postoperative period following kidney transplantation
Authors: Deryugina A. V. , Abaeva O. P. , Romanov S. V. , Vedunova M. V. , Ryabova E. N. , Vasenin S. A. , Titova N. A.
Published: July 2020

Objective: to study the electrokinetic and aggregation properties, as well as the pro-oxidant and antioxidant processes in red blood cells following kidney transplantation in donors and in recipients in the postoperative period. Materials and methods. Blood from 12 recipients and 5 kidney donors over time – before transplantation, as well as at week 1, months 1, 2, 7, 10 and 12 after surgery, as well as from 8 healthy volunteers who formed the control group. We used microelectrophoresis to measure the electrophoretic mobility of red blood cells, characterizing the electrokinetic properties of cells. Aggregation was calculated microscopically by counting unaggregated red blood cells. Malondialdehyde concentration was measured spectrophotometrically at its absorbance maximum at 530 nm by reaction with thiobarbituric acid. Catalase activity was analyzed by reducing hydrogen peroxide in the sample spectrophotometrically at 240 nm wavelength. The obtained values were compared using the Mann–Whitney U test. Results. Decreased electrophoretic mobility of red blood cells within 2 months after transplantation was associated with increased malondialdehyde concentration and erythrocyte aggregation, decreased catalase activity in kidney recipients, followed by restoration of indicators to the control values. Electrophoretic mobility of red blood cells decreased, while malondialdehyde concentrations increased in donors after surgery. However, the increase was less pronounced than in recipients. The changes indicate that the postoperative period causes changes at the cellular level both in donors and in recipients. This is manifested by decreased stability of erythrocyte membrane structure, which is largely determined by lipid peroxidation processes. At the systemic level, a change in the electrophoretic mobility of red blood cells indicates a stress reaction before and after kidney transplantation in recipients within 2 months after surgery, and in donors in 1–2 months in the postoperative period with gradual increase in the body’s resistance. Conclusion. Kidney transplantation is manifested at the cellular and systemic levels. At the cellular level, there is decreased stability of the membrane structure, which is largely determined by lipid peroxidation processes. At the systemic level, a change in the electrophoretic mobility of red blood cells indicates a stress reaction with gradual increase in the body’s resistance. The data obtained demonstrate changes in the functional properties of red blood cells both in kidney transplant recipients and in donors. These changes need to be taken into account when carrying out therapeutic measures.
Organ donation and transplantation in the Russian Federation in 2019. 12th report from the Registry of the Russian Transplant Society
Authors: Gautier S. V. , Khomyakov S. M.
Published: July 2020

Objective: to monitor current trends and developments in organ donation and transplantation in the Russian Federation based on the 2019 data. Materials and methods. Heads of organ transplant centers were surveyed. Data obtained over years from federal subjects of the Russian Federation and from organ transplant centers in the country were analyzed and compared. Results. Based on data retrieved from the 2019 Registry, only 46 kidney, 31 liver and 17 heart transplant centers were functioning in Russia. In 2019, there were 6,878 potential recipients in the kidney transplant waitlist. This represents 13.7% of the 50,000 dialysis patients in the country. Donation activity in 2019 reached 5.0 per million population; multi-organ procurement rate was 71.6%; 2.9 organs on average were procured from one effective donor. In 2019, there were 10.0 kidney transplants per million population, 4.0 liver transplants per million population and 2.3 heart transplants per million people. Same year, the number of transplant surgeries performed in Russia rose 10.7% from the previous year. Moscow and Moscow Oblast alone have 13 functioning organ transplantation centers. They account for half of all kidney transplant surgeries and 70% of all liver and heart transplants performed in the country. Organ recipients in the Russian Federation have exceeded 16,000 in number. Conclusion. Organ transplantations in Russia keep on increasing – 10–15% per year. Donor and transplant programs are also becoming more effective and efficient. However, the demand for organ transplants far exceeds the current supply of available organs in the Russian Federation. Peculiarities of the development of organ donation and organ transplantation in Russia in 2019 were associated with some factors, such as structure and geographical location of transplant centers, waitlisting of patients, funding sources and amount, and management of donor and transplant programs. The national transplantation registry will be developed taking into account new monitoring and analysis challenges.
Fluorescence imaging in evaluating the revascularization of heterotopically transplanted primate trachea segment
Authors: Akopov A. L. , Papayan G. V. , Gorbunkov S. D. , Orlov S. V. , Karal-Ogly D. D. , Kaplanyan P. A. , Gubareva E. A. , Kuevda E. V. , Kuznetsova D. M.
Published: July 2020

Objective:to assess the potentials of using indocyanine green fluorescence angiography in evaluating revascularization of tissue-engineered construct that was obtained from the decellularized biological matrix of primate trachea, including using mesenchymal stem cells, after heterotopic tracheal allotransplantation.Material and methods.Tracheas were obtained from two male hamadryas baboons. After decellularization, 4 cm segments of tracheas were implanted under the lateral part of the latissimus dorsi in two healthy primates, one after recellularization with mesenchymal stem cells (animal 1), and the second without recellularization (animal 2). Immunosuppressive therapy was not performed. Blood flow in the transplanted segment of the trachea was evaluated 60 days after transplantation by surgical isolation of the flap of the latissimus dorsi with the transplanted segment of the trachea, while maintaining blood flow through the thoracodorsal artery. Indocyanine green near-infrared fluorescence angiography was visualized using a FLUM-808 multispectral fluorescence organoscope.Results.Sixty days after implantation, the tracheal cartilaginous framework macroscopically appeared to be intact in both animals, tightly integrated into the muscle tissue. The framework retained its natural color. After intravenous injection of indocyanine green, the tracheal vessels were visualized in both animals. Intercartilaginous vessels and portions of the cartilaginous semi-rings devoid of vessels were clearly distinguished. The entire implanted segment was almost uniformly vascularized. No local disruptions in blood supply were observed. The fluorescence brightness of the tracheal vessels was 193 ± 17 cu and 198 ± 10 cu in animals 1 and 2, respectively. The average muscle brightness in the implantation zone was 159 ± 9 cu and 116 ± 8 cu in animals 1 and 2, respectively.Conclusion. Indocyanine green fluorescence angiography is characterized by high-contrast images and high sensitivity. This facilitates vascular patency visualization and allows to assess the degree of neoangiogenesis after experimental transplantation of the tracheal segment, at different stages of experiment, without euthanizing the animal.
MicroRNA expression levels in lung recipients: correlations with clinical and laboratory data
Authors: Shevchenko O. P. , Sharapchenko S. O. , Tsirulnikova O. M. , Pashkov I. V. , Gichkun O. E. , Velikiy D. A. , Shigaev E. F. , Oleshkevich D. O. , Bekov M. T.
Published: July 2020

Objective: to evaluate the expression levels of miRNA (miR-27, miR-101, miR-142, miR-339 and miR-424) and its relationship with clinical and laboratory parameters in lung transplant recipients. Materials and methods. The study included 57 lung recipients aged 10 to 74 years (35 ± 15), including six children (9%) – four boys 10, 12, 13 and 17 years and girls 13 and 14 years old – and 51 adult recipients, including 30 men (62.5%). The control group was made up of 14 healthy individuals that were not significantly different by gender and age. Expression levels of the microRNAs studied in blood plasma were determined via quantitative polymerase chain reaction (PCR). Correlations of miRNA expression levels with complete blood count and biochemical blood test indicators were analyzed. Results. Patients with end-stage chronic respiratory failure (potential lung recipients) were found to have significantly higher expression levels of miR-27, miR-101 and miR-339 in plasma than the healthy individuals (p = 0.02, p = 0.03 and p = 0.01, respectively). The expression level of miR-339 correlated with the age of potential lung recipients (p = 0.04). It was a negative correlation (r = –0.46). The expression levels of the other four miRNAs were age independent. The average expression level of miR-424 in lung recipients in the long-term period after lung transplant was higher than in waitlisted patients (p = 0.03). Analysis of the relationship between miRNA expression levels and external respiration function in the long-term post-transplant period showed that miR-142 expression level (r = 0.61; p = 0.04) positively correlates with the Tiffeneau-Pinelli index. This strong correlation, which exceeds 85%, indicates the presence of restrictive lung diseases. A year and more after transplantation, it was found that in the recipients, there were close positive correlations between miR-27, miR-142, miR-424 expression levels and blood leukocyte concentration, as well as between the miR-142 expression level and the sCD40L concentration during this period. Conclusion. A comparative study of the expression level of miRNAs (miR-27, miR-101, miR-142, miR-339 and miR-424) in the blood plasma of patients suffering from end-stage chronic lung diseases of various origin and in lung recipients enables us to conclude that further studies of the miRNA panels are needed in order to assess their effectiveness as potential molecular and genetic markers of post-transplant complications.
Assessment and monitoring of liver graft viability and initial function using interstitial microdialysis
Authors: Sushkov A. I. , Rudakov V. S. , Gubarev K. K. , Svetlakova D. S. , Artemiev A. I. , Voskanyan S. E.
Published: July 2020

Assessing the viability and monitoring the function of liver graft in the early postoperative period are critical clinical tasks. One possible solution is to determine the changes in concentration of blood glucose, its metabolites and glycerol in the graft using interstitial microdialysis. Objective: to study the dynamics of interstitial glucose, lactate, pyruvate and glycerol in the early post-liver transplant period – depending on the initial graft function (IGF) – and to compare with the results of standard laboratory blood tests. Materials and methods. Four selected clinical observations of deceased donor liver transplantation are presented. Two of the observations showed normal IGF, one observation – early allograft dysfunction (EAD), complicated by hepatic artery thrombosis (HAT), while one observation demonstrated primary non-function (PNF). Collection of microdialysis samples began after arterial reperfusion of the liver graft and continued continuously for 7 days or until death. Standard blood biochemistry and coagulation tests were performed at least once a day. Results. With normal IGF and a smooth postoperative period, interstitial concentrations of glucose, lactate, pyruvate and glycerol remained stable throughout the observation period, ranging from 5 to 20 mmol/L, 1.1 to 7.5 mmol/L, 90 to 380 μmol/L, and 10–100 μmol/L, respectively. EAD was associated with initially higher levels of glucose, lactate, and pyruvate. With HAT development, there was a rapid (within 2–4 hours) five-fold increase in interstitial concentration of lactate with simultaneous decrease in glucose and pyruvate levels to 0.1 mmol/L and 11 μmol/L, respectively. In the case of PNF, there was an initially high concentration of interstitial lactate – 16.4 mmol/L, which increased further to 35.5 mmol/L. Glucose concentration was close to 0. Changes in interstitial glucose, its metabolites and glycerol concentrations chronologically preceded the corresponding changes in peripheral blood composition by 3–5 hours. Conclusion. Microdialysis measurement of interstitial glucose, lactate, pyruvate and glycerol concentrations facilitates real-time monitoring of liver graft viability and function. The high sensitivity of the method could help in accelerating diagnosis of vascular complications (HAT in particular), as well as graft dysfunction with other causes. Therefore, the method is feasible in clinical practice.
Telehealth in cardiac rehabilitation: a review of current applications and future prospects for practical use
Authors: Kamenskaya O. V. , Loginova I. Yu. , Klinkova A. S. , Tarkova A. R. , Naydenov R. A. , Kretov E. I. , Lomivorotov V. V.
Published: July 2020

The article provides an overview of actual studies on cardiac rehabilitation using telehealth technologies, presents the types of telerehabilitation in clinical practice. The physiological mechanisms of exercise effects in rehabilitation programs in cardiovascular patients are considered in most detail. Telerehabilitation areas with potential for further study are presented.
The prevalence of wide QRS complex (≥110 ms) among the population, depending on sex, age and place of residence
Authors: Muromtseva G. A. , Vilkov V. G. , Shalnova S. A. , Konstantinov V. V. , Deev A. D. , Evstifeeva S. E. , Balanova Yu. A. , Imaeva A. E. , Kapustina A. V. , Karamnova N. S. , Shlyakhto E. V. , Boytsov S. A. , Nedogoda S. V. , Shabunova A. A. , Chernykh T. M. , Belova O. A. , Indukaeva E. V. , Grinshteyn Yu. I. , Trubacheva I. A. , Efanov A. Yu. , Astakhova Z. T. , Kulakova N. V.
Published: July 2020

Aim. To assess the prevalence of wide QRS complex (≥110 ms) among the population, depending on sex, age, place of residence (urban or rural area), the presence of obesity and cardiovascular disease.

Material and methods. The analysis was based on the ESSE-RF study (n=17,364, men — 38%). Twelve-lead resting electrocardiography (ECG) data from the regions participating in the study were analyzed according to the Minnesota code manual. Patients were divided into groups of QRS <110 ms and ≥110 ms (wide QRS).

Results. QRS groups did not differ in heart rate and age. The prevalence of wide QRS complex in the population amounted to 17,2%. Men were likely to have wide QRS than women (18,5% and 16,2%, respectively, p<0,0005) due to the increased frequency of “preblock” QRS duration (110-119 ms; 12,3% vs 10,9%, respectively, p<0,025). The prevalence of QRS≥120 ms in the sex groups was the same, almost 7%. The prevalence of widened QRS in the population significantly exceeded other unfavorable prognostic ECG indicators, such as major ECG abnormalities, conduction disorders, abnormal Q wave (QS). The prevalence of wide QRS complex increased with age from 11,1% to 19,2, (p<0,001). The highest increase in prevalence of wide QRS complex was observed after 55 years; nondynamic periods were recorded in men from 25, and in women from 35 to 54 years. In contrast to women, the prevalence of wide QRS in men did not depend on the place of residence (18,6% in urban and 18,3% in rural areas); in rural women this parameter was observed as often as in men. This may indicate a more severe epidemiological situation of car - diovascular disease in rural residents. Obesity, high blood pressure, and a history of coronary artery disease were more common in the group of wide QRS complex.

Conclusion. For wide QRS complex, the same age and sex relationships are cha - racteristic as for the basic routine ECG indicators. The prevalence of wide QRS in the population exceeds major ECG abnormalities, conduction disorders, abnormal Q wave (QS). In rural residents, the increased prevalence of wide QRS is probably due to the greater prevalence of obesity and hypertension.
Efficacy and safety of statin therapy in multimorbid outpatients with very high cardiovascular risk
Authors: Izmozherova N. V. , Popov A. A. , Bakhtin V. M.
Published: July 2020

Aim. To analyze the efficacy and safety of statin therapy in multimorbid outpatients with very high cardiovascular risk in actual clinical practice.

Material and methods. The study included 131 patients with an established very high cardiovascular risk. History and anthropometric data were collected. The Charlson Comorbidity Index (CCI) was calculated; patients were divided into groups of moderate (№ 1, ≤6 points) and high (№ 2,> 6 points) multimorbidity. The frequency of prescribing statins, the range of doses used, the achievement of lipid metabolism targets, and the incidence of adverse effects were evaluated.

Results. The median of the CCI was 6 (5÷8) points. Group 1 included 72 patients, group 2 — 59 patients. Statins received 87 (66,4%) patients, more often in group 1 (n=54) than 2 (n=33), p=0,026. The minimum doses were taken by 17 patients, the mean — 66, the maximum — 4. Patients of group 2 received higher dosages (χ2 =9,3, p=0,010). The target level of total cholesterol was achieved in 8 (6,1%) patients, low-density lipoprotein cholesterol — no one (0,0%). Of the 106 patients ever taking statins, they were withdrawn in 19 (17,9%) patients. The reason for discontinuation in 7 patients were adverse effects, in 5 — the high cost of therapy; in 7 patients, the reason was identified. Adverse effects were recorded in 12 (11,3%) patients; there were no differences between groups (p=0,118).

Conclusion. Patients with a very high cardiovascular risk are characterized by high multimorbidity. Statins are less commonly prescribed for patients with severe polymorbidity, but at higher doses. Despite the sufficient prescribing statins and the use of mean doses, target lipid levels were not achieved. The presence of multimorbidity was not associated with an increase in the incidence of statin adverse effects.
The results of using lean technologies in assessing the cardiovascular risk based on ultrasound markers of atherosclerosis
Authors: Tsukanova E. I. , Aleksanin S. S.
Published: July 2020

Aim. To establish the practical value of studying ultrasound markers of atherosclerosis for assessing cardiovascular risk as a part of screening of the population based on lean technologies.

Material and methods. The study included 305 patients. The age of participants ranged from 31 to 84 years, the median age was 61,0 years. The object of study was 1830 extracranial vessels, including common carotid arteries, internal carotid arteries, subclavian arteries. Duplex ultrasound was using an Acuson 2000 ultrasound system with a frequency of 3-9 MHz. An abbreviated ultrasound protocol was used. The obtained data were processed using the software package Statistica 12.0 (StatSoft, USA).

Results. As a result of lean technology application, the duration of procedure was significantly reduced, and the process was improved by 6 times. Changes in intimamedia thickness (IMT) were detected in 42,6% of cases, and significantly more changes in IMT were found in women (48,1%) than in men (25,0%), p=0,0005. Atherosclerotic plaques (ASP) were detected in 53,4% of cases (men — 68,1%; women — 48,9%), p=0,0043. In men <50 years of age, a more intense increase in ASP prevalence than in women was recorded. Starting from 50 years old, ASP prevalence has leveled off. The prevalence of carotid atherosclerosis at any age was higher in men. From the age of 50, sex differences had no significance, p=0,133. In 87,1% of cases, ASP was located within the bifurcation. In the studied groups, obstruction to 50% were more common (46,2%, p=0,0005). Questioning revealed that over the past three years, duplex ultrasound was performed in 21% of patients. Satisfaction with the quality of the procedure was 57,0% (174/305).

Conclusion. The results of the study indicate the high practical value of ultrasonic markers of atherosclerosis using abbreviated ultrasound protocol as a part of screening of the population. The inclusion of noninvasive vascular imaging data in screening programs will help to achieve targets for reducing cardiovascular mortality and personalize the assessment of cardiovascular risk.
Parameters of stressful events at a young age (data of cross-sectional epidemiological studies)
Authors: Akimov A. M.
Published: July 2020

Aim. To determine the parameters of family and work stress in the open population of the medium urban city of Western Siberia among young men and women.

Material and methods. The study of nonconventional (psychosocial) risk factors for coronary artery disease was carried out according to the WHO program “MONICA-psychosocial” using the standard “Knowledge and attitude to your health” questionnaire. Family and work stress was determined by a face-to-face interview.

Results. Stress in the family among young people in the medium urban city of Western Siberia was manifested mainly by the loss or severe illness of relatives, family conflicts; in men as well — a change in marital status, in women — lack of home rest. Stress at work was manifested mainly in high or low workplace responsibility; in men as well — in changing occupation, increasing workload and responsibility over the past year, changing job, in women — in the change of manager, lack of home rest among working women.

Conclusion. Consequently, the sex characteristics of psychosocial risk factors for cardiovascular diseases, regarding chronic social stress factors, are even more significant, which specifies the need for a further study of psychosocial factors, and thereby the possibilities for changing the epidemiological situation of cardiovascular diseases in region. This also confirms the need for future research on the relationships of psychological disorders with cardiovascular diseases.
The effect of aerobic exercise on muscle tissue in patients with severe heart failure and normal body weight
Authors: Galenko V. L. , Lelyavina T. A. , Sitnikova M. Yu. , Yukina G. Yu. , Bortsova M. A. , Dmitrieva R. I.
Published: July 2020

Aim. To assess the response of skeletal muscle and myocardium to original aerobic exercise (AE) program in patients with heart failure (HF) with reduced ejection fraction (HFrEF); to assess morphometric changes in skeletal muscle fiber after AE.

Material and methods. The study included 100 patients with class III HFrEF (age — 52±5,2 years; body mass index (BMI) — 23,5±2,8 kg/m2). At baseline and after 6 months of AE, an echocardiogram, peak oxygen uptake (VO2peak), exercise tolerance and quality of life (QOL) were evaluated. Lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) activity were evaluated in biopsy material of lower leg muscles.

Results. After 6 months of AE, the left ventricular ejection fraction (LVEF) increased by 10,5±2,3%, QOL — by 24,8±3,5 points, exercise tolerance — by 9,7±0,5 points, VO2peak — by 5,2±0,5 ml/min/kg (p1,2,3,4< 0,05). In 6 patients, the diameter of muscle fiber decreased slightly. The activity of ALP (initially — 0,33±0,09 D) increased by 24,2% (p< 0,05); LDH in glycolytic fibers was initially 0,213±0,08 D, in oxidative fibers — 0,083±0,04, and after 6 months of AE, decreased by 24,4% and 6,0%, respectively (p1 <0,05, p2 >0,05). A positive relationship was found between the dynamics of HF class and fiber diameter (r=0,4, p=0,05); an increase in сardiopulmonary exercise test was associated with ALP activity (r=0,5, p=0,05).

Conclusion. 1. Dosed aerobic exercise in patients with stable class III HFrEF, normal BMI, based on reaching the lactate threshold, had a positive effect on LVEF, QOL, exercise tolerance and VO2peak. 2. With exercise training, a decrease in fiber diameter and LDH activity in both oxidative and glycolytic fibers, an increase in ALP activity were revealed. 3. The functional relationship between the increase in exercise tolerance and ALP content in muscle tissue was revealed.
The effect of sex and age hormonal changes on the development of heart failure
Authors: Serezhina E. K. , Obrezan A. G.
Published: July 2020

Currently, there is an increase in the incidence of cardiac disease in the elderly. Both the morbidity and progression rate differ in different age and sex groups. Agerelated cardiovascular changes can also be associated with the influence of sex hormones both on the myocardium itself and on the signaling involved in the regulation of circulation. Estrogen affects the mechanisms of vasodilation, the relationship of hypoxia and angiogenesis, the development of left ventricular diastolic dysfunction. Therefore, estrogen deficiency is a risk factor for cardiovascular diseases. An increase in the androgen level is involved in pathophysiological mechanisms such as aging, heart failure, and vascular remodeling. Many studies have demonstrated the inverse relationship between sex hormone levels and cardiovascular risk, morbidity and mortality. However, efforts to control the natural hormonal changes show mixed results. Additional prospective studies are needed to clarify the roles of various sex hormones in initiating cardiovascular disease and cardiac failure itself, as well as evaluating the effectiveness of hormone therapy in patients with cardiovascular disease.
Chaotic global analysis of heart rate variability following power spectral adjustments during exposure to traffic noise in healthy adult women
Authors: Garner D. M. , Alves M. , Da Silva B. P. , De Alcantara Sousa L. V. , Valenti V. E.
Published: July 2020

Aim. Previous studies have described the substantial impact of different types of noise on the linear behaviour of heart rate variability (HRV). Yet, there are limited studies about the complexity or nonlinear dynamics of HRV during exposure to traffic noise. Here, we evaluated the complexity of HRV during traffic noise exposure via six power spectra and, when adjusted by the parameters of the Multi-Taper Method (MTM).

Material and methods. We analysed 31 healthy female students between 18 and 30 years old. Subjects remained at rest, seated under spontaneous breathing for 20 minutes with an earphone turned off and then the volunteers were exposed to traffic noise through an earphone for a period of 20 minutes. The traffic noise was recorded from a busy urban street and the sound involved car, bus, trucks engineers and horn sounds (71-104 dB).

Results. The results stipulate that CFP3 and CFP6 are the best metrics to distinguish the two groups. The most appropriate power spectra were, Welch and MTM. Increasing the DPSS parameter of MTM increased the performance of both CFP3 and CFP6 as mathematical markers. Adaptive was the preferred type for Thomson’s nonlinear combination method.

Conclusion. CFP3 with the adaptive option for MTM, and increased DPSS is designated as the best mathematical marker on the basis of five statistical tests.