Репозиторий Университета

© 2018, © 2018 Informa UK Limited, trading as Taylor  &  Francis Group. Objective: In the four SMILE (Survival of Myocardial Infarction Long-Term Evaluation) studies, early administration of zofenopril in acute myocardial infarction (AMI) showed beneficial effects as compared to placebo and other angiotensin converting enzyme inhibitors (ACEIs). This study investigated whether the concomitant administration of the dihydropyridine calcium channel-blocker amlodipine may improve zofenopril efficacy to prevent cardiovascular events in post-AMI patients. Methods: This was a post-hoc analysis of pooled individual patient data from the four large randomized SMILE studies. The primary endpoint was the 1-year combined occurrence of death or hospitalization for cardiovascular causes. Results: In total, 3488 patients were considered, 303 (8.7%) treated with concomitant amlodipine. Baseline systolic blood pressure and prevalence of metabolic syndrome were higher in amlodipine treated patients. The 1-year occurrence of major cardiovascular outcomes was significantly reduced in patients receiving concomitant treatment with amlodipine (hazard ratio, HR = 0.66; and 95% confidence interval, CI = 0.44–0.98; p =.039). After accounting for treatment with amlodipine, the risk of cardiovascular events was significantly reduced with zofenopril compared to placebo (HR = 0.78; 95% CI = 0.63–0.97; p =.026]. Among ACEI-treated patients, the zofenopril plus amlodipine combination reduced the risk of cardiovascular events by 38%, compared to the combination of other ACEIs plus amlodipine [HR = 0.76; 95% CI = 0.61–0.94); p =.013). The prognostic benefit of concomitant treatment with zofenopril plus amlodipine was independent from blood pressure lowering. Conclusions: Zofenopril had a positive impact on prognosis in post-AMI patients, compared to other ACEIs. Concomitant administration of amlodipine may help to reduce the risk of cardiovascular events at 1 year.

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. Purpose of Review: Sleep-wake disorders (SWD) are common not only in the general population but also in stroke patients, in whom SWD may be pre-existent or appear “de novo” as a consequence of brain damage. Despite increasing evidence of a negative impact of SWD on cardiocerebrovascular risk, cognitive functions, and quality of life, SWD are insufficiently considered in the prevention and management of patients with stroke. This narrative review aims at summarizing the current data on the bidirectional link between SWD and stroke. Recent Findings: Several studies have demonstrated that sleep-disordered breathing (SDB) is an independent risk factor for stroke and has a detrimental effect on stroke recovery. Short and long sleep duration and possibly other SWD (e.g., insomnia, circadian rhythm disorders) may also increase the risk of stroke and influence its outcome. Data on SDB treatment increasingly indicate a benefit on stroke risk and evolution while treatment of other SWD is still limited. Summary: A systematic search for SWD in stroke patients is justified due to their high frequency and their negative impact on stroke outcomes. Clinicians should actively consider available treatment options.

© 2017, Springer Science+Business Media, LLC, part of Springer Nature. We need to take into complex assessment a set of influencing factors of drinking water safety. This raises the task of developing an integrated methodology assessing the safety of drinking water that reaches the consumers. For the integrated assessment of the safety of drinking water, the method of clustering was chosen, namely, the neural network method of Kohonen self-organizing maps. Zones were separated by the method of cluster neural network analysis. The zones are characterized by different content of metal cations in drinking water, levels of carcinogenic and non-carcinogenic risk to the health of the child population, and the probability of the receipt of metal cations with potable water to consumers.

© 2018, Pediatria Ltd.. All rights reserved. Objective of the research: to dentify risk factors for growth retardation in patients with juvenile scleroderma (JSD). The presented data show that the most unfavorable factors for growth retardation in patients with JSD are the systemic form of the disease, debut age less than 4 years. Other unfavorable factors of growth retardation developing are father's height less than 175 cm and a mother's height less than 165 cm. Analysis of the effect of glucocorticoid saverage daily dose during the year on the growth rate in patients with JSD, normalization of growth rates was noted with its decrease to 0,2 mg/kg/day or less.

© 2018 Elsevier B.V. Although recent Cannabis use is widely reported to be associated with drug-related traffic accidents, the evidence that Cannabis users show an increased risk of being involved in road crashes is still not unequivocally proved. The purpose of the present work is to provide an objective assessment of this hypothesis, by comparing the frequency of occurrence of positive urine analyses in drivers involved in traffic accidents (n = 1406) with that observed in a control population undergoing mandatory urine drug testing (n = 1953). Urine analyses for drugs of abuse were performed by screening immunometric techniques followed by confirmation with UHPLC-QQQ MS, adopting a cut-off concentration for THC-COOH of 15 ng/mL. A case was classified as “positive” when a driver admitted to hospital for road traffic injuries showed urine concentrations of THC-COOH higher than the cut-off. All samples showing positive results for any other controlled drug in urine or blood alcohol concentrations >0.5 mg/mL were excluded from the study. Subjects positive to THC-COOH, and negative to all the other tested substances were 116 in Group 1 (8.2%) and 16 in Group 2 (0.8%). Subjects resulting negative to any tested substances were 1290 in Group 1 and 1937 in Group 2. The frequency of THC-COOH detection in the two groups was compared by using the “chi square” test, which resulted = 119.57, i.e. highly significant (P <<< 0.01). The Odds Ratio of the two groups was =10.88, showing a high degree of association between the presence of THC-COOH in urine and the occurrence of traffic accidents (P < 0.0001). The presented data, proving a high degree of association between Cannabis use and the occurrence of traffic accidents with injuries of the driver, support the use of urine testing for Cannabis in the procedures for the issuing of the driving licence, particularly in the case of subjects formerly or presently using Cannabis. This finding looks even more relevant in the present times, because of the increasing success of the policies of legalization of Cannabis for medical and non-medical purposes.

© NA Kuznetsov. This article reviews the main approaches to the interpretation of the term “risk”, which has acquired the status of a general scientific and widely interpreted concept. The unresolved issues of surgical risk terminology make it extremely difficult to solve the problem of perioperative prognosis at the narrow professional (medical) level. The author considers the problem of objec-tifying operational risk at an interdisciplinary level. In his opinion, understanding risk as a specific form of the subject’s active relation to the surrounding reality is the most justified at the present time. The essential particular features of such activities are the lack of confidence and the subject’s uncertainty in achieving the stated goal since a doctor’s professional activity takes place under conditions of risk, uncertainty and in contradictory situations. The author of the article suggests using the definition of “risk” proposed by A.P. Algin, according to which risk should be understood “as an activity connected with overcoming uncertainty and the situation of inevitable choice, in the process of which it is possible to quantitatively and qualitatively assess the probability of achieving the expected result, failure and deviation from the goal.” This definition prevents the use of antiscientific and scholastic views of this phenomenon. With reference to medical science (in particular, to surgery), this approach to risk allowed the author to formulate an individual quantitative prognosis and to distinguish five types of perioperative prognosis.

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Early detection of dorsopathies is an urgent task for primary care physicians, since such conditions can combine with other chronic noncommunicable diseases (NСD) and adversely affect the course all comorbidities, consequently disimproving the quality of life of patients and increasing the frequency of their requests for medical assistance. This study aimed to determine the value of routine checkups in the context of detection of dorsopathies, NCD, and identification of risk factors (RF). We have retrospectively analyzed the patient records database of a rural outpatient clinic in the Tver region (years 2015 to 2017). The prevalence of dorsopathies and NCD RF were the subjects investigated. Fisher's exact test and Spearman's rank correlation coefficient (SRCC) were applied for the purposes of statistical processing of the results. We discovered that dorsopathy most often was a comorbidity to arterial hypertension and gastrointestinal tract diseases; it was strongly related to the NCD (SRCC = 0.506), age (SRCC = 0.383), slightly less so - to hypodynamia (SRCC = 0.146), type of the patient's occupation (intellectual or physical labor) (SRCC = 0.07). Routine checkups improve the rate of detection of dorsopathy: the more patients undergo such examinations, the more cases of dorsopathy are diagnosed. Thus, it is necessary to increase the number of working people attending the checkups in order to detect dorsopathies early and prevent them effectively.

© Russian Journal of Cardiology. Renin-angiotensin-aldosterone axis activation is an important mechanism of hypertension and its cardiovascular and renal complications. Angiotensin receptor blockers are considered among the first-choice antihypertensive drugs in Russia, European countries, and the USA. In addition to antihypertensive action, these drugs positively influence several components of the cardiovascular continuum and can be used for individualized management of high cardiovascular risk patients. The paper discusses the benefits of angiotensin receptor blockers use in patients with cardiovascular comorbidities. The paper includes a clinical case scenario revealing antihypertensive efficacy of telmisartan as an initial agent in a patient with high risk of cardiovascular events.

© 2018 Stolichnaya Izdatelskaya Kompaniya. The metabolic syndrome is a highly prevalent condition associated with increased cardiovascular risk in the population. Microvasculature is the terminal part of the cardiovascular system which primarily reacts to the increased secretion of the pro inflammatory adipokines typical for the metabolic syndrome. Microcirculation and blood cell abnormalities are the leading mechanisms of cardiovascular events development in this condition. Prevalence of microcirculation abnormalities and red blood cell dysfunction in metabolic syndrome and their role in the increased blood viscosity and cardiovascular events development are covered by the paper. The microcirculation abnormalities with a special focus on red blood cell dysfunction (impaired aggregation, stiffness) seen in metabolic syndrome and associated conditions are discussed in detail. The impact of abnormal red blood cell deformability (secondary to cholesterol accumulation in the cellular membranes) on the hemorheological abnormalities is revealed. Abnormal red blood cell surface charge due to proinflammatory changes associated with insulin resistance in diabetes mellitus is highlighted. These abnormalities lead to increased red blood cell aggregation and plasma viscosity that are the essential components of cardiovascular events pathogenesis. Their timely diagnosis is crucial for effective cardiovascular prevention.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article covers the development of the problem of sudden cardiac death prevention with the implantable cardioverterdefibrillators from the moment of creation of these devices to our days. The current concept of primary prevention of sudden cardiac death, based on the severity of manifestation of heart failure and left ventricular dysfunction, is not effective enough. Its practical application is difficult because it requires mass application of implantable defibrillators, with low predictive accuracy of these criteria in terms of development of lifethreatening arrhythmias. The development of methods for visualizing the myocardium, allowing to assess the severity of myocardial fibrosis, as well as the possibilities of medical genetics, at the present stage, allows us to clarify indications for implantation of cardioverterdefibrillators and thereby significantly improve the concept of preventing sudden cardiac death with these instruments.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Purpose: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). Material and methods. We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning. Examination also included echocardiography. Results. In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 - 13.70±2.05 days, group 2- 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable - shin veins, popliteal, and common femoral veins, unfavorable - superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, postinfarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

© 2018, Silicea-Poligraf. All rights reserved. Pregnancy is a physiological condition that takes a defined period of time in a woman’s life. For nine months, the mother’s heart works under conditions of daily additional load, which is necessary to ensure placental blood flow. In this regard, structural and functional adaptation of the heart develops in a healthy woman with a normal pregnancy. A pregnant woman with some heart diseases is less likely to adapt. That leads to greater susceptibility to stress resulting in pathological changes of pregnancy. In addition, each pregnancy may develop new heart diseases, which in some cases may be relatively innocent, but in others — fatal. In this regard echocardiography (EchoCG) is a necessary procedure for assessing a woman’s health status that needs before bearing a fetus, during and after pregnancy.

© Russian Association of Endocrinologists, 2018. Influence of vaccination on the risk of developing diabetes mellitus type 1 (DM1) has been studied by different researchers for several decades. In rodents, vaccination can prevent development of DM1. This review summarises existing literature and discusses the results of a 2016 meta-analysis, pertaining to vaccination and DM1. No vaccines appear to increase the risk of DM1. Additional investigations are needed to determine if vaccines can be considered protective against DM1. Patients with DM1 are at increased risk of morbidities from controllable infections. Children with DM1 should receive regularly-scheduled vaccinations; choice of vaccines and inoculation with non-regular vaccines should be determined on an individual basis. We present basic principles surrounding vaccination in patients with DM1 and analyse the role of the paediatric endocrinologist in increasing vaccination uptake in children with DM1.

© 2013-2018 Federal Scientific Center for Medical and Preventive Health Risk Management Technologies. Yessotoxin (YTX) is a polyether. There are more than 90 known derivatives of yessotoxin. YTX was excluded from diarrhea toxins group as it, unlike okadaic acid, doesn't cause diarrhea. YTX chemical structure is similar to that of brevetoxins and ciguatoxins that influence functioning of calcium-sodium pump and trans-membrane ion channels. So, YTX can exert influence on functioning of all the organs and systems in a body. YTX is known to promote apoptosis in the cerebral tissues. Average lethal dose LD50 for YTX and its analogues varied from 100 μg/kg to 500-750 μg/kg; the figures were obtained in various experiments performed on mice. Safe YTX level for acute impact (acute reference dose) amounts to 25 μM/kg of body weight. Nowadays toxicity parameters for YTX and some of its analogues are determined; its basic action mechanisms and a role it plays in promoting apoptosis are well-known. In spite of more and more data on biological effects produced by YTX on a warm-blooded organism, experts are still unable to describe its action mechanisms precisely. Our research goal was to examine YTX toxicity in experiments in vivo in doses that were lower than the detected acute reference dose. The experiment was performed on 72 male Wistar rats with initial body weight being equal to 100±10 g. Animals were given dry balanced feedstuffproduced by "Laboratortakorm" LLC (Russia) and had free access to it. We used YTX preparation produced by "National Research Council Canada" (Canada) in our experiment; the preparation was a methanol solution (YTX content was equal to 4.3 μmol). We determined mass of internal organs, biochemical and hematological blood parameters, apoptosis of brain cells, malonic dialdehyde level in the brain and reduced glutathione in the liver. We showed that YTX doses (2μM/kg, 8μM/kg and 12μM/kg) lower than ARfD=2μM/kg can exert toxic impacts on a warm-blooded organism. The obtain data prove it is necessary to additionally assess risks of an increase in maximum permissible YTX contents in shellfish from 1 mg/kg to 3.75 mg/kg.

© Springer Nature Switzerland AG 2018. Video games are often seen as a reason for numerous psychological changes, both positive and negative, in players. For instance, many authors believe that video games push children and adults towards risky behaviors and impulsivity. The study aimed to analyze both theoretical and empirical evidences of that sort, as well as to investigate parameters of personal and cognitive impulsivity and risk-readiness in adult video gamers. The sample of gamers included 223 participants, all from Russia. Impulsivity and related personal traits were measured with Eysencks’ Impulsiveness Scale (I-7) and Kornilova’s Personal Risk Factors Questionnaire. Impulsivity as cognitive style was measured by Kagan’s MFFT. No evidence of high impulsivity was found, though video game players, who played more than 12 h per week turned out to be more venturesome, compared to less active gamers. Sex-related differences were investigated: female gamers scored lower in empathy, while male gamers showed higher venturesomeness. In a cognitive style study, video gamers were more accurate compared to non-gamers, and thus showed no tendency for impulsivity. The results are contrasted to the published data, when applicable.

© 2018 GEOTAR-Media Publishing Group. Yessotoxin and its derivatives (about 90) are isolated from algae belonging to the species Protoceratium reticulatum, Gonyaulax cf. Spinifera, Lingulodinium polyedrum and from invertebrate organisms that feed on these algae. Previously yessotoxin have been associated with the group of diarrheal toxins. Later studies of the possible impact of yessotoxin on the activity of alkaline phosphatase allowed to exclude them from this group. Yessotoxin causes a violation of calcium entry in the cells, which, in turn, effects the calcium-calmodulin system and thus influences into homeostasis of the organism as a whole. It was shown that yessotoxin induces a biphasic change in the concentration of adenosine monophosphate, an initial increase with a subsequent relative decrease, within some minutes after adding the toxin to the lymphocytes cell culture. Yessotoxin has effects on immune system; which is manifested in an increase of cytokines level, by inducing the expression of the genes encoding them. Yessotoxin have impact into processes of cell adhesion via E-cadherin and, thus, could be an important factor in the development of Alzheimer's disease. It has been established that yessotoxin caused the development of apoptosis. In those cases all three mechanisms of cell death took place - apoptosis, paraptosis and autophagy. Yessotoxin's acute toxicity doses according to different data are from 100 to 500-750 μg per 1kg of body weight. Yessotoxin's acute reference dose (ARfD) - 25 μg/kg of body weight per day. The results of the analysis of yessotoxin level in shellfish meat showed that none of the studied samples contained more than 3.75 mg yessotoxin equivalents/kg shellfish meat. This level has been adopted by the European Union as the maximum acceptable level of yessotoxin in shellfish meat (EU Regulation N 786/2013). Presented data on the mechanism of action, toxicity and prevalence of yessotoxins make it necessary to establish regulations of their content in seafood, placed on the markets of the Eurasian Economic Union.

© 2018 Blackwell Publishing Ltd. All rights reserved. AIMS: On the basis of echocardiography to evaluate the thickness of epicardial fat (TEF) in patients with metabolic syndrome (MS) and to establish a connection with the main indicators of laboratory and instrumental methods of research. MATERIALS AND METHODS: The study included 76 patients, 43 patients with MS and 33 without MS.The average age of patients in the MS group at the time of inclusion in the study was 62.7±10.3 years in the control group (without MS) - 60±14.7 years. All patients underwent a comprehensive examination that included the collection of complaints, study of history, physical examination, anthropometric measurements, laboratory (including the study of the levels of caspase - 8, leptin in blood plasma enzyme-linked immunosorbent assay using kits «Platinum ELISA») and instrumental examination (echocardiography, ultrasound examination of organs of small pelvis). TEF was determined using transthoracic echocardiography on the machine Acuson Sequoia 512. RESULTS: According transthoracic echocardiography was significantly higher in the group of patients with MS and was 4.67±1.7 mm, as compared to 2.66+1.15 mm in the control group (p<0.001). Identified moderate and strong correlation between TEF and weight of the patients, waist circumference, ratio of waist circumference to hip circumference, body mass index, glucose levels in the blood plasma, the presence of diabetes mellitus type 2, ultrasonic signs of steatosis of the liver and pancreas, increased aminotransferases, the level of caspase-8 concentration in plasma leptin. Patients the MS group with increased TEF increases the risk of developing hypertension, ischemic heart disease, left ventricular hypertrophy, diastolic dysfunction of the left ventricle type 2, level of caspase-8 and concentration in plasma leptin. CONCLUSION: Based on the obtained data, the measurement of TEF is justified in patients with MS in everyday clinical practice. The correlations between theTEF and the clinical and metabolic parameters of the CVD and MS make it possible to consider the TEF as a new marker of the risk of developing MS and cardiovascular diseases.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. The purpose of this study is to compare the diagnostic performance of coronary computed tomographic angiography (CCTA) and stress test as a first-line examination for the diagnosis of stable coronary artery disease in outpatient settings. Materials and methods. The study prospectively enrolled 74 patients with typical and atypical angina symptoms lasting longer than three weeks, mean age-63,9±10,4 years, 28 (37,8%) women. Exclusion criteria: contraindications to iodine-containing contrast media, statins; GFR <45ml/min/1,73 sq m; inability to perform stress testing. All patients consistently underwent stress testing (standard Bruce protocol and The Modified Bruce protocol) and standard CCTA on a 640-slice CT scanner Toshiba Aquilion ONE. We determined pretest probability of CAD and stratified risks using SCORE and ACC/AHA scales. Statistical processing was performed with SPSS version 11,5 software. Results. Treadmill test results were positive in 51,4% of patients, among them according to CCTA: 19,15% had stenosis = 70%, 35,3% had stenosis 50-69%. CCTA revealed that 28,6% of males and 46,2% of females with typical and 66,7% of males and 50,0% of females with atypical angina symptoms with positive treadmill test had no evidence of atherosclerotic lesions. 4,05% of patients with negative stress testing had evidence of significant arterial lesions (stenosis >70%). According to the SCORE risk estimation, 67,6% of patients with atherosclerotic changes in coronary arteries had high risk, ACC/AHA score-70,6%. The sensitivity and specificity of the SCORE and ACC/AHA scales in revealing coronary atherosclerosis were 83% and 71%, 81% and 88%, respectively (p> 0.05). Conclusion. CCTA can be considered as a method for the primary diagnosis of stable coronary artery disease in outpatient practice.

© 2018 Techno-Press, Ltd. In order to prevent the phenomena of "microbiological genocide", unjustified and unfavorable violations in microecological systems, and, first of all, human microbiota during the implementation of the disinfection prevention of diseases, the necessity for the scientific justification and practical provision of sufficient antimicrobial selectivity of disinfecting effects, is substantiated in the article. It is necessary to decode and take into account the susceptibility of different microbe pathogens to various disinfectants in comparison with saprophyte, and even more so, useful microflora.

© 2018 All-Russian Public Organization Antihypertensive League. All rights reserved. The review discusses the role of blood pressure variability as a novel risk factor and its prognostic value in hypertension associated with the coronary artery disease. We discuss the modern approaches to calculation of blood pressure variability, its classification. The choice of antihypertensive drugs based on the blood pressure variability is discussed considering hypertension associated with coronary artery disease. We pay special attention to angiotensin enzyme converting inhibitors and calcium channel blockers, as well as their combinations. We present the evidence of the effects of perindopril and amlodipine and their fixed combination on the blood pressure variability and the decrease in cardiovascular risk in hypertension associated with coronary artery disease.