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DA Sychev,1 OA Baturina,2 KB Mirzaev,1 E Rytkin,1 DV Ivashchenko,1 DA Andreev,2 KA Ryzhikova,1 EA Grishina,1 PO Bochkov,1 RV Shevchenko1 1Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, Russian Federation; 2Sechenov University, Moscow, Russian FederationCorrespondence: E RytkinRussian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, Russian FederationEmail erytkin@gmail.comIntroduction: The aim of this study is to assess the influence of gene CYP2C19, CYP3A4, CYP3A5 and ABCB1 polymorphisms on clopidogrel antiplatelet activity, rivaroxaban concentration equilibrium, and clinical outcomes among patients with acute coronary syndrome and non-valvular atrial fibrillation.Methods: In the multicenter prospective registry study of the efficacy and safety of a combined antithrombotic therapy 103 patients with non-valvular atrial fibrillation both undergoing or not a percutaneous coronary intervention were enrolled. The trial assessed the primary outcomes (major bleeding, in-hospital death, cardiovascular death, stroke ransient ischaemic attack, death/renal insufficiency) and secondary outcomes (platelet reactivity units (PRU), rivaroxaban concentration).Results: For none of the clinical outcomes when combined with other covariates, the carriership of polymorphisms CYP3A5*3 rs776746, CYP2C19*2 rs4244285;*17 rs12248560, ABCB1 3435 C>T, ABCB1 rs4148738 was significant. None of the markers under study (CYP3A5*3 rs776746, CYP2C19*2 rs4244285, *17 rs12248560, ABCB1 3435 C>T, ABCB1 rs4148738) has proven to affect rivaroxaban equilibrium concentration in blood plasma among patients with atrial fibrillation and acute coronary syndrome.Conclusion: In situations of double or triple antithrombotic rivaroxaban and clopidogrel therapy among patients with atrial fibrillation and acute coronary syndrome, the genetic factors associated with bleeding complications risk (CYP2C19*17) may prove to be clinically relevant.Keywords: rivaroxaban, clopidogrel, polymorphism, atrial fibrillation, acute coronary syndrome

Alexander Valerevich Kryukov,1 Dmitry Alekseevich Sychev,1 Denis Anatolevich Andreev,2 Kristina Anatolievna Ryzhikova,1 Elena Anatolievna Grishina,1 Anastasia Vladislavovna Ryabova,1 Mark Alekseevich Loskutnikov,3 Valeriy Valerevich Smirnov,4 Olga Dmitrievna Konova,1 Irina Andreevna Matsneva,2 Pavel Olegovich Bochkov1 1Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 2Department of General Medicine, Sechenov First Moscow State Medical University, Moscow, Russia; 3L.A. Vorohobov City Clinical Hospital, Moscow, Russia; 4NRC Institute of Immunology FMBA of Russia, Moscow, Russia Introduction: Difficulties in non-vitamin K anticoagulant (NOAC) administration in acute stroke can be associated with changes in pharmacokinetic parameters of NOAC such as biotransformation, distribution, and excretion. Therefore, obtaining data on pharmacokinetics of NOAC and factors that affect it may help develop algorithms for personalized use of this drug class in patients with acute cardioembolic stroke. Patients and methods: Pharmacokinetics of apixaban in patients with acute stroke was studied earlier by Kryukov et al. The present study enrolled 17 patients with cardioembolic stroke, who received 5 mg of apixaban. In order to evaluate the pharmacokinetic parameters of apixaban, venous blood samples were collected before taking 5 mg of apixaban (point 0) and 1, 2, 3, 4, 10, and 12 hours after drug intake. Blood samples were centrifuged at 3000 rpm for 15 minutes. Separate plasma was aliquoted in Eppendorf tubes and frozen at -70°C until analysis. High-performance liquid chromatography mass spectrometry analysis was used to determine apixaban plasma concentration. Genotyping was performed by real-time polymerase chain reaction. CYP3A isoenzyme group activity was evaluated by determining urinary concentration of endogenous substrate of the enzyme and its metabolite (6-β-hydroxycortisol to cortisol ratio). Statistical analysis was performed using SPSS Statistics version 20.0. The protocol of this study was reviewed and approved by the ethics committee; patients or their representatives signed an informed consent. Results: ABCB1 (rs1045642 and rs4148738) gene polymorphisms do not affect the pharmacokinetics of apixaban as well as CYP3A5 (rs776746) gene polymorphisms. Apixaban pharmacokinetics in groups with different genotypes did not differ statistically significantly. Correlation analysis showed no statistically significant relationship between pharmacokinetic parameters of apixaban and the metabolic activity of CYP3A. Conclusion: Questions such as depending on genotyping results for apixaban dosing and implementation of express genotyping in clinical practice remain open for NOACs. Large population studies are required to clarify the clinical significance of genotyping for this drug class. Keywords: cardioembolic stroke, atrial fibrillation, non-vitamin K anticoagulants, apixaban, pharmacokinetics, pharmacogenetics

Eric Rytkin,1 Karin B Mirzaev,1 Elena A Grishina,1 Valeriy V Smirnov,2 Kristina A Ryzhikova,1 Zhannet A Sozaeva,1 Michael Iu Giliarov,2 Denis A Andreev,2 Dmitriy A Sychev1 1Russian Medical Academy of Continuous Professional Education, 2I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russian Federation Aim: The aim of this study was to determine the impact of CYP2C19 and ABCB1 gene polymorphisms and CYP3A4 isoenzyme activity on stent implantation complications among patients with an acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI).Patients and methods: Seventy-six patients (median age 63, range 37–91 years) with an ACS who underwent PCI were screened for CYP2C19 and ABCB1 gene polymorphisms with real-time polymerase chain reaction: CYP2C19*2, CYP2C19*17, and ABCB1 3435. CYP3A4 isoenzyme activity was determined by urine cortisol and 6-beta-hydroxycortisol levels. Stent implantation complications such as stent thrombosis (n=2) and restenosis (n=1) were observed among drug-eluting stent recipients.Results: Low mean 6-beta-hydroxycortisol/cortisol ratio is indicative of impaired CYP3A4 activity and was associated with higher risk of thrombosis (β coefficient=0.022, SE 0.009, p=0.021 in the linear regression model). The increase in the length of the implanted stent was associated with higher risk of restenosis (β coefficient=0.006, SE=0.002, p=0.001 in the linear regression model). The presence of the CYP2C19*2 polymorphism did not affect the incidence of stent thrombosis (β coefficient=−1.626, SE=1.449, p=0.262 in the logistic regression model), nor did the CYP2C19*17 (β coefficient=−0.907, SE=1.438, p=0.528 in the logistic regression model) and ABCB1 3435 polymorphisms (β coefficient=1.270, SE=1.442, p=0.378 in the logistic regression model).Conclusion: We did not find evidence that the presence of CYP2C19*2, CYP2C19*17, and ABCB1 3435 polymorphisms may jeopardize the safety of stent implantation in patients with an ACS. Patients with low CYP3A4 isoenzyme activity may have increased risk of stent thrombosis. Keywords: acute coronary syndrome, clopidogrel, complications, polymorphism, stents

Atrial fibrillation (AF) and heart failure (HF) often accompany each other, as they share similar risk factors and pathophysiological mechanisms. AF in patients with HF is known to increase hospitalizations and worsen prognosis. A combination of AF and HF translates into high risks of thromboembolic complications, which renders anticoagulants an important aspect of therapy for these patients. Vitamin K antagonists make achieving the target level of anticoagulation challenging due to drug interactions and comorbidities. Direct oral anticoagulants (DOACs) are preferred medications owing to a more favorable risk-benefit ratio in this group of patients. At the same time, patients with HF often require a personalized approach when choosing an anticoagulant due to increased risks of thromboembolic complications and bleeding, as well as multiple comorbidities. The article presents the results of sub-analyses of key studies on the efficacy and safety of DOACs vs vitamin K antagonists in patients with HF and AF. It also explores DOACs use in patients with chronic kidney disease.

Introduction: Patients with chronic obstructive pulmonary disease (COPD) usually have a decreased quality of life (QOL). Specialized questionnaires on QOL may be more sensitive when studying individual issues of COPD therapy than general (universal) questionnaires., Goal: Conducting a review of specific tools for assessing the quality of life of patients with COPD., Materials and Methods: The study was carried out based on the results of a search of scientific literature presented in the bibliographic databases PubMed (USA) and ELIBRARY.RU (Russia, Russian-language sources). Keywords were used to search for relevant sources: «quality of life», «COPD», «chronic obstructive pulmonary disease» etc. In order to search for information on individual questionnaires, queries containing the names of the questionnaires were used. Additional references were obtained using the search engines Google and Yandex., Results: Based on the results of a study of the scientific literature and a search in the PubMed / Medline information base, 22 specific tests used to assess the quality of life of patients with COPD were considered. These tests demonstrate different relevance and scientific applicability in recent years. Five tests were most often used in foreign and domestic studies: St. George respiratory questionnaire (SGRQ), the COPD assessment test (CAT), the modified Medical Research Council dyspnea scale (mMRC), the chronic respiratory questionnaire (CRQ), the clinical COPD questionnaire (CCQ)., Conclusion: Further study as well as local adaptation (if so required) of some questionnaires will open up new opportunities for their wider implementation into the routine daily practice of providing medical care to patients with COPD in the regions.

Aim: To evaluate a potential role of different patterns of intrarenal blood flow using Doppler ultrasound as a part of determining the severity of venous congestion, predicting impairment of renal function and an unfavorable prognosis in patients with acute decompensated chronic heart failure (ADCHF)., Material and Methods: This prospective observational single-site study included 75 patients admitted in the intensive care unit for ADCHF. Upon admission all patients underwent bedside renal venous Doppler ultrasound to determine the blood flow pattern (continuous, biphasic, monophasic). In one hour after the initiation of intravenous diuretic therapy, sodium concentration was measured in a urine sample. The primary endpoint was the development of acute kidney injury (AKI). The secondary endpoints were the development of diuretic resistance (a need to increase the furosemide daily dose by more than 2 times compared with the baseline), decreased natriuretic response (defined as urine sodium concentration less than 50-70 mmol/l), and in-hospital death., Results: According to the data of Doppler ultrasound, normal renal blood flow was observed in 40 (53%) patients, biphasic in 21 (28%) patients, and monophasic in 14 (19%) patients. The monophasic pattern of intrarenal blood flow was associated with the highest incidence of AKI: among 14 patients in this group, AKI developed in 100% of cases (OR 3.8, 95% CI: 2.5-5.8, p<0.01), while among patients with normal and moderate impairment of renal blood flow, there was no significant increase in the risk of developing AKI. The odds of in-hospital death were increased 25.77 times in patients with monophasic renal blood flow (95% CI: 5.35-123.99, p<0.001). Patients with a monophasic intrarenal blood flow pattern were also more likely to develop diuretic resistance compared to patients with other blood flow patterns (p<0.001) and had a decreased sodium concentration to less than 50 mmol/l (p<0.001) in a spot urine test obtained one hour after the initiation of furosemide administration., Conclusion: Patients with monophasic intrarenal blood flow are at a higher risk of developing AKI, diuretic resistance with decreased natriuretic response, and in-hospital death.

Aim: To estimate the prevalence of amyloid cardiomyopathy (CM) caused by transthyretin amyloidosis (ATTR) and immunoglobulin light chain (AL) amyloidosis among patients aged >65 years with interventricular septal (IVS) hypertrophy of ≥14 mm., Material and Methods: From January through August 2023, 60 patients (mean age 7.2±7.3 years, 34 (56.67%) men) were enrolled. Patients meeting the inclusion criteria underwent an echocardiographic study with determining the myocardial longitudinal strain, myocardial scintigraphy with 99mTc-pyrfotech, myocardial single-photon emission computed tomography, measurement of N-terminal fragment of brain natriuretic peptide and troponin I, and the immunochemical study of serum and urine proteins with measurement of free light chains. In the presence of grades 2 and 3 radiopharmaceutical uptake according to scintigraphy, a molecular genetic study was performed for differential diagnosis of wild-type transthyretin amyloidosis (wtATTR) and hereditary/variant (hATTR) ATTR-CM., Results: According to data of myocardial scintigraphy with 99mTc-pyrfotech, grade 3 uptake in the absence of monoclonal secretion was detected in 5 (8.3%) cases and grade 2 radiotracer uptake in the absence of monoclonal secretion was detected in 6 (10%) patients. Myeloma complicated by AL amyloidosis and primary AL amyloidosis were found in 5 (8.3%) patients., Conclusion: Among patients aged ≥65 years with IVS hypertrophy ≥14 mm, amyloid CM was detected in 20% of cases (12 patients), including 5 cases (8.3%) of AL amyloidosis and 7 cases (11.7%) of ATTR amyloidosis.

Aim: To determine predictors for the development of atrial fibrillation (AF) in patients with chronic heart failure (CHF) with preserved and reduced ejection fraction by echocardiography (EchoCG) according to an extended protocol with determination of diastolic function and left atrial global strain., Material and Methods: Data of 168 patients with stage I-III CHF without a history of AF were analyzed. All patients underwent echocardiography according to an extended protocol with the determination of diastolic dysfunction (DD), left atrial ejection fraction (LA EF), and left atrial global strain (LA GS). Tissue Doppler imaging (TDI) was used to evaluate the early (E) and late (A) LV filling velocity and the early (E') and late (A') diastolic mitral annular velocity. In all patients, Holter ECG monitoring (HM ECG) of heart rhythm was performed for 3 days, and ECG monitoring with telemedicine technologies was performed for 7 days, 3 times a day for 3 minutes. The follow-up period was 3 months or until an AF episode., Results: During the study, paroxysmal AF (pAF) was detected in 41 (24.4%) patients using various methods of heart rhythm monitoring. Complaints of palpitations were noted for 10 (24.4%) patients during pAF, which was recorded using a CardioQVARK® device, HM ECG or a 12-lead ECG. In 5 (12.2%) patients, daily ECG monitoring revealed pAF without associated complaints. HM ECG detected 8, 2, 4 (19.5%, 4.8%, and 9.7%) cases during 24, 48 and 72 hours, respectively; a single-channel CardioQVARK® detected 30 (73.2%) cases when used 3 times a day for 7 days. These results showed that AF frequently develops in CHF without accompanying symptoms. The method for detecting pAF with CardioQVARK® showed good results: it was twice more effective than HM ECG and three times more effective than 12-lead ECG. Also, according to ultrasound data, significant changes in the following parameters were noted in patients with AF: LA EF <36% (OR 1.04, 95% CI: 1.02-1.08), p=0.003; LA GS <9.9% (OR 1.16, 95% CI: 1.02-1.38), p<0.001; TDI E med <5.7 cm/s (OR 0.97, 95% CI: 0.94-1.00), p=0.026. Grade 2 DD did not show statistically significant results (OR 1.1, 95% CI: 0.7-1.5, p=0.54). However, it was detected more frequently in patients with AF, in 34% of cases, compared to 29% of cases in patients without AF, which requires further study on a larger patient sample., Conclusion: Patients with CHF have a high risk of developing pAF (24.4%). 75% of patients with AF do not feel the development of paroxysm. All CHF patients should undergo EchoCG with assessment of LA EF, TDI E med and LA GS to identify a group at risk for the development of AF. Heart rhythm remote monitoring with CardioQVARK® devices can be considered a reliable method for early detection of pAF and timely initiation of anticoagulant therapy in patients with CHF.

Background: Anti-cancer treatment can be fraught with cardiovascular complications, which is the most common cause of death among oncological survivors. Without appropriate cardiomonitoring during anti-cancer treatment, it becomes challenging to detect early signs of cardiovascular complications. In order to achieve higher survival rates, it is necessary to monitor oncological patients outpatiently after anti-cancer treatment administration. In this regard, we aim to evaluate the efficacy of single-lead ECG remote monitoring to detect cardiotoxicity in cancer patients with minimal cardiovascular diseases after the first cycle of polychemotherapy., Materials and Methods: The study included patients 162 patients over 18 years old with first diagnosed different types of solid tumors, planed for adjuvant (within 8 weeks after surgery) or neoadjuvant polychemotherapy. All patients were monitored, outpatiently, during 14-21 days (depending on the regimen of polychemotherapy) after polychemotherapy administration using single-lead ECG., Results: QTc > 500 mc prolongation was detected in 8 patients (6.6 %), first-diagnosed arial fibrillation was detected in 11 patients (9 %) in period after chemotherapy administration. Moreover, left ventricular diastolic dysfunction using single-lead ECG after polychemotherapy was detected in 49 (40.1 %) patients with sensitivity 80 %, specificity 95 %, AUC 0.88 (95 % CI, 0.82-0.93)., Conclusions: The side effects of cancer treatment may cause life-threatening risks. Early identification of cardiotoxicity plays a vital role in the solution of this problem. Using portable devices to detect early cardiotoxicity is a simple, convenient and affordable screening method, that can be used for promptly observation of patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

A description of a COVID-19 patient with the development of exudative pericarditis complicated by cardiac tamponade is provid. A peculiarity of this case is the presence of an underlying disease in the patient (chronic lymphocytic leukemia), which was in remission for 1.5 years after chemotherapy. Another feature of the patient was the relatively small area of lung damage and the hemorrhagic nature of the pericardial effusion, which persisted for a long time. The insignificant activity of inflammatory markers was noteworthy. Possible mechanisms of development and features of the course of exudative pericarditis in the described patient, issues of diagnosis and treatment of this category of patients are discusse.

Introduction: Chronic obstructive pulmonary disease (COPD), usually in advanced stages, is associated with high mortality, being the third leading cause of death worldwide. In the Netherlands, care delivery to patients with COPD has become a focus of the regional medical community, since the COPD death rates in this country are higher than the European Union average. However, between 2011 and 2021, the number of people with COPD (under follow-u by general practitioners) decreased. The experience of this country is interesting, as a large set of measures to improve the situation has been developed and implemented in this region. The purpose of the study was to analyze the experience of the Netherlands in organizing medical care for COPD in primary care settings., Material and Methods: The search for scientific literature sources was carried out using the PubMed database and Google system. The search time horizon equaled to 5 years., Results: In the Netherlands, in the system of care delivery to patients with COPD, primary care settings are heavily burdened. The article summarizes approaches to identify COPD risk factors, summarizes current clinical recommendations as of December 2022, and highlights findings of the study on medical digital platforms with the potential to organize continuous monitoring of patients. The paper exemplifies criteria for assessing the treatment quality in specialized care settings, including primary care., Discussion: It is assumed that the most effective measure to further improve efficacy of COPD treatment is the introduction of remote digital medical devices. A possible integration of the updated standards and quality indicators into digital services will further strengthen the concept of continuous automated remote monitoring of COPD patients. Evidence-based selection and introduction of effective digital solutions into current practice will improve quality of care delivery to patients.

Aim      To determine the effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on kidney function in acute decompensated heart failure (ADHF).Material and methods  A controlled randomized study on the dapagliflozin treatment in ADHF was performed. Patients were randomized to a main group (standard therapy supplemented with dapagliflozin) or a control group (standard therapy for ADHF). The primary endpoint was the development of acute kidney injury (AKI). 200 patients were included (mean age, 74±12 years; 51% men). 31% of patients had type 2 diabetes mellitus (DM2). Mean left ventricular ejection fraction (LV EF) was 47±14 %; in 44.5% of patients, LV EF was less than 45%. Median concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) was 5225 [3120; 9743] pg / ml, glomerular filtration rate (GFR) was 51 [38; 64] ml / min / 1.73 m2.Results In-hospital mortality was 6.5%. Analysis of the dynamics of body weight loss showed significant differences (4200 [2925; 6300] g vs. 3000 [1113; 4850] g; p=0.011) in favor of the dapagliflozin group. The requirement for increasing the daily dose of furosemide and adding an another class diuretic (thiazide or acetazolamide) did not differ between the groups. However, median furosemide dose during the stay in the hospital was lower in the dapagliflozin group (80 [67; 120] mg vs. 102 [43; 120] mg; p=0.016). At 48 hours after randomization, GFR significantly decreased in the dapagliflozin group (-5.5 [-11; 3] ml/min/ 1.73 m2) compared to the control group (-0.3 [-4; 5] ml / min/1.73 m2, р=0.012). Despite this, GFR did not differ between the groups at discharge (51 [41; 66] ml/min/1.73 m2 and 49 [38; 67] ml/min/1.73 m2, respectively; p = 0.84). In the dapagliflozin group, frequency of AKI episodes was not increased compared to the control group (13 and 9.4%, respectively; p = 0.45).Conclusion      The dapagliflozin treatment in ADHF is associated with more pronounced body weight loss and lower average doses of loop diuretics during the period of stay in the hospital, with no associated clinically significant impairment of renal function.

Screening for atrial fibrillation (AF) has attracted considerable attention recently. Of special interest are patients with cardiac implantable electronic devices (CIEDs) that allow for recording episodes of atrial arrhythmias of various durations, including asymptomatic ones, in which case they are referred to as subclinical atrial fibrillation (SCAF). The available data suggest that the risk of thromboembolic events varies between patients with SCAF and clinically overt AF. As of today, the question regarding anticoagulant therapy in patients with SCAF remains unresolved. The article presents an overview of previous and ongoing studies on this issue, as well as current guidelines on anticoagulant use in patients with SCAF and CIEDs.

Objective: The aim of the study is to study the clinical features of asthenic disorders in chronic heart failure (CHF) considering the reaction to the disease., Material and Methods: 62 inpatients with CHF II-IV functional class (FC) according to NYHA were examined. Research methods included somatic, psychopathological and pathopsychological examination using psychometric scales., Results: According to a pathopsychological study using the Multidimensional Fatigue Inventory (MFI-20), asthenic disorders were discovered in all examined patients, realized mainly by «general fatigue» (75.8%) and «physical fatigue» (72.6%), more rarely «mental fatigue» was observed (32.2%). Correlations of «general fatigue» with the age of patients were revealed ( p =0.018). There was a relationship between the severity of asthenic disorders and the severity of CHF, as evidenced by the correlation between «general fatigue» and reduced ejection fraction (EF) of the left ventricle ( p =0.005), as well as «physical fatigue» and FC according to NYHA ( p =0.022). The negative impact of all components of the dimensions of asthenic disorders on the quality of life was determined ( p <0.05). According to the concept of the formation of different perceptions of the manifestations of a somatic disease, two types of reactions to asthenic disorders were identified: 1. Dissociative reactions, manifested by a discrepancy between the severity of CHF and a subjective assessment of the condition with an underestimation of the asthenic symptoms denial of its influence on the usual lifestyle and associated with an unfavorable course of CHF and 2. Adaptive reactions, realized by a harmonious perception of asthenia, awareness of the need to change lifestyle considering the presence of CHF symptoms., Conclusion: In accordance with the results, the described clinical features of asthenic disorders allow to distinguish asthenia in CHF and other pathology, and the identified types of reactions can contribute to the timely verification of asthenia, prevention of further progression of CHF, and the development of appropriate treatment approaches.

Introduction: In the last decade, there has been a «breakthrough» development of scientific approaches to the assay of genomic and immune factors underlying anti-cancer treatment efficiency. The choice of antitumor therapy in practice is increasingly determined by molecular signatures, and not only by the specificity of organ tumor originated from (or by the histological properties of the tumor). An urgent and important scientific and practical task is to study the successful experience of organizing Centers for Personalized Cancer Treatment (CPCT)., Aim: analysis of the 10-year experience of the Clinical Center for Personalized Cancer Treatment in the Netherlands., Materials and Methods: Data were extracted from the internet databases using keywords: personalized cancer therapy / treatment, cancer, targeted therapy etc.Results. The Center's research project collects data on patients with metastatic cancer who are eligible for anticancer treatment as part of standard practice. The system accumulates various information about tumor DNA, mutations and abnormalities in DNA, treatment results (outcomes), as well as other important clinical characteristics, including individual tumor process. Registered parameters are stored in a digital database and are available for scientific research., Discussion and Conclusions: CPCT consider the possibilities for the more in-depth genomic analysis of patient DNA (including non-tumor DNA) in the future in order to improve the medical decision making regarding early diagnosis and personalized choice of anticancer therapies. Rapid progress will lead to the emergence of more advanced methods for re-evaluating biological samples accumulated in biobanks, that will facilitate the understanding the pillars of personalized anti-cancer treatment approaches as well as create an additional bases for the new drug development.

Aim    To identify possible predictors of tachycardia-induced cardiomyopathy (TICMP) in patients with newly developed decompensated chronic heart failure (CHF) of nonischemic origin with reduced left ventricular ejection fraction (LV EF) and with persistent atrial tachyarrhythmias. Material and methods    This study included 88 patients with newly developed decompensated CHF of nonischemic origin with reduced LV EF and persistent atrial tachyarrhythmias. Resting 12-lead electrocardiography (EGC) and transthoracic echocardiography (EchoCG) were performed upon admission and following the electrical impulse therapy for all patients. Also, 24-h ECG monitoring was performed to confirm sinus rhythm stability. After recovery of sinus rhythm, outpatient monitoring was performed for three months, including repeated EchoCG to evaluate the dynamics of heart chamber dimensions and LV EF. Results    The patients were divided into two groups based on the increase in LV EF: 68 responders (TICMP patients with a LV EF increase by &gt;10%) and 20 non-responders (patients with an increase in LV EF by &lt;10% during 3 months following the sinus rhythm recovery). According to results of the baseline EchoCG, LV EF did not significantly differ in the two subgroups (TICMP, 40±8.3 %, 18-50 % and non-responders, 38.55±7.9 %, 24-50 %); moreover, the incidence of cases with LV EF &lt;30% did not differ either (9 patients TICMP and 2 non-responders, р=1.0). TICMP patients compared to non-responders, had significantly smaller left atrial dimensions (4.53±1.14 (2-7) cm and 5.68±1.41 (4-8) cm, р=0.034; 80.8±28.9 (27-215) ml and 117.8±41.3 (46-230) ml, р=0.03, respectively) and left ventricular end-systolic volume (ESV) (67.7±33.1 (29-140) ml and 104.5±44.7 (26-172) ml, р=0.02, respectively). The effect of major EchoCG parameters on the probability of TICMP development was assessed by one-factor and multifactor regression analyses with adjustments for age and sex. The probability of TICMP increased with the following baseline EchoCG parameters: end-diastolic volume (EDV) &lt;174 ml [odd ratio (OR), 0.115, 95 % confidence interval (CI): 0.035-0.371], ESV &lt;127 ml [OR, 0.034, 95 % CI: 0.007-0.181], left atrial volume &lt;96 ml [OR, 0.08 , 95 % CI: 0.023-0.274], right ventricular dimension &lt;4 cm [OR, 0.042 , 95 % CI: 0.005-0.389].Conclusion    Among patients with newly developed decompensation of CHF with reduced LV EF of non-ischemic origin and persistent atrial arrhythmias, TICMP was detected in 72 % of patients. The probability of TICMP did not depend on baseline EF and duration of arrhythmias, but increased with the following baseline EchoCG parameters: EDV&lt; 174 ml, ESV&lt; 127 ml, left atrial volume &lt;96 ml, right ventricular dimension &lt;4 cm. The multifactorial analysis showed that a right atrial volume &lt;96 ml is an independent predictor for the development of TICMP.

Adherence has a direct impact on reducing the effectiveness of atrial fibrillation therapy and increasing the risk of thromboembolic events. Among the factors involved in the decrease of adherence, the social and psychological characteristics of patients remain insufficiently studied. At the same time, the available publications allow us to conclude that there are markers of the risk of reduced adherence in patients with atrial fibrillation, which include age, cognitive impairment, psychoemotional disorders (including depression and anxiety) and specific behavioral patterns.

Aim: To evaluate the impact of anxiety disorders on adherence to anticoagulant therapy (ACT) in patients with atrial fibrillation (AF)., Materials and Methods: 179 outpatients (131 women, 48 men, mean age 69.96.2 years) with AF were examined. The research methods included a physical examination according to the standards of medical care in an outpatient facility, clinical and psychopathological examination using psychometric scales., Results: Based on the assessment of adherence to ACT using the MoriskyGreen test, 2 groups of patients were identified: Group 1 patients with high adherence to ACT, Group 2 patients with partial/low adherence to ACT. In group 1, anxiety disorders were verified in 51.7% of cases, in group 2 54.3%. There were no statistically significant differences in the prevalence and severity of anxiety in the study groups. In accordance with the binary logistic regression model, the probability of high adherence to therapy is determined by higher (compared with the group of patients with partial/low adherence to therapy) scores in terms of mental health (p0.001), vital activity (p=0.02) and the total score of the SF-36 scale (p=0.08), as well as the extraversion parameter (p=0.02) of the NEO-FFI scale., Conclusion: In the present study, no significant association was found between anxiety symptoms and a decrease in adherence to ACT in patients with AF. However, the results obtained suggest a contribution to the adherence to therapy of personality characteristics.

Objective: To study the typology of nosogenic reactions in chronic heart failure (CHF) with the determination of the contribution of cardiological and personality factors in their formation., Material and Methods: One hundred and twenty-one patients with nosogenic reactions associated with CHF were examined. Somatic, clinical-psychopathological and psychometric examinations were used., Results: Three types of nosogenic reactions in CHF have been identifiedSignificantly more frequent were dissociative reactions (76 (62.8%) patients, 40 men, 36 women, mean age 64.4±12.7) with an underestimation of the severity of the somatic condition, which formed in CHF with a short (3.2±3.8 years, p <0.05), but the most severe course. They were associated with hyperthymic, hysterical and schizoid personality radical. Hypochondriacal reactions (28 (23.1%) patients, 18 men, 20 women, mean age 63.4±15.2), due to anxiety about health and excessive fixation on the functioning of the heart, were characteristic of CHF, regardless of the severity of cardiological conditions, with an average duration of the course (4.1±4.2 years). They were observed in patients with anxious and hysterical radicals. Depressive reactions (17 (14%) patients, 8 men, 9 women, mean age 64.3±13.5), had the most protracted character (6.1±3.2 years), formed in patients with anankastic and schizoid radicals, and were noted in chronic heart failure with a long course and moderate severity. Heterogeneous nosogenic reactions in CHF were associated with low adherence to treatment due to maladaptive behavior of the patient, determined by the characteristics of the psychopathological structure., Conclusion: The study demonstrates the influence of the characteristics of a cardiac disease and personality on the clinical and psychopathological features of nosogenic reactions associated with maladaptive behavior of the patient.

Introduction: The radiation therapy (RT) plays a tremendous role in the consistent treatment of prostate cancer (PCa). The research ideas underpinning the wide implementation of innovative digitalized continuous (nonstop) dynamic auditing are coming true. Simultaneously, there are increasing challenges in selection of RT quality indicators., Objective: to study the pivotal indicators for RT quality assurance in treatment of PCa and to highlight the breaking through developments securing the delivery of top-quality cancer care in radiation oncology units., Materials and Methods: The literature search was performed in the PubMed database and the Google system. The inquiries included such terms as: "quality of care", "quality assessment criteria", "indicators", "prostate cancer" and "radiation therapy". A logical and semantic approaches were applicated to select the relevant scientific resources., Results: In most relevant studies, the variations of the Delphi technique are used to choose the quality assessment criteria. The targeted research papers describe the development of QIs for assessing the quality of radiation therapy in patients with locally advanced PCa; a hierarchical list of QIs has been generated. The adequate registration of information has huge impact on quality assessment to draw the definitive thorough conclusions., Discussion: The further improvement of Delphi technique may form one of pillars for the development of valuable RT quality measures. Considering the math aspects and the physical nature of RT, it seems being important to include the key opinion leaders in the field of clinical oncoinformatics, radiation informatics, and specialists from technical industries in the expert committees for the selection of RT QIs.

Aim      To evaluate outcomes in patients with acute coronary syndrome and atrial fibrillation who receive rivaroxaban and the patients' compliance with the antithrombotic therapy.Material and methods  The study was performed from October 2017 through December 2019 and included 129 patients. Events between the discharge from the hospital and 12 months of follow-up were recorded. The primary endpoint was development of major, minor or requiring medical attention bleeding according to the TIMI scale. The secondary endpoint was a combination of recurrent myocardial infarction, nonfatal acute ischemic cerebrovascular disease, nonfatal systemic embolism, stent thrombosis, and cardiovascular mortality.Results 32 (24.8%) patients early terminated the antiplatelet treatment and 22 (17.1%) patients terminated the rivaroxaban treatment. 26 (20.2 %) patients had hemorrhagic complications. The highest incidence of hemorrhage was observed within the first 2 months after the discharge. None of the bleedings was fatal. Composite endpoint events were observed in 24 (18.6 %) patients, including 14 (10.9 %) who died from cardiovascular causes.Conclusion      The compliance with the antiplatelet therapy was insufficient. The incidence of hemorrhagic complications was relatively high; minor and requiring medical attention hemorrhages mostly contributed to the structure of these complications. The observed incidence of recurrent ischemic events associated with a high mortality presents a more serious problem compared to hemorrhagic complications of the combination antiplatelet therapy and warrants a more aggressive tactics of the antiplatelet treatment in high-risk patients.

Aim To evaluate safety of using rivaroxaban in patients with stage 4 chronic kidney disease (CKD) or transient, stable decline of glomerular filtration rate (GFR) to 15-29 ml /min / 1.73 m2 in the presence of atrial fibrillation (AF).Material and methods This multicenter prospective, randomized study included patients admitted to cardiology departments from 2017 through 2019. Of 10 224 admitted patients 109 (3 %) patients with AF and stage 4 CKD or a stable decline of GFR to 15-29 ml /min / 1.73 m2 were randomized at 2:1 ratio to the rivaroxaban 15 mg /day (n=73) treatment group or to the warfarin treatment group (n=36). The primary endpoint was development of BARC and ISTH major, minor, and clinically relevant minor bleeding. Mean follow-up duration was 18 months.Results Patients receiving warfarin had a significantly higher incidence of BARC (n=26 (72.2 %) vs. n=31 (42.4 %), р&lt;0.01) and ISTH (n=22 (61.1 %) vs. n=27 (36.9 %), p&lt;0.01) minor bleeding and all ISTH clinically relevant (minor clinically relevant and major bleedings) n=10 (27.7 %) vs. n=8 (10.9 %), р=0.03]. The number of repeated hospitalizations was 65 (43% of patients) in the rivaroxaban treatment group and 27 (48% of patients) in the warfarin treatment group (р=0.57), including 24 (36.9 %) and 11 (40.7 %) emergency admissions in the rivaroxaban and warfarin treatment groups, respectively (р=0.96). Significant improvement of changes in creatinine clearance and GFR (by CKD-EPI and Cockroft-Gault) was observed in the rivaroxaban treatment group.Conclusion The study provided evidence for a more beneficial safety profile of rivaroxaban compared to warfarin in patients with AF and advanced CKD.

Objective: To estimate the prevalence of chronic kidney disease (CKD) 3b - 5 stages and the newly diagnosed sustained reduction in glomerular filtration rate (GFR) &lt;30 ml / min / 1.73 m2 in patients with atrial fibrillation (AF) in real clinical practice, as well as the features of their anticoagulant therapy., Materials and Methods:  Retrospectively, data of all discharge epicrisis from cardiological departments of five Moscow hospitals from June 1, 2016 to May 31, 2017 were analyzed. Patients over 18 years old with AF were enrolled. At the next stage, patients with CKD 3 b - 5 st and newly diagnosed sustained reduction in GFR &lt;30 ml / min / 1.73 m2 (at least 2 measurements during hospitalization) were selected., Results: Data of 9725 patients were analyzed, AF was diagnosed in 2983 (31 %) cases, of which a decreased GFR &lt;45 ml / min / 1.73 m2 was detected in 27 % (n = 794) cases. Among them, 349 (44 %) were diagnosed with CKD 3b st, 123 (15 %) with CKD 4 st, 44 (6 %) with CKD 5 st, 278 (35 %) had a newly diagnosed sustained reduction in GFR. In 63 % of patients with AF and GFR &lt;45 ml / min / 1.73 m2, anemia was diagnosed, 39 % of them had moderate and severe one. 711 (89 %) patients were prescribed anticoagulants, 53 % were assigned direct oral anticoagulants (DOACs). Patients with CKD 3 b st. more often rivaroxaban 15 mg (29 %) was prescribed, with CKD 4 and CKD 5 - warfarin (48 % and 25 %, respectively), in patients with newly diagnosed sustained reduction in GFR &lt;30 ml / min / 1.73 m2 - apixaban 10 mg / day (16.2 %)., Conclusion: A quarter of patients with AF revealed a decreased GFR &lt;45 ml / min / 1.73 m2, half of them were recommended DOACs. 42 % of patients with GFR &lt;30 ml / min / 1.72 m2 were prescribed DOACs, 27 % - warfarin. Patients with CKD 5 st DOACs were not assigned; in half of cases, none of the anticoagulants was recommended. Most often, the dose of the prescribed anticoagulant was not counted according to GFR in patients with newly diagnosed sustained reduction in GFR &lt;30 ml / min / 1.73 m2.

Background The aim of this study was to evaluate the association of the carriage of the rs2244613 polymorphism of the CES1 gene with clopidogrel resistance as well as to evaluate the effectiveness of antiplatelet therapy in the carriers of this marker who have had acute coronary syndrome (ACS). This study also analyzes the procedure of percutaneous coronary intervention and compares the rs2244613 carrier rate between patients with ACS and healthy participants. Methods The study involved 81 patients diagnosed with ACS and 136 conditionally healthy participants. The optical detection of platelet agglutination by VerifyNow was employed to measure residual platelet reactivity in patients with ACS. The rs2244613 polymorphism was determined using real-time polymerase chain reaction. Results According to the results, the AA genotype of the rs2244613 polymorphism of the CES1 gene was detected in 37 patients (45.6%), the CA genotype in 42 patients (51.8%) and the CC genotype in 2 patients (2.6%). The level of residual platelet reactivity in rs2244613 carriers was higher compared with patients who did not have this allelic variant: 183.23 PRU ± 37.24 vs. 154.3 PRU ± 60.36 (p = 0.01). The frequencies of the minor allele C were 28.4% and 28.3% in patients with ACS and healthy participants, respectively. The results of the linear statistical model PRU due to CES1 genotype were as follows: df = 1, F = 6.96, p = 0.01). The standardized beta was 0.285 (p = 0.01) and R2 was 0.081. However, we also added CYP2C19*2 and *17 into the linear regression model. The results of the model were as follows: df = 3, F = 5.1, p = 0.003) and R2 was 0.166. Conclusions We identified a statistically significant correlation between the carriage of the rs2244613 polymorphism of the CES1 gene and the level of residual platelet aggregation among patients with ACS and the procedure of percutaneous coronary intervention.

The objective of this study was to determine the impact of polymorphism of CYP3A subfamily isoenzymes (allelic variants of CYP3A4*22 and CYP3A5*3) on the efficacy clopidogrel in patients with an acute coronary syndrome (ACS), who have undergone percutaneous coronary intervention (PCI). Platelet activity was determined on a VerifyNow P2Y12 test system in 81 patients with ACS aged 37-91 who had PCI. The activity of CYP3A4/5 was expressed as the ratio of the concentrations of cortisol and 6β-hydroxycortisol was performed by using high performance liquid chromatography. Genotyping was performed by using real-time polymerase real-time chain reaction. The frequencies for the CYP3A5 gene, rs 776746, were identified as follows: 77 (95.1%)-CC, 4 (4.9%)-CT; the allele frequencies by loci for the CYP3A4, rs rs35599367, were as follows: 78 (96.3%)-GG, 3 (3.7%)-AG. There was no statistically significant genotype-dependent difference between the presence of a minor T and G alleles and the presence of clopidogrel resistance (OR 3.53; 95% CI 0.46-26.94; p = 0.233 and p = 0.443, respectively). The average level of the metabolic relationship (6β-hydroxycortisol/cortisol) between the clopidogrel-resistant group and the normal platelet reactivity group was not statistically significantly different: 3.3 ± 2.8 versus 3.2 ± 3.2; p = 0.947. So, the activity of CYP3A4/5 was not related to platelet aggregation rates in this model. Genotyping and phenotyping CYP3A4\CYP3A5 does not predict the antiplatelet effect of clopidogrel. More extensive research is required to establish their clinical relevance.

Purpose: To assess the prevalence of atrial fibrillation (AF) and use of antithrombotic agents in adult patients with acute coronary syndrome (ACS)., Materials and Methods: We consecutively enrolled all ACS patients (n=1155) who were hospitalized in two Moscowbased percutaneous coronary intervention centers (each center performs over 500 PCIs a year) between October 2017 and February 2018. AF was diagnosed in 204 patients (17.7%). The risk of thromboembolic complications was assessed using the CHA2DS2-VASc Score. The risk of hemorrhagic complications was assessed using the HAS-BLED Score. The data were processed using StatSoft Statistica 10.0 and IBM SPSS Statistics v.23 software., Results: The prevalence of diagnosed AF was 13.6%, while the prevalence of undiagnosed AF was 4.1%. Of the 179 discharged patients with AF, only 2 had a low risk of ischemic stroke (IS). One hundred and fifty patients (83.8%) eligible for oral anticoagulant therapy received oral anticoagulants. Patients with diagnosed AF were administered oral anticoagulants (OACs) significantly more often than patients with undiagnosed AF [125 (91.9%) vs. 25 (58.1%), р&lt;0.001]. Novel oral anticoagulants (NOACs) were administered four times more often than vitamin K antagonists [120 (80.0%) vs. 29 (19.3%), р&lt;0.001]. Rivaroxaban was used in 51.3% of cases. Of the 29 patients treated with warfarin, only 3 (10.3%) achieved the target international normalized ratio (INR) at discharge. Of the 107 patients who underwent percutaneous coronary intervention (PCI), 77 patients (80%) received an OAC and two antiplatelet agents (with 74% receiving this three-agent therapy for one month), 11 patients (10.3%) received an OAC and an antiplatelet agent, and 18 patients (16.8%) received two antiplatelet agents. The only antiplatelet agent used as part of the three-agent therapy was clopidogrel. The three-agent therapy without PCI was administered in 43.1% of cases., Conclusion: We found that the prevalence of AF in patients with ACS was high. The fact that doctors administered NOACs suggests that they are aware of the need to use these agents to prevent thromboembolic complications in AF patients.

The clinical manifestations of myocarditis are extremely variable and it may commonly manifest as acute myocardial infarction. The diagnosis of acute myocarditis is frequently empiric and substantiated by the clinical picture of the disease, ECG changes, elevated enzyme levels, and the lack of any data on coronary heart disease. Until recently, endomyocardial biopsy has been considered to be the most accurate diagnostic method. However, endomyocardial biopsy has a low sensitivity and is associated with the high risk of complications. This paper describes a clinical case of a patient with cardialgias occurring after acute respiratory viral disease, with ST segment elevation, and higher levels of cardiospecific enzymes. The diagnosis of myocarditis was verified by contrast-enhanced cardiac magnetic resonance imaging.

Aim: To specify the prognostic value of parameters of cardiopulmonary exercise testing (CPET) in patients with chronic heart value (CHF) on optimal medical treatment depending on gender, age, left ventricular ejection fraction (LVEF), cardiac rhythm and achievement of target respiratory exchange ratio (RER) > or = 1.0., Materials and Methods: 111 patients (83 male, mean age 60.6 +/- 12.8 years) with CHF NYHA class I-III on optimal treatment were included in the study. One third had preserved EF, 27.9%--permanent atrial fibrillation (AFib). Average followup was 19.4 +/- 9.6 months. Prognostic value of CPET indices and Heart Failure Survival Score (HFSS) for cardiovascular mortality (CVM) and combined endpoint including CVM or CHF hospitalization were evaluated using logistic regression analysis., Results: CVM amounted 14.4%, combined endpoint was observed in 46.8% of patients. HFSS had the highest predictive value for CVM (in all subgroups of patients) and for combined endpoint (except patients with AFib). In men, patients younger than 65 years, with reduced LVEF and with Afib CVM was also related to ventilatory indices (VE/VCO2, ventilatory class and PetCO2 peak), and combined endpoint was related to VO2peak and its derivativatives. Only HFSS and VE/VCO2 had prognostic value for CVM in patients with AFib. Ventilatory parameters were associated with combined endpoint in all subgroups except Afib. Blood pressure response and heart rate recovery had prognostic significance only in patients with sinus rhythm. Target RER > or = 1.0 was achieved only in 40.5% patients. In patients with RER < 1.0 significant relationship between VO2 peak and combined endpoint was observed. CONCLUSIONS; Heart Failure Survival Score, VE/VCO2, ventilatory class and PetCO peak are the strongest predictors of cardiovascular mortality and heart failure hospitalizations in all subgroups of patients with CHF. CPET has the highest significance for men, age < 65 years, patients with LVEF < 45% and sinus rhythm. In these subgroups VO2 peak and Weber class have predictive value for decompensation of CHF whether RER > or = 1.0 or not. Blood pressure response and heart rate recovery have prognostic significance only in patients with sinus rhythm.

Aim: To evaluate the efficiency and safety of outpatient physical exercises (PE), calculated using ergospirometry (ESM) in patients in the early periods after elective percutaneous coronary interventions (PCI) during incomplete coronary bed revascularization., Subjects and Methods: Three hundred and eighty-three patients were screened. The trial enrolled the patients after elective PCI in its early periods (3 to 14 days) who had signed an informed consent document to participate in the investigation and who could perform themselves PE at home or visit the medical center. Patients with angioplasty complications (myocardial infarction, severe hematomas, major bleeding, etc.) who had standard contraindications to exercise testing and PE were excluded. The patients included in the trial (n = 50) were divided into 2 groups: (1) 21 patients who had undergone incomplete revascularization; (2) 29 patients who had complete revascularization. The authors estimated exercise endurance by ergospirometry before the investigation, 8 weeks after a course of exercises, and following 6 months and assessed quality of life (QL) using the SF-36 questionnaire. A physical rehabilitation program was elaborated for all the patients according to exercise test results. During the trial, all the patients were allocated to groups of home and clinic exercises using exercise bikes. Medical control of the patients who were exercising at home was made by their telephone conversation, control visits to the medical center at least once monthly, and their concurrently keeping an exercise diary in which each training (duration, intensity), health status, and blood pressure were recorded. The patients could consult their physician at any time if required., Results: In the incomplete and complete revascularization groups, VO2 max increased by 6 and 15%, respectively. Following 6 months, no additional increment in VO2 max was seen in the study groups. According to SF-36 data, QL improved in patients in both groups after 8 weeks and remained at the same level after 6 months., Conclusion: An early time course of exercises only in combination with regular medical control has a positive impact on exercise tolerance and QL and preserves its efficiency for at least 6 months regardless of the degree of revascularization.

The article thoroughly covers development of wireless inertial sensors technology in medicine. The authors describe main criteria of diagnostic value of inertial sensors, advantages and prospects of using these systems in sports medicine, in comparison with other conventional methods of biomechanical examination in sports medicine. The results obtained necessitate further development of this approach, specifically creation of algorithms and methods of biomechanic examination of highly qualified athletes in high achievements sports.

It is a case report of bleeding when using dabigatran in patient with renal failure caused by the concurrent use of spironolactone and angiotensin-converting enzyme (ACE) inhibitors. The patient (75 years old) at the decompensation of chronic heart failure in the background of persistent atrial fibrillation was appointed the combination of ACE inhibitors, spironolactone, and dabigatran. 10 days after the start of using spironolactone and dabigatran bleeding was marked with decrease in hemoglobin levels to 69 g/l, creatinine level increases to 3.6 mg/dL (glomerular filtration rate by MDRD 18 ml/min/1,73 m2), and potassium to 5.5 mEq/ l. Against the background of the abolition of drugs normalization of renal function was marked. The question of an increased risk of nephrotoxicity with concurrent use of ACE inhibitors and spironolactone is discussed.

Fibrinolytic system components are important in the regulation of thrombogenesis therefore the aim of the investigation was to compare the level of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor 1 (PAI-1) in the monocytes of patients with stable coronary heart disease (CHD) and acute coronary syndrome (ACS) to reveal an association of the content of these proteins with the severity of disease, by applying two different techniques: immunocytochemistry and flow cytofluorimetry. The counts of uPA- and PAI-1-expressing monocytes were equal in each case and accounted for 81.9-99.9% in all groups. At the same time, the level of PAI-1 was higher than that of uPA and significantly higher in patients with ACS than in those without ACS and in the controls. No significant differences were found in uPA levels between the ACS and stable CHD groups; however, it was significantly higher in the patient groups than in the control one. The detection of the higher expression of PAI-1 in the peripheral blood monocytes of patients with ACS suggests that it can be used as a marker of disease severity.

The role of adipose tissue as an important endocrine organ is today beyond doubt. The adipose tissue is known to be a source of many biologically active substances, adipocitokines, one of them being the adiponectine possessing anti-inflammatory, antiatherogenic and cardioprotective properties; it is believed to be one of prospective biomarkers for risk assessment, for diagnostics and, possibly, for therapy of cardiovascular diseases.

Postcardiotomy syndrome (PCTS) is an idiopathic inflammatory disease affecting pericardium and pleura; it complicates the postoperative period in cardiosurgery. High efficiency of corticosteroid therapy suggests autoimmune nature of PCTS. As a rule, this condition develops within two weeks after surgery although cases of its delayed onset (after 1 year) were reported too. PCTS may proceed both as an acute disease and as a mild disorder characterized by general inflammation and obscure serositis making difficult its diagnosis. The existence of such "restricted" forms of PCTS is not universally recognized, however glucoocticoids are widely prescribed to patients with this condition.

The purpose of the study was to evaluate the influence of metoprolol succinate and carvedilol on the physical ability (FA) of patients with chronic heart failure (CHF) of different etiologies. The subjects of the study were 108 patients with postinfarction cardiosclerosis and 39 patients with dilated cardiomyopathy with I to V functional class (FC) CHF and left ventricular ejection fraction of less than 45%. The dynamics of functional parameters were assessed after 6 to 12 months of carvedilol therapy (57 patients) or metoprolol (81 patients) therapy. Therapy with beta-adrenoblockers resulted in a significant decrease in CHF FC (by 0.80 +/- 0.57; p < 0.05), an increase in the distance of six-minute walking test (by 110.7 +/- 86.5 m; p < 0.001) and everyday activity according to DASI questionnaire. The improvement was more substantial in patients with non-ischemic CHF. Peak oxygen consumption during treadmill test did not change, but CO2 ventilatory equivalent increased. The results demonstrate that carvedilol and metoprolol improve subjective and submaximum parameters of the functional status of patients with CHF without changing maximal FA.

Aim: To estimate sympathetic activity in patients with ischemic heart disease (IHD) complicated by chronic cardiac failure (CCF) depending on the volume of viable myocardium measured by dobutamine stress echocardiography (DSE)., Material and Methods: Planar myocardial I-231-MIBG scintigraphy and dobutamine stress echocardiography were made in 16 patients (9 males and 7 females) aged 43-75 years with CCF (NYHA class II-III) and ejection fraction under 35%. The ratio maximal MIBG absorption in the left ventricular myocardium to maximal MIBG absorption in the mediastenum (H/M) and lung (H/L) were estimated., Results: By DSE the patients were divided into two groups: responders in whom contractility improved by 4 and more points (9 patients) and non-responders in whom contractility improved by less than 4 scores (7 patients). The groups did not differ by clinical and hemodynamic parameters but group 2 patients had significantly lower H/M and H/L than group 1 patients (1.38 +/- 0.02 and 1.08 +/- 0.06 against 1.61 +/- 0.09 and 1.25 +/- 0.12, respectively, p < 0.05). A direct correlation was found between MIBG absorption (H/M, H/L) and ejection fraction on minimal dobutamine doses (r = 0.77, p < 0.01; r = 0.87, p < 0.001), gain in ejection fraction (r = 0.77, p < 0.01; r = 0.45, p < 0.05), and inverse correlation between MIBG absorption (H/M, H/L) and dyssynergia index on minimal dobutamine doses (r = -0.80, p < 0.001; r = -0.87, p < 0.0001)., Conclusion: Patients with CCF demonstrate a correlation between sympathetic activity and volume of viable myocardium, inotropic reserve.

Aim: To compare effects of metoprolol CR/XL and carvedilol on global and regional contractility of the left ventricle in patients with chronic cardiac failure (CCF)., Material and Methods: The results of two trials were compared: the effects of metoprolol CR/XL and on carvedilol left ventricular contractility in patients with chronic cardiac failure (CCF). A total of 52 patients with ischemic heart disease (IHD) and dilated cardiomyopathy (DCMP) entered the studies. Of them, the treatment was completed in 19 and 20 patients, respectively. Ejection fraction (EF), left ventricular end systolic and diastolic volumes were measured at radionuclide ventriculography before and 6 months after the start of the treatment., Results: Both beta-blockers significantly increased EF and reduced the volumes. In both groups the rise of contractility in EF < 30% was similar. EF augmentation in patients with DCMP was greater than that in patients with IHD and depended on improvement of segmental contractility., Conclusion: Significant differences were not found in the action of two beta-blockers on global and regional contractility of the left ventricle in patients with CCF.

Mutant alleles CYP2D63 and CYP2D64 were detected by PCR in 33 individuals. All examinees were given 50 mg methoprolol (orally). Plasma concentrations of the drug and its major metabolite was determined by high performance liquid chromatography and arterial pressure and heart rate were monitored. The rate of methoprolol metabolism was significantly lowered in subjects with CYP2D64 mutation. This determined blood pressure decrease and bradycardia in these subjects after drug intake.

Saitarin (an extract from the horns of antelope Saiga) depresses complex instrumental drinking behavior of rats and induced specific changes in the structure of goal-directed behavioral acts. Such changes are to a certain extent suppressed by naloxone. The obtained evidence suggest that the effects of saitarin are caused by its predominant influence on the processes of reinforcement in the course of realization by animals of the learned behavioral acts.

An in vivo comparative study on penetration of free gentamicin sulfate and liposome-entrapped gentamicin sulfate to macrophages was performed and the efficacy of the treatment of destructive pneumonia was estimated on albino mice. The liposome-entrapped antibiotic was arrested by the cells of the mononuclear phagocytic system thus providing higher concentrations of the drug in the organs with high counts of macrophages, the antibiotic retention time in the organs being longer than that after the use of free gentamicin. The use of liposome-entrapped gentamicin in the treatment of destructive pneumonia made it possible to increase the host protection from 17 to 50 per cent.

The paper analyzes the experience in treating 27 children suffering from complicated cysts of the lungs, which accounts for 1.1% of the total number of patients with pulmonary diseases. Eleven of them were treated conservatively, they underwent puncture or drainage of the cyst with bronchial occlusion. Satisfactory results were achieved in 4 children. Radical operations were made in all cases of recurrent solitary cysts and in genuine cysts not connecting with the bronchial tree. In all cases of complicated genuine cysts of the lung one should take into account their combination with intralobular sequestration of the lung.