Search

Despite chronic lymphocytic leukemia (CLL) is the most frequent type of leukemia and more than hundred years has passed from the moment of the first description of its clinical picture, the problem on nervous system involvement remains unresolved because of this kind of lesion remains _ very rarely sign of disease. There are less then ten case reports according to literary data. We observed just a one patient with CLL and diagnosed meningeal involvement at the hematologic department of Regional clinical hospital for more than thirty-year period. Clinical and laboratory symptoms were successfully treated by intrathecal administration of cytostatic agents.

Aim. To study the prevalence of familial hypercholesterolemia (FH), the characteristics of the clinical features and treatment of the disease in selected regions of the Russian Federation, this article describes the design and initial characteristics of patients included in the study.Material and methods. The study participants were selected among those included in the study “Epidemiology of cardiovascular risk factors and diseases in the regions of the Russian Federation” (ESSE-RF) in different regions of the Russian Federation. The study included individuals with lowdensity lipoprotein cholesterol (LDL-C) levels >4.9 mmol/l or LDL-C levels >1.8 mmol/l, but ≤4.9 mmol/l during statin therapy, according to the data obtained in the ESSE-RF study. These persons are invited for examination and questioning by experts in the field of FH diagnostics. On the basis of the survey data and provided medical documentation, the following information is collected: age, sex, smoking status, presence of hypertension, history of coronary artery disease, stroke, atherosclerosis of cerebral and peripheral arteries, LDL-C level, type, volume and duration of lipid-lowering therapy throughout life, presence and dates of secondary causes of hyperlipidemia, information about the family history of development of early cardiovascular diseases and atherosclerotic diseases, increased levels of LDL-C in relatives of the 1st and 2nd degree of kinship. All patients are examined for the presence of tendon xanthomas (Achilles, metacarpal, elbow, knee tendons) and Corneal arcus. During the visit, blood is taken for subsequent biobanking, measurement of current blood lipid levels, elimination of secondary forms of hypercholesterolemia (for subsequent determination of liver enzymes, thyroid stimulating hormone) and genetic testing. The diagnosis of FH is based on Dutch Lipid Clinical Network Criteria (DLCN). Besides, all participants in the study are tested for compliance with the diagnosis of FH according to Simon Broome criteria. All patients with a definite or probable diagnosis of FH according to DLCN or Simon Broome criteria are subjected to ultrasound examination of carotid, femoral arteries and heart and molecular genetic testing for LDLR, APOB and PCSK9 gene variants.Results. Out of 16 360 participants of the ESSE-RF study in 10 regions, 1787 people (10,9%) met the criteria for inclusion in this study. Among them, men accounted for 35.4%, of which 1150 (7%) patients had a LDL-C level >4.9 mmol/l and 637 (3,9%) had a LDL-C level from 1,81 mmol/l to 4.9 mmol/l during lipid-lowering therapy. When compared to the original cohorts of participants from the 10 regions as compared to 3 previously surveyed regions and selected sub-groups within these cohorts we observed significant differences in several parameters such as age, total cholesterol level, triglycerides, LDL-C, the frequency of cardiovascular diseases, that may indicate regional differences in FH prevalence.Conclusion. The analysis of clinical data of the participants of the ESSE-RF study shows that more than 10% of individuals require an additional examination to verify the FH diagnosis, and regional differences in the FH prevalence are possible.

A recently published article [1 ] on the problems of anticoagulant therapy in patients with frailty syndrome contains two statements which highlight ri-varoxaban among other non-vitamin K antagonist oral anticoagulants (NOAC): 1) none of the randomized controlled trials (RCTs) with NOAC (except for two RCTs with rivaroxaban - EINSTEIN-DVT and EINSTEIN-PE) contained data on the participation of frail patients; 2) one of the studies of real clinical practice showed that only therapy with rivaroxaban (out of three NOAC) in comparison to warfarin reduced the risk of stroke/systemic embolism and ischemic stroke in frail elderly patients with atrial fibrillation after 2 years of observation. The paper presents a critical analysis of these statements showing that the first statement is based on the incorrect use of the collective term "fragility” as a synonym for the term "frailty”, whereas the second statement is based on the results of a study that has a number of serious methodological limitations.

Aim. To conduct a pharmacoeconomic assessment of the use of modern technologies in the follow-up care of patients with arterial hypertension (AH) in the Tyumen region.Material and methods. Using a random sampling technique we selected and examined 1704 patients with AH in the Tyumen region. The average age of patients was 62±75 years, 31,5% were men. Patients are divided into active monitoring and control groups. Weekly sms and e-mail messages with prevention information were sent to patients of the active monitoring group. General practitioners receive a course of training seminars on the features of follow-up observation of patients with AH. After 12 months (±3,2), the patients had repeated examination. We conducted pharmacoeconomic analysis of the intervention.Results. The results of our study showed that the total cost of the disease with active follow-up of patients with AH decreases, which mainly occurs due to indirect expenses. Weekly sms and e-mail notification of patients in combination with educational seminars for general practitioners and cardiologists leads to a change in the structure of expenses for the treatment of patients with AH. We noticed reducing the cost of inpatient treatment, emergency calls, and a decrease in indirect expenses. On the other hand, there is a redistribution of funds spent on pharmacotherapy and cases of outpatient visits. Such redistribution, combined with a decrease in the total cost of the disease, leads to savings in the resources of the health care system and allows an additional 231 patients to be treated within 12 months.Conclusion. The proposed model of active follow-up is economically viable, both by reducing the total cost of the disease, and by redistributing funds towards using pharmacotherapy and outpatient visits, which is the most rational in the treatment of AH.

Aim. To evaluate the relationship of prehypertension (preHTN) with vascular wall damage and decreased renal function depending on cardiovascular risk in a representative sample of Russian population.Material and methods. As a part the ESSE-RF study in 4 regions (St. Petersburg, Tomsk, Tyumen, the Republic of North Ossetia), 7042 participants aged 25-64 were additionally examined for state of vessels. All participants signed informed consent and completed the approved questionnaires. Anthropometry, fasting glucose and blood pressure (BP) levels were assessed. BP was measured by the OMRON monitor (Japan) twice on the right hand in a sitting position; average BP was calculated. The optimal BP was considered

Aim. To evaluate the impact of treatment adherence on control of arterial hypertension (AH), and within a prospective study, to find out the predictors of adherence decline.Material and methods. Randomly, 321 AH patient selected, from the registry of chronic non-communicable diseases on the territory of Tymenskaya Oblast, visited physician office during year 2014. In analysis of outpatient chart, the prevalence of prescription analyzed, of the groups of antihypertension medications (AHM), including combination drugs. In 3 months (±2,1) after office visit, patients were investigated. The following characteristics were assessed: smoking status, alcohol consumption, comorbidities, economical level, employment, depression and anxiety levels, frequency of AHM intake, prevalence to treatment and BP control efficacy. In 12 months (±2,3) patients, during phone interview, answered the questions on adherence to AHM. The factors revealed, increasing the relative risk (RR) of compliance decline. RR calculated with 95% confidence interval (CI).Results. During a year, decrease of AHM intake found (from 73,2% in 3 months after office visit to 45,2% — in 12 months, р

The opinion is expressed in some domestic publications that rivaroxaban has the most favorable profile of drug interaction in comparison with other new oral anticoagulants (NOAC). The basis for such judgments is the summary table of drug interaction from the Guidelines of the European Heart Rhythm Association 2015 on the use of NOAC in patients with non-valvular atrial fibrillation.The paper discusses the issue that the abovementioned table contains some incorrect qualitative statements and quantitative data inconsistent with primary source of information of NOAC drug interactions, and provides the updated and extended information on changes in NOAC plasma concentrations when co-administered with drugs from the other groups. On the basis of the presented data, the authors come to the conclusion that the profile of drug interaction of rivaroxaban does not differ significantly from these of the other NOAC.

Aim. To study prevalence of arterial hypertension (AH), mean values of systolic (SBP) and diastolic (DBP) levels of blood pressure, awareness of patients on this, antihypertension drugs (AD) intake and treatment efficacy among inhabitants of Tyumen Region, age 25-64 year old.Material and methods. A cohort of Tyumen Region inhabitants, 25-64 y.o., investigated under the framework of multicenter observational study ESSE-RF. Number of participants — 1762, of those men 34,4% (n=607), women 65,6% (n=1155), mean age 48,9±11,4 y.o.Results. In Tyumen Region the prevalence of AH was 48,9%, which is 4,9% higher than general population in ESSE-RF (by 9 regions). The same high pressure was found in general population of men and women, however statistically significantly predominated in men aged 35 y.o., citizens, as rurals. Correlation of effective BP control with educational level was found only in male population. Among hypertensive males with middle and higher education, BP control was significantly better comparing to AH patients with low educational level. Conclusion. The results determined the aims of prevention work with AH taking the specifics of this factor prevalence in Tyumen Region.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness.Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study.Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)).Result. EQ-5D index of Russian population was 0,87 with no gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used, of representative selection of non-organized male and female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol (TC), cholesterol of lipoproteids low and high density were measured at SSRCPM and RSPCC.Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively.Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment of the persons with high and very high cardiovascular risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity of development and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Aim. To study prevalence of risk factors (RF) of cardiovascular diseases (CVD) in Tyumen region.Material and methods. The materials was a selection of Tyumen region inhabitants of the age 25-64 y.o., assessed under multi-center, observational study ESSE-RF (Epidemiology of cardiovascular diseases and risk factors in regions of Russian Federation). Total number of participants was 1658, of those men — 30,3% (n=503), mean age 48,9±11,4 y. The prevalence assessed of such risk factors as arterial hypertension (AH), smoking, obesity, dyslipidemia, hypodynamia, excessive salt consumption (ESC), low intake of vegetables and fruits (LIVF), carbohydrate metabolism disorders (CMD).Results. In Tyumen region the prevalence of risk factors was: AH — 49,0%, hypercholesterolemia — 56,1%, smoking — 26,8%, obesity — 40,3%, hypodynamia — 35,3%, ESC — 46,8%, LIVF — 34,1%, CMD — 5,9%. Gender differences analysis showed that in female subpopulation there are more common dyslipidemia and obesity. Males more commonly smoke and are hypodynamic. Comparing to the general ESSE-RF population, in Tyumen region there is higher prevalence of such RF as AH — 49,0% vs 44,0% and obesity — 40,3% vs 29,7%. However statistics of LIVF appears better — 34,1% vs 41,9% in general population. Conclusion. The ESSE-RF study in Tyumen region showed the specifics of epidemiology of such RF as AH, obesity, dyslipidemia, ESC, LIVF, hypodynamia, CMD. As a result, there was very high prevalence of AH revealed and unacceptably high prevalence of obesity among tyumenians, especially women, comorbid with hypercholesterolemia. This data shall be a direction for prevention management against these serious risk factors.

Russian Experts’ Consensus on Metabolic Syndrome Problem in the Russian Federation: Defenition, Diagnosis Criteria, Primary Prevention and Treatment.

Aim. To evaluate postprandial changes of lipid and glucose profiles, inflammation markers levels and flow-mediated vasodilatation in patients with metabolic syndrome (MS) and to estimate acarbose course treatment efficacy in glucose intolerant patients.Material and methods. A total of 114 MS patients (83 men, 31 women) were examined, MS was associated with impaired glucose tolerance (IGT) in 55 cases. At the first stage postpran- dial dynamics of flow-mediated dilation (FMD), lipid profile parameters, inflammation markers and insulin levels were estimated. At the second stage patients with MS and IGT (n=55) were randomly assigned to the two groups of treatment. Patients of the first group (n=28) had non-drug treatment. Patients of the second group (n=27) received acarbose 300 mg/day for 3 months in addition to recommendations for lifestyle change. 3 months later postprandial values of lipid and glucose profiles parameters, inflammation markers levels and FMD were reassessed. Results. MS patients with IGT revealed maximal disorders in metabolic parameters during postprandial period: increase in the plasma levels of total cholesterol by 6.1%, high density lipoproteins – by 1.7%, and triglycerides – by 27.87%, increase in atherogenic index by 4.8%, and plasma concentrations of glucose – by 54.7%, insulin – by 30.2%, HOMA index – by 73.3%, as well as concentrations of C-reactive protein (CRP) – by 49.7%, tumor necrose factor alpha – by 20.8%, and interleukin-6 (IL-6) – by 51.9%. FMD decreased by 34.3%.After 12 weeks of the acarbose treatment we had revealed positive dynamics of studied indices in postprandial period as compared to an only non-drug management: levels of glucose in- creased by 24.1% vs 44.4%, insulin – by 14.4% vs 24.4%, CRP – by 19.9% vs 36.6%, IL-6 – by 25.1% vs 41.7%; postprandial FMD decreased by 18.9% vs 31.1%.Conclusion. Prescription of acarbose 300 mg/day for 12 weeks in glucose intolerant patients is characterized by less significant postprandial increase in insulin resistance, inflammation mark- ers (CRP and IL-6) levels, less decrease in flow-mediated vasodilatation with no influence on lipid metabolism parameters.

Aim. To study the prevalence of ischemic heart disease as one of the most common cardiovascular disorders, together with arterial hypertension (AH), diabetes mellitus (DM) and liver diseases (LD) in adult (25-64 y.o.) population of selected RF regions, the variance of those with gender and age, and association of cardiovascular risk factors (FR).Material and methods. Into analysis we included the results of representative selections studies from 13 RF regions, studied according to the program of multicenter study ESSE-RF during the years 2012­2014; totally 21923 patients studied. Investigation included standard questioning, including anamnesis. For statistics we used applied software SAS.Results. In men the prevalence of IHD is associated with the growth of comorbidity from 0 in the age group 25-34 y. to 77% in the age 55-64 y., almost duplicating every decade. For women there is analogic tendency, less prominent. In men there are significant associations only with AH, which increases the risk of IHD 2,5 times, though in women together with AH the associations are significant for LD. Comorbidities with DM do not influence the prevalence of IHD in men and women. At the same time, any association with two diseases increases the risk of IHD >304 times. The most negative is the association of all three diseases, with which IHD is 8,7 times more prevalent, than in their absence. Using multidimensional logistic regression after correction for the age and comorbidity in the patients with IHD of both genders, there are associations revealed of high density cholesterol lipoproteids (HDL) in blood and abdominal obesity. In men there are also positive associations with smoking and negative — with increased cholesterol.Conclusion. Comorbidities of IHD with AH, DM and LD in adult population are common, are associated with the general FR, are increasing with the age. Taking modern tendencies of population ageing, it is plausible to expect an increase of the prevalence of comorbidities, that requires a necessity of the healthcare services to these changes.

Aim. To study social and economic gradients — educational and occupational statuses, wealth level, behavioral risk factors (FR) in Russian population by the ESSE-RF data.Material and methods. The data for the analysis consisted of representative selections of 13 regions of RF (n=22906) participants of the study, incl. men (n=8353) and women (n=13553) of 25-64 y.o., with response 80%. We calculated the odds ratios for the presence of behavioral FR: smoking, excessive alcohol consumption, insufficient physical activity (IPA), nonrational food consumption, anxiety and depressive disorders, — in persons from different social and economic groups by education level, type of inhabitation, professional status, wealth level.Results. Higher education was associated with better FR profile, except IPA (negative association) and alcohol consumption (absence of association). "White in general had less FR probability than Blue, excl. IPA and psychoemotional deviations (in men). As for the wealth association with the FR there is backward gradient, i.e. lesser the income, higher the risk of FR presence, excl. IPA and excessive alcohol intake in women. For example, in very wealthy men the odds ratio for depressive states was 3,09 [95% CI 2,08-4,57] comparing to the persons with low income. The type of territory of inhabitance was associated with less behavioral FR in Russian population, as significant associations are found only for depression and excessive salt consumption in both genders and IPA in men. Conclusion. The significant social and economic gradients of behavioral FR prevalence are found, the direction of those is not necessary the same as in European countries. The analysis of association with social and economic parameters would help to develop the directed preventive interventions.

Aim of investigation. To study the effect of nonpharmaceutical correction of body weight on the level ofhigh cardio-vascular risk markers at non-alcoholic fatty liver disease (NAFLD).Material and methods. Overall 117 patients with NAFLD at steatosis stage combined to obesity or metabolic syndrome (MS) — 59 and 58 patents respectively, mean age 43 years (38 to 46 years) and 45 years (39- 49) were investigated. Levels of lipid and carbohydrate metabolism markers, TNF-α, leptin, adiponectin and nitric oxide (NO) metabolites were evaluated.Results. Weight loss for at least 5% was gained in 44,1% of patients with NAFLD in association to obesityand in 56,6% of those with NAFLD in combination to MS, that was accompanied by significant reduction of lipid atherogenic fraction levels (cholesterol, low density lipoproteins), decrease of insulin resistance index, CRP and TNF-α inflammation markers, and decrease of leptin concentration in MS group. Comparative analysis of adiponectin and NO metabolites concentration has shown demonstrated, that in patients with NAFLD both in combination to obesity, and in combination to MS the target level of weight loss is accompanied by elevation of adiponectin level (р

The scope of neurobiological studies has been greatly expanded in the last years. It is accompanied by accumulation of a huge body of experimental data on the structure, function and evolution of the nervous system at different hierarchical levels of its organization. High-throughput sequencing technologies and microarray tests permit the expression of thousands of genes to be analyzed with regard to cell location in the brain. Methods of gene expression analysis are briefly reviewed in the context of brain research. We have analyzed specific features of genes differentially expressed in brain cells. Some genes overexpressed in brain tissues are associated with neurological diseases. The numbers of exons and active transcripts in genes differentially expressed in different organs are considered. Statistically significant difference in such parameters is shown for genes intensely expressed in the brain and other organs. Examples of such differentially expressed genes associated with neurological deceases are presented.

The pilot program complex for analysis of symbol sequences in genomics, ICGenomics, has been designed for storage, mining, and analysis of sequences related to theoretical and applied genomics. ICGenomics enables wet-lab biologists to perform high-quality processing of data in the fields of genomics, biomedicine, and biotechnology. ICGenomics implements both conventional and modern methods for processing, analyzing, and visualizing sequence data. They include novel methods of the processing of initial high-throughput sequencing data. Examples are: ChIP-seq analysis; functional annotation of gene regulatory regions in nucleotide and amino acid sequences; prediction of nucleosome positioning; and structural and functional annotation of proteins, including their allergenicity and evolution features. Application of ICGenomics to the analysis of genomic sequences of the parasite Opisthorchis felineus and to ChIP-seq data on the mouse and human is considered. The system is available at http://www-bionet.sscc.ru/icgenomics.

In the frame of Multicenter observational study ECVD-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) by the unique protocol the investigation of representative selections of adult population at the age of 25-64 y.o. of 11 regions RF (n=18305, including males, n=6919 and females n=11386): Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Orenburg, Samara, Tomsk, Tyumen, Saint-Petersburg and Northern Osetia-Alania. The prevalence of the following risk factors (RF) of cardiovascular diseases is evaluated: high blood pressure — 33,8%, obesity — 29,7%, high total cholesterol — 57,6%, high glucose level or diabetes — 4,6%, smoking (tobacco consumption) — 25,7%, insufficient (low) level of physical activity — 38,8%, excessive salt consumption — 49,9% and insufficient vegetables and fruits consumption — 41,9%. Gender differences and an increase with the age of the parameters mentioned are described.The absence of a epidemiologic monitoring system at the Federal level leads to an impossibility of clear conclusions on the RF dynamics in Russian population. While comparing the ECVD-RF study with previous epidemiological studies we can just cautiously suppose the existence in 21st age of negative dynamics of one RF (obesity, dyslipidemia) and positive dynamics of the others (smoking).

Aim. To study prevalence of arterial hypertension (AH), mean values of systolic and diastolic blood pressure (SBP, DBP), awareness of patients about their disease, medication consumption (MC) and efficacy of treatment in several regions of Russia.Material and methods. Representative selections were made in 9 regions of Russia: men (n=5563), women (n=9737) of 25–64 y.o., studied in 2012–2013 with the response 80%. Systematic stratified multilevel random selection was formed with localilty criteria (Kisch method). The Questionnaire on the presence of AH included: awareness of the patient about his disease, drug intake. BP measurement was performed on the right arm by automatic tonometer Omron in sitting position after 5 minutes resting. The mean value of two measurements was used. BP defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or if the patient had taken antihypertensive therapy. Efficacy of treatment — the part of patients (in %) who reached target BP. Control group — part of patients (in %) with BP

The paper addresses the analysis of the problem of employment of young specialists graduates of professional institutions. The youth is the human potential of the country, which is why employment and youth employment are a national issue. The disbalance in the labor market and the education market is one of the causes of youth unemployment. The solution to this problem is possible only from the perspective of a comprehensive and systematicapproach.

Nourishment peculiarities of 120 patients aged from 41 years having excess body mass and obesity were investigated. Interre-lations with changed hormonal-immune status were assessed. Method of food taking rate developed in the Institute of Nourishment, RAMS, taking into account nourishing peculiarities of Russian population was used. Study results revealed, that patients had imbal-ance concerning main macro- and micronutrients: nourishment regimen was disturbed in 90% of cases, taking main part of energy value was shifted to the second half of a day, increased calorie content of nourishment, excess of monosaccharides in the setting of decreased physical activity were seen which plays the main role in the development and advancing obesity, increased level of leuco-cytes, of TNF-α, IFN-γ, humoral immunity link imbalance, increased serum concentration of leptin and insulin which is closely cor-relates with excess body mass and nourishment peculiarities.

Information letter of Russian Medical Society of Arterial Hypertension.

Цель: оценить уровень ингибитора активатора плазминогена 1 типа (PAI-1) и его взаимосвязь с некоторыми метаболическими и клиническими параметрами у больных сахарным диабетом 2 типа (СД-2) c артериальной гипертензией (АГ). Материалы и методы исследования. Объектом исследования стали 70 больных СД-2 (21 мужчина и 49 женщин). Средний возраст составил 53,6±4,2 года. Все пациенты имели декомпенсацию показателей углеводного обмена - уровень гликированного гемоглобина (НвА1 С) >7%, среднее значение которого соответствовало 8,2%. Средний стаж заболевания в общей группе составил 14,2±4,2 года. Все пациенты имели в анамнезе АГ. У 84,3% пациентов (1-я группа) уровень артериального давления (АД) не достигал целевых значений, и лишь у 15,7% пациентов (2-я группа) на фоне адекватной терапии отмечались показатели, соответствующие целевым уровням АД (для систолического АД (САД)