Search

Aim: To evaluate the efficacy of cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF) associated with cardiac dyssynchrony and to identify the factors that influence the CRT efficacy., Material and Methods: This retrospective study included 155 patients after implantation of CRT devices. The CRT devices with a built-in cardioverter-defibrillator (CRT-D) and without it (CRT-P) were implanted in 139 (89.7%) and 16 (10.3%) patients, respectively. The follow-up period was 52.37±35.94 months. Based on the study results, two groups of patients were formed depending on the presence of a clinical response to CRT, responders and non-responders. The factors that influenced the clinical response to CRT were studied. The effect of the baseline state of patients on the effect of therapy was assessed. The need for CRT optimization and a possibility of using electrocardiographic criteria for that purpose were studied. Modern devices and leads for CRT, their functional capabilities and their influence on the CRT efficacy were characterized. Statistical analysis was performed with an IBM SPSS Statistics 21.0 (Chicago, USA) package., Results: CRT implantation with the left ventricular lead placement according to the traditional technique, through the coronary sinus, was successful in 130 (87.9%) patients. Difficulties with the left ventricular lead placement were noted in 13 (8.3%) patients when other techniques were used. After 6 months, a hemodynamic and clinical response was observed in 112 (72.2%) patients, and no positive response in 43 (27.8%). The increase in left ventricular ejection fraction in the responder group was more than 21.8±3.7%, which was associated with an improvement of the 6-minute walk test results. Th clinical response was significantly influenced by the possibility of stimulation from the basal parts of the heart; the use of more modern devices for CRT and quadripolar left ventricular leads; timely CRT optimization; and persistent dyssynchrony in non-responders. During the follow-up period, 34 (21.9%) patients died. The death rate in the non-responder group was significantly higher than in the responder group, 18 (41.3%) vs. 16 (14.3%), p=0.001. The main cause of death in the group of non-responders was CHF. Heart transplantation was performed in 3 (1.9%) patients., Conclusion: CRT increases the life span and improves the quality of life in patients with CHF and cardiac dyssynchrony. There was a group of patients with no benefit from CRT in this study. Modern devices allow increasing the number of patients who benefit from CRT. Periodic optimization of CRT is necessary. When optimizing CRT, it is possible to use electrocardiographic criteria of effectiveness: duration of the QRS complex and changes in the position of the electrical axis of the heart.

Bucky gel electrodes are composed of morphology-determining polyvinylidene difluoride (PVDF) filled with carbon nanotubes (CNT). The electrodes are commonly fabricated via the casting of a CNT dispersion containing PVDF and ionic liquid. In this study, several pore-forming additives such as polyethylene glycol (PEG), dibutyl phthalate (DBP), and the common ionic liquid BMIMBF4 were used to control the morphology of the bucky gel electrodes. The crystalline phase type and content of PVDF in the electrodes were determined by FT-IR and DSC, respectively. SEM revealed a sponge-like structure in the case of the use of BMIMBF4 and a spherulite structure if PEG and DBP were used as additives. A strong influence of morphology on the anisotropic increase in the volume of electrodes upon impregnation with electrolyte was observed. The PEG-based electrode elongated more than the others, while the BMIMBF4-based electrode thickened to a greater extent. Ionic actuators were fabricated to experimentally reveal the effect of electrode morphology on their electromechanical efficiency. A high-precision vat photopolymerization technique was used to fabricate identical ionic membranes and minimize their influence on the properties of the actuators. The electrodes were characterized by the same porosity and electrical capacitance, while the actuators differ significantly in performance. As a result, a simple method of using pore-forming additives made it possible to increase the maximum deformation of bucky gel ionic actuators by 1.5 times by changing the morphology of the electrodes.

Two types of poly(5-phenyl-2-norbornene) were synthesized via ring opening metathesis and addition polymerization. The polymers sulfonation reaction under homogeneous conditions resulted in ionomer with high sulfonation degree up to 79% (IEC 3.36 meq/g). The prepared ionomer was characterized by DSC, GPC, 1 H NMR and FT-IR. Polymers for electromechanical applications soluble in common polar organic solvents were obtained by replacing proton of sulfonic group with imidazolium and 1-methylimidazlium. Membranes were prepared using the above-mentioned polymers and 1-ethyl-3-methylimidazolium tetrafluoroborate (EMImBF4), as well as mixtures with polyvinylidene fluoride (PVDF). Mechanical, morphological, and conductive properties of the membranes were examined by tensile testing, SEM, and impedance spectroscopy, respectively. Dry and air-stable actuators with electrodes based on SWCNT were fabricated via hot-pressing. Actuators with membranes based on methylimidazolium containing ionomers outperformed classical bucky gel actuator and demonstrated high strain (up to 1.14%) and generated stress (up to 1.21 MPa) under low voltage of 2 V.

Aim      Analysis of responses of cardioverter-defibrillators implanted in patients with cardiomyopathies (CMPs) of various origins and a high risk of sudden cardiac death (SCD) to assess the effectiveness of a modern strategy for primary prevention of SCD.Material and methods  In the Federal Center for High Medical Technologies in Kaliningrad from 2014 through 2018, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) were installed in 165 patients. Major indications for device implantation in these patients included left ventricular (LV) systolic dysfunction with ejection fraction (EF) ≤35 %; chronic heart failure (CHF) consistent with the New York Heart Association (NYHA) functional class (FC) II-III (IV for CRT-D) without previous episodes of life-threatening ventricular arrhythmias, circulatory arrest and resuscitation, which was consistent with the current international strategy for primary prevention of SCD. The study patients were divided into two groups based on the CMP origin; group 1 included 101 (61.2 %) patients with CMP of ischemic origin (ICMP) and group 2 consisted of 64 (38.8 %) patients with CMP of non-ischemic origin (NCMP). Information about arrhythmic episodes and device activation was retrieved from the device electronic memory during visits of patients to the clinic and was also transmitted to the clinic by a remote monitoring system. This information was studied and evaluated for the validity and effectiveness of the device triggering. If necessary, the parameters of detection and treatment were adjusted taking into account the obtained information. Information was analyzed and statistically processed with the SPSS Statistics 20.0 software.Results The patients were followed up for 28.3 ± 15.6 months, during which the devices delivered therapy to 55 (33.3%) patients of the entire group. In the ICMP group, the devices were activated in 44 (26.7 %) patients and in the NCMP group, the devices were activated in 11 (6.7 %) patients. In group 1 (ICMP), appropriate triggering was observed in 33 (20.0%) patients and inappropriate triggering was observed in 11 (6.7%) patients. In group 2 (NCMP), appropriate triggering was observed in 2 (1.2 %) patients and inappropriate triggering was observed in 9 (5.5 %) patients. The main cause of inappropriate triggering was atrial fibrillation (AF). 17 (10.3 %) patients with ICMP had sustained ventricular tachycardia (VT), which did not reach the detection frequency for ICD therapy; these VTs were only detected by devices and terminated spontaneously. Intragroup differences in the number of patients who received an appropriate treatment were statistically significant: 33 (32.6 %) in the ICMP group vs. 2 (3.1 %) in the NCMP group (р<0.006). Differences in the number of patients who received an inappropriate treatment were not statistically significant although their number was greater in the NCMP group than in the ICMP group (9 (14.1 %) vs. 11 (10.9 %), р>0.05).Conclusion      A higher requirement for the ICD treatment was revealed in patients with ICMP compared to patients with NCMP. The low demand for the ICD treatment in patients with NCMP and the more frequent inappropriate actuation of the devices in this patient group due to AF allow a conclusion that the criteria for primary prevention of SCD with ICD (LV EF ≤35% and clinically significant CHF) are not equally effective indications for ICD implantation in patients with ICMP and NCMP. It can be assumed that life-threatening ventricular arrhythmias are evident in patients with NCMP before the development of hemodynamically significant LV dysfunction and CHF, which warrants further research in this direction.

The review discusses the data on the functional/phenotypic M1/M2 types of macrophages and their chimeric forms, the molecular mechanisms of polarization of these cells, and their role in the development of malignant tumors. Information on the prognostic value of the presence (density and location) of M1/M2 cells in tumor tissue is analyzed. Our own results evidence on the necessity of determination of the functional/phenotypic state of M1/M2 macrophages from different biological niches in the dynamics of tumor growth, in particular in terms of NO level and arginase activity.

This article describes data on preparation of sulfonated hydrogenated poly(phenylnorbornene) with different cations synthesized via sequential ring-opening metathesis polymerization, reduction, homogeneous sulfonation and cation exchange reactions. The data of the characterization of new polymers by nuclear magnetic resonance ( 1 H NMR) spectroscopy, Fourier-transform infrared (FT-IR) spectroscopy and differential scanning calorimetry (DSC) are presented. The effect of imidazolium and 1-methylimidazolium cations, ionic liquid and Zwitter-type ion liquid on ionic conductivities evaluated by impedance spectroscopy. Preparation procedure of polymer electrolyte membrane based on new polymers and Nafion as a blend with polyvinylidene fluoride (PVDF) is given. Scanning electron microscopy images and ionic conductivities of these membrane are presented., (© 2019 The Author(s).)

Ultrasound scanning of main vessels (common carotid, internal carotid, common and superficial femoral, posterior tibial arteries) in staffers of shipyard "Nerpa"--branch of JSC "Shipbuilding center Zvezdochka" (Snezhnogorsk city Murmansk region)--engaged into atomic submarines utilization. Findings are atherosclerotic changes in common carotid and common femoral arteries--increased thickness of intima-media complex over the reference values or atherosclerotic plaque formation. The changes were maximal in a group of males aged over 50 with length of service over 25 years. Discriminant analysis helped to suggest a mathematic model to forecast cardiovascular diseases in personnel of "Nerpa" shipyard.

Complex of occupational studies and medical, statistical research helped to reveal climate, geographic and other factors influencing health state of personnel servicing military nuclear technical objects. Considering peculiarities of occupational activities in various specialists, the authors specified measures to improve medical service for nuclear technical military officers directly working with nuclear ammunition. Practical application of the measures helped to gain 1.5-1.7 times improvement in morbidity parameters among nuclear technical military officers.

The given information classifies the protection means and methods containing the known for today and prospective decisions, as well as process elements of development, creation and testing of these means Presented as whole, these protection group comprise all the possible aspects of the service-men safety problem in operation of military equipment objects, being the source of non-ionizing radiation.

In the article the theoretical bases of preventive and ecological maintenance of the armed forces are discussed. It is specified, that the main reason for preventive maintenance is preservation and strengthening of health and performance of the personnel, and for the ecological maintenance-achievement of ecological safety: preservation and restoration of the environment. As a result, protection of the personnel from the effect of the adverse factors is offered as a sub-gain of the ecological maintenance, and a sub-gain of preventive maintenance is the control of the environment protection, which defines the health state of the personnel.

Low-frequency pulsing noise exerted an adverse effect upon acquired behaviour in rats and cats. The cerebral function of behavioural integration seems to suffer under the effect.