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Gallbladder cancer (GBC) is a rare but highly malignant neoplasm. Most cases are discovered incidentally in patients undergoing evaluation for gallstone disease. It is believed that an unfavorable prognosis associated with RZD is associated with a late stage at diagnosis, which is due to both the anatomical position of the gallbladder and the vagueness and non-specificity of symptoms, which increases the relevance of studying and highlighting this topic. Although the available evidence supports a decline in the overall incidence of RZD over the past 30 years, the incidence may be increasing in younger people. Globally, the burden of gallbladder and other biliary tract cancers has increased over the past 30 years. Several risk factors have been identified for RGB, many of which share the characteristics of chronic gallbladder inflammation. The article discusses the main risk factors and diseases that precede the development of cancer. The purpose of the review is to present an analysis of current literature data on the epidemiology of this disease and risk factors.

According to epidemiological studies, in Russia there is a tendency towards an increase in sudden cardiac death (SCD), including among young workingage people. The leading mechanism for SCD in young patients, including those with undifferentiated connective tissue disease, is recognized as rhythm and conduction disorders. At the same time, the most tragic cases are the first and only manifestation of SCD in children and young people without structural heart disease. The article presents a brief analysis of the genetic causes of life-threatening rhythm and conduction disorders in young people, as well as a generalization of the modern possibilities of a personalized diagnostic approach from the standpoint of early cardiovascular prevention. Timely genetic diagnosis of SCD risk makes it possible to identify a predisposition to the development of a fatal event long before its occurrence, which contributes to the timely implementation of preventive measures within a high cardiovascular risk strategy and secondary prevention, maintaining working capacity, creative and social activity of young patients, and improving the quality of life.

Aim. To assess quality of life (QoL) and its dynamics during nicorandil treatment in patients with stable ischemic heart disease, to study the relationship of treatment adherence and QoL indicators when treated with nicorandil.Material and methods. Observational program NIKEA included 590 patients with angina pectoris. Seattle Angina Questionnaire (SAQ) was used to assess QoL. Patients completed SAQ at the visit of inclusion (V0) and at the visit after 3 months of observation (V3). Potential and actual adherence to therapy was assessed by medical interviews at visits V0, V1 (1 month of observation) and V3. During the visit V0 417 people (from 590 ones enrolled into the study) completed SAQ (71% response); after 3 months (V3) SAQ was filled in by 454 of 552 people who came to this visit (82% response). According to the results of medical interviews, potential adherence (visit V0) was determined in all 590 patients, actual adherence to nicorandil (visits V1 and V3) was assessed in 552 patients who came to these visits. In accordance with the degree of adherence, all patients were divided into 3 groups: (1) adherent to treatment (taking nicorandil for the first three months), (2) non-adherent (who refused to take nicorandil), and (3) partially non-adherent (who started nicorandil, but for various reasons stopped taking the drug).Results. In all patients, regardless of their adherence to the recommended drug, there was an increase in QoL according to all five scales of the SAQ after 3 months of follow-up. Statistically significant positive dynamics of all SAQ indicators was found only in adherent patients (pConclusion. The results of the study confirm the interrelation and mutual influence of the QoL indicators and treatment adherence to nicorandil. Effective treatment with nicorandil in patients with lower health-related QoL indicators could increase treatment adherence. On the other hand, the mild degree of angina, the low level of confidence in the treating doctor, the side effects of the new drug reduce medication adherence of patients, which, as a result, negatively affects the QoL of these patients

Introduction Enlargement of the aortic root of occurs in many cases with cardiovascular disease, including congenital connective tissue disorders (CCTD), especially its differentiated and undifferentiated forms (UCCTD). A common deficiency of the generally accepted methods for diagnosing an aortic root dilation may be that persons with CCTD and cardiovascular diseases of potentially having a broader aortic root diameter could be included in the reference groups. The purpose of our study was to develop a modified method for determining the normal aortic root diameter in group of individuals without CCTD and cardiovascular diseases. Materials and methods The study included 464 apparently healthy people, men and women aged 15 to 65 years. All patients underwent general clinical examination, echocardiography. On the basis of external and internal signs of CCTD, patients with UCCTD were identified - the UCCTD group (n = 208) and without this pathology - the main group (n = 256). The calculation of the normal aortic root diameter (NARD) was made in accordance with the methods of Roman M. J. et al. (1989) and Devereux R. B. et al. (2012). The upper limit values of NARD (UL NARD) were calculated according to the algorithms of Roman M. J. et al. (1989), Devereux R. B. et al. (2012), Campens L. et al. (2014). Results The data obtained in the main group was used to develop a modified method for the determination of NARD. The mean values by echocardiography and calculated values of the aortic root by modified method of this study were practically the same in the main group, whereas the mean value of NARD calculated by the methods of Roman M. J. et al. and Devereux R. B. et al. in this sample were significantly higher in relation to the listed values. As the NARD values, the UL NARD were significantly higher for all evaluated algorithms in comparison with the modified method. In the group of patients with UCCTD, 13 cases of aortic root dilation were found according to the method of Roman M. J., compared to 19 cases by the modified method. At the same time, 3 patients with aortic root enlargement by the mew method had 7 points of systemic involvement, thus corresponding to the Ghent criteria of Marfan syndrome. The methods of Campens L. and Devereux R. B. were less sensitive, revealing only 5 and 1 patients with aortic root dilatation, respectively. Conclusions The results of the study demonstrate that, in order to obtain more reliable information on the condition of the root of the aorta and its proper values, the modified method obtained in the course of the study can be used. This method is more sensitive in detecting the enlargement of the aortic root in CCTD and in diagnosing syndromic CCTD.

We present here a method for computerized processing of electrocardiograms providing for averaging of the electrocardiogram signals over prolonged periods. The results of a comparative evaluation of the variability of the amplitude and time parameters of conventional and averaged electrocardiography are presented. Averaged electrocardiography is shown to have advantages over conventional methods of processing the electrocardiogram signals for personalized monitoring of electrocardiographic changes due to its higher reproducibility.

Aim. In the circumstances of real clinical practice, to evaluate the changes in life quality (LQ) parameters of the patients with coronary heart disease and stable angina with addition of nicorandil to standard treatment. Material and methods. Study design — prospective, observational, multicenter. In the trial, the physicians participated, from 14 institutions in a range ofRussia regions. Totally, 590 included: 261 (44,2%) females, 329 (55,8%) males. All patients, in addition to the standard antianginal treatment, were prescribed with nicorandil. At the visits V0 (baseline) and V3 (3 months of therapy) they completedSeattle questionnaire (SAQ) of LQ assessment. Five parameters were assessed: exercise intolerance, attacks frequency, stability, attitudes toward disease, treatment satisfaction. At the visit V0 417 questionnaires were completed (response 71%), at V3 — 454 (response 82%). Results. The significant increase was demonstrated, for parameters by SAQ in 3 months of observation, the highest parameters, except the scale exercise intolerance, were found in the group taking nicorandil during 3 months of follow-up (p

Working Group of the NIKEA Program. Ekaterinburg: Akulina E.N.; Izhevsk: Shinkareva S. E., Grebnev S.A.; Krasnodar: Kudryashov E.A., Fendrikova A.V.; Krasnoyarsk: Nemik D.B., Pitaev R.R., Altaev V.D., Samokhvalov E.V., Stolbikov Y.Y.; Moscow: Dmitrieva N.A., Zagrebelnyy A.D., Zakharova A.V., Balashov I.S., Leonov A.S., Sladkova T.A., Zelenova T.I., Shestakova G.N., Kolganova E.V., Maksimova M.A.; Novosibirsk: Moskalenko I.V., Shurkevich A.A.; Omsk: Loginova E.N., Gudilin V.A.; Orel: Zhuravleva L.L., Lobanova G.N., Luneva M.M.; Orenburg: Kondratenko V.Y.; Rostov-on-Don: Kalacheva N.M., Kolomatskaia O.E., Dubishcheva N.F., Romadina G.V., Chugunova I.B., Skarzhinskaia N.S.; Ryazan: Bulanov A.V., Trofimova Y.M., Nikolaeva A.S.; St. Petersburg: Savinova E.B., Ievskaia E.V., Vasileva L.B.; Tula: Zubareva L.A., Berberfish L.D., Gorina G.I., Nadezhkina K.N., Iunusova K.N., Nikitina V.F., Dabizha V.G., Renko I.E., Soin I.A. Aim. To study the adherence to treatment and the factors that affect it in patients with stable coronary heart disease during the treatment with nicorandil. Material and methods . The use of nicorandil in addition to standard antianginal therapy was recommended to patients (n=590) in a prospective, observational, multicenter NIKEA study. Patients completed original questionnaires on adherence, including a Morisky-Green test at the enroll visit. The questionnaires were filled by 423 patients (73% response). The factors that influence adherence were studied. Results. All patients were divided into 3 groups, depending on the adherence to the use of nicorandil: immediately refused to take the drug (n=150; group 1); started, but stopped taking nicorandil in the first 3 months of observation (n=75; group 2); who took nicorandil for 3 months (n=327; group 3). Potentially adherents (intention to treat) were 582 out of 590 (98.6%) patients, and actually adherents – only 327 of 552 (59.2%) patients. The main reason for non-adherence to the beginning of therapy is polypharmacy; to the continuation of the treatment that had just started – adverse events; for termination of long-term therapy – polypharmacy, adverse events and insufficient effectiveness of treatment. Group 3 had initially more severe angina pectoris: more number of angina attacks (p=0.014) and the need of short-acting nitrates (p

Experts consensus of the Russian Cardiology Society (RSC)

Enlargement of the aortic root of occurs in many cases with cardiovascular disease, including congenital connective tissue disorders (CCTD), especially its differentiated and undifferentiated forms (UCCTD). A common deficiency of the generally accepted methods for diagnosing an aortic root dilation may be that persons with CCTD and cardiovascular diseases of potentially having a broader aortic root diameter could be included in the reference groups. The purpose of our study was to develop a modified method for determining the normal aortic root diameter in group of individuals without CCTD and cardiovascular diseases.The study included 464 apparently healthy people, men and women aged 15 to 65 years. All patients underwent general clinical examination, echocardiography. On the basis of external and internal signs of CCTD, patients with UCCTD were identified - the UCCTD group (n = 208) and without this pathology - the main group (n = 256). The calculation of the normal aortic root diameter (NARD) was made in accordance with the methods of Roman M. J. et al. (1989) and Devereux R. B. et al. (2012). The upper limit values of NARD (UL NARD) were calculated according to the algorithms of Roman M. J. et al. (1989), Devereux R. B. et al. (2012), Campens L. et al. (2014).The data obtained in the main group was used to develop a modified method for the determination of NARD. The mean values by echocardiography and calculated values of the aortic root by modified method of this study were practically the same in the main group, whereas the mean value of NARD calculated by the methods of Roman M. J. et al. and Devereux R. B. et al. in this sample were significantly higher in relation to the listed values. As the NARD values, the UL NARD were significantly higher for all evaluated algorithms in comparison with the modified method. In the group of patients with UCCTD, 13 cases of aortic root dilation were found according to the method of Roman M. J., compared to 19 cases by the modified method. At the same time, 3 patients with aortic root enlargement by the mew method had 7 points of systemic involvement, thus corresponding to the Ghent criteria of Marfan syndrome. The methods of Campens L. and Devereux R. B. were less sensitive, revealing only 5 and 1 patients with aortic root dilatation, respectively.The results of the study demonstrate that, in order to obtain more reliable information on the condition of the root of the aorta and its proper values, the modified method obtained in the course of the study can be used. This method is more sensitive in detecting the enlargement of the aortic root in CCTD and in diagnosing syndromic CCTD.

Ref fling pathogenesis factors and the role of disorders of gastric secretion in the formation of the syndrome of malnutrition in patients with connective tissue dysplasia patients.In a cross-sectional comparative cohort study 83 patients were included: 59 patients with signs of connective tissue dysplasia (study group) and 24 patients with no signs of connective tissue-dysplasia (control group). In all patients the gastrointestinal symptoms were evaluated using a questionnaire GSRS, esophagogastroduodenoscopy, 24-hours pH monitoring, diagnostics H.pylori infection.in patients with connective tissue dysplasia the higher scores were recorded at body pH 1.2 (1.0; 2.8) and antral stomach 8.9 (6.6; 10.0). According to the morphological study the mucosal damage prevalents as pangastritis (20%), fundic gastritis (4%). Changes of intranagastric pH were associated with high rates of duodeno-gastric reflux in 74.5% patients. The severity of symptoms of dyspepsia (postprandial distress syndrome) and the degree of malnutrition correlated with indicators of intragastric pH in the body and antrum.The changes revealed intragastric pH may signifcantly alter the digestive conditions in all parts digestive tract contributing desynchronization receipt chyme and enzymes disrupting the normal regulation of pancreatic secretion, promoting the development of maldigestion syndromes, malabsorprion and, consequently aggravate genetically determined disorders trophological status.

Adverse cardiovascular manifestations (ACVM) were registered during 7-year follow-up of young patients with undifferentiated connective tissue dysplasia (CTD). ACVM developed in 28.42% of patients. Most frequent ACVMs were extension/aneurysm of the thoracic aorta (10.75%), cerebral vascular syndrome (10.56%), and arrhythmias (9.11%). Most significant risk factors for extension/aneurysm of the aorta were pathology of vertebral arteries, common risk factors (arterial hypertension, alcohol/drugs, smoking, heavy physical work, sports activities), bicuspid aortic valve); for pathology of cerebral vessels -completely open Willis Circle, pathology of vertebral arteries, CTD related changes of skin and spine, diagnostic CTD coefficient23, chronic diseases of veins; clinically significant cardiac rhythm disturbances - combined valve manifestations of CTD, myxomatous degeneration of heart valves, pathology of the aorta, male sex, metabolic changes of the myocardium, deviations of circadian index, predominance of sympathetic tone, and diastolic dysfunction. Analysis of clinical characteristics (age, symptoms and severity of CTD, QTc dispersion more or equal 50 ms) and presence of unfavorable genetic polymorphisms in 1-adrenergic receptor gene (Ser49Gly, rs1801252), transcription factor Sp4 gene (A80807T, rs1011168), genes of matrix metalloproteinases type 3 (5A/6A) and type 9 (8202 A/G) allowed to evaluate overall risk of ACVM.

The aim of PMICS (Postmyocardial Infarction Cardiosclerosis) patients therapy within the dispensary supervision is CCI (Chronic Cardio Insufficiency) progression prevention, life quality improvement, hospitalization number decrease and life prognosis improvement. Despite the developed approaches to the given patients treatment, CCI progression prevention, the main disease treatment ensuring and prognosis assessment are not always as much as possible effective. The search of methods improving the given patients prognosis is highly actual.To evaluate the meldonium clinical effectiveness in the early postmyocardial infarction period.67 patients were included in investigation, their age ranged from 40 to 70. They survived myocardial infarction (MI) and were discharged for further ambulatory supervision. The patients were randomized into two groups: the first one consisting of 32 patients got basic therapy for ischemic heart disease (IHD). The second group consisting of 35 patients besides basic therapy got mildronate during 12 weeks.meldonium included in standard ischemic heart disease therapy in early postmyocardial infarction cardiosclerosis reduces the rate of angina pectoris attacks (p=0,001), decreased the number of epiventricular extrasystoles (p=0,002) and the number of paroxysmal rhythm disturbances (p=0,001), decreased arterial blood pressure (middle SAP and DAP) p=0,001, improves life quality and lowered the level of anxiety (p=0,001).The results received are likely to depend on the use of energetically advantageous pyruvate in glycolytic cycle due to restoration of equilibrium in processes of oxygen supply and its consumption, prevention of ATA (adenozine tryphosphoric acid) transport disturbances, elimination of toxic metabolic products accumulation. No side effects were registered during the course of mildronate treatment.

OBJECTIVE To elucidate endothelial and metabolic effects of perindopril and their interaction in patients with uncomplicated essential hypertension. METHODS The study involved 30 patients treated with perindopril (5-10 mg/day) for 3 months. The following parameters were registered at baseline and at the end of the study: body mass index, waist circumference, blood lipids and glucose, flow-mediated vasodilation (FMVD) of brachial artery assessed by ultrasound. RESULTS Treatment with perindopril was associated with significant improvement of FMVD (6.7 ± 4.1% versus 8.7 ± 5.4% at the end of the study, p

In order to evaluate the effectiveness mildronate in rehabilitative treatment in connective tissue dysplasia examined 240 patients (24,41 ± 7,62 years, 130 men). All patients were treated with 5 ml of mildronate 10% intravenously for 10 days, then 1 capsule (250 mg), 2 times per day for 4 months. The therapy showed a significant decrease in asthenic complaints, reducing the incidence of violations repolarization I (p

To evaluate the antihypertensive efficiency and metabolic effects of controlled monotherapy with hydrochlorothiazide (HCT) and indapamide retard (IR) in hypertensive patients.The study included 50 patients with Stage II essential hypertension, grades 1-3 blood pressure (BP) elevation, who received 3-month monotherapy with IR (n=25) or HCT (n=25). Changes were determined in BP, blood lipid, glucose, and potassium levels. The efficiency of antihypertensive therapy was evaluated in the entire group and subgroups of patients identified in accordance with the used diuretic and the presence (n=27) or absence (n=23) of therapy at previous stages.A total of 54% of the patients included in the study achieved target BP after 3 months of therapy. The proportion of individuals with normalized BP was comparable in the HCT and IR groups (52 and 56%, respectively) and in previously treated patients and those who used for the first time antihypertensive drugs (51.8 and 56.5%, respectively). Normalization of systolic and diastolic BPs was achieved in 78 and 58% of the patients, respectively. Target BP was achieved in 94,1%, 42,9% and 16,7% of patients with grades 1,2 and 3 hypertension, respectively. IR proved to be metabolically neutral whereas HCT was found to significantly increase the blood levels of triglycerides and glucose by 15.3% (p0.05) and 12.2% (p0.05), respectively.Controlled diuretic monotherapy allows BP normalization in more than 50% of the hypertensive patients. HCT and IR have similar antihypertensive efficiency. Because of the negative changes observed in lipid and carbohydrate metabolism with the use of relatively small doses of HCT, IR is a preferential alternative in the long-term treatment of hypertensive patients.Цель исследования - оценить гипотензивную эффективность и метаболические эффекты контролируемой монотерапии гидрохлоротиазидом (ГХТ) и индапамида-ретардом (ИР) больных артериальной гипертонией (АГ). Материалы и методы. В исследование включили 50 больных эссенциальной АГ II стадии 1-3-й степени повышения артериального давления (АД), на протяжении 3 мес получавших монотерапию ИР (n=25) либо ГХТ (n=25). Определяли динамику АД, уровня липидов, глюкозы и калия в крови. Эффективность гипотензивной терапии оценивали в объединенной группе и в подгруппах больных, выделенных в зависимости от использованного диуретика и наличия (n=27) или отсутствия (n=23) терапии на предшествующих этапах. Результаты. В целом из всех включенных в исследование через 3 мес терапии целевого уровня АД достигли 54% пациентов. Доля лиц с нормализацией АД была сопоставима в группах ГХТ и ИР (52 и 56% соответственно) и у ранее леченных больных и тех, кому антигипертензивные препараты назначались впервые (51,8 и 56,5% соответственно). Нормализация систолического АД достигнута у 78% и диастолического у 58% больных. Наибольшая частота достижения целевых уровней АД отмечена у лиц с 1-й степенью повышения АД (94,1%), среди лиц с 2-й и 3-й степенью она составила 42,9 и 16,7% соответственно. ИР оказался метаболически нейтральным, тогда как на терапии ГХТ отмечено достоверное повышение уровня триглицеридов и глюкозы в крови на 15,3% (p0,05) и 12,2% (p0,05) соответственно. Заключение. Контролируемая монотерапия диуретиками позволяет добиваться нормализации АД более чем у 50% больных АГ. ГХТ и ИР дают сходную гипотензивную эффективность. Ввиду негативных изменений липидного и углеводного обмена на фоне приема относительно небольших доз ГХТ ИР является предпочтительной альтернативой при длительном лечении больных АГ.Резюме Цель исследования — оценить гипотензивную эффективность и метаболические эффекты контролируемой монотерапии гидрохлоротиазидом (ГХТ) и индапамида-ретардом (ИР) больных артериальной гипертонией (АГ). Материалы и методы. В исследование включили 50 больных эссенциальной АГ II стадии 1—3-й степени повышения артериального давления (АД), на протяжении 3 мес получавших монотерапию ИР (n=25) либо ГХТ (n=25). Определяли динамику АД, уровня липидов, глюкозы и калия в крови. Эффективность гипотензивной терапии оценивали в объединенной группе и в подгруппах больных, выделенных в зависимости от использованного диуретика и наличия (n=27) или отсутствия (n=23) терапии на предшествующих этапах. Результаты. В целом из всех включенных в исследование через 3 мес терапии целевого уровня АД достигли 54% пациентов. Доля лиц с нормализацией АД была сопоставима в группах ГХТ и ИР (52 и 56% соответственно) и у ранее леченных больных и тех, кому антигипертензивные препараты назначались впервые (51,8 и 56,5% соответственно). Нормализация систолического АД достигнута у 78% и диастолического у 58% больных. Наибольшая частота достижения целевых уровней АД отмечена у лиц с 1-й степенью повышения АД (94,1%), среди лиц с 2-й и 3-й степенью она составила 42,9 и 16,7% соответственно. ИР оказался метаболически нейтральным, тогда как на терапии ГХТ отмечено достоверное повышение уровня триглицеридов и глюкозы в крови на 15,3% (p0,05) и 12,2% (p0,05) соответственно. Заключение. Контролируемая монотерапия диуретиками позволяет добиваться нормализации АД более чем у 50% больных АГ. ГХТ и ИР дают сходную гипотензивную эффективность. Ввиду негативных изменений липидного и углеводного обмена на фоне приема относительно небольших доз ГХТ ИР является предпочтительной альтернативой при длительном лечении больных АГ.

Aim. To evaluate antihypertensive and metabolic effects of the therapy based on carvedilol (C) in comparison with metoprolol (M) in hypertensive patients with overweight or obesity.Material and methods. 320 patients were involved in multicenter, randomized open parallel study. One part of the patients received C 12,5 mg BID (Vedicardol, “Sintez”), another part – M 25 mg/day BID. Doubling dose of β-blockers (BB) and switching patients to combined therapy with AML 5-10 mg OD (Amlorus, “Sintez”) and hydrochlorothiazide (HCT) 12,5-25 mg OD was performed if necessary. The study duration was 24 weeks.Results. Significant reduction of systolic and diastolic blood pressure was revealed in both groups, there was no difference between groups (р=0,88 and p=0,61 respectively). Switching patients to combined therapy with AML and HCT was made more often in M group than in C group (p>0,05). Prescription of BB resulted in significant reduction of the heart rate, there was no difference between groups (p=0,61). 96,2% patients of group C and 95,5% of group M reached target levels of BP. Significant reduction of glucose (p0.05), half of them were not related to BB taking.Conclusion: Controlled antihypertensive therapy, based on С and M, allows reaching target levels of BP in majority of patients with overweight or obesity. Switching to combined therapy was made more seldom in group of С than in M group. Both drugs demonstrated metabolic neutrality, however significant lowering of glucose and uric acid levels and tendency to lowering of TC an LDLC levels was observed only in group С.

The aim of PMICS (Postmyocardial Infarction Cardiosclerosis) patients therapy within the dispensary supervision is CCI (Chronic Cardio Insufficiency) progression prevention, life quality improvement, hospitalization number decrease and life prognosis improvement. Despite the developed approaches to the given patients treatment, CCI progression prevention, the main disease treatment ensuring and prognosis assessment are not always as much as possible effective. The search of methods improving the given patients prognosis is highly actual.To evaluate the meldonium clinical effectiveness in the early postmyocardial infarction period.67 patients were included in investigation, their age ranged from 40 to 70. They survived myocardial infarction (MI) and were discharged for further ambulatory supervision. The patients were randomized into two groups: the first one consisting of 32 patients got basic therapy for ischemic heart disease (IHD). The second group consisting of 35 patients besides basic therapy got mildronate during 12 weeks.meldonium included in standard ischemic heart disease therapy in early postmyocardial infarction cardiosclerosis reduces the rate of angina pectoris attacks (p = 0.001), decreased the number of epiventricular extrasystoles (p = 0.002) and the number of paroxysmal rhythm disturbances (p = 0.001), decreased arterial blood pressure (middle SAP and DAP) p = 0.001, improves life quality and lowered the level of anxiety (p = 0.001).The results received are likely to depend on the use of energetically advantageous pyruvate in glycolytic cycle due to restoration of equilibrium in processes of oxygen supply and its consumption, prevention of ATA (adenozine tryphosphoric acid) transport disturbances, elimination of toxic metabolic products accumulation. No side effects were registered during the course of mildronate treatment.

To develop integral assessment of the health status based on the examination of representative samples from different regions of Russia (Veliky Novgorod, Nizhni-Novgorod, Vologda, Omsk and Nalchik) with the use of special questionnaires and simple anthropometric and functional methods in the framework of a prospective 3-year population study of organized groups.The above questionnaires allowed to elucidate the socio-economic status of the patients, their somatic and psychological conditions (lifestyle index or psychological protection mechanisms (PPM), social adaptation, sanogenic reflexia; also used were Eysenck's psychotism scale, hospital anxiety and depression scale, the perceived stress scale (PSS), and moral potential of personality development scale.It was shown that the profile of psychological protection mechanisms is dominated by primitive reactions, such as projection, protection, and negation. Most subjects from the sample formed the pathogenic type of reflexia (inability to resolve a problem situation based on the cognitive components of the patient's mental state). Mathematical treatment of the so-called "simple cross-tabulation" with unification of all negative PPM revealed the highly significant relationship of LSI (not norm) with most previous somatic diseases (p0.001), i.e. the history of myocardial infarction, angina of effort, cardiovascular syndromes, diabetes, hypertension, chronic broncho-pulmonary, hepatic, gastrointestinal, urogynecological, oncological, and psychic diseases. (p0.007).Pyschological changes have greater influence than somatic ones on physiological parameters determining the population health status which suggests the necessity of taking them into account when planning health promotion measures.

OBJECTIVE Our aim was to compare changes of vascular and metabolic parameters in patients with essential hypertension on treatment with combination of perindopril with either indapamide retard or hydrochlorothiazide. METHODS The study involved 40 patients who were randomly assigned to perindopril 5-10 mg/day in combination with indapamide retard (P+I) 1.5 mg/day (n = 20) or with hydrochlorothiazide (P+HT) 25 mg/day (n=20). Waist circumference, body mass index, blood lipids and glucose, endothelial function (EF) determined as the change of resistance index after inhalation of salbutamol, arterial stiffness measured as mean pulse wave velocity after sublingual trinitroglycerin (PWVtng) were evaluated at baseline and 6 months thereafter. Vascular responses were calculated from digital pulse waves registered using photoplethysmography. RESULTS Dynamics of BP after 6 months did not differ significantly between groups. Treatment with combination of P+HT resulted in significant decrease of EF (-24,3%, p

Elevated level of -adrenoreception of membranes is observed in patients with disturbances of heart rhythm at the background of connective tissue dysplasia. It is not related to characteristics of the arrhythmic syndrome. At the background of 4-months intake of preparation magnezium orotate significant decrease of degree of desensitization of of erythrocytes has been noted.

Clinical data are reported upon the examination of a group of 160 women aged 18-55, suffering of a breast cancer and subjected to polychemotherapy using various cytostatic schemes: (I) standard CAF scheme, course repetition each 4 weeks; (II) alternating CAF and AVCFM schemes (intermittent introductions), a total of 4 courses. For the reduction of the cardiotoxic effects of anthracyclines, one part of patients was given an antioxidant preparation of amber acid--Reamberin--whose administration substantially decreased both the frequency of cardial complaints and the expression of clinical manifestations of the astheno-neurotic syndrome and prevented the occurrence of systolic and diastolic dysfunction of myocardium and the heart rhythm and conductivity disturbances.

Gastrointestinal tract as one of the collagen organ systems, will inevitably become involved in the pathological process in connective tissue dysplasia. In order to optimize diagnosis and treatment tactics of practitioner choice needs to know the major gastrointestinal manifestations of connective tissue dysplasia and to distinguish between concepts: visceral manifestations of connective tissue dysplasia (syndromes of digestive diseases associated with connective tissue dysplasia), maldevelopments and diseases of the digestive system associated with connective tissue dysplasia. The authors have developed and presented a classification of major gastrointestinal syndromes in connective tissue dysplasia.

To assess efficacy of therapeutic medical education in the field of chronic cardiac failure (CCF) of social workers taking care of old persons on home nursing.87 social workers filled in a special questionnaire before and after training in management of old persons with CCF.Initial knowledge of the social workers about CCF was insufficient, especially their education was poor in CCF symptoms, medication, diet, regime, hospital and outpatient treatment, possible assistance from social personnel. Therapeutic training improved medical knowledge of the social workers.Therapeutic education of social workers improves their knowledge about outpatient treatment of old patients with CCF and understanding of a social worker behavior with old CCF outpatients.

The section of medical-social work was entered for the first time into National Recommendations VNOC and OSSN on diagnostics and treatment of chronic heart failure, the second revision. The social help is especially important for persons of senile age and long-livers. It is expedient to study to what extent the employees of social service are ready to participate in the complex observation and treatment of these patients. Interrogation of 274 workers of the complex centers for in-home social service has been worked out. The level of knowledge on matters of conducting persons of senile age with chronic heart failure proved to be low. Majority respondents have not shown any readiness to join medical-social programs carried out by public health institutions.

For the improvement of compliance of old age patients to therapy of chronic heart failure (CHF) we carried out therapeutic training of social workers serving these patients at their homes. Efficacy of training was assessed by means of analysis of questionnaires given to 87 social workers before and after training sessions. It has been established that therapeutic education of social workers significantly elevates level of their awareness of the problems of CHF, promotes more correct understanding of their role in organization of care of old age patients with CHF and interaction with medical institutions.

Aim. To study therapeutic equivalence of rosuvastatin generic and original medication and to conduct the pharmacoeconomic analysis to compare the impact of the drug on direct expenses in secondary prevention for the patients with chronic ischemic heart disease (CHD). Material and methods. The open label, prospective observational study performed with the switch of medication, that included 38 patients with chronic CHD and duration of 6 months. During 3 months the patients received original drug rosuvastatin Crestor 10-20 mg, leading to the target level of low density cholesterol

Connective tissue dysplasia is a systemic process that modifies the clinical picture and course of an acquired pathology. To search additional criteria for differential diagnosis, connective tissue metabolic parameters were studied in patients with infiltrative pulmonary tuberculosis and nosocomial pneumonia. A significant excess of the parameters of free urinary oxyproline and serum glycosaminoglycans was found in patients with infiltrative pulmonary tuberculosis.

The clinico-immunogenetic analysis of 47 patients with Marfan's syndrome and 83 patients with chest deformities combined with valvular prolapses and other connective tissues dysplasias elucidated a close relation of HLA-antigens allele variants with clinical dysplasia variants and specific immune alterations. The findings support the suggestion that clinical heterogeneity of connective tissue dysplasia forms results from their pathogenetic heterogeneity.

Seventy patients with pectus carinatum were examined. All the patients demonstrated the minimal signs of connective tissue deficiency. The ECG readings showed incomplete blockade of the bundle of His, ventricular extrasystole, WPW and CLC syndromes, and metabolic alterations in the myocardium. Mitral valve prolapse was discovered in 97% of cases by echocardiography. There was a decrease in myocardial contractility along with changes in cardio- and hemodynamics, which were more marked in patients having the corporocostal type of pectus carinatum. The correlation of these values with chest deformity was revealed.

Examinations of 70 patients with keeled deformation of the chest (KDC) have revealed signs of connective tissue dysplasia in all the examinees, as well as heart rhythm and conduction disorders. Echography has shown ventricular and atrial septal defects, mitral valve prolapse, dilatation of the aortic root, tricuspidal valve prolapse, abnormally located chorda. The development of KDC in the presence of external connective tissue stigmata, involvement of the cardiovascular system, changed dermatoglyphic pattern of the palms and fingers (as evidenced by dermatoglyphic analysis), as well as findings of histologic examinations of the cartilage removed in the course of thoracoplasty may indicate a generalized abnormality of the connective tissue in this patient population and KDC may be regarded as one of its manifestations.

Open noncomparative multicenter study of tolerability and efficacy of a retard form of indapamide (1.5 mg o.d. for 3 months) in patients older then 55 years was conducted in 14 centers in Russia. Numbers of patients included into was analysis of safety and tolerability were 1277 and 1121, respectively. After 3 months systolic, diastolic and pulse blood pressure (BP) decreased by 20.2, 13.2, 27.5% (supine) and by 19.4, 11.8, 26.9% (standing), respectively. There were no significant changes of heart rate. Effect of treatment was considered positive in 92.4% of patients. Normalization of blood pressure occurred in 51.8% of patients (in 46.2% and 53.4% among men and women, respectively, p=0.0252; in 55.7% and 48% among patients aged65 and65 years, respectively). In patients with type II diabetes rates of positive effect and achievement of target BP130/85 mm Hg were 60.8% and 31.4%, respectively. Hypokaliemia (3.0-3.5 mmol/l) was registered in 43 patients (3.4%), age of 27 of these patients was 65 years. There were no pronounced changes of blood serum levels of creatinine, glucose and uric acid. Significant lowering of atherogeneity cholesterol index occurred in the whole group while both this index and total cholesterol significantly decreased in patients with baseline hypercholesterolemia. Thus in patients older that 55 years monotherapy with retard form of indapamide was demonstrated to be safe and effective antihypertensive intervention.