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to study the role of clinical factors and treatment tactics in the development of adverse outcomes in patients with non-STelevation acute coronary syndrome (NSTEACS) for five years follow up.The study included 415 patients with NSTEACS observed for 60±4 months from the date of discharge. Adverse events (AE) were unstable angina (UA), myocardial infarction (MI), ischemic stroke or patient's death. The favorable 5-year outcome was identified in 200, adverse outcome - in 178 patients. Statistical processing was performed using STATISTICA 8.0 software package and MedCalc 11.0.Total mortality for 60 months was 16.1% (n=61). Highest mortality, maximal number of hospitalizations due to MI (41.1%) and UA (49.6%) were observed during first 12 months. Greatest impact on the development of AE produced: history of MI, higher GRACE score, age54 years (p=0.0021), stenosis in brachiocephalic arteries, ischemic changes on admission ECG and reduced left ventricular ejection fraction (LVEF) ≤ 52% (p=0.0001). Five-year survival rate was influenced by coronary angiography (p=0.0001) and percutaneous coronary intervention (PCI) during index hospitalization (p=0.0039).Mortality and frequency of AE in this register were close to generally reported. The observed adverse impact on the long-term outcome of such risk factors such as age over 60 years, history of MI, ischemic ECG changes at admission, decreased LVEF corresponded to literature data. Our study proved the need for coronary imaging in patients with NSTEACS to determine treatment strategy in in hospital period as these factors affected the 5-year survival.During five-year follow-up AE occurred in 47.1% of patients with NSTEACS. Maximal number of patients with AE was registered during the first (24.7%) and fifth (13.8%) year of observation. The development of AE was associated with older age, history of MI and coronary artery bypass grafting, ischemic ECG changes, decreased LVEF, higher GRACE score, and brachiocephalic artery stenosis. Carrying out diagnostic coronary angiography and PCI with stenting during hospitalization in patients with NSTEACS was associated with favorable 5-year outcome.

To study the relationship between polymorphous G-1082A (rs3024491) and C-592A (rs1800872) variants of the IL10 gene and multifocal atherosclerosis (MFA) in patients with acute coronary syndrome (ACS) without segment ST elevation.Genotypes of polymorphous G-1082A (rs3024491) and C-592A (rs1800872) variants of the IL10 gene were determined in 178 patients. Interleukin-10 (IL-10) level was measured in 93 of them using solid-phase immunoenzymatic assay. All patients underwent visualization of coronary and peripheral arteries.C-592A (rs1800872) polymorphism ofthe IL10 gene tended to be associated with type 2 diabetes mellitus in the carriers of the CC (gg) genotype and with elevated concentration of high density lipoproteins and reduced intima-media thickness in the carriers of the AA (tt) genotype. The frequency of MFA in the carriers of different genotypes of rs1800872 polymorphism was practically identical while the CA(gt) genotype was associated with more severe manifestations of atherosclerosis and AA(tt) genotype with lower frequency of peripheral artery stenosis. Patients with AA(tt) genotype of rs1800872 polymorphism had higher IL-10 levels. No relationship between rs3024491 polymorphism of IL10 gene, blood IL-10 level, clinical risk factors, and MFA was documented.CC (gg) genotype of C-592A (rs1800872) polymorphism of the IL10 gene in patients with acute coronary syndrome (ACS) without segment ST elevation was associated with type 2 diabetes mellitus while the AA(tt) genotype of the same polymorphism with elevated concentration of high density lipoproteins, reduced intima-media thickness, low frequency of peripheral artery stenosis, and increased IL-10 production. CA (gt) genotype of rs1800872 polymorphism of the IL10 gene was associated with MFA.

To make a prediction scale using a set of clinical and laboratory prognostic variables for patients with ST-segment elevation myocardial infarction (STEMI) on their electrocardiograms (ECG) who have undergone percutaneous coronary intervention.The study enrolled 154 STEMI patients who had undergone percutaneous coronary angioplasty with stenting of the artery supplying blood to the area of an ischemia. Enzyme immunoassay was used to determine the levels of cytokines and selectins on days 1 and 10.During a year, the authors identified the following independent risk factors of a poor outcome (PO): symptoms of Killip Class III-IV heart failure; a history of smoking; rhythm and conduction disturbances on day 1 of the disease; tumor necrosis factor-alpha levels determined on day 1 of the disease; IL-1alpha and sP-selectin levels measured on day 10. In the made prediction scale, a score was assigned to each independent prognostic variable to estimate the risk of PO. The borderline values of summing the scores, which divided the patients into groups at low, moderate, and high risk for PO, were determined for the practical application of the scale, by using the receiver operating characteristic curve (ROC) analysis. The performance of the model was tested using an independent sample of STEMI patients (n = 50). The probability that the classification of the model was correct amounted to 89.6% (p0.0001).The made prediction scale allows the patients with STEMI to be allocated to groups at low, moderate, high risks for PO during a year. Evaluation of the prognostic efficiency of the new scale versus the known scales PAMI, CADILLAC, and TIMI ST elevation, by plotting the ROC curve and estimating the area under the latter, demonstrated the high predictive ability of the new scale.

Aim of the study was to determine incidence of multifocal atherosclerosis (MFA), to assess its clinical and prognostic significance in the hospital phase in patients with non-ST elevation acute coronary syndrome (NSTEACS). We studied data from 225 patients with duration of NSTEACS 48 hours or less, who along with usual examination were subjected to coronary angiography and color duplex scanning of extracranial arteries and arteries of lower extremities. As lesions we considered any stenosis irrespective of intima media thickness. MFA was detected in 43.6% of cases. Patients with MFA were older, they more often had history of myocardial infarction, had lower creatinine clearance, and left ventricular ejection fraction. Presence of artery stenoses in 3 vascular regions was associated with multivessel coronary artery disease. Inhospital "endpoints" (myocardial infarction, stroke, death) occurred more frequently in patients with MFA. Patients with lesions in 2 and 3 vascular beds were characterized by maximal Grace score, while those without coronary and peripheral artery involvement- by minimal Grace score. The presence of MFA in patients with NSTEACS was associated with unfavourable course of the disease. Thus ptatients with MFA were characterized by high average rating on Grace scale; involvement of three vascular beds was associated with high mortality.

Basing on complex evaluation of clinical, angiographic, and laboratory data we revealed predictors of stent thrombosis in patients with ST-elevation acute coronary syndrome (ACS) subjected to percutaneous coronary interventions (PCI). Among studied sample of patients (n=124) we distinguished a group of patients with proven stent thrombosis at various stages of follow-up (n=22, group 1) and a group of patients with favorable outcome (n=102, group 2). Unifactorial analysis revealed unfavorable prognostic influence (p=0.025) of hemodynamically significant stenosis of proximal segment of anterior distending artery, disturbances of rhythm and conduction (p=0.0002), as well as degree of heart failure (HF) according to Killip on day 1 of development of symptoms of ACS, and also of high selectin P level on day 10 (p=0.031). With the aim of assessment of prognostic significance of revealed factors we conducted stepwise discriminant analysis according to results of which most significant parameter affecting development of stent thrombosis in patients with ST-elevation ACS appeared to be high Killip class of HF (plt;0.0003), to a lesser degree - elevated level of sP-selectin on day 10 of observation (p=0.005). Parameter for which prognostic significance was not revealed as a result of multifactorial analysis was lesion in proximal segment of anterior descending artery (p=0.496). Probability of correct classification of the model was 88.7% at plt;0.0001.

To evaluate long-term therapeutic effect and safety of structum in patients with manifest coxarthrosis.Twenty patients with manifest coxarthrosis of degree I-III were given a 6 month structum course. Criteria of efficacy were Leken index, pain in the affected joints, nonsteroid anti-inflammatory drugs requirement, assessment of the efficacy by the patient and the doctor. Structum effects were studied with x-ray examination, CT, INC index. The assessment was made at baseline, after 3 and 6 month therapy and 6.12 and 18 months after the end of the study.All the patients achieved positive results without side effects on coagulation.Structum is highly effective in patients with manifest osteoarthrosis of hip joints. Is modifies symptoms, has a potential chondroprotective effect, long-term aftereffect, no significant negative action of coagulation, is well tolerated.

In the city center of endovideosurgery during 1999-2005 there were 205 patients examined and treated for cholelithiasis combined with gastro-esophageal-reflux disease (GERD) and hiatal hernias. Simultaneous interventions, antireflux operation and cholecystectomy were performed in 150 patients. Cholecystectomy followed by conservative treatment of GERD was performed in 55 patients. The results of treatment were followed up during 1 and 6 months.

To study efficacy of the chondroprotector chondroitin sulphate (structum, Pier Fabr Medicament Production, France) in patients with rheumatoid arthritis (RA) and secondary osteoarthrosis of the knee joints.15 women with a long history of RA (mean duration 11.9 years) entered an open non-randomized trial of structum. The patients had a severe progressive highly active RA with a definite x-ray stage of the disease. 13 patients had a positive rheumatoid factor (1:80 to 1:1280) and involved knee joints which had been affected for 1 to 10 years (mean 5.3 years). The second x-ray stage was in 8 patients, the third stage of knee joints arthrosis was in 7 ones. A marked pain syndrome in the knee joints upon movement (mean 64.7 mm by VAS) was observed in all the examinees and at rest (mean 28 mm by VAS) in 13 of 15 patients. Structum was given according to a standard scheme: 500 mg 3 times a day for 3 weeks than 500 mg 2 times a day for up to 6 months. Basic drugs for RA were the same for all the observation period.Structum noticeably improved knee joint function (mean Leken's index 12.8, 11.3 and 9.4 scores before the treatment, on treatment month 3 and 6. Movement pain syndrome VAS reduced from 64.7 mm at the start to 51 mm 3 months and 37.5 mm 6 months later, rest VAS--from 19 to 10.3 and 6.4 mm, respectively. The demand in intraarticular glucocorticoids went down from 52 injections at the start of therapy to 6 after 6 months. Side effects for 6 months were absent. Overall efficacy was good (73.3% and 80%) as judged by the doctors and patients, respectively. After 6 months of therapy control x-rays found no progression of destructive changes in the knee joints (by MRI--in 4 patients).Structum has a marked positive therapeutic effect in patients with severe and long-term course of RA with associated pronounced secondary joint arthrosis.

The serum levels of Th1 (gamma-IFN and sIL-2r) and of Th2 (IL-10) cytokines were measured in 33 patients (23 males and 10 females, mean age 23.1 +/- 1.9) with chronic viral hepatitis (CVH) according to a disease etiology (6 patients with hepatitis B--CVHB, 15 patients with hepatitis C--CVHC, and 12 patients with a mixed form of chronic hepatitis B and C--HBV + HCV). Besides, the contents of the studied cytokines were compared with the traditional infection markers and the presence of viremia. The similar indices taken from 10 healthy persons served as controls. The concentration of gamma-IFN was found to be reliably higher (p0.05) in patients of all three groups (0.32 +/- 0.07, 0.34 +/- 0.09 and 0.25 +/- 0.06 pg/ml, respectively) regardless of a disease etiology and as compared with the control value (0.09 +/- 0.04) pg/ml). At the same time, the levels of gamma-IFN, sIL-2r and IL-10 (0.25 +/- 0.06 pg/ml, 166.5 +/- 31.3 IU/ml and 48.1 +/- 8.4 pg/ml, respectively) was found to be reliably (p0.05 and p0.01) higher, as compared to the controls (0.09 +/- 0.04, 57.1 +/- 5.6 and 10.8 +/- 7.8, respectively), only in patients with the mixed infection of hepatitis. Like in our previous study, a trend was established towards the growing mean values of the IL-r level from its lowest parameters in the group of CVHB patients towards its highest parameters in the group with the mixed hepatitis form. According to our data, the IL-2r level correlated reliably with the activity of AlAt (r = 0.452; p0.05), while the gamma-IFN content correlated reliably with the IL-10 concentration (r = 0.805; p0.05), and the gamma-IFN content correlated with the IL-10 concentration (r = 0.805; p0.01) irrespective of disease pathology.

Forty-four patients with chronic HBV and HCV were observed. Serum levels of interferon-gamma (IFN-gamma), interleukin-2 (IL-2), and soluble IL-2 receptor (IL-2r) were measured by enzyme immunoassay in 29 patients divided into 3 groups: group 1 (n = 9) with chronic HBV, group 2 (n = 9) with chronic HCV, and group 3 (n = 11) with mixed HBV + HCV infection. Control group consisted of 10 normal subjects without HBV, HCV, or HIV infection markers. The most informative of Th1 cytokines was IL-2r: its concentration was increased significantly (p0.01) in all patients with hepatitis B and/or C in comparison with the control. In addition, there was a trend to an increase in the mean concentrations of IL-2r from group 1 to groups 2 and 3. The concentrations of IFH-gamma and IL-2 did not differ significantly in the patients and controls. However, the concentrations of IFN-gamma were increased significantly (p0.01) in comparison with the control in 3 patients from group 1 and 4 patients from group 3 with more pronounced inflammation.

To test effectiveness of a new nonsteroid antiinflammatory drug movalis in osteoarthritis.113 patients aged 30-85 years from 8 Moscow clinics were treated with movalis. All the patients had long-standing osteoarthritis, 26 patients had concomitant gastric or duodenal ulcers. Movalis was given in daily dose from 7.5 to 15 mg for 1-4 weeks.None case of ulcer onset or recurrence was observed. The response was rated as good in 44.2, satisfactory in 47.0% and bad in 8.8% of the cases. Tolerance was good in 99.1% of patients and bad in 0.9%.Movalis has a definite antiinflammatory and analgetic activity in patients with osteoarthritis and spondylarthrosis.

The authors studied morphologic and constitutional features in individuals with various durability to vibration. Patients fragile to vibration were pectoral and indefinite somatotypes with connective tissue dysplasia and small congenital abnormalities (spondylodysplasia, venous wall deficiency. "dysplastic" heart signs and others). Patients durable to vibration were muscular and abdominal somatotypes with rare connective tissue dysplasia and small congenital abnormalities (2.5-10.2% of cases). Evaluation of morphologic and constitutional characteristics is recommended in preliminary and periodic medical examinations of workers subjected to vibration, for assessment of individual risk degree and differential medical follow-up.

The paper provides a brief account and technical data of an AP-94-type device (a refractometer) for examination of ocular refraction, which operates in the infrared spectrum and allows a correct diagnosis to be promptly and qualitatively established and corrective means to be chosen for the patient. The results of clinical tests of the device are given.

A sandwich ELISA system was used for the study of the identification of antigenic group A polysaccharide determinants by antibodies in a suspension of streptococcus cells with varying degrees of lysis. Antibodies were able to identify less than 0.01% of antigenic A polysaccharides determinants in intact streptococcal cells. It is concluded that A polysaccharide is a marker of the destroyed group A streptococcus cells. The circulation of group A polysaccharide was examined in the sera of patients with rheumatism and acute streptococcal tonsillitis. Group A polysaccharide was detectable more frequently in rheumatic patients, as compared to those with tonsillitis, and circulated for long periods of time in the vascular network. Avidity and titres of antibodies to group A polysaccharide were determined in rheumatic patients with different degrees of antigenemia. In cases of marked antigenemia, correlation was disrupted between the titre and avidity of antibodies to group A polysaccharides.

The level of sIgA saliva antibodies and Ig(M + G + A) serum antibodies to group polysaccharide A of streptococcus was studied in healthy donors and patients with streptococcal angina and rheumatic fever. It was shown that an elevated level of secretory and serum antibodies to polysaccharide A was registered in patients with angina and rheumatic fever reliably more frequently than in healthy donors. Independence of local and systemic humoral immune response to polysaccharide A was established.

The paper presents data concerning the incidence of brain strokes and the mortality rate. These indices were received for the first time on a large population by the method of brain stroke register. The frequency of brain strokes during one year equaled to 2.5 cases, the mortality rate 1 case per 1000 population. Genuine indices of the incidence and mortality rates for different age groups were established. They appeared to be relatively high in people over 60 years. The mortality coefficient is higher in females. In brain infarctions the frequency and mortality is higher than in brain and subarachnoidal hemorrhages.

The work was based on the data obtained by the epidemiological register method. The incidence of cerebral strokes and the patients' mortality were determined. By the end of the first year after the stroke in 42.5% of patients who survived there remained pareses and paralyses. In a part of the patients the ability for walking and using transport was impaired. 38.2% of the patients needed assistance in performing one or several ADL functions, such as, dressing, food taking, washing, use of toilet and bath. 20.2% of the patients who worked before the stroke could return to their work, and 17.1% of the patients who kept house before the stroke could return to their former household activity. The patients were divided into ADL classes and classes determining the state of their labour and everday-life rehabilitation. This distribution was found to be of practical importance.

Fifty patients with the clinical diagnosis of initial manifestations of the deficiency of the brain blood supply and 30 normal persons of the corresponding age (the control group) were studied. The main group consisted of patients from 40-67 years. Along with the similar clinical study rheoencephalographic and electroencephalographic studies with the aid of various functional samples were conducted. The initial manifestations of the inadequacy in the brain blood supply frequently developed on the background of cerebral atherosclerosis of a different type of expressiveness, hypertensive disease and their combination, vegetovascular dystonia. With the help of the functional samples the peculiarities of reactivity of the vascular system were established in these patients. The antiorthostatic and nitroglycerin samples appeared to be informative. The combined REG and EEG registrations demonstrated in these patients signs of a deficit of brain blood supply causing in a number of cases changes in its functional states. The clinical (seldom electrographic) changes are of a reversible character and regress during the treatment of the main vascular disease. The obtained data permit to recommend the method of functional electrography (REG and EEG) in order to reveal the initial forms of brain vascular diseases. These patients must be supervised by a dispansary.

On the basis of a critical analysis of Soviet and foreign literature, as well as on some results of long-term personal observations, the authors discuss some modern concepts (clinico-diagnostical, neurosurgical, rehabilitative, neurophysiological) of functional asymmetry in the human hemishperes. The authors underline a necessity for a detailed multidisciplinary study of this problem, having in view its importance for the theory and practice of medicine.

A new mathematical method is suggested for making the prognosis of the results of surgery for haemorrhagic strokes due to essential hypertension and atherosclerosis. Twenty-two signs characterizing the patient's state are fed into the computer trained on the basis of 124 case reports of patients, both surviving and dying after surgery. The computer operating in accordance with the "Kopa-3" programme works out a vital prognosis for both the medicamental and surgical treatment. The prognosis proved correct in 90% of the cases. The described method permits an objective determination of the indications for surgery in hemorrhagic stroke.

The results of the studies, obtained in a computer head tomography confirms its effectiveness in the diagnosis of ischemic and hemorrhagic strokes, tumor and degenerative brain diseases, as well as in investigations of the brain ventricular systems and subarachnoidal spaces. A computer head tomography--is a perspective method in the study of brain lesions with the aid of X-ray equipment and computers.