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Aim. To determine differences in laboratory coagulation parameters using routine and integral monitoring methods in patients depending on anticoagulant therapy >12 months after pulmonary embolism (PE) with a high recurrence risk.Material and methods. The study included 72 patients who, according to indications, received long-term anticoagulant therapy >12 months due to a high risk of recurrent thromboembolism. During the follow-up period (15-20 months from the first pulmonary embolism episode), the plasma coagulation parameters were studied using a conventional panel and D-dimer assessment, as well as a thrombin generation test and thrombodynamics. Patients adherent to prolonged anticoagulation were included in group 1. During the collection period, 8 patients independently stopped taking anticoagulants, despite the high risk of recurrent pulmonary embolism (group 2).Results. There were no significant differences in coagulation parameters and D-dimer levels between the studied groups of patients. In the group of patients continuing to take anticoagulants, there was an increase in clot growth delay parameters in comparison with patients of group 2 according to the thrombodynamics results (p=0,046) and the thrombin generation test in platelet-poor plasma in comparison with reference values (p=0,001).Conclusion. Long-term anticoagulant therapy effectively prevents recurrent venous thromboembolism. In patients after primary pulmonary embolism who refuse anticoagulation, the clot growth delay values are shortened, which indicates an increased risk of recurrent venous thromboembolism. The most stable plasma coagulation parameters are observed in patients taking direct oral anticoagulants.

Aim. To evaluate the incidence and severity of acute kidney injury (AKI), as well as its ability to reclassify the risk of premature mortality and association with inhospital mortality in patients with pulmonary embolism (PE) in the Russian population.Material and methods. From April 2018 to April 2019, the SIRENA Russian Multicenter Registry included patients with PE, as well as the deceased, in whom the PE was detected by autopsy. AKI was diagnosed according to current KDIGO guidelines (2012). Creatinine calculated according to the MDRD equation and corresponding to a glomerular filtration rate of 75 ml/min/1,73 m2 (baseline) was taken as the initial one, with subsequent assessment relative to the parameter value upon admission. The risk stratification of early death was carried out in accordance with the current ESC clinical guidelines (2019).Results. A total of 604 patients with PE were examined (men — 293 (49%), women — 311 (51%), mean age — 64±15 years). AKI was diagnosed in 223 (37%) of them. Stage 1 AKI was detected in 146 (65%), 2 — in 55 (25%), 3 — in 22 (10%) patients. Prior chronic kidney disease was recorded in 61 (10%) patients. Seventy-one (12%) patients had a high risk of death, 364 (61%) — intermediate risk, and 164 (27%) — low risk. The AKI incidence increased as the severity of PE increased: at low risk of death — 26%, intermediate — 38%, high — 59% (p

Aim. To study the blood coagulation status by various laboratory methods in patients after pulmonary embolism (PE) receiving long-term anticoagulant therapy.Material and methods. The blood of 23 patients with pulmonary embolism, who received long-term anticoagulant therapy, was studied. The study of coagulation profile, D-dimer, thrombodynamics, thromboelastography and thrombin generation test were carried out.Results. The thrombin generation test shows a significant increase in the time of its formation, while the maximum amount of thrombin formed is half that of the reference values. There is a slightly increased median fibrin clot growth rate in the thrombodynamics test — 30,4 gm/min with a normal coagulation rate of 20-29 gm/min. The result of thromboelastography also reflects the blood hypocoagulation, in terms of R, Angle a and CI.Conclusion. Integral methods for assessing the thrombotic readiness in combination with a routine coagulation panel demonstrate a complete picture of blood coagulation potential in patients after pulmonary embolism requiring long-term anticoagulant therapy.

Aim. To assess the prevalence, severity and prognostic value of renal dysfunction (RD) in patients with pulmonary embolism (PE) of the Russian population, as well as to determine the RD significance as a marker that improves the predictive ability of current risk stratification systems.Material and methods. From April 2018 to April 2019, patients hospitalized due to PE were sequentially included in the Russian multicenter observational prospective registry SIRENA. RD was diagnosed at a glomerular filtration rate (GFR)

Aim. To create a new prognostic scale for in-hospital mortality risk assessment in patients with pulmonary embolism (PE).Material and methods. The study was carried out on the basis of Russian register of acute pulmonary embolism SIRENA.Results. Based on the Russian register of acute pulmonary embolism SIRENA (n=609; women — 50,7%; mean age — 63,0±1,5 years), independent predictors of in-hospital death were determined: left ventricular ejection fraction

Aim. To assess the features of diagnosis, treatment and outcomes of pulmonary embolism (PE) in patients of Russian hospitals.Material and methods. The register included all hospitalized patients with PE identified by any diagnostic method. Duration of inclusion was 12 months. In-hospital period management was assessed. Information about the included patients was provided by 20 hospitals from 15 Russian cities.Results. For the period from April 15, 2018 to April 15, 2019, 609 patients were included in the register (women — 50,7%, mean age — 63,0±14,5 years, minimum-maximum — 19-94 years). Among the known risk factors for PE, the most common were lower limb varicose veins (31,4%), heart failure (23,3%), previous deep vein thrombosis (19,4%), cancer (17,1%). The median time from symptom onset to suspicion/confirmation of PE was 4 days (1-3 quartiles — 1-8 days). Shortness of breath, syncope/presyncope, chest pain/discomfort, cough, leg pain or lower extremity asymmetry and hemoptysis were noted in 88,7%, 30,0%, 29,8%, 17,3%, 9,4% and 8,5% of patients, respectively. Echocardiography was performed in 89,5%, and Doppler ultrasound of lower limb veins — in 85,9% of patients. Signs of venous thrombosis were found in 57,8% of patients. Computed tomographic (CT) pulmonary angiography was performed in 89,2% of patients, pulmonary scintigraphy and pulmonary angiography — 0,8% each.Conclusion. Symptoms and main risk factors for PE in Russian patients did not fundamentally differ from those previously known. There was good adherence to modern guidelines for the diagnosis of PE, but adherence to guidelines on drug therapy met requirements only in half of the cases. There was an excessive use of TLT, as well as the use of ineffective methods of administering and monitoring anticoagulant therapy.In total, imaging technologies were used in 90,6% of patients, and signs confirming PE were found in 92,7%. Thrombolytic therapy (TLT) was performed in 25,0%; 92,0% of patients received anticoagulants. At the same time, unfractionated heparin (UFH) was injected subcutaneously in 26,3% of cases, and in one third of patients the drug was injected in doses unadjusted by body weight. In 42,7% of patients received UFH, the target activated partial thromboplastin time was not achieved. With warfarin treatment, the target international normalized ratio was achieved in only 48,4% of patients. Inferior vena cava filter placement and thrombectomy were performed in 1,3% each. During hospitalization (median — 11 days), 9,9% of patients died.

Aim. To study the clinical course and management of patients with pulmonary embolism (PE) of various age groups hospitalized in a cardiology hospital.Material and methods. This prospective single-center study in the period from 2016 to 2018 included 154 patients with PE verified by computed tomography. Statistical processing was conducted using the MedCalcVersion 16.2.1 software package (Softwa, Belgium).Results. In all groups, female patients dominated, but the highest number of women (70,7%) belonged to the group of senile patients, while in the group

Lymphotoxin-α (LTA) is a major pro-inflammatory cytokine produced at the early stages of vascular inflammation, taking part in the formation of arterial atherosclerosis and development of coronary heart disease. Functional changes in the gene encoding LTA production may influence the development of coronary heart disease with unfavorable progression. However, studies for associations between rs1041981 (C-804A) LTA gene variant and development of acute cerebrovascular accidents, myocardial infarction, and severity of coronary atherosclerosis have yielded contradictory results. The purpose of our study was to investigate an association of rs1041981 gene LTA with risk of adverse events within five years of follow-up in the patients with acute coronary syndrome without ST elevation ST (nonST-ACS). 178 patients with nonST-ACS from the Kemerovo Cardiology Center Registry were included into the study. Genotyping of rs1041981 site variable LTA gene was performed by TaqMan technique using an “iCycler iQ” device (BIO-RAD, USA). Results: we have found that the A allele and A/A genotype polymorphism in LTA gene (rs1041981) have been associated with development of adverse cardiovascular events over five years of observation (respective p levels were 0.02 and 0.036). In patients with A/A genotype, the rs1041981 polymorphism in LTA gene was associated with 3.8-fold increase in adverse cardiovascular events, compared to patients having A/C or C/C genotype. Carriage of A allele in LTA gene (rs1041981) doubles the risk of adverse cardiovascular events in patients with nonST-ACS at long observation terms. By means of Kaplan-Meier method, we have determined that survival to the first endpoint occurred more often in carriers of the genotype A/A of LTA gene (rs1041981). The A/A genotype of LTA gene (rs1041981) proved to be more significant (p = 0.016) for development of adverse outcomes, when combining the patients with A/C and C/C genotypes. One may draw a conclusion that A allele and A/A genotype of rs1041981 LTA polymorphism is associated with development of adverse cardiovascular events during the five-year period following the index event in patients with nonST-ACS.

The study included 120 patients with acute coronary syndrome (ACS), which were divided: in two groups, respectively, with ACS-ST segment elevation (group 1, n = 80), and without this clinical sign (group 2, n = 40). The levels of interleukins (IL)-6, -8, -10, and tumor necrosis factor-α (TNFα) were determined by quantitative ELISA test on the 1st and 10th days of the study. In both groups, the IL-8 and TNFα values on day 1 were similar to the reference level, whereas IL-10 levels were significantly reduced as compared to the standard values. IL-6 level was increased in patients with ACS-ST elevation only in acute phase of ACS, while the patients from group 2 showed normal IL-6 values. On the day 10, TNFα levels in the both groups of patients were significantly increased as compared to the 1st day, whereas IL-6 and IL-10 levels were significantly decreased by the day 10 in both groups of patients. Differential dynamics of IL-8 was observed for these groups of the patients from the day 1 to day 10, i.e., the IL-8 concentration showed a tendency to increase (by 40%) for the group 1 and decrease by 54% in the group 2. In conclusion, the patient grouped by different clinical ACS variants exhibit a similar dynamics of cytokine concentrations, but an increase of IL-8 by the day 10 of the disease was seen only in patients with ACS segment elevation. It may be indicative of different intensity of the inflammatory response.

Aim. To present a clinical case of late diagnosis of granulomatosis with polyangiitis (GPA), which for a long time was interpreted as a pulmonary form of tuberculosis with the passage of anti-tuberculosis therapy without effect, which led to severe structural changes and resection of the lungs and deformation of the bones of the facial skeleton.Materials and methods. Patient S., 31 y. o., was hospitalized in the rheumatology department with complaints of bloody discharge from the nose with the formation of crusts, hearing loss on both sides, weakness, nose deformity. From the anamnesis: in 2012, a cough with mucous sputum appeared. During examination at the Center for Combating Tuberculosis, on the basis of multiple rounded foci of both lungs, despite a negative diaskin test and the absence of mycobacterium tuberculosis in the sputum analysis, infiltrative tuberculosis was diagnosed. For two years, combined therapy with anti-tuberculosis drugs was carried out. In 2013, a staged combined resection of the left lung was performed; in 2014, a resection of the lower lobe of the right lung was performed. In 2015, nasal discharge increased, large crusts began to stand out, followed by bleeding, and a change in the shape of the nose was observed. In 2016, due to hearing loss in the left ear, he turned to an otorhinolaryngologist, diagnosed with ulcerative necrotic rhinitis, perforation of the nasal septum. Antibiotic therapy - no effect. Blood tests revealed positive antibodies to proteinase-3. In March 2017, he was hospitalized in the rheumatology department.Results. There were CT signs of fibrotic changes in the lungs with calcifications, areas of compaction of the “frosted glass” type in the upper lobes of the lungs. Laboratory examination revealed positive antibodies to proteinase-3, decreased glomerular filtration and tubular reabsorption. Analysis of the biopsy material from the lung and nasal mucosa revealed morphological signs of granulomatosis with polyangiitis. For the first time in 5 years, granulomatosis with polyangiitis was diagnosed, generalized form, chronic course, moderate activity, with damage to the upper respiratory tract (pansinusitis, rhinitis, chronic bilateral adhesive otitis media), lungs (nonspecific interstitial pneumonia), kidneys (microhematuria, proteinuria), joints (arthralgia). The activity index according to the Birmingham BVAS scale is 16 points, the VDI organ damage index is 6 points. In a retrospective analysis, tuberculosis was not confirmed. Therapy with prednisolone, cyclophosphamide (endoxan), biseptol was carried out, against which the patient's condition improved significantly.Conclusion. The presented clinical case demonstrates the difficulties of differential diagnosis of GPA with other granulomatous processes. Late diagnosis led to damage to vital organs: lungs, kidneys, deformity of the back of the nose, which, most likely, could have been avoided in case of timely diagnosis and early initiation of adequate therapy. As a result of an erroneous diagnosis at the onset of the disease, the patient underwent unjustified resection of both lungs twice. Timely diagnosis of the granulomatous process with the involvement of several pathologists as experts, including those with a torpid course of pulmonary tuberculosis, significantly improves the prognosis of patients and avoids fatal complications.

Introduction. One of the distinguishing features of systemic vasculitis is their manifestation under the guise of a lesion of one or another organ system, which is often multi-organ in nature with signs of systemic inflammation. The latter is interpreted primarily as part of an infectious or paraneoplastic process, which causes a delay in the diagnosis.The aim of the study was to present the diversity of the clinical picture in vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA), the speed and large volume of diagnostic measures with the effective cooperation of therapeutic and surgical specialists, radiologists on the way to verifying granulomatosis with polyangiitis in a young woman.Materials and methods. Patient K., 46 y. o., was hospitalized in the Otolaryngology Department of the N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Health Department with complaints of hearing loss, pain and stuffiness in the left ear, unproductive cough, hoarseness and fever up to 38.5 °C. According to the radiography (RG) of the chest organs, right-sided pneumonia was detected. Conducted antibiotic therapy without effect. As part of the differential diagnostic search, the following nosologies were excluded: infective endocarditis, sepsis, tuberculosis, primary multiple or central lung cancer complicated by paracancer pneumonia, metastatic lesion, infectious, brucellosis spondylodiscitis.Results. In the blood test, attention was drawn to a decrease in the level of hemoglobin to 111 g / l, an increase in the rate of erythrocyte sedimentation to 45 mm / h and the level of C-reactive protein to 142 mg / l, microhematuria according to the general urine analysis. Instrumental research methods – RG of 16.02.22, MSCT of the chest organs on 17.02.22, 27.02.22, 10.03.22 showed progressive bilateral focal pneumonia with a focus of consolidation in the middle lobe, EchoCG, ultrasound of the abdominal cavity and small pelvis, RG of the temporal bone, bronchoscopy with bronchoalveolar lavage and microscopic analysis, for atypia and bacteriological culture. A gynecological examination and a smear from the cervical canal for microscopic analysis were performed, atypical cells, consulted by a phthisiatrician (no data for tuberculosis), consulted three times by a thoracic surgeon (exclusion of volumetric formation of the middle lobe of the right lung). Given the history and clinical presentation (female gender, young age, bilateral otitis media, hoarseness, and destructive nature of pneumonia), granulomatosis with polyangiitis was suspected, and tests for ANCA were prescribed. A transthoracic biopsy of the right lung was performed. A rheumatologist prescribed induction pulse therapy with corticosteroids, and after serological and histological confirmation (antibodies to Proteinase-3 Anti-PR3 > 200 IU / ml, productive pneumonitis, granulomas without signs of tuberculosis), immunosuppressive therapy with cyclophosphamide. Against the background of pathogenetic treatment, a pronounced clinical and laboratory effect was noted.Conclusion. In this clinical situation, the simultaneous involvement of specialists of various profiles, the performance of a large number of laboratory and instrumental studies in dynamics, the absence of delay in histological verification made it possible to quickly exclude common diseases in the population and suspect systemic vasculitis, establishing a correct diagnosis within 5 weeks of the hospitalization period.

Objective: to evaluate the efficacy and safety of glycosaminoglycan-peptide complex (GPC, Rumalon) used in patients with knee osteoarthritis (OA) and comorbidities (hypertension and/or type 2 diabetes mellitus (T2DM).Patients and methods: A 10-month multicenter (13 centers from 10 subjects of the Russian Federation) prospective study included 179 patients with Stages II–III primary tibiofemoral knee OA and comorbidity, a walking pain intensity of ≥40 mm on a visual analogue scale (VAS), and a need for nonsteroidal anti-inflammatory drugs (for at least 30 days in the previous 3 months). The efficiency of treatment was evaluated from the changes in VAS scores for knee pain intensity during walking, the overall WOMAC score and scores of its individual indicators, laboratory parameters, and ultrasound data. All the patients received 2 cycles of GPC treatment with 25 injections, by following the manufacturer's instructions.Results and discussion. Even at 2 months after starting the treatment, there was a statistically significant reduction in pain during walking from 60 (50–69) to 40 (27–53.5) mm on the VAS (p< 0.05), which persisted during the follow-up period. A similar pattern was found when assessing the WOMAC index and its components. The drug demonstrated an anti-inflammatory effect: a decrease in the number of patients with synovitis from 55.7 to 39.2% (p=0.02), the level of high-sensitivity C-reactive protein (hsCRP) from 3.2 (1.3–6.2) to 2.6 (1.2–5.7) mg/l (p< 0.05). GPC was ascertained to have a safety profile.Conclusion. The data of this study confirm the good therapeutic effect and safety of GPC Rumalon in knee OA patients with hypertension and/or T2DM. The drug is shown to have a rapid analgesic and anti-inflammatory effect, as well as a positive influence on all clinical manifestations of OA.

in 3 mL on patients with knee osteoarthritis (OA) in a multicenter prospective study. Materials and methods. 79 outpatients (predominantly females 81.0%) from 5 RF constituent territories with primary tibiofemoral KellgrenLawrence score grade II or III knee OA, 40 mm pain intensity during walking on visual analogue scale (VAS), requiring NSAIDs intake (for at least 30 days during 3 months prior to enrollment) were included into the study after signing the informed consent form. Mean age was 60.38.7 years, mean BMI 29.24.7 kg/m2, disease duration 6 (310) years. Grade II OA was documented in 68.4% of patients, Grade III in 31.6%. The study lasted for 6 months. Efficacy and safety evaluations were made based on VAS pain assessment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [WOMAC pain (0500), WOMAC function (01700), WOMAC stiffness (0200)], VAS patients health status, EQ-5D-based assessment of patients quality of life, global physicians and patients efficacy assessment, and daily NSAIDs requirements. Results. Obtained results demonstrate statistically significant VAS pain reduction during walking already in 1 week after intra-articular injection of the combination [respectively, 62 (5572) and 41 (3251) mm, р0.0001]. Moreover, pain continued to subside during all 3 months of follow up [in 1 month 28 (2042), in 3 month 22 (1437) mm]. A significant pan reduction achieved at Mo 3 persisted until Mo 6 20 (1442) mm, without documented pain increase. Similar trends were observed with total WOMAC score [1125 (8991540) at baseline, and 552 (309837) mm by the end of the study, p0.0001], and all WOMAC sub-scores [268 (189312) baseline WOMAC pain, 91 (48171) mm by the end of the study p0.0001; stiffness 101 (59130) and 40 (2061) mm, p0.0001; function 802 (6471095) and 402 (191638) mm, p0.0001, respectively]. Median time to the onset of therapeutic effect was 7 (518) days. Statistically significant improvement of patients quality of life by EQ-5D and general health status was observed during all follow up period [respectively, 0.52 (-0.020.59) and 0.69 (0.590.80), р0.0001; 48 (3060) and 72 (6080) mm, р0.0001]. One injection of the drug resulted in dose reduction or discontinuation of NSAIDs therapy: at baseline 76 patients (96.2%) were taking NSAIDs, in one week 31 (39.2%) patients discontinued NSAIDs, in 1 month 72.2%, in 3 months 73.4%, and by the end of the study at Mo 6 54.4% were not taking NSAIDs. These data were consistent with physicians and patients global assessment of the efficacy of treatment, who stated significant improvement and improvement in the majority of cases, with only few no effect or worsening cases documented in analyzed population. Adverse events, such as worsening of pain and/or swelling of the joint, were documented in 8 patients (10.1%); they resolved spontaneously or following NSAIDs intake. Conclusion. These results suggest that intra-articular injections of hyaluronic acid plus chondroitin sulfate in patients with knee OA are efficient and safe. A single injection of the drug resulted in statistically significant reduction of pain and stiffness, reduction in NSAIDs intake, as well as improvement in patients quality of life and function.

Osteoarthritis (OA) belongs to diseases with high comorbidity and most frequently concurrent with obesity, diabetes mellitus (DM), hypertension, and other cardiovascular diseases (coronary heart disease, atherosclerosis), gastrointestinal tract diseases, and chronic diseases of the lung and kidney. Irrational treatment of OA in the presence of comorbidity and without considering characteristics of drug interactions leads to a pronounced increase in the number of adverse reactions (ARs) and to aggravation of the course of all concomitant diseases. From this point of view, therapy seems to be relevant when the latter involves drugs that have both symptom- and structure-modifying properties and have a high safety profile.Objective: to compare the safety of alternating and standard treatment regimens with Alflutop® in patients with knee OA.Patients and methods. 130 patients were enrolled in the trial who had Kellgren-Lawrence Grade II–III primary tibiofemoral knee OA with pain intensity on walking ≥40 mm on a visual analogue scale and who needed to take nonsteroidal anti-inflammatory drugs (≥30 days in the previous 3 months). The patients were randomized into two groups: Group 1 was prescribed Alflutop® 1.0 ml intramuscularly (IM) daily for 20 days (a standard regimen); Group 2 was given 2 ml IM every other day (a total of 10 injections) (an alternating regimen). The duration of follow-up was 14 weeks. The safety of Alflutop® was evaluated by the incidence of ARs and serious ARs (SARs) varying in severity according to medical records, laboratory tests, physical examination, assessment of a patient' vital signs, and electrocardiography (ECG). The patients were examined at the beginning, at the end, and 1 month after therapy.Results and discussion. No SARs were recorded during the study period and follow-up. There were 10 ARs in the group of patients receiving Alflutop® in the standard regimen and 19 ARs in the other group (the alternating regimen). All ARs corresponded to mild and moderate severity, were unassociated with the test drug, and resolved by the end of the follow-up. 12-lead ECG identified only clinically insignificant abnormalities in the patients of both groups. Patients without DM displayed no clinically significant increase in glucose levels. Those with DM had no increased glycemia tendency. Biochemical studies in both groups revealed only clinically insignificant abnormalities, the frequency of which was insignificant.Conclusion. This study has confirmed the comparable high safety of Alflutop® in both standard and alternative therapy regimens. It has also shown that the drug has a good safety profile and can be recommended for wide clinical application in any use regimen: 1 ml daily (a total of 20 injections) or 2 ml every other day (a total of 10 injections).

Using of more convenient drug regimens is one of the ways to increase patient adherence to treatment for osteoarthritis (OA).Objective: to evaluate the efficacy of Alflutop® in an alternating dosing regimen versus its standard administration to patients with knee OA. Patients and methods. The investigation included 130 randomized patients who had Kellgren—Lawrence Grade II—IIIprimary tibiofemoral knee OA with pain intensity on walking at least 40 mm on a visual analogue scale and needed to take nonsteroidal anti-inflammatory drugs (at least 30 days in the previous 3 months). The patients were divided into two groups: 1) those who received Alflutop® 2 ml intramuscularly (IM) every other day (a total of 10 injections); 2) those who used the drug 1.0 ml IM daily for 20 days. The duration of the investigation was 14 weeks. Results and discussion. Just on days 20/21 of treatment, the patients of both groups were recorded to have statistically significant reductions in knee pain on walking (p

The synthesized sample of covellite was investigated by NQR 63,65Cu methods. The experimentally determined values of the quadrupole frequency νQ and the asymmetry parameter η have been used to study the distribution of electron density in the region of the quadrupole nuclei in position Cu1. It is found that Cu-S bond in position Cu1 is ionic, and the gap LUMO-HOMO decreases with increasing temperature.

Aim. To investigate factors that influence annual prognosis in patients with non-ST-segment elevation acute coronary syndrome ((NSTEACS) concurrent with type 2 diabetes mellitus (DM2). Subjects and methods. The registry of patients with NSTEACS (non-ST-segment elevation myocardial infarction (NSTEMI), unstable angina) included 415 patients, of them 335 had no carbohydrate metabolic disorders, 80 had DM2. The follow-up period, during which the prognosis was evaluated in the patients, was one year after hospital discharge following the index NSTEACS event. Lipidogram readings and the serum levels of endothelin-1 (ET-1), sP-selectin, sE-selectin, and sPECAM were determined on day 10 after admission to hospital. All the patients underwent coronary angiography (CA), Doppler ultrasound of peripheral arteries during their hospital stay. Results. The patients with DM2 versus those without diabetes proved to be significantly older and to have a higher body mass index; among them there were more women, they were noted to have more frequently hypertension and less frequently smoked. The presence of DM2 was associated with significantly increased intima-media thickness and higher GRACE scores (p=0.013) as compared to those in the patients with normal carbohydrate metabolism. There were significant differences in high-density lipoprotein levels that were lower, as well as in triglyceride levels and atherogenic index, which were higher in patients with DM2 than in those without this condition. In addition, there were significant differences in ET-1, sP-selectin, sE-selectin, and sPECAM levels that were significantly higher in the DM2 group. Moreover, the levels of ET-1 and sPECAM were above normal in both the DM and non-DM2 groups. Assessment of poor outcomes at one year of the observation established that cardiovascular mortality rates were significantly higher and coronary angiography was performed much less frequently in the DM2 group. The most significant prognostic factors associated with a poor prognosis were as follows: multifocal atherosclerosis, reduced left ventricular ejection fraction (LVEF) less than 51%, and increased ET-1 levels more than 0.87 fmol/ml. Conclusion. The register-based study has shown that the presence of DM2 statistically significantly increases cardiovascular mortality rates during a year after the index ACS event; the patients of this category are less commonly referred for CA for the estimation of the degree of coronary bed lesion. The most important factors of recurrent cardiovascular events in patients with DM2 within a year after prior ACS are multifocal atherosclerosis, reduced myocardial contractility (LVEF less than 51%), and increased vasospastic endothelial function (an increase in ET-1 levels more than 0.87 fmol/ml).

AIM: 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/MATERIAL AND METHODS: 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/RESULTS: 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-α levels determined on day 1 of the disease; IL-1α 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% (p

A reduction in immunological parameters during therapy for rheumatoid arthritis (RA) can yield new data on the mechanisms of anti-inflammatory action and be of great practical importance since this allows judgment of the depth of impact on the immunological process and therefore may be regarded as one of the components of improvement and remission. Objective: to study the effect of the tumor necrosis factor-a (TNF-а) inhibitor adalimumab (ADA) on a number of key immunological parameters in RA. Subjects and methods. The study included 100 patients (11 men and 89 women) diagnosed with RA from 5 research centers. The patients were observed to have high RA activity: at baseline, DAS28 6.22+0.84 scores; C-reactive protein (CRP) 37.1+34.7 mg/l. The mean number of disease-modifying antirheumatic drugs (DMARDs) used by a patient in the history was 2.1. During 24-week treatment, the patients took ADA in a subcutaneous dose of 40 mg every 2 weeks both alone and in combination with DMARDs. The time course of changes in the serum levels of CRP, IGM rheumatoid factor (RF) and in the concentration of anti-cyclic citrullinated peptide 2 (anti-CCP2) antibodies was determined by enzyme immunoassay (EIA) using the Axis-Shield Diagnostics commercial kits (United Kingdom). The levels of TNF-a, interleukin (IL) 6, 12, matrix metalloproteinase 3 (MMP3) were measured in pg/ml by EIA using the Bender MedSystems commercial kits (USA) according to the manufacturer's directions. Results. During ADA therapy, there was a rapid reduction in the level of CRP from 34.3 to 11.317.2 mg/l following 2 weeks (p0,05). The mean levels of anti-CCP2 antibodies, IL-12, VEGF, and MMP3 remained unchanged. Conclusion. The time course of changes in immunological parameters during ADA treatment demonstrates the rapid and deep effect of TNF-a inhibitors on the different components of the pathogenesis of RA.

Aim. To confirm the efficacy and safety of adalimumab (ADA) added to the standard antirheumatic therapy performed in patients with rheumatoid arthritis (RA) of moderate and high activities.Subjects and methods. The open-labeled multicenter study enrolled 100 adult patients (11 men, 89 women; mean age 50.9±11.1 years) with active RA according to the ACR criteria (1987) despite their treatment with disease-modifying antirheumatic drugs, the average number of which in the history was 2.1 per man. At baseline, DAS28 CRP was as many as 6.2±0.84 scores; C-reactive protein (CRP) was 37.1±34.7 mg/l. In accordance with the indications officially registered in the European Union and the Russian Federation, ADA was given in a dose of 40 mg 2 weeks. Before administration of the drug, every patient underwent screening examination for tuberculosis, which used a tuberculin test and chest X-ray. The screening covered a period of the treatment up to 24 weeks and its subsequent period within 70 days after administration of the last dose of ADA in order to study its safety. Results. DAS28-CRP scores decreased from 6.14±0.86 (at baseline) to 3.39±1.1 (by the end of the study). At 12 weeks, 22% of the patients achieved a low RA activity (DAS28-CRP ≤3.2 scores); 14% achieved clinical remission ((DAS28-CRP ≤2.6 scores); at 24 weeks, these were 37 and 25% of the patients, respectively. There were differences in effectiveness in terms of the baseline disease activity. At 24 weeks, ACR20, ACR50, and ACR 70 responses were achieved in 88, 67, and 26% of the patients, respectively. The HAQ functional index reduced from 1.9±0.6 (at baseline) to 1.081±0.64 (at 12 weeks) and 1.04±0.68 (at 24 weeks) scores. Twenty-four patients were recorded as having 40 adverse reactions (AR), including only one severe AR (septic arthritis). There were no cases of tuberculosis. Conclusion. The Russian multicenter study demonstrated the high clinical efficacy of ADA in patients with the moderate and high activity of RA unresponsive to standard therapy, as well as its satisfactory safety.