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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.

Objective: to analyze the roles of undifferentiated connective tissue dysplasia (UCTD) in the development of cartilage and ligamentous apparatus diseases.Material and methods. This paper presents the results of analyzing the literature on fundamental and clinical studies of relationships between chondroitin sulfate (CS) and connective tissue (CT) disease. A total of 922 publications on the relationship between CT dysplasia and CS and 2249 publications on CS receptor molecules were analyzed. These arrays of publications were analyzed using topological and metric approaches to data analysis.Results and discussion. The genetic predisposition to UCTD is substantially aggravated by inadequate nutrition that leads to deficiency of certain micronutrients that support CT reconstructive processes. The paper presents the results of a systematic analysis of prospects for the use of drugs based on standardized CS substances in patients with UCTD. CS is a material for CT reconstruction. CS increases the activity of growth factors and reduces CT inflammatory destruction (inhibition of the secretion of histamine, pro-inflammatory chemokines, Toll-like receptors, and the NF-κB cascade through exposure to the CD44 receptor).Conclusion. The pharmacological effects of CS indicate the importance of using standardized CS forms in the treatment of patients with UCTD.

Aim. In practice, to evaluate the efficacy, safety and long-term adherence to therapy with a fixed-dose combination of ramipril/indapamide (Konsilar-D24) in patients with grade 1-2 hypertension (HTN) who have not achieved blood pressure (BP) control with prior therapy or have not taken antihypertensive therapy.Material and methods. This multicenter open-label observational program included 524 patients with grade 1-2 HTN who did not take antihypertensive therapy or did not reach the target BP level with mono or dual antihypertensive therapy, as well as patients shifted to Konsilar-D24 therapy no later than two weeks before the start of the program. All patients signed a written informed consent to participate in the program. The safety analysis set includes all patients who have taken at least one dose of a fixed-dose combination of ramipril/indapamide and have visited physician at least once during the program. The effectiveness analysis set included all patients in the safety population who completed the study in accordance with protocol (n=511). Clinical systolic blood pressure (SBP), diastolic BP (DBP) and heart rate were assessed at baseline, as well as at 0,5, 1, 3 and 6 months of treatment. A post hoc subgroup analysis of changes in BP and heart rate was performed depending on age, sex and baseline body mass index.Results. The fixed-dose combination of ramipril with indapamide significantly reduced SBP and DBP after 2-week treatment (-20,9±10,1 mm Hg; pConclusion. Despite the limitations inherent in observational studies, the KONSONANS program has demonstrated high efficacy and safety of fixed-dose combination of ramipril/indapamide taken once a day in hypertensive patients. Ramipril/indapamide fixed-dose combination therapy significantly improved BP control and achieved even lower individual target BP levels in the majority of hypertensive patients.

Aim. To assess the influence of addition of nicorandil on long-term cardiovascular complications in patients with chronic coronary artery disease (CAD) in the framework of a prospective observational study.Material and methods. Prospective observational multicenter NIKEA study included 590 patients with stable CAD. All patients were recommended to add nicorandil to their baseline therapy. After 21 months, 547 telephone contacts were made, the life status of 524 people was specified, 23 patients were lost to follow-up. The following complications were registered: death from any cause; non-fatal myocardial infarction (MI); non-fatal stroke; urgent myocardial revascularization; hospitalization due to deterioration of CAD, chronic heart failure (CHF) or atrial fibrillation (AF). In 479 patients, a telephone survey was performed to identify adherence (persistence) to nicorandil– i.e. to verify the continuing the treatment for the prescribed duration.Results. During the follow-up period, 15 deaths were recorded, the causes of which were as follows: 3 CAD (2 MI, 1 left ventricular aneurysm), 1 pulmonary embolism, 2 CHF; 1 stroke, 1 oncology, 1 bilateral pneumonia. In the remaining 6 cases, the causes of death were not known. Cardiovascular (CV) complications were MI (8 cases in 7 patients, 1 patient had 2 MI in the follow-up period, 3 patients from this group died), stroke in 6 patients (7 cases, 1 patient had 2 strokes, 1 patient died). Urgent percutaneous coronary intervention was performed in 3 patients (in 2 patients due to acute MI, in 1 patient due to unstable angina). During the observation period, 21 people were urgently hospitalized due to deterioration of clinical condition. According to the results of a medical survey, by the end of the follow-up period, 237 people were not adherent to prescribed nicorandil, and 242 patients took the recommended medication (adherent patients). The main cardiovascular complications and death from any cause (рConclusion. The overall rate of CAD complications in NIKEA study was typical for patients with stable CAD receiving contemporary medical therapy. Addition of nicorandil significantly reduced the rate of CV complications in adherent patients in comparison with non-adherent patients.

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

The article is focused on a variety of aspects of aortic pathology in connective tissue dysplasias; approaches discussed to diagnostics and management of aortic dilation in dysplasias.

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. To assess the results of addition of nicorandil to the treatment of ischemic heart disease: clinical course and long-term outcomes, and to evaluate life quality and treatment adherence in stable angina patients. The article provides data on the NIKEA study design and results of antianginal efficacy of the drug. Material and methods. The design is prospective multicenter observational study. Totally, 14 institutions participated, from different Russia regions. Included 590 patients: 261 women (44,2%) and 329 men (55,8%). Mean age 65,1±9,6 y.o. All patients had inclusion criteria and no exclusion criteria. All participants, in addition to standard antianginal therapy, were recommended to take nicorandil dosage 20 mg daily with titration up to 40 mg daily in 1 month of the observation. By the protocol, three office visits were set (inclusion, in 1 month and in 3 months): V0, V1, V3. During the visits, physical examination was done, anthropometry, hemodynamics measurement. Antianginal efficacy was assessed with patients diaries on angina attacks and demand of short-acting nitrates (SAN). At the visits V0 and V3 patients completed Seattle life quality questionnaire in CHD, and at V0 also an original questionnaire was completed for adherence evaluation. Results. Among 590 patients included in NIKEA, 582 (98,6%) confirmed their intention to take nicorandil and 6 refused to buy additional medication. On the planned visits V1 and V3552 patients came: of them 402 started taking nicorandil, and in 1 month 383 continued; in 3 months — 327 patients continued. During the visits V1 and V3 a statistically significant decrease in angina attacks frequency and in demand of SAN was noted (p

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.

Aim. To compare the antihypertensive and metabolic effects of combined therapy (carvedilol reception and «School of the hypertensive patient») with these of the carvedilol monotherapy in young patients with arterial hypertension (HT) of 1-2 degrees with overweight and obesity.Material and methods. 63 out-patients with HT of 1-2 degrees (aged 18-27 y.o.) with overweight and obesity were included in the open parallel randomized clinical preventive trail. Patients wеre randomized into 2 groups. All hypertensive patients received the carvedilol (Vedicardol, Sintez, Russia) 25 mg daily. Carvedilol dose was enlarged twice in case of insufficient antihypertensive effect. Patients of the main group (n=32) also passed through the special educational program «School for hypertensive patients». Changes in blood pressure (BP) level, body mass index, biochemical markers and risk factors were evaluated initially and in 24 weeks of therapy.Results. Patients of the main group had more significant risk factor manifestations decrease than in group of comparison. More significant body mass index decrease was also observed in the main group in comparison with group of comparison: from 32,5±0,4 to 26,4±0,7 kg/m2 (pConclusion. It is reasonable to combine carvedilol therapy with special training in the young hypertensive patients with overweight and obesity.

Aim. To compare two therapies based on carvedilol or metoprolol in hypertensive patients with overweight and obesity.Material and methods. 320 patients with arterial hypertension (1-2 degree) were involved in the study. 160 patients received carvedilol and 160 patients – metoprolol. Both randomized groups were comparable on the main clinical characteristics.Results. By the end of the study both systolic and diastolic blood pressure (SBP, DBP) reduced in both groups рConclusion. The results of open, randomized CAMELLIA trial confirmed antihypertensive effect and good tolerability of carvedilol in common clinical practice as well as demonstrated some its advantages in patients with metabolic syndrome. Carvedilol has positive metabolic effects on lipid, glucose and uric acid levels. Carvedilol therapy is more preferable in patients with arterial hypertension and metabolic risk factors.

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 assess the adrenergic receptor activity and the effects of Magnerot therapy in patients with cardiac arrhythmias and connective tissue dysplasia (CTD). material and methods. The study included 18–35-year-old patients with cardiac arrhythmias and CTD. In all participants, sympathoadrenal system activity was evaluated via beta-adrenoreceptor sensitivity. In particular, erythrocyte osmotic resistance was measured in the presence of beta-adrenoblockers (diagnostic kit “AGAT Med”, Moscow). Results. Patients with ectopic cardiac arrhythmias and CTD demonstrated increased erythrocyte hemolysis levels in the presence of beta-adrenoblockers, which suggested adrenoreceptor desensitisation in this clinical group. A four-month Magnerot treatment was associated with a significant reduction in desensitisation of erythrocyte beta-adrenoreceptors (p

Aim. To evaluate the dynamics of cardiovascular risk factors (RFs) and quality of life (QoL) in young patients with Stage I-II arterial hypertension (AH) and overweight/obesity during pharmaceutical (carvedilol monotherapy) and non-pharmaceutical (School for AH Patient) intervention. Material and methods. This open, randomised, clinico-preventive study in parallel groups included 63 out-patients with Stage I-II AH and overweight/obesity. The patients aged 18-27 years were randomised into 2 groups. All participants were randomised into two groups and received carvedilol (25 mg/d). In patients with uncontrolled blood pressure (BP), carvedilol dose could be titrated up to 50 mg/d. In addition, the main group (MG; n=32) received non-pharmaceutical structured intervention “School for AH Patient”. At baseline and after 24 weeks of the therapy, the levels of BP, QoL, body mass index (BMI), biochemical parameters, and RFs were assessed. Results. In the MG, RF levels were reduced to a greater extent than in the comparison group (CG). The MG patients demonstrated a greater decline in BMI (from 32,5±0,4 to 26,4±0,7 kg/m2 ; p

Aim. 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. Material and methods. 87 social workers filled in a special questionnaire before and after training in management of old persons with CCF. Results. 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. Conclusion. 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.

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