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Hipertensiunea arterială și diabetul zaharat sunt afecțiuni coexistente, a căror prevalență se extinde exponențial, determinând creșterea riscului cardiovascular, avănd consecințe clinico-terapeutice și socio-economice importante. Asocierea între diabet zaharat și hipertensiune este frecventă, între cele două patologii existând o strânsa relație fiziopatologică ce explică prezența hipertensiunii la pacienții diabetici și a diabetului zaharat la pacienții hipertensivi. Procesul inflamator produs de acestea la nivelul endoteliului vascular determină declansarea evenimentelor cardiovasculare majore. Este necesară interventia terapeutică și nutrițională asupra valorilor tensionale și celor glicemice pentru a reduce riscul cardiovascular și încetinirea progresiei proceselor aterosclerotice.

Congestive heart failure with preserved left ventricular systolic function is termed “diastolic heart failure” and is more prevalent in the older population, may account for one half of the older population with congestive heart failure, and may be more common in women than men. The prognosis of patients with congestive heart failure due to diastolic dysfunction is less ominous than in patients with systolic dysfunction yet the morbidity can be high with frequent treatment failures and hospital readmissions.Conclusions: Thus, the diagnosis of heart failure with preserved ejection fraction (HFpEF) on elderly (≥ 85 years old) patients is cumbersome. Diagnosis of heart failure with preserved ejection fraction is challenging in euvolemic patients with dyspnea, and no evidence-based criteria are available. Diastolic LV dysfunction is very common parameter (58 %), but without any specificity for HFpEF, its treatments should be focused on the underlying disease etiology as well as on the derangement in left ventricular diastolic function.

În pofida administrării diverselor scheme de tratament farmacologic o mare parte dintre pacienții cu hipertensiunea arterială rezistentă rămân cu valori tensionale necontrolate, aceștia prezentând un risc sporit pentru complicații cardiovas- culare și renale. Recunoașterea rolulului major al sistemului nervos simpatic în patogenia hipertensiunii arteriale a dus la elaborarea unor metode minim invazive noi, care diminuează activitatea sistemului nervos simpatic la nivelul periferic renal, rezultând în reducerea valorilor tensionale. Un astfel de tratament reprezintă și desimpatizarea arterelor renale - metoda inovațională concepută acum 10 ani care presupune întreruperea fibrelor simpatice renale aferente și eferente prin aplicarea energiei cu radiofrecvență.În acest mod, ne-am propus realizarea unui studiu clinic deschis care va aprecia eficacitatea blocării sistemului nervos simpatic prin diverse regimuri terapeutice asupra variabilității nictemerale a tensiunii arteriale și profilului diurn circa- dian la pacienții cu hipertensiunea arterială rezistentă. Datele obținute au demonstrat eficacitatea antihipertensivă atât a tratamentului farmacologic, cât și cel intervențional, desimpatizarea arterelor renale însă având un impact net superior.

Tratamentul hipertensiunii arteriale rezistente rămâne a fi dificilă în pofida progresului înregistrat în dezvoltarea remediilor antihipertensive. În acest context, desimpatizarea arterelor renale și-a demostrat eficacitatea și siguranța confirmată în studii clinice publicate în ultimii trei ani. Ablația complexă a arterelor renale principale și ramificațiilor mici a acestora cu diametru peste 4 mm obținută cu catetere de a doua generație și-a demonstrat superioritatea în reducerea valorilor tensionale față de catetere de prima generație, care permiteau efectuarea ablației doar în ramurile principale ale arterelor renale. În lucrarea actuală este prezentată o parte din cercetarea efectuată în Departamentul Hipertensiuni arteriale, scopul acesteia fiind evaluarea eficacității denervării renale la pacienți cu HTA rezistentă.

INTRODUCTION: The choice of treatment strategy in patients with idiopathic pulmonary arterial hypertension (IPAH)/HPAH/DPAH (Hereditary pulmonary arterial hypertension/ Drug-induced pulmonary arterial hypertension) II-III functional class (FC) (WHO) based on an acute vasoreactive testing result (VRT). Positive VRT (VRT+) is an indication for calcium channel blockers therapy. Long-term vasoresponders demonstrate sustained low-risk status and the highest survival among all PH subtypes. THE STUDY AIMED: To characterize VRT performance in IPAH patients and differences in presentation between patients with positive, negative VRT, and patients with not done VRT due to physicians' decision. METHODS: One hundred and sixty-six adult IPAH patients (44.2 ± 15.3 years, 34 males) comprised into prospective single-center study between 2008 and 2023 years. Inhaled iloprost was used for VRT. Positive VRT was defined with established Sitbon criteria. Standard baseline pulmonary arterial hypertension (PAH) evaluation including cardiopulmonary exercise test (CPET) was performed. Risk status was evaluated using ESC/ERS (European Society of Cardiology/European Respiratory Society) risk scale 2015. Survival was assessed with the Kaplan-Mayer method. RESULTS: Eighty-five (51.2%) patients underwent VRT. VRT not done (ND VRT) due to the physicians' decision in 26.7% patients, due to the technical inability in 15.4% and IV FC (WHO) in 16.2% patients. Positive VRT registered in 26 (15.6%) patients. Patients with negative VRT demonstrated worse hemodynamics and exercise tolerance, higher N-terminal pro-brain-type natriuretic peptide (NT-proBNP) level, and right heart dilatation compared with VRT+. Patients with ND VRT due to the physicians decision were often older than 60 years, had higher body mass index, symptoms of right heart failure, hemoptysis, arrhythmias, high NT-proBNP, and hemodynamic criteria of high risk in comparison with patients with done VRT. Some CPET parameters were similar between VRT + group and patients ND VRT group. Loss of vasoreactivity and PAH worsening were detected in 50% of VRT + patients in a 1.76 year of follow-up. Patients with vasoreactivity loss exhibited the criteria of intermediate risk at a baseline. Five-year survival was 97% in VRT + group in comparison with 61% in VRT - and 53% in ND VRT group. CONCLUSIONS: Physicians' decision was the most common reason for not doing VRT in IPAH patients. Intermediate high-risk criteria presence at a baseline were associated with not done VRT due to physicians decision, negative VRT, and the vasoreactivity loss during the follow-up. CPET should be used more widely to detect the early signs of PAH progression in low risk or VRT + patients. Keywords: Cardiopulmonary exercise test, idiopathic pulmonary arterial hypertension, vasoreactive testing, vasoreactivity loss, Author(s): Goncharova Natalia (corresponding author) [1]; Kirill Lapshin [2]; Aelita Berezina [3]; Irina Zlobina [3]; Anton Ryzhkov [4]; Zhaneta Matakaeva [2]; Elizaveta Andreeva [1]; Olga Moiseeva [1] Idiopathic pulmonary arterial [...]

Aim. To evaluate the long-term safety and efficacy of goflkicept treatment in patients with idiopathic recurrent pericarditis (IRP). Materials and methods. This report presents the interim analysis of an ongoing open-label extension (OLE) clinical trial of goflkicept in patients with IRP (NCT 05673902), as a continuation of the core study (NCT04692766). The study assessed the frequency of pericarditis recurrence, time to recurrence after 12 and 60 weeks of goflkicept therapy, changes in C-reactive protein level, chest pain intensity, pericardial effusion size, and adverse events (AEs). Results. All patients remained in clinical-laboratory remission during the 60 weeks of goflkicept treatment. The recurrence frequency was 31.3% (5/16) after 60 weeks and 90% (9/10) after 12 weeks of goflkicept treatment (p0.001). A total of 64 AEs were reported in 16 patients (94.1%), mostly of mild to moderate severity. The most common AEs were infections, occurring in 11 patients (64.7%). Nine serious adverse events were reported in 5 patients, none of which were considered drug-related. There were no deaths. Conclusion. Long-term goflkicept therapy resulted in a significant reduction in the risk of recurrence and prolonged remission without an increase in adverse events.

Patologiile cronice invalidizante în timp , precum hipertensiunea arterială și diabetul zaharat tip 2 ramîn a fi în topul țintelor studiilor și abordărilor la nivel internațional. De aceea, oamenilor de știință , precum și personalului din cadrul bazelor practice nu le rămîne altceva decît să impună dezvoltarea si implementarea noilor preparate, care ar fi în stare să răspundă necesităților acestora. Un pas important ar fi sintetizarea moleculelor medicamentoase cu efecte pozitive în patologii concomitente, care de cele mai multe ori se întalnesc în perechi sau se complementează prin efectele adverse pe care le produc asupra organismului uman. Un astfel de preparat, care este la moment abordat prin prisma multitudinei efectelor benefice - este în plină companie de implementare în tratamentul a mai multor patologii cornice ca- diabet zaharat tip 2, insuficiența cardiacă cronică, insuficiența renală cronică si face parte din grupa inhibitorilor SGLT 2 este dapagliflozina.Efectul antihipertensiv al dapagliflozinei este relevant si impune o analiză bine documentată în această direcție

Datele prezentate fac parte componentă a reviului de literatură/rezultatele obținute în cadrul proiectului instituțional cu acronimul DIAFEREZIS. Hipertensiunea arterială (HTA) rezistentă la tratament reprezintă o povară semnificativă pentru sistemele de sănătate din întreaga lume datorită asocierii sale cu un risc cardiovascular extrem de ridicat și rămâne o dificultate terapeutică determinată de căi fiziopatologice complexe și insuficient abordate de terapia convențională. O serie de medicamente aflate în diferite stadii de investigare ar putea avea un impact semnificativ pe viitor asupra tratamentului HTA rezistente la tratament. Pe linga terapia farmacologică, studiile arată dovezi promițătoare în privința desimpatizării arterelor renale (DSAR) în gestionarea HTA rezistente. Utilizarea mai bună a terapiilor aprobate în prezent și integrarea terapiilor emergente sunt completări binevenite în arsenalul terapeutic antihipertensiv.

Rezumat. Introducere. Datele trialurilor clinice randomizate confirmă eficacitatea desimpatizării arterelor renale (DSAR) nu doar în rândul pacienților hipertensivi, dar și în alte patologii asociate cu activitatea sporită a SNS, precum diabet zaharat tip 2, insuficiență cardiacă și altele. Scopul. Evaluarea impactului DSAR asupra valorilor tensionale la două categorii de pacienții - HTA rezistentă cu și fără diabet zaharat tip 2. Materiale și metode. A fost proiectat studiul clinic prospectiv randomizat care a înrolat 250 pacienți hipertensivi rezistenți divizați în două grupuri egale a câte 125 pacienți în funcție de prezența DZ tip 2. Pacienților din primele două subloturi a fiecărui grup tratamentul standardizat a fost suplimentat cu blocantele SNS Moxonidina și Bisorpolol, pe când pacienților din subloturile III și VI a fost efectuată DSAR. Pacienții au fost evaluați prin monitorizarea dinamică ambulatorie a TA timp de 3 ani.Rezultate. Reducerea autentică a TAS și TAD de birou a fost notată începând cu 6 luni de evaluare în toate loturile de cercetare, analiza comparativă a dinamicilor TAS de birou la toate etapele de cercetare demonstr ând o superioritate certă a loturilor de tratament minim invaziv prin DSAR versus tratament farmacologic cu blocantele SNS Moxonidină și Bisoprolol în ameliorarea acestor parametri. Simultan, a fost înregistrată o reducere statistic semnificativă a valorilor medii ale TAS și TAD 24 ore atât în loturile de tratament farmacologic, cât și intervențional, independent de prezența diabetului zaharat tip 2, efectul antihipertensiv maxim fiind exprimat la 36 luni de evaluare. Loturile pacienților diabetici și non-diabetici supuși DSAR au manifestat superioritatea față de ambele regimuri farmacoterapice la toate etapele de monitorizare.Concluzii. Rezultatele obținute au demonstrat eficacitatea antihipertensivă comparabilă a DSAR la pacienții hipertensivi rezistenți cu sau fără diabet zaharat tip 2. Totodată, loturile pacienților diabetici și non-diabetici supuși DSAR au manifestat superioritatea față de ambele regimuri farmacoterapice cu blocantele SNS în reducerea valorilor tensionale, efectul benefic fiind menținut pentru o perioadă de trei ani de monitorizare.

The research examines fertility patterns in Russia by using current calendar birth rates and their implications for actual generations. Birth rates for these generations are derived from the 2020 Census data and are further refined through calculations employing one-year age-specific rates. This methodology allows us to estimate parameters for age-specific fertility models in real generations, offering a different approach compared to traditional population census methods. Given the variance in fertility rates by birth order, the analysis favors a segmented approach, separately considering trends for first, second, third, and subsequent births. Factors influencing fertility are examined both statistically, with a focus on the impact of population age–sex structure transformations on overall fertility rates, and through insights from Vyborochnoe nabliudenie reproduktivnykh planov naseleniia [Sample Observation of Population Reproductive Plans] performed by Rosstat [Federal State Statistics Service] in 2022. Value orientations are the primary determinant in reproductive behavior, which means that a key goal of demographic policy is to influence these orientations. However, it is also possible to influence fertility rates through social and demographic policies creating favorable conditions for families to fulfill their desire for children.

Background.The study presents the original results of studying the ecological and biological features of the seed-bearing seradella (Ornithopus sativus Brot.) during introduction in the conditions of the middle taiga of Western Siberia and gives a primary assessment of the prospects for its introduction into the culture of the region (using the example of the Surgut district). For the first time, the potential alum resistance of the crop was determined, the features of ontogenesis and biomorphological signs were revealed, the results of feed assessment and productivity were presented, the possibility of cultivating seradella for fodder in extreme soil and climatic conditions of the Khanty-Mansiysk Autonomous Area was established. Materials and methods. The research on the study of the ecological and biological features of the seradella sowing and the prospects of introduction in the conditions of the middle taiga of the Western Siberia was conducted on the basis of Botanical Garden of the Surgut State University of the Khanty-Mansiysk Autonomous Area-Yugra. The object of the study is the annual legume seradella seed (Ornithopus sativus Brot.). Results. As a result of the research, it was found that seradella sowing belongs to the 1st group of plant species resistant to aluminum ions, since the studied concentrations did not have a significant effect on the vegetative organs of the plant. And in the conditions of the cold northern climate of the Khanty-Mansiysk Autonomous Area, seradella sowing has a shortening of the duration of interphase periods in the virginal period of development and an elongation of the onset of the main phenological phases in the generative period. The feed obtained from the herbage of the crop has a high biological value. Conclusions. Based on the data obtained, it can be said that the seed seradella (Ornithopus sativus Brot.) has a high adaptive potential to the limiting soil and climatic factors of the middle taiga of the Western Siberia.

The interest in terbium radionuclides, which can be used in nuclear medicine, has increased tremendously over the last decade. Several research studies have shown the potential of four terbium radionuclides 149,152,155,161Tb both for cancer diagnosis as well as therapy. The comparison of 161Tb and 177Lu showed 161Tb as the preferred candidate not only for standard radiotherapy, but also for the treatment of minimal residual disease. Nevertheless, among the terbium sisters, currently, only 161Tb has an established production protocol where its no-carrier-added form is obtained via neutron irradiation of enriched 160Gd targets. The other terbium radioisotopes face challenges related to production capacity and production yield, which currently restricts their use in nuclear medicine. The purpose of this review is to report on recent research on the production and separation of terbium sisters and to assess the prospects for upscaling their production for nuclear medicine applications.

Background. The generally accepted approach to management in organizational systems today differs in that participants in problematic situations (PrS) are excluded from the processes of their solution. Complementing the traditional approach to management with the ability to solve PrS by the actors themselves makes it possible to enrich decision- making processes through the use of volitional and intellectual resources of subjects. For information support of actors, a decision support system (DSS) is being developed, the design of which faced the task of choosing methods for searching and comparing various objects in the process of intersubjective management of PrS solution. The purpose of the study is to analyze and select methods for searching and comparing various objects in the database, knowledge base, and library of DSS precedents, which can be used in the development of algorithms for supporting and making decisions by actors building personal ontologies of the DSS as a result of communication on the DSS site. Materials and methods. The materials are the main provisions of the theory of intersubjective management of problematic situations solution. Methods of comparison and search in the database and knowledge base of similar objects – algorithms for fuzzy string comparison and methods for finding substrings in a string, as well as management theory, system analysis, decision theory, knowledge engineering. Results. A review of methods for searching and comparing data is carried out, with an emphasis on methods applicable to subject-to-subject (intersubjective) management of the PrS solution. Among the well-known algorithms, four of the most popular fuzzy string comparison algorithms are highlighted: Hamming algorithm, Levenstein editorial distance (algorithm), Damerau–Levenstein editorial distance (algorithm) and distance (algorithm) Jaro-Winkler. Among the search algorithms applicable to one– dimensional string arrays of data, the following are highlighted and considered: the simple search algorithm (linear algorithm), the Robin–Karp algorithm and the Knuth–Morris-Pratt algorithm. Conclusions. It is proposed to use a linear algorithm as the most suitable for solving problems related, for example, to searching the library for use cases by the names of the PrS and keywords.

Aim. To study the features of macrophages in the tissues of resected valves in operated patients with infective endocarditis (IE), their significance and interaction with inflammatory markers to improve the effectiveness of IE diagnosis. Materials and methods. Prospectively the research included 25 adult patients with active IE (Duke criteria 2015) and 24 patients with heart defects without IE, hospitalized in a cardiosurgical hospital in Moscow (2021–2022). A standard laboratory and instrumental examination was carried out for the diagnosis of IE, including etiological diagnosis with microbiological and molecular biological methods, and echocardiographic examination of heart. Additionally, the neutrophil-to-lymphocyte ratio (NLR) was calculated. The study of macrophages was carried out in the tissues of resected valves with the determination of the expression of pro- and anti-inflammatory cytokine genes, macrophage markers (CD 68+) using real-time PCR. Results. Increased expression of proinflammatory cytokines IL-1β, TNF-α and IL-6 was revealed in the group of operated patients with IE with significant differences in IL-1β (CI [IQR] 0.00367 [0.00047–0.01553] vs 0.00018 [0.00012–0.00262]; p0.05) and IL-6 (CI [IQR] 0.00367 [0.00047–0.01553] vs 0.00018 [0.00012–0.00262]; p0.05) and IL-6 (CI [IQR] 0.00338 [0.00066–0.01674] vs 0.00054 [0.00044–0.00378]; p0.05). The expression of anti-inflammatory cytokines in valve tissues prevailed in the control group without significant differences from patients with IE. The macrophage marker CD 68+ was revealed in all examined patients with a significant quantitative predominance in the group of patients with IE. There were no differences in the expression of pro- and anti-inflammatory cytokines depending on the presence of embolic events, intracardiac complications, etiological affiliation to S. aureus, as well as hospital mortality and combined endpoint (death from all causes or recurrence of IE 6 months after surgery) in patients with IE with or without events. Cytokines IL-1β and IL-6 positively correlated with each other, with leukocytes and NLR. ROC analysis determined that IL-1β and NLR had the most favorable features for the diagnosis of IE [IL-1β AUC 0.816 (p=0.02), NLR AUC 0.807 (p=0.03)]. IL-6 did not show a diagnostic value in IE. The threshold value for IL-1β was 0.00029 (sensitivity 86.4%, specificity 60.0%, prognostic value of negative result 75.0% and positive 76.0%, AUC 0.761; p=0.008). Conclusion. The valve macrophages of patients with IE express elevated levels of proinflammatory cytokines IL-1β and IL-6, regardless of etiological affiliation or complicated course of IE. IL-1β has a high diagnostic value for determining the inflammatory activity in IE.

Background. Despite the clear trend towards infant mortality decrease in our country, there are significant differences in values in some federal districts and regions of Russian Federation. Thus, the assessment of infant mortality rates and health indicators is crucial topic of scientific analysis. Objective. The aim of the study is to investigate selected child health indicators and infant mortality rates in the Chechen Republic. Methods. We have conducted the retrospective cross-sectional study of infant mortality rates, prematurity incidence, infant and newborn morbidity, and mortality of children born sick or got sick. The study was based on the data from official statistics and from the extraction of statistical reporting forms No. 12 and No. 32. Results. The Chechen Republic belongs to the regions with high infant mortality rate, however, it has decreased by 11.6% from 6.9 to 6.1‰ in 2018–2022. The major diseases causing lethal outcomes in infants in this region, and in Russia as a whole, were certain conditions that occur in the perinatal period, and congenital disorders. Meanwhile, mortality from respiratory diseases and some infectious and parasitic diseases exceeded the national average. Prematurity incidence in the republic was 1.5 times lower than the national average, newborns morbidity was 1.7 times lower, infants morbidity was 4.0 times lower. Trend analysis has revealed that prematurity incidence and newborns morbidity have slightly changed over 5 years (+2.2% and –1.0%), while infants morbidity had significant trend (–40.2%). All morbidity rates of children who died at the age under 1 year were significantly lower than the national average for all classes of diseases that are the most common for infants mortality. The mortality rates among children born sick or got sick were on average 5.4 times higher than similar indicators in Russia. The highest mortality rate was observed among children who died from perinatal conditions, congenital disorders, external causes, and some infectious and parasitic diseases. The level of the maternal and child health service performance was 0.44 on average over the 5-year interval, that corresponds to the average level of efficacy. Conclusion. This study has allowed to reveal that there is an urge to improve the organization of medical care for infants in the Chechen Republic.

Purpose. Recognition of deer individuals by their graphic images based on convolutional neural network models. Research methods and materials. The material for the research was marked images of deer in different habitats, published in the public domain. Research methods: theory of design and development of artificial intelligence systems; image augmentation for computer vision tasks; hyperparameter tuning algorithms for training neural network models. Results. Conservation of the deer population is one of the important goals in ecology and agriculture. The control of the number of individuals affects the conservation of rare species of deer, and supports the production volumes on farms. For example, such a control method may be the detection of deer individuals in photographs. To accurately determine and count the number of deer, you can use a tool such as a neural network. We used deep learning methods for convolutional neural networks, as well as the concept of “transfer learning”. On the basis of the Faster R-CNN Resnet50 network, a neural network was trained, which allows, with an accuracy of 0.91, to determine individual individuals in the images using the F1-score metric with a threshold value of 0.6 (coincidence of the area of the predicted markup and the actual one) with an accuracy of 0.91. Conclusion. To solve the problem of deer detection, a data set has been prepared, including more than 30 thousand images, with markings of individual individuals. The marking of each individual included the coordinates of the bounding rectangle in the image. Based on this information, a neural network model was developed and trained using software tools to solve the problem of detecting deer objects in images. The experiments carried out showed that the accuracy of detection with augmentation in accordance with the F1-score indicator with a threshold value of 0.6 on the training sample was 0.96, and on the test sample was 0.91.

BACKGROUND: Considering the high cardiovascular risk in patients with familial hypercholesterolemia (FH), early diagnosis and treatment are the basis for the prevention of vascular accidents. In the absence of universal screening, the results of more targeted diagnostics are of interest — the search for lipid metabolism disorders in young relatives of patients with atherosclerotic vascular diseases. OBJECTIVE: To determine the effectiveness of targeted screening for identifying patients with FH, which will justify its widespread use in clinical practice. MATERIALS AND METHODS: At the start of the observational study, 584 patients were identified from the vascular centers of the Krasnoyarsk Regional Hospital, Krasnoyarsk Interdistrict Clinical Hospital No. 20 named after. I.S. Berzon, who had lipid profile data and early cardiovascular events (all forms of coronary heart diseases), including reconstructive vascular interventions up to 55 years in men and up to 60 years in women in the case of first-degree relatives and up to 50 years in second-degree relatives. The study examined patients’ relatives aged 44 years. To diagnose FH in participants aged 16 years, the scale developed by a network of Dutch lipid clinics was used; in participants aged 16 years, the S. Broome criteria were used. Targeted screening and lipid parameters in individuals with probable, possible, and definite FH were analyzed. Data processing was performed using Microsoft Excel and Statistica v. 12.0 (USA). Parametric (calculation of the median and 25th and 75th quartiles) and nonparametric (statistical significance of differences was determined using the Mann–Whitney and χ2 tests) methods were used. RESULTS: The study examined 70 children and 104 adults aged 44 years whose first- and/or second-degree relatives suffered premature vascular events. In the general group of participants, 42 (24.14%) patients had FH (of which 18 were 17 years old) and 37 (21.2%) had hyperlipoproteinemia (a). Definite FH was documented in 16 (9.1%) patients, probable in another 16, and possible in 9. Hyperlipoproteinemia (a) was found in 37 (21.2% of general group) patients, including 12 children (17.1% of pediatric group). CONCLUSION: Not more than 30% of the population are aware of the hereditary nature of lipid metabolism disorders and atherosclerotic diseases. Targeted screening is the least expensive and most effective tool for identifying patients with FH and hyperdipoproteinemia (a).