The article provides review of literature on the role of c Jun N terminal kinases (JNK) in ischemia/reperfusion injury of the myocardium. The classification of JNK is presented; JNK functions in signaling mechanisms are described in the context of ischemia/reperfusion injury. Authors discuss biological effects of pharmacological modulation of JNK by using synthetic and natural compounds in the models of myocardial ischemia/reperfusion. The role of JNK in the mechanisms of pre and postconditioning of the heart is highlighted. Results of experimental studies are demonstrated that JNK represent potential therapeutic targets for cardiac protection from ischemia/reperfusion injury. At the same time, the presence of multiple physiological JNK properties does not allow for systemic use of non specific JNK inhibitors for therapeutic purposes. Authors conclude that the actual problem is the further search for selective JNK3 inhibitors.

The study of comorbid depression in patients with coronary artery disease (CAD) is pivotal since its high incidence and prognostic significance for the underlying disease. Currently, biological mechanisms of depression and its relationship with coronary artery disease are not clearly defined, which is associated with a variety of predisposing and pathogenetic factors. The review discusses the role of genetic polymorphisms within the serotonergic system in the development of comorbid depression in patients with coronary artery disease.

The article is devoted to analysis of modern methods of atrial fibrillation treatment in patients with coronary artery disease and coronary artery bypass grafting. Systematic review of various surgical ablation techniques and methods has been done in particular. The necessity for radiofrequency ablation modification is substantiated.

Failure of sternal suture after median sternotomy is a severe cardiac surgery complication causing respiratory dysfunction and contributing to superficial and mediastinal infection affecting patients’ survival. Perioperative risk factors for sternal dehiscence include the approaches to sternal osteosynthesis and type of suture material. To improve respiratory biomechanics and quality of life in patients with postoperative sternal instability without infection as well as in patients with postoperative sterno mediastinitis, sternal osteosynthesis is a relevant final step of treatment after elimination of the infection. To achieve that, various suture and wound closure materials are used. Stainless steel wire or polyester material sternal sutures are common, but they are often cheese wire tissues due to chest motions leading to cascade of complications and requiring reoperations. Therefore, new approaches and systems for restoration of sternal integrity continue to be developed. This article reviews currently available sternal resynthesis methods used for treatment and prevention of sternal sternotomy complications.

The article reviews modern concepts regarding the effects of lead poisoning on the cardiovascular system and the effects of hypoxia on the development of pathological changes in the heart. Literature data describing the routes and the mechanisms of lead effects on the development of atherosclerosis, anemia and blood vessels are analyzed.

Aim. We have carried out the direct comparison between MR images of atherosclerotic plaques of carotid arteries and morphologic density of microvasculature of the plaques, as seen from surgical specimen removed at carotid endarterectomy.

Materials and Methods. Twenty two patients with internal carotid artery stenosis over 70% were included and all underwent contrast enhanced MRI and MR angiography of carotid arteries before carotid endarterectomy. In order to quantify the changes in T1 weighted images due to contrast uptake to the plaque, the index of enhancement (IE) was calculated in all patients as ratio of post and pre contrast intensities per voxel over the plaque. The index of vascularity was scored from the microscopy of the resected specimen based on the number of capillaries in plaque per field of view (f.o.v) (mag.x200). In particular: 0 – no capillaries detected; 1 degree – 1–3 /f.o.v; 2 – 4–6 /f.o.v; 3 – 7–9 /f.o.v; 4 – 10 or more.

Results. Vascularity degree 0–1 was observed when IE was in ranges of 1.01–1.15; degree 2 corresponded to IE of 1.16–1.34; degree 3 corresponded to IE of 1.35–1.46; vascularity degree 4 corresponded to IE >1.46. In all cases, the inter group significance of differences was p<0.05 or better. Correlation between morphologic degree of vascularity and MRI index of enhancement was revealed as: {Degree of vascularity} = –4.98+5.54 *{Index of enhancement}, r=0.92, p<0.05. The cerebral ishaemic micro and macro regions of damage were observed only in cases when degrees of plaque vascularity were 2 or more, respectively with IE >1.22.

Conclusions. Enhanced uptake of paramagnetic contrast agent to the atherosclerotic plaque occurs when the capillary vascularity of the plaque is enhanced and when revealed (i.e. if index of enhancement is over 1.22) should be accepted as additional indication to carotid endarterectomy or to stenting of the stenosis. The quantitative processing of the contract enhanced MRI of the carotid plaques and arterial walls of the carotid arteries should be employed for noninvasive evaluation of the vascularity of atherosclerotic lesions.

The aim of the study was to quantify the arterial and venous blood flow parameters by ultrasound in patients with atherosclerosis of the carotid artery before and after carotid surgery, at rest and during stress tests. The clinical group comprised 52 patients with hemodynamically significant stenoses of internal carotid arteries. The control group included 14 healthy volunteers. The parameters were quantified at rest and during the functional tests, before operation, and in the early period (7–10 days) after carotid endarterectomy. The results suggest that comprehensive arterial and venous ultrasonography provides adequate control of cerebral hemodynamics and cerebrovascular reserve follow up in the course of carotid endarterectomy.

Objectives. The objective of the study was to investigate the influence of the main right ventricular (RV) anatomical components on global RV function by using CMRI after tetralogy of Fallot (TOF) repair based on various surgical approaches.

Materials and Methods. A total of 52 asymptomatic, clinically stable patients (28 boys and 24 girls) aged 7.5 (5.5; 9.5) years were retrospectively examined after TOF repair to assess RV dysfunction in the Pediatric Cardiac Surgery Department of the Novosibirsk Research Institute of Circulation Pathology n.a. acad. E.N. Meshalkin. All patients were divided into 2 groups depending on surgery technique of TOF repair: transannular plasty (group 1, 26 pts) or TOF repair with pulmonary annulus preservation (group 2, 26 pts).

Results. Right ventricular ejection fraction for the entire ventricle and for its parts was significantly higher in group 2 whereas RV end diastolic volume (EDV) for the entire ventricle and for its parts and stroke volume (SV) were significantly higher in group 1. Pulmonary regurgitation was also higher in group 1: 36.7 (32; 44) versus 13.2 (3; 14) (p>0.01). Odds ratio for pulmonary regurgitation was lower in group 2 in comparison with group 1: OR (95% confidence interval, CI) 0.19 (0.04–0.72), р=0.02.

Conclusions. Right ventricular function after TOF repair depends on the type of right ventricular outflow tract (RVOT) reconstruction. Through separate functional analysis of the anatomical RV components, this study demonstrated that the global RV function is decreased in patients after transannular plasty. Long term RV dysfunction in group with transannular plasty was associated with significant pulmonary regurgitation and the presence of large akinetic RVOT region involving the sinus part in the contraction.

Objectives. The objective of the study was to assess functional hemodynamic parameters in patients who underwent primary repair of tetralogy of Fallot by using transpulmonary thermodilution in early post operative period.

Materials and Methods. The prospective nonrandomized clinical study of 52 children (28 boys and 24 girls) after primary repair of tetralogy of Fallot was performed in the Novosibirsk Research Institute of Circulation Pathology n.a. acad. E.N. Meshalkin. Patients were divided into 2 groups based on the type of right ventricular (RV) outflow tract reconstruction. Group 1 comprised patients with transannular plasty (26 pts). Group 2 comprised patients in whom the pulmonary valve was preserved (II group, 26 pts). Both groups were comparable by the height, weight, body surface area, age, peak systolic RV outflow tract (RVOT) gradient, and ejection fraction of the left ventricle. Monitoring of the hemodynamic parameters was performed by using PiCCO (pulse induced contour cardiac output), a method based on combination of the transpulmonary thermodilution and pulse waveform analysis.

Results. During the first hours after operation, the signs of heart function were lower in group 1 and significantly differed with those in group 2. However, during the following hours (12, 24, 48 h), heart function recovered in the group 1 and did not differ from that in group 2. Afterload was elevated in both groups throughout the entire study. Afterload was significantly higher in group 1 for the first 24 h and in group 2 at 48 h.

Conclusions. Preservation of RVOT components ensured significant improvement of the hemodynamic parameters including the indicators of systolic and diastolic functions in early post operative period compared with patients who underwent transannular RVOT plasty. Residual RVOT obstruction with systolic pressure gradient of 37 mm Hg did not significantly affect the hemodynamic parameters.

The role of acquired forms of vascular platelet hemostasis disorders in the presence of chronic alcoholism was studied for prediction of progression and complications of the disease, and also for elaboration of new approaches to the therapy of this pathology associated with alcoholic kidney damage.

Aim: The aim of the study was to identify special aspects of investigating the pharmacological modulation of the activity of antibacterial agents in periodic cultures of microorganisms.

Materials and Methods. The study was conducted by using the control strain of Klebsiella pneumoniae ATCC 13883. We studied the growth dynamics of the strain in the M9 mineral medium for 24 hours in the presence of sublethal concentrations of antibacterial agents (gentamicin, ceftazidime, ciprofloxacin), constituting 50% of the minimum inhibitory concentration. Antioxidant methylethylpiridinol in concentrations of 0.25–4 mM was used as a modulator.

Results. The study showed that, in the presence of sublethal concentrations of gentamicin or ciprofloxacin, the strain development complied with the classic growth curve for periodic culture. Methylethylpiridinol reduced the effects of gentamicin and ceftazidime, but enhanced the antibacterial effect of ciprofloxacin. In the mixtures containing gentamicin, a reversible change in the optical density of the bacterial suspension was observed 24 hours after beginning the incubation. The growth dynamics of bacteria in the mixtures containing ceftazidime was not described by classic growth curve and was intermittent.

Conclusion. To assess the effects of pharmacological substances on the activity of antibacterial agents in periodic cultures of microorganisms, dynamic monitoring of the incubation mixtures is necessary. Acquisition of the results only at endpoint can lead to erroneous data interpretation.

The article presents the analysis of gender specific aspects of mortality trend for the leading cause of death, cardiovascular diseases, in Tomsk, typical West Siberian city. The study was performed in a framework of the WHO project “Epihealth Russia” to analyze population size and mortality trends in men and women in 1990–2010. The results of this retrospective study suggested the presence of prognostically unfavorable regressive type of population, decline in the number of men (4.5%), significant decrease in the number of individuals aged 45 year old and older, and aging of the population. The gap in life expectancy between men and women was 11.92 years on average ranging from 13.42 years in 1993 to 10.68 years in 1999, respectively. The study demonstrated that cardiovascular diseases continued to be the number one cause of death for adult population in Tomsk. Standardized death rates from cardiovascular diseases ranged from a minimum of 686 in 1991 to maximum of 957 in 1994 and 761 in 2010 in men and from a minimum of 426 to maximum of 585 and 455 cases in women for the corresponding years, respectively. These data provided clear evidence for prevailing trend of cardiovascular mortality that was higher in men than in women by 1.6 times (p<0.001). Gender inequality, significant prevalence of cardiovascular mortality trend (twice as high in men as in women), and high mortality rates in urban population of young working age men and women negatively affect current demographic situation.

The article presents the analysis of the main demographic trends in the Tomsk region based on official statistics data. The analysis showed that the demographic status of the Tomsk Region was characterized by a positive dynamics with an increase in the population size and a simultaneous decrease in the overall mortality rate by 7.1% in the last analyzed year compared with baseline. During period of 2010–2014, we observed continuous increases in the coefficients of demographic loading by 3.9% on average across the Siberian Federal District and by 3.3% across the Russian Federation and the Tomsk Region. The study showed an increasing proportion of persons aged 60 years and older in the general population and an increase in the aging index. Due to progressive aging of population in the Tomsk region, Siberian Federal District and in the entire Russian Federation, every year thereafter will require urgent measures aimed at improvement and optimization of pharmaceutical care for geriatric patients with cardiovascular diseases usually requiring lifelong administration of drugs. As a result, it will cause an inevitable increase in the financial investments in the treatments of cardiovascular disease, a main cause of mortality in the country.

The study consisted in a retrospective analysis of the frequency of contrast induced nephropathy (CIN) and the effectiveness of its prevention after elective endovascular interventions on the coronary arteries in patients with stable coronary artery disease (CAD). Despite ongoing prevention, acute kidney injury was found in 24 patients (16.8%) in the group of patients with a predominance of moderate and high risk CIN (average Mehran Risk Score = 9). The increase in serum creatinine in patients with CIN after endovascular intervention was 42.5%; glomerular filtration rate decreased by 31%; and creatinine clearance decreased by 29.05%. Overall CIN was benign as the main indicators of renal function returned to baseline levels during the hospital period and did not require renal replacement therapy in any of the patients who developed CIN.

Aim. The purpose of the study was to investigate clinical manifestations in pregnant women with chronic viral hepatitis in the third trimester and their relationships with anxiety level.

Materials and Methods. A total of 169 pregnant women in the third trimester were studied. Women were divided into 2 groups: group 1 with chronic viral hepatitis (133 women) comprised pregnant women with chronic viral hepatitis В (50 women) and pregnant women with chronic viral hepatitis C (83 women); group 2 comprised 36 healthy women (control group). The groups with chronic viral hepatitis В and C were combined to form one group of pregnant women with chronic viral hepatitis.

Results. Pregnant women with chronic viral hepatitis in the third trimester showed a higher number of complaints than healthy pregnant women. The following complaints were documented: anxiety (42.11%), epigastric burning (41.36%), weakness (17.30%), etc. In healthy pregnant women, the following complaints were observed: epigastric burning, bloating, and swelling of the legs (8.34%). In pregnant women with chronic viral hepatitis, clinical manifestations were as follows: subicteric sclerae (23.31%), spider veins (21.06%), palmar erythema (72.19%), coated tongue (54.14%), etc. The level of general anxiety in pregnant women with chronic viral hepatitis was elevated and was consistent with subclinical anxiety with increases in mental, somatic, and autonomic anxiety scores (p≤0.01). In pregnant women with chronic viral hepatitis in the third trimester, the study identified the associations between a significant number of patient complaints, clinical symptoms and high anxiety score based on the Hamilton Anxiety Rating Scale.

Conclusions. In pregnant women with chronic viral hepatitis in the third trimester, the study revealed a higher number of complaints and clinical manifestations compared with those in healthy pregnant women. In pregnant women with chronic viral hepatitis in the third trimester, the total anxiety level was elevated and corresponded to subclinical anxiety score based on the Hamilton Anxiety Rating Scale. In the presence of high anxiety levels, women had a greater number of complaints and clinical symptoms.

The article presents the biography of the famous Russian histologist Sergey G. Chasovnikov and his contribution to the development of Russian histology. The author gives a brief review of his scientific, educational, medical, and social activities.

The paper describes the development of material and scientific basis for railway medicine during the period of 1917– 1990. The linkage of industry associated healthcare with the development and operation of railway transport in the USSR is presented. The features of delivering medical aid for the railway employees are demonstrated.