It was found that cannabinoids in anesthetized animals cause prolonged hypotension and bradycardia, which are the result of the stimulation of the CB1 receptor. The endogenous cannabinoids are not involved in the regulation of heart rate and blood pressure in intact animals. Studies carried out in patients with coronary heart disease have shown that marijuana can cause angina. It is established that cannabinoids induce prolonged hypotension and bradycardia, which may be preceded by transient tachycardia and hypertension associated with activation of the vanilloid TRPV1 receptor. Prolonged hypotension is a result of direct action of cannabinoids on the arteries.

The review article describes the current trends in the treatment of coronary artery disease (CAD) in patients with left main coronary artery stenosis (LMCA). The article shows the clinical and morphological characteristics of CAD in patients with LMCA stenosis, and describes the benefits of revascularization. Safety and efficacy of percutaneous coronary intervention versus coronary bypass surgery grafting were analyzed using up-to-date evidence base.

This review article is devoted to the identification of new predictors of the development of ventricular tachyarrhythmias (VA).The implantable cardioverter-defibrillator (ICD) in patients with the presence of risk factors is one of the main ways to prevent sudden cardiac death (SCD) due to VA. At the same time, data of 5 years of follow-up show that such kind of device is effective only in 15–25% of patients. For the reason that ICD implantation is associated with hospitalization and infection complications, there is a need to improve risk stratification and search for new prognostic markers of SCD and VA in order to reduce the number of inefficiently implanted ICDs and to reduce the costs of surgical intervention. In this regard, it is relevant to search for new predictors of VA development. In this field, it is promising to detect the disturbances of myocardial perfusion based on scintigraphy with thallium-199, to diagnose myocardial sympathetic innervation disorders by scintigraphy with iodine-131-labeled meta-iodine-benzylguanidine (MIBG), and to determine the levels of potential biochemical markers of myocardial fibrosis such as galectin-3 and ST2.

The present article provides an overview of the latest guidelines and the principles of selecting the patients with acquired heart diseases complicated by atrial fibrillation (AF) for surgical treatment. The effectiveness of various methods of AF treatment in such patients is analyzed. The criteria for selecting patients of this group for an operation are described. The use of antiarrhythmic drugs in patients with AF is ineffective and even inappropriate in cases of valvular heart disease and coronary artery disease requiring surgical correction. Surgical treatment of the main heart pathology and concomitant AF ablation in these patients is preferable. When choosing tactics of intervention, it is necessary to consider not only the presence of the pathology itself, but also the baseline functional state of the elements of cardiac conduction system. The presence of initial sinus node dysfunction in patients with long-lasting persistent AF significantly increases the probability of pacemaker implantation and prolongs a patient’s stay in the intensive care unit.

Congenital heart disease (CHD) accounts for nearly a half of the congenital anomalies in pediatric patients. However, the available methods of surgical correction for CHD are inefficient. Stenting as a minimally invasive procedure and an efficient intervention has been suggested as a promising method for CHD treatment. This review discusses the efficacy of stenting in patients with distinct forms of CHD.

Aim. To estimate the severity of systemic inflammation in subjects with coronary artery disease (CAD) coexisting with respiratory system diseases. Subjects and methods. Subjects with CAD were divided into three groups depending on the presence of respiratory system diseases and ventilation disorders. Respiratory pulmonary function tests included spirometry, body plethysmography, and estimation of diffusing capacity (Dlco). The assessment of laboratory markers of nonspecific inflammation in blood serum included determination of the levels of interleukin-12, interleukin-1β, tumor necrosis factor-α, matrix metalloproteinase-9, and C-reactive protein. Results. Subjects who had no anamnestic and instrumental signs of respiratory system damage revealed the lowest concentrations of all the analyzed inflammatory indicators; maximum concentrations of inflammatory markers in blood serum were observed in subjects who had symptoms of obstructive disorders. Severity of nonspecific inflammation correlated with the degree of heart failure, speed and volume parameters of respiration (FEV1, FVC, TLC, RV), as well as with Dlco. Conclusion. The coexistence of CAD and lung diseases both with obstructive abnormalities and without ventilation disorders caused higher levels of systemic inflammatory markers.

Aim. We evaluated the influence of renal cysts on the efficiency of reduction of arterial pressure in patients with treatment-resistant hypertension after renal denervation. Materials and Methods. A total of 33 patients (aged 57.8±8.75 years) with treatment-resistant hypertension were included. All patients underwent radiofrequency ablation (RFA) of the sympathetic nerves of renal arteries. The average level of arterial pressure was as high as 137–210/57–148 mm Hg according to 24-h monitoring. MRI studies were performed using MRI scanner “Titan Vantage” (by Toshiba Medical Ltd., 1.5 Т) in T1-W and T2-W spin-echo models. After this, the intravenous contrast enhancement was carried out (with 0.5 М solution, 0.2 ml/Kg), with subsequently repeated acquisition of Т1-weighted spin-echo images 3-5 min after contrast injection, employing exactly the same protocols as before enhancement. Results. Preoperative images demonstrated cysts in kidneys in half of patients (16 individuals). Positive effect (the arterial pressure decreased by 10 mm Hg) was observed in 70% of them. However, in 30% of population, the arterial pressure increased. Among the patients without cysts in the kidneys, negative effect was observed in 8% only, and positive effect was found in 77% of patients (arterial pressure decreased by over 20 mm Hg). Conclusion. There is a statistically significant trend towards a greater antihypertensive effect of renal denervation in patients without cystic changes in the renal parenchyma (cortex). Thus, MRI is of prognostic value for prediction of renal denervation efficacy.

Purpose. We aimed to estimate the efficiency of a training program in patients with myocardial infarction taking into account the medical and social factors of formation of adherence to treatment. We examined 92 patients with myocardial infarction (MI) with ST-segment elevation, mean age of 65.5±6.8 years, who were discharged from hospital and followed-up by the cardiologists of the Kemerovo Cardiology Dispensary. We estimated the adherence to treatment using S.V. Davydova method prior to and after a completion of the training. The leading reasons for reduced adherence to treatment in patients with MI were insufficient level of medical and social awareness and dissatisfaction with the regimen of the prescribed therapy. On the background of the training program a detection of negative factors of adherence formation decreased 3 times and the prevalence of positive factors increase 1.5 times. Medical and social awareness increased by 45.8%; a satisfaction with the regimen of the prescribed therapy increased by 45.7%; and a satisfaction with the results of the conducted therapy increased by 37.1%. The integral indicator of the adherence to treatment in patients with a recurrent MI prior to the training scored +4.39±0.09 and corresponded to a moderate positive compliance. On completion of the training program, a double increase in the adherence to treatment was registered (score +8.11±1.23; p=0.0000). The training program for the patients with MI based on the principle of continuity of inpatient and outpatient stages of patients’ management improves the adherence to treatment at an increase in medical and social adaptation and awareness of patients, their satisfaction with the regimen and the results of the conducted therapy.

Introduction. Currently, the standard surgical treatment of patients with transposition of the great arteries (TGA) is an arterial switch operation in the neonatal period. Reimplantation of the coronary arteries during the operation is the key to success. Therefore, constant search for new and modification of known techniques are ongoing. The goal of our work was to present the results of arterial switch operation using a modified closed technique for reimplantation of the coronary arteries. Materials and Methods. During the period from 2011 to December, 2016, in Research Institute — Regional Clinical Hospital No. 1 n.a. Prof. S.V. Ochapovsky, 63 operations of arterial switch using modified closed technique reimplantation of the coronary arteries were performed. The average age at operation was 4.77±2.54 days; the average weight was 3.33±0.35 kg. On average, the operation was performed on the 5th day after birth. Diagnoses: Patients with simple TGA (n=49); patients with TMA and ventricular septal defect (VSD) (n=11); patients with TGS and VSD (including one patient with multiple defects) who had obstruction of the aortic arch (n=3). The study showed that the only limitation of the modified closed method for reimplantation of the coronary arteries was an intramural course of the coronary arteries. 58 patients (92%) received alprostadil infusion; 22 patients (34.9%) received balloon atrioseptostomy (Rashkind procedure). Results. The hospital mortality rate was 7.93% (5 patients). The mortality rates were 6.1% (3 patients in the 49 operations) in the group with simple TGA and 18.1% (2/11 patients) in patients with VSD. No fatal outcomes occurred among patients with an anomaly of the aortic arc. The causes of mortality were the multiple organ failure (2 patients) and sepsis in the presence of necrotizing enterocolitis (3 patients). Discussion. Arterial switch operation at the present stage of pediatric cardiac surgery development is the operation of choice for patients with the transposition of the great vessels with feasible biventricular correction. Mortality was primarily due to the initial severity of patient condition and concomitant infection. Closed technique for reimplantation can improve the control of bleeding by reducing the number of weak spots of the aortic anastomosis (weak spots in U-shaped or trap door anastomoses are the areas of tying the yarns to create neoaortic root) and by generating the neoaortic sinotubular junction which reduces the risk of aortic insufficiency. Analysis of literature data and our own observations suggest that the closed technique and its modifications reduce the likelihood of coronary ischemia. Reimplantation of the coronary arteries by the closed procedure is feasible in case of any coronary anatomy except intramural coronary artery. Moreover, our modification allows to reduce the time of myocardial ischemia (due to the absence of a stage for aortic clamp removal for the filling neoaorta with blood) and, consequently, the duration of cardiopulmonary bypass and the time of entire procedure.

The registries of acute coronary syndrome (ACS) are the main tool for quality assessment of medical care and provision of medicines in this disease. Purpose: based on the results of the Russian RECORD-3 registry we aimed at estimating the main clinical characteristics, approaches to diagnosis, treatment and outcomes of in-hospital treatment in patients with non-STsegment elevation ACS (NSTE-ACS) in Russian hospitals participating in the registry. Materials and methods. RECORD-3 registry of ACS was performed in 47 hospitals of 37 Russian cities in March to April, 2015. The analysis comprised 1495 patients with NSTE-ACS. Results. When dividing the patients with NSTE-ACS into the groups of subjects, admitted to PCI centers (n=1012) and noninvasive hospitals (n=483), we found that the patients in PCI centers were more often males, were younger, and had more often history of revascularization procedures. At the same time, the patients in noninvasive hospitals had a greater severity: high incidence rates of arterial hypertension, hypercholesterinemia, and atrial fibrillation. ACS forms, complicated with acute heart failure, were more frequent in noninvasive hospitals: 16% (n=76) vs. 11% (n=111) in PCI centers, р=0.006. The patients from noninvasive hospitals less often received statins, beta-blockers, and fondaparinux, but they received more frequently clopidogrel, angiotensin-converting enzyme inhibitors, diuretics, nitroglycerin, pressor amines, and anticoagulants including subcutaneous administrations of unfractionated heparin. The frequency of fatal outcomes in NSTE-ACS was higher in noninvasive hospitals (3.7% vs. 1.7%, p=0.022). Conclusions. The situation with medication underuse in the treatment of patients with NSTE-ACS persists in noninvasive hospitals accompanied by an increase in the hospital mortality rate as compared with PCI centers.

Objective: to study the components of the metabolic syndrome (MS) in men, the urban population and to determine their linkages with the parameters of stress in the workplace. The study was conducted in the framework of cardiological screening of the urban population among men aged 25–64 years. A representative sample was formed based on the electoral lists of citizens from one of the administrative districts of Tyumen. The IDF criteria (2005) were used for the evaluation of MS. Evaluation of job stress was carried out according to the algorithms of the program WHO “MONICA-psychosocial”. In the Tyumen population, among men with the presence of MS components, persons with arterial hypertension and hyperglycemia, and, to a lesser extent, persons with dyslipidemia were primarily exposed of stress in the workplace.

The analysis of the annual statistical observation reporting forms No. 68 titled “Information on the Activities of Health Centers” of the regions of the Siberian Federal District was performed for the period from 2010 to 2015. The analysis showed that the structure of the form did not allow assessing the performance of health centers in accordance with the functions performed. Since there are no instructions for completing the reporting forms adopted at the federal level, it is required to develop it with mandatory intra- and cross-table control. The existing reporting form No. 68 requires a complete revision. On the basis of the analysis, recommendations for the changes in the structure of the form and for the implementation of events that can improve the efficiency of health centers in all regions of the Siberian Federal District are proposed.

The article reviews the algorithms for implementation of management system and healthcare quality policy in organization of obstetric care in the Tomsk region. Concept and strategy for achieving these objectives are presented.

Atherosclerotic damage of the aortic root and ascending aorta, especially in case of such extreme manifestation as porcelain aorta, is a major problem in cardiac surgery. This pathology is associated with potential thromboembolic complications and aortic dissection during intraoperative manipulation of the aorta, in particular, in case of standard cannulation technique. This situation requires surgeon to use nonstandard approaches to tactics of surgical intervention and cardiopulmonary bypass. This article presents a clinical case of intraoperatively detected porcelain aorta and describes an alternative technique for cardiopulmonary bypass connections to minimize complications.

Introduction. Methods of electrospinning and aerodynamic formation in the gas stream allow the fabrication of synthetic structures similar to intercellular matrices. But it is important to assess the suitability of such structures for colonization by cellular material. Materials and Methods. Porous matrices of polylactic acid are used. Matrix No. 1 was obtained by the method of electrospinning, matrix No. 2 — by the method of aerodynamic formation. The structure of the matrices was examined on an electron microscope. The matrices were dynamically populated with stromal cells from the rabbit’s bone marrow, then matrices were cultured for 3 days in a CO2 incubator at 37 °C. Cells were detected by fluorescence microscopy. Data were presented as mean ± standard deviation. Results. The matrices differed in structure. Matrix No. 1 was formed by fibers of regular cylindrical shape (diameter 1.5±0.7 μm) without its own relief. The average porosity was 67±3%. In the structure of matrix No.2 it was possible to single out a macrolevel represented by wisps (diameter 27.5±17.4 μm) formed by directed fibers (diameter 0.44±0.14 μm) with developed surface relief. The average porosity was 55±3% (p<0.05 as compared with matrix No. 1). The area of the free surface of matrix No. 2 exceeded this figure by 8 times for matrix No. 1. The matrices significantly (p><0.05) differed in the average number of cells: 56±9 cells and 120±40 cells for the matrix No. 1 against 81±6 cells and 215±18 cells for the matrix No. 2 in 2D and 3D regimes, respectively. Discussion. The best cell adhesion result obtained for the polylactic acid matrix formed by the aerodynamic formation method does not contradict other studies and probably was caused by its more optimal spatial organization. Keywords: nonwoven materials, electrospinning, aerodynamic formation, cell culture><0.05 as compared with matrix No. 1). The area of the free surface of matrix No. 2 exceeded this figure by 8 times for matrix No. 1. The matrices significantly (p<0.05) differed in the average number of cells: 56±9 cells and 120±40 cells for the matrix No. 1 against 81±6 cells and 215±18 cells for the matrix No. 2 in 2D and 3D regimes, respectively. Discussion. The best cell adhesion result obtained for the polylactic acid matrix formed by the aerodynamic formation method does not contradict other studies and probably was caused by its more optimal spatial organization.

Neutron capture therapy (NCT) with thermal neutron beams of high flux density is the most promising method of therapy for inoperable malignant brain tumors using Gd in stable acetate complexes with possibility of visualization by magnetic resonance imaging (MRI). The effectiveness of NCT is determined by the maximum dose that is created in tumor cells by products of the capture of thermal neutrons by Gd atoms. Analyzing the kinetics of direct absorption and inverse diffusion of Gd complexes in brain tumor tissue by MRI, we were able to show that it is linear in all cases and Gd concentration in the tumor at the moment T is defined as С_tum(Т) = k_pl-tum ∙ ∫ С_pl(t)∙exp(–k_tum-pl (T–t))dt. At the same time, the value of the direct transport factor k_plasma-tumor=5.87±0.31 is an order of magnitude higher than the rate of reverse diffusion k_tumor-plasma=0.91±0.23. Then, according to the data of a single diagnostic dynamic study, it is possible to calculate the optimal regimen of Gd administration to achieve the therapeutic effect of a neutron beam of known flux density for NCT, while avoiding the release of Gd in healthy tissues.

The question of identification of medicines in chemical-Toxicological forensic chemical and the research is always relevant, and in psychiatry is particularly important because people with mental illnesses are often abused with psychotropic drugs. Antidepressants found wide application in psychiatric practice. Fluoxetine a bicyclic antidepressant that is derived fenilalkilamina, prescribed individually or in combination with other potent drugs. In this article we propose the optimal conditions for the combined analysis of the combination of fluoxetine with tofizopama, sulpiride, risperidone, chlorpromazine, chlorprothixene, imipramine, buspirone, bromdihydrochlorphenylbenzodiazepin. The conditions of chromatographically proposed methodology in the identification of fluoxetine and psychotropic medicines from model compounds after their extraction from urine by high-performance liquid chromatography on device “Milichrom A-02” are presented.

The first steps to establish cardiology service in Novosibirsk were made well in advance (1969–1976) before the corresponding order of the Minister of Health of the USSR (1978). The country’s first cardiology office (1969), intensive care unit, myocardial infarction and stroke register, comprehensive rehabilitation service for patients, and municipal cardiology society were organized. The Municipal Health Department Order for the official establishment of the Municipal Cardiological Service was issued in 1976 and, based on this, the Regional Cardiology Clinic was opened in 1987.

The death rate from smallpox outbreaks during the prerevolutionary period was enormous. Both newborns and elderly people were getting sick. The extremely high death rate in the Transbaikalian region persisted due to the socio-economic, ethnocultural, and territorial peculiarities. Both the native and alien population suffered from regular smallpox outbreaks. Thus, the population loss and unstable epidemiological situation in the border area of the Transbaikalian region acquired military and political significance, especially in the field of the Far East diplomacy of the Russian government. Under these circumstances, the establishment of the Transbaikalian Cossack army in 1851 aimed to protect the Russian-Chinese border and to maintain internal order in the region. The need for the regular operational readiness of the Transbaikalian Cossack army consisting of the Russian, Buryat, and Tungus men required providing the conditions for efficient medical protection of the military officials and their families against smallpox outbreaks. That is why the preservation and strengthening of the gene pool of the Transbaikalian region inhabitants was the state’s top priority. So, in 1885, the statute for smallpox vaccination in the Transbaikalian region was prepared and signed by the Emperor. It provided the aims, objectives, and the methods for achieving the effective smallpox vaccination.

The article represents the biography of the famous Russian pediatrician Aleksandra F. Smyshlyaeva and her contribution to the development of Russian pediatrics. The author gives a brief review of her scientific, educational, medical, and social activities.

The publication is dedicated to the well-known Russian scientist, academician of the Russian Academy of Sciences Rostislav Sergeevich Karpov, who made a significant contribution to the development of Russian medical science. The main stages of his many-sided scientific, pedagogical and social activities are described.