In this article, we review data from the literature and our own data regarding comorbidity which constitutes an important problem in clinical medicine. Comorbidity definitions, main types of comorbidities and comorbidity assessment tools are reviewed. The causative factors of comorbid diseases and the mechanisms of syntropies development are analyzed. We present evidence indicating that syntropies are not a mere sum of several diseases. Phenotype of the disease is subject to change under influence of comorbid conditions. Comorbid diseases may have common genetic, epigenetic and pathogenetic mechanisms. Comorbidity prompts physicians and researchers to apply a holistic (personalized) approach to prevention, diagnosis, and treatment of chronic disease. For the first time, we suggest a strategy of “hub therapy” of syntropic diseases and discuss its rationale resting in new pathogenetic insights. We also provide several examples of successful use of hub therapy in some polypathies.

The article presents the stages of generating the model of multi-level regulation of oxygen delivery in the presence of ischemic heart disease. Ranking of the mechanisms involved in the compensation of abnormal cardiac function was performed. Significance of erythropoietin and the factors modulating its effectiveness was determined for different types of disease.

The article summarizes the published data on the radionuclide diagnosis of atherosclerotic vascular lesions. A special attention is given to the characteristics of gamma and positron emitting tracers, which are used for molecular imaging of unstable plaques.

The aim of this study was to compare the reperfusion methods in patients with STEMI between two age groups: >70 years (n=197) and <70 years (n=253). The patients in these groups were admitted to the hospital within the same time after the onset of myocardial infarction: 2.5 hours. As the primary reperfusion method, thrombolytic therapy was used more often in patients of older group: 55% versus 48%. Primary PCI was used accordingly less frequently: 45% versus 52% (ns). Prehospital thrombolysis was conducted less frequently at the prehospital stage in older patients compared with the younger group: 36% versus 65% (р<0.05). The rates of coronary artery reperfusion 90 min after thrombolysis did not significantly differ between two groups: 51% and 55%. The older patients underwent coronary angiography after thrombolysis and PCI less frequently compared with younger patients: 39% versus 61% (ns) and 18% versus 46% (p<0.05) for coronary angiography and PCI, respectively. The older patients had higher rates of bleeding complications (22% versus 10%; р<0.05) and inhospital mortality (17.3% versus 4.3%; р<0.05). We currently do not have clear guidelines or algorithms for indications for PCI in elderly patients who have high risk of bleeding complications. This question remains unsolved requiring further studies.

Objectives: To study the patterns of atherosclerotic lesions in brachiocephalic arteries, 24-hour blood pressure monitoring data, and heart rate variability in patients with arterial hypertension (AH) and coronary artery disease (CAD) among indigenous and alien populations of Yamalo-Nenets Autonomous District. A total of 100 patients aged 21-55 years (mean age of 52.3±0.4 years) with AH and CAD living in the Far North were examined. All patients were divided into two groups of 50 people each: group I included native population, group II included alien population. The patients underwent outpatient duplex scanning of brachiocephalic arteries and 24-hour blood pressure monitoring; heart rate variability and lipid profile were evaluated. Groups matched by age and gender. Duplex scanning of brachiocephalic arteries detected thickening of the intima-media complex of the common carotid artery in all patients: the highest level was observed in native inhabitants (p<0.001), the tendency to more frequent atherosclerotic stenosis of the left internal carotid artery (p=0.058) was found in natives compared with alien population. The lowest atherogenicity of lipid profile in native inhabitants was mediated by higher HDL level compared with alien population. Atherogenicity of lipid profile in alien population was characterized by a significantly higher level of triglycerides (p=0.035) and VLDL (p=0.021). Heart rate variability analysis revealed pronounced stress of the regulatory systems in most patients from both groups. The results of 24-hour blood pressure monitoring did not show significant differences.

The aim of this study was to evaluate the effects of the antihypertensive treatment with verapamil on the development of brain damage in hypertensive patients. We studied 26 hypertensive stroke-free patients. Following parameters were estimated: 24-hours BP monitoring, plasma levels of the lipids and basal postprandial glucose, and brain MRI. All the parameters were evaluated before and after 6-month therapy with verapamil. Our data demonstrated that antihypertensive therapy with verapamil in hypertensive patients significantly decreased BP, had good tolerability profile, and was accompanied by the reversal of the preclinical MRI signs indicative of structural brain damage, in particular, our data showed subsidence of hydrocephalus and decrease in the periventricular and subcortical edema that depended on the antihypertensive efficacy.

The aim of the study was to investigate cognitive disorders in patients with arterial hypertension (AH) and transitory ischemic attack (TIA) as well as their relation to changes in the brain magnetic resonance imaging (MRI) and homocysteine. Eighty male and female patients with AH and TIA aged 40 to 70 years were examined. The concentration of homocysteine in the blood serum was determined, the brain MRI was performed. Cognitive function was evaluated by using Mini-Mental State Examination (MMSE) score. Mild cognitive impairment was revealed in 38.7% of patients; average MMSE score was 27.91 (95% CI 27.52-28.30). Correlation between the levels of homocysteine and MMSE scores was revealed: r=-0.5466 (p=0.0000). Cognitive impairment was found more frequently in patients with structural changes in the brain compared with the patients without changes (52.6% versus 26.2%). The average MMSE scores were 27.42 (95% CI 26.78-28.06) in patients with MRI changes and 28.36 (95% CI 27.90-28.82) in patients without changes, r = 0.033. Cognitive impairment was found in 73.7% of patients with MRI signs of leukoaraiosis and in 31.6% of patients without leukoaraiosis. The average MMSE scores were 26.74 (95% CI 25.79-27.68) in patients with leukoaraiosis and 28.10 (95% CI 27.29-28.92) in patients without leukoaraiosis, r=0.034.

Objective: to study the circadian blood pressure profile, heart rate variability and the state of the autonomic nervous system (ANS) in elderly patients with chronic obstructive pulmonary disease (COPD) in combination with arterial hypertension (AH). A total of 205 individuals were examined. Group 1 consisted of 50-59-year-old patients with COPD in combination with hypertension (n = 26); group 2 included 60-74-year-old individuals with these pathologies (n = 42); group 3 included 75-89-year-old patients with COPD combined with AH (n = 42); group 4 consisted of 60-74-year-old patients with isolated AH (n=35); group 5 consisted of 75-89-year-old patients with this pathology (n = 35); group 6 (control) included 25 60-75-year-old individuals without COPD and AH. Ambulatory blood pressure monitoring, ECG, heart rate variability and ANS studies were performed. Statistical processing of the material was carried out by using statistical software package StatSoftStatistica 6.0 (2000). According to the results of the circadian blood pressure profile in the daytime, the values of average systolic arterial blood pressure in all patients were significantly (p<0.01) higher in comparison with control group. As the age of patients with comorbid pathology increased, all the indicators of the circadian blood pressure profile in the daytime and nighttime were significantly (p<0.001) different from corresponding parameters of the group of patients with isolated AH. The “non-dippers” prevailed in all patient groups. In most individuals with comorbidity, predominance of the activity of the sympathetic part of ANS and reduction in the reactivity of the parasympathetic nervous system were found. In patients of older age with combined pathology, high degrees of the left and right ventricular remodeling were revealed, as well as pronounced changes in the indicators of the circadian blood pressure profile with the predominance of the “non-dipper” type. Reduced reactivity of parasympathetic nervous system and increased activation of sympathetic part of VNS prevailed almost in all patients.

The aim of the study was to perform scintigraphic evaluation of the renoprotective efficacy of trimetazidine in patients who underwent endovascular myocardial revascularization (EMR). The study included 40 patients with ischemic heart disease (35 men and 5 women with the mean age of 56.98+1.40 years) who underwent EMR (stenting of the coronary arteries). All patients were randomized into 2 groups: patients (n=12) who took trimetazidine before angiographic procedures (group I) and patients (n=28) who underwent ER without nephroprotection (group II). Dynamic radionuclide renoscintigraphy with 99mTc-DTPA was performed before and 2 to 3 days after the ER with the calculation of the parameters of renal filtration and excretory functions. Patients of group II after ER showed negative dynamics in the renal filtration function parameters. Thus, there was a significant decrease in the mean value of the total glomerular filtration rate (GFR) mainly due to reduction in the filtration activity of the left kidney. Patients of this group demonstrated significant increase in the radiopharmaceutical clearance half-time from the renal pelvis system (RPS) and from the parenchyma of both kidneys and decrease in the cortical delay index of the left kidney. In the group of patients who were treated with trimetazidine (group I), mean values of parameters of filtration activity of the kidneys did not significantly change as compared with the baseline (before ER) data. In comparison with filtration activity, adverse changes in the processes of renal excretion were observed more frequently in group I. However, in patients of group I, average changes in the scintigraphic parameters reflecting the evacuation function of the kidney parenchyma and RPS were insignificant. The study showed that trimetazidine prevents contrast-induced renal dysfunction in patients who underwent coronary procedures.

In the article, the authors discuss the results of the metabolic and cardiorespiratory adaptation monitoring aimed at optimizing the intensive cardiac care for patients with coronary artery disease in the Cardiovascular Surgery Department of the FSBI “RI Cardiology” SO RAMS. The study included 96 patients. Forty three patients received ergospirometry examination the day before surgery to assess the level of metabolic and cardiorespiratory adaptation and effectiveness of the treatment. At the various stages of the operation, monitoring of metabolic and cardiorespiratory adaptation levels was performed via the determination of anaerobic threshold. Implementation of the method evaluating metabolic and cardiorespiratory adaptation allowed to optimize the doses of inotropic drugs and the regimes of overdrive pacing, to improve surgery outcomes, and to reduce the duration of inotropic support and the ICU length of stay.

For the first time, to increase the accuracy of triacilglyceride enzymatic estimation in biological material, preliminary lipid extracting was conducted with complementary addition of 25 мL of 10% tesit solution to chloroform extract with simultaneous admixture blending in a shaker under 20 °С and oscillation frequency of 120 per 1 min during 30 min.

The article presents methodological approach which uses the autopsy results from the forensic medical examination bureaus for prediction of the population health and health care planning. The authors provide evidence that the patterns of prevalence of the pathological processes, in particular of those leading to lethal outcomes due to cardiovascular (atherosclerotic processes in the heart, acute cardiac ischemia, cardiomyopathy, myocardial infarction, hemorrhagic and ischemic strokes), respiratory (inflammatory processes in the lungs), and digestive (adipose degeneration, liver fibrosis and cirrhosis, inflammatory processes in pancreas, and ulcerous processes in stomach and duodenum) disorders, have prognostic value in adult population aged 18-70.

The article presents a clinical case of successful simultaneous surgery for coronary artery disease and newly diagnosed apex lung tumor without postoperative complications.

The aim of the study was to analyze clinical case of a visceral form of Epstein-Barr virus infection in a teenager. The article presents clinical case of a malignant development of the visceral form of infectious mononucleosis with focal interstitial-parenchymatous myocarditis, central nervous system injury, and hemorrhagic syndrome. Data showed that the patient was homozygous carrier of C819T mutation in the IL-10.

The article presents biography of a well-known Russian surgeon, Professor Vitt N. Savvin. The authors review his scientific, academic, medical, and managerial activities and highlight his contribution to the administration of Tomsk State University in 1920s.

Professor Archibald Cochrane (1909-1988) is considered to be the originator of the idea of evidence-based medicine in our era. With his landmark book ‘Effectiveness and Efficiency: Random Reflections on Health services’ he managed to inspire and positively influence the medical society with respect to the proper assessment of reliable evidence for the provision of the best medical care. His vision combined with his scientific achievements can be considered as the foundation of the Cochrane Collaboration; named after him in recognition of and gratitude for his pioneering work. We present the highlights of his adventurous and vibrant personal and academic life in an attempt to honour his contribution to shaping modern medical research.