This paper presents an attempt to assess the level of contemporary medicine, its real capabilities, and promising directions based on the idea of similar mechanisms in the development of some diseases determining the lifetime of a person.

This review analyzes the results of randomized studies of the efficacy and safety of direct renin inhibitor aliskiren in the treatment of patients with arterial hypertension associated with obesity, diabetes, menopause, kidney failure, chronic kidney disease, and metabolic syndrome. The authors conclude that, along with the hypotensive action, aliskiren exerts cardioprotective and renoprotective effects that can expand the indications for the use of this drug.

This analytical article provides a review of the literature for using the endothelin receptor antagonists in the treatment of pulmonary arterial hypertension. The authors discuss the use of two main drugs widely used in clinical practice: bosentan (Tracleer) and ambrisentan. Both these drugs have been registered in the Russian Federation. The article presents findings of the main clinical trials of endothelin receptor antagonists.

It has been reported that the increased expression of natural inhibitors of the matrix metalloproteinases is associated with the high risk of mortality and heart failure progression. The aim of the study was to estimate the diagnostic value of tissue inhibitor of metalloproteinase-1 (TIMP-1) for the diagnosis of heart failure in patients with myocardial ischemia and/or post-myocardial infarction remodeling. A total of 52 patients with heart failure NYHA classes II, III, and IV were enrolled in the study. Diagnostic value and prognosis for adverse cardiovascular events were analyzed in the prospective 6-month observation. The patients were divided into three groups according to heart failure severity: group 1 included patients with NYHA class II (n=18) with preserved left ventricular (LV) ejection fraction (EF) (>45%), group 2 included patients with NYHA class III (n=23) with decreased LV EF, and group 3 included patients with the most severe NYHA class IV chronic heart failure (n=11) and LV EF of <32.5%. The age of the patients was 60.6+0.92 years. The TIMP-1 level in blood was determined by hard phase immunoenzyme analysis. All-cause mortality, cardiovascular mortality, nonfatal myocardial infarction (MI), need for revascularization, need for hospitalization, and definite progression of heart failure were the clinical endpoints with 6-month follow-up. The TIMP-1 level in patients of group 1 ranged from 181 to 375.9 ng/ml (Me=278.45 ng/ml); patients in group 2 had TIMP-1 levels ranging from 376.6 to 897.8 ng/ml (Me=637.2 ng/ml), and the levels of TIMP in patients of group 3 were significantly higher, ranging from 903.6 to 1687.9 ng/ml (Me=1295.8 ng/ml). Two patients with end-stage heart failure from group 2 and group 3 died during the study; their TIMP-1 levels were 1289.9 and 1687 ng/ml, respectively. In patients with ischemic heart disease, heart failure, and postmyocardial infarction remodeling, TIMP-1 can be considered a new independent predictor of ischemic myocardial dysfunction and LV fibrosis.

A total of 54 patients who underwent reconstructive surgery on carotid arteries were examined in the study. One year after surgery, all patients were divided into two groups depending on their long-term outcomes: group 1 included patients with unfavorable prognosis (n=34; 62.9%); group 2 consisted of patients with favorable prognosis (n=20; 37.1%). In preoperative period, all patients were tested for serum levels of C-reactive protein. The study showed that patients who developed cardiovascular events such as stroke, transient ischemic attack, myocardial infarction, death, and aggravation or the first presentation of the clinical signs of ischemia in any vascular region during the first year after the surgery had significantly higher preoperative levels of C-reactive protein in serum.

The aim of this study was to determine the features of endothelial dysfunction and hemostasis in patients with ST"segment elevation acute coronary syndrome (n=158) after percutaneous coronary intervention (PCI) with bare metal stents stenting of the infarct"related artery and to identify possible predictors of the complications such as thrombosis and stent restenosis. At baseline (5-7 days after stenting), all patients underwent the examination of the hemostasis system markers and the evaluation of the endothelial dysfunction via quantifying the levels of the intercellular adhesion molecules: sVCAM, sICAM, sP"selektine, and sE"selektine. The criterion for the assignment of patients into groups was the presence of repeated cases of acute coronary syndrome due to in"stent restenosis and stent thrombosis according to the results of coronary angiography within 12"month follow"up. The study demonstrated the potential predictive values of (i) endothelial dysfunction markers (sICAM"1, sVCAM"1, SP"selectine) for the prediction of the development of complications such as recurrent acute coronary syndrome after stenting and (ii) sP"selectinе for the prediction of stent thrombosis. The identified hemostatic disorders were characterized by an increased ADP"induced platelet response in the presence of dual antiplatelet therapy (2ATT) and were caused by resistance to clopidogrel; the presence of the identified hemostatic disorders predicted the development of the complications such as stent thrombosis in patients with ST"segment elevation acute coronary syndrome after PCI. The study showed direct correlation between sP"selectin and ADP"induced platelet aggregation suggesting the important role of inflammation in the development of resistance to antiplatelet drugs.

The accumulation of fluid in the pleural cavity is one of the most common multifactorial complications after cardiac surgery; the incidence of this condition varies from 23% to 50%. Leading role in the development of this condition plays the inflammation process in the pleura. To date, there are no laboratory methods for the qualitative and quantitative assessment of the severity of inflammation of the pleura. The aim of the present work was to study the activity of matrix metalloproteinase-9 isozyme (mmp-9) in the pleural fluid for qualitative and quantitative assessment of inflammation in the pleural cavity in patients after cardiac surgery. The study included 54 patients with coronary artery disease who underwent heart bypass surgery. In the early postoperative period, screening ultrasound examinations of pleural cavities were carried out. Patients were divided into two groups: group 1 (n=25; 46.2%) consisted of patients who required only one thoracentesis procedure; group 2 (n=29; 53.7%) consisted of patients who required more than 1 thoracentesis procedures. Amount of pleural fluid removed during one procedure, incidence of atelectasis, and LDH plasma-pleural effusion gradient did not significantly differ between groups. At the same time, there was statistically significant tendency to differences in the concentration of pro-mmp-9 enzyme in patients of group 1 and group 2: 0.376+0.012 ng/mL and 0.501+0.024 g/mL, respectively (p=0.004). Detection of mmp-9 concentrations in punctate from the pleural cavity provides the way for quantitative and qualitative evaluation of the inflammatory changes in the pleura in patients after cardiac surgery.

A total of 60 patients after occlusion of ventricular septal defect (VSD; n=56) and atrial septal defect (ASD; n=4 pts) and 10 patients after ASD repair with bypass were examined with aim to assess the levels of troponin I (TI), fatty acid binding protein (FABP), and antibodies (AB) against cardiac tissue in children before and after endovascular and surgical repair of septal defects. We used enzyme-linked immunoassay, indirect immunofluorescence method, and fluorescence microscopy taking into account the presence of fibrillar, sarcolemmal, and nuclear antibodies. Echocardiography and Holter monitoring with assessment of heart rhythm variability were performed. We found that the levels of TI and FABP were significantly increased in blood of patients with sympathetic heart rhythm activation before the repair of hemodynamically significant ASD and VSD. Closure of septal heart defects by occluders was not accompanied by significant increases in the TI and FABP levels. These data suggested minimal degree of negative influence of occluder implantation on the myocardium unlike the presence of significant increase in the markers of myocardial damage after surgical closure of the defects. Endovascular and surgical VSD repair in children did not augment the autoimmune myocardial inflammation.

The aim of the study was to evaluate the capabilities of contrast-enhanced magnetic resonance imaging (MRI) with the use of open MRI scanners for detection of atherosclerotic plaques in patients with extensive atherosclerosis and myocardial infarction which occurred two to six months prior the examination. Twenty four patients with angiologically verified coronary atherosclerosis comprised the patient’s group including 11 patients with predominant involvement of right coronary artery (RCA) and 13 patients with predominant atherosclerosis of left circumflex coronary artery. All patients received contrast-enhanced MRI study of the heart by using T1-weighted spin-echo with end-diastolic ECG gating (MRI scanners AZ-360 with 0.38T field and Magnetom Open with 0.22T) Thin 7-8-mm axial slices of the whole heart were obtained in four-chamber position in all patients; short axis slices were obtained in 16 out of 24 patients. Acquisition parameters were as follows: repetition time (TR) of 450-890 ms; echo time (ET) of 15-25 ms; 256х256 matrix; slice thickness of 7-8 mm; cross-dimension field of view of 25х25 cm; and voxel size of 0.1 to 0.12 mm. Paramagnetic (Optimark, Mallinckrodt Inc.) was injected as 2 mL of 0.5-M solution per 10 kg of body weight. For the atherosclerotic plaque itself and arterial wall beyond the plaque, the index of image enhancement (IE) was calculated as follows: IE = intensity of T1 w SE scan with paramagnetic / Intensity of T1 w sE scan initial. When analyzed visually, the T1-weighted contrast-enhanced MRI images in patients with coronary atherosclerosis provided clear delineation of coronary artery stenosis due to the significant uptake of paramagnetic by the plaque itself. In patients from the control group free of atherosclerosis, the RCA IE and LCA IE were 1.08+0.06 and 1.09±0.07, respectively. The atherosclerotic plaque in infarction-related LCA demonstrated IE as high as 1.52+0.23, whereas the plaque in infarction-related RCA was enhanced with IE=1.43±0.17. Also, the plaque-free areas of infarction-related arteries demonstrated mild but elevated enhancement with IE=1.18+0.10. In this small group, no significant correlations were revealed between IE and degree of stenosis or LV contractility indices. The authors conclude that contrast-enhanced MRI of coronary atherosclerotic plaques is recommended as an addition to inversion recovery protocol that provides effective imaging of paramagnetic uptake by damaged myocardium.

Physical rehabilitation of patients after coronary surgery is an important part of comprehensive medical rehabilitation. However, it is challenging to evaluate efficacy of the treatment considering that traditional electrocardiographic methods do not provide detailed information about the status of left ventricular inotropic reserve before and after the treatment. To achieve detailed expert evaluation, we proposed to use cycle ergometer stress-echocardiography with calculation of the degree of maximum increase in left ventricular ejection fraction (ΔEF) at test peak. The study included 35 individuals (mean age of 51.3+7.8 years). Data showed that group of convalescents (n=12) who completed the entire program of physical rehabilitation had the highest maximum EF values (89+2%; ΔEF=48%) in control stress-echocardiography. As a result of comprehensive surgical, pharmacological, and rehabilitational treatment, left ventricular inotropic reserve increased by 70%. Group of patients (n=15) who limited the program of training procedures and cancelled dynamic loads showed significantly lower values of EF and ΔEF: peak EF was 83+5% (ΔEF=37%); the total increase in inotropic reserve was 28%. In group of individuals (n=8) who excluded the regenerative kinetic therapy, control stress-echocardiography showed peak EF of 82+5% (ΔEF=36%) and only 20%-increase in inotropic reserve.

The article presents experimental study of whole-body hypothermia-induced changes in the morphofunctional status of internal organs and certain biochemical parameters in rats. The assessments of the morphological indicators in the brain, liver, and kidneys were performed every 60 min during eight hours after the beginning of the low temperature exposure. Data showed that the presence and severity of the pathomorphological changes in the internal organs as well as the values of certain biochemical parameters in non-lethal hypothermia depended on the duration of the exposure to low temperatures more than on the temperature itself. The morphological changes in the examined organs indicative of their involvement in the adaptive responses of body to cold were interrelated and developed in parallel, but not simultaneously.

Type 2 diabetes mellitus (T2DM) is a genetically heterogeneous, multifactorial disease that is involved in the pathogenesis of insulin resistance and β-cell dysfunction. The aim of the study was to analyze the associations between the frequencies of Pro12Ala polymorphisms (rs1801282) in PPARG gene and T2DM in Novosibirsk region and other populations. The study included 391 T2DM patients and 556 residents of Novosibirsk region without disorders in carbohydrate metabolism. Identification of alleles and genotypes was performed by using the technology TaqMan, allele-specific PCR with real-time detection of the results. The study found that the distributions of the T2DM risk alleles in PPARG gene (rs1801282) in T2DM and control groups were significantly different (OR [CI95%]=1.43 [1.10-1.86], p=7x10^-3). The main genotype was Pro12Pro in Novosibirsk region, as well as in other populations. The presence of the risk allele 12Pro of rs1801282 polymorphism in PPARG gene was associated with the development of T2DM in Novosibirsk region where it increased risk of T2DM to 1.43. The frequency of 12Ala allele was 17% which corresponded to its frequency in the European population.

The aim of the study was to investigate the frequency of lipid and glucose metabolism abnormalities in an organized population of women engaged in intellectual labor. A total of 483 female secondary school teachers aged 35-64 years (mean age: 49.3±7.8 years) living in Tomsk were surveyed at the workplace in a framework of cardiological screening with response rate of 84%. High prevalence of lipid and glucose metabolism abnormalities was found in the study population. The average levels of total cholesterol and LDL cholesterol were significantly higher than the currently recommended levels. One of five teachers (20.1%) had low HDL cholesterol and one of four teachers (24.9%) had elevated triglycerides levels. The frequencies of hyperglycemia were 38.1 and 24.1%, respectively, as defined by cut-off points of fasting plasma glucose ≥5.6 and ≥6.1 mmol/L. During the cardiac screening at the work place, six new cases of diabetes were detected via the HbA1c testing. Increasingly unfavorable epidemiological situation was found among female teachers in the 55-64-year-old group.

An integrated approach to the development of regional telemedicine information system and analysis of its functioning in a major region with low population density are presented. The main directions in the development of telemedicine systems are identified. Newly developed and practically tested technology of distance consulting of medical images is presented.

The article analyzes the legal consciousness of a health professional from the medico-legal point of view. The authors proposed the solutions to the problem of the underdeveloped sense of justice in health workers. Authors systematized the main directions in the studies of legal consciousness dynamism in medical workers and identified the trends for further development of sense of justice in health professionals.

The aim of the study was to evaluate the autonomous nervous system and psychoemotional status in girls doing sports such as rhythmic gymnastics during the non-drug combination treatment. The authors studied the autonomous nervous system and psychoemotional status in 42 7-14-year-old girls who had been doing rhythmic gymnastics in the Olympic Reserve School for 2 to 6 years. Before and after treatment, all children received the clinical examination and evaluation of autonomous nervous system status by the method of сardiointervalography, psychoemotional status by the Luscher and Spielberger-Khanin tests, and attention and exercise tolerance by an array of relevant tests. Combination treatment included manual massage, exercise therapy, mud therapy, laser therapy, and psychological counselling sessions. Before treatment, the examination showed prevailing vagus nerve effects on the heart suggesting the tolerance of the organism to strenuous exercise. During combination rehabilitation treatment, the gymnasts showed an increase in the activity of the sympathetic-adrenal system suggesting an improvement in the adaptation processes and in the regulation of the autonomous nervous system. All children showed high performance, high psychoemotional stress, and moderate level of state anxiety. Psychological correction measures provided way for improvement of the psychoemotional status in young athletes and exerted the stimulatory effect on the qualities crucial for sport.

Still’s disease in adults is a rare systemic inflammatory disease characterized by high fever, typical maculopapular rash, polyarthralgia, leukocytosis, and hyperferritinaemia. Clinical manifestations of the disease are diverse. Differential diagnosis involves a wide range of diseases including infections, autoimmune, and neoplastic diseases. The article presents a clinical case of Still’s disease in adults and provides analysis of typical clinical manifestations of the disease, diagnostic criteria, and treatment tactics.

This article reveals daily life of medical students of Tomsk State University in the 1920s to early 1930s based on the archival documents and periodicals. The authors reconstructed the details of students’ living conditions, fellowship support, public activity, and engagement in the scientific circles along with the analysis of changes that occurred in the education system and in the students’ social structure during those years. The article summarizes information about training of medical doctors in the specified period.