Many authors showed that the levels of cardiac biomarkers suggestive of death of cardiomyocytes and necrosis of the myocardium increased after percutaneous coronary intervention. Recent studies demonstrated the efficacy of statins for the prevention of these events, due to the presence of pleiotropic properties. The review presents the main studies regarding the use of loading doses of potent statins: atorvastatin (ARMIDA, ARMIDA-RECAPTURE, NAPLES II et al.) and rosuvastatin (ROMA, ROMA II et al.) for the prevention of periprocedural myocardial damage in patients with stable coronary artery disease. These data support the need for more frequent administration of high doses of statins for all patients referred for elective PCI for stable angina, including naive statins, as well as the need for reloading statins before PCI in patients already receiving them long-term.

In this review we discuss literature data and our own findings regarding treatment of syntropic comorbid diseases. We propose a pathogenetic rationale for the use of drugs targeting central intermolecular hubs linking inflammation, lipid homeostasis, and immune responses in patients with several autoimmune disorders complicated by accelerated atherosclerosis. We provide examples of successful and safe use of PPARa agonist fenofibrate and HMG CoA inhibitor simvastatin in patients with rheumatoid arthritis, osteoarthritis, and psoriasis. Anti-inflammatory action of these drugs was accompanied by lipid-modulating and immune modulating effects. Data on selective inhibition of NF-κB in several autoimmune disorders associated with comorbidities are reviewed. We also analyzed literature data on the use of a phosphodiesterase 4 inhibitor roflumilast in COPD-associated comorbid diseases. In conclusion, the use of drugs directed at intermolecular hub targets is a promising and pathogenetically based approach to the treatment of syntropic comorbid diseases.

Objective: To study the relationship between mechanical dyssynchrony assessed by echocardiography and the criteria for high risk of sudden cardiac death in patients with congestive heart failure (CHF). Material and methods: The study involved 162 patients with CHF (143 males and 19 females, mean age 57±10 years), among whom 118 (73%) patients had diagnosis of coronary artery disease (CAD) and 44 (27%) patients had non-ischemic cardiomyopathy. In all patients, LV ejection fraction (LV EF) decreased by <35% or <35-45% when life-threatening ventricular arrhythmias occurred. The following parameters of risk factors were estimated: CHF NYHA functional class; left bundle branch block (LBBB); ventricular tachycardia (VT); LV EF. Results: According to the results of echocardiography, signs of dyssynchrony were observed in 35% (56 out of 162) patients, while the frequency of dyssynchrony detection in non-ischemic cardiomyopathy was 50 and 29% (p<0.01) in CAD. LBBB was observed significantly more often in patients with signs of dyssynchrony (48 and 8%, p<0.001), regardless of diagnosis. There was no relationship between VT and dyssynchrony. LV EF was 30±5% in the presence and 32±5% (p<0.05) in the absence of dyssynchrony signs. In patients with non-ischemic cardiomyopathy, LV EF was 29±5% in the presence of dyssynchrony and 35±5% (p<0.01) in the absence of dyssynchrony. No significant differences in LV EF were found in the group of patients with cAd. Conclusions: Myocardial dyssynchrony was associated with LBBB in all patients and with decrease in LV EF only in the group of non-ischemic cardiomyopathy. Associations between dyssynchrony and VT as well as NYHA functional class were not detected.

The aim of this study was to evaluate the patients’ state of health by EQ-5D questionnaire before the “MAZE” radiofrequency endocardial catheter ablation procedure and long-term after the intervention based on the efficacy of the treatment. A total of 391 patients (247 male) aged 18 to 77 years (mean age 54.9±10.1 years) with atrial fibrillation (AF) were examined. All patients underwent catheter ablation, including pulmonary veins isolation, ablation of lines in the back wall, at roof of the left atrium, and along the mitral isthmus. The state of health was evaluated, according to the efficacy of the interventional treatment and EQ-5D questionnaire data. According to the results of our study, the long-term efficacy was 83.3% in patients with paroxysmal AF and 72.4% in patients with persistent AF. The state of health remained at the initial level in patients with successful ablation, but if the procedure was unsuccessful, the state of health significantly worsened.

Contrast-enhanced MRI of the heart was employed for visual detection of risk as well of anatomic locations of atrial arrhythmias in patients with previous myocardial infarction. Data showed that pathologic uptake of paramagnetic to the atrial myocardium with enhancement index over 1.27 (in T1-weighted spin-echo mode) and concomitant increase of left atrial volume over 75 mL provided prognostic factor for manifestation of atrial tachyarrhythmias and endocardial destruction procedure in the nearest future. Therefore the contrast-enhanced MRI can be included to the diagnostic algorithm for patients with ischaemic heart disease and risk of supraventricular tachyarrhythmias.

Purpose. To evaluate the efficacy and safety of independent physical trainings (PT) at the outpatient stage of rehabilitation in patients who underwent coronary artery bypass grafting (CABG). Material and methods. A total of 112 men with coronary artery disease (CAD) who underwent CABG were examined. Status of patients was evaluated after 1, 4 months and 1 year after CABG. Data demonstrated that the greatest effect on improving the exercise tolerance (ET), optimization of hemodynamic and lipid profile parameters was in patients who received controlled bicycle training (BT) within three months after CABG. Patients who received only drug therapy without controlled physical exercises during rehabilitation period had the lowest improvement of ET and left ventricular ejection fraction evaluated four months after CABG. Patients who received physical training at home in the form of controlled walking (CW) within three months after CABG had intermediate results. Conclusion. Individual PT of moderate intensity is safe, easy to perform, and is available for a large number of patients, but it is less efficacious than controlled BT.

The aim of the study was to evaluate efficacy and safety of sternal resynthesis by nitinol implants in patients with poststernotomy sternomediastinitis and in animal model. Material and Methods. Surgical nitinol alloy wire mesh implant was developed for sternal resynthesis. The experimental study comprised 60 Wistar rats: sternal tissue was cut by lancet, nitinol alloy wire mesh implant was placed, and wound was closed by suturing layer by layer (experimental animal group). Control animal group comprised sham-operated rats. The signs of swelling, hemorrhage, hyperemia, inflammatory infiltration, regeneration, and reaction to implant were studied histologically at days 14, 28, and 48 post-surgery. Clinical results of surgical treatment for postoperative sternomediastinitis were studied in 29 patients hospitalized during 5-year period (2010-2014). Patients were assigned to 2 groups. Group 1 - n=14; mean age of 62.64±7.69 years; 10 (71.4%) males - underwent sternal resynthesis with placement of nitinol alloy wire mesh implant. Group 2 - n=15; mean age of 61.07±7.86 years; 11 (73.3%) males - underwent surgical debridement with metallo-osteosynthesis (MOS) by metallic suture. Results. Six-week experimental animal study demonstrated no significant adverse reactions between the implant and sternal and parasternal soft tissues. In clinical group 1, successful sternal closure was achieved in 12 patients; mediastinitis resolved in 12 patients; healing by primary intention was observed in 11 patients. No implant-specific complications (fracture, migration, cheese-wiring, severe pain syndrome) were recorded. In group 2, successful sternal closure was achieved in 6 patients; mediastinitis resolved in 8 patients; healing by primary intention was observed in 10 patients. Routine MOS in patients with postoperative complications of medial sternotomy failed to achieve sternal closure in 60% of cases due to failed metallic sutures that aggravated sternal fragmentation. Recurrence of failed sternal sutures occurred more frequently in patients who received routine MOS (р<0.05). Uneventful postoperative period was observed more often in group 1 (р<0.05). There was significant association between the development of failed sternal closure and preceding attempt of routine MOS in group 1 (р<0.05). In both groups of patients, there was a significant association between the development of recurrent mediastinitis and recurrent failure of sternal closure (p<0.05). Conclusion. Six-week experimental animal study did not reveal adverse interactions between proposed implant and sternal and parasternal soft tissues. Clinical study demonstrated that method of sternal resynthesis, based on surgical nitinol alloy wire mesh implant, provided good early results and safe fixation of sternal fragments. However, this method is contraindicated in patients with severe sternal fragmentation. Efficacy of the proposed method exceeded that of routine MOS.

The study examined the markers of damage and inflammation of the vascular wall and abnormal blood coagulation in 60 patients with chronic alcoholism stage II (heavy drinkers). High-sensitive CRP (hsCRP) levels were measured by immunoturbidimetric assay with Termo Fisher reagents (Finland) and automatic biochemical analyzer Konelab 60i (Thermo Electron, Finland). Homocysteine was determined by ELISA by using Axis-Shield test system (Germany, Norway). The functional activity of von Willebrand factor (vWF) was determined by measuring ristomycin-cofactor activity (RSA) of blood plasma with Renamo test system (Russia). Level of vWF antigens were quantitively measured by ELISA with Technoclone test system (USA). Activated partial thrombin time (APTT) was determined with Platelin LS reagent (Organon Teknika Corporation). Data showed the increases in the level and activity of vWF (р<0.001) and in the levels of homocysteine (р<0.001) suggesting the damage to the vascular endothelium. The level of HsSRB increased by 3.8 times compared to healthy individuals (p<0.001) suggesting the presence of chronic indolent inflammation of the intima of the arterial wall. Decrease of aPTT (p=0.01) indicated hypercoagulability in patients with chronic alcoholism stage II. Positive correlation was found between homocysteine concentration and vWF level (r=0.46; p <0.001), homocysteine level and vWF activity (r=0.62; p<0.001), and between homocysteine and NsSRB levels (r=0.59; p<0.001). Inverse correlation was documented between APTT and vWF activity (p=0.01; r=-0.34) and homocysteine level (p=0.03; r=-0.36). In summary, hyperhomocysteinemia and increased VWF activity were accompanied by hypercoagulability in patients with chronic alcoholism stage II presented with high risk of cardiovascular diseases.

The article presents rationale for an introduction of a training complex into the program for higher professional education and training of qualified military personnel. The aim of the training complex is to form stable motivations for a healthy lifestyle and maintaining a high level of health throughout the life of future soldiers. To achieve this goal, the following research objectives were completed: medical case study with an analysis of the medical documentation was performed; training complex “Scientific view of the world was developed; and value motivations of cadets for health and healthy lifestyle”.

Aim: to assess the prognostic value of maternal heart rate variability (HRV) detrended fluctuation analysis (DFA) for the early prediction of gestational pathology taking into account special characteristics of neuroautonomic regulation in pregnant women. We have examined 102 somatically healthy women with uncomplicated pregnancy (control, Con) and 469 women at low and moderate pregnancy risk with different types of gestational pathology (GP group) diagnosed retrospectively (after delivery). The categories of obstetric complications considered were preeclampsia, intrauterine growth restriction, labor abnormalities and miscarriage. Mean age and gestational time at the moment of exam were 24.9±4.7 yrs. and 21.2+3.1 wks. (M+SD) respectively. I70.1% of them were primiparas. DFA decrease in dynamics of maternal moderate voluntary hyperventilation (not more than 1.5 of respiratory minute volume determined at rest), was found in 61.4 and 6.2% of GP and Con groups respectively (p<0.001) in women with autonomic misbalance of sympathetic predominance (overactivity). So, positive likelihood ratio (LR+) of DFA test was 0.614/0.062=9.9. As a comparison, women at unload condition and with one of the biased autonomic profile (sympathicotonic, vagotonic or baroactive) show LR+ value as low as 1.4. The positive DFA test result in the form of this index decrease under maternal voluntary hyperventilation upon initial condition of increased sympathetic activity in pregnant women enhances pretest odds for gestational pathology approximately tenfold. It makes this test informatively valuable as much as “gold standard” for the early prediction of pregnancy complications.

We present two clinical cases of severe neonatal encephalopathy. Features of the clinical picture, the changes of brain electrocortical activity, intracranial blood flow, morphological pattern, and the outcome of pathological condition are described.

The article presents the biography of the famous Russian pediatrician Evgeny I. Nebolyubov and his contribution to the development of Russian pediatrics. The author gives a brief review of his scientific, educational, medical, and social activities.

The diagnostics theory covers the clinical experience of century-old medicine. A clinical study should begin with the fundamentals of the diagnostics theory, which is equally important both for a practitioner and a medical scientist. Despite significant advances in modern medicine due to the development of new technologies, the priority of clinical examination of patient is strengthened. Nowadays the most important pathology theories developed in the end of 19^th and beginning of 20^th centuries are being tested clinically. A deeper research at the molecular level results in disappearance of the clinical specificity of diseases. The inflammatory nature of the pathological process and the generalization of the changes in cell membranes, including CNS, are now increasingly found in the pathogenesis of diseases of internal organs. It is highly probable that the specific presentation of clinical entities is determined by the changes in membranes in various parts of CNS. The etiology of diseases with autoimmune pathogenesis remains a mystery, with the vector of the dialectical relationship between conditionalism and monocausalism shifting toward the latter, in particular, to determining the infectious nature of disease. Challenging problem is the contradiction between the methodical and methodological levels of studying physiological and pathological processes in the human organism. The paradoxes observed in the relationship between theories and clinical manifestations of pathology must generate new hypotheses and the need to test them in the experiment.