Background Of Drug Therapy Research Articles

Relationship between free circulating DNA levels, ejection fraction and brain natriuretic peptide levels in patients with chronic heart failure: prospective observational study

BACKGROUND: Chronic heart failure (CHF) is one of the most serious problems in cardiovascular diseases, requiring accurate diagnosis and treatment. The search for new laboratory markers of CHF can improve the accuracy of diagnosis and identify the severity of the patients condition.
 AIM: Our aim was to study the relationship between the levels of free-circulating DNA (cfDNA) and brain natriuretic peptide (NT-proBNP) in the blood plasma of patients suffering from CHF with ejection fraction (EF), to investigate the relationship between these laboratory markers, and to evaluate the dynamics of changes in the studied parameters against the background of drug therapy.
 MATERIALS AND METHODS: The study involved 67 patients of both sexes with a diagnosis of CHF, verified by clinical and functional methods. 23 people without established chronic diseases formed the control group. At the stage of inclusion in the study, all patients underwent: physical examination, general blood test, biochemical blood test with determination of lipid profile, glucose, creatinine, NT-proBNP and cfDNA levels, as well as electrocardiography (ECG), electrocardiography (ECHO-CG), radiography of organs chest, ultrasound of the abdominal organs, 6-minute walk test. The level of cfDNA was determined using the method of P.P. Laktionov, S.N. Tamkovich, E.Yu. Rykova (2005). Repeated blood sampling with assessment of cfDNA and NT-proBNP levels was carried out in the group of patients with reduced ejection fraction 57 months from the start of treatment/correction of previous therapy.
 RESULTS: The study revealed significant differences in the levels of cfDNA in the blood plasma in patients with different EF (less than 40%, 4049%, 50% or more). At the same time, an inverse relationship was established between cfDNA indicators and EF, as well as between the level of NT-proBNP and EF, that is, a progressive decrease in myocardial contractility is accompanied by a combined increase in the levels of the studied markers in the blood, reflecting the severity of the patients condition. In addition, the positive effect of drug therapy on cfDNA and NT-proBNP levels in the group of patients with EF 40% has been proven.
 CONCLUSION: The identified patterns make it possible to consider the level of cfDNA in blood plasma as a potential biomarker of CHF, and also to use it for dynamic monitoring of patients.

ОЦЕНКА ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ АНАЛОГА ЧЕЛОВЕЧЕСКОГО ГЛЮКАГОНОПОДОБНОГО ПЕПТИДА-1 ЛИРАГЛУТИДА У ПАЦИЕНТОВ С ПОДАГРОЙ И МЕТАБОЛИЧЕСКИ НЕЗДОРОВЫМ ФЕНОТИПОМ ОЖИРЕНИЯ

Introduction. Obesity is a global problem of the XXI century. The most important aspect of metabolic disorders that develop with obesity is a change in the level of serum uric acid (UA) in the blood and the development of gout. Currently, the dynamics of cardiovascular risk factors in patients with obesity on the background of drug therapy is being widely studied. The aim of our study is to study the level of UA, vaspin (VsP), visfatin (VF), omentin (ITLN1), retinol-binding protein-4 (RBP4) in patients with gout and metabolically unhealthy obesity (MNHO) during diet therapy and 3 months of treatment with the drug from the group of human glucagon-like peptide-1 analog (aGLP-1) Liraglutide. Materials and methods: 25 men with gout were examined, the average age was 43.6±7.3 years. Gout was diagnosed according to the classification criteria ACR/EULAR, 2015, Wallace S.L., 1977. Metabolic syndrome was established according to the criteria of GNCA (2013): abdominal obesity - waist circumference ≥ 94 cm in combination with any 2 from the following criteria - an increase in triglycerides (TG) ≥ 1.7 mmol / l; a decrease in high-density lipoproteins (HDL) < 1.0 mmol / l, an increase in low-density lipoproteins (LDL) ≥3.0 mmol / l, blood pressure (BP) ≥ 140/90 mm Hg; increase in plasma glucose ≥ 6.1 mmol / l. At the time of inclusion in the study, all patients had an interictal period of gout. Body mass index (BMI) was calculated using the Quetelet formula: body weight (kg)/height (m²). To assess the type of distribution of adipose tissue, the waist circumference (WT, cm) and hip circumference (HB) were measured with a flexible centimeter tape, with the calculation of the W/H ratio. The concentration of VsP, VF, ITLN1, RBP4 was studied using the enzyme-linked immunosorbent assay method using the kits; the concentration of the level of UA in blood serum and daily urine was studied using the colorimetric method. Liraglutide was injected into the subcutaneous fat of the anterior abdominal wall at a dose of 0.6 mg once a day for the first week. Escalation by 0.6 mg every week was then recommended until a dose of 18 mg per day was reached. Participants then received injections at a dose of 1.8 mg for 3 months. Thus, the observation period was 3 months. Laboratory studies and assessment of anthropometric parameters were carried out initially, as well as after 3 months. The control group consisted of 16 healthy men matched in age. Statistical data processing was carried out using the statistical software package Statistica 13.0. Results. 3 months after treatment, a statistically significant decrease in body weight, BMI and WC was noted (in all cases, p<0.01). Median BMI before treatment was ˗ 38.4 [35.4; 39.2] kg/m², against the background of ongoing therapy - 33.2 [31.4; 34.2] kg/m², and thus the loss of body weight was 23% (p<0.05). Serum UA level decreased by 30.1% (p<0.05) during therapy with a drug from the GLP-1 group. In patients with gout, BMI and regression of obesity were associated with a significant decrease in VsP by 17.2%, VF by 13.8% and RBP4 by 10.4%, and a significant increase in ITLN1 by 12.6%. A direct correlation was established between BMI and WC with the content of VsP, RBP4 and VF in blood serum (correlation coefficients from 0.44 to 0.57, p<0.05) and an inverse correlation with the content of ITLN1 (correlation coefficient -0.29, p<0.05). A direct correlation was found between the serum UA index and the content of VsP, VF, RBP4 (correlation coefficients from 0.31 to 0.49, p<0.05). Conclusion. Patients with gout in combination with MNZO showed a significant increase in serum levels of UA, VsP, RBP4 and VF, against the background of a decrease in the concentration of ITLN1. The use of diet therapy using a drug from the GLP-1 group showed a statistically significant decrease in BMI, WC, serum UA, pro-inflammatory adipokines (VsP, VF and RBP4), and a significant increase in anti-inflammatory cytokines (ITLN1).

БЛЮДА ДИЕТИЧЕСКОГО ПИТАНИЯ ОПТИМИЗИРОВАННОГО СОСТАВА

Deficient concentrations of vitamins and minerals in the existing diets of patients in medical institutions were analyzed. When conducting studies of the state of the organism in patients of health care facilities, a deficien-cy of vitamin D, vitamins of group B, carotenoids is found, in certain categories of patients – antioxidant vit-amins A and E. This deficiency is aggravated against the background of drug therapy. To replenish the defi-cient states of the body, it is recommended to enrich the ATS with a mineral-vitamin complex at a concentra-tion of 50-100% of the daily norm of vitamins and minerals. The diet was enriched with GS-3093 premixes. The discrepancy between the content of the vitamin-mineral complex in the existing diet and the recommend-ed, enriched with GS-3093 premix for four especially deficient minerals and the studied vitamins A and group B ranges from – 0.59 to – 675.215 mg. It should be noted the lack of vitamins A (37%), B2 (14%) and C (52%), minerals Ca (26%), Zn (21%) and I (65%) of the recommended daily intake. This will ensure compli-ance with the requirements for conducting evidence-based dietary nutrition for 800 patients of the health care facility of GBUZ “MONIKI” named after. MF. Vladimirsky, who was assigned the main variant of the stand-ard diet (ATD).

Enrichment of dishes with the vitamin and mineral complex "GS-3093" according to the therapeutic diet

The article presents the basic information about the deficient concentrations of vitamins and minerals in the existing diets of patients in medical and preventive treatment facilities. The analysis of the current therapeutic diets showed deviations in vitamins A, B1, B2, PP, and C, as well as in macro- and microelements: Na, K, Ca, Mg, Zn, I, P, and Fe. When conducting studies of the state of the body in patients of health care facilities, a deficiency of vitamin D, B vitamins, and carotenoids, and in some categories of patients, a deficiency of antioxidant vitamins A and E, is found. This deficiency is aggravated against the background of drug therapy. In order to compensate for the deficient states of the body, it is recommended to enrich the therapeutic diet with a vitamin and mineral complex at a concentration of 50-100% of the daily norm of vitamins and minerals. The diet was enriched with GS-3093 premixes. The discrepancies between the content of the vitamin and mineral complex in the existing diet and the recommended, enriched with GS- 3093 premix, for four especially deficient minerals and the studied vitamins A and group B range from -0.59 to -675.215 mg. The defi ciency of vitamins A (37%), B2 (14%), and C (52%), minerals Ca (26%), Zn (21%), and I (65%) compared to the recommended daily intake should be noted. With a five-time meal, the calorie content of the diet according to the therapeutic diet is from 2500 to 3000 kcal and includes 1.5–2 liters of fluid per day. This will ensure compliance with the requirements for conducting evidence-based dietary nutrition for 800 patients of the health care facility of the SBHI Moscow Regional Clinical Research Institute named after M.F. Vladimirsky (MONIKI), who were prescribed the main variant of the standard (therapeutic) diet.

Remodeling of the Left Atrium and the Possibility of Predicting Recurrences of Atrial Fibrillation in Various Variants of Sinus Rhythm Restoration

OBJECTIVE: to compare the dynamics of left atrial remodeling in patients with AF with various CP recovery options and to identify the most reliable predictors of AF recurrence.
 MATERIALS AND METHODS: 153 patients with non-valvular AF lasting from 24 hours to 6 months were examined. All patients were divided into 3 groups depending on the type of cardioversion: the 1st group included 49 patients whose CP was restored against the background of drug therapy; the 2nd group included 57 patients after electro-pulse therapy (EIT); the 3rd group included 47 patients who underwent radiofrequency isolation of the pulmonary veins (RFI LV). All patients underwent ECHO-cardiographic examination (ECHO KG) at the time of AF, as well as on 1, 3, 5, 15 days and 6 months after CP recovery with an assessment of indexed indicators of linear left atrium size (LP), LP volume, LP function recovery time by the rate of peak A transmittal flow (TMF) and LP filling pressure in relation to E/E with the help of a fabric Doppler imaging.
 RESULTS: it was revealed that the absence of AF paroxysms in any variant of cardioversion for 2 weeks is a reliable predictor of maintaining CP after 6 months (p 0.001) and reducing the number of AF paroxysms for 6 months (p 0.001). Accordingly, relapses of AF during the first 2 weeks indicate an increase in their probability within 6 months [OR (risk ratio) = 15.37]. A significant relationship was found between the timing of recovery of LP function (peak A 0.5 m/sec) and recurrence of AF during 2 weeks and 6 months of follow-up (p 0.05). In patients after LV RF, the linear size and volume of LP significantly decreased in dynamics while maintaining CP in comparison with those who had AF relapses for 6 months (p 0.05). In patients after conservative cardioversion and RF ILV, LP filling pressure (E/E) significantly decreased after 14 days (p 0.05) in the absence of AF relapses and did not change significantly by 6 months of follow-up (p 0.05).While in the presence of repeated paroxysms of AF, this indicator did not change significantly by 6 months of follow-up. In the EIT group, no reliable dynamics of the estimated parameters of LP remodeling was found.
 CONCLUSIONS: The peak A 0.5 m/s measured by TMF on 1 day after the rhythm restoration is a reliable predictor of CP retention for 6 months in any variant of cardioversion (p 0.001). The absence of AF paroxysms within 2 weeks after CP recovery reduces the likelihood of their occurrence also within 6 months with any choice of cardioversion (p 0.001). In patients with CP recovery on the background of drug therapy and after RF ILV, the absence of recurrence of arrhythmia for 6 months is associated with a significant decrease in the size of LP (ILP and IOLP), (p 0.05). A decrease in LP filling pressure (E/E) 2 weeks after conservative cardioversion and LV RFI can be considered a reliable predictor of maintaining sinus rhythm by 6 months (p 0.05).

Clinical aspects of using non-invasive nasal ventilation in patients after COVID-19 complicated by bilateral multisegmental pneumonia

A clinical experience of using non-invasive nasal ventilation in patients after coronavirus disease 2019 (COVID-19) complicated by bilateral multisegmental pneumonia. It has been shown that, against the background of medication therapy, there is a restoration of ventilation-perfusion relationships in lung atelectasis areas, which is confirmed by spirometry and chest computed tomography. Implementation of non-invasive nasal ventilation against the background of drug therapy to restructure diffuse pulmonary fibrosis allows to accelerate the onset of dynamic exercise due to improved exercise tolerance.

Comparative effectiveness of various methods of physical rehabilitation in the complex treatment of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome

To compare the effectiveness of a special complex of therapeutic (vestibular) gymnastics and training with biofeedback (BFB) on a stabiloplatform in the rehabilitation of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome. A cohort prospective single-center randomized comparative study of the clinical effectiveness of the author's complex of therapeutic exercises and stabilometric training with BFB in the complex treatment of patients with dyscirculatory encephalopathy with vestibulo-atactic syndrome was carried out. The study involved 40 patients aged 65-89 years who were randomized into 2 equal groups. Patients of the 1st group, against the background of drug therapy and physiotherapy, were trained on a stabiloplatform with BFB (a training game according to the manufacturer's instructions). Patients of the 2nd group performed a complex of therapeutic (vestibular) gymnastics specially designed for this study. The effectiveness of physical rehabilitation was assessed by the dynamics of (1) subjective symptoms (complaints of patients), (2) indicators of stabilometry (symmetry index, the sum of the coordination indices for the right and left legs, fluctuation) and (3) the results of functional testing using the Get up and go test, the Berg balance scale and the Tinetti mobility scale. In the group of patients who performed vestibular gymnastics, in contrast to patients who participated in training using a multifunctional stabiloplatform with BFB, a statistically significant improvement was revealed when assessed by the Get up and go test and the Berg balance scale. In none of the groups, a distinct dynamics of stabilometry indicators was registered. No correlation was found between the main indicators of stabilometry and the data of functional tests. Thus, vestibular gymnastics has demonstrated greater effectiveness in the rehabilitation of patients with dyscirculatory encephalopathy and vestibulo-atactic syndrome in comparison with stabilometric training with biofeedback. The discrepancy between stabilometry indicators and the results of functional testing in patients requires a targeted study.

The first experience of arthroscopy in the case of aseptic necrosis of the femoral head

Observation of patients with avascular necrosis of the femoral head formed a hypothesis about inability to eliminate the hip contracture by tunneling the femoral head on the background of drug therapy and therapeutic exercises, which causes an unsatisfactory outcomes. Therefore, the was idea to use arthroscopy for performing capsulotomy, synovectomy and removal of free cartilage and bone fragments. Objective. To evaluate efficiency of arthroscopy in patients with avascular necrosis of the femoral head. Methods. In the period from 2010 to 2018, 60 patients were observed. With the I–II stages, absence of inflammatory processes in the joint, body mass index less than 35. In the comparison group (28 patients) we made only tunneling of the femoral head, in the study group (32) at first we performed arthroscopy of the hip joint, capsulotomy, synovectomy, removal of cartilage fragments, and only then — tunneling. We analyzed the proportion of hip joint replacement that was performed in the long term follow up and the intensity of pain by visual analog scale. Results. During arthroscopy we often revealed the joint cartilage lesions — 30 %, articular labrum lesions — 5 %, synovitis — 100 %, CAM impingement — 90 %. In the study group in the first 2 weeks after surgery, the pain was severe more than in the comparison group. Then the pain rate became the same in both groups. In the control group in the period from 3 to 5 years after tunneling of the femoral head, arthroplasty was performed in 11 patients (39.3 %), in the study group for 2 to 3 years after surgery — 8 (25.0 %). Conclusions. Analysis of long-term results of tunneling of the femoral head with arthroscopy of the hip joint in patients with avascular necrosis of the femoral head showed improvement in hip function, no disease progression in 60–75 % patients in 2–3 years after surgery.

Physiotherapy methods in the complex of cognitive rehabilitation of patients in the late recovery period in patients after ischemic stroke

BACKGROUND: For the purpose of early and late medical rehabilitation in recent decades, non-drug methods of physiotherapy have been actively used to restore patients who have had an ischemic stroke. AIMS: substantiation of the inclusion of multimodal physiotherapeutic effects from the Alpha LED Ohu Light_Spa apparatus and low-frequency electrostatic massage from the Khivamat apparatus for the correction of cognitive impairment in patients who have suffered an ischemic stroke, with motor disorders in the form of hemiparesis, increased muscle tone by the type of spasticity in the late recovery period. MATERIALS AND METHODS: The study included 120 patients who had an ischemic stroke with movement disorders in the form of hemiparesis with increased muscle tone in the form of spasticity in the late recovery period. Patients of group 3 (40 people) were prescribed standard drug therapy and medical rehabilitation, patients of group 1 (40 people in addition to standard therapy and rehabilitation, multimodal physiotherapeutic effects were used from the Alpha LED Oxy Light-Spa device and patients of group 2 (40 people) a low-frequency electrostatic massage from the Khivamat apparatus was added to the standard complex. RESULTS: At all control points after the course of treatment, after 6 and 12 months, in addition to general clinical studies, we assessed indicators of cognitive functions (according to the Montreal Cognitive Assessment Scale) and psycho-emotional state according to the HADS scale. In dynamics, it was revealed that in groups 1 and 2, where the developed rehabilitation programs were carried out, there was a significant improvement in cognitive functions (attention, memory, fluency, generalization, etc.), to a greater extent in group 1, while in patients who, against the background of drug therapy, underwent standard medical rehabilitation, only a positive trend was noted. CONCLUSION: The inclusion in the medical rehabilitation of patients who have suffered an ischemic stroke, to a greater extent, multimodal physiotherapeutic effects and to a somewhat lesser extent, low-frequency electrostatic massage contributes to a significant improvement in cognitive functions and a reduction in anxiety and depression.

Комплексная технология лазерной хирургии пигментной глаукомы

Purpose. To analyze the complex method effectiveness of pigmentary glaucoma laser surgery (YAG-laser iridectomy and a multistep SLT). Materials and methods. Laser iridectomy was performed in 14 patients (28 eyes) aged 13 to 54 years old with pigmentary glaucoma after achieving the values of the individual IOP level against the background of drug therapy. Then after 4 weeks SLT was carried out. If an exogenous pigmentation was ≥2 st., SLT repeated several times every 4-6 months. Observation period: from 4 to 15 years. Results. The glaucoma process stabilization was achieved in all cases. The level of true IOP decreased by 6.6±0.3 mm Hg (-30%, p<0.05), Becker's coefficient by 121±4.3 (-60%, p <0.001), the instillations number by 1.32±0.06 (-70%, p<0.001). The indicators increased: the average value of the total retinal photosensitivity by 381±4.3 dB (15%, p<0.001), the average threshold of the retinal photosensitivity by 2.6±0.1 dB (10%, p<0.001), the lightness of the intraocular liquid outflow by 0.08±0.013 (72%, p<0.001). Drug hypotensive therapy was canceled at 12 eyes (42.8%). Conclusion. The complex method of pigmentary glaucoma laser surgery in the form of YAG-laser iridectomy and the multistep SLT is effective and safe. It can be performed for a decrease of increased ophthalmotonus level to the individual IOP against the background of drug treatment. Key words: pigmentary glaucoma, YAG-laser iridectomy, selective laser trabeculoplasty.

Первый опыт применения микроимпульсной циклофотокоагуляции в комплексном лечении острого приступа закрытоугольной глаукомы

Purpose. To study effectiveness of micropulse cyclophotocoagulation (MP-CPC) in complex treatment acute angle closure glaucoma (ACG). Material and methods. Dynamic observation of 4 patients with acute ACG was carried out. There was stagnant injection of the conjunctiva, corneal edema, shallow anterior chamber, iris bombe, mydriasis up to 4–6 mm, closed anterior chamber angle in all quadrants. In three cases, the initial lens opacities were determined, in one eye the lens was transparent. Against the background of drug therapy and laser iridectomy, the intraocular pressure (IOP) level reached values from 26 to 33 mm Hg. On days 2–3 after admission to the hospital, all patients underwent MP-CPC using the Cyclo G6 Glaucoma Laser System the MicroPulse P3 glaucoma device (Iridex, USA). Results. The operation and postoperative period were uneventful. All patients had pain relief, inflammatory response was absent. Corneal edema was stopped 1–2 days after surgery. In all eyes, on the first day after the operation, there was significant decrease in IOP level to 14–23 mm Hg. One month after the complex treatment, the IOP level remained stably normal and ranged from 16 to 21 mm Hg in all patients. Increase in visual acuity was noted in all cases. Conclusion. MP-CPC is effective, safe and low-traumatic operation and can be used in complex treatment of patients with an acute ACG. Key words: micropulse cyclophotocoagulation, acute angle closure glaucoma, intraocular pressure.

USE OF FATTY STROMAL CELLS IN THE COMPLEX TREATMENT OF TROPHIC ULCERS IN THE EXPERIMENT

Abstract. The aim of the study. The purpose of the research is to study the effectiveness of the treatment of trophic ulcers by autologous transplantation of stromal cells from adipose tissue in the experiment. Materials and methods of research. Experimental studies of the effectiveness of the treatment of trophic ulcers of venous etiology by autotransplantation of adipose tissue cells on 14 rabbits of the Chinchilla line, aged more than 4 months in both sexes, weighing 3 kilograms, are presented. After receiving the trophic ulcer, the rabbits were divided into 2 groups. A control group of 7 rabbits who used drug therapy and a core group of 7 rabbits who underwent autotransplantation of stromal cells from adipose tissue against the background of drug therapy. Both groups performed morphological and immunohistochemical studies. Results and conclusions. It is determined that the use of the method of autotransplantation of the stromo-vascular fraction of adipose tissue (SVF) in the treatment of trophic ulcer of venous etiology in the experiment in rabbits leads to acceleration of the processes in the healing of trophic ulcer, which is increased by the level of cytokyntinucleation, into more mature connective tissue. Keywords: mesenchymal stromal cells from adipose tissue, trophic ulcer, chronic venous insufficiency, experiment, morphological study, immunohistochemically research.

Stem hemorrhagic stroke: opportunities for rehabilitation

The most severe and disabling among various types of cerebrovascular accidents are hemorrhages. High mortality in hemorrhagic stroke is due to the possible development of a generalized convulsive syndrome, accompanied by respiratory failure; a cascade of irreversible biological reactions (dislocation syndrome with wedging, ventricular system hemotamponade with the formation of acute obstructive hydrocephalus); the development of complications associated with forced immobilization of the patient or connecting to a ventilator. The diagnosis of cerebral stem strokes is highly relevant due to the increase in their prevalence in the structure of cerebrovascular diseases. With stem strokes, the prognosis of the disease is worse than with strokes of any other localization, which is explained by the location of many vital centers in these structures. The paper highlights the classification and clinical manifestations of hemorrhages in the brain stem, substantiates the feasibility of rehabilitation measures at all periods of the disease. The use of early individual rehabilitation complex treatment can improve the results of therapy of deeply located hematomas, reducing disability and mortality of patients. The article presents the clinical case of a patient with a stem hemorrhagic stroke, in which, against the background of drug therapy and rehabilitation measures developed according to an individual program, self-care skills and working capacity were fully restored. Key words: hemorrhagic stroke (hemorrhage), stem stroke, hemorrhage in pons, rehabilitation

Effect of complex therapy on indicators of intracardiac hemodynamics in patients with arterial hypertension combined with chronic obstructive pulmonary disease

Aim. To study the effect of complex treatment of patients with arterial hypertension in combination with chronic obstructive pulmonary disease (COPD), including drug treatment and training programs, on the indicators of intracardiac hemodynamics. Materials and methods. 84 patients with stage II hypertension in combination with COPD were examined. Males made up 69.5% and females 30.5%. The average age of patients was 53.9±0.49 years. All patients underwent clinical and laboratory tests, transthoracic Doppler echocardiography, ambulatory blood pressure (BP) monitoring, and indicators of lung function were determined. The studied patients were prescribed a fixed combination of antihypertensive drugs: amlodipine 5 mg with perindopril 4 mg (Dalneva, KRKA) and COPD therapy according to GOLD (2017). Patients of the 1st group (n=45) on the background of drug treatment were trained in the school of health, patients of the 2nd group (n=39) did not attend the school of health. Results . By the 6th month of therapy, 97.8% of patients in group 1 the target blood pressure level was achieved, in the 2nd group - in 74.4%. By the end of examination in patients of group 1, left ventricular myocardial mass index (LVMI) decreased by 10.9% (p=0.01). In group 2, on the background of drug therapy, there was a 5.9% decrease in LVMI (p=0.1), but in comparison with group 1, it was less pronounced (p=0.02). Normalization of LVMI was observed in 20.2% of patients in group 1 and 5.1% of patients in group 2, which was accompanied by an improvement in left ventricular myocardial diastolic function. An increase in the mean values of left ventricular stroke volume and left ventricular ejection fraction in group 1 (p=0.01) was registered, indicating an improvement in the systolic function of the left ventricular myocardium. By the 6th month of treatment, there was an improvement in bronchial patency, but in the 2nd group of patients, changes in spirometry indicators were statistically insignificant. Conclusion. The use of combination therapy, including fixed combinations of antihypertensive drugs and group training programs in patients with arterial hypertension in combination with COPD, contributes to adequate blood pressure control, increases adherence to treatment, which is accompanied by an improvement in hemodynamic parameters and respiratory function. Regression of signs of left ventricular hypertrophy and improvement of its diastolic function in these patients, calls for a wide application of training programs in the treatment of comorbid patients at the early stages of the disease.

The effect of electrical stimulation by bipolar-pulse microcurrents on regeneration processes in experiment and clinic

Objective. The purpose of this study is to study the effect of electrical stimulation by bipolar-pulsed microcurrents: in an experiment on lymphatic drainage of a marker from the mesentery of mice and in the clinic on patients with hypertrophic scars in the face.
 Materials and methods. In the experiment, the rate of resorption of the marker from the mesentery of mice (n = 10) receiving the placebo procedure and mice (n = 10) receiving the course of electrical stimulation with bipolar-pulsed microcurrents were measured under a light microscope. In addition, the clinic observed patients aged 18 to 60 years (n = 100), with hypertrophic scars in the face area that arose for various reasons. Of these, the 1st (control) group of patients (n = 10) received only one standard drug therapy, and the 2nd (main) group (n = 90) additionally received electrical stimulation with bipolar-pulsed microcurrents in the face area.
 Results. The experiment showed that the rate of resolution of the marker in the mesentery of the intestines of mice after a course of electrical stimulation was greater than in mice treated with the placebo procedure. In a clinical study in patients in the 2nd (main) group after a course of electrical stimulation, on the background of drug therapy, better results were achieved on the Vancouver Scar Scale and in a shorter time period than in patients in the 1st (control) group who received drug therapy . The greater effectiveness of the results in patients in the 2nd (main) group was confirmed by the data of statistical regression analysis.
 Conclusions. The results of this experiment showed that electrical stimulation by bipolar-pulsed microcurrents accelerates lymphatic drainage in the mesentery of the intestines of mice. In a clinical study, the use of electrical stimulation with bipolar-pulsed microcurrents in patients with hypertrophic scars in the face region in the 2nd group showed high efficiency and the transition of hypertrophic scars to normotrophic ones in earlier periods.

Effect of vitamin-mineral complexes on quality of life of patients with arterial hypertension

Objective:A considerable proportion of the population due to both economic reasons and traditions appear to be experiencing chronic deficit in micronutrients, which may be deteriorated on the background of drug therapy being performed. The purpose of our study was to optimize pharmacotherapy of patients with first-ever prescribed diuretic-containing combined therapy for arterial hypertension (AH) by means of adding a vitamin-mineral complex.Method:To determine B-group vitamins (thiamine, riboflavin, pyridoxine) in blood plasma by means of high-performance liquid chromatography (HPLC) and, on achieving the target values of arterial pressure (AP), to analyse the patients’ quality of life by means of such neuropsychological tests as the General Health Questionnaire – 36 (GHQ-36) and WAM (wellbeing, activity, mood) questionnaire.Results:The group of patients receiving antihypertensive therapy alone demonstrated a decrease in blood plasma thiamine, riboflavin and pyridoxine from 34.5±4.2 to 25.4±3.2 ng/ml (p<0.05), from 11.3±1.5 to 7.8±1.1 ng/ml (p<0.05) and from 13.4±1.5 to 9.1±1.3 ng ng/ml, respectively. In patients receiving the vitamin-mineral complex additionally to drug therapy of AH, no significant alterations in the content of micronutrients in blood plasma were revealed. We noted more pronounced dynamics in the scores by the GHQ-36 and a more pronounced increase in the patients’ activity by the WAM test, amounting to 28,9 Δ % and 15.51 Δ %, respectively (p<0.05).Conclusion:Supplementing antihypertensive pharmacotherapy with a vitamin-mineral complex makes it possible not only to maintain the level of micronutrients at the level of the physiological requirements but to improve the patients’ quality of life as assessed by neuropsychological scales.

Применение инфузий T-клеток памяти с целью профилактики вирусных инфекций у пациентов с гемобластозами, перенесших аллогенную трансплантацию гемопоэтических стволовых клеток с деплецией α/β-Т-лимфоцитов

Viral infections are frequent complications in the recipients of the HSCT with TCRαβ and CD19-graft depletion. Adoptive transfer of memory T cells may improve immune response to common pathogens. The work reflects the retrospective safety analysis of using the infusions of CD45RA-depleted donor lymphocytes. Data from 80 patients were analyzed. Up to 3 doses of donor lymphocytes were administered at monthly intervals, escalating to 100 × 103/kg in haploidentical transplants and 300 × 103/kg in MUD transplants. Median follow-up for alive patients was 18 (8–44) months. We did not observe any allergic reactions, septic complications after infusion of donor lymphocytes (DLI). The cumulative incidence of a de novo acute GVHD after DLI was 5% (95% CI: 2–13). In 64% patients (n = 51) was detected CMV in the blood. There were no cases of resistant CMV disease on the background of drug therapy. In patients who received DLI, 70% (n = 56) had documented appearance of virus-specific lymphocytes in peripheral blood (Elispot assay). Thus, the introduction of memory T cells at a dose of 25–100 × 103/kg body weight of the recipient for CD3+ in the case of HSCT from a haploidentical donor and 100–300 × 103/kg for an unrelated HSCT. Infusions of low dose memory T-lymphocytes after transplant engraftment are safe, potentially effective and constitute a simple measure to prevent infections in the setting of alpha/beta T-cell-depleted transplantation.

Technology of computer stabilography with biofeedback in the rehabilitation of patients with paraproteinemic polyneuropathy

The paper presents the experience of using the technology of computer stabilometry with biologic feedback in the rehabilitation of patients with paraproteinemic polyneuropathy. In the process of observation of 16 patients with clinical manifestations of peripheral neuropathy associated with paraproteinemia, verified by neurological exam, electroneuromyography, and laboratory tests, demonstrated diagnostic and rehabilitation efficiency in the use of stabilometric systems in the evaluation of neurological deficit and the process restoring balance equilibrium, coordination of movements and sensitivity. Received a statistically significant improvement in the balance of equilibrium in the form of a lower coefficient of Rombergfrom 670 to 295 % (p<0,05) on the background of drug therapy (neurometabolic drugs and vitamins) and a course of ten workout routines on stabiloplatform. In addition, the proven data on improvement of motor and sensory function in patients with paraproteinemic peripheral neuropathy at the end of rehabilitation technology computer stabilometry with biologic feedback was achieved.

Dynamics of kininogenesis in patients with peptic ulcer disease against the background of drug therapy

Many aspects of pathogenesis, diagnostics and treatment of peptic ulcer disease continue to attract the attention of researchers. In pathogenesis of this disease a great role is given to biologically active substances, among which the most powerful are kinins. The revealed increase of kinin system activity in the acute period and its decrease in the remission period of peptic ulcer disease began to be considered as participation of this system in pathogenesis of the disease. There were developed recommendations on the use of antienzyme drugs (trasylol, contrical, etc.) in order to inhibit the activity of kallikrein-kinin system of blood in patients with this pathology.