The potential for the development of renewable energy generation in Russian territories where the power supply system is decentralized

The problem of conservation of energy sources is actual in many countries. The energy strategies of developed countries are aimed at renewable energy sources. For instance, European Union has already developed a long-term strategy ENERGYSTRATEGY 2050 aimed to reduce greenhouse gas emission by more than 80-95% from 1990 levels. Russian Federation has also developed the national program "Energy saving and improvement of energy efficiency for the period until 2030". The distinctive feature of Russian energy system development is decentralized energy supply on large territories. Therefore, the renewable energy development is urgent. This article describes prospective directions of development of renewable energy generation systems in underpopulated and isolated territories of the Russian Federation where energy supply is decentralized. © Published under licence by IOP Publishing Ltd

Integrated solution for patients of a very high cardiovascular risk. Final results

Secondary prevention should be actively implemented at all stages of treatment and rehabilitation of patients after acute coronary syndrome (ACS). The integration of remote monitoring of patients with the transfer of vital and laboratory data into clinical practice seems promising.Aim. To evaluate the clinical and patient-centered effectiveness of the original 12-month combined face-to-face and telecare program in patients with recent ACS.Material and methods. For the present analysis the data from 84 (out of 100) patients (median age, 56 (50;61) years, 70 males) was used. These patients had to have hypertension and/or type 2 diabetes and an ACS with percutaneous revascularization within 12 months. Their low-density lipoprotein cholesterol (LDL-C) had to be above 2,4 mmol/L. Telehealth program supplemented routine care. A program contained electronic self-control diaries for blood pressure (BP) and lipid profile, and teleconsulting service (text chat). Mandatory face-to-face visits were carried out at 3 and 12 months after the enrollment. The primary end point was ∆LDL-C. Additional clinical and patient-specific endpoints were evaluated.Results. At the 12-month visit, there was a significant decrease in LDL-C by 1,6 (-2,3;-0,9) mmol/L. Besides the initial LDL-C value, the decrease in LDL-C was associated with the proper adherence to keeping diaries of BP and lipid profile (β=0,7), and the number of text messages sent by the doctor in the 1st month after the enrollment (β=0,04). In more adherent patients, the ∆LDL-C was greater by 0,49 mmol/L (95% CI (-1,2; -0,1)) after adjustment for abovementioned covariates. In 35 patients (42%), target LDL-C was achieved, in 60 patients (71%) — a decrease ≥1 mmol/l. Other lipids also have changed for the better. Moreover, adherent patients were twice as likely to achieve the target LDL-C (OR 2,2; 95% CI (0,6; 3,8)) than non-adherent ones. A decrease in office systolic BP by 5,8 mm Hg was shown (p=0,03). The number of physician-to-patient messages exceeded those from patients to physician (median 143 and 111 per patient for 12 months, respectively). The quality of life has improved, but only in terms of emotions. Satisfaction with the program remained high at all timepoints of the study.Conclusion. Our study showed the effectiveness of the integrated care in ACS patients with the telehealth tool included. Commitment to BP self-monitoring, as well as active consultative support at the first stages of rehabilitation, contributes to additional dynamic control of lipid profile, timely correction of lipid-lowering therapy with the achievement of the target LDL-C level. Most of the patients did not experience any difficulties in using the program and are ready to recommend integrated approach to other peers

Integrated solution for very high cardiovascular risk patients. Rationale and design of a pilot study

Coronary artery disease (CAD) is the most common cardiovascular disease and the leading cause of morbidity and mortality. Acute coronary syndrome (ACS) as an abrupt destabilization of CAD, multiplies the risk of cardiovascular events. To reduce the incidence of recurrent cardiovascular events, timely tackling potentially reversible risk factors such as hypertension and/or hyperglycemia is imperative. However, a solid basis for a secondary prevention lies in the treatment of dyslipidemia and begins in the first hours of hospital admission. Despite considerable evidence regarding the efficacy and safety of lipid-lowering therapy, averagely only one third of patients maintain control of lipids. The main challenges are low adherence, poor continuity of medical care, and the lack of an ambulatory routine follow-up. Telehealth solutions are believed to address these barriers and may be considered as an add-on to in-person patient care. Telemonitoring of vital and laboratory parameters, remote patient counseling can be introduced into routine care delivery. Telemedicine shows promise for fostering better clinical effect, and provides health-related quality of life improvement.It is planned to conduct a pilot observational study aimed to create and to test an integrated solution, i.e. telemonitoring and remote counseling in patients of very high cardiovascular risk with ACS followed by myocardial revascularization. The goal is to determine the clinical effectiveness, i.e achievement of target values of blood pressure, lipid profile and glycemia, and patient-centeredness of this approach

An integrated approach for very high cardiovascular risk patients. Intermediate results

The main objective of secondary prevention measures is to modify key risk factors such as hypertension (HTN) and dyslipidemia in patients with established cardiovascular diseases. Its proper implementation improves both short- and long-term outcomes. Telehealth technologies contributes to faster achievement of target levels and better control of key risk factors.Aim. To establish a comprehensive personalized follow-up framework for patients recovered from an acute coronary syndrome (ACS) that integrates telehealth software and to test its clinical and patient-centered efficacy.Material and methods. The three-month follow-up data of 50 patients (50% of planned enrollees; median age, 57 years [53; 61]; males, 84%) who suffered ACS with myocardial revascularization and low-density lipoprotein cholesterol (LDL-C) at least 2,5 mmol/L at admission. We introduced the simple and save telehealth software for home BP monitoring and lipid profiling. The basic demographic, clinical and laboratory characteristics of patients were described, as well as the changes lipid profile, office and home BP over this period was analyzed. The primary endpoint was a change in LDL-C after 3 months. In addition, we also focused on pharmacological therapy and its dynamics, as well as on remote counseling and patient’ experience with the mobile application.Results. Three months after inclusion, we have noted significant decrease of total cholesterol (-1,67 mmol/L, p<0,0001) and triglycerides (-0,48 mmol/L, p<0,0001). LDL-C changes were also significant (-1,49 mmol/L, adjusted for age, sex and lipid-lowering therapy; p<0,0001) and was associated only with the baseline LDL-C levels (R2=-0,521, p<0,0001). Thirty-nine (78%) patients achieved at least 1 mmol/L drop of LDL-C. Nine of them reached target LDL-C <1,4 mmol/L (and/or a decrease of 50% from baseline). Both high-density lipoprotein cholesterol (-0,48 mmol/l, p=0,348), office and home BP remained mostly unchanged. The proportion of patients with target office BP levels was almost the same (χ2=3,06, p=0,08). Patients who were recommended combined lipid-lowering therapy with cholesterol absorption inhibitor (ezetimibe) were more likely to achieve target LDL-C (χ2=10,95; p=0,003) than those with single agent (67% versus 17%, p=0,003). No differences were found in subgroups of patients in LDL-C reduction. In each patient an average of 15 remote consultations have been performed (from 1 to 54 per patient per 3 moths). Investigators have had to send reminders to 22 patients regarding the need for regular home BP monitoring. The majority of patients treated telehealth software as easy-to-use and user-friendly.Conclusion. According to the 3-month follow-up of patients after ACS who used the framework integrated with telemonitoring and remote counseling, a positive trend in reducing atherogenic lipid levels was demonstrated, but not in office BP. Only a fifth of patients reached the target LDL-C, but the vast majority had target BP. Despite the fact that the program is convenient to use, almost half of participants require additional reminders from physician on self-monitoring

Experience of using multielectrode catheter systems to perform radiofrequency renal sympathetic denervation in patients with resistant hypertension: immediate procedural effects

Aim. To investigate the baseline characteristics of patients with resistant hypertension (HTN) undergoing radiofrequency renal sympathetic denervation (RD) and to determine immediate procedural effects.Material and methods. During 2018-2019, two series of radiofrequency RD procedures were performed in patients with true resistant HTN using balloon-type (bipolar ablation) or spiral-type (unipolar ablation) multielectorde catheters. The basic demographic, clinical and laboratory characteristics of included patients were assessed. A comparative analysis of two groups was carried out depending on the type of catheter used. Dynamics of office systolic blood pressure (SBP) were assessed as ∆ between the two following timepoints: at screening and at hospital discharge. The safety of radiofrequency RD was assessed. Multiple linear regression was used to determine the factors associated with the ∆ of office SBP after radiofrequency RD.Results. A total of 48 patients taking 4 (4;6) antihypertensive drugs were sequentially included. Radiofrequency RD was performed with a balloon-type catheter in 27 patients (mean age, 56±12 years old; 12 males) and with a spiral-type catheter in 21 patients (50±14 years old; 8 males). Radiofrequency RD was significantly longer in the spiral catheter group than in balloon one (110 versus 60 minutes, p<0,001), as was the mean number of RF applications (24 versus 12, p=0,002). None of the patients had acute kidney injury after RD (creatinine ∆, -0,6 µmol/L; 95% CI [-3,97; 2,78]). A total of 4 patients had complications (3 femoral arterial pseudoaneurisms, one renal arterial dissection), all of which did not affect the average length of hospital stay (from 4 to 5 days). At discharge, there was a pronounced decrease in office SBP (adjusted for baseline characteristics) with the mean of -26 mm Hg (95% CI [-29; -23]). There were following main factors associated with the office SBP ∆: smoking status (positive), baseline office SBP (positive), and blood glucose (negative).Conclusion. Radiofrequency RD using multielectode catheters is characterized by favorable short-term hemodynamic effects. We have found novel potential predictors of these effects. Further research will focus on testing initial hypotheses in the long term

ICD-10 code-based definition of heart failure in Saint Petersburg electronic health records: prevalence, health care utilization and outcomes

Aim. To analyze prevalence of heart failure (HF), clinical and demographic characteristics, health care utilization, and outcomes according to the used International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in regional integrated electronic health record database in Saint Petersburg.Material and methods. The retrospective analysis of the Saint Petersburg regional integrated electronic health record database for 2019 was performed. At least one of the following ICD-10 codes has been considered as HF case: I50.x (standard coding) and/or I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I09.9, I43.0, I43.1, I43.2, I43.8, I42.5, I42.6, I42.7, I42.8 (extended coding).Results. A total of 64070 adult patients with HF had medical encounters in 2019, 34,5% of whom were identified using standard coding, 65,5% — using extended coding. The combination of codes was observed in 9,9% of cases. HF prevalence/mortality was 1,4%/6,8% in general, as well as 0,49%/15,7% and 0,93%/2,1% with standard and extended coding, respectively. HF patients had high healthcare utilization with the mean number of 14 encounters per patient per year. Actually, 24% of patients had more than 20 both inpatient and outpatient encounters and 54% of patients — at least 1 all-cause hospitalization during the year. Encounters of patients with HF accounted for 4,3% of all visits, 6,5% of all hospitalizations, 4,1% of all outpatient visits and 9,7% of all emergency contacts during the year. Patients identified by the standard coding compared with the extended coding had older age and higher incidence of comorbidities, as well as greater hospitalization and death rates, but lower number of outpatient visits.Conclusion. The prevalence of HF among the adult population of Saint. Petersburg in 2019 was 1,4%. HF was characterized by a high health care utilization and mortality rate reaching 15,7 % per year. The use of different approaches to coding presumably could help to identify different groups of patients with HF, which requires the adaptation of healthcare models and an active monitoring system to reduce the risk of adverse events

Comparative benchmark analysis of coverage by specialists involved in healthcare provision to patients with cardiovascular diseases in the regions of the Northwestern Federal District

Control of cardiovascular diseases  (CVDs), which are the cause of premature mortality and high economic  costs,  is one of the priorities of social policy. Human resources are a key link in health system performance.  In Russia, there is a significant geographical  heterogeneity  in the distribution of medical workers and structural disproportions  in certain specialties.  Regional  differences  in the availability of specialists in cardiology system have not been studied enough.Aim. To perform a comparative benchmark analysis of coverage by specialists involved  in healthcare  provision  to patients with cardiovascular  diseases  in the regions of the Northwestern Federal District (NWFD), identifying regional differences for the period from 2015 to 2019.Material and methods. To assess the number of specialists involved in providing care to patients with CVDs, data from the federal statistical monitoring forms №30 “Information on a medical organization” for 2015-2019 of the subjects of the Northwestern Federal District were used. Multiple linear regression was used to compare the basic estimated parameters of provision per 10000 population with specialists at the level of district as a whole and in NWFD regions  with data for Russia as a whole. P<0,05 was considered significant.Results. Among the subjects of Northwestern Federal District, differences  were revealed  in all specialties  of varying severity. While the estimated parameter of provision with cardiologists  in Russia is 0,896 (95%  CI, 0,794-0,998),  there are differences  in the regions in a wide range from -0,446 (Vologda Oblast) to +0,502 (St. Petersburg).  Regional  differences  in the provision of vascular radiology specialists from the basic estimated level for Russia were observed  only in two subjects. At the same time, for all subjects in general, an increase in the indicator from 2015 to 2019 by 0,011 [95% CI, 0,006; 0,016] per year (p<0,001) was observed.  The smallest range of differences was observed for cardiovascular surgeons:  with a baseline  estimate  in Russia of 0,158 [95% CI, 0,140; 0,176] the range of differences was from -0,086 to +0,198. For emergency  medicine paramedic, the largest number of subjects with positive values of the statistical correction of the average relative to Russia was noted (7 out of 11 regions). For neurologists and intensivists, on the contrary, the largest number of subjects with negative values (7 out of 11 regions)  was revealed.  Structural staff disproportions in cardiology care system were revealed.Conclusion. In the NWFD, in general, coverage  by specialists involved in health-care provision for CVD are higher than the estimated base level for Russia. However,  their uneven distribution within the district and its subjects is observed. The demonstrated mathematical approach to assessing staff differences  at the subject or district level can be used to develop measures to achieve the goals of the regional health personnel policy

Способ получения рекомбинантных антител, продуцируемых клеточной линией, трансдуцированной рекомбинантными аденовирусами

Objectives. To develop a technology for obtaining recombinant antibodies in a suspension culture of human HEK293 cells using transduction with recombinant adenovirus serotype 5 (rAd5) carrying genes expressing heavy and light chains of antibodies on the example of two broadspectrum anti-influenza antibodies 27F3 and CR9114.Methods. Ad5-27F3-H, Ad5-CR9114-H, and Ad5-27F3-L recombinant adenoviruses carrying the 27F3 antibody heavy chain gene, CR9114 antibody heavy chain gene, and 27F3 light chain gene, respectively, were generated using the AdEasy™ Adenoviral vector system. To accumulate preparative amounts of recombinant r27F3 and rCR9114 antibodies, the HEK293 suspension cell line was transduced with recombinant adenoviruses carrying genes for heavy and light chains of antibodies. The cells were cultured in a wave-type bioreactor. Chromatography was used to purify recombinant antibodies from the culture medium. After analyzing the molecular weights of purified antibodies using protein electrophoresis, their ability to interact with influenza A and B viruses was analyzed using the Western blot technique, while their ability to neutralize influenza A and B viruses was evaluated using the virus neutralization assay.Results. A method for the accumulation and purification of recombinant r27F3 and CR9114 antibodies from the culture medium of a suspension culture of human cells following transduction with its recombinant adenoviruses carrying the genes for heavy and light chains of these antibodies was developed. The ability of the r27F3 antibody to interact with and neutralize influenza A viruses of group 1 (except influenza A virus subtype H2) and group 2 was shown. The ability of the rCR9114 antibody to interact with influenza A viruses of group 1 and influenza B viruses, as well as to neutralize influenza A viruses of group 1, was demonstrated.Conclusions. A technology for obtaining recombinant antibodies in a suspension culture of HEK293 cells using transduction with recombinant adenoviruses carrying genes expressing heavy and light chains of antibodies was developed along with a confirmation of their specificity.Цели. Разработать технологию получения рекомбинантных антител в суспензионной культуре клеток человека HEK293 с помощью трансдукции рекомбинантными аденовирусами человека пятого серотипа, несущими гены, экспрессирующие тяжелые и легкие цепи антител, на примере двух противогриппозных антител широкого спектра действия 27F3 и CR9114.Методы. Рекомбинантные аденовирусы Ad5-27F3-H, Ad5-CR9114-H и Ad5-27F3-L, несущие ген тяжелой цепи антитела 27F3, ген тяжелой цепи антитела CR9114 и ген легкой цепи 27F3, были получены с помощью набора AdEasy™ Adenoviral vector system. Для накопления препаративных количеств рекомбинантных антител r27F3 и rCR9114 суспензионную клеточную линию HEK293 трансдуцировали рекомбинантными аденовирусами, несущими гены тяжелых и легких цепей антител, и культивировали клетки в биореакторе волнового типа. Рекомбинантные антитела очищали из культуральной жидкости хроматографическим методом. Молекулярную массу полученных антител анализировали с помощью белкового электрофореза, их способность взаимодействовать с вирусами гриппа А и В методом вестерн-блот анализа, а способность нейтрализовать вирусы гриппа А и В с помощью реакции вирус-нейтрализации.Результаты. Отработана методика накопления и очистки рекомбинантных антител r27F3 и CR9114 из культуральной жидкости суспензионной культуры клеток человека после трансдукции ее рекомбинантными аденовирусами, несущими гены тяжелых и легких цепей этих антител. Показана способность антитела r27F3 взаимодействовать с вирусами гриппа А подгруппы 1 (кроме вируса грипп А субтипа H2) и подгруппы 2 и нейтрализовать их. Показана способность антитела rCR9114 взаимодействовать с вирусами гриппа А подгруппы 1 и вирусами гриппа В, а также нейтрализовать вирусы гриппа А подгруппы 1.Выводы. Отработана технология получения рекомбинантных антител в суспензионной культуре клеток HEK293 с помощью трансдукции рекомбинантными аденовирусами, несущими гены, экспрессирующие тяжелые и легкие цепи антител, и показана их специфичность