170 research outputs found
ΠΡΠΎΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠ° ΠΈΠΌΠΈΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΌΠΎΠ΄Π΅Π»ΠΈ ΠΌΡΠ»ΡΡΠΈΠΊΠ»ΠΈΠ΅Π½ΡΡΠΊΠΎΠ³ΠΎ ΠΊΠ»Π°ΡΡΠ΅ΡΠ° Π±Π°Π· Π΄Π°Π½Π½ΡΡ
One of the main trends of recent years in software design is a shift to a Software as a Service (SaaS) paradigm which brings a number of advantages for both software developers and end users. However, along with these benefits this transition brings new architectural challenges. One of such challenges is the implementation of a data storage that would meet the needs of a service-provider, at the same time providing a fairly simple application programming interface for software developers. In order to develop effective solutions in this area, the architectural features of cloud-based applications should be taken into account. Among others, such key features are the need for scalability and quick adaptation to changing conditions. This paper provides a brief analysis of the problems in the field of cloud data storage systems based on the relational model and it proposes the concept of database cluster designed for applications with a multi-tenant architecture. Besides, the article describes a simulation model of such a cluster, as well as the main stages of its development and the main principles forming its foundation.ΠΠ΄Π½ΠΎΠΉ ΠΈΠ· Π³Π»Π°Π²Π½ΡΡ
ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΠΉ ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈΡ
Π»Π΅Ρ Π² ΠΏΡΠΎΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΠΎΠ³ΠΎ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΡ ΡΡΠ°Π» ΠΏΠ΅ΡΠ΅Ρ
ΠΎΠ΄ ΠΊ ΠΏΠ°ΡΠ°Π΄ΠΈΠ³ΠΌΠ΅ Software as a Service (SaaS), ΠΊΠΎΡΠΎΡΠ°Ρ Π½Π΅ΡΠ΅Ρ ΡΡΠ΄ Π½Π΅ΠΎΡΠΏΠΎΡΠΈΠΌΡΡ
ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ² ΠΊΠ°ΠΊ Π΄Π»Ρ ΠΊΠΎΠΌΠΏΠ°Π½ΠΈΠΉ-ΡΠ°Π·ΡΠ°Π±ΠΎΡΡΠΈΠΊΠΎΠ² ΠΠ, ΡΠ°ΠΊ ΠΈ Π΄Π»Ρ ΠΊΠΎΠ½Π΅ΡΠ½ΡΡ
ΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΠ΅Π»Π΅ΠΉ. ΠΠ΄Π½Π°ΠΊΠΎ Π²ΠΌΠ΅ΡΡΠ΅ Ρ ΡΡΠΈΠΌΠΈ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π°ΠΌΠΈ Π΄Π°Π½Π½ΡΠΉ ΠΏΠ΅ΡΠ΅Ρ
ΠΎΠ΄ Π½Π΅ΡΠ΅Ρ ΠΈ Π½ΠΎΠ²ΡΠ΅ Π°ΡΡ
ΠΈΡΠ΅ΠΊΡΡΡΠ½ΡΠ΅ Π²ΡΠ·ΠΎΠ²Ρ, ΠΎΠ΄Π½ΠΈΠΌ ΠΈΠ· ΠΊΠΎΡΠΎΡΡΡ
ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΡ Ρ
ΡΠ°Π½ΠΈΠ»ΠΈΡΠ° Π΄Π°Π½Π½ΡΡ
, ΠΊΠΎΡΠΎΡΠΎΠ΅ ΠΌΠΎΠ³Π»ΠΎ Π±Ρ ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΡ Π½ΡΠΆΠ΄Ρ ΠΊΠΎΠΌΠΏΠ°Π½ΠΈΠΈ-ΠΏΡΠΎΠ²Π°ΠΉΠ΄Π΅ΡΠ° ΡΡΠ»ΡΠ³, ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΠ² Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ ΠΏΡΠΎΡΡΠΎΠΉ ΠΏΡΠΈΠΊΠ»Π°Π΄Π½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΡΡΠ΅ΠΉΡ Π΄Π»Ρ ΡΠ°Π·ΡΠ°Π±ΠΎΡΡΠΈΠΊΠΎΠ². ΠΠ»Ρ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ Π² Π΄Π°Π½Π½ΠΎΠΉ ΠΎΠ±Π»Π°ΡΡΠΈ ΡΠ»Π΅Π΄ΡΠ΅Ρ ΠΏΡΠΈΠ½ΠΈΠΌΠ°ΡΡ Π²ΠΎ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π°ΡΡ
ΠΈΡΠ΅ΠΊΡΡΡΡ ΠΎΠ±Π»Π°ΡΠ½ΡΡ
ΠΏΡΠΈΠ»ΠΎΠΆΠ΅Π½ΠΈΠΉ, ΠΊΠ»ΡΡΠ΅Π²ΡΠΌΠΈ ΠΈΠ· ΠΊΠΎΡΠΎΡΡΡ
ΡΠ²Π»ΡΡΡΡΡ ΠΏΠΎΡΡΠ΅Π±Π½ΠΎΡΡΡ Π² ΠΏΡΠΎΡΡΠΎΠΌ ΠΌΠ°ΡΡΡΠ°Π±ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΈ Π±ΡΡΡΡΠΎΠΉ Π°Π΄Π°ΠΏΡΠ°ΡΠΈΠΈ ΠΊ ΠΌΠ΅Π½ΡΡΡΠΈΠΌΡΡ ΡΡΠ»ΠΎΠ²ΠΈΡΠΌ. Π Π΄Π°Π½Π½ΠΎΠΉ ΡΠ°Π±ΠΎΡΠ΅ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΡΡΡ ΠΊΡΠ°ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· ΡΡΡΠ΅ΡΡΠ²ΡΡΡΠΈΡ
ΠΏΡΠΎΠ±Π»Π΅ΠΌ Π² ΠΎΠ±Π»Π°ΡΡΠΈ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΈ ΠΎΠ±Π»Π°ΡΠ½ΡΡ
ΡΠΈΡΡΠ΅ΠΌ Ρ
ΡΠ°Π½Π΅Π½ΠΈΡ Π΄Π°Π½Π½ΡΡ
, ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΡΡ
Π½Π° ΡΠ΅Π»ΡΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΌΠΎΠ΄Π΅Π»ΠΈ, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΡΠ΅Π΄Π»Π°Π³Π°Π΅ΡΡΡ ΠΊΠΎΠ½ΡΠ΅ΠΏΡΠΈΡ ΠΊΠ»Π°ΡΡΠ΅ΡΠ° Π Π‘Π£ΠΠ, ΠΏΡΠ΅Π΄Π½Π°Π·Π½Π°ΡΠ΅Π½Π½ΠΎΠ³ΠΎ Π΄Π»Ρ ΠΎΠ±ΡΠ»ΡΠΆΠΈΠ²Π°Π½ΠΈΡ ΠΏΡΠΈΠ»ΠΎΠΆΠ΅Π½ΠΈΠΉ Ρ ΠΌΡΠ»ΡΡΠΈΠΊΠ»ΠΈΠ΅Π½ΡΡΠΊΠΎΠΉ Π°ΡΡ
ΠΈΡΠ΅ΠΊΡΡΡΠΎΠΉ. ΠΡΠΎΠΌΠ΅ ΡΠΎΠ³ΠΎ, Π² ΡΡΠ°ΡΡΠ΅ Π΄Π°Π΅ΡΡΡ ΠΎΠΏΠΈΡΠ°Π½ΠΈΠ΅ ΠΈΠΌΠΈΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΌΠΎΠ΄Π΅Π»ΠΈ ΠΏΠΎΠ΄ΠΎΠ±Π½ΠΎΠ³ΠΎ ΠΊΠ»Π°ΡΡΠ΅ΡΠ°, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΎΡΠ½ΠΎΠ²Π½ΡΡ
ΡΡΠ°ΠΏΠΎΠ² Π΅Π΅ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠΈ ΠΈ ΠΏΡΠΈΠ½ΡΠΈΠΏΠΎΠ², Π·Π°Π»ΠΎΠΆΠ΅Π½Π½ΡΡ
Π² Π΅Π΅ ΠΎΡΠ½ΠΎΠ²Ρ
ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΡΠΎΡ Π°ΡΡΠΈΡΠ΅ΡΠΊΠΈΡ ΠΌΠ΅ΡΠ°ΡΠ²ΡΠΈΡΡΠΈΠΊ Π² Π·Π°Π΄Π°ΡΠ΅ ΡΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ Π΄Π°Π½Π½ΡΠΌΠΈ Π² ΠΌΡΠ»ΡΡΠΈΠΊΠ»ΠΈΠ΅Π½ΡΡΠΊΠΎΠΌ ΠΊΠ»Π°ΡΡΠ΅ΡΠ΅ Π±Π°Π· Π΄Π°Π½Π½ΡΡ
A multi-tenant database cluster is a concept of a data-storage subsystem for cloud applications with the multi-tenant architecture. The cluster is a set of relational database servers with the single entry point, combined into one unit with a cluster controller. This system is aimed to be used by applications developed according to Software as a Service (SaaS) paradigm and allows to place tenants at database servers so that providing their isolation, data backup and the most effective usage of available computational power. One of the most important problems about such a system is an effective distribution of data into servers, which affects the degree of individual cluster nodes load and faulttolerance. This paper considers the data-management approach, based on the usage of a load-balancing quality measure function. This function is used during initial placement of new tenants and also during placement optimization steps. Standard schemes of metaheuristic optimization such as simulated annealing and tabu search are used to find a better tenant placement.ΠΡΠ»ΡΡΠΈΠΊΠ»ΠΈΠ΅Π½ΡΡΠΊΠΈΠΉ ΠΊΠ»Π°ΡΡΠ΅Ρ Π±Π°Π· Π΄Π°Π½Π½ΡΡ
β ΡΡΠΎ ΠΊΠΎΠ½ΡΠ΅ΠΏΡΠΈΡ Ρ
ΡΠ°Π½ΠΈΠ»ΠΈΡΠ° Π΄Π°Π½Π½ΡΡ
Π΄Π»Ρ ΠΎΠ±Π»Π°ΡΠ½ΡΡ
ΠΏΡΠΈΠ»ΠΎΠΆΠ΅Π½ΠΈΠΉ Ρ ΠΌΡΠ»ΡΡΠΈΠΊΠ»ΠΈΠ΅Π½ΡΡΠΊΠΎΠΉ Π°ΡΡ
ΠΈΡΠ΅ΠΊΡΡΡΠΎΠΉ. ΠΠ»Π°ΡΡΠ΅Ρ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ Π½Π°Π±ΠΎΡ ΡΠ΅ΡΠ²Π΅ΡΠΎΠ² ΡΠ΅Π»ΡΡΠΈΠΎΠ½Π½ΡΡ
Π±Π°Π· Π΄Π°Π½Π½ΡΡ
Ρ Π΅Π΄ΠΈΠ½ΠΎΠΉ ΡΠΎΡΠΊΠΎΠΉ Π²Ρ
ΠΎΠ΄Π°, ΠΎΠ±ΡΠ΅Π΄ΠΈΠ½Π΅Π½Π½ΡΡ
Π² ΠΎΠ΄Π½ΠΎ ΡΠ΅Π»ΠΎΠ΅ ΠΈ ΡΠ°Π±ΠΎΡΠ°ΡΡΠΈΡ
ΠΏΠΎΠ΄ ΡΠΏΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠ½ΡΡΠΎΠ»Π»Π΅ΡΠ° ΠΊΠ»Π°ΡΡΠ΅ΡΠ°. ΠΠ°Π½Π½Π°Ρ ΡΠΈΡΡΠ΅ΠΌΠ° Π½Π°ΡΠ΅Π»Π΅Π½Π° Π½Π° ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠΈΠ»ΠΎΠΆΠ΅Π½ΠΈΡΠΌΠΈ, ΡΠ°Π·ΡΠ°Π±Π°ΡΡΠ²Π°Π΅ΠΌΡΠΌΠΈ Π² ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠΈ Ρ ΠΏΠ°ΡΠ°Π΄ΠΈΠ³ΠΌΠΎΠΉ Software as a Service (SaaS), ΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΠ°Π·ΠΌΠ΅ΡΡΠΈΡΡ Π½Π° ΠΏΡΠ΅Π΄ΠΎΡΡΠ°Π²Π»Π΅Π½Π½ΡΡ
ΡΠ΅ΡΠ²Π΅ΡΠ°Ρ
Π΄Π°Π½Π½ΡΠ΅ Π±ΠΎΠ»ΡΡΠΎΠ³ΠΎ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° ΠΊΠ»ΠΈΠ΅Π½ΡΠΎΠ² ΡΠ°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, ΡΡΠΎΠ±Ρ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΡΡ ΠΈΡ
ΠΈΠ·ΠΎΠ»ΡΡΠΈΡ, ΡΠ΅Π·Π΅ΡΠ²ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠ΅Π΄ΠΎΡΡΠ°Π²Π»Π΅Π½Π½ΡΡ
Π²ΡΡΠΈΡΠ»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΌΠΎΡΠ½ΠΎΡΡΠ΅ΠΉ. ΠΠ΄Π½ΠΎΠΉ ΠΈΠ· Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π²Π°ΠΆΠ½ΡΡ
Π·Π°Π΄Π°Ρ ΠΏΡΠΈ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠ΅ ΡΠΈΡΡΠ΅ΠΌΡ ΠΏΠΎΠ΄ΠΎΠ±Π½ΠΎΠ³ΠΎ ΡΠΎΠ΄Π° ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ Π΄Π°Π½Π½ΡΡ
ΠΏΠΎ ΡΠ΅ΡΠ²Π΅ΡΠ°ΠΌ, ΠΊΠΎΡΠΎΡΠΎΠ΅ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ΅Ρ ΡΡΠ΅ΠΏΠ΅Π½Ρ Π·Π°Π³ΡΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΠΎΡΠ΄Π΅Π»ΡΠ½ΡΡ
ΡΠ·Π»ΠΎΠ², Π° ΡΠ°ΠΊΠΆΠ΅ ΡΡΡΠΎΠΉΡΠΈΠ²ΠΎΡΡΡ ΡΠΈΡΡΠ΅ΠΌΡ ΠΊ ΡΠ±ΠΎΡΠΌ. Π ΡΠ°Π±ΠΎΡΠ΅ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°Π΅ΡΡΡ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΊ ΡΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ Π΄Π°Π½Π½ΡΠΌΠΈ, ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΡΠΉ Π½Π° ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π±Π°Π»Π°Π½ΡΠΈΡΠΎΠ²ΠΊΠΈ Π½Π°Π³ΡΡΠ·ΠΊΠΈ. ΠΠ°Π½Π½Π°Ρ ΡΡΠ½ΠΊΡΠΈΡ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΡΡΡ ΠΊΠ°ΠΊ ΠΏΡΠΈ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΌ ΡΠ°Π·ΠΌΠ΅ΡΠ΅Π½ΠΈΠΈ ΠΊΠ»ΠΈΠ΅Π½ΡΠΎΠ², ΡΠ°ΠΊ ΠΈ Π΄Π»Ρ ΠΎΠΏΡΠΈΠΌΠΈΠ·Π°ΡΠΈΠΈ ΡΠΆΠ΅ ΠΈΠΌΠ΅ΡΡΠ΅Π³ΠΎΡΡ ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΠΊΠ»ΠΈΠ΅Π½ΡΠΎΠ². ΠΠΏΡΠΈΠΌΠΈΠ·Π°ΡΠΈΡ ΡΠ°Π·ΠΌΠ΅ΡΠ΅Π½ΠΈΡ Π²Π΅Π΄Π΅ΡΡΡ ΠΏΠΎ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΡΠΌ ΡΡ
Π΅ΠΌΠ°ΠΌ ΡΡΠΎΡ
Π°ΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ΅ΡΠ°ΡΠ²ΡΠΈΡΡΠΈΠΊ: ΠΈΠΌΠΈΡΠ°ΡΠΈΠΈ ΠΎΡΠΆΠΈΠ³Π° (simulated annealing) ΠΈ ΠΏΠΎΠΈΡΠΊΠ° Ρ Π·Π°ΠΏΡΠ΅ΡΠ°ΠΌΠΈ (tabu search)
Impact of the COVID-19 Pandemic on Myocardial Revascularization in Patients with Acute Coronary Syndrome in the Russian Federation
Aim. To compare and analyze the results of myocardial revascularization in the Russian Federation (RF) with acute coronary syndrome (ACS) before the onset (2018-2019) and during the novel coronavirus infection (COVID-19) pandemic (2020-2021).Material and methods. The analysis included the number of cases of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), the number of cases of myocardial revascularization in the above forms of ACS, the number of deaths depending on the form of ACS and the method performed revascularization. The period of time before the start of the coronavirus pandemic corresponded to the annual data received in the Russian Federation for 2018-2019. The period of the coronavirus disease pandemic corresponded to the annual data received in the country for 2020-2021. Absolute, relative, estimated values of patient hospitalization, myocardial revascularization procedures, and mortality in ACS were compared between time periods before and during the COVID-19 pandemic. The data for analysis were obtained from the monitoring of the Ministry of Health of Russia.Results. In 2018 and 2019 in the RF, 531,019 and 501,238 patients were hospitalized with a diagnosis of ACS, and during the pandemic (2020-2021) - 403,931 and 397,930 patients, respectively. Reduction in the number of patients diagnosed with ACS admitted to hospitals in Russia by 22.32% in 2020-2021 years was mainly due to a significant decrease in hospitalizations of patients with a diagnosis of NSTE-ACS (by 29.03%). At the same time, admission to clinics of patients with STEMI decreased only by 6.02%. During the COVID-19 pandemic, mortality increased significantly in PPCI (by 9.6%) and in the general STEMI group (by 12.3%); significantly increased mortality both in the general group (by 48%) and during PCI in patients with NSTE-ACS (by 28.6%); there was an increase in the average annual number of PPCI (by 12.6%), which was accompanied by an increased average annual number of PPCI per 1 million of population (up to 451 per 1 million of population); a slight increase in the average time "symptom-balloon" (by 2 minutes) was recorded; there was an absolute slight decrease and a relative increase in the number of PCIs in NSTE-ACS (by 2.7% and 37.1%, respectively). In 2021, in the Russian Federation, primary PCI was performed in 50.2%, thrombolytic therapy - in 23.1%, and 26.7% of patients remained without reperfusion. Pharmacoinphasive strategy was applied in 60%, and isolated thrombolysis - in 40% of patients.Conclusion. During the COVID-19 pandemic, revascularization in patients with ACS in Russia corresponded to the following trends recorded in the literature: increased hospital mortality in PPCI and in the general STEMI group; hospital mortality both in the general group and during PCI in patients with NSTE-ACS. The indicators of myocardial revascularization in ACS in the RF during the pandemic were fundamentally different from the data of Western countries: there was an increase in the average annual number of PPCI and the average annual number of PPCI per 1 million population; a slight increase in the average symptom-balloon time was recorded; revealed an absolute slight decrease and a relative increase in the number of PCIs in NSTE-ACS
Russian guidelines for sudden cardiac death risk assessment and prevention (second edition) β 2018. Pocket version
cardiovascular diseases, sudden cardiac death, risk, treatment, preventionCardiovascular mortality in Russia is one of the highest in the world reaching 614 deaths per 100,000 annually.
The main causes of death from cardiovascular diseases are the progression of congestive heart failure (about half of all cases) and sudden cardiac death (the other half). Thus, we can assume that the incidence of sudden cardiac death in 2016 was no less than 300,000. In the abbreviated version of the National Recommendations in English, the principles of decision-making algorithms in various clinical situations are used
Improvement of cardiovascular risk assessment using machine learning methods
The increase in the prevalence of cardiovascular diseases (CVDs) specifies the importance of their prediction, the need for accurate risk stratification, preventive and treatment interventions. Large medical databases and technologies for their processing in the form of machine learning algorithms that have appeared in recent years have the potential to improve predictive accuracy and personalize treatment approaches to CVDs. The review examines the application of machine learning in predicting and identifying cardiovascular events. The role of this technology both in the calculation of total cardiovascular risk and in the prediction of individual diseases and events is discussed. We compared the predictive accuracy of current risk scores and various machine learning algorithms. The conditions for using machine learning and developing personalized tactics for managing patients with CVDs are analyzed
BMI1 regulates PRC1 architecture and activity through homo- and hetero-oligomerization.
BMI1 is a core component of the polycomb repressive complex 1 (PRC1) and emerging data support a role of BMI1 in cancer. The central domain of BMI1 is involved in protein-protein interactions and is essential for its oncogenic activity. Here, we present the structure of BMI1 bound to the polyhomeotic protein PHC2 illustrating that the central domain of BMI1 adopts an ubiquitin-like (UBL) fold and binds PHC2 in a beta-hairpin conformation. Unexpectedly, we find that the UBL domain is involved in homo-oligomerization of BMI1. We demonstrate that both the interaction of BMI1 with polyhomeotic proteins and homo-oligomerization via UBL domain are necessary for H2A ubiquitination activity of PRC1 and for clonogenic potential of U2OS cells. Here, we also emphasize need for joint application of NMR spectroscopy and X-ray crystallography to determine the overall structure of the BMI1-PHC2 complex
Non-ST-segment elevation acute coronary syndrome in elderly patients and long-livers. Features of treatment. Literature review and case report
Despite the growing population of elderly people and long-livers every year, the treatment of acute coronary syndrome in these groups is not fully developed and is not regulated in clinical guidelines due to the lack of large randomized clinical trials. The article presents a literature review covering the following issues arising during clinical decision-making in the treatment of non-ST-segment elevation acute coronary syndrome in this group of patients: selection of invasive treatment strategy, scope of myocardial revascularization, appointment of dual antiplatelet therapy taking into account the bleeding risk, decreased renal function and senile asthenia. In addition, a case report of successful treatment of a 101-year-old female patient with non-ST-segment elevation myocardial infarction, who underwent percutaneous coronary intervention with stenting of infarct-related artery, was presented
Unsolved Issues of Atherosclerosis Prevention and of Adequate Lipid-lowering Therapy in Patients with Acute Ischemic Cerebrovascular Accident
The existing system of medical care for patients with acute cerebrovascular accident of atherothrombotic genesis, namely lipid metabolism disorders, the modern evidence base for lipid-lowering therapy in this category of patients and the feasibility of interdisciplinary interaction of cardiologists and neurologists were discussed at a meeting of the expert council of cardiologists and neurologists in Moscow on 2021 July 7
Transcatheter mitral valve edge-to-edge repair in patients with severe mitral regurgitation: data from the MitraClip Russia Trial
Aim. To study the immediate and short-term outcomes of transcatheter mitral valve edge-to-edge repair with the MitraClip NT in patients with severe mitral regurgitation as part of the MitraClip Russia prospective single-center study.Material and methods. The study included 16 patients (men, 10; women, 6) with mean age of 70,1Β±2,1 years (mean Euroscore II, 6,90Β±5,56%; STS, 6,33Β±3,94%). Immediate technical success was defined as successful access, delivery, and removal of the device, and adequate placing the clip(s) to reduce the mitral regurgitation to grade 2 or below without the need for device- or procedure-related reintervention.Results. Immediate technical success was achieved in all patients. The average number of implanted clips per 1 patient was 1,7. In 1 patient (6,3%), a clip was attached to one mitral leaflet, which required an non-scheduled implantation of a second clip. In hospital mortality was 6,3%: a 92-year-old patient on the 3rd day after the operation had a sudden cardiac arrest followed by coma, hemispheric ischemic stroke and death on the 6th day. An autopsy revealed an iatrogenic atrial septal defect. Echocardiography performed on the 10th and 30th day after surgery showed a decrease in mitral regurgitation grade in 15 patients, while grade 3 residual mitral regurgitation did not reveal in any patient.Conclusion. Transcatheter mitral valve edge-to-edge repair with the MitraClip is a minimally invasive method for treating severe symptomatic mitral regurgitation (degenerative and functional). The results demonstrate high immediate efficacy and an acceptable safety profile in high surgical risk patients. Based on the analysis of death causes, the authors conclude that it is necessary to include initial pulmonary hypertension above 75 mm Hg as a relative contraindication to this procedure. The study limitations are the small sample size and short follow-up period
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