Predictors of post-infarction left ventricular aneurysm

Post-infarction left ventricular aneurysm (LVA) is a complication of myocardial infarction (MI), which is of great clinical importance due to high mortality. Data on its incidence are contradictory. The aim of the review was to highlight the existing and novel predictors of post-infarction LVA, the identification of which will help in identifying high-risk patients in order to optimize their treatment and rehabilitation. Known predictors of post-infarction LVA include pain-to-balloon time, age, female sex, recurrent MI, coronary angiography parameters, echocardiography, and electrocardiography. Increased levels of leukocytes, C-reactive protein, growth differentiation factor, stimulating growth factor, interleukin-1β, interleukin-6, tumor necrosis factor-α, matrix metalloproteinases, proprotein convertase subtilisin-kexin type 9, N-terminal pro-brain natriuretic peptide >400 pg/ml indicate the risk of pathological left ventricular remodeling and LVA. In this connection, there is a need to assess the incidence of post-infarction LVA and a comprehensive assessment of its predictors in patients with MI

Characterization of Leishmania donovani MCM4: Expression Patterns and Interaction with PCNA

Events leading to origin firing and fork elongation in eukaryotes involve several proteins which are mostly conserved across the various eukaryotic species. Nuclear DNA replication in trypanosomatids has thus far remained a largely uninvestigated area. While several eukaryotic replication protein orthologs have been annotated, many are missing, suggesting that novel replication mechanisms may apply in this group of organisms. Here, we characterize the expression of Leishmania donovani MCM4, and find that while it broadly resembles other eukaryotes, noteworthy differences exist. MCM4 is constitutively nuclear, signifying that, unlike what is seen in S.cerevisiae, varying subcellular localization of MCM4 is not a mode of replication regulation in Leishmania. Overexpression of MCM4 in Leishmania promastigotes causes progress through S phase faster than usual, implicating a role for MCM4 in the modulation of cell cycle progression. We find for the first time in eukaryotes, an interaction between any of the proteins of the MCM2-7 (MCM4) and PCNA. MCM4 colocalizes with PCNA in S phase cells, in keeping with the MCM2-7 complex being involved not only in replication initiation, but fork elongation as well. Analysis of a LdMCM4 mutant indicates that MCM4 interacts with PCNA via the PIP box motif of MCM4 - perhaps as an integral component of the MCM2-7 complex, although we have no direct evidence that MCM4 harboring a PIP box mutation can still functionally associate with the other members of the MCM2-7 complex- and the PIP box motif is important for cell survival and viability. In Leishmania, MCM4 may possibly help in recruiting PCNA to chromatin, a role assigned to MCM10 in other eukaryotes

СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА МУЛЬТИМОРБИДНОСТИ, МЕДИКАМЕНТОЗНОГО ЛЕЧЕНИЯ И ИСХОДОВ У БОЛЬНЫХ С СОЧЕТАНИЕМ ПЕРЕНЕСЕННОГО ОСТРОГО НАРУШЕНИЯ МОЗГОВОГО КРОВООБРАЩЕНИЯ И ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ ПРИ НАЛИЧИИ ИЛИ ОТСУТСТВИИ АНАМНЕЗА ИНФАРКТА МИОКАРДА (ДАННЫЕ РЕГИСТРОВ РЕГИОН)

AIM. Within the framework of outpatient and hospital registers of REGION (REGIster of patients who have undergone acute cerebrovascular accident) to carry out a comparative assessment of demographic and clinical-anamnestical characteristics, medical treatment and outcomes in clinical practice in patients with a combination of undergone acute cerebrovascular accident (ACVA) and atrial fibrillation (AF) in the presence or absence of myocardial infarction (MI) in the medical history.MATERIAL AND METHODS. Outpatient registers REGION (Ryazan) and hospital register REGION (Moscow) included 1886 patients who have undergone ACVA (age 70.6 ± 12.5 years, 41.9% of men), of them 516 (27.4%) people with AF. Comparison groups included 152 (8.1%) patients with a combination of ACVA, AF and MI in medical history (ACVA + AF + MI group) and 364 (19.3%) patients with ACVA, AF without MI (ACVA + AF without MI group). The presence of cardiovascular diseases (CVD), concomitant diseases, drug therapy and outcomes were analyzed.RESULTS. In the group of ACVA + AF + MI patients, compared to the ACVA + AF without MI group, the share of patients with AH (100% and 97.2%), IHD (100% and 87.1%), CHD (68.4% and 57.1%), repeated ACVA (36.9% and 23.9%), diabetes mellitus in women (39.5% and 20.4%) was statistically significantly higher. In the comparison groups, the share of smokers (13.3% and 15.5%), patients with burdened heredity of early development of CVDs (2.1% and 1.1%) and hypercholesterolemia (41.1% and 50.0%) did not differ significantly, however, in the group of ACVA + AF + MI, in comparison with the group of ACVA + AF without MI, there was a higher risk on the CHA2DS2-VASc scale (5.26 ± 1.32 and 4.09 ± 1.44; p < 0.001) and HAS-BLED scale (1.91 ± 0.76 and 1.62 ± 0.79; p < 0.01). Patients with AF of REGION register, both with and without MI, had insufficient frequency of proper medical prescriptions for CVDs (46.6% and 38.9% on average), especially prescription of anticoagulants (19.1% and 21.4%), statins in case of IHD (33.6% and 27.4%) and beta-adrenoblockers in case of CHD (39.4% and 35.6%).  During the four-year period of observation, in comparison with post-stroke patients without a history of MI, the mortality rate for all causes was 1.5 times higher (56.6% and 37.6%, p = 0.0001), the incidence of non-fatal MI was higher (2.0% and 0.3%,p = 0.04). CONCLUSION. Patients with a combination of ACVA, AF and MI history are a very high risk group for adverse outcomes observed on an outpatient stage. For these patients it is very important to improve the quality of drug therapy and the effectiveness of secondary prophylaxis.ЦЕЛЬ. В рамках амбулаторных и госпитального регистров РЕГИОН (РЕГИстр больных, перенесших Острое Нарушение мозгового кровообращения) провести сравнительную оценку демографических и клинико-анамнестических характеристик, медикаментозного лечения и исходов в клинической практике у больных с сочетанием перенесенного острого нарушения мозгового кровообращения (ОНМК) и фибрилляции предсердий (ФП) при наличии или отсутствии инфаркта миокарда (ИМ) в анамнезе.МАТЕРИАЛ И МЕТОДЫ. В амбулаторные регистры РЕГИОН (Рязань) и в госпитальный регистр РЕГИОН (Москва) включено 1886 пациентов, перенесших ОНМК (возраст 70,6 ± 12,5 лет, 41,9% мужчин), из них с ФП 516 (27,4%) человек. Группы сравнения составили 152 (8,1%) пациента с сочетанием перенесенного ОНМК, ФП и ИМ в анамнезе (группа ОНМК + ФП + ИМ) и 364 (19,3%) больных с ОНМК, ФП без анамнеза ИМ (группа ОНМК + ФП без ИМ). Проанализированы наличие сердечно-сосудистых заболеваний (ССЗ), сопутствующих заболеваний, медикаментозная терапия и исходы.РЕЗУЛЬТАТЫ. В группе пациентов ОНМК + ФП + ИМ, по сравнению с пациентами группы ОНМК + ФП без ИМ, была статистически значимо выше доля лиц с АГ (100% и 97,2%), ИБС (100% и 87,1%), ХСН (68,4% и 57,1%), повторного ОНМК (36,9% и 23,9%), сахарного диабета у женщин (39,5% и 20,4%). В группах сравнения доля курящих (13,3% и 15,5%), пациентов с отягощенной наследственностью раннего развития ССЗ (2,1% и 1,1%) и гиперхолестеринемией (41,1% и 50,0%) существенно не различалась, однако в группе ОНМК + ФП + ИМ, по сравнению с группой ОНМК + ФП без ИМ, был выше риск по шкале СHA 2DS2–VASc (5,26 ± 1,32 и 4,09 ± 1,44; p < 0,001) и шкале HAS-BLED (1,91 ± 0,76 и 1,62 ± 0,79; p < 0,01). У больных с ФП регистра РЕГИОН, как с перенесенным ИМ, так и без ИМ, частота должных медикаментозных назначений по поводу ССЗ была недостаточной (в среднем 46,6% и 38,9%), особенно назначения антикоагулянтов (19,1% и 21,4%), статинов при ИБС (33,6% и 27,4%) и бета-адреноблокаторов при ХСН (39,4% и 35,6%). За четырехлетний период наблюдения у больных группы ОНМК + ФП + ИМ, по сравнению с постинсультными пациентами без анамнеза ИМ, смертность от всех причин была в 1,5 раза выше (56,6% и 37,6%, p = 0,0001), чаще развивался нефатальный ИМ (2,0% и 0,3%, р = 0,04).ЗАКЛЮЧЕНИЕ. Больные с сочетанием перенесенных ОНМК, ФП и анамнеза ИМ являются группой очень высокого риска неблагоприятного исхода при наблюдении на амбулаторном этапе. Для данных пациентов крайне важным является повышение качества медикаментозной терапии и эффективности вторичной профилактики

Selection of the optimal method of pain therapy for typical surgery at ENT clinic based on the evaluation of the circadian rhythm of heart rate

The article describes the characteristic features of circadian rhythms in heart rate under normal and stress conditions as a result of surgical interventions at ENT clinic using various analgesic schemes. The study included 45 physically healthy males aged 25 to 40 years divided into 4 groups depending on the method of perioperative analgesia: metamizole sodium group (n = 10), ketorolac group (n = 10), trimeperidine group (n = 10) and group of patients with anesthetic support (ketamine group, n = 5). A qualitative analysis of circadian profiles of heart rate was conducted. The study found that metamizole sodium and ketorolac groups were more likely to demonstrate changes in the configuration of the circadian HR profile, absence of sustained ventricular tachycardia and mild bradycardia at night. Trimeperidine group tended to tachycardia in the evening and night, though the heart rate profile did not show any marked deviations. In ketamine group, circadian HR rhythms were most positive. Recommendations are provided on the choice of the best method of analgesia in patients with concomitant diseases of the cardiovascular system

The mixer with z-shaped working blades for high viscosity components

The imperfection of the mixing technique affects the quality of products. The process of mixing the components is among the most energy-intensive, positively influencing the quality of finished products and shelf life. The mixer, having three chambers, through which pass two shafts, while the high speed shaft located in the first chamber, is installed inside the low-speed shaft. The design feature of a mixer is a z-shaped working blade, located on the fast shaft, which improves the process of mixing the components. On a high-speed shaft after the Z-shaped blades are two tape spirals of different diameter with opposite winding, providing a direction of flow of the mixture toward each other in a cross-counterflow. Working bodies (cone-shaped blades and band spirals) are three kinds of the movement of the mixture in the mixer: tangential, radial and axial flow. Mixer allows to optimize the mixing process of raw materials, different in grain-size composition and physical properties, due to the rational character of the movement of the mixture in each working chamber depending on the functional purpose of the product. In addition, expanding the scope of the mixer due to the achievement of the universalization of the mechanism of mixing taking into account characteristics of physical and mechanical properties of initial components. In addition, decreasing the duration of the technological cycle of obtaining ready mix, and hence reduce the specific energy consumption of the mixing process in achieving a better homogeneity of the finished product

Ventricular tachycardia and myocardial infarction during antiarrhythmic therapy: a case report

The article analyzes the case of the development of ventricular tachycardia and type 2 myocardial infarction (MI) in an 80-year-old patient with a history of coronary artery disease, MI and chronic heart failure. In 2020, the patient was diagnosed with ventricular extrasystole and started antiarrhythmic therapy with diethylamino propionylethoxycarbonylaminophenothiazine 150 mg per day and sotalol 160 mg per day. In 2022, the patient had an episode of clinical death due to ventricular tachycardia with successful resuscitation. A diagnosis of non-ST-elevation acute coronary syndrome was made, coronary angiography was performed, which did not reveal significant coronary stenosis. Upon further examination, the dynamics of biomarkers of myocardial necrosis confirmed the diagnosis of acute MI. In the analyzed case, the development of ventricular tachycardia and MI is most likely associated with the intake of diethylaminopropionylethoxycarbonylaminophenothiazine in combination with sotalol, prescribed in the presence of contraindications to their use

Optimization of the technology of fodder briquettes-licks with the use of a steam compression heat pump

In conditions of industrial maintenance of animals, their health is noticeably weakening, in the majority of the body, profound metabolic disorders are noted, and productivity is reduced. In such conditions it is necessary to use feed additives in the form of briquettes-licks, able to compensate for the lack of micro and macro elements, vitamins and many other substances. Intensification of feed production through the use of new advanced technologies allows to improve the quality of products and reduce losses in its production. The technologies used for briquettes-licks and equipment for their production do not always allow to provide high quality products and achieve the necessary effect when fed. In addition, they are energy-intensive, do not imply the use of secondary energy carriers. Therefore, the creation of a functional product, combining a complex of substances necessary for animal feeding, and the development of an energy-efficient method for its production is topical. The proposed technology makes it possible to obtain feed briquettes with high homogeneity and a specified content of biologically active substances, to ensure a longer-term preservation of the products. The developed line provides for the maximum rapid cooling of the finished product and a reduction in the specific energy consumption for its production as a result of the heat of spent coolants. The high-quality licks produced were homogeneous in their composition, resistant to unfavorable conditions. They are characterized by a higher stability of structural and mechanical properties and stability of storage quality for a long time: after twelve months, the technological properties of the products have not changed, signs of damage associated with increased humidity of the environment have not been noted. On the surface of briquettes, signs of development of microflora were not observed. The values of microbiological quality indicators were within acceptable limits. The development of energy-efficient method of its production is relevant. The proposed technology allows to obtain feed pellets with high uniformity and specify the content of biologically active substances, provide a long-term preservation products. It gives the possibility of issuing briquettes with high quality. In the developed line provides the most rapid cooling of the finished product and the reduction of specific energy consumption for its production as a result of the use of waste heat coolant. High licks were homogeneous resistant to adverse conditions and maintain the structural and mechanical properties and quality for a long time .If stored for twelve months technological properties of the product have not changed, deterioration of symptoms associated with high ambient humidity, it is noted. On the surface of briquettes signs of microflora is not observed. Values of microbiological quality parameters were within acceptable limits