COVID-19 и сердечно-сосудистые заболевания: от эпидемиологии до реабилитации

The article is devoted to a review of data on the prevalence and impact of cardiovascular diseases on the course and outcomes of the new coronavirus infection COVID-19. The review examines the relationship between COVID-19 and the functioning of the renin-angiotensin-aldosterone system, the pathophysiological mechanisms of their mutual influence. The analysis of the latest literature data on the safety of taking angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers is presented. The causes and pathophysiological mechanisms of the development of acute myocardial damage in COVID-19 are discussed. The issue of organizing rehabilitation assistance for patients who have undergone COVID-19 is being considered. The main components and features of the COVID-19 rehabilitation program are presented.Статья посвящена обзору данных о распространенности и влиянии сердечно-сосудистых заболеваний на течение и исходы новой коронавирусной инфекции COVID-19. В обзоре разбирается связь между COVID-19 и функционированием ренин-ангиотензин-альдостероновой системы, патофизиологические механизмы их взаимного влияния. Приведены результаты анализа последних данных литературы о безопасности приема ингибиторов ангиотензинпревращающего фермента и блокаторов рецепторов к ангиотензину II. Обсуждаются причины и патофизиологические механизмы развития острого миокардиального повреждения при COVID-19. Рассматривается вопрос организации реабилитационной помощи больным, перенесшим COVID-19. Представлены основные компоненты и особенности программы реабилитации при COVID-19

EFFICACY OF PHYSICAL TRAINING AND ANALYSIS OF LIPID-LOWERING THERAPY IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER ACUTE CORONARY INCIDENTS

Aim. To study efficacy of moderate-intensity physical training (PT) and evaluate lipid-lowering therapy in patients with ischemic heart disease (IHD) after acute coronary events in real practice.Material and methods. A total of 392 patients survived during last 3-8 weeks myocardial infarction, unstable angina or myocardial revascularization were included into the study. Inclusion of patients with stable angina pectoris after hospital treatment was also possible. Patients were randomized to the main (n=197) and control (n=195) groups. Patients of the main group received moderate-intensity PT. All patients received beta-blocker, nitrate, ACE inhibitors and acetylsalicylic acid. Frequency of lipid-lowering therapy prescription and its efficacy were assessed in both groups. Duration of the study was 1 year. The efficacy of interventions was evaluated by the dynamics of plasma lipid levels, results of bicycle ergometry and clinical end points.Results. We observed increase in exercise test duration by 32% (p<0.001), efficiency of heart work by 12% (p<0.05), decrease in frequency of angina attacks by 51% (p<0.001) in the main group. Decrease in total cholesterol (TC) by -3.6% (p<0.05) and increase in high density lipoproteins (HDL) cholesterol by 12.3% (p<0.01) were also observed. Differences in the dynamics of physical tolerance, levels of TC, HDL cholesterol and the TC/HDL cholesterol ratio were significant at intergroup comparison. Lipid-lowering drugs implementation was inadequate in both groups. Target plasma levels of low density lipoproteins (LDL) cholesterol were reached in no one group. We registered less cardiovascular events in the main group in comparison with control one (14% vs 28%, respectively) as well as hospitalizations due to IHD (11% vs 18%, respectively) and number of days of disability (2.2 vs. 4.2 days per patient annually, respectively). Differences in mentioned clinical end point rates were significant between groups (p<0.05).Conclusion. Results of the study shown PT efficacy in patients with IHD after cardiovascular events. Lipid-lowering therapy is conducted inefficiently in patients with IHD in real practice. It is advisable to introduce PT program in real practice as well as adequate pharmacotherapy

The effect of maximal vs submaximal exertion on postprandial lipid levels in individuals with and without coronary heart disease

Background: Decisions about fat consumption and levels of physical activity are among the everyday choices we make in life and risk of coronary heart disease (CHD) can be affected by those choices. Objective: The purpose of this study was to investigate the influence of a standard fat load combined with physical exertion of different intensities on the plasma lipid profile of CHD patients and CHD-free individuals. Methods: This study looked at the influence of different intensities of physical exercise on postprandial lipid metabolism in 20 healthy men and 36 men with diagnosis of CHD. Venous blood samples were obtained after overnight fasting, 3 hours after standard fat load (before the physical load), and immediately after maximal or submaximal physical exercise on bicycle ergometer. Results: After fat load total cholesterol (TC) concentration did not change in either group. However, after the addition of maximal exercise, TC, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein (Apo) B increased significantly (P < .01) in both groups. After fat load and maximal exercise, there was no change in high-density lipoprotein cholesterol (HDL-C) in healthy men, but in men with CHD, HDL-C fell significantly (P < .01); and Apo AI rose in healthy men (P < .01) but dropped significantly (P < .01) in men with CHD. Submaximal physical exercise (60% of max VO2 load for 40 minutes) after fat load decreased TG level in CHD patients (P < .01) and improved other lipid parameters in both groups significantly (↓LDL-C, ↑HDL-C, ↑Apo AI, ↓Apo B, P < .01). We observed a worsening of physical work capacity in men with CHD (significant reduction of duration and total amount of work performed, maximal VO2, oxygen pulse), during maximal stress test performed 3 hours after fat load. There was a doubling of the number of abnormal stress test results (P < .01). Healthy persons showed an increase in respiratory parameters (ventilation, CO2 production, maximal VO2, and oxygen pulse), but no significant change was found in work capacity. Thus, maximal physical exercise produced atherogenic blood lipid changes (increased TC, increased LDL-C, increased TG, increased Apo B, P < .01) in men with CHD and in healthy men; however, individuals with CHD also demonstrated a significant decrease in HDL-C and Apo AI (P < .01). In contrast, the submaximal physical load improved postprandial lipid changes in both healthy men and men with CHD. Conclusions: This study demonstrates that moderate exercise is beneficial in improving postprandial lipid abnormalities in both CHD and CHD-free subjects after fatty meal preload. In addition, maximal exercise demonstrated evidence of increase of lipid abnormalities in both CHD and CHD-free individuals under similar conditions of fatty meal preload

Clinical efficacy of a personalized exercise program in the rehabilitation of patients with atrial fibrillation after radiofrequency ablation

Aim. To study the clinical efficacy and safety of a personalized exercise program in the rehabilitation of patients with paroxysmal atrial fibrillation (AF) after primary pulmonary vein radiofrequency ablation (RFA).Material and methods. Patients (n=48) with paroxysmal AF who underwent RFA were randomized into two groups: main (n=24) — patients involved in the exercise program and received standard therapy; control (n=24) — patients received standard therapy. The program included exercise complexes with the calculation of energy consumption, step training and walking. The program lasted 6 months, while the follow-up period — 12 months. All patients in the study underwent a faceto-face learning interview.Results. After 6-month exercise program, bicycle ergometer test revealed an increase in duration (by 18,6%, p&lt;0,001) and power (by 24,8%, p&lt;0,01) of the load, while these changes were not revealed in the control group. The positive aftereffect of training on these parameters persisted even after the completion of program. Left atrial and left ventricular end-diastolic dimension remained stable in exercise program group and significantly increased in the control group. In contrast to the control group, the following parameters significantly decreased in trained patients after 6 months: body mass index by 2,8% (p&lt;0,05), systolic blood pressure by 2,1% (p&lt;0,05), heart rate by 12,1% (p&lt;0,05), low-density lipoprotein cholesterol concentration by 18,8% (p&lt;0,001), high-sensitivity C-reactive protein by 22,9% (p&lt;0,05), N-terminal pro-brain natriuretic peptide by 28,2% ( p&lt;0,05), aldosterone by 41,5% (p&lt;0,001) and angiotensin II by 41,3%, p&lt;0,05). In addition, in the exercise program group an increase in high-density lipoprotein cholesterol by 20,6% (p&lt;0,05) and physical activity level by 23,8% (p=0,001) was revealed. At the same time, both groups showed a significant decrease in the concentration of fibrinogen and transforming growth factor-β1. After 6 months, in the exercise program group versus the control group, there was a decrease in the number of registered supraventricular premature beats (p&lt;0,01), episodes of supraventricular tachyarrhythmia (p&lt;0,05), including AF (p&lt;0,05).Conclusion. Involvement of patients with AF after catheter RFA in a cardiac rehabilitation program based on moderate-intensity aerobic training improves exercise tolerance, cardiac function, corrects thrombogenic factors, and reduces the likelihood of arrhythmia recurrence, including AF

Effect of genetic specifics of patients on myocardial contractility after acute myocardial infarction: a literature review

In this literature review, we analyzed studies on the influence of genetic specifics of patients on the restoration of myocardial contractility after acute myocardial infarction. Data on the influence of genetic characteristics on the myocardial repair, remodeling process, and the restoration of cardiac contractility are presented. The use of genetic methods in the examination of patients and further consideration of individual characteristics when prescribing therapy will make it possible to implement a personalized approach to each patient. This will improve the effectiveness of treatment and the disease prognosis

16(th) IHIW: population global distribution of killer immunoglobulin-like receptor (KIR) and ligands.

In the last fifteen years, published reports have described KIR gene-content frequency distributions in more than 120 populations worldwide. However, there have been limited studies examining these data in aggregate to detect overall patterns of variation at regional and global levels. Here, we present a summary of the collection of KIR gene-content data for 105 worldwide populations collected as part of the 15th and 16th International Histocompatibility and Immunogenetics Workshops, and preliminary results for data analysis

Central nervous system involvement in childhood acute lymphoblastic leukemia is linked to upregulation of cholesterol biosynthetic pathways

No abstract available

Electrode Materials, Thermal Annealing Sequences, and Lateral/Vertical Phase Separation of Polymer Solar Cells from Multiscale Molecular Simulations

The nanomorphologies of the bulk heterojunction (BHJ) layer of polymer solar cells are extremely sensitive to the electrode materials and thermal annealing conditions. In this work, the correlations of electrode materials, thermal annealing sequences, and resultant BHJ nanomorphological details of P3HT:PCBM BHJ polymer solar cell are studied by a series of large-scale, coarse-grained (CG) molecular simulations of system comprised of PEDOT:PSS/P3HT:PCBM/Al layers. Simulations are performed for various configurations of electrode materials as well as processing temperature. The complex CG molecular data are characterized using a novel extension of our graph-based framework to quantify morphology and establish a link between morphology and processing conditions. Our analysis indicates that vertical phase segregation of P3HT:PCBM blend strongly depends on the electrode material and thermal annealing schedule. A thin P3HT-rich film is formed on the top, regardless of bottom electrode material, when the BHJ layer is exposed to the free surface during thermal annealing. In addition, preferential segregation of P3HT chains and PCBM molecules toward PEDOT:PSS and Al electrodes, respectively, is observed. Detailed morphology analysis indicated that, surprisingly, vertical phase segregation does not affect the connectivity of donor/acceptor domains with respective electrodes. However, the formation of P3HT/PCBM depletion zones next to the P3HT/PCBM-rich zones can be a potential bottleneck for electron/hole transport due to increase in transport pathway length. Analysis in terms of fraction of intra- and interchain charge transports revealed that processing schedule affects the average vertical orientation of polymer chains, which may be crucial for enhanced charge transport, nongeminate recombination, and charge collection. The present study establishes a more detailed link between processing and morphology by combining multiscale molecular simulation framework with an extensive morphology feature analysis, providing a quantitative means for process optimization

CLIPPERS. Обзор литературы и собственные наблюдения

CLIPPERS (Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is a rare inflammatory disease of the central nervous system, during which the pons of the brain is damaged. This disease was described for the first time in 2010 by S.J. Pittock et.al. At present, there have been around 50 described cases of the disease. Up to the present moment, there are difficulties diagnosing this disease. In the article, a literature review and three clinical cases are presented. Furthermore, the necessity of further research is shown for improving the accuracy and specificity of the diagnostic criteria, as well as for defining biomarkers and developing algorithms of effective therapy.CLIPPERS (Chronic lymphocytic inflammation with pontine perivascular enhancement responsive tosteroids) – хроническое лимфоцитарное воспаление с поражением моста, контрастным усилениемпериваскулярных пространств, отвечающее на терапию глюкокортикостероидными препаратами,представляет собой редкое воспалительное заболевание центральной нервной системы, вовлекающеепреимущественно мост головного мозга. Впервые заболевание было описано в 2010 г. S.J. Pittock исоавт. В настоящее время в литературе описано около 50 случаев. Заболевание до настоящего временивызывает диагностические проблемы. В статье приведен краткий обзор литературы и собственныенаблюдения трех клинических случаев. Показана необходимость дальнейших исследований дляповышения точности и специфичности диагностических критериев, определения биомаркеров иразработки алгоритмов эффективной терапии

ПИЛОТНЫЙ ПРОЕКТ «РАЗВИТИЕ СИСТЕМЫ МЕДИЦИНСКОЙ РЕАБИЛИТАЦИИ В РОССИЙСКОЙ ФЕДЕРАЦИИ». ПРОТОКОЛ ВТОРОЙ ФАЗЫ

The Pilot project «Development of medical rehabilitation system in Russian Federation» is the large Russian project which is intended to transform system of rehabilitation care for patients with stroke, heart attack, and after total hip arthroplasty. The present article is the second one in the series of publications of the Project’s protocol. The publication shows the criteria of translation from 1 to 2 stages of rehabilitation and from 2 to 3 stages for all three profiles of the project. Working peculiarities of the second phase of the project are prescribed which realizes the new model of rehabilitation with assessment according to the ICF, determination of rehabilitation diagnosis, work in multidistsiplinary team and the introduction of a new speciality – ergotherapy. Пилотный проект «Развитие системы медицинской реабилитации в Российской федерации» – большой всероссийский проект, призванный преобразовать систему оказания реабилитационной помощи больным с инсультом, инфарктом и после эндопротезирования тазобедренного сустава. Данная статья является второй в серии публикаций протокола Проекта. В данной публикации приведены критерии перевода с 1-го на 2-й этапы реабилитации и со 2-го на 3-й по всем трем профилям проекта. Прописаны особенности работы во 2-й фазе проекта, где реализована новая модель реабилитации с оценкой по МКФ, установкой реабилитационного диагноза, работой в мультидисциплинарной команде и введением новой специальности – эрготерапии