Role of ergoreflex activity in the pathogenesis of heart failure. The effectiveness of physical rehabilitation

Aim. To assess the change in ergoreflex activity in heart failure patients with reduced left ventricular systolic function in the study of the effectiveness of physical training (PT) with original regimen, compared with PT with conventionally estimated regimen.Material and methods. Single-center open-label study of 297 patients with class III HF. The patients were divided into two groups: main group (MG) — patients, in whom the PT intensity was estimated based on lactate threshold (LT); comparison group (CG), in whom the PT intensity was estimated based on 60% VO2peak. We analyzed ergoreflex activity, the relationship of ergoreflex with exercise tolerance (ET), routine systemic inflammation markers, clinical manifestations of HF, and ET based on VO2peak.Results. An increase in gait velocity at the LT level after 3 months of PT was registered in 94% (n=210) of the MG patients. After 3 months, the PT regimen was recalculated according to 60% VO2реак; an increase in gait velocity at this level after 3 months of PT was registered in 70% of CG patients (n=35). The severity of HF decreased in both groups, but the dynamics was more pronounced in the MG, where class II was achieved by 75% of patients (in CG — 44%, p=0,003). In the MG, to a greater extent than in the CG, the ET increased. Ergoreflex activity (according to ΔVE) decreased by ≥15% in 230 (97%) MG patients and in 31 (63%) patients with CG. After the completion of the PT period, when in some patients the HF severity decreased to class II, we revealed a direct association of the ergoreflex value (according to ΔVE) with a greater severity of HF (r=-0,57, p=0,01) and the relationship between the decrease in ergoreflex activity (according to ΔVE), an increase in VO2LT (r=-0,55, p=0,001), VO2peak (r=0,49, p=0,001), a decrease in monocyte count (r=0,63, p=0,01).Conclusion. In stable patients with class III HF receiving the proper disease-modifying therapy, ergoreflex activity is increased and is associated with functional class, ET, and systemic inflammation activity. In the course of physical rehabilitation, a decrease in ergoreflex activity is accompanied by a decrease in functional class, an increase in EF, which is more pronounced with personalized aerobic exercise using LT regimen assessment

CHRONIC HEART FAILURE OF ISCHEMIC GENESIS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE: POSSIBILITIES OF COMBINATION THERAPY INCLUDING NEBIVOLOL

Objective: to reveal the features of chronic heart failure (CHF) of ischemic genesis concurrent with chronic obstructive pulmonary disease (COPD) and to investigate the effect of the cardioselective β1-adrenoblocker (β1-AB) nebivolol on the course of COPD and the parameters of the bronchopulmonary system in patients with CHF of ischemic genesis during treatment.Subjects and methods.The investigation enrolled 63 patients aged 40–70 years, including 43 patients with functional class (FC) II–IV CHF with a Simpson left ventricular ejection fraction of 45 % concurrent with COPD (a study group) and 20 patients with CHF and no bronchopulmonary pathology (a control group). The study group patients were randomly divided into 2 subgroups: 1) 23 patients who received nebivolol in addition to background therapy; 2) 20 patients in whom the therapy ruled out the use of β1-AB. The control patients were switched to nebivolol therapy. During 6-month follow-up, the authors made clinical examination, recorded the rate, duration, and severity of COPD exacerbations, performed a 6-minute walking test (6MWT), and used a clinical status scale modified by R. Cody, a dyspnea 0–10 category ratio (Borg scale), and a Medical Research Council Dyspnoea Scale (MRS scale). Besides, quality of life in patients was assessed using the specific Minnesota Living with Heart Failure Questionnaire. All the patients underwent echocardiography, bronchodilatation-induced external respiratory function test, peak flowmetry, and blood brain natriuretic peptide quantification. These studies were conducted at baseline and at 1 and 6 months of therapy.Results. During the investigation, the patients with CHF concurrent with COPD were found to have a high rate of hypertensive disease, prior myocardial infarctions, atrial fibrillations, and higher FC exertional angina. These patients also showed a delayed optimal result achievement during the combination therapy involving the use of β1-AB. The group of patients without concomitant COPD was observedto have lower FV CHF and significantly reduced dyspnea during exercise (Borg scale) immediately following 1-month therapy whereas these were seen only after 6 months. Nebivolol (mean dose 5 mg) included in the treatment regimen for patients with CHF concurrent with COPD failed to have a significant effect on spirometric and peak flowmetric readings, but had a clear-cut positive effect on the health indicators of CHF patients, such as FC of the disease, heart rate, 6MWT distance, degree of dyspnea degree, and quality of life.Conclusion. Combination cardiopulmonary therapy including β1-AB leads to more effective control of comorbidity symptoms and to improvementof patient functional status.</p

Статистическое изучение конъюнктуры валютного рынка

The authors attempted to conduct a statistical study of foreign exchange market and its environment, determined the theoretical basis of the study and aspects of practical application of the obtained results. To achieve this goal, the authors defined the subject of the statistical study of the foreign exchange market environment, structured scorecard to assess the state of the foreign exchange market, indicated the sources of information for the statistical analysis of the foreign exchange market environment in various areas. In the process of writing the article, the authors also used relevant materials on the topic of the research developed and published by the authorized organizations, including the international ones. In the study of the currency market and its situation in various areas the authors identified its importance for the financial stability of the national economy, the relationship with other segments of the fi nancial market, and the impact on macroeconomic indicators of economic development. Special attention was paid to the system of indicators to characterize the currency market environment, which is the methodological basis of the study and analysis of phenomena and processes occurring in the foreign exchange market. The authors compiled and structured a system of statistical indicators for the analysis of the status and development of the currency market in various areas in accordance with the available sources of information. This article discusses the issues related to deriving statistical data about the currency market from offi cial and alternative sources, the assessment of the completeness and reliability of statistical information was conducted, directions to improve statistical monitoring of the foreign exchange segment of the fi nancial market were determined. In the article, considerable attention is paid to the methodology of calculating separate indicators, including derivatives, in accordance with national and international statistical standards. In the study the authors came to the conclusion that currently, primary foreign exchange statistical information is suffi cient for calculating the recommended indicators characterizing the foreign exchange market environment, including supply and demand, and their correlation. In addition, the Bank of Russia has enough statistics to study the current situation with the sources of currency supply and demand in a relatively longer term. The indicators of the currencies turnover, its detailed structure, currency exchange rates, their fluctuations, and the business activity indicators are calculated fully or have the necessary reliable information for their assessment.Авторы статьи предприняли попытку статистического исследования валютного рынка и его конъюнктуры, определили теоретические основы его изучения и аспекты практического применения полученных результатов. Для достижения поставленной цели авторы определили предмет статистического изучения конъюнктуры валютного рынка, структурировали систему показателей для оценки состояния валютного рынка, обозначили источники информации для проведения статистического анализа конъюнктуры валютного рынка по различным направлениям. В процессе работы над статьей авторы широко применяли актуальные материалы по теме исследования, которые разрабатывают и публикуют уполномоченные организации, в том числе международные. В рамках изучения валютного рынка и его конъюнктуры по различным направлениям авторы определили его значение для финансовой стабильности национальной экономики, связь с другими сегментами финансового рынка, влияние на макроэкономические индикаторы развития экономики. Особое внимание было уделено системе показателей для характеристики конъюнктуры валютного рынка, являющейся методологической основой исследования и анализа явлений и процессов, происходящих на валютном рынке. Авторы обобщили и структурировали систему статистических показателей для анализа состояния и развития валютного рынка по различным направлениям в соответствии с имеющимися источниками информации. В статье подробно рассмотрены вопросы, связанные с получением статистических данных о валютном рынке из официальных и альтернативных источников, проведена оценка полноты и достоверности статистической информации, определены направления совершенствования статистического наблюдения за валютным сегментом финансового рынка. В статье значительное внимание уделено методологии расчета отдельных показателей, в том числе производных, в соответствии с национальными и международными статистическими стандартами. В результате проведенного исследования авторы пришли к выводу, что в настоящее время для расчета рекомендуемых показателей, характеризующих конъюнктуру валютного рынка, в том числе спроса и предложения, их соотношения, достаточно имеющейся первичной биржевой статистической информации. Кроме того, в распоряжении Банка России достаточно статистики для исследования складывающейся ситуации с источниками предложения и спроса валюты в относительно более долгосрочной перспективе. Показатели же оборота валют, его детальной структуры, валютных котировок, их колебаний, а также показатели деловой активности рассчитаны полно или есть необходимая достоверная информация для их оценки

The effectiveness of biofilm formation of daily cultures of clinically significant strains of opportunistic bacteria

Background. The formation of biofilm structures by microorganisms living in the hospital environment is a serious medical problem. To conduct correct experimental studies, it is necessary to know the speed and efficiency of biofilm formation by clinically significant species of opportunistic bacteria.   Aim: to study the kinetics of plankton culture growth and the rate of biofilm formation by clinically significant pathogens of infections associated with medical care to substantiate the methodology of further research.   Materials and methods. The strains from the working collection of the Laboratory for Microbiome and Microecology of the Scientific Сentre for Family Health and Human Reproduction Problems were used. Experiments were carried out with conditionally pathogenic microorganisms of the Enterobacteriaceae family and non-fermenting gram-negative bacteria. The optical density was measured, the total microbial number of the cell suspension was determined, and the morphological structure of the biofilm was evaluated using a light microscope on sterile cover glasses for thespecies Pseudomonas aeruginosa, Klebsiella pneumoniae and Serratia marcescens.   Results. The duration of the lag phase of the kinetic curve of cell growth varied in isolates of S. marcescens, P. aeruginosa and K. pneumoniae from 1 to 4 and 6 hours of cultivation, respectively. Despite this, the exponential growth phase was the same for all tested isolates and amounted to 4 hours. Thus, isolates of clinically significant species entered the stationary growth phase after 5–10 hours of cultivation and were characterized as fast-growing. On abiotic surfaces, after 8 hours of incubation of the tested cultures, the initial stages of the formation of biofilm structures were observed, after 20 hours the formed multilayer biofilm was visualized, after 24 hours succession occurred, new single cells were attached to the place of the detached structures.   Conclusion. The data obtained on the duration of the main stages of growth kinetics compared with the visualization of the formation of biofilm structures on abiotic surfaces should be taken into account when studying the effects of disinfectants, antiseptics and antibacterial drugs on planktonic cells and biofilm associations of clinically significant opportunistic microorganisms

Management of heart failure patients in Russia: perspectives and realities of the second decade of the XXI century

The article highlights the central components of Russian heart failure (HF) management programs in actual clinical practice. The experience of the Competence Center of Almazov National Medical Research Center, as well as opportunities and prospects for improving the monitoring of decompensated HF

Influence on the autonomic cardiovascular system regulation in the treatment of hypertension, arrhythmias and heart failure

Cardiovascular diseases are widespread and are the leading death cause in most countries, despite the creation and improvement of strategies to reduce cardiovascular risk. A significant role in the development and evolution of cardiovascular diseases belongs to sympathetic nervous system hyperactivity, and therefore the methods of effecting it are relevant for the prevention and treatment of cardiovascular pathology. The article discusses modern approaches to interventional and conservative regulation of the autonomic nervous system and neuromodulation in the prevention and treatment of hypertension, heart failure, tachyarrhythmias, as well as reflects a conjoint expert judgment on these issues

ИСПОЛЬЗОВАНИЕ АКТИВИРОВАННОГО МЕДНОГО МИКРОЭЛЕКТРОДА ДЛЯ ВОЛЬТАМПЕРОМЕТРИЧЕСКОГО ОПРЕДЕЛЕНИЯ СПИРТОВ

A method for fabricating a copper microdisk electrode of an original design based on 50 μm diameter wire sealed in borosilicate glass is described. The electrochemical properties of the copper microelectrode were studied by the method of steady-state voltammetry in a 2 M NaOH solution in the potential range from -1.1 to 0.8 V (versus saturated Ag/AgCl-electrode). In order to improve the electrochemical response a method for two-stage electrode activation based on a copper dissolution / redeposition procedure followed by polarization in an alkaline medium is suggested. Morphological and physico-chemical changes on copper surface after activation were examined by atomic force microscopy and X-ray photoelectron spectroscopy. After this procedure, the electrode showed a heterogeneous morphology with coarse texture and high roughness parameters, and a layer of catalytically active Cu(III) species was formed on copper surface. The best results were achieved with an activation time of 60 s and a polarization potential of -0.3 V. The effectiveness of the activation procedure was tested during the chronoamperometric determination of methanol, ethanol and ethylene glycol. Factors affecting the formation of the analytical signal of alcohols were studied, and optimal conditions of amperometric measurements were selected on their basis. Under optimal conditions, the metrological characteristics of the method were determined. The peak current response increases linearly with alcohols concentration over the range 0.01 - 0.45 M (0.04 - 3% v/v). The repeatability of the electrode response was evaluated as 3.8% (n = 10). The activated copper microelectrode was used for the determination of ethanol in pharmaceutical and other products.Описан способ изготовления медного микродискового электрода оригинальной конструкции на основе медной проволоки диаметром 50 мкм, вплавленной в боросиликатное стекло. Электрохимические свойства медного микроэлектрода изучены методом постоянно-токовой циклической вольтамперометрии в 2 M растворе NaOH в диапазоне потенциалов от -1.1 до +0.8 В (относительно насыщенного Ag/AgCl-электрода). Для улучшения электрохимического отклика предложен способ двухстадийной активации электрода на основе процедуры растворения/переосаждения меди с последующей поляризацией в щелочной среде. Морфологические и физико-химические изменения поверхности меди после активации подтверждены методами атомно-силовой микроскопии и рентгенофотоэлектронной спектроскопии. Эффективность процедуры активации проверена путем проведении хроноамперометрического определения спиртов: метанола, этанола и этиленгликоля. Прослежено влияние различных факторов на формирование аналитического сигнала спиртов, позволившее выбрать оптимальные условия проведения амперометрических измерений. Определены метрологические характеристики методики, проведена проверка правильности. Активированный медный микроэлектрод применен для определения этанола в фармацевтической и других видах продукции

Psychophysiological Mechanisms of Two Quantity Systems in Adolescents

Исследование посвящено изучению роли двух систем оценки количества в разных условиях доступа к визуальным параметрам стимулов в подростковом возрасте. 20 подростков (M = 14,65 лет, SD = 1,46 года) выполняли задачи на несимволическое сравнение количества, на перцептивную точность, на соотнесение количества, представленного в несимволическом и символическом формате. Показано, что в условиях облегченного доступа к визуальным параметрам активируется система оценки количества, основанной на визуальных параметрах; в условиях затрудненного доступа к визуальным параметрам активируется система прямой (непосредственной) оценки количества.The study is devoted to investigation of the role of two quantity systems in different conditions of access to stimuli visual parameters in adolescence. 20 adolescents (M = 14,65 years, SD = 1,46 years) performed tasks for non-symbolic comparison of quantities, for perceptual accuracy, for comparison of non-symbolic and symbolic quantities. As a result, it is shown that in conditions of easy access to visual parameters a quantity estimation system based on visual parameters is activated; in conditions of difficult access to visual parameters the system of direct quantity estimation is activated.Исследование выполнено при финансовой поддержке РФФИ в рамках научного проекта № 19‑29‑14138 «Когнитивные и психофизиологические механизмы чувства числа»

Инвазивный аспергиллез легких после трансплантации сердца

Objective: to assess the incidence, determine the peculiarities of the course of invasive pulmonary aspergillosis (IPA) and identify risk factors for IPA in heart transplant recipients.Materials and methods. From January 2010 to December 2019, 137 heart transplantations (HT) were performed: mean age 46 ± 14 years; male 102 (74%) and female 35 (26%). All patients received a three-component immunosuppressive therapy: calcineurin inhibitors, mycophenolate mofetil (MMF) and Glucocorticoid (GCs). Induction therapy consisted of Basiliximab (81%, n = 111) and antithymocyte immunoglobulin (15%, n = 20). A retrospective analysis of patients with identified post-HT invasive IPA was performed; risk factors for IPA were assessed. In patients with early IPA, the length of stay in the intensive care unit (ICU), the duration of mechanical ventilation, and the initial severity of the condition were studied. All patients with suspected pneumonia underwent bronchoscopy with examination of bronchoalveolar lavage (BAL) and chest computed tomography (chest CT scan).Results. During the follow-up, there were 58 episodes of pneumonia, of which 16 (28%) were IPA (age 33 to 64 years). All patients had a target level of immunosuppressive drugs concentration in blood; basiliximab was used as induction therapy in 15 of 16 patients. Half of the recipients developed IPA in the early post-HT period (less than 3 months after HT), in the rest (n = 8) – at a later date (3 months to 1 year after HT). The diagnosis was verified: 14 out of 16 patients showed an increase in the Aspergillus antigen positivity in the BAL to 7.2 (2.8 ± 1.6); chest CT scan revealed specific changes. In two patients, there were no diagnostic criteria for IPA, but the diagnosis was made based on the results of histological examination after resection of the left lower lobe of the lung. All patients received voriconazole therapy for 2 to 6 months, their immunosuppressive therapy was adjusted (tacrolimus and MMF dose adjustment) and their white blood cell count was monitored. Complete cure of the disease was achieved in 13 (81%) patients. Two patients died within 30 days after HT in the intensive care unit, one died from urogenital diseases caused by bacterial flora and leading to urosepsis, 4 months after IPA treatment was initiated. All patients had risk factors for IPA: taking immunosuppression, including GCs (n = 16), prolonged ICU stay (n = 14), inotropic support exceeding 2 days in the early post-transplant period (n = 10), cachexia during HT (n = 6), leukopenia (n = 9) and neutropenia (n = 14).Conclusion. In heart transplantat recipients, the incidence of IPA among respiratory tract infections is 28%. The risk of developing IPA was highest during the first year following HT. In the majority of recipients, the disease was detected at the early stages; diagnosis required surgical intervention in 12% of cases. A decrease in the risk of developing IPA was associated with correction of the following risk factors for this disease in all patients: volume of immunosuppressive therapy during the first year after transplantation and prevention of the development of neutropenia as a marker of infectious complications or immunosuppression overdose. Early diagnosis of IPA allowed for initiation of timely specific therapy in most recipients and achievement of a positive effect in 80% of them.Цель. Оценить частоту развития, определить особенности течения инвазивного аспергиллеза легких (АСП) и выявить факторы риска развития заболевания у реципиентов после трансплантации сердца (ТС).Материалы и методы. C января 2010-го по декабрь 2019 г. было выполнено 137 ТС: средний возраст 46 ± 14 лет; мужчин – 102 (74%), женщин – 35 (26%). Все пациенты получали трехкомпонентную иммуносупрессивную терапию: ингибиторы кальциневрина, микофенолата мофетил (ММФ) и глюкокортикостероиды (ГКС). Индукционная терапия была представлена базиликсимабом (81%, n = 111) и антитимоцитарным иммуноглобулином (15%, n = 20). Проведен ретроспективный анализ пациентов с выявленным инвазивным АСП, перенесенным после ТС, оценены факторы риска развития АСП. У пациентов с ранним АСП изучены длительность нахождения в отделении реанимации (ОР) и продолжительность ИВЛ, исходная тяжесть состояния. Всем пациентам с подозрением на пневмонию проводились бронхоскопия с исследованием бронхоальвеолярного лаважа (БАЛ) и компьютерная томография грудной клетки (КТ ОГК).Результаты. За время наблюдения было зарегистрировано 58 эпизодов пневмоний, из них 16 (28%) – АСП (возраст от 33 до 64 лет). У всех пациентов был целевой уровень концентрации иммуносупрессивных препаратов в крови, у 15 из 16 пациентов в качестве индукционной терапии был применен базиликсимаб. У половины реципиентов АСП развился в ранние сроки после ТС (менее 3 месяцев после ТС), у остальных (n = 8) – в поздние сроки (3 месяца – 1 год после ТС). Диагноз был верифицирован: у 14 из 16 пациентов наблюдалось повышение коэффициента позитивности антиген Aspergillus в БАЛ до 7,2 (2,8 ± 1,6), имели место специфические изменения по КТ ОГК. У двух пациентов диагностические критерии АСП отсутствовали, но диагноз был поставлен по результатам гистологического исследования после резекции нижней доли левого легкого. Всем пациентам проводилась терапия вориконазолом продолжительностью от 2 до 6 месяцев, коррекция иммуносупрессивной терапии (коррекция дозы такролимуса и ММФ) и контроль уровня лейкоцитов в динамике. Полное излечение заболевания было достигнуто у 13 (81%) пациентов. Двое больных умерли в течение 30 дней после ТС в отделении реанимации, один – от заболеваний мочеполовой системы, вызванных бактериальной флорой и приведших к развитию уросепсиса, через 4 месяца после начала лечения АСП. У всех пациентов имели место факторы риска развития АСП: прием иммуносупрессии, в том числе ГКС (n = 16), длительное пребывание в ОР (n = 14), инотропная поддержка более 2 суток в раннем посттрансплантационном периоде (n = 10), кахексия на момент ТС (n = 6), лейкопения (n = 9) и нейтропения (n = 14).Заключение. У пациентов после ТС встречаемость АСП среди инфекций дыхательных путей составляет 28%. Наиболее высоким риск развития АСП был в течение первого года после ТС. У большинства реципиентов заболевание было выявлено на начальных стадиях, в 12% случаев для диагностики потребовалось проведение оперативного вмешательства. Снижение риска развития АСП было ассоциировано с коррекцией следующих факторов риска этого заболевания у всех пациентов: объем иммуносупрессивной терапии в течение первого года после трансплантации и предотвращение развития нейтропении как маркера инфекционных осложнений или переизбытка иммуносупрессии. Ранняя диагностика АСП позволила у большинства реципиентов начать своевременную специфическую терапию и добиться положительного эффекта у 80% из них