Сравнительное исследование влияния десимпатизации почечных артерий и фармакологического лечения на артериальное давление и диастолическую функцию при резистентной гипертонии.

Effects of renal artery denervation versus pharmacological treatment on blood pressure values and diastolic function parameters in patients with treatment-resistant hypertension.Problema controlului valorilor tensionale la pacienți cu HTA rezistentă rămâne a fi o povară a cardiologiei contemporane. Astfel s-a dezvoltat o nouă ramură în tratamentul acestor pacienți – cea intervențională, și în special desimpatizarea arterelor renale. Articolul dat reprezintă datele preliminare a unui studiu clinic original, desfășurat în Departamentul Hipertensiuni arteriale a Institutului de Cardiologie, scopul principal al căruia a fost evaluarea efectului antihipertensiv și de ameliorare a parametrilor de funcție diastolică la pacienți cu HTA rezistentă sub influența tratamentului prin desimpatizarea arterelor renale versus cel farmacologic. Datele obținute au demonstrat eficacitatea DSAR atât în reducerea valorilor tensionale, cât și ameliorarea funcției diastolice, efectul antihipertensiv fiind unul superior tratamentului farmacologic, statistic autentic deja la a 3-a lună post-proceduralСравнительное исследование влияния десимпатизации почечных артерий и фармакологического лечения на артериальное давление и диастолическую функцию при резистентной гипертонии

Novel approaches to the treatment of patients with resistant hypertension: renal sympathetic denervation

Background: Hypertension continues to be a major burden of public health concern despite the recent advances and proven benefit of pharmacological therapy. A certain subset of patients has hypertension resistant to maximal medical therapy and appropriate lifestyle measures. Resistant hypertension continues to pose a major challenge to clinicians worldwide and has serious implications for patients who are at increased risk of cardiovascular morbidity and mortality with this diagnosis. Pharmacological therapy for resistant hypertension follows guidelines-based regimens, although there is surprisingly scant evidence for beneficial outcomes using additional drug treatment after three antihypertensives have failed to achieve target blood pressure. Through modulation of renin secretion, glomerular filtration rate and renal absorption of sodium, the sympathetic innervation of the kidneys plays an important role in the pathogenesis of hypertension. A novel catheter-based technique for renal sympathetic denervation (RSDN) as a new therapeutic avenue has great promise for the treatment of resistant hypertension. Renal denervation has the unique advantage of offering the denervation at the renal level, thus mitigating the systemic side effects. Various trials evaluated the role of renal denervation in the management of resistant hypertension and have found promising results. More studies are underway to evaluate the role of renal denervation in patients presenting with resistant hypertension in different scenarios.  Conclusions: This review included the physiology of the renal sympathetic nervous system and the renal nerve anatomy. Furthermore, the RSDN procedure, technology systems, and RSDN clinical trials as well as findings besides antihypertensive effects were discussed. Findings on safety and efficacy seem to suggest that renal sympathetic denervation could be of therapeutic benefit in refractory hypertensive patients. Despite the fast pace of development in RSDN therapies, only initial and very limited clinical data are available. Large gaps in knowledge concerning the long-term effects and consequences of RSDN still exist, and solid, randomized data are warranted

РЕКОНСТРУКЦИИ СЛАВЯНСКИХ МИФОВ В ПОЭТИЧЕСКИХ ЦИКЛАХ К. БАЛЬМОНТА, С. ГОРОДЕЦКОГО, А. КОНДРАТЬЕВА

The article deals with three different variants of reconstruction and interpretation Slavic mythology in three poetic cycles of the beginning 20th century. Three poets create specific poetic pictures of Slavic past. All of them – Konstantin Balmont’s idyllic world of past, Sergey Gorodetsky’s cruel world of primitive passions and Aleksey Kondratyev’s universal picture of world cultural relationships – try to understand beginnings of national character

ПУШКИН, ПЕРМЬ И ПОЛЬША: ИНТЕРПРЕТАЦИЯ ОДНОГО ЗНАЧИМОГО ЭПИЗОДА МЕМУАРНОЙ ХРОНИКИ А.И. ГЕРЦЕНА «БЫЛОЕ И ДУМЫ»

In this article you can find the interpretation of one important episode from memoir Chronicles “Past and thoughts” by Alexander Herzen. Author’s meeting with the exiled Pole in Perm connects with Pushkin’s theme in literature.В статье предлагается интерпретация одного значимого эпизода мемуарной хроники А.И. Герцена «Былое и думы». Встреча автора со ссыльным поляком в Перми соединяется с пушкинской темой в литературе

Asymptotic analysis of retrial queueing system M/M/1 with non-persistent customers and collisions

A queuing system with repeated calls, one server, collisions (conflicts) of calls, H-persistence and rejections is considered. A call that found the device free occupies it, and service begins, which ends successfully if no other requests were received during it. If the server is busy, then a conflict (collision) arises between the call that have come for service and the ones being serviced, and in the general case, both calls instantly go to the orbit and repeat the attempt to successfully serve after a random time. In this article, in the event of a collision, one of the calls, for example, which was in service (on the device), goes into the orbit with probability H1, the other goes into orbit with probability H2, and with probability (1−H1) and (1−H2) respectively refuses service and leaves the system. The problem is to find asymptotic probabilities distribution of the calls number in the orbit

Сравнительное исследование влияния денервации почечных артерий и фармакологического лечения на артериальное давление у пациентов с резистентной гипертензией.

The correlation of the reduction of blood pressure values with the improvement of degree of heart failure in patients with resistant hypertension.În articol sunt prezentate datele unui studiu clinic original desfășurat în Departamentul Hipertensiuni arteriale al Institutului de Cardiologie. Scopul principal al studiului a fost analiza corelativă între valorile tensionale și gradul de insuficiență cardiacă, apreciat prin nivelul plasmatic al NTpro-BNP și distanța parcursă la test „mers 6 minute” la pacienți cu hipertensiune arterială rezistentă și insuficiență cardiacă cu fracția de ejecție păstrată.Сравнительное исследование влияния денервации почечных артерий и фармакологического лечения на артериальное давление у пациентов с резистентной гипертензией

Оценка эффективности ингибирования симпатической нервной системы с помощью различных терапевтических режимов на вариабельность и суточный профиль артериального давления у пациентов с резистентной артериальной гипертензией

Despite administration of various drug treatment regimens leaves a large proportion of patients with resistant hyperten- sion with uncontrolled blood pressure values, who are at increased risk for cardiovascular and renal complications. Recognition of the major role of the sympathetic nervous system in the pathogenesis of hypertension has led to the development of new minimally invasive methods, which reduce the activity of the sympathetic nervous system at the peripheral renal level, resulting in reduced blood pressure. One such treatment is renal artery denervation - an innovative method devised 10 years ago that involves disrupting afferent and efferent renal sympathetic fibers by applying radiofrequency energy.In this way, we aimed to conduct an open-label clinical study that will assess the effectiveness of blocking the sympathetic nervous system through various therapeutic regimens on blood pressure variability and diurnal profile in patients with resistant hypertension. The data obtained demonstrated the antihypertensive effectiveness of both pharmacological and interventional treatment, but renal denervation having a much higher impact.În pofida administrării diverselor scheme de tratament farmacologic o mare parte dintre pacienții cu hipertensiunea arterială rezistentă rămân cu valori tensionale necontrolate, aceștia prezentând un risc sporit pentru complicații cardiovas- culare și renale. Recunoașterea rolulului major al sistemului nervos simpatic în patogenia hipertensiunii arteriale a dus la elaborarea unor metode minim invazive noi, care diminuează activitatea sistemului nervos simpatic la nivelul periferic renal, rezultând în reducerea valorilor tensionale. Un astfel de tratament reprezintă și desimpatizarea arterelor renale - metoda inovațională concepută acum 10 ani care presupune întreruperea fibrelor simpatice renale aferente și eferente prin aplicarea energiei cu radiofrecvență.În acest mod, ne-am propus realizarea unui studiu clinic deschis care va aprecia eficacitatea blocării sistemului nervos simpatic prin diverse regimuri terapeutice asupra variabilității nictemerale a tensiunii arteriale și profilului diurn circa- dian la pacienții cu hipertensiunea arterială rezistentă. Datele obținute au demonstrat eficacitatea antihipertensivă atât a tratamentului farmacologic, cât și cel intervențional, desimpatizarea arterelor renale însă având un impact net superior.Несмотря на применение различных схем медикаментозного лечения большая часть пациентов с резистентной артериальной гипертензией остаётся с неконтролируемыми значениями артериального давления, последняя, будучи подвержена повышенному риску сердечно-сосудистых и почечных осложнений. Признание ведущей роли симпатической нервной системы в патогенезе артериальной гипертензии привело к разработке новых мини инвазивных методов лечения, которые уменьшают активность симпатической нервной системы на периферическом почечном уровне, что приводит к снижению артериального давления. Одним из таких методов лечения является денервация почечных артерии - инновационный метод, разработанный 10 лет назад, который включает в себя прерывание афферентных и эфферентных почечных симпатических волокон с помощью радиочастотной энергии.Исходя из этого, нами было решено проведение открытого клинического исследования, которое позволит оценить эффективность блокирования симпатической нервной системы с помощью различных схем лечения на вариабельность и суточный профиль артериального давления у пациентов с резистентной гипертензией. Полученные данные продемонстрировали антигипертензивную эффективность как фармакологического, так и интервенционного лечения, но ренальная денервация проявила гораздо более эффективной