33 research outputs found
Rotation-induced 3D vorticity in 4He superfluid films adsorbed on a porous glass
Detailed study of torsional oscillator experiments under steady rotation up
to 6.28 rad/sec is reported for a 4He superfluid monolayer film formed in 1
micrometer-pore diameter porous glass. We found a new dissipation peak with the
height being in proportion to the rotation speed, which is located to the lower
temperature than the vortex pair unbinding peak observed in the static state.
We propose that 3D coreless vortices ("pore vortices") appear under rotation to
explain this new peak. That is, the new peak originates from dissipation close
to the pore vortex lines, where large superfluid velocity shifts the vortex
pair unbinding dissipation to lower temperature. This explanation is confirmed
by observation of nonlinear effects at high oscillation amplitudes.Comment: 4pages, 5figure
Fast Diffusion Process in Quenched hcp Dilute Solid He-He Mixture
The study of phase structure of dilute He - He solid mixture of
different quality is performed by spin echo NMR technique. The diffusion
coefficient is determined for each coexistent phase. Two diffusion processes
are observed in rapidly quenched (non-equilibrium) hcp samples: the first
process has a diffusion coefficient corresponding to hcp phase, the second one
has huge diffusion coefficient corresponding to liquid phase. That is evidence
of liquid-like inclusions formation during fast crystal growing. It is
established that these inclusions disappear in equilibrium crystals after
careful annealing.Comment: 7 pages, 3 figures, QFS200
NMR Study of Disordered Inclusions in the Quenched Solid Helium
Phase structure of rapidly quenched solid helium samples is studied by the
NMR technique. The pulse NMR method is used for measurements of spin-lattice
and spin-spin relaxation times and spin diffusion coefficient
for all coexisting phases. It was found that quenched samples are two-phase
systems consisting of the hcp matrix and some inclusions which are
characterized by and values close to those in liquid phase. Such
liquid-like inclusions undergo a spontaneous transition to a new state with
anomalously short times. It is found that inclusions observed in both the
states disappear on careful annealing near the melting curve. It is assumed
that the liquid-like inclusions transform into a new state - a glass or a
crystal with a large number of dislocations. These disordered inclusions may be
responsible for the anomalous phenomena observed in supersolid region.Comment: 10 pages, 3 figure
ΠΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΌΠΎΠ΄Π΅Π»Ρ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ½ΡΠ΅ΡΠ°Π»ΠΎΠΏΠ°ΡΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π°Π»ΠΈΠΌΠ΅Π½ΡΠ°ΡΠ½ΡΠΌ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·ΠΎΠΌ
The objective: to develop a predictive model for assessing the risk of developing encephalopathy (EP) in patients with nutritional pancreatic necrosis.Subjects and Methods. A single-center prospective cohort study was conducted at Faculty Surgery Clinic of Volgograd State Medical University from 2010 to 2020. Logistic regression analysis was used to build a model for predicting the risk of developing EP.Results. A total of 429 patients were included in the study. It was determined that in the majority of patients EP manifested in the first three days after hospitalization. A statistically significant predictive model of correlation of the risk to develop EP with clinical and demographic variables showed that an increase in the severity of the patient's condition (according to the SOFA scale) by 1 point increased the risk by 1.9 times, and an increase in bilirubin levels by 1 ΞΌmol/l, and urea by 1 mmol/l increased the risk of AED by 8.0% and 28.0%, respectively. In non-alcoholic pancreatic necrosis, compared with the alcoholic genesis of the disease, and when using early (before day 3) enteral nutrition, there was a significant reduction in the risk of developing EP by 175.5% and 137% of cases. The specificity and sensitivity of the model were 78.7% and 82.8%, respectively.Conclusions. In nurtitional pancreatic necrosis, an increase in the severity of the patient's condition, alcoholic genesis of the disease, progression of signs of liver and kidney failure significantly increased the risk of developing EP. At the same time, early enteral nutrition contributed to a significant reduction in the risk of this complication. The presented predictive model is recommended to be used in routine clinical practice. Β Π¦Π΅Π»Ρ: ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°ΡΡ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΠΌΠΎΠ΄Π΅Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ½ΡΠ΅ΡΠ°Π»ΠΎΠΏΠ°ΡΠΈΠΈ (ΠΠ) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π°Π»ΠΈΠΌΠ΅Π½ΡΠ°ΡΠ½ΡΠΌ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·ΠΎΠΌ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΎΠ΄Π½ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎΠ΅ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΊΠΎΠ³ΠΎΡΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π½Π° Π±Π°Π·Π΅ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΈ ΡΠ°ΠΊΡΠ»ΡΡΠ΅ΡΡΠΊΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ ΠΠΎΠ»Π³ΠΠΠ£ Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 2010 ΠΏΠΎ 2020 Π³. ΠΠ»Ρ ΠΏΠΎΡΡΡΠΎΠ΅Π½ΠΈΡ ΠΌΠΎΠ΄Π΅Π»ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΠ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ Π»ΠΎΠ³ΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ΅Π³ΡΠ΅ΡΡΠΈΠΎΠ½Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ·.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠ΅Π³ΠΎ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΎ 429 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΎ, ΡΡΠΎ Ρ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΠ ΠΌΠ°Π½ΠΈΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π»Π° Π² 1-Π΅, 2-Π΅ ΠΈΠ»ΠΈ 3-ΠΈ ΡΡΡ ΠΏΠΎΡΠ»Π΅ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ. Π‘ΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠ°Ρ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΌΠΎΠ΄Π΅Π»Ρ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ ΠΎΡ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π΄Π΅ΠΌΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠ΅ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
ΠΏΠΎΠΊΠ°Π·Π°Π»Π°, ΡΡΠΎ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΡΠΆΠ΅ΡΡΠΈ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (ΠΏΠΎ ΡΠΊΠ°Π»Π΅ SOFA) Π½Π° 1 Π±Π°Π»Π» ΠΏΠΎΠ²ΡΡΠ°Π»ΠΎ ΡΠΈΡΠΊ Π² 1,9 ΡΠ°Π·Π°, Π° ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Π΅ΠΉ Π±ΠΈΠ»ΠΈΡΡΠ±ΠΈΠ½Π° Π½Π° 1 ΠΌΠΊΠΌΠΎΠ»Ρ/Π» ΠΈ ΠΌΠΎΡΠ΅Π²ΠΈΠ½Ρ Π½Π° 1 ΠΌΠΌΠΎΠ»Ρ/Π» ΡΠ²Π΅Π»ΠΈΡΠΈΠ²Π°Π»ΠΎ ΡΠΈΡΠΊ ΠΠ Π½Π° 8 ΠΈ 28% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. ΠΡΠΈ Π½Π΅Π°Π»ΠΊΠΎΠ³ΠΎΠ»ΡΠ½ΠΎΠΌ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·Π΅, ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ Π°Π»ΠΊΠΎΠ³ΠΎΠ»ΡΠ½ΡΠΌ Π³Π΅Π½Π΅Π·ΠΎΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, ΠΈ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠ°Π½Π½Π΅Π³ΠΎ (Π΄ΠΎ 3 ΡΡΡ) ΡΠ½ΡΠ΅ΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΈΡΠ°Π½ΠΈΡ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ Π½Π° 175,5 ΠΈ 137% ΡΠ»ΡΡΠ°Π΅Π². Π‘ΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ ΠΈ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΌΠΎΠ΄Π΅Π»ΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ 78,7 ΠΈ 82,8% ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ.ΠΡΠ²ΠΎΠ΄Ρ. ΠΡΠΈ Π°Π»ΠΈΠΌΠ΅Π½ΡΠ°ΡΠ½ΠΎΠΌ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·Π΅ ΡΡΡΠ³ΡΠ±Π»Π΅Π½ΠΈΠ΅ ΡΡΠΆΠ΅ΡΡΠΈ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°, Π°Π»ΠΊΠΎΠ³ΠΎΠ»ΡΠ½ΡΠΉ Π³Π΅Π½Π΅Π· Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ, ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠ² ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠ½ΠΎΠΉ ΠΈ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ ΡΠ²Π΅Π»ΠΈΡΠΈΠ²Π°Π»ΠΈ ΡΠΈΡΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ. Π ΡΠΎ ΠΆΠ΅ Π²ΡΠ΅ΠΌΡ ΡΠ°Π½Π½Π΅Π΅ ΡΠ½ΡΠ΅ΡΠ°Π»ΡΠ½ΠΎΠ΅ ΠΏΠΈΡΠ°Π½ΠΈΠ΅ ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΠΎΠ²Π°Π»ΠΎ Π·Π½Π°ΡΠΈΠΌΠΎΠΌΡ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΡΠΈΡΠΊΠ° ΡΡΠΎΠ³ΠΎ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ. ΠΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Π½Π°Ρ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΌΠΎΠ΄Π΅Π»Ρ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΡΠ΅ΡΡΡ ΠΊ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π² ΡΡΡΠΈΠ½Π½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅.
Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial
IMPORTANCE: Secretory phospholipase A2(sPLA2) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA2inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. OBJECTIVE: To determine the effects of sPLA2inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS: Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. RESULTS: At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA2inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014 American Medical Association. All rights reserved
Patients with a Combination of Atrial Fibrillation and Chronic Heart Failure in Clinical Practice: Comorbidities, Drug Treatment and Outcomes
Aim. To assess in clinical practice the structure of multimorbidity, cardiovascular pharmacotherapy and outcomes in patients with a combination of atrial fibrillation (AF) and chronic heart failure (CHF) based on prospective registries of patients with cardiovascular diseases (CVD).Materials and Methods. The data of 3795 patients with atrial fibrillation (AF) were analyzed within the registries RECVASA (Ryazan), RECVASA FP (Moscow, Kursk, Tula, Yaroslavl), REGION-PO and REGION-LD (Ryazan), REGION-Moscow, REGATA (Ryazan). The comparison groups consisted of 3016 (79.5%) patients with AF in combination with CHF and 779 (29.5%) patients with AF without CHF. The duration of prospective observation is from 2 to 6 years.Results. Patients with a combination of AF and CHF (n=3016, age was 72.0Β±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3Β±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc β 4.68Β±1.59 and 3.10Β±1.50; p<0.001) and hemorrhagic complications (HAS-BLED β 1.59Β±0.77 and 1.33Β±0.76; p<0.05). Patients with a combination of AF and CHF significantly more often (p<0.001) than in the absence of CHF were diagnosed with arterial hypertension (93.9% and 83.8%), coronary heart disease (87.9% and 53,5%), myocardial infarction (28.4% and 14.0%), diabetes mellitus (22.4% and 7.7%), chronic kidney disease (24.8% and 16.2%), as well as respiratory diseases (20.1% and 15.3%; p=0.002). Patients with AF in the presence of CHF, compared with patients without CHF, were more often diagnosed with a permanent form of arrhythmia (49.3% and 32.9%; p<0.001) and less often paroxysmal (22.5% and 46.2%; p<0.001) formΒ ofΒ arrhythmia.Β EjectionΒ fractionΒ β€40%Β (9.3%Β andΒ 1.2%;Β p<0.001),Β heartΒ rateΒ β₯90/minΒ (23.7% and 19.3%; p=0.008) and blood pressure β₯140/90 mm Hg (59.9% and 52.2%; p<0.001) were recorded with AF in the presence of CHF more often than in the absence of CHF. The frequency of proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF (64.9%) than in the absence of it (56.1%), but anticoagulants were prescribed less frequently when AF and CHF were combined (38.8% andΒ 49, 0%; p<0.001). The frequency of unreasonable prescription of antiplatelet agents instead of anticoagulants was 52.5% and 33.3% (p<0.001) in the combination of AF, CHF and coronary heart disease, as well as in the combination of AF with coronary heart disease but without CHF. Patients with AF and CHF during the observation period compared with those without CHF had higher mortality from all causes (37.6% and 30.3%; p=0.001), the frequency of non-fatal cerebral stroke (8.2% and 5.4%; p=0.032) and myocardial infarction (4.7% and 2.5%; p=0.036), hospitalizations for CVD (22.8% and 15.5%; p<0.001).Conclusion. Patients with a combination of AF and CHF, compared with the group of patients with AF without CHF, were older, had a higher risk of thromboembolic and hemorrhagic complications, they were more often diagnosed with other concomitant cardiovascular and chronic noncardiac diseases, decreased left ventricular ejection fraction, tachysystole, failure to achieve the target blood pressure level in the presence of arterial hypertension. The frequency of prescribing proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF, while the frequency of prescribing anticoagulants was less. TheΒ incidence of mortality from all causes, the development of non-fatal myocardial infarctionΒ Β and cerebral stroke, as well as the incidence of hospitalizations for CVDs were higher in AF associated with CHF
Patients with Atrial Fibrillation in Clinical Practice: Comorbidity, Drug Treatment and Outcomes (Data from RECVASA Registries)
Aim. To study comorbidity, drug therapy and outcomes in patients with atrial fibrillation (AF) included in the outpatient and hospital RECVASA registries.Material and methods. Patients with AF (n=3169; age 70.9Β±10.7 years; 43.1% of men) in whom comorbidity, drug therapy, short-term and longterm outcomes (follow-up period from 2 to 6 years) were included in hospital registers RECVASA AF (Moscow, Kursk, Tula), as well as outpatient registers RECVASA (Ryazan) and RECVASA AF-Yaroslavl.Results. Outpatient registries (n=934), as compared to hospital registries (n=2235), had a higher average age of patients (73.4Β±10.9 vs 69.9Β±10.5; p<0.05), the proportion of women ( 66.2% vs 53.0%; p<0.0001) and patients with combination of 3-4 cardiovascular diseases (CVD), including AF (98.0% vs 81.7%, p<0.0001), and also with chronic noncardiac diseases (81.5% vs 63.5%, p<0.0001), the risk of thromboembolic complications (CHA2DS2-VASc 4.65Β±1.58 vs 4.15Β±1.71; p<0.05) and hemorrhagic complications (HAS-BLED 1.69Β±0.75 vs 1.41Β±0.77; p<0.05), as well as a lower frequency of prescribing appropriate pharmacotherapy for CVD (55.6% vs 74.6%, p<0.0001). During the observation period, 633 (20.0%) patients died, and in 61.8% of cases - from cardiovascular causes. The mortality rate in one year in Moscow was 3.7%, in Yaroslavl - 9.7%, in Ryazan - 10.7%, in Kursk - 12.5% (on average for four registers - 10.3%). A higher risk of death (1.5-2.7 times) was significantly associated with age, male sex, persistent AF, history of myocardial infarction (MI) and acute cerebrovascular accident (ACVE), diabetes mellitus, chronic obstructive disease lungs (COPD), heart rate>80 bpm, systolic blood pressure <110 mm Hg, decreased hemoglobin level. A lower risk of death (1.2-2.4 times) was associated with the prescription of anticoagulants, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), betablockers, statins. The number of cases of stroke and MI was, respectively, 5.1 and 9.4 times less than the number of deaths from all causes. The higher risk of stroke in patients with AF during follow-up was significantly associated with female sex (risk ratio [RR]=1.61), permanent AF (RR=1.85), history of MI (RR=1.68) and ACVA (RR=2.69), HR>80 bpm (RR=1.50). Anticoagulant prescription in women was associated with a lower risk of ACVA (if adjusted for age: RR=0.54; p=0.04), in contrast to men (RR=1.11; p=0.79).Conclusion. The majority of patients with AF registries in 5 regions of Russia had a combination of three or more cardiovascular diseases (73.9%), as well as chronic non-cardiac diseases (68.8%). The frequency of proper cardiovascular pharmacotherapy was insufficient (68.6%), especially at the outpatient stage (55.6%). Over the observation period (2-6 years), the average mortality per year was 10.3%, but at the same time it differed significantly in the regions (from 3.7% in Moscow to 9.7-12.5% in Yaroslavl, Ryazan and Kursk). Cardiovascular causes of deaths occurred in 62%. A higher risk of death (1.5-2.7 times) was associated with a history of stroke and MI, diabetes mellitus, COPD, heart rate>80 bpm, systolic blood pressure <110 mm Hg, decreased hemoglobin level. However, the risk of death decreased by 1.2-2.4 times in cases of prescription of anticoagulants, ACE inhibitors / ARBs, beta-blockers and statins. The risk of ACVA and MI was the highest in the presence of the history of this event (2.7 and 2.6 times, respectively). Anticoagulant prescription was significantly associated with a reduced risk of stroke in women
Combination of Atrial Fibrillation and Coronary Heart Disease in Patients in Clinical Practice: Comorbidities, Pharmacotherapy and Outcomes (Data from the REΠ‘VASA Registries)
Aim. Assess the structure of comorbid conditions, cardiovascular pharmacotherapy and outcomes in patients with atrial fibrillation (AF) and concomitant coronary artery disease (CAD) included in the outpatient and hospital RECVASA registries.Materials and methods. 3169 patients with AF were enrolled in outpatient RECVASA (Ryazan), RECVASA AF-Yaroslavl registries and hospital RECVASA AF (Moscow, Kursk, Tula). 2497 (78.8%) registries of patients with AF had CAD and 703 (28.2%) of them had a previous myocardial infarction (MI).Results. There were 2,497 patients with a combination of AF and CAD (age was 72.2Β±9.9 years; 43.1% of men; CHA2DS2-VASc β 4.57Β±1.61 points; HAS-BLED β 1.60Β±0,75 points), and the group with AF without CAD included 672 patients (age was 66.0Β±12.3 years; 43.2% of men; CHA2DS2-VASc β 3.26Β±1.67 points; HAS-BLED β 1,11Β±0.74 points). Patients with CAD were on average 6.2 years older and had a higher risk of thromboembolic and hemorrhagic complications (p<0.05). 703 patients with a combination of AF and CAD had the previous myocardial infarction (MI; age was 72.3Β±9.5 years; 55.2% of men; CHA2DS2-VASc β 4.57Β±1.61; HAS-BLED β 1.65Β±0.76), and 1794 patients didn't have previous MI (age was 72.2Β±10.0 years; 38.4% of men; CHA2DS2-VASc β 4.30Β±1.50; HAS-BLED β 1.58Β±0.78). The proportion of men was 1.4 times higher among those with the previous MI. Patients with a combination of AF and CAD significantly more often (p <0.0001) than in the absence of CAD received a diagnosis of hypertension (93.8% and 78.6%), chronic heart failure (90.1% and 51.2%), diabetes mellitus (21.4% and 13.8%), chronic kidney disease (24.8% and 17.7%), as well as anemia (7.0% and 3.0%; p=0.001). Patients with and without the previous MI had the only significant difference in the form of a diabetes mellitus higher incidence having the previous MI (27% versus 19.2%, p=0.0008). The frequency of proper cardiovascular pharmacotherapy was insufficient, mainly in the presence of CAD (67.8%) than in its absence (74.5%), especially the prescription of anticoagulants (39.1% and 66.2%; p <0.0001), as well as in the presence of the previous MI (63.3%) than in its absence (74.3%). The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death (risk ratio [RR]=1.58; 95% confidence interval [CI] was 1.33-1.88; p <0.001 and RR=1.59; 95% CI was 1.33-1.90; p <0.001), as well as with a higher risk of developing a combined cardiovascular endpoint (RR=1.88; 95% CI was 1.17-3 , 00; p <0.001 and RR=1.75; 95% CI was 1.44-2.12; p<0.001, respectively).Conclusion. 78.8% of patients from AF registries in 5 regions of Russia were diagnosed with CAD, of which 28.2% had previously suffered myocardial infarction. Patients with a combination of AF and CAD more often than in the absence of CAD had hypertension, chronic heart failure, diabetes, chronic kidney disease and anemia. Patients with the previous MI had higher incidence of diabetes than those without the previous MI. The frequency of proper cardiovascular pharmacotherapy was insufficient, and to a greater extent in the presence of CAD and the previous MI than in their absence. All-cause mortality was recorded in patients with a combination of AF and CAD more often than in the absence of CAD. All-cause mortality and the incidence of nonfatal myocardial infarction were higher in patients with AF and the previous MI than in those without the previous MI. The presence of CAD and, in particular, the previous MI, was significantly associated with a higher risk of death, as well as a higher risk of developing a combined cardiovascular endpoint
ΠΠ΅ΡΡΠΎΠ½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ΅ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΏΠΎΡΠ΅ΠΊ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·ΠΎΠΌ
Relevance. The incidence of acute pancreatitis is growing worldwide, being one of the leading causes of hospitalization in urgent surgery. The most common complication of pancreatic necrosis (PN) in the aseptic phase is acute kidney injury (AKI), which is an independent risk factor for an unfavorable outcome.The objective was to develop a personalized risk model for AKI in the aseptic phase of pancreatic necrosis.Materials and methods. A comparative cohort study of the results of treatment of 502 patients with pancreatic necrosis was conducted. The primary endpoint was considered to be the development of AKI, for the development of a personalized model of the probability of its development in sterile pancreatic necrosis, binary logistic regression analysis was used.Results. A model of independent variables was developed that reliably (p < 0.001) determined that with an increase in age by 1 year, the probability of developing AKI increased by 2.3%, and with a history of chronic kidney disease in a patient β by 3.2 times.The same model demonstrates that the risk of AKI in patients with pancreatic necrosis with an increase in glomerular filtration rate by 1 mlΒ·minβ1Β·1.73 m2 and with the use of balanced crystalloid solutions decreased by 5.0% and 3.0 times, respectively.The specificity of the model was 79.8%, sensitivity β 79.1%.Conclusion. The proposed model makes it possible to reliably predict the individual risk of AKI on the first day of hospitalization.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΠ°Π±ΠΎΠ»Π΅Π²Π°Π΅ΠΌΠΎΡΡΡ ΠΎΡΡΡΡΠΌ ΠΏΠ°Π½ΠΊΡΠ΅Π°ΡΠΈΡΠΎΠΌ ΡΠ°ΡΡΠ΅Ρ Π²ΠΎ Π²ΡΠ΅ΠΌ ΠΌΠΈΡΠ΅, ΡΠ²Π»ΡΡΡΡ ΠΎΠ΄Π½ΠΎΠΉ ΠΈΠ· Π²Π΅Π΄ΡΡΠΈΡ
ΠΏΡΠΈΡΠΈΠ½ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ Π² ΡΡΠ³Π΅Π½ΡΠ½ΠΎΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΠΈ. ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΡΡΠΌ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠ΅ΠΌ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·Π° (ΠΠ) Π² Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠ°Π·Ρ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΡΡΡΠΎΠ΅ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠ΅ ΠΏΠΎΡΠ΅ΠΊ (ΠΠΠ), ΠΊΠΎΡΠΎΡΠΎΠ΅ ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΡΠΌ ΡΠ°ΠΊΡΠΎΡΠΎΠΌ ΡΠΈΡΠΊΠ° Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π°.Π¦Π΅Π»Ρ β ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠ° ΠΏΠ΅ΡΡΠΎΠ½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΌΠΎΠ΄Π΅Π»ΠΈ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠΠ Π² Π°ΡΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ°Π·Π΅ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·Π°.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΊΠΎΠ³ΠΎΡΡΠ½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ 502 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΡΠΎΠ·ΠΎΠΌ. ΠΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΠΉ ΡΠΎΡΠΊΠΎΠΉ ΡΡΠΈΡΠ°Π»ΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ ΠΠΠ, Π΄Π»Ρ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠΈ ΠΏΠ΅ΡΡΠΎΠ½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΌΠΎΠ΄Π΅Π»ΠΈ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΊΠΎΡΠΎΡΠΎΠΉ ΠΏΡΠΈ ΡΡΠ΅ΡΠΈΠ»ΡΠ½ΠΎΠΌ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·Π΅ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ»ΠΈ Π±ΠΈΠ½Π°ΡΠ½ΡΠΉ Π»ΠΎΠ³ΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ΅Π³ΡΠ΅ΡΡΠΈΠΎΠ½Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ·.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π Π°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π° ΠΌΠΎΠ΄Π΅Π»Ρ Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΡΡ
ΠΏΠ΅ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
, Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ (p < 0,001) ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΡΡΠ°Ρ, ΡΡΠΎ ΠΏΡΠΈ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠΈ Π²ΠΎΠ·ΡΠ°ΡΡΠ° Π½Π° 1 Π³ΠΎΠ΄ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠΠ ΡΠ²Π΅Π»ΠΈΡΠΈΠ²Π°Π΅ΡΡΡ Π½Π° 2,3%, Π° ΠΏΡΠΈ Π½Π°Π»ΠΈΡΠΈΠΈ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΏΠΎΡΠ΅ΠΊ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π² Π°Π½Π°ΠΌΠ½Π΅Π·Π΅ β Π² 3,2 ΡΠ°Π·Π°. ΠΡΠ° ΠΆΠ΅ ΠΌΠΎΠ΄Π΅Π»Ρ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΡΠ΅Ρ, ΡΡΠΎ ΡΠΈΡΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠΠ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΠ°Π½ΠΊΡΠ΅ΠΎΠ½Π΅ΠΊΡΠΎΠ·ΠΎΠΌ ΠΏΡΠΈ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠΈ ΡΠΊΠΎΡΠΎΡΡΠΈ ΠΊΠ»ΡΠ±ΠΎΡΠΊΠΎΠ²ΠΎΠΉ ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠΈ Π½Π° 1 ΠΌΠ»βΠΌΠΈΠ½β1/1,73ΠΌ2 ΠΈ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠ±Π°Π»Π°Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΊΡΠΈΡΡΠ°Π»Π»ΠΎΠΈΠ΄Π½ΡΡ
ΡΠ°ΡΡΠ²ΠΎΡΠΎΠ² ΡΠ½ΠΈΠΆΠ°Π»ΡΡ Π½Π° 5,0% ΠΈ Π² 3,0 ΡΠ°Π·Π° ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. Π‘ΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ ΠΌΠΎΠ΄Π΅Π»ΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 79,8%, ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ β 79,1%.ΠΡΠ²ΠΎΠ΄. ΠΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π½Π°Ρ ΠΌΠΎΠ΄Π΅Π»Ρ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΡΠΉ ΡΠΈΡΠΊ ΠΠΠ Π² ΠΏΠ΅ΡΠ²ΡΠ΅ ΡΡΡΠΊΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ