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 3^3He-4^4He Mixture

The study of phase structure of dilute $^3$He - $^4$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 $T_1$ and spin-spin $T_2$ relaxation times and spin diffusion coefficient $D$ 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 $D$ and $T_2$ values close to those in liquid phase. Such liquid-like inclusions undergo a spontaneous transition to a new state with anomalously short $T_2$ 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

Прогностическая модель риска развития энцефалопатии у пациентов с алиментарным панкреонекрозом

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 μmol/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.  Цель: разработать прогностическую модель оценки риска развития энцефалопатии (ЭП) у пациентов с алиментарным панкреонекрозом.Материалы и методы. Проведено одноцентровое проспективное когортное исследование на базе клиники факультетской хирургии ВолгГМУ за период с 2010 по 2020 г. Для построения модели прогнозирования риска развития панкреатической ЭП использовали логистический регрессионный анализ.Результаты. Всего в исследование включено 429 пациентов. Определено, что у большинства больных ЭП манифестировала в 1-е, 2-е или 3-и сут после госпитализации. Статистически значимая прогностическая модель зависимости риска развития ЭП от клинико-демографических переменных показала, что увеличение тяжести состояния пациентов (по шкале SOFA) на 1 балл повышало риск в 1,9 раза, а повышение уровней билирубина на 1 мкмоль/л и мочевины на 1 ммоль/л увеличивало риск ЭП на 8 и 28% соответственно. При неалкогольном панкреонекрозе, по сравнению с алкогольным генезом заболевания, и при использовании раннего (до 3 сут) энтерального питания наблюдали статистически значимое снижение риска развития ЭП на 175,5 и 137% случаев. Специфичность и чувствительность модели составили 78,7 и 82,8% соответственно.Выводы. При алиментарном панкреонекрозе усугубление тяжести состояния пациента, алкогольный генез заболевания, прогрессирование признаков печеночной и почечной недостаточности статистически значимо увеличивали риск развития ЭП. В то же время раннее энтеральное питание способствовало значимому снижению риска этого осложнения. Представленная прогностическая модель рекомендуется к применению в рутинной клинической практике.

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 72.0±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc – 4.68±1.59 and 3.10±1.50; p<0.001) and hemorrhagic complications (HAS-BLED – 1.59±0.77 and 1.33±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) form  of  arrhythmia.  Ejection  fraction  ≤40%  (9.3%  and  1.2%;  p<0.001),  heart  rate  ≥90/min  (23.7% and 19.3%; p=0.008) and blood pressure ≥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% and  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. The  incidence of mortality from all causes, the development of non-fatal myocardial infarction   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 70.9±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 (73.4±10.9 vs 69.9±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 4.65±1.58 vs 4.15±1.71; p<0.05) and hemorrhagic complications (HAS-BLED 1.69±0.75 vs 1.41±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 REСVASA 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 72.2±9.9 years; 43.1% of men; CHA2DS2-VASc – 4.57±1.61 points; HAS-BLED – 1.60±0,75 points), and the group with AF without CAD included 672 patients (age was 66.0±12.3 years; 43.2% of men; CHA2DS2-VASc – 3.26±1.67 points; HAS-BLED – 1,11±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 72.3±9.5 years; 55.2% of men; CHA2DS2-VASc – 4.57±1.61; HAS-BLED – 1.65±0.76), and 1794 patients didn't have previous MI (age was 72.2±10.0 years; 38.4% of men; CHA2DS2-VASc – 4.30±1.50; HAS-BLED – 1.58±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

Персонализированное прогнозирование острого повреждения почек у пациентов с панкреонекрозом

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 – 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 ml·min–1·1.73 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 – 79.1%.Conclusion. The proposed model makes it possible to reliably predict the individual risk of AKI on the first day of hospitalization.Актуальность. Заболеваемость острым панкреатитом растет во всем мире, являясь одной из ведущих причин госпитализации в ургентной хирургии. Наиболее частым осложнением панкреонекроза (ПН) в асептическую фазу является острое повреждение почек (ОПП), которое является независимым фактором риска неблагоприятного исхода.Цель – разработка персонализированной модели риска развития ОПП в асептической фазе панкреонекроза.Материалы и методы. Проведено сравнительное когортное исследование результатов лечения 502 пациентов с панкреонерозом. Первичной конечной точкой считали развитие ОПП, для разработки персонализированной модели вероятности развития которой при стерильном панкреонекрозе применяли бинарный логистический регрессионный анализ.Результаты. Разработана модель независимых переменных, достоверно (p < 0,001) определяющая, что при увеличении возраста на 1 год вероятность развития ОПП увеличивается на 2,3%, а при наличии хронической болезни почек у пациента в анамнезе – в 3,2 раза. Эта же модель демонстрирует, что риск развития ОПП у пациентов с панкреонекрозом при увеличении скорости клубочковой фильтрации на 1 мл∙мин–1/1,73м2 и при использовании сбалансированных кристаллоидных растворов снижался на 5,0% и в 3,0 раза соответственно. Специфичность модели составила 79,8%, чувствительность – 79,1%.Вывод. Предложенная модель позволяет достоверно прогнозировать индивидуальный риск ОПП в первые сутки госпитализации