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

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

АРИТМИЧЕСКАЯ АКТИВНОСТЬ МИОКАРДА НА РАЗНЫХ ЭТАПАХ АНЕСТЕЗИИ И ПЕРИОПЕРАЦИОННОГО ПЕРИОДА У ПАЦИЕНТОВ, ПОДВЕРГАЕМЫХ ХОЛЕЦИСТЭКТОМИИ

Prevention of cardiovascular complications, which often result in fatal events in the peri-operative period, is one of the most crucial issues of modern anesthesiology.The objective: to investigate the changes in arrhythmic activity and conduction disorders during anesthesia and in the peri-operative period in the patients undergoing open cholecystectomy under general anesthesia.Subjects and methods. 57 patients of 60.1 ± 3.8 years old were enrolled in the study; they all underwent planned open cholecystectomy under combined anesthesia with tracheal intubation and artificial pulmonary ventilation. Group 1 consisted of 28 patients suffering from coronary heart disease (CHD) in the form of exertional angina of functional classes of I and II; and Group 2 included 29 patients without CHD. The frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was analyzed by daily Holter ECG monitoring for certain time periods during anesthesia and the peri-operative period. Stages of the study: I – on the eve of the surgery (18 h); II – within 6 hours before the surgery; III – immediate preparation and induction of anesthesia (62.0 ± 6.7 min); IV – maintenance of anesthesia (57 ± 14 min); V – recovery from anesthesia (48 ± 11 min); VI – the 2nd day after surgery (18 h).Results. A significant increase in the frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was found out at the stages of induction, maintenance and recovery from anesthesia in patients with CHD and in patients without concurrent cardiovascular disorders. Increased frequency of episodes of group and polymorphic premature ventricular contractions was observed in patients with CHD at the stages of induction and recovery from anesthesia (by 242 and 225%). The highest increase in the frequency of polymorphic premature ventricular contractions was observed in patients with CHD during recovery from anesthesia (by 284%) and in those without cardiovascular pathology at the induction stage (by 461%); the increase in episodes of supraventricular tachycardia was maximum at the induction stage in the patients without cardiovascular pathology (by 291%).Conclusion: Open cholecystectomy in general anesthesia is associated with increased arrhythmic activity and higher conduction disturbances incidence at all stages of anesthesia in patients with coronary heart disease and those without concurrent cardiovascular disorders. Профилактика сердечно-сосудистых осложнений, которые часто лежат в основе фатальных событий в периоперационном периоде, является одной из важнейших проблем в современной анестезиологии.Цель: изучение динамики аритмической активности и нарушений проводимости во время анестезии и в периоперационном периоде у пациентов, которым выполняется открытая холецистэктомия в условиях общей анестезии.Материал и методы. В исследование включено 57 пациентов в возрасте 60,1 ± 3,8 года, которым выполняли плановую открытую холецистэктомию в условиях комбинированной анестезии с интубацией трахеи и искусственной вентиляцией легких. Первую группу составили 28 пациентов с наличием ишемической болезни сердца (ИБС) в виде стенокардии напряжения I‒II функционального класса, вторую ‒ 29 пациентов без ИБС. Анализ количества эпизодов групповых и полиморфных желудочковых экстрасистол, наджелудочковой тахикардии и атриовентрикулярной блокады II степени проводили путем суточного холтеровского мониторинга ЭКГ на протяжении определенных временных промежутков во время анестезии и в периоперационном периоде. Исследовательские этапы: I – накануне операции (18 ч); II – в течение 6 ч перед операцией; III – непосредственная подготовка и введение в анестезию (62,0 ± 6,7 мин); IV – поддержание анестезии (57 ± 14 мин); V – выход из анестезии (48 ± 11мин); VI – 2-е сут после операции (18 ч).Результаты. Установлено значимое увеличение частоты эпизодов групповых, полиморфных желудочковых экстрасистол и наджелудочковой тахикардии и атриовентрикулярной блокады II степени на этапах введения, поддержания и выхода из анестезии как у пациентов с ИБС, так и у лиц без сопутствующей сердечно-сосудистой патологии. В большей степени наблюдалось увеличение эпизодов групповых и полиморфных желудочковых экстрасистол у больных с ИБС на этапах введения и выхода из анестезии (на 242 и 225%). Наибольший подъем частоты полиморфных желудочковых экстрасистол отмечен у пациентов с ИБС во время выхода из анестезии (на 284%) и у лиц без сердечно-сосудистой патологии на этапе введения в анестезию (на 461%); повышение эпизодов наджелудочковой тахикардии было максимальным на этапе введения в анестезию у больных без сердечно-сосудистой патологии (на 291%).Вывод. Выполнение открытой холецистэктомии в условиях общей анестезии сопровождается повышением уровня аритмической активности и увеличением случаев нарушения проводимости на всех этапах анестезии как у пациентов с ИБС, так и у лиц без сопутствующей сердечно-сосудистой патологии.

Коррекция гемодинамики гипертоническим раствором хлорида натрия при критических состояниях

Objective: to assess the capabilities of small-volume hypertonic infusion in the context of early goal-directed therapy for critical conditions in surgical patients.Subjects and methods. Twenty-nine patients (SAPS II 47.5±6.81 scores) operated on for generalized peritonitis (n=24) or severe concomitant injury with damages to chest and/or abdominal organs (n=5) who had the clinical and laboratory signs of a systemic inflammatory reaction were intravenously injected 4 ml/kg of 7.5% of hypertonic sodium chloride solution (HS) and colloidal solution, followed by infusion and, if indicated, inotropic maintenance of hemodynamics for 6 hours in order to achieve the goal vales of mean blood pressure (BP), central venous pressure (CVP), central venous blood oxygen saturation (ScvO2), and diuresis. Plasma concentrations of sodium, chlorine, and lactate, acid-base balance, and osmotic blood pressure were monitored.Results. The patients were found to have infusion therapy-refractory critical arterial hypotension, low ScvO2, and oliguria before small-volume circulation maintenance. In all the patients, HS infusion originally caused a rapid rise in BP up to the goal value, with its further colloid infusion maintenance requiring additional dopamine infusion in 12 patients and red blood cell transfusion in 3. This could stabilize over 6 hours BP at the required level in 25 patients, in 9 of whom CVP only approximated the goal value. All the patients were found to have a significant increase in ScvO2 up to an average of 68% in response to HP infusion after 30—60 minutes; in 14 out of them ScvO2 exceeded 70%. By hour 6, ScvO2 stabilized at its goal level in 23 (79%) examinees. Administration of HS caused a significantly increased diuresis. In patients with recovered renal function, the observed hypernatremia, hyperchloremia with hyperchloremic acidosis were transient.Conclusion. The results of the study show it possible to include small-volume hypertonic infusion at the starting stage of early goal-directed therapy, the net result of which will be determined by the recovery of water-electrolyte homeostasis. Цель исследования — оценка возможностей малообъемной гипертонической инфузии с позиций ранней целенаправленной терапии критических состояний хирургических больных.Материалы и методы. 29-и больным (SAPS II 47,5±6,81 баллов), прооперированным по поводу разлитого перитонита (24), тяжелой сочетанной травмы с повреждением органов груди и/или живота (5), имеющим клинические и лабораторные признаки системной воспалительной реакции, для достижения целевых значений среднего артериального давления (АД), центрального венозного давления (ЦВД), насыщения кислородом крови в центральной вене (ScvO2) и диуреза, внутривенно вводили 4 мл/кг 7,5% раствора хлорида натрия (ГР) и коллоидного раствора с последующей инфузионной и, по показаниям, инотропной поддержкой гемодинамики на протяжении 6 часов. Мониторировались плазменная концентрация натрия, хлора, лактата, кислотно-основное состояние и осмотическое давление крови.Результаты. До малообъемной поддержки кровообращения у больных отмечались критическая артериальная гипотензия, рефрактерная к проводимой инфузионной терапии, низкая ScvO2, олигурия. Инфузия ГР первоначально приводила у всех больных к быстрому подъему АД до целевого значения с его дальнейшей инфузионной поддержкой коллоидами, к которой у 12 больных потребовались дополнительная инфузия допмина, и у 3 — трансфузия эритроцитов. Это позволило за 6 часов стабилизировать на требуемом уровне АД у 25 больных, у 9 из которых показатели ЦВД только приблизились к целевому значению. В ответ на инфузию ГР у всех больных через 30—60 минут отмечалось достоверное повышение ScvO2 в среднем до 68%, причем у 14 из них ScvO2 превысила 70% . К 6 часам ScvO2 стабилизировалась на уровне своего целевого значения у 23 больных, т. е. у 79% исследованных. Введение ГР вызывало к этому времени выраженное увеличение диуреза. У больных с восстановленной функцией почек наблюдавшиеся гипернатриемия, гиперхлоремия с гиперхлоремическим ацидозом имели транзиторный характер.Заключение. Результаты исследования показывают возможность включения малообъемной гипертонической инфузии в стартовый этап ранней целенаправленной терапии, конечный результат которого будет определяться восстановлением водно-электролитного гомеостаза организма.

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

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

Mildronate effectiveness in post-hospital rehabilitation of patients with myocardial infarction

Aim. To study the effects of mildronate, as a component of complex therapy, on left ventricular (LV) systolic and diastolic function and exercise capacity (EC) in myocardial infarction (MI) patients undergoing post-hospital rehabilitation. Material and methods. This open, randomized study included 2 groups (50 men in each group; mean age 53,8±2,7 years): the control group (CG) and the main group (MG), which suffered MI in 4 weeks prior to the study inclusion (70% with Q-wave MI and 30% with transmural MI), and had stable post-infarction angina, Functional Class (FC) II, and ejection fraction (EF) >35%. In both groups, pharmaceutical therapy included metoprolol (75-150 mg/d), isosorbide mononitrate (40 mg/d), aspirin (100 mg/d), clopidogrel (75 mg/d), atorvastatin (20-40 mg/d), and enalapril (2,5-5 mg/d). The MG patients additionally received mildronate (1,5 g/d) for 3 months. The follow-up period was 1 year. EC was assessed using veloergometry (VEM) and 6-minute walk test (6MWT). LV systolic and diastolic function was assessed with the use of Doppler echocardiography. The following parameters were calculated: EF, DTE, LV isovolumetric relaxation time (IVRT), and enddiastolic pressure (EDP). Two types of diastolic dysfunction (DD) were defined: Type I (E/A <1; DTE >0,220 ms) and Type II (E/A >1,5; DTE <0,150 ms). Results. Mildronate therapy facilitated EC recovery, improved VEM threshold capacity, and increased 6MWT velocity and distance. In addition, mildronate improved LV systolic and diastolic function in both types of DD, by increasing EF and reducing EDP. In type I DD, E/A and IVRT increased, while DTE decreased. In Type II DD, the changes were also positive, but different: E/A decreased, while IVRT increased. Conclusion. Adding mildronate to the complex therapy of MI patients at the post-hospital rehabilitation stage facilitates EC improvement and benefits LV systolic and diastolic function

MILDRONATE POTENTIAL FOR CARDIAC ARRHYTHMIA PREVENTION IN PERIOPERATIVE PERIODcardiac arrhythmias, ischemia, metabolic disturbances, cytoprotectors, antioxidants, operation-related stress, general anesthesia, Mildronate

Aim. To assess the effectiveness of Mildronate in the prevention of arrhythmias during the perioperative period of open cholecystectomy under intravenous multicomponent anesthesia.Material and methods. In total, 69 patients were divided into 3 groups: with concomitant coronary heart disease (CHD), with essential arterial hypertension (EAH), or without concomitant cardiovascular disease (CVD). Each group was divided into a control subgroup (total n=36) receiving conventional treatment and a main subgroup (total n=33) additionally receiving Mildronate (500 mg twice a day intravenously: 24 hour before the operation, during premedication, during early postanesthetic period, and for 2 days after the operation). Arrhythmic episodes were registered at Holter ECG monitoring for 4 days: 24 hours before the operation; 24 hours of the operation; and 48 hours after the operation. The monitoring period was divided into 6 intervals: 1 — preoperation; 2–6 hours before the operation; 3 — anesthesia start; 4 — anesthesia maintenance; 5 — anesthesia finish; and 6 — second day after the operation.Results. Cardiac arrhythmias were registered not only among patients with EAH and CHD, but also with patients without concomitant CVD.Conclusion. Mildronate therapy reduced the number of arrhythmic episodes at different stages of perioperative period, particularly in the anesthesia start, finish, and maintenance periods among patients with CHD and EAH, as well as among CVD-free patients