КЛИНИЧЕСКИЕ И ПРОГНОСТИЧЕСКИЕ ОСОБЕННОСТИ ПАЦИЕНТОВ СТАРЧЕСКОГО ВОЗРАСТА С НЕСТАБИЛЬНОЙ СТЕНОКАРДИЕЙ ПРИ КОНСЕРВАТИВНОЙ ТАКТИКЕ ЛЕЧЕНИЯ В ЗАВИСИМОСТИ ОТ ФРАКЦИИ ВЫБРОСА ЛЕВОГО ЖЕЛУДОЧКА

Highlights High cardiovascular morbidity and mortality in the Russian Federation and in Kuzbass is mainly due to high number of elderly and senile patients; it simply reflects the current demographic situation in the country. Elderly and senile patients with acute coronary syndrome (ACS) account for 50% of hospitalized patients. In real clinical practice, a significant number of elderly patients with ACS receive conservative treatment, whereas the prognosis in this cohort is determined by the development of recurrent coronary events and the progression of heart failure. Due to small number of patients older than 75-80 years included in randomized clinical trials, there are certain gaps in the management of elderly patients with ACS and heart failure. Obviously, elderly patients require a special approach to patient management, taking into account the complexity of clinical and anamnestic factors affecting the prognosis. AbstractAim. To study clinical and prognostic features of elderly patients with unstable angina pectoris undergoing conservative treatment depending on left ventricular ejection fraction (LVEF).Methods. 130 elderly patients, with mean age of 82 (77; 89) years, hospitalized for unstable angina with a GRACE score of less than 140 to a vascular center in Kemerovo were included in the study. During hospitalization, standard laboratory and instrumental studies were performed, except coronary angiography. The quality of life was assessed using the EQ-5D 3L questionnaire. After 12 months, patient compliance with treatment recommendations, primary and secondary endpoints, and quality of life were analyzed.Results. All patients were diagnosed with heart failure, 50 (38.5%) patients presented with LV EF less than 40% (the group I), 80 (61.5%) patients presented with LV EF more than 40% (the group II). The groups were comparable in gender, age, presence of multifocal of atherosclerotic disease, prevalence of aortic stenosis, arrhythmias and comorbidities. Women predominated in both groups, and arterial hypertension was noted in all patients. In the group I, a history of myocardial infarction, coronary revascularization, and NYHA FC III were more common (p<0.05). The level of quality of life at discharge was low in both groups: 34.8 (29; 42) and 39.4 (34; 46) points, respectively (p>0.05). Almost all patients were on triple neurohumoral blockade (beta-blockers, renin-angiotensin-aldosterone system inhibitors and mineralocorticoid receptor antagonists) for heart failure and dual antiplatelet therapy. One year later, 85.2% of patients in the group I and 90% of patients in the group II were taking all prescribed medication at low or medium therapeutic doses (without the need for drug titration). The overall mortality in the groups was 46% and 37.5%; cardiovascular deaths accounted for 32% and 30%, respectively (p>0.05). There were no differences in the frequency of endpoints (hospitalization, stroke, acute coronary syndrome, coronary revascularization) between the groups. The level of quality of life remained low in both groups.Conclusion. In patients over 75 years hospitalized for unstable angina, main clinical and anamnestic characteristics, annual prognosis and quality of life do not depend on LV EF, whereas the need for coronary revascularization during the 1 year remains high.Основные положенияРост сердечно-сосудистой заболеваемости и смертности в РФ, в том числе в Кузбассе, в основном вызван увеличением числа больных пожилого и старческого возраста, что отражает текущую демографическую ситуацию в стране. Пациенты пожилого и старческого возраста с острым коронарным синдромом (ОКС) составляют до 50% госпитализированных в стационар. В реальной клинической практике значительное количество больных старческого возраста с ОКС получают консервативное лечение, а прогноз в этой когорте обусловлен развитием повторных коронарных событий и прогрессированием сердечной недостаточности. В связи с небольшой долей лиц старше 75–80 лет, включенных в рандомизированные клинические исследования, в вопросах ведения пациентов старческого возраста с ОКС и сердечной недостаточностью остаются пробелы. Очевидно, что больные старческого возраста требуют особого подхода с учетом наличия комплекса клинических и анамнестических факторов, оказывающих влияние на прогноз. РезюмеЦель. Изучение клинических и прогностических особенностей когорты пациентов старческого возраста с нестабильной стенокардией при консервативной тактике стационарного лечения в зависимости от величины фракции выброса левого желудочка (ФВ ЛЖ).Материалы и методы. В исследование включены 130 больных старческого возраста, 82 (77; 89) лет, госпитализированных по поводу нестабильной стенокардии в первичный сосудистый центр г. Кемерово с баллом по шкале GRACE менее 140. В течение госпитализации больным проведены стандартные лабораторные и инструментальные исследования, за исключением коронароангиографии. Оценено качество жизни с помощью опросника EQ-5D 3L. Через 12 мес. проанализированы соблюдение рекомендаций по лечению, первичные и вторичные конечные точки, качество жизни.Результаты. У всех пациентов диагностирована сердечная недостаточность: у 50 (38,5%) – с ФВ ЛЖ менее 40% (группа I), у 80 (61,5%) – с ФВ ЛЖ более 40% (группа II). Сравниваемые группы не отличались по полу, возрасту, мультифокальности атеросклеротического поражения, частоте аортального стеноза, нарушениям ритма и сопутствующей патологии. В обеих группах преобладали женщины, у всех больных зарегистрирована артериальная гипертензия. В группе I в анамнезе чаще отмечены перенесенный инфаркт миокарда, реваскуляризация миокарда и III функциональный класс хронической сердечной недостаточности по классификации NYHA (р<0,05). Уровень качества жизни при выписке был низким в обеих группах: 34,8 (29; 42) и 39,4 (34; 46) балла соответственно (р>0,05). Практически все пациенты в соответствии с существовавшими на период проведения исследования рекомендациями получали тройную нейрогуморальную терапию сердечной недостаточности (блокаторы ренин-ангиотензин-альдостероновой системы, бета-блокаторы, антагонисты минералокортикоидных рецепторов) и двойную дезагрегантную терапию. Через год 85,2% больных группы I и 90% группы II принимали назначенные препараты в низких или среднетерапевтических дозах без титрации. Общая смертность в группах составила 46 и 37,5%; сердечно-сосудистая – 32 и 30% соответственно (р>0,05). Различий в частоте регистрации жестких конечных точек (госпитализация, инсульт, острый коронарный синдром, коронарная реваскуляризация) между группами не обнаружено. Уровень качества жизни оставался низким в обеих группах.Заключение. У пациентов старше 75 лет, госпитализированных по поводу нестабильной стенокардии, основные клинико-анамнестические характеристики, годовой прогноз и уровень качества жизни не зависят от величины ФВ ЛЖ, а потребность в реваскуляризации миокарда в течение года остается высокой.

Atrial fibrillation genetic risk differentiates cardioembolic stroke from other stroke subtypes

AbstractObjectiveWe sought to assess whether genetic risk factors for atrial fibrillation can explain cardioembolic stroke risk.MethodsWe evaluated genetic correlations between a prior genetic study of AF and AF in the presence of cardioembolic stroke using genome-wide genotypes from the Stroke Genetics Network (N = 3,190 AF cases, 3,000 cardioembolic stroke cases, and 28,026 referents). We tested whether a previously-validated AF polygenic risk score (PRS) associated with cardioembolic and other stroke subtypes after accounting for AF clinical risk factors.ResultsWe observed strong correlation between previously reported genetic risk for AF, AF in the presence of stroke, and cardioembolic stroke (Pearson’s r=0.77 and 0.76, respectively, across SNPs with p &lt; 4.4 × 10−4 in the prior AF meta-analysis). An AF PRS, adjusted for clinical AF risk factors, was associated with cardioembolic stroke (odds ratio (OR) per standard deviation (sd) = 1.40, p = 1.45×10−48), explaining ∼20% of the heritable component of cardioembolic stroke risk. The AF PRS was also associated with stroke of undetermined cause (OR per sd = 1.07, p = 0.004), but no other primary stroke subtypes (all p &gt; 0.1).ConclusionsGenetic risk for AF is associated with cardioembolic stroke, independent of clinical risk factors. Studies are warranted to determine whether AF genetic risk can serve as a biomarker for strokes caused by AF.</jats:sec

Asthma, Wheezing, and Allergies in Russian Schoolchildren in Relation to New Surface Materials in the Home

In a cross-sectional study of 5951 Russian 8–12-year-old schoolchildren, risks of current asthma, wheezing, and allergy were related to recent renovation and the installation of materials with potential chemical emissions. New linoleum flooring, synthetic carpeting, particleboard, wall coverings, and furniture and recent painting were determinants of 1 or several of these 3 health outcomes. These findings warrant further attention to the type of materials used in interior design

Jurassic palynoevents in the circum-Arctic region

Successions of Jurassic strata located in the Arctic region normally yield rich assemblages of terrestriallyderived and marine palynomorphs, reflecting relatively warm air and sea-surface temperatures. The land plant floras were prone to the development of local communities and regional provincialism, whereas the marine biotas thrived across extensive open marine areas with high productivity, resulting in the rapid evolution of dinoflagellate cysts (dinocysts) following their earliest fossil record in the Triassic. Dinocysts exhibit low taxonomic richness and provide low biostratigraphic resolution throughout the Lower Jurassic sections. By contrast, they are diverse in Middle and Upper Jurassic strata where they provide excellent biostratigraphic markers for correlating and dating both surface and subsurface sections. Over twenty formal and informal biozonations based on the first and last occurrences of dinocysts have been erected in Alaska, Arctic Canada, the Barents Sea region, Greenland and northern Russia, many of which are correlated with macrofossils, including ammonites, that occur in the same sections. This paper presents a compilation of 214 Jurassic palynostratigraphic events (118 first occurrences and 96 last occurrences) that have regional chronostratigraphic value in the Circum-Arctic, based on their published records. Each event is correlated with the base of a chronostratigraphical unit (including formal stages and sub-Boreal ammonite zones), or as an estimated percentage above the base of the chronostratigraphical unit relative to the entire unit. The relationships of each event to stages and key fossil zonal schemes is shown on chronostratigraphic plots using the 2020 version of TimeScale Creato

Palynophénomènes jurassiques dans la région circumarctique

Successions of Jurassic strata located in the Arctic region normally yield rich assemblages of terrestriallyderived and marine palynomorphs, reflecting relatively warm air and sea-surface temperatures. The land plant floras were prone to the development of local communities and regional provincialism, whereas the marine biotas thrived across extensive open marine areas with high productivity, resulting in the rapid evolution of dinoflagellate cysts (dinocysts) following their earliest fossil record in the Triassic. Dinocysts exhibit low taxonomic richness and provide low biostratigraphic resolution throughout the Lower Jurassic sections. By contrast, they are diverse in Middle and Upper Jurassic strata where they provide excellent biostratigraphic markers for correlating and dating both surface and subsurface sections. Over twenty formal and informal biozonations based on the firstand last occurrences of dinocysts have been erected in Alaska, Arctic Canada, the Barents Sea region, Greenland and northern Russia, many of which are correlated with macrofossils, including ammonites, that occur in the same sections. This paper presents a compilation of 214 Jurassic palynostratigraphic events (118 first occurrences and 96 last occurrences) that have regional chronostratigraphic value in the Circum-Arctic, based on their published records. Each event is correlated with the base of a chronostratigraphical unit (including formal stages and sub-Boreal ammonite zones), or as an estimated percentage above the base of the chronostratigraphical unit relative to the entire unit. The relationships of each event to stages and key fossil zonal schemes is shown on chronostratigraphic plots using the 2020 version of TimeScale Creator®.Les successions de strates jurassiques dans la région de l’Arctique recèlent normalement de riches assemblages de palynomorphes d’origine terrestre et marins reflétant les températures relativement chaudes de l’air et à la surface de la mer.  Les flores de plantes terrestres étaient susceptibles de favoriser l’épanouissement de communautés locales et d’un provincialisme régional, alors que les biotes marins se développaient sur de vastes secteurs marins ouverts à un rythme de productivité élevé, ce qui a entraîné l’évolution rapide de kystes de dinoflagellés (dinokystes) d’après leur plus récents enregistrements fossiles au cours du Trias. Les dinokystes affichent une faible richesse taxonomique et produisent une faible résolution biostratigraphique dans toutes les sections du Jurassique inférieur. Par contre, ils se diversifient dans les strates du Jurassique moyen et supérieur, où ils représentent d’excellents repères biostratigraphiques pour la corrélation et la datation de sections de surface et de subsurface. Plus d’une vingtaine de biozonations officielles et officieuses basées sur les premières et dernières manifestations de dinokystes ont été établies en Alaska, dans l’Arctique canadien, dans la région de la mer de Barents, au Groenland et dans le nord de la Russie, lesquelles sont dans de nombreux cas corrélées avec des macrofossiles, notamment des ammonites, présents dans les mêmes sections. Le présent article présente une compilation de 214 phénomènes palynostratigraphiques du Jurassique (118 premières manifestations et 96 dernières manifestations) ayant une valeur chronostratigraphique régionale dans la région circumarctique, d’après les documents pertinents publiés. Chaque phénomène est corrélé avec la base d’une unité chronostratigraphique (notamment les stades et les zones d’ammonites subboréales officielles), ou sous forme d’un pourcentage estimatif au-dessus de la base de l’unité chronostratigraphique par rapport à l’ensemble de l’unité. Les liens entre chaque phénomène et les stades et principaux mécanismes zonaux fossiles sont illustrés dans les schémas chronostratigrapiques des figures 1 à 9 au moyen de la version de 2020 de TimeScale Creator®

Imaging-Guided Delivery of a Hydrophilic Drug to Eukaryotic Cells Based on Its Hydrophobic Ion Pairing with Poly(hexamethylene guanidine) in a Maleated Chitosan Carrier

Imaging-guided delivery is developed for hydrophobic drugs, and to a much lesser extent, hydrophilic ones. In this work we have designed a novel strategy for real-time monitoring of hydrophilic drug delivery. Traditionally, the drug and the dye are covalently attached to a nanocarrier or are electrostatically adsorbed. Recently, we found an efficient way to bind the drug by ion-paring with an appropriate counter-ion to form the aggregate that embeds a hydrophobic dye with a considerable fluorescence enhancement. We synthesized a series of carbocyanine dyes of hydrophobicity sufficient for solubilization in hydrophobic ion pairs, which restores their emission in the near-infrared (NIR) region upon the formation of the ternary aggregates. To avoid using toxic surfactants, we applied an amphiphilic polymer-oligomer poly(hexamethylene guanidine) (PHMG) as a counter-ion. Сeftriaxone was used as a model hydrophilic drug ensuring the highest fluorescent signal. The so-formed drug–counter-ion–dye aggregates were encapsulated into a cross-linked maleated chitosan carrier. Confocal laser scanning microscopy (CLSM) studies have demonstrated internalization of the encapsulated model drug by breast adenocarcinoma cells at 40 min after treatment. These results suggest the potential application of hydrophobic ion pairs containing an NIR dye in imaging-guided delivery of hydrophilic compounds