Controversial and open issues of diagnosis and treatment of myocarditis (based on the discussion of Russian national recommendations)

In October 2020, the Russian Ministry of Health approved clinical guidelines for the management of patients with myocarditis. The aim of this review was to highlight controversial and open issues without unambiguous answer or those that were not described in the paper. The review highlights the objective factors that complicate the development of practical guidelines for the management of this category of patients. Comments on the definition and classification of inflammatory heart diseases are given. The approaches to the diagnosis of patients with suspected myocarditis are discussed. Particular attention is paid to the decision-making strategy in selecting optimal therapy in patients with documented myocarditis and the role of endomyocardial biopsy

PEDAGOGICAL FRAMEWORKS OF EDUCATION POLICY FOR SUSTAINABLE DEVELOPMENT OF THE EURASIAN SPACE

Introduction. In the context of the widespread environmental degradation as recorded in UN documents, the issues of environmental protection are under active consideration at the international level; the measures for ensuring ecological safety are taken both within the countries and in the global space. It is possible to resolve these issues vital for further human existence only by forming ecological culture and conscientious careful attitude to the nature and environmental conditions among the population; in turn, the questions listed above could not be undertaken without fundamental re-examination of the content of education. The aims of the research presented in the publication are the following: to highlight the main directions of education policy in the Euroasian space; to define key problems of education in behalf of sustainable development of society.Methodology and research methods. Methodological framework of the research is based on the concepts of humanistic pedagogy; holistic and activity approaches to education; principles of nature conformity and co-evolution. The methods of theoretical analysis, synthesis, generalization and modeling were applied in the course of the research.Results and scientific novelty. The authors define the concept of “sustainable development of society”. The main problems that disrupt such development are identified; the main problem is that the declared statements, scientific-theoretical and scientific-practical results in the sphere of sustainable development and noospherism are in contradiction with the existing system of the industrial civilization. The philosophical and pedagogical foundations for formation of noospheric ideology among new generations as alternatives to destructive consumer anthropocentrism are briefly stated. Against this background, the common objectives of “sustainable” education development for the states of Eurasia are outlined; the conditions with an influence on its qualitative characteristics are singled out. These conditions are related to the basic principles proposed by the International Commission on Education that reflect target educational tendencies of the 21st century: “learning to know, learning to do, learning to live together, and learning to be”. It is emphasized that only the constant methodological line of development of social and economic consciousness is adherence to the principle of co-evolution – optimum ratio and coherence between co-development of elements within the triad “person-society-nature”. The institute of education is ascribed the primary role in joint creative evolutionary-gradual process as it is intended to bring up and form the identity of the responsible citizen of the Earth. The possibilities for creation of the educational ecosystem environment functioning are shown by the experience of the Republic of Kazakhstan where the Green Economy Transition (GET) is actively implemented.Practical significance. The authors’ version of an educational ecosystem structure, its way of construction and regulation are demonstrated. It is offered to use anthropo-ecocultural practices-events as educational tools.Введение. В связи с повсеместным, фиксирующимся в документах ООН, ухудшением экологии на международном уровне активно обсуждаются вопросы охраны окружающей среды и принимаются меры по обеспечению экологической безопасности как внутри стран, так и на общем мировом пространстве. Решить эти жизненно важные для дальнейшего существования всего человечества вопросы можно только формируя у населения экологическую культуру и сознательное бережное отношение к природе и среде обитания, что невозможно сделать без кардинального пересмотра содержания образования. Цели представленного в публикации исследования – обозначить магистральные направления образовательной политики в евразийском пространстве и сформулировать ключевые задачи образования в интересах устойчивого развития общества. Методология и методы. Методологической базой исследования являются концептуальные положения гуманистической педагогики, холистический и деятельностный подходы к обучению и воспитанию, принципы природосообразности и коэволюции. В ходе работы применялись методы теоретического анализа, синтеза, обобщения и моделирования. Результаты и научная новизна. Сформулировано авторское определение устойчивого развития общества. Обозначены основные проблемы, мешающие такому развитию, главная из которых заключается в том, что декларируемые заявления, научно-теоретические и научно-практические разработки в сфере устойчивого развития и ноосферизма входят в противоречие со сложившимся устройством техногенной цивилизации. Кратко изложены философско-педагогические основания для становления у новых поколений ноосферного мировоззрения как альтернативы разрушительному потребительскому антропоцентризму. На этом фоне намечены единые для государств Евразии задачи «устойчивого» образования и выделены условия, способные влиять на его качественные характеристики. Данные условия соотнесены с предписанными Международной комиссией по образованию базовыми принципами, отражающими целевые образовательные тенденции XXI века: «учиться жить, учиться познавать, учиться делать и учиться сосуществовать». Подчеркивается, что единственно верной методологической линией развития социально-экономического сознания является следование принципу коэволюции – соблюдению оптимального соотношения и согласованности в соразвитии элементов триады «человек – общество – природа». В совместном созидательном эволюционно-поступательном процессе институту образования отводится первоочередная роль, так как именно оно призвано воспитывать и формировать личность гражданина Земли.На примере опыта Республики Казахстан, где активно осуществляется переход к «зеленой» экономике, показаны возможности создания среды функционирования образовательной экосистемы. Практическая значимость. Продемонстрирован вариант структуры образовательной экосистемы, способ ее построения и регулирования. В качестве средств воспитания и обучения предлагается использовать антропоэкокультурные практики-события

Neurotrophins in the pathogenesis of pulmonary hypertension and right ventricular dysfunction

Pulmonary hypertension (PH) is a pathophysiological and hemodynamic condition that complicates the course of various diseases and negatively affects morbidity and mortality. The search for the new pathophysiological mechanisms for PH development and progression, the markers for predicting the PH course, and the possible targets for therapy remains relevant. This review is devoted to the role of neurotrophin (NT) system in PH pathogenesis, the possible use of NT and their receptors as a laboratory marker of its severity, and also as a potential target for influencing the pulmonary artery remodeling in PH. In addition, the participation of NTs in neoangiogenesis and restoration of nervous and muscle tissues was described

Phytoplankton light absorption in the deep chlorophyll maximum layer of the Black Sea

© The Author(s), 2019. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Churilova, T., Suslin, V., Sosik, H. M., Efimova, T., Moiseeva, N., Moncheva, S., Mukhanov, V., Rylkova, O., & Krivenko, O. Phytoplankton light absorption in the deep chlorophyll maximum layer of the Black Sea. European Journal of Remote Sensing, 52, (2019): 123-136, doi: 10.1080/22797254.2018.1533389.Bio-optical data, obtained during six cruises in the Black Sea carried out during periods of seasonal stratification in years between 1996 and 2016, have been used to parametrize phytoplankton light absorption (aph(λ)) in the deep chlorophyll maximum (DCM) layer located near the bottom of euphotic zone. Relationships between aph(λ) and the sum of chlorophyll-a and phaeopigment concentrations (Chl-a) differed from those for the summertime upper mixed layer (UML). Notably, chlorophyll a specific absorption coefficients (a∗ph(λ)) were lower in the DCM and more comparable with a∗ph(λ) values typical for winter phytoplankton in the Black Sea. The aph(λ) spectral shapes in the DCM differed markedly from those in winter and in the summer UML, due to a shoulder at ~490 nm and a local maximum at ~550 nm corresponding to the absorption bands of phycourobilin and phycoerythrobilin. Light absorbing properties of phytoplankton in the DCM (amplitude and spectral shape of a∗ph(λ)) reflected physiological acclimation to local conditions on the cellular level and population shifts leading to changes in the biomass-dominant species, with Synechococcus spp. domination in the DCM. The parameterization of phytoplankton absorption in the DCM will enable refined spectral models of the downwelling radiance and primary production in the Black Sea.RAS funded this research [grant numbers АААА-А18-118020890112-1, АААА-А18-118020790229-7 and АААА-18-118012690119-7]. This work was partly supported by the Russian Foundation for Basic Research, projects [numbers 17-05-00113 and 18-45-920070]

COMPARATIVE RESEARCH OF ENALAPRIL AND ATENOLOL ANTIHYPERTENSIVE EFFICACY IN HIGH RISK PATIENTS

Aim. To evaluate the effecacy of enalapril (Enam, Dr.Reddy’s, India) and atenolol (Tenormin, AstraZeneca, UK) and their influence on processes of cardiovascular system remodeling in comparative research in patients with arterial hypertension. Material and methods. 38 patients with arterial hypertension stage II were examined. 21 patients were treated with enalapril (10-40 mg\d) and 17 – with atenolol (50-100 mg\d). Duration of therapy was 24 weeks.  A daily monitoring of blood pressure and echocardiography were made before and after the treatment. Spontaneous erythrocyte aggregation and deformability, spontaneous platelet aggregation and adhesive property of neutrophils were also estimated. A number of leucocytes carrying activation markers and expressing adhesive molecules was calculated. The plasma concentration of adhesive molecules (ICAM-1) and von Willebrand protein as well as serum concentration of N-terminal peptide of procollagen type III was also estimated. Results. Enalapril versus atenolol improved blood rheology, reduced functional leucocytes activity, plasma concentration of von Willebrand protein and intercellular adhesive molecules. The reduction in collagen III synthesis activity in enalapril therapy was proved. A significant regress of left ventricle hypertrophy due to enalapril treatment was related with favorable non-hemodynamic effects. Conclusion. The research revealed that the blockage of tissue rennin-angiotensin system is very important in prevention of cardiovascular complications especially in high risk patients

Principles of healthcare management for patients with pulmonary hypertension: focus on continuity

In managing care for patients with rare, rapidly progressive pathologies such as pulmonary hypertension (PH) and chronic thromboembolic hypertension (CTEPH), early diagnosis and speed of routing are of particular importance. Reducing the time spent on patient routing reduces the risk of disease progression, the rate of hospitalizations, and thereby the socioeconomic burden of the disease.In the Republic of Karelia, an algorithm for routing patients with PH and CTEPH has been created, which is an example of a successful healthcare management

РОЛЬ МЕДИЧНОЇ СЕСТРИ У ПРОФІЛАКТИЦІ АЛІМЕНТАРНОГО ОЖИРІННЯ: ВІД РЕКОМЕНДАЦІЙ ДО ПРАКТИЧНОГО ЗАСТОСУВАННЯ

Summary. The interest of scientists and health professionals in alimentary obesity as a serious health threat is growing every year. Today, overweight occurs in more than 30 % of the population, so obesity is seen as a global epidemic that has affected various segments of the population. The aim of the study – to analyze scientific data on the prevention of alimentary obesity and the role of the nurse in this process. Materials and Methods. Recommendations for weight management of the American Heart Association, the American College of Cardiology, the American Association of Clinical Endocrinologists, the Society of Obesity, the Endocrine Society, the European Society of Endocrinology were analyzed and our own algorithm was proposed. Results. A systematic review of the literature on the role of nurses in the prevention of chronic diseases in the United Kingdom, the United States, Finland, the Netherlands and New Zealand shows the effectiveness of measures aimed at adjusting the lifestyle of such patients. The nurses measured weight, controlled blood pressure and cholesterol, and promoted healthy eating habits and exercise. In the UK, the Netherlands and the Nordic countries, nurses provide advice on healthy living to control weight. In the United States, the activities of nurses to optimize body weight are still not clearly defined, so they work on their own initiative. It is noted that nurses are more accessible to communicate with patients than doctors. In Ukraine, research is being conducted on the role of nurses in optimizing the body weight of obese people, but in practice the proposed algorithms are not implemented. Conclusions. Although nurses have limited time and resources, regular support for overweight and obese patients improves weight loss outcomes. Prevention of alimentary obesity should include the usual measures: clear motivation, lifestyle changes (diet and physical activity) and maintenance of weight loss. At the same time, the nurse must provide the necessary care for the patient at each of these stages.Резюме. З кожним роком зростає інтерес науковців та медичних працівників до аліментарного ожиріння як серйозної загрози здоров’ю. Сьогодні надмірна маса тіла зустрічається у понад 30 % населення, тому ожиріння розглядається як глобальна епідемія, що охопила різні верстви населення. Мета дослідження – проаналізувати наукові дані щодо профілактики аліментарного ожиріння та ролі медсестри у цьому процесі. Матеріали і методи. Було проаналізовано рекомендації щодо керування масою тіла Американської асоціації серця, Американського коледжу кардіологів, Американської асоціації клінічних ендокринологів, Товариства ожиріння, Ендокринного товариства, Європейського товариства ендокринології та запропоновано власний алгоритм. Результати. Проведений систематичний огляд літератури щодо ролі медичних сестер у профілактиці хронічних захворювань у Великобританії, США, Фінляндії, Нідерландах та Новій Зеландії свідчить про ефективність заходів, спрямованих на корекцію способу життя таких пацієнтів. При цьому медсестри проводили вимірювання маси, контроль за артеріальним тиском та холестерином, заохочення здорових харчових звичок та занять фізичними навантаженнями. У Великобританії, Нідерландах та скандинавських країнах медсестри проводять консультації щодо здорового способу життя з метою контролю маси тіла. У США діяльність медичних сестер у напрямку оптимізації маси тіла до цього часу не визначена чітко, тому вони працюють за власною ініціативою. При цьому зазначається, що медсестри є більш доступнішими для спілкування з пацієнтами, аніж лікарі. В Україні проводяться дослідження щодо ролі медичних сестер в оптимізації маси тіла осіб з ожирінням, проте практично запропоновані алгоритми не впроваджуються. Висновки. Хоча медичні сестри мають обмежений час та ресурси, проте регулярна підтримка пацієнтів із надмірною масою тіла та ожирінням покращує результати щодо зменшення маси. Профілактика аліментарного ожиріння має включати звичайні заходи: чітку мотивацію, зміну способу життя (харчування й фізична активність) та підтримку зменшеної маси. При цьому медична сестра повинна надавати необхідну для пацієнта допомогу на кожному з цих етапів

THE SIGNIFICANCE OF OSTEOPONTINE AND MATRIX METALLOPROTEASE-9 IN THORACAL AORTA ANEURYSM DEVELOPMENT

Aim. To evaluate the significance of osteopontine and MMP-9 in the development of thoracal aorta aneurysm in patients with tricuspid (TAV) and bicuspid (BAV) aorta valve. Material and methods. Totally 94 patients included with the dilation of thoracal aorta for more than 40 mm, and 50 patients without aorta pathology, that were the comparison group. All patients underwent echocardiographic study by Vivid 7 (GE, USA) device by standard protocol. The osteopontine concentration and MMP-9 were measured in blood serum with manual plate immune-enzyme assay. Results. The concentration of MMP-9 in blood serum of the patients with aorta pathology and TAV did not differ significantly with the value in comparison group. Otherwise, in IHD the concentration of MMP-9 was significantly higher than in patients without aorta pathology (164,9±76,6 ng/ml and 106,8±82,7 ng/ml, respectively, p<0,01) and closely correlated with the Valsalva sinuses diameters (r=0,302, р=0,007). Comparative analysis of the osteopontine serum concentration did not show differences in the subgroups studied.Conclusion. The positive correlation revealed of the aorta diameter and concentration of MMP-9 in blood serum of the patients with BAV confirms not only the differences in the pathogenesis of thoracal aorta aneurysm in TAV and BAV, but makes it possible to think on the usage of MMP-9 as biomarker of thoracal aorta dilatation

Late Paleocene Flora of the Northern Alaska Peninsula: The Role of Transberingian Plant Migrations and Climatic Change

For the first time, the Late Sagwon Flora is described from the upper beds of the Prince Creek Formation (Upper Paleocene) at the Sagavanirktok River (northern Alaska Peninsula). The flora is dominated by the angiosperm Tiliaephyllum brooksense Moiseeva et Herman sp. nov. and conifer Metasequoia occidentalis (Newb.) Chaney. The Late Sagwon Flora is most similar to the Danian or Danian-Selandian flora from the middle part of the Upper Tsagayan Subformation (Amur Region) and lower part of the Wuyun Formation (Heilongjiang Province, China). This similarity allows us to hypothesize that the genus Tiliaephyllum, which dominated in the Late Tsagayan Flora, migrated via the Bering Land Bridge from southern paleolatitudes of the Far East to high latitudes of the Arctic Pacific, due to the progressively warming climate of the Paleocene. Additional new angiosperm species are described from the Late Sagwon Flora: Archeampelos mullii Moiseeva et Herman sp. nov., Tiliaephyllum brooksense Moiseeva et Herman sp. nov., and Dicotylophyllum sagwonicum Moiseeva et Herman sp. nov

Effectiveness of immunosuppressive therapy for lymphocytic myocarditis according: data from actual clinical practice

Aim. To compare the effectiveness of standard heart failure therapy with and without combined immunosuppressive therapy in patients with documented lymphocytic myocarditis (LM) based on data from actual clinical practice.Material and methods. This observational study included 70 patients with documented LM, 40% (n=28) of whom received immunosuppressive therapy. All patients underwent standard echocardiographic and laboratory investigations, endomyocardial biopsy with histological, immunohistochemical and molecular genetic analysis. Contrast-enhanced cardiac magnetic resonance imaging was performed in 74% of patients. All patients received standard therapy for heart failure at baseline.Results. The groups did not differ in demographic and echocardiographic characteristics. The appointment of immunosuppressive therapy was accompanied by an increase in ejection fraction by 12,2% compared to 6,4% (p=0,02). There were no significant differences in combined endpoints (survival and the need for heart transplantation) depending on therapy regimen (log-rank p=0,97).Conclusion. The prognosis of patients with chronic LM depends on the process activity, the severity of impaired hemodynamics and ventricular arrhythmias, as well as on the presence of persistent viral infection. Compliance with patient selection algorithm before prescribing immunosuppressive therapy is associated with the improvement in myocardial global contractility