Relationship between the degree of myocardial damage according to contrast-enhanced cardiac magnetic resonance imaging and laboratory data in patients with acute myocardial infarction

Aim. To evaluate the information value of a complex of clinical and biochemical parameters of myocardial damage in predicting the development of transmural myocardial damage according to magnetic resonance imaging (MRI) in patients with acute myocardial infarction (AMI).Material and methods. The study included patients admitted to the emergency cardiology department with acute coronary syndrome. All patients underwent invasive coronary angiography, laboratory tests, and dynamic determination of cardiac biomarkers. In the interval of 6,1±4 days from admission to the hospital, patients underwent contrast-enhanced cardiac MRI. According to the pattern of delayed contrast enhancement, patients were divided into two groups: with a transmural and subendocardial pattern.Results. The mean age of patients was 62,5±10,5 years, while 27 (71,1%) had ST-segment elevation AMI. Among the risk factors for coronary artery disease, dyslipidemia (89,5%), hypertension (68,4%), and smoking (57,9%) were the most common. Creatine phosphokinase-MB (CPK-MB), serum high-sensitivity cardiac troponin I (cTnI) and C-reactive protein (CRP) values after 24 h were significantly higher in patients with transmural hyperenhancement. Moderate positive relationship was found between the global size of left ventricular (LV) damage according to MRI data and the levels of CPK-MB after 24 h and 4 days, as well as with CRP after 24 h, 4 and 7 days, and cTnI level after 24 h and 4 days. In the group of patients with transmural pattern, the global size of LV damage was significantly higher. Patients of this group were characterized by higher prevalence of microvascular obstruction. In a univariate regression analysis, there were following significant predictors of transmural myocardial damage: CPK-MB after 4 days (p=0,023) and ST segment elevation (p=0,029). Multivariate regression analysis showed that the only independent predictor of transmural myocardial damage was an increase in CPKMB after 4 days (p=0,023).Conclusion. An independent predictor of LV transmural damage in AMI was an elevated level of CPK-MB after 4 days. However, this laboratory marker had unsatisfactory information completeness and predictive quality. In this regard, cardiac MRI in patients with AMI, compared with the standard clinical assessment, can be considered preferable for assessing the depth of myocardial damage, risk stratification, and prognosis

Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions?

This literature review covers the publications of Russian vascular surgeons in recent years and deals with debatable issues of carotid surgery, including: 1. What is the best technique for carotid endarterectomy (CEA)? 2. Why does restenosis of the internal carotid artery (ICA) develop and how to eliminate it? 3. How to operate on bilateral ICA stenosis? 4. Should carotid glomus be preserved? 5. Is CEA safe in the acute phase of cerebrovascular accident (CVA)? 6. Is CEA safe in elderly patients? 7. How to operate on patients with combined internal carotid and coronary artery involvement? The evidence presented in this publication makes it possible to draw the following conclusions: 1. When choosing a CEA technique, the classical technique with patch angioplasty should be avoided due to the high risk of ICA restenosis. 2. To eliminate ICA restenosis, carotid angioplasty with stenting (CAS) should be used. When performing primary CEA with ICA transposition over the hypoglossal nerve, reCEA can be used 3. In the absence of contraindications, bilateral ICA stenosis can be operated at the same time using CEA. 4. CEA with carotid glomus preservation is the operation of choice in the treatment of patients with hemodynamically significant ICA stenosis due to the elimination of the risks of postoperative hypertension and the formation of hemorrhagic transformation. 5. If there are indications for cerebral revascularization in the most acute period of stroke, CEA should be abandoned in favor of CAS. 6. In old age, CAS is the safest treatment strategy. 7. In the presence of a combined ICA and coronary involvement, the choice of treatment tactics should be carried out only by a multidisciplinary commission, taking into account the risk stratification of adverse cardiovascular events

Canagliflozin: from glycemic control to improvement of cardiovascular and renal prognosis in patients with type 2 diabetes mellitus. Resolution of Advisory Board

Inhibitors of the sodium-glucose cotransporter type 2 (SGLT2i) are a modern class of antihyperglycemic drugs with an insulin-independent mechanism of action. Due to its ability to effectively lower blood glucose levels, improve a number of other cardiometabolic parameters (body weight, blood pressure, uric acid), as well as reduce cardiovascular and renal risks, SGLT2i have become drugs of choice for many of patients with type 2 diabetes mellitus (T2DM). Meanwhile, along with the generally recognized classes-effects of this group of drugs, there are intragroup features, including those associated with their different selectivity in sodium-glucose cotransporters of types 1 and 2 (SGLT1 and SGLT 2). For example, one of the most studied SGLT2i, canagliflozin, in addition to its inhibitory activity against SGLT2, can also moderately block SGLT1 in the intestine and kidneys that could give a maximum efficiency in the control glycemia and others cardiometabolic parameters. In addition, canagliflozin improves not only cardiovascular, but also renal prognosis in patients with T2DM, which is reflected in the corresponding indications in the summary of product characteristics of the drug. This document summarize the established and new data regarding the efficacy and safety of canagliflozin, as well as its place in the treatment of T2DM

Inhibition of Soluble Tumor Necrosis Factor Ameliorates Synaptic Alterations and Ca2+ Dysregulation in Aged Rats

The role of tumor necrosis factor α (TNF) in neural function has been investigated extensively in several neurodegenerative conditions, but rarely in brain aging, where cognitive and physiologic changes are milder and more variable. Here, we show that protein levels for TNF receptor 1 (TNFR1) are significantly elevated in the hippocampus relative to TNF receptor 2 (TNFR2) in aged (22 months) but not young adult (6 months) Fischer 344 rats. To determine if altered TNF/TNFR1 interactions contribute to key brain aging biomarkers, aged rats received chronic (4–6 week) intracranial infusions of XPro1595: a soluble dominant negative TNF that preferentially inhibits TNFR1 signaling. Aged rats treated with XPro1595 showed improved Morris Water Maze performance, reduced microglial activation, reduced susceptibility to hippocampal long-term depression, increased protein levels for the GluR1 type glutamate receptor, and lower L-type voltage sensitive Ca2+ channel (VSCC) activity in hippocampal CA1 neurons. The results suggest that diverse functional changes associated with brain aging may arise, in part, from selective alterations in TNF signaling

Возможности фармакологического лечения остеоартрита: фокус на симптоматические медленно действующие препараты (SYSADOA) и индивидуальные особенности пациента. Резолюция международного совещания экспертов

The paper presents the results of the Osteoarthritis (OA) Expert Council held on September 8, 2019, which was attended by Russian and foreign specialists. The experts considered pharmacological treatment options for OA. The expert meeting resolution states that the treatment of patients with OA should be based on an individual assessment of the patient and on a modern evidence base of therapy efficacy.Treatment of patients with OA is based on the principles of evidence-based medicine that requires an integrated approach and the need of SYSADOAs prescription. Combined drugs with therapeutic dosages of chondroitin sulfate and glucosamine in the early stages of the disease are available as basic agents. The place of paracetamol in the anesthetic therapy algorithm in OA needs to be clarified. It is also noted that when choosing nonsteroidal anti-inflammatory drugs for OA treatment, it is important to take into account individual patient characteristics and the presence of comorbidities.Представлены результаты Экспертного совета по остеоартриту (ОА), проходившего 8 сентября 2019 г., в котором приняли участие российские и зарубежные специалисты. Рассматривались возможности фармакологического лечения ОА. В резолюции совещания указано, что лечение больных ОА должно быть основано на индивидуальной оценке состояния пациента и современных доказательствах эффективности терапии. Лечение больных ОА на основании принципов доказательной медицины предполагает комплексный подход и назначение SYSADOA. Комбинированные препараты с терапевтическими дозами хондроитина сульфата и глюкозамина уже на ранних стадиях заболевания рассматриваются в качестве базисных средств. Место парацетамола в алгоритме обезболивающей терапии при ОА требует уточнения. Отмечено также, что при выборе нестероидных противовоспалительных препаратов для лечения ОА важно учитывать индивидуальные особенности пациента и наличие коморбидных состояний

Встановлення поліцією причин та особливостей домашнього насильства щодо дітей

The article reveals the most pressing issues regarding the protection of children from domestic violence. The problem of protecting such children has certain difficulties. This is due to the fact that the vast majority of affected children are children from disadvantaged families, as a rule, few people want to protect this category of people. It is suggested to pay special attention to the peculiarities of the method of interviewing a child who has experienced domestic violence, to the procedure of interviewing such children. A list of grounds that are undesirable to use when communicating with children is identified, and recommendations for interviewing children affected by violence are provided. The main types of violence against children, subjects who commit violence against children, dangerous consequences for the society where domestic violence against children is actively manifested are described. It is stated that in accordance with international standards and world practice, the interview of a child who is a victim of violent crimes, domestic violence or witnessed violence should be conducted in a child-friendly atmosphere, where they feel protected and comfortable. The "green room" was described as a specially equipped room for interviewing such children. The legal status of the child is determined, the circumstances, causes and types of domestic violence against children are established. Suggestions for improving the use of tactics in the survey of this category of minors in order to effectively protect the rights and interests of the latter. The problems considered in the work relate to both theory and practice. There are two consequences for children who have experienced domestic violence, which are manifested simultaneously: harm to the victim and harm to society.У статті розкрито найбільш актуальні проблеми щодо захисту дітей від домашнього насильства. Проблема захисту таких дітей має певні складнощі. Це пояснюється тим, що переважна більшість постраждалих дітей – це діти з неблагополучних родин, як правило, захистити таку категорію осіб мало у кого виникає бажання. Звернено увагу на процедуру опитування дітей постраждалих від домашнього насильства. Встановлено, що процес отримання показань неповнолітніх, які зазнали домашнього насилля, має певні труднощі. Охарактеризовано основні види насильства над дітьми, суб’єктів, які вчиняють насильство над дітьми, небезпечні наслідки для суспільства, де активно проявляється домашнє насильство над дітьми

Мікро- та макроелементне забезпечення в дітей з тимомегалією, хворих на гострий обструктивний бронхіт

Purpose — to study of concentration of zinc, copper, iron and magnesium in children with acute obstructive bronchitis and thymomegaly during the acute phase of the disease and during recovery period. Patients and methods. The children were divided into 2 groups according to the presence of thymomegaly: I group — patients with acute obstructive bronchitis without thymomegaly (28 children); Group II — patients with acute obstructive bronchitis with thymomegaly (28 children). Results. It was observed the increase of concentration of copper and low levels of zinc, iron and magnesium in all children with thymomegaly in the first days of illness. After a standard treatment the copper levels decreased, but it was still higher than in the control group. The content of zinc and iron was tended to increase in recovery period, but it did not reach the level of healthy children. Conclusions. When comparing the content of macro- and microelements in both groups, it was found that children with thymomegaly in acute zinc levels significantly lower than those of children with acute obstructive bronchitis without thymomegaly, while copper concentration remained significantly higher. Key words: infants, obstructive bronchitis, thymomegaly, zinc, iron, magnesium, copper.Цель — исследовать содержание цинка, меди, железа и магния у детей, больных острым обструктивным бронхитом с сопутствующей тимомегалией в остром периоде болезни и в период реконвалесценции. Пациенты и методы. В ходе работы дети были разделены на две группы в зависимости от наличия тимомегалии: I группа — больные острым обструктивным бронхитом без тимомегалии (28 детей); II группа — пациенты с острым обструктивным бронхитом с тимомегалией (28 детей). Результаты. Установлено, что у всех детей с тимомегалией в первые дни болезни наблюдалось повышение концентрации меди и низкий уровень цинка, железа и магния. После проведенного стандартного лечения уровень меди снизился, однако оставался выше, чем у детей контрольной группы, тогда как содержание цинка и железа на этапе выздоровления имело тенденцию к повышению, но не достигало уровня здоровых детей. Выводы. При сравнении содержания микро- и макроэлементов у больных обеих групп установлено, что у детей с тимомегалией в остром периоде уровень цинка достоверно ниже, чем у больных острым обструктивным бронхитом без тимомегалии, тогда как концентрация меди оставалась достоверно выше. Ключевые слова: дети раннего возраста, обструктивный бронхит, тимомегалия, цинк, железо, магний, медь.Мета — дослідити вміст цинку, міді, заліза та магнію в дітей, хворих на гострий обструктивний бронхіт із супутньою тимомегалією у гострому періоді хвороби та в періоді реконвалесценції. Пацієнти та методи. У ході роботи діти були поділені на дві групи залежно від наявності тимомегалії: І група — хворі на гострий обструктивний бронхіт без тимомегалії (28 дітей); ІІ група — пацієнти з гострим обструктивним бронхітом із тимомегалією (28 дітей). Результати. Встановлено, що в усіх дітей з тимомегалією в перші дні хвороби спостерігалося підвищення концентрації міді та низький рівень цинку, заліза та магнію. Після проведеного стандартного лікування рівень міді знижувався, проте залишався вищим, ніж у дітей контрольної групи, тоді як вміст цинку та заліза на етапі видужання мав тенденцію до підвищення, але не досягав рівня здорових дітей. Висновки. При порівнянні вмісту мікро- та макроелементів у хворих обох груп встановлено, що в дітей з тимомегалією в гострому періоді захворювання рівень цинку був достовірно нижчим, ніж у дітей, хворих на гострий обструктивний бронхіт без тимомегалії, тоді як концентрація міді залишалась достовірно вищою. Ключові слова: діти раннього віку, обструктивний бронхіт, тимомегалія, цинк, залізо, магній, мідь

Remittances, rituals and reconsidering women's norms in mahallas : emigrant labour and its social effects in Ferghana Valley

This paper describes recent economic and social changes in Central Asian neighbourhood communities known as mahallas, using data from a town in the Ferghana Valley. First, the paper examines how the increasing costs of life-cycle rituals are damaging the harmony of mahallas. Since 2007, more and more hosts have begun to outsource the provision of food and services for these rituals, using money acquired mostly through emigrant labour. This in turn lessens mahallas’ mutual aid practices, and reveals emerging economic disparities between neighbours. Secondly, the paper argues that emigration has had transformative effects on the lifestyles of Muslim women in mahallas. With the globalization of their economy, conventional local norms are becoming harder to obey, and some young and middle-aged women are choosing to live outside these norms. Dependence on emigrant labour and the associated remittances has significantly affected the lifestyles and morals of mahalla inhabitants.参考文献の記載方法等の点で、出版社版とは微細な違いあ