Use of Meldonium in the Treatment of Patients with Coronary Artery Disease and Concomitant Arterial Hypertension

Coronary artery disease (CAD) remains one of the leading causes of mortality and disability in Ukraine. Arterial hypertension (AH) is one of the most common diseases and a leading risk factor for coronary artery disease.The aim of the work is to evaluate the antianginal activity of meldonium in the complex therapy in patients with CAD with stable angina and concomitant AH.Materials and methods. The study included 82 patients with CAD, stable angina pectoris II–III functional class, including 52 patients with concomitant AH stage II. The patients were divided into 2 groups. Patients in group 1 were prescribed meldonium at a dose of 750 mg/d for 2 months in addition to basic therapy for the underlying disease. Patients in group 2 continued basic antianginal, disaggregant, hypolipidemic therapy.Results. The use of meldonium led to a decrease in the frequency of angina attacks and the need for nitroglycerin. From the 1st month of therapy and up to 2 months treatment decreased it consumption by 63 and 82.3 % respectively. Adding meldonium to basic therapy led to a likely reduction in shortness of breath, episodes of palpitations, tinnitus, and headache. In all patients, after the treatment, an increase in exercise tolerance was observed, which was more pronounced in the group where patients were receiving meldonium. In the group of patients receiving meldonium, normalisation of blood pressure was faster and more pronounced.Conclusions. Meldonium has antianginal activity, which is manifested by an increase in the physical tolerance of patients, a decrease in the frequency of angina attacks, the need for sublingual nitroglycerin intake and improvement in the well-being of patients. Additional use of meldonium promotes faster and better normalization of blood pressure. The use of meldonium in the complex therapy of patients with stable angina and concomitant AH allows to increase the effectiveness of traditional antianginal therapy and to improve the quality of life of such patients

Dynamics of Heart Failure Markers in Patients after Past Myocardial Infarction with the Use of Potassium and Magnesium Salts of Gluconic Acid, Eplerenone and Rivaroxaban

The objective of the research was to increase the efficiency of treatment of patients with chronic heart failure (CHF) and post-infarction cardiosclerosis by adding potassium and magnesium salts of gluconic acid, eplerenone and rivaroxaban to the background therapy taking into account the indices of growth differentiation factor 15 (GDF-15), aldosterone and galectin-3. Materials and methods of the research. Emmunoenzymometric determination of the galectin-3, GDF-15 and aldosterone levels concentration in blood serum was conducted to achieve the stated objective. 42 patients with CHF and post-infarction cardiosclerosis after coronary artery stenting in the acute period of myocardial infarction (MI) were examined. The patients were randomized into four groups according to the peculiarities of treatment. Group I included patients with CHF and post-infarction cardiosclerosis treated with the background therapy (BT). Group II consisted of patients with CHF who were treated with BT and addition of potassium and magnesium salts of gluconic acid. Group III included patients with CHF who were prescribed eplerenone secondary to BT. Group IV consisted of patients who were treated with BT and rivaroxaban. Results. The proposed treatment regimens were proved to be effective in reduction of GDF-15, aldosterone and galectin-3 indices in 12 months of treatment. Conducted therapy with the use of rivaroxaban secondary to BT led to more intensive decrease in GDF-15 concentration in comparison with the use of potassium and magnesium salts of gluconic acid or eplerenone on the background of BT. This index constituted (2110.21±107.4) pg/ml before the treatment in these patients and significantly decreased to (1286.75±109.6) pg/ml being significantly before the therapy. The performed treatment with the use of eplerenone secondary to BT was proved to be more effective for normalization of aldosterone and galectin-3 levels in blood serum compared to other studied treatment regimens. The average value of aldosterone changed in the treatment process by 67.24%. Thus, the average level of this index constituted (139.8±7.63) pg/ml before the treatment and was equal to (45.8±5.52) pg/ml at the end of the treatment course. The average value of galectin-3 in patients with CHF and post-infarction cardiosclerosis was noted to be (34.69±1.67) ng/ml before the treatment. It constituted (22.53±0.98) ng/ml after the end of treatment being significantly lower compared to the value before the treatment. The average value of this index changed in the course of twelve-month treatment by 35.05%. Lower risk of sudden cardiac arrest (SCA), acute coronary syndrome (ACS) and stroke was observed in the patients with CHF and post-infarction cardiosclerosis with the use of rivaroxaban secondary to BT.Conclusions. Thus, the use of rivaroxaban combination therapy secondary to BT led to more intensive decrease in GDF-15 concentration in comparison with the use of potassium and magnesium salts of gluconic acid or eplerenone. Conducted therapy with the use of eplerenone on the background of BT was more effective for the normalization of galectin-3 and aldosterone levels in the blood compared to other studied treatment regimens

ПЕРЕБІГ СТАБІЛЬНОЇ ІШЕМІЧНОЇ ХВОРОБИ СЕРЦЯ НА ТЛІ НЕАЛКОГОЛЬНОЇ ЖИРОВОЇ ХВОРОБИ ПЕЧІНКИ В РЕАБІЛІТАЦІЙНОМУ ПЕРІОДІ ПІСЛЯ РЕВАСКУЛЯРИЗАЦІЙНИХ ВТРУЧАНЬ

The course of stable coronary artery disease combined with non-alcoholic fatty liver disease in the rehabilitation period after revascularization procedures – The aim of study was to evaluate the course of stable coronary heart disease (CHD) combined with non-alcoholic fatty liver disease (NAFLD) in the rehabilitation period after revascularization procedures. 220 patients with stable CHD combined with NAFLD, including 80 patients after revascularization procedures were examined. All patients were conducted general clinical and functional methods of examination for verification of stable CHD and NAFLD. It was established more favorable course of stable CHD, concomitant heart failure and arterial hypertension combined with NAFLD after myocardial revascularization. It was determined that the clinical peculiarities of stable CHD combined with NAFLD were expressed by clinical symptoms of the main and comorbidity diseases, less pronounced after myocardial revascularization. It was proved that myocardial revascularization improves long-term prognosis in patients with stable CHD combined with NAFLD. Целью исследования было оценить течение стабильной ишемической болезни сердца (ИБС) на фоне неалкогольной жировой болезни печени (НАЖБП) в реабилитационном периоде после проведения вмешательств по реваскуляризации миокарда. Обследовано 220 больных стабильной ИБС, совмещенную с НАЖБП, из них 80 пациентов после реваскуляризационных вмешательств. Всем больным проведены общеклинические и функциональные методы обследования с целью верификации стабильной ИБС и НАЖБП. Установлено более благоприятное течение стабильной ИБС, сопутствующих сердечной недостаточности и артериальной гипертензии на фоне НАЖБП после реваскуляризации миокарда. Определено, что клиническими особенностями течения стабильной ИБС на фоне НАЖБП имеются выраженные клинические симптомы основного заболевания и сопутствующей патологии, менее выражены после реваскуляризации миокарда. Доказано, что реваскуляризация миокарда способствует улучшению долгосрочного прогноза у больных стабильной ИБС на фоне НАЖБП.Метою дослідження було оцінити перебіг стабільної ішемічної хвороби серця (ІХС) на тлі неалкогольної жирової хвороби печінки (НАЖХП) у реабілітаційному періоді після проведення втручань із реваскуляризації міокарда. Обстежено 220 хворих на стабільну ІХС, поєднану з НАЖХП, із них 80 пацієнтів після реваскуляризаційних втручань. Усім хворим проведено загальноклінічні та функціональні методи обстеження з метою верифікації стабільної ІХС та НАЖХП. Встановлено більш сприятливий перебіг стабільної ІХС, супутніх серцевої недостатності (СН) та артеріальної гіпертензії (АГ) на тлі НАЖХП після реваскуляризації міокарда. Визначено, що клінічними особливостями перебігу стабільної ІХС на тлі НАЖХП є виражені клінічні симптоми основного захворювання та супутньої патології, менш виражені після реваскуляризації міокарда. Доведено, що реваскуляризація міокарда сприяє поліпшенню довгострокового прогнозу в хворих на стабільну ІХС на тлі НАЖХП

Аналіз засобів розробки доповненої реальності

The article considers cross-platform products that should be used to develop augmented reality technologies: Unreal Development, Kit, Unity, Godot, Engine, Cocos2D, MonoGame, Unreal Engine, Marmalade, and others. Also, the possibilities of known SDKs for the development of augmented reality applications (Wikitude, Vuforia, Kudan, Maxst, Xzimg, NyARToolkit, Metaio SDK) are given. It is established that for the development of augmented reality technologies can be used not only cross-platform engines but also sets of development tools. Such kits allow you to speed up and simplify the process of developing any program with elements of augmented reality. These advantages and disadvantages will help beginners to choose the most convenient tool for developing augmented reality technologies. In addition, the article attempts to identify criteria and indicators for the selection of such environments, as well as their expert evaluation.У статті розглянуто міжплатформові продукти, які слід використовувати для розробки технологій доповненої реальності: Unreal Development, Kit, Unity, Godot, Engine, Cocos2D, MonoGame, Unreal Engine, Marmalade та ін. Також наведені можливості відомих SDK для розробки додатків доповненої реальності (Wikitude, Vuforia, Kudan, Maxst, Xzimg, NyARToolkit, Metaio SDK). Встановлено, що для розвитку технологій доповненої реальності можуть бути використані не тільки кроссплатформенні двигуни, а й набори засобів розробки. Такі набори дозволяють прискорити і спростити процес розробки будь -якої програми з елементами доповненої реальності. Ці переваги та недоліки допоможуть новачкам вибрати найбільш зручний інструмент для розробки технологій доповненої реальності. Крім того, у статті намагаються визначити критерії та показники для вибору таких середовищ, а також їх експертну оцінку

Можливості застосування доповненої реальності в різних галузях освіти

Augmented reality has a great impact on the student in the presentation of educational material: objects of augmented reality affect the development of facial expressions, attention, stimulate thinking, and increase the level of understanding of information. Its implementation in various spheres has indisputable advantages: realism, clarity, application in many industries, information completeness and interactivity. That is why the study presents the possibilities of using augmented reality in the study of mathematics, anatomy, physics, chemistry, architecture, as well as in other fields. The comparison of domestic and foreign proposals for augmented reality is presented. The use of augmented reality in various fields (technology, entertainment, science and medicine, education, games, etc.) should be well thought out and pedagogically appropriate. That is why in the future it is planned to conduct research on the feasibility of using augmented reality and to develop elements of augmented reality accordingly.Доповнена реальність має великий вплив на школяра при поданні навчального матеріалу: предмети доповненої реальності впливають на розвиток міміки, уваги, стимулюють мислення та підвищують рівень розуміння інформації. Її реалізація в різних сферах має незаперечні переваги: ​​реалістичність, чіткість, застосування у багатьох галузях, інформаційна повнота та інтерактивність. Саме тому у дослідженні представлені можливості використання розширеної реальності при вивченні математики, анатомії, фізики, хімії, архітектури, а також в інших галузях. Представлено порівняння вітчизняних та зарубіжних пропозицій щодо доповненої реальності. Використання доповненої реальності в різних галузях (технології, розваги, наука і медицина, освіта, ігри тощо) повинно бути продуманим і педагогічно доцільним. Ось чому в майбутньому планується провести дослідження доцільності використання розширеної реальності та відповідно розробити елементи доповненої реальності

Evidence of d-wave Superconductivity in K_(1-x)Na_xFe_2As_2 (x = 0, 0.1) Single Crystals from Low-Temperature Specific Heat Measurements

From the measurement and analysis of the specific heat of high-quality K_(1-x)Na_xFe_2As_2 single crystals we establish the presence of large T^2 contributions with coefficients alpha_sc ~ 30 mJ/mol K^3 at low-T for both x=0 and 0.1. Together with the observed square root field behavior of the specific heat in the superconducting state both findings evidence d-wave superconductivity on almost all Fermi surface sheets with an average gap amplitude of Delta_0 in the range of 0.4 - 0.8 meV. The derived Delta_0 and the observed T_c agree well with the values calculated within the Eliashberg theory, adopting a spin-fluctuation mediated pairing in the intermediate coupling regime.Comment: 8 pages, 5 figures, field dependence of the specific heat added, slightly changed title, changed sequence of authors, one author added, accepted by Phys. Rev. B Rapid Communication

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

Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

Background Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown. Methods Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding. Results A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55). Conclusions Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218. opens in new tab.

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Оцінка ефективності монотерапії капікором та глутаргіном у осіб з постійною фібриляцією передсердь та поєднаною патологією печінки на фоні тривалої терапії варфарином

An aim of the study was effectiveness evaluation of separate use of capicor and glutargin at treatment of patients with ischemic heart disease (IHD) complicated with atrial fibrillation (AF) during long-term antiplatelet and anticoagulant therapy. The patients were divided into two groups: the first one got a primarily specified optimal basic therapy, the second one was divided into two subgroups: the subgroup 1 got therapy correction with addition of capicor in individually selected doses to the basic therapy, in the subgroup 2 the main treatment was complemented by glutargin in individually selected doses. It was proved that separate use of capicor or glutargin in individually selected doses allows to optimize the clinical course of diseases only partially, and improve functional ability of the liver in patients with IHD and permanent AF, and comorbid pathologies of the liver that receive long-term antiplatelet and anticoagulant therapy. That was stated according to data of metacetin breath test and biochemical blood tests.Целью исследования стало провести оценку эффективности отдельного применения препаратов капикор и глутаргин в лечении больных ишемической болезнью сердца (ИБС), осложненной фибрилляцией предсердий (ФП) при условии долговременной антитромбоцитарной и антикоагулянтной терапии. Исследуемые были разделены на две группы: одна находилась на первично определенной базовой терапии, вторая была разделена на две подгруппы: в подгруппе 1 применена коррекция лечения, заключающаяся в добавлении к базовой терапии препарату капикор в индивидуально подобранной дозировке, в подгруппе 2 к основному лечению добавлялся глутаргин в индивидуально подобранной дозировке. Доказано, что отдельное применение капикора или глутаргина в индивидуально подобранной дозировке у больных ИБС и ФП, а также коморбидными заболеваниями печени, что находятся на долговременной антикоагулянтной и антитромбоцитарной терапии, позволяет только частично оптимизировать клиническое течение заболеваний, а также улучшить функциональную способность печени, как констатировано данными дихательного метацитинового теста и биохимического анализа крови.Метою дослідження стало проведення оцінки ефективності окремого застосування препаратів капікор та глутаргін у лікуванні хворих на ішемічну хворобу серця (ІХС), ускладнену фібриляцією передсердь (ФП) за умов тривалої антитромбоцитарної та антикоагулянтної терапії. Досліджувані розподілені на дві групи: одна знаходилась на первинно визначеній оптимальній базовій терапії, друга група – розподілена на дві підгрупи: у підгрупі 1 застосована корекція лікування, що полягала у додаванні до базової терапії препарату капікор в індивідуально підібраних дозах, у підгрупі 2 до основного лікування додавався глутаргін в індивідуально підібраних дозах. Доведено, що окреме застосування капікору або глутаргіну в індивідуально підібраних дозах у хворих на ІХС та з постійною формою ФП, а також коморбідними захворюваннями печінки, що знаходяться на тривалій антикоагулянтній і антитромбоцитарній терапії, дозволяє тільки частково оптимізувати клінічний перебіг захворювань, а також покращити функціональну здатність печінки, як констатовано за даними дихального метацетинового тесту та біохімічного аналізу крові