Распространенность и течение остеопороза у пациентовс сердечно-сосудистыми заболеваниями

Tsel' issledovaniya. Opredelit' rasprostranennost', techenie i effektivnost' profilaktiki i lecheniya osteoporoza (OP) u patsientov, perenesshikh perelom sheyki bedrennoy kosti. Materialy i metody. Na pervom etape issledovaniya izuchali dannye 117 patsientov (28 muzhchin i 89 zhenshchin posle atravmaticheskogo pereloma sheyki bedrennoy kosti; sredniy vozrast - 76,8±7,4 goda). U vsekh bol'nykh utochnyali, diagnostirovalsya li do pereloma OP, vyyavlyali faktory riska OP v sootvetstvii s mezhdunarodnym minutnym testom. Vtoroy etap - izuchali dve gruppy patsientov: 1-ya gruppa - 396 bol'nykh s arterial'noy gipertenziey (AG) i ishemicheskoy bolezn'yu serdtsa (IBS); 2-ya gruppa -194 patsienta bez somaticheskoy patologii. Patsientam s AG provodili sutochnoe monitorirovanie AD, patsientam s IBS - kholterovskoe monitorirovanie EKG po standartnoy metodike. Krome togo, vypolnyali EkhoKG, izuchali pokazateli lipidnogo obmena. U vsekh patsientov otsenivali uroven' bolevogo sindroma v spine po VAIII, opredelyali mineral'nuyu plotnost' kostnoy tkani (MPK). Zaklyuchitel'nyy etap issledovaniya - metodom sluchay-kontrol' otobran 151 patsient iz 1-y gruppy. V zavisimosti ot vida osteoporoticheskoy terapii patsienty byli razdeleny na 3 podgruppy. Nablyudenie za patsientami provodili v techenie 12 mes, posle chego otsenivali obshchee sostoyanie, dinamiku MPK po dannym densitometrii, dinamiku klinicheskikh i instrumental'nykh priznakov serdechno-sosudistykh zabolevaniy. Rezul'taty issledovaniya. Atravmaticheskiy perelom sheyki bedra u muzhchin otmechalsya v srednem na 7,1 goda ran'she, chem u zhenshchin. Gospital'naya letal'nost' pri perelome sheyki bedra - 6,8%; eshche okolo 25% bol'nykh umirayut v techenie goda. U bol'shinstva patsientov imelas' kardi-ovaskulyarnaya patologiya, po povodu kotoroy oni nablyudalis' u terapevta, pri etom OP ili faktory ego riska do pereloma ni v odnom sluchae ne byli diagnostirovany. Faktory riska OP pri kardiovaskulyarnoy patologii vstrechalis' v 86,6% sluchaev, u patsientov bez takovoy - v 81,4%. Nizkaya MPK vyyavlena u 65,2% bol'nykh s serdechno-sosudistymi zabolevaniyami i sostavlyala pri IBS -1,9 SD, pri AG-1,6 SD, a u patsientov bez kardiovaskulyarnoy patologii etot pokazatel' dostigal -0,9 SD. Pri nekontroliruemoy AG, gipertrofii levogo zheludochka s narusheniem ego sokratimosti poterya MPK bolee vyrazhennaya. Otmecheny prirost MPK i znachitel'noe klinicheskoe uluchshenie sostoyaniya u patsientov s kardiovaskulyarnoy patologiey i OP na fone terapii kal'tsitoninom lososya i preparatami kal'tsiya v sochetanii s vitaminom Ds. Zaklyuchenie. Privedennye dannye rasshiryayut nashi predstavleniya o svyazi kardiovaskulyarnoy patologii so snizheniem MPK. Vysokaya obrashchaemost' patsientov s sosudistoy patologiey k kardiologam, terapevtam, nevrologam trebuet sozdaniya usloviy dlya uluchsheniya diagnostiki OP.Цель исследования. Определить распространенность, течение и эффективность профилактики и лечения остеопороза (ОП) у пациентов, перенесших перелом шейки бедренной кости. Материалы и методы. На первом этапе исследования изучали данные 117 пациентов (28 мужчин и 89 женщин после атравматического перелома шейки бедренной кости; средний возраст - 76,8±7,4 года). У всех больных уточняли, диагностировался ли до перелома ОП, выявляли факторы риска ОП в соответствии с международным минутным тестом. Второй этап - изучали две группы пациентов: 1-я группа - 396 больных с артериальной гипертензией (АГ) и ишемической болезнью сердца (ИБС); 2-я группа -194 пациента без соматической патологии. Пациентам с АГ проводили суточное мониторирование АД, пациентам с ИБС - холтеровское мониторирование ЭКГ по стандартной методике. Кроме того, выполняли ЭхоКГ, изучали показатели липидного обмена. У всех пациентов оценивали уровень болевого синдрома в спине по ВАIII, определяли минеральную плотность костной ткани (МПК). Заключительный этап исследования - методом случай-контроль отобран 151 пациент из 1-й группы. В зависимости от вида остеопоротической терапии пациенты были разделены на 3 подгруппы. Наблюдение за пациентами проводили в течение 12 мес, после чего оценивали общее состояние, динамику МПК по данным денситометрии, динамику клинических и инструментальных признаков сердечно-сосудистых заболеваний. Результаты исследования. Атравматический перелом шейки бедра у мужчин отмечался в среднем на 7,1 года раньше, чем у женщин. Госпитальная летальность при переломе шейки бедра - 6,8%; еще около 25% больных умирают в течение года. У большинства пациентов имелась карди-оваскулярная патология, по поводу которой они наблюдались у терапевта, при этом ОП или факторы его риска до перелома ни в одном случае не были диагностированы. Факторы риска ОП при кардиоваскулярной патологии встречались в 86,6% случаев, у пациентов без таковой - в 81,4%. Низкая МПК выявлена у 65,2% больных с сердечно-сосудистыми заболеваниями и составляла при ИБС -1,9 SD, при АГ-1,6 SD, а у пациентов без кардиоваскулярной патологии этот показатель достигал -0,9 SD. При неконтролируемой АГ, гипертрофии левого желудочка с нарушением его сократимости потеря МПК более выраженная. Отмечены прирост МПК и значительное клиническое улучшение состояния у пациентов с кардиоваскулярной патологией и ОП на фоне терапии кальцитонином лосося и препаратами кальция в сочетании с витамином Ds. Заключение. Приведенные данные расширяют наши представления о связи кардиоваскулярной патологии со снижением МПК. Высокая обращаемость пациентов с сосудистой патологией к кардиологам, терапевтам, неврологам требует создания условий для улучшения диагностики ОП

Compartmentalization of the GABAB receptor signaling complex is required for presynaptic inhibition at hippocampal synapses

Presynaptic inhibition via G-protein-coupled receptors (GPCRs) and voltage-gated Ca(2+) channels constitutes a widespread regulatory mechanism of synaptic strength. Yet, the mechanism of intermolecular coupling underlying GPCR-mediated signaling at central synapses remains unresolved. Using FRET spectroscopy, we provide evidence for formation of spatially restricted (>100 ?) complexes between GABA(B) receptors composed of GB(1a)/GB(2) subunits, G?(o)?(1)?(2) G-protein heterotrimer, and Ca(V)2.2 channels in hippocampal boutons. GABA release was not required for the assembly but for structural reorganization of the precoupled complex. Unexpectedly, GB(1a) deletion disrupted intermolecular associations within the complex. The GB(1a) proximal C-terminal domain was essential for association of the receptor, Ca(V)2.2 and G??, but was dispensable for agonist-induced receptor activation and cAMP inhibition. Functionally, boutons lacking this complex-formation domain displayed impaired presynaptic inhibition of Ca(2+) transients and synaptic vesicle release. Thus, compartmentalization of the GABA(B1a) receptor, G??, and Ca(V)2.2 channel in a signaling complex is required for presynaptic inhibition at hippocampal synapses

Sleep characteristics in obesity

Aim. To study sleep disturbance role in obesity pathogenesis among co-morbidity-free patients. Material and methods. The study included 66 co-morbidity-free obese patients and 24 healthy volunteers. All participants underwent detailed clinical examination. Psychometrical scales for subjective self-assessment were used: subjective sleep disturbance assessment scale, hospital anxiety and depression scale; vegetative disturbance scale. Somnological function was assessed by polysomnography method. Results. Sleep pathology in obesity was registered in 86% of the patients, including 59% with sleep respiratory disturbances (RD) and typical complaints: poor quality of morning wake-up, morning headache, daytime somnolence. Falling asleep process, sleep continuity, and total sleep length were unchanged, but deep stages of slow-wave sleep (stages 3 and 4) and fast sleep phase (FSP) were deficient. In 27% of the patients, sleep RD were absent, with premature wake-ups as a typical complaint. Objectively, total sleep time reduction, falling asleep and intra-sleep vigilance time increase, sleep structure disturbance, mostly due to frequent wake-ups, decrease of deep stage slow-wave sleep and FSP were observed. No subjective or objective sleep quality disturbances were registered in 14% of the patients. Conclusion. In complex obesity treatment, differential sleep pathology correction is important, including RD management and adequate psycho-pathology therapy

ARTERIAL HYPERTENSION IN PREGNANCY: MECHANISMS OF FORMATION, PREVENTION AND THERAPEUTIC APPROACHES

Arterial hypertension in pregnancy: mechanisms of formation, prevention and therapeutic approaches

The prevalence and course of osteoporosis in patients with cardiovascular diseases

Tsel' issledovaniya. Opredelit' rasprostranennost', techenie i effektivnost' profilaktiki i lecheniya osteoporoza (OP) u patsientov, perenesshikh perelom sheyki bedrennoy kosti. Materialy i metody. Na pervom etape issledovaniya izuchali dannye 117 patsientov (28 muzhchin i 89 zhenshchin posle atravmaticheskogo pereloma sheyki bedrennoy kosti; sredniy vozrast - 76,8±7,4 goda). U vsekh bol'nykh utochnyali, diagnostirovalsya li do pereloma OP, vyyavlyali faktory riska OP v sootvetstvii s mezhdunarodnym minutnym testom. Vtoroy etap - izuchali dve gruppy patsientov: 1-ya gruppa - 396 bol'nykh s arterial'noy gipertenziey (AG) i ishemicheskoy bolezn'yu serdtsa (IBS); 2-ya gruppa -194 patsienta bez somaticheskoy patologii. Patsientam s AG provodili sutochnoe monitorirovanie AD, patsientam s IBS - kholterovskoe monitorirovanie EKG po standartnoy metodike. Krome togo, vypolnyali EkhoKG, izuchali pokazateli lipidnogo obmena. U vsekh patsientov otsenivali uroven' bolevogo sindroma v spine po VAIII, opredelyali mineral'nuyu plotnost' kostnoy tkani (MPK). Zaklyuchitel'nyy etap issledovaniya - metodom sluchay-kontrol' otobran 151 patsient iz 1-y gruppy. V zavisimosti ot vida osteoporoticheskoy terapii patsienty byli razdeleny na 3 podgruppy. Nablyudenie za patsientami provodili v techenie 12 mes, posle chego otsenivali obshchee sostoyanie, dinamiku MPK po dannym densitometrii, dinamiku klinicheskikh i instrumental'nykh priznakov serdechno-sosudistykh zabolevaniy. Rezul'taty issledovaniya. Atravmaticheskiy perelom sheyki bedra u muzhchin otmechalsya v srednem na 7,1 goda ran'she, chem u zhenshchin. Gospital'naya letal'nost' pri perelome sheyki bedra - 6,8%; eshche okolo 25% bol'nykh umirayut v techenie goda. U bol'shinstva patsientov imelas' kardi-ovaskulyarnaya patologiya, po povodu kotoroy oni nablyudalis' u terapevta, pri etom OP ili faktory ego riska do pereloma ni v odnom sluchae ne byli diagnostirovany. Faktory riska OP pri kardiovaskulyarnoy patologii vstrechalis' v 86,6% sluchaev, u patsientov bez takovoy - v 81,4%. Nizkaya MPK vyyavlena u 65,2% bol'nykh s serdechno-sosudistymi zabolevaniyami i sostavlyala pri IBS -1,9 SD, pri AG-1,6 SD, a u patsientov bez kardiovaskulyarnoy patologii etot pokazatel' dostigal -0,9 SD. Pri nekontroliruemoy AG, gipertrofii levogo zheludochka s narusheniem ego sokratimosti poterya MPK bolee vyrazhennaya. Otmecheny prirost MPK i znachitel'noe klinicheskoe uluchshenie sostoyaniya u patsientov s kardiovaskulyarnoy patologiey i OP na fone terapii kal'tsitoninom lososya i preparatami kal'tsiya v sochetanii s vitaminom Ds. Zaklyuchenie. Privedennye dannye rasshiryayut nashi predstavleniya o svyazi kardiovaskulyarnoy patologii so snizheniem MPK. Vysokaya obrashchaemost' patsientov s sosudistoy patologiey k kardiologam, terapevtam, nevrologam trebuet sozdaniya usloviy dlya uluchsheniya diagnostiki OP

ANEMIC PATIENT AT GP’S OFFICE

In contemporary medicine anemia is not just a decrease of hemoglobin level, but risk factor for worse outcome in vascular patients. At the same time anemia usually is not stated in the diagnosis and is not registered in statistic reports. Anemia – is always a complication that is why it always requires diagnostic algorithm to explore the underlying reason. Low hemoglobin level must be always marked by general physician. However in practice this happens just in 25% cases. Due to time deficiency at outpatient visits there is a demand for algorithm to provide GP with. This article concerns such algorithms to investigate the patients with found low hemoglobin level

DEATH CAUSES AND THEIR PREDICTION IN PATIENTS WITH THE ST SEGMENT ELEVATION ACUTE CORONARY SYNDROME AND PRE-HOSPITAL THROMBOLYSIS

Aim. To assess effectiveness and safety of pre-hospital medical treatment in patients with acute coronary syndrome and ST segment elevation (ST-ACS) who are undergoing thrombolytic therapy (TLT); to identify TLT complications and the methods for their prediction.Material and methods. In total, the pre-hospital TLT effectiveness was assessed in 237 patients. The comparison group included 274 patients who did not undergo TLT, due to various reasons. The causes of death by Day 7–10 were analysed.Results. The leading cause of death was cardiogenic shock. In addition, in the main group, indirect myocardial rupture was a cause of death more often than in the comparison group (28% vs. 5,3%). Indirect myocardial rupture was associated with haemorrhagic complications of pre-hospital TLT. The proposed method for predicting TLT complications is based on the TIMI scale: 1–4 points suggest TLT safety; 4–5 points correspond to a higher risk of external myocardial rupture (11,6%), which implies the need to perform TLT under control of blood coagulation parameters; and ≥6 points denote the need to avoid pre-hospital TLT and use a mechanic reperfusion strategy.Conclusion. Among ST-ACS patients, mortality levels were 20,9%, which was 2,4 times higher than in the comparison group. In the main group, the morphological data obtained at autopsy demonstrated hemorrhagic myocardial transformation, which was associated with the high risk of indirect myocardial rupture (28,1%). In patients with pre-existing arterial hypertension and with the time from the ST-ACS onset of 2–3 hours, the risk of indirect myocardial rupture should be predicted, based on the TIMI scale. This will facilitate more effective assessment of the systemic TLT complication risk and selection of the optimal reperfusion strategy

MODERN POTENTIAL IN THE TREATMENT OF METABOLIC SYNDROME PATIENTS - FOCUS ON ENDOTHELIUM

Numerous publications on the use of p-blockers in patients with arterial hypertension (AH) and metabolic syndrome (MS) have reported adverse effects of these medications on carbohydrate and lipid metabolism, as well as reduced cerebral perfusion. This review presents the benefits of a third-generation p-blocker — nebivolol (Nebilet®) — in the treatment of MS patients. The authors refer to their own findings that demonstrate effectiveness and safety of nebivolol monotherapy in individuals with AH and MS. Nebivolol treatment resulted in a sustained reduction of systolic and diastolic blood pressure levels and also improved carbohydrate and lipid metabolism parameters, which beneficially differentiates nebivolol from all other known p-blockers. Nebivolol treatment did not demonstrate any negative effects on thyroid hormone levels and reduced aldosterone levels. Nebivolol-induced increase in the endothelial production of nitric oxide resulted in a significant improvement of cerebral perfusion. Moreover, nebivolol treatment a reduction in mean 24-hour QT interval duration, which was increased at baseline. These findings suggest a beneficial effect of nebivolol on myocardial electrophysiology. Nebivolol appears to be a promising medication in the treatment of patients with MS and AH