Some results of cislunar plasma research

The main results of plasma cislunar investigations, carried out during Luna-19 and Luna-22 spacecraft flights by means of dual frequency dispersion interferrometry, are briefly outlined. It is shown that a thin layer of plasma, with a height of several tens of kilometers and a maximum concentration of the order 1,000 electrons/cu cm exists above the solar illuminated lunar surface. A physical model of the formation and existence of such a plasma in cislunar space is proposed, taking into account the influence of local magnetic areas on the moon

The nighttime ionosphere of Mars from Mars-4 and Mars-5 radio occultation dual-frequency measurements

Dual frequency radio sounding of the Martian nighttime ionosphere was carried out during the exits from behind the planet of the Mars-4 spacecraft on February 2, 1974 and the Mars-5 spacecraft on February 18, 1974. In these experiments, the spacecraft transmitter emitted two coherent monochromatic signals in decimeter and centimeter wavelength ranges. At the Earth receiving station, the reduced phase difference (or frequencies) of these signals was measured. The nighttime ionosphere of Mars measured in both cases had a peak electron density of approximately 5 X 1,000/cu cm at an altitude of 110 to 130 km. At the times of spacecraft exit, the solar zenith angles at the point of occultation were 127 deg and 106 deg, respectively. The height profiles of electron concentration were obtained assuming spherical symmetry of the Martian ionosphere

Advanced results of Fortelyzin® use in the FRIDOM1 study and real clinical practice

Aim. To study the effectiveness of Fortelyzin® in subgroups with different body weights in patients with ST-segment elevation acute myocardial infarction (STEMI) in the FRIDOM1 study and real clinical practice.Material and methods. Fortelyzin® was administered in a single-bolus dose of 15 mg over 10 seconds, regardless of the body weight of patients. Metalyse® was administered in a single-bolus dose of 30-50 mg over 10 seconds, depending on body weight. The one-year results of the FRIDOM1 study were evaluated by the clinical centers using telephone contact. Monitoring of Fortelyzin® use was carried out by inpatient physicians, emergency doctors and paramedics by filling out a monitoring sheet in the period from June 2013 to December 2021 in 19243 patients with STEMI.Results. In the FRIDOM1 study, the distribution of patients depending on body weight in the Fortelyzin® (n=190) and Metalyse® (n=191) drug groups was as follows: up to 60 kg — 4 people each (p=1,00); from 60 to 70 kg — 21 and 23 (p=0,87); from 70 to 80 kg — 39 and 43 (p=0,71), from 80 to 90 kg — 63 and 47 (p=0,07); from 90 to 100 kg — 30 and 41 (p=0,19); over 100 kg — 33 people (p=1,00) in each group. The effectiveness of thrombolysis according to electrocardiographic (ECG) data in the Fortelyzin® and Metalyse® groups was as follows: up to 60 kg — 75% each (p=1,00); from 60 to 70 kg — 76% vs 83% (p=0,72); from 70 to 80 kg — 82% vs 86% (p=0,76); from 80 to 90 kg — 81% vs 77% (p=0,64); from 90 to 100 kg — 80% vs 81% (p=1,00); over 100 kg — 79% vs 76% (p=1,00); in total — 80% vs 80% (p=0,87). The effectiveness of thrombolysis according to coronary angiography (CAG) (TIMI 2-3) in the Fortelyzin® and Metalyse® groups was as follows: up to 60 kg — 100% vs 50% (p=0,43); from 60 to 70 kg — 81% vs 67% (p=0,48); from 70 to 80 kg — 74% vs 84% (p=0,41); from 80 to 90 kg — 70% vs 72% (p=1,00); from 90 to 100 kg — 67% vs 66% (p=1,00); over 100 kg — 58% vs 64% (p=0,80); in total — 70% vs 71% (p=0,76). The one-year survival rate in the FRIDOM1 study in the Fortelyzin® and Metalyse® groups was 94% (p=0,91). The administration of Fortelyzin® in patients with STEMI caused blood flow restoration according to ECG data in 14624 of 19243 patients (76%), while according to CAG (TIMI 2-3) — in 3422 of 4805 patients (71%). Inhospital mortality was 5% (n=962), while intracranial hemorrhage developed in 0,5% (n=92).Conclusion. The use of Fortelyzin® in the FRIDOM1 study and in real clinical practice in a single-bolus (10 sec) dose of 15 mg in patients with STEMI with any body weight showed its high efficacy and safety, including at the prehospital stage

МРТ С ПАРАМАГНИТНЫМ КОНТРАСТНЫМ УСИЛЕНИЕМ В СТРУКТУРНО-ВРЕМЕНН>ОЙ ОЦЕНКЕ ПОВРЕЖДЕНИЯ МИОКАРДА ПРИ ОСТРОМ ИНФАРКТЕ И ДОГОСПИТАЛЬНОЙ ТРОМБОЛИТИЧЕСКОЙ ТЕРАПИИ

Purpose: to evaluate the dependence of absolute and relative thickness of damaged myocardium in the acute myocardial infarction (AMI) area from the time interval between oncet of pain and start of intravenous thrombolysis (so-called “pain–needle time”), in AMI patients treated with prehospital intravenous thrombolysis  and also later on with subsequent percutaneous coronary angiplasty (PCA) and stenting, using contrast-enhanced MRI of the heart Materials and methods. The study comprised data of CE-MRI studies in 25 patients with theyr first acute myocardial infarction, in whom the pre-hospital thrombolytic therapy (TLT) was carried out in the course of 35–300 min after onset of chest pain, with coronarography and percutaneous coronary angioplasty and stenting after admission to the institute of cardiology. In six patients the TLT was not success ful and in these the restoration of coronary blood flow was obtained only at PCA. In all patients in terms 18–34 hours after TLT the CE-MRI of the heart was carried out using gadobutrol or gadoversetamid, as 0.1 mM per kg of BW, in T1-weighted mode with fat suppression and as inversion-recovery with inversion time adjusted to get the normal myocardium “nulled”. We calculated the segmental extension of damage, the thickness of infarcted irreversibly damaged myocardium and of non-damaged myocardium in the same locations, the index of transmurality, as ratio of thickness of damaged myocardium to the overall wall thickness. We analyzed the dependence of these indices of damage from the time interval between pain oncet and beginning of intravenous thrombolytic therapy (or PCA – when TLT was unsuccessful).Results. The dependence of thickness of non-damaged myocardium from the “pain-needle” time  was as exponential as Y = 2.08 + 17.11 · exp(−t/42.4), r = 0.843, p < 0.002. Index of transmurality did depend on the time interval “pain – needle” as Boltzmann function, pretty closely to reverse exponential one:                                                 No-reflow zone with absent blood flow in the infarcted area was present only in cases with the “pain–needle” time interval over 70 min. Later on the full or partial restoration of contractility in infarcted segments was observed only if the IT was below 0.55–0.6.Conclusion. CE-MRI delivers adequate quantitative estimates of anatomic transmural extent of myocardial infarction from early acute period of the AMI. The depth of myocardial damage is a function of “pain–needle” time and approaches the half of wall thickness for as short as 55–65 min, determining by this the future prognosis of the mechanical restitution of contractility in the infarcted region. It is suggested the CE-MRI of the heart must be carried out in every patient in whom due to AMI the thrombolytic therapy and/or percutaneous coronary angioplasty has been done, for unbiased  myocardium-focused control of efficiency of restoration of coronary arterial patency. Цель исследования: оценить зависимость абсолютной и относительной толщины инфарктного повреждения миокарда от времени “боль–игла” у пациентов, получавших при остром инфаркте раннюю догоспитальную тромболитическую терапию (ТЛТ) с последующей чрескожной баллонной ангиопластикой (ЧКВ) инфарктсвязанной коронарной артерии, с постановкой стента по данным МРТ с парамагнитным контрастным усилением (ПМКУ).Материал и методы. В исследование вошли результаты МРТ с ПМКУ 25 пациентов с внезапно развившимся первичным инфарктом миокарда, которым выполнялся догоспитальный тромболизис в течение 35–300 мин после начала тяжелых “инфарктных” болей с последующей коронарографией и стентированием непосредственно после доставки и госпитализации в отделение неотложной кардиологии. У 6 пациентов тромболизис был неэффективен и им реканализация коронарных артерий было осуществлена только при ЧКВ. Всем пациентам в срок 18–34 ч после ТЛТ была выполнена МРТ с ПМКУ (гадобутрол или гадоверсетамид как 0,1 мМ на 1 кг массы тела) в Т1-взвешенном режиме с подавлением сигнала от жира или как инверсия-восстановление с подбором времени инверсии до обнуления сигнала здорового миокарда. Рассчитывались посегментная распространенность повреждения, толщина инфарцированного необратимо поврежденного миокарда, толщина неповрежденого миокарда в области инфаркта, показатель трансмуральности повреждения – как отношение глубины повреждения к толщине стенки в целом. Анализировалась зависимость тяжести повреждения от времени “боль–игла” – между началом болей и введением тромболитика или (при безуспешности ТЛТ) – ЧКВ.Результаты. Зависимость между толщиной оставшегося неповрежденного миокарда и временем носила убывающий экспоненциальный характер вида Y = 2,08 + 17,11 · exp(−t/42,4), r = 0,843, p < 0,002. Индекс трансмуральности, характеризовавший относительную глубину повреждения миокарда в зоне инфаркта, зависел от времени “боль–игла”, близким к обратной экспоненте образом, как:Зона с отсутствующим кровот оком и микро- или макрогеморрагиями в толще инфарцированного миокарда формировалась только при величине времени “боль– игла” более 70 мин. Впоследствии полное или частичное восстановление сократимости в инфарцированных сегментах происходило только в случае трансмуральности повреждения менее 0,55–0,6. Заключение. МРТ с ПМКУ позволяет точно оценить анатомическую распространенность повреждения миокарда в остром периоде инфаркта. Глубина повреждения миокарда в зоне инфарктсвязанной артерии, характеризуемая индексом трансмуральности, определяется временем “боль–игла” и достигает половины толщины стенки левого желудочка за 45–55 мин, что определяет эффективность последующего восстановления функции области инфаркта. Предположено, что МРТ сердца с ПМКУ должна выполняться всем пациентам с острым инфарктом миокарда, которым осуществляются реканализирующие коронарное русло вмешательства, для контроля миокардиальной эффективности восстановления кровотока

CORONARY REPERFUSION IN ST ELEVATION MYOCARDIAL INFARCTION: PROBLEMS AND SOLUTIONS

The article analyzes a comparative efficacy of pharmacoinvasive reperfusion and primary percutaneous intervention in patients with ST elevation acute myocardial infarction in real clinical practice with fulfillment of Guidelines for the “first-medical-contact — balloon time”. The problem of choice is underlined on the most effective reperfusion method by emergency teams. The data is provided on a novel medication — non-immunogenic staphylokinase made in Russia (Fortelyzin®). The detailed analysis has been done on hospital mortality in myocardial infarction in Russian and abroad hospitals

PRIMARY ANGIOPLASTICS AND PHARMACOINVASIVE REPERFUSION IN MYOCARDIAL INFARCTION: IMPACT ON CLINICAL OUTCOMES AND NO-REFLOW PHENOMENON

Aim. To compare efficacy and safety of primary angioplastics and pharmacoinvasive revascularization in patients with acute myocardial infarction with ST elevation in the modern moderately urbanized city. Material and methods. To achieve the aim we randomized 326 patients with acute myocardial infarction with ST elevation and without cardiogenic shock during first 6 hours of the disease during prehospital stage into 2 groups: patients of the 1st group (n=162) transported to primary angioplastics, patients of the 2nd group (n=164) underwent prehospital thrombolysis with further rescue or delayed angioplastics, depended on the thrombolysis results. The clinical and anamnestic properties of patients were analyzed, timing and efficacy of reperfusion strategies, no-reflow occurrence, left ventricle ejection fraction (LVEF) and clinical course of the disease.Results. The time from pain onset to the emergency call and to the first medical contact (emergency team arrival) the groups did not differ. Reperfusion rate after thrombolysis in pharmacoinvasive strategy group reached 71,3%, and mean time of reperfusion — 86,1±32,1 min. In patients with non-effective thrombolytic therapy time from the drug load to angioplastics was 152,6±95,1 min. Primary angioplastics was performed in 117,02±42,3 min from the first medical contact. Therefore, total duration of myocardial ischemia in groups did not differ and was 232±71,6 min and 236±138,2 min in I and II groups, respectively.In-hospital mortality was 5,6% and 4,9%, resp. However the mechanisms of death differ: in primary percutaneous intervention (PCI) the death was due to cardiogenic shock: 89% vs. 37,5% (p <0,05), but in pharmacoinvasive reperfusion more often myocardium ruptures developed: 37,5% vs. 0% (p <0,05). In the II group there was a decrease of no-reflow development during delayed PCI comparing to primary PCI: 1,2% vs. 11,1% (p <0,05); more common TIMI-3 blood flow achievement after PCI: 80,5% vs. 71,2% (p<0,05), and more effectively preserved LVEF : 56,5±10,2% vs 53,6±9,1% (р<0,05).Conclusion. With estimated time for primary PCI wait about 120 min. after first medical contact, i.e. at the threshold of possible delay, the preferable is prehospital thrombolysis with PCI according to guidelines, because this reperfusion method more effectively saves LVEF

COMPARATIVE EFFICACY OF ENZYME MEDICATION WITH THROMBOLYTIC EFFECT IN ATRIUM THROMBOSIS AND SPONTANEOUS ECHO-CONTRAST PHENOMENON IN PATIENTS WITH ATRIAL FIBRILLATION

Aim. To assess efficacy of Thrombovazim® in combination antithrombotic therapy in atrial fibrillation (AF) with intra-atrial clots of spontaneous echo-contrasting found by echocardiography.Material and methods. Totally 28 patients included with persisting atrial fibrillation: 20 with thrombosis of the left atrium appendage and 8 with the phenomenon of spontaneous echo-contrasting of II-III grate in atrium by transesophageal ultrasound contrast study (TEECS). Among patients with left appendage thrombosis there were 15 men and 5 women, mean age 60,3±1,6. Among those with spontaneous echocontrasting — 4 men and 4 women, mean age 58,2±1,2. After detecting the thrombus or spontaneous echo-contrasting phenomenon all patients were prescribed Thrombovazim® in dosage 800U t.i.d. for 7 days with standard warfarin therapy.Results. On the control TEECS at the 8th day of therapy among 20 patients with previously diagnosed left appendage thrombosis in 19 were found the absence of clots. Level of total fibrinogen and soluble fibrin-monomers complexes in Thrombovazim® intake did not change. In all patients with spontaneous echocontrasting phenomenon after Thrombovazim® course this phenomenon still existed, so Thrombovazim® was not effective in this phenomenon elimination. There were no side effects of Thrombovazim®.Conclusion. In atrial fibrillation patients and thrombus in left atrium appendage the use of Thrombovazim® 800U t. i.d. per os at the background of standard therapy by warfarin during 7 days in 95% leads to the lysis of clots without side effects. In spontaneous echo-contrasting phenomenon in atrial fibrillation Thrombovazim® 800U t. i.d. per os with standard therapy for 7 days does not lead to this phenomenon elimination. The lack of effect of Thrombovazim® in the phenomenon of spontaneous echo-contrasting indirectly suggests that there are not fibrin strands in this phenomenon

Fortelyzin® in comparison with Metalyse® for ST-elevated myocardial infarction: one-year results and clinical outcomes of a multicenter randomized study FRIDOM1

Aim. Evaluate the one­year results and clinical outcomes of a multi­center randomized clinical trial FRIDOM1.Material and methods. The study FRIDOM1 was conducted in 11 clinical centers of the Russian Federation in the period 2014­2016. The study included 382 patients with acute ST­elevated myocardial infarction (STEMI), who were randomly divided into the Fortelyzin® and Metalyse®. Thrombolysis was accompanied by anticoagulant and dual antiplatelet therapy followed by percutaneous coronary intervention (PCI). One­year patient status, all­cause mortality, including cardiovascular diseases (CVD), hospitalization, and one­year survival were assessed by telephone contact.Results. The one­year patient status was determined in 186 out of 191 (97,4%) in the Fortelyzin® group and in 185 out of 191 (96,9%) patients in the Metalyse® group. One­year all­cause mortality was 5,9% and 6,5% in the Fortelyzin® and Metalyse® groups, respectively (p=0,83; OR 0,91; 95% CI — 0,42­1,98). One­year mortality from CVD in the Fortelyzin® group is 5,4%, in the Metalyse® group — 6,5% (p=0,67; OR 0,83; 95% CI — 0,37­1,83). All­cause mortality between 30 days and 1 year in the Fortelyzin® group was in 2,2% of patients, CVD — in 1,6%, in the group of Metalise® mortality was in 2,7% of patients (all — CVD). One­year survival was 94,1% and 93,5% in the Fortelyzin® and Metalyse® groups, respectively.Conclusion. The one­year results of the FRIDOM1 study showed the efficacy and safety of a single bolus administration of Fortelyzin® as part of a pharmaco­invasive strategy for treating patients with STEMI, as well as clinical outcomes that are comparable with Metalyse®, including high survival rates and low CVD mortality