ОСОБЕННОСТИ ТЕЧЕНИЯ И ПРИВЕРЖЕННОСТЬ ЛЕЧЕНИЮ ПРИ РАЗЛИЧНЫХ ВАРИАНТАХ СТАБИЛЬНОЙ СТЕНОКАРДИИ В СОЧЕТАНИИ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ У ЖИТЕЛЕЙ г. НОВОСИБИРСКА

The purpose. To study clinical and angiographic status, N-terminal pro-brain natriuretic peptide (Nt-proBNP) level and treatment adherence in stable angina associated with hypertension patients (pts).Materials and methods. 151 pts (men) divided into 3 groups were investigated. The 1st group was consisted of 43 men with uncomplicated angina without significant lesions of coronary artery. The 2nd group included 47 men with angina with history of coronary revascularization (percutaneous coronary intervention). The 3rd group included 61 men with angina after previous cardiovascular event (myocardial infarction or stroke).Results. There were less number of current smokers in uncomplicated stable angina group. 3rd group pts took more alcohol drinks before cardiovascular events. Biochemical blood status were compared in three groups. Structure-functional heart parameters were more disturbed in pts with previous cardiovascular events. Coronary arteries were more lesion in complicated angina pts too. Nt-proBNP levels were significantly higher in patients undergoing cardiovascular events. Factors determining in stable angina associated with hypertension were extent of coronary artery lesion, left-atrium, and left-ventricular size, left-ventricular hypertrophy, and ejection fraction. The relationship between Nt-proBNP levels and left ventricular remodelling as well as between Nt-proBNP levels and extent of coronary arteries lesions were revealed. Adherence to treatment was higher in patients underwent percutaneous coronary intervention.Цель. Целью исследования явилось изучение факторов риска, клинико-ангиографической картины, уровня N-концевого фрагмента предшественника мозгового натрийуретического пептида и приверженности лечению при различных клинических вариантах стабильной стенокардии.Материалы и методы. Обследован 151 мужчина со стабильной стенокардией. Больные были разделены на три группы: 1-ю группу составили 43 пациента с неосложненным течением стенокардии с гемодинамически незначимыми стенозами коронарных артерий, 2-ю – 47 пациентов со стабильной стенокардией, подвергшихся чрескожному коронарному вмешательству и 3-ю – 61 пациент со стабильной стенокардией с перенесенным кардиоваскулярным событием (инфаркт миокарда, мозговой инсульт) независимо от характера поражения коронарных артерий.Результаты. Выявлено достоверно меньшее число курящих больных в группе неосложненного течения стенокардии, а больные, перенесшие кардиоваскулярное событие, употребляли в прошлом большее количество алкоголя. Структурно-функциональное состояние миокарда в большей степени изменено у больных стенокардией с наличием кардиоваскулярных событий, у них же имелось более значимое поражение коронарных артерий. Уровень N-концевого фрагмента мозгового натрийуретического пептида был достоверно выше у больных, перенесших инфаркт миокарда, его значения коррелировали со степенью ремоделирования левого желудочка и выраженностью стеноза коронарных артерий. Приверженность лечению оказалась выше у больных, подвергшихся чрескожному коронарному вмешательству

Stable angina with intermedium coronary artery stenosis: the most typical clinical phenotypes

Aim of the study was to investigate the most typical phenotypes and to study cardiovascular risk factors and assess of the clinical angiographic picture in stable angina patients with intermedium coronary artery stenosis. Material and methods. 236 stable angina functional class I–III patients (190 men) aged 49–59 with intermedium (40–70 %) coronary artery stenosis were examined. A general clinical examination, ultrasound examination and coronary angiography were performed. Study design – non-randomized descriptive study of four parallel groups. Differences in the compared parameters were considered statistically significant at p < 0.05. Results. The prevailing phenotypes in stable angina patients with intermedium coronary artery stenosis turned out to be coronary artery disease (CAD) without a previous myocardial infarction (MI); CAD with previous MI less than a 6 months ago; CAD with metabolically unhealthy obesity phenotype (MUOP) without diabetes mellitus (DM), and CAD with DM type 2. Patients of different phenotypes did not significantly differ in the frequency of past MI. CAD and MUOP patients with previous MI were characterized by the earliest age of its occurrence. Despite the 100 % availability of hypertension in different phenotypes groups, in CAD and DM type 2 patients were largest left ventricle myocardium mass values. They also had the most frequently recorded multivessel lesion during the coronary angiography study. Despite ongoing outpatient treatment for one year, the values of lipid and inflammation indices (content of low-density cholesterol, triglyceride, C-reactive protein) were high in all phenotypes patients as well as number of people with insufficient blood pressure control. Conclusions. In stable angina patients with intermedium coronary artery stenosis despite the absence of obstructive coronary artery lesion, the cardiovascular complications risk is due to the presence of 100 % arterial hypertension, high body mass index, significant frequency of obesity, dyslipidemia, carbohydrates metabolism disorders. That is why such patients represent a rather serious group in terms of prognosis. The clinical and angiographic picture, as well as residual risk levels, vary depending on the clinical phenotype

Biological and physical mechanisms of cerebral aneurysms formation, growth and rupture

According to various researchers, the prevalence of unruptured cerebral aneurysms (CAs) in the general population varies from 2 to 5 %. In the vast majority of cases, CAs do not have clinical and neurological manifestations and are discovered incidentally during routine neuroimaging studies. CAs can cause intracranial hemorrhage. As a rule, hemorrhages of this type occur in patients aged 40–60 years. It has been established that about 10–15 % of patients die from an aneurysmal hemorrhage before they receive specialized medical care. Recurrent aneurysmal intracranial hemorrhage is the main cause of high mortality and disability in this group of patients. The search for literature sources in the scientific databases PubMed/Medline, EMBASE, Cochrane Library and eLibrary demonstrated the existence of numerous studies devoted to the study of molecular biology and biophysical mechanisms of formation, growth and rupture of CAs. Combining the results of these studies was the motivation for writing this literature review. The paper reflects in detail the role of inflammation and molecular genetic factors in the growth and rupture of the CAs, and presents the biophysical factors of the rupture of the CAs. The authors pay special attention to the shape, size and coefficient of the CAs as the most important geometric risk factors for the formation and rupture of the CAs. This review presents current data on mathematical modeling of various types of CAs with an assessment of the risk of rupture of the latter, which has found its application in wide clinical practice. The authors also attempted to describe the hemodynamic features in various types of CAs. In turn, the type of blood flow in the CAs cavity largely depends on the size and shape of the latter and the geometry of the carrier artery, which is the basis for preoperative planning and the choice of tactics for surgical treatment of patients with unruptured CAs

MicroRNA level in patients with stable coronary artery disease with borderline coronary artery stenosis

Aim. To assess the level of microRNA (miR) -21, -22, -126, -221 in patients with coronary artery disease (CAD) with borderline coronary artery stenosis depending on comorbidities and sex.Material and methods. We examined 37 patients with class 1-3 stable CAD aged 49-59 years with borderline (40-70%) coronary artery stenosis. The relative level of miRNA was determined using real-time polymerase chain reaction. Statistical analysis was performed using the non-parametric Mann-Whitney U-test. P&lt;0,05 were considered statistically significant. Results. The miR-221 level was higher in the group of patients with stable CAD with borderline coronary artery stenosis with a metabolically unhealthy obesity (MUO) phenotype, but without diabetes (p=0,042). The level of miR-22 and miR-126 was higher in the group of patients with stable CAD phenotype with borderline stenosis and diabetes (p=0,007 and p=0,034, respectively). The analysis of miR levels in stable CAD patients depending on sex, without taking into account the phenotype, found that miR-21 and miR-221 values were higher in men (p=0,021 and p=0,014, respectively). The study of the sex characteristics of miR content in relation to different phenotypes revealed an increase of miR22 levels in men with MUO and diabetes (p=0,048) and an increase of miR-126 levels in women with concomitant diabetes in the comparison both with patients without MUO and diabetes (p=0,018), as well as with MUO and without diabetes (p=0,007). Conclusion. The study of the miRNA level in patients with CAD with borderline coronary artery stenosis is of great interest and reflects a promising direction in diagnosis based on comorbid pathology. Keywords: miRNA, obesity phenotypes, coronary artery disease, borderline coronary artery stenosis. Relationships and Activities: none. 1Novosibirsk State Medical University, Novosibirsk; 2Federal Research Center of Fundamental and Translational Medicine, Novosibirsk; 3E.N. Meshalkin National Medical Research Center, Novosibirsk, Russia.&gt;&lt;0,05 were considered statistically significant.Results. The miR-221 level was higher in the group of patients with stable CAD with borderline coronary artery stenosis with a metabolically unhealthy obesity (MUO) phenotype, but without diabetes (p=0,042). The level of miR-22 and miR-126 was higher in the group of patients with stable CAD phenotype with borderline stenosis and diabetes (p=0,007 and p=0,034, respectively). The analysis of miR levels in stable CAD patients depending on sex, without taking into account the phenotype, found that miR-21 and miR-221 values were higher in men (p=0,021 and p=0,014, respectively). The study of the sex characteristics of miR content in relation to different phenotypes revealed an increase of miR22 levels in men with MUO and diabetes (p=0,048) and an increase of miR-126 levels in women with concomitant diabetes in the comparison both with patients without MUO and diabetes (p=0,018), as well as with MUO and without diabetes (p=0,007).Conclusion. The study of the miRNA level in patients with CAD with borderline coronary artery stenosis is of great interest and reflects a promising direction in diagnosis based on comorbid pathology

Triple coalescence singularity in a dynamical atomic process

We show that the high energy limit for the amplitude of the double electron capture to the bound state of the Coulomb field of a nucleus with emission of a single photon is determined by behavior of the wave function in the vicinity of the singular triple coalescence point.Comment: 3 page

Atrial fibrillation and arterial hypertension in hypothyroid pathology

A special role in the formation of atrial fibrillation in patients with arterial hypertension is played by diseases of the thyroid gland. In any form of hypothyroidism, vascular tone increases, hypervolemia is formed, which leads to changes in blood pressure, myocardial dystrophy and the development of AF. The development and progression of AF affects the lack of thyroid hormones: TH suppresses aldosterone synthesis and stimulates the secretion of atrial and cerebral natriuretic peptide. Therefore, hypothyroidism develops hyperaldosteronism and decreases the content of natriuretic hormone in the blood, which leads to hypervolemia. Atrophic processes in cardiomyocytes are exacerbated by intracellular potassium deficiency, which is caused by hyper aldosteronism characteristic of all types of hypothyroidism. TG plays the role of physiological antagonists of antidiuretic hormone, and their deficiency leads to increased water reabsorption and increases the likelihood of the formation of a volume-dependent form of hypertension, the effect on the endothelium of the cell, releasing vasoactive substances and reducing the sensitivity of adrenoreceptors to the action of catecholamines. In hypothyroidism, almost all soft tissues, including the vascular wall, accumulate in an excessive amount of glycosaminoglycans, which binds sodium ions and water, which leads to swelling of the vascular wall, reduction of nitric oxide production and narrowing of the lumen of arteries and veins. Hyperproduction of thyroliberin, which leads to a decrease in dopaminergic activity of the brain. In addition, hypothyroidism causes thickening of the basement membrane of capillaries and the diffusion of oxygen through their wall is disturbed. The effect of hypothyroidism and drugs used in its treatment on AF is ambiguous. The authors disagree about the course of AF and the frequency of relapse, the risk of complications of AF. All this indicates the need to continue research in this direction.В статье изложен обзор литературы, отражающий преставления о значении гипотиреоидной патологии в развитии фибрилляции предсердий. особую роль в формирование фибрилляции предсердий у больных артериальной гипертонией играют заболевания щитовидной железы. При любой форме гипотиреоза повышается сосудистый тонус, формируется гиперволемия, что приводит к изменению уровня артериального давления, дистрофии миокарда и развитию фибрилляции предсердий. На развитие и прогрессирование ФП влияет недостаток гормонов щитовидной железы: тиреоидные гормоны подавляют синтез альдостерона и стимулируют секрецию предсердного и церебрального натрийуретического пептида. Поэтому при гипотиреозе развивается гиперальдостеронизм и снижается содержание в крови натрийуретического гормона, что приводит к гиперволемии. Атрофические процессы в кардиомиоцитах усугубляются внутриклеточным дефицитом калия, который обусловлен гиперальдостеронизмом, характерным для всех видов гипотиреоза. ТГ выполняют роль физиологических антагонистов антидиуретического гормона,а их дефицит приводит к усилению реабсорбции воды и повышает вероятность формирования объемзависимой формы АГ, влиянию на эндотелий клетки, высвобождающий вазоактивные вещества и уменьшения чувствительности адренорецепторов к действию катехоламинов. При гипотиреозе почти во всех мягких тканях, включая сосудистую стенку, накапливаются в избыточном количестве гликозаминогликаны, который связывает ионы натрия и воду, это приводит к отеку сосудистой стенки, снижению продукции оксида азота и сужению просвета артерий и вен. Гиперпродукция тиреолиберина, которая приводит к снижению дофаминергической активности головного мозга. кроме того, при гипотиреозе происходит утолщение базальной мембраны капилляров и нарушается диффузия кислорода через их стенку. Влияние гипотиреоза и препаратов, используемых при его лечении, на ФП неоднозначно. авторы расходятся во мнении относительно течения ФП частоты развития рецидивов, риска возникновения осложнений ФП. Все это указывает на необходимость продолжения исследований в данном направлении