Evaluating the Efficacy of Synbiotic Mouthwash in Patients with Dyscirculatory Encephalopathy: Observational Clinical Study

Background. At present, the priority direction of medical science and practice is the prevention of dental diseases, especially in patients with somatic pathology. Patients with dyscirculatory encephalopathy develop a complex of neurological disorders, accompanied by impaired motor functions of hands, lips and chewing muscles, which leads to ineffective cleansing of the oral cavity from food residues and formation of soft and mineralized dental deposits on the dental surface. Therefore, these patients should use additional personal hygiene products.Objective. To evaluate the efficacy of hygienic care in patients with dyscirculatory encephalopathy using mouthwash with synbiotic complex.Methods. An observational clinical study was conducted on the basis of Neurology Unit No. 2 of Research Center of Neurology, Department of Cariology and Endodontics and Department of Biological Chemistry, A.I. Yevdokimov Moscow State Medical and Dental University. The study enrolled 82 patients aged from 45 to 74 years with cerebrovascular disease, dyscirculatory encephalopathy, decompensation (I68.7, according to ICD-10). Patients were divided into two study groups: group 1 (n = 44) — patients who used mouthwash with synbiotic complex; group 2 (n = 38) — patients who did not use mouthwash. The efficacy of mouthwash with synbiotic complex was assessed by using an index score of a simplified Greene Vermillion Oral Hygiene Index (OHI-S), Russell Periodontal Index (PI), Papillary Bleeding Index (PBI), and physicochemical parameters of the oral fluid. Statistical processing of the results was carried out using Stat Plus 7 (Analyst Soft Inc., USA).Results. The comparative analysis proved the efficacy of mouthwash with synbiotic complex. The hygienic status improved to (1.50 ± 0.12) points, the state of periodontal tissues — to (PI = (1.94 ± 1.45) points; PBI = (1.12 ± 0.11) points). The hydrogen index (pH) of the oral fluid decreased to weakly alkaline values — (7.92 ± 0.22) points; the activity of alkaline phosphatase decreased by a factor of 1.4, lactate dehydrogenase — by half, aminotransferases — by a factor of 1.3, and D-dimer — by a factor of 1.2.Conclusion. The obtained results demonstrate the efficacy of mouthwash as an additional means for personal hygiene. Mouthwash with synbiotic complex should be included in the daily oral hygiene care for patients with dyscirculatory encephalopathy

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<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.><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

Current aspects of stable ischemic heart disease. ISСHEMIA study: breakthrough or constant optimism in approaches to treatment. Myocardial ischemia in non-obstructive coronary arteries (INOCA)

Approaches to stable coronary artery disease (CАD) treatment have been subject to debate for a long time. One of the first and fundamental studies in stable coronary artery disease patients treatment is the COURAGE study, which showed the advantage of rational drug therapy in comparison with percutaneous intervention in such patients. However, CAD high prevalence with medical and social significance cause the need for future development of relationship between conservative and invasive approaches in the problem of this disease treatment. It was particularly the focus of recently completed multicentre ISCHEMIA trail. The aim of review is to analyze the available data on the management of stable coronary artery disease patients based on the ISCHEMIA study data. Results. In the largest multicenter randomized clinical trial ISCHEMIA, the primary outcome (cardiovascular death, myocardial infarction, cardiac arrest with effective resuscitation, hospitalization due to heart failure) rate was 13.3% in the routine invasive strategy group and 15.5% in the conservative strategy group (p = 0.34). The main secondary outcome rate also does not differ between groups significantly. Quality of life in the non-invasive group was higher only in those patients who had angina at baseline. Study subanalysis demonstrated that left coronary artery borderline stenosis accompanied by a poor prognosis, and an invasive strategy improves angina symptoms. Also, low density lipoprotein cholesterol target values achievement predictors were determined. In addition, women, participated in ISCHEMIA study had more frequent angina episodes, regardless less extensive coronary artery damage, and less severe ischemia manifestations than men. Among stable CAD accompanied moderate to severe ischemia and severe chronic kidney disease patients, no evidence initial invasive strategy, compared initial conservative strategy, in relation of death or non-fatal myocardial infarction risk reduction was found. Conclusion: ISCHEMIA trial data demonstrated necessity more carefully stable coronary artery disease patients selection for invasive treatment, taking into account angina pectoris severity and modern antianginal therapy possibilities

Vascular pathology in hereditary connective tissue disorders

The large group of hereditary connective tissue disorders includes several hundreds of genetically heterogeneous diseases with systemic connective tissue pathology. The clinical manifestations of the latter are determined by mutation types. Some syndromes are well-known and extensively described (such as Marfan syndrome and Ehlers-Danlos syndrome), while the others have been described only recently and are less known. The clinical presentation of these syndromes typically includes vascular pathology, particularly aortic and arterial disorders, which are the focus of the present review