Myocardial strain parameters and autonomic balance in various variants of the postinfarction course in patients receiving high-dose atorvastatin therapy

Aim. To study parameters of left ventricular (LV) strain and heart rate variability (HRV) in patients with ST-segment elevation myocardial infarction (STEMI) in various variants of postinfarction receiving high-dose atorvastatin therapy.Material and methods. The study included 96 patients with STEMI. All patients underwent two-dimensional speckle tracking echocardiography and 24-hour electrocardiographic monitoring with HRV analysis. The included individuals were divided into groups without pathological LV remodeling (R (-), n=57) and with pathological post-infarction LV remodeling (R (+), n=39), the criterion for which was an increase in end-diastolic and/or end-systolic volume >20% and >15%, respectively. Further, depending on the achievement of target low-density lipoprotein cholesterol (LDL-C) (1,5 mmol/l and/or a decrease of more than 50%), the following subgroups were identified: 17 (43,6%) people, who reached target LDL-C levels (group 1), 22 (56,4%) patients, who did not reach target LDL-C levels (group 2). Similar subgroups were identified in the R (-) group as follows: 28 (49,1%) people, who reached target LDL-C levels (group 3) and 29 (50,9%) people, who did not reach target LDL-C levels (group 4).Results. Starting from the 12th week of follow-up, worsening of global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain (p<0,01) was registered in group 2. In group 1, worsening of these parameters was registered only by the 48th week (p<0,01). In group 3, an increase in GLS was revealed by the 48th week (p=0,001), GCS and GRS — by the 12th week (p<0,05). In group 4, favorable changes were observed only in GLS and GCS by the 48th week (p<0,01). A significant change in HRV parameters was observed in group 3. By the 48th week, there was an increase in temporal indicators (SDNN, SDNNi, SDANN, RMSSD, pNN50) (p<0,0001) and total spectrum power (p=0,0001) due to an increase in all frequency indicators (p<0,001), while the index of autonomic balance L/H decreased by 33% (p=0,002). In group 4, only SDNN, SDANN and pNN50 (p<0,05), as well as the total spectrum power (p=0,001) increased, but no change in frequencies. According to intergroup analysis in the acute period of STEMI, group 4 patients had higher HRV than in group 3 (p<0,05).Conclusion. High-dose atorvastatin therapy improves LV strain characteristics and autonomic balance during the rehabilitation period after STEMI

Collection and processing of environmental information in oil and gas production areas and solving other applied problems using active search methods (Review article)

The methods of monitoring the environmental situation as well as the problems of solving related applied environmental and resource problems in hard-to-reach areas of oil and gas production and also in other sectors of the national economy using unmanned aerial vehicles, are investigated. The methods of studying the types and thicknesses of the layers of the underlying surface by probing them with electromagnetic pulses of the radiofrequency range and gamma radiation are considered. Based on the existing theoretical dependencies of the interaction of electromagnetic radiation with the Earth’s surface, diagrams of the passage of electromagnetic waves in the decimeter and centimeter ranges through various landscape structures (snow-ice-water-frozen soil) are presented. It is shown that the use of gamma radiation makes it possible to solve the problem of determining the effective altitude of an aircraft during environmental monitoring due to the high energy of photon radiation and albedo from various surfaces including snow cover. A method for calculating the pollutant content on the underlying surface with a given probability of its reliable detection is presented. It is noted that the reliability of the readings of measuring instruments is significantly influenced by their geometric location on the transport platform. It is shown that the proposed solution is advisable to implement using two unmanned aerial vehicles or as mall-sized unmanned airship. Based on the review, the composition of the technical means of the complex for recognizing the types and thicknesses of layers of contamination of the underlying surface is proposed. A possible methodology for assessing the environmental situation is presented. The results of the work can be used in conducting environmental exploration of infrastructure used for transporting oil and gas resources in conditions of difficult access to it as well as for solving similar military-applied and engineering-construction tasks. At the same time, for the first time, the joint use of the radio frequency range of electromagnetic waves and gamma radiation was proposed. The radio frequency range makes it possible to study the structure of the landscape, and gamma radiation from backscattered ionizing radiation is a type of pollutant, as well as to ensure high accuracy in measuring the distance from the module to the upper layer of the underlying surface

Spiropyrans Containing the Reactive Substituents in the 2H-Chromene Moiety

Some spiropyrans containing functional substituents in the [2H]-chromene part of the molecule were synthesized and their photochromic properties in solution and solid state were investigated. The presence of the formyl group in the [2H]-chromene fragment enhances the possibility to show photochromic properties in solution

Твердофазный синтез отрицательно заряженных олигомеров полиамидных миметиков нуклеиновых кислот

A Boc-protocol for manual solid-phase synthesis of novel sequences of negatively charged oligomeric polyamide mimetics of nucleic acids with a regular structure of the pseudopeptide backbone based on L-glutamic acid and glycine and having various positions of the carbethoxyethyl moiety was developed. Conditions for their cleavage from polymeric carrier, isolation and structure confirmation are presented.Разработан Вос-протокол ручного твердофазного синтеза новых последовательностей отрицательно заряженных олигомеров полиамидных миметиков нуклеиновых кислот с регулярной структурой псевдопептидного остова на основе L-глутаминовой кислоты и глицина и различным положением карбоксиэтильного остатка. Представлены условия для их удаления с полимерного носителя, выделения и доказательства структуры

Преемственность идей и поколений. Исторические факты о деятельности Шереметевской больницы (к 100-летию НИИ скорой помощи им. Н.В. Склифосовского)

BACKGROUND The activities of the Hospice House established by Count N.P. Sheremetev and opened on June 28, 1810, pursued a noble goal to help the suffering, sick and low-income people. However, this intention alone was not enough, and N.P. Sheremetev took care to really ensure the stable work of the Hospice House, providing for both its publicity and reliable state protection.MATERIAL AND RESEARCH METHODS Annual financial statements of the Hospice Board of Trustees for 1862–1866, 1868, 1871, 1872 and 1902 were introduced into scientific circulation for the first time. To prepare the article, archival material was used, including 6 sources, as well as rare publications dated 1859–1927. Research methods: historical-genetic, comparative-historical, problem-chronological and systemic.RESULTS The analysis of the activities of the Sheremetev hospital for 1810–1909 showed that funds were enlarged regularly with increasing amounts from its budget for the treatment of patients, which number was maximum in 1865 (1,798 people), and the lowest in 1814 (127 people).The personnel of the Sheremetev Hospital took an active part in all major military operations with the participation of Russia (the creation of sanitary detachments to provide assistance to the wounded and sick in combat areas, as well as additional beds located on the territory of the hospital itself).The Sheremetev Hospital played an important role in higher medical education in Russia, becoming the clinical base of the Moscow Medical and Surgical Academy, and later of the Faculty of Medicine of Moscow University; many of its employees were teachers of these educational institutions. The high level of teaching was also ensured by equipping the hospital with modern medical devices and the active introduction of the latest medical achievements into its work.On the initiative of chief doctor A.T. Tarasenkov, a department for incoming patients was organized as an independent structure for the first time in Russia. It provided assistance to 175–200 patients per day. The department became the prototype of a comprehensive outpatient network that was subsequently created in our country.The high prestige of the hospital was brought by the activities of its main doctors and operators, tirelessly working to improve the organizational and medical aspects of the provision of qualified medical care.The final period of the hospital’s activity (1910–1923) until the October Revolution was characterized by the greatest volume of medical work, which subsequently decreased dramatically due to financial difficulties. Since 1919, the hospital functioned as a state institution, and also became the base for the revival of the ambulance service in Moscow.CONCLUSION A review of the activities of the Sheremetev Hospital indicates that the organization of emergency medical care for the population of Moscow, pedagogic work, participation in the treatment of the wounded patients, high surgical activity and versatility were the foundation on which its work was widely developed. It is no coincidence that this particular hospital was reorganized in 1923 into the N.V. Sklifosovsky Institute of Acute Care (since 1944 — N.V. Sklifosovsky Research Institute for Emergency Medicine).Economic difficulties and political storms could not destroy what was created at the Sheremetev hospital and was the moral and material basis for the further 100 years of successful activity of the institute.ВВЕДЕНИЕ Деятельность Странноприимного дома, учрежденного графом Н.П. Шереметевым и открытого 28 июня 1810 года, преследовала благородную цель – помогать страждущим, среди которых были больные и малообеспеченные люди. Однако одного такого намерения было мало, и Н.П. Шереметев позаботился о том, чтобы реально обеспечить устойчивую работу Странноприимного дома, предусмотрев как ее гласность, так и надежное покровительство государства.МАТЕРИАЛ И МЕТОДЫ ИССЛЕДОВАНИЯ В научный оборот впервые введены ежегодные финансовые отчеты Попечительского совета Странноприимного дома за 1862–1866, 1868, 1871, 1872 и 1902 годы. Для подготовки статьи привлечен архивный материал, включающий 6 источников, а также раритетные публикации, датированные 1859–1927 годами. Методы исследования: историко-генетический, сравнительно-исторический, проблемно-хронологический и системный.РЕЗУЛЬТАТЫ Анализ деятельности Шереметевской больницы за 1810–1909 годы показал, что из его бюджета регулярно и в возрастающем объеме выделялись средства на лечение больных, число которых было максимальным в 1865 (1798 человек), а наименьшим — в 1814 году (127 человек).Персонал Шереметевской больницы принимал активное участие во всех крупных военных действиях с участием России (создание санитарных отрядов для оказания помощи раненым и больным в районах боевых действий, а также дополнительных коек, размещаемых на территории самой больницы).Шереметевская больница также сыграла важную роль в деле высшего медицинского образования в России, став клинической базой Московской медико-хирургической академии, а позже — медицинского факультета Московского университета; многие из ее сотрудников были преподавателями этих учебных заведений. Высокий уровень преподавания был обеспечен, кроме того, благодаря оснащению больницы современным медицинским оборудованием и активному внедрению в ее работу новейших достижений медицины.В больнице в одной из первых в России по инициативе ее главного доктора А.Т. Тарасенкова было организовано отделение для приходящих больных как самостоятельная структура. В нем оказывалась помощь 175–200 больным в день. Это стало прообразом всеобъемлющей амбулаторно-поликлинической сети, созданной в нашей стране в последующем.Высокий авторитет больнице принесла деятельность ее главных докторов и операторов, неустанно работающих над совершенствованием организационной и лечебной сторон оказания квалифицированной медицинской помощи.Заключительный период деятельности больницы (1910–1923) до Октябрьской революции характеризовался наибольшим объемом лечебной работы, который в дальнейшем резко уменьшился ввиду финансовых трудностей. С 1919 года больница функционировала как государственное учреждение, став также базой возрождения в Москве службы скорой медицинской помощи.ЗАКЛЮЧЕНИЕ Обзор деятельности Шереметевской больницы указывает на то, что организация экстренной и неотложной медицинской помощи населению Москвы, педагогическая работа, участие в лечении раненых, высокая хирургическая активность и многопрофильность явились тем фундаментом, на котором широко развернулась ее работа. Отнюдь не случайно именно эта больница была реорганизована в 1923 году в институт неотложной помощи имени Н.В. Склифосовского (с 1943 года — НИИ скорой помощи им. Н.В. Склифосовского).Экономические трудности и политические бури не смогли разрушить того, что было создано в Шереметевской больнице и явилось нравственной и материальной основой дальнейшей 100-летней успешной деятельности института

Коморбидность туберкулеза, алкоголизма и наркомании

One of the reasons of growing incidence of tuberculosis (TB) is spread of AIDS, drug dependence, and alcoholism. To investigate their mutual influence the authors examined 185 lung TB patients (of them, 124 males) admitted to TB hospitals of St-Petersburg in 2003-2005. Inclusive criteria were age of 18 to 79 yrs, recent admission to the hospital, the patient's consent to participate the study. Patients were excluded if they were severely ill or had psychiatric disorders. The lung TB was evaluated using medical history, physical, clinic, laboratory, radiologic, and bacteriologic data. Alcohol and drug abuse was assessed with Addiction Severity Index (ASI), retrospective analysis of alcohol and substance use for previous 90 days, Michigan Alcohol Screening Test (MAST), measurement of alcohol in exhaled air and detection of substances in urine. Somatic and psychic health was evaluated using ASI, Beck Depression Inventory, and Spielberger Trait Anxiety Inventory. Risk of HIV-infection was determined in a test of HIV risk assessment and with HIV risk questionnaire developed at Johns Hopkins University. The average age of the participants was 40.5 yrs. More than 60 % of them had abuse-related disorders: alcohol abuse in 51.9 %, alcoholism plus drug dependence in 8.6 %, and drug dependence in 3.8 %. Alcohol dependence facilitated development of TB multiple drug resistance (21 % vs 7.6 % in patients without alcohol dependence, p < 0.05), extensive (73.9 % and 40.9 %, respectively, p < 0.001) and chronic (28.6 % and 16.7 %, respectively) forms of TB. Most of TB patients with abuse-related disorders tended to have psychiatric disorders (depression, anxiety). The risk of HIV-infection was significantly higher in TB patients with drug abuse (3.51 vs 0.07). Thus, it is necessary to consider co-morbidity in TB patients for more effective treatment of lung tuberculosis.Одной из причин роста заболеваемости туберкулезом является распространение СПИДа, наркомании и алкоголизма. С целью изучения взаимного влияния этих заболеваний обследованы 185 больных туберкулезом органов дыхания (124 мужчины), находившихся в стационарах г. Санкт-Петербурга в 2003–2005 гг. Критериями включения в исследование были возраст от 18 до 79 лет, недавнее поступление в стационар и согласие больного на участие в исследовании. Из исследования исключались больные в тяжелом состоянии и больные с выраженными психическими расстройствами. Для оценки туберкулезного процесса анализировали анамнез, данные физикального, клинико-лабораторного, рентгенологического и бактериологического обследований. Для определения употребления алкоголя и наркотиков оценивали индекс тяжести зависимости (ИТЗ), ретроспективно анализировали употребление алкоголя и наркотиков за 90 дней, проводили Мичиганский алкогольный скрининг-тест (МАSТ), определяли алкоголь в выдыхаемом воздухе и наркотики в моче. Для оценки соматического и психического здоровья использовали ИТЗ, вопросник депрессии Бека, шкалу тревоги Спилбергера. Риск ВИЧ-инфекции устанавливали в тесте оценки степени риска ВИЧ-инфекции (ТОСР) и по вопроснику риска ВИЧ-инфекции, разработанному университетом Дж. Хопкинса. Средний возраст обследованных больных составил 40,5 лет. Более 60 % больных имели наркологическую патологию (злоупотребление алкоголем в 51,9%, алкоголизм в сочетании с наркоманией в 8,6 %, наркомания в 3,8 %). Алкогольная зависимость способствовала развитию множественной лекарственной устойчивости (21 против 7,6 % у больных туберкулезом без наркологической патологии, p < 0,05), развитию распространенных (73,9 и 40,9 % соответственно, p < 0,001) и хронических (28,6 и 16,7 % соответственно) форм заболевания. Большинство туберкулезных больных с наркологическим диагнозом склонны к психическим расстройствам (депрессии, тревожные состояния). Риск ВИЧ-инфекции у больных туберкулезом, употреблявшим наркотики, был существенно выше (3,51 против 0,07). Таким образом, для улучшения эффективности лечения туберкулеза у наркологических больных необходимо учитывать все стороны коморбидности указанных патологий

Influence of status of heart rate autonomic control on the course of the post-infarction period and cardiac rehabilitation

Aim. To study the effect of heart rate variability parameters recorded in the acute ST-segment elevation myocardial infarction (STEMI) on the prognosis; to study laboratory and functional markers of heart failure. Material and methods. The study included 199 people. The comparison group of 79 healthy volunteers was necessary to determine the normal ranges of heart rate variability. One hundred and twenty patients on the 7th-9th day, the 24th and the 48th week of STEMI underwent a 12-lead Holter monitoring with an assessment of time parameters of heart rate variability. In the same periods, blood tests for brain natriuretic peptide (BNP) and highly sensitive C-reactive protein (hs-CRP) were performed every 12 weeks. Observations evaluated the distance in the 6-min walk test, as well as the quality of life using the Minnesota and Seattle questionnaires.Results. Depending on the values of heart rate variability on the 7th-9th day, all patients with STEMI were divided into 2 groups: group “S” — with a sympathetic predominance, group “N” — with balanced neurohumoral effects. We revealed twofold BNP decrease in group “H” patients by 24th week and subsequent visits. In group “S” patients, BNP levels remained high throughout the observation period. The level of hs-CRP returned to normal range by 24th week of observation in all patients. Tolerance to physical activity in group “S” was initially lower than in patients of group “H”, but by the 48th week the walking distance gradually became equal in both groups. The prevalence of ventricular tachycardia and the quality of life between groups did not statistically differ. The risk of recurrent cardiovascular events and deaths in group “S” was significantly higher than that in group “H”. Conclusion. Enhanced sympathetic activity on the 7th-9th day of STEMI was associated with an increased risk of recurrent cardiovascular events, and also adversely affected changes of heart failure laboratory markers — BNP and hs-CRP