ФАКТОРЫ РИСКА СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ И ЦЕНТРАЛЬНОЙ ГЕМОДИНАМИКИ У СТУДЕНТОВ-СТАРШЕКУРСНИКОВ

HighlightsThe article examines the prevalence of risk factors for cardiovascular diseases (CVD) and the state of central hemodynamics (CHD) in senior students. Aim. To study the risk factors for CHD and CVD in senior students with the aim of early detection of arterial hypertension (AH) and the implementation of therapeutic and prophylactic measures.Methods. The study involved 223 senior students of medical universities in Moscow aged 20-27 years (the mean age was 22.8±0.17 years). The following cardiovascular risk factors were assessed for each student: age, gender, smoking, physical activity, genetic predispositions; body mass index. The indicators of CHD were studied by volumetric compression oscillometry using a portable automated software-hardware complex for non-invasive research of central hemodynamics (“SHCNIR CHD vco-“Globus” device).Results. The presence of CVD risk factors in senior students was revealed in 52.5% of cases; more than two risk factors were found in 19.3% of cases; 1st degree arterial hypertension (AH) in 11.2% of cases; “white coat hypertension” in 10.8% of cases; genetic predisposition to CVD in 30.0% of cases; overweight in 17.0% of cases; obesity in 5.4% of cases; low physical activity in 23.8% of cases; smoking in 16.1% of cases. An altered CHD profile was found in 62.1% of students. An increase in total peripheral vascular resistance at normal blood pressure levels was noted in 31.8% of cases. Indicators of total peripheral vascular resistance, mean blood pressure, systolic and diastolic blood pressure were significantly higher in the group of students with CHD risk factors.Conclusion. Outpatient follow-up groups should include students with established risk factors for cardiovascular diseases, diagnosed AH, and with altered indicators of CHD. Preventive examinations should include a simple method for studying hemodynamics – compression oscillometry.Основные положенияВ статье исследованы частота факторов риска развития сердечно-сосудистых заболеваний и состояние центральной гемодинамики у студентов старших курсов. Цель. Изучить основные факторы риска сердечно-сосудистых заболеваний (ФР ССЗ) и центральной гемодинамики (ЦГД) у студентов-старшекурсников.Материалы и методы. Обследованы 223 студента старших курсов медицинских вузов Москвы в возрасте 20–27 лет (средний возраст составил 22,8±0,17 года). У каждого студента оценены основные ФР ССЗ: возраст, пол, курение, физическая активность, наследственность, индекс массы тела. Показатели ЦГД исследованы методом объемной компрессионной осциллометрии с помощью портативного автоматизированного программно-аппаратного комплекса неинвазивного исследования центральной гемодинамики (прибор «КАП ЦГ осм-«Глобус»).Результаты. ФР ССЗ выявлены у 52,5% студентов старших курсов, более двух факторов риска обнаружено у 19,3%. Артериальная гипертензия I степени зарегистрирована у 11,2% лиц, артериальная гипертензия «белого халата» – у 10,8%, отягощенная наследственность – у 30,0%, избыточная масса тела – у 17,0%, ожирение – у 5,4%, гиподинамия – у 3,8%, курение – у 16,1% обследованных. Измененный профиль ЦГД обнаружен у 62,1% студентов. Повышение общего периферического сосудистого сопротивления при нормальных уровнях артериального давления определено у 31,8% лиц. Показатели общего периферического сосудистого сопротивления, среднего, систолического и диастолического артериального давления были достоверно выше в группе студентов с ФР ССЗ.Заключение. В группу диспансерного наблюдения необходимо включать студентов не только с установленными ФР ССЗ, выявленной артериальной гипертензией, но и измененными показателями ЦГД. В профилактические осмотры необходимо добавить простой метод исследования гемодинамики – компрессионную осциллометрию

Improved functionalization of oleic acid-coated iron oxide nanoparticles for biomedical applications

Superparamagnetic iron oxide nanoparticles can providemultiple benefits for biomedical applications in aqueous environments such asmagnetic separation or magnetic resonance imaging. To increase the colloidal stability and allow subsequent reactions, the introduction of hydrophilic functional groups onto the particles’ surface is essential. During this process, the original coating is exchanged by preferably covalently bonded ligands such as trialkoxysilanes. The duration of the silane exchange reaction, which commonly takes more than 24 h, is an important drawback for this approach. In this paper, we present a novel method, which introduces ultrasonication as an energy source to dramatically accelerate this process, resulting in high-quality waterdispersible nanoparticles around 10 nmin size. To prove the generic character, different functional groups were introduced on the surface including polyethylene glycol chains, carboxylic acid, amine, and thiol groups. Their colloidal stability in various aqueous buffer solutions as well as human plasma and serum was investigated to allow implementation in biomedical and sensing applications.status: publishe

Therapeutic learning as an organizational technology of tomorrow

BACKGROUND: According to the World Health Organization, global population aging is the main trend in the development of the society on the planet. Russia ranks 116th worldwide in terms of life expectancy. The development and implementation of measures aimed at preserving the able-bodied population of the country and slowing down the current trend of aging of the population with a focus on increasing life expectancy is manifested in national projects such as Health and Demography. Health-saving technologies for prolonging effective professional longevity of medical workers of older age groups will preserve a labor resource of the country and exclude economic losses of the state. AIM: The study aimed to determine the significance of individual risk factors affecting the professional effective longevity of physicians and form a set of measures to prolong the professional competence of physicians of older age groups. METHODS: In this study, the unit of observation is a physician providing medical care in the outpatient segment of Moscow and the Moscow region. The total number of subjects was 378. Sociological, analytical, and statistical methods and the method of organizational modeling were used. The main method was a face-to-face survey that included questionnaire data, questions on training, seniority, category, workload, and information assurance, and two blocks of questions to assess professional competencies and cognitive functions. RESULTS: An age-related decrease in the level of the physicians professional competence. An age-related decrease in the effectiveness of the prescribed treatment. A tendency toward an age-related increase in the proportion of cognitive disorders among physicians. Data analysis showing the need to implement a set of measures aimed at supporting the professional effective longevity of physicians of older age groups. CONCLUSIONS: The organizational technology represented by a complex of measures providing prolongation of professional effective longevity of physicians of older age groups was proposed. Essentially, the organizational technology is the prevention of chronic non-infectious diseases in conjunction with measures to optimize work activities and stimulate the professional competence of the physician. Therapeutic Learning Technology is a parallel annual dispensary examination of physicians of older age groups followed by a therapeutic and rehabilitation course based on the morbidity profile and combined with a cycle of continuing medical education. The therapeutic and rehabilitative course should include older physicians undergoing cognitive training and hemodynamic stabilization. Information support (a block of federally approved training materials, i.e. normative legal acts regulating medical activity, clinical guidelines, video manuals on schools for different categories of patients, and other materials) is placed at the geriatric contact center, providing each physician from the target group with prompt access both for the period of treatment and rehabilitation course and the entire period of the physicians medical activity

A study of bending effect on the femtosecond-pulse inscribed fiber Bragg gratings in a dual-core fiber

Fiber Bragg gratings with different reflection wavelengths have been inscribed in different cores of a dual-core fiber section. The effect of fiber bending on the FBG reflection spectra has been studied. Various interrogation schemes are presented, including a single-end scheme based on a cross-talk between the cores that uses only standard optical components. Simultaneous interrogation of the FBGs in both cores allows to achieve a bending sensitivity of 12.8 pm/m−1, being free of temperature and strain influence. The technology enables the development of real-time bending sensors with high spatial resolution based on series of FBGs with different wavelength inscribed along the multi-core fiber

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

Background: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagonlike peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. Methods: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallelgroup, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. Results: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m2, and duration of T2DM was 9.3±8.2 years. The qualifying ACS wasamyocardial infarctionin83% and unstableangina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. Conclusion: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk. © 2015 Elsevier Inc. All rights reserved

Edoxaban versus warfarin in patients with atrial fibrillation

Contains fulltext : 125374.pdf (publisher's version ) (Open Access)BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 years). The primary efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding. RESULTS: The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority) and 1.61% with low-dose edoxaban (hazard ratio, 1.07; 97.5% CI, 0.87 to 1.31; P=0.005 for noninferiority). In the intention-to-treat analysis, there was a trend favoring high-dose edoxaban versus warfarin (hazard ratio, 0.87; 97.5% CI, 0.73 to 1.04; P=0.08) and an unfavorable trend with low-dose edoxaban versus warfarin (hazard ratio, 1.13; 97.5% CI, 0.96 to 1.34; P=0.10). The annualized rate of major bleeding was 3.43% with warfarin versus 2.75% with high-dose edoxaban (hazard ratio, 0.80; 95% CI, 0.71 to 0.91; P<0.001) and 1.61% with low-dose edoxaban (hazard ratio, 0.47; 95% CI, 0.41 to 0.55; P<0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), and 2.71% (hazard ratio, 0.85; 95% CI, 0.76 to 0.96; P=0.008), and the corresponding rates of the key secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (hazard ratio, 0.87; 95% CI, 0.78 to 0.96; P=0.005), and 4.23% (hazard ratio, 0.95; 95% CI, 0.86 to 1.05; P=0.32). CONCLUSIONS: Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. (Funded by Daiichi Sankyo Pharma Development; ENGAGE AF-TIMI 48 ClinicalTrials.gov number, NCT00781391.)

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN

Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk