[Impact of a learning program on the psychological aspects of quality of life in patients with prosthetic heart valves].

AIM: To evaluate the impact of a learning program on quality of life indicators in patients with prosthetic heart valves (PHV). SUBJECTS AND METHODS: One hundred and twenty-two patients with PHV were examined. A study group consisted of 72 patients who were trained at PHV school; a control group comprised 50 untrained patients. The comparison groups were matched for age, gender, education level, the underlying disease that had been a cause of heart disease, and the type of PHV. The SF-36 questionnaire assessing quality of life was used to evaluate the effectiveness of the learning program. RESULTS: At baseline, before cardiac surgery, the patients with PHV showed low physical and mental health indicators in both groups. At 6-month follow-up, the physical health component was increased by 23.8% in the control group and by 27.4% in the study group trained by the learning program (p < 0.05). Analysis of the scores of each scale of the questionnaire yielded significant results in both groups after 6 months of cardiac surgery (p < 0.05), which showed better quality of life. The comparison groups had significant differences only in the scores of the mental health component. Thus, following 6 months the mental health component was 24.1% higher in the learning program group than in the control one (p < 0.05). CONCLUSION: The learning program for patients with PHV, which is based on the principle of continuity of the in- and outpatient management, contributes to better quality of life mainly due to an improvement in the mental health component.

[Efficacy of the education program in the improvement of treatment compliance in patients with artificial heart valves].

The study included 94 patients with artificial heart valves aged 55.5 +/- 68 years including 47 (50%) with rheumatic heart diseases, 26 (27.7%) with infectious endocarditis, 21 (22.3%) with connective tissue dysplasia. Compliance with the treatment was estimated by the method of S.V. Davydov before and after education. The leading causes of poor compliance was insufficient socio-medical knowledge and dissatisfaction with the prescribed therapeutic regimen. The education program permitted to achieve a 3-fold decrease in the incidence of negative factors affecting compliance and 1.5-fold increase in the frequency of positive factors; socio-medical awareness and satisfaction with the prescribed treatment increased by 45.8% and 37.1% respectively (p < 0.05). The integral index of compliance before education +4.39 +/- 0.09 characterized it as a moderately positive one. It increased to +8.11 +/- 1.23 after education (p < 0.01). It is concluded that the education program based on the principle of continuity of in- and out-patient treatment improved compliance and socio-medical awareness of the patients, promoted their medico-social adaptation, increased satisfaction with the prescribed treatment and its outcome.

[The alpha subunit of glycoprotein hormones as a biochemical marker of pituitary tumors]. / Al'fa-sub''edinitsa glikoproteinovykh gormonov kak biokhimicheskii marker opukholei gipofiza.

Specific radioimmunoassay was developed for detection free glycoprotein hormone alpha-subunit (AS), by using AS prepared from highly purified human thyroid-stimulating hormone (TSH). The assay showed that the basal content of free serum AS in the majority of 24 females with hormonally pituitary tumors secreting somatotropic hormone (STH, growth hormone), prolactin or either and in 24 females with unfunctioning pituitary tumors was significantly higher the mean one in 12 females matched for the same age who had no endocrine diseases (control). The cultured cells of STH- and P-secreting tumors released excessive quantities of free AS along with STH and P into the medium with low glycoprotein holo-hormone levels. The content of AS changed little in 12 patients with non-functioning pituitary tumors despite the greatly increased serum TSH levels in response to the hypothalamic stimulator thyroid-releasing hormone. The findings suggest that free AS secreted into blood in excess despite hypothalamic control may be regarded as a biochemical marker of pituitary tumors.

[Immunoanalysis of free alpha-subunits of glycoprotein hormones in human blood serum and its relationship with pituitary glycoprotein hormones]. / Immunoanaliz svobodnoi alpha-sub"edinitsy glikoproteinovykh gormonov v syvorotke krovi cheloveka i ee vzaimootnosheniia s glikoproteinovymi gormonami gipofiza.

A radioimmunoassay test system has been designed for measurements of free alpha-subunit (AS) of glycoprotein hormones in human blood serum with a sensitivity of 0.15 ng/ml. This test system revealed the absence of a direct correlation between the levels of free AS and levels of glycoprotein hormones in the blood sera of women with various endocrine profile, this being indicative of the specificity of this test system, on the one hand, and, on the other, confirming the possibility of independent secretion by the pituitary of free AS into the blood. Basal blood serum level of free AS in normal subjects is low: 0.9 ng/ml in women aged 17 to 30. The level of free AS secretion in the blood of many patients with nonfunctioning tumors of the pituitary was found increased, this demonstrating the diagnostic significance of measuring free AS as a marker of such tumors.

[Changes in the activity of adenylate- and guanylate cyclase in different rat tissues after chronic administration of ACTH or cortisol]. / Izmeneniia aktivnosti adenilat- i guanilattsiklazy v razlichnykh tkaniakh krys pri khronicheskom vvedenii AKTG ili kortizola.

The state of adenylate and guanylate cyclases in the adrenals, suprarenal fat and ventricular myocardium of the rat was studied under conditions of chronic administration of ACTH or cortisol. By the end of ACTH injections the weight of the adrenals and the DNA content in them increased 6 and 3 times, respectively; both parameters showed a gradual increase. The corticosteroid level in the blood changed throughout the experiment. The changes in the DNA content in the adrenals and in the corticosteroid level in the blood were oppositely directed. This was paralleled with cyclic changes in the basal and stimulated activities of adenylate and guanylate cyclases occurring with a periodicity of 15 days. The peaks of the cyclase activity preceded the increase in the DNA content. Similar cyclic changes in the enzyme activity were observed in the adipose tissue and myocardium. It was supposed that periodic changes in the cyclase activity are the main prerequisites for the growth and replication of cells under conditions of changed hormonal status of the organism.

[Dynamics of adenylate cyclase desensitization during long-term exposure to the hormone]. / Izuchenie dinamiki desensitizatsii adenilattsiklazy pri dlitel'nom deistvii gormona.

The dependence of adrenal gland adenylate cyclase desensitization on the dose of in vivo injected ACTH, the time of occurrence and duration of the enzyme refractory period and the dependence of desensitization on the number of ACTH injections were analyzed. The experiments were carried out on guinea pigs injected with prolonged action preparations of ACTH (4 and 6 units) daily for 1-6 days. Intramuscular injections of ACTH caused adenylate cyclase refraction to the repeated action of the hormone. The effect of desensitization was the most conspicuous within the first few hours after hormone injection. The decrease of adenylate cyclase sensitivity and the duration of this effect were found to depend on the ACTH dose as well as on the number of injections. It has been shown for the first time that a single in vivo injection of 0.9% NaCl causes short-term desensitization of adenylate cyclase to the repeated action of much higher doses of ACTH in vitro, presumably due to endogenous ACTH release in response to weak stress exposure. The periodicity of changes in adenylate cyclase sensitivity upon prolonged hormone administration is discussed. Sensitization of the enzyme upon daily short-term exposure to physiological doses of ACTH (administration of 0.9% NaCl for 6 days) was revealed.

[The role of periodic changes in cyclase and protein kinase activity in the mechanism of the proliferative effect of ACTH]. / Rol' periodicheskikh izmenenii aktivnosti tsiklaz i proteinkinaz v mekhanizme proliferativnogo deistviia AKTG.

A prolonged effect of ACTH on the state of adenylate and guanylate cyclase systems in the adrenal glands of experimental animals was investigated. It was found that in guinea pigs injected with ACTH (4 units daily for 1-50 days) the weight of adrenal glands and the DNA content in these organs increased 2.0-2.5-fold by the end of experiment; the increase in both values was stepwise. The corticosteroid level in the blood varied throughout the experiment: the changes in the DNA content in adrenals and in the corticosteroid content in the blood were oppositely directed. This was accompanied by cyclic changes in the basal and stimulated activities of adenylate and guanylate cyclases and proteinases in the adrenal glands occurring with a periodicity of 6-15 days. The activity peaks for cyclases and protein kinases preceded the rise in the DNA content in the adrenals. A clearcut correlation between the changes in the enzyme activity and the hormone dose was observed. The changes in the basal and stimulated activities of guanylate cyclase seem to be due to the control of cAMP level in the cell (stimulation of cGMP-dependent cAMP phosphodiesterase). Apparently, the periodic changes in the activity of cAMP-dependent protein kinases in the cytoplasmic and nuclear fractions and a relatively high activation of nuclear protein kinases (by 30-60%) in comparison of cytoplasmic ones (8-10%) are related to stimulation of DNA synthesis. It is concluded that the changes in the activity of cyclases and protein kinases play a role in the mechanism of proliferative effect of ACTH.

[Species and organ differences in the activity and regulation of adenylate and guanylate cyclases]. / Vidovye i organnye razlichiia v aktivnosti i reguliatsii adenilat- i guanilattsiklaz.

The activity of adenylate and guanylate cyclases was determined in adrenal, heart, liver and fat tissues of guinea pigs, mice, rabbits and monkeys. The enzymes activities varied markedly depending both on the species and organs. The highest basal activities of adenylate cyclase was observed in all organs of guinea pigs. It was found that organs with low basal level of adenylate cyclase possess high guanylate cyclase. Species variations of the basal and stimulated adenylate cyclase activity may determine the functional activity of an organ: the higher the adenylate cyclase activity, the more intensive steroidogenesis in adrenals, lipolysis in the fat tissue, muscle contraction and nerve impulse conduction in heart.

[Histoxic hypoxia as one of the causes of ventricular fibrillation and decreased myocardial contractility]. / Gistotoksicheskaia gipoksiia kak odna iz prichin fibrilliatsii zheludochkov i ponizheniia sokratitel'noi sposobnosti miokarda

Long-lasting infusions of adrenalin were demonstrated to result in histotoxic hypoxy of the myocardium and its decreased contractility. After a preliminary ligation of several branches of the coronary arteries such situations often caused ventricular fibrillation. The restoration of the myocardial contractility and of the oxydation processes was achieved by the administration of Unithiol, Methionin, Cystein and Succimere. The latter often produce an unusual effect--arrest of ventricular fibrillation and restoration of a normal cardiac rhythm without electric defibrillation. The beneficial effect of these drugs is attributed by the authors to the presence of thiol groups in their structure.