[The cytoprotective role of endogenous heat shock proteins during the treatment of patients with acute coronary syndrome].

The study involving 48 patients with the preliminary diagnosis of acute coronary syndrome aged 54-78 years included analysis of clinical, laboratory and instrumental data for subgroups with different definitive diagnosis (myocardial infarction and unstable angina in 28 and 22 patients respectively). On the whole, the mean content of HSP-70 at admission averaged 2.1 ± 0.3 ng/ml and decreased to 1.6 ± 0.4 ng/ml (p < 0.05) after therapy. In the subgroup with myocardial infarction, the HSP-70 level (1.6 ± 0.4 ng/ml) was significantly lower than in patients with unstable angina (2.1 ± 0.3 ng/ml); p < 0.05. The reduced HSP-70 level associated with a severe myocardial lesion gives evidence against the hypothesis of these proteins as markers of myocardial dysfunction whereas a rise in their content at the onset of ischemic process suggests their protective role.

[Dynamics of echocardiographic index in aquanauts during the period of long-term effects of deep diving (to 500 m)].

The authors presented the echocardiography and doppler sonography of aquanauts during the period of long-term effects of deep diving (to 500 m). According to the analysis of the given data the following was revealed: imperceptible atrium distensibility, left ventricular concentric remodeling without myocardial hypertrophy, saving of general and regional myocardial contractile function, left ventricular diastolic dysfunction grade 1, intact right ventricle, orthoarteriotony in pulmonary artery, change of size and distensibility of the aortic root. The authors came to conclusion that there are 2 different process in the structural ventricular remodeling during the period of long-term effects of deep diving--envolving myocardial consolidation and heart chamber dilation. These two processes is connected with temporary factor atypical for natural age dynamic. The aortic root has a atherosclerotic change and distensibility. There is no further dynamic distensibility. The abovementioned changes in heart and aorta can progress in aquanauts, which have too many dives. Patients in the study group haven't dived over the years, but nevertheless have the abovementioned changes.

["Diver's lung": features of respiratory system remodeling in Navy aquanauts in long-term period after deep saturation dives].

It is established that after the termination of deep saturation dives reorganization of respiratory system at navy aquanauts proceeds. This remodeling is specific, atypical for natural age dynamics.

[Rheumatic fever].

This lecture-style paper highlights all major problems pertinent to rheumatic fever Definition of acute RF and chronic rheumatic heart disease is proposed and desirability of the use of these terms in clinical practice is explained. Present-day epidemiology of RF is described with reference to marked differences in its prevalence in developed and developing countries. Modern classification of acute RF is described as adopted by the Russian Association of Rheumatologists and recommended for the use in Russian medical facilities. Discussion of etiological issues is focused on such virulence factors as beta-hemolytic streptococcus A and genetic predisposition confirming hereditary nature of RE Its clinical features are described along with laboratory and instrumental methods applied for its diagnostics. Large and small diagnostic criteria of RF are considered. Special attention is given to the treatment of RF and its complications (antibiotic, pathogenetic, and drug therapy). Its primary and secondary prophylaxis is discussed in detail, preparations for the purpose are listed (with doses and duration of application). In conclusion, criteria for the efficacy of therapy are presented along with indications for hospitalization and emergency treatment.

[Use of SPECT-scanning of the heart in estimating of influence of drugs of the background therapy of ischemic heart disease on myocardial perfusion].

Some new facts about the influence of different groups of drugs on myocardial perfusion were educed during the research. Educed facts conduce representation extension by matching the optimal therapy of ischemic heart disease. With the help of SPECT-scanning were educed myocardial blood flow, areas of maximal hypoperfusion and its influence on time pattern and redistribution of myocardial blood flow in patients receiving disease-modifying agents and statins. Some regularities of change of myocardial blood flow depending on applied group of drugs and peculiarities of influence of myocardial perfusion in certain time interval were revealed. Criteria with prognostic significance in prospective individual effectiveness of anti-ischemic drugs were pointed out. New approach, based on choice of anti-ischemic therapy depending on extent of influence on myocardial perfusion and also individual clinical and functional traits of patients, was applied.

[The role of dynamic perfusion scyntiography of myocardium at rest and during exercise in the assessment of the clinical course of chronic cardiac failure and angina of effort in patients with stable forms of coronary heart disease].

The ever-growing morbidity, disablement, and mortality from coronary heart disease, chronic cardiac failure dictate the necessity of the search for new methods to verify, and evaluate prognosis of the clinical course of these diseases. Currently, myocardial perfusion scintiography is most widely used for the purpose.

[The indices of biological age and early aging in the liquidators of the consequences of radiation accidents].

The researches of biological age and rates of aging of liquidators of the sequels to radiation accidents were carried out. The biological age (BA) index can serve as a characteristic of social-hygienic factors influence on state of health of the officers and veterans of special risk subdivisions, liquidators of the sequels to radiation accidents. Chronic diseases exert influence on the biological age and proper biological age (PBA) index, increase mean value of BA-PBA index, bring contribution into acceleration of human organism aging. A direct connection between increase of functional class of the BA and duration of service in the Navy and ships was revealed. It was ascertained that radiation influence was a factor that increased the BA and rates of aging of liquidators of the sequels to radiation accidents.

[Analysis of maintenance therapy in hospitalized patients with exacerbation of bronchial asthma: a six-year observation].

The subjects of the study were 504 patients with bronchial asthma (BA) exacerbation, hospitalized in Saint Petersburg Hospital #32 in 1997 - 2004; the maintenance therapy in these patients was analyzed. Severe exacerbations were diagnosed in 256 (51%) of the patients, moderate--in 200 (40%), and mild--in 48 (9%). The study revealed that 78% of patients had been given instructions on their preventive anti-inflammatory therapy, informed about the doses of medications and the duration of the therapy. However, only 13% of the patients received anti-inflammatory therapy that was adequate to the severity of the illness, and only 32% of all the patients demonstrated correct technique of using meter dose inhalers. Correlations (p < 0.05) were established between these factors and poorer asthma control (R = -0.07) and the severity of the exacerbations (R = -0.41). Seventy-seven per cent of BA patients hospitalized for severe exacerbations either did not received inhaled glucocorticosteroids (IG) or received them irregularly, and only 8% of the patients received adequate anti-inflammatory therapy. The main causes of inadequate therapy were low compliance (46%) and poor level of patients' knowledge (22%). Unavailability of medications was reported only by 29% of the patients. The main cause of poor compliance was fear of corticosteroid therapy side effects; and the most common scenario of not following physician's recommendation was premature discontinuation of IG therapy. In conclusion, the rational way of the maintenance therapy optimization is correct choice of preventive anti-inflammatory medications and adequate inhalation delivery systems, patients' education, and overcoming of poor compliance at hospital stage. This is of particular importance in frequently hospitalized patients with BA.

[Efficacy of nebulized budesonide in severe exacerbation of bronchial asthma]. / Effektivnost' nebulizirovannogo budesonida pri tiazhelom obostrenii bronkhial'noi astmy.

The study was undertaken to examine the clinical effectiveness of nebulizer inhalations of budesonide suspension during severe attacks of bronchial asthma (BA) and the possibility of its use versus systemic glucocorticosteroids (GCSs). Sixty-eight patients admitted for a severe attack of BA were examined. The forced expiratory volume per sec (FEV1) was less than 40% and the peak forced expiration rate (PFER) was less than 150 l/min. First-line therapy included inhaled salbutamol (5-10 mg within 1.5-2 hours), oxygen, and intravenous prednisolone (120 mg). Thirty-two patients showed a good response to first-line therapy (a more than 50% increase in FEV1) as compared with the normal values) (Group 1) and 36 patients with concurrent obstructive lung disease (COLD) had an inadequate response (FEV1 was less than 40% of the normal values) was found in 32 patients (Group 2). Then the patients were randomized: 16 patients from Group 1 took budesonide, 4 mg/day, the other 16 received intravenous prednisolone, 120 mg/day. In Group 2, the efficacy of the drug added to therapy with oral prednisolone, 30 mg/day, was evaluated: 18 patients were given budesonide, 4 mg/day, and 18 received placebo. In patients with a good response to primary therapy, positive clinical and functional changes were found on day 6 of treatment. Group 2 patients receiving budesonide showed a significantly (p < 0.05) more marked positive changes in BA symptoms, FEV1, and PFER, which allowed a course of therapy with systemic GCSs to be reduced. Nebulized budesonide may be used instead of systemic GCSs to treat exacerbated BA if there is a good clinical and functional response to first-line broncholytic therapy, which is indicative of successful abatement of bronchospasm. If there is a poor response to first-line therapy in patients with more severe BA concurrent COLD, the early use of budesonide suspension in addition to systemic GCSs may enhance the efficiency of therapy for BA attacks and reduce the volume of systemic steroidal therapy.

[Risk factors of ischemic heart disease, data of exercise tests, 24-hour ECG monitoring and coronary angiography in young women with history of myocardial infarction]. / Osobennosti faktorov riska ishemicheskoi bolezni serdtsa, dannykh veloérgometricheskikh prob, sutochnogo monitorirovaniia EKG i koronarografii u zhenshchin molodogo vozrasta, perenesshikh infarkt miokarda.

Most frequent risk factors in a group of 40 premenopausal women with history of myocardial infarction were smoking (70%) and hypertension (62.5%). Reaction to bicycle exercise tests was negative in 42% and ischemic (mainly pain combined with ST-segment changes) in 50% of these women. Ischemic ECG changes were found during both exercise test and 24-hour ECG monitoring in 30% and were not found at all in 40% of women. Angiography revealed coronary artery stenoses in 58% of women.

[A prospective study of hypolipidemic therapy in young women after myocardial infarction]. / Prospektivnoe issledovanie gipolipidemicheskoi terapii u zhenshchin molodogo vozrasta, perenesshikh infarkt miokarda.

A 3-year prospective trial has been performed of a course of ischemic heart disease (IHD) in postmyocardial infarction women (PIW) on antianginal treatment alone vs women on hypolipidemic drugs. IHD ran a less severe course in young PIW than in menopausal IHD. Aggravation of IHD occurred more frequently in women with previous MI and in hypertension. Comparison of the two groups of women demonstrated that hypolipidemic drugs improved a course of IHD in the women. In menopausal women taking hypolipidemic drugs IHD improvement occurred 6.2 times more frequently while aggravation 2.3 times less frequently than in women on standard antianginal treatment. Young women benefited from hypolipidemic therapy 1.6 times more frequently.

[Adrenergic innervation of the myocardium in patients with cardiac syndrome X]. / Issledovanie adrenergicheskoi innervatsii miokarda u bol'nykh kardial'nym sindromom X.

11 syndrome X patients and 8 healthy controls were investigated by myocardial scintigraphy (SPECT) with 123-I-MIBG. Regional defects in cardiac 123-I-MIBG uptake were found in 90% syndrome X patients. Total cardiac 123-I-MIBG uptake appeared significantly higher in syndrome X patients. Perfusion defects on stress 99m-Tc-MIBI scintigraphy were found in 10 syndrome X patients who had also abnormal 123-I-MIBG scintigrams. It is suggested that impairment of efferent cardiac adrenergic nerve fiber function in syndrome X patients may contribute to pathophysiologic and clinical features of syndrome X.

Heat shock proteins in cardiosurgery patients.

OBJECTIVE: Cytoplasmic members of the heat shock protein HSP70, family, inducible HSP72 and constitutive HSC73, are known to protect cells and organisms against harmful factors including ischemia, trauma, etc. The up-regulation of HSP70 was shown to greatly increase resistance of myocardial cells in vitro as well as in transgenic animals. It seems reasonable to expect that in patients undergoing open heart surgery cytoplasmic HSP70 should play a protective role, reducing the risk of the myocardial cell injury. METHODS: Using Western blotting, we determined levels of HSP72 and HSC73 in myocardium and peripheral blood lymphocytes of 51 patients with coronary and valvular diseases. In all the cases, HSP70 was detected in samples of the right atria before and after cardiopulmonary bypass. RESULTS: Induction of HSP72 was observed in 40% of all patients and correlated with the endurance of cardiopulmonary bypass and with disease duration in 33 patients with coronary artery disease. The cardioprotective effect of the elevated pre-operational level of HSP72 was shown to correlate with the lower activity of cardiospecific enzymes in the coronary disease patients. The HSC73 level in the right atria did not depend on conditions of the open heart surgery, while in some cases, it was increased after bypass. No correlation has been found between preoperational content of HSP72/HSC73 in lymphocytes and its pre- or post-bypass content in myocardium. CONCLUSION: HSP72 is implicated in cardioprotection in combination with some other factors, and its pre-operational level, among other parameters, might be of prognostic value.

[Role of heat-shock proteins in cardioprotection of patients operated on for ischemic heart disease]. / Rol' belka teplovogo shoka v kardioprotektsii u bol'nykh, operirovannykh po povodu ishemicheskoi bolezni serdtsa.

Major stress protein HSP72 is known to participate in protecting cells and organisms against harmful factors including ischemia, trauma etc. Under study was the level of HSP72 in the myocardium of 32 patients with coronary disease operated in Military-medical academy. HSP72 was detected in probes of the right atria before and after pre-cardiopulmonary bypass in all cases induction of HSP72 was observed in 40% of patients, and directly correlated with the time of cardiopulmonary bypass and standing of the disease. The cardioprotective effect of the elevated pre-operational level of HSP72 was shown to be proportionate to the lower activity of cardiospecific enzymes, creatine phosphokinase (CK-MB). It is suggested that HSP72 is involved in the mechanism of cardioprotection during cardiopulmonary bypass.