[Prevalence of Advanced Chronic Kidney Disease in Patients with Nonvalvular Atrial Fibrillation Hospitalized in Cardiology Departments].

OBJECTIVE: To estimate the prevalence of chronic kidney disease (CKD) 3b - 5 stages and the newly diagnosed sustained reduction in glomerular filtration rate (GFR) <30 ml / min / 1.73 m2 in patients with atrial fibrillation (AF) in real clinical practice, as well as the features of their anticoagulant therapy. MATERIALS AND METHODS:  Retrospectively, data of all discharge epicrisis from cardiological departments of five Moscow hospitals from June 1, 2016 to May 31, 2017 were analyzed. Patients over 18 years old with AF were enrolled. At the next stage, patients with CKD 3 b - 5 st and newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 (at least 2 measurements during hospitalization) were selected. RESULTS: Data of 9725 patients were analyzed, AF was diagnosed in 2983 (31 %) cases, of which a decreased GFR <45 ml / min / 1.73 m2 was detected in 27 % (n = 794) cases. Among them, 349 (44 %) were diagnosed with CKD 3b st, 123 (15 %) with CKD 4 st, 44 (6 %) with CKD 5 st, 278 (35 %) had a newly diagnosed sustained reduction in GFR. In 63 % of patients with AF and GFR <45 ml / min / 1.73 m2, anemia was diagnosed, 39 % of them had moderate and severe one. 711 (89 %) patients were prescribed anticoagulants, 53 % were assigned direct oral anticoagulants (DOACs). Patients with CKD 3 b st. more often rivaroxaban 15 mg (29 %) was prescribed, with CKD 4 and CKD 5 - warfarin (48 % and 25 %, respectively), in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 - apixaban 10 mg / day (16.2 %). CONCLUSION: A quarter of patients with AF revealed a decreased GFR <45 ml / min / 1.73 m2, half of them were recommended DOACs. 42 % of patients with GFR <30 ml / min / 1.72 m2 were prescribed DOACs, 27 % - warfarin. Patients with CKD 5 st DOACs were not assigned; in half of cases, none of the anticoagulants was recommended. Most often, the dose of the prescribed anticoagulant was not counted according to GFR in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2.

[Safety performance of rivaroxaban versus warfarin in patients with atrial fibrillation and advanced chro-nic kidney disease].

Aim To evaluate safety of using rivaroxaban in patients with stage 4 chronic kidney disease (CKD) or transient, stable decline of glomerular filtration rate (GFR) to 15-29 ml /min / 1.73 m2 in the presence of atrial fibrillation (AF).Material and methods This multicenter prospective, randomized study included patients admitted to cardiology departments from 2017 through 2019. Of 10 224 admitted patients 109 (3 %) patients with AF and stage 4 CKD or a stable decline of GFR to 15-29 ml /min / 1.73 m2 were randomized at 2:1 ratio to the rivaroxaban 15 mg /day (n=73) treatment group or to the warfarin treatment group (n=36). The primary endpoint was development of BARC and ISTH major, minor, and clinically relevant minor bleeding. Mean follow-up duration was 18 months.Results Patients receiving warfarin had a significantly higher incidence of BARC (n=26 (72.2 %) vs. n=31 (42.4 %), р<0.01) and ISTH (n=22 (61.1 %) vs. n=27 (36.9 %), p<0.01) minor bleeding and all ISTH clinically relevant (minor clinically relevant and major bleedings) n=10 (27.7 %) vs. n=8 (10.9 %), р=0.03]. The number of repeated hospitalizations was 65 (43% of patients) in the rivaroxaban treatment group and 27 (48% of patients) in the warfarin treatment group (р=0.57), including 24 (36.9 %) and 11 (40.7 %) emergency admissions in the rivaroxaban and warfarin treatment groups, respectively (р=0.96). Significant improvement of changes in creatinine clearance and GFR (by CKD-EPI and Cockroft-Gault) was observed in the rivaroxaban treatment group.Conclusion The study provided evidence for a more beneficial safety profile of rivaroxaban compared to warfarin in patients with AF and advanced CKD.

GPI-Modified Proteins Non-covalently Attached to Saccharomyces cerevisiae Yeast Cell Wall.

Yeast cell wall GPI-anchored proteins lack the lipid part of the anchor and are covalently bound to the high-molecular-weight polysaccharides glucan and/or chitin through the mannose residues. They perform many functions, including participation in the cell wall molecular ensemble formation and providing cell resistance to stress. In this work, we identified a pool of GPI-modified proteins firmly bound to the cell wall by non-covalent interactions with the high-molecular-weight structural polysaccharides. We believe that the detected proteins are intermediate forms in the processing of the cell wall GPI-proteins, since they had already lost the lipid part of the GPI anchor and are absent in the lipoprotein fraction extracted according to Folch, but were not yet incorporated into the cell wall by the covalent binding to high-molecular-weight polysaccharides because they could be extracted into water by heating of delipidized cell walls. This group of previously unknown proteins might be present in the cell wall in a form of lipid-associated microcompartments represented by transport vesicles recently found in yeast. GPI-modified proteins non-covalently attached to the high-molecular-weight polysaccharides were found in the cell walls of both the parent strain and yeast devoid of glucanosyltransglycosylase Bgl2, which indicates that the pathway of their incorporation into the cell wall is independent on this enzyme.

[Exhaled Breath Analysis in Diagnostics of Cardiovascular Diseases].

Exhaled breath analysis is a novel tool for diagnostics of different diseases. Taking into account the secretory function of the lungs, the composition of exhaled breath is different in physiological and pathological conditions. In this review we consider of some substances which content vary in cardiovascular diseases - pentane, isoprene, carbon monoxide and trimethylamine. Modern technologies allow to move the analysis of exhaled breath from research laboratories into clinical practice. Thus, a new tool for real time of screening various cardiovascular diseases has appeared in the arsenal of physicians.

Noninvasive Assessment of Fractional Flow Reserve Using Mathematical Modeling of Coronary Flow.

Nowadays an invasive evaluation of fractional flow reserve (FFR) is one of the main methods used for detecting lesions that cause ischemia. Invasively obtained FFR <0.75 has the specificity of 100 %, and FFR >0.80 has the sensitivity >90 %. Recent achievements in computational fluid dynamics and computer simulations allow noninvasive assessment of FFR using data obtained by CT angiography performed according to standard protocol at rest without additional radiation, modification of image acquisition protocols, or added medications for vasodilatation. The present review covers the results of the DISCOVER, the NXT, the DEFACTO and the PLATFORM randomized multicenter studies as well as the prospects of using a noninvasive method for measuring FFR developed by specialists of the Institute of Numerical Mathematics in collaboration with specialists of the I. M. Sechenov First Moscow State Medical University.

[Asymptomatic atherosclerosis of the brachiocephalic arteries: Current approaches to diagnosis and treatment]. / Bessimptomnyi ateroskleroz brakhiotsefal'nykh arterii - sovremennye podkhody k diagnostike i lecheniiu.

Acute cerebrovascular accident (ACVA) and transient ischemic attack are among the leading causes of morbidity, disability, and mortality in the Russian Federation and the world. Ischemic strokes account for 70-80% of all ACVAs, with 20-30% of them being associated with stenotic atherosclerosis of the brachiocephalic arteries (BCA). The paper describes modern views on the problem of asymptomatic BCA atherosclerosis and considers the possibilities of identifying risk groups among the patients with asymptomatic atherosclerosis of the BCA.

[Proton Transfer Reaction Mass Spectrometry of Exhaled Breath in Diagnostics of Heart Failure].

BACKGROUND: Exhaled breath analysis is one of directions in the search for novel biomarkers of chronic heart failure (CHF). According.

[Role of measurement of fractional flow reserve in coronary artery atherosclerosis].

The paper considers coronary flow in health and coronary flow autoregulation in health and disease. It gives basic methods used to estimate coronary flow reserve in patients with coronary atherosclerosis. The physiological bases for determining fractional flow reserve are presented. Clinical trials investigating the use of fractional flow reserve in patients with coronary heart disease are analyzed.

[Pathology diagnostics by human breath analyze].

Modern medicine experiences deficit of inexpensive rapid screening technologies despite progress in the development of diagnostic methods for various diseases. A promising approach is the analysis of exhaled air known to contain thousands of volatile organic substances whose composition differs considerably in health and disease. We isolated certain compounds that may be used as biomarkers of cardiovascular pathology (nitric oxide, carbon monoxide, pentane, isoprene, acetone). There is a variety of methods for the detection of substances in the exhaled air; such as gas spectrography, mass spectrometry, etc. However, ion mobility spectrometry appears the most suitable technique for the purpose of screening studies due to its high speed and sensitivity, small size of the apparatus, and possibility to measure trace amounts of the substances of interest. Possibilities to diagnose lung cancer based on exhaled air composition are considered.

[The neuromediatory system in liquidators of the radiation accident at the Chernobyl nuclear power station].

The condition of mediatory systems, those of serotonin-, dopamin- and cholinergic, were studied in liquidators of the accident at the Chernobyl power station 15 year after the accident during the reaction of rosette-formation. The results showed an activated status of the studied serotonin- and cholinergic systems.

[Catheter measurements of the urethral pressure]. / O kateternykh izmereniiakh davleniia v uretre.

The outflow of viscous incompressible fluid from catheter holes into a small gap between the catheter and surrounding elastic tube is considered. Initially, the catheter is inserted into the tube lumen in such a manner that a considerable tube wall prestress exists. An additional longitudinally non-uniform external load is applied to the outer tube surface. The procedure of measuring the urethral "pressure profile" is discussed. It is shown that there is no easy way for extracting the external load (muscle forces in reality) from the measured pressure.

[A method of immunodiagnosis of myasthenia gravis]. / Sposob immunodiagnostiki miastenii.

A high-sensitive "immune" proserine++ test was developed for the early detection of myasthenia, especially of its concealed and unclear forms. The results are derived from counting Ach-ROK immune to blood acetylcholine (Ach) before and 30 min after subcutaneous proserin administration. A high (over 10%) baseline Ach-ROK blood count which fell sharply after proserin injection was characteristic of myasthenia patients as compared to controls (under 10%). The reverse was found in healthy individuals and patients with other nervous diseases: an increase of ROK up to 24-39%.

[The polyclonal nature of the immune response to xenobiotics and endobiotics]. / O poliklonal'nom kharaktere immunnogo otveta na ksenobiotiki i éndobiotiki.

The results of many experiments and clinical observations showed that each chemical agent and its metabolites introduced into or mobilized in the organism act, along with others, on the lymphoid cells obligatorily inducing a polyclonal immune response directed at restoration of the chemism of the internal medium. The specificity of the response is attested by the absence of intensification of the immune rosette formation phenomenon in administration of a chemical agent of a different structure into the animal, as well as when erythrocytes, sensibilized by some other chemical agent not introduced or freed in the organism is used in the reaction. That an excess of the agent saturates the receptors of cells only specific of its clone testifies to the monospecificity of each of the lymphocyte clones. Our data are in agreement in this respect with one of the main postulates of immunology on the narrow specialization and strict manner of clone formation of the lymphocyte B-pool. Our data may possibly set the way for understanding the phenomenon of the polyclonal character of the immune response to various antigens and effects. We studied intensified immune responses specific of endobiotics, in exposure of the lymphocytes of animal organs to the effect fo PGA, tuberculin, antiglobulin sera, foreign protein, genetically foreign cells (sheep erythrocytes), microbial antigens and toxins. This, possibly, underlies the well known phenomenon of synthesis of nonspecific immunoglobulins in the organism in response to the effect of an antigen, the mechanism of which is still not clear.

[Immune and autoimmune effects of ethanol]. / Immunnye i autoimmunnye éffekty étanola.

It is established that ethyl alcohol exhibits both immune and autoimmune effects. The blood of healthy people always contains a small amount of ethanol- and dopamine-sensitized lymphocytes and autoantibodies specific to these compounds. The ability of lymphocytes to interact with ethanol or dopamine bound to erythrocytes shows evidence that the corresponding receptors are available on the erythrocyte membrane. The action of ethanol upon these receptors leads to the development of immune response in vivo and ex vivo. The administration of ethanol is accompanied by an increase in the number of ethanol-sensitive lymphocytes which can be detected, thus indicating the presence of excess ethanol. The blood of patients with alcohol addiction contains of ethanol- and dopamine-sensitized lymphocytes and anti-ethanol antibodies. This is indicative of the permanent pathologic synthesis of autoantibodies specific to ethanol and dopamine. These data confirm the concept of the immune mechanism of chemical homeostasis, according to which the immune system participates in regulation of these biologically active agents and in maintenance of the chemical homeostasis in the organism. These conclusions extend our notions about the immune and autoimmune aspects of pathogenesis of the chronic alcohol intoxication and constitute a basis for further development of the laboratory diagnostic methods.

[The character of development of the immune response to sheep erythrocytes and parallel responses to exo- and endobiotics]. / O kharaktere razvitiia imunnogo otveta na eritrotsity barana i parallel'nykh otvetakh na ekzo- i endobiotiki.

The immune response to sheep erythrocytes (SE) is usually used as the indicator system in screening of immunotropic compounds. We had shown earlier that a rapid immune reaction develops in response to a chemical compound (drug). It is characterized by an increase in the number of antigen-recognizing and antigen-producing lymphocytes and their blast forms, titers of antibodies specific of the introduced compound and endobiotics mobilized under its effect.

[Immune mechanism of regulating the balance of chemical compounds of endogenous origin]. / Ob immunnom mekhanizme reguliatsii balansa khimicheskikh soedinenii éndogennogo proiskhozhdeniia.

Specific autoantibodies of neutralizing character to histamine, serotonin, kallikrein, bradykuinine, acetylcholine, adrenalin, noradrenalin, insulin, and to the serotonin metabolite--5-hydroxyindolacetic acid, were found in donor serum (47.2%) and in intact rabbits, guinea pigs, rats, and mice (24.4%). Anti0odies to histamine, serotonin, kallikrein were found in a number of samples of commercial gamma-globulin. They were relatively often observed during the morning and day-time hours, in summer and in winter, in luteal phase of menstrual cycle, early in pregnancy (6-8 weeks), after surgical treatment, burns, inflammation, administration of foreign albumin, in the course of immunization by different antigens. The results of fractional analysis of serum showed that antibodies belonged to immunoglobulins with the constant of sedimantation 7S and 19S. The data obtained suggest the existence of an immune mechanism for the content regulation of different substances of endogenous origination in any organism.

[The early response of the blood lymphocytes in mice to phosphacol and its practical significance]. / Rannii otvet limfotsitov krovi myshei na fosfakol i ego prakticheskaia znachimost'.

Phosphacol drops applied to the eye of a mouse caused an immediate response of the blood lymphocytes. The number of phosphacol-immune rosette-forming and blast forms of lymphocytes increased. The response is specific since the formation of rosettes is blocked by the excess of phosphacol in vitro and does not occur when rausedyl-sensibilized erythrocytes are used. The formation of blast forms is intensified after small doses of phosphacol (10-9), but not rausedyl, are put into a suspension of blood cells. The technique proposed may be used for determination of phosphorus-containing compounds in the organism and the diagnosis of poisoning with them.

[The participation of the T system and macrophages in the immediate immune response to drug compounds]. / Uchastie T-sistemy i makrofagov v nemedlennom immunnom otvete na lekarstvennye soedineniia.

Experiments on rats and on human lymphocytes have indicated that a prompt immune response to low-molecular-weight biologically active agents is thymus-dependent, calls for cooperative interaction of T and B lymphocytes and macrophages, it is enhanced by T mitogens and implemented through the specific pharmacological receptors of T and B lymphocytes. The findings offer ample scope for controlling the immune mechanisms of habituation to drugs and poisons.

[State of the blood phagocytic system in the Nitroblue tetrazolium test conducted in clean-up workers following an extended period of time after the Chernobyl nuclear plant accident]. / Sostoianie fagotsitarnoi sistemy krovi v NST-teste v otdalennom periode u uchastnikov likvidatsii avarii na Chernobyl'skoi AES.

The functional-and-metabolic status of neutrophil granulocytes was studied in liquidators of consequences of the accident (LCA) at the Chernobyl nuclear power station (CNPS) by using the nitroblue tetrazolium test (NTT). Tests, involving the recovery of nitroblue tetrazolium in both spontaneous and stimulated variants, were made in LCAs and the obtained data were compared with the results of similar tests in the control groups. High NTT parameters were found in spontaneous tests. A lack of the activation in response to zymosan is a specific feature of LCA blood granulocytes. Profound disorders were detected in the phagocyte systems of LCAs, which is indicative of disrupted enzymatic processes in neutrophil granulocytes. On the whole, a sharp functional reduction of neutrophils inhibits their bactericidity. The obtained results were used to work out and to patient "The method of detecting a radioactive irradiation of the body."

[Noncontrast computed tomography in the diagnosis of tumors of the major salivary glands].

Non-contrast computed tomography (CT) of the major salivary glands was made in 127 patients, which revealed 95 space-occupying lesions (88 intraglandular and 7 extraglandular ones). Pleomorphic tumors of the parotid glands are solitary, round, high-density (29.6 +/- 4.2 HU) masses with well-defined, smooth margins. Salivary cysts were characterized by the presence of a dense capsule; the density of cyst contents was 8.0 +/- 2.0 HU. Salivary lipomas had a characteristic tomographic pattern due to the presence of adipose tissue; the lipoma density was -108.3 +/- 7.8 HU. Malignant parotid tumors were characterized by the presence of higher-density masses with irregular shapes and ill-defined, indistinct margins. Benign submandibular gland tumors had no well-defined margins that separated the tumor from the gland; the density of a tumor matched that of the parenchyma; the mean tumor size was 3.6 +/- 1.3 cm; there was an increase in the sizes of the gland as compared to those of the contralateral gland, as well as a displacement of the adjacent soft tissues. Malignant submandibular gland neoplasms tumors were characterized by the presence of inhomogenous lower-density masses with irregular shapes. Enlarged paraglandular lymph nodes were observed. The sensitivity, specificity, and accuracy of native CT in diagnosing space-occupying lesions of the salivary glands were 97.6, 96.4, and 97.6%, respectively.