[The Efficacy of the Smart-Rehabilitation Program in Patients After the Correction of Valvular Heart Diseases].

Aim      Comparative analysis of the effectiveness of a new approach, "SMART rehabilitation of patients after heart valve replacement", which includes, in addition to face-to-face training, Internet technologies in the form of video conferencing, the mobile application "Calculation of the warfarin dose", and a traditional program for educating patients after correction of valvular defects.Material and methods  The study included 190 patients with prosthetic heart valves. The main group consisted of 98 patients who completed a distance learning course. The control group included 92 patients participating in face-to-face training. Clinical and instrumental examinations (electrocardiography, echocardiography, determination of international normalized ratio (INR)), and surveys to evaluate awareness, compliance with treatment, and quality of life (QoL) were performed.Results At baseline, the awareness, compliance and QoL did not differ between the compared groups. After 6-month follow-up, the mean score of awareness increased by 53.6 % (р=0.0001). The compliance with treatment increased 3.3 times in the main group and 1.7 times in the control group (p=0.0247). Patients of the main group were more prone to self-management (p=0.0001), had better medical and social awareness (p=0.0335), medical and social communicability (p=0.0392), confidence in the therapeutic strategy of the attending physician (p=0.0001), and treatment effectiveness (p=0.0057). Analysis of QoL showed increases in living activity 2.1 times (р=0.0001), social functioning 1.6 times (р=0.0001), and mental health 1.9 times (р=0.0001).Conclusion      The novel approach of distance learning, "SMART rehabilitation of patients after heart valve replacement", provides improvements in awareness, compliance with treatment and QoL.

[Efficiency of the Decision-Making Module in the Personalized Choice of an Anticoagulant].

Aim        To evaluate the effectiveness of the decision-making module in selecting an oral anticoagulant for patients with atrial fibrillation.Material and methods        638 patients with atrial fibrillation aged 68.2±4.5 years were evaluated. The CHA2DS2-VASc, HAS-BLED, and 2MАСЕ scales, the creatinine clearance calculator, and the Morisky-Green questionnaire were used.Results   311 (48.75 %) patients had paroxysmal atrial fibrillation, 138 (21.6%) had persistent atrial fibrillation, 44 (22.7%) had long-standing persistent atrial fibrillation, and 145 (22.7 %) had permanent atrial fibrillation. Mean CHADS2­VASc scale score was 4.82; НAS-BLED scale score was 2.9; 2MACE score was 2.28; and compliance score was 3.52. 172 (26.9 %) patients were treated with rivaroxaban; 166 (26 %), with apixaban; 84 (13.2 %), with dabigatran; 210 (32.9 %), with warfarin; and 6 (1 %), with acetylsalicylic acid.Conclusion            The developed decision-making module is based on scientific justification of personalized selection of the oral anticoagulant and updates the knowledge on major issues of prescription.

[Role of preoperative cardiology consultation in patients undergoing cancer surgery].

AIM: To evaluate the effects of preoperative cardiology consultation on the risk of perioperative cardiac complications in patients undergoing cancer surgery. MATERIALS AND METHODS: 74 patients with bronchial, lung, mediastinal and gastrointestinal cancer were referred to the cardiologist as a part of the preoperative management. Patients were assigned either to Group 1 (n=21), who required non - invasive testing or invasive coronary angiography (CAG), or to Group 2 (n=53), who did not have any indications to additional testing. RESULTS: The median age was 65.8 years in Group 1 and 64.5 years in Group 2, p=0.408. Group 1 patients had higher RCRI than Group 2 patients (7.4±4.5 vs. 2.9±4.5, respectively, p=0.002). Four (19.05%) patients in Group 1 underwent minimally invasive examination without any further indications to CAG. 16 (76.2%) patients underwent CAG. Of them, 5 (23.8%) patients had severe coronary artery stenosis, and 4 (19.0%) patients had severe brachycephalic artery stenosis (≥50%). After CAG findings, one carotid artery and three coronary arteries (14.3%) were stented. Drug therapy was prescribed to one patient. One patient required stenting after the treatment of the underlying disease. Group 2 patients were more likely to achieve the endpoints - heart rhythm disturbances, decompensation of chronic heart failure, cardiac death (5.45% in Group 2 vs. 4.76% in Group 1, p>0.05). Multivariate analysis reported that angina pectoris was an independent factor to refer patients to the additional testing (p.

[Efficiency of pharmacogenetic approach to anticoagulant therapy in patients with prosthetic heart valves].

BACKGROUND: This study examined clinical, demographic, anthropometric, and inheritance factors that influence individual sensitivity to warfarin therapy after heart valve surgery. The clinical significance of the pharmacogenetic approach was assessed using the individual time frame and time spent in the INR therapeutic range. AIMS: We determined the clinical outcome of the pharmacogenetic approach at the start of warfarin therapy in patients with prosthetic heart valves. MATERIALS AND METHODS: The study included 915 patients, of which 512 women and 403 men (mean age 56±10 years), living in Western Siberia. Rheumatic heart disease was the main diagnosis that caused the acquired defect. Mechanical prostheses were used in 70% of cases of cardiac surgery. Real-time polymerase chain reaction used for molecular genetic testing. RESULTS: The frequencies of the alleles and genotypes of CYP2C9 and VKORC1 in the study population of patients with heart valves prosthetic correspond to the distribution in Caucasoid populations. The use of pharmacogenetic testing results at the beginning of warfarin therapy reduced the time required for selecting a therapeutic dose of anticoagulant by 2 times and increased the duration of stay in the INR therapeutic range by 20.2%. CONCLUSION: The use of the pharmacogenetic approach at the begin­ ning of warfarin therapy contributes to the effectiveness and safety of anticoagulant therapy in this category of patients.

High-resolution large-scale plasmonic laser color printing for jewelry applications.

We offer to use optical features of surface plasmon resonance in Ag nanoparticles for jewelry application as a method for the well-controlled decoration of silver items. The novel approach of silver nanoparticles formation with sizes from 5 to 50 nm via nanosecond direct laser writing allows for controlling the reflectance spectra, thus creating a color image on precious metals with a high resolution of about 450 dpi without dyes or hazardous chemicals. Moreover, the large-scale color image can be applied in single-step processing with significant productivity of 2 cm2 per minute. This work opens a strong direction for the practical application in the jewelry industry, art, and coining.

Assessing exterior egg quality indicators using machine vision.

1. The objective of this study was to develop a machine vision method for analysing exterior parameters of chicken eggs to automate the stage of primary sorting. 2. The developed algorithm based on predetermined thresholds calculated egg quality indicators, including geometric dimensions, shape index and the mottling grade. The algorithm was implemented with an experimental setup that combined the image-based and the candling methods. A total of 400 egg samples were analysed. 3. Comparison of results of the algorithm with those obtained using the traditional manual method showed that mean value of radii values difference was 0.095 ± 0.058 mm for the sharp and 0.080 ± 0.047 mm for the blunt end of the egg, with standard deviations of 0.58 mm and 0.49 mm, respectively. 4. The correlation coefficient between the shape index values determined by the two methods was 0.93; the standard deviation of absolute differences between corresponding values was 1.05%. 5. The results of mottling grade estimation were compared using F-measure and confusion matrix. 6. The results allow the possibility to perform the assessment of egg exterior quality factors in an automatic mode, independent of the expertise of a grader.

Psychological and social factors of adherence to treatment in patients with myocardial infarction.

AIM: The aim of the study was to assess the impact of psychological and social factors on adherence to treatment in patients with primary and repeated myocardial infarction (MI). MATERIALS AND METHODS: Patients with primary (n=61) and repeated (n=72) ST-segment elevation MI were enrolled in the study. State and trait anxiety, accentuation of personality traits, patient awareness, and adherence to treatment, represented by adherence rate to treatment were evaluated. RESULTS: There were no statistically significant differences found in adherence to treatment between the study groups. Patients' adherence to treatment in the whole cohort was low positive. Patients with primary MI demonstrated higher state anxiety than patients with repeated MI (p=0.0173). The following accentuation of personality traits were determined: hypertimity, emotivity, anxiety, dysthymia and cyclothymic. They were comparable in their severity in primary and repeated MI patients. The regression analysis revealed that the higher the level of education, the higher (by 0.40 scores) adherence rate to treatment (p=0.0210). Higher patients' awareness resulted in increased adherence rate by 0.54 scores (p=0.0010). CONCLUSION: The main factors contributing to increased adherence rate in patients with MI were the level of education and awareness on the issues of preventing an unfavorable cardiovascular prognosis.

[The Integrated Approach to Improving Efficiency and Safety of Anticoagulation Therapy in Patients With Prosthetic Mitral Valve].

AIM: To assess advantages of integrated approach to improvement of efficiency and safety of warfarin therapy after heart valve replacement. MATERIALS AND METHODS: We included in this study 118 patients who had undergone simultaneous mitral valve replacement and maze procedure. Group 1 patients (n=37) underwent just sinus rhythm restoration, group 2 patients (n=54) underwent sinus rhythm restoration and participated in a patient education program, group 3 patients (n=27) underwent sinus rhythm restoration, participated in a patient education program, and were subjected to pharmacogenetic testing for warfarin sensitivity. In examination of patients we used clinical, demographic, and instrumental methods. Estimation of the time in the therapeutic range (TTR) of an international normalized ratio (INR) was used as a measure of warfarin therapy quality, and the Kaplan-Meier method was applied for analysis of hemorrhagic and thrombotic complications. RESULTS: TTR was 42 % in group 1, 68 % in group 2 (p=0.0327), and 82 % in group 3 (p=0.0019). Application of integrated approach was associated with absence of hemorrhagic and thrombotic complications within one year after heart valve replacement. CONCLUSION: The integrated approach comprising restoration of sinus rhythm, patient education, and pharmacogenetic testing for warfarin sensitivity was associated with improved anticoagulation control, and prevention of hemorrhagic and thrombotic complications.

[Factors affecting effective patient management for preventing recurrent coronary events].

AIM: To identify factors affecting effective management of patients with myocardial infarction for preventing recurrent coronary events in the outpatient setting. MATERIALS AND METHODS: The study group consisted of patients (n=111) with recurrent myocardial infarction. The control group consisted of patients with primary myocardial infarction (n=89) after percutaneous coronary intervention. Social and demographic, clinical and behavioral factors (weight loss, smoking cessation, adherence to therapy, physical and psychological rehabilitation) were evaluated. RESULTS: Risk factors contributing to the development of repeated MI were as follows: patients' age, concomitant polyvascular and multivessel disease, arterial hypertension, hypercholesterolemia, excess weight and smoking, poor adherence to the recommendations of cardiologists and general physicians. CONCLUSION: The analysis of the effectiveness of the management of patients with myocardial infarction demonstrated the importance of the outpatient rehabilitation in preventing repeated acute coronary events.

[Effectiveness of a long-term education program in patients with prosthetic heart valves].

AIM: The current study was aimed at assessing the effectiveness and the impact of a long-term education program, in both inpatient and outpatient treatment settings, on adherence to treatment and the quality of life 5 years after heart valve replacement. MATERIALS AND METHODS: All the patients were randomly included into two study groups. The study group patients (n=176) underwent the long-term education program in both inpatient and outpatient treatment settings. The control group (n=108) consisted of patients who underwent only an inpatient education program. Adherence to treatment and the quality of life were assessed before education, at the end of the inpatient and outpatient education and 5 years after heart valve replacement. Patients' treatment adherence was estimated with the Davydov's questionnaire, and the quality of life - with the 36­Item Short Form Health Survey. RESULTS: After the completion of the education program, the integral index reflecting patients' adherence to treatment in the study group remained at the same level, but was 1.4­fold higher compared to the control group in the 5­year follow-up. The long-term education program is associated with improved quality of life, mainly due to emotional well-being. The study reported a correlation between physical functioning and emotional well-being and the integral index reflecting patients' adherence to treatment during the follow-up period. CONCLUSION: The long-term education program in both inpatient and outpatient treatment settings contributed to improved patients' adherence to treatment and the quality of life, mainly due to physical functioning. The inpatient education program was associated with poor patients' adherence to treatment and the quality of life 5 years after heart valve replacement.

[The Use of Dabigatran for Prevention of Thromboembolic Complications in Patients Underwent Atrial Fibrillation Catheter Ablation].

UNLABELLED: The aim of the study was to estimate the efficacy and safety of dabigatran in comparison with warfarin after atrial fibrillation (AF) catheter ablation (CA). METHODS: 228 consecutive patients, having undergone AF CA, were enrolled in retrospective trial. In group I (n=170) warfarin was administered by modified interrupted scheme, in group II (n=58) dabigatran was administered by 150 mg twice a day. The main clinical efficacy and safety indicators were evaluated during the procedure and within 12 months after the procedure. RESULTS: There was no statistically significant difference between patients taking warfarin and dabigatran (p>0,1) in all of the investigated parameters, including the amount of bleeding and thromboembolic events. Side effects of mild dyspepsia were observed in the dabigatran group in 2.7% of the observations and in the warfarin group in 2.4% (p = 0,589). None of them required discontinuation of the therapy. CONCLUSION: Dabigatran can be considered as an alternative to warfarin for anticoagulation in patients undergoing AF CA.

[Strategy of sinus rhythm restoration after single stage correction of mitral valve defect and maze procedure for improvement of efficacy and safety of anticoagulant therapy].

We analyzed clinical efficacy of a strategy of sinus rhythm (SR) restoration after single stage correction of mitral valve defect and failed radiofrequency maze procedure elaborated and realized in the Research Institute for Complex Issues of Cardiovascular Diseases, and assessed its value for increase of efficacy and safety of anticoagulant therapy. First stage of this strategy--cardiosurgical treatment with maze procedure--resulted in restoration of SR in 61.8% of cases. In case of persistence of tachyarrhythmia external elelectro-impulse therapy was used in 1-1.5 months after cardiac surgery as a second stage of our strategy. Third stage--catheter radiofrequency ablation--was applied to patients with implanted biological cardiac valves. Second and third stages facilitated restoration of SR in 84.8 and 93.2% of patients, respectively, and provided 100% SR restoration in patients with biological valve prostheses. The suggested strategy allowed to withdraw anticoagulant therapy in patients with biological valves and to reduce level of hypocoagulation to lower limit of target range in patients with mechanical prostheses.

[Effect of an educational program on effectiveness and safety of anticoagulant therapy in patients with prostheses of cardiac valves].

We analyzed effectiveness and safety of anticoagulant therapy in patients with prostheses of cardiac valves at the background of educational program and without special training. We revealed positive effect of educational program during participation in which in 80 cases (67.8%) patients determined international normalized ratio every month and in 50 of them (62,5%) level of hypocoagulation corresponded to target range (p=0.001). At the background of educational program rate of thrombotic complications was 2.73% per patient year, at the background of no educational program - 4.90% per patient year (p=0.040) while rates of hemorrhagic complications were 2.73 and 7.20% per patient year, respectively (p=0.002).

[Approaches for prescribing anticoagulant therapy to patients with prosthetic heart valves].

The lack of national recommendations and generally accepted strategy of anticoagulant therapy for patients with prosthetic heart valves are principal causes precluding the solution of this problem. The factors responsible for poor efficiency of current therapeutic modalities are heterogeneous response to warfarin, genetic diversity, and frequent thrombosis of prosthetic valves. Neither pharmacogenetic testing for elusive susceptibility to warfarin nor use of portable equipment for detecting threshold coagulation levels can resolve these current problems without improving compliance to medical recommendations and awareness of anticoagulant therapy by both doctors and patients.

[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.

[Hydraulic pressing in complex treatment of recurrent TMJ disc dislocation].

The aim of the study was to estimate the complex treatment efficiency in patients with TMJ internal disorder. TMJ structures repositions and its functional rehabilitation was achieved in 87.2% of cases by using minimally invasive treatment modes (TMJ splint and hydraulic pressing).

[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.

[KatG Ser3 15Thr mutation as the main reason of isoniazid resistance in Mycobacterium tuberculosis isolated in the Novosibirsk and Kemerovo Regions]. / Mutatsiia Ser315Thr gena katG--osnovnaia prichina ustoichivosti k izoniazidu u izoliatov Mycobacterium tuberculosis, rasprostranennykh v Novosibirskoi i Kemerovskoi oblastiakh.

KatG Ser3 15Thr mutation is one of the main reasons of resistance to isoniazid in Mycobacterium tuberculosis isolates. The frequency rate of the above mutation among isoniazid-resistant isolates made 94% in Novosibirsk Region and 93% in Kemerovo Region. The use of PCR-restriction fragment length polymorphism (PCR-RFLP) can be regarded as an adequate method for rapid screening of isoniazid resistance in Mycobacterium tuberculosis isolated in the West-Siberian Region.

[Analysis of the DRD4 gene polymorphism in populations of Russia and neighboring countries]. / Issledovanie polimorfizma gena DRD4 v populiatsiiakh Rossia i sopredel'nykh stran.

Allele and genotype frequencies of the VNTR polymorphism in the third exon of human DRD4 gene were determined in 544 individuals living in Russia (Russians, Bashkirs, Tatars, and Mordovians) and in the neighboring countries (Kazakhs and Ukrainians). The data obtained were compared with the allele frequency distribution patterns reported for the populations of Eurasia. Similarly to other Eurasian populations, in our population samples R4 allele was prevalent (64 to 87%). The frequency of this allele in the populations of Western Europe constitute 61 to 71%, while in the populations of Asia it varies from 74 to 96%. In this respect, the populations studied occupied the intermediate position. In the samples examined the R7 allele frequency decreased from 7% in Ukrainians to 1% in Bashkirs, while in Kazakhs and Mordovians the allele was absent. This finding was consistent with the R7 allele distribution pattern in the populations of Eurasia, characterized by higher frequency in the West and lower frequency or absence of the allele in the East. In the group of 22 Eurasian populations, the R7 allele frequency negatively correlated with the frequency of the R4 allele (r = -0.86 at P < 0.001). Unlike the R4 and R7 alleles, the frequency of which changed in the eastward direction, the R2 allele frequency distribution displayed slightly expressed latitudinal increase southwards. The DRD4 genotype distribution deviated from the equilibrium in most of the samples examined. In some samples, statistically significant increase of the R2/R2 homozygotes frequency was demonstrated. One of the possible explanations of this phenomenon is assortative mating with respect to phenotypic (behavioral) allele manifestation. The data obtained can serve as the basis for the investigation of the possible role of the DRD4 alleles as the risk factors for the development of alcoholism and other types of addictions.

[A study of the insertion-deletion polymorphism of the serotonin transporter gene in populations from the Volga-Ural region]. / Izuchenie insertsionno-deletsionnogo polimorfizma v gene perenoschika serotonina v populiatsiiakh Volgo-Ural'skogo regiona.

The insertion-deletion polymorphism of the serotonin transporter gene (SLC6A4) was studied using the polymerase chain reaction (PCR) in eight populations from the Volga-Ural region (the Bashkir, Chuvash, Tatar, Udmurt, Mari, Mordovian, and Komi populations and the population of Russians living in the Arkhangel's skii raion of Bashkortostan). For this polymorphic system, the pattern of distribution of main population parameters was established in the region studied. Depending on population ethnicity, specific trends were revealed in the pattern of frequencies of alleles and genotypes of gene SLC6A4.