[Polypositional transcutaneous ultrasound assessment of vocal folds mobility. Ultrasonographic sign of laryngeal dysfunction]. / Polipozitsionnoe ul'trazvukovoe issledovanie golosovykh skladok v diagnostike narushenii podvizhnosti gortani.

Fiberoptic laryngoscopy is a standard procedure for evaluation of vocal folds immobility. However, this method is invasive, requires special qualifications and technical equipment, which limits its routine use. Therefore, in daily practice, the vast majority of laryngoscopy are performed by an indirect way, the accuracy of which depends on the specialist experience and the patient compliance. On the other hand, a large number of patients require for a convenient, non-invasive and inexpensive approach to assess the vocal folds mobility. The transcutaneous laryngeal ultrasonography can be such a method. However, the disadvantage of this technique is low informative value. OBJECTIVE: To increase the effectiveness of the diagnosis of laryngeal dysfunction using transcutaneous laryngeal ultrasonography. MATERIAL AND METHODS: Patients underwent laryngeal ultrasonography and videolaryngoscopy before and after thyroid or parathyroid surgery. Ultrasound was performed polypositionally in the transverse and oblique planes. Functional tests with breathing and breath holding were used. Qualitative (the smile or flying bird signs, the vertical closing line of the vocal folds, synchronicity and symmetry movement of the arytenoid cartilages) and quantitative (the length contraction of the vocal cord, the rotation angle of the arytenoid cartilage) ultrasonic parameters determin the normal vocal folds mobility. RESULTS: 996 patients were included in the study. Vocal folds paresis was detected in 106 (10.6%) patients. In 72 (7.2%) cases partial impaired mobility of the vocal folds (laryngeal dyskinesia) were detected. The echographic patterns of these patients were analyzed. Qualitative ultrasound signs of laryngeal dysfunction were identified: a crooked smile or falling bird signs, a closing line deformation of the vocal folds, an arytenoid immobility. Quantitative ultrasound signs included: a decrease in the length contraction of the vocal cord and a reduction of rotation angle of the arytenoid cartilage. Unilateral laryngeal paresis was diagnosed in 101 (10.1%) patients. In unilateral disorders the rotation angle of the arytenoid on the affected side was 0-14° and the length contraction of the vocal cord was 0-1.8 mm. A crooked smile or falling bird signs, a closing line deformation of the vocal folds and immobility of the arytenoid cartilages were also determined. In 5 (0.5%) cases bilateral laryngeal paresis was revealed, in which on both sides the rotation angles of the arytenoid were 0-14°, and the length contraction of the vocal cords was 0-1.8 mm. At the same time there was no a smile or flying bird signs and a closing line of the vocal folds. Laryngeal dyskinesia was characterized by a crooked smile or falling bird signs and a closing line deformation of the vocal folds. At the same time, partial mobility of the arytenoid cartilage was noted in comparison with the contralateral side (there was a difference in the rotation angle of the arytenoid between the right and left sides of 15 ° or more degrees). CONCLUSION: The sensitivity and specificity polypositional ultrasound of the vocal folds in women were 100% and 99.8%, in men - 85.7% and 99.2%, respectively.

Raman study of colloidal Cu2ZnSnS4 nanocrystals obtained by "green" synthesis modified by seed nanocrystals or extra cations in the solution.

The method of affordable colloidal synthesis of nanocrystalline Cu2ZnSnS4 (CZTS) is developed, which is suitable for obtaining bare CZTS nanocrystals (NCs), cation substituted CZTS NCs, and CZTS-based hetero-NCs. For the hetero-NCs, the synthesized in advance NCs of another material are introduced into the reaction solution so that the formation of CZTS takes place preferably on these "seed" NCs. Raman spectroscopy is used as the primary method of structural characterization of the NCs in this work because it is very sensitive to the CZTS structure and allows to probe NCs both in solutions and films. Raman data are corroborated by optical absorption measurements and transmission electron microscopy on selected samples. The CdTe and Ag NCs are found to be good seed NCs, resulting in a comparable or even better quality of the CZTS compound compared to bare CZTS NCs. For Au NCs, on the contrary, no hetero-NCs could be obtained under the given condition. Partial substitution of Zn for Ba during the synthesis of bare CZTS NCs results in a superior structural quality of NCs, while the introduction of Ag for partial substitution of Cu deteriorates the structural quality of the NCs.

[Fat cardiomyopathy in patients with severe degree of obesity. Case report].

Currently, the world is constantly increasing the number of people with obesity. As was shown by the Framingham study, obesity is a risk factor for many cardiovascular diseases. The effect of obesity on the structure and function of the heart is manifested in the form of cardiac remodeling, the effect on energy metabolism in the heart and infiltration of both myocardium with lipids, and an increase in the accumulation of adipose tissue in the pericardium, imbalance of adipokines and activation of inflammatory markers. Cardiac remodeling occurs primarily due to thickening of the left ventricle (LV) walls and an increase in the LV myocardium mass. Systolic dysfunction of the heart is less common in obese individuals compared with diastolic dysfunction. However, more modern methods (tissue Doppler, visualization of the deformation of the chambers of the heart strain imaging) reveal a subclinical decrease in systolic function in people with obesity. It is not fully known whether obesity is associated with systolic dysfunction, regardless of other risk factors. In any case, it has been proven that heart failure in people with obesity can develop independently of other risk factors. As an illustration, we give an example when the presence of obesity and concomitant pathology (arterial hypertension, diabetes) led to the development of systolic dysfunction with a decrease in the LV ejection fraction to 35% (fat cardiopathy), which show the potential for the influence of both obesity itself and in combination with concomitant diseases to lead to severe systolic heart failure.

[The «obesity paradox¼ and its degree of proof].

The article gives a critical assessment of the so-called obesity paradox. Methodological errors that occur in the organization of studies that studied the obesity paradox and the formation of comparison groups are highlighted. There are also examples of the disappearance of the obesity paradox when taking into account additional risk factors. The organization of prospective studies or more careful consideration of all currently known risk factors for cardiovascular diseases (CVD) will significantly improve the results of the study of the effect of overweight and obesity on mortality in patients with CVD. Thus, despite the biological possibility of the existence of a positive effect of adipose tissue in CVD, the presence of a large number of errors identified in the analysis of the work of researchers obesity paradox require to reconsider the existence of this phenomenon, it should be taken into account the possibility that the obesity paradox may be a consequence of improper design studies to investigate this phenomenon.

Post-trial Access in Maternal Vaccine Trials.

Provisions for post-trial access (PTA) of the experimental intervention are required before the start of a clinical trial. Although there has been ample attention for PTA in the context of preventive vaccine research, discussions on PTA barely include maternal vaccine trials in which mother-infant pairs are exposed to the intervention. In maternal vaccination trials, specific PTA arrangements are required because pregnancy is transient and PTA may apply to the next pregnancy or the child. In this article, we examine the application and adherence to PTA in the context of maternal vaccine trials. We focused on differences between publications before and after 2000 when international ethical guidance documents formalized PTA requirements. Randomized maternal vaccine trials were included after a systematic search for clinical trials in phases II and III with a maternal vaccine as intervention. We used PTA as defined at the time of publication in the World Medical Association's Declaration of Helsinki (DoH) or in the ethical guidelines of the Council for International Organizations of Medical Sciences (CIOMS). In addition, we investigated whether PTA was included in the trial design. Therefore, we contacted principal investigators (PI's) of the publications found in the review to fill out a questionnaire regarding provisions for PTA. Before and after 2000, no trial articles examined in the systematic review described PTA in their trial publication (0/7, 0% and 0/17, 0%, respectively). In addition, more than half of the PI's of the trials found were not familiar with PTA recommendations in international ethical guidelines. Most cases of PTA included making knowledge available by publishing the results of the trial. The revision of the DoH in 2002 and the CIOMS ethical guidelines in 2002 has not resulted in increased PTA provisions for maternal vaccination trials. PTA is a shared responsibility of various stakeholders including sponsors, Institutional Review Boards, regulators, political entities, and researchers. Inclusion of PTA provisions in trial protocols and publications on maternal vaccination trials is essential to increase transparency on the form and content of these provisions.

Comparison of loop-mediated isothermal amplification (LAMP) and cross-priming amplification (CPA) for detection of African swine fever virus.

The reliable and rapid diagnosis of infectious animal diseases presents an exceptionally im- portant aspect when considering their control and prevention. The paper describes the compara- tive evaluation of two rapid isothermal amplification methods for diagnosis of African swine fever (ASF). The robustness of loop-mediated isothermal amplification (LAMP) and the cross-priming amplification (CPA) were compared using samples obtained from ASF confirmed animals. Both assays were evaluated in order to define their diagnostic capabilities in terms of ASF diagnosis and reproducibility of the results. Investigations showed no cross-reactivity for other pig patho- gens and no significant differences in the specificity of both assays. The sensitivity of LAMP reached 90%, while that of CPA was 70%. In conclusion, both methods are suitable for imple- mentation in preliminary ASF diagnosis but further improvements are required to enhance their diagnostic sensitivity.

[Desaggregant Therapy of Patients With Ischemic Heart Disease: Unsolved Problems].

At present, choice of antiplatelet therapy in ischemic heart disease (IHD) patients depends on the IHD form, accepted treatment guidelines, contraindications, and cost of drugs. Usually, there is no regular control of the action of antiplatelet drugs. However, in many patients such therapy does not improve the long-term outcome. Increasing dosage of antiaggregants has no positive effect on prognosis. Presently attempts have been made to improve survival by introduction of double or triple drug combinations. Furthermore, although long-term treatment with combination of aspirin and clopidogrel, or both drugs plus one of the new oral anticoagulants (thrombin or a factor inhibitors) has no significant positive effect on total mortality, such therapy significantly increases risk of massive internal and particularly intracranial bleeding. In view of small decreasing effect of such therapy on the rate of reinfarction and stroke, one should search for new approaches. One of such approaches is selection of an antiplatelet drug taking into consideration its effect on the aggregative reactivity of platelets. There are considerable data proving that high residual platelet reactivity (RPR) during antiplatelet therapy is associated with elevated risk of diseases caused by arterial thrombosis. Our research demonstrates that one can overcome high RPR by substituting clopidogrel for aspirin and vice versa or by using combination of these drugs. Indeed, in patients with high RPR during aspirin or clopidogrel monotherapy this combination is associated only with slight increase of number of patients with target level of platelet reactivity. It can be supposed that in this group of patients one of oral anticoagulants (e.g. rivaroxaban) should be used in combination with clopidogrel.

[Control of myocardial ischemia in patients with effort angina and polyvascular atherosclerotic involvement].

In patients with ischemic heart disease with various degree of severity of atherosclerotic involvement of peripheral arteries maintenance of target levels of arterial pressure and heart rate with the help of therapy which includes cardioselective -adrenoblocker as a preparation of choice with addition if necessary of a calcium antagonist and angiotensin converting enzyme inhibitor allows to successfully control myocardial ischemia and heart rate under conditions of everyday life.

[N-terminal pro-brain natriuretic peptide and cardiac involvement in patients with hypertensive disease].

The purpose of this study was to define a correlation between N-terminal proBNP level and extent of cardiac abnormalities. A total of 40 patients with hypertension were included in the study (60.5+/-7.6 years of age; 18 men, 22 women). It was found that patients with hypertension had increased plasma N-terminal proBNP level, that it increased with age and tended to be higher in patients with concentric hypertrophy compared with those with normal geometry and eccentric hypertrophy; however, the differences were not significant. N-terminal proBNP concentration depended on ventricular septal thickness and left ventricular wall thickness. Analysis of association between N-proBNP level and parameters of myocardial diastolic function showed that increased plasma peptide levels correlated with degree of diastolic dysfunction in patients with altered left ventricular relaxation.

[Effect of hypotensive therapy on metalloproteinase activity of the blood in patients with arterial hypertension].

Aim of the study--investigation of dynamics of levels of serum markers of myocardial fibrosis matrix metalloproteinase-1 (MMP-1), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1)--at the background of 3 months hypotensive therapy in 39 patients with arterial hypertension and paroxysmal form of atrial fibrillation. Twenty patients received sotalol, 19--retard form of verapamil. After 3 months of hypotensive therapy in all patients and separately in groups of patients receiving sotalol and verapamil no significant changes of MMP-1 and TIMP-1 occurred. However in patients with most pronounced hypotensive effect according to 24-hour blood pressure monitoring significant elevation of MMP-1 and lowering of TIMP-1 levels took place. This was associated with improvement of ventricular diastolic function. In most patients longer period of therapy (more than 3 months) is required for achievement of regression of damage to the heart.

[Effect of hypotensive drugs on painless ischemia of the myocardium and diastolic function of the left ventricle].

UNLABELLED: Aim of the study was comparative assessment of hypotensive, antiischemic efficacy and effect on left ventricular (LV) diastolic function of calcium antagonists, angiotensin converting enzyme inhibitor and blockers of beta-adrenoreceptors. RESULTS: The data obtained evidence that at monotherapy most pronounced lowering of arterial pressure is observed during use of verapamil CR or amlodipine. Therapy with all studied drugs led to significant decrease of number of episodes of ST-segment depressions, their duration and amplitude during 24 hours. Greatest decrease of frequency of episodes of ST-segment depression was observed during therapy with heart rate reducing calcium antagonists. Disturbed LV diastolic function improved under action of calcium antagonists and beta-adrenoblockers did not change during therapy with angiotensin converting enzyme inhibitor. Diminishment of severity of disturbance of diastolic function under influence of pulse slowing calcium antagonists was associated in the first place with augmentation of LV filling in the first phase of diastole, but during therapy with amlodipine and beta-adrenoblockers - with decrease of contribution of systole of the left atrium. beta-adrenoblockers and diltiazem improved LV diastolic function in patients with episodes of painless myocardial ischemia. CONCLUSION: Comparative assessment of hypotensive action of preparations from three groups revealed that greatest lowering of arterial pressure occurred during monotherapy with verapamil SR and amlodipine. The stadied drugs differently affected damage of a target organ - the heart - in patients with AH.

[Therapy of patients with chronic coronary artery disease and the actual state of the problem in practical public health].

This review presents the analysis of the results of large controlled studies of the efficiency of lipid-lowering agents, disaggregants, and anti-ischemic drugs for treatment of coronary artery disease (stenocardia). It has been shown that not all preparations in one group are equally efficient. The review also adduces comparative data on the use of the listed groups of pharmaceuticals in different European countries and Russian Federation.

[Metalloproteinase activity of the blood in patients with arterial hypertension with paroxysmal form of atrial fibrillation].

Aim of the study was to investigate interrelationship between serum markers of myocardial fibrosis: matrix metalloproteinase -1 (MMP-1), tissue inhibitor of metalloproteinase-1 (TIMP-1) and parameters of echocardiography in patients with arterial hypertension (AH) and paroxysmal form of atrial fibrillation (n=39). We revealed positive correlation of levels of TIMP-1 with thickness of interventricular septum in diastole (r=0,47, p=0,02), peak velocity of late filling of the right ventricle (r=0,46, p=0,01), and negative relation between MMP-1 levels and degree of mitral and tricuspid regurgitation (r=0,43, p=0,005 and r=0,38, p=0,04, respectively). In the group of patients with increased left ventricular myocardial mass index (LVMMI) TIMP-1 level was significantly higher than in patients with normal LVMMI (p < 0,05). In the group combining patients with concentric and eccentric LV hypertrophy TIMP-1 level was significantly higher than in the group combining patients with LV concentric remodeling and normal geometry (p < 0,05). No correlations were revealed between MMP-1 and TIMP-1 levels and parameters of diastolic dysfunction. In patients with AH increase of serum concentrations of TIMP-1 was associated with increased thickness of interventricular septum, increase of LVMMI, and with prognostically unfavorable types of LV remodeling.