[A new class of phenomena identified during the analysis of neural network of multidimensional data from patients with inflammatory lung diseases].

AIM: To apply the neural network analysis method of multi-data of patients with community-acquired pneumonia (CAP) to recognize the variability of their diagnoses and discovery of new analytical capabilities of NSA based on new methodological approaches of the meeting. MATERIALS AND METHODS: In this paper, we applied a new approach of neural network analysis of multivariate data, obtained based on clinical, laboratory and instrumental tests in 60 patients older than 65 years at various stages of the treatment of community-acquired pneumonia. Anthropometric data were used together with the results of immunological and immunochemical studies of blood serum of patients with community-acquired pneumonia who were in the acute phase of the disease. RESULTS: A new approach analysis of these data revealed the presence of characteristic groups of the biomarkers, which consist from a combination of a small number of the signs that are necessary and sufficient in the aggregate for accurate classification of diagnoses for patients. CONCLUSIONS: The presence of these symptoms characteristic series shows that we have discovered a new class of phenomena. These phenomena manifest themselves in the hidden relationships between the signs which included in these groups and are reflect features of the flow processes in the pathogenesis of inflammatory diseases of the lungs in different diagnostic areas. Their study can be an important and interesting in terms of understanding the many aspects of this disease.

Analysis of polymorphisms in T(H)2-associated genes in Russian patients with atopic bronchial asthma.

BACKGROUND: Bronchial asthma is a chronic respiratory disorder characterized by airway inflammation, airway hyperresponsiveness, and periodic reversible airway obstruction. Subtype 2 helperT cell (T(H)2) cytokines play an important role in the development of allergic airway inflammation in patients with bronchial asthma. OBJECTIVE: To investigate whether the single-nucleotide polymorphisms (SNPs) Ile75Val and Gln576Arg in the IL4RA gene, -33C>T in the IL4 gene, and Gly237Glu in the FCER1B gene contribute to the development and severity of atopic bronchial asthma in Russian patients from Moscow. METHODS: We analyzed DNA samples from 224 patients with atopic bronchial asthma and 172 healthy individuals. Genotyping was performed by primer extension followed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry. RESULTS: We observed a moderate association between the Arg/Arg genotype of Gln576Arg and protection against asthma (odds ratio [OR], 0.16; P < .012) and a strong association between the T allele and TT genotype of -33C> and atopic bronchial asthma (OR, 1.91 and 4.65, respectively; P < .0001). Carriers of the C allele had a reduced risk of asthma (OR, 0.53; P < .0001). Furthermore, we found that the TT genotype of -33C>T correlated with higher concentrations of total serum immunoglobulin E and interleukin 4 than the CC and CT genotypes. CONCLUSION: We found an association between atopic bronchial asthma and the SNPs Gln576Arg in IL4RA and -33C>T in IL4. IL4RA and IL4 seem to be involved in the pathogenesis of asthma.

[CARD15 and TLR4 genes polymorphisms in atopic bronchial asthma].

In order to investigate whether single nucleotide polymorphisms G(+2722)C and 3020insC in CARD15 gene and Asp299Gly in TLR4 gene contribute to atopic bronchial asthma we performed a comparative analysis of alleles and genotypes frequencies of these polymorphisms in Russian patients from Moscow. DNA samples from 283 patients with atopic bronchial asthma and 227 healthy donors were genotyped. There were associations neither of G(+2722)C and 3020insC in CARD15 gene and Asp299Gly in TLR4 gene with asthma nor of markers of CARD15 gene with asthma severity. Haplotype frequency analysis of CARD15 gene polymorphisms did not reveal significant difference between groups. However, a strong association was found between Asp299Gly and asthma severity. Allele Asp of this marker showed association with mild atopic bronchial asthma and allele Gl--with moderate/severe asthma = 0.47, 95% CI [0.24-0.93] i OR = 2.12, 95% CI [1.08-4.18] respectively).

[M31R and R335C polymorphic variants of the IL8RA gene in Russian and Buryat patients with atopic bronchial asthma].

To test the M31R and R335C polymorphisms of the Il8RA gene for association with atopic bronchial asthma (BA), the allele and genotype frequency distributions of the polymorphisms were studied in Russian patients from Moscow and Buryat patients from Ulan-Ude. The study involved two Russian groups, one including 291 DNA samples of patients with atopic BA, and the other, 266 DNA samples of healthy people. The two Buryat groups included 124 and 152 DNA samples from patients with atopic BA and healthy people, respectively. The M31R polymorphism proved to be associated with atopic BA in Russians. Allele Arg and genotype Met/Arg suggested a higher risk of BA (OR= 4.45, P = 0.003 and OR = 4.58, P = 0.003, respectively), while allele Met and genotype Met/Metwere associated with a lower risk (OR = 0.22, P = 0.003 and OR = 0.22, P = 0.003, respectively). The R335C polymorphism was not associated with atopic BA in Russians and was in Buryats. Allele Arg and homozygous genotype Arg/Arg suggested a higher risk of the disease (OR = 3.06, P = 0.030 and OR = 3.20, P = 0.027, respectively), while allele Cys and genotype Arg/Cys suggested a lower risk (OR = 0.33, P = 0.030 and OR = 0.31, P = 0.027, respectively). The results support the role of the IL8RA gene in atopic BA.

[Antithrombotic therapy in patients with prosthetic heart valves].

Anticoagulant therapy is an important component of treatment of patients with prosthetic heart valves. The article contains consideration of specific problems of antithrombotic therapy in patients with various types of prostheses and its tactics in different clinical situations. In the absence of national recommendations on the use of anticoagulants in these patients the authors suggest schemes of management based on recent European and American guidelines.

[The efficacy and safety of infliximab in patients with ankylosing spondylitis: results of an open-labeled multicenter study].

AIM: To evaluate the efficacy and tolerability of the anti-tumor necrosis factor-alpha infliximab in patients with active ankylosing spondylitis (AS) in a 54-week multicenter open-label study. SUBJECTS AND METHODS: The study enrolled 42 patients with AS who continued to have an active phase of the disease despite that they had received standard therapy. All but one patient had signs of active spondylitis; peripheral arthritis was noted in 52%; enthesitis was seen in 79%. Infliximab was administered in a dose of 5 mg/kg as 2-hour intravenous infusions; the second and third infusions were injected 2 and 6 weeks after the first one; all further infusions were used at an interval of 6-8 weeks. RESULTS: Thirty-three (78.6%) of the 42 patients completed the trial. There was a considerable, at least 50%, improvement in the ASAS criteria in 84.8% of the patients who completed the trial. A substantial therapeutic effect was observed in the majority of patients just a week after the first infusion of infliximab. There was a statistically improvement in all the analyzed clinical effectiveness indicators, including the Bath AS Disease Activity Index (BASDAI); pain became less in the vertebral column and joints (on an average from 49.6 to 12.4 mm on the 100-mm visual analog scale); the level of C-reactive protein and the number of swollen and tender entheses were decreased. The patients' functional capacity improved considerably (the Bath AS Functional index (BASFI) decreased on average from 59.7 to 16.3 scores). Nine (21.4%) patients were withdrawn from the study ahead of time: 7 and 2 patients because of adverse reactions (AR) and contact loss, respectively. The most common ARs were airway infections (13.6%), hepatic dysfunction (12.0%), and herpes simplex virus infections (10.4%). Four patients developed the severest ARs (pulmonary tuberculosis, generalized psoriasis-like dermatitis, pneumonia, and abscess of the epithelial coccygeal tract); the outcome of all complications was good. CONCLUSION: The results of the study suggest that infliximab has a high, rapidly occurring and stably preserving efficiency in most patients with active AS. The frequency and spectrum of ARs corresponded to the available data on the tolerability of infliximab.

Effect of serotonin on impulse activity of bulbar cardiovascular neurons.

Alteration of impulse activity of afferent and intercalatory neurons of bulbar cardiovascular center upon serotonin microinjection was demonstrated in acute experiments in rabbit. Afferent neurons were more sensitive to serotonin than interneurons.

[Risk factors and pathogenetic mechanisms of left ventricular hypertrophy in progressive chronic kidney disease and after transplantation of the kidney].

AIM: To specify the trend in the incidence of left ventricular hypertrophy (LVH) at a predialysis stage of chronic kidney disease (CKD) in the course of its progression from stage III to stage V and after transplantation of the kidney (TK); to study correlations between homeostatic disorders caused by CKD progression and myocardial remodeling; to define the role of some hemodynamic and nonhemodynamic factors in formation of LVH. MATERIAL AND METHODS: The study enrolled 128 patients (58 males and 70 females, age 18-55 years, mean age 42 +/- 11 years) at a predialysis stage of CKD (group 1) and 225 recipients of renal allotransplant--RRA (group 2, 140 males and 85 females, age 18-69 years, mean age 43 +/- 12 years). General clinical examination, biochemical and immunological blood tests, echocardiography were made. RESULTS: At a predialysis stage of CKD, LVH was diagnosed in 56% patients. Incidence of LVH was directly related with age of the patients (p = 0.001), blood pressure (p < 0.001), duration of arterial hypertension (p = 0.004), severity of anemia (p = 0.017), the level of C-reactive protein (p = 0.003), blood phosphorus concentration and inversely correlated with glomerular filtration rate--GFR (p = < 0.001), albumin level (p = 0.023) and blood Ca (p < 0.001). LVH was followed up for 12 months in 35 patients with predialysis CKD. Factors of LVH progression and factors hindering its regression were systolic blood pressure, Hb and Ca in the blood. In group 2 of RRA incidence of LVH was 53%. Significant factors of LVH risk after transplantation were age (p = 0.002), hypertension (p = 0.005) and anemia (p = 0.04). Moreover, LVH closely correlated with proteinuria (p < 0.03), transplant dysfunction (p = 0.002) and posttransplantation ischemic heart disease (p < 0.037). Changes in LVH were analysed in 30 RRA. Frequency of LVH decreased for 2 years after transplantation (from 56 to 32%) but 36-60 and more months after transplantation it increased (46 and 64%, respectively). Transplant dysfunction was the leading factor hindering LVH regression after transplantation. CONCLUSION: The same mechanisms are involved in LVH pathogenesis after transplantation and at a predialysis stage of CKD. The significance of initial renal lesion signs--minimal proteinuria and hypercreatininemia--was higher after renal transplantation than in patients with CKD.

[Tactics of antihypertensive therapy in patients with hypertonic crisis complicated with hemorrhagic stroke]. / Taktika antigipertenzivnoi terapii u patsientov s gipertonicheskim krizom, oslozhnennym gemorragicheskim insul'tom.

OBJECTIVE: To determine an optimal tactics of antihypertensive therapy in patients with hypertonic crisis complicated with hemorrhagic stroke. MATERIAL AND METHODS: We examined 86 inpatients, 42 men and 44 women, aged 46-87 years, with hypertonic crisis complicated with hemorrhagic stroke. The severity of neurological deficit, parameters of cardiac output and Kaplan-Meier survival curve based on the level of arterial pressure (AP) were assessed. RESULTS: The best survival rate of the patients with systolic blood pressure >162 mm Hg to the 20th min from the beginning of treatment with the greater rate of its increase was established. The efficacy of antihypertensive therapy did not depend on the baseline neurological deficit. The remote survival rate did not depend on such factors as sex, age, baseline AP level, AP, frequency of heart contractions, hematoma's volume.

[Echocardiographic diagnosis of mitral valve insufficiency]. / Ekhokardiograficheskaia diagnostika nedostatochnosti mitral'nogo kaplana.

Seventy-two persons with various forms of mitral insufficiency of rheumatic and non-rheumatic etiology and 17 healthy individuals (control group) were examined. The results of echocardiography in 35 patients were compared with operative (mitral commissurotomy, valve plastics) findings. Several typical variants of a mitral echogram in patients with "pure", predominant and concomitant mitral insufficiency were distinguished. The predominantly "valvular" mechanism of mitral insufficiency in patients with rheumatic disease and the predominant role of "subvalvular" pathology in nonrheumatic insufficiency were revealed. The diagnostic value of determining the indices of cardiac activity and the size of the left parts of the heart by means of echocardiography is confirmed.

[Left ventricular contractile function in asymmetrical septal hypertrophy]. / Sokratitel'naia funktsiia levogo zheludochka u bol'nykh s asimmetrichnoi gipertrofiei peregorodki.

To study the state of the contractile function of the myocardium and the function of the left ventricle with hypertrophic cardiomyopathy 27 patients were examined. The main method of examination was mono- and bi-dimensional echocardiography. As a result of this examination it became possible to determine the output fraction, the rate of circulatory contraction of the myocardial fibres, the degree of shortening of the antero-posterior dimension of the left ventricle and a number of other indices of the contractile properties of the interventricular septum and the posterior wall of the left ventricle which enables one to use different medicinal agents in such patients under the ECG control.

[Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin]. / Opyt lecheniia bol'nykh s gipertroficheskoi kardiomiopatiei obzidanom i izoptinom.

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.

[Echocardiographic diagnosis of the mitral valve cusp flotation syndrome]. / Ekhokardiograficheskaia diagnostika sindroma flotatsii stvorok mitral'nogo kaplana.

The flotation of the mitral cusps is one of the forms of non-rheumatic mitral regurgitation due to disorders in the chordal fixation of the cusps. The authors have examined 26 patients with echocardiographic signs of flotation of the anterior or posterior mitral cusps. In 21 patients there was flotation of the posterior cusp and 5 had flotation of both the cusps. The comparative diagnostic value of separate echocardiographic signs of flotation of the anterior and posterior cusps of the mitral valve is discussed. It is stressed that echocardiography is a valuable method of investigation.

[Clinical aspects and diagnosis of the mitral valve prolapse syndrome]. / Klinika i diagnostika sindroma prolapsa mitral'nogo klapana.

The work discusses the results of the examination of 108 patients with the syndrome of mitral valve prolapse encountered in the presence of various diseases (cardiomyopathy, acquired heart diseases, ischemic heart disease, pericarditis, etc.). The methods for the diagnosis of this syndrome are discussed: electro- phono-, echocardiography, radiography of the heart, and ventriculography. The clinical manifestations of the syndrome are analyzed.

[Myocardial perfusion in mitral valve prolapse with arrhythmic syndrome]. / Perfuziia miokarda pri prolabirovanii mitral'nogo klapana s aritmicheskim sindromom.

Myocardial perfusion was studied in 12 patients with mitral valve prolapse concurrent with cardiac arrhythmias by using two-dimensional 201Tl myocardial scintigraphy at rest and during exercise test. Signs of myocardial ischemia were revealed only in one case. Five patients were found to have steady-state perfusion defects whose extent correlated with the depth of mitral valve prolapse. There was an irregular distribution of myocardial blood flow, which ceased on exercise in 10 out of 12 patients. Patients with ventricular premature contraction displayed a decreased reserve of myocardial blood flow as compared to those with supraventricular premature contraction, presumably by enhancing myocardial perfusion at rest.

[Liver fatty degeneration and chronic hepatitis HCV]. / Zhirovaia distrofiia gepatotsitov i khronicheskii HCV-gepatit.

Fatty degeneration in HCV-hepatitis is, according to the authors' data, an active process determining progression of liver fibrosis. This allow to formulate new approaches to treatment of chronic HCV-hepatitis.

[Hypertrophic cardiomyopathy in children (clinico-echocardiographic study)]. / Gipertroficheskaia kardiomiopatiia u detei (kliniko-ékhokardiograficheskoe issledovanie).

On the grounds of clinical, electro- and echo-cardiographic examination of 39 patients with hypertrophic cardiomyopathy from 3 to 15 years of age three types of this pathological condition are distinguished: asymmetrical septal hypertrophy, idiopathic hypertrophic subaortic stenosis and symmetrical hypertrophic cardiomyopathy. The value of signs of hypertrophic myopathy obtained on clinical and instrumental examination is discussed. The high diagnostic value of echocardiography in the examination of patients is emphasized.