[Realization of medical and medical psychological rehabilitation in sanatorium-resort organizations of Ministry of Defence of the Russian Federation]. / Organizatsiya meditsinskoi i mediko-psikhologicheskoi reabilitatsii v sanatorno-kurortnykh organizatsiyakh Minoborony Rossii.

Current conditions of military service demand higher standards of servicemen health status, whose professional activity in extreme combat conditions is accompanied by the impact of many adverse environmental factors on the body. One of the priority tasks of medical service of Armed Forces of the Russian Federation in 2023 yr. is to improve the system of curative and preventive measures in medical and medical psychological rehabilitation to recover health and increase working capacity of servicemen. The article includes an overview of measures given to servicemen for medical and medical psychological rehabilitation in sanatorium-resort organizations of Ministry of Defence in the Russian Federation for the period from 2013 to 2022 yrs.

[The role of the vascular surgeon in improvement of organization of dialysis help]. / Rol' angiokhirurga v uluchshenii organizatsii dializnoi pomoshchi.

Analysed herein are one-year results of formation of arteriovenous fistulas in 109 patients with end-stage chronic renal failure, as well as therapeutic decision-making after angiosurgical counselling of 144 patients presenting with 'problem' permanent vascular accesses. The counselling and formation of arteriovenous fistulas were carried out in conditions of interdepartmental collaboration between outpatient centres dealing with haemodialysis and vascular surgeons specialized in ultrasound mapping of peripheral vessels and performing different variants of arteriovenous fistulas. The angiosurgical care was as close to the patient as possible. Of the 109 operated patients, primary arteriovenous fistulas were made in 46 (42.2%) cases, secondary AVF - in 27 (24.8%) cases, and reconstruction of AVF - in 36 (33.0%) cases. Of the 144 patients with 'problem' permanent vascular assesses, correction of arteriovenous fistulas turned out impossible in 13 (9.1%). In the remaining 131 (90.9%) patients there was a possibility of different variants of open reconstruction of arteriovenous fistulas or performing angioplasty. Active policy of vascular surgeons in interdepartmental collaboration with nephrologists made it possible to bridge over the difficulties of patients routing which resulted in reduction of the terms of formation of arteriovenous fistulas by 2 months. Preventive arteriovenous fistulas were carried out in 17.4% of cases of primary permanent vascular assesses. During a year after formation of permanent vascular accesses, the number of patients with vascular catheters in ambulatory centres decreased from 22 to 17%. These positive changes in organization of the dialysis treatment made it possible to reduce the risks of infectious complications, to obtain adequate blood flow characteristics for haemodialysis procedures, as well as to decrease financial expenses and labour costs for AVF care.

Pre-treatment condition effects on blood pressure and heart rate variability change in patients with arterial hypertension on therapy.

AIM: To study the relationship of the initial clinical and functional state of patients with arterial hypertension (AH) with the dynamics of daily indices of blood pressure (BP) and sinus rhythm on antihypertensive therapy. MATERIALS AND METHODS: 38 patients were examined (general clinical examination, electrocardiography, echocardiography, daily bifunctional monitoring with the determination of weighted average rhythmogram variations - WARV, clinical and biochemical analysis of blood, glycated hemoglobin, thyroid hormones) and distribyted according to the use of hypotensive drugs of main classes and combined therapy AH. Dynamic monitoring of the effectiveness of treatment was carried out (after 2-4 weeks, then every 1-2 months), clinically and with bifunctional monitoring, correction of therapy. The observation period was 8 months. RESULTS: By the end of the study, 27 patients had target blood pressure, significant decrease in systolic / diastolic blood pressure (10/5 mm Hg and more) occurred in 30 patients. A correlation was found between the effectiveness of antihypertensive treatment and the initial clinical and instrumental parameters of patients: age, heart size (including left ventricular hypertrophy - LVH), thyroid stimulating blood hormone (TSH) level and fasting blood glucose (within normal limits). The level of WARV also correlated with these indicators and was significantly higher in patients who achieved a significant reduction in blood pressure. No significant dynamics of WARV was detected. No relationship between baseline blood pressure with WARV and their changes were identified. The connection of the myocardial mass index with the level of TSH and glycated hemoglobin was demostrated. CONCLUSION: The WARV reflects the severity of organic heart changes associated with age, disease duration, metabolic profile, LVH - heart damage as a target organ in AH, but is not suitable for analyzing its functional changes within one stage of the disease.

[Diagnosis and treatment of allergic rhinitis aggravated by respiratory tract infection].

The objective of the present paper was to propose an optimal scope of diagnostic studies for the patients complaining of rhinitis symptoms for the early detection of allergic rhinitis, including a differential diagnosis with associated respiratory tract infections. A comprehensive treatment is offered including the use of vasoconstrictors and antihistamines, eliminationand immunocorrectivetherapy with Ribomunyl.

Magnetic structures of Fe32+δGe33As2 and Fe32+δ'Ge35-xPx intermetallic compounds: a neutron diffraction and 57Fe Mössbauer spectroscopy study.

Fe32+δGe33As2 and Fe32+δ'Ge35-xPx are quasi-binary intermetallic compounds that possess a rare variant of intergrowth-type crystal structure, which is a combination of the column shaped Co2Al5 and MgFe6Ge6 structure type blocks. The compounds are antiferromagnets with the Néel temperatures around 125 K. Neutron powder diffraction experiments on the samples with δ≈ 0.1, δ'≈ 0.5 and x≈ 3 reveal commensurate magnetic ordering of low symmetry in both compounds and a non-monotonic change in the intensities of magnetic reflections. On the other hand, temperature dependence of the hyperfine fields obtained from 57Fe Mössbauer spectroscopy indicates a gradual, monotonic increase in local magnetic fields upon cooling. We interpret these results as a spin reorientation within the Co2Al5-type block of the crystal structure, with the possible formation of a non-collinear magnetic order at low temperatures. Between the compounds, the reorientation occurs at significantly different temperatures, however the resulting magnetic structures themselves are similar as well as the average values of the magnetic moments and the hyperfine fields.

[Heart rate variability dynamics during treatment of arterial hypertension].

UNLABELLED: Investigation of the dynamics of heart rate variability (HRV) in anti-hypertension therapy can facilitate the evaluation of the effectiveness of treatment. AIM OF INVESTIGATION: to compare anti-hypertension effect of monotherapy with nebivolol and dilatrend with dynamics of HRV and the estimation of the state of patients with mild arterial hypertension (AH) and metabolic syndrome (MS). MATERIAL AND METHODS: HRV was studied in 42 patients with mild AH and MS at the age of 32-60. Eighteen of them were treated with 5 mg of nebivolol during 24 weeks, and twenty-four with 25-50 mg of dilatrend during 16 weeks. All the patients were subjected to 24-hour ECG monitoring with analysis of HRV and arterial pressure (AP) before and after treatment. The main feature of HRV analysis was investigation of dependence of sinus arrhythmia on the mean value of heart rate (HR) RESULTS: With nebivolol treatment AP decreased in 11 patients, HRV became better in 9 patients. 7 cases manifested coincidence of AP reduction and HRV improvement. In 6 cases out of 7 when AP did not decrease, HRV did not change. Worsened HRV was observed in 3 cases: in one case with growing AP and in 2 cases with decreasing AP. All the patients, except one, regarded their state as improved. With dilatrend treatment AP lowered in 16 cases. In 9 cases HRV became better, in 11 cases it remained the same, and in 4 cases it became worse. Positive HRV dynamics in 7 cases out of 9 was accompanied by lowering of AP, while negative dynamics was observed in one case with rise of AP and in three cases with very low AP or in the absence of AP dynamics. 14 patients felt better, 6 of them manifested better level both of AP and HRV. CONCLUSION: The method of 24-hour HRV analysis based on assessment of dependence of the value of sinus arrhythmia on HR is useful in evaluating the effectiveness of anti-hypertension therapy. As a rule, an effective decrease in AP is accompanied with improvement of HRV. The absence of improvement of deterioration of HRV in anti-hypertension therapy is a factor which should be taken into consideration when choosing the mode of therapy.

[Changes in ST segment on ECG of hypertensive patients].

AIM: To evaluate ST depression in hypertensive patients with electrocardiographic signs of left ventricular hypertrophy (LVH), correlation of ST segment changes with heart rate (HR) and blood pressure (BP) during Holter monitoring (HM) and bi-functional ECG and BP monitoring (BFM), and to compare ST depression and local left ventricular contractility during stress-echocardiography in hypertensive patients with unaffected coronary arteries according to the data of coronary angiography. MATERIAL AND METHODS: We examined 344 hypertensive patients without clinical signs of ischemic heart disease. Correlation between ST segment depression and ECG signs of LVH was evaluated in 192 patients. 180 patients underwent HM, 122--BFM and 30 hypertensive patients with normal coronary arteries according to the data of coronary angiography underwent stress-echocardiography. RESULTS: According to the data of 12 lead ECG 40 cases of ST depression were found, with LVH signs in 26 (65%) of these patients. During HM in 34 of 180 patients 2 types of ST depression were found: type 1--short periods of transient ST depression without persistent ST depression was fond in 8 patients; type 2--persistent ST depression more than 1 mm during the whole time of recording--in 26 patients. In 7 of 8 cases of type 1 and in 5 of 26 cases of type 2 ST depression had rhythm-dependent character. During BFM in 9 cases ST depression during HR or BP increase was found. In 2 cases ST depression during BP increase was unrelated to HR increase which may be consequence of systolic myocardial strain syndrome. In 7 of 30 hypertensive patients with normal coronary arteries and without local myocardial contractility disturbances according to the data of stress-echocardiography positive criteria of ischemia were found. CONCLUSION: The cause of ST segment depression in hypertensive patients more often are secondary disturbances of repolarizaion processes related with LVH development. In some cases such patients during HM show rhythm-dependent valuable ST depressions. In BFM cases of left ventricular myocardial strain syndrome are found, similar cases are also seen in stress-echocardiography. However, in some cases one fails to define the reason of ST changes even approximately. One of the factors leading to disturbances of repolarization processes in hypertensive patients may be disturbances of microcirculation at the level of prearteriols and capillaries.

[Trends in heart rate variability in patients with ischemic heart disease and depression treated with antidepressant tianeptine].

AIM: To study heart rate variability (HRV) according to 24-h Holter monitoring of ECG in patients with ischemic heart disease (IHD) and to examine effects of tianeptine on HRV. MATERIAL AND METHODS: Twenty eight patients with IHD (17 males and 11 females aged 40-70 years) with a verified IHD diagnosis and atherosclerosis of the coronary arteries participated in the trial. Severity of depressive syndrome was assessed by CES-D questionnaire. HR V was assessed by weighted mean variation of the rhythmogram (WMVR) for 24 hours. RESULTS: Initial WMVR (m +/- sigma) in the study group (IHD with depression, n = 15) was 670 +/- 260 ms, in the control group (IHD without depression, n = 13) - 625 +/- 191 ms (the difference was insignificant (p = 0.72). Initial (m +/- sigma) WMVR in men of the study group (n = 6) before therapy was 460 +/- 139 ms that was less than in the control group (633 +/- 183 ms, n = 11). CONCLUSION: In men HRV depends on duration of the disease. There was a negative correlation between WMVR difference before and after treatment with tianeptine and difference of relevant depression indices with high correlation coefficient (-0.74, p = 0.03).

[Urgent surgical correction of ventricular septal defects in children of first months of life].

The article presents the results of urgent surgical correction of ventricular septal defects (VSDs) and a range of associated congenital heart diseases (CHDs) in 123 children of the first 6 months of life, hospitalized between 1988 and 2002 in a severe or critical condition. In 102 patients the progression of clinical symptoms was caused by a big single VSD and in 21 patients--by multiple VSDs. 70 patients had significant associated CHDs. Significant extracardiac anomalies were revealed in 75 patients. The condition of 55.3% of children had deteriorated due to pneumonia. Correction of defects with cardiopulmonary bypass was performed after urgent examination and intensive therapy. Hemodynamically significant VSD were closed in 117 (95.2%) patients. Two patients were reoperatied due to the presence of residual VSD. Partial or full simultaneous correction of associated CHDs was performed in 68 patients. 93.5% of patients with isolated VSDs survived the operation. The survival rate of patients with associated CHDs and extracardiac anomalies was 81.5%. Postoperative mortality risk factors were found to be critical condition at hospitalization and preoperative activity of infectious process (P < 0.01 and < 0.05, respectively). Accumulation of experience and introduction of a special approach allowed an 8-time decrease of the hospital mortality, which has not exceeded 3.4% within last 3 years. Good and excellent follow-up results were obtained in 98% of the survived patients within 10 to 67 months after operation. Precise diagnostics of associated CHDs and extracardiac anomalies, intensive preoperative treatment and weighed estimation of indications and risk factors allow significant improvement in the results of primary correction of VSD and accompanying cardiovascular anomalies in children of the first months of life in a heavy and critical condition upon admission.

Two-year dynamics of vectorcardiography parameters in patients with primary pulmonary hypertension.

VCG data (McFee--Parungao system) were obtained from 12 patients with primary pulmonary hypertension (PPH). During 2 years, VCG investigations were repeated from 2 to 5 times. Various VCG-parameters were analyzed. Space and horizontal QRS areas, projection of integra QRS vector to axis y and the sum of Rx and Sx were diagnostically most significant. Their values proved abnormal at the beginning of survey. In the course of observation, states of the right heart chambers together with VCG-parameter dynamics were investigated in every patient. States of the right cardiac chambers improved in 4 patients. In all of them the parameter turned to normal values. In two patients, during the monitoring time monotonous increase of parameters was observed, with the state of the right heart chambers declining. In 6 patients, state of right heart chambers appeared relatively stable. In these patients, values of all the parameters were either stable or insignificantly changeable around some mean values. Thus, the dynamics of VCG-parameters makes it possible to estimate adequately the states of the right cardiac chambers in PPH patients. (Tab. 1, Fig. 4, Ref. 4)

Influence of left ventricular hypertrophy on heart rate variability in hypertensive patients.

Long-term heart rate variability (HRV) data were obtained from 38 patients with arterial hypertension and 20 healthy persons. New method of HRV analysis based on calculation and estimation of variations of short rhythmogram intervals (SRV) was applied. This method showed that HRV level depends on number of factors. The most significant of them are patient's age, arterial hypertension form and duration, and left ventricular hypertrophy degree. Patients with these risk factors may be highly predisposed to rate variability decrease. (Tab. 8, Ref. 8.)

[A novel approach to assessment of individual 24-hour heart rate variability]. / Novyi podkhod k otsenke individual'noi sutochnoi variabel'nosti ritma serdtsa u patsienta.

A novel approach to assessment of individual 24-hour heart rate variability (HRV) has been suggested. This approach allows to compare sequences of RR intervals with knowingly nonstationary rhythm and to obtain valuable information on direction (increase or decrease) of HRV changes. The latter was not achievable by existing techniques. Main feature of the novel approach is consideration of dependence of sinus arrhythmia on heart rate on a given time interval (rhythmogram fragment). This became possible due to use of implementation of a new characteristic of 24-hour HRV - mean weighted variation of rhythmogram (MWVR). This parameter repesented a generalization of a previously introduced variation of short rhythmogram fragment (VSRF) and was formed in the following way. Rhythmogram was divided into short fragments and within each fragment VSRF was calculated. Then average variations were averaged for different ranges of HR changes. Each averaged variation was multiplied by weight coefficient which depended on corresponding range of HR changes, and by portion (expressed in percent) of overall number of short rhythmogram fragments belonging to this range. MWVR was determined as sum of resulting multiples. Analysis of rhythmograms from 58 healthy persons showed that MWVR declined with age. In patients with heart failure (n=80) mean MWVR was lower than in healthy persons and decreased with increase of NYHA class of heart failure. Eight patients were restudied while they were classified to a different heart failure class. Transition to a higher class was associated with lowering of MWVR and vice versa. Thus MWVR adequately reflected dynamics of functional state of an individual patient.

[The use of non-linear methods of statistical analysis in the differential electrocardiographic diagnosis of hypertrophic cardiomyopathy (data from precordial mapping)]. / Ispol'zovanie metodov nelineinogo ctaticheskogo analiza v differentsial'noi élektrokardiograficheskoi diagnostike gipertroficheskoi kardiomiopatii (dannye prekordial'nogo kartirovaniia).

An algorithm was proposed to make a differential diagnosis of hypertrophic cardiomyopathy by precordial ECG mapping in 35 leads (PECG-35) of 82 patients with hypertrophic cardiomyopathy and 339 matched patients: those with isolated left and right ventricular hypertrophy, concurrent ventricular hypertrophy, those with coronary heart disease having scars of various sites and having no cicatricial myocardial changes, including those in the presence of left ventricular hypertrophy, as well as 98 healthy individuals. Computer-aided analysis of their mapping was used to calculate the area of Q, R, S, T waves and ST segment and the prolongation of QRS complex. ECG parameters were analyzed by using cluster and dispersion analyses and the kNN method. The cluster analysis of PECG-35 made it possible to divide all the data on hypertrophic cardiomyopathy into 2 groups. For each the complexes of PECG-35 parameters were identified, in whose range the kNN method differentiated hypertrophic cardiomyopathy with a broad spectrum of abnormalities at a high sensitivity of 67-75% and a specificity of 86-90%.

[Use of integral indicators of precordial mapping in differential diagnosis of focal-cicatricial lesions of the myocardium]. / Ispol'zovanie integral'nykh pokazatelei prekordial'noi kartogrammy v differentsial'noi diagnostike ochagovo-rubtsovogo porazheniia miokarda.

The paper proposes new criteria for differential diagnosis of myocardial "focal scarring" and "++pseudo-scarring" changes in various cardiac abnormalities and homogeneous morphological alterations in the ventricular complex on ECG (the QS, Qr-type abnormalities of the R line) by using the findings of 35 lead ECG mapping (PM-35). ECG-12 and PM-35 were analysed in 427 patients, including those with coronary heart disease (n-122), arterial hypertension and aortic malformations (n-130), dilated cardiomyopathy, congenital cardiac disease (n-175). Electrocardiographic signs of focal scarring lesions were revealed in all the cases with coronary heart disease and 66 with myocardial hypertrophy. The total value of ST segment depression and the sum of Q wave squares in three to five vertical mapping columns were found to be the most significant differential and diagnostic criterion. When scars and ++pseudo-scars were differentiated, a sensitivity of 75% was obtained at a specificity of 87%.

[Dynamics of heart rate variability in ischemic heart disease patients after coronary artery bypass grafting]. / Dinamika variabel'nosti ritma serdtsa u bol'nykh ishemicheskoi bolezn'iu serdtsa posle operatsii koronarnogo shuntirovaniia.

AIM: To study dynamics of 24-hour heart rate variability (HRV) after coronary artery bypass grafting (CABG) and to elucidate relationship between HRV dynamics and clinical course of the disease. METHODS AND MATERIAL: A novel methodological approach to evaluation of HRV based on measurement of mean weighted rhythmogram variation (MWRV) was implemented. Ninety patients were studied before CABG. Then HRV was assessed in 2 weeks (61 patients), 2 (45 patients), 6 (24 patients)and 12 (33 patients) months after surgery. RESULTS: At all study points HRV was lower in CHD patients than in healthy persons. Substantial lowering of average MWRV 2 weeks after surgery was followed by return to preoperative level by the end of 2 months, leveling off until 6 months and some decline by the end of a year. Individual changes of MWRV were assessed in 29 patients in whom HRV was evaluated at 5 or 4 study points. Three types of MWRV changes were distinguished: type 1 - "normal" dynamics (9 patients) - elevation of MWRV 2, 6 and 12 months; type 2 (10 patients) - elevation of MWRV after 2 and 6 months with subsequent lowering by the end of 1 year; type 3 (10 patients) - lowering of MWRV In 2 and/or 6 months. The following relationships between MWRV changes and clinical course after surgery were observed: there were no complications among patients with type 1 MWRV dynamics; 8 of 10 type 2 patients had signs of heart failure, or blood pressure elevation, or recurrence of angina by the end of 1 year: among 10 type 3 patients 6 experienced various complications. Recurrence of angina at various intervals after CABG occurred in 5 patients and in all it was associated with MWRV decrease. CONCLUSION: Pronounced decrease of MWRV between 2 and 12 months after CABG is associated with worse clinical course and its detection should trigger additional investigation and care of a patient.

[Information value of different leads for precordial mapping in left ventricular hypertrophy]. / Informativnost' razlichnykh otvedenii prekordial'nogo kartografirovaniia pri gipertrofii levogo zheludochka.

New electrocardiographic criteria of left-ventricular hypertrophy (LVH) have been identified at automated analysis of ECG-35 cartograms (71 normal and 88 LVH recordings). Simultaneous application of 2 sums of S and R amplitudes (S32 + R14 and S30 + R19) obtained from the leads other than Wilsonian chest leads enabled a 1.5-fold increase in the sensitivity of electrocardiographic LVH diagnosis, as compared to the Sokolov-Lyon criteria, without loss of specificity. The use of summary R and S areas at the same points on the cartogram further improves the method's sensitivity.

[Integral indices of the automatically reproduced spatial QRS loop in the diagnosis of different forms of myocardial hypertrophy]. / Integral'nye pokazateli avtomaticheski vosproizvedennoi prostranstvennoi petli QRS v diagnostike raznykh form gipertrofii miokarda.

A total of 249 patients with arterial hypertension taking a variety of clinical forms, primary pulmonary hypertension, dilatation cardiomyopathy, congenital heart diseases with secondary pulmonary hypertension were examined and allocated to 3 groups: 125 patients with left-ventricular hypertrophy (LVH) (group 1); 44 patients with right-ventricular hypertrophy (RVH) (group 2), and 80 patients with combined hypertrophy of both ventricles (CH). Eighty-one normal subjects were taken as controls. New parameters of diagnostic significance were identified by automated reproduction of vectorcardiographic spatial QRSxyz loop (the Macfee-Parungao system) and computer analysis of vectorcardiographic parameters, that improve electrocardiographic diagnosis of cardiac hypertrophies, as compared to the conventional criteria, bringing its accuracy to 88.8% for LVH, 100% for RVH, and 45% for CH. Typical features of myocardial hypertrophy at large are increased area enclosed by the spatial loop (SQRS greater than 3.4 mV2) and/or increased mean vector (LQRSxyz greater than 0.76 mV), while Lx greater than 0.6 mV and/or Lz less than -0.4 mV were specific for LVH; Lx less than 0.05 mV was specific for RVH, and the H angle ranging from -70 degrees to -140 degrees or H of -60 degrees to -140 degrees at Lz less than 1.1 mV, or -50 degrees to -140 degrees at Lz less than 1.5 mV were specific for CH.

[Diagnostic significance of the vectorcardiogram spatial indices in combined atrial dilatation]. / Diagnosticheskoe znachenie prostranstvennykh pokazatelei vektorkardiogrammy pri kombinirovannoi dilatatsii predserdii.

Eighty-two apparently normal subjects and 90 patients with combined atrial dilatation were investigated, using automated amplified-image atrial VCG reproduction with an output of spatial characteristics of the Macfee-Parungao P loop, a method developed at the All-Union Center for Cardiologic Research (USSR Academy of Medical Sciences). Area enclosed by spatial P loop (SPxyz greater than or equal to 0.017 mV2), mean vector size (MPxyz greater than or equal to 120.6 microV) and P loop duration (tPxyz greater than or equal to 0.116 sec) showed the highest diagnostic value. The use of these integral characteristics of the spatial P loop improved identification of two dilated atria, bringing the detection rate to 92%, as compared to 53.3% obtainable with ECG from 12 standard and orthogonal leads.

[Automated selection of optimal parameters of precordial mapping in the diagnosis of right-ventricular hypertrophy]. / Avtomatizirovannyi vybor optimal'nykh parametrov prekordial'noi karty dlia diagnostiki gipertrofil pravogo zheludochka.

New diagnostic parameters, improving the specificity and sensitivity of electrocardiographic diagnosis of right-ventricular hypertrophy, have been identified on the basis of an automated analysis of precordial maps in 56 patients with isolated right-ventricular hypertrophy and 71 normal subjects.