[Clinical features of asthenic disorders in chronic heart failure]. / Klinicheskie osobennosti astenicheskikh rasstroistv pri khronicheskoi serdechnoi nedostatochnosti.

OBJECTIVE: The aim of the study is to study the clinical features of asthenic disorders in chronic heart failure (CHF) considering the reaction to the disease. MATERIAL AND METHODS: 62 inpatients with CHF II-IV functional class (FC) according to NYHA were examined. Research methods included somatic, psychopathological and pathopsychological examination using psychometric scales. RESULTS: According to a pathopsychological study using the Multidimensional Fatigue Inventory (MFI-20), asthenic disorders were discovered in all examined patients, realized mainly by «general fatigue¼ (75.8%) and «physical fatigue¼ (72.6%), more rarely «mental fatigue¼ was observed (32.2%). Correlations of «general fatigue¼ with the age of patients were revealed (p=0.018). There was a relationship between the severity of asthenic disorders and the severity of CHF, as evidenced by the correlation between «general fatigue¼ and reduced ejection fraction (EF) of the left ventricle (p=0.005), as well as «physical fatigue¼ and FC according to NYHA (p=0.022). The negative impact of all components of the dimensions of asthenic disorders on the quality of life was determined (p<0.05). According to the concept of the formation of different perceptions of the manifestations of a somatic disease, two types of reactions to asthenic disorders were identified: 1. Dissociative reactions, manifested by a discrepancy between the severity of CHF and a subjective assessment of the condition with an underestimation of the asthenic symptoms denial of its influence on the usual lifestyle and associated with an unfavorable course of CHF and 2. Adaptive reactions, realized by a harmonious perception of asthenia, awareness of the need to change lifestyle considering the presence of CHF symptoms. CONCLUSION: In accordance with the results, the described clinical features of asthenic disorders allow to distinguish asthenia in CHF and other pathology, and the identified types of reactions can contribute to the timely verification of asthenia, prevention of further progression of CHF, and the development of appropriate treatment approaches.

[Social and psychological risk factors for decreased adherence among patients with atrial fibrillation].

Adherence has a direct impact on reducing the effectiveness of atrial fibrillation therapy and increasing the risk of thromboembolic events. Among the factors involved in the decrease of adherence, the social and psychological characteristics of patients remain insufficiently studied. At the same time, the available publications allow us to conclude that there are markers of the risk of reduced adherence in patients with atrial fibrillation, which include age, cognitive impairment, psychoemotional disorders (including depression and anxiety) and specific behavioral patterns.

[Impact of anxiety disorders on adherence to anticoagulant therapy in patients with atrial fibrillation].

AIM: To evaluate the impact of anxiety disorders on adherence to anticoagulant therapy (ACT) in patients with atrial fibrillation (AF). MATERIALS AND METHODS: 179 outpatients (131 women, 48 men, mean age 69.96.2 years) with AF were examined. The research methods included a physical examination according to the standards of medical care in an outpatient facility, clinical and psychopathological examination using psychometric scales. RESULTS: Based on the assessment of adherence to ACT using the MoriskyGreen test, 2 groups of patients were identified: Group 1 patients with high adherence to ACT, Group 2 patients with partial/low adherence to ACT. In group 1, anxiety disorders were verified in 51.7% of cases, in group 2 54.3%. There were no statistically significant differences in the prevalence and severity of anxiety in the study groups. In accordance with the binary logistic regression model, the probability of high adherence to therapy is determined by higher (compared with the group of patients with partial/low adherence to therapy) scores in terms of mental health (p0.001), vital activity (p=0.02) and the total score of the SF-36 scale (p=0.08), as well as the extraversion parameter (p=0.02) of the NEO-FFI scale. CONCLUSION: In the present study, no significant association was found between anxiety symptoms and a decrease in adherence to ACT in patients with AF. However, the results obtained suggest a contribution to the adherence to therapy of personality characteristics.

[Clinical and psychopathological aspects of nosogenic reactions in chronic heart failure]. / Kliniko-psikhopatologicheskie aspekty nozogennykh reaktsii pri khronicheskoi serdechnoi nedostatochnosti.

OBJECTIVE: To study the typology of nosogenic reactions in chronic heart failure (CHF) with the determination of the contribution of cardiological and personality factors in their formation. MATERIAL AND METHODS: One hundred and twenty-one patients with nosogenic reactions associated with CHF were examined. Somatic, clinical-psychopathological and psychometric examinations were used. RESULTS: Three types of nosogenic reactions in CHF have been identifiedSignificantly more frequent were dissociative reactions (76 (62.8%) patients, 40 men, 36 women, mean age 64.4±12.7) with an underestimation of the severity of the somatic condition, which formed in CHF with a short (3.2±3.8 years, p<0.05), but the most severe course. They were associated with hyperthymic, hysterical and schizoid personality radical. Hypochondriacal reactions (28 (23.1%) patients, 18 men, 20 women, mean age 63.4±15.2), due to anxiety about health and excessive fixation on the functioning of the heart, were characteristic of CHF, regardless of the severity of cardiological conditions, with an average duration of the course (4.1±4.2 years). They were observed in patients with anxious and hysterical radicals. Depressive reactions (17 (14%) patients, 8 men, 9 women, mean age 64.3±13.5), had the most protracted character (6.1±3.2 years), formed in patients with anankastic and schizoid radicals, and were noted in chronic heart failure with a long course and moderate severity. Heterogeneous nosogenic reactions in CHF were associated with low adherence to treatment due to maladaptive behavior of the patient, determined by the characteristics of the psychopathological structure. CONCLUSION: The study demonstrates the influence of the characteristics of a cardiac disease and personality on the clinical and psychopathological features of nosogenic reactions associated with maladaptive behavior of the patient.

[Using stromal stem cells for the periodontal tissue regeneration and their interaction with tissue microenvironment].

This review paper describes the evolution of the ideas of periodontal tissue regeneration, starting with the concept of selective cellular repopulation, stimulation of resident precursor cells in the regeneration focus, up to the application of versatile potential of the stromal stem cells (SSC). Effects of stem cells isolated from an embryo, bone marrow, and adipose tissue, are described, as well as the immunophenotype of freshly isolated SSC, that of precultured vascular cell fraction as compared with the immunophenotype of SSC cultured during various time periods. The results of the study of the processes of proliferation and cell differentiation of SSC transplanted into the deep periodontal defects, are analyzed using proliferating cell nuclear antigen (PCNA) and green fluorescent protein. During the process of regeneration, the interaction of transplanted SSC with the local microenvironment is mediated by special membranous cell receptors. The coordination of cell behavior by means of adhesive and communicative contacts which provide a signal platform for the control of cellular functions, is discussed.

[Pressure-regulated pulmonary ventilation with an inverse ratio of the duration of the inhalation and exhalation phases]. / Ventiliatsiia legkikh, reguliruemaia po davleniiu, pri obratnom sootnoshenii prodolzhitel'nosti faz vdokha i vydokha.

Clinical and physiological effects of pressure-regulated ventilation of the lungs using the inverse rate of inhalation to exhalation (PCV-IR) were studied in two groups of patients. No appreciable advantages of this mode of pulmonary ventilation in comparison with common ("volumic") method were observed in group 1 patients (following open-heart surgery) with moderately expressed respiratory disorders (PaO2/FIO2 = 340c13 and index of lung comprometation 0.7c0.04). At the same time, the level of the peak inhalation pressure in the airways at PCV-IR was reliably lower than during common artificial ventilation of the lungs (AVL). In patients with grave respiratory disturbances (PaO2/FIO2 = 93c10 and index of lung comprometation 6.88c0.56) application of this scheme brought about an improvement of pulmonary biomechanics and gas exchange, but the hemodynamics was virtually the same. It is noteworthy that the process of PCV-IR adaptation required a thorough preliminary "adjustment" of the ventilation parameters and took rather a long time in the majority of patients. Positive effects of PCV-IR may be due to several mechanisms: a slowing down (ramp-like) flow, limitation of the upper pressure during inhalation, prolongation of exhalation in comparison with inhalation, and a regulated level of internal positive end expiratory pressure. PCV-IR is recommended as a variant of respiratory support in the treatment of patients with severe involvement of the lungs, when the potentialities of common AVL are exhausted.