[ISCHEMIA - the Largest Ever R andomized Study in Stable Coronary Artery Disease. Baseline Characteristics of Enrolled Patients in One Russian Site].

Indications for coronary revascularization in patients with stable coronary heart disease (CHD), presented in the current international guidelines are largely based on the clinical trials conducted sometimes more than 30 years ago. ISCHEMIA is the major multicenter international randomized trial intended to answer the question about the optimal treatment strategy in stable coronary artery disease at the present time. PURPOSE: To analyze the most important baseline characteristics of patients enrolled in the ISCHEMIA study in one Russian site. METHODS: The principal inclusion criteria are a positive stress test (in our center, exercise stress echocardiography) of at least moderate risk and obstructive coronary heart disease confirmed by coronary computed tomography angiography (CCTA). Main exclusion criteria are a significant stenosis of the left main coronary artery by CCTA, clinical progression/destabilization of the ischemic heart disease, angina of IV CCS class, left ventricular ejection fraction (EF) 80% - beta blockers, >80% - ACE inhibitors/ARBs. They are at well controlled resting heart rate (.

[CURRENT VIEWS OF DIAGNOSTICS AND STRATEGY OF THE TREATMENT OF STABLE ISCHEMIC HEART DISEASE].

Ischemic heart disease (IHD) is a leading cause of mortality worldwide and stable IHD is one of its most important clinical forms. Recent decades brought new data on algorithms of diagnostics, pharmacotherapy and myocardium revascularization in patients with stable IHD. They were summarised in American (2012) and European (2013) recommendations on the management of this condition. The present paper is designed to discuss these algorithms with reference to the currently available evidence, results of the last studies and international guidelines.

[Revascularization or conservative strategy in patients with stable coronary heart disease: a contemporary view].

Choice between revascularization and conservative strategy in patients with stable coronary heart disease (CHD) is an important clinical problem, especially when the need for revascularization is not urged by severe ischemic symptoms. Revascularization aimed to improve prognosis is most justified in patients having high risk, based both on results of coronary angiography and functional tests. In the opinion of many experts, the high-risk features at stress-test is a key to identify patients in whom revascularization is most required among persons with high-risk coronary anatomy, as well as to select candidates for invasive treatment among patients with more favorable variants of coronary lesions. The advantage of revascularization over conservative treatment was demonstrated primarily in relation to coronary bypass surgery; however, the prospect of replacing surgery by an interventional treatment for prognostic reasons is extremely attractive. Although comparison of prognostic efficiency of percutaneous coronary intervention (PCI) and coronary bypass surgery (CABG) for some categories of patients with stable ischemic heart disease has yielded encouraging results, improved survival when using the PCI in direct comparison with optimal medical therapy was not convincingly confirmed to date. Implementation of PCI to improve prognosis in stable ischemic heart disease is still limited by a rather narrow range of indications and the relief of symptoms of ischemia remains its main purpose.

Crystallization of type I chloramphenicol acetyltransferase: an approach based on the concept of ionic strength reducers.

Chloramphenicol acetyltransferase (CAT) is responsible for bacterial resistance to chloramphenicol. It catalyzes inactivation of the antibiotic by acetyl-group transfer from acetyl CoA to one or both hydroxyl groups of chloramphenicol. Type I CAT possesses some unique properties which are not observed in other CAT variants. Type I CAT overexpressed in Escherichia coli was purified and crystals with a resolution limit of 2.22 A have been obtained using a novel procedure which is based on the concept of 'ionic strength reducers'. The crystals have the symmetry of space group P1 and unit-cell parameters a = 96.46, b = 113.86, c = 114.21 A, alpha = 119.9, beta = 94.1, gamma = 98.6 degrees. These dimensions are consistent with four to six trimers per unit cell, corresponding to a solvent fraction ranging from 65 to 47%.