SPECT/PET myocardial perfusion imaging versus coronary CT angiography in patients with known or suspected CAD.

Stress SPECT myocardial perfusion imaging (MPI) is the most commonly utilized stress imaging technique for patients with suspected or known coronary artery disease (CAD) and has a robust evidence base including the support of numerous clinical guidelines. Gated SPECT is a well-established noninvasive imaging modalities that is a core element in evaluation of patients with both acute and stable chest pain syndromes. Over the past decade, PET has become increasingly used for the same applications. By comparison, cardiac computed tomography (CT) is a more recently developed method, providing non-invasive approaches for imaging coronary atherosclerosis and coronary artery stenosis. Non-contrast CT for imaging the extent of coronary artery calcification (CAC), in clinical use since the mid-1990's, has a very extensive evidence base supporting its use in CAD prevention. While contrast-enhanced CT for noninvasive CT coronary angiography (CCTA) is relatively new, it has already developed an extensive base of evidence regarding diagnosing obstructive CAD and more recently evidence has emerged regarding its prognostic value. It is likely that non-contrast CT or CCTA for assessment of extent of atherosclerosis will become an increasing part of mainstream cardiovascular imaging practices as a first line test. In some patients, further ischemia testing with MPI will be required. Similarly, MPI will continue to be widely used as a first-line test, and in some patients, further anatomic definition of atherosclerosis with CT will also be appropriate. This review will provide a synopsis of the available literature on imaging that integrates both CT and MPI in strategies for the assessment of asymptomatic patients for their atherosclerotic coronary disease burden and risk as well as symptomatic patients for diagnosis and guiding management. We propose possible strategies through which imaging might be used to identify asymptomatic candidates for more intensive prevention and risk factor modification strategies as well as symptomatic patients who would benefit from referral to invasive coronary angiography for consideration of revascularization.

[Experimental and clinical evaluation of the efficacy of ecdysten in the treatment of hepatitis]. / éksperimental'no-klinicheskaia otsenka effectivnosti primeneniia ékdistena pri lechenii gepatita.

The properties of ecdysten, an exdysterone-based preparation, were studied under experimental (of heliotrine induced hepatitis model in rats) and clinical (chronic viral hepatitis B) conditions. A 2-week treatment with ecdysten in a daily dose of 5 mg/kg (p.o.) significantly improved the state of rat liver, as manifested by normalization of the enzymatic activity of blood serum, stimulation of the protein and glycogen synthesis, inhibition of lipid peroxidation, and activation of all chains of microsomal oxidation of hepatocytes. The inclusion of ecdysten into a complex therapy scheme for patients with chronic viral hepatitis B (5-mg tablets twice per day over a period of 30 days) substantially improved the clinical and biochemical indices of the functional state of liver, positively influenced the humoral and cell immunity and the resistance factors, and normalized the course of autoimmune processes accompanying the liver pathology.

Modern nuclear cardiac imaging in diagnosis and clinical management of patients with left ventricular dysfunction.

Congestive heart failure (CHF) has become a large social burden in modern Western society, with very high morbidity and mortality and extremely large financial costs. The largest cause of CHF is coronary heart disease, with ventricular dysfunction that may or may not be reversible by revascularization. Thus, evaluation of the viable myocardial tissue in patients with ischemic left ventricular (LV) dysfunction has important clinical and therapeutic implications. Furthermore, since patients with ventricular dysfunction are at higher operative risk, cardiologists and cardiac surgeons are commonly faced with issues regarding the balance between the potential risk vs benefit of revascularization procedures. Cardiac nuclear imaging [myocardial perfusion SPECT (MPS) and positron emission tomography (PET)] provide objective information that augments standard clinical and angiographic assessments of patients with ventricular dysfunction with respect to diagnosis (etiology), prognosis, and potential benefit from intervention. Development of the technology and methodology of gated MPS, now the routine method for MPS, allows assessment of the extent and severity of inducible ischemia as well as hypoperfused but viable myocardium, and also provides measurements of LV ejection fraction, regional wall motion, LV volume measurements, diastolic function and LV geometry. With PET, myocardial metabolism and blood flow reserve can be added to the measurements provided by nuclear cardiology procedures. This paper provides insight into the current evidence regarding settings in which nuclear cardiac imaging procedures are helpful in assessment of patients in the setting of coronary artery disease with severe LV dysfunction. A risk-benefit approach to MPS results is proposed, with principal focus on identifying patients at risk for major cardiac events who may benefit from myocardial revascularization.

[Treatment of disorders in interferon status of patients with urogenital chlamydial infection]. / Narushenie interferonovogo statusa u bol'nykh s urogenital'noi khlamidiinoi infektsiei i sposoby ego korrektsii.

The interferon status was studied in 54 patients with urogenital chlamydiosis, presenting with disturbances in the reproductive system. The blood serum content of gamma-interferon was 32-fold in the above patient population vs control subjects on conventional therapy. Supplementing such a therapy with cycloferon, an inducer of endogenous interferon, and with immunomodulin have been shown to activate production of interferon.

[Phospholipid composition of erythrocytes in patients with chronic kidney failure]. / Fosfolipidnyi sostav éritrotsitov u bol'nykh khronicheskoi pochechnoi nedostatochnost'iu.

Qualitative and quantitative composition of lipid fractions was studied in erythrocytes of 221 patients (16-62 years old) in the terminal step of chronic renal failure. The following lipid fractions were studied: total phospholipids, monoglycerides, cholesterol, free fatty acids, diglycerides, triglycerides, methyl esters of fatty acids, cholesterol esters, lysophosphatidyl choline, phosphatidyl serine, lysophosphatidyl ethanolamine, sphingomyelin, phosphatidyl inositol, phosphatidyl choline, lysocardiolipin, phosphatidyl ethanolamine, cardiolipin, lysophosphatidic acid and phosphatidic acid. The alterations observed in the phospholipid composition of erythrocyte membranes appear to occur due to intracellular transformations related to specific metabolism in uremia. These alterations of phospholipid composition in erythrocyte membranes of patients with chronic renal failure, which were found to be intoxication-dependent, may be used in prognostic evaluation of patients' state under conditions of uremia development.

[The neurohumoral and hemodynamic effect of aldizem in patients with stable and unstable angina pectoris]. / Neirogumoral'nye i gemodinamicheskie éffekty aldizema u bol'nykh stabil'noi i nestabil'noi stenokardiei.

A study is presented of hemodynamic effects and reactions of prostacyclin--thromboxane system in patients with stable (63 pts) and unstable angina pectoris (57 pts) who took aldizem 240 mg daily during 3 week. It was found that the aldizem improved clinical and hemodynamic indices and increased plasma concentration of 6-keto-PGF1 alpha and FPE2, but reduced TxB2 and PGF2 alpha. Also these changes depended on time of therapy: long-term therapy resulted in improvement of the prostacyclin-thromboxane balance.

[Effect of the calcium antagonist diltiazem on the prostacyclin-thromboxane ratio in the plasma of ischemic heart disease patients]. / Vliianie antagonista kal'tsiia diltiazema na prostatsiklin-tromboksanovoe sootnoshenie v plazme krovi bol'nykh IBS.

Content of prostacyclin and thromboxane was studied in blood plasma of patients with ischemic heart disease after single administration of calcium antagonist diltiazem. The drug caused an increase in content of prostacyclin and in the ratio prostacyclin/thromboxane. Diltiazem appears to differently affect the arachidonic acid metabolism in platelets and endothelial cells that may be involved in therapeutic effect of the drug under conditions of ischemic heart disease.

[Erythrocyte lipids in diabetes mellitus with vascular involvement]. / Lipidy éritrotsitov pri sakharnom diabete s sosudistymi porazheniiami.

Alterations in content of neutral lipids, phospholipids and of their lysoforms were studied in erythrocyte membranes of patients with various severity of vascular impairments considering clinical manifestation of diabetes mellitus. Impairments of lipid composition in erythrocyte membranes observed correlated with the steps of diabetic angiopathies, thus considering an importance of these alterations in pathogenesis of vascular diseases of patients with diabetes mellitus.

[Lipid composition of thrombocytes in diabetes mellitus depending on the degree of microangiopathy]. / Lipidnyi sostav trombotsitov pri sakharnom diabete v zavisimosti ot stepeni mikroangiopatii.

The paper is concerned with the results of a study of the content of platelet lipid fractions in 115 patients with type I and II diabetes mellitus with a different degree of vascular complications. The results showed that the development of vascular lesions caused the appearance of specific disorders of platelet lipid composition characteristic for type I and II diabetes mellitus. In type I disorders of neutral phospholipids and free fatty acids were noted whereas in type II the above changes were noted in parallel with changes in the levels of cholesterol and acid phospholipids. With an increase in vascular lesions in type II there was a significant increase in phospholipase A2 activity, in type I under the same conditions the activity of this enzyme was absent. These facts suggest correlation between the development of vascular complications of diabetes mellitus and disorders in platelet membrane lipid structure.

[Comparative study of the effect of ecdysterone, turkesterone and nerobol on the function of rat liver mitochondria in experimental diabetes]. / Sravnitel'noe izuchenie deistviia ékdisterona, turkesterona i nerobola na funktsii mitokhondrii pecheni krys pri éksperimental'nom diabete.

Oxidative phosphorylation and Ca2+-transport functions of liver mitochondria were normalized in rats with alloxane diabetes after peroral administration of phytoecdisteroids - ecdisterone and turkesterone (5 mg/kg) or nerobol (10 mg/kg) within 15 days. These drugs normalized the activity of NADH dehydrogenase and succinate dehydrogenase in respiratory chain of mitochondria, increased distinctly stability of the enzymes to the effect of such factors as heating, effect of phospholipase A2 or trypsin.

[Phospholipid composition and oxidative phosphorylation in liver mitochondria in hepatitis]. / Izmerenie fosfolipidnogo sostava i okislitel'nogo fosforilirovaniia v mitokhondriiakh pecheni pri gepatite.

Phospholipid composition and oxidative phosphorylation were studied in liver mitochondria of rats with experimental chronic hepatitis. The hepatitis was simulated by means of two hepatotropic drugs--heliotrin and CCl4. Content of phosphatidyl inositol was decreased and that of phosphatidic acid--increased in the hepatitis independently of the nature of the agent inducing the disease. At the same time, content of lysophosphatidyl ethanolamine was decreased but content of lysocardiolipine and lysophosphatidic acid was increased. In CCl4-induced hepatitis content of cardiolipine and sphingomyelin was decreased, whereas after the treatment with heliotrin content of cardiolipine in liver tissue was unaltered and that of sphingomyelin was increased. Content of lysophosphatidyl choline was considerably increased in CCl4-hepatitis but it was only slightly altered after the treatment with heliotrin. The most pronounced alterations in the phospholipid spectrum and oxidative phosphorylation were found in liver mitochondria in the CCl4-induced hepatitis.

[Effect of total ischemia and 3',5'-cAMP on the activity of the thermostable cytoplasmic inhibitor of Ca2+ ion transport in rat heart mitochondria]. / Vliianie total'noi ishemii i ts-3',5'-AMF na aktivnost' termostabil'nogo tsitoplazmaticheskogo ingibitora transporta ionov Ca2+ v mitokhondrii serdtsa krysy.

Activity of cytoplasmic inhibitor of Ca2+ transport in rat heart mitochondria was studied after total ischemia and incubation of heart homogenates with cAMP. Distinct inactivation of the inhibitor occurred under these conditions. The decrease of the inhibitor activity in ischemic myocardium appears to serve as a compensatory mechanism: 1. pyruvate dehydrogenase and the enzymes of tricarboxylic acid cycle were activated due to increase in Ca2+ concentration in mitochondria, 2. as a result of Ca2+ accumulation in mitochondria the elevated concentration of Ca2+ was decreased in myoplasm, which developed after impairment of plasmatic membranes and of sarcoplasmic reticulum membranes.

[Effect of phytoecdisteroids and anabolic steroids on liver mitochondrial respiration and oxidative phosphorylation in alloxan diabetic rats]. / Vliianie fitoékdisteroidov i steranabolov na dykhanie i okislitel'noe fosforilirovanie mitokhondrii pecheni krys pri alloksanovom diabete.

Administration of phytoecdisteroides ecdisterone and turkesterone in the dose of 5 mg/kg and anabolic steroid preparation nerobol in the dose 10 mg/kg in rats with experimental diabetes removes the activation of respiration under all metabolic conditions of rats liver mitochondria revealing at given pathology. The normalized effect of phytoecdisteroides on the cells energetic processes is observed on the 7th day of the administration. The same effect of nerobol is revealed at more prolonged (15 days) administration.

[Phospholipid composition of normal thrombocytes and in diabetes mellitus]. / Fosfolipidnyi sostav trombotsitov krovi v norme i pri sakharnom diabete.

Adhesive and aggregating properties of the blood platelets are dependent to a higher degree on phospholipid content of their cellular membranes. A tendency of the blood platelets to hyperaggregation was seen in patients with diabetes mellitus. The aim of these studies is to investigate lipid composition of the blood platelets in healthy subjects and in patients with diabetes mellitus during the treatment. Sixty five diabetic patients and 18 healthy humans were examined. A significant decrease in sphingomyelin content down to 10.4% (normal 15.2%) and an increase in phosphatidylserine concentration up to 11.7% (normal 6.8%) were observed in diabetic patients in the process of determination of phospholipid content in the blood plate lets. The changes were revealed in phospholipid content, when calculation was carried out in micrograms/100 mg of protein. During the decompensation stage a decreased concentration of total phospholipids and their choline-containing fractions is observed in the presence of rising phosphatidyl and cholesterol contents and the cholesterol-phospholipid ratio. In diabetes compensation stage the lipid composition of the blood platelets is absolutely within normal.

[Avidity of sera-neutralizing snake venom]. / Avidnost' syvorotok, neitralizuiushchikh iady zmei.

Avidity of antivenom sera used for the treatment of snake bites was studied. Sera against the venom of Vipera libetina obtained from producers immunized with crude venoms were more avid than analogous sera obtained to anavenoms. In studying the avidity of polyvalent serum neutralizing the Vipera libetina, echis and cobra venoms showed the serum obtained in immunization with the mixture of crude venoms to be highly avid to all the venoms composing the antigen; besides, it bound the venoms of Vipera libetina and echis more rapidly and more stably than the corresponding monovalent sera.

Participation of the thymus in the mechanism of bacterial discharge in carriers of typhoid bacteria. / Ob uchastii timusa v mekhanizme bakteriovydeleniia u nositelei briushnotifoznykh bakterii

Typhoid carrier state was reproduced in 54 rabbits by the injection of typhoid bacilli into the bone marrow of the femoral bone. The animals were divided into 3 groups. Those in the 1st and 2nd group were hydrocortisone and ATC before the infection, respectively, whereas the 3rd group served as control. The data obtained pointed to the great incidence of prolonged persistence of typhoid bacilli in the bone marrow. A much greater vital disharge of the causative agent with the feces was noted in the animals which before the infection were given hydrocortisone and ATC preparations depressing the functional activity of the thymus. In the second experimental series it was shown that ATC administration to rabbits on the 85th day after their intraosseous infection with typhoid bacilli promoted vital discharge of the causative agent with the feces. Problem of participation of the thymus in the mechanism of bacterial discharge in the carriers of typhoid bacilli are discussed.