[Unresolved issues in the prevention of bronchopulmonary complications in a cardiac surgery patient from the standpoint of a rehabilitation therapist]. / Nereshennye voprosy v profilaktike bronkholegochnykh oslozhnenii u kardiokhirurgicheskogo patsienta s pozitsii reabilitologa.

Bronchopulmonary complications are one of the leading causes of morbidity after cardiac surgery; they lengthen a patient's hospital stay and increase the cost of treatment. The most common postoperative bronchopulmonary complications include pneumonia, atelectasis, respiratory failure, pneumothorax, and bronchospasm. These complications are the consequences of anesthesia and surgical trauma aggravated by the presence of risk factors in the patient in the preoperative period such as any chronic disease involving the lungs, smoking history, persistent cough and / or wheezing, chest and spinal deformities, obesity, senior age. In addition, the presence of chronic heart failure, diabetes mellitus, and chronic kidney disease also increase the risk of developing bronchopulmonary complications. In the prevention and treatment of bronchopulmonary complications the clinical effectiveness of rehabilitation programs after coronary artery bypass grafting is undeniable. The effectiveness of the programs has been proven on the basis of both domestic and foreign long-term in-practice and scientific research. However, despite the significant advances in cardiac rehabilitation there are a number of unresolved issues. Is it possible in a short period of time of the first stationary rehabilitation stage to form the patient's skill to perform breathing exercises and, accordingly, to obtain the maximum effect in the prevention of bronchopulmonary complications? What factors can affect the speed of motor skill formation in the patient's mastering of breathing exercises? What should be the frequency of procedures per day and the number of exercises when a physical therapy instructor works with a patient to increase the effectiveness of the prevention of bronchopulmonary complications in the postoperative period? What category of patients is strictly required for the pre-rehabilitation stage? How should the pre-rehabilitation stage be organized and how long should it take? All these questions require the work-out and implementation of scientifically grounded individual rehabilitation programs with a step-by-step algorithm for managing the patient by a rehabilitation multi-team from the first hours after surgery with the mandatory inclusion of pre-rehabilitation and taking into account the social, anamnestic, clinical and psychological characteristics of the patient.

[Efficacy of Home-Based Exercise Training and Adherence to Therapy in Patients After Coronary Artery Bypass Grafting].

AIM: to assess efficacy of home-based exercise training (HBET) at outpatient stage of cardiac rehabilitation and its impact on adherence to treatment in patients after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: In 1 month after CABG 112 male patients (after completion of rehabilitation program in the sanatorium) were distributed to 3 groups with comparable demographic, clinical, and functional parameters: group 1 - patients fulfilling supervised cycling training program (SCTP), group 2 - patients subjected to home-based exercise training (HBET) with defined walking sessions (WS), and the control group of usual care without exercise training. Patients were examined 1, 4 months and 1 year after CABG. RESULTS: Three months SCTP was most efficient relative to improvement of exercise tolerance (ET), modification of cardiovascular risk factors (smoking, obesity, dyslipidemia), and of adherence to medical therapy. Lowest ET and worst adherence to medical and non-medical therapies were found in the group of usual care without exercise training. The intermediate position was occupied by patients subjected to HBET and WS. Effects of 3 months of HBET diminished by 1 year of follow-up. CONCLUSION: HBET of moderate intensity appeared to be safe, easily workable and affordable training program for patients after CABG. However, it was less effective, compared with SCTP. Moreover, effects of this rehabilitation program were transitory.

[The comparative analysis of the influence of the supervised exercise training and home-based exercise training on the psychological status of the following coronary artery bypass grafting].

This article was designed to report the results of the comparative analysis of the influence of the home-based exercise training (HBT) and the supervised exercise training in the form of the controlled training (CVT) under conditions of outpatient rehabilitative treatment on the patients' quality of life (QoL) and psychological status (including manifestations of anxiety and depression) following coronary artery bypass grafting (CABG). AIM: The objective of the present study was to evaluate the consequences of the application of different programs of physical rehabilitation under the outpatient conditions on the psychoemotional status and quality of life of the patients who had undergone coronary artery bypass grafting. MATERIALS AND METHODS: A total of 114 male patients suffering from coronary artery disease (CAD) who had undergone CABG were available for the examination. All the patients were allocated to three groups. Group 1 was comprised of the patients (n=36) treated with the use of the supervised cycling training (SCT) while group 2 consisted of the patients who had to perform home-based walking training (HBWT) (n=36). The group of comparison included 42 patients. The psychophysiological assessment was carried out based on the Beck Depression Inventory (BDI) and the Spielberger-Hanin Personal and Reactive Anxiety Scale. The quality of life (QoL) was assessed with the use of the SF-36 questionnaire. All the patients were examined prior to surgery, 1.4 months and 1 year after CABG. RESULTS: The study has demonstrated the most pronounced improvement in the quality of life of the patients following the 3-month supervised cycling training after CABG that was manifested as the decrease of anxiety and depression. The minimal changes in the psychological and emotional status were documented in the absence of any exercise training integrated into the postoperative rehabilitation program. Only the moderate improvement of QoL was observed in the patients treated with the application of the 3-month home-based walking training program after CABG. The positive effects of the three-month exercise training were evened out within 1 year after its initiation. DISCUSSION: It has been shown that the effectiveness of HBT is somewhat lower than that of CVT in terms of the influence on the psychoemotional status of the patients following CABG. This finding is at variance with the results reported by the foreign authors and should provide a basis for the enhancement of the effectiveness of the post-CABG rehabilitation programs to be implemented under conditions of the medical facilities, their principal objective being the education of the patients in safe and efficient methods for the pots-surgical self-rehabilitation with the emphasis placed on the measures intended for the improvement of the approaches to monitoring the compliance of the patients with the prescribed recommendations and for increasing their motivation to observe as long as possible the advices given by the health care professionals. CONCLUSION: The home-based walking training of moderate intensity provides a safe, easy to perform, and readily available tool for a large number of patients who underwent coronary artery bypass grafting even though it is somewhat less effective than the supervised cycling training. The effects of both rehabilitation modalities are rather short-term.

[Clinical and epidemiological characteristics of acute myeloid leukemias in adults according to the data of municipal hematology departments in Moscow].

AIM: To estimate the incidence of acute myeloid leukemias (AML) in Moscow adults and to evaluate the efficiency of their treatment. SUBJECTS AND METHODS: Data on Moscow residents who were first diagnosed with AML in 2010 were retrospectively collected. The efficiency of their treatment was evaluated from the rates of complete remissions (CR), recurrences, deaths, and 4-year overall (OS) and relapse-free survival (RFS). The data as of September 1, 2013, were analyzed. RESULTS: According to the 2010 pooled materials of the city's municipal hematology departments, AML (non-M3 types) was diagnosed in 286 patients whose median age at diagnosis was 64.9 years (range, 18.2-92.0 years). The notified incidence rate was 2.9 (3.3 for men and 2.6 for women) cases per 100,000 population. 118 (41%) patients received intensive chemotherapy (ICT); 119 (42%) had chemotherapy with low-dose cytarabine (LDC); 7 (2%) had that with hypomethylating agents (HA); and 42 (15%) had palliative therapy (PT). During first-line therapy, none of the patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). In the entire group, the early (within the first 60 days) mortality rates were 42% (119 deaths); that of patients with primary refractory disease was 32% (90 deaths). CR was achieved in 77 (27%) patients: 57 (48%) on ICT, 17 (14%) on LDC, and 3 (43%) on HA. Recurrences occurred in 37 (48%) of the 77 patients who had achieved CR at a median follow-up of 43.9 months. Four-year OS in all the patients receiving PT was 9.8±1.9% (18.2±3.9% in the patients on ICT versus 4.5±2% in those of LDC; p=0.028); 4-year RFS was 36.1±5.7% (39.6±6.7% inthe patients on ICT versus 31.3±11 .6% in those on LDC; p=0.8). CONCLUSION: High mortality rates in the induction, which are caused by the limited resources of accompanying therapy, poor sanitary conditions, and no own opportunities to perform allo-HSCT, remain a key problem of AML therapy in adults.

[The dynamics of detection of antibodies class G against Chlamydia pneumoniae and Chlamydia psittaci in blood serum of patients of different age groups].

The detection of antibodies class G in blood serum of patients of different age groups was carried out in 2005-2010. The analysis permitted to establish the peak of activity of chlamydiae infection in 2006 and increase of activity of morbidity in 2010.

[Diffusion and diffusion-osmosis models of the charged macromolecule transfer in barriers of biosystems].

Mathematical models of the transfer of charged macromolecules have been constructed on the basis of the classical equations of electromigration diffusion of Helmholtz-Smolukhovskii, Goldman, and Goldman-Hodgkin-Katz. It was shown that ion transfer in placental (mimicking lipid-protein barriers) and muscle barriers occurs by different mechanisms. In placental barriers, the electromigration diffusion occurs along lipid-protein channels formed due to the conformational deformation of phospholipid and protein molecules with the coefficients of diffusion D = (2.6-3.6) x 10(-8) cm2/s. The transfer in muscle barriers is due to the migration across charged interfibrillar channels with the negative diffusion activation energy, which is explained by changes in the structure of muscle fibers and expenditures of thermal energy for the extrusion of Cl- from channel walls with the diffusion coefficient D = (6.0-10.0) x 10(-6) cm2/s.

[Simulation methods in biophysical pharmacokinetics].

The effect of low-amplitude physical fields of various natures (electric, magnetic, acoustic, electromagnetic, microwave, etc.) on drug transport in biological tissues is analyzed to assess the efficiency of combined physical and chemotherapy. The obtained data are used to develop devices for phoretic physical therapy based on combination of effects of various physical fields. Examination methods and equipment are described.

[Methods of assessment and control of house dust mites population and mite allergen exposure].

The work is devoted to analysis of various methods of assessment and control of house dust mites population and mite allergens in city dwellings using own results and the literature data. Data about in-house dust mites biology and ecology, mechanisms of their migration and circulation in modern city conditions are presented. The comparison of several methods of mites number assessment and mite allergens exposure (classical acarological analysis, colorimetric method of guanine detection in house dust, immunochemical methods) has been performed and their advantages and disadvantages analyzed. As choice of adequate avoidance measures is one of the key question, various such measures (mechanical, physical and chemical) have been compared.

[Domestic dust mites in the dwellings of Penza].

Twenty-seven mite species belonging to 23 genera, 13 families, and 2 orders were identified. The mites of the family Pyroglyphidae, amounting to 91.1% of the total number of mites, were found to dominate in the acarocomplex of Penza dwellings. Pyroglyphid mites were represented by 3 species with Dermatophagoides pteronyssinus and Dermatophagoides farinae absolutely prevailing in both their abundance (20.0 and 68.5%) and frequency (39 and 75%). The maximum number of D. pteronyssinus and D. farinae reached 2.867 and 3.400 mites per g of dust, respectively. Mites of the families Acaridae and Glycyphagidae were registered in 27 and 15% of the apartments, respectively; and their abundance was about 4%. G. destructor is most frequently encountered. The specific abundance and detection rate of other mites were not high. The influence of various socioeconomic factors on the number of D. pteronyssinus and D. farinae was analyzed using statistical methods. A significant correlation was found between the number of mites, the air moisture of a premise, the building material used for the construction of a house, the type of a housing estate (a private or tenement house) and heating (central or self-contained). No significant relationship was established between the number of mites, the ventilation of premises, the presence of domestic animals and plants or flowers, and the number of dwellers. Out of 81 patients with allergic diseases (allergic rhinitis (73%), bronchial asthma (4%), and allergic rhinitis concurrent with asthma (23%)), 44 and 25% patients had positive skin tests for D. pteronyssinus and allergens of D. farinae, respectively. There was no positive correlation between the number of pyroglyphid mites, positive skin tests, and the diagnosis.

[Time of analysis and final parameters of peripheral blood].

The blood parameters are influenced by the balanced state of all blood elements preserved during a certain time interval. A comparison of blood-test findings obtained during the initial two hours and in 20-24 hours after sampling and storage in presence of a stabilizer denoted a decreased quantity of leukocytes and erythrocytes by 2.57.7% and 12-22%, respectively. At the same time, the leukocytic formula and ESR remained unchanged.

[The hypereosinophilic variant of Ph'-positive chronic myeloleukemia]. / Giperéozinofil'nyi variant Ph"-polozhitel'nogo khronicheskogo mieloleikoza.

AIM: To confirm clonal nature of idiopathic hypereosinophilic syndrome (IHES), its relevance to Ph'-positive chronic myeloid leukemia. MATERIALS AND METHODS: 3 cases of idiopathic hypereosinophilic syndrome are reported with morphologic analysis of bone marrow cells and cytogenetic examinations. In one patient the presence of Ph'-chromosome was confirmed at fluorescent in situ hybridization (FISH) and molecular-genetic analysis (bcr/abl). Samples of bone marrow, spleen and liver were examined pathohistologically. RESULTS: The presence of chromosome anomaly t(9;22), i.e. Ph'-chromosome, associated with chronic myeloid leukemia (CML) was identified in all the 3 cases. There was also myeloid hyperplasia in the bone marrow (with primarily mature, eosinophilic granulocytes), spleen and liver, depression of megakaryocyto- and erythropoiesis. 2 patients had similar clinical symptoms which was not typical for CML in chronic phase: fever, elevated ESR, clear-cut anemia and thrombocytopenia. In the absence of hyperleukocytosis, blood and bone marrow eosinophils remained high (42.5, 21.5, 42.5% and 21.4, 7.1, 6.5%, respectively) due to "mature" forms. The number of blasts in the bone marrow was maximum 2.4%. CONCLUSION: The literature and the obtained data suggest closeness of idiopathic hypereosinophilic syndrome and Ph'-positive CML within myeloproliferative diseases.

[An evaluation of the prognostic significance of the structure of the chromosomal translocation t (9; 22) locus in chronic myeloleukemia]. / Otsenka prognosticheskoi zanchimosti struktury lokusa khromosomnoi translokatsii t (9; 22) pri khronicheskom mieloleikoze.

The site of the break of chromosome 22 was investigated by blot hybridization and polymerase chain reaction in 41 patients with chronic myeloid leukemia (CML). It is stated that the break site in various regions is not associated with the disease stage and clinicohematological manifestations in the time of the diagnosis. The break in the 5' subregion was indicative of longer survival than that in the subregion 3' patients. Median survival reached 60.8 and 32.4 months, respectively.