[Physicians' Adherence to Clinical Guidelines on the Chronic Heart Failure Diagnosis and Treatment: Changes Over 2 Years of the Document's Existence].

AIM: To study how physicians' commitment to the basic provisions of clinical guidelines (CGs) for the diagnosis and treatment of chronic heart failure (CHF) has changed over the two years of the document existence. MATERIAL AND METHODS: An anonymous survey was performed for 263 physicians (204 cardiologists, 46 internists and 13 other specialists) who were trained in advanced training programs in 2022. The questionnaire included questions regarding self-assessment of the respondents' professional knowledge, their attitude to the role of CGs in everyday practice and ideas about methods for treatment of CHF. RESULTS: Respondents gave 60.6 % correct answers to questions related to the treatment of CHF. More than 70% correct answers were given by 42.7% of cardiologists and 17.4% of internists. Compared to 2020, the proportion of cardiologists who gave more than 70 % correct answers increased significantly (p<0.05). CGs were considered mandatory by 26.2% and important or sometimes useful by 71.5% of respondents. Cardiologists considered CGs mandatory more frequently than internists (29.9 and 15.2 %, respectively; p=0.04). The mean number of correct answers was greater in the subgroup of respondents who considered CGs mandatory (p<0.001). More than 70% correct answers were given by only 43.8% of cardiologists, who considered themselves fully informed and able to advise colleagues on complex issues of diagnosis and treatment of CHF, and 40.6% of physicians who considered their knowledge acceptable for managing patients with CHF. CONCLUSION: The majority of physician consider CGs an important methodological document but only a little more than 25 % are aware that CGs are mandatory. Cardiologists are better informed than internists about the principal provisions of National Clinical Guidelines for the diagnosis and treatment of CHF, but the average level of physician knowledge remains low.

[Combined chemoreflexes of the vertebral arteries zone on the systemic arterial pressure, cerebral and infra-aural blood circulation in the experiment]. / Sochetannye khemorefleksy zony pozvonochnykh arterii na sistemnoe arterial'noe davlenie, tserebral'noe i vnutriushnoe krovoobrashchenie v eksperimente.

OBJECTIVE: To study reflexes coming from the chemoreceptors in the humoral-isolated vertebral artery zone on systemic arterial pressure, cerebral and intra-ear hemodynamics in separate stimulation with angioprotectors. RESULTS: A more pronounced reflex depression of the above-described effectors was caused by Nicergoline, it was less pronounced when using Vinpocetine and Pentoxifylline. Correlation analysis in doing so of the dynamics of arterio-venular coefficient of bulbar conjunctiva vessels and the membrane of the ears labyrinth round window revealed a direct relationship. CONCLUSION: These studies objectivize the therapy of ear labyrinth discirculation with angioprotectives.

[Physicians' adherence to the guidelines on the chronic heart failure diagnosis and treatment].

Aim      To evaluate the physician's knowledge of basic provisions of clinical guidelines for diagnosis and treatment of chronic heart failure (CHF) and to determine how the actions of physicians in their everyday clinical practice comply with these provisions.Materials and methods The study analyzed anonymous questionnaires of 185 physicians (127 cardiologists, 40 internists and general practitioners, 18 other specialists) who were trained in advanced training programs during the 2020/2021 academic year. The main part of the questionnaire included 15 questions related to the classification, diagnosis, pharmacotherapy, and the use of implantable devices in the treatment of patients with CHF.Results The results showed that internists were less than cardiologists aware of major provisions of clinical guidelines for diagnosis and treatment of CHF. However, the knowledge of cardiologists could not be considered sufficient either. 57.5% of internists and 30% of cardiologists incorrectly indicated the main echocardiographic criterion for diagnosis of CHF with reduced left ventricular ejection fraction (CHFrEF). More than 40% of internists did not consider fluid retention with development of the congestion syndrome as a mandatory condition for administration of a loop diuretic to a patient with CHFrEF. 34.6% of cardiologists and 25% of internists correctly determined the indication for the administration of mineralocorticoid receptor antagonists. 37.6% of internists and 21.1% of cardiologists incorrectly indicated the dose of spironolactone recommended for achieving the neuromodulation effect.   In determining doses of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, after arriving at which it is necessary to stop their up-titration, most of the physicians preferred to be based on systolic blood pressure (SBP) rather than on symptoms of hypotension. However, among therapists there were doctors for whom the patient's well-being and clinical symptoms, and not the level of SBP, were priority factors for choosing the tactics of the treatment with ACE inhibitors and beta-blockers. Physicians of both specialties were poorly familiar with indications for cardioverter defibrillator implantation; only 14.2% of cardiologists and 5% of internists chose the correct wording of indications.Conclusion      The insufficient knowledge should be considered the basis for the low adherence of doctors to guidelines for diagnosis and treatment of CHF. When developing programs for advanced training of physicians in CHF, special attention should be paid to the use of renin-angiotensin-aldosterone system inhibitors and beta-blockers with detailed discussion of the dosing principles as well as of indications for implantation and results of using cardioverter defibrillators.

Psychological Satisfaction of Parents of Young Football Players with a Mosaic Form of Down Syndrome by the Quality of Sports Training

Physical culture and sports are still an effective means of rehaabilitation and social integration of persons with weakened health. They allow people with disabilities to fully discover all their functional reserves and be active members of society. In this regard, the further development of physical culture and sports work with people with various health problems is very promising. One of the types of such activities are footbal groups, where children and young people with Down's syndrome are becoming more active. For athletes with a mosaic form of Down's syndrome, it is very important, first of all, that there are conditions for practicing football, that is, a gym with inventory, as evidencedby high marks to the quality of the classes. The use of visual training methods (instructions, drawings, schemes) in training improves the interaction of athletes with the coach, facilitates the assimilation of the training material and thereby increases the motor density of the session. It is clear that the personality of the coach plays the leading role in the training process. From how competently he interacts with his athletes, how attentive to the, how uch he carries them into playing sports ultimately depends the result of his activities ad the success of the students. It is also very important attention to the success of young athletes with a mosaic form of Down syndrome. Promotion of football among them and their active encouragement for sportes success is a serious incentive form their further employment in football and increases the popularity not only of this sport, but also of a healthy lifestyle (AU)

[ Spectrum of oncogene mutations is different in melanoma subtypes].

Melanoma is the most lethal malignancy of skin, which is comprised of clinically relevant molecular subsets defined by specific "driver" mutations in BRAF, NRAS, and KIT genes. Recently, the better results in melanoma treatment were obtained with the mutation-specific inhibitors that have been developed for clinical use and target only patients with particular tumor genotypes. The aim of the study was to characterize the spectrum of "driver" mutations in melanoma subtypes from 137 patients with skin melanoma and 14 patients with mucosal melanoma. In total 151 melanoma cases, the frequency of BRAF, NRAS, KIT, PDGFRA, and KRAS mutations was 55.0, 10.6, 4.0, 0.7, and 0.7%, respectively. BRAF mutations were found in 69% of cutaneous melanoma without UV exposure and in 43% of cutaneous melanoma with chronic UV exposure (p=0.045), rarely in acral and mucosal melanomas. Most of melanomas containing BRAF mutations, V600E (92%) and V600K (6.0%) were potentially sensitive to inhibitors vemurafenib and dabrafenib. NRAS mutations were more common in cutaneous melanoma with chronic UV exposure (26.0%), in acral and mucosal melanomas; the dominant mutations being Q61R/K/L (87.5%). KIT mutations were found in cutaneous melanoma with chronic UV exposure (8.7%) and mucosal one (28.6%), but not in acral melanoma. Most of KIT mutations were identified in exon 11; these tumors being sensitive to tyrosine kinase inhibitors. This is the first monitoring of BRAF, NRAS, KIT, PDGFRA, and KRAS hotspot mutations in different subtypes of melanoma for Russian population. On the base of data obtained, one can suppose that at the molecular level melanomas are heterogeneous tumors that should be tested for "driver" mutations in the each case for evaluation of the potential sensitivity to target therapy. The obtained results were used for treatment of melanoma patients.

[INFECTIOUS ENDOCARDITIS IN PREGNANT WOMEN].

A case of primary infectious endocarditis with the lesion of mitral valve in a pregnant woman is reported The diseases was caused by meticillin-resistant Staphylococcus aureus. Special attention is given to inefficiency of beta-lactame antibiotics against this infection and beneficial effect of daptomycin therapy. This observation confirms literature data about high frequency of thromboembolic complications of S aureus-induced infectious endocarditis due to the production of various coagulases and von Willebrand factor-binding protein by these microorganisms. An increase of coagulation caused by S. aureus is mediated through activation of prothrombin, factor XIII, and fibrin-binding fibronectin. It requires prescription of direct thrombin inhibitor pradax that proved to yield good results in the treatment of our patient. It is concluded that infectious endocarditis in pregnant women is characterized by an atypical clinical picture due to impaired immunity associated with rapid progression of the process after delivery, high frequency of thromboembolic and DIC syndromes.

[Some indices of trace elements and antioxidant status in rats under chromic intoxication].

There was investigated the effect of chronic Cr (VI) on the content of chromium, iron, copper; zinc, nickel in the blood of rats and activity of antioxidant enzymes of erythrocytes in Wistar rats. The chromium concentration has been shown to increase multifold while the level of other metal is more or less declining. Also it was found a decrease in the activity of such antioxidant enzymes as superoxide dismutase, catalase, and the activation of the processes of free radical oxidation. Thus, it can be assumed that the effect of Cr (VI) is implemented via an imbalance of trace elements and the activation of the processes of free radical oxidation.

[Modeling of different degrees of microvessel laser-induced endothelium damage].

A comparative analysis of rat mesentery micro vascular reactions on thermal impact during radiation to the focused laser irradiation in UV and visible regions of spectrum is made. Local intravascular temperature rise during laser irradiation both impulse (lambda = 337 nm) and continuous (lambda = 532 nm) states causes thrombus formation. The thrombus development that determined by laser irradiation parameters gives a possibility to modulate different degrees of microvessel endothelium damage.

[Effect of benzene and chromium on the trace element composition in biosubstrates in Wistar rats].

The chronic effects of benzene and chromium on the level of trace elements in the biospheres of Wistar rats were studied for 45, 90, and 135 days. As compared to the controls, the experimental groups of patients were found to have lower concentrations of copper (in blood) and iron (in blood and spleen) and higher levels of zinc (in blood, spleen) and chromium (in blood, spleen).

Mathematical modeling of thrombus growth in mesenteric vessels.

Richardson's phenomenological mathematical model of the thrombi growth in microvessels is extended to describe the realistic features of the phenomenon. The main directions of the generalization of Richardson's model are: (1) the dependence of platelet activation time on the distance from the injured vessel wall; (2) the non-homogeneity of the platelet distribution in blood flow in the vicinity of the vessel wall; (3) the adequate choice of the phenomenological function describing the dependence of blood velocity on the thrombus size. The generalization of the model corresponds to the main experimental results and theoretical considerations concerning thrombus formation obtained in recent years. The extended model permits to achieve qualitative agreement between model and experimental data.

[Comparative characteristic of sociologic study results in the field of orthodotia during the period from 2004 to 2009 (monitoring study)].

Monitoring of the results was carried out including own sociologic study in the field of orthodotia during the last 6 years. The investigation was done with the help of standardized specially developed questionnaire form reflecting the questions connected with orthodontic help appealability and population motivation to receive it. The received data let to evaluate in dynamics the orthodontic service status and prospects of its development.

[Humoral immune response in experimental animals exposed to organic and inorganic compounds].

A humoral immune response was studied in the Wistar rats and (CBAxC57B16)F1 mice orally given potassium bichromate, benzene, and their mixture with drinking water. The test substances were found to have an immunosuppressive effect on both the parameters of an immune response and the level of lysozyme in the experimental animals, which appeared as reductions in the number of splenocytes in the rats, the relative count of antibody-forming cells in the mice, the absolute count of AFC on the spleen in the rats and mice, the level of hemagglutinins in the rats, and that of lysozyme in the rats and mice. Benzene and a mixture of benzene and potassium bichromate showed the most marked immunosuppressive effect on these animals.

[Blood lipid spectrum in hypertensive patients and normotensive subjects living in the Khanty-Mansiysk region].

AIM: To evaluate basic parameters of lipid metabolism in patients with arterial hypertension (AH) stage I and II and normotensive subjects living in the far North of the Russian Federation (Khanty-Mansiysk Autonomic Region, Nyagan). MATERIAL AND METHODS: Lipid spectrum was studied in 70 males and females with AH stage I and II, 280 normotensive males and females matched for sex, age, time of residence in the North. RESULTS: Sex-related differences by concentrations of blood lipids become less pronounced with progression of AH while a concentration of atherogenic lipid fractions in AH patients rises. High prevalence of dyslipidemia, primarily hypercholesterolemia, in hypertensive and normotensive subjects is a prognostic factor of coronary atherosclerosis. Paired correlations indirectly confirm the effect of climatic factors on blood lipids. CONCLUSION: It is necessary to correct lipid spectrum and risk factors in hypertensive and normotensive subjects as a prophylactic measure.

[Effects of chromium and benzene on cell immunological parameters and the content of trace elements in rats].

The effects of potassium bichromate, benzene, and their mixture on cell immunological parameters and the blood content of trace elements were studied in Wistar rats. Oral administration of benzene, potassium bichromate, and their mixture to Wistar rats was found to result in reductions in cell immunological parameters (the count of leukocytes, thymocytes, splenocytes, myelokaryocytes, the level of phagocytic indices) and the levels of copper, iron, nickel, and, on the contrary, increases in the concentrations of zinc and chromium in blood.

Use of recombinant interleukin-2 for intrapleural therapy of tumor-associated pleurisy.

Clinical efficiency of low dose Roncoleukin was studied in 30 patients with metastatic exudative pleurisy. Intrapleural therapy proved to be highly effective (overall effect reached 84%), was well tolerated, and improved patients' quality of life.

[Micronuclei in mucose cells and colonization of human stomach epithelium with coccoid forms of Helicobacter pylori].

International Agency for Research on Cancer recognized as sufficient the evidence of Helicobacter pylori (HP) infection carcinogenicity and placed it into the 1 st group of carcinogens. Micronucleus level in gastric epithelial cells of antral stomach region of patients with chronic non-atrophy gastritis (n = 62) was studied. 40 patients of 62 had HP-associated gastritis. The HP-bacterium exists in a spiral and coccoid form. Both morphological forms were examined using immunocytochemistry. Significantly increased micronucleus number was observed in the cells of HP-infected patients compared with non-infected person (P < 0.05). The frequency of stomach epithelium cells with micronuclei was enhanced considerably in the patients infected with the coccoid HP form. Therefore the patients with HP-associated chronic gastritis caused by the coccoid form with high degree of colonization must be considered as a group of enhanced risk of gastric carcinogenesis.

[The system-oriented model of psychosocial rehabilitation].

A model of psychosocial rehabilitation based on the system approach that allows taking into account both the patient-centered approach of the rehabilitation service, the development of its resource basis, the effectiveness of this care system in whole and its patterns as well has been worked out. In the framework of this model, the authors suggest to single out three basic stages of the psychosocial rehabilitation process: evaluation and planning, rehabilitation interventions per se, achievement of the result. In author's opinion, the most successful way for constructing a modern model of psychosocial rehabilitation is a method of hierarchic modeling which can reveal a complex chain of interactions between all participants of the rehabilitation process and factors involved in this process and at the same time specify the multi-level hierarchic character of these interactions and factors. An important advantage of this method is the possibility of obtaining as static as well dynamic evaluations of the rehabilitation service activity that may be used on the following levels: 1) patient; 2) his/her close environment; 3) macrosocial level. The obvious merits of the system-oriented model appear to be the possibility of application of its principles in the organization of specialized care for psychiatric patients on the local, regional and federal levels. The authors emphasize that hierarchic models have universal character and can be implemented in the elaboration of information-analytical systems aimed at solving the problems of monitoring and analysis of social-medical service activity in order to increase its effectiveness.

The lichen transplant methodology in the source apportionment of metal deposition around a copper smelter in the former mining town of Karabash, Russia.

The lichen transplant monitoring methodology has been tested for source apportionment of metal deposition around the Cu smelter and former mining town of Karabash. Transplants of the lichen Hypogymnia physodes (L.) Nyl., collected from a 'control' site in July 2001, were set up at 10 stations along a 60 km NE-SW transect centred on Karabash. Samples were collected after 2 and 3 month monitoring periods and analysed using established wet-chemical techniques. The sources of particulate investigated were the smelter blast furnace and converter, floatation tailings, metallurgical slags, local road dusts, top soils and ambient airborne total suspended particulate. From multi-element least-squares modelling the blast furnace was the main source of particulate in transplants close to the smelter (<10 km). Particulate from the converter, with relatively high Pb and Zn, was found to be more widely dispersed, being finer-grained and so having a longer atmospheric residence time. Ambient airborne particulate, sampled in Karabash town using air-pump apparatus, was almost entirely derived from the converter, very different to the lichen transplants from the same area which mainly contained blast furnace particulate. It is proposed that lichens close to the smelter mainly trapped larger blast furnace-derived particulate as they have a low capture efficiency for smaller (converter) particles. The study demonstrates the utility of lichen transplants for monitoring atmospheric deposition and highlights the caution required in their use to assess ambient air quality in human health studies.

[Cancer vaccinotherapy: from the experiment to clinical application].

Methods of cancer immunotherapy with dendritic cell-based vaccines, activated outside the organism, as well as techniques employing genetically modified whole-cell antitumoral vaccines, transfected by cytokine gens and stimulating the patient's dendritic cell stimulation in vivo, have been developed in Russian Oncological Research Center. Phase 1 clinical trials of dendritic cell vaccine in patients with disseminated melanoma and colon cancer have been carried out. The treatment is well-tolerated; significant adverse effects are absent. Moderate clinical efficacy and immune activation have been noted. Preclinical and phase 1 clinical studies of genetically modified vaccines also demonstrate the safety of this treatment and its ability to activate antitumoral immune response. Both vaccines are promising as subjects of rationally planned clinical trials of the efficacy of this treatment.