[Palivizumab: four seasons in Russia].

In 2010, the Russian Federation (RF) registered palivizumab--innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization.

[Correcting posthypoxic damage of myocardium in newborns with cerebral ischemia].

A multicenter trial involving 30 newborns with post-hypoxic myocardial lesions associated with I-II degree cerebral ischemia has revealed that the inclusion of cytoflavin infusions into the complex standard treatment leads, besides the improvement of general clinical status, to significantly more rapid, as compared to the control group, positive dynamics of pump and contractile myocardial functions, elimination of hyperenzymemia, hypoxia and electrical instability of the myocardium, decrease in energetic deficit, and repolarization changes within the first 5 days of in-hospital therapy as well as during the follow-up from 1 to 6 months of life.

[Immunohematologic screening and immunocorrection in cardiac surgery at an early age]. / Immunogematologicheskii skrining i immunokorrektsiia v kardiokhirurgii rannego vozrasta.

110 patients with "blue" and "pale" congenital heart disease in age of 2.43-0.18yrs have been inspected in order to work out the diagnostic criterion of the manifest latent, local and generalized infection, presence during the patients' training for operative healing and in postoperative period. The indexes of cellular and humoral immunity links, the state of phagocytosis, leukocyte index of intoxication have been analysed. Value of NST-test as a 1st level screening and dependence of this index from the degree of blood circulation incompetence, hypoxemia, general stigmatization have been established.

[The inhibition by the tumor necrosis factor of the death and DNA fragmentation of lymphoid cells in irradiated rats]. / Ingibirovanie faktorom nekroza opukholi gibeli i fragmentatsii DNK limfoidnykh kletok obluchennykh krys.

The influence of a tumor necrosis factor, administered 16 h before irradiation of rats, on the radiation response of thymus and bone marrow cells has been investigated. Three and 6 h after irradiation the following indices were analyzed: the number of apoptotic cells in the thymus; the accumulation of polydeoxyribonucleotides and the appearance of single-strand breaks in DNA of bone marrow and thymus cells; and the electrophoretic properties of thymocyte DNA. The injection of a tumor necrosis factor reduced the number of polydeoxyribonucleotides, inhibited internucleosome DNA fragmentation, and did not influence the formation of single-strand breaks in DNA.

[Disorders of cardiac rhythm and conductivity after radical correction of tetralogy of Fallot in young children]. / Narusheniia serdechnogo ritma i provodimosti posle radikal'noi korrektsii tetrady Fallo u detei rannego vozrasta.

Analysis of electrocardiograms in 55 children who underwent operation for Fallot's tetralogy at early age showed that the frequency and severity of postoperative disorders of rhythm and conductivity were determined by the degree of trauma inflicted by the used surgical techniques. Data obtained in the early and late-term postoperative periods confirm the expediency of performing surgical correction of the anomaly as early as possible by means of surgical methods which cause little injury. The results of the study are recommended for use in choosing the surgical tactics, for functional appraisal of the operative results.

[Initial experience in the correction of the tetralogy of Fallot in infants using an approach through the right atrium and the pulmonary artery]. / Pervyi opyt korrektsii tetrady Fallo u detei rannego vozrasta dostupom cherez pravoe predserdtsie i legochnuiu arteriiu.

Radical correction of Fallot's tetralogy by means of an approach through the right atrium and pulmonary artery without ventriculotomy (10 patients) or with minimal ventriculotomy (23 patients) was carried out in children whose ages ranged from 13 to 50 months and body weight from 7.9 to 15 kg. Lethality was 12%. The death of 3 patients was not connected with the peculiarities of the surgical tactics, the death of the fourth patient was due to insufficient experience in development of the surgical techniques of the first operations. The operative techniques applied are described in detail and the possibility of adequate correction of Fallot's tetralogy by it is proved principally. The late-term operative results are good in 10 patients. The first results of the suggested method of surgical correction of the anomaly are claimed by the authors to be promising, which allows them to continue its further elaboration.

[Mechanisms of adaptation of the cardiorespiratory system to physical loads in cardiosurgical patients]. / Mekhanizmy adaptatsii kardiorespiratornoi sistemy k fizicheskim nagruzkam u kardiokhirurgicheskikh bol'nykh.

Problems related to the assessment of systemic oxygen transport and central hemodynamic parameters at exercise tests after surgical correction of congenital and acquired heart diseases are discussed. Several types of adaptation to stress have been identified. Noninvasive direct measurement of cardiac output under stress is shown to be useful as cardiac output values may be different where oxygen consumption levels are similar. It is suggested that the results may be used for functional assessment of surgical outcomes and the choice of treatment and rehabilitation strategy.

[A new approach to the qualitative assessment of the reaction to physical loading during bicycle ergometry of patients following aortic prosthesis]. / Novyi podkhod k kachestvennoi otsenke reaktsii na fizicheskuiu nagruzku pri veloérgometrii u patsientov posle aortal'nogo protezirovaniia.

The paper is concerned with the objectivization of qualitative assessment of a response to exercise testing during rehabilitation of patients after aortic valve replacement. The authors propose methods for a study of hemodynamic provision of submaximum and threshold exercises confirming significantly a higher myocardial reserve in patients after submaximum exercises. Hemodynamic characterization of different types of threshold reactions has shown that a common feature in the majority of patients is a decrease in cardiac ejection during exercise testing, mainly as a result of ino- or chronotropic depletion. A significant increase in the number of submaximum bicycle ergometric exercises is an important criterion of the efficacy of a rehabilitation program.

[Changes in ECG indices and hemodynamics during bicycle ergometry of patients following aortic valve prosthesis]. / Izmeneniia pokazatelei EKG i gemodinamiki vo vremia veloérgometrii u bol'nykh posle protezirovaniia aortal'nogo klapana.

Correlated electrocardiographic and hemodynamic changes have been demonstrated in 60 convalescent patients within 3 years after aortic valve replacement by means of bicycle ergometry (BEM) and simultaneous Kubicek's impedance rheoplethysmography. As electrocardiographic ischemic changes are more frequent during recovery, while their hemodynamic causes are different during and after exercise, BEM load increment should be intermittent in patients with aortic valve prosthesis. Exercise-induced increase of R voltage that was mostly combined with inadequate hemodynamic response and accompanied by ischemic ST depression may be an additional criterion of threshold stress.

[Evaluation of the cardiorespiratory system during rehabilitation of patients after prosthesis of the mitral and annuloplasty of the tricuspid valves]. / Otsenka funktsii kardiorespiratornoi sistemy v protsesse reabilitatsii bol'nykh posle protezirovaniia mitral'nogo i annuloplastiki trikuspidal'nogo klapanov.

Twenty-five patients undergoing rehabilitation for 2 to 3 years after surgery were examined. External respiratory parameters were investigated by means of bicycle spiroergometry, and the pump and contractile functions of the heart were assessed using tetrapolar chest rheography. In addition to positive clinical developments and improved functional class, physical working capacity of the patients was found to be increased. External respiratory function was improved accordingly. The efficacy of surgical correction of the defect was evidenced early after surgery by the normalization of minute flow volume and only slightly reduced stroke volume at rest. Hemodynamic support of physical working capacity that increases progressively in the course of rehabilitation is characterized by overstrain of inotropic mechanisms, uneconomically increased minute volume, and insufficiently increased stroke volume, mostly due to the incompetence of the Frank-Starling mechanism associated with tachycardia that is inadequate to the effort.

[ECG and hemodynamic changes during the bicycle ergometry of patients following aortic valve prosthesis]. / Izmeneniia EKG i gemodinamiki vo vremia veloérgometrii u bol'nykh posle protezirovaniia aortal'nogo klapana.

Interrelated ECG and hemodynamic changes were revealed in an analysis of the results of a bicycle ergometry test (BET) with the recording of ECG in 12 accepted leads and simultaneous impedance rheoplethysmography after Kubichek in 60 patients during rehabilitation for 3 yrs after aortic valve replacement. Impedance-measuring investigation of hemodynamics after physical exercise provided valuable information on causes of ECG changes. More frequent development of ischemic changes during rehabilitation and a variety of hemodynamic causes of changes in physical exercise and in the period of restitution necessitated intermittent BET in patients with a prosthesis of the aortic valve. An increase in voltage of the R wave during BET was combined in most cases with other inadequate hemodynamic reactions and was accompanied by an "ischemic" decrease in ST, and could serve as an additional criterion of threshold exercise.

[Evaluation of the pump and contractile functions of the heart in healthy persons by tetrapolar chest rheography]. / Otsenka nasosnoi i sokratitel'noi funktsii serdtsa u zdorovykh metodom tetrapoliarnoi grudnoi reografii.

The central hemodynamics and myocardial contractility were studied in 40 normal untrained men by tetrapolar chest rheography. The response to exercise was studied and compared in subjects with eu- and hypokinetic circulatory types. It was revealed that marked differences in the SI, CI, SPR recorded at rest lessen with exercise increase and disappear at submaximal and maximal levels of exercise at the expense of a higher rate of changes in these parameters in subjects with the hypokinetic circulatory type. The energy and tension adequacy of both types of normal circulation under exercise has been proved. The linear increase in the index of myocardial contractility (Formula: see text) has been shown to be dependent on the exercise rate and to be in a good agreement with an increase in the MV (r = 0.82), which is highly informative.