[Cardiac amyloidosis and aortic valve stenosis]. / Kardiale Amyloidose und Aortenklappenstenose.

Aortic valve stenosis in old age has become a topic of interest for cardiology and cardiac surgery after the development of transvascular and transluminal minimally invasive techniques for aortic valve implantation. The observation of amyloid deposits in surgically excised valvular material led to the diagnostics of amyloidosis of the myocardium, which was discovered in up to 20% of the patients who underwent valve implantation. Clinical signs of cardiac amyloidosis, such as carpal tunnel syndrome and ruptured distal biceps tendon should be taken into account. In addition to the electrocardiogram (ECG), echocardiogram and magnetic resonance imaging, 99mtechnetium bone scintigraphy plays a key diagnostic role. The simultaneous occurrence of severe aortic valve stenosis and amyloidosis explains the special hemodynamic situation of a low gradient with low blood flow in high-grade valve stenosis. The interventional or surgical valve implantation improves the prognosis for these patients, similarly to aortic valve stenosis alone, followed by a specific pharmaceutical treatment depending on the type of amyloidosis.

The effect of intravenous magnesium on postoperative morphine consumption in noncardiac surgery: A systematic review and meta-analysis with trial sequential analysis.

BACKGROUND: Several studies suggest that systemic magnesium reduces postoperative opioid consumption and the intensity of pain, but others report conflicting results. The efficacy and safety profile of intravenous magnesium in noncardiac surgery remain uncertain. OBJECTIVES: The aim of this review was to investigate the effect of intravenous magnesium on the consumption of postoperative morphine in the first 24 h in adults undergoing noncardiac surgery. DESIGN: Systematic review and meta-analysis with trial sequential analysis. DATA SOURCES: MEDLINE, EMBASE, CENTRAL from their inception until January 2019. ELIGIBILITY CRITERIA: All randomised clinical trials comparing intravenous magnesium versus placebo in noncardiac surgery were systematically searched in the databases. Observational studies, case reports, case series and nonsystematic reviews were excluded. RESULTS: Fifty-one trials (n=3311) were included for quantitative meta-analysis. In comparison with placebo, postoperative morphine consumption at 24-h was significantly reduced in the magnesium group, with a mean difference [95% confidence interval (CI)] of -5.6 mg (-7.54 to -3.66, P < 0.001, I = 92%, level of evidence low). The trial sequential analysis for the effect of magnesium on postoperative morphine consumption was conclusive. Patients who received magnesium had a longer time to the first analgesia request [143 (103 to 183) min, P < 0.001, I = 99%, level of evidence low] and a lower incidence of shivering [0.26 (0.15 to 0.44), P < 0.001, I = 35%, level of evidence very low]. However, no significance differences were demonstrated in postoperative pain scores in the first 24 h (mean difference, 95% CI) -0.30 (-0.69 to 0.09, P = 0.13, I = 91%, level of evidence low), bradycardia (odds ratio, 95% CI) 1.13 (0.43 to 2.98, P = 0.80, I = 35%, level of evidence very low) and postoperative nausea and vomiting (odds ratio, 95% CI) 0.90 (0.67 to 1.22, P = 0.49, I = 25%, level of evidence moderate). CONCLUSION: The current meta-analysis demonstrates that the use of intravenous magnesium as part of multimodal analgesia may reduce morphine consumption in the first 24 h after surgery and delay the time to the first request for analgesia in patients undergoing noncardiac surgery. However, the included studies were of low-quality with substantial heterogeneity. TRIAL REGISTRATION: CRD42018086846.

[Negative effects of termination statinotherapy in patients after acute coronary event with concominent non-alcoholic steatohepatitis].

140 patients with myocardial infarction in combination with non-alcoholic steatohepatitis, 58 patients took medium theraupeutic doses of rosuvastatin of 10 mg/day and 82 patients--torvastatin of 40 mg/day, have been examined. The study found significant progression of dyslipidemia, when the statins (improving blood total cholesterol and TG by 34% and LDL cholesterol by 38%). In patients who continued receiving statins, noted the positive dynamics of lipidohramy: in patients receiving rosuvastatin 10 mg levels of total cholesterol and LDL cholesterol decreased by 36% and 43%, respectively, with atorvastatin 40 mg level indicators fell by 34% and 40% respectively. Therapy rosuvastatin 10 mg had an advantage over the use of atorvastatin 40 mg in raising HDL cholesterol by 21%, and reduction of TG level by 37%. It is proved that the method furthers statins improves disease in patients with acute myocardial infarction, prevents the development of coronary artery disease resistant and recurrent acute coronary events, reduces the incidence of hospitalizations for heart failure progression.

[Diagnostic markers of anthracycline-induced cardiomyopathy in children with acute leukemia].

The results of the survey 16 children with acute lymphoblastic leukemia, in which the resulting protocol chemotherapy using doxorubicin developed toxic anthracycline-induced cardiomyopathy. The control group was 20 healthy children of similar age studied. Distribution of research groups included age status and cumulative dose of doxorubicin. Studies of the cardiovascular system in children with acute leukemia was conducted before and at the end of each protocol chemotherapy. It is noted that the complaints of the cardiovascular system as palpitations and disruptions in the heart, cardialgia, autonomic crises occurred at the end of the first phase I protocol chemotherapy. Severity of complaints prevalent in patients with higher cumulative dose of doxorubicin. Noted a decrease in left ventricular contractile capacity and the development of myocardial ischemia in patients with acute leukemia at the end of the first phase II protocol. The increase pro-brain natriuretic peptide in all patients with acute lymphoblastic leukemia at the end of the first phase I protocols that can be considered as an early diagnostic marker of myocardial injury in these patients.

[LYMPHOCYTES MEMBRANES FATTY ACID SPECTRUM IN PATIENTS WITH CORONARY HEART DISEASE].

Lymphocytes phospholipid membranes fatty acid spectrum was studied in patients with coronary heart disease. The study involved 77 patients aged 45 to 72 years. Significant decrease of the oleic fatty acid relative content was determined, which violates the lymphocytes membranes structure and possibly negatively affect their functioning. The relative content of arachidonic, palmitic and stearic saturated fatty acids composition of lymphocytes lipids increased. The result indicate that in patients with coronary heart disease increasing polyunsaturated fatty acids elongation in lymphocytes. These changes in the lipid blood, lymphocytes state can explain the observed increase in lymphocytes functional activity.

[Pulmonary atresia with ventricular septal defect and major aorto-pulmonary collateral arteries: diagnosis and treatment].

The basic principles of diagnosis and management of pulmonary atresia with ventricular septal defect and major aorto-pulmonary collateral arteries are systematizes in this paper. The personal experience of surgical treatment of consecutive 66 patients with this disease is analyzed, including one-stage and multistage approaches.

[Optimization of long-term treatment with rosuvastatin of patients with myocardial infarction in combination with non-alcoholic steatohepatitis].

Dynamics of indices of lipidograma, functional state of liver and level C-reactive of protein (CRP) was investigated in 36 patients with heart attack of myocardium diseases in combination with non-alcoholic steatohepatitis, who received 9-months treatment by rosuvastatin of 20 mg dose and rosuvastatin of 10 mg dose in combination with ursodeoxycholic acid (UDCA), in a comparative aspect. The equivalence of hypolipidemia effect of both conditions reliable advantage in decline of triglycerides level and CRP normalization under the influence of combined therapy was discovered. The treatment by combination of rosuvastatin of 10 mg dose with UDCA has shown the advantages in comparison with the treatment by rosuvastatin of 20 mg dose in decline and normalization of transaminases and gamma-glutamiltranspeptidase activity. The data obtained resulted in optimization of standard treatment by statins of patients with heart attack of myocardium diseases in combination with non-alcoholic steatohepatitis by means of combination the initial rosuvastatin dose with UDCA.

[Effects of stimulation and blockade of the synthesis of endogenous hydrogen sulfide at myocardial ischemia-reperfusion].

In experiments on isolated rat hearts, perfused according to Langendorff method, the effects of stimulation of the synthesis and blockade of endogenous hydrogen sulfide in myocardial ischemia-reperfusion (20 min/40 min) was studied. L-cysteine (121 mg/kg), precursor of endogenous hydrogen sulfide was injected intraperitoneally 30 minutes before the experiment without and within 10 minutes after administration of DL-propargylglycine (11.3 mg/kg) ("Sigma", USA)--inhibitor of cystathionine-gamma-lyase. The heart function was assessed by measuring the LVDP, dP/dt, coronary flow, heart rate. The opening of mitochondria permeability transition (MPT) pore was estimated by releasing of a stable factor with UV absorbance (lambda(max) 250 nm) into the coronary outflow probes during the initial phase of reperfusion. Administration L-cysteine was accompanied by a decrease of reperfusion disorders in cardiac function compared to control rats. The results showed that L-cysteine pretreated hearts against the blockade of cystathionine-gamma-lyase with DL-propargylglycine exerted a powerful cardioprotective effect in ischemia-reperfusion injury. Significant post-ischemic recover of heart function and improving the efficiency of oxygen metabolism was accompanied with tiny quantity of mitochondrial factor releasing comparing to I/R group. Positive influence of the combined DL-propargylglycine and L-cysteine action was the prevention of MPT pore opening.

[Mice myometrial contractility in conditions of mitochondrial functional changes].

It has been investigated the temporal amplitude features of mice myometrium in conditions of action mitochondrial carriers inhibitor, the mitochondrial pore activator, calcium uniporters inhibitor. For the first time it is established that the functional condition of myometrium depends on a mitochondrial carriers functioning; the mitochondrial carrier is NO-dependent itself (on arginaze way of its formation); the carrier functions depending on mitochondrial membrane potential and mitochondrion nonspecific conductivity (mitochondrial pores).

[Glycoproteins of mucus of gastric and duodenal wall surface during ulcerogenesis and the impact of fenugreek].

The comparative evaluation of qualitative and quantitative composition of glycoproteins of gastric and duodenal wall surface layer of protective mucus in the normal, at the modeling of ulcers in rats and at the introduction to animals with ulcerative lesions of fenugreek extract carried out. It was shown in control (normally) the general level of glycosylation of glycoproteins gastric mucus is 1.7 times more than the duodenum. Under acute stress model ulceration in the stomach mucus decrease in hexosamine (1.4 times), galactose (2.2 times), fucose (1.3-fold) and an increase in NANA (3.6 times) observed. Under cysteamine model ulceration in duodenal mucus increase galactose (2.7 times), NANA (2.4 times), fucose (1.8-fold) but significant decrease in the amount of hexosamines 3 times compared to the control occurred. It was proved the protective effect of fenugreek extract to the wall surface mucus of the stomach and duodenum mucosa under conditions modeling ulceration in rats.

[Postprandial hypotension].

Postprandial hypotension is the independent risk factor of general mortality, coronary disorders and stroke. It is reviewed risk factors, pathogenesis, symptoms, treatment and prognosis of this disease.

[The effects of oxygen partial pressure changes on the osteometric markers of the bone tissue in rats].

Our purpose was to investigate the oxygen partial pressure changes on the osteometric and biochemical markers of bone tissue in rats. It was shown that breathing of altered gas mixture did not change the mass, general length, sagittal diameter and density thigh-bones in 12-month Wistar male-rats. The dosed normobaric hypoxia increased the activity of alkaline phosphatase and decreased the activity of tartrate-resistant acid phosphatase. At the same time normobaric hyperoxia with 40 and 90% oxygen conversely decreased the activity of alkaline phosphatase and increased the activity of tartrate-resistant acid phosphatase.

[Influence of poly(ADP-ribose) polymerase inhibitors on some parameters of oxidative stress in blood leukocytes of rats with experimental diabetes].

The study was undertaken to investigate the influence of specific inhibitors of poly(ADP-ribose)polymerase-1 (PARP-1), in particular nicotinamide and 1,5-isoqinolinediol on white blood cells of rats with diabetes. Using the fluorescent probe 2',7'-dichlorodihydrofluorescein diacetate ROS production in leukocytes was asseced. It was found that the development of streptozotocin-induced diabetes was accompanied by an intensification of oxidative stress and a significant decrease in viability of blood leukocytes as compared to control animals. Administration of PARP-1 inhibitors prevented the development of oxidative stress in leukocytes and increased their viability. It was shown a reduction of superoxide dismutase activity in serum in diabetes. Investigated PARP-1 inhibitors had no effect on the activity of superoxide dismutase and glucose levels in the blood. The findings suggest the intensification of oxidative stress in leukocytes of diabetic animals and the ability of nicotinamide and 1,5-isoqinolinediol to prevent its development depending on the features of their structure.

[The impact of clopidogrel and aspigrel on fatty acid spectrum of platelet membrane phospholipids in patients with new-onset angina].

The research of more effective unstable angina treatment is still actual despite the definite protocols exist. It was investigated the lipid acids spectrum of platelet membrane phospholipids in patients with new-onset angina and was analyzed the impact of clopidogrel and aspigrel on its changes.

[The lipid acids spectrum of platelet in patients with new-onset and progressive angina].

The coronary thrombosis is the main factor which leads to acute coronary syndrome. The mechanisms of the coronary thrombogenesis are not found out in detail. It was investigated the changes of the lipid acids spectrum of platelet membrane phospholipids in patients with unstable angina.

[The effect of clopidogrel and aspigrel on myocardial ischemia in patients with unstable angina pectoris].

The modern cardiology pays much attention to research of myocardial ischemia, especially painless myocardial ischemia as the problem of sudden coronary death. Findings from the current study suggest that antianginal therapy which includes antiaggregant and anticoagulant is effective because of decreasing general myocardial ischemia and its painless form.

[Methods of diagnostic, differential diagnostic and criteria of the prognosis of hypoxemic-ischaemic brain damage of premature born in acute period].

The research is devoted to establishing of early diagnostic, differential-diagnostic criteria and the prognosis of hypixemic-ischaemic damage of central nervous system (that differs due to characteristics and the degree of complexity) of preliminary-born in acuity on the basis of their complex interdisciplinary research (anamnesis, neurological, clinical, instrumental--neurovoiceprint, immune-enzyme, in particular the dynamics of quantity level changes of brain-derived neurotropic factor in blood serum).

[The role of branched-chain amino acids metabolism in development of cardiovascular diseases and its risk factors].

Branched-chain amino acids play the key role in many metabolism processes in organism generally and in cardiovascular protection. It was discovered its importance in mitochondrial biogenesis, antioxidant and antiaging processes, its antihypertension and antiarrhythmic effects, its role in obesity and diabetes mellitus.