[Current approaches to the treatment of patients with dyslipidemia in the real practice in the outpatient stage].

Aim    To evaluate the frequency and structure of lipid-lowering therapy and of achieving the goal of low-density lipoprotein cholesterol (LDL-C) in patients with very high cardiovascular risk (CVR) who were monitored at the outpatient stage. Material and methods    A retrospective snapshot analysis was performed by continuous sampling method for 136 medical records of outpatient patients (71 men, 65 women) aged 42 to 91 years [median, 68 years; 25th and 75th percentiles (59; 78)].Results    134 (98,53 %) patients took statins; 8 (5.88 %) patients took a combination of statin and ezetimibe; 2 (1.47 %) patients took proprotein convertase subtilisin/kexin type 9 enzyme inhibitors (PCSK9): 2 (1.47 %) patients took evolocumab and 1 (0.74%) of 2 PCSK9-treated patients took a combination of PCSK9 inhibitor and statin. Atorvastatin at a dose of 20 (20; 40) mg as recommended at the hospital was the most frequently prescribed statin. 5 (3.68%) patients achieved the goal LDL-C of ≤1.4 mmol/l.Conclusion    Statins prevail in the structure of lipid-lowering therapy in patients with very high CVR. The frequency of combination therapy (statin/ezetimibe, 5.88%; PCSK9 inhibitor/statin, 0.74%) and PCSK9 inhibitors was noted to be low. Only 3.68% of patients achieved the goal LDL-C during the lipid-lowering treatment.

Study of the Dynamics of Biofilm Formation and Elastase Activity of Pseudomonas aeruginosa in the Presence of Dodecanoyl-Homoserine Lactone.

We studied the effect of early accumulation of N-3-oxo-dodecanoyl-homoserine lactone on the suppression of Pseudomonas aeruginosa reproduction, biofilm formation, and elastase activity. N-3-oxo-dodecanoyl-homoserine lactone in various concentrations was added to the P. aeruginosa culture, and changes in the concentration of bacteria and the formation of biofilms were studied in dynamics. N-3-oxo-dodecanoyl-homoserine lactone in a concentration of 25 µM, decelerated proliferation of bacterial cells during the first 6 h of culturing (p<0.05) and stimulated biofilm formation after 18 h of culturing. Elastase activity of P. aeruginosa increased significantly after addition of N-3-oxo-dodecanoyl-homoserine lactone in a concentration of 0.75 µM.

Morphological Variability of the Mandible Shape of the Common Vole Microtus arvalis (Rodentia, Arvicolidae) Semi-species from the Hybrid Zone.

The mandible shape of the common vole semi-species from the hybrid zone was studied for the first time using the methods of geometric morphometry. The hybrid specimens were found to display high morphological variability being closer to the parental Microtus obscurus than to M. arvalis form. The main trends of changes in the mandible shape were primarily observed in the horizontal plane.

Clinical observation of a patient with arterial hypertension and obstructive sleep apnea syndrome.

The clinical observation of a postmenopausal patient with the syndrome of obstructive sleep apnea in the outpatient health care stage.

[Caucasian cryptic species of rodents as models for studying the problem of species and speciation].

The problem of species and speciation is considered using as a model the cryptic species of rodents inhabiting the Caucasus, the mountain chain with prominent altitude environmental gradient and insular pattern of mountain habitats. These circumstances open additional possibilities for the choice of species conception (biological or phylogenetic), exploration of ancestry pathways (sympatric or allopatric speciation) of model cryptic species groups, and testing the 'refuge' hypothesis. As model species, sibling-species Sicista from the group 'caucasica' (a group of unstriped birch mice) and representatives of the vole subspecies Terricola (Microtus, Arvicolinae) were used. Based on the new data on karyology, nucleotide sequences of mitochondrial gene cytb, multivariate statistical analysis of odontologic traits, and biogeography of sibling-species Sicista from the group 'caucasica' and voles from subspecies Terricola (Microtus, Arvicolinae), their evolutionary history is reconstructed and applicable species concepts are examined. For the present sibling-species Sicista from the group 'caucasica' the allopatric dispersion is typical, which agrees with the hypothesis of speciation in refuges. The sympatry of Terricola sibling-species in the Caucasus is considered as being secondary, and their phenotypic likeness--as an adaptation to similar environmental conditions. Affirmed coexistence of sibling-species Microtus (Terricola) majori and Microtus (Terricola) daghestanicus in the Caucasus (without their hybridization) supports the biological conception of species. The existence of Sicista allospecies from the group of Caucasian unstriped birch mice is best conformed to the phylogenetic conception. However, the high level of chromosomal differences between sibling-species and, in particular, between extreme variants of common evolutionary line (Sicista kazbegica, Sicista kluchorica) does not contradict the biological conception of species.

[PERIPHERAL AUTONOMOUS REGULATION OF SINUS (SINOATRIAL) NODE IN TYPE 1 AND 2 DIABETES MELLITUS].

The aim of this work was to study peripheral vegetative regulation of pacemaker activity of the sinus (sinoatrial) node (SN) by high resolution analysis of cardiac rhythm variability (CRV) in patients with type 1 and 2 diabetes mellitus (DM). All CRV waves in the temporal and spectral regions were shown to be reduced. Regulatory effects of SN were pathologically distributed as appears from the increase of inefficient sympatho-metabolic influence due to the decrease of sympatho-parasympathetic one. Such change and redistribution of effects of regulatory SN factors are the predictors of cardiovascular disorders associated with DM1 and DM2. The low-amplitude CRV fluctuations of certain period and frequency suggest their pathogenetic relationship with DM decompensation. They differed from normal parasympathetic lengthening of a single RR-interval due to the high speed of pulse passage along parasympathetic fibers. It is supposed that these waves with periods 2.33. ± 2.35 and 2.3 ± 2.1 s and spectral density peaks 0.23 ± 0.045 and 0.24 ± 0.16 Hz showing average and moderate correlation with clinical and laboratory data (r = 0.543 ± 0.028 in DM1 and 0.388 ± 0.034 in DM2) are markers of diabetic endotoxicosis.

[Efficacy and safety of valdoxan in patients with irritable bowel syndrome].

OBJECTIVES: To evaluate the efficacy and safety of the antidepressant valdoxan in irritable bowel syndrome (IBS) with comorbid mild and moderate depression. METHODS: Twenty-eight patients with IBS and depression without psychotic symptoms were studied using clinical examination and psychometric scales. RESULTS: A significant reduction in psychopathological symptoms, along with the improvement of health status, was recorded for most patients treated with valdoxan (25-50 mg/night) in the end of the 1st week. CONCLUSION: Valdoxan has a good tolerability and safety profile, does not exert any negative effect on the IBS course and provides a high level of compliance.

[Autonomous pharmacodynamics of organic nitrates in patients with unstable angina].

The pharmacological test with the use of high-resolution rhythmocardiography for the analysis of cardiac rhythm variability associated with peripheral vegetative regulation of the synoatrial node was applied to study effects of a single dose of organic nitrates (nitroglycerin and mononitrate isosorbide) in 41 patients with unstable angina. Rhythmocardiograms were obtained before and after a morning sublingual dose of nitrates preceding intake of basal drugs. The results suggest negative action of nitrates on peripheral vegetative regulation of pacemaker activity of the synoatrial node.

[Autonomous cardioneuropathy in patients with coronary heart disease].

This paper reports the results of an electron microscopic study of the sinoatrial node in deceased patients with CHD in whom high-resolution rhythmocardiography revealed autonomous cardioneuropathy. Non-specific morphological changes in pacemaker cells of the sinoatrial node (swelling and disintegration of mitochondria, incorporation of calcium and accumulation of lipofuscin in mitochondria) can be regarded as manifestations of ischemic insufficiency of cardiac tissue perfusion. The rhythmocardiograms of such patients showed signs of autonomous cardioneuropathy manifest as the sharply decreased amplitude of all vegetative waves. The spectral power pattern was dominated by inefficient humoral-metabolic regulation due to suppression of protective parasympathetic regulation.

[Dysregulation of the sinoatrial node of the heart in patients with coronary heart disease during coronary artery bypass surgery].

Results of estimation of variability of cardiac rhythms in patients with coronary heart disease during coronary artery bypass surgery are presented. The aim of the study was to search for innovative methods for the assessment of the patients' conditions as a criterion for their rational choice for cardiosurgical intervention to enable adequate anesthesiological support and postoperative follow-up. We revealed additional characteristics of cardiac rhythm variability facilitating such choice and predictors of the risk of life-threatening heart arrhythmias. It is shown that high-resolution analysis of cardiac rhythms allows such peculiarities of dynamics of patient's conditions to be revealed that can not be exposed by the existing standard methods.

[Sinus node activity in Parkinson's disease].

Results of evaluation of cardiac rhythm variability (CRV) in Parkinson's disease (PD) are presented. High-resolution rhythmocardiography with a KAP-RK-01-Mikor diagnostic system was used to register CRY, peripheral and autonomous dysregulation of pacemaker activity of the synoatrial node. Reduced CRV was documented in 107 PD patients of whom 26% exhibited synoatrial dysfunction. The temporal statistical and spectral analysis of CRV, comparison of its results with clinical data suggest dissociation between cerebral and peripheral vegetative effects in PD, relatively well preserved suprasegmental ergotropic regulatory afferent impacts, and inadequate vegetative control at the post-ganglionic level.

[Analysis of cardiac rhythm variability in patients with sinoatrial node dysfunction].

The study was designed to elucidate the wave structure of heart rhythm variability (HRV) for the assessment of vegetative regulation of pacemaker activity of the sinoatrial node in 362 patients with coronary heart disease. The results were compared with the data of routine cardiologic examination. Sinus node dysfunction and weakness were shown to be accompanied by differential autonomous dysregulations that may be used as additional symptoms for the diagnosis of arrhythmias. Precision analysis of HRV permits to evaluate the arrhythmogenic events behind vegetative regulation of the sinus node, hemodynamic significance of arrhythmic episodes, and dependence of sinoatrial blockade on the degree of autonomous dysregulation. Autonomous cardioneuropathy syndrome is distinguished, its association with necrobiotic changes in the sinus node is demonstrated by electron microscopy.

[Cardiac rhythm variability in chronic bronchial asthma].

The study of cardiac rhythm variability (CRV) in bronchial asthma (BA) and its diagnostic significance included 265 patients aged 41.9 +/- 1.36 yr. They were examined using the rhythmocardiographic technique based on the high-resolution diagnostic system KAP-RK-01 "Mikor" (Chelyabinsk) allowing for the evaluation of sinus rhythm wave structure under conditions of targeted stimulation. Statistical and spectral analysis of CRV showed that BA is associated with autonomous dysregulation of pacemaker activity of the sinoatrial node (SAN) in the form of suppressed peripheral vegetative influence on chronotropic function and functional incompetence of SAN pacemaker cells. Non-specific CRV peculiarities of SAN dysregulation inherent in BA were demonstrated, such as decreased general variability due to reduction of the fast sympato-parasympathetic influence and enhancement of humoral and metabolic effects, impaired response to oppositely directed stimuli in the tests with lengthening the time of achievement of maximum reaction and recovery. BA patients showed very low-frequency CRV waves with a period of 35.332 +/- 8,773 s and a spectral power "peak" at 0.021 +/- 0.005 Hz. Their association with bronchial obstruction was confirmed by comparative analysis of CRV before and after intake of a bronchodilator and by correlation of CRV with the results of spirometry and peak flowmetry. The study suggests the possibility to use high-resolution rhythmocardiography in practical work of pulmonologists.

[Heart rate variability in chronic pulmonary heart].

Early signs of dysregulation of the cardiovascular system were revealed in 265 patients by studying peripheral vegetative regulation of pacemaker activity of the sinus node by rhythmocardiography with the use of a high-resolution KAP-RK-01 Mikor system (Chelyabinsk). Cardiac rhythm variability suggested impaired peripheral vegetative regulation of sinus node chronotropic function and functional insufficiency of pacemaker cells. Early symptoms of chronic pulmonary heart in patients with persistent asthma were associated with autonomous cardioneuropathy that correlated with structural changes in the heart. Peripheral vegetative dysregulation and functional insufficiency of pacemaker make up a pathogenetic component of cardiac disorder in patients with bronchial asthma. It is concluded that autonomous cardioneuropathy with marked suppression of sympathetic and parasympathetic regulation in the sinus node is an early manifestation of pulmonary heart development.

[Free-radical processes in cardiomyopathy and concomitant vibration disease].

Progression from local vibration to cardiovascular pathology in patients with vibration disease is associated with remodeling cardiac and vascular tissues under effect of oxidative stress. Myocardium and nodular tissue are most vulnerable during development of occupational cardiopathy. Alteration of the heart rhythm wave structure is a predictor of remodeling.

[Hygienic analysis of conditions of work at the aircraft repair plants and ways to improve the acoustic situation].

Inspection of the conditions of work at aircraft repair plants showed that employees are impacted by a number of harmful in-plant factors including noise, infrasound, kerosene, microclimate and others. Acoustic conditions correspond to harmful (3.2-3.4) or dangerous (4) classes. The general rating of the conditions of work is determined by the degree of noise harmfulness and danger. To reduce the risk of professional pathologies, employees must use personal means of acoustic protection.

[Occupational diseases-related autonomic system cardioneuropathy in Chelyabinsk region].

Cardiovascular diseases appear to be the most frequent complication and death cause in patients with various forms of occupational diseases. Autonomous nervous system could play significant role in genesis of those complications.

[Sinus rhythm variability in bronchial asthma].

The subjects, 265 patients with bronchial asthma (BA) patients (mean age: 41.92 +/- 1.36 yr), were examined using spirometry, peak-flowmetry, body plethysmography, EchoCG, and bronchoscopy with biopsy and histologic study. A high-resolution method--rhythmocardiography with temporal statistical and spectral analysis of sinus rhythm variability at rest and at directed testing using hardware and software complex KAP-RK-01-Micor (Chelyabinsk)--was applied. The patients with BA displayed sinus node dysregulation, insufficient vegetative providence, significant depression of peripheral sympathico-parasympathetic regulation in general, intensification of humoral-and-metabolic influence on pacemaker cells in the sinus node, and the forming of a pathophysiological pattern of response to stimuli during tests.

Possibilities of high-resolution HRV analysis.

OBJECTIVE: The purpose of the study was to present the results of 15-year application in practical cardiology of the method of high-resolution registration and analysis of heart rate variability (HRV) for diagnosis of the cardiovascular pathology. METHODS: Database consists of more than 46 thousand cases with different cardiovascular diseases. Here are shown some peculiarities of the HRV analysis and perspective possibilities of the method, named rhythmocardiography. RESULTS: Experience of rhythmocardiography use in cardiology supposes a wide perspective of this method application for the cardiovascular diagnosis. It allows to define various disregulations of the sinus node pacemaker activity, characterized for every form of the coronary artery disease, cardiac arrhythmias, stages of the hypertension disease, syndrome of autonomic cardioneuropathy, high risk of lethal outcome and etc. The rhythmocardiography may be used in treatment choice, in control of the therapy and studying of the autonomic efficacy of some drugs. CONCLUSION: Thereby, rhythmocardiography is an informative method for diagnosis of the cardiovascular pathology. The high-resolution measurement of HRV and following such computer analysis in time-domain and frequency-domain can be considered highly informative, because of reliable correspondence and comparable RCG-results with data of other studies and clinical symptoms of the diseases.