[The cellular factors of innate immunity in nonpsychotic patients at high risk for schizophrenia]. / Kletochnye faktory estestvennogo immuniteta u bol'nykh s nepsikhoticheskimi psikhicheskimi rasstroistvami, otrazhayushchimi vysokii risk razvitiya shizofrenii.

AIM: Changes in the parameters of innate immunity in patients with schizophrenia are observed already in the first episode. The study was performed to find out whether these changes take place prior to disease manifestation, and what role do they play in the pathogenesis of schizophrenia. MATERIAL AND METHODS: Thirty-five male nonpsychotic patients at high risk of psychosis, aged between 17 to 23 years, were examined. Phagocyte activity (PA) of neutrophils in the blood serum was evaluated by the number of active neutrophils, i.e. phagocytic index (PhI), and phagocytic number (PhN), which was determined by counting latex particles absorbed with a single phagocytic cell. Cytotoxic activity of natural killer lymphocytes (NK CA) was evaluated by the number of cell targets K-562, which remained non-degraded after the contact with natural killer cells. The influence of monocytes on NKCA was determined as well. RESULTS AND CONCLUSION: Compared to controls, patients had the lower PhI level (p<0.001) which was compensated by the increase in PhN levels, and the lower NK CA level which was increased due to the influence of monocytes. Negative correlations between PhI and PhN (r= -0.83, p<0.01) and between the level of NKCA and PhI (r= -0.83, p<0.05) as well as the positive correlation between PhN and SOPS scores (r=0.69, p<0.01) were found. After treatment, there was the decreasein the severity of mental disorders (p<0.001). The level of PhAN was normalized in 61.9% of patients compared to 36.7% before treatment. After treatment, the proportion of patients with normal levels of NK CA was the same as before treatment (40 and 35%, respectively). The immune disturbances revealed in the study may play a role in the pathogenesis of the disease and have predictive value for schizophrenia.

[Features of the immune system and the risk of endogenous psychosis at juvenile age].

OBJECTIVE: To study an immunological profile at prodromal and manifesting stages of endogenous juvenile psychosis. METHODS: Authors studied 77 patients, aged from 16 to 25 years. Patients were stratified into 2 groups. The first group included 39 patients without psychotic symptoms (prodromal group) and the second one -- 38 patients with the first episode of psychosis (psychotic group). A complex of immunological parameters included phagocyte activity, cytotoxic activity, natural killer lymphocytes, production of interleukins (IL-1, IL-4, IL-10 and γ-interferon), content of circulating immune complexes. These parameters were measured at baseline and after treatment. RESULTS: The changes in the immune system emerged at the very early stages of the disease. There was the activation of proinflammatory and anti-inflammatory interleukins, decrease in the phagocyte index and cytotoxic activity of natural killer lymphocytes. The high activity of IL-10 production, decreased levels of the cytotoxic activity of natural killer lymphocytes and reduced phagocyte index as well as the accumulation of circulating immune complexes are maintained during psychosis. CONCLUSIONS: The authors recommend to use immunomodulating drugs, along with psychotropics, at the very early stages of the disease to prevent poor outcome.

[The cytotoxic activity of natural killer cells in patients with the first episode of endogenous psychosis (a comparative study of test methods)].

Authors studied the cytotoxic activity (CA) of natural killer cells (NK) in 16 schizophrenic patients, aged from 18 to 25 years, with the first episode of psychosis. A significant decrease in CA NK was found in the total group of patients compared to healthy controls that suggested the dysregulation of natural immunity at this stage of disease. The addition of serotonin to the cell culture in vitro in concentrations 10-9 M stimulated the NK activity while the elimination of monocytes resulted in the significant reduction of CA NK. The parallel use of two methods for assessment of CA NK (a radioactive method and an easy and safe method using multifunctional particle size analyzer Multisizer MS-4) revealed similar results.

[Efficacy and safety of enoxaparin use during drug-eluting stents implantation].

We assessed possibility of the use of low molecular heparin enoxaparin during percutaneous coronary interventions (PCI) with implantation of drug eluting stents. Enoxaparin was administered to 225 (0.3 mg/kg intraarterially via catheter) and 215 (0.5 mg/kg intravenously) patients. In comparison group (n=207) we used unfractionated heparin (UFG) intravenously according to standard scheme under control of activated clotting time. Stents implanted (n=797) were Cypher, Taxus, and Endeavor. Immediate angiographic success was 100%. During 48 hours after PCI pronounced bleeding (4.3%) and blood transfusions predominated in UFG treated patients. Number of bleedings was minimal after the intra-arterial use of enoxaparin (0.3 mg/kg). However total rate of all adverse events after PCI turned out to be minimal (7.0%) in the group of patients receiving enoxaparin intravenously (0.5 mg/kg). Thus the use of low molecular heparin enoxaparin is justified during implantation of drug eluting stents. Its optimal dose according to data obtained is 0.5 mg/kg intravenously.

[Causes and outcomes of coronary arteries perforations].

Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. Aim of this study--to assess inhospital and long term outcomes in patients in whom perforation occurred during coronary intervention and elucidation of predictors of coronary artery perforation. Between May 1997 and October 2002 perforations were formed in the course of percutaneous interventions in 127 patients what amounted 1.08% of 11,793 patients, subjected to coronary interventions, and 0.77% of 16,494 treated coronary segments. Causes of perforations were complex stenoses, chronic occlusions, calcified lesions, small predicted and minimal vessel lumen, high percent stenosis, use of excimer laser or thromboextrator. Rates of arterial perforations and subsequent adverse events including cardiac tamponade and urgent coronary artery bypass surgery as well as mortality had been declining throughout observation period.

[Restenosis after bare-metal stents implantation in small coronary arteries.].

Potential of bare uncoated metal stents in prevention of restenosis in coronary arteries with diameter of 2.2-3.0 mm in comparison with balloon angioplasty (BA) was studied in 426 patients with ischemic heart disease (mean age 58+/-11 years, 16% women, 8% with diabetes, total cholesterol 211+/-44 mg/dl, all received aspirin and clopidogrel). BA was carried out in 214 patients (mean artery diameter 2.45+/-0.25 mm) and coronary stenting (CS) - in 212 patients (mean artery diameter 2.43+/-0.27 mm). Immediate success rate was 85.5 and 96.2% in BA and CS groups, respectively (p<0.001). When complementary methods of revascularization were taken into account success rate of the whole intervention was 100% in both groups. Inhospital cardiovascular complications developed in 3.7 and 2.8% of patients in BA and CS groups, respectively (p=ns). During 6 months of follow-up rates of target vessel restenosis and repeat percutaneous interventions were 24.3 and 15.6% (p=0.034) while total rate of complications related to target vessel was 36.9 and 26.9% in BA and CS groups, respectively (p=0.035). Thus CS compared with BA in patients with low risk of restenosis development in small coronary arteria provides better immediate, inhospital and remote results.

[Predictive role of exercise tests in development of restenosis in patients after coronary stent implantation].

Bicycle exercise tests were carried out in 2 weeks -- 9 months after successful stent implantation in 1463 patients. Result of exercise test was positive in 472 and negative -- in 991 patients. At control angiography which was performed within 1 week after exercise test binary in-stent restenosis >50% was found in 326 of 1463 patients. Sensitivity, specificity, predictive value of positive and negative results of exercise test for the presence of restenosis were 85, 83, 59 and 5%, respectively.

[Efficacy and safety of coronary stenting during diagnostic coronary angiography in patients with stable angina].

UNLABELLED: The authors assessed the in-hospital and long-term (up to 6 months) results of coronary stenting conducted just after diagnostic coronarography during a common procedure in patients with stable angina pectoris on effort. The 2001-2002 study included 2277 patients. The clinical indications for catheterization were Functional Classes II-IV stable angina on effort in 83 % of patients and silent ischemia in 17%. The study excluded patients with previous coronarography, acute coronary syndrome on admission, renal failure, left ventricular ejection fraction <30%, and left trunk stenosis. All the patients received aspirin and clopidogrel before catheterization. RESULTS: 57% of patients had multivessel disease; full revascularization was performed in 59% of the patients with multivessel disease. The coronary intervention was successful in 100% of cases. Significant in-hospital events (myocardial infarction without Q wave) were in 1.2% of cases. The mean length of hospital stay was 2.9 +/- 2.4 days. The rate of stent thrombosis for as long as 30 days was 0.2%. Recurrent angina and/or positive exercise tests were in 12% during 6 months. CONCLUSION: immediate stening is effective and safe in most patients with stable angina during diagnostic catheterization. It does not increase immediate and late complications.

[Prognosis of unstable angina resulting from restenosis after percutaneous angioplasty of saphenous vein grafts]. / Prognozirovanie nestabil'noi stenokardii vsledstvie restenoza posle chreskozhnoi angioplastiki venoznykh shuntov.

AIM: To assess frequency of unstable angina due to restenosis after percutaneous angioplasty of venous grafts and to elucidate risk factors of its development. MATERIAL AND METHODS: Percutaneous interventions were successfully performed in 100 out of 106 patients with venous graft stenoses. These patients were followed up for 17+/-11 (maximum 36) months. RESULTS: Unstable angina due to venous graft restenosis developed in 24% of patients. Patients with unstable angina compared with those without were characterized by higher frequency of hyperlipidemia (83 vs. 51%, respectively, p=0.032), lower rate of stenting (46 and 72%, respectively, p=0.032), greater residual stenosis (15+/-13 and 9+/-8%, respectively, p=0.008). At multifactorial regression analysis the following factors were significant predictors of unstable angina: hyperlipidemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.64-8.39), and residual stenosis after intervention (OR 1.04, 95% CI 1.01-1.07, p=0.04). In a subgroup of patients with hyperlipidemia there was a tendency to greater rate of unstable angina among patients not taking statins compared with users of statin (50 and 29%, respectively, p=0.083). CONCLUSION: Unstable angina developed in (1/4) of patients after balloon dilatation of venous grafts and hyperlipidemia was its most powerful predictor.

[Clinical, angiographical, and procedural causes of acute vessel closure during transluminal coronary intervention]. / Klinicheskie, angiograficheskie i protsedurnye prichiny vnezapnogo zakrytiia sosuda vo vremia transliuminal'nogo koronarnogo vmeshatel'stva.

AIM: To elucidate factors related to acute vessel closure (AVC) after transluminal coronary intervention. METHODS: From population of 10439 patients subjected to transluminal coronary intervention 2 groups were formed: with (n=885) and without (n=885) acute vessel closure (AVC). Twenty five clinical, angiographical and procedural characteristics of patients of these 2 groups were included into mono and multifactorial logistic regression analysis. RESULTS AND CONCLUSION: The following factors were univariate predictors of acute vessel closure: smoking [odds ratio (OR) 1.42], unstable angina (OR=2.130, acute myocardial infarction within previous 24 hours (OR 2.76), cardiogenic shock (OR 4.31), urgent procedure (OR 1.94), eccentric stenosis (OR 1.67), calcified lesion (OR 2.21), preexisting thrombosis (OR 3.79), lacerated complicated stenosis (OR 2.02), tortuous lesion (OR 1.35), low operator experience (OR 3.37), balloon angioplasty as sole procedure (OR 1.66), concomitant rheolytic thrombectomy (OR 1.95), urgent stenting (OR 1.45). Elective stenting significantly lowered risk of acute vessel thrombosis. Multifactorial step-up analysis selected the following independent predictors of AVC: smoking, acute myocardial infarction within previous 24 hours, cardiogenic shock, preexisting thrombosis, lacerated complicated stenosis, and concomitant rheolytic thrombus extraction. Thus only elective stenting significantly reduced risk of AVC.

[Effectiveness of excimer laser coronary angioplasty in treatment of patients with in-stent restenosis]. / Effektivnost' éksimernoi lazernoi koronarnoi angioplastiki v lechenii bol'nykh s restenozom posle koronarnogo stentirovaniia.

In-stent restenosis (ISR), when treated with balloon angioplasty (PTCA) alone, has an angiographic recurrence rate of 30-85%. Ablating the hypertrophic neointimal tissue prior to PTCA is an attractive alternative, however late outcomes of such treatment have not been fully determined. This multicenter case control study assessed angiographic and clinical outcomes of 137 consecutive procedures in 125 patients treated for ISR with either PTCA alone (n = 58) or excimer laser assisted coronary angioplasty (ELCA, n = 67). Demographics were similar. Lesions selected for ELCA compared with those selected for \PTCA were longer (17.1+/-9.9 mm vs. 13.6+/-9.1 mm; p=0,034), more complex (ACC/AHA type C: 36,5% vs. 14,3%; p=0,006), and with reduced antegrade flow (TIMI flow < 3: 18,9% vs. 4,8%; p = 0,025). ELCA- and PTCA treated patients had similar rates of procedural success (98,5 and 98,3%, respectively, p=1,0), major clinical complications (3,0% and 8,6%; respectively, NS), major cardiac events at 1 year (37,3 and 46,6%. respectively, NS), and target lesion revascularization (32,8 and. 34,5%; respectively, NS). These data suggest that ELCA in patients with complex in-stent restenosis is as safe and effective as PTCA. Despite higher lesion complexity in ELCA-treated patients, no increase in event rates was observed.