USE OF Β-ADRENOBLOCKERS IN PATIENTS WITH HEART FAILURE AND CONCOMITANT THYROID PATHOLOGY (LITERATURE REVIEW AND OWN OBSERVATIONS).

The systematization of literature data on the use of ß-adrenoblockers in patients with heart failure and concomitant thyroid pathology was carried out, and the results of our own study were presented. It has been suggested that the final chapter in the history of the use of ß-adrenoblockers in patients with heart failure with reduced left ventricular ejection fraction and thyroid pathology has not yet been written. Further studies are needed, including pharmacogenetic ones. The use of a selective ß-adrenoblockers - bisoprolol in patients with chronic heart failure with reduced left ventricular ejection fraction and concomitant low triiodothyronine syndrome does not lead to a decrease in the frequency of rehospitalization due to decompensation. At the same time, the frequency of rehospitalization in the group of patients with heart failure without low triiodothyronine syndrome is higher at a dose of 1.25-5.0 mg of bisoprolol compared with a higher dose. The effect of bisoprolol is reversed in patients with low triiodothyronine syndrome: the risk of re-hospitalization increases when the dose of bisoprolol is exceeded, there is a decrease in the serum level of triiodothyronine, an increase in thyroxine levels, a decrease in the ratio of triiodothyronine / thyroxine; further increase in the cavities of the heart and decrease in size. Probably, in patients with heart failure, against the background of low triiodothyronine syndrome, it is not advisable to titrate the dose of bisoprolol above 5 mg, and the time to titrate the drug to the indicated dose should be more than 63 days. Today it can be argued that, in general, recommendations for the use ß-adrenoblockers in patients with chronic heart failure with reduced left ventricular ejection fraction apply to patients with concomitant thyroid dysfunction, subject to the above restrictions.

[CLINICAL EFFICACY OF A REPRESENTATIVE OF A NEW CLASS OF INOTROPIC AGENTS - THE DIRECT ACTIVATOR OF MYOSIN OF CARDIOMYOCYTES OMECAMTIV MECARBIL IN HEART FAILURE WITH A REDUCED EJECTION FRACTION].

Over the past decades, there has been an active scientific search for drugs that can increase myocardial contractility and improve the course of heart failure. Omecamtiv Mecarbil, a drug from the group of cardiac myosin activators, heads the list of applicants for clinical use. The article presents the results of several randomized clinical trials which studied the efficacy and safety of Omecamtiv Mecarbil in heart failure: ATOMIC-AHF, COSMIC-HF and GALACTIC-HF. ATOMIC-AHF showed a tendency to reduce the risk of developing supraventricular and ventricular arrhythmias in heart failure. COSMIC-HF has proven the ability of Omecamtiv Mecarbil to improve the quality of life of patients with heart failure. GALACTIC-HF may be a turning point in the medical treatment of heart failure. For the first time, clinical evidence of the ability of the selective cardiac myosin activator Omecamtiv Mecarbil to improve myocardial contractile function, reduce the severity of symptoms of heart failure and reduce the risk of cardiovascular death was obtained.

[Postoperative features in lung cancer patients receiving intraoperative radiotherapy and radiosensitization].

Research Institute of Oncology, Research Center, Russian Academy of Medical Sciences, Siberian Branch, Tomsk. Postoperative course was studied of stage III non-small cell lung cancer (35) treated radically using intraoperative radiotherapy (15Gy) and cisplatin radiosensitization. Postoperative complications were reported in 11.4 +/- 5.4%. Reduction in complication rates was due to the use of a combined treatment complex. There were no postoperative lethalities.

[Complications of intraoperative radiotherapy and adjuvant chemotherapy in patients with lung cancer]. / Oslozhneniia pri sochetanii intraoperatsionnogo oblucheniia i ad''iuvantnoi khimioluchevoi terpii u bol'nykh rakom lëgkogo.

A high single dose of radiation can be delivered precisely to tumor or regional metastasis area by means of intraoperative radiation therapy (IORT). A program of combined treatment including radical IORT, postoperative distant gamma-therapy and adjuvant polychemotherapy with cisplatin and etoposide has been developed at the Center. Treatment was given to 43 patients with stage III lung cancer. Complications were reported in 23.3 +/- 6.0%. Prophylactic methods have been worked out to minimize IORT--related postoperative complications. The postoperative lethality rate was 2.3 +/- 1.4%. No program-related hazards have been observed. Complications from adjuvant polychemotherapy were moderate.

[Study of the calmodulin-dependent regulation of calcium adenosine triphosphatase of erythrocyte membranes in patients with ischemic heart disease]. / Issledovanie kal'modulinzavisimoi reguliatsii Ca-ATFazy membran éritrotsitov bol'nykh ishemicheskoi bolezn'iu serdtsa.

The inhibitor calmodulin (R 24571) was examined for effects on the activity of red blood cell Ca-ATPases in patients with coronary heart disease during the treatment with nitrates, beta-blockers and calcium antagonists. The maximum activity of Ca-ATPase was measured in the erythrocytes perforated with saponine in the presence of endogenous regulators at a concentration of Ca2+ of 3-5 microM. Patients with high and low Ca-ATPase activity were identified. In the control group R24571 failed to affect Ca-ATPase activity. In patients, the calmodulin inhibitor caused both Ca-ATPase activation and inhibition. The effects of R 24571 correlated with the severity of the patients' condition. In effective therapy, the action of the calmodulin inhibitor became lower on Ca-ATPase activity. It was concluded that there was Ca-ATPase regulation imbalance in patients with coronary heart diseases.