[META-ANALYSIS OF CLINICAL STUDIES ON THE USE OF STATINS FOR PREVENTION OF ATRIAL FIBRILLATION SOON AFTER CORONARY BYPASS SURGERY].

BACKGROUND: Atrial fibrillation (AF) develops in the early postoperative period in each third patient undergoing coronary bypass surgery (CBPS). Multifactorial pathogenesis of postoperative AF is unclear. The concept of postoperative inflammation as a potential basic mechanism of this condition has been implied in many studies. Pre- and postoperative treatment with antiinflammatory statins proved beneficial as a means for reducing the frequency of AF. MATERIALS AND METHODS: The meta-analysis is based on the results of 15 clinical studies carried out in the last 15 years. They included 9369 patients of whom 5598 (59.75%) used statins and 3771 (49.25%) did not receive them. The following endpoints were evaluated in the early postoperative periods: fiequency of AF, overall lethality, frequency of cerebral circulation disorders and myocardial infarction. Odds ratio (OR) and 95% CI were calculated, levels of inflammation markers before and after surgery and duration of hospitalization were determined. RESULTS: Statins decreased the frequency of AF soon after CBPS (OR 0,481 at 95% CI 0,345-0,672; p = 0,000), they did not influence overall lethality (OR 0,837 at 95% CI 0,501-1,399: p = 0,497) and frequency of myocardial infarction (OR 1,001 at 95% CI 0,702-1,426; p = 0,997), but decreased frequency of cerebral circulation disorders (OR 0,067 at 95% Cl 0,037- 0,121; p = 0,000). Also, they reduced duration of hospitalization and serum levels of inflammation markers. CONCLUSION: Results of clinical studies available to date leave no doubt that statins produce anti-inflammatory and anti-arrhythmic effects. Meta-analysis of relevant studies confirmed on the whole the positive role of statin therapy prior to CBPS.

[The possibility of selecting optimal antiplatelet therapy in patients with coronary heart disease in terms of CYP2C19 polymorphism].

AIM: To estimate whether optimal antiplatelet therapy can be selected in terms of CYP2C19 polymorphism. SUBJECTS AND METHODS: The prospective randomized trial included 124 patients (93 men and 31 women) who were to undergo percutaneous coronary intervention. They initially received dual antiplatelet therapy: clopidogrel 75 mg + acetylsalicylic acid (ASA) 300 mg. Genetic testing was performed in all the patients to reveal the carriage of allelic variants of the genes of cytochrome P-450 isoenzymes and the efficiency of antiplatelet therapy was evaluated. The carriers of one allele (CYP2C19*2/*1) were randomized into 3 subgroups according to further antiplatelet therapy. The therapy was not changed in Subgroup 1. The dose of clopidogrel was increased up to 150 mg/day and that of ASA remained unchanged in Subgroup 2. In Subgroup 3, the therapy was completely changed to the regimen: ASA 300 mg + ticagrelor 90 mg twice daily. Three days later, platelet aggregation was reinvestigated in all the three subgroups. RESULTS: In our investigation, the prevalence of carriage of at least one of the CYP2C19*2 alleles was about 35%. Comparison of the baseline platelet aggregation levels during the same platelet therapy showed statistically significant differences between the carriers and non-carriers: 32.7±11.6 and 44.8±12.9 (p=0.0024). Compared with the baseline values, there was a drug therapy switching-induced reduction in platelet aggregation in Subgroups 2 and 3 (p=0.0001 and p=0.0056, respectively). No statistically significant differences were found in Subgroup 1. CONCLUSION: The determination of CYP2C19 gene polymorphism allows a personalized approach to be applied in antiplatelet therapy for all patients with coronary artery disease.

[Phase and frequency locking of 0.1 Hz oscillations in heart rhythm and baroreflex control of arterial pressure by respiration with linearly varying frequency in healthy subjects].

We studied the features of functional interaction between the subsystems of autonomic control of heart rate (HR) and arterial pressure (AP) giving rise to 0.1 Hz oscillations in R-R intervals (RRI) and photoplethysmogram (PPG). The study included 25 healthy subjects (6 women and 19 men) aged between 18 and 32 years. The signals of RRI, PPG and respiration were simultaneously recorded under breathing with a frequency linearly increasing from 0.05 Hz to 0.25 Hz within 25 minutes in a sitting position of a subject. The possibility of phase and frequency locking of 0.1 Hz oscillations in RRI and PPG by respiration is shown. We revealed that theses oscillations have different width and location of the intervals of phase and frequency locking by respiration. This distinction points to the functional independence between the mechanisms of autonomic control of 0.1 Hz oscillations in RRI and PPG.

[Investigation of biophysical features of interaction between 0.1 Hz oscillations in heart rate variability and distal blood flow variability].

We studied biophysical features of interaction between 0.1 Hz oscillations in heart rate variability (HRV) and distal blood flow (DBF) variability in healthy subjects and patients after acute myocardial infarction (MI). 125 patients after acute MI (72 male and 53 female) aged between 30 and 83 years and 33 healthy subjects (23 male and 10 female) aged between 20 and 46 years were included in the study. The duration of prospective study of MI patients was one year. We estimated the delay in coupling between 0.1 Hz oscillations in H RV and DBF variability. It is found out that in healthy subjects the delay in coupling from heart rate to DBF is less than delay in coupling from DBF to heart rate. Acute MI results mainly in disruption of coupling from heart rate to DBF. This coupling is partially restored in one year after acute MI, but the delay in coupling remains significantly smaller than in healthy subjects. The features of coupling from DBF to heart rate are restored in MI patients within three weeks after infarction. After this period the delay in this coupling in MI patients is approximately the same as it is in healthy subjects.

[Outpatient prophylaxis and treatment of arterial hypertension with application of mobile telephone systems and Internet techniques].

AIM: To compare clinical efficacy of standard outpatient follow-up of hypertensive patients with efficacy of such follow-up with application of internet techniques and mobile telephone systems (ITMTS). MATERIAL AND METHODS: Two groups of hypertensive patients were examined: group 1 (n=97, 45% females, age 49 +/- 11 years) on one-year ITMTS follow-up; group 2 (n=102, 50% females, age 51 +/- 11 years) on standard one-year follow-up. Clinical efficacy was assessed by the rate of achievement and maintenance of target blood pressure, dynamics of modifiable risk factors (smoking, obesity) for a year. RESULTS: Withdrawal in group 1 was 36%, target blood pressure was achieved in 77% patients vs. 12% in group 2 (p < 0.001). CONCLUSION: Introduction of ITMTS technologies into outpatient clinics activity considerably raises efficacy of outpatient treatment of hypertensive patients.

Novel magnetism in 3He nanoclusters.

The magnetic susceptibility of 3He nanoclusters embedded in a 4He matrix has been measured from 0.5 to 10 mK at pressures from 2.88 to 3.54 MPa. Even the lowest pressure clusters have a solid fraction in the region of the phase diagram where bulk solid is unstable. At 3.54 MPa, straight theta = -250 microK, equal to that of bulk 3He for v = 21.3 cm3/mole. For 2.88 MPa, straight theta = 140 microK, indicating a ferromagnetic tendency, similar to 2D films at some coverages. At intermediate pressures, chi has a peak near 1.05 mK, but with no discontinuity. Magnetic ordering in nanoclusters appears to be different than the U2D2 phase of bulk 3He.

[The health indices of those working in the cleanup during accident recovery operations]. / Nekotorye pokazateli zdorov'ia likvidatorov v period avariino-vosstanovitel'nykh rabot.

Having analyzed the data base of All-Army register contained information about 35,970 rescuers it was determined that 45.5% of them during works in dangerous radiative conditions complained of the health change for the worse characterized by the state of irritation of mucous membrane of superior respiratory and gastrointestinal tracts. The direct correlation between value of irradiation dose and frequency of complaints, and also degree of lowering of there physical performance have been defined.