[Automatic detection of ventricular and supraventricular wide QRS arrhythmias using complex of morphological criteria and algorithms].

AIM: The aim of study is a detection of ventricular and supraventricular wide QRS arrhythmias using complex of morphological criteria and algorithms by method of automatic analysis. MATERIALS AND METHODS: For 100 patients (m/f - 61/39, Me (min; max) - 44.5 (10; 85) years) of researched group the analysis of 14306 single wide ectopic complexes (QRS 120-230 ms) has been done. Wide complexes include 11028 (77%) ventricular complexes and 3278 (23%) supraventricular complexes represented by 145 different forms of QRS. For verification of arrhythmias origin transesophageal ECG recording and endocardial electrophysiological study were done. The control group included 59 patients (m/f - 25/34, Me (min; max) - 49.5 (14,85) years) with 720 wide QRS, including 467 (65%) ventricular and 253 (35%) supraventricular complexes represented by 86 forms of QRS. The criteria Drew B.J., Scheinman M.M. (1995); Wellens H.J. (1978), RWPT II (Pava LF, 2010) and the algorithms of Brugada P. (1991); Bayesian (2000); Vereckei A. (2008) were used to evaluate sensitivity, specificity and diagnostic accuracy of wide QRS complexes recognition one by one and together, using the method of Wald sequential automatic analysis (KT Result3, CJSC INCART, Russia) and method of artificial neural networks. RESULTS: The best results for the detection of ventricular arrhythmias algorithms were demonstrated by the  Brugada  P., Drew  B.J., Scheinman  M.M. algorithm (sensitivity 86.43%, specificity 66.73%, diagnostic accuracy 82.14% in the study group, sensitivity 81.80%, specificity 73.12%, diagnostic accuracy 78.75% in the control group), and the Bayesian algorithm (sensitivity 87.81%, specificity 73.62%, diagnostic accuracy 84.72% in the study group, sensitivity 83.30%, specificity 77.08%, diagnostic accuracy 81.11% in the control group). A complex analysis of the Wald method recognized ventricular arrhythmias in the research group with sensitivity 83.11%, specificity 83.65%, diagnostic accuracy 83.23% and in the control group with a sensitivity 83.51%, specificity of 84.58% and diagnostic accuracy 83.89%. Artificial neural networks recognized ventricular arrhythmias with sensitivity 91.43%, specificity 91.30% and diagnostic accuracy 91.39% in the control group and with sensitivity 97.06%, specificity 99.39% and diagnostic accuracy 97.6% in the research group. CONCLUSION: Automatic analysis allows obtaining simultaneously the results of each algorithms/criteria and in combination. It significantly reduces the doctor's work in assessing of amplitude-time characteristics of the complexes. Using artificial neural networks increases the accuracy of of ventricular and supraventricular arrhythmias recognition.

[The state of membranes of mononuclear leukocytes in patients with tuberculosis of lungs.]

The sampling of examined patients comprised 308 individuals with medication sensitive (or with absence of data about resistance) tuberculosis of lungs without decay of pulmonary tissue with purpose to detect characteristics of alteration of content and structural organization of monocytic membranes before treatment and also against the background of application of chemotherapy according 1 standard regimen. The data of clinical radiologic examination of patients, bacterioscopy, molecular genetic analysis and analysis of phospholipid spectrum of membranes of mononuclears of peripheral blood were used. To detect particular classes of phospholipids the thin-layer flow chromatography was applied. The following fractions of phospholipids were detected: aggregated lysophospholipids, sphingomyelin, phosphatidylinositol, phosphatidylcholine, phosphatidylserine, phosphatidylethanolamine. To evaluate structurally functional condition of mononuclears of peripheral blood under tuberculosis the coefficients of activity of phospholipase and membrane permeability were applied. It is established that in case of tuberculosis infection an alteration of functional activity and restructuring of membranes of mononuclears of peripheral blood is observed expressed by increasing of content percentage of phosphatidylinositol and phosphatidylethanolamine and in decreasing of level of sphingomyelin, phosphatidylcholine and phosphatidylserine. In patients with tuberculosis prior to treatment decreasing of coefficient of membrane permeability. After application of chemotherapy coefficient of membrane permeability returned to standard. The anti-tuberculosis chemotherapy gives rise to activation of phospholipase A2 that shows membrane destructive effect on mononuclears of peripheral blood and results in disorganization of their membranes manifesting in cumulation of lysophospholipids at simultaneous decreasing of percentage content of phosphatidylserine and phosphatidylcholine. The toxic effect of anti-tuberculosis chemotherapy has no effect on number of monocytes in peripheral blood. At that, disorganization of membrane structures of these cells and possible suppression of their functional activity occur.

[Long-term results of treatment in patients with pulmonary tuberculosis, by using main bronchial occlusion, impact of pulmonary hemodynamics].

The outcomes of treatment were analyzed in 108 patients with disseminated and complicated pulmonary tuberculosis. The patient's mean age was 38.3 +/- 4.2 years. Transsternal occlusion of the main bronchus was performed. Concurrently, the following draining interventions were made: thoracostomy, cavernotomy, cavernostomy, or stepwise thoracoplasty. Nine (8.3%) patients intraoperatively died; 20 (18.5%) patients developed recanalization of the main bronchus. Twenty-four (22.2%) patients had a progressive tuberculous process in the contralateral lung. The operation was effective and ensured recovery or stabilization of the tuberculous process in 55 (50.9%) patients. After surgery, dilatation of the pulmonary trunk was 2.8 cm; stroke volume in the pulmonary trunk was 42.4 ml and its distribution along the branches was 83% on the side of the least affection and 17% on that of the greatest affection. At diastole, there was a retrograde blood flow in the branch of the pulmonary artery of the collapsed lung in the volume of 61% of the systolic stroke volume. The calculated pulmonary pressure was 52 mm Hg. Transsternal occlusion of the main bronchus, involving stepwise draining interventions, should be considered the method of choice in treating these patients.

[The attitude of medical institute students to cancer patients]. / Otnoshenie studentov meditsinskogo instituta k onkologicheskim bol'nym.

One hundred and twenty-eight fourth-year and 106 fifth-year medical students were questioned to evaluate their attitude to cancer patients. After taking a course in oncology, 11.3% of students considered cancer "contagious" or "likely to be contagious" and half the students considered cancer prevention "ineffective" or "likely to be ineffective". They distance themselves from cancer patients in family relations and their relations were closer in every day life and with friends.

[The rehabilitation of breast cancer patients]. / Reabilitatsiia bol'nykh rakom molochnoi zhelezy.

Immediate and long-term anatomic, functional, psychologic and social results of radical treatment of breast cancer were assessed in 2 groups of patients who had either undergone or not undergone rehabilitation. The study showed that purposeful rehabilitative treatment and organizational measures assured a decrease in invalidism rate in working age patients from 75 to 43.6% and better quality of life.