[Analysis of the effectiveness of various methods of rehabilitation of patients with subacromial impingement syndrome]. / Analiz effektivnosti primeneniya razlichnykh metodov reabilitatsii patsientov s subakromial'nym impindzhment-sindromom.

INTRODUCTION: Subacromial impingement syndrome is a common pathology that leads to a persistent decrease in the functioning of the affected limb and, as a consequence, a decrease in the quality of life and work ability of patients. According to various authors, the study of the effectiveness of treatment and rehabilitation of this pathology is quite widely presented in the literature: surgical, including arthroscopic operations, rehabilitation using various factors of physical therapy, manual and other practices. However, the issue of assessing the effectiveness of movement therapy, both alone and in combination with other therapeutic methods, remains relevant. AIM: To evaluate the effectiveness of therapeutic gymnastics procedures, both monotherapy and in combination with manual massage according to the therapeutic method and extracorporeal shock wave therapy (ESWT), in patients with subacromial impingement syndrome of the shoulder, in order to reduce pain and improve the function of the shoulder joint. MATERIAL AND METHODS: The study included 70 patients whose age was 42.18±10.42 years. Patients were divided into two main groups: group 1 (n=34) and group 2 (n=36). All patients received a course of treatment, including 10 procedures of therapeutic exercises, with recommendations at the end of the course for continuation in the form of independent studies using the proven methodology. The duration of the course of therapeutic exercises (in the form of procedures with a physical therapy instructor and subsequent independent studies) was 30 days. Patients in group 2 were divided into three subgroups: subgroup 2A, in which PH procedures were combined with massage of the cervical-collar area and the upper limb area of the affected side; subgroup 2B, where PH gymnastics was carried out in combination with extracorporeal shock wave therapy (ESWT) procedures; subgroup 2C - a comprehensive program including LH procedures, manual massage and shock wave therapy. RESULTS: 3 months after the end of the course of rehabilitation measures, patients of all groups showed a significant improvement in scores on the ASES and VAS scales, but there were no reliably significant differences between the results of different groups. CONCLUSION: The study indicates that movement therapy is an effective method of rehabilitation for patients with subacromial impingement syndrome, and conducting complex programs in which PH is combined with other rehabilitation methods (massage, shock wave therapy) doesn't have statistically significant advantages over PH alone within a 3-month observation period.

[Ultrastructure of neointima of native and artificial elements of the blood circulatory system]. / Ul'trastruktura neointimy nativnykh i iskusstvennykh elementov sistemy krovoobrashcheniya.

OBJECTIVE: To compare the neointima structure in conduits for coronary bypass grafting, bioprosthetic heart valves, tissue-engineered vascular grafts, and metal stents. MATERIAL AND METHODS: The objects of the study were the fragments of the human internal thoracic artery, experimental biodegradable vascular prostheses, leaflets of xenopericardial bioprostheses of heart valves, and fragments of stented vessels. Tissue samples were fixed in formalin and post-fixed in osmium tetroxide. After dehydration and epoxy resin embedding, the samples were ground and polished. Samples were counterstained with uranyl acetate and lead citrate and visualized by means of backscattered scanning electron microscopy. RESULTS: Neointimal pattern in all samples was similar. Neointima was comprised of endothelial cells, smooth muscle cells, fibroblasts, and the extracellular matrix. Endothelial cells showed significant diversity both between different elements of the circulatory system and within the same tissue, having either elongated or polygonal shape. Adhesion of leukocytes testified to the endothelial cell activation. In the absence of inflammation in the superficial layer of the neointima, the arrangement of smooth muscle cells and extracellular matrix fibers was parallel to the endothelium. Clusters of foam cells were frequently detected around the neointimal layers with solid inclusions (metal stents or calcium deposits). Thickening of the neointima was accompanied by the presence of capillaries and capillary-like structures. CONCLUSION: Neointima formation is a typical response to the damage inflicted to the elements of the circulatory system. Neointima underwent a constant remodeling characterized by an altered cellular composition, macrophage invasion, neovascularization, and calcification.

A Digital Electrocardiographic System for Assessing Myocardial Electrical Instability: Principles and Applications.

The aim of the study was to develop an ECG hardware and software system for monitoring electrical instability of the myocardium and to assess the diagnostic and prognostic capabilities of this setup in a cardiology clinic. MATERIALS AND METHODS: The Intecard 7.3 software and hardware system developed in this study makes it possible to measure fluctuations of the ECG amplitude-time parameters using the beat-to-beat mode. Intecard 7.3 evaluates a number of ECG markers that reflect electrical instability of the myocardium. Among them are the fragmented QRS complex, the spatial QRS-T angle, the T-wave alternans, the duration, and dispersion of the QT interval, the turbulence and acceleration/deceleration of the heart rhythm.Clinical trials of Intecard 7.3 were carried out with 734 patients with ischemic heart disease or cardiomyopathy and 112 healthy individuals. RESULTS: Intecard 7.3 reliably identifies fragmented QRS complexes by detecting short spikes of <25 ms in the ascending parts of the Q, R, and S waves. The QRS-T angle is determined from the reference amplitudes of the R and T waves in leads avF, V2, V5, and V6. Digital precision processing of the ECG signal improves its accuracy to microvolts and microseconds.The software was designed to measure the T-wave amplitude in each of 300-500 cardiobeats; T-wave alternans was estimated by the moving average method. In a typical cardiobeat, the QT dispersion was calculated based on 12 ECG leads. From the sequence of RR intervals, turbulence, and deceleration of the heart rhythm were determined.During the observation period of 5.0 [2.1; 5.9] years, 90 out of 734 patients (12.3%) experienced adverse cardiovascular events (ACVE). In this period, the myocardial electrical instability was recorded in patients with ACVE more frequently than in those without ACVE. Thus, the frequency of fragmented QRS was 72.2±4.7 vs 16.8±1.5% (p<0.01), the values of the QRS-T angle were 128 [55; 101] vs 80 [53; 121]° (p<0.001), the T-wave alternans - 36.9 [15.5; 62.1] vs 21.9 [10.2; 30.7] µV (p<0.005), the QT interval - 408 [383; 438] vs 376 [351; 400] ms (p<0.001), the QT dispersion - 76 [57; 96] vs 64 [50; 92] ms (p<0.005), respectively. In patients with ACVE, the threshold that triggers pathological rhythm turbulence was higher (>0%) than that in healthy controls (p<0.001); the deceleration of the heart rhythm was reduced from 19.2 [2.2; 38.0] to 8.8 [4.0; 16.8] ms (p<0.05).A personalized model for ACVE risk stratification has been developed. In this model, the area under the ROC curve was 0.856; sensitivity - 75%; specificity - 78%; predictive accuracy - 77%. CONCLUSION: Using the ECG markers of myocardial electrical instability, the Intecard 7.3 system allows one to predict life-threatening ventricular tachyarrhythmias and sudden cardiac death with an accuracy of 77%. The non-invasiveness, high productivity, and reasonable cost ensure the availability of this predictive technology in all levels of healthcare.

[Comparative study of vasa vasorum and neointima in conduits for coronary artery bypass grafting]. / Sravnitel'noe izuchenie vasa vasorum i neointimy v konduitakh dlia koronarnogo shuntirovaniia.

AIM: This study was undertaken to investigate the preoperative incidence and severity of intimal hypertrophy, as well as the level of blood supply of arterial and venous conduits for coronary artery bypass grafting. MATERIAL AND METHODS: Segments of the internal thoracic artery and great saphenous vein (n=13) were harvested pairwise during coronary artery bypass grafting and were then visualized by scanning electron microscopy in back-scattered electrons. The analysis of the incidence and thickness of intimal hypertrophy, as well as the calculation of the number and the area of the vasa vasorum were performed using the programme ImageJ. RESULTS: Intimal hypertrophy was more characteristic for the great saphenous vein as compared with the internal thoracic artery (9/13 (69.2%) and 7/13 (55.8%), respectively), although this difference did not reach statistical significance. The maximal-to-minimal neointimal thickness ratio correlated with the percentage of stenosis (r=0.875, p<0.0001), the area (r=0.45, p=0.023) and the number (r=0.47, p=0.015) of the vasa vasorum in the conduits, thus confirming the hypothesis on possible participation of these vessels in the development of intimal hypertrophy, with the area of the vasa vasorum being greater in the vessels with >10% stenosis (p=0.051). The number of the vasa vasorum in the great saphenous vein exceeded that in the internal thoracic artery (p=0.0005), with this difference remaining significant after adjustment for the area of the adventitia (p=0.027). The number of the vasa vasorum per the percentage of stenosis in the great saphenous vein also exceeded that in the internal thoracic artery (p=0.039) and more strongly correlated with intimal hypertrophy in the great saphenous vein as compared with that in the internal thoracic artery (r=0.53 and r=0.27, respectively). CONCLUSION: Intimal hypertrophy correlates with the area and number of the vasa vasorum in conduits. The great saphenous vein is characterised by a larger number and higher density of the vasa vasorum as compared with the internal thoracic artery. The number of the vasa vasorum is correlated with stenosis of the great saphenous vein more closely than with stenosis of the internal thoracic artery. This may be suggestive of significant predisposition of the great saphenous vein to the onset of adventitial inflammation followed by the development of intimal hypertrophy.

[Analysis of Heteroplasmy in the Major Noncoding Region of Mitochondrial DNA in the Blood and Atherosclerotic Plaques of Carotid Arteries].

For identification of somatic mitochondrial DNA (mtDNA) mutations, the mtDNA major noncoding region (D-loop) sequence in blood samples and carotid atherosclerosis plaques from patients with atherosclerosis was analyzed. Five point heteroplasmic positions were observed in 4 of 23 individuals (17%). Only in two cases could heteroplasmy have resulted from somatic mutation, whereas three heteroplasmic positions were found in both vascular tissue and blood. In addition, length heteroplasmy in a polycytosine stretches was registered at nucleotide positions 303-315 in 16 individuals, and also in the 16184-16193 region--in four patients. The results suggest that somatic mtDNA mutations can occur during atherosclerosis, but some heteroplasmic mutations may appear in all tissues, possibly being inherited.

[Somatic genome variations in vascular tissues and peripheral blood leukocytes in patients with atherosclerosis].

The first data on the existence of multiple genomic rearrangements, such as copy number variation (CNV) and copy neutral loss of heterozygosity, in vascular tissues and peripheral blood leukocytes from patients with atherosclerosis, are presented. Compared to internal mammary arteries and peripheral blood leukocytes, right coronary arteries in the atherosclerotic plaque area presented with a higher CNV length and number of genes located in their vicinity. In each of the patients, 6-16% of CNVs were common to the three types of tissues examined. Therefore, most of the copy number variations in the tissues affected by atherosclerosis (from 68 to 91% in each of the patients) were of somatic origin. The gains in 3p21.31 (CACNA2D2), 7q32.1 (FLNC), 19p13.3 (C19orf29, PIP5K1C), and 21q22.3 (COL6A1) were detected in vascular tissues but not in peripheral blood leukocytes. Moreover, the gain in 7p15.2 (SKAP2), detected in the patients with atherosclerosis, did not overlap with any CNV regions currently reported in The Database of Genomic Variants. The loss of heterozygosity in 12 out of 13 chromosomal regions was copy neutral and covered tumor suppressor genes (SFRP1, CEBPD, RB1CC1, DIRAS3, TUSC3, and ZDHHC2).

[DNA methylation profiling of the vascular tissues in the setting of atherosclerosis].

To date the question of epigenetic mechanisms of gene regulation in the context of cardiovascular diseases is of a considerable interest. Here, for the first time DNA methylation profiles of vascular tissues of atherosclerotic patients have been analyzed with using the microarray Infinium HumanMethylation27 BeadChip ("Illumina", USA). As the result, within 286 genes 314 CpG-sites that varied significantly in the DNA methylation level between the tissue samples of carotid (in the area of atherosclerotic plaques and nearby macroscopically intact tissues of the vascular wall) and mammary arteries as well saphenous veins have been identified. The most pronounced differences in the methylation level were registered for CpG-sites of homeobox genes HOXA2 and HOXD4 as well as imprinted gene MEST. In particular, these genes were found to be hypomethylated in the carotid atherosclerotic plaques compared to their methylation patterns in intact tissues of internal mammary arteries and saphenous veins.

[Methylation profile of INK4B-ARF-INK4A locus in atherosclerosis].

Single-nucleotide polymorphisms (SNPs) in the 9p21.3 locus have recently been demonstrated to be strongly associated with the risk of developing human atherosclerotic lesions. However, the pathophysiology of this locus is insufficiently studied. Here, the methylation profile of the nearest mapped genes for cyclin-dependent kinase inhibitors CDKN2A (p16(INK4a), p14(ARF)) and CDKN2B (p15(LNK4b)) in the tissues of the carotid artery in patients with atherosclerosis was evaluated for the first time. Aberrant DNA methylation of the analyzed loci was not established in either the atherosclerotic plaques and in the tissues from the macroscopically unchanged previa vascular wall in the same patients.

[Determination of phases of stress in clinical cardiology].

Aim of the study was to determine criteria of phases of stress reaction in humans to psychoemotional loading taking into account regulatory systems of adaptational reserves of organism. We examined representatives of professions potentially exposed to stress and investigated a spectrum of derangements of regulatory systems of the organism (neurovegetative system and cognitive function) under conditions of development of different phases of stress reaction to psychoemotinal loads. The proposed approach will allow to obtain efficiently quantitative assessment of phases of stress reaction in humans at different levels of adaptation to it. This approach can be used in clinical medicine.

[Methylation profiling of human atherosclerotic plaques].

Somatic mutation theory of atherogenesis proved by alterations at the DNA level such as "loss of heterozygosity" and microsatellite instability in atherosclerotic plaque is complemented by the date of epigenetic variability of genetic loci involved in the pathological process. However, only recently large-scale analysis of epigenetic modifications in the human genome became possible. For the first time quantitative microarray-based methylation profiling of 1505 CpG-sites across 807 genes was performed in atherosclerotic aorta and carotid artery wall lesions using the GoldenGate Methylation Cancer Panel I ("Illumina", USA). One hundred and three (7%) CpG-sites in 90 (11%) genes were differentially methylated between tissue samples. The most pronounced differences in DNA methylation levels were registered for a site which is located in CpG-island of imprinted gene H19. By comparing 90 genes that were differentially methylated between tissue samples in our study, 10 genes (ICAM1, GSTM1, IGFBP1, POMC, APOA1, IL1RN, INS, LTA, MMP3, THBS2) were overlapped with data in Human Genome Epidemiology Network (HuGENet), in which they were identified as candidates for cardiovascular disease continuum.

[The heart rate variability in the acute lacunar cerebral infarct].

Clinical-electrophysiological investigation has been performed in 30 patients with acute lacunar cerebral infarct. Patients with atrial fibrillation, severe extrasystole weren't included to the study. The control group includes 7 health volunteers. EKG registration within 5 minutes with time domain, frequency domain analysis have been made. Brain attack on the type of lacunar IS associates with evident HRV disturbances. Centralization of the heart rate autonomic control, caused by suprasegmental part of the vegetative nervous system hyperactivity occurs against a background relative sympaticothonia and decrease of parasympathetic nervous system. In case of right carotid stroke there is significant lowering of standard deviation of the RR intervals (p=0,024), triangular index (p<0,001), total power (p=0,016), increase of mode of the histogram distribution of RR intervals (p=0,002) and the proportion derived by the number of RR intervals, that match the value of mode (p=0,001).

[Modern aspects of war against smoking: are there any opportunities left?].

The war against smoking requires taking immediate measures because of the growing spread and severe consequences. All minuses and pluses of the Mass Media are underlined in this article. Anti-smoking technical means should to meet the following requirements: (1) each inhalation of cigarette smoke should be carried to the level of conscience; (2) each smoking act should be accompanied by unpleasant perceptions; (3) A conscientious registration number of cigarettes smoked is necessary. These problems have been solved by now. artery stiffness, defined by pulse wave propagation velocity increases after the act of smoking thus imitating aging. The smoker should be aware of this fact.

[Chronic hepatitis B, hemosiderosis, and hepatic fibrosis in a renal graft recipient].

Chronic hepatitis B is a frequent concomitant disease in recipients of a renal graft that worsens results of kidney transplantation due to renal and extrarenal complications. Much rarer hemochromatosis either has genetic roots (hereditary hemochromatosis) or results from multiple blood transfusions and hemolysis during treatment by hemodialysis (secondary hemochromatosis). Combination of chronic hepatitis B and hemochromatosis increases the risk of chronic liver disease leading to cirrhosis and hepatocellular carcinoma. Success of antiviral therapy combined with massive phlebotomy is illustrated by a case of kidney transplantation to a patient with chronic hepatitis B of large duration and iron overload syndrome.

[Radio wave influence upon the local processes of free radicals oxidation intensity in oral cavity operational field in laboratory animals].

Experimental study of free radicals oxidation intensity processes in the tissues of oral cavity operational field in case of the use of the traditional surgical scalpel and radio wave device. The status of the primary and final products of lipid peroxidation and local antioxidation activity was assessed. Appropriate peculiarities of the studied processes in experimental animals wounds were detected. During all periods of the study there was no negative dynamics of the local antioxidation activity of the studied substrate that testified to compensation and controllability of the running processes and softer local processes flow of free radicals oxidation in operational field in experiment especially when radio wave surgery method was used.

[The first break-through of the genotype 2.3.2 of high-virulence influenza A virus A/HSN1, which is new for Russia, in the Far East].

The epizootic etiologically associated with highly pathogenic avian influenza H5N1 genotype 2.3.2 that is new for Russia among wild and domestic birds in the south of the Primorye Territory during spring migration in April 2008 has been decoded. About 25% of the wild birds of a water complex, which include European teals (Anas crecca), mallard ducks (Anas platyrhynchos), great-crested grebes (Podiceps cristatus), are involved in viral circulation in the area of the Suifun-Khankai plain. Chicken embryos and the cell lines MDCK, SPEV, BHK-21, SW-13 were used to isolate 3 strains from recently deceased hens (A/chicken/Primorje/1/08, A/chicken/Primorje/11/08, and A/chicken/Primorje/12/08) and one strain from a European teal (A/Anas crecca/Primorje/8/08). The strains were deposited in the State Collection of Viruses of the Russian Federation, D. I. Ivanovsky Research Institute of Virology, Russian Academy of Medical Sciences. The nucleotide sequences of the full-sized genomes of A/chicken/Primorje/1/08 and A/Anas crecca/Primorje/8/08 were sent to the International databank GenBank. The strains from domestic and wild birds were shown to be identical. The isolated strains are most close to the strains Alchicken/Viet Nam/10/05, A/chicken/Guangdong/178/04, and A/duck/Viet Nam/12/05. Molecular genetic analysis has indicated that the strains isolated are susceptible to rimantadine and ozeltamivir and less adapted to mammalian cells (particularly, they contain E627 in RV2, which agrees with the biological properties of these strains in vitro). Penetration of the newly isolated virus into the Far East ecosystem provides in the foreseeable future a way for infecting the birds wintering in America and Australia in the nesting places, with further carriage of viral populations there in the period of autumn migrations.

[Interpretation of the epizootic outbreak among wild and domestic birds in the south of the European part of Russia in December 2007].

The paper presents the results of interpreting the epizootic outbreak etiologically associated with high-virulent influenza virus A/H5N1 among domestic and wild birds in the Zernogradsky and Tselinsky districts of the Rostov Region. Epizooty was characterized by a high infection rate in the synanthropic birds of a ground-based complex. RT-PCT revealed influenza virus A/H5 in 60% of pigeons and crows and in around 20% of starlings, and in 10% of tree sparrows. Fifteen viral strains from chickens (Gallus gallus domesticus), Indian ducks (Cairina moschata), rooks (Corvus frugilegus), rock pigeons (Columba livia), tree sparrows (Passer montanus), common starlings (Sturnus vulgaris), and great white herons (Egretta alba) were isolated and deposited in the State Collection of Viruses of the Russian Federation. Full-sized genomes of 5 strains were sequenced and deposited in the international database GenBank. The isolated strains belong to the Quinhai-Siberian (2.2) genotype, an Iranian-Northern Caucasian subgroup, they are phylogenetically closest to the strain A/chicken/Moscow/2/2007 (inducing epizooty among poultry in the near-Moscow Region in February 2007) and have 13 unique amino acid replacements as the consensus of the Quinhai-Siberian genotypes in the proteins PB2, PA, HA, NP, NA, and M2, by preserving thereby 4 unique replacements first describes for the strain A/chicken/Moscow/2/2007. The findings are indicative of a different mechanism that is responsible for bringing the virus into the northeastern part of the Azov Sea area in September 2007 (during the fall migration of wild birds) and in December 2007 in the south-western Rostov Region where a human factor cannot be excluded. Mass infection of synanthropic birds endangers the further spread of epizooty, including that in the central regions of the Russian Federation in spring after near migrants return after wintering.

[Rapidly progressive glomerulonephritis in ANCA-associated vasculitis: a course, treatment efficacy, prognosis].

AIM: To study efficacy of ANCA-RPGN treatment with corticosteroids and cyclophosphamide or mycophenolic acid drugs. MATERIAL AND METHODS: We treated 28 patients (17 males and 11 females aged 19-71 years) with morphologically verified ANCA-associated crescentic RPGN (crescentic median 79 (63:88)%. The patients received corticosteroids and cytostatics. RESULTS: The response to the treatment was registered in 22 (78%) patients in 8-16 weeks: a complete remission was achieved in 8 patients, a partial one--in 14 patients. In partial remission renal functions recovered incompletely (median Pcr 200 (180;255) mcmol/l) in persistence of moderate proteinuria (median 0.7 (0.6;1.3)g/day) and absence of microhematuria. Probability of the treatment success depended on severity of glomerulosclerosis and weakly depended on activity of extracapillary reaction. Severe renal failure was not an absolute predictor of treatment failure. CONCLUSION: In the absence of advanced nephrosclerosis early treatment with corticosteroid in combination with cytostatics can produce a positive effect in 70-80% patients with ANCA associated RPGN.

[Epizooty caused by high-virulent influenza virus A/H5N1 of genotype 2.2 (Qinghai-Siberian) among wild and domestic birds on the paths of fall migrations to the north-western part of the Azov Sea basin (Krasnodar Territory)].

Isolation, followed by the sequencing the full-size genome of strains of A/chicken/Krasnodarl300/07 and A/Cygnus cygnus/Krasnodar/329/07, has shown that they belong to genotype 2.2 (Qinghai-Siberian). The strains were deposited at the State Virus Collection of the Russian Federation and nucleotide consequences were at the International databank GenBank. The strains contained 10 unique amino acid replacements in reference to the consensus of the Qinghai-Siberian genotype in the PB2, PA, HA, NA, and NS1, which suggests that regional variants may form in different parts of an area.

[Conventional X-ray study in the diagnosis of esophageal achalasia and at its treatment stages].

The paper deals with one of rather common and clinically urgent diseases of the esophagus--esophageal achalasia (EA). By using 173 cases as an example, the authors show a diversity of clinical symptoms and basic X-ray diagnostic criteria for this abnormality. Analysis of the results of clinical and instrumental studies has enabled the authors to differentiate the complicated and uncomplicated forms of the disease, identification of which determines the choice of an algorithm of complex treatment. The paper provides strong evidence that the classical techniques of a conventional X-ray study ensure a valid differential diagnosis of EA and cardioesophageal cancer and evaluates the efficiency of treatments.