[Pathogenetic and Prognostic Role of Growth Factors in the Development of Chronic Heart Failure].

AIM: To study the role of growth factors ((vascular endothelial growth factor (VEGF), platelet derived growth factor AB (PDGF-AB) and basic fibroblast growth factor (FGF-basic)) in the development and progression of chronic heart failure (CHF) in patients with ishcemic heart disease (IHD). MATERIALS AND METHODS: We included in this study 94 patients with CHF. The control group comprised 32 persons. Blood serum levels of growth factors were determined at baseline and after 12 months of observation by enzyme-linked immunosorbent assay. RESULTS: VEGF, PDGF-AB and FGF-basic play an important role in the pathogenesis and progression of heart failure in patients with IHD, determining the increased risk of adverse cardiovascular events in this pathology. Serum activity of growth factors characterizes the severity and course of CHF: with disease progression levels of VEGF and FGF-basic decrease and PDGF-AB concentration increases. Initial low level of VEGF expression regardless of the sex of the patient's sex, significantly low level of FGF-basic and significantly high PDGF-AB in men characterizes unfavorable course of CHF. CONCLUSION: A correlation has been established between blood serum levels of VEGF, PDGF-AB and FGF-basic and severity and course of CHF.

[Role of soluble Fas ligand in myocardial remodeling, severity and outcomes of chronic heart failure]. / Rol' rastvorimogo Fas-liganda v remodelirovanii miokarda, tyazhesti techeniya i iskhodakh khronicheskoi serdechnoi nedostatochnosti.

AIM: to reveal the specific features of Fas ligand-mediated ischemic myocardial remodeling and those of chronic heart failure (CHF) development during a 12-month prospective follow-up. SUBJECTS AND METHODS: A total of 94 patients with ischemic CHF were examined and divided into 3 groups according to NYHA Functional Class (FC): 1) FC II CHF in 35 patients; 2) FC III CHF in 31; 3) FC IV CHF in 28. According to the results of the 12-month follow-up, the patients were randomized into 2 groups: A) 49 patients with a favorable course of cardiovascular disease and B) 45 patients with its poor course. Serum soluble Fas ligand (sFas-L) levels were measured by enzyme immunoassay. RESULTS: In the patients with CHF, the baseline sFas-L levels substantially exceeded that in the control group by 3-6 times (p<0.01). In the men with the poor course of CHF, the baseline serum sFAS-L levels (85.94±4.14 pg/ml) were significantly higher than that in the favorable CHF group (107.33±5.13 pg/ml; р=0.0015). ROC analysis of the sensitivity and specificity of cardiovascular risk stratification according to sFAS-L levels revealed the high prognostic value of this marker - ROC-Area±S.E. was 0.75±0.05 (95% confidence interval, 0.60 to 0.81; p=0.0005). There was a statistically significant moderate correlation of left ventricular (LV) ejection fraction with sFAS-L concentrations and a moderate direct correlation between serum sFAS-L concentrations and LV remodeling parameters. CONCLUSION: The serum level of sFas-L determines the development of ischemic LV remodeling and the severity of CHF, by increasing in proportion to the degree of disease progression. The determination of serum sFas-L levels assists in objectively estimating the severity of apoptosis and may be an important prognostic test to assess the course of CHF in patients with coronary heart disease.

COMPARATIVE ASSESSMENT OF THORACOSCOPY AND DESTRUCTION OF PULMONARY BULLAS COMBINED WITH PLEURODESIS AND PLEURECTOMY.

The article presents the results of thoracoscopic surgeries in case of bullous emphysema of the lung in 88 patients. The patients have been divided into 2 groups according to the method of treatment: 1) destruction of pulmonary bullas and pleurodesis using diathermic electrocoagulation (42 people); 2) destruction of pulmonary bullas and subtotal pleurectomy (47 people). The operative periods weren't statistically differentiated in patient's groups. The volume of hemorrhage and exudation period from the pleural cavity were significantly higher in patient's group, where patients underwent pleurectomy. However, lung spreading terms and ending of air leakage, periods of drains removal from the pleural cavity, hospital stay and rate of pneumothorax recurrence were considerably smaller in the group without application of pleurodesis.

[Assessment of the role of matrix metalloproteinase-3 gene polymorphism in the development of chronic heart failure].

AIM: To study the impact of a polymorphic variant of the matrix metalloproteinase-3 (MMP-3) gene on the development and course of chronic heart failure (CHF) in patients with coronary heart disease. SUBJECTS AND METHODS: A total of 277 patients with New York Heart Association (NYHA) Functional Class (FC) II-IV CHF were examined. MMP-3 -1171 5A/6A genetic polymorphism was studied by polymerase chain reaction. A control group included 136 patients (mean age 53.6 ± 4.8 years) with no signs of cardiovascular diseases, as evidenced by the examination. RESULTS: The frequency of the 5A allele and the 5A/5A genotype of the 1171 5A/6A polymorphic locus in the MMP-3 gene proved to be higher in the patients with CHF than that in the control group. Thus, the variability of the 5A allele (odds ratio (OR), 1.39; 95% confidence interval (CI): 1.033 to 1.869; p = 0.03) and the 5A/5A genotype (OR, 2.15; 95% CI: 1.131 to 4.070; p = 0.02) was associated with increased risk for CHF. There were significant differences in the frequency of MMP-3 alleles and genotypes in relation to FC of CHF. The frequency of the 5A/5A genotype was substantially higher in the patients with NYHA FC IV CHF than that in those with NYHA FC II CHF (32.8% versus 15.2%; p = 0.039). The frequency of the 5A allele was significantly higher in the patients with NYHA FC IV CHF than that in those with NYHA FC II CHF (55.5% and 39.3%; respectively; p = 0.019). Thus, the carriage of the 5A allele and the 5A/5A genotype of the 1171 5A/6A polymorphic locus in the MMP-3 gene is a risk factor of severe CHF. CONCLUSION: The determination of MMP-3 -1171 5A/6A polymorphism may be recommended for the early prediction of a risk for the development and severe course of CHF.

Expression of vascular endothelial growth factor (VEGF-A) in rat mandibular salivary gland during paraneoplastic process and treatment with cyclophosphamide and melatonin.

Expression of VEGF-A in Walker 256 carcinosarcoma and mandibular salivary gland of rats during paraneoplastic process and various regimens of chemotherapy with melatonin and cyclophosphamide were studied by immunohistochemical methods. VEGF-A expression increased in the tumor node and salivary gland after monotherapy with melatonin and cyclophosphamide during progression of tumor growth and paraneoplastic syndrome. A decrease in VEGF-A expression in the tumor node and salivary gland was found after monotherapy with melatonin and cyclophosphamide and, especially, after combined treatment, which proves maximum therapeutic efficiency of combined administration of chemical agents with various mechanisms of action. Overexpression of VEGF-A in the mandibular salivary gland can have diagnostic and predictive value in early diagnostics of neoplasms.

[Ultrastructural changes in endothelial cells of blood capillaries of the Walker 256 carcinosarcoma while treated with melatonin].

In Wistar rats with transplanted Walker 256 carcinosarcoma a use of melatonin as monoagent causes changes in intracellular organization of endothelial cells: reduced volume density of mitochondria, granular cytoplasmic network, micropinocytic vesicles, reduced the number density of free and attached ribosomes, which leads to increased apoptosis of tumor cells of Walker 256 carcinosarcoma.

[The evaluation of metastatic damage of the liver of the Wistar rats under conditions of spontaneous development of the Walker 256 carcinosarcoma].

There was held micro- and ultrastructural study of the liver of the Wistar rats in the dynamics of development of transplantable Walker 256 carcinosarcoma. The regularities of the progression of the tumor process in the form of liver metastases with appearance of intralobular metastases. In the early stages of tumor development it was marked activation of cytotoxic function of the liver with necrosis of tumor lesions accompanied by a decrease of the structural density of metastases. In advanced stages of development of the Walker 256 carcinosarcoma an estimation of parameters of tumor invasion in the liver showed an intensification of these processes with increased severity of inflammatory reactions.

[Pharmacogenomic control of angiotensin converting enzyme gene I/D polymorphism predominant risk factor of development of chronic heart failure and target of enalapril treatment].

Aim of investigation - to study effect of angiotensin-converting enzyme (ACE) gene polymorphism as a dominant risk factor of development of chronic heart failure (CHF) and target for effective therapy with ACE inhibitor enalapril in patients with ischemic heart disease. We followed 226 patients with CHF on stable permanent basic therapy comprising -adrenoblocker, diuretic, aldosterone antagonist, digoxin, and ACE inhibitor. Seventy eight patients received enalapril (starting dose 2.5 mg twice daily with subsequent titration up to 10-20 mg twice daily). Control group comprised 136 patients without cardiovascular abnormalities. Allele D of polymorphic locus I/D of ACE gene in homozygous state was associated with high risk of development and severity of clinical manifestations of CHF. In patients with D/D genotype of ACE gene at the background of therapy with enelapril we noted more pronounced lowering of CHF functional class and augmentation of left ventricular ejection fraction compared with patients having I/I and I/D genotypes. We revealed associative interrelationships of ACE gene polymorphism (polymorphic locus I/D) with development and severity of CHF as well as effectiveness of therapy with an ACE inhibitor enalapril.

[Impact of angiotensionogen and angiotensin II receptor type 1 gene polymorphisms on the development and course of chronic heart failure].

AIM: To study the impact of angiotensinogen (AGT) and angiotensin II receptor type 1 (AGTR1) gene polymorphisms on the development and course of chronic heart failure (CHF) in patients with coronary heart disease (CHD). SUBJECTS AND METHODS: Two hundred and twenty-six patients (149 men and 77 women; mean age 55.9 +/- 5.8 years) with CHF were examined. Genotypes were identified by the restriction fragment length polymorphism analysis of polymerase chain reaction products. A control group comprised 136 subjects (63 men and 73 women; mean age 53.6 +/- 4.8 years) without signs of cardiovascular diseases, as evidenced by the examination. RESULTS: The T allele of the M235T polymorphism in the AGT gene was found to be associated with the development and unfavorable course of CHF in patients with CHD. At the same time, carriage of the M allele of the M235T polymorphism in the AGT gene reflected the favorable course of this disease. That of the C allele and A/C genotype of the A1166C polymorphism in the AGTR1 gene was associated with the development of CHF and the A allele and A/A genotype manifested themselves as protective factors. According to the severity of CHF and the nature of its course, the distribution of frequencies of the genotypes and alleles of the A1166C polymorphism in the AGTR1 gene showed no significant differences between the patient groups. CONCLUSION: There were associations of the polymorphisms of the AGT gene (the M235T polymorphic marker) and the AGTR1 gene (the A1166C polymorphic marker) with the development of CHF in patients with CHD.

[The experience with the application of selective polarized chromotherapy in the clinical practice].

A series of investigations have demonstrated the anti-inflammatory, bactericidal, analgesic, and vegetocorrective effects of extraocular selective polarized chromotherapy using blue and red light and the possibility to optimize autonomous regulation with the help of this technique. The results of the study confirmed the high clinical effectiveness and safety of the method being considered for the treatment of acute respiratory diseases, chronic tonsillitis, cervical dorsopathies, and vegetative dysfunction.

[Characteristics of systemic inflammatory reaction in elderly patients of different age with the chronic heart failure].

The peculiarities of development systemic inflammatory reactions during the chronic heart failure were studied in the research. The patients with different severity of the chronic heart failure and different clinical course were examined at the beginning and in the dynamics of the clinical observation. The functional activity of neutrophils, pro- and antioxidant activity of serum were estimated in these patients. It was found that the functional activity of neutrophils in the course of systemic inflammatory reactions during the chronic heart failure decreased against the misbalances between pro- and antioxidative