[Characteristics of Inferior Myocardial Infarction With a Special Electrocardiographic Pattern (Aslanger) in Metabolic Syndrome].

AIM: To evaluate the features of ST-segment elevation myocardial infarction with the Aslanger pattern in comparison with traditional forms of inferior myocardial infarction in metabolic syndrome. MATERIAL AND METHODS: This study included 30 patients with inferior myocardial infarction in the presence of metabolic syndrome: 9 patients with the Aslanger electrocardiographic pattern (group 1, age 59.7 [58.4; 63.1] years) and the rest with one of the traditional forms (control group, 59.9 [57.2; 63.8] years, matched by all criteria of metabolic syndrome). All patients underwent primary percutaneous intervention with assessment of the angiographic picture. The magnitude of ST-segment elevation was measured in lead III at the J point and following 0.06 seconds, and the optimal threshold value of this indicator was determined for a new picture of myocardial infarction. RESULTS: The infarct-related artery in the Aslanger pattern was more often the circumflex artery (p=0.0099), and coronary thrombosis was characterized by a lower TIMI thrombus grade (p=0.014). SYNTAX values for the Aslanger pattern and for the traditional picture of inferior infarction with ST elevation in lead II≥III were higher than for a similar picture with ST elevation in lead III>II. The level of cTnI at admission (p=0.013) and after 24 hours (p=0.0017), the platelet count (p=0.0011) and mean volume (p=0.0047) in group 1 had smaller values than with traditional inferior infarction. The ST elevation at J point and at J+0.06 s point for lead III with the Aslanger pattern was significantly lower than values of such shift in lead III>II and lead II≥III with traditional inferior infarction (p<0.001). An elevation value ≤1.5 mm at J point +0.06 s was a predictor of infarction with the Aslanger pattern. Constructing the ROC curve made it possible to determine that with the Aslanger pattern, the best cutoff value for this index is 2 mm. CONCLUSION: Myocardial infarction with the Aslanger pattern as compared with traditional lower infarction in metabolic syndrome is characterized by specific individual angiographic signs, lower ST segment elevation, cTnI level, and thrombotic disorders.

[Pulmonary embolism and diffuse alveolar bleeding: combination options and therapy features].

The analysis of the mechanisms of the formation of a rare clinical combination of pulmonary embolism (PE) and diffuse alveolar hemorrhage (DAH), which are complications of systemic vasculitis associated with antibodies to the cytoplasm of neutrophils (primarily granulomatosis with polyangiitis), systemic lupus erythematosus and secondary antiphlogistic syndrome primary antiphospholipid syndrome and Goodpastures syndrome. Taking into account the chronological sequence of the occurrence of PE and DAH, 3 variants of the onset of these potentially fatal additions to the underlying disease were considered: the anticipatory DAH development of PE, delayed from DAH PE and joint (within 24 hours) formation of PE and DAH. A review of single descriptions of such a combination of complications of granulomatosis with polyangiitis is carried out, criteria are indicated, a working classification of severity is given and, taking this into account, a modern program of therapy for DAH as an independent event and in combination with PE.

Clinical observation of a combination of diffuse alveolar-septal pulmonary lesion and amyloid cardiomyopathy in systemic AL-amyloidosis in the elderly.

A rare observation of systemic AL-amyloidosis with a debut in old age, accompanied by diffuse alveolar-septal lesion of the lungs and mediastinal lymphadenopathy in combination with amyloid cardiomyopathy in the absence of pathology of kidney and liver function.

Covariates of high-risk human papillomavirus (HPV) infections are distinct for incident CIN1, CIN2 and CIN3 as disclosed by competing-risks regression models.

BACKGROUND: In addition to the oncogenic human papillomavirus (HPV), several cofactors are needed in cervical carcinogenesis, but whether the HPV covariates associated with incident (i) CIN1 are different from those of incident (ii) CIN2 and (iii) CIN3 needs further assessment. OBJECTIVES: To gain further insights into the true biological differences between CIN1, CIN2 and CIN3, we assessed HPV covariates associated with incident CIN1, CIN2, and CIN3. STUDY DESIGN AND METHODS: HPV covariates associated with progression to CIN1, CIN2 and CIN3 were analysed in the combined cohort of the NIS (n = 3187) and LAMS study (n = 12,114), using competing-risks regression models (in panel data) for baseline HR-HPV-positive women (n = 1105), who represent a sub-cohort of all 1865 women prospectively followed-up in these two studies. RESULTS: Altogether, 90 (4.8%), 39 (2.1%) and 14 (1.4%) cases progressed to CIN1, CIN2, and CIN3, respectively. Among these baseline HR-HPV-positive women, the risk profiles of incident CIN1, CIN2 and CIN3 were unique in that completely different HPV covariates were associated with progression to CIN1, CIN2 and CIN3, irrespective which categories (non-progression, CIN1, CIN2, CIN3 or all) were used as competing-risks events in univariate and multivariate models. CONCLUSIONS: These data confirm our previous analysis based on multinomial regression models implicating that distinct covariates of HR-HPV are associated with progression to CIN1, CIN2 and CIN3. This emphasises true biological differences between the three grades of CIN, which revisits the concept of combining CIN2 with CIN3 or with CIN1 in histological classification or used as a common endpoint, e.g., in HPV vaccine trials.

Longitudinal outcomes of high-risk human papillomavirus (HPV) infections as competing-risks events following cervical HPV test at baseline visit in the NIS-LAMS cohort.

BACKGROUND: The complex natural history of human papillomavirus (HPV) infections following a single HPV test can be modeled as competing-risks events (i.e., no-, transient- or persistent infection) in a longitudinal setting. The covariates associated with these competing events have not been previously assessed using competing-risks regression models. OBJECTIVES: To gain further insights in the outcomes of cervical HPV infections, we used univariate- and multivariate competing-risks regression models to assess the covariates associated with these competing events. STUDY DESIGN AND METHODS: Covariates associated with three competing outcomes (no-, transient- or persistent HR-HPV infection) were analysed in a sub-cohort of 1,865 women prospectively followed-up in the NIS (n = 3,187) and LAMS Study (n = 12,114). RESULTS: In multivariate competing-risks models (with two other outcomes as competing events), permanently HR-HPV negative outcome was significantly predicted only by the clearance ofASCUS+ Pap during FU, while three independent covariates predicted transient HR-HPV infections: i) number of recent (< 12 months) sexual partners (risk increased), ii) previous Pap screening history (protective), and history of previous CIN (increased risk). The two most powerful predictors of persistent HR-HPV infections were persistent ASCUS+ Pap (risk increased), and previous Pap screening history (protective). In pair-wise comparisons, number of recent sexual partners and previous CIN history increase the probability of transient HR-HPV infection against the HR-HPV negative competing event, while previous Pap screening history is protective. Persistent ASCUS+ Pap during FU and no previous Pap screening history are significantly associated with the persistent HR-HPV outcome (compared both with i) always negative, and ii) transient events), whereas multiparity is protective. CONCLUSIONS: Different covariates are associated with the three main outcomes of cervical HPV infections. The most significant covariates of each competing events are probably distinct enough to enable constructing of a risk-profile for each main outcome.

[Ulcer disease in schizophrenic patients as a model for the estimation of neurogenic factors predisposing to a somatic disease].

The objective of the present study was to elucidate specific clinical features of ulcer disease (UD), diseases associated with Helicobacter pylori infection, and motor disturbances in the upper portion of the gastrointestinal tract in the patients presenting with schizophrenia (n = 35). Their observation was based at a psychiatric hospital and a psychiatric dispensary, The control group was comprised of 80 psychically healthy subjects suffering ulcer disease. The program of examination included endoscopic and histological studies in conjunction with pathologoanatomic expertise. It was shown that ulcer disease in the patients with schizophrenia was characterized by the prevalence of gastric and combined forms of pathology (p = 0.001), the development of rare forms of ulcers of duodenal localization (p = 0.009), and motor disturbances in the upper portion of the gastrointestinal tract (p = 0.001) in conjunction with the impaired activity of Helicobacter pylori-associated gastritis (p < 0.05) when the development of the somatic disease preceded the onset of psychosis that, in its turn, was not precipitated by chronic alcoholism. Both the primary manifestation and the relapse of UD occurred either in the absence of a marked personality defect in the psychically ill patient or in the presence of chronic alcoholism concomitant with schizophrenia.

[The role of dynamic perfusion scyntiography of myocardium at rest and during exercise in the assessment of the clinical course of chronic cardiac failure and angina of effort in patients with stable forms of coronary heart disease].

The ever-growing morbidity, disablement, and mortality from coronary heart disease, chronic cardiac failure dictate the necessity of the search for new methods to verify, and evaluate prognosis of the clinical course of these diseases. Currently, myocardial perfusion scintiography is most widely used for the purpose.

[Population models in the study of neurogenic domnants of arterial hypertension. Report 2. The peculiarities of arterial hypertension matched with personal motivational priorities].

The peculiarities of primary arterial hypertension in persons with opposite types of motivational priorities were studied. The features and prevalence of the disease in two populations were analyzed. Group 1 consisted of 141 subjects whose profession and working conditions required maximum realization of the market-oriented motivational dominant ("socially active persons"); Group 2 consisted of 147 "altruistic" type subjects who lacked the first group's motivational dominant. The study found a higher prevalence of the disease and a lower level of psychological health as part of quality of life in Group 1 (p = 0.018); the disease in this group was more intensive and significant structural and functional left ventricular transformation was typical. The absence of pernicious habits and healthy life-style should not be considered primary factors of a more favorable clinical course of the disease in the "altruistic" group.

[Population models in the study of the neurogenic determinants of arterial hypertension. Report I. Peculiarities of arterial hypertension in schizophrenia].

In order to clarify the role of the central nervous system in the genesis of arterial hypertension (AH) a population analysis of somatic pathology in schizophrenia was performed. Using clinical and postmortem data, the study found lower frequency of AH among mental patients vs. somatic ones; primary AH was benign independently of the psychotropic therapy regimen. II to III stage AH in psychosis was associated with primary or secondary renal pathology or magistral vessel atherosclerosis. Severe schizophrenia and a pronounced personality defect were associated with low intensity of the primary form of somatic nosology.

[Coping with the disease phenomenon and peculiarities of the course of bronchial asthma].

The aim of the study was to evaluate coping stratages (the degree of coping with the disease, CD) in 239 patients with moderate or severe bronchial asthma (BA). A method making it possible to calculate coping with the disease index (CDI) and thus to divide the patients into groups with a high (1) or low (2) degree of CD, was used. In addition, the levels of sputum eosinophilia, bronchial permeability, and pulmonary hemodynamics, were studied in both groups by two control examinations (after 6 and 10 to 12 months). The absence of severe cases of BA, stable results achieved during the first stage of treatment, stable remission on a smaller dose of inhaled glucocorticosteroids after 6 months with a significant growth of the number of well-controled BA and a decrease in pulmonary hypertension by the end of follow-up period, were typical of patients with a high CD. Evaluation of CDI allows for differentiation of BA patients into the groups with prognostically favorable and unfavourable BA, rationalizing therapeutic strategy, and lowering the probability of pulmonary hypertension progression.

[Gastric ulcer accompanying schizophrenia: variants of combination and particulars of development].

Using clinical and pathologicoanatomic data, particular features of gastric ulcer accompanying schizophrenia have been studied. It was determined that the disease is characterized by the specific ulcer localization of the concomitant Helicobacter pylori-associated gastritis and motor disorders of upper gastro-intestinal tract in combination with psychiatric pathology unlike the somatic group. The propagation of the nosology under examination at schizophrenia is inverse to the severity index of psychosis development.

[Ulcer disease in schizophrenia: variants of combination and particular features of the course].

Using clinical and pathologoanatomic data, particular features of gastric ulcer at schizophrenia were studied. It was determined that in combination with psychiatric pathology the disease (unlike the somatic group) is characterized by specific localization of ulcer, Helicobacter pylori-associated gastritis and motor disorders of the upper gastrointestinal tract. The spreading of the nosology under study is inverse to the index of severity of the psychosis course.

Co-factors of high-risk human papillomavirus infections display unique profiles in incident CIN1, CIN2 and CIN3.

In addition to oncogenic 'high-risk' human papillomaviruses (HR-HPV), several co-factors are needed in cervical carcinogenesis, but it is poorly understood whether these HPV co-factors associated with incident cervical intraepithelial neoplasia (CIN) grade 1 are different from those required for progression to CIN2 and CIN3. To gain further insights into the true biological differences between CIN1, CIN2 and CIN3, we assessed HPV co-factors increasing the risk of incident CIN1, CIN2 and CIN3. Data from the New Independent States of the Former Soviet Union (NIS) Cohort (n = 3187) and the Latin American Screening (LAMS) Study (n = 12,114) were combined, and co-factors associated with progression to CIN1, CIN2 and CIN3 were analysed using multinomial logistic regression models with all covariates recorded at baseline. HR-HPV-positive women (n = 1105) represented a subcohort of all 1865 women prospectively followed up in both studies. Altogether, 90 (4.8%), 39 (2.1%) and 14 (1.4%) cases progressed to CIN1, CIN2 and CIN3, respectively. Baseline HR-HPV was the single most powerful predictor of incident CIN1, CIN2 and CIN3. When controlled for residual HPV confounding by analysing HR-HPV-positive women only, the risk profiles of incident CIN1, CIN2 and CIN3 were unique. Completely different HPV co-factors were associated with progression to CIN1, CIN2 and CIN3 in univariate and multivariate analyses, irrespective of whether non-progression, CIN1 or CIN2 was used as the reference outcome. HPV co-factors associated with progression to CIN1, CIN2 and CIN3 display unique profiles, implicating genuine biological differences between the three CIN grades, which prompts us to re-visit the concept of combining CIN2 with CIN3 or CIN1.

Risk estimates for persistent high-risk human papillomavirus infections as surrogate endpoints of progressive cervical disease critically depend on reference category: analysis of the combined prospective cohort of the New Independent States of the Former Soviet Union and Latin American Screening studies.

To make feasible future clinical trials with new-generation human papillomavirus (HPV) vaccines, novel virological surrogate endpoints of progressive disease have been proposed, including high-risk HPV (HR-HPV) persistence for six months (6M+) or 12 months (12M+). The risk estimates (relative risks [RRs]) of these 'virological endpoints' are influenced by several variables, not yet validated adequately. We compared the impact of three referent groups: (i) HPV-negative, (ii) HPV-transient, (iii) HPV-mixed outcome on the risk estimates for 6M+ or 12M+ HR-HPV persistence as predictors of progressive disease. Generalized estimating equation models were used to estimate the strength of 6M+ and 12M+ HR-HPV persistence with disease progression to squamous intraepithelial lesions (SILs), cervical intraepithelial neoplasia (CIN) grade 1+, CIN2+, CIN/SIL endpoints, comparing three optional reference categories (i)-(iii) in a prospective sub-cohort of 1865 women from the combined New Independent States of the Former Soviet Union (NIS) and Latin American Screening (LAMS) studies cohort (n = 15,301). The RRs of these viral endpoints as predictors of progressive disease are affected by the length of viral persistence (6M+ or 12M+) and the surrogate endpoint (SIL, CIN1, CIN2, CIN/SIL). Most dramatic is the effect of the referent group used in risk estimates, with the HPV-negative referent group giving the highest and most consistent RRs for both 6M+ and 12M+ viral persistence, irrespective of which surrogate is used. In addition to deciding on whether to use 6M+ or 12M+ persistence criteria, and cytological, histological or combined surrogate endpoints, one should adopt the HPV-negative referent group as the gold standard in all future studies using viral persistence as the surrogate endpoint of progressive disease.