[The problems and perspectives of development of mandatory medical insurance in the Russian Federation].

The main results of the functioning of the compulsory health insurance system in the Russian Federation for 25 years were analyzed. A brief review of the assessment of the Russian healthcare model by foreign and domestic experts is presented. Negative and positive results of the modernization of compulsory medical insurance, the impact of payment methods on the efficient use of resources, increasing the availability and quality of medical care are formulated. Areas were proposed of activity to create a patient-oriented insurance environment in the Russian health care.

LAMPBRUSH CHROMOSOMES AS A MODEL FOR EXPLORATION INTO LOCI OF NUCLEAR DOMAINS FORMATION.

Nuclear domains can be divided into two major groups: those arising freely in nucleoplasm and those forming at specific chromosomal loci as a result of their activity. The advantages of giant transcriptionally active lampbrush chromosomes for the investigation of nuclear bodies formed in particular chromosomal regions have been demonstrated in a series of studies. We propose to use two strategies to analyze the loci of nuclear domains formation on lampbrush chromosomes typical for avian and amphibian oocytes. The first approach implies consecutive mapping of BAC-clones, containing the fragments of DNA assigned to genomic coordinates, in close proximity to the nuclear domains. The second approach is based on mechanical microdissection of chromosomal regions adjacent to a particular nuclear structure. DNA of dissected material can be amplified by PCR with degenerate primers and mapped by fluorescent in situ hybridization (FISH) on chromosomal spreads. Utilization of high-throughput sequencing (next generation sequencing, NGS) technologies also proves to be prospective for subsequent deciphering of regions underlying nuclear structures formation. Deciphered fragments can be aligned against reference genome assembly to define precisely the loci responsible for nuclear domains assembly. In this review, the possibilities of using two complementary strategies for investigation of nuclear domains associated with lampbrush chromosomes are demonstrated.

[Experience with 5 years of drug therapy of ischemic heart disease patients with stable angina and stenosing atherosclerosis of the coronary arteries]. / Opyt 5-letnego medikamentoznogo lecheniia bol'nykh ishemicheskoi bolezn'iu serdtsa so stabil'noi stenokardiei i stenoziruiushchim aterosklerozom koronarnykh arterii.

The results of 5-year pharmacologic treatment of 234 coronary patients with stable angina of varying functional classes are reported. Coronarography detected stenosis of major coronary arteries in all cases; ventriculography demonstrated no disorders of left-ventricular contractility. Clinical improvement and stabilization occurred in 75.2% of patients, deterioration, in 24.8%. Of the latter group, nonfatal myocardial infarction occurred in 13.7%, and signs of heart failure developed in 9.8%. Repeat bicycle ergometry demonstrated increased or unchanged physical stress tolerance in 67.1%. Working capacity was intact after five years in 61.1%. Therefore, long-term medication of coronary patients with stable angina and normal left-ventricular contractility has proved efficient.

[Pharmacodynamics of the new beta blockader corgard (nadolol) in patients with stress-induced angina pectoris]. / Farmakodinamika novogo beta-blokatora korgarda (nadolola) u bol'nykh so stenokardiei napriazheniia.

Antianginal effect of a new beta-blocker corgard (nadolol) was studied in 17 male patients with stable stress angina, aged 42 to 56, in comparison to obsidan and placebo. An original method was used to assess the extent and duration of antianginal effect consisting in repeat identical treadmill exercise coupled with continuous ECG monitoring. Corgard was shown to produce a marked antianginal effect as reflected in significantly reduced ST depression and elevation of angina of effort for more than 24 hours after a single 80 mg dose. Compared to an adequate dose of propranolol, corgard is 20-25% more effective in terms of markedness, and at least 14 hours more effective in terms of duration of the effect.

[Transesophageal electric stimulation of the left atrium in the diagnosis of ischemic heart disease]. / Chrespishchevodnaia elektricheskaia stimuliatsiia levogo predserdiia v diagnostike ishemicheskoi bolezni serdtsa.

The clinical picture and the results of bicycle ergometry and selective coronarography were compared with the findings of electrical stimulation of the left atrium in 24 patients. It was demonstrated that transesophagus electric stimulation of the left atrium may serve as a diagnostic method in coronary heart disease.

[Role of many hours of ECG monitoring (Holter method) in the diagnosis of ischemic heart disease and the selection and evaluation of antianginal therapy]. / Znachenie mnogochasovogo monitorirovaniia EKG (po Kholteru) dlia diagnostiki ishemicheskoi bolezni serdtsa, podbora i otsenki antianginal'noi terapii.

The diagnostic value of 24-hour ECG monitoring was assessed in 81 patients with stable angina of effort (functional classes II-IV) and 8 spontaneously-anginal patients. The pattern and frequency of transitory ST displacements, and their distribution by the hours of the day are reviewed. The results of 24-hour ECG monitoring are compared with clinical, bicycle-ergometric and coronaroangiographic findings. Spontaneously anginal patients showed peculiar episodes of transitory ischemia, with typically elevated ST, shorter duration and the occurrence mostly during the night and morning hours; 2/3 of such episodes were painless. High diagnostic value of the method for the assessment of the efficacy of anti-anginal drugs is demonstrated.

[The state of microcirculation, hemoperfusion and tissue oxygen consumption in patients with ischemic heart disease and angina pectoris]. / Sostoianie mikrotsirkuliatornogo rusla, gemoperfuzii i kislorodnogo rezhima tkani u bol'nykh ishemicheskoi bolezn'iu serdtsa so stenokardiei.

In patients with associated coronary heart disease and angina pectoris functional classes II-IV, microcirculatory disorders are linked with the gravity of the patients' clinico-functional status. Application of the functional tests (inhalation of 100% moistened oxygen, regional occlusion of the vessels of the limb under study) revealed the presence of latent deficiency of oxygen transport to the cellular substrate. In functional classes III and IV of disease, an appreciable reduction in the level of tissue hemoperfusion, of tissue oxygen supply, and an increase in the summary conjunctival index were recorded.