[Predictors of survival after heart transplantation: role of pretransplantation and posttransplantation factors].

Objective of this study was to assess the impact of pre- and posttransplantation factors on 12-month survival after orthotopic heart transplantation (OHT). Annual survival after OHT was 79.2%. The following factors were significantly negatively associated with annual survival: recipient's serum C-reactive protein (CRP) > or = 11.5 mg/ml prior to donor heart transplant (odds ratio [OR] 5.74, p = 0.011) and infectious complications after OHT (OR = 4.80, p = 0.009). Recipient's high CRP level was associated with mortality due to infectious complications (r(pb) = 0.47, p = 0.006), elevated troponin I concentrations (r(s) = 0.44, p = 0.012), and impaired hemodynamics of both recipient's heart and graft: right ventricular (RV) end diastolic area (EDA) prior to OHT (r(s) = 0.41, p = 0.015), elevated pulmonary artery pressure (PAP) (r(s) = 0.36, p < 0.001), and decreased left ventricular ejection fraction (LVEF) (r(s) = -0.45, p < 0.001) of the transplanted heart. Hearts of those who died after OHT irrespective of cause of death were characterized by more severe right heart dilation as evidenced by statistically significant increase of median RV EDA prior to OHT. After heart transplantation in those who later died decreased RV contractility was accompanied with elevation of PAP and decrease of LVEF. Acute graft rejection events 71.4% of which occurred in patients younger than 30 years had no influence on survival during 12 months after OHT. Other factors not associated with 12 months survival were donor and recipient age, pretransplant pathology, patient's UNOS status, graft ischemia duration, artificial circulatory support and preexistent surgical interventions. Development of diabetes mellitus in posttransplantation period, arterial hypertension and sinus node dysfunction requiring permanent pacing also were not identified as factors affecting 1 year survival after OTH.

[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.

[he use ethylmethylhydroxypyridine succinate in the treatment of patients with heart failure].

We studied impact of ethylmethylhydroxypyridine succinate n the course of chronic heart failure during 3 years follow-up after myocardial infarction. Dynamics of objective and subjective parameters was assessed in 100 patients; 48 patients received conventional therapy (control group) and 52 patients received conventional therapy plus ethylmethylhydroxypyridine succinate (main group). Addition of ethylmethylhydroxypyridine succinate resulted in decreases of rates of complications, mortality, and re-hospitalizations. Increases of myocardial contractile function, myocardial adaptation, as well as improvement of range of biochemical parameters were also observed. The latter changes were indicative of antioxidant, anti-inflammatory, anti-stress activities of Ethylmethylhydroxypyridine succinate. Moreover, antidepressant and antineurotic effects of complex therapy including ethylmethylhydroxypyridine succinate was confirmed.

[Pharmacological protection of the myocardium with reamberin in coronary artery bypass grafting in patients with postinfarction angina].

AIM: To assess efficacy of reamberin in preoperative preparation and after coronary bypass (CB) in patients with macrofocal myocardial infarction (MI) complicated with postinfarction angina. MATERIAL AND METHODS: A total of 45 patients with Q-positive MI complicated with postinfarction angina pectoris entered the trial. The study group consisted of 20 (44.4%) patients given 200-400 ml injections of 1.5% reamberin solution for 3 days before coronary artery bypass grafting (CABG) and 3-5 days after it. The control group consisted of 25 (55.6%) patients given basic therapy without cardioprotection. ECTG-60, echocardiography, CM-ECG, laboratory tests were made before CABG. CABG was made in conditions of artificial blood circulation in all the patients. RESULTS: Clinical stabilization was observed after direct myocardial revascularization in hospitalized 25 (100%) patients of the study group and 22 (88%) patients of the control group. Early postoperative acute cardiac failure (ACF) developed in 3 (12%) patients from the study group and 9 (36%) from the control group (p = 0.04), arrhythmia occurred in 2(8%) and 8(32%) patients, respectively (p = 0.03). Two (8%) control patients died in early postoperative period from acute cardiac failure. Perioperative MI occurred in 2(8%) control patients. After 12 months of the follow-up, patients of the study group had no recurrent angina pectoris, while among the controls 4(16%) patients had recurrent angina of FC III. After surgical intervention at discharge and 12 months after treatment patients of both groups improved systolic and diastolic functions of the left ventricle. Normalization of the diastolic function was registered in 80% patients of the study group (p < 0.001) and in 44% from the control group (p < 0.001) after 1 year follow-up. CONCLUSION: Reamberin reduces the number of postoperative complications, ischemic damage to the myocardium, significantly improves systolic and diastolic functions of the left ventricle.

[The assessment of stress phase objective criteria in humans].

The stress reactions phases have been studied in humans in psychoemotional strain. The stress reactions phases objective criteria associated with certain cardiac rhythm variability alterations and cognitive function have been revealed. The study was performed using computerized Stroop-test.

[The dynamics of the conception of preconditioning].

The syndrome of preconditioning was described by Murry and patented simultaneously in the USSR (G.I. Sidorenko, 1986). As preconditioning is displayed both in clinic and experiment including isolated endothelial cells it seems appropriate to disclose its nature. The characteristics of living matter are aim, information, and feedback. Preconditioning has been investigated from these positions with autoregulation studied as feedback. Dynamics of further study of preconditioning is proposed.

[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.

Concentration--time relationship for various regimens of inhalation of organic compounds.

An attempt was made to establish a concentration--time relationship for continuous and interrupted inhalation of a number of nonelectrolytes to establish norms for the permissible content of harmful substances in atmospheric air. The tests showed that the indicated relationship can be expressed in the form of a straight line on a logarithmic grid by using either acute toxicity parameters or the onset of physiological and biochemical shifts. This makes it possible to predict the chronic effect thresholds of substances on the basis of the results of short-term experiments.

Scientific basis for the study of demineralization of highly mineralized water for use in public water supply systems.

New criteria (full physiological value and preservation of the properties of drinking water) are scientifically substantiated. Also discussed are indices (minimal admissible and optimal levels of basic water mineralization and calcium content, standards of microelements such as boron and bromine content, content of individual groups of microorganisms, water temperature) for evaluating the quality of demineralized water obtained from brackish and briny water (including water from the sea and ocean) by various methods which are designed for public water supply systems. Research results served as the scientific hygiene basis for the development of a new technology of obtaining drinking water. The necessity for developing a special quality standard for demineralized drinking water is shown.

Predicting toxicometric parameters on the basis of studying the concentration--time dependence.

A short-time exposure on the concentration--time relationship base, a classification of substances according to the degree of hazard and the program for assessing safety coefficients have been suggested in order to predict the basic toxicometric parameters (chronic exposure thresholds, maximum allowable concentrations, safety coefficients, and others).

Methodological approaches to the study of the combined effect of atmospheric pollutants as illustrated by chlorinated hydrocarbons.

The combined effect of substances with a unidirectional toxic action was studied with the use of several chlorinated hydrocarbons, including 1,2-dichloropropane, 1,2,3-trichloropropane, and perchlorethylene at various concentrations. The results of the study can be used as the basis for the development of methodological approaches to the study of the combined action of toxic substances administered by inhalation. The research plan also incorporated the problem of explaining the nature of the action of the mixture of the test compounds in acute, subacute, and chronic animal experiments. All of the studies were conducted with each compound alone and then in various combinations by using the concentration--time relationship, since a correct evaluation of the combined action of compounds can be obtained by comparing these with the effects observed for the action of each component alone. A graphic representation was obtained of the onset time for a given effect (loss of righting reflex for 50% of the animals) as a function of the active concentrations for the short-term effect of high concentrations of 1,2-dichloropropane, 1,2,3-trichloropropane, and perchloroethylene based on the concentration--time relationship. The nature of the combined action of various combinations (two and three substances) with respect to concentration was studied by using these graphs. At high concentrations, the action of various combinations of the studied substances is additive. An inverse relationship was discovered in subacute experiments between the inactive concentrations and the onset time for changes in the vital activity indices of an organism: the lower the concentration, the later the changes. Additional data were obtained as the result of morphofunctional studies on the toxic properties of the studied compounds, on damage reactions and on adaptational changes. This is of interest from the point of view of explaining the mechanism of action at various concentrations.

Study of the combined action of a group of chlorine derivatives of hydrocarbons entering the organism by inhalation.

The combined action of substances having a munidirectional toxic effect on the organism was studied for several typical chlorine derivatives of hydrocarbons (1,2-dichloropropane, 1,2,3,-trichloropropane, and perchloroethylene). Since a correct assessment of the combined action of substances is based on the comparison of the effect of mixed compounds and the effects observed for each component alone, research was conducted on each individual substances on the basis of the "concentration--time" relationship. The reaction of several mixtures of substances was also studied at various concentration levels, from high to low concentration levels of substances which are actually present in the atmosphere. Research result showed that the character of the mixture at both high and low levels of concentration was identical and approximate to the overall effects.

Methodology of hygienic standard-setting in the U.S.S.R.

This article describes basic principles, criteria and methods of hygienic standard-setting for different environmental factors. It deals with hygienic standards for chemical pollutants in atmospheric air, water and soil, for bacterial and viral contamination, as well as for physical environmental factors with regard to their respective specificity. The article demonstrates the necessity of further development of methodology.

[Ecological hygiene--a science of global health]. / Ekogigiena--nauka o planetarnom zdorov'e.

The paper defines ecological hygiene, a science that combines a preventive trend and comprehensive ecological analysis of man-made changes occurring in the biosphere. Ecological hygiene may be regarded as a science of global human health in relation to ecological situations, of modes of its maintenance, promotion, and improvement. As for its application, ecological hygiene may be determined as a complex of medical preventive research subjects whose purpose is to maintain and promote health by preventing diseases and premature aging. To apply this approach, ecological hygiene studies the environment and its influence on the human body, reveals unfavourable environmental factors and defines the maximum acceptable levels of their influence, works out recommendation how to eliminate unfavourable factors and how to rationally apply useful ones.

[Present-day health education in the field of cardiology]. / Propaganda meditsinskikh zbanii v oblasti kardiologii na sovremennom étape.

Causes of limited efficiency of efforts to disseminate cardiologic knowledge are analysed. Ways to increase education efficiency are proposed, such as educational dialogue variants, warranting an efficient system for the control of preventive work. Rationale and recommendations are given for the use of television programs and other media. Variants of the adjustment of the educational effort to the level of the audience are proposed. Educational aspects of the work of a rural cardiologic practitioner are pointed out. Formal ways of data presentation are described with reference to current possibilities of the available projection equipment.

[The problem of optimization in cardiology]. / Problema optimizatsii v kardiologii.

Optimization is understood as choice of the best version out of the competitive decisions. The strategy and tactics of prevention is presented from this point of view. Optimization of diagnostic investigations is viewed from the positions of continuum with quantitative assessment of results. Characteristics of loads and heart activity, as recommendations suggest, should be in agreement in stress tests. Optimization of dynamic investigations of biochemical markers is described on the model of acute coronary syndrome. Optimization of therapy is based on the determination of criteria of optimum. This statement is illustrated by the example of antihypertensive therapy. Optimization of pharmacotherapy must envisage the preservation of favorable effect of protective natural mechanisms in the form of autoregulation and adaptation to intermittent ischemia (preconditioning).

[Some unsolved problems of assessment of blood pressure level]. / Nekotorye nereshennye voprosy otsenki arterial'nogo davleniia.

The paper deals with blood pressure level assessment and selection of individual optimal blood pressure by means of determination of critical frequency of fusion of flashes. The problem of "white coat" and office hypertension as well as encoding of these states in the context of WHO International Classification of Diseases is also discussed.

[Neurocirculatory dystonia (does this disease exist?)]. / Neirotsirkuliatornaia distoniia.

Difficulties of diagnostics of neurocirculatory dystonia are discussed. Definition based on Myasnikov's ideas about hyperreactivity, that is inadequate cardiovascular responses to psychoemotional stress, is proposed. Peculiarities of classification and therapy of neurocirculatory dystonia are presented.