Pulse wave velocity and other indicators of arterial stiffness in hypertension comorbidity and chronic obstructive pulmonary disease.

AIM: The aim is to study pulse wave velocity (PWV) and other parameters of arterial stiffness in patients with comorbid arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: 32 patients with a combination of AH and COPD (group 1), 30 patients with isolated hypertension (group 2), 18 patients with isolated COPD (group 3), 30 healthy subjects (control group) were examined. Applanation tonometry and pulse wave contour analysis at the carotid-femoral segment were made by SphygmoCor (AtCor Medical). RESULTS: Aortic systolic blood pressure in patients with the combination of hypertension and COPD was higher compared to the group of the patients with isolated hypertension by 9.83% (p=0.02), and the patients with COPD by 41.5% (p = 0.000042), respectively. Central pulse pressure in the first group was higher compared to the second group by 29.58% (p=0.00022), in the third group - by 53.4% (p=0.0029). The combination of hypertension and COPD (ß=0.42, p=0.00019), age (ß=0.39, p=0.0002) and the level of aortic pulse pressure (ß=0.54, p=0.001) were marked as independent factors of PWV increasing according to the multiple regression analysis. CONCLUSION: In patients with a combination of hypertension and COPD the increase in PWV, systolic and pulse pressure in the ascending aorta was observed, compared to patients with isolated hypertension, isolated COPD and the control group during applanation tonometry.

[PREDICTORS OF RESISTANT ARTERIAL HYPERTENSION].

The paper reports results of 6 year prospective observation of 7959 members of locomotive crews engaged at the Transbaikal Railways. The study aimed to estimate the probability and time of development of resistant arterial hypertension under effect of predictors of this disease. The data obtained are of value for diagnostic, prophylactic, and therapeutic practice.

[Assessing the influence of predictors of the development of chronic obliterating diseases of lower-limb arteries]. / Otsenka vliyaniya prediktorov razvitiya khronicheskikh obliteriruyushchikh zabolevanii arterii nizhnikh konechnostei.

The authors assessed the probability and terms of the development of chronic obliterating diseases of lower-limb arteries under the influence of the predictors studied. Using the Statistica 6.0 programme we carried out the analysis of the function of survival on a sample of 7,959 people. Based on the Kaplan-Mayer method and Cox regression model we determined the most significant predictors influencing the development of subclinical lesions of lower-extremity arteries. Also determined was the duration of the influence of each predictor prior to clinical manifestation and contribution of each predictor to the development of the examined outcomes.

[The levels of osteoprotegerin, transforming growth factor-ß, and some cytokines in women with coronary heart disease concurrent with severe osteoporosis].

AIM: To determine the serum level of cytokines in women with coronary heart disease (CHD) concurrent with osteoporosis (OP) and in those with isolated CHD; to assess a relationship of the levels of cytokines, osteoprotegerin (OPG), and transforming growth factor-ß (TGF-ß) to the ten-year absolute risk of osteoporotic fractures, the presence of fractures in the history, and that of CHD; and to establish the role of elevated cytokine levels in the development of future fractures. SUBJECTS AND METHODS: A cross-sectional cohort study included 98 women (mean age, 71.2?8.6 years) with CHD. Forty-eight patients had CHD concurrent with severe OP. The Fracture Risk Assessment Tool (FRAX) was applied to estimate a ten-year absolute risk for fractures in all the patients. The serum levels of OPG, TGF-ß, interleukin (IL)-1ß, IL-4, IL-6, IL-8, and IL-10, and tumor necrosis factor-a (TNF-α) were measured by enzyme immunoassay. RESULTS: The women with comorbidity were found to have higher levels of OPG, TGF-ß, IL-6, IL-8, IL-10, and TNF-α than those with isolated CHID. There was a direct correlation between fractures, CHID, and IL-10 and TNF-α levels and an inverse relationship between fractures, CHD, and IL-8; between CHD and OPG levels. Conclusion. The women with comorbidity were noted to have elevated levels of proinflammatory cytokines and OPG; a correlation was between cytokine levels and fractures and CHD. Increased OPG and IL-6 levels are independent predictors of fractures.

[Prognostic value of risk factors for cardiovascular diseases and target organ damages for the occurrence of resistant hypertension].

AIM: To estimate the prognostic value of risk factors for cardiovascular events and target organ damages tor the occurrence of resistant hypertension (RH). SUBJECTS AND METHODS: The 2008-2013 survey covered 7959 members of locomotive crews of the Transbaikal Railway whose medical expert examination revealed risk factors for cardiovascular diseases and target organ damages. RESULTS: During the survey, a group of 7959 people with final outcomes included 21 RH cases to be statistically analyzed. Atherosclerotic plaques in the carotids arteries, proteinuria, creatininemia, overweight, left ventricular hypertrophy, a family history of early cardiovascular diseases, and stress were the major predictors of RH. CONCLUSION: The association of the established predictors must be considered in the treatment of patients with RH.

[ARTERIAL STIFFNESS AND BONE MINERAL DENSITY IN WOMEN WITH CORONARY HEART DISEASE AND CONCOMITANT SEVERE OSTEOPOROSIS].

The aim of the study was to estimate arterial stiffness and bone mineral density (BMD) in women with coronary heart disease (CHD) and concomitant osteoporosis. It included 120 patients (mean age 68.5 ± 8.7 years) divided into 2 groups matched for age and CHD duration. Group I was comprised of 74 women with CHD and severe osteoporosis, group 2 consisted of 46 women with isolated CHD. Carotid-femoral pulse wave velocity and central pulse wave were subjected to contour analysis by applanation tonometry using a SphygmoCor AtCor Medical apparatus (Australia). BMD was measured in lumbar vertebrae and proximal part of the femur by X-ray densitometer (XRD). Statistical treatment of the data obtained was performed with the use of Statistica 6.0 package, Wald-Wolfovitz criterion, and multifactorial regressive analysis; differences were considered statistically significant when the calculated P value was less than 0.05. Women with CHD and osteoporosis had higher arterial (diastolic/systolic) pressure, mean aortic pressure, and pulse wave velocity than patients with isolated CHD. The independent determinants of carotid-femoral segment stffness were age (ß = 0.3, 95% CI 0.08-0.11, p = 0.027), BMD in the proximal part of the femur based on Z criterion (ß = 5.02, 95% CI 8.4-10.6, p = 0.0059), BMD in the Wards area based on T criterion ß = 5.07, 95% CI 6.0-8.1, p = 0.005). It is concluded that women with CHD and osteoporosis have elevated parameters of arterial stiffness including carotid-femoral pulse wave velocity, augmentation index, central pulse pressure, BMD in lumbar vertebrae and proximal part of the femur. Age and BMD in the proximal part of the femur are independent factors affecting arterial stiffness.

[The level of interleukin-101, tumor a necrosis factor and their dissolving receptors in women with ischemic heart disease comorbide with osteoporosis].

The sampling consisted of 98 women (average age 71.2 ± 8.6 years) with ischemic heart disease. The combination of ischemic heart disease and severe osteoporosis was diagnosed in 48 out of them. All female patients were analyzed for level of IL-1ß, TNF-α and their soluble receptors in blood serum. The technique of immune enzyme analysis was applied. It was revealed that in women with associated pathology the level of TNF-α was higher and concentration of soluble receptors reliably lower than in women with isolated ischemic heart disease. It was established that direct correlation relationship exists between occurrence of bone fractures, coronary atherosclerosis and level of TNF-α. The occurrence of bone fractures was inversely correlated with level of soluble receptors of TNF (γ = 0.3; p = 0.0029), and occurrence of ischemic heart disease with soluble receptors of IL-1.

[Adherence to guidelines on management of acute coronary syndrome in Russian hospitals and outcomes of hospitalization (data from the RECORD-2 Registry)].

BACKGROUND: Complete following existing guidelines for management of acute coronary syndrome (ACS) is known to be associated with better outcomes. Partly this is explained by lesser adherence to recommendations in high risk patients. Aim of our study was to assess relationship between degree of following current guidelines and in hospital outcomes independently from initial assessment of risk. METHODS: Each key recommendation from guidelines issued between 2008 and 2011 (13 for STE ACS, 12 for NSTE ACS) was given weight of 1. Sum of these units constituted index of guideline adherence (IGA). IGA was retrospectively calculated for 1656 patients included in Russian independent ACS registry RECORD-2 (7 hospitals, duration 04.2009 to 04.2011). The patients were divided into 2 groups according to quartiles of IGA distribution: 1) low adherence group (quartiles I-II); 2) high adherence group (quartiles III-IV). RESULTS: In low adherence compared with high adherence group there were significantly more patients more or equal 65 years (=0.0007), with chronic heart failure [CHF] (<0.0001), previous stroke (<0.0001), atrial fibrillation [AF] (=0.0002), Killip class more or equal II (=0.0065), high risk of death by GRACE score (=0.035). Inhospital mortality was 9.3 and 2.4% in low and high adherence group, respectively (p<0.0001). The following independent predictors of inhospital death were identified: IGA quartiles I-II (odds ratio [OR] 4.0; 95% confidence interval [CI] 2.3-7.1; <0.0001), high GRACE score (OR 3.3; 95% CI 1.8-6.0; <0.0001), admission systolic BP less or equal 100 mm Hg (OR 3.1; 95% CI 1.8-5.4; <0.0001), admission serum glucose more or equal 8 mmol/l (OR 2.9; 95% CI 1.8-4.7; <0.0001), age more or equal 65 years (OR 2.3; 95% CI 1.3-4.0; =0.005), ST elevation more or equal 1 mm on first ECG (OR 1.7; 95% CI 1.1-2.5; =0.013). From groups with low and high adherence to guidelines we selected pairs of patients (n=588) with similar (or close) age, type of ACS, GRACE score, Killip class, presence of other important risk factors (CHF, AF, previous stroke), and formed 2 equal subgroups without significant differences in important demographic, anamnestic, clinical and laboratory data. Hospital mortality was 7.8 and 2.7% in low and high adherence subgroup, respectively (p<0.0001). CONCLUSIONS: In RECORD-2 ACS registry low adherence to guidelines was more frequent among high risk patients and was independent predictor of inhospital death. Association between degree of guidelines adherence and outcomes persisted after equalizing groups by some factors of risk of mortality.

[24-hour monitoring central aortic pressure in patients with hypertensive disease and concomitant chronic obstructive pulmonary disease].

A total of 58 patients with essential hypertension were examined. 27 of them had a combination of essential hypertension and chronic obstructive pulmonary disease (COPD), 31 persons had isolated essential hypertension. The control group included 13 healthy individuals. The daily monitoring of blood pressure with a BPLab apparatus and the analysis of peripheral and central aortic pressure were performed. Comparison of groups was carried out using the Mann-Whitney test. The combination of hypertension and COPD was associated with increased daily and average daily peripheral and central aortic pressure compared with isolated essential hypertension and the control group. During daily monitoring of peripheral blood pressure the "dipper" type predominated in patients with isolated essential hypertension (41, 95%) and "non-dipper" type in those with comorbid disorders (44, 44%). The analysis of nocturnal blood pressure reduction in the aorta in patients with essential hypertension and COPD revealed the increased frequency of "non-dipper" type (55, 55%). The analysis of the central aortic pressure in patients with isolated essential hypertension showed the decreased incidence of "dipper" type (21, 87%). It is concluded that daily monitoring of the central aortic pressure permits to identify abnormal profiles with a higher frequency than the study of peripheral blood pressure.

[Expert evaluation--measures to objectivize subjective opinion].

Reliability of expert evaluation remains a topical problem for occupational medicine, industrial ecology, ergonomics, psychology, sport refereeing and special examinations without instrumental assessment of work state, conditions, their jeopardy, etc. In this connection, the algorithm of mathematic and statistic processing of subjective opinions increases objectivity of expert evaluation of such parameters.

[Peculiarities of some psycho-physiologic parameters change in pilots experiencing variable work and rest modes in long flights].

The authors studied changes in some psycho-physiologic parameters in pilots during long flights with variable work and rest modes. Findings are peculiarities in changes of registered parameters--heart rate, attention, work load and performance in connection with variable work and rest modes in 7-hours piloting of aircraft.

[Lymphocytic-thrombocytic adhesion and production of blood serum cytokines in rheumatic heart disease].

AIM: To study changes of cytokine production and lymphocytic-thrombocytic adhesion (LTA) in patients with rheumatic heart disease. MATERIAL AND METHODS: Concentrations of interleukine-1beta, interleukine-4, tumor necrosis factor alpha in the blood serum and lymphocytic-thrombocytic adhesion by Yu. A. Vitkovsky's method were measured in 84 patients with rheumatic fever and 26 healthy ones. RESULTS: A correlation was found between increased production of inflammatory cytokines, lymphocytic-thrombocytic adhesion and activation of rheumatic process. CONCLUSION: A monodirection of changes of inflammatory cytokine production, lymphocytic-thrombocytic adhesion and rheumatic fever activation allows using them as nonspecific diagnostic methods in assessment of inflammation activity.

[Tissue factor molecules and some other indices of coagulation hemostasis in patients with rheumatic heart disease].

This comparative study of interleukins, tissue factor activity, and certain parameters of coagulation hemostasis included patients with rheumatic heart disease. It revealed an increased production of proinflammatory cytokines including interleukin-1b (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) in all groups of patients. The procoagulative activity was also enhanced and positively correlated with the IL-1 beta level. Tissue factor activity was directly proportional to the concentration of IL-1 beta and inversely proportional to that of interleukin-4 (IL-4).

[Production of certain cytokines in blood sera of patients with hypertensive disease and early stages of concomitant chronic obstructive pulmonary disease].

The results of investigation of blood serum interleikins in hypertensive patients in combination with early stages of chronic obstructive pulmonary disease (COPD) are presented. The increase of interleikin 1beta, tumor necrosis factor-alpha in hypertensive patients of the I - II stages in comparison with healthy person was marked. In the presence of accompanied COPD of the I stage more increased number of cytokins was determined. Changes of interleukin-4 patients of both groups were not found.

[Lipid peroxidation in hypertensive disease concurrent with chronic obstructive pulmonary disease].

A hundred and thirty-four hypertensive patients were examined, 75 of them had concomitant first-degree chronic obstructive pulmonary disease (COPD). As compared with the control group, the patients were found to have elevated levels of primary, secondary, and intermediate products of serum lipid peroxidation and lower activities of catalase of red blood cells and their peroxide resistance. All changes were most pronounced in concomitant COPD.

[The changes of pilot's cardianc rhythm indices and components of his operator's activity during modelling flight situations].

The changes of pilot's cardiac rhythm and components of his operator's activity were investigated on the flight simulator under the conditions of modelling the fly over landing with the different centres causing the level of pilot's load. Under such conditions the heart rate was connected mainly with the subjective assessment of his operator's and psychological comfort by the pilot himself an d cardiac rhythm variability was connected with the level of operator's comfort during controlling flight parameters.

[Information value of "additional tasks" method to evaluate pilot's work load].

"Additional task" method was used to evaluate pilot's work load in prolonged flight. Calculated through durations of latent periods of motor responses, quantitative criterion of work load is more informative for objective evaluation of pilot's involvement in his piloting functions rather than of other registered parameters.

[System automatically processing psychophysiologic parameters of pilots].

For ergonomic evaluation of aircraft, the authors developed and subjected to flight testing a system automatically processing psychophysiologic parameters of pilots, providing post-flight automated PC processing of values registered during flight--cardiac rhythm, skin and sub-clothing temperatures, pulmonary ventilation and working load.

[Changes in different human physiologic indices during the processing of growing volumes of visual information]. / Osobennosti izmenenii razlichnykh fiziologicheskikh pokazatelei cheloveka pri pererabotke vozrastaiushchikh ob"emov zritel'noi informatsii.

The paper deals with correlations of EEG, EMG, EGG, pneumogramme parameters of human operator, as well as of the intensity and efficiency parameters of his activity, with the degree of mental load, determined by the speed of presentation of visual signals. A physiological criterion has been elaborated of the difficulty of operator's activity in processing of increasing visual information, i. e. the level of behavioural activity. This criterion revealed unidirected changes with an increase of mental load, and showed close connections with the speed of signals' presentation, number of errors and of motor responses during successful task performance.

[Physiologic evaluation of possibilities of processing increasing volumes of visual information by human operators]. / Fiziologicheskaia otsenka vozmozhnostei pererabotki vozrastaiushchikh ob"emov zritel'noi informatsii chelovekom-operatorom.

On the base of studying the changes in complex physiological index of the difficulties in the operator's activity during processing of increasing volumes of visual information in conditions of time deficit, physiological reserves of operators organism, their maximum possible capacity and time informational load are predicted.