The novel method of assessment of individual total cardiovascular risk for the population of Russia

Novel innovative technology of assessment of level of total cardiovascular risk with consideration of a broad list of parameters of the state of individual health and its determining factors is described. The proposed model of risk is based on results of 20-year prospective observation of large contingents of population of Russia. For the first time the model of risk was constructed taking into account in addition to traditional risk factors and clinical characteristics peculiarities of population of Russia, in particular level of education. It was found in prospective studies that level of education in this country appeared to be an independent marker of risk and that traditional risk factors (behavioral, biochemical etc) had different prognostic value at different levels of education. Novel scale of risk and elaborated on its basis computer program of risk assessment allow to widen indications to its application, elevate accuracy of estimation of risk of development of fatal cardiovascular diseases for population of Russia, to obtain for a concrete patient parameters of absolute as well as relative risk (in % of excess or lowering of risk relative to its average statistical value for population with same age, sex, and level of education). The elaborated technology of estimation of total individual risk was tested on various contingents of patients with verified diagnoses of cardiovascular diseases as well as in groups of relatively healthy volunteers. Medical technology of risk assessment by novel scale is designed for application during primary screening of various population groups and can be fulfilled by both physicians and intermediate medical personnel. At present the computer program for assessment of cardiovascular risk based on this novel method is being prepared for clinical testing and subsequent implementation.     

The program of lowering of residual risk (the residual risk reduction initiative). Part I. Factors of residual risk

Substantial residual risk of development of macro- and microvascular complications is retained in most patients despite contemporary standards of therapy. The search for the solution of actual problem of lowering of residual risk of vascular complications is the aim of multiple current scientific studies conducted in medical practice of the world. The program Residual Vascular Risk Reduction Initiative (R3i) was called upon to join efforts of medical professionals and patients from different countries for solution of the global problem of residual risk of development of vascular complications. In the review we describe objective and main directions of activity of this project. We also give characteristics of individual component factors of residual risk of development of vascular complications investigated in the framework of the R3i program as well as possible methods of improvement of their correction.     

Ecological bases of the combination of natural foci of Trematoda infections in the floodplain-river ecosystem of the Konda River. Communication 2. Host population-combined foci of Trematoda infections

In the context of the present-day teaching of parasitocenoses and the proposition that the pathogen's population is the only compulsory and specific component of a natural focus, the author discloses the ecological bases of the combination of natural foci of opisthorchiasis and methorchiasis (M. bilis), methorchiasis (M. bilis) and methorchiasis (M. xanthosomus). These foci are host population-combined. While analyzing the combination of foci, it is expedient to consider them in pairs since this provides a way of identifying only the combination bases that are unique to these foci. The parasitic systems of flukes, the parasitocenoses of co-acting parasitic systems of "twin types", the structure of foci, the species-specific composition of ecosystems, and the ecological relations of the Opisthorchis fluke hosts act as the biotic bases of a combination of foci of Trematoda infections. By coinciding, the multihost hemipopulations of parasites and the susceptibility of host populations predetermine the combination of Opisthorchis fluke foci. The susceptibility of hosts, the multihost pattern of Opisthorchis flukes, the identity of parasitic systems, and the common mechanism of pathogen transmission act as the epizootic bases of a combination of invasion foci. The morphological structure and hydrological regime of a landscape act as the abiotic bases of a combination of foci. The hydrological regime is by its nature a universal mechanism of pathogen transmission. The foci of Opisthorchis flukes at the level of parasitocenosis of metacercarium populations and fish populations in the Konda River ecosystem are combined in the age groups of only carp (Cyprinidae) underyearlings and yearlings. The abiotic, biotic, and epizootic bases of a combination of natural foci of Opisthorchis flukes are, in the aggregate, the ecological bases of a combination of foci.     

The Evaluation of the Effectiveness of Reinforcement by Cemented-Carbide Plates in Two Design Variants of the Chisels Intended for Cultivation–Sowing Aggregates

Field tribological tests of two design variants of chisels used in the teeth of a cultivation-sowing unit were carried out in this research. A characteristic feature of the first variant of chisels was the reinforcement of their contact surface and almost the entire rake surface by plates made of cemented carbides. On the other hand, the second variant of chisels was reinforced only in the area of the blade by two plates made of cemented carbides, soldered on the rake face of the elements. The use of the first variant of chisels contributed to a significant reduction in the wear rate of elements, especially in terms of thickness and width loss. Effective reinforcement of the rake face, with relatively lower resistance to length reduction in the elements, raises doubts as to the validity of the use of cemented-carbide plates on almost the entire length of their rake face, because the applied variant of chisels contributed to a significantly higher price. However, the second variant of chisels effectively limited the intensity of the loss of the length of the elements, and the cause of the loss of their usefulness as part of the base material wear. It was found that the main wear mechanism of the cemented-carbide plates consisted of matrix removal under the influence of the finest fraction of the soil, which weakened the embedding of carbides, and then crushing or chipping of carbide grains from the matrix, whereas the dominant wear mechanisms of martensitic steel were grooving and micro-cutting.     

Pathogenetic mechanisms and morphological manifestations of medical liver damage

In the review of literature the modern data on mechanisms of development, features of pathogenesis and morphological appearance of drug-induced lesions of liver are presented. The cytotoxic lesions resulting in development of acute or chronic hepatitis, cholestatic lesions linked to structural changes in elements of bile excretion system or mechanisms of formation of bile are illustrated. The morphological features of infringement of a lipid metabolism in hepatocytes with development of steatosis of liver and steatohepatitis are described also. In some cases the influence of medicaments resulted in the damage of vascular network of liver, in accumulation of pigments, development of granulomas and liver fibrosis is observed. The main morphological signs of drug-induced lesions of liver are illustrated on the own histological data from liver biopsies.     

Statins: therapeutic cascade of their effects

Concept of sequence and time of appearance of various effects of statins is presented. Apart from hypolipidemic action due to inhibition of HMG CoA reductase activity statins exert multiple pleiotropic effects. Combination of these effects makes statins a unique instrument for solution of global tasks of prevention and treatment of atherosclerosis and its consequences (ischemic heart disease etc.). Manifestations of various pleiotropic effects of statins appear after different time intervals and in most cases are not related to suppression of cholesterol synthesis in the body. First 3-4 months (first level of the statin cascade) are characterized mainly by activity of pleiotropic properties aimed at restoration of endothelial function. These properties are responsible for enhanced eNOS expression, antiischemic, antithrombotic and antiatherogenic effects. During same period of time stabilization of unstable atheromas takes place. Manifestations of second level of the cascade of statin action appear after 2 years of treatment. They are represented by retardation of progression and even partial regression of atheromatosis of coronary and peripheral arteries. Third level is signified by achievement of strategic aims of therapy with statins (in 4-5 years) -- lowering of total and cardiac mortality, reduction of number of cardiac complications. Forth level of the cascade is represented by beneficial influences on nonatherogenic cardiological phenomena and comprise hypotensive, antiarrhythmic and cardiotonic effects. And finally some other important properties of statins constitute the fifth level of the therapeutic cascade. These properties are responsible for effects directed at noncardiac pathology (prevention of diabetes, dementia, including dementia associated with Alzheimer's disease, fractures). Immunodepression, ability to reduce saturation of bile with cholesterol belong to this group of effects.     

Synthesis of nitric oxide and development of atherosclerosis

The paper reviews data on the possible role of malfunction of nitric oxide (NO) synthesis in pathogenesis of atherosclerosis. The singularities of NO synthesis, types of enzymes catalyzing this reaction (a set of NO-synthases), and some possible aspects of regulation of their activity are briefly surveyed. Available data concerning effect of derangements of NO synthesis on development of endothelial dysfunction and atherosclerosis are discussed. Possible mechanisms of abnormalities of NO synthesis caused by the influence of atherogenic risk factors (hypercholesterolemia, oxidized LDL, diabetes, inflammation etc.) as well as probable clinical consequences of these abnormalities are presented. Genetic aspects of NO synthesis are considered and probable role of NO-synthase genes in inheritance of predisposition to the majority of cardiovascular diseases is stressed. A conclusion is made that available knowledge is not sufficient for unequivocal formulation of the role of NO in development of atherosclerosis, that further studies are necessary.     

Quantitative estimation of information influence of law intensive laser radiation on macro- and the microelement status in patients of the senior age groups

Law intensive laser radiation is a multifactorial, inherently information-power influence on biological tissues. Coinciding under characteristics with natural, the dosed out external influence is necessary for live organisms not only as a source of free energy, but also as the supplier of building materials. As an alarm indicator we had chosen the change of concentration of microcells in blood whey, owing to high sensitivity of this parameter. Photoexcitation conducts to acceleration of chemical reactions, in particular the oxidation-reduction. The probability of "capture" of a photon by a molecule depends on its energy and from power level of a molecule. Absorption of a photon by a molecule occurs when the direction transition coincides with fluctuations of an electric vector of a light wave. Efficiency of carrying over can be defined on time of a life of a luminescence. The quantum exit can be expressed through the relation of intensity of fluorescence to a difference of capacities of falling and leaving light streams. As a result of occurrence of a gradient of temperature in around membrane areas there is a change of electric potential of a membrane that causes outflow of ions from a membrane. Thereof the albuminous channels causing active transportation of ions and polar molecules reveal. As a result of change of electrochemical ionic balance lability of microcells to information doses of laser influence is provided.     

Development of main disturbances of hemostasis in patients with obesity

According to current views obesity especially with increased amount of visceral fat is characterized by prothrombogenic changes of hemostasis and fibrinolysis. This combined with insulin resistance, compensatory hyperinsulinemia, disturbances of carbohydrate metabolism, atherogenic dyslipidemia and hypertension substantially increases risk of origination and progression of cardiovascular diseases. Results of our study demonstrate high prevalence of various prothrombogenic abnormalities in coagulation and anticoagulation systems in patients with visceral obesity and metabolic syndrome (MS). Disturbances of hemostasis were detected by such screening methods as measurement of APTT, INR and concentration of fibrinogen in blood plasma. We received data on positive association of severity of some abnormalities of hemostasis with anthropometric and biochemical parameters of obesity and MS, parameters of lipid and carbohydrate metabolism. Revealed disturbances of hemostasis create prerequisites for development of thrombophilia and make additional contribution to increase of cardiovascular risk in this category of patients. This dictates necessity of more thorough and deepened examination of patients with visceral obesity and MS with the aim of detection and correction of pathological changes of lipid and carbohydrate metabolism, system of hemostasis and fibrinolysis at earliest stages.     

Metabolic syndrome from the point of view of a cardiologist: diagnosis,non drug and drug treatment

Timely diagnosis and treatment of metabolic syndrome is important because of high prevalence of this pathology in population. For the elaboration of approaches to complex treatment of this syndrome it is necessary to understand pathogenetic mechanisms of development of hypertension and metabolic changes as well as acquire an array of non drug and drug methods of influence on elevated blood pressure and disordered carbohydrate, lipid and purine metabolism. Phenylalkylamine calcium antagonists should be used as drugs of choice for treatment of hypertension. These agents exert slowing of heart rate, coronarolytic and antiatherogenic effects, the latter being especially important in this group of patients. Resistance of hypertension to treatment developing on the background of insulin resistance of peripheral tissues dictates necessity of the use of combinations of antihypertensive drugs with consideration of their metabolic effects. For correction of metabolic changes metformin is used in addition to non drug methods which include diet and exercise. Treatment with metformin allows to decrease insulin resistance and thus severity of derangements of metabolism.     

The dependence of follicle-stimulating hormone secretion on the level of sex hormone receptors in the hypophysis and on the activity of the CNS catecholaminergic systems

A study was made of the influence of agonists and antagonists of catecholamine action on LH and FSH secretion during the second rise of FSH secretion at the early hours of the estrous stage (E). Administration of phentolamine (a blocker of alpha-adrenoceptors) did not change the level of gonadotropins. On the contrary, haloperidol (a blocker of dopamine receptors) lowered the level of FSH at 3 o'clock of the estrous stage but made no effect on the blood concentration of LH. Administration of a stimulator of dopamine receptors increased the blood concentration of FSH at 1 and 3 o'clock of the estrous stage. Acute administration of haloperidol decreased the number of nuclear estradiol-binding sites in the adenohypophysis at 3 o'clock of the estrous stage but did not change the concentration of nuclear receptors of testosterone at either of the above time intervals. The results suggest that estrogenic and androgenic receptors and dopamine cerebral systems are involved in the stimulation of the second wave of FSH secretion. The interrelation of the dopamine activity and level of hypophyseal estradiol receptors, influencing FSH secretion in the early estrus, was established.     

Quantitative evaluation and grading of physical state of patients with cardiovascular disease]

The important role of quantitative assessment of the physical state of cardiovascular patients is emphasized in terms of determining the severity of their pathology, the efficiency of the treatment and rehabilitation. Five groups of physical state of cardiovascular patients were distinguished on the basis of the results of sub-maximal exercises tests, judged by the value of maximal oxygen uptake, physical endurance and threshold exercises. The rationale of the employment of such grouping is illustrated by the data concerning the risk of prosthetic valve replacement according to the group of the physical state of the patient before surgery and by the quantitative data on the dynamics of the functional state of these patients during postoperative rehabilitation.     

肝硬化患者肺功能状态观察

目的：了解肝硬化患者的肺功能状态。方法：测定40例肝硬化患者的肺功能及血气分析,并以健康人群作对照。结果：肝硬化患者肺功能指标（FVC、FEV1、FEV1／FVC、MVV、V25、V50、V75、DLco,PaO2)较健康对照组明显减低,P（A-a)O2明显升高,有显著差异（P＜0．01）,且肝硬化患者病情越严重肺功能损害越明显。结论：肝硬化患者的FVC、FEV1、FEV1／FVC、MVV、V25、V50、V75、DLco,PaO2较对照组明显降低,P（A－a)O2明显升高,表明肝硬化患者存在肺通气功能障碍和弥散功能障碍。腹水、肝性胸水是肺通气功能障碍的主要原因;而肺内血流异常（肺内动－静脉分流和肺血管扩张）是肺弥散功能障碍的主要原因。     

Suppression of development of autoimmune thyroiditis during prolonged stimulation of T-cellular immunity]

The purpose of this experiment was to investigate the suppression of autoimmune thyroiditis in guinea-pigs by prolonged stimulation of T-cellular immunity with T-activin, a thymic hormone. The development of experimental autoimmune thyroiditis (EAT) at early stages was shown to be characterized by deficiency of T-cells of helper and suppressor phenotypes, hypersecretion of thyroid hormones and insignificant development of a thyroid autoimmune process. With disease development indices of peripheral blood immunity of guinea-pigs were close to normal, and the frequency and degree of lymphoid infiltration of the gland were increased in parallel with the development of hypofunction of the organ. Immuno-correction of developing EAT with injections of T-activin according to our scheme resulted in a prolonged stimulation of T-cellular immunity, prevented sensitization of lymphocytes with thyroid antigens, increased secretion of the thymic hormones in parallel with a decrease in a degree of lymphoid-plasmacytic infiltration from thyroid tissues, indicating suppression of the disease.     

Pathogenetic aspects of chronic urinary tract infections

Infections of the urinary tract belong to the most frequent bacterially caused diseases. Strains of bacteria which are able to evoke an infection of the urinary tract distinguish themselves by particular properties. Hereby the existence of O- and K-antigens, the demonstration of adhesins (F-antigens), the ability of the formation of haemolysin and production of colicin V (aerobactin), the serum resistance as well the plasmid profile an important role is ascribed. The ability of uropathogenic bacteria to the adhesion to the epithelial cells of the urinary tract is significant for the development and the course of a disease. A connection is to be established between the rate of bacterial attachment of the epithelial cells and the activity of a pyelonephritis. The defence of an infection of the urinary tract takes place above all in the local area, in which cases among others the phenomenon of the antibody coated bacteria and disturbances of the formation of the secretory IgA are of interest. Various pathogenetic aspects of chronic infections of the urinary tract are discussed on the basis of reports from literature and findings of own investigations.     

Incidence and clinical aspects of aneurysm rupture in the abdominal aorta]

On the basis of the section material of 25 years in Tartu a significant increase of the frequency of arteriosclerotic aneurysms of the aorta, especially of the abdominal aorta and its ruptures, could be established. At the same time the appearance of luetic aortic aneurysms decreased. Due to its variable symptomatology the diagnosis of the rupture of an aneurysm of the abdominal aorta is often not exactly diagnosed by the physician who is first in charge of the case. On the basis of a clinical material of 21 post-mortem examinations the diagnostics of the rupture of the aneurysm of the abdominal aorta is discussed, and the most important symptoms are emphasized. It is emphasized that an aneurysms of the abdominal aorta shall be recognized in every case allready before its rupture as the prognosis of the operation is relatively good in this stage. Since it must be reckoned with a continuous increase of the frequency of the arteriosclerotic lesions of the aorta the physician shall, too, always think of an aneurysm of the abdominal aorta when uncertain complaints of the abdomen and the back are present.     

The causes of death of pulmonary tuberculosis: late sequelae of pulmonary tuberculosis

We investigated the causes of death of late sequelae of pulmonary tuberculosis. Chronic respiratory failure is one of the most frequent cause of death in the patients of late sequelae of pulmonary tuberculosis. We compared the long term prognosis of chronic respiratory failure in case of emphysema and pulmonary tuberculosis. In the patients with chronic respiratory failure by pulmonary emphysema, the prognosis was poor in those with pulmonary hypertension. But in case of late sequelae of pulmonary tuberculosis, prognosis was not affected by presence or absence of pulmonary hypertension. The determinants of prognosis of late sequelae of pulmonary tuberculosis are the indication of home oxygen therapy, malnutrition, and hypoxemia. Fungal infection, especially aspergilloma, is a common secondary infection of late sequelae of pulmonary tuberculosis. We investigated forty-two cases of aspergilloma as late sequelae of pulmonary tuberculosis, and of those 15 patients died. The causes of death were pneumonia and respiratory failure. Measurement of galactomannan antigen of aspergillus in serum using ELISA or PCR, it was apparent that the outcome was poor in the patients positive for antigen. It suggested that the prognosis of the patients with aspergilloma related with some degree of invasion of Aspergillus in parenchyma. It was reported that neoplasm is closely related to chronic tuberculous empyema. Lymphoma is most frequently complicated with chronic tuberculous empyema, and squamous cell carcinoma, adenocarcinoma, sarcoma and carcinoid were reported as complication of chronic empyema. We reported the case of angiosarcoma, originated from chronic empyema in left thoracic cavity formed after being treated for tuberculosis with artificial pneumothorax. Recently, the number of patients with late sequelae of pulmonary tuberculosis have been decreased, but some severe cases of patients of pulmonary tuberculosis will suffer from late sequelae of pulmonary tuberculosis, and that is still a great problem of the clinical course of pulmonary tuberculosis.     

The role of noninvasive methods of investigation in diagnosis of atherosclerosis

Visualization of the myocardium with the use of various high technologies gains more and more important significance in diseases of cardiovascular system. Large value for investigations of the heart and blood vessels have acquired methods of echocardiography, magnetic resonance tomography, spiral computed tomography, as well as large spectrum of methods of nuclear cardiology. Contemporary value of instrumental methods of investigation for diagnostics of atherosclerosis is discussed in this paper and diagnostic possibilities of various techniques for assessment of the state of myocardium, pathological changes of vascular wall and for visualization of atherosclerotic plaques (AP) are presented. Advantages and drawbacks of methods, their complex application for objective analysis of changes in AP and their clinical significance are considered. Special accent is made on early diagnosis of pathological derangements, because full value information allows making adequate decisions about subsequent curative measures. It is shown that detection and evaluation of early signs of atherosclerosis appears to be determining factor of efficacy of treatment. In patients without obvious symptoms of ischemic heart disease or at the background of postinfarction cardiosclerosis nuclear cardiology with assessment of myocardial perfusion by single photon emission computed tomography and positron emission tomography (PET) appears rather valuable for assessment of viability even when coronary arteries are unchanged. Important significance for detection of cardiosclerosis has also acquired spiral computed tomography, which allows to reveal calcium in blood vessels. The use of multislice computed tomography in perspective might partially replace coronary angiography especially for assessment of degree of stenoses and patency of grafts. On initial stages of atherosclerosis information on AP structure especially on the presence of inflammatory component is very important. Definite successes become noticeable with application of magnetic resonance tomography for detection of AP. However, probably, further perfection of equipment and methodological approaches with the use of novel contrasts is necessary. In this plane definite successes are achieved by PET and combined examinations by methods of PET/CT integrating advantages of both techniques.     

Diagnosis and therapy of anemia in chronic diseases

The article deals with contemporary views on anaemia associated with chronic diseases. The authors present the definition of this nosological unit, draw attention to its high incidence in clinical practice and fact that it is frequently mistaken for iron deficiency anaemia. The authors submit a review of the most frequent diseases which cause the development of this type of anaemia and analyze the role of activation of the system of cellular immunity, the monocyte-macrophage system, agents of the cytokine network in inhibition of proliferation and differentiation of erythroid precursors, reduced production of endogenous erythropoietin with a reduced sensitivity of erythroid progenitor cells to its action and impaired iron homeostasis and inhibition of its reutilization. Special attention is devoted to diagnostic and differential diagnostic criteria in relation to other types of anaemia caused by impaired haeme synthesis and some secondary multifactorially conditioned types of anaemia. More detailed attention is paid to the diagnostic value of evaluating serum levels of soluble transferrin receptors and explanation of the asset of calculation of the transferrin receptor/ferririn index as a sensitive indicator of latent sideropenia as well as the Fe-absorption test using low oral iron doses. Part of the paper is also an account of contemporary possibilities of treatment including the use of the recombinant form of human erythropoietin, and attention is drawn to the unsuitability and pitfalls of iron therapy in this type of anaemia.     

Analysis of Deformation and Prediction of Cracks in the Cogging Process for Die Steel at Elevated Temperatures

In this paper, an analysis of a three-dimensional state of strain and stress in the case of the hot cogging process of X32CrMoV12-28 die steel with the application of the finite element method is presented. The results of the investigations connected with the simulation of the kinematics of metal flow and thermal phenomena are presented, accompanied by prognosing the formation of ductile fractures in the course of the hot cogging process conducted with the application of three different shape tools and of a proposed deformation criterion of the loss of cohesion. The applied anvils were found to be highly effective in the aspects of distribution of effective strains and stresses, absence of tensile stresses in the axial zones of a forging, and also of a significant thermal stability in the internal layers of a deformed material. The developed course of changes in the deformation of the damage factor in the case of forging in the investigated anvils renders it possible to predict the situation and the phase of deformation in which the loss of cohesion by a deformed material will occur. The comparison between the predicted and the experimental results showed a good agreement.