Vol 88, No 8 (2016)

Aim. To investigate time course of changes in the adrenoreactivity (AR) of erythrocyte membranes (EM) after radiofrequency ablation of the synaptic nerves of the renal arteries (RA) in patients with resistant hypertension (RH) and to assess whether this indicator can be used for the early evaluation of the efficiency of an invasive intervention into the RA. Subjects and methods. 24 patients with RH, who received full-dose antihypertensive therapy with at least three drugs, including a diuretic, were examined. Renal sympathetic denervation (RSD) was carried out by endovascular radiofrequency ablation (RFA) of the RA. 24-hour blood pressure (BP) monitoring and determination of the β-adrenoreactivity (β-AR) of EM were performed, by taking into account the change in erythrocyte osmoresistence at baseline and 1 and 24 weeks after RFA. The therapy was not changed during the observation. Results. The patients included in the study were divided into 2 groups. One week following RSD, 15 patients of Group 1 were noted to have a decrease in the β-AR of EM by 10 conditional units or more; average daily systolic BP (SBP) and diastolic BP (DBP) reduced by 8.3 and 2.8 mm Hg, respectively. In 9 patients of Group 2, the β-AR of EM was unchanged in this observation period or increased compared with baseline. In this group, the decrease in average daily SBP and DBP was noted to be less pronounced than that in Group 1 (by 1.4 and 1.5 mm Hg, respectively). At 24 weeks after RSD, Group 1 was seen to have an effective daily decrease in average daily SBP and DBP by 25.6 and 14.3 mm Hg, respectively (p=0.01 and 0.05). The average value of the β-AR of EM significantly declined compared with baseline. In Group 2, no statistically significant changes were reported; SPB and DBP lowered by 7.0 and 3.0 mm Hg, respectively. There was a significant decrease in the β-AR of EM compared with that at week 1. Conclusion. The decline in the β-AR of EM within the first week after RFA is suggestive of the decreased activity of the sympathoadrenal system and may be used as an early efficiency index of RSD after the procedure.

Aim. To evaluate the efficiency of decimeter wave therapy and halotherapy, which were additionally added to basic therapy, in patients with chronic obstructive pulmonary disease (COPD) concurrent with hypertension at the inpatient stage. Subject and methods. 36 patients aged 20 to 75 years with Stages I—II COPD concurrent with Stages I—II, first-second grade hypertension were examined and treated. The clinical examination included collection of complaints and medical history data, clinical laboratory and instrumental (electrocardiography, spirography) studies, and health-related quality of life (using the SF-36 questionnaire). The patients were randomized into two groups: a study group and a comparison group. The study group patients received decimeter wave therapy and halotherapy in addition to basic drug treatment; the comparison patients had basic drug therapy. Results. Pre- and postoperative comparative analysis of the major clinical manifestations of comorbidities revealed more pronounced positive changes with the lower rate of clinical manifestations in the study group. It was also observed to have a more marked reduction in blood pressure (BP) with its goal levels achieved. The mean pulse BP decreased by 28% in the study group (p=0.000005) and did not statistically reduced in the comparison group. In the study group patients, the integral quality-of-life indicator after a package of medical rehabilitation measures became statistically significantly higher by 35%. This indicator in the comparison group was statistically significantly unchanged. Conclusion. The directionality of the proposed rehabilitation complex towards the common pathogenetic components of the development and progression of COPD and hypertension, as well as the high efficiency of the complex justify its appropriate inclusion in the combination treatment and rehabilitation of this category of patients.

Aim. To investigate the composition of plasma fatty acids (FA) and red blood cells and the level of eicosanoids in patients with metabolic syndrome (MS) and to assess whether metabolic disturbances may be corrected during a cycle use of an ω-3 polyunsaturated fatty acid (PUFA). Subjects and methods. Examinations were made in 46 patients, including Group 1 (a control group) of 15 persons without MS components; Group 2 of 31 patients with MS, Group 3 of 16 MS patients who had taken an ω-3 PUFA for 6 months, and Group 4 of 15 MS patients who had received the drug for 12 months. The composition of plasma FA and red blood cells was analyzed on a gas-liquid chromatograph. An enzyme immunoassay was used to measure the serum levels of tumor necrosis factor-α (TNF-α) and eicosanoids (thromboxane B2, 6-keto-prostaglandin F1α, leukotriene B4). A biologically active additive from the king crab (Paralithodes camtschatica) hepatopancreas was used as a source of ω-3 PUFA. Results. Having a higher proportion of linoleic and α-linolenic acids in the plasma, the patients were found to have decreased levels of ω-3 and ω-6 PUFAs (linoleic and α-linolenic, arachidonic, and eicosapentaenoic acids) and a larger proportion of Mead acid and saturated FAs (myristic and stearic acids) in the red blood cells, suggesting that that cellular blood FA transfer was impaired and FAs were absorbed by cells. Their serum samples showed the high levels of leukotriene B4, 6-keto-prostaglandin F1α, and thromboxane A2. The long-term (6- and 12-month) use of ω-3 PUFA from the king crab hepatopancreas had a positive impact in modifying the lipid FA composition of red blood cells and in eliminating deficiencies of physiologically important ω-3 and ω-6 PUFAs in the blood cells. Conclusion. The findings suggest that FAs and their metabolites play an important role in the pathogenesis of MS and that dietary ω-3 PUFA should be incorporated into a package of preventive and therapeutic measures for MS.

Aim. To determine the efficacy and safety of Kolofort in the treatment of patients with irritable bowel syndrome (IBS). Subjects and methods. 52 patients (16 men and 36 women) aged 26 to 59 years were examined over 4 months to rule out organic disease. The diagnosis of IBS was established on the basis of the Rome III diagnostic criteria (2006). Seven patients were diagnosed as having IBS with a preponderance of constipation; 3 had IBS with a preponderance of diarrhea, and 42 had mixed IBS. Thereafter they were given Kolofort, a combination release-active antibody drug having anxiolytic, anti-inflammatory, and spasmolytic effects. Kolofort affects the ligand-receptor interactions of the brain-specific protein S-100 with serotonin receptors and σ1-receptors in the central nervous system and that of histamine with histamine H4 receptors in the gastrointestinal tract and modifies (regulates) the functional activity of tumor necrosis factor-α (TNF-α). The regulatory action of the drug at the level of the central and autonomic nervous system and the immune system manifests itself as spasmolytic, anti-inflammatory, and sedative effects, which as a whole effectively normalizes gastrointestinal motility. For 3 months, the patients took sublingual Kolofort in a dose of 2 tablets thrice daily for 2 weeks, then 2 tablets twice daily for 2.5 months. Control was made 2 weeks, 1, 2, and 3 months after treatment initiation. The investigators assessed abdominal pain syndrome, defecation disorders, abdominal distension, and flatulence by the visual analogue scale (VAS-IBS questionnaire), visceral sensitivity index (VSI questionnaire), quality of life (QL) in patients with IBS (IBS-QoL questionnaire), and stool form according to the Bristol Stool Chart and measured the levels of TNF-α and interleukin (IL)-1β and IL-10 before and after treatment. Results. The efficacy of Kolofort showed itself within 2 weeks of its administration against all the study functional parameters (pain, defecation disorder, and flatulence). After one month of therapy, the efficacy of Kolofort achieved meaningful statistical significance against abdominal pain, complaints of flatulence, visceral sensitivity index, and QL. The statistically significant restoration of a stool form was achieved 2 months after treatment and 3-month Kolofort treatment showed a clear-cut positive clinical effect that appeared as reductions in pain syndrome (214±0.22; р < 0.001) and visceral hypersensitivity symptoms (from 30.33±2.9 to 67.76±6.5; р < 0.001), improvements in subjective sensations associated with defecation disorders (from 6.95±0.71 to 2.74±0.28; р < 0.001), stool form, and QL indicators (from 103.48±9.06 to 44.95±5.4; р < 0.001), and a decrease in blood TNF-α levels after treatment termination (from 9.16 to 7.02 pg/ml; р < 0.026). A Kolofort treatment cycle for IBS produced no clinically relevant side effects. Conclusion. Kolofort was highly effective in relieving symptoms, in normalizing the psychological status, and in lowering the levels of TNF-α in the treatment of IBS. The efficacy of the drug was achieved because of its combined effect on the main components of the pathogenesis of IBS.

Aim. To define some clinical characteristics of synchronous and metachronous colorectal cancer (CRC). Materials and methods. The investigation was concerned with the data of 150 patients with T1—4N0—2M0—1 multiple primary CRC. The clinical, biological, and morphological characteristics of synchronous and metachronous tumors were analyzed. Results. Multiple primary tumors were 6.01% of all the cases of CRC. There was a preponderance of synchronous CRC (63.75%) with the tumor localized in the sigmoid colon and rectum. In women, synchronous colorectal tumors were more often concurrent with breast tumors; metachronous ones were detected after treatment for genital tumors. In men, synchronous colorectal tumors were more frequently concurrent with kidney cancer; metachronous ones were identified after treatment for gastric cancer. Conclusion. The found characteristics of multiple primary colorectal tumors may be taken in account in programs for both primary diagnosis and follow-up after treatment for malignant tumors, which will be able to improve the early detection of cancer patients and their treatment results.

Aim. To comparatively assess desensitization schemes with and without plasmapheresis in patients with low presensitization. Subjects and methods. The investigators studied the efficiency of the two desensitization schemes (cascade plasma filtration + intravenous immunoglobulin used in a dose of 100 mg/kg in 19 patients (a study group; panel reactive antibodies (PRA) 25.1±6.1%) versus 2 g/kg in 23 patients (a comparison group, PRA 18.9±4.4%). The crossmatch reaction was negative in both groups. The median follow-up period was 23.5 (quartiles 1 and 3: 10.25 and 26) months. Results. The study group was noted to have 6 episodes of acute rejection and 1 episode of infection; the comparison group had 13 and 3 episodes, respectively. The overall renal graft survival was 79 and 65% in the study and comparison groups, respectively; the 1-year graft survival was 94 and 62%. Graft function was significantly better in the study group: there was a lower daily proteinuria level (p<0.001) at 3 months after transplantation; a higher glomerular filtration rate (GFR) (p=0.001) and a lower daily proteinuria level (p=0.01) at 6 months; a lower serum creatinine comcentration (p=0.001) and lower daily proteinuria (p=0.001) and a higher GFR (p=0.001) at one year. Conclusion. Even with the relatively low level of sensitization, there is an increase in the frequency of acute rejection episodes and worse graft function. The efficiency of desensitization using cascade plasma filtration and low-dose intravenous immunoglobulin is higher than that with high-dose intravenous immunoglobulin.

Aim. To generalize the regional experience in implementing a package of organizational and methodical and antiepidemic measures for preventing pneumococcal infections. Materials and methods. How the prevention programs were implemented using the materials and methods of the epidemiological and statistical monitoring of the incidence of pneumonia in the Amur Region was analyzed. Pneumococcal conjugate vaccine (Prevenar-13) and influenza vaccines were used for immunoprophylaxis against acute respiratory viral and pneumococcal infections. Information on the incidence of acute respiratory viral infections and pneumonia over time in the period 2010 to 2015 must be taken into account. Indicators and special criteria are used to evaluate the efficiency of vaccination. Results. The comparative statistical analysis revealed the high efficiency of regional programs using the methods for immunoprophylaxis against pneumococcal infections: the vaccination prophylactic efficiency index in terms of the incidence of pneumonia might be as high as 75—100%. Pneumonia morbidity rates became 2.3 times lower in the vaccinated population of the region. Conclusion. The results of the investigation suggest that the Program for the clinical and epidemiological monitoring and prevention of community-acquired pneumonias, by using the vaccine against pneumococcal infection in the Amur Region, has a high medical and socioeconomic efficiency.

Aim. To estimate the contribution of liver cirrhosis (LC) to the development of heart diseases in alcohol abusers. Subjects and methods. The investigation included 80 patients with alcoholic LC without a history of cardiovascular and respiratory diseases and, as a control group, 32 alcohol abusers without a history of chronic diseases of the liver and cardiovascular and respiratory systems; 45 patients with alcoholic cardiomyopathy (ACM) and congestive heart failure without a history of coronary heart disease and valvular diseases, among whom 11 patients were found to have LC. In addition to standard clinical examination, all the patients underwent electrocardiography, by estimating the corrected QT interval (QTc), standard echocardiography; and those without ACM underwent estimation of left ventricular (LV) kinetics using speckle-tracking echocardiography. Results. The patients with alcoholic LC were found to have a higher LV ejection fraction and a more obvious impairment of LV global longitudinal deformity, and more commonly LV diastolic dysfunction. 16 of the 80 patients with LC were observed to have moderate pulmonary hypertension while the mean pulmonary artery pressure (MPAP) was within the normal range in all the patients without LC. A prolonged QTc interval was revealed in the patients with LC. The duration of QTc was directly correlated with the MELD severity of LC. The patients with chronic heart failure in the presence of ACM and CL showed a more obvious LV diastolic dysfunction, as estimated by E/E’, a greater LV mass index, and a higher MPAP than those with ACM without LC. Conclusion. The LC patients both with ACM and without a history of diseases of the heart were noted to have its more evident disorders as diastolic dysfunction and elevated MPAP. Those without ACM were observed to have impaired LV global deformity and a prolonged QTc interval.

The paper considers the pathogenesis and clinical features of Fabry’s disease. It is stressed that along with cardiovascular system damage and kidney injury, there are peripheral and central nervous system lesions in this disease. In Fabry’s disease, great attention is paid to cerebrovascular diseases that frequently give rise to disability. Peripheral neuropathy is mainly due to involvement of minor fibers and autonomic disorders. Signs that allow this disease to be diagnosed are given.

The results of experimental and clinical studies strongly suggest that remote ischemic preconditioning (RIP) has no neuroprotective effect during cardiac surgery performed under extracorporeal circulation. Remote preconditioning (RP) has no neuroprotective effect in hemorrhagic stroke. A randomized multicenter study is needed to evaluate the efficiency RIP in patients with ischemic stroke. RP reduces the severity of ischemia/reperfusion kidney injury during transplantation. RIP has been established to prevent contrast-induced nephropathy. There is a need for a multicenter trial to evaluate the efficiency of RIP in patients with abdominal aortic aneurysm repair. Analysis of the presented data indicates that RIP fails to prevent cardiorenal syndrome in infants and children during cardiac surgery. The data available in the literature on the capacity of RIP to provide nephroprotective effect in patients after coronary artery bypass surgery are discordant and indicative of the advisability of a multicenter study.