[Features of the Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction According to the Russian Registry of Acute Myocardial Infarction - REGION-IM].

AIM: Based on data from the Russian REGION-IM registry, to study the features of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) in real-life clinical practice. MATERIAL AND METHODS: REGION-IM is a multicenter prospective observational study. The observational period is divided into 3 stages: during the stay in the hospital and at 6 and 12 months after inclusion in the registry. The patient's records contain demographic and history data; information about the present case of MI, including the time of the first symptom onset, first contact with medical personnel, and admission to the hospital; coronary angiography (CAG) data, percutaneous coronary intervention (PCI) data, and information about the thrombolytic therapy (TLT). RESULTS: Reperfusion therapy was performed in 88.9 % of patients with STEMI. Primary PCI (pPCI) was performed in 60.6 % of patients. The median time from the onset of symptoms to pPCI was 315 minutes [195; 720]. The median time from ECG to pPCI was 110 minutes [84;150]. Isolated TLT was performed in 7.4 %, pharmaco-invasive treatment tactics were used only in 20.9 % of cases. The median time from ECG to TLT (prehospital and in-hospital) was 30 minutes [10; 59], whereas the median time from ECG to prehospital TLT was 18 minutes [10; 39], and in 63 % of patients, TLT was performed more than 10 minutes after diagnosis. PCI followed TLT in 73 % of patients. CONCLUSION: The frequency of reperfusion therapy for STEMI in the Russian Federation has increased considerably in recent years. The high frequency of pPCI is noteworthy, but the timing of pPCI does not always comply with clinical guidelines. The results of this registry confirm the high demand for pharmaco-invasive strategies in real-life clinical practice. Taking into account geographical and logistical features, implementing timely myocardial reperfusion requires prehospital TLT. However, the TLT frequency in the Russian Federation is still insufficient despite its proven maximum effectiveness in the shortest possible time from the detection of acute MI.

Synthesis and Anti-influenza Activity of Vinylphosphonic Acid (Co)polymers.

New copolymers of vinylphosphonic acid (VPA) with 2-deoxy-2-methacrylamido-D-glucose, 4-acryloylmorpholine (4-AM), and acrylamide have been synthesized, and their antiviral activity against influenza virus has been studied in in vitro and in vivo experiments. Optimal antiviral characteristics and low cytotoxicity were exhibited by the copolymer of VPA with 4-AM, composition 56 : 44 mol %, molecular weight 33 000. The polymer exhibited virus-inhibiting properties with an IC50 = 1 µg/mL and a selectivity index of 302. Prophylactic intranasal administration of the polymer in a murine model of influenza pneumonia completely prevented the virus-induced death of animals, whereas the level of mortality in the placebo group was 90%. The results of this study indicate a high antiviral potential of polymeric compounds based on VPA.

Registry of Acute Myocardial Infarction. REGION-MI - Russian Registry of Acute Myocardial Infarction.

Aim      To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods  The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion      REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.

[Complex formation of cholesterol-containing polymers in water solutions].

The dynamic light scattering method was used to study the process of complex formation in water solutions with cholesterol-containing polymers of vinylsaccharide 2-deoxy-2-methacrylamido-D-glucose (double and triple copolymers) in the different solution/polymer mole ratio. Compared to the initial triple cholesterol-containing copolymer the conditions of compaction of the complex formed are found.

[Evaluation of vascular modification in hypertensive patients].

Assessment of arterial stiffness for revealing vascular modification in hypertensive patients seems to be an actual problem in clinical practice. 377 patients with arterial hypertension and 232 nonhypertensive subjects were included in the research. The noninvasive technique of investigation of pulse wave velocity (PWV) was used. The reference values of carotid-femoral and carotid-radial PWV in relation of age and gender in nonhypertensive subjects and hypertensive population are described. Dependence of PWV on different clinical markers are shown. Correlations between PWV and left ventricular hypertrophy, PWV and carotid artery intima-media thickness are introduced. Therefore noninvasive technique of assessment of large and medium arterial stiffness can be used for separating patients with vascular modification from general population.

[Effect of atorvastatin on hemorheological parameters in patients with arterial hypertension with dyslipidemia].

We assessed effect of 6-weeks therapy with atorvastatin on parameters of lipid metabolism and some hemorheological characteristics in 27 patients with arterial hypertension (AH) and dyslipoproteinemia (DLP). In addition to general clinical examination we studied hemorheological profile including hematocrit, blood plasma and whole blood viscosity with the method of rotational viscosimetry at various shear rates, deformability of erythrocytes by filtration method, and cytoarchitectonics of erythrocytes. At the background of pronounced lipid lowering effect of atorvastatin we noted obvious improvement of microrheological properties of erythrocytes appearing as significant decrease of rigidity index of erythrocytes and of their aggregation. Basing on these findings we concluded that improvement of fluidity of erythrocytes promoting facilitation of blood flow efficacy in microcirculatory vascular bed can be a supplementary reason for administration of atorvastatin to patients with AH and DLP.

[Change in glutathione content in rat thymocytes under apoptosis induced by H2O2 or irradiation].

Glutathione (GSH) content as well as GSH-peroxidase and GSH-reductase activity in isolated rat thymocytes X-irradiated in a dose of 4.5 Gy or treated with 0.1 mM H2O2 were studied in a period preceding the appearance of apoptosis morphological symptoms. The early adaptive response of thymocytes to radiation - increase of both GSH content and glutathione peroxidase and glutathione reductase activity was revealed. On the contrary the rapid fall of GSH level in H2O2-treated thymocytes was observed simultaneousely with glutathione reductase inhibition and enhanced GSH consumption by glutathione peroxidase, this disbalance of GSH-dependent antioxidant system probably facilitates mitochondrial way of apoptosis.

[DNA complexes with polycations used for delivery of DNA into cells].

The formation and physicochemical properties of high-molecular thymus and plasmid DNA complexes with synthetic polymers based on (dimethyl-amino)ethyl methacrylate (DMAEM), (diethyl-amino)ethyl methacrylate (DEAEM), and polyvinyl amine (PVA) were investigated in solutions of different ionic strength by low-gradient viscometry, electrophoresis, circular dichroism, spectrophotometry, and dynamic light scattering. The toxicity of complexes in T98G cells was studied. It was shown that, when the ratio of polycations to DNA charged groups concentration (N+/P) reaches values > 1, DNA condensation occurs. It is accompanied by increasing optical density of solutions. Changes in DNA size after condensation were estimated. Phase diagrams of systems DNA/polycation in the presence of NaCl were obtained. It was shown by MTT-analysis that DNA complexes with polycations in the range of concentrations used have low toxicity.

[Complex approach to treatment of patients with bone and joint pathology in a geriatric department].

The influence of therapeutic training of 240 patients with postmenopausal osteoporosis in combination with degenerate-dystrophic diseases of spine and joints on the awareness of the disease, dynamics of physical activity, and quality of life was studied. The training was conducted on the structured program for patients with osteoporosis and osteoarthrosis. It was worked out by the Family medicine department of Ural State Medical Academy. The program was revised by us and adapted to patients of gerontological hospital and given as "School for patients with chronic pain syndrome". The training was followed by the true increase of awareness of the disease and physical activity. In studying the quality of life, there were noticed improvements on the scale of pain, activity of work about the house, social activity and general status.

[Effects of hypotensive treatment on structural-functional properties of the vascular wall in hypertensive patients].

AIM: To study structural-functional properties of the walls of large and middle-size arteries and changes of these properties in the course of hypotensive therapy in hypertensive patients. MATERIAL AND METHODS: Of 609 participants of the trial (233 males and 376 females), 377 patients with essential hypertension stage I-II (mean age 46.9 +/- 7.2 years) entered the study group, 232 healthy subjects (mean age 45.7 +/- 6.9 years)--the control group. Pulse wave velocity (PWV) for vessels of elastic and muscular type was measured in all the examinees. Circadian blood pressure monitoring, echocardiography, duplex scanning of the common carotid artery were performed in hypertensive patients. 76 hypertensive patients were reexamined 6 months after treatment with amlodipin (n = 32) or fixed combination perindopril+indapamide (n = 44). RESULTS: Mean PWV appeared to be higher in hypertensive patients in whom PWV correlated with left ventricular (LV) remodeling and thickness of intima-media complex (IMC). After 6 months of hypotensive therapy PWV significantly lowered for both types of vessels studied. IMC thickness reduced by 10.1%, on the average, LV myocardial mass index--by 6.3%. CONCLUSION: The link between PWV, LV hypertrophy and IMC allows PWV use as a method of detection of cardiovascular remodeling in hypertension and for follow-up of antihypertensive treatment effect on this remodeling in outpatient treatment of hypertension.

DNA-polycation complexes: effect of polycation structure on physico-chemical and biological properties.

The purpose of the study was to investigate the influence of cationic polymer structure on the formation of DNA-polycation complexes and their transfection activity. Primary, tertiary, and quaternary polyamines with molecular masses ranging from 8000 to 200,000 were investigated. DNA-cationic polymer interaction was characterized by low gradient viscometry, dynamic light scattering, circular dichroism, UV spectrometry, flow birefringence, DNA electrophoresis, and electron microscopy. Transfection activity of the complexes was evaluated by the expression of reporter gene (beta-galactosidase) and using synthetic FITC-labelled oligonucleotides. Complex formation was found to be dependent on the structure and molecular weight of the polymer and the ionic strength of the solution. Secondary DNA structure in complexes was not disrupted, and DNA was protected from protonation. Cell lines of different origin were used for testing of transfection activity of the complexes. The sensitivity of the cells to transfection was established to be highly dependent on the cell line. DNA-polycation complexes are non-toxic according to MTT. Polyallylamine, and polydimethylaminoethylmethacrylate were found to be the most promising polycations for gene delivery. Transfection efficacy of their complexes with DNA to T-98G cells reaches up to 90-100%. It was found that optimal molecular mass of polydimethylaminoethylmethacrylate is in the range of 8000-50,000 Da.

[A short test for potential carcinogenicity of water soluble synthetic polymers].

The effect of synthetic water-soluble polymer with different structure on the appearance in SZNA mice of carcinogen-protein adducts (CPA) containing endogenous carcinogen, 3-oxyanthranilic acid (3-OAA), was investigated. CPA containing 3-OAA (3-OAA-CPA) were detected during the administration of 24 of 30 investigated polymers. The induction of 3-OAA-CPA and the character of their distribution in the organism (in all investigated tissues: serum, extracts of liver, spleen, lungs and kidneys tissues or in single tissues) depended on the chemical structure of polymers. It is concluded, that synthetic polymers represent potential cancerogenic danger, because their administration causes formation of 3-OAA-CPA in the organism of animals.

[Structural and functional characteristics of cardiovascular system in elderly patients with borderline hypertension].

Structural and functional state of the heart and vessels was studied in elderly patients with borderline hypertension. Remodeling in these patients was compared with that in patients of the same age with normal or higher blood pressure levels. Analysis revealed substantial contribution in remodeling of both age and hypertensive factors. Compared with subjects with normal blood pressure patients with hypertension had greater myocardial mass, higher frequency of left ventricular hypertrophy with cases of concentric hypertrophy and isolated hypertrophy of interventricular septum. Elderly patients with borderline hypertension had more pronounced disturbances of diastolic function. Overall characteristics of patients with borderline hypertension were similar to those found in the elderly with higher level of hypertension. Presence of borderline hypertension was associated with higher than age specific stiffness of vessels. Character and degree of remodeling of the heart and vessels in the elderly patients with borderline hypertension evidence for elevated risk of cardiovascular complications.

[Arterial hypertension in aged patients in practice of therapists of the Ivanovo region]. / Arterial'naia gipertoniia u bol'nykh pozhilogo vozrasta v praktike vrachei-terapevtov Ivanovskoi oblasti.

The authors analyse current practice of management of elderly patients with arterial hypertension in medical institutions of the Ivanovo region to find out factors impeding introduction of modern approaches to treatment of the hypertensive elderly. Medical documents were analysed for aged 291 outpatients and 178 inpatients with arterial hypertension (AH). 100 physicians filled in questionnaires. The following data were obtained: 91% physicians are sure about age-specific standards of arterial pressure; 85% physicians make their decision on elderly hypertensive patients' treatment basing on diastolic pressure; the necessity of AH treatment in the elderly is supported by only 6% physicians; nonpharmacological treatment of AH in practiced in 9% elderly patients; 40, 39, 28 and 16% patients receive ACE inhibitors, calcium antagonists, beta-blockers, diuretics, respectively; the percentage of unjustified hospitalizations is high; target arterial pressure was reached only in 0.9% hypertensive aged patients. It is concluded that the impeding factors for updating AH treatment in the region studied are the following: lack of information, stereotypes in medical practice, uneffective organization of medical aid for aged patients with hypertension.

[Diagnosis of parvovirus B19 infection in patients with secondary immunodeficiency diseases]. / Laboratornaia immunodiagnostika infektsii, vyzvannoi parvovirusom B19, u bol'nykh vtorichnymi immunodefitsitami.

The method of immune-enzyme assay was used to examine 113 patients with secondary immunodeficiency, including 16 HIV-infected drug-addicts (group 1), 36 patients with cytomegalovirus infection (CMVI) and with immunoregating index CD4/CD8 below 1.0 (group 2), 30 patients with CMVI and with CD4/CD8 below 1.2 (group 3) and 31 patients with aplastic anemia and with anemia of unclear genesis (group 4), for parvovirus infection caused by parvovirus B19. As for groups 1 and 4, the antibodies were detected in 50 and 48.4% of cases; it is noteworthy that an active parvovirus infection was registered in the above groups more often than in groups 2 and 3. There were patients with the antibodies in group 2 by 1.8 times more than in group 3. It is suggested that the simultaneous impact of HIV, CMV and parvoviruses significantly aggravates the immunodeficiency and contributes to a more severe clinical course.

[Prevalence of electrocardiographic signs of pulmonary hypertension in a sample of male population of Novosibirsk]. / Rasprostranennost' élektrokardiograficheskikh pokazatelei legochnoi gipertenzii v muzhskoi populiatsii.

Prevalence of ECG signs of right ventricular hypertrophy and pulmonary hypertension was assessed in a representative sample (n=715) of nonorganized male population (age 25-64 years) of Novosibirsk studied within a framework of WHO MONICA project. Other methods of investigation included Rose questionnaire, anthropometry, ECG interpreted with Minnesota code, and echocardiography. Echocardiography data were used as reference for determination of sensitivity and specificity of ECG-criteria of pulmonary hypertension.

[Laboratory diagnostics of infections caused by cytomegalovirus and parvovirus B19 in patients with secondary immunodeficiency]. / Laboratornaia diagnostika infektsii, vyzvannykh tsitomegalovirusom i parvovirusom B19, u bol'nykh s vtorichnymi immunodefitsitami.

To improve the quality of diagnostics and treatment of patients with immunodeficient states, two groups of patients were examined for the presence of cytomegalovirus (CMV) infection, among them 1,348--with clinical manifestations of CMV infection (group 1) and 335 hematological patients (group 2); in addition, 36 patients with secondary immunodeficiency and 31 patients with aplastic and hemolytic anemia, or with anemia of unclear origin were examined for the presence of parvovirusinfection (B19). The results of enzyme immunoassay, polymerase chain reaction and immunofluorescence tests active CMV infection, confirmed by determination of IgM, low avidity IgG, antigen and DNAemia, was registered in group 2 more often than in group 1. Examinations on the presence of parvovirus infection revealed that in anemia patients with the low level of IgG or its absence IgM was also detected more often than in group 1. In mixed infection caused by CMV and parvovirus B19 the disease took a more severe course than in monoinfection, which was probably due to the parallel action exerted by parvovirus on erythrocyte production in hematopoiesis and by CMV on the monocytic and macrophagal row of cell.