[Calculator "Available prognosis": Method of evaluation for predicting survival of patients with chronic heart failure and reduced left ventricular ejection fraction].

BACKGROUND: A method for predicting one-year survival of patients with heart failure and reduced ejection fraction (HFrEF) is required to choose a management tactics and determine indications for high-tech care at the outpatient stage. AIM: To develop a method for proper prediction of survival of patients with HFrEF in outpatient clinics. MATERIALS AND METHODS: This was a prospective study of 212 patients with functional class II-IV CHF of non-valvular origin and LV EF (Simpson) ≤35 % aged 18-70, including 176 (83 %) men and 36 (17 %) women who had given an informed consent to participate in the study. STUDY DESIGN: hospitalization to a specialized department for treatment of heart failure; best titration of tolerated doses and stabilization of the patient's condition; evaluation of status; laboratory and instrumental tests; outpatient follow-up by an HF specialist (visits, telephone contacts, therapy adjustment, and admission to a specialized HF department in case of decompensation); 200­item database population; recording the composite endpoint (cardiovascular death, or implantation of a mechanical circulatory assist (MCA) device, or heart transplantation (HT) within 12 months). RESULTS: For 12 months, 135 (64 %) patients survived; a MCA device was implanted to 5 (2 %) patients; HT was performed for 21 (10 %) patients; and a fatal outcome was observed in 51 (24 %) patients. Therefore, 77 patients had the composite endpoint. A method for predicting survival was developed using a multiple logistic regression analysis. The developed proper method for survival prediction included the following parameters: age of HFrEF onset; frequency of respiratory movements; systolic blood pressure measured at 3-5 min of orthostasis; lymphocyte count, and red cell distribution width. An identified patient with a predicted survival less than one year should be as soon as possible forwarded to a selection panel for considering HT or MCA implantation as a «bridge¼ to HT. A predicted survival longer than one year is an indication for further outpatient management and considering cardioverter defibrillator implantation. CONCLUSION: The method for proper outpatient evaluation of survival prognosis for patients with HFrEF allows to predict the one-year survival using routine indexes, such as results of objective examination, case history, and blood count, without additional expenses.

[The epidemiological and clinicoimmunological aspects of the outburst of trichinosis in the Krymsky District of the Krasnodar Territory].

The present paper presents the epidemiological and clinicoimmunological aspects of the outburst of trichinosis in the Krymsky District of the Krasnodar Territory in January 2001. Six hundred and forty-eight persons ate infested wild boar meat, 119 (74.8%) fell ill with moderate and severe trichinosis. The authors provide the results of 3.5-year immunological studies of the patients with trichinosis and convalescents, infection-risk and healthy individuals; those of autopsies of the corpses of those who died from accidental causes unassociated with trichinosis, as well as examinations of domestic, synanthropic, and wild animals. The findings indicate that there is a focus of trichinosis with the low level of endemia in the Krymsky District of the Krasnodar Territory.

[Impact of effect of natural disasters on the circulation of causative agents of parasitic diseases].

The southern region is marked by a high incidence of parasitic diseases and a significant contamination of environmental objects with the eggs and cysts of their pathogens. Background examinations revealed the greatest soil contamination with helminthic eggs in the Temryuksky District of the Krasnodar Territory and in the towns of Vladikavkaz and Digora of the Republic of North Ossetia (Alania). The least contamination was found in Rostov-on-Don and the towns of the south-western area of the Krasnodar Territory. The eggs of Toxocara and astamination. There is an increase in the proportion of soil positive tests from 26.6 to 50.0, with the high (up to 82.0-100.0%) viability of eggs and a rise in the intensive index of their content per kg of soil (from 2.7 to 4.7-11.0). Toxocara eggs were mainly detected. The established high proportion of seropositive persons (10.7-18.0%) among the local population is an additional verification of the wide circulation of Toxocara eggs in nature. By the helminthic egg contamination index, the soils of localities of the south of Russia are qualified as those of moderate epidemic hazard. The floods accompanied by the increased helminthological contamination of the upper soil layer may lead to a higher human risk for contamination with helminthic diseases.

[The use of the CO2 laser in the combined treatment of chronic osteomyelitis in children]. / Ispol'zovanie CO2-lazera v komplekse lecheniia khronicheskogo osteomielita u detei.

The results of performance of sanation according to the conventional technique and with the use of CO2-laser in chronic osteomyelitis in 73 children have been analysed. Use of the CO2-laser contributed to improvement of quality of sanation, increase in incidence of an operative wound healing by first intention, reduction in duration of hospital treatment of a patient, improvement of the long-term results.

[Effect of intravascular laser therapy on the rheologic properties of blood in children with bilateral destructive pneumonia]. / Vliianie vnutrisosudistoi lazeroterapii na reologicheskie svoistva krovi u detei s dvustoronnei destruktivnoi pnevmoniei.

The effect of intravascular blood irradiation with helium-neon laser in 20 children with bilateral destructive pneumonia at a dose of 10-30 J/cm2 for a course of treatment on indices of hemostasis and rheologic blood properties was studied. Decrease in blood viscosity, hypocoagulative effect of intravascular laser therapy, normalization of clinico-roentgenologic data were revealed.

[Thermal effect existing in the action of carbon dioxide laser on the bone tissue]. / Termicheskii éffekt, voznikaiushchii pri vozdeistvii uglekislotnogo lazera na kostnuiu tkan'.

In the experiments in vitro we have studied the influence of carbon dioxide laser radiation on bone tissues of man. We have found out the range and thermal effect dependence on the density of laser energy, the character and thickness of radiated tissues. We have determined the dynamics of temperatures at any time. The received results give us the possibility to differentiate the optimum regimen of radiation.

[Comparative evaluation of the results of conservative surgery for benign tumors and tumor-like bone lesions in children]. / Sravnitel'naia otsenka rezul'tatov sokhrannykh operatsii pri dobrokachestvennykh opukholiakh i opukholepodobnykh porazheniiakh kostei u detei.

The results of sparing operations of 576 children with benign tumors and tumor-like bone affections have been analysed. There have been revealed the advantages of the complex method of treatment, envisaging the sparing approach to the damaged segment, thermal treatment of the residual osseous walls by means of CO2--laser and recipient-like plasty of the operational defect (UV--irradiated autologous bone marrow+allomaterial): absence of recurrencies, complete restoration of the bone structure in 9-12 months after the operation.

[Use of UV-irradiated autospongiosa in osseo-plastic operations in children]. / Ispol'zovanie UF-obluchennoi autospongiozy pri kostno-plasticheskikh operatsiiakh u detei.

The stimulating influence of the integral UV-radiation upon the reparative osteogenesis was found in an experiment on animals and with bone marrow cells-precursors of man. The UV-irradiation of autospongiosa was used in combined osseoplastic procedures in 23 children with benign tumors, tumor-like injuries and defects of bones which allowed to achieve the recovery of the bone structure 9-12 months after operation, to shorten the hospital period and terms of rehabilitation of the patients.

[Treatment of diaphyseal fractures of crural bones in children]. / Lechenie diafizarnykh perelomov kostei goleni u detei.

The article describes results of treatment of 81 patients with fractures of leg bones. Comparative characteristics of different methods of treatment are given. Approximate formulas of terms of fixation were developed depending on the fracture character and age of the patients. The authors made conclusions on the effectiveness of transosseous osteosynthesis and expediency of using the method for treatment of "unstable" fractures of leg bones in children.

[Use of UV-irradiated autologous bone marrow in the treatment of bone defects in children]. / Ispol'zovanie UF-obluchennogo autologichnogo kostnogo mozga pri lechenii defektov kostei u detei.

On the basis of experimental researches has been revealed dose-dependent influence of integral UV-irradiation on osteogenic potential of stromal cells--precursors of bone marrow and determined osteogenesis--stimulating dose (300 J/m2). The technique of photomodified bone marrow application for treatment of osseous defects in children has been worked out. Clinical approval (36 observations) has demonstrated high efficiency of the proposed version of osteoplasty: acceleration of reparative processes, reduction of normal osseous structure restoration terms.

[Use of Co2-laser in the treatment of bone tumors in children]. / Ispol'zovanie Co2-lazera pri lechenii opukholei kostei u detei.

By means of the recognized methods, 229 children with benign tumors and tumor-like dysplasia of the skeleton were treated. In 59 patients, the CO2-laser scanning of the residual osteal bed was used. This permitted to reduce considerably the volume of surgical intervention, and provide its radicality.

[Early decompression of an osteomyelitic focus in children]. / O rannei dekompressii osteomieliticheskogo ochaga u detei.

Having carried out experimental and morphologic studies of the properties of metaepiphyseal cartilage the authors determined a correlation between its morphfunctional maturity and the age of the child and proposed a conceptual model of metaepiphyseal osteomyelitis in children of an early age which was based on the thesis of the degree of maturity of the growth plate. With the aim of preventing an injury to the growth area and to the epiphysis as well as the orthopaedic consequences the authors carry on early decompression of the focus of inflammation in the metaphysis. The results of treatment of 28 patients are presented.

[Surgical debridement of bone cavities in the complex treatment of chronic osteomyelitis in children]. / Khirurgicheskaia obrabotka kostnykh polostei v kompleksnom lechenii khronicheskogo osteomielita u detei.

The authors propose fulfilling radical necrectomy in chronic osteomyelitis with special instruments which is responsible for sparing character of the surgery. The sparing tactics in radical necrectomy was used in 173 patients. The method described when combined with autoplasty of osseous cavities by the prepared spongiosis with the bone marrow after radical sanitation resulted in recovery of 96.5% of the patients.