EFFICACY OF THE ALGORITHMIC STEP-UP APPROACH OF INTERVENTIONAL TREATMENT OF PATIENTS WITH ACUTE NECROTIZING PANCREATITIS.

Aim - to estimate the efficacy of the algorithmic step-up approach of interventional treatment of acute necrotizing pancreatitis (ANP).; We performed a prospective observational cohort study of the efficacy of the developed approach of surgical treatment of 317 patients with different morphological forms of ANP. The following parameters were collected for each episode: length of hospital stay, mortality rate, occurrence of organ failure and local complications.; Transcutaneous punction/drainages were applied as the first step in 37 patients with acute necrotic collections. In the presence of walled-off pancreatic necrosis (WOPN) endoscopic procedures were preferred in case their close localization to the stomach or duodenum in 65 observations. Initial surgical treatment was not effective in 18.8% and video-assisted retroperitoneal debridement in patients with ANP or necrosectomies under endoscopic control in cases of WOPN were performed. Involuntary laparotomic necrosectomies were conducted in 14.5% of patients as a final step of the suggested algorithmic approach. During postoperative period complications occurred in 28.3% of patients. They included 7 new episodes of organ failure, 4 cases of arosive hemorrhage, and 5 cases of pancreatic and duodenal fistulas. Overall mortality rate was 3.3%, after laparotomic surgical treatment - 6.5%.; Surgical treatment in patients with ANP based on the developed algorithmic step-up approach is followed by acceptable complication and mortality level.

[Sleep-wake cycle regularity and cardiometabolic indicators]. / Regulyarnost' ritma «son ­ bodrstvovanie¼ i kardiometabolicheskie pokazateli.

OBJECTIVE: To evaluate the association between sleep-wake rhythm and cardiometabolic parameters. MATERIAL AND METHODS: 103 participants, aged 25-64 years, underwent actigraphy study with Actigraph Actilife GT3X + device (USA) for 7 days. We assessed actigraphy indicators (physical activity and sleep data), anthropometric indicators, blood pressure and laboratory parameters. Actigraphy data was processed using the nparACT package in the R program with the calculation of nonparametric indicators: intraday variability, interday stability, the average level of lowest activity for five hours (L5) and ten hours with the highest activity (M10), relative amplitude is the ratio of M10/L5. RESULTS: The nonparametric analysis showed an association of the higher night activity with sleep effectiveness, wake after sleep onset, indicators of physical activity. A more stable sleep pattern is associated with more steps, less weight and waist circumference, lower levels of diastolic blood pressure, creatinine and insulin. Increased fragmentation of sleep patterns is associated with increased CRP and increased sedentary time. Participants with higher activity contrast have less waist circumference, hips and body mass index, lower levels of CRP and insulin. CONCLUSIONS: Rhythm and quality of sleep are important parameters associated with cardiometabolic indicators. Stable sleep patterns, higher activity during the day and lower night activity are associated with a more favorable condition of cardiovascular system.

[Empirical dietary patterns in the Russian population and the risk factors of chronic non-infectious diseases (Research ECVD-RF)].

Currently, in the epidemiology of nutrition, methodological approaches to the empirical assessment of the diets of the population and their relationship to health indicators are actively using. In Russia, these approaches have been used in a number of cohort and regional studies, however, such studies are not available for the entire Russian population. Aim. Identification of empirical dietary patterns in the Russian population and analysis of their associations with risk factors for chronic non-communicable diseases. Material and methods. The work was carried out as part of a multicenter epidemiological study "Epidemiology of cardiovascular diseases in the regions of the Russian Federation" (ECVD-RF) in 2013-2014. The final sample size was 19 520 people aged 25- 64 years. Arterial hypertension, general and abdominal obesity, hypercholesterolemia, hypertriglyceridemia, low HDL, high LDL, and hyperglycemia were observed as risk factors for chronic non-infectious diseases. The data on the frequency of consumption of 13 food groups, which were grouped into 10 groups by combining dairy products into one were collected by interviewing. The identification of dietary patterns and assessment of their sustainability was performed using factor analysis (principal component analysis). In accordance with the individual commitment of the participants to the selected dietary patterns the sample was grouped into quartiles for each of the patterns. In order to ensure associations between patterns commitment and risk factors, a logistic regression analysis was used adjusted for the socio-demographic characteristics of the participants. Results and discussion. Four stable dietary patterns with a total specific gravity of the explained variance of 55.9% were identified and conventionally designated as "Reasonable" (milk, sweets and confectionery, fresh fruits and vegetables, cereals and pasta), "Salt" (sausages, pickles and pickled products), "Meat" (meat, fish and seafood, poultry meat) and "Mixed" (beans, pickles and pickled products, fish and seafood). The set of products of the "Reasonable" patterns mainly corresponds to the "Healthy" or "Balanced" patterns in foreign studies, the combination of the "Salt" and "Meat" patterns - the "Western Salt". Adherence to a "Reasonable" pattern was associated with a decrease in the likelihood of risk factors for chronic non-communicable diseases, and to a "Salt" and "Meat" patterns, on the contrary, with an increase. The associations obtained generally correspond to the results of similar foreign studies. A "Mixed" dietary pattern was associated with a few risk factors, which did not allow an unambiguous assessment of the pattern in terms of its impact on health. Conclusion. The study identified empirical dietary patterns of the Russian population and characterized them in terms of associations with the state of health of risk factors for chronic non-communicable diseases.

[Sleep disorders and stroke: data of the esse-rf study]. / Narusheniia sna i insul't: dannye issledovaniia ÉSSE-RF.

AIM: To assess the association between stroke and self-reported sleep disorders in the epidemiological studies of cardiovascular diseases in various regions of Russia (ESSE-RF). MATERIAL AND METHODS: A questionnaire survey included unorganized male and female population, aged 25 to 64 years, from 13 regions of the Russian Federation. In the analysis, answers to the question related to history of stroke: 'Did the doctor ever tell you that you had / had the following diseases?' (the 'Diseases' module) were included. The authors also evaluated answers about sleep duration, insomnia complaints, and sleepiness (the 'Sleep assessment' module). RESULTS AND CONCLUSION: Of 20 357 respondents, 422 (2%) confirmed the history of stroke. Both short and long sleep duration were not associated with stroke. Complaints of sleep disorders (snoring, sleep apnea, difficulty falling and maintaining sleep, as well as their combinations) were more frequently correlated with stroke. After adjustment for gender, age, body mass index, office blood pressure, the regression analysis showed that odds ratio was not significant for all complaints, except the combination of sleep apnea with frequent daytime sleepiness (1.7 (95% CI 1.04-2.8) (p=0.034). Therefore, symptoms of sleep-disordered breathing and insomnia are more common in respondents with the history of stroke. The combination of sleep apnea and frequent sleepiness complaints may indicate more severe sleep disorders in post-stroke patients.

[Epidemiology of Arterial Hypertension in Russian Federation - Importance of Choice of Criteria of Diagnosis].

PURPOSE: Assessment of prevalence of arterial hypertension (AH), need for prescription of antihypertensive therapy (AHT), and efficacy of AHT in Russian population in accordance with novel guideline of the American College of Cardiology/American Heart Association ("American recommendations") on diagnosis and treatment of AH (2017). MATERIALS AND METHODS: Epidemiological study ESSE-RF (ЭССЕ-РФ) was carried out in 12 regions of Russian Federation (RF) with different climatic-geographic characteristics. Number of examined residents of RF aged 25-65 years was 20 652. The sample was stratified by  gender and age. Examination included anthropometry, laboratory tests, blood pressure (BP) measurement with the OMRON tonometer. The SCORE scale was used for evaluation of risk of development of cardiovascular diseases (CVD). In  American recommendations AH was defined as  follows: 1-st degree  - systolic BP (SBP) 130-139  and/or diastolic BP (DBP) 80-89 mm Hg, 2-nd degree - BP ≥140/90 mm Hg and/or presence of AHT. In recommendations of the European Society of Cardiology (2013, 2018) ("European recommendations") AH was defined as BP ≥140/90 mm Hg and/or presence of AHT. RESULTS: We analyzed data of examination of  20 607  participants - 7806 men (37.9%) and 12 801  women (62.1%). According to  European recommendations AH was diagnosed in 10 347  persons (50.2%)  - 3987 men (51.1%) men and 6 360 women (49.7%). According to American recommendations AH was registered in 14 853 persons (72.1%) - 6 059 men (77.6%) and 8 794 women (68.7%). AHT received 6324 persons (61.1% of those with AH); according to American recommendations, the onset of AHT was indicated to additional 620 persons with 1-st degree AH because of high CVD risk. Among all participants with AH (on and without AHT) strengthening of AHT for achievement of target BP level was required in 77.8 and 92.6% of patients according to European and American recommendations, respectively. CONCLUSION: Application of novel criteria of AH diagnosis from 2017 ACC/AHA guideline to Russian population would increase prevalence of AH up to 72.1%. Onset of AHT would be indicated in 13.8% of patients with 1-st degree AH, while in 93% of patients receiving AHT its strengthening would be required.

Vascular Age Concept: Which Approach Is Preferable in Clinical Practice?

AIM: to compare various approaches to estimation of vascular age in patients from sample of citizens of Saint-Petersburg (SPB) with arterial pressure (AP) above 130 / 80 mm Hg without history of cardiovascular events. MATERIALS AND METHODS: Examination of a population sample of SPB citizens (n=1600) was carried out within framework of the observational epidemiological study ESSE-RF (ЭССЕ-РФ) in 2012-2013. We selected from this sample 477 women and man aged 40-65 years without history of cardiovascular events, diabetes, or chronic kidney disease, and AP >130 / 80 mm Hg. Examination included anthropometry, sampling of fasting blood for measurement of lipids, glucose, creatinine levels, urine sampling for determination of albumin excretion, and AP measurement in ac-cordance with standard methods. The SCORE scale was used of evaluation of 10-year risk of fatal stroke and fatal myocardial infarction. Volume sphygmography (VaSera device) was applied for determination of cardio-ankle vascular index (CAVI) with calculation of vascular age, and ankle-brachial index. ASCORE scale was used for determination of сalculated vascular age was determined with help of the ASCORE scale. RESULTS: Mean age of participants (182 men [38.2 %], 295 women [61.8 %]) was 52.5±6.2 years. Calculated and instrumental methods of determination of vascular age and early vascular aging had low concordance (κ = 0.099). With elevation of cardiovascular risk early vascular aging was more frequently detected by method of its calculation ASCORE than with instrumental method (VaSera). In the absence of achievement of target AP level signs of early vascular aging were significantly more often detected by the method of vascular age calculation than by the instrumental method VaSera. CONCLUSION: Application of the concept of vascular age and early vascular aging syndrome might be an effective tool for stratification of cardiovascular risk by a physician and improvement of adherence of a patient. This is especially actual for young patients with burdened heredity. One can assume that estimation of virtual risk factor load on blood vessels by the ASCORE method of calculation is more sensitive to detection of premature vascular aging, while requiring less financial and organizational efforts.

Large artery stiffness according to different assessment methods in adult population of St.Petersburg.

OBJECTIVE: The aim of the present study was to assess the prevalence of increased arterial stiffness by different diagnostic methods and its association with cardiovascular risk in Russian population-based cohort. DESIGN AND METHODS: In terms of Russian epidemiological study ESSE-RF a random selection of 452 apparently healthy Saint-Petersburg inhabitants aged 25-65 years was performed. Fasting lipids, glucose and blood pressure measurements were performed. We used 3 diagnostic methods of arterial stiffness assessment: pulse wave velocity by applanation tonometry (SphygmoCor - PWV-S) and pulse wave velocity by volumetric sphygmography (VaSera - PWV-V), and cardio-ankle vascular index (CAVI) by VaSera. RESULTS: 341 (75,4%) had normal parameters of arterial stiffness assessed by all methods. Spearmen's coefficient of correlation and "kappa" coefficient for PWV-S and CAVI were 0,74 and 0,04, for PWV-S and PWV-V - 0,10 and 0,06, for CAVI and PWV-V - 0,28 and 0,03, respectively. There was a significant correlation between cardiovascular risk (defined by SCORE) and PWV-S (r = 0,38, p < 0,001) and a non-significant trend of increasing CAVI along with cardiovascular risk (r = 0,35, p = 0,14). CONCLUSIONS: Different methods of arterial stiffness assessment showed a weak correlation with each other. Carotid-femoral pulse wave velocity detected by applanation tonometry is associated with high cardiovascular risk score and might be considered as better additional risk marker for cardiovascular risk stratification.

[Social-demographic aspects of insomnia in the Russian population according to ESSE-RF study]. / Sotsial'no-demograficheskie aspekty insomnii v rossiiskoi populiatsii po dannym issledovaniia ÉSSE-RF.

AIM: To estimate the prevalence of insomnia symptoms and their association with socio-demographic characteristics in the regions participated in the study. MATERIAL AND METHODS: Data from participants of the cohort study Epidemiology of cardiovascular disease in various regions of the Russian Federation (ESSE-RF), aged 25-64 years, from 13 regions of the Russian Federation were analyzed. They were interviewed about sleep complaints: difficulties falling asleep, maintaining sleep, sleepiness and sleeping pill intake (response variants: never, less than once a week, 1-2 times a week, three and more times a week). Responses with complaints occurring at least three times a week were considered as insomnia symptoms. Social and demographics characteristics from survey included: age, gender, education, marital status, job/employment, type of housing. The final analysis included 20 359 respondents. RESULTS: Clinically significant frequent (≥3 times a week) difficulties of falling asleep were reported by 17.2% respondents, difficulties in maintaining sleep by 13.6%; drowsiness by 6.3%, taking sleeping pills by 2.9% respondents. Women reported sleep complaints twice more after comared to men. The occurrence of frequent difficulties to falling asleep and nocturnal awakenings increased with age - from 11.4% and 5.9% to 24.2% and 20.7%. The highest occurrence of insomnia symptoms to such as difficulties in falling asleep and nocturnal awakenings was found in women, older age groups, divorced subjects or living separately, those with primary education, retired or disabled and living in a communal apartment or 'other' type of housing. CONCLUSION: Symptoms of insomnia are widespread among participants of the ESSE-RF study and associated with socio-demographic characteristics. Groups with high risk of insomnia include women, older age groups, divorced or living separately, those with primary education, unemployed pensioners and people with disabilities living in a communal apartment or 'other' type of housing.

The prevalence of abdominal obesity and the association with socioeconomic status in Regions of the Russian Federation, the results of the epidemiological study - ESSE-RF.

AIM: The aim of the study is to determine the prevalence of AO in the population and to assess the association with socioeconomic factors according to the data of the ESSE-RF study (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation). MATERIALS AND METHODS: The object of the study is a random population sample of men and women aged 25-64 years from 13 regions of the Russian Federation (n=21 817). Abdominal obesity in men was defined as waist circumference (WC) >94 cm, and in women - WC >80 cm. Body mass index (BMI) >30.0 kg/m2 was adopted as the criterion of common obesity. RESULTS: The prevalence of AO in Russia was 55% (61.8% in women and 44% in men), while the percent of people with obesity, defined by BMI was significantly lower (33.4%). The number of examined patients with AO increased with age among both men and women (p<0.0001). A person with AO more often were people with low and very low income and low education levels (p<0.0001). Direct association between employment status and family status and AO in present study did not find, but WC was statistically significantly important criterion among male workers in comparison with those who never worked (p<0.0001), young men and women married, as well as married men of older age groups (p<0.0001).

[DIAGNOSTIC AND PROGNOSTIC UTILITY OF ENTERAL FAILURE IN PATIENTS WITH ACUTE NECROTIC PANCREATITIS].

Acute necrotic pancreatitis was followed by disorders of intestinal functions in 96.7% of patients and in 68% ­ its failure was occurred what had directly influenced on frequency of purulent­septic complication and mortality rate. It was proved that citrulline plasma level had been objectively reflected the severity of enteral failure and served as independent lethality criteria in patients with acute necrotic pancreatitis.

[Elevated Level of the Natriuretic Peptide Among Adult Population in Regions Participating in the ESSE-RF Study and Its Association With Cardiovascular Diseases and Risk Factors].

AIM: to study associations between elevated blood plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), risk factors and cardiovascular diseases (CVD) in samples of adult population of Russian Federation (RF) aged 25-64 years. MATERIALS AND METHODS: We analyzed data of examination of representative samples of population of 5 regions of RF obtained within the framework of the multicenter ESSE-RF study (2012-2013). Number of examined subjects was 8 077 (3 176 men). Methods included use of standard questionnaire, measurements of height, body mass, blood pressure (BP), and plasma NT-proBNP level. The following CVD were included into analysis: arterial hypertension (AH), ischemic heart disease (IHD), atrial fibrillation (AF), and stroke. RESULTS: Women compared to men had higher NT-proBNT concentration was higher in women compared to men, in both genders it rose with age. Overall 17.9 % of examinees had elevated NT-proBNT levels (14.2 and 20.3 % among men and women, respectively). Elevated NTproBNP level was associated in men with age, myocardial infarction, angina pectoris, ischemic ECG changes, left ventricular hypertrophy, AF, bradycardia, smoking, in women with age, IHD, ischemic ECG changes, AF, bradycardia, heart rate ≥80 bpm, BP ≥160/95 mm Hg. CONCLUSION: In studied RF population elevated NT-proBNP level was significantly associated with gender, age, smoking, and CVD.

[APPLICATION OF PRESEPSIN IN DIAGNOSIS AND TREATMENT OF PURULENT-SEPTIC COMPLICATIONS OF ACUTE NECROTIC PANCREATITIS].

In 70 patients, suffering an acute necrotic pancreatitis (ANP), and 10 practically healthy persons a content of presepsin in a blood plasm, using immunochemiluminescent method and conducted bacteriological investigations, were analyzed. The infection occurrence is accompanied by plausible upgrading of a presepsin level in a blood plasm, depending on activity and severity of a septic process: in local infection--up to (677 ± 30) pg/ml, sepsis--up to (988 ± 47) pg/ml, severe sepsis--up to 2668 pg/ml; in an ANP without infection it have constituted (332 ± 38) pg/mI at average, in practically healthy persons--(184 ± 16) pg/mI. A presepsin level correlates with a state severity in accordance to APACHE I scale, what permits to estimate the patients state severity objectively, to prognosticate a favorable and unfavorable consequences of treatment, rapidly changing, depending on efficacy of treatment.

Lifetime Prevalence of Transient Loss of Consciousness in an Urban Russian Population / Prevalência de Perda de Consciência Temporária em População Russa Urbana

Abstract Background: Most international studies on epidemiology of transient loss of consciousness (TLC) were performed many years ago. There are no data about the lifetime prevalence of TLC in Russia. Objective: To identify the lifetime prevalence and presumed mechanisms of TLC in an urban Russian population. Methods: 1796 individuals (540 males [30.1%] and 1256 females [69.9%]) aged 20 to 69 years (mean age 45.8 ± 11.9 years) were randomly selected and interviewed within the framework of multicentre randomised observational trial. Results: The overall prevalence of TLC in the studied population was 23.3% (418/1796), with the highest proportion (28%) seen in 40-49 year age group. TLC was significantly more common in women than in men (27.5% vs 13.5%). The mean age of patients at the time of the first event was 16 (11; 23) years, with 333 (85%) individuals experiencing the first episode of TLC under 30 years. The average time after the first episode of TLC was 27 (12; 47) years. The following mechanisms of TLC were determined using the questionnaire: neurally-mediated syncope (56.5%), arrhythmogenic onset of syncope (6.0%), nonsyncopal origin of TLC (1.4%), single episode during lifetime (2.1%). Reasons for TLC remained unidentified in 34% cases. 27 persons (6.5%) reported a family history of sudden death, mainly patients with presumably arrhythmogenic origin (24%). Conclusion: Our findings suggest that the overall prevalence of TLC in individuals aged 20-69 years is high. The most common cause of TLC is neurally-mediated syncope. These data about the epidemiology can help to develop cost-effective management approaches to TLC.

Resumo Fundamento: A maioria dos estudos internacionais sobre epidemiologia da perda de consciência temporária (PCT) foi realizada há muitos anos. Não há dados sobre sua prevalência ao longo da vida na Rússia. Objetivo: Identificar a prevalência ao longo da vida e os supostos mecanismos da PCT em uma população russa urbana. Métodos: 1.796 indivíduos (540 homens 30,1% e 1.256 mulheres 69,9%) com idade entre 20 e 69 anos (idade média, 45,8 ± 11,9 anos) foram selecionados aleatoriamente e entrevistados no contexto de um estudo multicêntrico randomizado observacional. Resultados: A prevalência global de PCT na população estudada foi 23,3% (418/1.796), sendo a mais alta proporção (28%) observada na faixa etária de 40-49 anos. PCT foi significativamente mais comum nas mulheres (27,5% vs 13,5%). A idade média dos pacientes por ocasião do primeiro evento foi 16 (11; 23) anos, com 333 (85%) indivíduos experienciando o primeiro episódio de PCT antes dos 30 anos. O tempo médio após o primeiro episódio de PCT foi 27 (12; 47) anos. Os seguintes mecanismos de PCT foram determinados usando-se um questionário: síncope neuromediada (56,5%), síncope de origem arritmogênica (6,0%), PCT de origem não sincopal (1,4%), episódio único durante a vida (2,1%). A causa de PCT não foi identificada em 34% dos casos, sendo que 27 pacientes (6,5%) relataram história familiar de morte súbita, principalmente aqueles com PCT de suposta origem arritmogênica (24%). Conclusão: Nossos achados sugerem uma alta prevalência global de PCT em indivíduos com idade entre 20 e 69 anos. A causa mais comum de PCT é a síncope neuromediada. Esse dado sobre a epidemiologia pode contribuir para o desenvolvimento de abordagem custo-efetiva para PCT.

Lifetime Prevalence of Transient Loss of Consciousness in an Urban Russian Population.

BACKGROUND: Most international studies on epidemiology of transient loss of consciousness (TLC) were performed many years ago. There are no data about the lifetime prevalence of TLC in Russia. OBJECTIVE: To identify the lifetime prevalence and presumed mechanisms of TLC in an urban Russian population. METHODS: 1796 individuals (540 males [30.1%] and 1256 females [69.9%]) aged 20 to 69 years (mean age 45.8 ± 11.9 years) were randomly selected and interviewed within the framework of multicentre randomised observational trial. RESULTS: The overall prevalence of TLC in the studied population was 23.3% (418/1796), with the highest proportion (28%) seen in 40-49 year age group. TLC was significantly more common in women than in men (27.5% vs 13.5%). The mean age of patients at the time of the first event was 16 (11; 23) years, with 333 (85%) individuals experiencing the first episode of TLC under 30 years. The average time after the first episode of TLC was 27 (12; 47) years. The following mechanisms of TLC were determined using the questionnaire: neurally-mediated syncope (56.5%), arrhythmogenic onset of syncope (6.0%), nonsyncopal origin of TLC (1.4%), single episode during lifetime (2.1%). Reasons for TLC remained unidentified in 34% cases. 27 persons (6.5%) reported a family history of sudden death, mainly patients with presumably arrhythmogenic origin (24%). CONCLUSION: Our findings suggest that the overall prevalence of TLC in individuals aged 20-69 years is high. The most common cause of TLC is neurally-mediated syncope. These data about the epidemiology can help to develop cost-effective management approaches to TLC.

ROLE OF BIOLOGICAL MARKERS IN DIAGNOSIS OF PURULENT­SEPTIC COMPLICATIONS OF AN ACUTE NECROTIC PANCREATITIS.

Examination and treatment of 70 patients, suffering an acute necrotic pancreatitits, was conducted. Content of presepsin, procalcitonin, С­reactive protein and interleukin­6 (ІL­6) in the patients' blood plasma was determined, and bacteriological investiga' tions, contrast­enhanced CT were conducted as well. Positive results of bacteriologi' cal investigations were noted in 43 patients. Level of presepsin and procalcitonin in patients, suffering purulent­septic complications, in 3 ­ 4 times exceeded such in a sterile pancreonecrosis. Presersin level,exceeding over 632 pg/ml, have permitted to confirm the presence of local and systemic infection with high specificity and sensitivi' ty, and this have exceeded diagnostic possibilities of the procalcitonin content determi' nation. High level of ІL­6 and С­reactive protein is characteristic for the systemic inflammatory response syndrome (SIRS) of infective and noninfective origin.

[Adipokines Level in Metabolically Healthy Obese Saint-Petersburg Inhabitants (ESSE-RF)].

AIM: to elucidate prevalence of phenotypes of metabolically heathy obesity (MHO) among inhabitants of Saint-Petersburg using various criteria and assess dependence levels of adipokines on obesity phenotype. MATERIAL AND METHODS: Within a framework of epidemiologic study ESSE-RF we formed a random sample of 1600 Saint-Petersburg inhabitants stratified according to gender and age. Examination of participants included anthropometry with measurement of waist circumference CRP and estimation of body mass index (BMI), measurement of arterial pressure, determination of fasting blood glucose, insulin (with calculation of index of insulin resistance -IIR), lipid spectrum, C-reactive protein (CRP), adiponectin, leptin. In subjects with obesity (BMI more or equal 30 kg/m) we used Meigs and Wildman MHO criteria. To Wildman criteria we applied 3 variants of definition of elevated CRP and IIR: 90th percentile among subjects with BMI <25 kg/m (variant 1) or among all participants (variant 2), and (variant 3) definition from publication by E.Oliveros et al. (2014). RESULTS: Obesity (BMI more or equal 30 kg/m) was found in 430 participants. Numbers/rates of MHO according to the Wildman criteria were the following: variant 1 - 49/12% (among them 13/10% men and 36/14% women, =0.15); variant 2 - 85/22% (24/18% men, 61/23% women, =0.13); variant 3 - 59/15% (13/10% men, 46/18% women, =0.02). Portion of MHO according to Meigs criteria was 138/35% (among them 48/36% men, 90/35% women, =0.4). Significant differences in adipokines levels between subjects with MHO and metabolically unhealthy obesity (MUHO) were revealed only among women. There was no difference in leptin level between subjects with MHO and MUHO irrespective of gender. CONCLUSION: Rate of MHO phenotype in a sample of inhabitants of Saint-Petersburg varied from 12 to 35% depending on criteria used. Gender differences in MHO rates were minimal and depended on selected criteria. Elevated adiponectin level among obese women could be presumably related to more favorable metabolic profile.

[PROGNOSTIC SIGNIFICANCE OF ELEMENTS OF THE MULTIORGAN INSUFFICIENCY SYNDROME AND ESTIMATION OF THE PATIENTS STATE SEVERITY IN ACCORDANCE TO INTEGRAL SCALES IN AN ACUTE NECROTIC PANCREATITIS].

There were examined 113 patients, in whom an acute necrotic pancreatitis was diagnosed. While admittance to hospital a constant organ insufficiency was revealed in 50 (44%), a transient one--in 63 (56%) patients. In total 31 (27.4%) patients died. Respiratory insufficiency have occurred in 67% patients, and almost with similar rate--cardio-vascular (in 59%), renal (in 56%) and enteral (in 54%), dominating in the lethality structure. The BISAP (Bedcide Index for Severity in Acute Pancreatitis) scales applied permit with high probability to prognosticate the organ insufficiency and lethality in patients, suffering an acute necrotic pancreatitis.

[Gender Differences of Behavioral Risk Factors in Saint-Petersburg Inhabitants].

BACKGROUND: In developed countries there are significant gender differences in lifetime expectancy that can be explained by behavioral risk factors (RF). OBJECTIVE: The aim of our study was to estimate gender features of behavioral RF in general population of Saint-Petersburg, Russia. METHODS: As a part of all-Russian epidemiology survey ESSE-RF a random sampling of 1600 Saint-Petersburg inhabitants (25-64 y.o.) stratified by age and sex was performed. All participants filled in the questionnaire. Anthropometry (weight, height, body-mass index (BMI), waist circumference (WC) and fasting blood-tests (lipids, glucose by Abbott Architect 8000 (USA)) were performed. RESULTS: There were examined 573 (36%) men and 1027 (64%) women. No gender differences in obesity were found according to BMI criteria--in 178 (31.2%) women and 352 (35.1%) men. Obesity was more often detected in females according to WC criteria: ATPIII--44.1 vs 30.3%; IDF 51.2 vs 66.4% (p < 0.001 for both). Linear regression analysis was performed and age was associated with BMI--1.6 kg/m2/decade, WC in women--5.2 cm/decade and WC in men--2.8 cm/decade, p < 0.001 for all anthropometric parameters. Optimal level of physical activity was equally documented in both genders--540 (61.2%) women and 286 (58.9%) men. Daily intake of sweets was lower in men--228 (39.8%) vs 539 (52.5%) in women (p < 0.001). 810 (50.6%) of trial subjects were non-smokers, 395 (24.7%) were former smokers, and 395 (24.7%) were smokers at the moment of trial. The higher number of female smokers was observed--194 (19.1%). CONCLUSION: A high prevalence of obesity is observed in sample of Saint-Petersburg inhabitants--it is higher among women according to WC criteria regardless of menopause, possibly due to bigger sweets consumption. Males smoke more often and consume less fresh fruits and vegetables which is accompanied by a higher prevalence of hyperglycemia and hypertriglyceridemia.

[The prevalence of anxiety and depression in different regions of the Russian Federation and its association with sociodemographic factors (according to the data of the ESSE-RF study)].

AIM: To study the prevalence of anxiety and depression by psychometric methods (the Hospital Anxiety and Depression Scale (HADS) in different regions of the Russian Federation (RF), which are characterized by various climatic, geographic, economic, and demographic indicators. SUBJECTS AND METHODS: The investigation used the data of the multicenter epidemiological survey of cardiovascular diseases in different regions of the Russian Federation--the ESSE-RF study. The subjects of the study were representative samples from unorganized male and female populations aged 25-64 years from 10 RF regions. The survey included a total 16,877 people (6244 men and 10,623 women). All the examinees were interviewed using a standard questionnaire. An analysis involved their gender, age, education level, place and region of residence, and income and morbidity level. The HADS validated in Russia was used to rate the level of anxiety/depression. RESULTS: The total prevalence of higher anxiety and depression averaged 46.3 and 25.6%, respectively. Respondents with clinical anxiety/depression constituted more than one third of those who had a higher level of these conditions. In the examined population, the moderate level of anxiety/depression was 7.5 ± 0.06 and 5.1 ± 0.04, respectively. The population of Volgograd, Samara, Saint Petersburg, and Tomsk had the similar values of the moderate level of anxiety/depression (p > 0.05). The lowest level of anxiety/ depression (p < 0.0001) was seen in the dwellers of Tyumen (5.9 ± 0.1 and 3.4 ± 0.1, respectively) and the highest in the Republic of North Ossetia-Alania (NOA) (8.4 ± 0.1 and 6.8 ± 0.1, respectively). These regions showed the lowest and highest prevalence of higher anxiety (22% in Tyumen and 59.8% in the Republic of NOA (p < 0.0001). CONCLUSION: All the 10 selected RF regions differing in demographic, economic, climatic, and geographical parameters are characterized by a high level of anxiety that remains statistically significant after adjusting for gender and age, so are parameters, such as income and morbidity levels are present in only 4 of the 10 regions.