[Russian eligibility criteria prescribing menopausal hormonal hormones therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Cardiological Society, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia].

Menopausal symptoms can disrupt the life course of women at the peak of their career and family life. Currently, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormonal therapy is the fear of doctors who are afraid of doing more harm to patients than good. Caution is especially important when it comes to women with underlying health conditions. Moreover, it should be recognized that there is a lack of high-quality research regarding the safety of MHT for major chronic non-infectious diseases and common comorbid conditions. The presented consensus document analyzed all currently available data obtained from clinical trials of various designs and created a set of criteria for the acceptability of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, doctors of various specialties who advise women in menopause will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real practice.

[Russian Eligibility Criteria for Prescribing Menopausal Hormone Therapy to Patients With Cardiovascular and Metabolic Diseases. Consensus Document of RSC, RSOG, RAE, EUAT, RAP].

Menopausal symptoms can impair the life of women at the peak of their career and family life. At the present time, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormone therapy is the fear of physicians to do more harm to patients than good. Caution is especially important when it comes to women with concurrent diseases. Moreover, it should be recognized that there is a shortage of high-quality research on the safety of MHT for underlying chronic non-infectious diseases and common comorbidities. The presented consensus analyzed all currently available data from clinical trials of various designs and created a set of criteria for the appropriateness of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, physicians of various specialties who advise menopausal women will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real-life practice.

Effects of turbulent environment and random noise on self-organized critical behavior: Universality versus nonuniversality.

Self-organized criticality in the Hwa-Kardar model of a "running sandpile" [Phys. Rev. Lett. 62, 1813 (1989)10.1103/PhysRevLett.62.1813; Phys. Rev. A 45, 7002 (1992)10.1103/PhysRevA.45.7002] with a turbulent motion of the environment taken into account is studied with the field theoretic renormalization group (RG). The turbulent flow is modeled by the synthetic d-dimensional generalization of the anisotropic Gaussian velocity ensemble with finite correlation time, introduced by Avellaneda and Majda [Commun. Math. Phys. 131, 381 (1990)10.1007/BF02161420; Commun. Math. Phys. 146, 139 (1992)10.1007/BF02099212]. The Hwa-Kardar model with time-independent (spatially quenched) random noise is considered alongside the original model with white noise. The aim of the present paper is to explore fixed points of the RG equations which determine the possible types of universality classes (regimes of critical behavior of the system) and critical dimensions of the measurable quantities. Our calculations demonstrate that influence of the type of random noise is extremely large: in contrast to the case of white noise where the system possesses three fixed points, the case of spatially quenched noise involves four fixed points with overlapping stability regions. This means that in the latter case the critical behavior of the system depends not only on the global parameters of the system, which is the usual case, but also on the initial values of the charges (coupling constants) of the system. These initial conditions determine the specific fixed point which will be reached by the RG flow. Since now the critical properties of the system are not defined strictly by its parameters, the situation may be interpreted as a universality violation. Such systems are not forbidden, but they are rather rare. It is especially interesting that the same model without turbulent motion of the environment does not predict this nonuniversal behavior and demonstrates the usual one with prescribed universality classes instead [J. Stat. Phys. 178, 392 (2020)10.1007/s10955-019-02436-8].

[Clinical features of community-acquired pneumonia associated with acute kidney injury in elderly patients.]

The aim of the study was to determin the incidence, severity and prognostic significance of acute kidney injury (AKI) in elderly patients with community-acquired pneumonia (CAP). 122 older patients (≥60 years) with community-acquired pneumonia were examined. Acute kidney injury was diagnosed in 49 (40,2%) patients including 47 (95,9%) patients with AKI occurring prehospital. In patients with community-acquired pneumonia associated with acute kidney injury the clinical picture of AKI was harder. Also disturbance of consciousness, dyspnea, leg swelling, tachycardia, abnormal liver function tests such as hyperbilirubinemia and hypertransaminasemia were diagnosed more frequently in this group of patients. With the development of AKI increased in-hospital mortality: odds ratio of death among patients with CAP associated with AKI was 8,3 (95% CI 2,75-25,28). So, the development of AKI in elderly patients with CAP is an actual health problem requiring the development of preventive measures and drug therapy in patients with CAP and also mandatory monitoring of patients who have had acute kidney injury.

Publisher Correction: Imaging the square of the correlated two-electron wave function of a hydrogen molecule.

The original version of this Article contained an error in the fifth sentence of the first paragraph of the 'Application on H2' section of the Results, which incorrectly read 'The role of electron correlation is quite apparent in this presentation: Fig. 1a is empty for the uncorrelated Hartree-Fock wave function, since projection of the latter wave function onto the 2pσu orbital is exactly zero, while this is not the case for the fully correlated wave function (Fig. 1d); also, Fig. 1b, c for the uncorrelated description are identical, while Fig. 1e, f for the correlated case are significantly different.' The correct version replaces 'Fig. 1e, f' with 'Fig. 2e and f'.

Imaging the square of the correlated two-electron wave function of a hydrogen molecule.

The toolbox for imaging molecules is well-equipped today. Some techniques visualize the geometrical structure, others the electron density or electron orbitals. Molecules are many-body systems for which the correlation between the constituents is decisive and the spatial and the momentum distribution of one electron depends on those of the other electrons and the nuclei. Such correlations have escaped direct observation by imaging techniques so far. Here, we implement an imaging scheme which visualizes correlations between electrons by coincident detection of the reaction fragments after high energy photofragmentation. With this technique, we examine the H2 two-electron wave function in which electron-electron correlation beyond the mean-field level is prominent. We visualize the dependence of the wave function on the internuclear distance. High energy photoelectrons are shown to be a powerful tool for molecular imaging. Our study paves the way for future time resolved correlation imaging at FELs and laser based X-ray sources.

[Prognostic value of acute kidney injury in patients with community-acquired pneumonia].

AIM: To investigate the incidence, severity, and prognostic value of acute kidney injury (AKI) in patients with community-acquired pneumonia (CAP). SUBJECTS AND METHODS: A total of 293 CAP patients (185 men and 108 women; mean age 54.3±17.1 years) were examined. AKI was diagnosed and classified in accordance with the 2012 KDIGO guidelines. RESULTS: On admission, the serum concentration of creatinine averaged 104.5±73.3 µmol/l. AKI was diagnosed in 83 (28.3%) patients with CAP. Hospital-acquired AKI was found in 25 (8.5%) patients, which amounted to 30.1% of all the AKI cases. The disease severity according to both the CURB-65 scale and the CRB-65 scale, which neglect blood urea nitrogen concentrations, was higher than that in patients with CAP associated with AKI (1.4±1.0 versus 0.4±0.6 scores; respectively; р<0.0001 and 0.8±0.7 versus 0.3±0.5 scores, respectively р<0.0001). The disease ended in a fatal outcome in 16 (5.5%) patients. The mortality in the presence of AKI was higher: 9 (10.1%) patients died in the AKI-complicated CAP group; that in the absence of AKI was 7 (5.2%; χ(2)=4.78; р=0.03), the odds ratio for death in the patients with CAP associated with AKI was 3.4; 95% confidence interval, 2.27 to 17.46. Multivariate logistic regression analysis revealed that the occurrence of AKI was independently influenced by age (р<0.001), systolic and diastolic blood pressures (p=0.01 and p=0.01, respectively), and a history of urinary tract diseases (p=0.04) and diabetes mellitus (p<0.001). CONCLUSION: AKI complicates CAP in 28.3% of cases and increases mortality in patients with CAP. The predictors of AKI in CAP patients are old age, hemodynamic disorders, diabetes mellitus, and prior urinary tract diseases.

[Type of Thrombolytic Agent and Rate of Acute Kidney Injury in Patients With Myocardial Infarction].

Aim of this study was to assess incidence and severity of acute kidney injury (AKI) in patients with ST-elevation (STE) myocardial infarction (MI) after thrombolytic therapy with alteplase or streptokinase. Among 292 included patients (227 men, 65 women, mean age 58 ± 11 years) 170 received streptokinase, 122 - alteplase. Coronary angiography in acute stage of MI was an exclusion criterion. Thrombolysis was effective in 213 (73%) patients. There was no statistically significant difference in effectiveness of thrombolysis among streptokinase or alteplase treated patients. Incidence of AKI in patients with STEMI was 25%. Both incidence and severity of AKI were higher in streptokinase treated patients. Only stage II-III AKI was significantly associated with higher in-hospital mortality.

[Type of Thrombolytic Agent and Rate of Acute Kidney Injury in Patients With Myocardial Infarction].

Aim of this study was to assess incidence and severity of acute kidney injury (AKI) in patients with ST-elevation (STE) myocardial infarction (MI) after thrombolytic therapy with alteplase or streptokinase. Among 292 included patients (227 men, 65 women, mean age 58+/-11 years) 170 received streptokinase, 122 - alteplase. Coronary angiography in acute stage of MI was an exclusion criterion. Thrombolysis was effective in 213 (73%) patients. There was no statistically significant difference in effectiveness of thrombolysis among streptokinase or alteplase treated patients. Incidence of AKI in patients with STEMI was 25%. Both incidence and severity of AKI were higher in streptokinase treated patients. Only stage II-III AKI was significantly associated with higher in-hospital mortality.

[Prognostic value of detection of arterial hypotensive episodes in patients with chronic heart failure].

AIM: To define the prognostic value of arterial hypotension (AH) episodes in patients with chronic heart failure (CHF). SUBJECTS AND METHODS: One hundred and ninety-nine patients (mean age 57.2 +/- 10.5 years) were examined. Functional Class I, II, III, and IV CHF was diagnosed in 24, 92, 82, and 1 patients, respectively. The cause of CHF was coronary heart disease concurrent with hypertensive disease in 160 patients. AH was diagnosed when their blood pressure (BP) was < or = 100/60 mm Hg during medical visits and daytime BP < or = 100/60 mm Hg and nocturnal BP < or = 85/47 mm Hg were measured during 24-hour BP monitoring (BPM). The follow-up lasted 24 months. The major end-point was a combined measure of death rates from any cause, incidence rates of myocardial infarction (MI) or stroke. RESULTS: AH was identified in 6.5% of the patients with CHF when BP was measured during their medical visit; 24-hour BPM revealed hypotensive episodes in 65.8%. There were no differences in the major endpoint in relation to the presence of AH episodes. MI developed only in patients with systolic AH episodes (5 versus 0 patients; chi2 = 5.55; p = 0.02) and the risk of MI was associated with the greater magnitude of diastolic AH. CONCLUSION: 24-hour BPM can substantially increase the detection rate of potentially dangerous BP changes. Almost three fourths of patients with CHF were observed to have AH episodes during a day. The use of angiotensin-converting enzyme (ACE) inhibitor/ diuretic, ACE inhibitor/mineral corticoid receptor antagonist, ACE inhibitor/nitrate combinations in the treatment of patients with CHF increase the risk of transient AH. In patients with CHF, the risk of MI is associated with the detection of systolic AH episodes and the magnitude of diastolic AH.

[Problems in the diagnosis of acute kidney injury in patients with ST-segment elevation myocardial infarction].

AIM: To estimate the frequency and severity of acute kidney injury (AKI) in patients with ST-segment elevation acute myocardial infarction (STSEAMI), to specify whether the changes in diuresis and serum creatinine levels are equally sensitive diagnostic criteria for AKI, and to define their prognostic value. SUBJECTS AND METHODS: Three hundred and nineteen patients (249 (78%) men and 70 (22%) women; age 58 +/- 10 years) with STSEAMI who received thrombolytic therapy (TLT) were examined. The diagnosis of STSEAMI, indications for and contraindications to TLT, evaluation of its efficiency were made in accordance with the All-Russian Scientific Society of Cardiology guidelines (2007). AKI was diagnosed and classified using the KDIGO guidelines (2012). RESULTS: AKI was diagnosed in terms of diuresis, calculated creatinine levels, and creatinine level changes in 107 (34%), 73 (23%), and 68 (22%) patients, respectively. Among the patients with AKI diagnosed in view of diuresis, in-hospital death rates were higher than in those without AKI (chi2 = 25.46; p < 0.001); the similar pattern was seen in patients with AKI diagnosed in terms of calculated creatinine levels (chi2 = 3.99; p = 0.045). Logistic regression analysis indicated that regardless of gender, age, and time interval between onset of clinical manifestation and hospital admission, the in-hospital death rates were associated with the presence of AKI in view of diuresis (relative risk 14; 95% confidence interval, 4.03 to 52.08; p < 0.001). CONCLUSION: The STSEAMI patents receiving TLT exhibited a high rate of AKI. The major problem in the early detection of AKI is associated with difficulties in the differential diagnosis of AKI and chronic kidney disease. AKI diagnosed in view of diuresis is of greater prognostic value for in-hospital mortality than that diagnosed in terms of creatinine levels. The diagnosis of renal dysfunction in view of basal creatinine levels is prognostically important despite the fact that this cannot differentiate AKI from chronic kidney disease in the early stage.

[S24-hour arterial pressure monitoring in patients with chronic cardiac failure and the state of renal function].

The 24-hr AP profiles were obtained in 194 patients with chronic cardiac failure (CCF) depending on the glomerular filtration rate (GFR). It was shown that 24-hour arterial pressure monitoring markedly improves detection of potentially dangerous changes of AP The target AP was achieved in 42.9 and 18.4% of the patients with GFR < or = 45.1 and > or = 69.8 ml/min/1.73 m2 respectively. Episodes of systolic arterial hypotony were diagnosed in 51.0 and 26.5% of the patients with GFR < or = 45.1 and 69.8 ml/min/1.73 m' respectively; episodes of diastolic arterial hypotony in 71.4 and 61.2% of the patients with GFR < or = 45.1 and > or = 69.8 ml/min/1.73 m2 respectively. Duration of systolic and diastolic arterial hypotony during 24 hr correlated with the level of glycemia and the age of the patients respectively.

[Acute kidney injury in patients with myocardial infarction and efficacy of thrombolytic therapy].

Aim of the study was to assess rate and severity of acute kidney injury (AKJ) (RIFLE and AKIN criteria) in patients with ST-elevation myocardial infarction (STEMI), to determine relationship between AKJ, mortality and effectiveness of thrombolytic therapy (TLT). We examined 146 patients (117 men, 29 women, mean age 56.7+/-10.8 ) with STEMI subjected to TLT with streptokinase. AKJ was diagnosed and classified according to RIFLE and AKIN criteria by creatinine (RIFLECr, AKINCr) and diuresis (RIFLEou, AKINou). TLT was effective in 104(71%) patients. AKJ was found in 74 (51%) according to RIFLECr and in 86 (59%) - AKINCr, in 51 (35%) - RIFLEou and AKINou criteria. Eight patients 8 (5%) died. Results of logistic regression analysis showed that AKJ according to RIFLEou or AKINou irrespective of sex, age, and time after appearance of symptoms to hospitalization, was associated with mortality (relative risk [RR] 12.9, 95% confidence interval [95%CI] 1.45-115,58, p=0.002). Thus more than 50% of STEMI patients have AKJ according to RIFLECr AKINCr criteria. Frequency of AKJ according to RIFLEou and AKINou was by 40% and one third less than that according to AKINCr and RIFLECr, respectively. Presence of AKJ was associated with TLT inefficacy and elevation of mortality.

[Total body water and recurrent atrial fibrillation].

AIM: To specify the relationship between content of total body water and recurrent atrial fibrillation (AF) of non-valvular etiology. MATERIAL AND METHODS: Pharmacological amiodaron cardioversion followed by amiodaron supportive anti-arrhythmic therapy was made in 76 patients (47 males, 29 females, mean age 58 +/- 8 years) with persistent AF of non-valvular etiology. Measurements were made of the height, body mass, arm circumference, thickness of the lipocutaneous fold above the biceps. Body mass index (BMI) and arm muscular circumference were estimated. Body composition was calculated according to Watson formula. RESULTS: Fifty three (70%) patients with recurrent AF had overweight or obesity. Body fat mass in patients with frequent (1 recurrence and more for 3 months) and rare AF recurrences did not significantly differ (24.4 +/- 10.6 and 30.0 +/- 13.8 kg, respectively; p = 0.064). Total body water was significantly less (36.8 +/- 5.2 and 42.7 +/- 5.4 kg, respectively; p = 0.0009) in patients with frequent AF recurrences. Multifactor regression analysis showed that content of total body water, irrespective of gender and age, inversely correlates with an early AF recurrence (R2 = 0.24; beta = -0.49; p = 0.0003). CONCLUSION: Low content of body water is associated with a risk of early AF recurrence.

[Prophylaxis and treatment of severe bleeding in obstetrics (draft guidelines)].

The article represents draft guidelines on severe bleeding in obstetrics which is the major reason of maternal mortality throughout the world. Criteria of estimation the physiological, pathological and massive blood loss are given. Algorithms of conservative and surgical treatment are presented, as well as major indications for administration of anti-fibrinolythics, infusion and transfusion treatment.

[Combined application of interference therapy and "dry" carbon dioxide baths for the treatment of hemodynamic disorders in patients with implantation failure due to inflammation].

This work was designed to evaluate the influence of different physiotherapeutic modalities on the possibility of implantation, development and outcome of pregnancy in patients with chronic endometriosis and previous failures of implantation. The study confirmed initial sonographic changes and deficit of uterine blood supply as well as gradual improvement of these parameters under effect of adequate physiotherapy. Inclusion of dry carbon dioxide baths in the combined treatment of hemodynamic disorders made it possible to "prepare" endometrium for implantation and optimize blood circulation in the uterine vasculature in order to enhance the probability of implantation, development of pregnancy, and its success.

Molecular dissociative ionization and wave-packet dynamics studied using two-color XUV and IR pump-probe spectroscopy.

We present a combined theoretical and experimental study of ultrafast wave-packet dynamics in the dissociative ionization of H_{2} molecules as a result of irradiation with an extreme-ultraviolet (XUV) pulse followed by an infrared (IR) pulse. In experiments where the duration of both the XUV and IR pulses are shorter than the vibrational period of H_{2};{+}, dephasing and rephasing of the vibrational wave packet that is formed in H_{2};{+} upon ionization of the neutral molecule by the XUV pulse is observed. In experiments where the duration of the IR pulse exceeds the vibrational period of H_{2};{+} (15 fs), a pronounced dependence of the H;{+} kinetic energy distribution on XUV-IR delay is observed that can be explained in terms of the adiabatic propagation of the H_{2};{+} wave packet on field-dressed potential energy curves.

[Specific features of cardiac insufficiency in elderly patients with chronic renal disease].

AIM OF THE STUDY: To evaluate clinical features of chronic cardiac insufficiency (CCI) in elderly patients with renal dysfunction. MATERIALS AND METHODS: 260 patents (143 men and 117 women) aged above 60 (mean 68.7 +/- 6.6) yr with I-IV FC CCI. 25 patients had hypertensive disease (HD), 30 coronary heart disease (CHD), 205 HD+CHD. Glomerular filtration rate (GFR) was estimated using MDRD formula. RESULTS: Chronic renal disease (CRD) with GFR reduced below 60 ml/min/1.73 m2 was diagnosed in 126 (48.5%) patients. Its severity was not significantly different between patients with and without CCI. (2.3 +/- 0.7 and 2.1 +/- 0.7 respectively, p = 0.13). The entire study group was dominated by men, the CCI group by women. Atrial fibrillation (AF) was diagnosed in 25.8% of the patients with CI + CRD. Multivariate regression analysis revealed independent correlation of AF with CCI FC (p = 0.02) and GFR (p = 0.2). CCI patients with CRD had higher frequency of mitral regurgitation (MR) than without CRD. Occurrence of MR correlated with age (p < 0.001) and GFR (p < 0.001). CONCLUSION: 1. Renal dysfunction occurred in 48.55% of elderly patients with CCI. 2. A distinctive clinical feature of CCI + CRD in elderly patients is frequent development of AF and MR. 3. CCI + CRD is more frequent in women and CCI without CRD in men.

[Chronic renal disease and atrial fibrillation in patients with chronic heart failure].

AIM: To specify an association between reduced renal function and atrial fibrillation (AF) in patients with chronic heart failure (CHF). SUBJECTS AND METHODS: Three hundred and forty patients (200 males and 140 females, mean age 58 +/- 13 years) with CHF were examined. The causes of CHF were arterial hypertension in 44 (13%) patients, coronary heart disease (CHD) in 112 (33%), and their concomitance in 184 (54%). Sixty-six (19%) patients had diabetes mellitus and 180 (53%) had sustained myocardial infarction. Glomerular filtration rate (GFR) was calculated using the MDRD (Modification of Diet in Renal Disease) formula. Thirty patients presented with paroxysmal persistent AF and 27 had continuous AF. RESULTS: GFR was 68.8 +/- 20.9 ml/min/1.73 m2 (19.2 to 149.7 ml/min/1.73 m2), 114 (33.5%) patients having a GFR of < 60 ml/min/1.73 m2. Proteinuria was observed in 38 (11.2%) patients. GFR was lower in patients with CHF and AF (58.8 +/- 14.2 ml/min/1.73 m2 than that in those without AF (69.1 +/- 18.8 ml/min/1.73 m2; p < 0.001). The patients with decreased renal function had a larger diameter of the left atrium and more commonly mitral regurgitation. Logistic regression analysis revealed that chronic renal disease (CRD) (relative risk (RR) 2.3, 95% confidence interval (CI) 1.2 to 4.3), functional class CHF (RR, 1.8, 95% CI 1.0 to 3.1) were independently associated with AF. CONCLUSION: Decreased renal function predisposes to the development of AF in patients CHF. CRD should be considered as a condition presenting a risk for AF.

[Renal dysfunction and mitral regurgitation in patients with chronic heart failure].

The objective of this study was to elucidate the relationship between mitral regurgitation (MR) and the glomerular filtration rate (GFR) in patients with chronic heart failure (CHF). A total of 340 patients with CHF (200 men and 140 women, mean age 58.0 +/- 12.9 years) were included in the study. Arterial hypertension (AH) was the cause of CHF in 44 (13%) patients, coronary heart disease in 112 (33%) patients, and combination of the two disorders in 184 (54%) patients. CHF of functional classes I and II was diagnosed in 112 (33%) and 177 (53%) patients respectively, CHF of functional classes III and IV in 34 (10%) and 17 (5%) patients. GFR was calculated using the MDRD formula. The left ventricular ejection fraction (EF) was 56.9 +/- 10.5%. Systolic dysfunction occurred in 90 (26%) patients and mitral regurgitation in 221 (65%). GFR varied from 19.2 to 149.7 (mean 68.8 +/- 2.9) ml/min/1.73 m2. CRF was below 60 ml/min/1.73 m2 in 114 (34%) patients. There was significant positive correlation between the occurrence of MR and the functional class of CHF (r = 0.35; p < 0.001) while GFR was inversely related to MR (r = -0.43; p < 0.001). Multifactor regression analysis demonstrated that manifestation of MR was associated with the decreased functional activity of the kidneys regardless of the patients" age. It is concluded that changes in the structure of the echo signal from the mitral valve in patients with CHF due to coronary heart disease and/or arterial hypertension are most common in patients with GFR below 60 ml/min/1.73 m2. The degree of MR manifestation is closely associated with the impaired functional activity of the kidneys.