Streptomyces tsukubensis VKM Aс-2618D-an Effective Producer of Tacrolimus.

The Streptomyces sp. VKM Ac-2618D strain has been identified, and its morphological and physiological features have been studied in relation to the production of the immunosuppressant tacrolimus. The phenotypic variability of the strain was analyzed, and a dissociant with a high level of tacrolimus production was selected. Based on a comprehensive study of morphological, physiological, and chemotaxonomic properties and on phylogenetic analysis, the strain was named Streptomyces tsukubensis VKM Ac-2618D. The strain genome contains the full version of the tacrolimus biosynthetic gene cluster. The advantages of fed-batch cultivation mode for tacrolimus biosynthesis are shown. The results broaden the understanding of the characteristics of polyketide biosynthesis and can be used in the development of technology for tacrolimus production.

Geometrically nonlinear modelling of pre-stressed viscoelastic fibre-reinforced composites with application to arteries.

Mechanical behaviour of pre-stressed fibre-reinforced composites is modelled in a geometrically exact setting. A general approach which includes two different reference configurations is employed: one configuration corresponds to the load-free state of the structure and another one to the stress-free state of each material particle. The applicability of the approach is demonstrated in terms of a viscoelastic material model; both the matrix and the fibre are modelled using a multiplicative split of the deformation gradient tensor; a transformation rule for initial conditions is elaborated and specified. Apart from its simplicity, an important advantage of the approach is that well-established numerical algorithms can be used for pre-stressed inelastic structures. The interrelation between the advocated approach and the widely used "opening angle" approach is clarified. A full-scale FEM simulation confirms the main predictions of the "opening angle" approach. A locking effect is discovered: in some cases the opening angle of the composite is essentially smaller than the opening angles of its individual layers. Thus, the standard cutting test typically used to analyse pre-stresses does not carry enough information and more refined experimental techniques are needed.

Studies of equation of state properties of high-energy-density matter generated by intense ion beams at the facility for antiprotons and ion research.

The work presented in this paper shows with the help of two-dimensional hydrodynamic simulations that intense heavy-ion beams are a very efficient tool to induce high energy density (HED) states in solid matter. These simulations have been carried out using a computer code BIG2 that is based on a Godunov-type numerical algorithm. This code includes ion beam energy deposition using the cold stopping model, which is a valid approximation for the temperature range accessed in these simulations. Different phases of matter achieved due to the beam heating are treated using a semiempirical equation-of-state (EOS) model. To take care of the solid material properties, the Prandl-Reuss model is used. The high specific power deposited by the projectile particles in the target leads to phase transitions on a timescale of the order of tens of nanosecond, which means that the sample material achieves thermodynamic equilibrium during the heating process. In these calculations we use Pb as the sample material that is irradiated by an intense uranium beam. The beam parameters including particle energy, focal spot size, bunch length, and bunch intensity are considered to be the same as the design parameters of the ion beam to be generated by the SIS100 heavy-ion synchrotron at the Facility for Antiprotons and Ion Research (FAIR), at Darmstadt. The purpose of this work is to propose experiments to measure the EOS properties of HED matter including studies of the processes of phase transitions at the FAIR facility. Our simulations have shown that depending on the specific energy deposition, solid lead will undergo phase transitions leading to an expanded hot liquid state, two-phase liquid-gas state, or the critical parameter regime. In a similar manner, other materials can be studied in such experiments, which will be a very useful addition to the knowledge in this important field of research.

Chirp-controlled high-harmonic and attosecond-pulse generation via coherent-wake plasma emission driven by mid-infrared laser pulses.

Coherent-wake plasma emission induced by ultrashort mid-infrared laser pulses on a solid target is shown to give rise to high-brightness, high-order harmonic radiation, offering a promising source of attosecond pulses and a probe for ultrafast subrelativistic plasma dynamics. With 80-fs, 0.2-TW pulses of 3.9-µm radiation used as a driver, optical harmonics up to the 34th order are detected, with their spectra stretching from the mid-infrared region to the extreme ultraviolet region. The harmonic spectrum is found to be highly sensitive to the chirp of the driver. Particle-in-cell analysis of this effect suggests, in agreement with the generic scenario of coherent-wake emission, that optical harmonics are radiated as trains of extremely short, attosecond ultraviolet pulses with a pulse-to-pulse interval varying over the pulse train. A positive chirp of the driver pulse can partially compensate for this variation in the interpulse separation, allowing harmonics of the highest orders to be generated in the plasma emission spectrum.

[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.

Microbiological synthesis of stereoisomeric 7(α/ß)-hydroxytestololactones and 7(α/ß)-hydroxytestolactones.

Microbiological synthesis of 7α- and 7ß-hydroxy derivatives of testololactone and testolactone was developed based on bioconversion of dehydroepiandrosterone (DHEA) by fungus of Isaria fumosorosea VKM F-881 with subsequent modification of the obtained stereoisomers by actinobacteria. The first stage included obtaining of the stereoisomers of 3ß,7(α/ß)-dihydroxy-17a-oxa-D-homo-androst-5-en-17-ones in the preparative amounts. Then the conversion of 7-hydroxylated D-lactones obtained by selected actinobacteria of Nocardioides simplex VKM Ac-2033D, Saccharopolyspora hirsuta VKM Ac-666, and Streptomyces parvulus MTOC Ac-21v was studied. Under the transformation of 3ß,7α-dihydroxy-17a-oxa-D-homo-androst-5-en-17-one and its corresponding 7ß-stereoisomer by N. simplex VKM Ac-2033D and S. hirsuta VKM Ac-666 the 7α- and 7ß-hydroxy-17a-oxa-D-homo-androst-4-ene-3,17-dione (7α- and 7ß-hydroxytestololactone), 7α- and 7ß-hydroxy-17a-oxa-D-homo-androsta-1,4-diene-3,17-dione (7α- and 7ß-hydroxytestolactone) were obtained with molar yields in a range of 60.3-90.9 mol%. The crystalline products of 7α-hydroxytestololactone, 7α-hydroxytestolactone, and their corresponding 7ß-hydroxy stereoisomers were isolated, and their structures were confirmed by mass spectrometry and 1H-NMR spectroscopy analyses. The strain of Str. parvulus MTOC Ac-21v transformed 3ß,7(α/ß)-dihydroxy-17a-oxa-D-homo-androst-5-en-17-ones into the corresponding 3-keto-4-ene analogs and did not show 3-ketosteroid 1(2)-dehydrogenase activity. The activity of actinobacteria towards steroid D-lactones was hitherto unreported.The results contribute to the knowledge of metabolic versatility of actinobacteria capable of transforming steroid substrates and may be applied in the synthesis of potential aromatase inhibitors.

Hypoxia-inducible factor 1 (HIF-1) as a biomarker of acute kidney injury in patients with acute decompensation of chronic heart failure.

Actuality. Impaired kidney function adversely influences both immediate and remote prognosis for patients with chronic heart failure (CHF). However, early detection and prediction of acute kidney injury (AKI) are understudied.The aim of study was to investigate hypoxia-inducible factor 1 (HIF-1) as a biomarker for early diagnosis of AKI and determining prognosis in patients with acute decompensated CHF (ADCHF). MATERIALS AND METHODS: 84 patients admitted for ADCHF (18 women; mean age, 61.4±7.1) were evaluated. ADCHF was diagnosed in accordance with SEHF guidelines for diagnosis and treatment of chronic heart failure (RCS, 2016). AKI was diagnosed according to KDIGO criteria (2012). HIF-1, N-terminal pro B-type natriuretic peptide (NТ-proBNP), and erythropoietin were measured in blood serum. The follow-up period lasted for 12 months. RESULTS: AKI was diagnosed in 27 (32.1 %) patients. Level of HIF-1 was 1.27±0.63 ng / ml; NТ-proBNP - 2469.6 (interquartile range (IQR), 1312.2; 3300.0) pg / ml; eryhthropoietin - 56.0 mIU / ml (IQR, 13.2; 68.1). No correlation was found between HIF-1 and glomerular filtration rate, NТ-proBNP, or erythropoietin. Differences in biomarker levels were not observed between patients with and without AKI; however, HIF-1 was higher in the group of deceased patients than in the group of survived patients (1.64±0.9 vs. 1.17±0.44 ng / ml, р=0.004), which was not observed for NТ-proBNP and erythropoietin. CONCLUSION: AKI was observed in every third patient with ADCHF. In ADCHF, HIF-1 was not correlated with the kidney function; however, a relationship was found between the HIF-1 level and prediction for patients with CHF.

[Prevalence of Markers of Chronic Kidney Disease in Patients With Arterial Hypertension: Results of Epidemiological Study CHRONOGRAF].

In an noninterventional observational open multicenter program CHRONOGRAF the prevalence of markers of chronic kidney disease (CKD) was studied in 1600 patients with arterial hypertension with and without type 2 diabetes mellitus. Glomerular filtration rate (GFR) was calculated (CKD­EPI formula) and albuminuria (AU) was determined as albumin/creatinine (A/Cr) ratio in the morning portion of urine. In 49.4% of patients decreased GFR 30 mg/g was detected. Decrease of GFR 30 mg/g - in 32.6%, combination of reduced GFR and high/very high AU - in 18%. High or very high level of combined risk of progression to CKD and cardiovascular complications had 28.5% of patients.

Fifteen meter long uninterrupted filaments from sub-terawatt ultraviolet pulse in air.

A technique is presented to create uninterrupted long ultraviolet filaments in air using appropriately structured transmission mesh. The mesh with different cell sizes was inserted into 10-cm parallel beam of 0.2-J, 248-nm, and 870-fs pulse propagating along ~100-m corridor. Transverse positions of multiple filaments formed by the optimum size cells were reproducible within at least 15 m along the propagation path. 3D+time simulations confirmed uninterrupted plasma channels with fixed positions in the transverse space similar to the experiment. Unoptimized cell size resulted in filaments shifting towards the cell center and destruction of uninterrupted filaments.

[Causal relationships in stroke and kidney injury]. / Prichinno-sledstvennye vzaimootnosheniia pri insul'te i porazhenii pochek.

AIM: To assess the frequency, severity, and causes of acute kidney injury (AKI) in patients with stroke. SUBJECTS AND METHODS: 272 patients (143 men and 129 women) (mean age, 66.7±11.6 years) with stroke were examined. The 2008 European Stroke Organization (ESO) guidelines were used to diagnose stroke, to determine indications for and contraindications to thrombolytic therapy, and to evaluate its efficiency. Hemorrhagic and ischemic strokes (HS and IS) were diagnosed in 52 (19%) and 220 (81%) patients, respectively. AKI was diagnosed and classified according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. RESULTS: AKI was diagnosed in 89 (33%) patients: 19 (36.5%) with HS and 70 (31.8%) with IS. The relative risk of death in patients with AKI-associated stroke was 2.6 (95% confidence interval (CI) 1.6-4.0). A poor outcome (the combined endpoint of death or Rankin scale scores of 4-5) was noted in 56 (62.9%) patients with AKI and in 70 (38.2 %) without AKI (χ2=14.6; p=0.0002). The relative risk of a poor outcome in patients with AKI-associated with stroke was 1.64 (95% CI 1.3-2.0). Forty-five (50.6%) patients with stroke developed AKI in the prehospital period. CONCLUSION: AKI complicates stroke in every three patients and increases death rates. 50% of cases develop AKI in the prehospital period due to the common causes of stroke and AKI.

[Value of N-terminal pro brain natriuretic peptide in predicting acute kidney injury in patients with acute decompensated chronic heart failure]. / Znachenie N-kontsevogo predshestvennika mozgovogo natriiureticheskogo peptida v prognozirovanii ostrogo povrezhdeniya pochek u bol'nykh s ostroi dekompensatsiei khronicheskoi serdechnoi nedostatochnosti.

AIM: To investigate the prognostic value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in the development of acute kidney injury (AKI) in patients with acute decompensated chronic heart failure (ADCHF). SUBJECTS AND METHODS: Eighty-three patients (55 (66%) men and 28 (34%) women; mean age, 65±11 years) with ADCHF were examined. AKI was diagnosed and classified according to the 2012 Kidney Disease Improving Global Outcomes Clinical Practice guidelines. To rule out contrast-induced AKI, the investigation enrolled only patients in whom radiopague agents had not been injected 7 days before and during hospitalization. Enzyme immunoassay was used to determine serum NT-proBNP concentrations in all the patients upon hospital admission. RESULTS: AKI was diagnosed in 18 (22%) patients, 13 (16%) had Stage I, 4 (5%) had Stage II, and 1 (1%) had Stage III. The serum concentration of NT-proBNP was significantly higher in patients with AKI than that in the other patients [1512.1 (981.0; 2246.2) and 861.8 (499.0; 1383.6) pg/ml (p=0.008). The rise in NT-proBNP concentrations of more than 942 pg/ml was established to be associated with a considerable increase in the risk of AKI (relative risk (RR) was 4.3; 95% confidence interval (CI), 1.27-14.90; p=0.02). RОС analysis indicated that a NT-proBNP level of >942 pg/ml allows prediction of AKI with a sensitivity of 78% (52; 94) and a specificity of 55% (44; 69) (AUC=0.70; p=0.006). Four (5%) patients died in hospital. NT-proBNP levels in all the dead were greater than 942 pg/ml. Two of the 4 deceased patients had AKI. CONCLUSION: A high level of NT-proBNP in a patient with ADCHF during hospitalization can serve as a biomarker for high risk of AKI and for high mortality rates.

[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.

[Use of somatostatin analogues in the pancreonecrosis therapy (kliniko-experimental research)]. / Osobennosti primeneniya sinteticheskogo analoga somatostatina v terapii pankreonekroza (kliniko-eksperimental'noe issledovanie).

The article is devoted to the study and optimization of therapeutic strategy in pancreatic necrosis. We studied the effectiveness of clinical application of human somatostatin analog - octreotide in different dosages. Submitted investigationconsists of experimental and clinical parts. MATERIAL AND METHODS: Experimentalmodel of acute destructive pancreatitis onrats of Wistar line with weight of 300±30 gwas reproduced.There were 5 animal groups (one control group and four experimental groups). Experimental animals received oktreotidin different doses. In 2 days there were estimated the blood biochemistryand histopathologic features of liver and pancreas of operated animals. In clinical part there were formed two groups of patients out of selected case histories by a principle of similarity of complex therapy differing in oktreotid doses, namely: 1) pancreatonecrosis patients estimated of 3 to 8 points by Ranson scale in whose treatment regimen oktreotid 300 mkg/day (n=70) dose was included; 2) pancreatonecrosispatients estimated of 3 to 8 points by Ransonin whose treatment regimenoktreoid1200 mkg/day (n=38) was included. There were compared indices of lethal outcomes, average bed-days, and dynamics of laboratory findings, number and volume of surgical procedures. RESULTS AND CONCLUSION: Dose-related effect of a synthetic analogue of somatostatin, acetateoktreotid, was proved. Introduction in complex therapy of pancreatonecrosisthe highest possible authorized doses of oktreotid (1200 mkg/day) is conducive to more favorable course of illness, dynamic reduction of amilazemia, decrease of lethal outcomes and total bed-day, and also, reduction of initial and repeated operative procedures.

[Prognostic Significance of Erythropoietin in Patients With Acute Coronary Syndrome].

AIM: to investigate the prognostic role of erythropoietin (EPO) in patients with acute coronary syndrome (ACS). MATERIAL AND METHODS: Eighty-four patients (46 men, 38 women, mean age 63+/-11 years) with ACS were studied. Twenty-one patients had ST-elevation myocardial infarction (STEMI), 12 - non-ST-elevation myocardial infarction, 51 - unstable angina (UA). Ten patients with STEMI received thrombolytic therapy. Coronary angiography during hospitalization was criterion for exclusion from the study. Serum EPO was measured at hospital admission. RESULTS: In-hospital mortality was 5%. Median EPO serum level was higher among patients who died (78.1 [27.8-143.5] vs. 9.0 [6.4-14.1]I.U./ml, p=0.004). Acute kidney injury (AKI) was observed in 7 patients with myocardial infarction (21%) and only in 1 with UA.EPO >10.5 I.U./ml was a significant predictor of AKI development (area under curve 0.73; sensitivity 71%, specificity 67%). CONCLUSION: The results of the present study indicate that in patients with ACS admission serum level of EPO may be an important biomarker of development of AKI and in-hospital mortality.

Seed Storage Globulins: Origin and Evolution of Primary and Higher Order Structures.

Legumin and vicilin are two-domain seed storage globulins similar in primary and higher order structures of their domains to single-domain plant germins as well as to the domains of two-domain and single-domain bacterial oxalate decarboxylases. Independent evolutionary pathways have been shown for the descent of the storage globulins and germins from two-domain and single-domain bacterial oxalate decarboxylases, respectively. As compared to vicilins, the primary and tertiary structures of legumins were found to most closely reflect the ancient features characteristic of a common precursor of storage globulins. During the evolution of the storage globulins, a mechanism specifically controlling their degradation has been formed. We found that limited proteolysis of soybean legumin and kidney bean vicilin in germinating seeds and in vitro leads to their regular changes, which initiate an extensive cleavage of storage globulin molecules by the one-by-one mechanism. As also shown, limited proteolysis of soybean legumin loosens the intersubunit interactions in its oligomeric molecule. Based on these data, we hypothesize that the deep one-by-one degradation of soybean legumin is triggered by its dissociation, which bares peptide bonds potentially susceptible to proteolytic attack but are masked in the oligomer.

[ACUTE KIDNEY INJURY AND IN-HOSPITAL MORTALITY IN PATIENTS WITH STROKE].

AIM: to estimate the frequency and severity of acute kidney injury (AKI) in patients with stroke and the influence of AKI on intra-hospital lethality. MATERIALS AND METHODS: 180 patients with stroke. 8 (4.4%) of them died within 24 hr after admission. It was impossible to diagnose AKI in these patients from serum creatinine dynamics. The development of AKI was followed up in the remaining 80 (47.1%) men and 91 (52.9%) women (mean age 66.6 ± 11.2 yr). AKI was diagnosed and classified as recommended by KDIGO (2012). RESULTS: AKI was documented in 47 (27.3%) patients including 13 (41.9%) and 34 (24.1%) with hemorrhagic and ischemic stroke respectively. Logistic regressive analysis revealed association of in-hospital lethality with AKI (relative risk 2.5; 95%, CI 1.7-3.8) regardless of sex, age, stroke type, duration of the disease prior to hospitalisation, arterial hypertension, and diabetes. CONCLUSION: stroke is complicated by AKI in every fourth patient; in combination, they significantly increase intra-hospital lethality.

[Endogenous erythropoietin, acute kidney injury, and prognosis in patients with acute coronary syndrome].

AIM: To investigate the prognostic value of serum endogenous erythropoietin (EPO) in patients with acute coronary syndrome (ACS), including that in the development of acute kidney injury (AKI). SUBJECTS AND METHODS: Eighty-four patients (46 men, 38 women; mean age 63 ± 11 years) with ACS were examined. Twenty-one (25%) patents were diagnosed with ECG ST-segment elevation acute myocardial infarction (STSEAMI), 12 (14%) had ECG non-STSEAMI, and 51 (61%) had unstable angina. Thrombolytic therapy was performed in 10 (48%) patients with STSEAMI. The patients whom had not undergone coronarography were included in the investigation to exclude the nephrotoxic effect of X-ray contrast agents. RESULTS: AKI was observed in 7 of the patients with acute myocardial infarction and in only 1 of those with unstable angina. Four (5%) patients died during hospitalization. The EPO level of > 10.5 IU/ml predicted the development of AKI in the ACS patients with a sensitivity of 71% and a specificity of 67%. That of > 13.7 IU/ml was associated with hospital death in the ACS patients with a sensitivity of 100% and a specificity of 75% (AUC = 0.93%). CONCLUSION: High serum EPO levels in an ACS patent during his hospital stay may serve as a biomarker for a high risk for AKI and high death rates.

[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.

[11beta-Hydroxylation of 6alpha-Fluoro-16alpha-Methyl-Deoxycorticosterone 21-Acetate by filamentous fungi].

Selected filamentous fungi--98 strains of 31 genera--were screened for the ability to catalyze 11beta-hydroxylation of 6alpha-fluoro-16alpha-methyl-deoxycorticosterone 21-acetate (FM-DCA). It was established that representatives of the genera Gongronella, Scopulariopsis, Epicoccum, and Curvularia have the ability to activate 11beta-hydroxylase steroids. The strains of Curvularia lunata VKM F-644 and Gongronella butleri VKM F-1033 expressed maximal activity and formed 6lpha-fluoro-16alpha-methyl-corticosterone as a major bioconversion product from FM-DCA. The structures of the major products and intermediates of the bioconversion were confirmed by TLC, H PLC, MS and 1H NMR analyses. Different pathways of 6alpha-fluoro-16alpha-methyl-corticosterone formation by C. lunata and G. butleri strains were proposed based on intermediate identification. The constitutive character and membrane-binding localization were evidence of a 11beta-hydroxylating system in G. butleri, while an inducible character and microsomal localization was confirmed for 11beta-hydroxylase of C. lunata. Under optimized conditions, the molar yield of 6alpha-fluoro-16alpha-methyl-corticosterone reached 65% at a FM-DCA substrate loading of 6 g/L.

[Treatment motivation in patients with chronic cardiorenal syndrome].

AIM: To study treatment motivation in patients with chronic heart failure (CHF) and in those with CHF concurrent with chronic kidney disease (CKD). SUBJECTS AND METHODS: A total of 203 patients (130 men and 73 women; mean age, 61.8±9.6 years) with CHF diagnosed and assessed in accordance with the National Guidelines of the All-Russian Research Society of Cardiology and the Heart Failure Society for the diagnosis and treatment of CHF (third edition, 2009) were examined. CKD was diagnosed according to the 2012 National Guidelines of the Research Nephrology Society of Russia. A group of patients with chronic cardiorenal syndrome (CRS) included those with CHF and CKD with a glomerular filtration rate (GFR) of <60 ml/min/1.73 m2. The clinical course of CHF, personality profile, and motivation for non-drug and drug treatments were assessed in patients with chronic CRS. RESULTS: CFR was 67.7±17.2 ml/min/1.73 m2; chronic CRS was observed in 89 (44%) patients. Psychological functioning assessment showed that the patients with chronic CRS as compared with those with CHF without CKD had high anxiety and maladaptive disease attitudes. CHF treatment motivation (compliance with lifestyle modification and medication) was proved inadequate and detected only in 31 (15.3%) patients with CHF regardless of the presence of CKD. The specific features of psychological functioning, which affected treatment motivation, were seen in patients with chronic CRS: those who were lowly motivated had a euphoric attitude towards their disease (p=0.03); those who were satisfactorily motivated showed an emotive accentuation of character (p=0.002). CONCLUSION: The presence of CKD aggravates the clinical course of CHF and negatively affects the psychological functioning of patients with CHF. The patients with chronic CRS are characterized by a low level of motivation for both drug and non-drug treatments, which should be taken into account when managing this cohort of patients.