Hemodynamic Changes in Intrarenal Blood Flow are Associated With Poor Prognosis in Patients With Acute Decompensated Heart Failure.

AIM: To evaluate a potential role of different patterns of intrarenal blood flow using Doppler ultrasound as a part of determining the severity of venous congestion, predicting impairment of renal function and an unfavorable prognosis in patients with acute decompensated chronic heart failure (ADCHF). MATERIAL AND METHODS: This prospective observational single-site study included 75 patients admitted in the intensive care unit for ADCHF. Upon admission all patients underwent bedside renal venous Doppler ultrasound to determine the blood flow pattern (continuous, biphasic, monophasic). In one hour after the initiation of intravenous diuretic therapy, sodium concentration was measured in a urine sample. The primary endpoint was the development of acute kidney injury (AKI). The secondary endpoints were the development of diuretic resistance (a need to increase the furosemide daily dose by more than 2 times compared with the baseline), decreased natriuretic response (defined as urine sodium concentration less than 50-70 mmol/l), and in-hospital death. RESULTS: According to the data of Doppler ultrasound, normal renal blood flow was observed in 40 (53%) patients, biphasic in 21 (28%) patients, and monophasic in 14 (19%) patients. The monophasic pattern of intrarenal blood flow was associated with the highest incidence of AKI: among 14 patients in this group, AKI developed in 100% of cases (OR 3.8, 95% CI: 2.5-5.8, p<0.01), while among patients with normal and moderate impairment of renal blood flow, there was no significant increase in the risk of developing AKI. The odds of in-hospital death were increased 25.77 times in patients with monophasic renal blood flow (95% CI: 5.35-123.99, p<0.001). Patients with a monophasic intrarenal blood flow pattern were also more likely to develop diuretic resistance compared to patients with other blood flow patterns (p<0.001) and had a decreased sodium concentration to less than 50 mmol/l (p<0.001) in a spot urine test obtained one hour after the initiation of furosemide administration. CONCLUSION: Patients with monophasic intrarenal blood flow are at a higher risk of developing AKI, diuretic resistance with decreased natriuretic response, and in-hospital death.

[Safety performance of rivaroxaban versus warfarin in patients with atrial fibrillation and advanced chro-nic kidney disease].

Aim To evaluate safety of using rivaroxaban in patients with stage 4 chronic kidney disease (CKD) or transient, stable decline of glomerular filtration rate (GFR) to 15-29 ml /min / 1.73 m2 in the presence of atrial fibrillation (AF).Material and methods This multicenter prospective, randomized study included patients admitted to cardiology departments from 2017 through 2019. Of 10 224 admitted patients 109 (3 %) patients with AF and stage 4 CKD or a stable decline of GFR to 15-29 ml /min / 1.73 m2 were randomized at 2:1 ratio to the rivaroxaban 15 mg /day (n=73) treatment group or to the warfarin treatment group (n=36). The primary endpoint was development of BARC and ISTH major, minor, and clinically relevant minor bleeding. Mean follow-up duration was 18 months.Results Patients receiving warfarin had a significantly higher incidence of BARC (n=26 (72.2 %) vs. n=31 (42.4 %), р<0.01) and ISTH (n=22 (61.1 %) vs. n=27 (36.9 %), p<0.01) minor bleeding and all ISTH clinically relevant (minor clinically relevant and major bleedings) n=10 (27.7 %) vs. n=8 (10.9 %), р=0.03]. The number of repeated hospitalizations was 65 (43% of patients) in the rivaroxaban treatment group and 27 (48% of patients) in the warfarin treatment group (р=0.57), including 24 (36.9 %) and 11 (40.7 %) emergency admissions in the rivaroxaban and warfarin treatment groups, respectively (р=0.96). Significant improvement of changes in creatinine clearance and GFR (by CKD-EPI and Cockroft-Gault) was observed in the rivaroxaban treatment group.Conclusion The study provided evidence for a more beneficial safety profile of rivaroxaban compared to warfarin in patients with AF and advanced CKD.

Controlling the Local Electronic Properties of Si(553)-Au through Hydrogen Doping.

We propose a quantitative and reversible method for tuning the charge localization of Au-stabilized stepped Si surfaces by site-specific hydrogenation. This is demonstrated for Si(553)-Au as a model system by combining density functional theory simulations and reflectance anisotropy spectroscopy experiments. We find that controlled H passivation is a two-step process: step-edge adsorption drives excess charge into the conducting metal chain "reservoir" and renders it insulating, while surplus H recovers metallic behavior. Our approach illustrates a route towards microscopic manipulation of the local surface charge distribution and establishes a reversible switch of site-specific chemical reactivity and magnetic properties on vicinal surfaces.

[Comparison of the efficacy and safety of electrical cardioversion and pharmacological cardioversion with nibentan in patients with persisting atrial fibrillation and flutter].

The aim of the study was to compare the efficacy and safety of pharmacological cardioversion (PC) by nibentan, a class III antiarrhythmic agent, and electrical cardioversion (EC) in patients with persisting atrial fibrillation (AFib) and atrial flutter (AFI) receiving basic antiarrhythmic therapy. Ninety-seven patients with persisting AFib and AFI were included in the trial (45 patients constituted PC group, and 52 constituted EC group). Both groups were comparable according to basic demographic and clinical parameters as well as antiarrhythmic therapy being applied. The results of the study showed that the efficacy of PC did not differ from that of EC (86.7% and 92.3% respectively, p = 0.282). the frequency of arrhythmogenic effect did not differ between the groups either (p = 0.46). One case of non-stable ventricular tachycardia was registered in the PC group. The most significant adverse effect was bradicardia, which was registered more often in the PC group than in EC group (26.7% and 3.8%, respectively, p = 0.001). In conclusion, the efficacy and safety of PC with nibentan in patients with persisting AFib/AFI is comparable with those of EC.

[Anginal States provoked by psychogenic stimuli. To the problem of psychosomatic reactions in patients with ischemic heart disease]. / Psikhogenno provotsirovannye anginoznye sostoianiia (k probleme psikhosomaticheskikh reaktsii u bol'nykh ishemicheskoi bolezn'iu serdtsa).

Two types of vulnerability of coronary vessels damaged by atherosclerosis were proposed basing on results of a study of 94 patients with psychosomatic reactions accompanied with ischemia or myocardial infarction. First variant (35 patients) was characterized by stable course of the disease (high effort angina without coronary catastrophes, episodes of unstable angina, etc.) and selective sensitivity to definite key affect of high personal value. Second variant (49 patients) was distinguished by pronounced clinical manifestations (effort angina with progressive lowering of exercise tolerance). Cardiovascular system displays universal susceptibility to negative emotions of various intensity.

[Psychosomatic reactions comorbid with ischemic heart disease: psychogenically provoked infarctions and myocardial ischemia]. / Psikhosomaticheskie reaktsii, komorbidnye ishemicheskoi bolezni serdtsa: psikhogenno provotsirovannye infarkty i ishemii miokarda.

Ischemic heart disease (IHD) with psychogenic provoked myocardial infarctions (MI) and myocardial ischemic disease (MID) is considered as a psychosomatic disorder. Seventy patients, 17 female and 53 male, aged between 39-77 years, mean age 61.2 +/- 9.9 years, were observed. The presence of both somatic (prolonged atherosclerotic lesion of coronary arteries) and mental (personality disorders with symptoms of reactive lability under psychic trauma influence) predisposition is obligate for manifestation or exacerbation of this IHD type. It is suggested that atherosclerotic coronary vessels affection of heterogeneity may exist. Two types of vulnerability are described. In type 1 cardiovascular system exhibits selective sensitivity to the influence of obligate and of great personality significance cathatymic affect. A strict condition of its realization is amplification of negative emotions up to a level of pathological affective outbursts in the spectrum of paranoiac or explosive reactions. In these cases, IHD is characterized by a stable course (angina of high tensions, without instable anginal episodes etc). In type 2 cardiovascular system reveals vulnerability to negative emotions, the continuum of which is ended by polar pathological affects-cathatymic and anxiety. In contrast to cathatymic affect, a common feature of anxiety affect is a fast, like short-term emotional outburst, manifestation of instable, labile, dramatic external appearances (with tears, converse disorders etc). IHD symptom complex is distinguished by pronounced clinical manifestations (stenocardia of tension with progressive impairment of tolerability to loadings).

[Relationship between the cyclic nucleotide content of blood plasma and the clinical course of chronic alcoholism]. / Issledovanie zavisimosti mezhdu soderzhaniem tsiklicheskikh nukleotidov v plazme kvori i klinicheskim techeniem khronicheskogo alkogolizma.

In patients with chronic alcoholism out of abstinence the plasma cAMP concentration was shown to decrease and that of cGMP to increase, cAMP/cGMP ratio was 1.8 in contrast to control value of 4.2. During abstinence the plasma cAMP level was higher and cAMP/cGMP ratio in patients with abstinence was 3.1. In patients with acute hallucinosis the plasma cAMP level was lower but during delirium, on the contrary, as well as the plasma cGMP level, higher than in control. The treatment of alcoholic patients relieved clinical symptoms of abstinence but the plasma cyclic nucleotide levels didn't change significantly. In most patients after cessation of delirium the plasma cAMP level was significantly lower as compared with pretreatment level.

[Phospholipid characteristics of the HDLP2 and HDLP3 composition in dysalphalipoproteinemia]. / Osobennosti fosfolipidngoo sostava LPVP2 i LPVP3 pri disal'falipoproteidemii.

There has been determined the phospholipid composition in HDLP2 and HDLP3 obtained from the blood plasma of males with different cholesterol (CS) level of HDLP. An increase in CS of HDLP is shown to be associated with the increase in a percentage of phosphatidylcholine, a proportion of phosphatidylcholine/sphingomyelin and a reduction of the percentage of sphingomyelin (mainly in HDLP2) and to a lesser extent--in HDLP3. A direct correlation has been established between the level of CS of HDLP obtained from the blood plasma of males living in 3 different geographical zones of the USSR and the indices of the phospholipid composition of HDLP2. Changes found in the phospholipid composition of HDLP3 in dysalphalipoproteidemia are associated with a difference in the triglyceride level of the blood plasma.

[Effect of hyperalphalipoproteinemia on structural characteristics of plasma lipoproteins according to electron paramagnetic resonance spin probe findings]. / Vliianie giperal'falipoproteidemii na strukturnye kharakteristiki lipoproteidov plazmy po dannym él ektronnogo paramagnitnogo rezonansa spinovykh zondov.

Spin probe, a stearic acid derivative, was used to study the structural features of different lipoproteins (LP) from plasma of subjects with different plasma level of high density LP (HDLP). Access of spin probe located in the internal nonpolar regions of HDLP for the reducer, ascorbic acid, was higher in hyperalphalipoproteinemia than in mean values of HDLP cholesterol concentration. An analogous effect was seen in subjects with LP of very low density. Possible causes of such differences as well as their role in biochemical reactions that proceed with LP participation are discussed.

[Collagen metabolism indices, and plasma concentrations of lipids, cyclic 3',5'-AMP, and certain hormones in 40-59-year-old men]. / Pokazateli obmena kollagena, soderzhanie lipidov, tsiklicheskogo 3',5'-AMF i nekotorykh gormonov v plazme krovi muzhchin 40-59 let.

Concentrations of protein-bound hydroxyprolin, free hydroxyproline, cholesterol, alpha-cholesterol, triglycerides, testosterone, estradiol, insuline and 3',5'-cAMP were estimated in blood plasma of 40-59 years old men. The persons thus examined were divided into three groups depending on the content of protein-bound hydroxyproline. Only in blood plasma of persons with low concentration of the protein-bound hydroxyproline a direct correlation was found between cAMP and testosterone, cAMP and alpha-cholesterol, between cAMP and the ratio of the cholesterol from atherogenous lipoproteins to the cholesterol from alpha-lipoproteins, as well as reciprocal correlation--between cAMP and insulin. The increase of protein-bound hydroxyproline concentration and the decrease of cAMP content in blood plasma might be related to proliferation of smooth muscle cells in the vessel wall, dependent, first, on alteration in the ratio of lipoproteins of various density in blood plasma and, second, on alteration in the hormone concentration in blood and tissues.

[Structural characteristics of plasma lipoproteins studied with spin-labelled fatty acids]. / Issledovanie strukturnykh osobennostei lipoproteidov plazmy s pomoshch'iu spin-mechennykh zhirnykh kislot.

As shown by means of electrone paramagnetic resonance of spin probes, a magnitude of ordering of lipoprotein molecular arrangement both internal and external parts of molecule was decreased in a following sequence: high density lipoproteins greater than low density greater than very low density lipoproteins. Permeability towards a reducing agent - ascorbic acid - was altered similarly in the lipoprotein surface monolayer.

[Lipid peroxides and atherosclerosis. The enzymatic detoxication of lipid peroxides in the blood in ischemic heart disease due to coronary artery arteriosclerosis]. / Perekisi lipidov i ateroskleroz. Fermentativnaia detoksikatsiia perekisei lipidov v krovi bol'nykh ishemicheskoi bolezn'iu serdtsa, obuslovlennoi aterosklerozom koronarnykh arterii.

It was established that in blood of patients with ischemic heart disease due to atherosclerosis of the coronary arteries (the diagnosis was verified in selective coronaroangiography) the content of acylhydroperoxides grows while the activity of glutathione-peroxidase II decreases. In blood of patients with no damage to the coronary vessels (according to the results of angiography), glutathione-peroxidase II activity does not differ significantly from the values in the control group. The decrease of glutathione-peroxidase II activity was most marked in patients with ischemic heart disease and hypercholesterolemia. It is suggested that the increase in the peroxide content in blood of patients with ischemic heart disease may be due to the sharp decrease in the activity of glutathione-peroxidase II.

[Changes in the quality of hormones in blood plasma and ischemic heart disease risk factors in 40--59-year-old men]. / Izmeneniia kolichestva gormonov v plazme krovi i faktory riska ishemicheskoi bolezni serdtsa u muzhchin v vozraste 40--59 let.

Testosterone, estradiol, hydrocortisone, total cholesterol, triglycerides, cholesterol of alpha-lipoproteins (alpha-CS) were estimated in blood plasma of 124 40--59 years old men examined in the course of an epidemyolodical study (representative selection). Content of insulin was estimated in 112 persons and of growth hormone--in 102 persons. Disbalance of steroid hormones (decrease in alpha-CS) was observed in men with one factor of risk of heart ischemic impairment. Occurrence of two factors of risk of heart ischemic impairment--hypertriglyceridemia and decrease in alpha-CS--was related not only to disbalance of steroid hormones but also to alteration in the ratio of protein hormones--insulin and growth hormone.

[Spin label study of plasma lipoproteins]. / Issledovanie lipoproteidov plazmy metodom spinovykh metok.

Lipoprotein structure was studied by means of EPR-spectroscopy of spin probes--iminoxyl derivatives of stearic acid and of androstane--in blood plasma of 40-59 years old men. The mode of wrapping of external monolayer of lipoprotein particles, the type of their intermolecular interactions were similar to corresponding characteristics of bilayer in biological and model membranes. Correlation was observed between concentration of separate lipoproteins in blood plasma and the structural parameters of the probe distribution in hydrophobic and polar regions of the lipoprotein preparations. The phenomena observed might be related to capacity of the high density lipoproteins to accept cholesterol from cell membranes with transfer of cholesterol into liver tissue, where it is subsequently metabolized, as well as to the property of the very low density lipoproteins to transfer cholesterol into tissues, particularly, into vascular walls.

[Thrombocyte aggregating capacity in ischemic heart disease caused by coronary arteriosclerosis]. / Agregatsionnaia sposobnost' trombotsitov u bol'nykh ishemicheskoi bolezn'iu serdtsa, obuslovlennoi koronarynym aterosclerozom.

A distinct increase in the aggregative property of blood platelets, displayed by an increased degree of aggregation and enlargement of the platelet aggregates, was revealed in patients with ischemic disease of the heart. The more severe the atherosclerotic process in the coronary arteries (according to the findings of selective coronarography), the more is the aggregative property of platelets intensified. The stimulating effect of smoking on platelet aggregation was also established.

[New approaches to the evaluation of the cholesterol content of plasma lipoprotein fractions in normo- and hyperlipoproteinemias]. / Novye podkhody k otsenke soderzhaniia kholesterina fraktsii lipoproteidov plazmy krovi pri normo- i giperlipoproteidemii.

The examination of 1073 males ranging in age from 40 to 59 living in Moscow and Leningrad, and of 146 patients with ischemic heart disease showed a decrease in the alpha-lipoprotein cholesterol level and an increase in the cholesterol content of atherogenic fractions (beta- and pre-beta-lipoproteins) in individuals with ischemic heart disease in the absence of hyperlipoproteinemia (HLP). In combination of ischemic heart disease with hyperlipoproteinemia these changes are pronounced to a larger degree. From the analysis of the results of the studies it is suggested that the coefficient (see article) is determined to reveal disorders in lipoprotein metabolism particularly in the absence of hyperlipoproteinemia. This coefficient is significantly higher in individuals with ischemic heart disease and no hyperlipoproteinemia than in healthy males of the same age group; its value is highest in ischemic disease with hyperlipoproteinemia.

[Study of low density lipoproteins in hyperlipoproteinemia by the method of double immunodiffusion]. / Issledovanie lipoproteidov nizkoi plotnosti pri giperlipoproteidemii metodom dvoinoi immunodiffuzii.

By way of gel double immunodiffusion a certain heterogeneity of low density lipoproteins was observed to manifest itself in an additional band of immunoprecipitation. The incidence of this additional band does not exceed 1/3 of the cases of low density lipoproteins studies in normal individuals, while in those with ischaemic heart disease the additional band is found twice-thrice as often, the highest incidence being noted in patients with ischaemic heart disease and Type IIb hyperlipoproteinemia (93% of cases). The revealed immunochemical heterogeneity of low density lipoproteins was shown to be not connected with the appearance of any new, additional antigen in their structure. Most probably it is attributable to the presence of lipoprotein particles with a quantitatively different protein and lipid composition, probably of intermediate lipoprotein metabolites in blood plasma, or conformation changes in the structure of low density lipoproteins.