[THE CENTURY OF WAGNER PERM STATE MEDICAL UNIVERSITY].

Perm City is the large industrial, scientific, educational and cultural center in Volga Federal District. Also it is one of the oldest and the most attractive Ural cities. Higher medical education on the West Ural was founded in 1916. The main stages of the development of Perm State Medical University are lightened in the article. Perm State Medical University is the peculiar school of experts of different medical specialties, scientific and educational personnel, specialists of the middle range of the health care system. The history of the university is full of historical, professional and creative traditions. 2016 year is the century of the higher medical education on the West Ural and the anniversary year for Perm State Medical University by E.A. Wagner.

[SYSTEMIC INFLAMMATION MARKERS AND MICROALBUMINURIA IN INFLAMMATORY BOWEL DISEASES].

PURPOSE: The aim of the investigation was to study the characteristics of endothelial function in patients with IBD. MATERIALS AND METHODS: 61 patients with ulcerative colitis (UC) and Crohn's disease (CD) in the acute phase or with newly diagnosed forms of the disease were examined. CD group included 16 people (8 women and 8 men) mean age 35.63 ± 5.51 years. UC group included 45 patients (18 women and 27 men), their average age was 36.76 ± 3.17 years. To assess the endothelial dysfunction the level of microalbuminuria (MAU) was examined with Micral-Test strips. Serum concentration levels of CRP, TNF--α, alpha1 and alpha 2-globulins, fibrinogen as well as ESR were evaluated as the markers of systemic inflammation. RESULTS: In CD patients a significant increase of MAU in severe forms of the disease 32 ± 10.95 mg/I (p < 0.05). was revealed. Furthermore, MAU was significantly higher in individuals with extraintestinal manifestations and complications of CD (28.01 ± 17.89 mg/I and 20.00 ± 14.14 mg/, respectively). A significant relationship of the MAU levels and severity of CD (r = 0.797, p = 0.0002) as well as the presence of extraintestinal symptoms (r = 0.625, p = 0.0096) were identified. The evaluation of the systemic inflammation narkers showed a significant increase of CRP levels and ESR in severe forms of IBD. A positive correlation of CD with the ESR (r = 0.802, p = 0.0021), CRP (r = 0.773, p = 0.0004), alpha-2 globulin (r = 0.534, p = 0.0298) and fibrinogen (r = 0.647, p = 0.0067) was identified. CONCLUSIONS: The evidence of endothelial dysfunction in patients with IBD was revealed that was expressed in the MAU levels elevation. The MAU level can be regarded as the criterion of the CD severity as well as the sign of its unfavorable course.

[FEATURES OF HEART RATE VARIABILITY IN PATIENTS WITH ASSOCIATIVE COURSE OF GASTROESOPHAGEAL REFLUX DISEASE AND HYPERTENSION].

The paper presents the results of a study of 83 patients with gastroesophageal reflux disease, hypertension and in their comorbidial course. The purpose of the study is to examine the characteristics of heart rate variability (HRV) in the given cohort of patients. Materials and Methods: The main group consisted of 68 patients with a mean age of 35,37 ± 10,34 years. Patients with isolated pathologies: 20 - with gastroesophageal reflux disease (GERD), 25 - with arterial disease (hypertension) without concomitant diseases. 23 patients had a combination of hypertension and GERD. The comparison group consisted of 15 healthy men. All the subjects were comparable in terms of age, sex, duration of Arterial hypertension and GERD. Results: Patients with associated course of arterial hypertension and GERD were found to have distinctions in HRV parameters, which indicate an increase in sympathetic nervous system activation and a decrease in parasympathetic influence. HRV was non-uniform in patients with different clinical and endoscopic GERD variants. In patients with endoscopically positive GERD (EPRD), there was a significant increase in both time (SDNN, SDANN, SDNN-index), and spectral parameters of HRV (VLF, HF). Conclusion: In associated course of acid dependent diseases (GERD) and hypertension, time and spectral parameters of heart rate variability significantly reduce, reaching the lowest values in patients with signs of reflux esophagitis. Comorbidity of GERD and hypertension exacerbates originally existing excessive influence of the sympathetic nervous system in patients with hypertension, leading to parasympathetic failure, and, ultimately, significantly weakening adaptive capabilities. Revealed changes in HRV parameters among patients with the given sintropy defines such a combination of diseases as undesirable, both for cardiovascular and autonomic nervous systems.

[Immune status of patients with persistent atrial fibrillation and coronary heart disease].

We estimated the strength of immune response to chlamydial infection in patients with CHD. It was most pronounced in CHD patients with atrial fibrillation (AF). There was close relationship between past chlamydial infection and markers of inflammation (CRP and TNF-alpha). The study demonstrated high prognostic value of these markers for the development of AF during CHD and their relationship with characteristics of structural and functional remodeling of myocardium during CHD with AF. The study confirmed the role of inflammation in pathogenesis of AF in CHD patients.

[Peculiarities of the course of arterial hypertension in patients with atherosclerotic stenoses of brachiocephalic arteries before and after surgery on carotid arteries].

Study aim was to investigate relationship between atherosclerosis of carotid arteries (CA) and the presence of arterial hypertension (AH) and possibilities of correction of AH after surgery. We examined 70 patients with episodes of elevation of arterial pressure (AP) scheduled for surgical interventions on brachiocephalic arteries (BCA) because of CA stenoses (n=50, group 1) or anomalies of BCA development (n=20, group 2). Before operation patients of group 1 had higher mean AP than patients of group 2 (103.6+/-11.3 and 91.7+/-6.6 mm Hg, respectively, p=0.00007). This difference disappeared after surgery. In postoperative period in patients with CA stenoses levels of both systolic and diastolic AP decreased (from 145.1+/-14.7 to 135.6+/-12.3, p=0.02; and from 83.3+/-10.2 78.1+/-9.7 mm Hg, =0.02, respectively). In group 2 no significant AP reduction was observed. Thus AP elevation in patients with involvement of BCA to a considerable degree is caused by CA stenosis. Surgical treatment of these patients facilitates lowering of AP.

[Problem of a comorbidity of arterial hypertension and acid-dependent diseases].

The paper presents a concise literature review on the concomitant course of the most common nosological entities in the population, such as arterial hypertension (AH) and acid-dependent diseases (ADD). Data on the prevalence, commonness of etiological and pathogenetic factors, the specific features of a clinical course, and diagnostic difficulties are analyzed in persons with AH associated with ulcerative and gastrointestinal reflux diseases. The causes and consequences of these nosological entities are shown; their clinical, morphological, and hemodynamic features are covered. The results of investigations characterizing the specific features of autonomic regulation, diurnal blood pressure variations, and the central hemodynamics in the comorbidity of the diseases in question are given. The rational antihypertensive therapy of AH concurrent with ADD is presented in terms of their impact on gastrointestinal tract disease.

[The prediction of atrial fibrillation in patients with arterial hypertension].

AIM: To study the parameters of the structural and functional state of the myocardium in patients with hypertension, to determine their prognostic value on the risk of atrial fibrillation (AF). PATIENTS AND METHODS: The study involved 72 people: patients with hypertension and AF, with isolated hypertension and apparently healthy individuals. All of them performed echocardiography, blood pressure monitoring and monitoring of cardiogram. RESULTS: The dilatation of left atrial was founded: patients with the atrial fibrillation on the background of hypertension observed the most pronounced changes in the left atrial. In patients with hypertension without arrhythmias and in combination with atrial fibrillation severe left ventricular hypertrophy was observed. Left ventricle systolic function in groups has been stored but in patients with atrial fibrillation on the background of hypertension was significantly lower. The risk of atrial fibrillation in patients with hypertension prognostic value are the only values of the age, the volume index of the left atrial to the body surface area and left ventricular ejection fraction. CONCLUSIONS: The risk of AF in hypertension occurs over the age of 55 and each subsequent year increases it in 1,2 times, it increases with an index value of the left atrial to the body surface over 29 ml/m2 and with a decrease in left ventricular ejection fraction less than 58%.

[Changes in the serum marker of cardiac fibrosis and inflammation associated with atrial fibrillation].

This work was designed to study characteristics of cardiac fibrosis and inflammation associated with idiopathic atrial fibrillation (AF) and AF with concomitant arterial hypertension (AH). The same parameters were investigated in connection with different types of arrhythmia. It is shown that patients with AF have increased levels of serum markers of fibrosis and inflammation (C-terminalpropeptide of type I procollagen (PICP) and IL-6); they are especially high in case of combination ofAF and AH. Characteristics of fibrosis are related to the form of AF. PICP levels increase in patients with chronic and recurrent AF. Activity of matrix metalloproteinase-9 (MMP-9) does not depend on the type of AF whereas concentration of tissue metalloproteinase inhibitor-1 (TMPI-1) tends to decrease in case of permanent AF. Patients with recurrent and especially permanent AF have higher IL-6 levels than practically healthy subjects. Permanent AF is associated with a slightly elevated level of tumour necrosis factor-alpha.

[Ventricular arrhythmias and arterial hypertension: role of inflammatory biomarkers in arrhythmia development].

Arrhythmogenic role of proinflammatory cytokines is still unclear despite of wide discussion on inflammatory arrhythmogenic mechanisms. The main goal of study was to compare levels of tumor necrosis factor a, interleukin 6 and interleukin 4 in hypertensive patients with and without ventricular rhythm disturbances. The study included 100 cases, 50 of those had ventricular arrhythmias. Levels of tumor necrosis factor a, interleukin 6 and interleukin 4 were studied. Possible connections of above mentioned biomarkers with ventricular arrhythmias, blood pressure, echocardiography left ventricle data were evaluated. Higher level of biomarkers was associated with presence of ventricular arrhythmias; higher rate of ventricular extrasystoles was accompanied with insignificantly lower biomarker level.

[Method for determining leukocytic lipid-releasing capacity in the diagnosis of mechanisms responsible for atherogenesis in patients with coronary heart disease and ischemic stroke].

The authors have studied the mechanism responsible for neutrophilic accumulation and release of protein-lipid complexes in patients with atherosclerosis and the clinical value of this reaction. They present the results of experimental studies and clinical observations in the groups of patients with ischemic stroke, coronary heart disease, bronchial asthma, chronic obstructive pulmonary disease, and rheumatoid arthritis. Whether the process of neutrophilic and release of protein-lipid can be in vitro modulated in a 3-day culture has been demonstrated. The high diagnostic value of the method for determining the lipid-releasing capacity of leukocytes is shown. Some proteins involving in the formation of pathogenic protein-lipid complexes are identified. There is evidence for the use of new differential criteria for visceral diseases originating from atherosclerosis.

[Possibility of predicting the use of doxazosin in the treatment of arterial hypertension]. / Vozmozhnost' prognozirovaniia ispol'zovaniia doksazozina v lechenii arterial'noi gipertenzii.

Fifteen patients with arterial hypertension (AH) were examined. Their peripheral venous hemodynamics, central circulation, systolic and diastolic functions were studied and a course therapy with doxazosin (cardura, Pfizer, USA) was performed for 30 days. Cardura (doxazosin) was found to be the drug of choice for antihypertensive therapy in patients with AH concurrent with baseline systemic venous normo- or hypertension. In patients with baseline venous hypervolemia in the presence of venous hypotension, cardura therapy resulted in deterioration of signs of venous insufficiency and promoted the development (in 38% of the cases) or progression (in 38%) of diastolic dysfunction of the left ventricle (LV). Thus, the venous circulation and LV myocardial function should be originally assessed in order to decide whether cardura (doxazosin) is used in antihypertensive therapy in patients with AH.

[Venous dysfunction in patients with hypertension and different hemodynamic variants of disease]. / Varianty venoznoi disfunktsii u bol'nykh gipertonicheskoi bolezn'iu s razlichnymi gemodinamicheskimi variantami zabolevaniia.

AIM: To identify variants of venous dysfunction in patients with arterial hypertension (AH) in respect of the disease hemodynamic profile. MATERIAL AND METHODS: The assessment of central hemodynamics and peripheral venous circulation in the veins of the lower limbs was made in 60 patients with different hemodynamic variants of primary AH. RESULTS: Patients with ejection hypertension were characterized by high extensibility of the peripheral veins and low tolerance to orthostatic loads. In patients with hypertension of resistance venous dysfunction was characterized by signs of venous hypertension in rigidity of the venous wall as well as low and inadequate reactivity of peripheral large vessels. CONCLUSION: The results of the orthostatic test show different response of venous hemodynamics in patients with hypertension of ejection and resistance. This provides adequate activity of the heart in erect position.

[Effect of capoten on hemostasis of patients with hypertension]. / Optimizatsiia pod vliianiem kapotena sostoianiia gemostaza u bolnykh gipertonicheskoi boleznìu.

The effects of capoten on hemostasis were studied in 63 patients with Stages I and II hypertensive disease in relation to the hemodynamic type and severity of the disease. Thrombophilia was revealed just at the onset of the disease mainly due to hemostatic endothelial dysfunction which progresses with the hemodynamic development of hypertensive disease. Capoten optimizes hemostatic parameters by affecting endothelial function, which serves an additional mechanism of the antihypertensive effect of the drug. Supplementary techniques affecting the rheological properties should be used in the treatment of hypertensives with moderate-to-serve courses along with resistive hemodynamics.

[The effect of hypoglycemic therapy on atherogenesis in diabetic patients]. / Vliianie sakharosnizhaiushchei terapii na aterogenez u bol'nykh sakharnym diabetom.

Lipid blood fractions, malonic dialdehyde and antioxidant activity of plasma and red blood cells were evaluated in 56 patients with type I diabetes mellitus. Twenty-three of those had coronary heart disease. It was established that, if the patients received mean doses of insulin 80.5 +/- 2.70 U/day, they had higher levels of cholesterol, triglycerides and VLDL cholesterol than those who were treated with insulin in a dose of 43.2 +/- 1.84 U/day.

[Several indicators of hormonal homeostasis (hypophysis--gonads) in patients with hypertension]. / Nekotorye pokazateli gormonal'nogo gomeostaza (gipofiz--gonady) u bol'nykh gipertonicheskoi bolezn'iu.

One hundred and sixty-three male patients with essential hypertension (EH) stage I (68 subjects) and II (95 subjects) were compared to healthy controls by concentrations of renin, aldosterone, LH, FSH, prolactin and estradiol assessed by means of radioimmunoassay. The findings show that unlike healthy controls EH patients have low levels of LH and testosterone, high prolactin and unchanged FSH and estradiol concentrations. The involutional dynamics is similar for patients and controls: dissociation in the levels of hypophyseal hormones and testosterone. An age-specific trend in prolactinemia was related to EH severity.

[The sick sinus syndrome and lipid peroxidation: its possible role in the pathogenesis of the disease]. / Sindrom slabosti sinusovogo uzla i perekisnoe okislenie lipidov: vozmozhnaia rol' v patogeneze zabolevaniia.

As many as 196 persons were examined. Of these, 106 were with a normal sinus rhythm and 90 had sick-sinus syndrome (SSS). Measurements were made of the level of malonic dialdehyde and the total antioxidant blood activity, the lipoprotein spectrum. Electrophysiological studies of the heart, ECG monitoring and bicycle ergometry were carried out. Maximal impairment of lipid peroxidation (LP) in type IIA hyperlipoproteinemia (HLP) was identified according to Fredrickson both in patients with SSS and without it. In patients with SSS, the rise of the closeness of the relationship between LP and HLP was observed. In patients with CHD and (or) EH, LP was mostly disturbed in EH and in associated CHD and EH (both in patients with and without SSS). As compared with the respective control groups, SSS patients showed considerable disorders of LP. It is suggested that LP disorders related to HLP may play a role in the pathogenesis of SSS.