[Effect of atorvastatin on pro-inflammatory status (in vivo and in vitro) in patients with essential hypertension and metabolic syndrome].

AIM: To study effect of atorvastatin on spontaneous production of cytokines and reactive oxygen species by mononuclear leukocytes of blood of hypertensive patients with metabolic syndrome in vivo and in vitro. MATERIAL AND METHODS: We conducted an 8-week open prospective study on 36 patients with essential stage II hypertension associated with metabolic syndrome. Along with examination made in specialized cardiological clinic we assessed spontaneous production of cytokines and reactive oxygen species by blood mononuclear leukocytes during therapy with atorvastatin (in vivo). Dynamics of these parameters under the influence of atorvastatin on suspension of mononuclear leukocytes was also assessed in vitro. RESULTS: Therapy with atorvastatin (20 to 40 mg/day) facilitated reduction of serum concentration of acute phase proteins (C-reactive protein and neopterin) and decrease of spontaneous production by blood mononuclear leukocytes of proinflammatory cytokines (interleukin [IL]-1ß, IL-6 and tumor necrosis factor [TNF]-α) and reactive oxygen species. Dynamics of cytokine concentrations in supernatants of mononuclear leukocytes obtained after incubation of the cells with atorvastatin in vitro confirmed the assumption of direct inhibitory effect of this drug on spontaneous production of some proinflammatory cytokines (IL-6 and monocyte chemotactic protein-1). Absence of significant lowering of concentrations of other proinflammatory cytokines (IL-1ß and TNF-α) and expression of reactive oxygen species in vitro evidenced for complex indirect effect of therapy with atorvastatin on their production.

[Effect of eprosartan on the hemostatic system in patients with chronic kidney disease associated with hereditary thrombophilia].

AIM: To study the effect of eprosartan, an angiotensin II type 1 (AT1) receptor blocker, with sympatholytic activity on the hemostatic system in patients with chronic kidney disease (CKD) associated with hereditary thrombophilia. SUBJECTS AND METHODS: The 12-week open-label uncontrolled trial included 31 patients with Stages I-II CKD: 15 patients with chronic glomerulonephritis and 16 with diabetic nephropathy burdening types 1 and 2 diabetes mellitus (DM) in 10 and 6 cases, respectively. In all the patients, CKD was associated with one of the heterozygous forms of thrombophilia: the polymorphic methylenetetrahydrofolate reductase gene variant C677T was found in 18 patients; the polymorphic coagulation factor V gene variant G1691A was in 9; and the polymorphic coagulation factor II gene variant G20210A in 4. Along with the thorough examination accepted in nephrology and endocrinology clinics, investigations of vascular-thrombocytic and secondary hemostasis and the anticoagulant and fibrinolytic systems were made before and after treatment. RESULTS: Eprosartan therapy caused positive changes in the indicators of vascular-thrombocytic (diminished platelet aggregation, reduced surplus of von Willebrand factor and endothelin-1) and secondary (decreased coagulation factor VII activity, longer activated partial thromboplastin time) hemostasis and the anticoagulant (reduced antithrombin III deficiency) and fibrinolytic (elevated blood plasminogen concentrations) systems. CONCLUSION: The pleiotropic effects of eprosartan may be used to correct hypercoagulability syndrome in patients with CKD associated with hereditary thrombophilia.

[The influence of amlodipine on transcapillary metabolism of oxygen during coronary heart disease with insulin resistance].

This three-week open uncontrolled study included 34 men (mean age 53.14+-1.19 yr) with coronary heart disease (CHD) and insulin resistance (HOMA >2. 77); it was designed to estimate effect of amlodipine on transcapillary oxygen metabolism (TCOM). Multivascular stenosing coronary atherosclerosis was managed by aortocoronary bypass surgery. Traditional methods applied in specialized cardiological clinics were supplemented by TCOM measurement using a PA-2 polarograph (Czech Rep.). Polarography revealed deterioration of TCOM parameters including permeability of hemocapillaries, adaptive reserves of the microcirculatory bed, and oxygen supply to the tissues. Amlodipine therapy demonstrated high antianginal potency of this drug and its ability to improve TCOM

[Prothrombotic state in patients with metabolic syndrome: an association with inflammation].

AIM: To comprehensively study hemostasis pathology and its association with the laboratory markers and mediators of inflammation in patients with metabolic syndrome (MS). SUBJECTS AND METHODS: One hundred and eleven patients with type 2 diabetes mellitus, who were diagnosed as having MS, were examined. Vascular-platelet and secondary hemostases and anticoagulant and fibrinolytic systems were evaluated, by performing the complete clinical, laboratory, and instrumental study accepted in a specialized endocrinology clinic. The blood concentrations of high-sensitivity C-reactive protein and proinflammatory cytokines were determined in all the patients with MS and control persons (n = 50). RESULTS: It was found that in patients with MS, hemostasis pathology that might be classified as the combined form of a prethrombotic state, which was caused by different types of a constellation of vascular-platelet and plasma hemostases, as well as physiological anticoagulant deficiency, was linked to the laboratory markers and mediators of subclinical inflammation. CONCLUSION: In the patients with MS, subclinical systemic inflammation is of substantial importance for the mechanisms of a prethrombotic state.

[Pleiotropic effects of atorvastatin and dynamics of quality of life characteristics in patients with hypertensive disease and metabolic syndrome].

AIM: To study pleiotropic effects of atorvastatin during 8-week therapy of metabolic syndrome and estimate their relationship with dynamics of quality of life characteristics (QLC). MATERIAL AND METHODS: This 8-week study included 36 patients with stage II hypertensive disease associated with metabolic syndrome (MS). Comprehensive clinical, laboratory and instrumental examination was supplemented by QLC assessment using the MOS SF-36 questionnaire. RESULTS: 8-week therapy of stage II hypertensive disease associated with metabolic syndrome using individually selected doses of atorvastatin (20 to 40 mg/d) significantly reduced atherogenic cholesterol fraction and serum leptin levels; it had positive effect on carbohydrate and purine metabolism and safely maintained positive dynamics of subjective assessment of most points of the MOS SF-36 questionnaire.

[The biochemical markers of endothelium dysfunction in patients with diabetic nephropathy].

The article deals with studying the degree of increase of the von Willebrand factor and the concentration of endothelin-1 in blood plasma in the subgroups of patients with diabetes mellitus formed depending on of type of disease and presence of phenotype with affection of kidneys. The sampling of 176 patients with diabetes mellitus (65 patients with diabetes mellitus type 1, 111 patients with diabetes mellitus type II) was examined. The control group consisted of 30 healthy persons. In the capacity of biochemical markers of endothelium dysfunction the activity of the von Willebrand factor and the concentration of endothelin-1 in blood were considered. In all patients with diabetes mellitus the biochemical characteristics of endothelium dysfunction are present manifesting by increase of concentration of endothelin-1 in blood which is especially expressed under disease phenotype with affection of kidneys. Despite of the apparent lesion of endothelium in patients with diabetes mellitus compromised with diabetic nephropathy the thrombocytes aggregation induced by ristomicine does not undergo natural changes. Hence, to consider in these patients the increasing activity of the von Willebrand factor as a reliable marker of endothelium dysfunction is not seemed possible.

[Quality of life in patients with coronary heart disease associated with metabolic syndrome: results of factor analysis].

AIM: To identify the factors most substantially influencing the quality of life (QL) in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS), by using the principal component method. SUBJECTS AND METHODS: One hundred and two male patients (mean age 48.6 +/- 1.02 years) with CHD associated with MS, who had experienced large-focal myocardial infarction not earlier than 6 months before, were examined. Estimation of QL (EORTC QLQ CORE 30) and emotional-personal sphere (brief multifactorial personality questionnaire test and Spielberg's trait anxiety inventory) was made along with the complete clinical, laboratory, and instrumental examination accepted in specialized clinical practice of cardiology. RESULTS: A factor analysis of the variables obtained after a thorough examination of the patients could identify 4 common QL determinants, such as postinfarction cardiac remodeling, neurotization, obesity, and the degree of heart and coronary failure. CONCLUSION: MS in patients with CHD appreciably determines the total score of physical, emotional, and social well-being. In the cluster of MS components, obesity is a major factor that influences QL in patients who have sustained myocardial infarction.

[Effect of lipid free radical oxidation on renal functional status in patients with alcohol withdrawal syndrome].

AIM: to study the activity of free radical processes in patients with alcoholism and renal lesion (A+RL) and the implication of depressed efficiency of the regulatory mechanisms limiting the accumulation of highly toxic products of lipid free radical oxidation (LFRO) in the development of secondary nephropathy. SUBJECTS AND METHODS: Fifty-seven patients (mean age 31 +/- 2.8 years) with a 5-10 history of alcoholism who had been admitted to hospital for uncomplicated alcohol withdrawal syndrome were examined. Alcoholic renal lesion was detected in 17 (29.8%) patients. A control group comprised 20 healthy individuals. The activity of LFRO and antioxidative defense (AOD) was studied. RESULTS: In patients with alcoholism, the study indicators reflecting the activity of LFRO statistically significantly exceeded those in the group of healthy individuals. These patients were found to have also suppressed mechanisms of first- and second-line AOD in the A+RL group. CONCLUSION: LFRO activation developing in the presence of suppressed AOD seems to contribute to the development of secondary nephropathy in patients with alcoholism.

[Diastolic dysfunction of left ventricle in psoriatic patients with concomitant opisthorchiasis before and after antihelminthic therapy].

The aim of the study was to evaluate left ventricular diastolic function in psoriatic patients with chronic opisthrochosis (CO) before and after antihelminthic therapy. It included 75 patients with psoriasis and CO, 50 with psoriasis alone, 50 with CO, and 20 healthy subjects. All patients underwent standard echocardiographic examination in the M-, B-, and Doppler mode. The study revealed impaired active relaxation of the left ventricle manifest as increased isovolumic relaxation time more pronounced in patients with concurrent CO and psoriasis than in those with psoriasis alone. Antihelminthic therapy did not cause deterioration of the diastolic function in these patients and should be recommended in case of combined pathology.

[Study of the emotional-and-personality sphere in patients with psoriasis concurrent with chronic opisthorchiasis].

The study was undertaken to evaluate the emotional-and-personality sphere in patients with psoriasis concurrent with chronic opisthorchiasis (CO). A hundred and fifty patients with psoriasis concurrent with CO, 100 psoriatic patients without helminthiasis, 100 patients with CO, and 30 healthy individuals were examined. The SMOL test was used to evaluate the emotional-and-personality sphere. Clinical and psychological studies of patients with psoriasis alone and in combination with CO revealed unidirectional psychoemotional (mainly hypochondriacal) changes in patients in these groups. However, anxiety and hypochondriac disorders were clinically significant in patients with comorbidity (psoriasis + CO). This suggests that Opisthorchis invasion is of considerable importance in the genesis of these changes and requires medical correction of helminthiasis.

[The effectiveness of eprosartan in patients with chronic glomerulonephritis].

The subjects of this 12-week open non-controlled study of the organoprotective efficiency of eprosartan were 15 patients with chronic glomerulonephritis. The results of the investigation demonstrated high organoprotective activity of eprosartan in a dose of 600 mg a day, which manifested by anti-proteinuric and anti-hematuric effects, as well as positive changes in the parameters of intragromerular filtration, reduction of left ventricular hypertrophy and rigidity, and normalization of the vascularmotor function of the brachial arterial endothelium. To a large extent, the organoprotective activity of eprosartan depends on the unique pharmacodynamic profile of this drug, which is able to decrease excessive functional activity of the sympathetico-adrenal system, which is reflected in the dynamics of the cardiac rhythm dispersion parameters.

[Estimation of the levels of reactive and personality anxiety in patients with psoriasis concurrent with chronic opisthorchiasis].

The purpose of the study was to evaluate reactive and personality anxiety in patients with psoriasis concurrent with chronic opisthorchiasis (CO). Seventy-five patients with psoroasis concurrent with CO, 70 psoriatic patients without helminthism, 70 patients with CO, and 30 healthy individuals were examined. The level of anxiety at the moment of the study and that of personality anxiety were determined by the procedure described by Ch.D. Silberger, which was modified by Yu.L. Khanina (1976). In patients with psoriasis concurrent with CO, the level of reactive and personality anxiety was 51.60+/-0.89 and 51.30+/-1.26 scores, respectively, which was significantly greater than those in the group of healthy individuals (35.53+/-1.27 and 36.77+/- 1.27 scores, respectively) and psoriatic patients (47.10+/-1.27 and 44.45+/-1.29 scores, respectively). The findings suggest that Opisthorchis invasion is of considerable importance in the genesis of these changes and requires medical correction of helminthism.

[The contingency of the parameters of the human brain electroencephalograms and electromagnetic fields of the Schuman resonator based on monitoring studies].

The contingency of the variations in the amplitude frequency parameters of the main modes of extremely-low-frequency resonances ionosphere waveguide (Shuman resonances) and changes in the parameters of human electroencephalograms in the range of the frequency "window" (6-16 Hz) was studied. The results of studies in the regimes of synchronized monitoring suggest that the contingency of the parameters of electroencephalograms and extremely-low-frequency resonances, expressed in the parameters of the cross-correlation function, is statistically significant and varies from 0.12 to 0.65 at alpha = 0.95. It was found that the magnitude of contingency is largely the function of the current value of the solar and geomagnetic activity.

[Clinical analysis of autonomic nervous system disorders in patients with psoriasis concurrent with chronic opisthorchiasis].

The study was undertaken to detect the characteristics of autonomic nervous system disorders in patients with psoriasis concurrent with chronic opisthorchiasis and, on their basis, to develop therapeutic manipulations. Examinations were made in 150 patients with psoriasis concurrent with chronic opisthorchiasis, 100 psoriatic patients without helminthiasis, 100 patients with chronic opisthorchiasis, and 30 healthy individuals. The questionnaire method developed and recommended for use by the All-Union Center of Autonomic Nervous System Diseases was employed for the screening diagnosis of vegetative dystonia syndrome and for the estimation of its severity. The vegetative dystonia syndrome was observed in all patients with psoriasis concurrent with chronic opisthorchiasis. There was an association of the vegetative dystonia syndrome with the area of skin involvement, the severity of psoriasis, the duration of the latter and opisthorchiasis.

[Quality of life of patients with old myocardial infarction on prolonged therapy with atenolol].

The purpose of the study was to evaluate the influence of atenolol, a selective, beta1-adrenoblocker, on the quality of life (QL) of patients with old myocardial infarction (MI). The subjects of this 12-month open uncontrolled study were 40 male patients aged 29 to 59 years (mean age 46.8 +/- 1.19) suffering from functional class II-III stable exertional angina, which occurred 6 months after their first large-focal MI. QL was evaluated before and during the course of therapy (after 1, 3, 6, and 12 months) using EORTC QLQ CORE 30, short version of MMPI test, and Spielberg State-Trait Anxiety inventory. The patients received atenolol in effective doses selected on an individual basis (mean day dose was 67.9 +/- 4.2 mg) within one year; the study revealed increase of QL falling in all the categories of EORTC QLQ CORE 30, decrease of reactive and personal anxiety, as well as positive changes in averaged MMPI profile, which reflected lowering of anxiety and depression level in the actual psyche status.

[Influence of long-term therapy with enalapril on late postinfarction remodeling and functional state of the left ventricle in patients with diastolic heart failure.].

Enalapril (average dose 7,0+/-0.8 mg) was given for 12 weeks to 15 patients with preserved left ventricular (LV) systolic function who had survived large focal myocardial infarction small i, Ukrainian6 months before that. The use of enalapril was associated with 49% lessening of severity of clinical signs of heart failure (p<0.001) and 47% increase of tolerance to physical exercise. It also provided dose dependent 17.8% reduction of LV myocardial mass (p<0.05), normalization of initially "hypertrophic" type of transmitral flow, 21% lowering of LV end diastolic pressure (p<0.05) without effect on LV volume, geometry, global and local systolic function.

[The condition of immune homeostasis in patients with chronic renal failure].

The condition of immune homeostasis was studied in 100 patients with chronic renal failure (CRF), including 70 patients on hemodialysis. The patients displayed disbalance in the immune homeostasis characterized by a decrease in the number of CD3+, CD4+, and CD72+ cells, and phagocytosis intensification. Priority Th1-cell response of the immune system tends to intensify during the pre-dialysis period of CRF and becomes the most prominent at the terminal stage.

[Effects of carvedilol, atenolol and their combination with fosinopril on cardiac rhythm variability, clinicofunctional status and quality of life in patients with postinfarction left ventricular dysfunction]. / Otsenka vliianiia Karvediola, Atenolola i ikh kombinatsii s Fozinoprilom na variabel'nost' ritma sedrtsa, kliniko-funktsional'nyi status i kachestvo zhizni bol'nukh s postinfarktnoi disfunktsiei levogo zheludochka.

AIM: To study effects of carvedilol and atenolol and their combination with fosinopril on heart rhythm variability (HRV, clinicofunctional status and quality of life in postmyocardial infarction patients with moderate chronic cardiac failure (CCF). MATERIAL AND METHODS: An 8-week randomized open study enrolled 50 male patients (mean age 55.7 +/- 1.58 years) with postinfarction CCF. They were divided into two equal groups. Group one received carvedilol (24.4 +/- 2.0 mg/day) followed by addition of fosinopril (2.5-40 mg/day). Group 2 received atenolol (44.1 +/- 5.1 mg/day) followed by fosinopril in the same dose as in group 1. RESULTS: A 4-week therapy with carvedilol and atenolol effectively corrected depression of HRV in both the group. Combined therapy with these beta-adrenoblockers and fosinopril improved impaired global left ventricular contractility, exercise tolerance, quality of life, relieved symptoms of CCF. CONCLUSION: Carvedilol, atenolol and their combination with fosinopril in patients with postinfarction CCF improve clinico-hemodynamic and functional status, raise HRV and quality of life.

[Anti-ischemic effects of trimetazidine in patients with post-infarction heart failure]. / Anti-ishemicheskaia éffektivnost' trimetazidina u bol'nykh s postinfarktnoi serdechnoi nedostatochnost'iu.

The antiishemic efficiency of course monotherapy with trimethazidine and its impact on myocardial perfusion were studied in patients with postinfarct dysfunction of the left ventricle (LV), which was associated with moderate heart failure (HF). This prospective controlled clinical study included 47 patients who had experienced myocardial infarction. The patients had also angina pectoris on exertion and NYHA Functional Classes (FC) II-III HF. The patients were randomized into 2 groups: Group 1 comprised patients with more than 50-W exercise tolerance (ET), FC II angina, and FC II HF; Group 2 consisted of those with 50-W or less ET, FC II-III angina, and FC II-III HF. Four-week course therapy with trimethazidine in a dose of 60 mg/day was found to exert a pronounced antiischemic effect in patients with reversible LV ischemia associated with HF. The tolerance of the drug during its 4-week course therapy was good and the drug caused no adverse reactions.

[Mechanism of biotropic effects of regional electromagnetic fields in patients with left ventricular ischemic dysfunction]. / Mekhanizm biotropnogo vliiania regional'nykh élektromagnitnykh polei u bol'nykh s ishemicheskoi disfunktsiei levogo zheludochka.

AIM: To study the role of disturbed autonomic regulation of the cardiovascular system in formation of the phenomenon of geliogeomagnetic sensitivity of patients with left ventricular ischemic dysfunction. MATERIAL AND METHODS: 24-h synchronous monitoring of ECG and electromagnetic situation was made in 11 patients (mean age 49.4 +/- 0.9 years) who had survived macrofocal myocardial infarction (MI) at least 6 months before and in 15 healthy volunteers. RESULTS: Heart rhythm dispersion, correlation between variations of magnetic field vector component amplitudes and standard deviation of ECG R-R intervals duration in MI survivors were significantly less than in healthy subjects. High conjugacy of heart rhythm dispersion and mean value of R-R intervals (functions synchronization index) was characteristic only for the control group. A 3-week therapy with atenolol provided normalization of the disturbed correlations in 4 patients. CONCLUSION: Pathogenic geliogeotropic reactions in MI survivors develop because of intra- and inter-systemic desynchronisation of the functions mechanism of which is mediated by sympathicoadrenal activation and is correctable by beta 1-adrenoblocker atenolol.