[Dynamics of functional parameters in different schemes for bronchial asthma therapy: results of the STRELA-ACT multicentre study].

Different strategies for disease control in real clinical practice are compared in terms of dynamics of functional parameters in patients with persistent bronchial asthma. This prospective multicentre surveillance study was carried out in 19 Russian clinics using the common protocol. The patients were divided in 3 groups in accordance with the changes of basal antiinflammatory therapy during the study period. Group A--stepwise increase in the extent of combined salmoterol/fluticason therapy, group B--long-term stable-dose salmoterol/fluticason therapy, group C--salmoterol/fluticason therapy with gradual decrease of the dose and/or transition to an alternative variant. Statistical analysis using Statistica 6.0 program included data from 543 patients. The results suggest that the two first modalities increased the level of control (ACT test) and improved characteristics of external respiration throughout the study period. Strategy 3 was associated with a decrease in the external respiration function and the level of control.

[The early and subclinical forms of cerebrovascular pathology in patients with chronic ischemic heart disease]. / Rannie i subklinicheskie formy tserebrovaskuliarnoi patologii u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa.

The results of a cardioneurological follow-up enabled the authors to develop the principles of the angioneurological evaluation of patients with chronic coronary heart disease (CCHD). The survey covered 118 CCHD males aged 40-59 of functional class I and II. A differential complex of tests involving neuropathological and neuropsychological examinations, rheoencephalography with pharmacological and bicycle ergometry tests, biomicroscopy of bulbar conjunctiva allows early detection of subclinical and initial manifestations of cerebral circulatory failure (CCF) in CCHD patients. Quantitation of cerebral circulation at graded exercise test according to specially devised criteria is intended for differentiation of subclinical CCF in CCHD patients from age-specific changes in cerebral vessels and residual brain pathology of nonvascular genesis. Using a discriminant analysis of risk factors, ECG and echo-CG findings, the authors have designed a method of predicting dyscirculatory encephalopathy in CCHD patients free of cerebrovascular symptoms. The method can contribute to advanced efficacy of preventive and therapeutic measures in coronary patients.

[The prediction of the development of circulatory encephalopathy in hypertension patients with the initial manifestations of brain blood supply insufficiency]. / Prognozirovanie razvitiia distsirkuliatornoi éntsefalopatii u bol'nykh gipertonicheskoi bolezn'iu s nachal'nymi proiavleniiami nedostatochnosti krovosnabzheniia mozga.

The principal risk factors conducive to the development of cardiovascular diseases in young and middle-aged subjects with chronic cerebrovascular insufficiency due to Stage I or II essential hypertension were under study. Thirty-four male patients with the initial manifestations of inadequate blood supply to the brain (IMIBS), 35 male patients with stages I or II dyscirculatory encephalopathy (DE), and 32 and 33 female patients with the same conditions, respectively, were examined. Hypertensive cerebral crises were significantly more frequent in DE patients of both sexes than in IMIBS patients, and a tendency to a longer standing of arterial hypertension was observed in DE patients as against those with IMIBS. The results of the examinations evidence that excessive body mass, hypokinesia and psychoemotional stress, as well as an 'accumulation' of risk factors were conducive to the development of DE in essential hypertension patients with IMIBS. Basing on the discriminant analysis of risk factors, the authors have developed a method for predicting the development of DE in patients with IMIBS of a hypertensive origin. Use of this method will essentially improve the efficacy of prophylactic and therapeutic measures in IMIBS patients.

[Status of cerebral hemodynamics during measured physical loading in healthy subjects and patients with cerebral atherosclerosis]. / Sostoianie tserebral'noi gemodinamiki v usloviiakh dozirovannoi fizicheskoi nagruzki u zdorovykh i u bol'nykh tserebral'nym aterosklerozom.

The authors analyzed the results of the rheoencephalographic examination of the cerebral hemodynamics under graded exercise (GE) in 42 normal subjects and 60 patients with cerebral atherosclerosis. All individuals were males aged 40-59 years. It was shown that an increase in the blood content of the brain in the process of GE in the patients with cerebral atherosclerosis was significantly lower than in the normal subjects. With a greater volume of the work done the difference became more pronounced. According to the nature of the response to GE the cerebral hemodynamics in the patients was divided into compensated, subcompensated and decompensated types.

[Physical exertion tolerance and the characteristics of hemodynamics in healthy persons depending on its type]. / Tolerantnost' k fizicheskoi nagruzke i osobennosti ee gemodinamicheskogo obespecheniia u zdorovykh liudei v zavisimosti ot tipa gemodinamiki.

Central hemodynamic parameters were studied in 113 normal male subjects, aged 20-59, at rest and during bicycle ergometric exercise, with the help of tetrapolar chest rheography. Capacity for physical exercise was shown to depend on both the age and the basic hemodynamic type. Subjects with hyperkinetic circulation had the greatest, and those with hypokinetic circulation, the smallest capacity for exercise. The evaluation of BP and heart rate patterns, stroke and cardiac indices, and the indicator of heart performance during bicycle ergometry suggested that cardiovascular operation was more economical in normal subjects with eukinetic or hyperkinetic circulation, hence their greater capacity for physical exercise.

[Physical work capacity among the early manifestations of cerebral atherosclerosis]. / Fizicheskaia rabotosposobnost' pri rannikh proiavleniiakh tserebral'nogo ateroskleroza.

A bicycle ergometric study of 54 males, aged 40-59 years, suffering from atherosclerotic dyscirculatory encephalopathy of Stage I-II and of 57 age-matched healthy males showed a considerable decrease in exercise tolerance of the patients. The fall in their capacity for physical work was attended by an inadequate hemodynamic response toward exercise in the form of a faster increase of the heart rate and a greater elevation of the arterial pressure. It is pointed out that level of exercise and the nature in which it is ensured hemodynamically may serve as additional criteria in assessing the functional potentialities of the cardiovascular system in early manifestations of cerebral atherosclerosis.

[Physical exertion tolerance in patients with ischemic heart disease associated with cerebral arteriosclerosis]. / Tolerantnost' k fizicheskoi nagruzke u bol'nykh ishemicheskoi bolezn'iu serdtsa s soputstvuiushchim tserebral'nym aterosklerozom.

The authors provide the results of a comparative study of exercise tolerance (bicycle ergometry test) in 64 patients with coronary heart disease (CHD) and in 68 patients with associated CHD and cerebral atherosclerosis. During the latter syndrome the working capacity was lowered as a result of less economical work of the circulatory apparatus. In particular, physical loading in such patients was accompanied by marked increment of the heart rate and blood pressure elevation. Increased heart oxygen requirement in the second group patients during exercise was accompanied by more frequent ischemic alterations in the myocardium attended by ST segment depression on the ECG. It is concluded that concomitant cerebral atherosclerosis aggravates the basic pathogenetic mechanisms of CHD, namely the disagreement between myocardium oxygen requirement and supply.