[Melatonin: its role in the system of neurohumoral regulation in man. Part 2].

Part 2 of this review concerns the application of melatonin (Mt) to the treatment of aged patients with cardiovascular diseases and other pathology with reference to its genoprotective and anticarcinogenic action. Effects of Mt on the cardiovascular system are underlain by its antioxidative, vasodilating, and sedative activities, the ability to regulate the heart rate and inhibit platelet aggregation. Certain authors report negative correlation between Mt production and blood cholesterol level. Mt was shown to protect from cardiac lesions associated with ischemia and reperfusion. Mt inhibits carcinogenesis and is active at systemic, tissue, cellular and subcellular levels. At the systemic level, Mt decreases hormonal production, stimulates immune activity, and prevents the development of metabolic syndrome. It inhibits cell proliferation and promotes apoptosis of tumour cells but suppresses it the nervous tissue. Mt activates telomerase. It decreases expression of oncogens and interferes with the action of mutagens and clastogens at the genetic level. Extensive studies of Mt protective action in nervous diseases are underway with special reference to spinal cord, brain, neuron and glial cell lesions; experimental cerebral stroke, Parkinson's and Alzheimer's diseases. Similar studies concern the role of Mt in the protection against ionizing radiation, the development of renal pathology, and ophthalmology (glaucoma, cataract). Mt is shown to influence practically all organ systems by inhibiting mutagenesis and maintaining correlation between circadian rhythms of different biological processes throughout human evolution.

[Melatonin in the system of neurohormonal regulation in man. Part 1].

Part I of this systematic review is devoted to the history of melatonin (MT) studies, mechanisms of MT action, and its clinical importance as a universal modulator of physiological functions applicable to the treatment of numerous disorders, in the first place respiratory diseases. MT participates in regulation of arterial pressure and myocardial contractility, it increases antioxidative potential, plays an important role in regulation of circadian rhythms, sleep and adaptation to jet lag. Antioxidative, antitumorigenic, immunomodulatory, antidepressive, anti-anxiety, and hypnogenic activities of exogenous MT coupled to the absence of toxicity make it an attractive agent for the treatment of many human diseases especially in old age.

[Alternative medicine. Past, present, and future. Part 3].

Part 1 was devoted to general problems of alternative and auxiliary medicine; also, it contained information on evidence-based nutrition practice for patients with cardiovascular diseases. Part 2 highlighted the use of food products, bioactive supplements, micronutrients, and phytotherapy for prevention of cardiovascular diseases. Part 3 is focused on the analysis of certain non-medicamentous methods of alternative medicine and their clinical applications.

[The use of melaxen in combined therapy of arterial hypertension in subjects occupied in assembly line production].

The work was designed to study effect of melaxen on circadian chronostructure of arterial pressure and pulse rate in subjects with arterial hypertension occupied in assembly line production. A total of 57 patients were examined of whom 23 received teveten together with melaxen and 34 were treated with teveten alone for 3 weeks. Inclusion of melaxen in combined therapy of hypertension reduced arterial pressure and normalized disturbed circadian hemodynamics. It is concluded that combined therapy effectively eliminates sleep disorders frequent in this group of patients.

[Analysis of behavioural and emotional personality characteristics in patients with hypertensive disease and effect of therapeutic education on the quality of life].

The study was designed to assess selected behavioural and psychic personality characteristics in subjects with hypertensive disease engaged in strenuous labour activity and evaluate effect of their self-care education on quality of life. A total of 126 patients were involved in the study of whom 96 were treated and instructed in the framework of the "School of psychophysiological adaptation" program and 30 comprised the control group. They were followed up for 2 years. It was shown that emotional stress promoted formation of a complex of behavioural and psychic reactions resulting in reduced level of motivation and aspiration to achieve vocational rehabilitation and health resumption. The targeted system of education proved instrumental in raising the level of motivation to comply with medical recommendations and exercise self-control. Accomplishment of the program allowed to reduce effect of risk factors on the course of disease, improve performance efficiency and quality of life. It is concluded that introduction of education programs into clinical practice is an important line of further development of preventive medicine.

[Alternative medicine. Past, present, future. Part 2].

Part 2 highlights the use of food products, bioactive additives, micronutrients, and phytotherapyforprevention of diseases. Many studies demonstrated positive effect of omega-3 PUFA, stanols, sterols, and esterified pargarines, soluble cellulose, controlled alcohol consumption, tea, Mg-enriched dietetic factors, folic acid combined with vitamins B6 and B12 on subjects with the initially enhanced homocysteine level. Garlic is known to reduce blood lipids, hawthorn may be useful at early stages of cardiac insufficiency, ginkgo biloba in arterial and cerebral disorders, horse chestnut for the treatment of peripheral vascular pathology. Results of controlled studies indicate that the use of many foods for prevention of different diseases is currently based on recommendations of individual doctors and needs to be substantiated by evidence-based practice. Physicians treating and educating patients must be well aware of alternative and supplemental therapeutic modalities with the use of foodstuffs, bioactive additives, micronutrients, and phytotherapy.

[Alternative and complementary medicine. Past, present, future. Part 1].

Part 1 highlights general problems of alternative and auxiliary medical treatment and presents the evidence base of dietetic nutrition of patients with cardiovascular diseases. Many studies demonstrated effect of dietetic factors on arterial pressure (AP). It drops with a decrease in body weight due to rational nutrition, reduced salt and alcohol consumption, elevated intake of potassium, and compliance with DASH regimen. Effect of other factors influencing AP is either dual, less significant or inexplicable. Reduction of the burden of cardiovascular diseases requires the development of new strategies including dietary treatment.

[Psychosomatics in patients with hypertensive disease under conditions of occupational stress].

The aim of the work--the investigation of peculiarities of psychosomatic relations in patients with different stages of hypertensive disease (HD) in conditions of direct occupation activity. The 225 workers from a number of large pharmaceutical industries, who was engaged in performance of the basic occupation activities in conditions of conveyor manufacture at the alternating working regimen, that seemed to be an origin of stresses. On grounds of blood pressure level the patients were selected into 3 groups. The 65 cases with border arterial hypertension (BAH) were included into the 1st group, 69 patients with stage 1 HB were included into the 2nd group and 61 patient--into the third group. The control group consisted of 30 health volunteers. The results of the study testify that occupational stress results in development of neurosis, stable sympathicotonia with formation of hyperkinetic and in consequent advance--hypokinetic type of circulation, gradual aggravation of changes from heart side, decrease of productiveness of mentality. One of causes of persistence of neurosis is a deficiency of a pragmatic information in conditions of complicate and strenuous process of occupational activity.

[Clinicopathogenetic features of coronary heart disease combined with chronic obstructive pulmonary diseases and efficiency of therapy with trimetazidin].

Based on retrospective analysis of 2446 in-patient cards, autopsy protocols, outpatient medical documentation, prevalence and features of clinical manifestation of cardiorespiratory pathology (CRP): coronary heart disease (CHD) combined with chronic obstructive pulmonary disease (COPD)--1 stage of study, and also (after randomization and forming of main and control groups), efficiency of myocardial cytoprotector trimetazidin (TMZ) at its long-term use (1 year) in combined therapy (2 stage of study): 135 CHD patients (stable exertional angina functional class II-III: 92 and 43 persons respectively) with COPD of medium severe (111 persons) and severe course (24 persons), were studied. It is shown that CRP is prevailed in elder age groups (after 45 years) and noticed in 56.7% CHD patients. More sevenre course with great risk of myocardial infarction with Q wave (twice, p < 0.001), prolongation of painless ischemia (62.4+/-11.5 min/day vs. 22.8+/-11.1 min/day), inclination to complicated rhythm disturbances (38 vs. 21.9, p < 0.05) and earlier clinical manifestations of heart failure (4.3+/-0.6 years earlier, p < 0.001) is typical for CHD with COPD vs. patients without pulmonary pathology. In one year after beginning of treatment with TMZ (35 mg) number of weekly pain attacks was decreased in patients of 1st group vs. 2nd group (at the average -50.8% -29.3% vs. +12.5% +16.6% respectively); significant (p < 0.05) decrease in duration of painless myocardial ischemia was registered. Decrease in number of supraventricular and ventricular extrasystoles (42.7+/-1.48 vs. 20.5+/-1.07 cases in a day, a < 0.0001), significant (p < 0.05) increase in ejection fraction and decrease in left ventricle end-diastolic volume (12.2+/-0.4% E 12.2+/-0.3% respectively), in dimensions of left (10.9+/-0.03%) and right (8.8+/-0.9%) atrium, in risk of development of acute coronary syndrome were noticed in the patients of main group received TMZ. Thus, long-term (not less then 1 year) use of TMZ (35 mg) in combined treatment assists to normalization of cardiovascular indices, decreases cardiovascular complication occurrence, improves disease prognosis and do not has negative side-effects.

[Clinical efficiency of ivabradine in patients with cardiorespiratory pathology].

Clinical efficiency of If-inhibitor ivabradin (Coraxan, Servier) in 40 patients with cardiorespiratory pathology (CRP) was studied. It was shown, that use of ivabradin in dose of 5 mg two times a day leaded to significant decrease in number of angina attacks in a week, and also in time of painless myocardial ischemia, decrease in heart rate at a day and during physical exercises, increase in 6 minutes walking distance and circadian index, oxygen saturation and partial tension, decrease in average pressure in pulmonary artery, increase in ejection fraction of left ventricle. Thus, ivabradin (Coraxan, Servier) is an effective antianginal drug for CRP patients, it improves life quality and do not has an influence on external respiration function. Ivabradin in dose of 5 mg two times a day can be used for CRP patients and as alternative to beta-adrenoblockers.

[Erythropoietin in clinical practice].

In numerous studies, erythropoietin (EP) has been shown to be a "universal" protective tissue cytokine, and EP receptors have been shown to exist in a lot of tissues. The pleiotropic effects of EP (the anti-inflammatory effect, angiogenesis, anti-apoptosis etc.) make clinical application of EP (especially recombinant EP, REP, and EP analogs without erythropoietic activity) promising in different diseases. Possibilities provided by REP application in neurology, cardiology, hematology, oncology, and other clinical areas are being studied intensively. Clinical studies of EP are now solitary, and they should be continued; new EP analogs with specified qualities and selective mechanisms of action should be developed. This review discusses the modern state of EP investigation and possibilities provided by its clinical application.

[Phosphodiesterase inhibitors in clinical practice. The present and the future. Part I].

Type 5 phosphodiesterase inhibitors (5-PDEI), which have been applied as the basic medication for erectile dysfunction, are now being studied in various areas of clinical medicine (pulmonology, cardiology, gastroenterology, gynecology etc.) This systematic literature review is dedicated to 5-PDEI, the state of the problem, the prospects of clinical application of sildenafil, and is based upon 450 literature sources from MEDLINE database (from 1954 to June 2006) and the Cochrane Collaboration database (from 1977 to March 2005) found by key words sildenafil, phosphodiesterase, and 5-PDEI. The issues of physiology and pathophysiology of 5-PDEI, the historical background of their creation, the appropriateness and efficacy of sildenafil in pulmonary arterial hypertension are considered in Part I of the review.

[Multifactor stress-echocardiography in the diagnostics of coronary artery disease at the pre-hospital stage].

The aim of the study was to assess tolerance to and the appropriateness of multi-factor stress-echoCG for the diagnostics of initial stages of coronary artery disease (CAD) in out-patient practice. The subjects of the study were 25 men aged 32 to 51 (mean age 43.2 +/- 4.9 years). Of these patients, 10 men with heartache were suspected to have CAD, and 15 suffered from stage II essential hypertension (EH). In five patients (including four with stage II EH) chest pain which was untypical for stenocardia, was observed, and in five other patients rare attacks of class lexertional stenocardia took place. All the patients underwent stress-echoCG with a combination of two stress agents: transesophageal left ventricular cardiostimulation (TEES) and dipiridamol test (DP). Stress echoCG was positive in eight (32%) of the patients including seven subjects with stenoses of less than 50% of anterior interventricular artery (AIVA) diameter and one patient with stenoses of 50 to 70% of AIVA diameter. Of these patients, 20% (n = 5) had stage II EH. There were no complications or undesirable reactions. The method of multifactor stress-echoCG allowed for the early diagnosis of CAD in 32% of patients, in whom conventional functional diagnostic techniques were of little informative value, including the 20% of patients with stage II EH. Thus, multifactor stress-echoCG (DP+ TEES) is an approachable, informative, and safe method of early CAD diagnostics, which may be recommended for wide application in outpatient departments for a rational selection of patients for further CG and planning therapeutic tactics in CAD patients.