[Hemodynamic Derangements in Patients With Functional Univentricular Heart: Mechanisms of Development, Possibilities of Treatment].

Heart failure (HF) is a predictable outcome of nearly all cardiovascular diseases including congenital heart diseases (CHD). A special category comprises patients with functional single ventricle (FSV) of the heart because of extreme diversity of anatomical changes of the heart and great vessels, complex mechanisms of development of HF, multistage surgical correction of the defect, presence of arrhythmias, progressive rise of pulmonary vascular resistance, etc. Prevention and treatment of HF in patients with FSV includes surgical optimization of pulmonary blood flow during neonatal period, timely staged surgical correction of the defect, pharmacotherapy, cardiac resynchronization therapy, and in severe cases mechanical cardiac support and heart transplantation. This article contains review of the mechanisms of HF development in patients with FSV as well as analysis of current approaches to recognition and treatment of this condition.

[Search for an Optimal Formula for Calculation of the Corrected QT Interval in Children Based on Data of Clinical-Epidemiological Study].

The aim of the study was to compare different types of QT correction, establish age norms of QT duration, and assess associations between QT duration and heart rate (HR) in children. The sample comprised 0-18-year-old children (n=5909) selected from general population. The study examined several existing formulas of corrected QT (Bazett, Fridericia, Framingham, and Hodges) and modified Bazett formula developed for healthy children. The analysis demonstrated that neither formula enabled complete exclusion of the correlation between QT and RR intervals. Among existing formulas, Bazett formula provided maximum possible elimination of the HR influence on QT duration. Modified Bazett formula, developed by us, provided even less correlation of QT and RR intervals. Therefore, we recommend implementing modified Bazett formula to pediatric practice.

[Autoantibodies to Neuropeptides in the Different States of Opium Addiction].

Background: During the last years the addiction rate remains stable high. While the neurochemical drug effect remains unclear. Aims: To analyze the changes of the idiotypic (аАТ1) and anti-idiotypic (аАТ2) autoantibodies to the neuroproteins S100, MBP, GFAP, NGF on the different stages of opium addiction and to indicate prognosis criteria of their effect. Materials and Methods: 70 patients (only men, aged 22−38) with diagnosis opium addiction underwent examination. According to the results of testing, we detected the intoxication in 24 patients, withdrawal ­ in 24, and 22 patients were at remission stage of 21−28 days. The control group included only healthy people (n=18). The survey was focused on the rate detection of the idiotypic and anti-idiotypic IgG class antibodies in relation to the rate of neural proteins (S100, MBP, GFAP, NGF) in the serum with the IEA. Results: In patients with opium intoxication, we revealed statistical assurance in the rate of autoantibodies amount and their counterweights to the neural proteins rate between control and experimental groups. Only the rate of the аАТ2 protein significantly decreased relatively to the MBP. In patients with abstinence, the rate of аАТ1 to the MBP, GFAP (р≤0,05) increased. The rate of аАТ2 in relation to the GFAP and MBP also increased (р≤0,05), at the same time it decreased in relation to the S100 and NGF (р≤0,05). The autoantibodies amount at the remission stage corresponded to the amount at the intoxication stage. The comparative analysis of the patient groups with the different stages of opium addiction detected the identity criteria both in the intoxication and remission. We revealed statistical assurance in the rates of аАТ1 to MBP and аАТ2 to NGF in patients with intoxication and abstinence, and in the rates of аАТ1 to GFAP, MBP, and аАТ2 to GFAP (decreased in the remission) and to S100, MBP (increased in the remission) in patients with abstinence and at remission. Conclusion: Levels of idiotypic and anti-idiotypic antibodies to the neural proteins S100, MBP, GFAP, NGF (especially аАТ2 to MPB) could be used as diagnostic factor and for accessing different states of opium addiction.

[Correlation of Endothelial Dysfunction With Course of Essential Arterial Hypertension in Adolescence].

AIM: to study laboratory parameters of endothelial dysfunction (ED) and their correlation with risk factors (RF) of cardiovascular diseases at early stages of essential arterial hypertension (AH) in adolescents. MATERIAL AND METHODS: We examined 299 adolescents aged 12-18 years with EAH. According to results of 24-hour blood pressure (BP) monitoring all patients were divided into three groups: (1) 98 adolescents with "white coat hypertension", (2) 108 adolescents with liable AH (LAH), (3) 93 patients with stable AH (stAH). Control group consisted of 27 healthy adolescents. Examination included 24-hour BP monitoring, measurement of some laboratory parameters of ED (Von Willebrand factor [vWF], nitric oxide metabolites, urine catecholamines), and assessment of cardiovascular RF. RESULTS: Mean vWF values in groups (2) and (3) were clinically significantly different from control. Increase of vWF activity by 1 unit was associated with increase of mean nocturnal pulse pressure by 0.36 mm Hg (p = 0.048). Markers of ED were related to family history of AH, overweight and low birth weight.

[Cardiac Resynchronization Therapy in the Treatment of Heart Failure in Children].

Cardiac resynchronizing therapy (CRT) is currently a leading approach to the treatment of heart failure in adults. However, data regarding application of CRT in children remain limited and indications for CRT are unclear. There is evidence that the best treatment outcomes result from the administration of CRT to the group of children whose heart failure is caused by dyssynchrony mediated by traditional stimulation of the right ventricle in patient with complete atrioventricular block. On the contrary, the presence of dilated cardiomyopathy and functional class III-IV heart failure are the predictors of ineffective CRT. Implantation of CRT devices in children has many peculiarities and challenges associated with anatomic and physiological characteristics of childhood age. Taking into consideration the expected length of treatment, one should admit that epicardial biventricular stimulation should be preferred. In the present paper the authors discuss pathophysiology of the electromechanical dyssynchrony, analyze their own experience with CRT, and suggest indications for this kind of treatment.

[Cardiac Resynchronization Therapy in the Treatment of Heart Failure in Children].

Cardiac resynchronizing therapy (CRT) is currently a leading approach to the treatment of heart failure in adults. However, data regarding application of CRT in children remain limited and indications for CRT are unclear. There is evidence that the best treatment outcomes result from the administration of CRT to the group of children whose heart failure is caused by dyssynchrony mediated by traditional stimulation of the right ventricle in patient with complete atrioventricular block. On the contrary, the presence of dilated cardiomyopathy and functional class III-IV heart failure are the predictors of ineffective CRT. Implantation of CRT devices in children has many peculiarities and challenges associated with anatomic and physiological characteristics of childhood age. Taking into consideration the expected length of treatment, one should admit that epicardial biventricular stimulation should be preferred. In the present paper the authors discuss pathophysiology of the electromechanical dyssynchrony, analyze their own experience with CRT, and suggest indications for this kind of treatment.

[Correlation of Endothelial Dysfunction With Course of Essential Arterial hypertension in Adolescence].

AIM: to study laboratory parameters of endothelial dysfunction (ED) and their correlation with risk factors (RF) of cardiovascular diseases at early stages of essential arterial hypertension (AH) in adolescents. MATERIAL AND METHODS: We examined 299 adolescents aged 12 - 18 years with EAH. According to results of 24-hour blood pressure (BP) monitoring all patients were divided into three groups: (1) 98 adolescents with "white coat hypertension", (2) 108 adolescents with liable AH (LAH), (3) 93 patients with stable AH (stAH). Control group consisted of 27 healthy adolescents. Examination included 24-hour BP monitoring, measurement of some laboratory parameters of ED (Von Willebrand factor [vWF], nitric oxide metabolites, urine catecholamines), and assessment of cardiovascular RF. RESULTS: Mean vWF values in groups (2) and (3) were clinically significantly different from control. Increase of vWF activity by 1 unit was associated with increase of mean nocturnal pulse pressure by 0.36 mm Hg (=0,048). Markers of ED were related to family history of AH, overweight and low birth weight.

[Palivizumab: four seasons in Russia].

In 2010, the Russian Federation (RF) registered palivizumab--innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization.

[Experience of using reamberin for detoxification therapy at the stage of deworming in children with chronic opisthorchiasis].

The study presents data on the reversible aggregation of erythrocytes in 50 children with chronic opisthorchiasis and 45 children with inflammatory diseases of the upper digestive tract without opisthorchiasis (chronic gastroduodenitis, duodenal ulcers), all patients aged from 7 to 17 years. The results of using reamberin for detoxification therapy at the stage of deworming in children with chronic opisthorchiasis are assessed.

[Remodeling of left ventricular myocardium at early stages of essential arterial hypertension in adolescents].

We studied geometric changes of the left heart in 299 teenagers aged 12-18 years with essential arterial hypertension (EAH). According to 24-hour blood pressure monitoring all patients were divided into three groups: patients with phenomenon of "white coat hypertension" (WCH, n=98); patients with labile arterial hypertension (LAH, n=108); patients with stable atrial hypertension (SAH, n=93). Control group comprised 27 healthy adolescents. Parameters of central hemodynamics were assessed by echocardiography. Geometric left ventricular (LV) changes were found in 69 (23.1%) teenagers with EAH. Risk of formation of eccentric LV hypertrophy in teenagers with SAH was significantly higher than in subjects with WCH and LAH. Pulse pressure made significant contribution to formation of LV hypertrophy. Excess weight contributed significantly to formation of structural and geometric changes of LV and left atrium.

[Effect of radiofrequency ablation of accessory atrio-ventricular junctions on electromechanical coupling of the myocardium in children with manifesting Wolf-Parkinson-White syndrome].

Aim of the study was to assess immediate and remote hemodynamic and electromechanical effects of radiofrequency ablation of accessory atrio-ventricular pathways in children with manifesting Wolf-Parkinson-White (WPW) syndrome. Radiofrequency ablation of accessory atrio-ventricular pathways resulted in diminishment of intraventricular dyssynchrony, what appeared as lowering of the degree of heterogeneity of electromechanical intervals and was associated with significant augmentation of left ventricular stroke volume. Presence of pronounced intraventricular asynchrony might be an additional indication to radiofrequency ablation of accessory atrio-ventricular pathways in patients with WPW syndrome without history of documented attacks of tachycardia.

[Endothelial dysfunction and risk factors of its development in subjects with family history of atherosclerosis]. / Disfunktsiia éndoteliia u lits s otiagoshchennoi po aterosklerozu nasledstvennost'iu.

Brachial artery blood flow reactions to hyperemia and hyperventilation (endothelium dependent vasodilation and vasoconstriction) were studied by doppler sonography in 60 persons aged 19-39 years with family history of atherosclerosis and risk factors of this disease. Reactivity of peripheral artery and risk factors of atherosclerosis development were found to be interrelated. The results allowed to suggest participation of atherogenic fractions of lipoproteins, triglycerides, proinflammatory cytokines, and monocyte derived NO in formation of pathological vascular reactions in persons with family history of atherosclerosis.

[Lipids of lymphocyte plasma membranes in patients with atherosclerosis and their children]. / Lipidy plazmaticheskikh membran limfotsitov u bol'nykh aterosklerozom i ikh detei.

Phospholipid composition and activity of 5'nucleotidase of lymphocyte plasmatic membranes were studied in patients with atherosclerosis (AS) and their children. The content of phosphatidylcholine, cholesterol/total phospholipid ratio, transmembrane asymmetry of lipids were increased, 5'nucleotidase activity decreased, and lymphocyte plasmatic membranes contained accumulations of lisophospholipids (LPL). This indicated increased hydrophobia and decreased functional activity and damage of lymphocyte plasmatic membranes. Increased transmembrane lipid asymmetry and LPL accumulations were detected in the lymphocyte plasmatic membranes of children with aggravated heredity for AS. Presumably these disorders anticipate the changes in the structure of plasmatic membranes, observed in adult patients with AS, and progress in case of exposure to unfavorable factors.

FIA-FAAS system including on-line solid phase extraction for the determination of palladium, platinum and rhodium in alloys and ores.

A number of aliphatic mono- and triamines have been investigated as potential reagents for solid phase extraction of Rh, Pd and Pt. Platinum group metals are recovered from hydrochloric acid solutions as ionic associates of their chloride complexes with protonated amines. The recovery of metals depends both on hydrophobic properties of amine and sorbent and on sorption behaviour of amine itself. For on-line solid phase extraction of platinum group metals 4-(n-octyl)diethylenetriamine and hyper cross-linked polystyrene sorbent SSPS have been applied. Quantitative recovery of rhodium and platinum in the form of their hexachloride complexes was achieved under non-equilibrium conditions of on-line dilution. Metals recovered are quantitatively eluted with 1 M hydrochloric acid solution in ethanol. A new FIA-FAAS method for the determination of Rh, Pd and Pt in solutions based on the decomposition of ores and alloys has been proposed. The RSD values are 0.03-0.08 at 50-ppb concentration level. The detection limits are 3-8 ppb for 1 min of preconcentration. The accuracy of the procedure was verified by the analysis of standard reference materials of sulfide ores and alloys.

[General biological characteristics of the etiology of postoperative complications in patients with surgical diseases of the lungs]. / Obshchebiologicheskie zakonomernosti formirovaniia posleoperatsionnykh oslozhnenii u bol'nykh s khirurgicheskoi patologiei legkikh.

The causes of lethal outcomes (n = 60) and postoperative complications which occurred in 26.1% of 610 patients operated on for lung cancer were investigated with due consideration for the regularities of thermodynamics of nonequilibrium processes and theory of disasters. A total systems pathological inflammatory reaction, which augments the injury by many times and develops as a result of inadequate anesthesiological protection, underlies the development of the most unfavorable variant of response to surgery leading to life-threatening complications, such as pneumonia, thromboembolism, or ulcerative hemorrhages.