[COMPARATIVE EFFECTIVENESS AND SAFETY OF NEW ORAL ANTICOAGULANTS AND WARFARIN IN PATIENTS WITH AGE-SPECIFIC NON-VALVULAR ATRIAL FIBRILLATION].

This study was designed to compare effectiveness and safety of warfarin, direct thrombin inhibitor dabigatran, Xa factor inhibitors rivaroxaban and apixaban used to prevent stroke in 280 elderly patients in patients with age-specific non-valvular atrial fibrillation. The treatment of patients aged 65-74 and 75-80 yearsfor 2 years with dab itragan (110 mg b.i.d), apixaban (5 mg b. i. d), and rivaroxaban (20 mg once daily) prevented stroke as effectively as warfarin therapy but less frequently caused severe intracranial hemorrhage. It is concluded that these new anticoagulants can be used as alternative medication for antithrombotic therapy of elderly patients with age-specific non-valvular atrialfibrillation.

[Comparison of Novel Oral Anticoagulants and Warfarin in Elderly Patients With Nonvalvular Atrial Fibrillation].

We compared efficacy and safety of warfarin with those of direct thrombin inhibitor dabigatran, factor Xa inhibitors rivaroxaban and apixaban used for stroke prevention in 280 patients aged 65-80 years with non-valvular atrial fibrillation. Treatment for two years with dabigatran (110 mg twice daily), apixaban (5 mg twice daily) or rivaroxaban (20 mg/day) prevented strokes no less successfully than warfarin, but more rarely caused severe intracranial hemorrhages. When selecting antithrombotic therapy in geriatric patients with non-valvular AF new oral anticoagulants may be regarded as an acceptable alternative to warfarin.

[Antihypertensive therapy and dynamics of vascular wall rigidity in elderly patients with non-valvular atrial fibrillation].

This comparative ultrasound study included 210 patients aged 65-80 years with non-valvular atrial fibrillation treated with the use of 4 different therapeutic modalities. Intake of perindopril, valsartan, valsartan + rozuvastatin, and lercanidipine resulted in a rise in distension index of common carotid artery, decrease of rigidity coefficient of the aortic wall and increase of the pulsed wave propagation speed. Combination of valsartan (80-160 mg/d) and rozuvastatin (10 mg/d) had the most pronounced effect on the vascular wall compliance compared with other modalities and reduced the frequency of ischemic stroke, myocardial infarction, and mortality. It is concluded that therapy of non-valvular atrial fibrillation in elderly patients with valsartan + rozuvaststin is the optimal strategy for the improvement of elastic properties of the vascular wall and reduction of the frequency of cardiovascular complications.

[Effect of various types of antihypertensive therapy on elasticity of arterial wall in elderly patients with hypertensive disease and nonvalvular atrial fibrillation].

Basing on the data of ultrasound study we compared effects of various antihypertensive therapies on elastic properties of common carotid arteries and the thoracic aorta in 133 patients aged 65-80 years with nonvalvular atrial fibrillation (AF). The use of perindopril, lercanidipin, valsartan and its combination with rosuvastatin was associated with elevation of the distensibility index of common carotid artery and lowering of coefficient of stiffness of aortic wall compared with the initial state. Combination of valsartan (80-160 mg/day) with rosuvastatin 10 (mg/day) produced most pronounced effect on compliance of vascular wall compared with other variants of treatment. Combination of valsartan and rosuvastatin can be considered an optimal strategy of antihypertensive therapy allowing to improve elastic properties of arterial wall in elderly patients with nonvalvular AF.

[Comparison of three methods of antithrombotic therapy in elderly patients with nonvalvular atrial fibrillation].

We compared efficacy and safety of warfarin, direct thrombin inhibitor dabigatran and clopidogrel in prevention of stroke in 210 patients with nonvalvular atrial fibrillation (AF) aged 65-80 years. The use of dabigatran (110 mg twice daily) for 12 months or warfarin was associated with similar rate of ischemic stroke but caused less bleeding (2.8 vs. 16.9%, p<0.05). Treatment with clopidogrel prevented stroke no less successfully, than those with warfarin and dabigatran and turned out to be sufficiently safe. When chosing antithrombotic therapy in gerontological patients with nonvalvular AF dabigatran and clopidogrel can be considered acceptable alternative to warfarin.

[Safety and efficacy of various modalities of antiplatelet prophylaxis of ischemic stroke in elderly patients with non-valvular atrial fibrillation].

We compared the efficacy and safety of warfarin, dabigartan, and clopidogrel used to prevent tromboembolism in 210 elderly patients with non-valvular atrial fibrillation depending on the age. In patients aged 65--74 yr treatment with dabigartan (110 mg twice daily) for 6 months was associated with ischemic stroke as frequently as warfarin therapy but less frequently than with severe hemorrhages (4.4 vs. 27.7%, p < 0.05). Clopidogrel prevented stroke as effectively as warfarin and dabigartan and was equally safe. There were no differences in the frequency of thromboembolic and hemorrhagic complications in 75-80 year-old patients given the three medications. It is concluded that dabigartan and clopidorgel may be regarded as a good alternative to warfarin for anti-platelet treatment of 65-74 year-old patients with non-valvular atrial fibrillation.

Risk factors for the development of delayed graft function in deceased donor renal transplants.

INTRODUCTION: Delayed renal graft function (DGF) is associated with various factors and with a higher complication rate in the posttransplant period. Determination of center-specific risk factors may help to reduce the incidence of DGF and improve transplantation results. The aim of this study was to define risk factors for the development of DGF after renal transplantation. PATIENTS AND METHODS: This study included 290 consecutive deceased donor renal transplantations performed in a single center between January 1, 2004, and November 30, 2007. All cases were examined for the presence of DGF, defined as the need for at least 1 dialysis during the first posttransplant week. The subjects were divided into 2 groups: immediate graft function and DGF. Both groups were compared for donor and recipient transplantation factors as well as early posttransplant results. RESULTS: DGF was observed in 61 cases (21%). Our analysis revealed associations of DGF with recipient age (P = .011), female gender (P = .028), donor age (P = .033), body mass index (P = .007), severe hemodynamic disturbances (P = .005) preexistent glomerular or interstitial sclerosis (P = .002 or P = .028, respectively); and cold ischemia time (CIT; P = .019). Trends toward significance were observed with recipient weight > 100 kg (P = .078), and diabetes mellitus (P = .109). Recipients who experienced DGF showed on higher rate of acute rejection, a longer hospital stay, and an higher level serum creatinine at discharge (P < .001 for all). CONCLUSION: DGF had deleterious effects in the early posttransplant period. Careful allocation and reduction of CIT may improve transplantation results.

[Immunity in chronic bronchitis patients with significant residual changes after prior pulmonary tuberculosis].

To study the immunological features in chronic bronchitis (CB) patients with great residual changes (GRC) after prior pulmonary tuberculosis, the authors examined two groups: 1) 40 CB patients with GRC after prior pulmonary tuberculosis (a study group) and 2) 30 CB patients without a history of pulmonary tuberculosis. The examination revealed that CB patients with GRC after prior pulmonary tuberculosis were found to have higher T lymphocytes, lower B lymphocytes on an exacerbation of the disease. The phagocytic properties of neutrophils were altered as their high phagocytic activity, decreased oxygen-dependent microbicidal activity of phagocytes with their stimulation. The humoral response remained to be slightly pronounced in CB bronchitis with GRC. The low serum levels of TBC active products may suggest the low activity of lipid peroxidation processes in the study group patients. After prior pulmonary tuberculosis, antioxidative activity preserves to be high in CB patients with GRC.

[Prospective assessment of a training effect in correction of endothelial dysfunction and atherosclerosis risk factors in students (results of examination of Tomsk male students)].

AIM: To assess a training effect correcting endothelial dysfunction (ED), neurovegetative status and atherosclerosis risk factors (ARF) in male students. MATERIAL AND METHODS: Ninety healthy students aged 18-25 years with ARF and ED were followed up after bicycle exercise (BE) 3 times a week: 30 males did BE for 1 month, 30--for 2 months and 30--for 3 months. Blood lipids, exercise tolerance (ET), parameters of cardiointervalography, dopplerangiography of the brachial artery and rheovasography of the forearm at rest and in tests with reactive hyperemia, hyperventilation were estimated immediately after, 1 and 3 months after BE. RESULTS: Two-month BE forms adequate structural trace the effect of which can be partially found 3 months later. Three-month BE tells on adaptation as it produces proatherogenic shifts in blood lipids. After the two-month cycle of BE positive effects regress in the following order: normalization of blood lipids, improvement of vegetovascular reactivity, high exercise tolerance and endothelium-related vasodilation. CONCLUSION: Two-month exercise is effective and safe, forms adaptive reserve of the body, structural effect of which partially persists for 3 months.

Donation and transplantation in Latvia--2006.

The 75 kidney transplant operations (32.6 per million population per year) and 2 heart transplant operations were performed in 2006 in Latvia. This represents a slight decrease of 3% compared to 2005. 86 kidneys were procured from 43 deceased donors. There were 46% donors with brain death and 54% non-heart-beating donors among them. During last decade the donor rate increased from 10.9 per million population in 1996 to 18.7 per million population in 2006. In our center patient survival was 93.2% at 1 year and 87.4% at 5 years, and graft survival was 84.5% at 1 year and 72.3% at 5 years. Such transplantation activity ensures mean waiting time of 6-7 months for patients accepted for kidney transplantation.

[Prevention of ischemic stroke in middle aged patients with atrial fibrillation. Effect of sinus rhythm maintenance, aspirin, warfarin, and simvastatin].

Patients (n=263, age 49-64 years) with persistent nonvalvular atrial fibrillation were subjected to controlled treatment aimed at restoration and maintenance of sinus rhythm (n=134) or slowing of rate of ventricular contractions. Efficacy of complementary use of combination of simvastatin with aspirin, warfarin and aspirin for prevention of ischemic stroke was assessed in both of these strategies. First strategy, supplemented with combination of simvastatin and aspirin prevented ischemic stroke and lethal outcome most successfully, while the use of warfarin was unexpectedly associated with comparative elevation of risk of ischemic stroke. It is impossible to exclude that long term administration of warfarin in strategy of sinus rhythm maintenance attenuated advantages of normal rhythm in relation of lowering of stroke risk in AFFIRM study and other similar works. Contrary to known cardio-embolic mechanism of cerebral embolism in permanent atrial fibrillation main aim of the treatment in successful sinus rhythm maintenance may become prevention of arterio-arterial emboli.

[Preclinical assessment of disturbances of vascular and vegetative reactivity of peripheral blood circulation in young men (students) with risk factors of atherosclerosis].

Hemodynamics of forearm and neurovegetative status were studied in 142 clinically healthy male students with risk factors of atherosclerosis and in 54 male students without risk factors of atherosclerosis at rest and during test with reactive hyperemia. Rheovasography of forearm, cardiointervalography, Doppler examination of brachial artery, and test with reactive hyperemia were undertaken in all subjects. The results testify to the fact that endothelial dysfunction leads to spastic state of regional hemodynamics and hyperactivity of sympathetic nervous system at rest as well as during reactive hyperemia which has a "delayed" character.

[The influence of hyperventilation in combination with active orthostasis on the condition of vegetative homeostasis in young men with atherosclerosis risk factors and endothelial dysfunction].

The aim of the study was to evaluate the effects of hyperventilation test (HVT), active orthostatic position test (AOPT), and their combination on the vegetative homeostasis in male students with risk factors of atherosclerosis (RFA) and endothelial dysfunction (ED). The mentioned tests and their combination were performed in 142 male students with RFA and ED, and 54 male students without them during brachial arterial rheovasography and cardiointervalography. Hyperactivation of the central regulatory circuit and a spastic hemodynamic condition at rest were found in subjects with FRA and ED. The sympathetic functional reserve was overstrained according to AOPT, distinctly decreased according to HVT, and exhausted when both tests were performed. The combination of HVT and AOPT is an informative stress test for pre-clinical evaluation of disturbances in adaptation mechanisms and vegetative homeostasis tensity in young men with RFA and ED. A "high value" of adaptation and the vegetative homeostasis overstrain in male students with FRA and ED indicate a premorbid condition in them.

[Search for an optimal therapy of patients with atrial fibrillation (results of many years of comparison of three treatment strategies).]. / Poisk optimal'noi terapii bol'nykh s fibrilliatsiei predserdii (rezul'taty mnogoletnego sravneniia trekh strategii lecheniia).

Patients with nonrheumatic atrial fibrillation (n=465, mean age 59.4+/-3.8 years) received controlled therapy for 7.4+/-1.6 years. Group 1 comprised 306 patients with paroxysmal and persistent atrial fibrillation who after restoration of sinus rhythm received antiarrhythmic therapy aimed at prevention of recurrences and repetitive cardioversions. Group 2 consisted of 67 similar patients who did not receive continuous antiarrhythmic therapy. Therapy of patients with persistent atrial fibrillation (group 3, n=92) included heart rate slowing drugs and anticoagulants. Group 1 was characterized by lowest rate of complications and all cause mortality, and best quality of life. There were more nonfatal strokes in group 2. All cause mortality in group 2 was 15% (p<0.05). Highest rate of nonfatal strokes, and deaths due to chronic heart failure was observed in group 3. All cause mortality in this group was 22.8% (p<0.001 vs group 1).

[Comparative morphological characteristics of bronchial mucosa in patients with chronic obstructive bronchitis and bronchial asthma]. / Sravnitel'naia morfologicheskaia kharakteristika slizistoi obolochki bronkhov u bol'nykh khronicheskim obstruktivnym beonkhitom i bronkhial'noi astmoi.

The material for histoultrastructural study was biopsies obtained by fibrobronchoscopy from 12 patients with endogenic bronchial asthma (BA) and 4 patients with chronic obstructive bronchitis (COB). The principal periods of affection in these diseases, the role of bronchial epithelium, effector cells of inflammation, nervous elements, smooth muscle cells, microcirculatory disturbances in patho- and morphogenesis of chronic obstructive pulmonary lesions are determined. The results indicate that BA develops due to disturbances of adaptive mechanisms being in some cases the issue of COB progression.

Attitudes towards organ donation and transplantation--a study involving Baltic physicians.

The aim of this study was to identify and describe attitudes towards organ donation and transplantation among a group of Baltic physicians who are involved in this aspect of medical care. A total of 151 neurosurgeons, anesthesiologists, and neurologists anonymously answered a questionnaire between February and March 1995. The majority of physicians said they would be willing to donate their own organs after their death but disagreed with the idea of using organs from a dead person who had had a negative opinion towards organ donation. Given a patient who fulfilled the criteria for brain death, this group of physicians found it widely acceptable to keep the patient on a ventilator until organ donation could take place. We conclude that the participating physicians generally have similar attitudes towards organ donation and transplantation. This study is valuable in that it shows the interest in, and the need for, clinical and research collaboration, including a discussion of ethics, within the area of organ donation and transplantation. This is essential for future collaboration with Western countries.

[Systems analysis of polyparametrical syndromes in students under study-induced stress]. / Sistemnyi analiz poliparametricheskikh sindromov u studentov pri razvitii stressa v period ucheby.

In addition to routine physical examinations, the polyparametrical method was used to examine 250 students to assess their health. For this, the methods of pattern discrimination and classification were employed to analyze multiparameter data. Clinical and polymetric findings correlated well. The polymetric method revealed 4 main classes of the students' functional and autonomic status. Autonomic changes can be systemic and local. The visualized data of objective functional parameters controlled by the autonomic system made it possible to give a syndromal assessment of functional states and to reveal the intermediate stage between health and disease.