Problems and prospects for finding new pharmacological agents among adenosine receptor agonists, antagonists, or their allosteric modulators for the treatment of cardiovascular diseases.

A1-adenosine receptors (A1AR) are widely distributed in the human body and mediate many different effects. They are abundantly present in the cardiovascular system, where they control angiogenesis, vascular tone, heart rate, and conduction. This makes the cardiovascular system A1AR an attractive target for the treatment of cardiovascular diseases (CVD). The review summarizes the literature data on the structure and functioning of A1AR, and analyzes their involvement in the formation of myocardial hypertrophy, ischemia-reperfusion damage, various types of heart rhythm disorders, chronic heart failure, and arterial hypertension. Special attention is paid to the role of some allosteric regulators of A1AR as potential agents for the CVD treatment.

RISK FACTORS AND COMORBIDITY IN DIFFERENT TYPES OF FUNCTIONAL DYSPEPSIA: RETROSPECTIVE COHORT ANALYSIS.

There is a significant data about overlap of functional dyspepsia (FD) and irritable bowel syndrome (IBS), however mostly the data is based on the previous diagnostic criteria and do not include other pathologies. In the previous researches there were no differential statistical analysis performed for different types of FD - postprandial distress syndrome (PDS) and epigastric pain syndrome (EBS). Aim of the study - to assess potential risk factors and the prevalence of comorbid conditions associated with FD and to compare their frequency with the same in the group with no dyspeptic complaints and in patients with different types of FD - PDS and EPS. This study was conducted as a retrospective database analysis of the patients with newly set diagnosis of FD and control group. For all the cases the information on demographic (working status, family status) and lifestyle characteristics (body mass index, smoking status, and alcohol consumption), and comorbidities were collected from the medical files. We statistically analyzed the presence of risk factors, comorbidity and its frequency in the patients with FD and compared the results with control group and in the groups with different types of FD according to the generally accepted standards. This study included 158 patients with PDS, 87 patients with EBS, and 90 volunteers with no dyspeptic complaints. Smoking, alcohol consumption, and family status were not associated with the risk of FD. The presence of sleep disorders and being unemployed increased the risk of FD. The comparison of the results of the patients with different types of FD demonstrated that there were no statistical difference in risk factors for the PDS and EPS. Gastroesophageal reflux disease (GERD), IBS, chronic gastritis and / or duodenitis, anxiety, and depression occur more frequently in the group of patients with FD. No association between autoimmune thyroiditis (AIT), arterial hypertension and ischemic heart disease (IHD) was evaluated. There was no statistical difference for the frequency of GERD, chronic gastritis and / or duodenitis, anxiety, AIT, arterial hypertension, and IHD in the patients with different types of FD. However, it was evaluated that IBS and depression occur more frequently in the group of patients with PDS, than in the patients with EPS.

MORPHOLOGICAL PECULIARITIES OF CHRONIC GASTRITIS IN PATIENTS WITH FUNCTIONAL DYSPEPSIA.

Functional dyspepsia (FD) is the most common cause of chronic epigastric pain and abdominal fullness. Helicobacter pylori-associated gastritis is one of the pathophysiological factors of FD, however the peculiarities of it are still unknown. Aim of the study - to compare the morphological changes in biopsy specimens of gastroduodenal area in patients with different types of functional dyspepsia. This study was conducted as a cross-sectional study in adult subjects with FD. Biopsy specimens were taken from the stomach as per the Houston-updated gastric biopsy sampling protocol. To measure gastritis grade we used OLGA and OLGIM staging systems. Analysis was performed by pathologist who was blinded to the clinical diagnosis of the patients. We compare the degree of inflammation, activity of gastritis, presence and degree of atrophy, metaplasia and dysplasia in patients with different types of FD. This study included 33 subjects with postprandial distress syndrome (PDS) and 28 subjects with epigastric pain syndrome (EPS) according to Rome IV criteria. The level of gastric body and antral inflammation, activity degree, and metaplasia were detected at the same frequency in both groups (p>0.05). The grade of antral atrophy was significantly higher in patients with PDS (p=0,002) with no difference in the gastric body.

Willingness of Patients with Breast Cancer in the Adjuvant and Metastatic Setting to Use Electronic Surveys (ePRO) Depends on Sociodemographic Factors, Health-related Quality of Life, Disease Status and Computer Skills.

Introduction: Because of the often unfavorable prognosis, particularly for patients with metastases, health-related quality of life is extremely important for breast cancer patients. In recent years, data on patient-relevant endpoints is being increasingly collected electronically; however, knowledge on the acceptance and practicability of, and barriers to, this form of data collection remains limited. Material and Methods: A questionnaire was completed by 96 patients to determine to what extent existing computer skills, disease status, health-related quality of life and sociodemographic factors affect patients' potential willingness to use electronics methods of data collection (ePRO). Results: 52 of 96 (55 %) patients reported a priori that they could envisage using ePRO. Patients who a priori preferred a paper-based survey (pPRO) tended to be older (ePRO 53 years vs. pPRO 62 years; p = 0.0014) and typically had lower levels of education (p = 0.0002), were in poorer health (p = 0.0327) and had fewer computer skills (p = 0.0003). Conclusion: Barriers to the prospective use of ePRO were identified in older patients and patients with a lower quality of life. Given the appropriate conditions with regard to age, education and current health status, opportunities to participate should be provided to encourage patients' willingness to take part and ensure the validity of survey results. Focusing on ease of use of ePRO applications and making applications more patient-oriented and straightforward appears to be the way forward.

Clinical and Autopsy Diagnoses of Visceral Affections of Patients Who Died Because of Complicated Burns with Multi-organ Failure.

The anatomicopathological investigations carried out in a total number of 186 cadavers during the last decade were reviewed. In these retrospective studies of necropsy protocols related to different affections of visceral organ systems that evolved asymptomatically, 30.1% involved the neurological system, 36.0% the uropoiesis system, 34.4% the gastrointestinal system, 52.0% the hepatobiliary system, and 39.7% the cardiovascular system, with a prevalence in the pulmonary system of 64.2%. A comparative analysis of the incidence of affections detected in various visceral organs (on the basis of necropsy data in the 186 burn patients) and the incidence of their clinical manifestations showed that in 35% of patients with extensive and deep burns all of these conditions developed asymptomatically and were diagnosed only through autopsy.

Sensitivity and positive predictive values of presurgical clinical diagnosis of excised benign and malignant skin tumors: a prospective study of 835 lesions in 778 patients.

This article reports on the sensitivity and positive predictive value of clinical diagnosis of benign and malignant skin tumors by expert plastic surgeons in an Israeli clinic. Most published reports have focused on the sensitivity of clinicians' diagnoses, a general measure of the physician's skill that does not predict the rate of accuracy of a physician's diagnoses. Our study of 835 lesions in 778 patients, one of the largest Israeli series, assesses the clinical diagnosis of malignant and benign skin tumors and is one of the few that provide information on the positive predictive value, the measure that is of interest to both physicians and patients. The majority of tumors were benign (56.8 percent), 31.6 percent were malignant, and 11.6 percent were premalignant. Among the 474 benign lesions, 46 percent were nevi. The most common nevi subclass was compound nevi (53 percent), 9 percent of the nevi were dysplastic, and 5 percent were blue nevi. The most common malignant tumor was basal cell carcinoma, accounting for 78 percent of malignant tumors. Although sensitivity for clinical diagnosis of malignancy was 91.3 percent, the positive predictive value for clinical diagnosis of malignancy was 71.3 percent. The sensitivity rate for clinically diagnosing premalignant tumors was 42.3 percent, whereas the positive predictive value for these diagnoses was higher (64.1 percent). The sensitivity rate for diagnosis of all benign lesions was 85.9 percent, and the positive predictive value was 94.2 percent. The sensitivity rate for diagnosis of all nevi was 87.6 percent, and the positive predictive value was 85.7 percent: i.e., only seven of the 218 pathologically proven diagnoses of nevi (3.2 percent) were falsely diagnosed as malignant lesions. Even more interestingly, five of the 223 clinical diagnoses of nevi (2.2 percent) were pathologically proven to be malignant melanomas, and seven were found to be premalignant lesions (3.1 percent). It was concluded that publications which report only on the sensitivity neglect to provide information of interest regarding the positive predictive value. Often, positive predictive value is qualitatively different from the sensitivity, and thus relying only on the sensitivity may lead to incorrect evaluation of a clinical judgment, which may result in erroneous surgical decisions.

Distal arteriovenous fistula to maintain patency of the venous drainage of a latissimus dorsi flap following subclavian vein repair.

Successful reconstructive surgery with muscle flaps depends on adequate arterial supply and undisturbed venous drainage. Combining such surgery with reconstructive vascular surgery of a large-caliber vein that is responsible for the venous drainage of the flap poses an additional challenge--the repaired vein's susceptibility to thrombosis. Every attempt must be made to prevent venous outflow obstruction following muscle flap surgery. Data from the vascular surgery literature demonstrate a low success rate for subclavian vein repair. The success rate with venous reconstructive surgery has been greater when a distal arteriovenous fistula accompanied the repair. The present case described the use of a temporary distal cephalic-brachial arteriovenous fistula to maintain the patency of the venous drainage of a pedicled latissimus dorsi muscle flap, following subclavian vein repair, for one-stage coverage of a large chest wall defect.

[Experience gained with the use of local administration of medicinal remedies in rheumatic diseases]. / Dosvid zastosuvannia lokal'nogo vvedennia likars'kykh zasobiv pry revmatychnykh zakhvoriuvanniakh.

In the article, errors that are frequently encountered in dealing with rheumatic diseases are analysed together with the experience gained by the authors themselves with the management of 380 patients using local injections of corticosteroids (diprospan) and chondroprotectors (alflutop). The employment of local injection therapy has been shown to shorten considerably the patient's hospital stay, to improve the quality of life of the patients, with them being practically free from ill effects and complications.

Improved vitality of experimental random dorsal skin flaps in rats treated with enriched cell culture medium.

A defined, serum-free cell culture medium supplemented with nonsteroidal anabolic hormones, insulin, thyroxin, and growth hormone was found to accelerate wound healing by stimulating vascularized granulation tissue formation, epithelialization, and angiogenesis. The aim of this work was to study the effect of cell culture medium on the survival rate of cephalically based random dorsal skin flaps in an animal model. A total of 77 Sprague-Dawley rats were randomized into five treatment groups: pharmacologic delay with cell culture medium, flap enhancement with cell culture medium, surgical delay, biological delay with saline, and control. Statistically significant differences in distal flap necrosis were found among all groups (p<0.003). The rats treated with cell culture medium before flap elevation showed a significant increase in flap viability: a survival rate of 83 percent, compared with the control group, which demonstrated a survival rate of only 58 percent (p<0.0001). The surgical delay and the groups treated with cell culture medium yielded similar results with no significant difference between them. This study indicates that preoperative injection of cell culture medium may play a role in decreasing skin flap necrosis.

[Treatment of mild and moderate hypertension with enalapril (multicenter study of enap and enap N in Ukraine)]. / Lechenie miagkoi i umerennoi arterial'noi gipertonii énalaprilom (mnogotsentrovoe issledovanie énapa i énapa-N na Ukraine).

AIM: Assessment of efficiency and safety of enalapril (enap) and its combination with hydrochlorotiaside (enap-N). MATERIALS AND METHODS: 127 patients with mild and moderate blood hypertension entered an open non-comparative multicenter trial. 60 of them received enap (group 1), 67--enap N (group 2). Group 1 patients were given enap for 2 weeks in a dose 10 mg/day. If this dose was not adequate to normalize blood pressure, it was raised to 20-40 mg/day. Patients of group 2 received enap-N one tablet a day for 3 weeks. If the pressure persisted higher than 140/90 mm Hg, the treatment was continued for 3 weeks more in a dose of 2 tablets a day. RESULTS: Blood pressure lowered under 140/90 mm Hg in 40 patients of group 1 (66.7%). Systolic pressure dropped by 10 mm Hg minimum and diastolic by 5 mm minimum in 18 group 1 patients (30%). Enap-N reduced blood pressure under 140-90 mm Hg in 44 of 67 patients (65.7%). Systolic and diastolic pressure dropped, respectively, in 23(34.3%) patients. CONCLUSION: Enap and enap-N tablets were found highly effective and well tolerated. Side effects were caused by lowering of blood pressure.

Striae distensae of augmented breasts after oral contraceptive therapy.

A case of striae distensae (SD) of bilateral augmented breasts following oral contraceptive therapy is presented. Striae maturation and the prevention of additional skin marks was achieved with immediate cessation of oral contraceptive pill therapy and long-term daily topical application of tretinoin cream. It is suggested that patients who are candidates for breast augmentation surgery should be informed of the possible risk of developing SD if they are taking or planning to take the contraceptive pill.

PIP: This is a descriptive report on the development of striae distensae (SD) on augmented breasts following oral contraceptive (OC) therapy. The subject was a 17-year-old nulliparous girl who had undergone bilateral augmentation mammoplasty and developed SD following low-dose OC therapy for 4 months after surgery. The pathogenesis of SD seems to be multifactorial and includes mechanical stretching, age, hormonal effects, and genetic and familial predisposition. Certain changes in the endocrine system also have a role in the development of the striae. In this case, the stretch marks began when the patient started taking the Mercillon contraceptive pills and matured after she ceased to take the birth control pills and began a long-term daily application of tretinoin cream. While patients who are candidates for augmentation mammoplasty should be informed of the possible risk in taking OCs, there is no conclusive evidence that there is a relationship between the use of birth control pills and the development of striae distensae following augmentation mammoplasty.

Partial breast necrosis after MIDCABG via small anterolateral thoracotomy.

We report a case in which partial breast necrosis developed after minimally invasive direct coronary artery bypass grafting using an IMA Retractor (Cardio-Thoracic Systems Inc, Cupertino, CA). We suggest that during minimally invasive direct coronary artery bypass grafting in the presence of a large breast, it is advisable to reduce the intraoperative additive forces of pressure and traction caused by the retractor arm on the breast tissue, thus avoiding further excessive compression on the partially compromised blood circulation of the breast.