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Ter Arkh [journal]
- [Risk of cardiovascular death in relation to blood pressure levels in Tyumen men and women: results of a 12-year prospective study]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):70-4.
To evaluate the effect of blood pressures (BP) on the risk of cardiovascular death (CVD) in a Tyumen open population through a 12-year prospective follow-up study.Standard methods were used to make a cardiac screening of a representative sample of 25-to-64-year-old Tyumen citizens in 1996. The response rate was 80.4% or 1608 persons. CVD cases were recorded in 85 (10.69%) men and 33 (4.06%) women during the 12-year subsequent prospective follow-up study. The Cox regression model was used to assess the relative risk (RR) for CVD. Survival rates were analyzed with the Kaplan-Meier method.In the men, RR for CVD statistically significant increased from the 4th quintile of the distribution of systolic blood pressure (SBP) (2.88) and from the 3rd quintile of that of diastolic BP (DBP) (2.33). The women showed a statistically significant increase i RR for CVD only in the 5th quintile both of SBP and DBP (11.0 and 7.95%, respectively). Analysis of the absolute risk showed that SBP made a greater contribution to CVD that DBP in both the men and women (52.8 and 46.9% for the men and 92 and 83.8% for the women, respectively).The open population from Tyumen was ascertained to have a high RR for CVD starting with a SBP of > or = 141 mm Hg and a DBP > or = 86 mm Hg for the men and with a SBP of > or = 152 mm Hg and a DBP of > or = 95 mm Hg for the women, which determined a lower survival in the population with elevated SBP and elevated DBP.
- [Impact of the intake of cardiac drugs on adaptation to high temperatures in patients with cardiovascular diseases under the conditions of the abnormally hot summer of 2010]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):63-9.
To evaluate the impact of intake of cardiac drugs on adaptation to abnormal heat in patients with cardiovascular diseases (CVD).The study covered 188 patients with CVD, who had visited the Research Dispensary Department in January 2011. General clinical examination, biochemical blood analysis, and electrocardiography were made; the hospital anxiety and depression scale, the visual analog scale, and the questionnaire specially developed for this investigation were used. The authors considered acute myocardial infarction, acute stroke, hospital admission, a medical emergency team call, temporary disability (days), hypertensive crises, and unplanned visits to a doctor as estimated outcomes (endpoints) and the number of undesirable reactions a week during the abnormal heat and from September to December 2010 as a combined endpoint.There were a larger number of weekly adverse reactions than usual and a reduction in quality of life (QL) during the abnormal heat. Both an increase and a reduction in the dose of cardiac drugs during the abnormal heat were associated with its worse tolerability. The use of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (CCB) was an independent factor associated with the smaller number of complications during the abnormal heat. That of diuretics was an independent factor that was associated with a more decrease in QL in elderly patients during the heat. The intake of angiotensin receptor blockers (ARB) or nitrates was an independent factor associated with the larger number of complications during the abnormal heat.The use of ACE inhibitors and CCB is associated with fewer complications during the abnormal heat of 2010. The intake of diuretics in patients over 65 years of age and that of ARB or nitrates was associated with worse heat tolerance.
- [TNF-alpha, IL-10, and eNOS gene polymorphisms in patients with influenza A/H1N1 complicated by pneumonia]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):58-62.
To study the specific features of cytokine gene polymorphisms (such as TNF G308A, IL10 C592A, IL10 C819T, IL10 G1082A) and vascular tone regulatory gene polymorphism (eNOS C786T) in patients with influenza A/H1N1 complicated by pneumonia.Patients treated for pneumonia in the presence of influenza A/H1N1, divided into 3 groups: 1) 37 patients with severe pneumonia; 2) 74 with mild pneumonia; and 3) 68 healthy individuals, were examined. Molecular genetic testing was made using a polymerase chain reaction technique. Serum TNFalpha, IL-10 and s-ICAM-1 concentrations were measured by enzyme immunoassay.As compared to the control group, the patients with influenza-related pneumonia were more frequently homozygous for the G allele of the TNF 308 G/A polymorphism. The IL-10 G allele (1082 G/A) was considerably prevalent as homozygous carriage and the IL-10 G allele (592 G/A) was as a homozygous type to a greater extent. An abnormal zygote of the eNOS T/T (786 C/T) polymorphism was found to be prevalent among the patients with influenza-related pneumonia; on the contrary, there were mainly heterozygous C/T carriers in the control group. In the C/T genotype group, the level of soluble intercellular adhesion molecule 1 (sICAM-1) was lower than in other polymorphic variants (786 C/T). CONCLUSION; The study of the patients' genetic status in influenza A/H1N1 will be able to evaluate the severity of the disease and to predict possible complications.
- [Type D personality in chronic lung diseases: prevalence, psychological features]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):51-7.
To estimate the prevalence and impact of Type D personality on the psychological status and quality of life (QL) of patients with chronic lung diseases.117 patients (105 men and 12 women; mean age 59.6 +/- 0.9 years) with chronic lung diseases were examined. The DS14 questionnaire was used to identify Type D personality. According to the test results, the patients were divided into 2 groups: 1) 39 Type D patients; 2) 78 non-Type D patients. The levels of depression and anxiety and QL were additionally determined using the SF-36 questionnaire. Clinical and laboratory parameters, spirometric data, and 6-minute walk test (6'WT) distance were estimated.The Type D versus non-Type D patients had higher levels of situational (46.6 +/- 1.7 and 41.2 +/- 1.2 scores; p = 0.01) and personality (47.6 +/- 1.5 and 43.7 +/- 0.9 scores; p = 0.02) anxiety and depression (42.9 +/- 1.6 and 35.9 +/- 0.8 scores; p = 0.00004), as well as lower QL levels in the vitality (42.2 +/- 2.2 and 52.2 +/- 1.9 scores; p = 0.002), emotional function (20.5 +/- 4.0 and 36.8 +/- 4.4 scores; p = 0.02), and mental health (56.2 +/- 1.9 and 63.4 +/- 1.9 scores; p = 0.006) scales. The 6'WT distance was less in the Type D patients (463.3 +/- 17.2 m)than in non-Type D patients (504.1 +/- 8.7 m); p = 0.02.Type D personality is encountered in 33% of patients with chronic lung diseases associated with the higher level of psychological distress in the patients, with the worsening of a mental component of QL, and with the reduction in exercise tolerance.
- [Analysis of fatal outcomes from pulmonary thromboembolism in young subjects]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):44-50.
To investigate the risk factors and main clinical signs of fatal pulmonary thromboembolism (PTE) in young subjects.Medical case reports and postmortem examination results were retrospectively analyzed in 32 patients (all males) who had died from PTE in different Moscow health care facilities in 2002 to 2010.No idiopathic thromboembolism cases were found. Each patient had at least two risk factors. Most patients developed generalized obstruction of the pulmonary vascular bed, by involving mainly the great arteries, which resulted in right ventricular failure and sudden death. CONCLUSION; The findings may be used not only to assess the clinical probability of PTE diagnosis, but also to choose adequate preventive measures.
- [First clinical experience with endothelin receptor antagonist bosentan used in patients with pulmonary hypertension: results of a one-year study]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):38-43.
To evaluate the efficiency and safety of long-term (12-month) treatment with the endothelin receptor antagonist bosentan (tracleer (Actelion, Switzerland)) in patients with pulmonary hypertension (PH).The prospective observational study enrolled 10 patients (8 with idiopathic PH and 2 with PH and systemic scleroderma). The patients' mean age was 50.0 +/- 6.9 years; mean pulmonary artery pressure (mPAP) 65 +/- 12 mm Hg; cardiac output (CO) 3.4 +/- 0.8 l/min; 6-minute walk test (6'WT) distance, 318 +/- 94 m. Before and 3, 6, and 12 months after the treatment, the patients underwent Doppler echocardiography, arterial blood gas analysis, external respiratory function test, and dyspnea evaluation using the MRC scale and 6'WT. The initial dose of bosentan was 62.5 mg b.i.d., then 125 mg b.i.d. following 4 weeks.Bosentan treatment resulted in a reduction in pulmonary artery systolic pressure and mPAP (at 12 months: 76.8 +/- 11.5 and 58.8 +/- 11.4 mm Hg, respectively; p < 0.01) and an increase in CO (at 12 months: 4.2 +/- 1.2 l/min; p = 0.002). Six patients were observed to have a lower WHO classification functional class (FC). Lung diffusing capacity tended to improve (at 12 months, the increment was more than 6% of the reference value; p = 0.059). In the patients, dyspnea was relieved as shown by MRS scores from 3.1 +/- 0.7 (at baseline) to 2.1 +/- 0.6 (at 12 months); p = 0.002. The 6'WT distance increased up to 342 +/- 67 m (at 12 months); p = 0.005. The drug was well tolerated; only one patient had a transient increase in the activity of liver enzymes.The long-term bosentan treatment in patients with PH leads to improvements in pulmonary hemodynamics, WHO classification functional class, a reduction in dyspnea, and a rise in exercise tolerance.
- [The clinical features of cystic fibrosis in adult patients with carbohydrate metabolic disturbances]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):32-7.
To investigate the clinical features of cystic fibrosis (CF) in adult patients with carbohydrate metabolic disturbances (CMD).CF was diagnosed on the basis of its clinical picture and a positive sweat test, and/or genetic study. Clinical, anthropometric, functional, microbiological data were compared with the results of imaging diagnosis in CF patients with and without CMD.The data of 350 patients were retrospectively analyzed. An oral glucose tolerance test was randomly performed in 154 CF patients without CMD. There was normal carbohydrate metabolism in 92 (59.7%) patients with CF, impaired glucose tolerance (IGT) in 44 (28.6%), CF-dependent diabetes mellitus (CFDDM) in 18 (11.70%). The latter had been previously diagnosed in 37 (10.6%) other patients with CF. Three groups of patients were formed: 1) 92 patients without CMD; 2) 44 with IGT, and 3) 55 with CFDDM. The patients with CFDDM had lower stature, weight, and lung function, significantly more common bronchiectases, a lower Staphylococcus aureus colonization with a tendency toward a higher Burkholderia cepacia colonization than those without CMD. As compared with the patients without CMD, those with this disorder were found to have a high rate of severe mutations; mild mutations were absent in the patients with CFDDM.CMD in CF is characterized by its high rates and latent course. The patients with CMD have retarded physical development, more pronounced morphofunctional disorders in the bronchopulmonary system, lower lung functional parameters, and more aggressive sputum microbial composition.
- [Predictors of osteopenic syndrome in idiopathic pulmonary fibrosis]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):28-31.
To evaluate the functional state of bone tissue in patients with idiopathic pulmonary fibrosis (IPF), waiting for lung transplantation, and to determine possible predictors of lower bone mineral density (BMD) in this pathology in the pretransplantation period.Forty-nine IPF patients waiting for lung transplantation were examined. The patients' mean age was 53.4 +/- 6.4 years. BMD in the lumbar spine (L(II)-L(IV)) and femoral neck (FN) was estimated using dual-energy X-ray absorptiometry. All the patients underwent external respiratory function test, pulmonary diffusing capacity (DL(CO)), gasometry, and 6-minute walk test (6'WT).Osteopenia was recorded in 77% of the examinees, of them 28% had osteoporosis (OP). Normal BMD in both L(II)-L(IV) and FN was found only in 13% of the patients. The T score in L(II)-L(IV) was directly related to body mass index. There was a direct correlation between BMD in L(II)-L(IV) and FN, forced vital capacity (FVC), DL(CO), and arterial blood oxygen saturation (SaO2) and an inverse correlation with arterial carbon dioxide partial pressure (pCO2). No significant correlation was found between the distance covered in 6'WT, FEV1, pO2, and BMD in both L(II)-L(IV) and FN. Six (15%) subjects had atraumatic fractures at different sites.Osteopenia is a common systemic manifestation in patients with IPF in the pre-transplantation period. BMI, FVC, exercise desaturation, and DL(CO) may be considered as predictors for the development of OP initiated by IPF.
- [Change in the blood cytokine spectrum in patients with pulmonary sarcoidosis]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):23-7.
To assess cytokine spectrum changes in different types of pulmonary sarcoidosis (PS).Twenty-seven PS patients without signs of pulmonary fibrosis and 14 patients with sarcoidosis complicated by pulmonary fibrosis were examined. Baseline serum Th1 and Th2 cytokine concentrations were studied. A control group comprised 30 healthy donors.A higher interleukin (IL)-4/IL-2 ratio was found in the peripheral blood of the patients with pulmonary fibrosis-complicated sarcoidosis than in the other patients (326.4 +/- 122.6 and 88.2 +/- 28.6%, respectively; p = 0.002). The sarcoidosis patients with signs of pulmonary fibrosis and no symptoms of disease inflammatory activity had elevated blood IL-1 levels whereas an IL-1 receptor antagonist was decreased.In the patients with PS, the development and progression of pulmonary fibrosis occur with a shift in the Th1/Th2 balance towards Th2, which manifests itself as a higher IL-4/IL-2 ratio in the peripheral blood. At the same time, the signs of systemic inflammatory activity remain.
- [Role of endothelial dysfunction, the interface between hemostatic and system inflammatory responses in the pathogenesis of an infectious inflammation-dependent exacerbation of chronic obstructive pulmonary disease]. [English Abstract, Journal Article]
- Ter Arkh 2013; 85(3):17-22.
To analyze the systemic manifestations of vascular endothelial damage, the activation of hemostatic and inflammatory responses in patients with an infectious inflammation-dependent exacerbation of chronic obstructive pulmonary disease (COPD).The paper provides the data of examinations of 111 patients with the clinical signs of an infectious inflammation-dependent exacerbation of COPD who had 2 or 3 positive criteria elaborated by N. Anthonisen et al. (1987). The patients were divided into 2 phenotypically different subgroups: 1) 92 (82.9%) COPD patients without clinical manifestations of bronchoectasis; 2) 19 (17.1%) patients with COPD concurrent with documented bronchiectasis. The patient subgroups were matched for smoking status and the characteristics of COPD and respiratory failure. The investigators assessed the time course of changes in the serum level of endothelin-1 (ET-1), the aggregation function of platelets, and the plasma concentrations of D-dimers and homocysteine in patients with COPD compared to healthy, never smokers (n = 35) and smokers (n = 27).An increase in the levels of the endothelial dysfunction markers ET-1 and homocysteine was found in patients with COPD, which was comparable with the changes in these indicators in the group of smokers. In both subgroups, the rise in plasma D-dimer levels was more pronounced in the patients with a COPD exacerbation than in the smokers. Its therapy with systemic and inhaled glucocorticosteroids reduced C-reactive protein and ET-1 levels in both patient subgroups and in D-dimers in subgroup 1. Elevated D-dimer levels remained when achieving remission, which points to the risk of thrombogenic and thromboembolic events in the patients with an infectious inflammation-dependent exacerbation of COPD and concomitant circulatory system diseases.The patients with an infectious inflammation-dependent exacerbation of COPD are observed to have elevated peripheral blood markers of endothelial dysfunction and thrombinemia. These changes are pathogenetically caused by smoking or neutrophilic inflammation and associated with a higher risk of thrombogenic events.