In connection with the precarious prognosis of the global distribution of heart failure (HF), we tried to summarize last years’ data on primary and secondary prevention of this disease. We reviewed a level of threat influences of the major risk factors of HF and the possible ways of their reduction. It was recommended to elaborate and use the individual complex programs for the physical rehabilitation of the patients and prevention for each stage of HF. 

Purpose: To evaluate the frequency of insulin induced lipohypertrophy (LH) in diabetic patients revealed by observation and palpation techniques, as well as ultrasonography of subcutaneous fat.

Materials and methods: This study was done on 192 diabetic patients (mean duration of disease was 10 years) who had been under the treatment with insulin a mean 8 years. Observation and palpation techniques, as well as ultrasonography of subcutaneous fat were used in assessing LH in these diabetics.

Results: On the basis of palpation LH were revealed in 27,7% patients. Further ultrasonography of injection sites was performed to all patients. LH were revealed in 83,2% patients, including those subjects with palpatory changes. Pathologic areas of subcutaneous fat the most often were occurred in paraumbilical regions – 61% patients.

Summary: Problem of LH has been modified. As a result, traditional methods of LH diagnostics have become not an informative. This question is needed an additional investigation. 

Purpose: testing in clinical practice a mathematical model of risk assessment of the presence of silent myocardial ischemia (SMI) in type 2 diabetic patients.

Material and Methods: 55 type 2 diabetic patients have been studied; among them 26 (47,27%) men and 29 (52,73%) women, mean age – 57,79 ± 8,39 years, diabetes duration – 9,65 ± 6,41 years. Identified 11 parameters included in the model. Calculated and assessed the presence of factor SMI. To verify the diagnosis, all patients completed ECG monitoring with mandatory achievement of submaximal heart rate.

Results: Higher risk of having SMI was detected in 14 (25.45%) patients, low risk - in 41 (74.54%). SMI was diagnosed in 10 (71.43%) patients at high risk. In patients at low risk SIM was not found. Thus, the sensitivity of the model was 100%, specificity - 91%, the positive predictive value - 71%, and the negative - 100%.

Conclusions: This mathematical model assesses the risk of having a SMI in type 2 diabetic patients and can be used in actual practice to optimize early detection of this disease. 

Purpose: Improving efficiency of treatment mixed tubercular and ps.aeruginosa pleural empyema.

Materials and methods: The results of treatment of 65 patients with mixed tubercular and ps.aeruginosa pleural empyema have been analyzed. Local ozone therapy was used in 29 cases.

Results: The strict keeping of procedure allows to have expressed local and systemic activity with absence of side effects.

Conclusions: Application of ozonated solutions is effective and economic method of sanitation empyemic pleural cavities. So, ozone therapy can be recommended in the complex treatment of pleural empyema produced by mixed flora. 

Purpose: To study the role of lymphocyte apoptosis induced by Vibrio cholerae microbial cells and cholera toxin in the formation of the postvaccinal apoptotic immunodeficiency, as well as the possibility of its correction with the use of immunomodulator imunofan.

Materials and methods: The apoptosis has been evaluated on the base of characteristic morphological changes of cells in preparations stained by histological stains, as well as by the method of flow cytofluorometry with propidium iodide staining on the cytofluorometer “NaviosТМ”.

Results: It has been found that the etiological agent of cholera and its cholera toxin possess the apoptogenic activity towards murine T-lymphocytes. It has been shown that CD4+ T-cells are preferentially involved in the apoptosis. The role of scheduled cell death of immunocompetent cells in the formation of postvaccinal immunodeficiency in case of cholera is demonstrated. The preparation for immunocorrection of these changes is proposed.

Summary: These findings confirm the usefulness of immunomodulator imunofan in vaccination against cholera and also open new perspectives for the improvement of cholera infection prophylaxis. 

Purpose: To study interrelation of ultrasonic specifications of a thyroid gland with type of the constitution at healthy men and women of 17-30 years.

Materials and Methods: 288 healthy people (from them men - 132, women - 156) the youthful and first period of mature age are surveyed. In order to identify the somatic types according to R.N. Dorokhov and V.G. Petruhin method (1989) we examined 132 men and 156 women. Thyroid volume was determined with ultrasound scanner «Aspen» with frequency of 7.0 MHz.

Results: The difference between the values of thyroid volume meanings in representatives of the MiC and MaC types for men was 2.41 cm3 (p <0,05), for women - 3.96 cm3 (p <0,05).

Summary: Anatomic variability indices of thyroid ultrasound correlated with individual-typological characteristics of the subject.

Purpose: To reveal clinical effects of epoetin alfa in the sharp period the serious сoncomitant brain injury.

Materials and Methods: Controllable blind randomized research at 77 patients at the age of 38,6±15,2 years old was held. Epoetin alfa was entered intravenously. The given preparation was applied from first days of the posttraumatic period, in a course dose not less than 50000 МЕ (on 10000 МЕ within 5 days).

Results: The given preparation has reduced number of patients with a Multiple organ dysfunction syndrome, grasping infringements of functions of three and more bodies (in 1,7 times). In group of patients by which it was applied epoetin alfa, the number of complications has decreased from bronho-pulmonary system. The number of cases respiratory distress has decreased in 2,1 times, pneumonia - in 3 times, trophic infringements - in 5,5 times.

Summary: Inclusion in intensive therapy the serious сoncomitant brain injury epoetin alfa leads to more favorable current of traumatic illness. 

Purpose: To investigate the state of autonomic nervous system in patients with asthma during the period of both aggravation and remission of the disease.

Materials and Methods: 121 patients are examined in the study (81 during the period of an exacerbation of a disease and 40 during the remission). The study of autonomic nervous system state was performed by using cardioanalizator «ANKAR-131».

Results: According to the spectral analysis of heart rate variability in children of both groups the predominance of slow waves II order were noted in spectrogram, it testifying to increase of humoral-metabolic effects. The VLF waves made 2700,275±248,35мс2 values spectral power averaged in children during the period of remission of the disease. The vagosympathetic balance factor (LF/ HF) in 33,3% of patients experiencing an attack of asthma and in 42,5% of patients during the remission of the disease is greater than 2,0, it indicating activation of sympathetic nervous system.

Summary: Analyzing the data one can say that the findings of the spectral analysis of heart rate variability in children with asthma are early markers of abnormal autonomic regulation. 

Purpose: To analyse the metabolic changes in the liver cells of experimental animals after prolonged treatment with simvastatin.

Materials and Methods: Our experiment was taken on 40 rates (males) which were divided on two groups: 1-st (control) – 20 intact animals; 2-nd (experimental) – 20 animals who took simvastatin during 3 months (Zocor, 20 mg) on 1,5 mg once per day.

Results and Summary: Estimation the level of glycolysis metabolites, activity of enzymes of carbohydrates and energetic metabolism and antioxidant protection gave us possibility to established that one of the pathophysiologic damage of liver functions after the prolonged treatment with statins was hypoxia which characterized by decreasing velocityof key pathways of energetic metabolism and decreasingof powerof enzymatic antioxidant defense. 

Purpose: to examine the frequency of mutations W 515K and W 515L in the Mpl, the encoder receptors platelets to thrombopoietin and determine the degree of activity of enzymes of blood platelets - glycogen, alpha-naphthylhesterase(αANАE) and adenosine triphosphatase (ATPase). at patients with chronic active liver disease.

Materials and methods. The RT PCR was used for research mutations in Mpl (W 515K and Mpl W 515L),to determine the degree of activity of enzymes studied the strokes of the peripheral blood.

Results: HCV-infected patients of both groups have demonstrated more high frequency of strong mutation in W515L than in healthy people. The same trend had been observed in regards to mutation in W515K. In the group of CHC patients with thrombocytopenia level of glycogen was lower and activity of αANАE was higher than in the group of patients without thrombocytopenia. Essential difference of ATPase activity in both groups was not established.

Summary. Expressed point mutations in platelet thrombopoietin receptors and the identified violations of the enzymatic activity of platelets, may serve as prognostic aggravate factors of the course of CHC. 

Purpose: To study inner disease image (IDI) and type of disease perception of the operated patients with pituitary adenomas, the impact on the success of the IDI on neurorehabilitation process.

Materials and methods. The study sample consisted of 52 patients (28 females, 24 males) aged 32 to 46 years (37,7 ± 1,2 years old), operated on pituitary adenoma. The following methods were used: medical records analysis, clinical interview, «Method for psychological diagnostics of attitude towards disease».

Results. Most patients have high level of post-traumatic stress reactions caused by pituitary adenoma.

Summary. Patients have a dominant type of maladaptive IDI which significantly reduces the social and psychological adaptation in the postoperative period. In the formation of post-operative neurorehabilitation strategies for the successful recovery of psychosocial status in patients with pituitary adenomas is necessary to consider the nature of maladaptive personality reactions. 

Purpose: To reveal the peculiarities of violations of the vegetative regulation of a rhythm of cardiac activity in patients with refractory hypertension on the background of type 2 diabetes.

Materials and methods: we examined 30 patients with hypertension (group 1) and 16 patients with refractory hypertension(group 2). Patients of the two groups were of type 2 diabetes. Control group - 30 practically healthy people. All patients were Holter ECG monitoring, autonomic tests Шелонга, Вальсальвы, the sample with a deep breath, and also evaluated the oxidative modification of proteins and antioxidant protection.

Results: in 1-St and 2-nd groups identified the reduction of pNN50 to 20.2± 2.9 ms and 10.4± 4.1 ms and rMSSD to 31.2± 5.3% and 23.9± 6.1%,respectively. Electrical instability infarction is detected in 60% of patients of the 1st group and in 81.2% of patients of the 2nd group in the form of альтернации detection.

Summary: the violation of the variability of cardiac rhythm - earlier manifestation of defeat infarction in patients with hypertension and diabetes 2типа, and a progressive decline in the activity of the parasympathetic nerve and/or the increase of the sympathetic Department of the vegetative nervous system is associated with increased intensity of oxidative modification of proteins. 

Purpose: To study the peculiarities of the course of coronary heart disease (CHD) patients with a 5-year history of myocardial infarction (AMI) depending on the adherence to therapy.

Materials and methods: the study involved 168 patients with 5-year history of AMI. 4 (2.4%) patients dropped out of the study by 2010-2011. Depending on adherence to therapy all the patients were divided into 2 groups: group 1 - patients regularly take antiaggregants, beta-blockers, statins and blockers RAAS, within 5 years, group 2 - patients, who have not taken regularly therapy. Conducted analysis of the course of ischemic heart disease after suffering AMI.

Results: it was noted that among the patients not devoted to therapy were 15% more deaths, on a 32% increase in the frequency of detection of stable angina, and 20% - AG, the more pronounced the progression of heart failure (CHF).

Findings: identified low adherence of patients to treatment (46,3%). In the group of patients, not devoted to therapy, there was a significantly more high percentage of mortality, including in connection with the repeated AMI as well as the increase in the number of patients with hypertension, stable angina pectoris and progression of CHF. 

Purpose: to assess the quality of life in patients with chronic obstructive bronchitis in the development and progression of chronic pulmonary heart.

Materials and methods: we examined 140 persons with chronic obstructive bronchitis at the age from 37 till 69 years of age, of which 96 - men (68,5%) and 44 women (31,4%). The average age of the examined patients made 55,2±1.2 years. To study the quality of life in patients with cob in the development of chronic pulmonary heart and at different stages of its progression used the Russian version of the common questionnaire MOS SF-36. In the surveyed citizens chosen so as to represent all social groups, people with different material level, of different age.

Results: the average indicators of physical and mental health of patients with chronic obstructive bronchitis down the progression of the underlying disease and the development of chronic pulmonary heart.

Summary: each stage of progression of chronic pulmonary heart is not only characterized by distinct clinical and functional parameters, but also clearly defined the quantitative indicators of the quality of life to a large extent determined the severity of symptoms of the disease, functional parameters and the gravity of the course of the disease. 

Purpose: To identify the peculiarities of the central hemodynamics formation among the children in long-term remission of acute lymphoblastic leukemia.

Materials and Methods: The monitored group consisted of 22 children having been in long-term remission of acute lymphoblastic leukemia for more than 5 years. All the children had previously been treated according to the standard and intermediate risk groups of the ALL-MB-2002protocol. The control group included 81 children belonging to the first and second health groups. All the children had gone through a complex medical examination including electrocardiography, cardiointervalography, Doppler echocardiography.

Results: Cardiac syndrome is significantly more frequently registered among the children in long-term remission of acutelymphoblastic leukemia. At the same time authentic differences in the incidence of repolarization violations were detected among the patients in long-term remission of acute lymphoblasticleukemia. Early signs of diastolic myocardial dysfunction were also revealed among the patients with acute lymphoblastic leukemia despite the absence of systolic function changes and hyperkinetic type of blood circulation was significantly more often formed. In assessing the vegetative function the prevalence of the original sympathicotony and asympathicotonic vegetative reactivity was established. 

Purpose: To describe the differential features of Essential Tremor and Parkinson Disease.

Materials and Methods: 205 consecutive patients with idiopathic Parkinson Disease (PD) and 29 patients with Essential Tremor (ET) were questioned at time of routine clinic visits.

Results and Summary: There was a more rapid disease progression in patient with PD and a more benign disease progression in patients with ET. The incidence and severity of pathology according to the cutting food and handling utensils, dressing, hygiene, intellectual impairment, thought disorder, and motivation/initiative subscales were significantly higher in PD patients than in ET patients. Symptomatic orthostatic hypotension, constipation, olfactory dysfunction, and vivid dreaming were significantly more common in PD patients than in ET patients. In all probability, all of these symptoms in combination with other diagnostic features (characteristics of tremor, the presence or absence of bradykinesia, etc.) can be used for the differential diagnosis of Parkinson Disease. 

Purpose: To describe the differential features of Essential Tremor and Parkinson Disease. Purpose. Characterized efficiency of ademol in the regenerative period of ischemic insult according neuromorphological changes in the cortex of the brain of the rats.

Materials and methods. Experimental therapy of the rats with cerebral infarction (bilateral carotid occlusion) by derivate of adamantan 1-adamantilethyloxy-3-morpholino-2 propanol hydrochloride (under conventional name ademol) was conducted in dose 2 mg/kg intraabdominal in the treatment mode (in an hour after modeling of insult and further after every 24 hours during 21 days).

Results. In the course of conducted investigations were established that in the regenerative period of the modeling acute disorder of cerebral circulation (bilateral carotid occlusion) takes place increasing of quantity and density of destructively changed neurons parallel with decreasing of area and density of morphologically undamaged neurons and also contents of nucleinic acids in them. Therapeutic course injection of ademol by the scheme as outlined above contributes to the normalization of micromorphometric characteristics of somatosensory cortex of the brain, that is manifested by conservation of density and area of structurally undamaged neurons on the background of decreasing of density of neuroglia and destructively changed nervous cells.

Summary. Ability of ademol to maintain cytoarchitectonics of the brains’ cortex indicates the presence of cerebroprotective characteristics of it and justifies the perspective of development of new cerebroprotector on its base. 

Purpose: To improve results of surgical treatment of children with left-sided congenital diaphragmatic hernia.

Materials and methods: 54 clinical observations were analyzed. Anatomical experiment performed on two corpses of children with hernia and 3 corpses of children without them with infusion red lead in mesenteric arteries. Radiovasograms were made.

Results: The authors think that congenital diaphragmatic hernia should be considered as ectopic into the pleural cavity abdominal organs displaced sources of blood supply, arising as a result of fetal malformations. It determines the characteristics of surgical correction of the congenital abnormality, associated with fixing the front edge of the diaphragm in the defect area with X or XI rib, consciously reducing the volume of the pleural cavity, as well as the viscero-abdominal disproportion. In the preoperative preparation of appropriate use of high-frequency oscillatory ventilationof lungs (HFOVL), allows to operation children 4-5 days of age with stable main vital systems of the body. Of the 54 children in the near term after surgery, 4 children died, accounting for 7.4%.

Summary: Developed surgical techniques and the use of preoperative HFOVL have reduced the mortality rate to near 0. 

The case of successful treatment of the patient with heavy post-traumatic osteoartrosis of the knee joint, being combined with damage of the muscles extensori of the knee joint (EMKJ) is presented. Two-stage surgical intervention is executed. The first stage – combined alloplastic and autoplastic a defect of a muscle quadriceps of the hip, EMKJ restoration. The second stage – a total arthroplasty of the left knee joint an oncological prothesis. At an assessment of the remote results of the Oxford scale for a knee joint the results of the knee joint arthroplasty is estimated as excellent in 12 months at 23 points, in 24 and 36 months in 12 points.