Vol 8, No 9 (2022)

Material and methods. The content of sFas, sFasL, TNF-a, sTNF-R1, IL-6 was detected in the blood on days 1, 7, and 21 by ELISA in 155 patients with LMBA or RMBA IS, as well as Fas-positive lymphocytes by flow cytofluorometry. Neurological suffering was assessed using the NIHSS. Results. A significant increase in blood concentrations of sFasL, sFas and TNF-a was shown compared to the control. Conclusion. In stroke manifestation the role of the Fas system is associated with inflammatory response; at the end of the acute period, with the dominance of adaptive mechanisms and processes of neuroplasticity.

One of the frequent manifestations of rheumatoid arthritis (RA) is thrombocytosis (platelet count >450x109), but its influence on the course of RA and complications development is not fully solved. Aim: to study features of course of RA on the background of thrombocytosis. Material and methods. The study enrolled 180 patients with RA having average and high degree of activity of the disease, 90 of them had normal level of thrombocytosis and 90 patients with thrombocytosis. Laboratory examination data included assessment of rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (CCP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antinuclear factor (ANF), thrombopoietin (TPO), interleukin 6 (IL-6) and soluble p-selectin levels. RA activity was determined by DAS28 (Disease Activity Score). Results. The levels of ESR, CRP, IL-6, TPO, rF and median values of activity of DAS28 by SOE and CRP were significantly higher in subjects with RA and thrombocytosis in comparison with patients with normal level of platelets. In addition, in patients with thrombocytosis, systemic manifestations of RA were significantly more frequently determined. Conclusions. In our study, thrombocytosis was a significant marker of high clinical, laboratory and immunological activity in RA patients. At the same time, platelet counts >450x109 were found to be at high risk for the development of extra-articular manifestations of RA.

Experiments have shown that innate immune cells are involved in the development of acute kidney injury (AKI) during myocardial ischemia. However, it is not clear how the development of AKI affects the changes in the macrophage composition of the kidneys and myocardium and, ultimately, the processes of cardiorenal correlations and subsequent regeneration of the heart muscle in patients with myocardial infarction (MI). The aim of the study is to evaluate the peculiarities of macrophage composition of kidneys and myocardium tissues, their relationship with the development of an unfavorable outcome of the disease in patients with fatal MI and AKi presence. Material and methods. We analyzed histological sections of the kidneys and myocardium (from the infarct zone) obtained at autopsy in patients (n=28) who died from type I MI (age 74,8±9,3 years). The macrophage composition of the kidneys and myocardium was assessed by means of immunohistochemical studies using antibodies (CD68, CD163, CD206, stabilin-1). Depending on the presence of AKI, patients were divided into two groups: group 1 - AKI+ (n=10); and 2nd - AKI- (n=18). Results. The main disease of the majority of patients included in the study is MI with ST-segment elevation, the cause of death is cardiogenic shock. Among all the cells of the macrophage series studied by us, the predominance of CD163+ cells was revealed both in the kidneys and in the myocardium. In the kidneys, the number of these cells was 30 (8; 108) in the total sample, 25 (8; 53) in the AKI- group, 30 (13; 108) in the AKI+ group; in the myocardium, similar indicators were 500 (21; 1729), 484 (21; 1729) and 598 (26; 1504) cells, respectively. The groups differed from each other only by the number of CD206+ cells in the kidneys: 2 (2; 3) in AKI+ versus 5 (2; 6) in AKI- (p=0.0004). Correlations were found between the time of death (r=-0,7, p <0,05), as well as between the number of CD206+ cells in the kidneys (r=-0,5, p <0,05) and the presence of AKI. Conclusion. The macrophage composition of kidney and myocardial tissue in patients with fatal MI, regardless of the degree of kidney damage, was characterized by the predominance of CD163+ cells. AKI in individuals with fatal MI was associated with lower levels of CD206+ cells in the kidneys and a faster onset of death.

In recent years, bendopnea and the left ventricular global function index (LVGFI) have been considered as markers of decompensation of cardiovascular diseases, while studies on the correlation of these markers in chronic heart failure (CHF) patients have not been presented. The aim of the study was to evaluate the correlation and prognostic value of LVGFI and bendopnea in outpatients with CHF aged 60 years and older. Material and methods. The study included 55 outpatients with CHF II-IV FC: 25 persons with bendopnea (64% of male patients) aged 75 (66; 79) years (main group) and 30 people without bendopnea (23% of male patients) aged 76 (73,5; 79) years (comparison group). LVGFI (%) was calculated by the following formula: LV/ [0.5 X (LV EDV + lV ESV) + LV myocardial mass/ 1.05] х 100. The follow-up period was 36 (24; 36) months. Results. LVGFI in the main group consisted 18,5 (16,6; 21,3)%, in the comparison group - 21.4 (19,5; 22,7)% (p=0.011). LVGFI correlated with bendopnea (r=-0,35, p=0,010), CHF FC(r=-0,52, p <0,001), N-terminal proBNP (r=-0,52, p=0,015), a history of myocardial infarction in anamnesis (r=-0,28, p=0,040). In its turn, bendopnea correlated with FC CHF (r=0,82, p <0,001) and N-terminal proBNP (r=0,54, p=0,012). The development of bendopnea is most likely in patients with LVGFI «20,5% (AUC 0,70±0,07; 95% CI: 0,56-0,84; p=0.011; sensitivity 64,0%, specificity 63,3%; OR 3,07; 95% CI: 1,02-9,26; p <0,05). The value of LVGFI for predicting death was «19,2% (AUC 0,79±0,07; 95% CI: 0,65-0,93; p=0.002; sensitivity 75,0%, specificity 74,4%). Multiple regression analysis revealed an association of bendopnea and death in patients with LVGFI «19,2% (R2=0,446; sensitivity 88,4%, specificity 75%). For the cohort of patients with bendopnea and LVGFI «19.2%, the Rr was 2,2 (95% CI: 1,15-4,20; p<0.05). Conclusion. The combination of bendopnea and LVGFI «19,2% reflects the severity of clinical condition, significant remodeling of the left ventricular myocardium, and with a high probability can predict a lethal outcome in the group of CHF elderly patients.

Recently, researchers and clinicians have been paying increasing attention to the concept of thromboinflammation, i.e., a dysregulation of thrombosis and inflammation equilibrium, with the transition to a prothrombotic and proinflammatory phenotype. Thromboinflammation plays an important role in the development and progression of cerebrovascular diseases. In acute and chronic ischemic damage to the brain, several pathological processes are activated, leading to the depletion of all neural cell pools and irreversible neural pathway damage, manifesting as focal neurological deficits and cognitive decline. These closely interconnected pathological processes include neuroinflammation, oxidative stress, blood-brain barrier damage with neurovascular unit metabolic decoupling, intrinsic and extrinsic apoptosis. This review covers the interrelation between neuroinflammation and thrombosis within the thromboinflammation concept.

This review of the literature data is dedicated to the choice of an oral anticoagulant for the prevention of ischemic stroke and systemic embolism in patients with atrial fibrillation. Detailed results of real-world clinical practice studies comparing the efficacy and safety of various direct oral anticoagulants are presented. Special attention is paid to groups of patients with atrial fibrillation and obesity, elderly and frail patients, as well as atrial fibrillation and impaired renal function.

Asthenic disorders occurring in a significant proportion (23-100%) of patients in the general medical network, require an early start of treatment, since, among other things, they increase the probability of an unfavorable course of somatic pathology. The practical problem of medicine remains the selection of effective medicines for the relief and prevention of this condition, taking into account the need for their combination with somatotropic medicaments. The article presents data on the prevalence, clinical course and pharmacotherapy of asthenia, including information on the medicine preparation sulbutiamine (Enerion), whose effectiveness in the symptomatic treatment of asthenic disorders has been confirmed by the results of various clinical studies. Also information about the own clinical observations regarding this medicine’s use in patients with asthenic syndrome manifestations is represented.

A modern view on the role of physical and psychosocial stress in the development of cardiovascular diseases (CVD) is highlighted in the review. The review presents stress research directions and application of their results in clinical practice, current knowledge about the transformation of brain architectonics, cardiovascular system, and the correlation with clinical symptoms of CVD. The search depth of publications was 10 years, from 2011 to 2021, and a number of earlier, fundamental works on stress subject area were also included in the review. For the selection of publications, the PubMed, MEDLINE, Cochrane Library databases were studied, were selected the studies that meet the requirements of the class and level of evidence IA and IB, IIA (randomized clinical trials, meta-analyses, systematic reviews).

Influenza remains to be one of the most common infections, due to its ubiquity, annual outbreaks and epidemics. That is why vaccination against this disease is of a central importance. The article considers most of the influenza vaccines registered in Russia that are relevant in the current season, their features, composition and advantages. Tactics of vaccination of various population groups and the specifics of vaccines use are described, including taking into account ongoing vaccination against COVID-19. Recommendations are given on the use of this group of immunobiological preparations, including aspects of vaccination of pregnant women and persons belonging to other risk groups.

Cognitive impairment (CI) is a widespread clinical syndrome, with which specialists of various profiles often meet in outpatient settings. Diagnosis of CI is a responsible task, the correct solution of which requires a comprehensive analysis of anamnestic information, the nature of the clinical picture, the results of laboratory and instrumental examination. Cerebrovascular diseases are a common cause of CI. The article discusses the issues of management of patients with coronary artery disease, in particular, the main aspects of correction of cardiovascular risk factors, the choice of optimal drug therapy are considered. Information is provided on the possibility of using the drug Mexidol for the treatment of this contingent of patients. The results of studies devoted to the study of the possibility of using Mexidol in patients with chronic disorders of cerebral circulation with CI are analyzed.