INTRODUCTION
Acute chest pain is one of the most common caus­es for emergency medical care seeking. In some cases, it is considered as a manifestation of acute coronary syndrome (ACS). However, in patients with normal cardiac troponin (cTn) levels and a normal or non­diagnostic electrocardiogram (ECG) (non-ST eleva­tion ACS (NSTE-ACS) low-risk patients), the inci­dence of stenotic coronary atherosclerosis is not high. Stress echocardiography in this category of patients is indicated for ischemia visualization. Analysis of heart rhythm, ECG changes, systemic and intra­cardiac hemodynamics, in addition to assessing lo­cal contractility, allows us to identify other patholog­ical responses to stress. It is already known that their comprehensive assessment has predictive potential for long-term adverse events in patients with chron­ic coronary syndrome.
THE AIM
To identify non-ischemic phenotypes in low-risk patients with non-ST elevation acute coronary syn­drome.
MATERIAL AND METHODS
A single-center, prospective, continuous study included 70 patients aged 54 (45; 63) years (60%
men) hospitalized in the department of the region­al vascular center in 2022—2023 with acute chest pain, normal or non-diagnostic ECG, normal cTn level, low (< 3 %) GRACE risk and no restrictions for exercise stress echocardiography. The patients had not previously verified coronary heart disease (which was an inclusion criterion) and had no wall motion abnormality at rest. Stress echocardiography on a horizontal bicycle ergometer was performed in the first 2 (0; 3) days of the hospital period. The tests were carried out in the absence of rhythm­slowing therapy. The results of tests completed ear­ly for subjective reasons (muscle fatigue, failure) were not included in further analysis. To determine patient phenotypes based on stress echocardiogra­phy data, pathological responses to stress in the form of dichotomous variables were used to perform clus­ter analysis. The final group consisted of 50 of a non­ischemic phenotype — those who did not belong to the cluster, which was characterized by the high­est frequencies of wall motion abnormality, ST seg­ment depression > 1 mm, and angina. To determine the potential significance of the identified pheno­types, the cardiac performance reserve (P/m) was ad­ditionally determined as the difference in P/m val­ues, calculated using the formula
0,222 - CO - APBmean
LVM
where CO — cardiac output; APBmean — mean arterial blood pressure; LVM — left ventricular mass), at peak load and at rest.
RESULTS
Four patient phenotypes were identified that dif­fered statistically significantly (p < 0.05) in terms of exercise tolerance, volumetric contractile reserve and heart rate reserve. Type 1 (n = 17) was character­ized by a high frequency of combined decreases in all 3 indicators; type 2 (n = 11) — by the decreased ex­ercise tolerance and heart rate reserve, normal con­tractile reserve; type 3 (n = 11) — by normal exercise tolerance and heart rate reserve, but decreased con­tractile reserve; type 4 (n = 11) — by normal exer­cise tolerance, contractile reserve and heart rate re­serve. The decrease in contractile reserve (types 1 and 3) was consistent with a statistically significant lower increase in left ventricular ejection fraction at peak exercise (5 (2; 7) vs. 12 (8; 13), respective­ly; p < 0.001) and P/m reserve (1.0 (0.6; 1.4) versus 1.3 (1.1; 1.6), respectively; p = 0.010). Patients with decreased contractile reserve were statistically signif­
icantly older (60 (48; 68) vs. 47 (43; 54) years, re­spectively; p = 0.003). Type 4 included predominant­ly men (91 %). For type 2, no statistically significant differences in the clinical and demographic data of pa­tients were identified.
CONCLUSION
In the structure of patients with low-risk pa­tients with NSTE-ACS, the phenotypes are identi­fied that are determined by a decrease in exercise tol­erance, contractile deficiency and chronotropic re­serve. Phenotypes are characterized by different levels of P/m reserve and may differ in the frequency of ad­verse events in the long-term period, and a decrease in contractile and heart rate reserve can be considered as potential targets for personalized therapy, however, in the diagnostic algorithm for ACS this remains a top­ic for further research.

BACKGROUND
It is known that the autonomic nervous system plays a significant role in the onset, maintenance and arrest of atrial fibrillation. Its influence is deter­mined by a combination of direct and indirect ef­fects on the special conductive cardiac tissue, myo­cardium, baroreceptors and cardiac vessels. An indi­rect indicator of the activity of the sympathoadrenal system is beta-adrenoreactivity of erythrocyte mem­branes (beta-ARM). It is determined by the distribu­tion density of в-adrenergic receptors on cell mem­branes and the degree of their affinity for plasma cat­echolamines.
THE AIM OF THE STUDY
To evaluate the level of beta-adrenoreactivi­ty of erythrocyte membranes before and after cath­eter treatment of atrial fibrillation and its influence on the effectiveness of this treatment.
MATERIALS AND METHODS
The study sample included 40 patients with vari­ous forms of atrial fibrillation: paroxysmal atrial fibril­lation was found in 25 (62.5 %) patients, persistent — in 10 (25.0 %), long-term persistent — in 5 (12.5 %). 13 (22.5 %) out of 40 patients were women. The me­dian age was 49 (44; 55) years. All patients underwent either interventional or radiofrequency or cryoballon ablation of atrial fibrillation. In order to study the level of beta-ARM, blood was taken from a peripheral vein
RESULTS
Cryoballon ablation was performed in 7 patients, radiofrequency ablation — in 33. The overall annu­al effectiveness of ablation (absence of atrial fibrilla­tion paroxysms) was 71.5 % for cryoballon ablation, 73.5 % — for radiofrequency ablation. Early relapses (up to 3 months after surgery) were more common after cryoballon ablation — in 28.5 % of cases versus 16.3 % after radiofrequency ablation. In the sample, myocar­ditis was diagnosed in 9 (22.5 %) patients. Beta-ARM value before surgery was 19.16 (12.46; 27.46), 3 days af­ter the surgery — 24.43 (15.38; 33.65), 3 months after the surgery — 20.27 (9.90; 27.71). The influence of beta­ARM levels at all control points on the overall effective­ness of the catheter procedure and on the development of early relapses of arrhythmia after ablation was assessed. The initial beta-ARM value differed in patients with ear­ly and late relapses of arrhythmia (14.28 (12.39; 22.55) and 24.68 (16.20; 39.26), respectively).
CONCLUSIONS
The study revealed the dynamics of changes in the level of beta-ARM with an increase in the indica­tor after surgery and its decrease almost to the initial lev­el 3 months after the surgery. However, it was not pos­sible to identify the influence of the level of erythrocyte membranes beta-ARM on the effectiveness of catheter treatment of atrial fibrillation in patients.

BACKGROUND

Mitomycin C (MMC) has a wide spectrum of genotoxicity, including inhibition of DNA synthesis, clastogenesis and mutagenesis. As an immediate-action clastogen requiring exclusively intracellular reductive activation, MMC initiates efficient DNA cross-linking. Most studies are aimed at studying single-stage acute effects, which are caused by high doses of mutagen. In turn, there are no or very few studies aimed at studying the chronic effects of MMC. Polychrome red blood cells have been accepted as a suitable target for the evaluation of micronuclei in both acute and cumulative injury. The in vivo micronucleus test is well established as a standard assay for assessing genotoxicity at the chromosomal level of mouse erythrocytes.
THE AIM OF THE STUDY
To create a chronic genotoxic effect of mitomycin C without lethal outcome in ApoE knockout mice while selecting the optimal dose of MMC.
MATERIALS AND METHODS
The study design included 6 groups of ApoE-/- mice, two doses of MMC with a concentration of 0.1 and 0.5 mg/kg, one-time and three-time administration. To assess genotoxicity, 1000 polychrome erythrocytes (PCEs) extracted from the bone marrow of a mousefemur were counted on each sample, and PCEs
with micronuclei were identified.
RESULTS
This study aimed to find the optimal dose of MMC that has a clear genotoxic effect and does not lead to death in an ApoE knockout mouse model. With a single injection, PCEs with chromosomal damage were more common (more than 2 times; p < 0.05) in groups of mice with MMC administration (0.1 and 0.5 mg/kg; 0.39 % and 0.26 %, respectively) compared to the control group (0.15 %). We also found that the frequency of occurrence of PCEs with micronuclei in groups of mice with MMC dose of 0.1 and 0.5 mg/kg (0.36 % and 0.47 %, respectively) and three-time administration exceeded this indicator in mice from the control group (0.2 %).
CONCLUSION
The present study on the determination of the optimal dose of mitomycin C provides further evidence that 0.1 mg/kg is the threshold value for genotoxic effects caused by MMC. An increase in the frequency of micronucleated immature red blood cells in animals exposed to a mutagen is an indicator of induced structural or numerical chromosomal aberrations. Our results further suggest that careful selection of MMC dose is critical. Dose-response studies in rodents can provide useful information on mechanisms and dose selection for long-term toxicity studies.

Introduction. To date, 36 types of amyloidosis are known, the most common types associated with heart damage are: light chain amyloidosis (AL), transthyretin amyloidosis and AA amyloidosis. Transthyretin amyloidosis (ATTR) is a fatal progressive disease caused by extracellular deposition of an abnormal monomer of the transthyretin protein. There are two forms: hereditary and senile systemic.

Clinical case. A clinical case of patient A., aged 65, with hereditary familial transthyretin amyloidosis without neuropathy is presented. From the anamnesis, he periodically noted an increase in blood pressure to maximum values of 145/90 mm Hg, he did not regularly take antihypertensive drugs. Deterioration since 2021, when he first noted the appearance of complaints of shortness of breath during everyday physical activity, swelling of the lower extremities, weight gain by 7 kg in 2 weeks. Repeatedly underwent treatment in a hospital at the place of residence in connection with decompensated heart failure. Examination by echocardiography (ECHOCG) revealed hypertrophy of the walls of the left ventricle, intact left ventricular ejection fraction (LVEF). In 2023, the cardiologist of the Irkutsk Regional Order of the Badge of Honor Clinical Hospital was routinely examined.

According to the electrocardiogram (ECG), heart attack-like changes in the QRS complex. In the anamnesis, there were no reliable data for myocardial infarction. In the dynamics of ECHOCG, it was revealed: a decrease in LVEF according to Simpson up to 41%; an increase in hypertrophy of the walls of the left and right ventricles, papillary muscles, the appearance of hypokinesis of the walls of the left ventricle; increased calculated pressure in the right ventricle. Dilatation of the right heart. Coronary angiography revealed no stenotic lesions of the coronary arteries.

Based on the presence of severe hypertrophy of the myocardium of both ventricles, which does not correspond to the severity of arterial hypertension, as well as the discrepancy between the thickness of the walls of the left ventricle and the QRS voltage on the ECG; a decrease in myocardial contractility in the absence of evidence of significant myocardial damage, a probable cardiac amyloidosis was suggested.

Natriuretic peptide, cardiospecific markers are elevated. According to computed tomography in the parenchyma of both lungs, mainly in the lower lobes, multiple small rounded foci, up to 2-5-7 mm in size, are visualized. Mediastinal lymph nodes are not enlarged. Information on the frequency of lung damage in amyloidosis is currently not available. Lung involvement in transtriretin amyloidosis is mainly detected only by autopsy findings.

In order to exclude AL-amyloidosis, a biopsy of the rectum was performed. Monoclonal gammopathy was not found. According to single-photon emission computed tomography with 99m Tc-pyrophosphate in the projection of the heart, there is an increased accumulation of the radiopharmaceutical (RP) in the myocardium of the left and right ventricles. Evaluation of the intensity of accumulation of radiopharmaceuticals in the myocardium according to the Perugini - Grade 3 scale, the coefficient of differential accumulation of the heart / contralateral zone is 1.6, which is characteristic of ATTR-amyloidosis. In connection with obtaining data sufficient to make a diagnosis, it was decided to refrain from performing endomyocardial biopsy.

The patient underwent a confirmatory molecular genetic study. In exon 3 of the TTR gene, the pathogenic variant c.302C>T (p.(Ala101Val) is in the heterozygous state. A comprehensive examination did not reveal any data for neuropathy.

Thus, transthyretin amyloidosis of the heart was verified in the patient. As a basic therapy, the drug tafamidis is recommended at a dose of 61 mg 1 time per day.

Conclusion. Given the high lethality of the disease and the availability of modern treatment options, there is an obvious need to increase the awareness and alertness of doctors of various specialties regarding this pathology.

Introduction: All patients with diabetes are recommended to determine glycated hemoglobin no earlier than 3 months before any surgical interventions, including before coronary bypass surgery. Patients with multivessel coronary disease often have a severe comorbid background. Factors such as anemia, bleeding, severe chronic kidney disease in patients with can affect the result of measuring HbA1c, due to these limitations, alternative markers may be useful: fructosamine, 1,5-anhydroglucitol, which reflect the glucose level for 1-3 weeks previous research.

Target. The study of alternative markers of carbohydrate metabolism (fructosamine and 1,5-anhydroglucitol (1,5-AG)), and their relationship with the clinical characteristics of patients and the incidence of hospital complications after coronary bypass grafting (CABG).

Materials and methods. 383 consecutive patients with ischemic heart disease who underwent elective CABG at one center were examined. Before surgery, all patients were examined for glycemic status and additionally determined glycated hemoglobin (HbA1c), fructosamine and 1,5-anhydroglucitol before CABG and on days 7-8 after surgery. Patients were divided into 3 groups depending on their glycemic status: Group 1 - patients with type 2 diabetes mellitus (DM 2, n=125), Group 2 - patients with prediabetes (n=67), Group 3 - patients without disorders carbohydrate metabolism (n=191). We assessed the perioperative dynamics of carbohydrate metabolism parameters, their relationship with the clinical characteristics of patients and postoperative complications.

Results. In groups without DM, the values of glucose, fructosamine, and 1,5-anhydroglucitol had a small interquartile range when assessed before surgery, which significantly increased on days 7-8 after CABG. In all 3 groups, there was a significant decrease in the level of fructosamine on the 7th day after CABG compared with the baseline (p 1-2nd point 0.030, 0.001, 0.038 in groups 1, 2 and 3, respectively), while level 1 ,5-anhydroglucitol and HbA1c did not change significantly after surgery. The preoperative level of fructosamine had a direct correlation with the risk of surgery according to the EuroSCORE II scale (p=0.002), the number of shunts (p=0.012), body mass index and overweight (p<0.001 in both cases), triglycerides (p<0.001), fibrinogen (p=0.002), preoperative and postoperative glucose and HbA1c levels (p<0.001 in all cases), left atrial size (p=0.028), number of cardioplegia, duration of cardiopulmonary bypass, and time of aortic clamping (p<0.001 in all cases) . Preoperative 1,5-anhydroglucitol levels were inversely correlated with preoperative fasting glucose and fructosamine levels (p<0.001 in all cases), intima-media thickness (p=0.016) and positively correlated with LV end-diastolic volume (p=0.020) . Any significant postoperative complication and/or hospital stay after CABG >10 days was selected as the composite endpoint (CCT). In binary logistic regression analysis, fructosamine levels were independently associated with the development of this composite endpoint. Also, independent predictors of CCT were: female gender, age, body mass index, duration of cardiopulmonary bypass, size of the left atrium, end diastolic size of the left ventricle, DM 2, average glycemia on the 1st day after CABG, failure to achieve the target range of perioperative glycemia. At the same time, other markers of carbohydrate metabolism showed no connection with CCP.

Conclusions. The preoperative level of fructosamine, the average glycemia on the 1st postoperative day are independent predictors of postoperative complications of CABG.

Introduction. Adipose tissue (AT) is a potential source of ceramides. Of particular interest is the expression of de novo ceramide synthesis enzymes in the AT of the heart and blood vessels localized in close proximity to the lesion. Male gender and age are considered to be one of the main risk factors for coronary heart disease (CHD).

Purpose: to study the relationship between the expression of de novo ceramide synthesis enzymes in adipose tissue (AT) and non-modifiable risk factors for cardiovascular disease (CVD) in coronary heart disease (CHD).

Materials and methods. The study included 30 patients with coronary artery disease who underwent coronary artery bypass grafting. During the operation, biopsies of subcutaneous, epicardial, perivascular VT (SVT, EAT, PVAT, respectively) were obtained. Expression of genes for de novo ceramide synthesis enzymes (subunits of serine palmitoyltransferases C1 and C2 SPTLC1, SPTLC2; ceramide synthase 1-6 CERS1-6; dihydroceramide desaturase DEGS1) was assessed by quantitative real-time PCR. Statistical analysis of the results was performed using GraphPad Prism 8 (GraphPad Software).

Results. Men with CAD were characterized by a higher level of expression of de novo ceramide synthesis enzymes SPTLC1, CERS1, 5 and DEGS1 in EAT and PVAT than women. The expression of the studied enzymes in SAT did not differ significantly depending on gender. In patients older than 60 years, the maximum expression levels of SPTLC1, CERS1,2,6, DEGS1 were found in cardiac VT compared with patients younger than 50 years and 50-59 years (p<0.005). Correlation analysis revealed a direct dependence of the mRNA level of SPTLC1, CERS1,2,6, DEGS1 in EAT and PVAT with age (p<0.05). Correlation analysis showed a direct relationship between age and gene expression levels of the following enzymes: CERS1 in EAT and PVAT (r=0.60, p=0.027 and r=0.51, p=0.02), CERS2 in PVAT (r=0, 69, p=0.013), CERS5 in EAT (r=0.57, p=0.011), DEGS1 in EAT (r=0.66, p=0.043). Attention is drawn to the increased expression of genes for key enzymes of de novo ceramide biosynthesis in cardiac VT in patients with coronary artery disease aged 50–59 years and PVAT in patients older than 60 years, which does not contradict the generally accepted opinion about an increase in ceramide production with age. Using logistic regression analysis, it was shown that the presence of CVD risk factors is associated with an increase in the expression of de novo ceramide biosynthesis enzymes in patients with CAD. Thus, male sex is associated with an increase in SPTLC1 expression in EAT (OR=1.72, 95% CI 1.17-1.94, p=0.013) and PVAT (OR=1.21, 95% CI 1.03-1 .52, p=0.032), as well as CERS1 and DEGS1 in EAT (OR=1.55, 95% CI 1.13-1.83, p=0.024 and OR=1.31, 95% CI 1.07- 1.64, p=0.041, respectively). The age of patients is associated with increased expression of CERS2 in EAT (OR=1.43, 95% CI 1.07-1.71, p=0.004) and DEGS1 in PVAT (OR=1.50, 95% CI 1.12-1 .83, p=0.002).

Conclusion. Close relationships were found between the expression of enzymes of the main ceramide synthesis pathway in VT of cardiac localization and gender and age characteristics of patients with coronary artery disease. Determination of the expression of de novo ceramide biosynthesis enzymes plays an important role for risk stratification both in addition to traditional risk factors and independently, which is important for primary and secondary prevention of CVD.

Introduction. It is well known about the risk factors (RF) for arterial hypertension in the general population, however, their significance in hypertension is well known, however, their significance in pregnant women has been little studied.

The purpose of the study was to evaluate the effect of the most common risk factors on the development of hypertension in pregnant women.

Materials and methods. The study group consisted of 312 pregnant women suffering from hypertension, the control group - 358 pregnant women with normal blood pressure. The relative odds (OR) were calculated using the logistic regression method for the following risk factors: age, smoking, family history, and overweight.

Results. With overweight (25≤ BMI ≥29.9 kg/m2), the OR for the development of hypertension was 3.1 (1.7-5.8), while with obesity (compared with normal and overweight) it increased to 12 ( 7.6-19.1). With aggravated heredity, the OR was 6.9 (4.7-10.3). OR in pregnant women with aggravated heredity on the paternal side was 5.2 (2.7-10.2), on the maternal side - 7.4 (4.6-11.8), on both parents - 9.3 (3.6 -24.9). In our study, 20% of women in the group with hypertension smoked, which is significantly more than in the group without hypertension - 13%, p=0.01. At the same time, IPI in the group of pregnant women with AH was 7.5 (2.5-15), which was significantly higher than in the control group 1.9 (1-7.5), p<0.001. It was found that smoking increased the OR of developing hypertension in pregnant women by 4.6 times (2.43-9.4). At the same time, with a pack/year index (PLI) of more than 10 (compared with non-smokers), the OR was 13.1 (5.5–29.9), which was statistically significantly higher than with smoking with a PLI ≤10 (compared with non-smokers) OR was only 2.6 (1.6-3.9), p=0.006.

When comparing two groups by age, it was found that pregnant women with hypertension were older than those with normal blood pressure (32 (28-36) and 28 (24-32) years, respectively, p=0.002). ROC analysis with a probability of more than 80% determined that age over 33 years is a risk factor for the presence of hypertension in pregnant women. Thus, the risk of developing hypertension in the group of pregnant women over the age of 33 is 1.8 times higher than in the younger age group.

When analyzing combinations of several FGs for the development of AH, a multiple increase in the risk in pregnant women was found. Thus, in the group of smoking women under 33 years of age, the OR for the development of AH was 2.2 (1.3-3.8), and in smoking pregnant women over 33 years of age it was 14.1 (5.9-33.5). With a combination of smoking and heredity, the OR increased to 27 (11.5-56), and with a combination of smoking and obesity - 33 (7.3-62). It is noteworthy that with a combination of obesity and hereditary burden, the risk of developing hypertension during pregnancy increased by 54 (6.2-429) times.

Conclusion. Smoking ranks third among other risk factors for arterial hypertension in pregnant women, increasing the OR of developing hypertension by 13 times compared to non-smokers. The combination of smoking with other risk factors significantly increased the chance of developing hypertension in pregnant women.

Introduction. Acute myocardial infarction is accompanied by an intense inflammatory response. On the other hand, the severity of inflammation is a marker of the risk of poor prognosis. Type 2 diabetes mellitus (DM2) is associated with the development of chronic inflammation and oxidative stress.

Objective: To conduct a comparative analysis of leukocyte indicators of inflammation and highly sensitive C-reactive protein (hsCRP) in patients with ST-segment elevation acute myocardial infarction (STEMI) with and without DM 2.

Materials and methods. Inclusion criteria: men and women with STEMI with or without type 2 diabetes, age over 45 years, primary percutaneous coronary intervention (PCI). Exclusion criteria: cases of hospital mortality, acute heart failure according to Killip 3-4 at admission. The study included 30 patients with STEMI in combination with type 2 diabetes and 30 patients with STEMI without type 2 diabetes. The groups were matched by sex (15 men and 15 women in each group) and age (64.2 vs 63.8 years, p= 0.8049). In both groups, we compared leukocyte indicators of inflammation (the number of leukocytes, neutrophils, lymphocytes, neutrophil-lymphocyte ratio (NLO) and hsCRP before pcCI, as well as their dynamics on days 5–7 after pcCI. The study of the cellular composition of blood was performed on a hematological analyzer BC- 6800Plus, Mindray, China.HsCRP was determined by the method of biochemical analysis of blood on the analyzer BS-200, Mindray, China.Data are presented as mean (M) and standard deviation (SD).The distribution of variables was normal, therefore, to compare quantitative indicators in independent and in paired samples, Student's t-test was used, and Pearson's chi-square, 2 test was used to compare lesion locations in study groups.

Results. Body mass index was higher in the STEMI group with type 2 diabetes (30.2 kg/m2 and 26.6 kg/m2, p = 0.001). Groups of patients with and without type 2 diabetes did not differ in the incidence of anterior STEMI (43.3% and 56.6%; p2 =0.302), left ventricular ejection fraction 46.4% and 47.3%, p=0.399) . In the study groups with STEMI and DM 2 and without DM 2, such indicators as leukocytes (14.66±2.07×109/l vs 10.19±1.08×109/l, p<0.001) and (13, 92±1.73×109/L vs 9.81±1.77×109/L, p<0.001), neutrophils (8.64±1.2×109/L vs 5.36±0.97×109 /l, p<0.001) and (7.99±0.76×109/l vs 5.01±0.75×109/l, p<0.001), UFO (5.34±1.34 vs 2, 92±0.81, p<0.001) and (4.71±0.89 vs 2.75±0.96, p<0.001) and hsCRP (27.97±6.87 mg/l vs 13.23± 3.57 mg/l, p<0.001) and (29.86±5.91 mg/l vs 11.63±3.48 mg/l, p<0.001) decreased statistically significantly on days 5–7 of treatment in both groups, respectively. Lymphocytes (1.68±0.33×109/L vs 1.92±0.42×109/L, p<0.001) and (1.74±0.29×109/L vs 1.95±0, 45×109/l, p<0.001) in dynamics significantly increased in both groups, respectively. An intergroup comparative analysis showed that the degree of change in UFO at admission (5.34±1.34 vs 4.71±0.89, p=0.038) was statistically greater in the group with STEMI and DM 2. HsCRP decreased over time to a greater extent in the group with STEMI without DM 2 (-14.74±5.33 mg/l vs -18.23±5.25 mg/l, p=0.013). Upon admission, neutrophils (8.64±1.20×109/L vs 7.99±0.76×109/L, p=0.015) and UFOs (5.34±1.34 vs 4.71±0.89 , p=0.038) was statistically higher in the STEMI group with DM 2 than in the STEMI group without DM 2, respectively.

Conclusions: In both groups, all studied leukocyte indicators of inflammation, with the exception of monocytes, decreased by 5-7 days from the moment of admission. In patients with STEMI and type 2 DM, there was a significant increase in the level of neutrophils and UFO at admission and a slower dynamics of the decrease in hsCRP, compared with the group of patients with STEMI and without type 2 DM, which indicates a more pronounced inflammatory response associated with acute infarction in type 2 DM myocardium.

Introduction. Combat trauma is one of the factors that cause impaired hemostasis in the wounded. Currently, there is not enough information about the significance of hereditary thrombophilia in the development of venous thromboembolic complications in the wounded.

Target. Study of the effect of polymorphism of the genes of the components of the hemostasis system on the development of venous thrombosis in the wounded with a combat injury.

Materials and methods. The prospective study included young men (n=81) (mean age 36.0 ± 8.5 years) who received a combat wound and were treated at the Military Medical Academy. CM. Kirov. The subjects were divided into 2 groups: the main group included 40 patients (49.4%) who were diagnosed with venous thrombosis during treatment, the control group included 41 patients without signs of thrombosis (50.6%). The study of allelic polymorphism of genes associated with the process of thrombus formation was carried out using a real-time polymerase chain reaction based on the study of human DNA in peripheral blood material.

Results. In a comparative analysis, no statistically significant differences were found in the frequency of occurrence of the studied genetic variants between the study group and the control group. When assessing the prevalence of polymorphisms in the MTHFR and MTRR genes, it was found that the combination of the MTHFR 677 CT and MTRR 66 GG genotypes is associated with an 8.5-fold increase in the risk of developing venous thromboembolic complications [OR=8.5; p=0.029].

Conclusion. The analysis of the obtained results showed that, despite the high prevalence (the presence of prothrombogenic alleles of various genes was detected in 79 military personnel (97.5%)), it was not possible to establish a relationship between individual genetic variants and the risk of developing venous thrombosis in the studied group of wounded. At the same time, it has been shown that the combination of the MTHFR 677 CT and MTRR 66 GG genotypes is associated with a significant increase in the risk of thrombosis.

Introduction. Deep vein thrombosis of the lower extremities (DVT) currently remains one of the most important problems affecting not only vascular surgeons, but also doctors of other specialties.

Target. Carry out a comparative monitoring of methods for monitoring the effectiveness of anticoagulant therapy in the wounded using the Thrombodynamics test and determining anti-Xa activity.

Materials and methods. The study included 30 wounded individuals with established DVT, hospitalized for examination and treatment at the Military Medical Academy. CM. Kirov. Against the background of treatment with enoxaparin sodium (hereinafter referred to as enoxaparin) at therapeutic doses, depending on body weight, all patients were assessed the parameters of the "Thrombodynamics" (TD) test and the determination of anti-Xa activity at the peak of the drug's action (after 3-4 hours), and on outcome (before the next injection) of the drug. Statistical data processing was carried out using the Statistica 10.0 application package.

Results and discussion. A strong inverse correlation was established between the clot growth rate (V) of the TD test and the determination of anti-Xa activity at the peak (-0.777; p<0.05) and at the end (-0.715; p<0.05) of anticoagulant therapy. With the standard prescription of doses of anticoagulant therapy depending on body weight, it was found that 30% of patients did not reach the target values of the V TD test and anti-Xa activity and were in the hypercoagulable zone.

Conclusion. The indicator of clot growth rate of the "Thrombodynamics" test correlates with the level of anti-Xa activity and can be used as another tool for laboratory monitoring of ongoing therapy with low molecular weight heparins (LMWH) in the wounded. The standard use of LMWH in therapeutic doses by body weight in the wounded does not always lead to the achievement of target coagulation parameters, which requires the development of a personalized approach to LMWH titration, which can be based on the indicators of TD tests and anti-Xa activity.

Introduction. Obesity is a global problem of the XXI century. The most important aspect of metabolic disorders that develop with obesity is a change in the level of serum uric acid (UA) in the blood and the development of gout. Currently, the dynamics of cardiovascular risk factors in patients with obesity on the background of drug therapy is being widely studied.

The aim of our study is to study the level of UA, vaspin (VsP), visfatin (VF), omentin (ITLN1), retinol-binding protein-4 (RBP4) in patients with gout and metabolically unhealthy obesity (MNHO) during diet therapy and 3 months of treatment with the drug from the group of human glucagon-like peptide-1 analog (aGLP-1) Liraglutide.

Materials and methods: 25 men with gout were examined, the average age was 43.6±7.3 years. Gout was diagnosed according to the classification criteria ACR/EULAR, 2015, Wallace S.L., 1977. Metabolic syndrome was established according to the criteria of GNCA (2013): abdominal obesity - waist circumference ≥ 94 cm in combination with any 2 from the following criteria - an increase in triglycerides (TG) ≥ 1.7 mmol / l; a decrease in high-density lipoproteins (HDL) < 1.0 mmol / l, an increase in low-density lipoproteins (LDL) ≥3.0 mmol / l, blood pressure (BP) ≥ 140/90 mm Hg; increase in plasma glucose ≥ 6.1 mmol / l. At the time of inclusion in the study, all patients had an interictal period of gout. Body mass index (BMI) was calculated using the Quetelet formula: body weight (kg)/height (m²). To assess the type of distribution of adipose tissue, the waist circumference (WT, cm) and hip circumference (HB) were measured with a flexible centimeter tape, with the calculation of the W/H ratio. The concentration of VsP, VF, ITLN1, RBP4 was studied using the enzyme-linked immunosorbent assay method using the kits; the concentration of the level of UA in blood serum and daily urine was studied using the colorimetric method. Liraglutide was injected into the subcutaneous fat of the anterior abdominal wall at a dose of 0.6 mg once a day for the first week. Escalation by 0.6 mg every week was then recommended until a dose of 18 mg per day was reached. Participants then received injections at a dose of 1.8 mg for 3 months. Thus, the observation period was 3 months. Laboratory studies and assessment of anthropometric parameters were carried out initially, as well as after 3 months. The control group consisted of 16 healthy men matched in age. Statistical data processing was carried out using the statistical software package Statistica 13.0.

Results. 3 months after treatment, a statistically significant decrease in body weight, BMI and WC was noted (in all cases, p<0.01). Median BMI before treatment was ˗ 38.4 [35.4; 39.2] kg/m², against the background of ongoing therapy - 33.2 [31.4; 34.2] kg/m², and thus the loss of body weight was 23% (p<0.05). Serum UA level decreased by 30.1% (p<0.05) during therapy with a drug from the GLP-1 group. In patients with gout, BMI and regression of obesity were associated with a significant decrease in VsP by 17.2%, VF by 13.8% and RBP4 by 10.4%, and a significant increase in ITLN1 by 12.6%. A direct correlation was established between BMI and WC with the content of VsP, RBP4 and VF in blood serum (correlation coefficients from 0.44 to 0.57, p<0.05) and an inverse correlation with the content of ITLN1 (correlation coefficient -0.29, p<0.05). A direct correlation was found between the serum UA index and the content of VsP, VF, RBP4 (correlation coefficients from 0.31 to 0.49, p<0.05).

Conclusion. Patients with gout in combination with MNZO showed a significant increase in serum levels of UA, VsP, RBP4 and VF, against the background of a decrease in the concentration of ITLN1. The use of diet therapy using a drug from the GLP-1 group showed a statistically significant decrease in BMI, WC, serum UA, pro-inflammatory adipokines (VsP, VF and RBP4), and a significant increase in anti-inflammatory cytokines (ITLN1).

Introduction: The term "vascular age" (VA) was developed to motivate and increase patients' commitment to a healthy lifestyle. This assessment can significantly help in communication between the doctor and the patient. CO is the age of a person who has the same probability of death from cardiovascular diseases as the patient, only without modifiable risk factors. CV can be determined using instrumental methods or risk can be calculated using the modified SCORE scale, the latter method is currently limited due to the modification of the SCORE2 and SCORE-OP scales.

The aim of our study was to assess the vascular age in patients with arterial hypertension (AH) using the method of volumetric sphygmography and the relationship of vascular aging with the main clinical and laboratory parameters.

Materials and methods: 48 patients with AH were examined, including 21 men (44%) and 27 women (56%), the mean age was 66.9 years and 67.3 years, respectively. The duration of the disease was about 10 years. All patients were receiving antihypertensive therapy at the time of the examination. Vascular age was assessed using the volumetric sphygmography method using the BPLab-Vasotens apparatus (LLC Petr Telegin, Russia). This technique is quite simple, non-invasive, does not require the use of expensive equipment and additional specialists. Statistical processing was carried out using the Microsoft Excel package (Microsoft Office 2011) and Statistica 10.0.

Results. Our assessment showed that CO in patients with AH was 69.0 years and did not differ statistically from the passport (67.0 years, р˃0.05). The groups of men and women did not differ from each other in terms of the passport age of the patients (р˃0.05). Correlation analysis showed a positive relationship between passport and vascular age (r=0.88, p<0.001).

When analyzing hemodynamic parameters, the patients were divided into 2 groups: group 1 included patients with CO less than or equal to the passport one (n=22), and group 2 included patients with CO greater than the passport one (n=26). In the first group there were more men (14 - 63.6%), and in the second group there were more women (19 - 73.1%), р=0.1. It was found that the indicators of systolic, mean and pulse BP in group 2 were higher: 117.0 [109.0;133.0] and 137.0 [122.0;146.0] mm Hg (p=0.005), 86.5 [84.0;94.0] and 100.5 [92.0;108.0] mm Hg (p=0.006), 44.5 [38.0;64.0] and 70.5 [48.0;74.0] mm Hg (p=0.01), respectively.

The groups did not differ from each other in terms of passport age, body mass index, diastolic BP level, length of service, stage of hypertension, lipid profile, creatinine, glomerular filtration rate, incidence of coronary artery disease, history of stroke (р˃0.05).

Conclusion. The assessment of vascular age using volumetric sphygmography is simple and improves communication between the doctor and the patient. Vascular age directly correlates with passport age. In the group of patients whose vascular age was higher than the passport one, an increase in systolic, mean and pulse BP was revealed, compared with the group of patients in whom the CO was less than or equal to the passport one. The absence of statistically significant correlations between CO and other generally recognized risk factors indicates the need for an individualized comprehensive assessment of cardiovascular risk using clinical, laboratory and instrumental data.

Introduction. Leptin resistance (LR) is characterized by a weakening of the positive metabolic effect of leptin, despite its elevated level, while maintaining some of the pleiotropic effects, including those on the cardiovascular system. However, since most of the data have been obtained in cellular and animal models, the role of LR in cardiovascular diseases remains unclear. The lack of precise diagnostic criteria for assessing LR limits the study of this phenomenon. As a result, data on the incidence and contribution of LR in MI are critically scarce today, in addition, they are extremely contradictory.

Purpose: to evaluate the prevalence of LR and its clinical and prognostic significance in conjunction with metabolic disorders in the hospital period of myocardial infarction (MI).

Materials and methods. The study included 114 men with an established diagnosis of ST elevation MI. Patients on the 1st and 12th day of MI measured the concentration of leptin, the leptin receptor. The free leptin index (FLI) was calculated as the ratio of leptin concentration (ng/mL) to the concentration of soluble leptin receptor (ng/mL) multiplied by 100. LR was recorded at leptin > 6.45 ng/mL and LL >25. Assessment of glucose, lipid spectrum (total cholesterol, TAG, LDL-C, VLDL-C, HDL-C, FFA) in blood serum was performed using standard test systems from Thermo Fisher Sientific on an automatic biochemical analyzer Konelab 30i (Finland) , the content of C-peptide and insulin were determined using enzyme immunoassay (Monobind, USA) according to the protocol established by the manufacturer. To determine insulin resistance (IR), the QUICKI index was calculated, the severity of IR was assessed according to A. Katz et al. A comparative analysis of clinical and anamnestic characteristics and cardiovascular prognosis between patients with and without PR was carried out. Data analyzed using Statistica 10.0.

Results. In patients with MI in the whole group in the hospital period, there was an increased content of leptin relative to the reference interval of 2.0-5.6 ng/ml. On the 1st and 12th days of the disease, the leptin concentration in patients with MI was 11.6 [6.6;20.5] ng/ml and 11.5 [5.4;13.9] ng/ml, respectively. . The content of the leptin receptor did not go beyond the established reference interval. LSI on the 1st day of the disease was 32.7 [14.3; 70.5], on the 12th day - 31.9 [16.2; 64.5]. The prevalence of LR in the hospital period for MI was 64%. LR was associated with CVD risk factors - hereditary burden for cardiovascular pathology (p=0.02), arterial hypertension (p=0.01), dyslipidemia (p=0.001), obesity (p=0.001). When assessing the metabolic profile, a statistically significant increase in the content of glucose (p=0.02), insulin (p=0.02) and C-peptide (p=0.03) on the 1st day of MI, insulin (p=0 .01) and C-peptide (p=0.03) on the 12th day of the disease, a decrease in the QUICKI index (p=0.03) throughout the hospital period in patients with PR compared with patients without PR. In the group of patients with PR, 45 people (61.8%) had a moderate and severe degree of IR, in patients without PR - in 12 patients (29.2%). When conducting a correlation analysis, a significantly significant direct relationship was found between the level of insulin on the 12th day of MI and LSI (r=0.509, p=0.02), as well as an inverse correlation between the QUICKI index on the 12th day and LSI (r= -0.367, p=0.01). Among the studied parameters of lipid metabolism, only the content of FFA on the 1st day of the disease in the group of patients with LR was higher than in the group without LR (p=0.03). Patients with LR were more often prone to early postinfarction angina (p=0.03), recurrent MI (p=0.001), rhythm and conduction disturbances (p=0.03) during the hospital period of MI. Prognostic significance in relation to the risk of adverse cardiovascular events in the hospital period of MI, according to logistic regression analysis, had LSI both on the 1st and 12th days of the disease, as well as FFA levels on the 1st day of the disease.

Conclusion. Patients with MI are characterized by a high prevalence of LR in the hospital period. LR is associated with CVD risk factors, metabolic disorders, and IR formation. The identified features in the presence of LR can probably contribute to the development of adverse cardiovascular events in the hospital period of MI.

Introduction. Comorbidity in the modern world is a predictor of a more severe course of most diseases and has a significant impact on the characteristics, course and outcomes of the disease in the structure of occupational pathology. This is characterized by an increase in clinical syndromes, a deterioration in the quality of life and disability.

Purpose of the study. Optimization of diagnostics in the form of studying clinical, functional and nutritional and metabolic parameters in professional patients on a model of comorbid pathology of vibration disease in combination with arterial hypertension.

Materials and methods. In the course of a single-stage open, descriptive, comparative clinical study, 431 patients were examined in the conditions of the regional center of professional pathology in the city of Novosibirsk. Patients were divided into groups: patients with isolated vibration disease (n = 104), a group of comorbid WB+AH model (n = 101), a comparison group were patients with arterial hypertension (107 patients), a control group of conditionally healthy individuals (119 people) . The study duration was 4.9 ± 0.25 years. The indicators of the main analyzers, nutritional and metabolic status, nutritional adequacy, indicators of protein, lipid, carbohydrate metabolism, adipokine status, blood 25OH vitamin D, indicators of endothelial dysfunction, RAAS components, oxidative stress and systemic inflammation were evaluated.

Results and its discussion. With VP+AH, the most unfavorable metabolic status was revealed. In this group, higher levels of insulin, glycated hemoglobin, HOMA-IR index, total cholesterol, LDL, triglycerides, atherogenic coefficient were determined in comparison with the isolated WB group and the control group, respectively.

The phenotype of WB and AH shows the highest concentration of resistin, significantly higher than in the comparison and control groups, against the background of low levels of adiponectin, as well as an increase in the level of free leptin against the background of a decrease in the leptin-binding receptor. In the course of bioimpedancemetry, significant deviations were found in the group of the comorbid model of HF in combination with AH in the following indicators: an increase in fat mass normalized for growth and extracellular fluid with a decrease in the parameters of lean and active cell mass and phase angle. In the group of the comorbid model of WB and AH, changes were also detected in the following indicators of the molecular endotype: an increase in markers of oxidative stress (total antioxidant status of serum, Cu/ZnSOD, concentration of free radicals, lipid peroxides, protein oxidation products), the RAAS system, markers of endothelial dysfunction (endothelin 1, nitric oxide, tissue factor) and systemic inflammation (IL1 β, MCP-1, FGF 2, cardiotrophin, MMP 1, MMP 9, pentraxin 3, neutrophil elastase).

Conclusions. A variant of the comorbid model is characterized by clinical-molecular and nutritional-metabolic features in professional patients, which are caused by a multifactorial pathomorphosis of a combination of vibration disease and arterial hypertension. In this variant, indicators of worse metabolic and adipokine status relative to the compared groups, pronounced processes of systemic inflammation, oxidative stress, and endothelial dysfunction were revealed.

Introduction: AKI (acute kidney injury) is a common comorbid condition in patients with AMI (acute myocardial infarction), complicating its course and treatment. In the future, the prognosis of these patients after discharge from the hospital, as well as the incidence of recurrent cardiovascular events (CVS) and chronic kidney disease (CKD) are not known.

The purpose of the study: to study the predictors of the development of recurrent cardiovascular events (CVS) in patients with myocardial infarction (MI) with acute kidney injury (AKI). Develop a calculator - a risk meter for repeated CCC.

Materials and methods: the study was performed in the Altai Regional Cardiological Dispensary. 193 patients with MI and PCI (percutaneous coronary intervention) were included, divided into 2 groups: the first - 123 patients aged 62.8±1.1 years with MI and AKI, the second - 70 patients without AKI, age 61.3± 1.6 years. Upon admission and before discharge, the level of the KIM-1 molecule (Kidney Injury Molecule-1) and IL-18 (interleukin-18) was studied by ELISA in the urine. All patients underwent coronary angiography using low-osmolar contrast. One year after discharge, the frequency of development of repeated CCC was assessed. Statistical calculations were carried out using statistical packages STATISTICA 12.0. The level of statistical significance was taken equal to 0.05.

Results. The level of KIM-1 (at admission) in the first group was statistically higher than in the second: 1998.9±147.6 versus 1289.8±126.1 pg/ml p=0.001, and IL-18 in the AKI group exceeded the corresponding parameter of the group without AKI: 179.0±12.9 versus 114.9±11.5 pg/ml p=0.007, respectively. A year later, it was found that the frequency of recurrent cardiovascular events was higher in the group with AMI and AKI: unstable angina was diagnosed in 26 (21.1%) patients in the group with AKI and 5 (7.1%) patients without AKI in history, p=0.010; 19 (15.4%) and 2 (2.8%) patients, p=0.006, 20 (16.2%) and 3 (4.2%), p=0.013 patients, respectively, had repeated myocardial infarction and progression of CHF in a year . Progression of renal dysfunction during the year was observed 5 times more often in patients with MI and AKI: CKD C2 was diagnosed in 49 (39.8%) patients of the first group and 16 (22.8%) of the second, p = 0.01; CKD C3a and C3b stages - in 34 (27.6%), p˂0.001 and 19 (15.4%) patients, p=0.002, respectively, CKD stage C4 was detected in 4 (3.2%) patients of the group with AMI and AKI in the early postinfarction period. As a result of constructing a multifactorial logistic regression model, predictors were identified that have a multiplicative effect on the development of recurrent CV events: BMI over 25 kg/m2 increases the risk of recurrent CV events by 0.91 [0.83; 0.99] times, p=0.028, history of prior MI in 3.32 [1.24; 9.86] times, p=0.022. Increase in CRP by 1.01 [1; 1.03] times, p=0.045, troponin I, 0.97 [0.94;1] times, p=0.037, and IMT-1, 1 [1;1] times, p=0.030. On the development of CKD: an increase in age is associated with an increase in the chances of developing CKD by 1.18 [1.1; 1.29], p ˂0.001; troponin I by 0.96 times [0.92; 1], p=0.030; systolic blood pressure in 1.03 [1; 1.07] times, p = 0.029. A calculator has been developed for risk stratification of the development of recurrent CV events and an algorithm for managing this category of patients after discharge from the hospital.

Conclusions: thus, the identified predictors make it possible to calculate the risk of developing recurrent CV events and CKD using the developed calculator and allocate these patients to a separate group for personalized observation, taking appropriate measures of secondary prevention.

Introduction. Atrial fibrillation (AF) is one of the most common heart rhythm disorders. The risk of developing thromboembolic complications, including ischemic stroke, in patients with AF is 5 times higher than that in patients with sinus rhythm; therefore, one of the main directions in the treatment of patients with this rhythm disorder is the prevention of thromboembolic complications.

Objective: to study the markers of monitoring the blood coagulation system in the blood serum of patients with non-valvular AF receiving anticoagulant therapy and having a history of thrombotic and thromboembolic complications.

Materials and methods. The study included 31 healthy volunteers (without a history of AF, thrombosis) and 31 patients over 18 years of age with a diagnosis of AF (mean age 66.2±8.1), receiving anticoagulant therapy and having a history of thrombotic and thromboembolic events. complications. Therapy taken by patients at the time of inclusion in the study was in line with current recommendations and included standard conventional antiarrhythmic and anticoagulant therapy, as well as therapy for the underlying cardiovascular disease. Biomarkers of thrombus formation and pro-inflammatory activation (L-selectin, thrombomodulin) were determined by enzyme immunoassay using diagnostic kits from BiomedicaGmbH, Austria.

Results. During the screening of 2820 patients treated in the Department of CHLSRS&EX for the nosology of AF in the period 01.2020-01.2023, 31 patients were included in the study, who were diagnosed with thrombotic and thromboembolic complications (0.01% of the total number of screened patients) against the background of regular anticoagulant therapy . Among all patients included in the study, thrombotic complications in AF were as follows: thrombosis of the left atrial appendage was noted in 17 patients (54%), spontaneous echo contrast of grade II or more in 5 patients (16%), cardioembolic stroke - in 3 patients (10%) , thrombosis of peripheral arteries (2 (6%)), thrombosis on EKS electrodes (2 (6%)).

The concentration of soluble thrombomodulin in the blood serum of patients with thrombotic and thromboembolic complications was reduced compared with the group of healthy volunteers (2073.0±548.6 vs. 2845.3±726.4 pg/ml; p=0.004).

Serum levels of L-selectin in patients with thrombotic and thromboembolic complications were reduced compared to healthy volunteers (1.5±0.6 vs. 2.4±1.3 µg/mL; p=0.04).

Conclusion. In patients with thrombotic and thromboembolic complications that occurred against the background of adequate anticoagulant therapy, there was a decrease in serum soluble thrombomodulin and L-selectin, which may indicate damage to the endothelium, activation of thrombus formation and inflammation.

Introduction. The assessment of factors associated with the deterioration of the quality of life (QOL) and emotional state after heart surgery suggests the possibility of their timely elimination and, as a result, a faster return to working capacity and socialization of a patient with acquired heart disease.

Target. Identification of factors affecting the deterioration of QoL and emotional state of patients undergoing surgical correction of acquired heart valve defects in the postoperative period.

Materials and methods. The study included 103 patients (median age 60.0 years [51.0; 66.0]) from November 2020 to October 2022 who underwent surgical correction of mitral valve disease or in combination with correction of aortic valve disease and /or tricuspid valves. To assess the level of QOL, patients filled out the questionnaire "Shot Form-36 health status survey" (SF-36), to assess the emotional state of the Hospital Anxiety and Depression Scale (HADS) before surgical treatment, on the 7th, 30th day, a year later after the intervention.

Results. According to regression analysis, the presence of preoperative atrial fibrillation (AF) was associated with a decrease in the physical component of health according to the SF-36 questionnaire by B-factor = -6.39; p=0.002 before surgery, and B-factor = -10.92; p=0.03 one week after the operation, as well as with a decrease in the mental health component on the 30th day (B-coefficient = -12.66; p=0.006). With an increase in age by 1 unit, the initial level of the physical component of health decreased by B-coefficient = -0.21 (p=0.014). There was an association of males with levels of anxiety (B-value = 3.58; p=0.002) and depression (B-value = 3.04; p=0.002) assessed before and one week after surgery: B-value = 2.34; p=0.03 and B-factor=2.47; p=0.02, respectively, as well as with a higher level of anxiety after a month (B-factor = 2.79; p=0.03). Patients were divided into groups with the presence (group 1) or absence (group 2) of pulmonary hypertension (PH) before surgery according to echocardiography. On the 7th day after the operation, group 1 noted an improvement in mental health (MH; p=0.03), regardless of the increase in the intensity of the pain syndrome (BP; p=0.005). Patients without PH noted a worsening of QoL in terms of self-service and freedom of movement (PF, p=0.04), because of the pain syndrome they considered their QoL to be lower compared to preoperative (BP; p=0.03). On the 7th day in the group without PH, the median level of anxiety decreased by 3 points, in the group with PH only by 1.5 points (p=0.04). The level of depression by the 30th day decreased to 1 point in both groups, remaining stable throughout the year. A month later, the PH group noted an increase in physical capabilities (PF; p=0.03), an increase in overall health (GH; p=0.003), an increase in physical (p<0.0001) and mental (p=0.006) components of QoL , and patients without PH indicated a limitation in the performance of work duties (RP, p=0.047). During the year after the operation, the PH group noted a decrease in pain intensity (BP, p=0.003), an improvement in the emotional state (RE, p=0.04), an increase in the possibility of self-care and free movement (PF, p=0.00008), work responsibilities (RP, p=0.001), which increased overall health (GH, p=0.002), vitality (VT, p=0.0002) and increased social contacts (SF, p=0.001). The quality of life of patients from the group without PH improved only on three points with less significant dynamics: physical functioning (PF, p=0.03), pain intensity (BP, p=0.01) and vital activity (VT, p=0.04 ).

Conclusion. The factors influencing the deterioration of QoL and emotional state after surgical correction of PPS are: the presence of preoperative AF, male gender. And the presence of PH before defect correction is associated with better QoL and emotional status after the intervention compared to patients without PH, which may be due to a more severe condition before surgery in people with PH.

Introduction. Ceramides are bioactive lipids that are not only structural components of cell membranes, but also second messengers in the transmission of cell signals. Ceramides are associated with risk factors for cardiovascular disease, may be independent predictors of cardiovascular events and proatherogenic mediators. However, due attention has not been paid to the problem of ceramide accumulation in the adipose tissue (AT) of the heart, while the accumulation of ceramides in adipocytes of epicardial and perivascular AT in coronary heart disease (CHD) is of particular interest, since they are localized in close proximity to the coronary vessels and the focus of the lesion.

Objective: to evaluate the expression of de novo ceramide biosynthesis enzymes in the adipose tissue of the heart of various locations in patients with coronary heart disease and acquired heart defects.

Materials and methods. The study included 30 patients with CAD, the comparison group consisted of 30 patients with acquired valvular disease (aortic stenosis/insufficiency) without CAD. During the operation, biopsies of subcutaneous, epicardial, perivascular adipose tissue (VT) (SAT, EAT, PVAT, respectively) were obtained. Expression of genes encoding de novo ceramide synthesis enzymes (subunits of C1 and C2 serine palmitoyltransferases: SPTLC1, SPTLC2; ceramide synthase 1-6: CERS1-6; dihydroceramide desaturase: DEGS1) was assessed by real-time quantitative polymerase chain reaction (qPCR) with primers synthesized by Evrogen (Moscow, Russia) on the ViiA 7 Real-Time PCR System (Applied Biosystems, Foster City, California, USA). Statistical analysis of the results was performed using GraphPad Prism 8 (GraphPad Software).

Results. Patients with CAD were characterized by higher levels of SPTLC1 mRNA in subcutaneous and epicardial VT and SPTLC2 mRNA in EAT. DEGS1 expression was maximal in SVT and EAT. The expression of ceramide synthase genes in VT of patients with coronary artery disease had tissue-specific features. Expression of the CERS1 gene, encoding the enzyme ceramide synthase-1, which produces ceramides with a fatty acid residue in its composition of 18 carbon atoms (C18), expression of CERS5 and CERS6, encoding ceramide synthase-5 and -6, synthesizing ceramides C14-C16 was maximum in epicardial adipocytes. At the same time, CERS5 expression was higher than CERS6 expression. Gene expression of CERS2, encoding the enzyme ceramide synthase-2, which produces long-chain ceramides and attaches C20–C24 fatty acyl-CoA to the sphingoid base in ceramide, was maximal in subcutaneous adipocytes. While perivascular VT was characterized by a higher expression of the CERS4 and CERS3 genes, which synthesize very long chain ceramides C26 and higher. In the group of patients with valvular disease, VT samples did not differ in terms of SPTLC1, SPTLC2, CERS1, CERS2, CERS5, and CERS6 mRNA levels. However, high expression of CERS4 and DEGS1 was observed in EAT, while CERS3 and CERS4 were expressed in PVAT. When comparing the level of expression of genes for ceramide synthesis enzymes between the two studied groups, it was found that in patients with IHD, the mRNA level of SPTLC1 in SAT and EAT, SPTLC2 in EAT, CERS2 in all types of AT, CERS4 and CERS5 in EAT, DEGS1 in SAT and EAT was higher in compared with patients with valvular heart disease.

Conclusion. Regional fat depots of the heart differed in the level of expression of de novo ceramide biosynthesis enzymes. The results obtained indicate the activation of ceramide synthesis along this pathway in adipocytes of predominantly epicardial localization in coronarogenic pathology, which may contribute to the accumulation of long-chain ceramides in the VT of this localization.

Introduction. Numerous literature data report a significant increase in mortality during the peak of the incidence of COVID-19, even in patients without confirmed coronavirus infection. The most vulnerable group during this period were patients with diabetes mellitus (DM) due to more frequent comorbid conditions.

Materials and methods. An analysis of all protocols for the autopsy of deceased patients for 2020 and 2021 was carried out. in a multidisciplinary hospital, when the institution provided emergency medical care to the population of the city of Irkutsk in the surgical and therapeutic profile without a confirmed coronavirus infection. Groups of patients with and without type 2 DM were analyzed separately by pairwise comparisons (92 groups of patients matched by sex and age).

Results. An analysis of the annual dynamics of nosocomial mortality showed an increase in the indicator during the peak of the pandemic by about 2.5 times (in 2018 - 65 cases, in 2019 - 109 cases, in 2020 - 254 cases, in 2021 - 244 cases, in 2022 – 81 cases). In the structure of the causes of deaths in both groups, diseases associated with atherosclerosis dominated - in 44% of cases, significantly more often in the group of patients with DM (53% vs 36%, p≤0.05). Also, patients with DM had a higher incidence of stenosing coronary atherosclerosis (86% vs 73%, p=0.03). In second place in terms of frequency of occurrence were infectious causes of death - 16%, malignant neoplasms - 17%, comparable in both groups, as well as surgical pathology of the gastrointestinal tract (GIT) - 17%, which was more common in the group of patients without DM (24 % vs 10%, p≤0.05). An analysis of the immediate causes of death in patients without DM and with type 2 DM was comparable in most indicators, with the exception of the number of bleeding and posthemorrhagic anemia, which occurred in a larger percentage of cases in patients without DM (11% vs 3%, p = 0.003), which due to the predominance of surgical pathology of the gastrointestinal tract in these patients. Thus, the leading direct cause of death among all patients was pulmonary edema - in 81%, then in descending order - pulmonary embolism in 34%, sepsis in 23%, bleeding in 14%, acute myocardial infarction and peritonitis in 12% of cases. The analysis of comorbidities in both groups of patients did not reveal significant differences, with the exception of arterial hypertension, which was more common in patients with DM (76% vs 61%, p=0.03). Histological changes in the kidneys (glomerulosclerosis, interstitium sclerosis, arteriological alinosa) were equally common in patients without and with type 2 diabetes (92% vs 86%, p≥0.05), which is probably due to high comorbidity in both groups . Thus, signs of histologically confirmed pyelonephritis were detected in almost every second patient in the study groups (with DM - in 63%, without DM - in 65%, p≥0.05), which exceeds the literature data by 2-3 times.

Conclusion. In a multidisciplinary hospital during the COVID-19 pandemic, there was a significant increase in mortality (by 2.5 times). In the structure of the causes of deaths in both groups, diseases associated with atherosclerosis dominated, significantly more often in the group of patients with DM. In the group of patients with DM, stenosing coronary atherosclerosis and arterial hypertension were more common. In patients without DM, one of the leading causes of mortality was surgical pathology of the gastrointestinal tract, which was accompanied by significantly higher cases of bleeding. Attention is drawn to the high frequency of histologically confirmed pyelonephritis in both groups (over 60%), which can make a significant contribution to thanatogenesis.

Introduction. Ischemic heart disease (CHD) is the most common pathology in the structure of cardiovascular diseases. Ischemia is a trigger for the occurrence of cardiac arrhythmias (HRDs), requiring the implantation of cardioverter-defibrillators. The functioning of cardiomyocytes is closely associated with respiratory processes in mitochondria (Mtx). Normally, all Mtx in the human body carry the same genome - mitochondrial DNA (mtDNA), respectively, the functional capabilities of all Mtx within the body are similar. Carriage of polymorphic variants of genes encoding subunits of respiratory chain complexes and rRNA may affect the functionality of Mthx.

Target. To study the respiratory function of Mtx and the features of mtDNA of leukocytes in patients with coronary artery disease, accompanied by life-threatening NRS.

Material and methods. Peripheral venous blood was taken from patients with coronary artery disease (n=45) and ischemic heart disease with HRS (n=120). Mtx was obtained by differential centrifugation in a sucrose gradient. Oxygen consumption rates (OCR) (nM O2/min/mg protein) Mthx were measured in two energy states: V3, the presence of oxidation substrate(s) and phosphorylation substrate (ADP) in the incubation buffer; V4 - after the consumption of ADP in the buffer. Succinate and a mixture of pyruvate and malate were used as oxidation substrates. To assess the functional reserve of Mtx, OPC was determined in the presence and in the absence of saturated palmitic acid (PA) in buffer. The coefficient of conjugation of oxidative processes and phosphorylation was calculated - respiratory control (RC) (V3/V4). The mtDNA haplogroup was established, as well as the carriage of polymorphic variants of genes encoding subunits of the respiratory chain complexes and ribosomal RNA (rRNA) (12S and 16S subunits). Statistical evaluation was carried out in the STATISTICA 13 program using the Mann-Whitney test for independent samples and the Wilcoxon test for dependent data groups. Data are presented as medians and quartiles (Me (Q1; Q3). Differences were considered statistically significant at p<0.05.

Results. SPK in V3, V4 and DC of mitochondria in CAD and CAD with HRS did not have significant differences in both buffers without PC. When PA was added to the buffer, a significant increase in SEC was observed in Mth patients with isolated CAD. Thus, in the V3 state, SPK in pyruvate-malate buffer increased from 127.7 (85.3; 196.4) to 198.3 (162.7; 234.9) nM O2/min/mg of protein (p=0, 04), and in the V4 state from (46.6 (38.5; 56.3) to 64.4 (60.3; 87.7) nM O2/min/mg protein (p=0.02). the use of succinate buffer and PC, the mitochondrial SPK in patients with uncomplicated coronary artery disease increased slightly (p = 0.07) from 125.5 (64.4; 172.3) to 184.3 (47.3; 406.3) and from 44, 2 (27.5; 71.9) to 86.1 (36.9; 159.4) nM O2 / min / mg protein in V3 and V4, respectively. In the group of CAD with HRS, the addition of PA to the buffer did not affect the SEC in V3 and V4, as well as DC when using both buffers.mtDNA genotyping found that the main haplogroup in patients with IHD and HRS is haplogroup H - 41%.In 90% of cases, patients in this group were carriers of missense polymorphisms of 16S rRNA genes, which correlates with earlier studies of mtDNA in patients with uncomplicated CAD.In almost half of the cases, tRNA polymorphisms were detected in patients with CAD with HRS.Rarely (less than 40%), missense polymorphisms of the respiratory chain complex I genes were found. Polymorphisms of the genes for cytochrome B, cytochrome c oxidase, ATP synthase, and 12S rRNA turned out to be minor in frequency of occurrence. The frequencies of occurrence of all these polymorphic variants of the genes were similar to those in patients with uncomplicated coronary artery disease. The mtDNA of patients with HRS was 1.5 times more likely to have multiple missense polymorphisms in the protein genes of two different respiratory chain complexes. For genes with missense substitutions in three complexes and substitutions simultaneously in 12S and 16S rRNA, the differences between the groups were 1.6 and 1.7 times.

Conclusion. Patients with CAD complicated by HRS are characterized by a reduced functional reserve of mitochondria, in contrast to patients with uncomplicated CAD. This may be due to the carriage of polymorphic variants of the mtDNA genes responsible for coding subunits of proteins of the Mth electron transport chain and mitochondrial rRNA. Also, in patients with CAD and HRS, compared with patients with uncomplicated CAD, the combined carriage of several polymorphic variants of the genes encoding these proteins and rRNA was more often detected.

Introduction. The use of equipment in the provision of medical care is associated with risks of harm to health and life with the likelihood of adverse events, for this reason, a risk-based approach is a prerequisite in modern realities.

The goal is to identify the risks of operating medical equipment (MO) in a cardiac surgery clinic.

Material and methods. The Research Institute for Complex Problems of Cardiovascular Diseases (NII KPSSZ) used the technique of failure cause and effect analysis (FMEA) to identify risks. By the number of points of the generalized quantitative characteristic of the risk of non-compliance (priority risk number - RPR), all risks are divided into levels: low, medium, high and catastrophic. The obtained data were systematized in the "Risk Passport", including: the definition of risk, its indicator, indicator, level, source. The cause and consequences of the risk, as well as measures to manage them are indicated. The whole process is formalized within the framework of the Quality Manual and documented QMS procedures.

Results. Indicators of the equipment of the Ministry of Defense and the performance of the engineering service of the Research Institute of the KPSS for the period from 2012 to 2022 indicate a high load on the management system of the Ministry of Defense, in particular, an increase in the number of units of the Ministry of Defense (from 976 units to 2520 units, the average annual (chain) growth rate was 13%), carried out Maintenance (from 555 to 2361) and repair of the Ministry of Defense (335-897). In the process, 8 risks were identified, including two high levels (purchase of low-quality spare parts, consumables and improper operation of the MO). The consequences of high risks include: violations in the operation of medical equipment, reduction of service life, deterioration of performance, downtime, unscheduled maintenance, repairs and the risk of obtaining erroneous diagnostic results, injury hazard for personnel and patients. Consequence management includes: compliance with the procedure for acceptance of consumables and spare parts, organization of claims work, timely repairs, internal investigation of cases of violations. The medium level of risk includes “improper maintenance of the MO by the outsourcer’s personnel”, the consequences of which may also be a decrease in the resource and deterioration in performance, downtime for repairs. Measures to manage the causes of this risk were the development of technical specifications for the conclusion of a contract with qualification requirements. The low level of risk includes: delay in the procedure for preparing documents for write-off, the reasons for which are the short deadlines for completing the task, the limited horizontal links with related services, difficulties in identifying by the departments allowing the write-off; violation of the requirements for the terms of delivery of MO (the reason is the violation by the supplier of the manufacturer's requirements for the conditions of storage and transportation, violation of the delivery time); lack of conditions for launching a new MO (the reason is non-compliance with the procedure for organizing the purchase of equipment); MOs requiring verification may not be included in the lists, and some of the already verified equipment may mistakenly be included in the lists of verified measuring instruments (the reason is errors made in the preparation and approval of statements according to F3.5-15, F3.5-17); refusal of the CMS to verify the MO due to a malfunction or incompleteness (the reason is a violation of the procedure for preparing equipment for verification of the measuring instruments) - the control measure is the introduction of a pre-verification control of the technical condition.

Conclusion. A risk-based approach when working with MO allows medical organizations to prevent, identify and prevent risks that pose a threat to the life and health of both patients and staff, to minimize the consequences of their occurrence by improving approaches to the implementation of medical activities.

Introduction. In patients with atrial fibrillation (AF), an informative indicator for predicting the effectiveness of catheter ablation (CA) is atrial function, assessed using speakle treaking echocardiography (EchoCG). A pronounced effect of CA on atrial function was proven, but the study of the dynamics of deformation of both the left (LA) and right atria (RA) has not been previously carried out, despite the fact that many sources describe a significant contribution of LA to the development and maintenance of arrhythmia.

Target. To evaluate the dynamics of changes in the function of the left and right atria in patients with atrial fibrillation after radiofrequency ablation.

Materials and methods. The study included 57 patients aged 31 to 72 years (55.4±9.8 years) with paroxysmal (n=40) and persistent (n=17) forms of AF. The main diagnoses were hypertension (n=51), coronary heart disease (n=17) without indications for myocardial revascularization, myocarditis without signs of activity (n=3). All patients underwent RFA. Before RFA, 3 days, 3 months and 12 months after, echocardiography was performed in sinus rhythm with an assessment of LA deformity (reservoir, conduction and pumping) and LA (peak longitudinal deformity, PPD).

Results. In patients before RFA, the function of the LA reservoir was 26.0±4.99%, the function of the conductor was 16.4 [12.5;20.0]%, the pumping function was 9.19±3.86%, the peak longitudinal deformation of the LA was 28, 1±5.99%. After RFA, a statistically significant decrease in LA function was noted: reservoir 20.2±4.07% (p<0.001), conduction 12.4 [9.4;16.0]% (p<0.001) and pumping 7.08± 3.37 (p<0.001) and the peak longitudinal deformation of the PP increased by 31.0±6.36% (p<0.001). After 3 months, there was a statistically significant increase in the function of the LA reservoir 26.6±4.29% (p<0.001), the function of the conductor 16.7±4.36% (p<0.001), the pumping function 9.13 [6.50;11 .9] % (p<0.001). The peak longitudinal deformity of the RA was 30.6±6.31, which was statistically significantly higher than before surgery (p=0.011). A year later, the function of the LP reservoir was 25.9±5.16% (p<0.001), the function of the conductor was 16.7±4.52% (p<0.001), the pumping function was 9.21±3.39% (p<0.001 ), which was statistically significantly higher than in the early postoperative period. The peak longitudinal deformation of the RA after one year was statistically significantly higher than before RFA – 33.0±6.25% (p<0.001).

Conclusion. Radiofrequency ablation has a significant effect on the function of both atria: there is an inhibition of the reservoir, pumping and pipeline function of the LA and an increase in the longitudinal deformation of the RA in the early postoperative period. Restoration of left atrial deformity is observed 3 months after RFA, and persists after a year. The function of the PP after 3 months does not change significantly, but after a year it increases statistically significantly compared with the preoperative 3-month period.

Introduction. Currently, there are a few experimental data on the effect of alcohol consumption on the surfactant proteins SP-A and SP-D, while these aspects remain unexplored in humans. In view of the high social significance of the problem of alcohol abuse, and also due to the fact that the lungs are one of the "target organs" in excessive alcohol consumption, the study of the effect of alcohol consumption on the levels of surfactant proteins SP-A and SP-D in men and women is undoubtedly topical direction of modern medical science.

The aim of the work is to determine the effect of alcohol consumption on the levels of surfactant proteins SP-A and SP-D in men and women in Novosibirsk.

Materials and methods. On the basis of the NIITPM-branch of the Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, in 2022, 174 people (87 men and 87 women), aged 45 to 69 years, randomly selected from the residents of Novosibirsk, were examined. Alcohol consumption was assessed using the AUDIT questionnaire. The content of surfactant proteins SP-A and SP-D in blood serum was determined by enzyme immunoassay using standard ELISA kits. Statistical analysis used parametric and non-parametric methods of descriptive statistics, correlation analysis was carried out using the Spearman test, and multivariate analysis using binary logistic regression. ROC-analysis was used to assess the diagnostic significance of variables with the determination of sensitivity and specificity. In all procedures of statistical analysis, the critical significance level of the null statistical hypothesis (p) was taken equal to 0.05.

Results. In the general sample of men and women aged 45-69 years, it was determined that the usual single dose of alcohol consumed equal to 7-9 alcohol units is inversely associated with SP-A (r=-0.154, p=0.043). Using ROC analysis, it was found that SP-A is a marker (the area under the ROC curve is 71.2%) of alcohol intake in a typical single dose of alcohol consumed equal to 7-9 alcohol units. With an SP-A level of no more than 921 pg / ml, its sensitivity in relation to the determination of alcohol consumption in a typical single dose of 7-9 alcohol units is 68.7%, and the specificity is 87.5%. Using regression analysis, it was determined that the variable "usual single dose of alcohol consumed equal to 7-9 alcohol units" directly affects the presence of SP-A no more than 921 pg / ml (Exp (B) = 13.0; 95% CI = 1, 5; 111.0, p=0.019) regardless of age and male sex.

Conclusion. Thus, it has been established that in men and women of Novosibirsk aged 45-69 years, a high single dose of alcohol consumed equal to 7-9 alcohol units is an independent factor that directly affects the presence of SP-A levels in the blood that do not exceed 921 pg/ml .

Introduction. Every year there is more and more data on the gender characteristics of cardiovascular diseases and factors predisposing to their development. It is now well known that men and women with atrial fibrillation (AF) differ in most clinical and demographic characteristics. The most formidable complication of atrial fibrillation is thromboembolic syndrome, which develops in 8-15% of cases. The system of signaling molecules CD40-CD40L is involved in the processes of thrombosis and inflammation. The main source of soluble CD40L is activated platelets. In this regard, it seems relevant to us to analyze the CD40/CD40L system in patients with AF of different sexes.

Purpose: to study the content of CD40 and soluble CD40 ligand in blood serum in patients with non-valvular atrial fibrillation of different sexes, receiving anticoagulant therapy and having a history of TO and patients without thrombotic complications.

Materials and Methods: The study included 22 healthy volunteers (11 women and 11 men) and 60 patients over 18 years of age with a diagnosis of atrial fibrillation (mean age 56.6±17.9), verified on the basis of clinical guidelines (ESC 2020 recommendations on diagnosis and treatment of atrial fibrillation), confirmed by ECG, receiving anticoagulant therapy in accordance with current recommendations. Of these, 21 patients developed thrombotic complications on the background of adequate anticoagulant therapy. Two groups of patients were formed: the group without thrombotic complications consisted of 18 women and 21 men, and the group of patients with thrombotic complications that occurred consisted of 10 women and 11 men. The study of the content of CD40 (pg/ml) and sCD40L (ng/ml) in blood serum was carried out by enzyme immunoassay.

Results: an increased content of sCD40L was found in women compared with men in the group of patients with TO Me-17.98(14.71;19.58) vs 14.07(9.83;17.95) and in the group without TO Me-15.58(10.82;19.21) vs 9.58(6.19;15.14) p≤0.005; no differences were found in the group of healthy volunteers. There was no statistically significant difference in CD40 levels between men and women in the groups of patients with AF.

Conclusion: thus, a comparative analysis of the indicators of the CD40/sCD40L system demonstrated significant gender differences in patients with AF. Thus, women were characterized by higher levels of the thrombus marker sCD40L compared to men, the highest level was observed in women in the group with thrombotic complications.

Introduction. The combination of cardiovascular pathology with osteoporosis and fractures in men, especially at a younger age, requires the study of the causes and risk factors for the strategy of early diagnosis, treatment and prevention.

Target. To study the clinical and pathogenetic relationships of cardiovascular pathology with the risk of fractures in men over 45 years of age.

Materials and methods: 201 men over the age of 45 were examined, mean age 51.1 [46.1; 56.3]. The accuracy and statistical significance of the distribution of groups was assessed using discriminant analysis. High values of canonical correlation (Canonic.R=0.941) and chi-square test (χ²=630.4) with zero probability of not rejecting the null hypothesis (p=0.000) and coincidence of the results of discrimination and cluster analysis in 95% of cases made it possible to assume the reliability of the model , built on the basis of the proposed variables.

Results. The frequency of risk factors in the examined patients was: smoking - 107 people. (53.2%), abdominal obesity 74 people. (36.8%); arterial hypertension - 75 people. (37.3%), hypercholesterolemia (total cholesterol> 5.0 mmol / l) - 39 people. (19.4%), increased low-density lipoprotein cholesterol (LDL cholesterol)> 3.0 mmol / l - 32 people. (15.9%), hypertriglyceridemia (TG> 1.7 mmol / l) - 27 people. (13.4%); fasting glycemia or diabetes mellitus - 28 people. (13.9%). Among patients with fractures, men with an increased body mass index (26.5±3.3 kg/m² and 24.1±4.5 kg/m² p=0.008) and abdominal obesity (104.1±7.0 and 100.1±6.2 cm, p=0.004), vitamin D deficiency or insufficiency (37 (18.4%) versus 4 (1.9%) p=0.000) and androgen deficiency (15 (7 .4%) and 7 (3.4%) p=0.048). Fractures were significantly more often associated with diabetes mellitus (19 (9.4%) and 4 (1.9%) p=0.029), respectively. Based on the identified factors, the discriminant analysis made it possible to build a mathematical model for predicting fractures in men over 45 years of age. The canonical correlation coefficient R was 0.841. Wilkson's lambda statistics values of 0.292 indicate good discrimination (with χ² - 223.7 p<0.01). The established most significant signs were assigned gradations (X1 - 6) and numerical values, where: X1 - history of fractures: no - 0, yes - 1; Х2 – age of the first fracture older than 50 years: no – 0, yes – 1; smoking: no - 0, yes - 1; diabetes mellitus: no - 0, yes - 1; walking less than 1 hour a day: no - 0, yes - 1; X6 - osteoporosis or osteopenia: no - 0, yes - 1. X1-X6 values are standardized initial data calculated by the formula: Z = (X I - X) / s, where Z - initial distribution values, X I - results dimensions of the distribution with the original dimension. The values of the constants F1 and F2 are determined: F1 = -5.99; F2 = -4.54. Having established the gradations and numerical values of the risk factors, the predictive coefficients F1 and F2 are determined according to the following formulas: F1= -5.99–0.854×X1–0.192×X2+0.855×X3–0.179×X4+8.755×X5+3.904×X6. F2= –4.54+1.24×X1+ 2.94×X2+2.165×X3+1.60×X4–0.77×X5+5.75×X6. With an absolute value of F2 greater than the absolute value of F1, a high risk is predicted, and with an F2 value less than F1, a low risk of fractures in comorbid men is predicted.

Conclusions. Among men in a random sample over 45 years of age, a high incidence of cardiovascular risk factors was established. A third of the examined men had bone fractures of various localization. The mathematical model makes it possible to predict the development of fractures in men over 45 years of age, the risk of which increases in the presence of the following risk factors: a history of fractures before the age of 50, physical inactivity, smoking, the presence of diabetes mellitus and osteoporosis according to x-ray osteodensitometry.  

Introduction. Data on the role of inflammation in the progression and manifestation of multifocal atherosclerosis (MFA) are contradictory. The systemic process of multiple lesions of different vascular beds in patients with an established diagnosis of coronary heart disease (CHD) is due to several parallel pathological mechanisms. In general, in the pathogenesis of both coronary atherosclerosis and atherosclerosis of peripheral arteries, one of the factors is the variability of immune response genes and cytokines, regulators of the inflammatory response.

The aim of this work was to determine the role of variability in the genes of cytokines and innate immune response receptors in the structure of mechanisms associated with the development of MFA in patients with coronary artery atherosclerosis.

Materials and methods. 260 patients with CAD (mean age 58 years) were examined. Of all those included in the study, at the time of the survey, MFA was found in 180 people (69.23%), while the incidence of MFA in men and women is comparable (70.33 vs. 64.71%, respectively). There is also no significant difference in the incidence of MFA in the two age groups (up to 60 years, 45% have lesions of two or more vascular beds, and in people older than 60 years, MFA was found in 55% of cases). All patients were informed about the course of the study and voluntarily signed an informed consent. Blood was collected from the cubital vein into Vacutainer tubes with K3EDTA. DNA isolation was carried out using the phenol-chloroform extraction method. Genotyping of 47 polymorphic sites with a single nucleotide change (SNV) of 19 genes proven to be associated with the regulation of the systemic inflammatory response (cytokines, innate immunity receptors) was performed in a 96-well format using TaqMan technology (LifeTechnologies, USA) and real-time result detection with using the ViiATM 7 RealTime PCR System (LifeTechnologies, USA) for polymerase chain reaction in accordance with the instructions. Associations were analyzed using Snpstats (https://www.snpstats.net/start.htm). Odds ratio (OR) and 95% CI for OR were calculated for risk assessment.

Results. One association has been established that demonstrates a negative impact and increases the risk of developing MFA in young and middle age. Carriage of the G rs11685424 IL1RL1 allele increases the risks of earlier development of peripheral arterial lesions by 2 times (OR 2.11 (95% CI 1.09-4.06), p = 0.024) according to the recessive inheritance model. At the same time, variability in three sites (rs1974675; rs6758936; rs3755276) of the IL18 receptor gene (IL18R1) reduces the risk of MFA detection by three times (p=0.12; p=0.034: p=0.026, respectively) and this pattern is also observed in patients older age group. In the carriers of the A/A rs1974675, T/T rs3755276 and A/A rs6758936 genotypes in persons over 60 years of age, MFA was diagnosed less frequently (p=0.024; p=0.037; p=0.011, respectively).

Conclusion. It has been shown that in patients with significant coronary atherosclerosis, the progression of peripheral vascular atherosclerosis is more associated with the variability of the genes responsible for the regulation of the systemic inflammatory response, rather than genes and their variants that determine the severity and strength of the immune response.

Introduction. The combination of CAD and GERD is a common clinical situation. In recent years, more and more information has appeared indicating that the coexistence of both diseases is not accidental.

Clinical example. A 51-year-old man was admitted to the KGBUZ "AKKD" by transfer from the Central District Hospital with complaints of burning, pressing pains behind the sternum without a clear connection with physical activity, more often in the early morning hours, lasting up to 5 minutes, stopped by sitting, drinking cold water.

Upon admission, the state of the average degree. BMI 23.9 kg/m2. Temperature 36.6 0С. NPV 16 per min. SpO2 - 96%. Heart rate 55 beats. in min. AD = 110/60 mm. rt. Art. Vesicular breathing in the lungs, no wheezing. The heart sounds are clear, the rhythm is correct. There are no edema. The abdomen is soft and painless. ECG at admission: sinus rhythm with a heart rate of 55 per minute. Negative T wave II, III, aVF, V7-V9. From the anamnesis: he had not previously controlled blood pressure, he did not take regular medications. Long history of smoking. During the year, he began to notice rare episodes of burning behind the sternum lasting up to 10 minutes without a clear connection with physical activity. He was examined at the place of residence, EGD was performed, where a hernia of the esophageal opening of the diaphragm, chronic atrophic gastritis were diagnosed. During the week before hospitalization, the condition worsened in the form of a decrease in exercise tolerance, an increase in burning sensation, pressing pain behind the sternum. On May 11, 23, due to a long-term pain syndrome behind the sternum, he called an ambulance, was hospitalized at the Central District Hospital, and then transferred to the AKKD. Upon admission to the AKKD, emergency coronary angiography was performed, where subocclusion of the circumflex artery (OA) was diagnosed, stenting of the OA with a drug-eluting stent. Echocardiography revealed hypokinesis along the lateral wall, the ejection fraction of the left ventricle was 59%. Laboratory: troponin I at admission and in dynamics within the reference values; dyslipidemia. After PCI in the department, daily recurrences of burning in the epigastrium and behind the sternum more often at night. Repeated EGD - reflux gastritis with metaplasia, cardiac insufficiency. HMECG recorded episodes of ST segment elevation in II, III, aVF, V5-V6, duration up to 70 minutes; frequent polymorphic ventricular extrasystole. Taking into account recurrent pains, the results of HMECG, a control coronary angiography was performed - the coronary arteries were without pathology, the OA stent was passable. Treatment was corrected, antianginal therapy was increased with beta-blockers, dihydropyridine calcium antagonists and long-acting nitrates, as well as therapy with proton pump inhibitors. During therapy, the condition improved, anginal pain did not recur. According to HMECG in dynamics - no ischemic changes. Discharged from the hospital in a satisfactory condition with recommendations.

Conclusion. To date, a number of pathophysiological mechanisms have been established, both causing the pathogenetic relationship between IHD and GERD, and contributing to their mutual aggravation. The basis of the occurrence of associated angina pectoris is the esophagocardial reflex, caused by irritation of the esophagus and the development of coronary spasm as a result. In patients with variant angina pectoris, a time relationship was found between periods of esophageal spasm and episodes of ECG-registered ischemia. At the same time, it was found that with impaired esophageal motility in patients with coronary artery disease, a vicious circle may form: esophagospasm provokes myocardial ischemia, which, in turn, contributes to new episodes of esophageal spasm.

Introduction. It is known that cardiovascular diseases, including cardiac arrhythmias, are accompanied by increased activation of the sympathetic-adrenal system (SAS). Hyperactivation of the SAS causes an increase in the level of circulating catecholamines - adrenaline and norepinephrine, resulting in desensitization of β-adrenergic receptors (β-AR), aggravation of myocardial contractile dysfunction and the development of arrhythmia. Indicators of SAS tension are β-adrenergic reactivity of erythrocyte membranes (β-ARM) and the level of circulating catecholamines. One of the most common arrhythmias is atrial fibrillation (AF), which leads to a decrease in the quality of life, disability and high mortality. Therefore, among patients with AF, it is important to study the functional viability of β-AR in different periods of the disease.

Purpose: to evaluate β-ARM and the level of adrenaline, norepinephrine in patients with AF before and after surgical treatment.

Materials and methods. The sample included 47 patients - 31 men and 16 women, the age in the sample was 51 (26; 77) years. All patients were diagnosed with AF based on ECG and 24-hour monitoring. Among the entire sample, 59.6% of patients had paroxysmal, 25.5% persistent, 14.9% long-term persistent forms of AF. All patients underwent surgical treatment of AF using radiofrequency or cryoablation. β-ARM was determined by the method of assessing changes in erythrocyte osmotic resistance as a result of blockade of β-AR in vitro with a selective β-adrenergic blocker (Β-ARM, AGAT, Russia). Plasma epinephrine and norepinephrine concentrations were determined by enzyme-linked immunosorbent assay using Adrenalin ELISA and Noradrenalin ELISA kits (Tecan IBL International, Germany). The parameters were studied in all patients before treatment, in 44 patients after 3 days, in 18 patients after 3 months and in 9 patients after 12 months after ablation. The significance of changes in β-ARM and catecholamine levels before and after ablation was assessed using the Wilcoxon test. The strength of the linear relationship between quantitative indicators was assessed using the Spearman rank correlation coefficient.

Results. In the study sample, there were no statistically significant changes in β-ARM and adrenaline levels before and at different times after ablation. Thus, the level of β-ARM before surgery was 18.2 (12.6; 25.4), after 3 days - 22.3 (14.4; 26.6), after 3 months - 20.3 (9.3 ; 29.3), and 12 months after the operation - 27.7 (16.8; 36.7). The level of adrenaline before surgery, 3 days, 3 months and 12 months after surgery was 4.4 (3.7; 6.9), 4.7 (3.0; 6.4), 4.6 (2 .5; 6.6), 5.6 (9.1; 8.8). However, an increase in the level of norepinephrine was found 12 months after ablation compared with the values before treatment and 3 days after treatment by 1.7 and 1.8 times, respectively (p = 0.028). The level of norepinephrine before surgery, 3 days, 3 months and 12 months after surgery was 40.9 (18.7; 56.6), 38.6 (14.8; 49.6), 46.7 (25 .6; 57.3), 69.3 (65.1; 80.1). Before surgery, β-ARM and norepinephrine levels were linearly correlated (r = 0.335, p = 0.037), but after treatment, the linear correlation disappeared. At 3 and 12 months after ablation, there was a strong linear correlation between adrenaline and norepinephrine levels (r = 0.611, p = 0.012; r = 0.786, p = 0.036, respectively).

Conclusion. In the sample of patients with AF, β-ARM and norepinephrine levels were linearly correlated before treatment, but after ablation, the correlation disappeared. At the same time, the values of β-ARM do not change statistically significantly, and the level of norepinephrine increases during a 12-month follow-up. Thus, 12 months after treatment in patients with AF, the activity of the CAS increases, but the functional viability of beta-AR does not change significantly.

Introduction. In patients with chronic heart failure (CHF), anemia is more common than in the general population, and its prevalence, according to various authors, ranges from 15 to 61%. Decreased hemoglobin levels are an independent factor contributing to mortality in this cohort. According to a retrospective analysis of the Val-HeFT study, patients with CHF with a decrease in hemoglobin during 12 months of follow-up had a higher rate of readmissions, complications and death compared with patients without a decrease in hemoglobin (Hb).

The aim of our work was to study the clinical features and laboratory and instrumental manifestations in patients with CHF with low ejection fraction (CHFrEF) and anemia.

Material and methods. We conducted a continuous sample and analyzed 105 case histories of patients for 2022, who were admitted with CHFlEF (EF < 40%) to the cardiology department of the City Clinical Hospital No. 3. The functional class (FC) of CHF was established according to the scale for assessing the clinical condition in CHF (SHOKS, modified by Mareeva V.Yu., 2000), stage - according to the Strazhesko-Vasilenko classification. The edematous syndrome was assessed by points (1 - feet, 2 - lower leg, 3 - scrotum / inguinal region, 4 - abdomen, 5 - chest wall). The presence of anemia was determined by the level of Hb: <130 g/l for men, <120 g/l for women. All patients underwent Holter monitoring of the electrocardiogram (HM ECG) and echocardiography (EchoCG). The indicators of patients with CHFrEF with and without anemia were studied and compared. For this purpose, the Mann–Whitney, Wilcoxon, and c2 tests were used for nonparametric data. The Statistica 12.0 software package (Statsoft, USA) was used.

Results. The general group of patients with CHFrEF included 72.4% of men (n=76) and 27.6% of women (n=29), mean age 66.9±12.3. Of these, anemia was detected in 25.7% of cases (n=27), the proportion of men was 66.7% (n=18, mean age 69.1±9.4), women - 33.3% (n=9 , mean age 68.9±16.7). The mean age of patients with CHFrEF in the group with and without anemia did not differ significantly (69.0±12.0 and 66.1±12.3, respectively, р˃0.05). In patients with CHFrEF and anemia, hemoglobin values were significantly lower (106.9±12.7 and 151.6±15.8 g/l, respectively, p<0.001), mean hemoglobin content in erythrocytes (29.1±13, 2 and 31.2±7.7 pg, respectively, p<0.001), the number of erythrocytes (4.2±1.0 and 5.0±0.6 1012/l, respectively, p<0.001), serum iron ( 9.9±9.6 and 10.4±4.1 µmol/l, respectively, p<0.001), erythrocyte sedimentation rate (ESR) (20.9±13.7 and 8.8±8.8 mm/ hour, respectively, p<0.001). Patients with anemia had lower FC (10.3±2.2 and 8.9±2.7 points, respectively, p=0.022) and CHF stage (IIa - 19%, IIB - III - 81% versus IIa - 57 %, IIB - III - 43%, respectively, p=0.02), more pronounced edematous syndrome (2.3±1.0 and 1.8±1.1 points, respectively, p=0.039). According to HM ECG data, patients with anemia had a greater number of ventricular extrasystoles (3445.4±4439 versus 1727.4±3059.0, respectively, p=0.05). EchoCG parameters did not differ in both groups.

Conclusion. Every fourth patient with CHFrEF has anemia, while there are no significant differences in age and gender. The combination of CHFrEF with anemia significantly aggravates the course of CHF (according to SHOKS, stage of CHF, severity of edematous syndrome).

Introduction. Cardiovascular disease (CVD) is the leading cause of death in industrialized countries. The pathology of lipid metabolism, which underlies the atherosclerotic process, is one of the main risk factors for the development of CVD. Genetic markers of predisposition to the development of lipid metabolism disorders can be used for early diagnosis and development of programs for the primary prevention of CVD. Apolipoprotein E is the main apolipoprotein of chylomicrons and is required for the normal catabolism of triglyceride-rich lipoprotein components.

The aim of the study was to analyze the association of rs7412 and rs429358 of the APOE gene with the risk of myocardial infarction (MI) in the population of Western Siberia (Russia).

Materials and methods: the main group (9360 people, 45-69 years old, mean age 53.8±7) was formed from residents of Novosibirsk, surveyed in 2003-2005. within the framework of the International multicenter project "Risk Factors for Cardiovascular Diseases in Eastern Europe" HAPIEE. The study protocol was approved by the local ethics committee of NIITPM, a branch of the ICG SB RAS. Informed consent was obtained from each study participant for the examination (including the collection of biological materials). For genetic research, 2690 people were selected from the main group by random number method. After excluding unconfirmed MI cases and non-MI deaths, the sample size was 2286 people. The endpoints of the study were MI, stroke, and death from all causes. Data were obtained from the following sources: (i) clinical re-survey of the sample in 2006-2008, 2015; (II) databases: Novosibirsk City Myocardial Infarction Registry, Novosibirsk City Stroke Registry, and Novosibirsk City Mortality Registry (register data are collected at NIITPM, a branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences from 1988 to the present). The group with MI consisted of 183 people (128 men, 55 women), inclusion criteria: MI that occurred during the observation period (according to all registries and repeated screenings); MI in history, confirmed by instrumental methods of examination. Exclusion criteria: history of MI, not confirmed by instrumental methods of examination. DNA from blood was isolated by phenol-chloroform extraction. Genotyping of rs429358 and rs7412 of the APOE gene was carried out by the Real-Time PCR method on the StepOnePlus Real-Time PCR System (Thermo Fisher Scientific, Foster City, California, USA). Significance of differences in allele frequencies and verification of compliance with the Hardy-Weinberg equilibrium were calculated using Pearson's χ2 test.

Results: The association of rs429358 and rs7412 of the APOE gene with the development of MI in men (p = 0.009) and in the general group (p = 0.001) was revealed. Carrying the ɛ2ɛ4 genotype is associated with an increased risk of MI in men (OR = 3.931, 95% CI: 1.772-8.720, p < 0.0001) and in the general group (OR = 3.753, 95% CI: 1.976-7.127, p < 0 ,0001).

Conclusion: our study confirmed a statistically significant association between the genotypes rs7412 and rs429358 and the development of MI both in men and in the general group of the population of Western Siberia (Russia). Structural changes in DNA can independently affect the risk of myocardial infarction. Individuals with confirmed increased genetic risk may receive additional motivation to lead a healthy lifestyle. Data on genetic risk factors for pathology can be used to optimize the clinical management of patients.

Doing. The pathogenesis of acquired heart defects is a complex process involving many different factors. One of the triggers for the development of dysfunctions of native heart valves can be an inflammatory process caused by various types of pathogens.

The aim of the study was to evaluate the local profile of cytokines expressed by native heart valves obtained from patients with acquired heart defects during cardiac surgery.

Materials and Methods: As a material for the study, biopsies of native mitral heart valves were obtained from 4 patients with infective endocarditis and from 10 patients with rheumatic heart disease. RNA was isolated using a commercial RNeasy® Plus Universal Mini Kit (Qiagen, Germany), protein extraction was performed using T-PER™ Tissue Protein Extraction Reagent lysis buffer (ThermoScientific, USA) with the addition of protease inhibitors Halt™ Protease Inhibitor Cocktail (ThermoScientific, USA) and 0.5M EDTA solution (ThermoScientific, USA). The level of cytokines expressed by native valves was determined by dot blotting using the Proteome Profiler™ Human Cytokine Array Kit (ARY005B) (R&D Systems, USA). Cytokine gene expression was assessed by qPCR using SYBR Green probes (JSC Evrogen, Russia) on a ViiA7 Real-Time PCR System amplifier (Applied Biosystems, USA). Statistical analysis of the results obtained was performed using the GraphPad Prism 8 program (GraphPad Software, USA).

Results: The proteins MIF (macrophage migration inhibitory factor), PAI-1 (plasminogen activator inhibitor-1), ICAM-1 (intercellular adhesion molecule-1) and CXCL12 (stromal growth factor-1) were found to be registered in native valves, obtained from both patients with IE and patients with RHD. Semi-quantitative analysis showed that native valves obtained from patients with IE are characterized by a four-fold increase in the level of PAI-1 secretion and a two-fold decrease in the level of ICAM-1 and CXCL12 compared with the control. MIF was expressed at the same level in both studied groups. IL-1ra (interleukin 1 receptor antagonist), IL-6 (interleukin 6), IL-8 (interleukin 8), IL-16 (interleukin 16), CCL4 (chemokine ligand 4), CCL5 (chemokine ligand 5), and CXCL1 ( chemokine ligand 1) were found only in valves affected by IE. The expression of the MIF, IL6, and IL8 genes was increased in the experimental group relative to the control, and the expression of the PAI1, IL1RA, and CXCL1– genes was decreased in the experiment relative to the control. The gene expression of ICAM1, CXCL12, CCL4, CCL5 and IL16 was the same in both studied groups.

Conclusions: The results of the study show that native heart valves affected by IE are characterized by a unique cytokine profile compared to valves obtained from patients with non-infectious endocardial pathology. Native heart valves affected by IE show nonspecific local inflammation, active neovascularization, and decreased resistance to pathogenic bacteremia.

Introduction: The past decade has seen an increased research interest in anxiety disorders, in large part due to greater recognition of their burden and consequences associated with an untreated disease. Untreated anxiety is associated with significant personal and societal costs associated with frequent visits to primary and emergency care, reduced work productivity, unemployment, and deteriorating social relationships.

Purpose: to study the relationship between personal anxiety (PT) and self-determination of health among young people

Materials and methods: a study was conducted in 2013-2016. sampling of the population of Novosibirsk. A total of 975 persons were examined, of which 43.7% were men. A test was used to determine LT in the modification of Yu.L. Khanin.

Results: 57% of men with a high level of anxiety (HUT) considered themselves not quite healthy, while with a low level of anxiety (LAT) 27%. Among females experiencing excessive anxiety, in 65% of cases they assumed poor health, while women who feel safe are 2 times less. Over-anxious young people were 2 times more likely to express complaints related to health. Moreover, excessive anxiety prevented them from taking full care of maintaining their health, both young men and women believed. Expressed anxiety also manifested itself in obsessive thoughts in the near future to get a serious illness, which was more pronounced in women. Young men were more distrustful in communicating with medical specialists and believed that they could trust only after rigorous checks. Only 14% of men who were excessively anxious felt confidence in self-checking their health, assuming that they could completely rely only on their feelings of health or ill health. However, VUT did not prevent positive emotions from interacting with medical staff, according to the men's responses.

Conclusion: personal anxiety contributes to low self-esteem of the state of one's own

health. On the other hand, anxiety may be associated with a delay, irregular

or inconsistent seeking of medical care.

Introduction. Often, carbohydrate metabolism disorders (type 2 diabetes mellitus, prediabetes) are detected in patients with severe coronary heart disease who are preparing for elective coronary bypass surgery. Insulin resistance can occur even in the absence of manifest disorders of carbohydrate metabolism and have its own influence on the course of coronary artery disease. With regard to the prognosis of coronary artery bypass grafting, the role of insulin resistance is not clearly defined, there are isolated reports on the relationship between the estimated indices of insulin resistance and free fatty acids and the number of postoperative complications of CABG

Purpose of the study. To study the effect of carbohydrate metabolism disorders and insulin resistance indicators on the immediate results of coronary bypass grafting (CABG).

Materials and methods. 383 consecutive patients who underwent CABG in 2011-2012 at the Research Institute of the KPSSZ were included, free fatty acids and fasting insulin in plasma were determined in all patients, insulin resistance indices HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), QUICKI (Quantitative Insulin Sensitivity Chek) were calculated Index) and Revised-QUICKI, McAuley. A logistic regression analysis was performed to identify predictors of the composite endpoint of hospital stay after CABG >10 days or significant complication. Perioperative characteristics were analyzed in two cohort groups: group 1 - patients with a combined endpoint (CCT>10 days), n=291, and group 2 (n=92) without CCT.

Results. In the CCT group, the median age was higher, and the proportion of women was 30% versus 14.1% (p=0.003). Patients of the 1st group (with CCT) had a higher percentage of type 2 diabetes mellitus (37.5% versus 17.4%, p<0.001, more people with obesity (p<0.001) and a higher percentage of combined operations (p =0.007) In group 1 (with CCT), the median of glucose (p=0.031), glycated hemoglobin HbA1c (p=0.009), free fatty acids (p=0.007) and Revised-QUICKI (p=0.020) was higher than In a binary regression, the predictors of the combined endpoint (significant complications or hospital stay after CABG >10 days) were female gender, age, left atrial size, and free fatty acids before surgery (p<0.001). per 1 mmol l, the probability of the endpoint increased by 255.9%, and with an increase in LA by 1 cm - by 219.5%, each year of age added 6.9% to the probability of the index event.For this model, the statistical significance was χ2 (2 ) = 38.337, p<0.001 The Nagelkerke R2 value was 0.336 (explaining 33.6% of the combined variance of the results) and the model correctly classified 78.5% of the cases. At the same time, fasting glucose, insulin, lipid levels, HOMA, QUICKI, Revised-QUICKI, McAuley indices did not show their relationship with the studied outcome.

Conclusions: In the group with a complicated postoperative period of CABG, there were significantly more women, patients with DM 2, and obese individuals, there was a higher median of free fatty acids and the Revised-QUICKI index. Free fatty acids and type 2 diabetes mellitus were independent predictors of hospital complications or length of stay after CABG.

Introduction. Despite the decrease in activity and the trend towards the end of the pandemic of a new coronovirus infection (NCI), the burden of NCI remains a serious problem of modern healthcare. Since the beginning of the NCI pandemic, evidence has been obtained that the long-term consequences of COVID-19 infection for patients with cardiovascular pathology will be characterized by an unfavorable prognosis. The ability to predict complications in the early and late postoperative period after CABG for patients after CCI is an important tool to influence the prognosis.

Materials and methods. We examined 60 patients with various forms of coronary artery disease who were selected for CABG. The first group consisted of 30 patients who had previously undergone NCI. The second group consisted of 30 persons without NCI in history. The groups were comparable in terms of gender (21 men (70%) in the first group and 25 (83.3%) men in the second, p=0.2) and age (mean age 64.4±1.1 years in the first group and 63.3±1.04 in the second, p=0.46). In all patients, except for standard laboratory and instrumental diagnostic methods, Echo-KG parameters, EuroScore and Syntax index, the frequency of concomitant diseases and postoperative complications were evaluated. Statistical analysis was carried out using the Microsoft Excel 2017 program, the calculation of the significance of differences (p) was carried out using the Fisher test.

Results: Most patients of both groups had AH (29 each (96.6%), p=0.4), CHF was observed in 7 (23.3%) persons of the first group and 6 (20%) of the second (p=0, 47). The Syntax SCORE index was initially statistically significantly higher in patients of the first group than in the second - 25.55 ps 21.62 (p=0.03). DM was somewhat more common in patients of the first group than in the second (15 (50% ps 9 (30%, p=0.13). 0.87 hours, p = 0.008. In 5 (16.6%) patients of the first group, the postoperative period was complicated by major bleeding, in the second group, this complication had 2 (6.6%) patients p = 0.28. In most patients of both groups in the postoperative period, hydrothorax was diagnosed (25 (83.3% of persons of the first group and 24 (80%) of the second, p = 0.4), four patients of the first group (13.3%) had hydropericardium, in the second group of similar cases not noted, p=0.04).Atrial fibrillation was observed in more patients of the first group than the second - 11 (36.6%) ps 6 (20%), p=0.19.12 months after the surgical treatment An analysis of late complications of surgery was carried out.There were no differences between the groups in the frequency of newly emerging angina pectoris (5 patients in each group (16.6%)). Clinical CHF was more often observed in patients of the first group — 16 (53.3%) than in the second — 11 (36.6%) p=0.19. Atrial fibrillation was more common in patients of the first group — 4 (13.3%) ps 2 (6.6%) (p=0.67). The high frequency of detection of oncological diseases in patients after undergoing NCI is cause for concern - 5 (16.6%); in patients of the second group, oncological diseases were not diagnosed (p=0.05).

Conclusion: Thus, patients with NCI were more likely to have diabetes, bleeding in the perioperative period, they had a longer duration of EC. The late postoperative period for this group of patients was characterized by a higher incidence of cardiac arrhythmias, a higher incidence of CHF, and a rather high (compared with the group after CABG without a history of NCI) incidence of newly diagnosed oncological diseases. The data obtained indicate a higher risk of late perioperative complications after CABG in patients after CCI, which emphasizes the need for more detailed preparation of this category of patients and the development of individual follow-up follow-up programs, as well as more in-depth oncological screening.

Introduction. Cerebral microangiopathy associated with vascular risk factors makes a significant contribution to the deterioration of the morphological state of the brain.

The aim of the study was to assess the neurological status and state of the brain in patients with stable coronary heart disease (CHD) who are treated in the cardiology department before coronary bypass surgery.

Material and methods. 170 male patients, aged 58±6 years, were examined. Patients with a history of acute cerebrovascular accident, trauma and brain masses, carotid artery stenosis >50%, depression and dementia were not included. All of them underwent a neurological examination and testing according to the Mini Mental Status Assessment Scale (MSSS). The brain examination was performed on a multislice computed tomography (MSCT) Somatom Sensation 64, Siemens. In describing the results, the following were taken into account: the width of the ventricles of the brain (the age norm of the width of the third ventricle is <7 mm for persons under 60 years of age, and <9 mm - over 60 years of age), leukoaraiosis, cysts, signs of cortical atrophy, the ventriculocranial index 3 (VKI 3) was calculated - the ratio of the maximum width of the third ventricle to the greatest distance between the internal plates of the skull bones (age norms: persons 41-60 years old - 3.3%; 61-70 years old - 3.9%; over 70 years old - 4.3%). Standard methods of descriptive statistics were used.

Results. After a neurological examination, it was found that the frequency of occurrence of vestibulopathy syndrome was 24%, asthenic syndrome - 56%, mild cognitive impairment syndrome - 46% (test results for KShOPS - 27 [26; 28] points). The identified neurological symptoms were accompanied by morphological changes in the brain tissues. The width of the third ventricle was 7.6 ± 2.0 mm, the IHF index was 3 - 4.2%, the number of patients with leukoaraiosis was 26%, with signs of cortical atrophy - 19% of patients. When comparing the obtained results of neuroimaging with the established age norms, it was found that, despite the fact that the average age of our patients did not exceed 60 years, the width of the third ventricle in them corresponded to the indicators of the age category of healthy people over 60 years old, and the values of the VKI 3 index corresponded to the age norms. for healthy subjects over 70 years of age.

Conclusion. The data obtained indicate that asthenia, moderate cognitive disorders, disorders of the coordinating-motor sphere are very common in patients with coronary artery disease. Neuroimaging signs of cerebral microangiopathy (leukoareosis, expansion of cerebrospinal fluid spaces) indicate the vascular nature of the identified neurological disorders. Issues of progression of cerebrovascular pathology in this cohort of patients require further study.

Introduction. Previously, clinical studies have proven a pronounced antihypertensive effect of spironolactone in patients with true resistant hypertension. The effectiveness of spironolactone as part of first-line therapy, as well as the effect on vascular wall remodeling, has not been studied.

Target. To study the effect of spiroconolactone as part of the first line of therapy when added to telmisartan on indicators of vascular wall stiffness in patients with hypertension at high/very high cardiovascular risk.

Materials and methods 32 patients (54 (45; 59) years old) were randomly divided into two groups: in the main group receiving spironolactone at a dose of 25 mg in addition to telmisartan (ARB/spironolactone) and in the group receiving hydrochlorothiazide/ARB combination (control). group).

Inclusion criteria: age of patients (30-65 years), hypertension at high/very high cardiovascular risk without antihypertensive therapy, no contraindications to prescribed drugs. At baseline and 6 months later, all patients underwent clinical (office) blood pressure (BP) measurements, ABPM, endothelium-dependent vasodilation (EDVD), vascular remodeling indicators: central blood pressure (CAP), augmentation index, pulse wave velocity (PWV). In patients in the ARB/spironolactone group, serum potassium levels were assessed at baseline and after 4 weeks of treatment.

Results. In both groups, a significant decrease in clinical and average daily blood pressure was revealed, as well as a decrease in the augmentation index and CAP. PWV in the carotid-radial segment (CWCR) did not significantly decrease in both groups, while PWV in the carotid-femoral area (CWCF) decreased in the ARB/spironolactone group from 9.8 (9.0; 10.6) m/s to 8.6 (8.0; 10.2) m/s (p = 0.0007). The dynamics of SPWcr was 0.9 (1.3;-0.5) m/s in the ARB/HCT group. In all patients, blood potassium was within reference values.

Conclusions. Spironolactone as part of first-line therapy, when added to ARBs in patients with hypertension at high/very high cardiovascular risk, led to a significant decrease in clinical and mean daily blood pressure, as well as a decrease in PWCF.

Introduction. The World Health Organization has put healthy sleep on a par with such important indicators as the state of the cardiovascular and respiratory systems, the level of immune defense, body resistance, etc. (WHO, 2013).

As you know, sleep takes up about a third of our lives. Sleep is a biological necessity (Shea SA., 2009). Sleep disorders are one of the most common psychogenic conditions in humans and are defined as a lack of quantity, rhythm or quality of sleep (ICD-10, DSM-IV), which is necessary for normal life

About 30% of the population has periodic sleep disturbances, about 10% of the adult population suffers from chronic insomnia, which has already become an epidemic of the new millennium (Centre for Disease and Control and Prevention, CDC, 2018).

Since the beginning of the 80s, publications began to appear on the effect of sleep disturbance on the cardiovascular system. Although sleep is an outwardly seemingly passive state of the body, nevertheless, there are many pathophysiological changes that can lead to circulatory disorders, including heart attack and stroke.

Purpose of the study: to study the change in self-reported sleep quality over a 30-year period and to assess its relationship with psychosocial risk factors for cardiovascular disease.

Materials and methods: Within the framework of five screening studies of the population aged 25-64 years in a typical district of Novosibirsk from 1988 to 2018. 2650 men and 3113 women were examined. The questionnaire “Knowledge and attitude to one's health” was proposed. The study was carried out within the framework of the budgetary topic Reg. No. 122031700094-5.

Results: The lowest self-reported sleep was observed among women aged 55 to 64 years - 24.9% (p<0.001). A relationship has been established between the rise in low self-reported sleep and age. Men (4.3%) and women (5.7%) of young age from 25 to 34 years complained about the quality of sleep the least (p<0.01). On the contrary, complaints about sleep were more common among the representatives of the older age group - among men, 19.7% were dissatisfied with sleep, and among women - 24.9% (p<0.001). The peak of sleep disorders occurred in the late 1980s, then in the mid-1990s there was a decrease in the number of complaints about sleep, then an increase in the zero years in all age groups, except for men from 45 to 54 years (p<0.001). Low self-assessment of sleep quality in two thirds of both sexes was accompanied by a feeling of poor health, an increase in the number of health complaints (p<0.001). A third of men and women who were dissatisfied with their sleep believed that they did not take good care of their health and this could result in a disease of the cardiovascular system. Decreased sleep quality led to distrust in the ability of modern medicine to prevent and treat cardiovascular diseases, only 10.9% of men and 13.3% of women trusted doctors (p<0.01).

Conclusion: Over the past 30 years, there has been a deterioration in the quality of sleep among the population, with the deterioration of sleep detrimental to cardiovascular health.

Introduction. Due to a set of unique properties, for example, the ability to differentiate into different types of connective tissue cells, mesenchymal stem cells (MSCs) are attracting more and more attention from researchers. In 2001, stem cells were found in the stromal-vascular fraction of adipose tissue, which, unlike bone marrow MSCs, show a higher tissue density, grow faster, and are available in large numbers when collected from a small amount of adipose tissue. Currently, a large number of studies are devoted to the study of the morphology and immunophenotype of subcutaneous and visceral adipose tissue stem cells (ASSCs) due to the possibility of easy cell production. Experimental work aimed at studying MSCs of cardiac localization is currently insufficient.

Objective: to evaluate the immunophenotype of adipose tissue stromal cells isolated from epicardial and perivascular fat depots in patients with coronary heart disease and acquired heart defects.

Materials and methods. The study included 5 patients with ischemic heart disease and 5 with acquired heart disease. The average age is 64.5±2.5 years. All patients had indications for open heart intervention - direct myocardial revascularization by coronary bypass grafting (CABG) or heart valve surgery. SCZhT from subcutaneous, epicardial and perivascular VT biopsies (3-5 years) obtained from patients during surgery (CABG or correction of heart defects) and isolated according to the method of Zeng G. [Zeng G. et al., 2013] . When cells grew to 80–90% confluence, they were digested with 0.25% trypsin and subjected to continuous cell growth and proliferation for subsequent experimental analyses. Flow cytometry analysis was performed on passage 2 cells.

Results: The obtained results showed that the MSC culture of the 2nd passage was characterized by increased expression of CD73, CD90, CD105 antigens. Approximately 90% of passage 2 cells derived from epicardial adipose tissue (EAT) and perivascular adipose tissue (PVAT) from a patient with coronary heart disease (CHD) expressed classical MSC markers (CD73, CD90, CD105). In EAT cell culture in a patient with acquired heart disease (ACD), we observed a lower level of co-expression of the main markers of stem cells, in contrast to a patient with CHD (CD90 and CD105 about 61% of cells, and CD90 and CD73 - 58.72%) . The percentage of the studied stem markers on cells isolated from PVAT in a patient with heart disease did not differ significantly from the level of expression of these markers in a patient with coronary artery disease. The level of CD34 expression varied depending on the localization of VT and the disease: thus, in patients with coronary artery disease, the level of CD34 did not exceed 3.5% in both epicardial and perivascular VT. At the same time, a higher percentage of CD34 (32.32%) was found in the epicardial adipose tissue of a patient with PPS. It should be noted that in addition to the main population, both in the EAT culture and in the PVAT, there were 2 minor ones: 1 - CD 90- CD 105+ CD 34-/+ CD 73+ - presumably endothelial population, 2 - CD 90+ CD 105- CD 34- CD 73- - the smallest population.

Conclusion: In the early stages of cultivation, cells of the stromal-vascular fraction isolated from epicardial and perivascular adipose tissue express surface markers characteristic of adipose tissue stem cells.

Introduction. There is a trend towards an increase in the number of people with long-term consequences of COVID-19, including those with psychocognitive dysfunction, which is probably a manifestation of the “post-COVID-19 condition”.

Target. To conduct a comparative assessment of the psychocognitive status in comorbid elderly patients, depending on the presence of post-COVID syndrome.

Methods and materials. In an observational analytical cohort study, 223 patients with atrial fibrillation and comorbidity (ischemic heart disease, arterial hypertension, obesity, type II diabetes mellitus) aged 60-74 years, without a history of SARS-CoV-2 infection and with a history of documented confirmed SARS- CoV-2 infection with post-COVID syndrome (PCS). The patients were divided into 2 groups: I - 123 patients without a history of a new coronavirus infection COVID-19 and II - 110 patients with a past SARS-CoV-2 infection. A general clinical study of patients was carried out; assessment of psychocognitive impairments using the SPMSQ and HADS questionnaires. Statistical data processing was carried out in the RStudio program (version 2021.09.2 Build 382 — © 2009–2022 RStudio, Inc., USA, URL https://www.rstudio.com/) in the R language (version 4.0.2, URL https: //www.R-project.org/).

Results. It was found that anxiety-depressive syndrome (ADS) with concomitant comorbid pathology was observed in 49-61% of cases, with a higher frequency in patients with Сovid-19. Subclinical anxiety - in 26% without covid-19 and 27% of patients with PCS; clinically expressed anxiety in 13% of patients in both groups. When assessing cognitive function, it was found that in patients with PCS, dysfunction was significantly more common (p=0.007); at the same time, mild cognitive impairment in the compared groups did not differ statistically significantly, but the number of patients in the group with PCD prevailed, moderate cognitive impairment was found in a greater number in patients with PCD - 22% vs. 8% (p = 0.005), severe cognitive impairment was detected in persons with PCS - 2%. Evaluation in individual clinical comorbid groups showed a significant difference in patients with type 2 diabetes, so in patients without PKD - 51% compared with 28% with PKD (p = 0.012).

Conclusion. The post-COVID-19 future remains uncertain, therefore an assessment of its long-term consequences in comorbid patients is needed, which can be achieved by repurposing or initiating large cohort studies to focus not only on the long-term consequences of SARS-CoV-2 infection, but also on acquired psychocognitive dysfunction.

Introduction. Cardiovascular diseases (CVD) continue to be the subject of scientific research in relation to molecular genetic predictors of their development. It has been proven that diseases of the cardiovascular continuum have a multifactorial nature with a significant genetic component, including the hereditary risk of myocardial infarction (MI). CVDs are characterized by a complex genetic structure with diverse combinations of single nucleotide polymorphic variants (SNVs). A promising task is to study the relationship of SNV adaptogenesis genes: inflammatory response, myocardial and endothelial dysfunction with developed MI in the Siberian population.

Purpose: to reveal the relationship between SNV genes of natriuretic peptides and the antioxidant defense system with the development of myocardial infarction.

Materials and methods. The material for the study was genomic DNA isolated from the peripheral blood of patients (n=146, 38 women and 108 men) admitted for treatment at the Kuzbass Clinical Cardiological Dispensary, Kemerovo, with a diagnosis of MI. The control group is represented by a population sample of residents of the city of Kemerovo (n=300, 190 women and 110 men). 20 polymorphic variants of 7 natriuritic peptide genes (NPPA, NPPA-AS1, NPPB, NPPC, NPR1, NPR2, NPR3) and 5 genes of the antioxidant defense system (SOD2, NCF4, CBR1, CBR3, CAT) were selected for the study. Genotyping of selected polymorphic variants was performed by real-time PCR using TaqMan technology. Statistical data analysis was carried out using GraphPad Prism 8 and SNPstats software.

Results. Protective associations of allelic variants of the CBR1 rs9024 genes (OR=0.21 (95% CI 0.13-0.34); p=0.0001) and CBR3 (OR=0.44 (95% CI 0.28-0) .69); p=0.001) regardless of gender according to the dominant model of inheritance. When separating patients by gender, it was found that in men, the rs9024 CBR1 allele A (OR=0.20 (95% CI 0.11-0.36); p<0.0001) and the rs1056892 CBR3 allele A (OR=0, 51 (95% CI 0.28-0.91); p=0.022) have a protective effect in the development of MI according to the dominant model of inheritance. Allele T rs2236289 (OR=1.93 (95% CI 1.04-3.58); p=0.035) and allele A rs7034957 (OR=1.88 (95% CI 1.03-3.45); p =0.038) of the NPR2 gene are associated with a risk effect on the development of myocardial infarction in men according to the dominant model of inheritance. In women, rare alleles of the polymorphic loci rs13288085 (OR=0.25 (95% CI 0.08-0.73); p=0.0034) and rs7034957 (OR=0.30 (95% CI 0.11-0, 79); p=0.007) of the NPR2 gene, rs9024 (OR=0.21 (95% CI 0.09-0.47); p=0.00001) of CBR1, as well as rs1056892 (OR=0.31 (95% CI 0.15-0.64); p=0.0014) CBR3 are characterized by a protective effect on the development of MI according to the dominant model of inheritance.

Conclusion. It has been shown that polymorphism of genes for natriuretic peptides and antioxidant protection may have a risky and protective effect in relation to predisposition to the development of MI. The obtained preliminary results indicate the need for further studies of the identified SNV genes of adaptogenesis in relation to the severity of MI and the risk of recurrent cardiovascular events in the long-term period after MI.

Introduction. Doxorubicin is an anthracycline antibiotic widely used in the treatment of malignant neoplasms. Anthracyclines have been shown to have an undesirable side effect associated with the development of cardiotoxic effects. Today, a promising direction in fundamental and practical medicine is the search for highly sensitive, highly specific markers for the early diagnosis of cardiotoxic effects of anthracycline antibiotics. Thus, for the last five years, special attention has been paid to circulating miRNAs, which are small sequences (19-25 nucleotides) and regulate gene expression at the post-transcriptional level. An important role of microRNAs in many physiological and pathological processes is noted, and therefore they can be considered as diagnostic and therapeutic targets.

Purpose of the study: To assess the level of expression of circulating miRNAs in dynamics in patients with breast cancer receiving anthracyclines therapy.

Materials and methods. In 15 women with a verified diagnosis of breast cancer, whose therapy included anthracyclines, venous blood was taken into vacutainers with K3EDTA at two time points: before the start of treatment and 6 months after the start of chemotherapy. The resulting plasma, after centrifugation, was used for microRNA isolation using commercial kits from Qiagen (cat. no. 217184). The amount of isolated miRNA was measured on a Qubit 4 instrument (Thermofisher Scientific, USA) using the Qubit™ microRNA Assay Kits (cat. no. Q32881). The level of circulating miRNAs (hsa-mir-1-3p, hsa-mir-200a-3p, hsa-mir-21-3p, hsa-mir-133b, hsa-mir-429, hsa-mir -30a-3p). hsa-mir-486-5p was used to normalize the results. The relative expression level was calculated using the ΔСt method. The results were expressed as fold change. Statistical processing was carried out using the program "GraphPad Prism 8".

Results. The study showed a change in the expression level of circulating miRNAs 6 months after the start of anthracycline therapy. A significant decrease in the expression of the following circulating miRNAs was revealed: hsa-mir-1-3p, hsa-mir-200a-3p, hsa-mir-133b, hsa-mir-30a-3p. For hsa-mir-21-3p and hsa-mir-429 no statistically significant differences were obtained.

Conclusions. Four microRNAs were identified, the expression of which decreases 6 months after doxorubicin administration, which indicates the influence of anthracyclines on gene expression and, possibly, on the epigenetic regulation of pathological processes associated with cardiotoxic effects of therapy. Validation of the expression in a larger sample of patients is required to confirm the results obtained.

Introduction: It is known that the variability of immune response genes and the corresponding immune profile modulate the risk of a number of pathologies. Understanding the role of the immunogenetic status based on the variability of innate immunity receptors in the dynamics of the systemic inflammatory response of non-infectious genesis in open cardiac surgery, as well as the issues of objective assessment and possible correction of complications in the form of multiple organ failure (MOF), remain relevant.

Objective: To determine those alleles of the TREM1 gene that are associated with the risk of developing POF in patients after coronary artery bypass grafting and which levels of sTREM1 may be of diagnostic significance.

Materials and methods: A comprehensive examination of 680 patients with atherosclerosis of the coronary arteries was performed on the basis of the Federal State Budgetary Scientific Institution "NII KPSSZ" in the preoperative and early postoperative periods of coronary artery bypass grafting. Two groups were retrospectively formed, differing in the presence/absence of MOF in the early postoperative period. Based on clinical and laboratory data, the first group included 30 patients (4.4%) with MOF established in the early postoperative period (SOFA score over 4 points, combined dysfunction of 2 or more systems with further progression of organ disorders) and 650 patients (95.6%) were included in the second group - with an uncomplicated course of the postoperative period (score on the SOFA scale less than 4 points, disorders of 1-2 organ systems that occur with minor clinical manifestations and do not require long-term correction and support). Serum concentrations were determined by ELISA twice - before surgery and 24 hours (1 day) after surgery. Genotyping of 8 TREM1 polymorphic variants (rs1817537, rs3804277, rs6910730, rs7768162, rs2234246, rs4711668, rs9471535, rs2234237) was performed according to the protocol of the TagMan probe manufacturer by PCR with real-time detection of amplification products. Statistical data processing was carried out using SNPstats and GraphPad Prism 8 software.

Results: It was found that in individuals with the T rs2234246 allele (p=0.0076), the G rs1817537 allele (p=0.019) and the T rs3804277 allele (p=0.019) of TREM1, the risk of developing POF after coronary artery bypass grafting increases. Carrying a homozygous genotype for a rare allele in these polymorphic variants is associated with a high concentration of sTREM1 at the preoperative stage (p=0.0005). It was also found that the most pronounced increase in the concentration of sTREM1 in the preoperative and early postoperative periods was observed in critically ill patients. Differences in sTREM1 concentrations between groups were significant throughout the intraoperative period (p<0.0001 and p<0.0001, respectively).

Conclusion: It has been established that the concentration of sTREM and the carriage of rare alleles in certain polymorphic sites of the TREM1 gene (T rs2234246 allele, G rs1817537 allele and T rs3804277 allele), as well as their relationship with the level of circulating sTREM, demonstrate their significance in the development of MOF in patients with coronary artery disease after undergoing coronary artery bypass grafting.

Introduction. The most common cause of aortic valve surgery is aortic stenosis. So far, the focus has been on evaluating the valve itself, while increasing aortic stiffness increases the load on the left ventricle, contributing to greater impairment of cardiovascular function. Arterial stiffness is a well-established predictor of cardiovascular complications.

Objective: To evaluate the dynamics of aortic stiffness in patients with degenerative aortic stenosis against the background of surgical correction of the defect.

Material and methods. The study included 33 patients referred for surgical treatment of the defect. Among them, men predominated somewhat (57.6%). All patients were diagnosed with severe aortic stenosis - the area was 0.74 (0.60; 0.90) cm2, the peak and mean pressure gradients on the aortic valve were 85.5 (72.0; 98) mm Hg. Art. and 50.2 (41.0; 56.0) mm Hg. Art. respectively. 22 patients (66.7%) underwent aortic valve replacement with a mechanical prosthesis, the rest of the patients underwent operations combined with coronary artery bypass grafting or prosthetics of the ascending aorta. All patients underwent a study of aortic stiffness indicators, namely: pulse wave velocity in the carotid-radial (CR PWS) and carotid-femoral segments (CF PWS), central systolic pressure in the aorta (CSBP), central diastolic pressure in the aorta (CDAP), aortic central pulse pressure (CPAP), aortic pressure augmentation (AP), augmentation index normalized to heart rate 75 (AIx75). The parameters were measured before the operation and 7-14 days after it. The registration of the pulse wave was carried out by a non-invasive method of applanation tonometry using the SphygmoCor device (AtCor Medical Inc., Australia). Mean values are presented as median and interquartile range. Mean differences in dependent groups were assessed using the Wilcoxon test.

Results. CR PWV in the postoperative period decreased and amounted to 7.2 (6.4; 7.5) m/s versus 7.9 (6.6; 9.4) m/s before surgery (p=0.03). There was no significant decrease in PWV CF after aortic valve replacement, however, there was a tendency to decrease (8.1 (6.7; 9.4) m/s before surgery versus 7.4 (6.4; 7.6) m/s). s after surgery, p=0.07). After surgery, CBP decreased and amounted to 103.8 (97; 113) mm Hg. Art. against the original 117.8 (102; 132) mm Hg. Art., (p<0.001). CDAP also decreased and amounted to 69.4 (66; 74) mm Hg. Art. after surgery, while the initial CDBP was 74.8 (70; 81) mm Hg. Art. after surgery (p=0.01). The CPA indicators decreased and amounted to 36 (27; 44) mm Hg after the operation. Art. against the initial value of 43 (31; 53) mm Hg. Art. (p=0.03). There was also a decrease in AIx75 from 31.7 (19.5; 43)% to 17.5 (7; 25)% (p < 0.001) and AR from 16.4 (7; 24.5) mm Hg. Art. up to 10.2 (6; 12) mm Hg Art. (p=0.002).

Conclusion. Thus, in patients with degenerative aortic stenosis after its surgical correction, the following indicators of vascular stiffness decrease: carotid-radial pulse wave velocity, central systolic and diastolic pressure in the aorta, index and augmentation pressure. There was no statistically significant dynamics of the carotid-femoral velocity of pulse wave propagation.

Introduction. Over the past 50 years, epidemiological studies have actively studied the effect of nutrition on the cardiovascular system. Large-scale studies have confirmed the role of nutrition in terms of global reduction in the risk of cardiovascular disease. It has been established that a rational diet reduces the risk of developing cardiovascular pathology by influencing cardiovascular risk factors.

Purpose: to assess the qualitative composition of dietary stereotypes of Siberian residents and its role in the development of the main factors of cardiovascular risk.

Material and methods. To analyze the daily diet, respondents were examined in the framework of the international study PURE, aged 35-70 years (n=353). A questionnaire was used for a semi-quantitative assessment of the frequency of food consumption by the adult population with further use of the own computer program “Assessment of the relationship between nutritional characteristics and its nutritional value and the prevalence of cardiovascular diseases and their risk factors among the urban and rural population” (RU 2019662710). Factor analysis identified three stereotypes of eating behavior: the first included the consumption of thermally processed and unprocessed vegetables, in season and throughout the year, as well as fruits throughout the year; the second - the consumption of non-dietary meat, complex carbohydrates and sweets, the third included persons who were not defined by the previous two stereotypes.

Results. The first stereotype was associated with an increased risk of developing hypertriglyceridemia (OR=1.44, at 95% CI: 1.0-2.0, p=0.029) and obesity (OR=1.9, at 95% CI: 1.4- 2.5, p<0.001). Adherence to the second - with a reduced risk of developing a low level of HDL (OR = 0.58, at 95% CI: 0.4-0.8, p = 0.001), a high level of LDL (OR = 0.58, at 95% CI : 0.38-0.9, p=0.015), hypertriglyceridemia (OR=0.54, 95% CI: 0.4-0.7, p<0.001), hypercholesterolemia (OR=0.63, 95% CI : 0.44-0.9, p=0.013), obesity (OR=0.61, 95% CI: 0.4-0.8, p=0.002).

In a qualitative analysis of the components of the selected stereotypes, it was determined that an excess amount of protein (more than 0.6-0.83 g/kg of body weight) was consumed by 55.5% of persons who followed the second nutritional stereotype, 42.7% - the third and 39.8 % - the first (p=0.052). Excess fat (more than 70-15 g/day for men and 60-102 g/day for women) was consumed by 100% of persons with the first and second stereotypes and 97.7% with the third (p=0.163). An excessive amount of carbohydrates (more than 257-586 g/day) was noted in 1.0% of respondents with the second stereotype and 1.5% with the third. Persons with the first nutritional stereotype did not show excessive consumption of carbohydrates (p=0.674).

When conducting a logistic regression analysis, it was found that excess protein in the diet of Siberian residents was associated with a decrease in the risk of developing arterial hypertension (OR=0.6, CI:0.3-1.1, p=0.113) and high levels of low-density lipoproteins (OR=0.5, CI:0.3-0.98, p=0.447), but not statistically significant, as well as diabetes mellitus (OR=0.59, CI:0.3-0.99, p=0.044 ) and obesity (OR=0.4, CI:0.2-0.6, p<0.001).

Conclusions. Despite generally accepted international recommendations, the first dietary stereotype was associated with the development of hypertriglyceridemia and obesity, in contrast to the second stereotype (which was associated with a reduced risk of dyslipidemia and obesity). In addition, excess protein intake was associated with a reduced risk of diabetes and obesity, which is contrary to WHO recommendations for healthy eating. Taking into account the results obtained, it is necessary to continue studying the nutritional habits of the inhabitants of Siberia in order to modernize the principles of healthy nutrition.

Introduction. Personality type D in cardiac patients is associated with poor quality of life and poor prognosis. Since these personal characteristics are stable under dynamic observation, the question arises - are there other points of application for behavioral influences? Therefore, the aim of this study was to study the choice of coping strategies and coping intensity in young healthy individuals with personality type D.

Material and methods. The study included 98 students of the medical faculty of KemGMU, 68 girls and 30 boys aged 18 to 23 years (19.1 ± 2.0 years). All surveyed people filled out psychological questionnaires to identify personality type D (DS-14) and the choice of coping strategies (“Ways of Coping Questionnaire” and “Coping Strategy Indication”).

Results. Two groups were distinguished: with the presence of personality type D (n=44) and without it (n=54). In students with type D, the mean scores on the NA and SI scales were higher than in students without type D (p<0.001 in both cases). Individuals with personality type D had higher scores on the scales "Escape-avoidance" (p<0.001), "Take responsibility" (p=0.009), "Distancing" (p=0.05) of the WSQ questionnaire and "Avoidance strategy" ( p=0.007) of the CSI questionnaire. Students with type D are characterized by a pronounced preference for the "Escape-Avoidance" strategy (p<0.001). According to univariate logistic regression analysis, a 1-point increase in values on the Escape-Avoidance scale increased the chance of identifying personality type D by 1.15 times (95% CI 1.07–1.23; p<0.001). On the contrary, an increase in scores on the “Positive reassessment” scale reduced the likelihood of identifying personality type D (OR 0.98; 95% CI 0.86-0.98; p=0.005). The ROC-analysis showed that the identified association of the Escape-Avoidance coping strategy with personality type D has rather high values (AUC=0.779; 95% CI 0.688-0.870).

Conclusion. Healthy medical students with personality type D have a preponderance of inadequate coping strategies. In logistic regression analysis, the independent strategies associated with personality type D are the "Escape-avoidance" strategy, and with the type of non-D - the "Positive reappraisal" strategy. These studies can serve as a basis for the development of behavioral influences in individuals with personality type D.

Doctor of Medical Sciences, Professor of the Department of Normal Physiology Leonid Innokent'evich Korytov is 80 years old. Leonid Innokent'evich was born on August 28, 1943 in the Buryat ASSR in a large family. In 1960 he graduated from the Dyrestuevskaya secondary school in the Dzhidinsky district of the Buryat ASSR. The choice of a profession in his youth was greatly influenced by teachers of biology and physics: O.V. Mironov and V.A. Zarubin, who noticed the creative approach and extraordinary thinking of their student and, together with their parents, insisted on continuing their studies. After leaving school, Leonid Innokentyevich entered the Irkutsk Medical Institute, with which his whole future life would be connected.

The formation of Leonid Innokent'evich as a scientist-physiologist began with a student scientific circle, in which he came from the first year, having passed competitive tests, since the circle was very popular. His first teachers were A.I. Nikitin, V.L. Yaroslavtsev, P.N. Orlov. During the years of study, Leonid Innokent'evich confidently mastered the surgical technique in experimental physiology, worked in the vivarium and laboratory-operating room, participated in the research work "Transmeridian desynchronosis", in conferences of various levels.

The talented student was noted by the university teachers, and after graduating from the Faculty of Dentistry of the Irkutsk Medical Institute in 1965, he was offered to continue his postgraduate studies at the Department of Normal Physiology. The main scientific problem of the department in the 60s of the XX century was the physiology and pathology of the digestive system. Leonid Innokent'evich's Ph.D. thesis was devoted to the study of the mechanisms of conjugation of the secretory activity of the stomach and energy metabolism in the experiment. The dissertation was completed in 2.5 years and successfully defended in 1969.

Leonid Innokent'evich went all the way from a graduate student to a professor and head of the Department of Normal Physiology, was the Deputy Dean of the Faculty of Dentistry. He left the walls of his native university only once, when from 1978 to 1981 he taught in Conakry, the capital of the People's Revolutionary Republic of Guinea. Leonid Innokentievich served as the head of the Department of Fundamental Disciplines and has always enjoyed well-deserved respect among students and colleagues from different countries. Teaching students, giving lectures, methodical work in this troubled country in those years, was conducted in French, which Leonid Innokent'evich was fluent in. During the years of work in Guinea, he published 2 volumes of textbooks, scientific articles that have not lost their relevance to this day. For work with foreign students, Leonid Innokent'evich was awarded Certificates of Honor from the Ministry of Foreign Affairs and the Ministry of Health of the USSR and the USSR Embassy in the People's Revolutionary Republic of Guinea.

Returning to Alma Mater, Leonid Innokentievich continued to collect materials for his doctoral dissertation, and in 1992 at the Institute of Normal Physiology. PC. Anokhin RAMS in Moscow successfully defended his doctoral dissertation "Central and peripheral mechanisms of adaptation of the organism under the influence of aromatic carbohydrates." In 1993, he received the academic title of professor, and from 1994 to 2013 he headed the Department of Normal Physiology and prepared 8 candidates and 5 doctors of science during this time.

Leonid Innokentievich Korytov – scientific adviser of the complex scientific problem “Systemic mechanisms of stress and ways of its correction”, member of the specialized dissertation council at the Federal State Budgetary Scientific Institution “Scientific Center for Family Health and Human Reproduction”, specializing in Pathological Physiology. Since 1998 he has been a corresponding member of the Academy of Sciences of the Higher School.

Over the years of his work, he published 267 scientific papers, published 2 monographs and 1 textbook in French, received 5 patents for inventions and rationalization proposals.

Leonid Innokentievich is an experienced teacher with more than 50 years of experience, who lectures interestingly and at a high professional level, conducts classes, and continues to engage in educational and methodological work. For many years, at the end of the course of lectures, students applaud their lecturer, who is able to present the most complex material in a simple and accessible way.

For long-term and impeccable work, Leonid Innokent'evich was repeatedly awarded diplomas of IGMU, the Ministry of Foreign Affairs, the Ministry of Health of the Russian Federation, the Governor of the Irkutsk Region; has government awards: academician I.P. Pavlov’s medal from the Russian Academy of Sciences for a major scientific contribution to the physiology of adaptation and visceral systems (2001), the medal “Excellent Health Worker of Mongolia” (2010), the medal “Veteran of Labor”, the badge of honor “Inventor of the USSR” ( 1989).

Leonid Innokent'evich performs a great social work: he is a member of the Central Council of the Physiological Society at the Russian Academy of Sciences, Chairman of the Irkutsk Department of the Physiological Society, a member of the Council under the Governor of the Irkutsk Region on the problems of combating the spread of drug addiction among the population of the Irkutsk Region.

Leonid Innokentyevich is not only a talented scientist and an experienced teacher, but also a very versatile, creative person with a wonderful sense of humor, a master of all trades. He plays sports, plays football, paints, restores and makes furniture. A distinctive quality of Leonid Innokentyevich is a deep decency towards people, a friendly attitude towards colleagues and students, the ability to find a compromise in the most difficult situation, combined with high demands on himself and his work.

The staff of the Department of Normal Physiology, colleagues and students wholeheartedly congratulate Leonid Innokentevich on a significant date and wish him good health, long life and creative success!