The study objective is to examine electrophysiological parameters of atrial myocardium, characteristics of atrioventricular conduction, and potential factors affecting recurrent atrial fibrillation (AF) in patients with persistent and long-term persistent forms of AF prior to the Labirynth IIIB surgery with single-step correction of valvular heart disease.

Materials and methods. The study included 100 adults (48 men, 52 women) with persistent and long-term persistent forms of AF and different valvular heart diseases. Mean patient age was 59 years. Mean AF duration was 4 years. All patients were prescribed antiarrhythmic therapy but it proved ineffective. In 15 % of patients, restoration of the sinus rhythm was attempted through electrical cardioversion but long-term control of the sinus rhythm wasn’t achieved. All patients were diagnosed with organic pathology of the mitral valve. Also, in 80 % of patients, relative insufficiency of the tricuspid valve was detected. Chronic heart failure functional class per NYHA was III. Size of the left atrium was 5 cm, mean left ventricular ejection fraction was 61 %. All patients underwent electrical cardioversion. After successful restoration of the sinus rhythm, endocardial electrophysiology study (EES) of the heart was performed. Then, correction of valvular pathologies and the Labyrinth IIIB surgery were performed.

Results. Examination of refractoriness of different parts of the atriums has shown that effective refractory period (ERP) of the atrioventricular node was minimal compared to other parts of the atriums. Maximal ERP duration was observed in the upper part of the right atrium. Therefore, in patients with long history of AF, heterogeneity of atrial myocardium ERP duration is observed. In 17 % of patients, atrial vulnerability was detected. The area of atrial vulnerability was always associated with ERP. Its duration in patients with atrial vulnerability was significantly higher.

Conclusion. Long-term mitral valve incompetence and persistent AF lead to anatomical and electrophysiological remodeling of the atriums, which manifests through increased volume of the left atrium, as well as increased duration of intra-atrial conduction and heterogeneity  of refractory periods. EES allows to evaluate these functions of the atrioventricular conduction system and atrial electrophysiological parameters: detect aberrations in conduction through atrial myocardium, dispersion of its refractoriness, and the area of atrial vulnerability. These factors can serve as predictors of AF recurrence. 

The study objective is to investigate characteristics of mixed anxiety-depressive disorders (MADD) and the level of subjective self-control  in relation to health (SSCh), as well as the effect of affective disorder severity on clinical course and prognosis of the disease in men and women with acute myocardial infarction (AMI).

Materials and methods. The study included 124 patients with AMI aged between 30 and 85 years (mean age 58.6  ±  12.1 years), who were divided into 2 groups: the 1st group contained 88 (71 %) men, the 2nd group – 36 (29 %) women.

Results. Per the screening test, MADD was more frequently diagnosed in the female group (91.7 %) compared to the male group (56.8 %),  р <0.001. Absence of anxiety symptoms per the Hospital Anxiety and Depression Scale (HADS) was more frequently observed in the male group (77.3 % vs. 52.8 %, р <0.01; relative risk (RR) 1.46; 95 % confidence interval (CI) 1.05–2.03), and significant level of anxiety per HADS was more frequently diagnosed in the female group (4.5 % vs. 27.8 %, р <0.01; RR 0.16; 95 % CI 0.05–0.48). Absence of depression symptoms per HADS was more frequently observed in the male group (68.2 % vs. 30.6 %, р <0.01; RR 2.23; 95 % CI 1.33–3.72), and moderate (14.8 % vs. 33.3 %, р <0.05; RR 0.44; 95 % CI 0.22–0.87) and severe (17.0 % vs. 36.1 %, р <0.05; RR 0.47; 95 % CI 0.25– 0.88) levels of depression per HADS were more common in the female group. Absence of depression symptoms per the Beck Depression Inventory (BDI) was more frequently observed in the male group (42.1 % vs. 11.1 % women, р <0.01; RR 3.78; 95 % CI 1.45–9.84). In the female group, moderate (27.8 % vs. 10.2 %, р <0.05; RR 0.36; 95 % CI 0.16–0.83) and severe (13.9 % vs. 3.4 %, р <0.05; RR 0.24; 95 % CI 0.06–0.97) levels of depression per this scale were more common than in the male group. Left ventricular ejection fraction was lower  in the female group (41.4 ± 11.4 %) compared to the male group (45.8 ± 10.3 %), р <0.05. Mortality was higher in the female group compared to the male group: overall (19.4 % vs. 5.7 %, р <0.05), hospital (8.3 % vs. 1.1 %, р <0.05), and post-hospital (11.1 % vs. 4.5 %,  р >0.05) mortality, respectively. 

Conclusion. Psychometric tests have shown higher rate and severity of MADD in the female group compared to the male group. In the female group, left ventricular ejection fraction was significantly lower than in the male group, and overall and hospital mortality was higher. 

The review presents the clinical characteristics and comparative data of application of modern non-invasive and invasive methods of ambulatory electrocardiographic monitoring in the diagnosis of arrhythmias and cardiac conduction. The properties of each of the methods  of extended electrocardiographic monitoring, the effectiveness of their application and tactics for improving the diagnosis of arrhythmias and syncope during the process of diagnosis are presented.

Purpose of study – to examine effectiveness and tolerability of therapy рatch NANOPLAST forte in comparison with “placebo” patch in patients with back pain syndrome in conditions of prospective comparative randomized study, approved by the local ethics committee.

Materials and methods. The study included 60 patients with acute/ recrudescence of chronic primary back pain syndrome, there were 30 patients in each group, which were comparable in main clinical parameters. A primary effectiveness criterion was reduction of back pain syndrome intensity at rest and during movements by no less than 50% from initial level according to visual analogue scale (mm). Overall effectiveness of NANOPLAST forte patch was evaluated separately by doctor and patient on the 10th day according to the following grading: significant improvement; improvement; absence of effect. A need for administration of non-steroidal anti-inflammatory drugs (NSAID) was assessed during the study. A patch was applied once a day for 12 h (from 9 to 21 h). Tolerability of NANOPLAST forte patch and “Placebo” patch was evaluated according to frequency and severity of local and/or systemic adverse events, and to tolerability grading: very good effect, good effect, satisfactory effect, absence of effect. Frequency of achievement of not less than 50% of back pain reduction at rest was significantly higher in NANOPLAST forte group than in “placebo” group (96,6% versus 23.3% respectively; р=0.001, Pearson’s chi-squared test), as well as during movements (93,3% versus 40% respectively; р=0.001, Pearson’s chi-squared test). Evaluation of treatment effectiveness was higher in NANOPLAST forte group in comparison with “Placebo” group in the opinion of both patient and doctor. Pain intensity during walking and at rest statistically significantly decreased according to visual analogue scale (p<0.05, Wilcoxon test) by the 10th day  in NANOPLAST forte group. A need for additional administration of non-steroidal anti-inflammatory drugs was statistically significantly lower in NANOPLAST forte group in comparison with “Placebo” group (р<0.05, Pearson’s chi-squared test). All patients completed the study. Adverse events related to use of NANOPLAST forte patch were not detected.

Conclusion. NANOPLAST forte can be recommended as an effective and safe method of local therapy in case of back pains. 

Currently, differential diagnosis of systemic bacterial infection and active rheumatic process remains a challenging problem in rheumatology. In the review, current data on the role of procalcitonin biomarker in diagnosis and differential diagnosis of rheumatic diseases (RD) and infectious pathology are presented. In particular, some authors recommend procalcitonin (PCT) test as a marker of bacterial infection in bones and joints at levels above 0.5 ng/ml; at PCT level below 0.3 ng/ml, infection can be ruled out. In patients with microcrystalline arthritis, data on the significance of PCT for differential diagnosis are contradictory. PCT level doesn’t correlate with systemic lupus erythematosus activity and is elevated only during bacterial infection proportionally to its systematicity. In some studies, elevated PCT level was observed in ANCA-associated vasculitis with high activity without bacterial infection. It was shown that in 80 % of adults with Still’s disease, PCT level was higher than the threshold value even without infection. For patients with RD hospitalized in intensive care units, PCT clearance is a more informative predictive characteristic than its level, regardless of the cause of PCT elevation (infection, injury, severe organ damage, etc.); slowdown of its decrease is a factor of poor prognosis and is associated with higher mortality. At the same time, PCT level positively correlates with the SOFA score in presence of bacterial infection. For some rheumatic diseases, the threshold PCT value at which the test has optimal sensitivity and specificity is yet to be established. Nonetheless, PCT should be evaluated in relation
to the clinical picture and data of additional examinations. The effect of various therapy methods used in rheumatology on PCT level requires further research.

Nowadays, there is no doubt about the relationship between immune inflammation and the development of thrombosis due to the similarity of many pathogenetic machanisms underlying both pathological processes. Systemic vasculitis, along with other immuno- mediated inflammatory diseases, represent one of the most clear examples of such interaction. Thrombotic complications remain one of the most serious and life-threatening conditions that occur in patients with autoimmune diseases, in particular systemic vasculitis. This serves as powerful stimulus for studing the problem of hypercoagulation, which often accompanies the course of systemic vasculitis. Of interest are thrombosis that occure both in the injury of large vessel and in the involvement of medium and small vessels in the pathological process. According to the literature, thrombotic and thromboembolic complications are most common in ANCA-associated vasculitis and Behçet’s disease. This review discusses current studies regarding features of clinical picture and mechanisms of thrombosis development in systemic vasculitis. Because of these studies it became clear that for some vasculitis a high frequency of both arterial and venous thrombosis is characteristic. At the same time, other vasculitis are accompanied by high risk of only venous thrombosis. Finally, thrombosis and thromboembolism are quite rare complications for some vasculitis. Among the presented mechanisms of thrombosis involvement, disruptions of the hemostasis are widely considered. For examples, the presents the results of researches, which is actively discussed the role of neutrophil extracellular traps and antiendothelial cell antibodies in the development on thrombotic complictions. Special attention is paid to the possible role of some disorders of hemostasis, such as polymorphism V coagulation factor G1691FA and prothrombin G20210A. To search for literature sources, the following queries were used: “vasculitis”, “thrombosis”, “neutrophil extracellular traps”, “ANCA-associated vasculitis”, “venous thrombosis”, “arterial thrombosis”, “Behçet’s disease”, “Takayasu arteritis”, “granulomatosis with polyangiitis”, “eosinophilic granulomatosis with polyangiitis”, “Mmicroscopic polyangiitis”, “Henoch–Schönlein purpura”, “Kawasaki disease”, “polyarteritis nodosa”, “giant cell arteritis”, “Buerger’s disease”. In addition, use similar requests in English. The search was carried out in PubMed.

In article the review of modern foreign and Russian researches about value of adherence of patients to medicinal therapy of сardiovascular diseases is carried out. Relevance of a problem of non-compliance with appointments of the doctor is described. Factors of adherence which are associated with drug (the price, quantity, reception frequency, amount of drugs), with personal qualities and medical characteristics  of the patient (forgetfulness, age, sex, the diagnosis and the accompanying pathologies, existence of complications in the anamnesis, education, quality of life), with insufficient knowledge of a disease and/or of medicines, side effects, fears and doubts of patients are defined. The review of various methods and ways of rise of adherence, their use in medical practice is provided.

The article presents an overview of modern data and an analysis of the recommendations of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery published in 2017 regarding the use of antithrombotic therapy in patients with valvular heart disease. The results of studies devoted to the use of new oral anticoagulants in patients with valvular heart disease are demonstrated.