The objective is to study the outcomes after 9 and 18 months in the framework of the REKUR-AF study and the dynamics of the drug treatment while implementing the components of the integrated approach in patients with atrial fibrillation (AF) under the regional center.

Materials and methods. The study was conducted in three stages: 1 – inclusion of 896 patients with AF being observed in medical organizations (MO) of Kursk and Kursk region from September 2015 to August 2016; 2 – receiving information on outcomes and pharmacotherapy from patients by telephone contact 9 months after; 3 – receiving information 18 months after the recruitment of patients with the research similar to the second stage. After 9 months of follow-up, the system to support pharmacotherapeutic decisions on antithrombotic therapy in patients with AF (DSS-AF) was introduced in MO of Kursk Region.

Results. The 2 and 3 stages provided the information obtained on 532 and 436 patients, among them 60 and 37 people died, respectively. The cause of death of most patients is cardiovascular pathology. Among the surviving patients, every third needed hospitalization mainly due to decompensation of chronic heart failure or paroxysm of AF. After 18 months of observation, the frequency of prescribing antiplatelet drugs (57.1%), angiotensin-converting enzyme inhibitors (55.6%), statins (53.9%) and diuretics (48.6%) was significantly lower than in the first stage of the study. The level of using oral anticoagulants (OAC) has significantly increased due to the period after the introduction of DSS-AF (from 18.3% of the stage 1 to 26.1% at the stage 3 of the work). In patients taking OAC, the frequency of fatal outcomes was significantly lower than in patients without anticoagulant therapy within 9 and 18 months of follow-up.

Conclusion. The paper shows the feasibility of using DSS-AF as a part of an integrated approach to the management of patients with AF to optimize the antithrombotic therapy of the indicated group of patients.

50% of all cardiovascular outcomes in patients with chronic kidney disease (CKD) fall into the share of coronary heart disease (CHD). The vascular wall stiffness is a common denominator when combined coronary heart disease and CKD.

Objective: determination of initial level of indicators of vascular wall stiffness in patients with chronic forms of CHD in combination with CKD of 1-3 degrees and also their dynamic control with different therapeutic approaches.

Materials and methods. 74 patients with chronic forms of CHD, I-III functional classes stable angina in combination with СKD of 1-3 degrees are examined. The regional stiffness of arteries was estimated by volumetric sphygmography by means of the VS-1500 device (Fucuda Denshi, Japan).

Results. Patients with coronary heart disease in combination with СKD develop a significant increase in pulse wave velocityand an increase in the augmentation index. Against the background of treatment all groups tend to normalize the indicators of vascular wall stiffness. It is most clearly seen when studying pulse wave velocity and CAVI. The conservative therapy with inhibitors of angiotensin-converting enzyme contributed to reducting pulse wave velocity by 2.3% within12 weeks of observation; in the group with surgical revascularization of myocardium – by 5.4%; and in using sartan – by 15.7% (p <0.05).

Conclusion. Determination of parameters of arterial stiffness, namely, speed of pulse wave velocity and CAVI, can be used as an objective marker for monitoring the efficiency of therapy in patients with coronary heart disease in combination with CKD. Carrying out revascularization of myocardium through stenting coronary arteries leads to normalization of stiffness indicators of the vascular wall to a greater extent than conservative tactics. Sartan within 12 weeks showed a significantly more favorable effect on the stiffness of the vascular wall in patients with comorbid pathology, than inhibitors of angiotensin-converting enzyme with other things being equal.

Chronic obstructive pulmonary disease (COPD) is an important issue in modern healthcare. According to GOLD (2018), great attention is paid to the programs of pulmonary rehabilitation (PR), which also include respiratory muscle training (RMT).

Indications for RMT. According to the latest research data, the routine use of RMT is not advised for patients with COPD who can properly participate in PR programs with a full range of necessary general physical exercises. RMT can be considered as a compound to treatment in patients with COPD who cannot fully participate in general physical training due to the presence of comorbid diseases.

Contraindications for RMT. In most studies of RMT in patients with COPD, the exclusion criteria were the following: the need for long-term oxygen therapy, a recent exacerbation of the disease, severe concomitant cardiovascular or neurological pathology. Also, RMT is not recommended for patients with: 1) a history of spontaneous pneumothorax; 2) large bullae on chest x-ray films; 3) marked osteoporosis with history of rib fractures; 4) lung surgery within the last 12 months.

The choice of training methods. It is recommended to use devices with an adjustable threshold applied force. Despite the fact that the use of devices with fixed inspiratory resistance is described in the literature as a possible RMT technique, the use of such devices requires special attention to breathing pattern, since a patient can reduce the training load by decreasing the inspiratory flow.

Conclusion. RMT is recommended for those patients with COPD, who have significant limitations for general physical training, usually due to concomitant diseases.

Acute pancreatitis is considered an important issue in medicine. A special role in the regulation of lipid metabolism is played by the enzyme phosphatidylethanolamine N-methyltransferase, which catalyzes the process of methylation of phosphatidylethanolamine into phosphatidylcholine. These lipids are the main components of the mitochondrial membrane and the cell membrane, providing its fluid and plastic properties, and also participate in the transport of fats, fatty acids and cholesterol. In addition to its function in the synthesis of phosphatidylcholine, methylation of phosphatidylethanolamine promotes SAM turnover for the synthesis of cysteine and glutathione through transulfurization. PEMT is a gene encoding the enzyme phosphatidylethanolamine N-methyltransferase.

Objective. The purpose of this study is to determine the role of polymorphism (rs12449964) of the PEMT gene with the risk of acute pancreatitis in Russian residents of Central Russia.

Materials and methods. Whole blood samples were collected from 502 patients with acute pancreatitis and 513 healthy individuals. Genotyping of polymorphism (rs12449964) of the PEMT gene was performed using the PCR method of discriminating alleles using TaqMan probes.

Results. The C allele and the C/C genotype of the PEMT gene (rs12449964) were associated with the risk of acute
pancreatitis. The identified association is enhanced when patients use 1–1.5 g of fat per kg of body weight per day; with
BMI = 21-25.

Conclusion. Thus, disruption of the processes of methylation of phosphatidylethanolamine leads to the development of acute pancreatitis.

Objective: the aim of the study was to assess the functional reserves of the cardiovascular system in women with undifferentiated connective tissue dysplasia (UCTD).

Materials and methods. 97 female patients aged from 19 to 37 years (mean age was 25.0±6.5 years), mainly with visceral, skin, bone and joint manifestations of UCTD, were examined. The study of the functional reserves of the cardiovascular system was carried out according to the indicators of Holter ECG monitoring (HM ECG) and the results of the bicycle ergometry test.

Results. HM ECG in women with various numbers of phenotypic features of UCTD established the predominated prevalence of supraventricular rhythm disturbances over ventricular arrhythmia. A significantly higher number of supraventricular extrasystoles was found in women with more than 10 UCTD phenes. When conducting bicycle ergometry test, a low to moderate tolerance to physical exertion was registered in 90% female patients with UCTD. Thus, the positive correlation of supraventricular heart rhythm disorders with the number of predictors of undifferentiated connective tissue dysplasia registered in the study can be used not only as a marker of systemic pathology, but also be evaluated as an indicator of an unfavorable prognosis for any manifestations of CTD.

Conclusion. The results indicate the predominant supraventricular arrhythmias compared to ventricular type rhythm disturbances and also the low exercise tolerance in women with connective tissue dysplasia. Young women with undifferentiated connective tissue dysplasia should be recommended to have regular aerobic training (dosed walking, jogging, biking) to increase the adaptive capacity of the cardiovascular system.

The chromosome 22q11.2 deletion (DiGeorge Syndrome) is a set of morphological, immunological and neurological changes that are a consequence of 22q11.2 deletion. In a typical case, this pathology is a triad of symptoms, including: congenital heart disease, hypoplasia or aplasia of the thymus gland and hypocalcemia which is a consequence of hypoplasia of the parathyroid gland. DiGeorge syndrome is variable in its manifestations and the degree of its severity, which explains the fact that this syndrome has many names, the most famous of which are Sprintzen syndrome, Kyler's syndrome, facial and conotruncal abnormalities. The article describes a clinical case of congenital heart disease in a child of 8 months, who was diagnosed with 22 chromosome microdeletion syndrome, its main clinical manifestations, features of diagnosis and treatment methods. The tactics of managing a patient with DiGiorge syndrome should meet the standards and be focused not only on surgical elimination of the defect from the heart, but also on therapy aimed at timely stabilization of the immune response, prevention of repeated infectious diseases which contributes to the favorable course of the disease and determines a successful prognosis in the future.

Objective: substantiation for the use of modified submandibular approach for treating odontogenic infection of the mouth floor.

Materials and methods. 62 patients were involved in this prospective study. The main group consisted of 30 patients with mean age 46.8±11.8, 16 men (53.3%), 14 women (46.7%). Patients were treated with the modified submandibular approach with partial incision of the mandibulohyoid sac; the application for invention No. 2019118924, priority of 17.06.2019. The comparison group consisted of 32 patients with mean age 48.0±11.8, 17 men (53.1%), 15 women (46.9%). Patients were treated with the standard submandibular approach. The main group and the comparison group were comparable in age and sex (p>0.05), the background pathology and antibacterial therapy.

Results. The modified approach allows to reduce the time of postoperative surgical site purification from 5.9±1.9 days in the comparison group, in the main group up to 4.5±1.1 days (p<0.05); granulation tissue from 5.1±2.0 days in the comparison group, in the main group up to 3.7±1.0 days (p<0.05); secondary suture application from 7.0±2.2 days in the comparison group, in the main group up to 5.8±1.2 days (p<0.05). There were no differences in the average bed days (the main group – 8.2±0.9 days, the comparison group – 9.0±2.1 days, p>0.05) and the spread of the infection to adjacent organs (1 case in the main group, 3 cases in the comparison group, p>0.05).

Conclusion. The modified method of treating odontogenic infection allows reducing the time of postoperative wound purification, and facilitating the appearance of granulation tissue and application of sutures.

Objective: the aim of the study is to compare the life quality of patients with ischemic heart disease resulted from multivascular coronary artery blockage after CABG surgery on working heart (Off-Pump Coronary Artery Bypass) and CABG surgery in the environment of artificial circulation and on this basis to determine the most optimal choice of surgery depending on the projected life expectancy of the patient.

Materials and methods. The life quality of 40 patients with ischemic heart disease who had had CABG surgery was analyzed. All patients were separated into two groups, each consisting of 20 patients. Patients in the first group had CABG surgery on the working heart. The second group of patients had surgery on the arrested heart with artificial circulation. 6 and 12 months after surgery, the life quality of patients was assessed using SF-36 questioner.

Results. In comparison with the healthy population of the Russian Federation, patients’ physical functioning and mental health before surgery had been decreased to 23.6±3.3 and to 10.2±3.1 respectively (p<0.05). 6 months after surgery, the physical functioning of the first group patients increased by 5.7±1.0, whereas in the second group by 4.9±0.7. Mental health increased by 2.0±0.4 and 1.8 ±0.4 (p>0.05) respectively. 12 months after surgery patients’ physical functioning in the first group was higher by 4.9±0.1 in the second group and mental health by 3.4±0.7 (p<0.05) respectively.

Conclusion. Operations on the working heart should be performed in patients with a short predictable life expectancy with less than 40% ejection fraction of the left ventricular.

Objective. The establishment of immune and metabolic disorders at the systemic and local level in patients with infertility of tubal peritoneal genesis against the background of a chronic infectious-inflammatory process of the reproductive sphere in the stage of clinical remission before and after the basic pharmocotherapy.

Material and methods. A total of 96 patients with verified diagnosis of secondary infertility of tubal peritoneal genesis against the background of a chronic infectious and inflammatory process of bacterial viral etiology in the remission stage were under observation. The parameters of the immune status, the intensity of lipid peroxidation processes and the state of the antioxidant system were detected in peripheral blood and cervicovaginal lavage.

Results. Within 24 hours after diagnostic and treatment laparoscopy and basic pharmacotherapy had been conducted, the presence of immune inflammation, endothelial dysfunction, “oxidative stress”, activation of lipid peroxidation processes was established at the systemic and local level, as evidenced by changes in 97.8% of laboratory immunometabolic parameters from the studied data. After conducted basic treatment, this percentage decreased to 90.9%, while 9.1% returned to normal, 75.0% of contravene laboratory parameters were corrected, 15.9% remained unchanged at the same level before the treatment.

Conclusion. The obtained results indicate that the conducted basic pharmacotherapy in this category of patients has no adequate corrective effect on the impaired parameters of the immune and metabolic status that requires the additional pharmacological immuno-rehabilitation resources in this category of patients during pharmacological rehabilitation.

First of all, the main task of pharmacy is search for new compounds, including those with high biological activity. Although lots of known compounds have antinociceptive and anti-inflammatory effects, almost all of them have a toxic effect on the gastrointestinal tract and cause a large number of side effects from various organs and systems of the body, since they are non-selective inhibitors of cyclooxygenase enzyme. The relief of pain and inflammatory processes as well the following search for safe and more efficient compounds is the significant task of pharmacology. It was found that hydrazonamides have very effective anti-inflammatory and antinociceptive activity; they will be perspective for following pharmacological screening.

Objective: synthesis and study of anti-inflammatory and antinociceptive activity of N-alkyl(aryl)-4-R-4-oxo-2-(2-phenylaminobenzoylhydrazono)butanamides.

Materials and methods. We synthesized the compounds investigated by means of classic organic synthesis; their structures were analyzed with IR, NMR¹H, NMR¹³C spectroscopy and mass spectrometry. We studied the antinociceptive activity on outbred white mice by «hot plate» method, and anti-inflammatory activity on outbred white rats by the model of acute inflammatory edema.

Results. N-alkyl(aryl)-4-R-4-oxo-2-(2-phenylaminobenzoylhydrazono)butanamides showed the high antinociceptive activity, several compounds exhibited anti-inflammatory effect.

Conclusion. N-alkyl(aryl)-4-R-4-oxo-2-(2-phenylaminobenzoylhydrazono)butanamides have perspective for the following in-depth study, including on acute toxicity and other types of biological activity.

Representatives of the family Rosaceae are ones of the most widespread among the domestic flora. Among Rosaceae there are many official medicinal species, food and decorative plants. One of the representatives of this family is Amelanchier spicata (Lam.) C. Koch. In Russia and Kazakhstan this species has long been grown as a decorative and food plant. In scientific medicine Amelanchier spicata (Lam.) C. Koch is not currently used since there is no approved pharmacopeial monograph for this plant. The introduction into scientific medicine requires to develop indicators of authenticity and to conduct a study of morphological and anatomical features of the structure of Amelanchier spicata (Lam.) C. Koch leaves.

Objective: to study the morphological and anatomical features of leaves of Amelanchier spicata (Lam.) C. Koch.

Materials and methods. Morphological and anatomical study of Amelanchier spicata (Lam.) C. Koch leaves was carried out on fresh, air-dried and fixed plant material. The common Pharmacopoeia articles of both the XIV edition State Pharmacopoeia of Russian Federation and the State Pharmacopoeia of the Republic of Kazakhstan were used to establish the diagnostic features of raw materials.

Results. For the first time the morphological and anatomical study of Amelanchier spicata (Lam.) C. Koch. leaves was carried out.

Conclusion. For the first time a set of macro- and microdiagnostic features that can be used to determine the authenticity of medicinal plant raw materials in the development of regulatory documentation for the leaves of Amelanchier spicata (Lam.) C. Koch. in the sections «External signs» and «Microscopic signs» was revealed.

The article analyzes the world scientific literature concerning the study of types of Gleditsia L. (Gledichiya), growing almost on all continents, but the special attention is drawn to the types of Gleditsia caspia Desf. and Gleditsia tricanthos L. as main representatives of North American flora in Russian Federation. Different morphological parts of Gleditsia L. contain the rich chemical composition which ratio depends on a plant species. In raw materials of G. sinensis phenolic compounds and phenolic acids, flavonoids, lupic acid, echinocystic acid, and triterpene saponins are found. G. caspica contains triterpene saponins, monoterpenic acids and sterols, bisdesmosidic saponins, flavonons. In G. delavayi triterpene saponins are found. Galactomannans are found in beans of G. macracantha and G. triacanthos. In raw materials of G. triacanthos 8 flavonoids, including 6 flavonoid glycosides are found: vicenin -II, lucenin, isoorientin, orientin, vitexin, isovitexin along with two aglycones, namely luteolin and apigenin. The wide range of pharmacological action of the sort Gleditsia L. is confirmed by long-term experience of Chinese and Korean traditional medicine, indigenous people of North America and modern scientific data. Different authors under the conditions in vitro for the raw materials of Gleditsia L. confirmed spasmolytic and cytotoxic activity, anti-inflammatory, anti-mutagen and antimicrobic action.