Репозиторий Университета

Copyright: © 2018 Sapelnikov et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 License. Mitral valve disease, including dysfunction of the mitral valve, is often accompanied by atrial fibrillation. Among the patients with prosthetic mitral valves, atrial fibrillation occurs in 30-50% cases. Development of atrial arrhythmias and incisional tachycardia in the early and late postoperative periods can significantly influence patients' rehabilitation and prognosis. Our clinical case describes a patient with a mechanical mitral valve and incisional tachycardia, which led to progression of heart failure and reduced left ventricular systolic function. The patient underwent catheter ablation with non-invasive myocardium mapping. The case reveals the potentials of treatment of incisional tachycardia and atrial fibrillation, which do not respond to drug therapy. Modern methods of visualization enable the cardiac surgeons to reduce possible intraoperative risks and development of complications in this group of patients.

© 2018 Pirogov Russian National Research Medical University. All Rights Reserved.  Rivaroxaban is a safer and more effective alternative to warfarin. However, there are reports of some cases of major hemorrhagic complications associated with rivaroxaban that significantly impair the patients' quality of life and can lead to a fatality. Personalized therapy, including pharmacogenetic testing, may help prevent such adverse events. This study aimed to investigate how ABCB1 3435C>T (rs1045642) and CYP3A5 6986A>G (rs776746) gene polymorphisms, when carried by a patient taking rivaroxaban to prevent thrombosis after total hip or knee replacement surgery, affect prothrombin time (PT). Sixty-five patients participated in the study. Their genotypes were identified by PCR in real time. To learn PT peculiar to each patient, we collected venous blood on the 5 th day of their anticoagulation therapy, 1 hour before they took rivaroxaban and 3 hours after. Having calculated %∆PT, we divided the patients into 2 groups: 1) %∆PT ≤ 0 (n = 7; 10.8%); 2) %∆PT > 0 (n = 58; 89.2%). Regarding the distribution of rs1045642 polymorphism, we determined the difference between the groups to be statistically significant (χ 2 = 6.64; p = 0.027). As for rs776746 polymorphism, the difference was insignificant (χ 2 = 0.101; p = 1.0). We discovered that rs1045642 polymorphism has a significant effect on PT variance in patients taking rivaroxaban to prevent thrombosis after total hip or knee replacement surgery.

© 2018 Paediatrician Publishers, LLC. All Rights Reserved. Background. Improving the quality of medical care is based on a coordinated policy at the federal, regional and municipal levels in the field of health. The implementation of this goal is based on a regular assessment of the current state of the healthcare system in the Russian Federation. Objective. Our aim was to analyse of the main indicators characterizing medical care for children with cancer in the South Federal District. Methods. The operative reports for 2017 of the executive authorities in the sphere of health protection of 8 subjects of the Russian Federation that are part of the South Federal District of the Russian Federation have been analyzed. Results. The number of children were 3 216 797 people (aged 0-17 years), the number of children's oncological beds is 272 (0.8 per 10 thousand children aged 0-17 years), the average number of days of berth employment in the year is 289.9 bed days. In 4 (50%) subjects of the department of pediatric oncology are absent, in 1 (12.5%) - there are no children's oncological beds. The number of doctors providing medical care to children with cancer is 50, of them 42 (84%, 0.1 per 10 thousand children aged 0-17 years) have a certificate of a pediatric oncologist. In 2 (25%) subjects, there are no pediatric oncologists. Incidence of malignant tumors was 13.9 (per 100,000 children aged 0-17 years), prevalence was 86.5 (per 100,000 children aged 0-17 years), mortality was 2.5 (per 100,000 children aged 0-17 years), a one-year mortality rate of 4.7%. 8% of patients were actively detected. 104 (23.2%) of primary patients were sent to medical organizations of federal subordination, 4 (0.9%) of primary patients left the territory of the Russian Federation. Conclusion. The analysis revealed a number of defects: incorrect information contained in the reports, low incidence (detectability) of patients, including during planned preventive examinations, staff shortages and non-rational use of bed facilities.

© 2018 by the MediaSphere. A case of thyrotoxic myocarditis in a 60-year-old female patient is oresented. With the diagnosis of «Unstable angina» she was admitted to the intensive care unit for patients with myocardial infarction at the Yudin city clinical hospital in Moscow. Earlier, the patient had been treated with tyrosol for thyrotoxicosis, but she independently abolished the drug. She ecperienced pain in the chest for the first time in her life. Emergency, coronaroangiography was performed. No hemodynamically significant damage to the blood vessels of the heart was detected. Later, according to the outpatient blood test for thyroid hormones, a diagnosis was established — «severe thyrotoxicosis». The next day after hospitalization, treatment with tyrosol was started at a dose of 30 mg per day. Sinus tachycardia persisted. A reliable increase in cardiospecific enzymes was detected. The pain in the chest did not recur. Echocardiography did not reveal impairment of local or global myocardial contractility. On the fifth day of hospital treatment the patient suddenly died of cardiac and respiratory arrest. The autopsy study revealed autoimmune thyroiditis, thyrotoxic serous-lymphocytic myocarditis, which was complicated by a rupture of the myocardium, and pericardial gemotamponade. The difficulties of differential diagnosis of myocarditis and acute coronary syndrome and the features of treatment tactics in elderly patients with thyrotoxicosis are discussed.

© 2018 University of Rijeka, Faculty of Medicine. All Rights Reserved. Background. The analysis of the quality of medical care for children with cancer is based on statistical data. Evaluation of the results is also the basis of the strategy for the development of medical care for this category of patients. Objective. Our aim was to analysie the main indicators characterizing medical care for children with cancer in the North-Caucasian, Volga, Urals, Siberian and Far Eastern Federal Districts. Methods. In ecological study the operative reports for 2017 of the executive authorities in the sphere of health protection of 44/48 (91.6%) subjects of the Russian Federation that are part of the listed above federal districts have been analyzed (Chuvash Republic, Irkutsk Region, Republic of Sakha (Yakutia) and Khabarovsk Territory did not provide data). Results. The number of children's population was 15 555 306 people (0-17 years), the number of children's oncological beds - 1166 (0.7 per 10 thousand 0-17 years), the average number of days of berth employment in the year - 324.6 bed days. In 13 (29.5%) subjects of the department of pediatric oncology are absent, in 6 (13.6%) - there are no children's oncological beds. The number of doctors providing medical care to children with cancer is 213, of which 132 (62%; 0.08 for 10 thousand 0-17 years) have a certificate of a pediatric oncologist. In 6 (13.6%) subjects there are no doctors-children oncologists (6 more (13.6%) subjects did not provide data). The incidence of malignant neoplasms was 13.1 (per 100.000 0-17 years), the prevalence of 93.1 (per 100.000 0-17 years), mortality rate 2.5 (per 100.000 0-17 years), one-year lethality - 6.8%. 10.1% of patients were actively detected. 781 (38.3%) of primary patients were sent to medical organizations for federal subordination, 39 (1.9%) of primary patients left the territory of the Russian Federation. Conclusion. Obvious accounting defects (low incidence rate) and lack of reliable follow-up data (estimation of mortality levels is difficult) are eliminated by introducing electronic accounting systems. For reliable estimation of the level of provision of the population with children's cancer beds and the percentage of patients sent for treatment in medical organizations of federal subordination, audit of patients' illnesses is necessary. The traditional problems - the deficiency of doctors and children's oncologists and a low percentage of patients identified actively - must be addressed through the reform of the training program for medical personnel.

The aim of the study was to prove the anatomical and clinical effectiveness of the modified anesthesia of mental nerve. The effectiveness of conductive anesthesia near the mental foramen was objectively evaluated using the electric pulp test (EPT) in 100 volunteers of both sexes, aged 35-43 years. Wet anterior mandible preparations obtained from 350 cadavers aged 18-74 years were also studied. EPT value after local mental anesthesia conducted according to Malamed C. using 4% articain solution of local anesthetic with vasoconstrictor concentration of 1:200.000 after 2 minutes was 93±0.82 mA, after 4 minutes - 188±1.26 mA. Yield variability indicators of intraosseous mental nerve anesthesia was slightly higher varying from 94.11 mA to 96.61 mA after 2 minutes and from 197.4 to 199.92 mA after 4 minutes survey. The study showed the efficiency and predictability of intraosseous anesthesia of the mental nerve.

The modern model of inpatient surgical care of private and optimized state/govermental medical institutions allows us to change the paradigm of nosological attachment of the hospital bed to one profile of specialists for an adaptive model, when the wards can be reassigned depending on the needs of the hospital. In such multidisciplinary medical centers with mixed hospital beds without a nominal distinction in the nosological departments, a new therapeutic service is being developed - hospitalists, which provide a consistent curation of hospitalized patients, compensation of chronic therapeutic illnesses with patient's preparation for surgical interventions. Our work describes the experience of Fast Track recovery program with the active participation of a hospitalist in a surgical team, which is a new experience in the practice of Russian colorectal surgery.

AIM: To evaluate bile ducts injuries and effect of biliary decompression technique on the outcomes of reconstructive surgery. MATERIAL AND METHODS: There were 21 patients with biliary injury during cholecystectomy, 20 patients with cholelithiasis, and 1 patient after surgery for perforated duodenal ulcer. Their age was 22-81 years (mean 54.3 years). Primary surgery through median laparotomy was followed by biliary injury in 12 patients, laparoscopic cholecystectomy - in 6 patients, open laparoscopy - in 3 patients. Patients were divided into 2 groups. In group 1 (n=11) biliary injury was diagnosed intraoperatively, in group 2 (n=10) - in 2-11 days after primary procedure. According to European Association for Endoscopic Surgery (EAES) 2013 classification biliary injury type 1 was found in 5 patients, type 2 - in 9 cases, high damage involving confluence (type 3) - in 1 patient, type 4 - in 1 patient, and type 6 - in 5 patients. Endoscopic retrograde cholangiopancreatography in 3 patients revealed that biliary drainage output after laparoscopic cholecystectomy was caused by cystic duct clipping failure, endoscopic papillosphincterotomy was successfully used for biliary drainage output (type 6). In 3 patients operated through median laparotomy biliary excretion cessation was observed after 2-3 days that indicated damage of aberrant bile ducts. RESULTS: Bile outflow into gastrointestinal tract was restored in 11 out of 16 patients with iatrogenic biliary injury types 1-4, external biliary drainage was used in 4 patients due to their severe condition and abdominal inflammatory changes. Biliary fistulae occurred in 5 out of 8 patients in both groups after primary reconstructive surgery. Biliary stricture was observed in 3 cases due to external biliary drainage failure followed by peritonitis. 7 patients underwent reconstructive surgery with positive result. Mortality was absent. In 1 patient with biliary fistula outcome is unknown. CONCLUSION: Transumbilical biliary drainage is optimal during reconstructive surgery.

Flavonoids are herbal medicines and widely used for chronic venous diseases and hemorrhoids. Flavonoid diosmin in both micronized and non-micronized form is a part of various drugs. According to literature data, flavonoids are able to reduce venous stasis, suppress local inflammation, improve venous tone and lymphatic outflow. It should be noted that biological models of in vivo trials have certain limitations while available data of different researches are contradictory. However, flavonoids were recommended for hemorrhoids in view of meta-analysis of 14 trials comparing flavonoids (diosmin, micronized purified flavonoid fraction and rutosides) with placebo in 1514 patients with hemorrhoids and Cochrane review of 24 randomized controlled trials (2,334 participants). These drugs should be administered as a part of complex therapy. At the same time, there is no conclusive evidence to prefer only one of these medicines. There are also no data confirming the benefits of daily dosage of 3000 mg per day of micronized fraction of flavonoids compared with 1800 mg of purified diosmin per day for treatment of acute hemorrhoids.

AIM: To analyze proceedings of the I-X Conferences 'Modern problems of somnology'. MATERIAL AND METHODS: The authors have analyzed 888 abstracts from the abstract books of the conferences held from 1998 to 2016 in Moscow and Saint-Petersburg. The territorial, sectoral and scientific indicators of the activity of participants as well as longitudinal research trends were analyzed. Mathematical and statistical data analysis was carried out using the methods of descriptive statistics (95% confidence intervals) and χ2 tests. RESULTS: On average, 300 researchers from 6 countries and 14 regions of Russia participated in each conference, most from higher education (19), research (16) and medical (12) institutions. The highest number of publications were related to clinical somnology and sleep medicine (50% to different neurological conditions), the numeral material was included in 83% and statistical analysis was performed in 32.5%. A trend towards more active participation of research and medical institutions from all the country and involvement of new regions was observed. The interest to the clinical subjects, including treatment choices in sleep disorders as well as organizing aspects of sleep medicine, has been increasing. The number of studies on different aspects of sleep apnea has increased significantly as well. CONCLUSION: The features of scientific and clinical activity in the field of somnology presented in the materials of conferences are stable in terms of the institutional and territorial representation. It complies to international trends of research and clinical development. This allows better planning of the structure and main issues of the further conferences.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Aim. To evaluate cost effectiveness of coronary endovascular treatment in patients with stable IHD during “one-night” hospitalization. Materials and methods. Using the cost-minimization analysis direct medical cost of coronary endovascular treatment in patients with stable IHD during the “one-night” hospitalization was compared with the “classic” hospitalization. Results. The most cost-effective strategy for hospitalization of patients for transcutaneous coronary intervention (TCI) with stenting was the “one-night” hospitalization. Differences in direct medical costs (DMC) were statistically significant (p=0.01) in favor of the patient group hospitalized for one night. Conclusion. The “one-night” hospitalization plan for patients with stable IHD to undergo TCI with stenting increases the cost-effectiveness due to the decreased number of days of stay in the hospital and the associated decrease in cost of in-patient maintenance, which resultes in considerable financial savings (∆ between the hospitalization plans was 21.2% in favor of the “one-might” hospitalization). This ∆ indicates high cost effectiveness of the selected approach.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article discusses various mechanisms of developmentt and progression of arterial hypertension in young and middle aged adults. It emphasizes the predominant role of hypersympathicotonia in the development of the disease in this category of patients. Various mechanisms are considered, by means of which the increase of activity of the sympathetic nervous system leads to elevation of arterial pressure and potentiates early damage of target organs, first of all, damage of the heart. The data of numerous studies demonstrating pronounced cardioprotective effects of a highly selective representative of the class of β-blockers bisoprolol in young and middle aged hypertensive patients are presented.

The article reviews the phenomenology of sleep and wakefulness disorders in Parkinson's disease and Alzheimer's disease. Degeneration of sleep and wakefulness centers, secondary effect of other symptoms of diseases and side-effects of drug therapy lead to a widespread prevalence of sleep and wakefulness disturbances in these patients. Along with the review of actual literature concerning mechanisms of development and clinical features of these disorders, the authors discuss principal methods for their treatment.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Purpose: to assess prevalence of dyslipidemia in patients with ischemic heart disease (IHD) older than 75 years as well as to evaluate possible associations between serum lipids and various cardiovascular and other diseases in these patients. Methods: We enrolled in this cross sectional study 555 hospitalized IHD patients aged 75-98 years (mean age 86.8 years, 74.5% women). Levels of lipids (total cholesterol [TC], triglycerides [TG], low and high-density lipoprotein cholesterol [LDLC, HDLC]) were measured by enzyme method on the biochemistry analyzer Konelab 60i. Results: Elevated TC; hypertriglyceridemia and elevated LDLC were observed in 13.3, 10.4 and 26.3% of patients, respectively. In the majority of patients severity of dyslipidemia was mild. With increasing age serum levels of TC and LDLC decreased. Negative correlation between TC level and patient's age was significant (r= -0.13; p=0.001). Mean TC level was 5.43, 5.0 and 4.7 mmol/l in patients aged <80 (group 1), 80-89 (group 2), and ≥90 (group 3) years, respectively (p=0.001 for differences between groups 1-and 3). Similar results were registered in respect of LDLC: mean LDLC level was 3.7 and 2.7 mmol/l in groups 1 and 3, respectively (p=0.004). Mean concentrations of all lipids in women were higher than in men: TC 5.1 vs 4.5 (p<0.0001), LDLC 3.1 vs 2.5 (p=0.0002), HDLC - 1.26 vs 1.17 mmol/l (p=0.01). Lower lipids levels (especially those of TC) were significantly associated with clinically significant heart failure (p<0.0001) and atrial fibrillation (p<0.0001). Higher TC and TG correlated positively with higher systolic and diastolic blood pressure (p=0.001). Significant positive correlations existed between TG and glucose concentration (p<0.0001) as well as between TG and uric acid level (p=0.001). Higher TG and lower HDLC levels were registered in patients with higher creatinine level (p=0.001 and 0.0003, respectively). Only 11.4% of study patients received statins. Conclusion: The study results evidence for considerable peculiarities of lipid profile in the very elderly patients with IHD. Significant associations between dyslipidemia and a number of diseases were also revealed.

© 2018, Dynasty Publishing House. All rights reserved. The objective. Assessment of the practice of breastfeeding support in a department of neonatal and premature infant pathology of the Tambov Regional Children’s Clinical Hospital (TRCCH) after 3–4 years of becoming a WHO/UNICEF Baby Friendly Hospital. Patients and methods. Mothers were questioned using specially designed questionnaires at their admission to the department and at discharge from hospital. Overall, 356 mothers were questioned at admission and 327 at discharge. The results were processed on the SPSS.19 statistical programme. Frequency distribution, mean values (± standard deviation) and Student’s t-coefficient were determined. Results. The practice of supporting breastfeeding in the department consisted in observance of the 10 steps of successful breastfeeding: mother and infant remaining together (98.2%), breastfeeding on an infant’s demand (91.3%), breastfeeding at night (98.6%), breast milk extraction for infant feeding and lactation stimulation (88.6%), informing mothers about the benefits and technique of breastfeeding (90.5%). The percentage of breastfed infants significantly increased by the time of discharge from the department – to 89.4% (at admission – 71.9%; p < 0.0001), among them exclusively breastfed infants – to 66.5% (at admission – 45.3%; p < 0.0001). Conclusion. The practice of breastfeeding based on current international recommendations is successfully supported in the neonatal department of TRCCH. Nevertheless, breastfeeding parameters might be considerably improved due to attainment of continuity in the work of maternity clinics and TRCCH and optimization of the practices of breast milk extraction, storage and use in the department.

© 2018 Brovko et al. Purpose: Experimental studies suggest that the nephrotic syndrome is associated with “vasopressin escape”, characterized by low aquaporin-2 (AQP2) expression in the collecting duct despite high vasopressin secretion. We investigated this phenomenon in patients with the nephrotic syndrome. Patients and methods: We recruited 47 patients with proteinuric kidney disease who were distributed into the following four groups: 1) nephrotic syndrome with kidney dysfunction (n=10); 2) nephrotic syndrome with normal kidney function (n=16); 3) partial remission of nephrotic syndrome (n=10); and 4) minimal proteinuria (n=11). Nine healthy volunteers comprised a control group. Serum copeptin level (as a marker of vasopressin secretion) and urinary AQP2 were measured using ELISA. Results: Nephrotic syndrome was associated with a significant increase in serum copeptin levels compared with those in the other groups (all P<0.05). In patients with nephrotic syndrome and a partial remission of nephrotic syndrome combined, there was more than a ten-fold decrease in the median urinary AQP2 excretion (0.03 ng/mL) compared with healthy volunteers (0.41 ng/mL; P<0.001) and more than a five-fold decrease compared with patients with minimal proteinuria (0.21 ng/mL; P<0.05). Unlike copeptin levels, the median urinary AQP2 excretion in patients with minimal proteinuria also decreased but less significantly than in those with nephrotic syndrome. There was a negative correlation between the urinary AQP2 excretion and daily proteinuria (R=−0.41; P=0.005). Conclusion: Our clinical study was the first to demonstrate low AQP2 excretion in nephrotic syndrome that may indicate an escape from the vasopressin regulating effect.

© 2018 Institute of Europe Russian Academy of Sciences. All Rights Reserved. Introduction. In the modern world, volunteering is one of the most effective ways for successful social development and improvement of the quality of human life. By the Decree of the President of Russia Vladimir Putin, the year of 2018 has been declared the Year of Volunteer in the Russian Federation. Voluntary activity has a positive impact not only on people who are provided with help but also on volunteers. Volunteering is beneficial for the formation and strengthening of moral position and citizenship, development of philanthropy, responsiveness, sense of justice, leadership skills. Besides, youth volunteering abroad has long been used as an important element of preparation to perform professional duties. Participating in the professionally focused volunteering, the student has an opportunity to gain professional experience, to check the correctness of own professional self-determination and career aptitude. Similar volunteer service is especially relevant for representatives of the “caring” professions - teachers, social workers, psychologists and doctors, i.e. people who have to be a priori ready for pro-social activity and have such qualities as goodwill, communicability and conscientiousness. The aim of the paper is to study the dynamics of the psychological characteristics of future health-care professionals regularly participating in professionally-oriented volunteer activities. Methodology and research methods. The research is based on competency-based and activity approaches to education. Also, research methodology involves the key provisions of the concept of a humanization of the pedagogical process of the higher education institution, and the basic principles of volunteers' activity declared in documents of the “United Nations Volunteers” (UNV) programme. The survey among students was the main method of information collection. Psycho-diagnostic tools involved: the assessment technique for communicative and organizing tendencies of an individual (V. V. Sinyavsky, V. A. Fedoroshin); the questionnaire for assessing the development level of empathic tendencies (A. Megrabyan, N. Epstein); the methodology for studying of valuable orientations of the individual (M. Rokich); the questionnaire “Motivation of Assistance” (S. K. Nartov-Bochaver). To objectify the data obtained, the Mann-Whitney U Test statistical technique was applied to reveal a difference in values of the parameter between small selections. Results and scientific novelty. The volunteer team was organized at the Department of Psychology of Health and Correctional Psychology of the Kursk State Medical University. This team is engaged in volunteering at the boarding school for children with disabilities. The authors came to the conclusion that the real directions of quasi-professional voluntary student unionism substantially correspond to the abilities and skills required of future health professionals. The authors analyzed the two-year dynamics of changes in students' psychological characteristics and professional competencies under the influence of their constant involvement in the volunteer movement. The key personality traits of an experienced student volunteer were designated: orientation towards humanistic values; motivation and readiness of providing assistance to needy people; well-developed communicative abilities and empathy. It has been established empirically that the level of development of these professionally important qualities among the student volunteers is initially above, compared with fellow students who were not involved in volunteering. Also, the level mentioned above continues to evolve actively due to the performance of the professionally focused and socially important volunteer mission. Practical significance. Results of the undertaken research prove convincingly that inclusion in the pedagogical process of higher education institution of professional volunteering as one of the priority activities contributes to the spiritual-moral education of students, the formation of professional and general humanistic outlook. In addition, student volunteering allows future graduates to find the necessary experience in the chosen field of employment.

© 2018, Silicea-Poligraf. All rights reserved. Aim. Study of efficacy and safety of taurin in management of stable angina patients with postinfarction cardiosclerosis. Material and methods. Totally, 95 postinfarction cardiosclerosis patients included, with stable angina of II and III functional class. The patients that were included, had refused revascularization. To the main group, 48 were included with added taurin (Dibicor, “PIK-Pharma”, Russia, 750 mg daily), and to comparison group — 47 patients that were taking standard treatment and placebo. Treatment duration 3 months. Results. Clinical efficacy of taurin in postinfarction cardiosclerosis and stable angina is confirmed by significant improvement of the following parameters: subjective state (decreased fatigue, less complaints on palpitation, less severity of dyspnea and rarer angina attacks), of the life quality parameters by Seattle questionnaire; echocardiographic parameters, normalized cardiac rhythm. Postive changes achieved on the basis therapy with taurin, remained for 3 months after drug discontinuation. Conclusion. Positive influence of taurin on clinical and instrumental parameters of patients make it to recommend its prescription for stable angina treatment in postinfarction cardiosclerosis patients.

© 2018, Silicea-Poligraf. All rights reserved. Aim. Assessment of prognostic significance of endothelial dysfunction markers: stable metabolites of nitric oxide (NOx), von Willebrand factor (vWF), endothelin-1 (E1), homocysteine and tissue plasminogen activator (tPA) in essential hypertension (EAH) patients not taking antihypertension therapy systematically. Material and methods. Totally, 12 EAH patients investigated (45 males, 79 females) (mean age 51,4±6,5 y.o., mean duration of AH 7,9±7,3 y.). Concentration of NOx in plasma was measured by spectrophotometry, and of vWF, homocysteine, E1 and tPA — by immune enzyme assay. Results. By the increase of SCORE risk level, there was significant increase of concentrations of NOx, E1, homocysteine and vWF in EAH patients (p<0,05), there were no changes in tPA levels (p>0,05). In 8 (8±1,1) years after baseline assessment, 115 patients were assessed second time. Of those 13 (11,3%) had cardiovascular events (CVE) and 5 (4,3%) died. By single factorial regression, the rate of CVE in EAH patients relate to homocystein level (р=0,01), NOx (р=0,001) and vWF (р=0,001). By multifactorial analysis, prognostic statistical significance is found for NOx (relative risk (RR) =3,8, р=0,006) and vWF (RR =3,5, р=0,005). In ROC-analysis there were found threshold levels of NOx (>46,6 mcM/L, AUC =0,863) and vWF (>1,68 mg/dL, AUC =0,738), the increase of which is followed by CVE development risk for the levels of NOx >46,6 mcM/L 3,8 times (sensitivity 81,9% and specificity 65,8%), vWF >1,68 mg/dL — 3,5 times (sensitivity 74,3% and specificity 62,7%). Combination of the parameters point on the risk increase up to 6,5 times (р=0,00007). Conclusion. NOx with the threshold of >46,6 mcM/L (RR =3,8) and vWF >1,68 mg/dL (RR =3,5) do show independent prognostic value for 5-year CVE risk assessment in EAH patients that can be applied as an additional method for risk stratification to estimate a group for more aggressive therapy and CVE prevention.

© 2019 All rights reserved. Objective: to compare strategies of invasive treatment of patients with non-ST elevation acute coronary syndrome (NSTEACS) hospitalized in 2014 and 2015. Materials and methods. We have analyzed treatment strategy used in patients with NSTEACS hospitalized in cardio-reanimation department of a city hospital during one month in two successive years (January 2014 and November 2015). We have compared indications to, and timing of coronary angiography, numbers of performed percutaneous coronary interventions (PCI) and coronary artery bypass grafting surgeries. Results. Portion of patients subjected to invasive procedures in 2014 was 26 %, in 2015-42 %. All 32 primary procedures were PCIs. An increase was due to delayed interventions (24-72 hours), which were not performed in 2014. We also more often used selective multivessel coronary stenting, what facilitated availability of invasive treatment for elderly patients. Hospital mortality of patients with NSTEACS decreased from 16 to 7 %.