[Conservative treatment of chronic diseases of lower limb veins: major risks of poor patient compliance]

Presented herein are the results of the Russian part of the International Research Programme 'VEIN ACT' aimed at studying approaches to conservative treatment of chronic vein diseases in the Russian Federation, assessing its efficacy and safety, as well as monitoring the patient compliance. Also discussed are the regimen and results of conservative therapy, depending on patients' gender, age and body mass index, as well as the level of adherence to various methods of treatment in the cohorts concerned. High efficacy of conservative therapy in all patients was confirmed. However, the regimen of drug therapy needs to be adjusted depending on the disease severity, especially in patients of a more advanced age and those with obesity. The lowest patient compliance was observed in relation to compression treatment. The existing situation may be improved by be means of appropriate recommendations and a possible decrease of the level and degree of compression. This should of course be done carefully and attentively, with obligatorily taking into consideration the patients' age and body mass index.

Structural and Thermodynamic Stability of the "1111" Structure Type: A Case Study of the EuFZnPn Series

Two new compounds with the LaOAgS structure, EuFZnAs (1) and EuFZnSb (2), were obtained via solid state reaction. Both compounds are tetragonal (P4/nmm) with the cell parameters a = 4.1000(1) Å and c = 9.0811(1) Å for 1 and a = 4.2852(1)Å and c = 9.4238(1)Å for 2. The absence of their phosphide analog can be explained based on crystal chemical considerations as well as on quantum-chemical estimates of their thermodynamic stability with respect to EuF₂ and EuZn₂Pn₂. The magnetic response of 1 and 2 is ascribed to the presence of Eu²⁺ ions. Both compounds are paramagnetic down to low temperatures, where they order antiferromagnetically at ∼5 K and ∼3 K, respectively. They are narrow-gap semiconductors, and EuFZnSb demonstrates a relatively high value of the Seebeck coefficient.

Iodobismuthates Containing One-Dimensional BiI4(-) Anions as Prospective Light-Harvesting Materials: Synthesis, Crystal and Electronic Structure, and Optical Properties

Four iodobismuthates, LiBiI4·5H2O (1), MgBi2I8·8H2O (2), MnBi2I8·8H2O (3), and KBiI4·H2O (4), were prepared by a facile solution route and revealed thermal stability in air up to 120 °C. Crystal structures of compounds 1-4 were solved by a single crystal X-ray diffraction method. 1: space group C2/c, a = 12.535(2), b = 16.0294(18), c = 7.6214(9) Å, β = 107.189(11)°, Z = 4, R = 0.029. 2: space group P21/c, a = 7.559(2), b = 13.1225(15), c = 13.927(4) Å, β = 97.14(3)°, Z = 2, R = 0.031. 3: space group P21/c, a = 7.606(3), b = 13.137(3), c = 14.026(5) Å, β = 97.14(3)°, Z = 2, R = 0.056. 4: space group P21/n, a = 7.9050(16), b = 7.7718(16), c = 18.233(4) Å, β = 97.45(3)°, Z = 4, R = 0.043. All solid state structures feature one-dimensional (BiI4)(-) anionic chains built of [BiI6] octahedra that share two opposite edges in such a fashion that two iodine atoms in cis-positions remain terminal. The calculated electronic structures and observed optical properties confirmed that compounds 1-4 are semiconductors with direct band gaps of 1.70-1.76 eV, which correspond to their intense red color. It was shown that the cations do not affect the optical properties, and the optical absorption is primarily associated with the charge transfer from the I 5p orbitals at the top of the valence band to the Bi 6p orbitals at the bottom of the conduction band. Based on their properties and facile synthesis, the title compounds are proposed as promising light-harvesting materials for all-solid solar cells.

Kinematic constituents of the extreme head turn of Strix aluco estimated by means of CT-scanning

To analyze extreme sideways turn of the head in owls, a total fresh specimen of Strix aluco was frozen in respective posture and CT-scanned. The maximum turn to one side was found to be 360°, provided that the head is drawn into the shoulders. 160° of this full turn are ensured by the neck axial rotation (this includes ~90° twist of the head relative to epistropheus and, posterior to it, less than 15° per every cervical joint), and the rest 200° are ensured by combination of dorsal and lateral flexion. The 15° limit is overcome in five joints in respect of dorsiflexion, and in six joints in respect of lateral flexion. So large a degree of lateral mobility is unusual among birds, and is appreciated as a crucial adaptation to extreme head turning.

A novel quasi-one-dimensional topological insulator in bismuth iodide β-Bi4I4

Recent progress in the field of topological states of matter has largely been initiated by the discovery of bismuth and antimony chalcogenide bulk topological insulators (TIs; refs ,,,), followed by closely related ternary compounds and predictions of several weak TIs (refs ,,). However, both the conceptual richness of Z2 classification of TIs as well as their structural and compositional diversity are far from being fully exploited. Here, a new Z2 topological insulator is theoretically predicted and experimentally confirmed in the β-phase of quasi-one-dimensional bismuth iodide Bi4I4. The electronic structure of β-Bi4I4, characterized by Z2 invariants (1;110), is in proximity of both the weak TI phase (0;001) and the trivial insulator phase (0;000). Our angle-resolved photoemission spectroscopy measurements performed on the (001) surface reveal a highly anisotropic band-crossing feature located at the  point of the surface Brillouin zone and showing no dispersion with the photon energy, thus being fully consistent with the theoretical prediction.

Fluxes of energy, H2O, and CO2 between the atmosphere and the monsoon tropical forest in Southern Vietnam

The 2.5-year dynamics of heat, water and carbon dioxide fluxes in the tropical monsoon semi-evergreen forest in Southern Vietnam obtained by means of continuous eddy covariance observations using standard procedures of FLUXNET global network are analyzed. The features of wet seasons during the measurement period were close to long-term average ones, but dry seasons had a great heterogeneity. The maximal duration of the period with little precipitation was 4 months. The annual radiation balance in the south of Vietnam exceeded the balance at all stations of FLUXNET in tropical forests, except one. Annual evapotranspiration in monsoon forest of south of Vietnam is approximately equal to the evaporation of the rain forests of Central Amazonia. During the wet season evapotranspiration spent 80% of the radiation balance, and in the driest months this value decreased to 50%. In the dry season reduction of evapotranspiration and gross primary production was relatively small due to photosynthesizing trees of 2-4 canopy sub-layers. For the first time a large net sink of carbon dioxide from the atmosphere in the monsoon forest ecosystem was identified.

[Melatonin in the correction of sleep in post-stroke patients]

AIM

To assess an effect of melatonin on quality of life and effectiveness of rehabilitation in patients with ischemic stroke (IS) suffered from insomnia due to sleep initiation disturbance.

MATERIAL AND METHODS

Sixty post-stroke patients with insomnia were stratified into two groups matched for characteristics assessed in the study. Patients of the main group received melatonin during 21 days. In the first three days after admission and 21 days after the first examination, we administered the MMSE, the Rankin scale, FOSQ, NIHSS, EuroQol, the Epworth sleepiness scale (ESS) and used instrumental methods of examination (computed and magnetic-resonance tomography, electroencephalography, polysomnography).

RESULTS

After 3 weeks, there was a reduction (p<0.05) in ESS scores in the main group compared to the control group (5.7 and 10 scores, respectively). Significant between-group differences were identified for polysomnographic parameters: latency to sleep was 17.8 min in the main group and 20.5 min in the control group (p<0.05), the number of microactivations was 15 and 18, respectively (p<0.05). There was a trend towards more rapid recovery in the main group (on average 8.4 days) compared to the control group (10.2 days), but the differences did not reach the level of statistical significance p<0.05.

CONCLUSION

Melatonin reduced sleepiness (measured with the ESS), latency to sleep and number of wakings (microactivations) and was likely to promote the recovery in IS patients with insomnia due to sleep initiation disturbance.

Electrical muscle stimulation with Veinoplus® device in the treatment of venous ulcers

AIM

The aim of the study was to analyze the results of the electrical muscle stimulation (EMS) usage in patients with venous ulcers developed on top of a post-thrombotic syndrome (PTS).

METHODS

Sixty patients (60 legs) with active venous ulcer (C6EsAsdpPr according to CEAP classification) were divided into two groups. In addition to the background therapy consisting of a standardized compression with ULCER X and intake of micronized purified flavonoid fraction (MPFF 1000 mg daily), all the patients in the main group underwent EMS with Veinoplus® V.I. for at least 3 times a day. Follow-up examinations were performed on days 30, 60 and 90. These included pain severity assessment with 100-mm Visual Analogue Scale (VAS), disease severity measurement with VCSS (Venous Clinical Severity Score) and ankle circumference above malleolus, as well as recording number of healed venous ulcers.

RESULTS

At day 90 pain severity was reduced in both main and control groups. However, according to VAS pain reduction rates were significantly higher in patients of the main group (from 8.7 ± 0.6 to 1.9 ± 0.3 in the main group and 8.4 ± 0.6 to 3.9 ± 0.5 in the control group). At the end of the study, ankle circumference decreased from 270.9 ± 4.6 mm to 257.1 ± 4.2 mm in the main and from 269.7 ± 5.3 mm to 263.4 ± 5.2 in the control group. VCSS before treatment was 7.3 ± 0.6 in the main group and 6.8 ± 0.5 in the control group. By day 90 VCSS significantly decreased to 2.3 ± 0.4 and 4.6 ± 0.5 in the main and control groups respectively. Healing rates were significantly higher in the main group. On day 90, the number of open venous ulcers in the main group was 3 times lower than in the control group (4 vs. 12).

CONCLUSION

EMS demonstrated high efficacy and good tolerability and provided significant reduction in pain severity, VCSS score and ankle edema, as well as a 3-fold increase in the number of healed venous ulcers.

[Peculiarities of treatment of chronic venous diseases in Russia. Preliminary results of the "VEIN ACT Program"]

Presented herein are the results of the Russian part of the International Research Program "VEIN ACT" aimed at studying the structure of variants of conservative treatment for chronic venous diseases in the Russian Federation, assessing its efficacy and safety, as well as monitoring of patient compliance. The obtained findings demonstrated high popularity, among both physicians and patients, of phlebotrophic drugs, determining high patient's adherence thereto. Recommendations on correction of the lifestyle were complied with by more than 80% of patients, however frequently not in the full scale. Noted was sufficiently low compliance to compression therapy, manifesting itself as a decrease in the class of compression and irregular use thereof in more than 30% of patients. Usefulness of conservative therapy was objectively proved, consisting in satisfaction with treatment and a statistically significant decrease in severity of symptoms of chronic venous diseases in the overwhelming majority of patients.

[Treatment of sleep disorders in patients with mild cranial-brain injury in the early rehabilitation period]

OBJECTIVE

To study the effect of melatonin (melaxen) on sleep disorders in patients with mild cranial-brain injury (CBI) in the early rehabilitation period.

MATERIAL AND METHODS

Sixty patients were randomized to equal groups treated or not treated with melaxen. Along with neurological and somatic examination, polysomnography and scales for measurement depression and quality of life ( ESS, BDI, EuroQol etc) were used.

RESULTS AND CONCLUSION

Melatonin improved sleep (sleep latency, number of wakings per night etc) and decreased the severity of depression in the early rehabilitation period after mild CBI. Further research is needed to fully understand the effect of melatonin on sleep disorders in CBI, in particular in its later stages.

[Activation of neurohormonal system as an independent mechanism of heart remodeling in patients with chronic obstructive pulmonary disease]

AIM

To evaluate the contribution of activation of cytokines and renin-angiotensin-aldosterone system to heart remodeling in patients with chronic obstructive pulmonary disease in the course of a 2 year study and to estimate its relation to severe pulmonary hypertension.

MATERIALS AND METHODS

117 patients with COPD underwent measurement of TNFα, IL-6 levels and renin levels, spirometry and echocardiography (mean pressure in pulmonary artery, MPPA)). The data obtainedwere compared with the degree of remodeling of right and left ventricles. After 2 years 30 and 33 of the 63 patients were referred to groups with aggressive and moderate remodeling of the right ventricle respectively. Regressive analysis was used to detect predictors of aggressive remodeling.

RESULTS

Initial remodeling severity and rate showed stronger correlation with TNFα, IL-6 levels and renin levels than with MPPA. Multifactor analysis demonstrated that renin activity and creatinine level were the most reliable predictors of remodeling (p = 0.041 and 0.049 respectively).

CONCLUSION

Neurohormonal and imunno-inflammatory changes stimulate remodeling of right and left heart chambers. They independently affect myocardium and their influence is only partly mediated through exacerbation of pulmonary hypertension.

[Tropical monsoon forests of Vietnam (results of 20 years of phytoecological research)]

This study was carried out during the period 1989-2011. The following areas were included: Vietnam, Laos, Cambodia, Indonesia, and Malaysia. Climax tropical forest and anthropogenically transformed ecosystems, including those damaged by the chemical warfare program of the United States in Vietnam, were investigated. Some regularities in the structure dynamics and functioning of forests ecosystems under a tropical monsoon climate have been revealed. The principles of classification of tropical forests have been elaborated. The major results of investigation of the tropical monsoon forests in Vietnam are given.

[The combined drug ascoril in the treatment of patients with chronic obstructive pulmonary disease concurrent with coronary heart disease]

AIM

To evaluate the clinical efficacy of the combined drug ascoril (Glenmark, India) in patients with grade I-Ii chronic obstructive pulmonary disease (COPD) concurrent with coronary heart disease (CHD).

SUBJECTS AND METHODS

Sixty patients, including 12 (20%) women and 48 (80%) men, aged 43 to 68 years (mean age 55.1 +9.9 years), with COPD were examined. The patients were divided into 2 groups. Group 1 used the combined broncholytic and expectorant drug ascoril and Group 2 took mucolytic agent ambroxol. The follow-up period was 7 days.

RESULTS

On day 2 of ascoril treatment, all the patients showed a significant reduction in the intensity of cough that was completely relieved in 26 (87%) patients by treatment day 7. Prior to ascoril treatment, heart rate (HR) was 64.4+/-5.5 beats/min. A significant increase in HR to 72.7+/-10.1 beats/min was observed 20 min after the first drug intake (p < 0.05) and a decrease to 68.6+/-10.5 beats/min was seen after 60 min. On treatment day 7, HR was 63.0+/-6.5 beats/min, which was similar to that before ascoril treatment (p = 0.6).

CONCLUSION

In the patients with COPD concurrent with CHD, the combined drug ascoril exerts broncholytic and expectorant effects, with no pronounced negative action on HR.

[Chronic venous oedema (C3 according to CEAP): new international guidelines and consensuses]

The review based on analysing the results of epidemiological studies, as well as international guidelines and consensuses published in 2011-2012 reflects the present-day data concerning prevalence, principles of diagnosis and treatment of chronic venous oedema. This is followed by determining the role of compression and drug therapy in treatment thereof from the positions of evidence-based medicine.

[Bioflavonoids and their significance in angiology: focus on diosmin]

The article deals with historical information dedicated to the discovery of bioflavonoids and their effect on the human cardiovascular system, also considering the modern classification of phlebotrophic agents, followed by generalization and analysis of their mechanisms of action, as well as detailed discussion of different forms of diosmin. Summing up contains generalization of the Russian, European, and American guidelines on using phlebotrophic drugs for various forms and stages of chronic venous diseases.

Electromuscular stimulation with VEINOPLUS® for the treatment of chronic venous edema

AIM

Electromuscular stimulation (EMS) with VEINOPLUS® has recently emerged as a new technique to activate the calf muscle pump, improving the symptoms of venous disease. The aim of the study was to evaluate efficacy of EMS and its impact on evening edema, venous pain, venous outflow and patients quality of life.

METHODS

Thirty patients (32 legs) aged 19-50 (mean 45.2±1.3) classified CEAP C3 with chronic evening venous edema took part in the study (22 limbs: C3, S, Ep, Asp, Pr and 10 limbs: C3, S, Es, Aspd, Pr). All patients were treated with CE-registered VEINOPLUS® neuromuscular stimulator for 30 days. 3 sessions per day (each session lasted for 20 minutes) for the first 10 days, the next 10 days 2 sessions per day and one session per day for the last 10 days. The main evaluated criteria for venous edema was the circumference of the supramaleoal shin segment, measured twice with a tape measure; in the evening the day before and then 5 days after the treatment. All measurements were taken during the interval between 6 and 8 o'clock P.M. All the patients were asked to evaluate venous pain using the Visual Analog Scale, and to fill in a CIVIQ questionnaire (validated for Russian patients) for the Quality Of Life (QOL) measurement. Also venous refilling time (RT) was measured by digital PPG. That was also made twice - before the treatment and in 35 days after the treatment. No other treatments were used.

RESULTS

The EMS treatment was well tolerated by patients. There were no drop outs and patients had no need to change their lifestyles. After the treatment, total or partial reduction of evening edema was shown in 93.8% of limbs, the circumference of the lower leg diminished by 20.3mm (P<0.001), the number of painful legs reduced from 28 to 12 and the severity score of venous pain was cut from 8.3 ±1.1 to 3.8 points ±0.9 (P<0.001), QOL improved significantly as the score dropped from 34.5 ±7.8 to 17.2 points ±4.6 (P<0.001) and RT increased from 17.3 ±0.9 to 21.5 seconds ±1.1 (P<0.001). Three months after VEINOPLUS® treatment, total remission of symptoms was observed in 50% of legs, despite there being no other treatments.

CONCLUSION

VEINOPLUS® stimulation is an effective and well-tolerated therapeutic method for the treatment of chronic venous disease. The introduced scheme of EMS application was shown to be useful for treatment of chronic edema, for reducing pain and improving quality of life. It can be used as an additional mean in treatment and to prevent symptoms of CVI. This study also reveals that stimulation of calf muscles with VEINOPLUS® can improve venous outflow and symptoms of CVI. This finding should be investigated and confirmed in further studies.

[Participation of leucocytes in pathogenesis of primary forms of lower limb chronic venous disease]

AIM

The purpose of the study was to test the hypothesis on participation of WBCs in damaging the venous wall in patients presenting with primary forms of lower limb chronic venous diseases LLCVD .

MATERIAL AND METHODS

The study included a total of fifteen consecutively selected patients (13 women and 2 men) diagnosed as having grade C2-C-4 LLCVD according to the CEAP classification. Static loading (30 minutes in the sitting position) was followed by simultaneous sampling of blood from the varicose vein of the cms and ulnar vein. The total blood count including determination of both the absolute values and percentage of blood formed elements was performed using the automated haematological counter «Advia 7» («Bayer», USA). The obtained findings were statistically processed using the Microsoft Office Excel software by means of the pared two-sample τ-test for the average values.

RESULTS

The number of leukocytes and their subpopulations in blood samples obtained from the crural varicose veins turned out to be significantly less as compared with that in blood sampled from the ulnar vein. Thus, blood sampled from the crural varicose veins demonstrated a decrease in the counts of WBC by 9.6% in fourteen (93.3%) patients, that of neutrophils by 4.9% in twelve (80%) patients, that of lymphocytes by 16,8% in fifteen (100%) patients, and that oi monocytes by 24% in twelve (80%) patients. The mentioned differences were statistically significant at a = 0.05. The eosinophilic counts in blood sampled from the upper and lower extremities appeared similar in 66.7% of the examined subjects. In 33.3% of cases the eosinophilic count in blood samples from crural varicose vein was by 16.7% lower than that for blood samples form the ulnar vein. No differences for the rest parameters of the clinical blood count were revealed.

CONCLUSION

The absolute lymphocytic count in the blood samples taken after the 30-minute static loading from the crural varicose veins was significantly lower as compared with that in blood sampled form the cubital vein. The counts for RBCs and blood platelets, as well as other qualitative haematological indices (haemoglobin, haematocrit, average volume of the RBC, erythrocytic diameter, etc.) in blood sampled form crural and ulnar veins in the same patient were identical, thus strongly suggesting the lack of either haemodynamic or haemorheological phenomena capable of leading to redistribution of the blood formed elements in varicose veins. Hence a decrease in the counts of leukocytes and their subpopulations in blood sampled from crural varicose veins might be associated with the «leukocytic trap» phenomenon.