ENDS - a growing threat: results from Russian tobacco control policy evaluation survey EPOCHA-RF

Background

Electronic nicotine delivery systems (ENDS) including heated tobacco products not yet legally regulated are more and more imposed over the Russian population. Still very little is known about these products.

Aim

To assess the exposure of Russian population to advertisement, promotion, of ENDS, and its attitudes and beliefs regarding these products.

Methods

Data from Russian tobacco control policy evaluation survey (2017-2018) are analysed which used a systematic stratified multistage random sampling based on territorial household principle, representing the adult population (18+) of Russia in 10 Federal subjects. 20380 randomly selected respondents were interviewed and a stratified sample (n = 11625) of smokers (n = 6569), former smokers (n = 2377) and never smokers (n = 2679) participated in the survey.

Results

In past 6 months 15.7% of the respondents were exposed to promotion of ENDS via internet, 14%-via social networks and 13.4% at the points of sale. Remarkably the youngest age group (18-24) was significantly more exposed to advertisement and promotion of ENDS from all sources than the rest of age groups: 32.6%, 32.3% and 24.3% respectively (p<.0001).

48% of respondents believe that secondhand vape of e-cigarettes is harmful for health of people, with significant differences among current smokers (40%), recent quitters (53%), former smokers (60%) and never smokers (66%). Majority agreed that it is necessary to regulate allowed amounts of nicotine in e-liquids (54%), to ban vaping in public places where tobacco smoking is banned (59.2%), ban the sales of these products to minors (68%), and the use of e-cigarettes by those (71.2%). 61.5% support the need for ban of all forms of advertisement, marketing and promotion of ENDS.

Conclusions

ENDS present a real threat for Russian tobacco control policy achievements. The findings will be used to support new strong legislation to regulate ENDS in Russia.

Key messages

Young people much more than the others are targeted with advertisement and promotion of ENDS. ENDS present a real threat for Russian tobacco control policy and should be legally regulated like any tobacco products.

Who does use ENDS in Russia? Results from Russian tobacco control policy evaluation survey EPOCHA-RF

Background

Electronic Nicotine Delivery Systems (ENDS) become popular in Russia. Still little is known about use of these products.

Aim

To assess patterns of active and passive exposure to ENDS in Russian population.

Methods

Data from Russian tobacco control policy evaluation survey (2017-2018) are analysed, conducted on the basis of multistage territorial random sample of 11625 respondents: 6569 smokers, 2377 former smokers and 2679 never smokers 18years and older in 10 Russian Federal subjects.

Results

38.8% of the respondents were familiar with ENDS, with the highest proportion in the youngest age group (18-24): 53.8%(p<.0001). 9.3%had tried ENDS, among 18-24 years old - those were 23.5%(p<.0001). The amount was significantly higher among recent quitters (in last 3years)-17.2%, and current smokers-13% compared with former (quitters for more than 3years) and never smokers. Of those 26.4% used ENDS regularly-with highest proportion among 18-24years old (29.1%), and current smokers (27.1%). This comprises 2.5% of respondents as regular ENDS users, and 6.8%-among the youngest group. Half of the smokers had tried to quit by means of ENDS, of those 69% failed to quit smoking, and 79% could neither give up smoking nor ENDS. However, only 18% ENDS users agreed that e-cigarettes cause addiction, and 37% even denied the fact. Those were mostly the youngest respondents (45%). Vaping was not allowed at homes of 67.4%respondents, at workplaces-of 65.6%. 14% of respondents had witnessed vaping at workplaces, 55.8% in public places, 20.3% cafes, restaurants and bars. 51.4% had been exposed to secondhand aerosols of ENDS and 73.2%-among 18-24years olds. 37%found exposure to the aerosols annoying, with significant differences between never/former smokers (58% and 50.3%) and recent quitters and current smokers (39.3% and 29.2%).

Conclusions

Young people are mostly exposed to ENDS in Russia. Strong legislation should be considered to regulate ENDS and protect people from their exposure.

Key messages

Electronic cigarettes are mostly prevalent among the youngest age groups, current smokers and recent quitters in Russia. ENDS do not help smokers to quit: vast majority of smokers who used ENDS for this purpose failed to give up both smoking and electronic cigarettes.

[Possibilities of digital fluorography and other X-ray methods in the detection of carotid atherosclerosis]

AIM

To evaluate possibilities of routine X-ray methods for the diagnosis of atherosclerosis of carotid arteries.

MATERIAL AND METHODS

At the initial stage of the study, 468 X-ray radiograms of the cervical spine with the detailed description of soft tissues and projections of the neck vessels were studied. The next stage included evaluation of 'screening' abilities of digital fluorography of lungs (886 X-ray radiograms were analyzed). The last stage is a current pilot project aimed to introduce opportunistic screening of atherosclerosis of carotid arteries using X-ray and ultrasound examination of the thyroid gland taking into account disease history collected with help of a special questionnaire and clinical examination.

RESULTS AND CONCLUSION

The study shows a high specificity of the shadows in the projections of the neck vessels as a sign of atherocalcinosis. During mass examinations these X-ray findings are useful to identify patients who need duplex scanning and other high-tech methods.

P3351The new organizational scheme for research on rare and interesting clinical cases in cardiology

Introduction

There is a challenge to study rare and unusual diseases in cardiology. Patients with such cases often concentrate in large scientific medical centers, where implementation of new organizational research approaches may be useful to overcome this challenge.

Purpose

To develop and approbate new organizational scheme to study of rare and interesting clinical cases in cardiology.

Methods

The new organizational scheme for research on rare and interesting clinical cases in cardiology is based on three main interconnected teams: clinical cardiologists, scientific researchers, and biobanking specialists. In 2016 the joint team of experts in these areas developed: 1) criteria for selection of patients with rare and interesting clinical cases, 2) requirements for collection of biomaterial and data, 3) ethical rules, 4) logistics of all processes, 5) organization of teamwork of all participants from different departments, 6) promotion of the project and involvement of all clinicians of the medical scientific center.

Results

The teamwork of cardiologists, scientific researchers and biobanking specialists was organized. Cardiologists are responsible for selection of patients; scientific researchers - for formation and analysis of database; biobanking specialists - for standardization of biospecimens' collection, preparation and safe responsible storage, partly - for database formation. Special training for all participants of the project was conducted. It included issues of selection of patients; the procedure of informed consent signing and information encoding; logistics of interaction of clinical, scientific, and biobank's personnel; proper documentation etc. As a result since the start of the project from June 2016 to January 2019, biomaterial and depersonalized data were collected from 753 patients, including: early (<45 y.o. in men, <50 y.o. in women) development of coronary artery disease – 167, early (<50 y.o.) development of atrial fibrillation – 197, morbid obesity (BMI>40 kg/m2) - 71, primary electric heart diseases - 42, cardiomyopathies - 272, other rare diseases – 96 patients. The project is currently ongoing. This approach allows collecting and preserving valuable biomaterial and data for research in present and future. To date these materials have been already used for several research initiatives such as investigation of hypertrophic and non-compact cardiomyopathies, familial hypercholesterolemia; identification of novel genetic markers of type 2 diabetes and obesity; reports and publications about rare clinical cases.

Conclusion

The integrated teamwork of clinical cardiologists, scientific researchers and biobanking specialists in large scientific medical center gives qualitatively new opportunities: increase of the dynamicity, efficiency, standardization, and as a result, quality of present and future research on rare and interesting clinical cases in cardiology.

P5352The main characteristics and multimorbidity in patients with history of stroke, myocardial infarction and their combination (hospital registry data)

Aim

To assess characteristics and patterns of cardiovascular (CV) and non-cardiovascular (non-CV) multimorbidity in patients with history of stroke (STR) without myocardial infarction (STRH), history of myocardial infarction (MI) without stroke (MIH), and their combination (STRH+MIH) on a basis of the hospital registry.

Methods

The hospital registry included 8954 patients with arterial hypertension (AH), ischemic heart disease, chronic heart failure (CHF), atrial fibrillation (AF) and their combinations hospitalized to the National Medical Research Center for Preventive Medicine (Moscow, Russia) from 01.04.13 to 31.03.17. 2020 (22.6%) patients had a MIH, 857 (9.6%) – a STRH and 318 (3.6%) had a combination of them.

Results

The age of patients with MIH was significantly less than in STRH and in the combined group (66.8±11.3 vs 70.8±10.9 and 71.6±9.9 years, p<0.05). 70% of patients in STRH+MIH group had primary MI earlier than STR (on the average 3.8 years). The age of primary MI and STR was 61.3±11.4 and 65.8±11.7 years respectively (p<0.001). 27% of all STRH and 14% of MIH cases were presented in MIH+STRH group. Men prevailed in MIH and MIH+STRH (70% and 64.5%) groups, women – in STRH (59%). In MIH group compared with STRH and STRH+ MIH groups was lower frequency of AH (90.2% vs 97.2%; 96.5%) and AF (21.2% vs 41.5%; 41.5%). CHF patients prevailed in STRH+MIH and MIH groups (70.4%; 57.1% vs 40.7%), p<0.0001. The most number of CV diseases (CVDs) was in STRH+MIH group (3.09±0.8) and less in MIH (2.9±1.0) and STRH (1.96±0.9) groups. In STRH+MIH patients compared with STRH and MIH groups were also more often identified: diabetes (35.2%; 22.3%; 24.7%, p<0.0001), digestive diseases (80.2% vs 73.4%; 75.6%, p<0.0001 and p=0.025), kidney diseases (56.6% vs 44,7%; 29%, p<0.0001 and p=0.0003), respiratory diseases (37.4% vs 23.9%; 31.9%, p=0.005; p=0,001), anemia (12.9% vs 7.9% and 6.9%, p=0.0002 and p=0.009). The number of obese patients did not differ significantly in all groups (33.0%; 30.7%; 28.1%, p>0.05). The average number of comorbid non-CV diseases (non-CVDs) was: 1.96±0.5 in MIH group; 2.03±0.3 in patients with STRH and 2.55±0.3 in STRH+MIH group (p<0.05, adjusted to age and sex). The total number of CVDs and non-CVDs was maximal (5,6) in STRH+MIH group, less in MIH (4.65) and STRH (3,99) groups.

Conclusions

Patients with history of stroke and myocardial infarction had maximal number both of CVDs and non-CVDs compared with groups of only myocardial infarction or stroke history, i.e. they had the higher CV risk and the most unfavorable profile in hospital registry. So, the multidisciplinary approach for the treatment and prevention in this multimorbid group is most indicated. 70% of patients in combined group had primary MI earlier than primary stroke (on the average 3.8 years). This fact confirmed the suggestion that MI is the earlier part of cardiovascular continuum than stroke.

P5677Ictal asystole and bradycardia patients with epilepsy

Background

Events of ictal bradycardia or asystole may be of importance in epilepsy patients showing with ictal falls and are a funder to SUDEP. With using implantable loop recorders, we can detect ictal bradycardia or asystole. And implantation of cardiac pacemakers may prevent life-threatening syncope, cardiac arrest, and disturbances.

Purpose

The purpose of this study is to look at how many ictal bradycardia or asystole and match with localization, types of seizure and antiepileptic drugs in a patient with hard to treat epilepsy.

Methods

Patients with hard to treat epilepsy were implanted loop recorders. Patients or their relations were activated loop recorder (with a special patient assistant) during or after seizure depending on the type of seizure.

Results

204 patients included in the study. The mean duration of loop recording 24 months. 1168 ECG seizure were reordered of 204 patients, 494 (42%) secondary generalized seizures and 674 (58%) partial seizures. Nine patients (4%) were recorded ictal bradycardia and ictal asystole. Only four patients with ictal asystole and bradycardia take AED (antiepileptic drug) inhibit sodium channels. During seizure were recorded only 14 (1, 1%) seizure with ictal asystole and bradycardia of nine patients, 6 (42%) – with ictal asystole (5 – SA-block, 1 – AV-block), 8 (57%) – ictal bradycardia. Ten (71%) events of 14 was secondary generalized seizures, 4 (28%) - partial seizures. Five ictal asystoles recorded during secondarily generalized seizures, and only 1 partial seizure. Five ictal bradycardias reordered during secondarily generalized seizures, 3 - partial seizure. Frontal-temporal localization only 4 patients, 1 – occipital-frontal, 1 – frontal, 3 – without consistent epilepsy localization. Three patients with bilateral lateralization, 2 – left lateralization, 1 – right lateralization, 3 – without consistent epilepsy lateralization.

Conclusions

Ictal asystole can be problematic to diagnose because of both its under-recognition and its appearance only during seizures. In this study, we showed the most life-threatening events occurred in patients with the secondarily generalized seizures. Bradyarrhythmias can one of possible sudden unexplained death in epilepsy patients (SUDEP). No clear association was seen between ictal bradycardia/asystole and lateralization or localization of seizure onset.

219Serum Trimethylamine N-Oxide levels and 16S rRNA gut microbiota profiling in patients with heart failure and preserved ejection fraction and healthy individuals

Introduction

Recent evidence suggests the role of gut microbiota dysregulation in the pathophysiology of chronic heart failure (HF). Elevated levels of Trimethylamine N-Oxide (TMAO) have shown to increase the risk of cardiovascular events and HF. Among patients with HF and preserved ejection fraction (HF-pEF) the link between TMAO levels and ventricular fibrosis was observed in studies, however, the data regarding 16S rRNA microbiome profiling in this particular group of HF are lacking.

Purpose

The research was aimed at investigating the gut microbiome diversity and composition as well as the serum TMAO levels among two groups of patients: healthy controls (HC) and HF-pEF.

Methods

44 patients with HF-pEF and 45 HC with body mass index <35 kg/m2, no history of acute coronary syndrome, myocardial infarction or diabetes were enrolled in the study. All patients underwent transthoracic echocardiography with Doppler study to exclude diastolic dysfunction (E/e' <8 cm/s) or to prove HF-pEF (according to the recent ESC guidelines based on E/e' ratio, N-terminal pro-B type natriuretic peptide >125 pg/ml and symptoms of HF). The intestinal microbiome was investigated using high-throughput sequencing of bacterial 16S rRNA gene. TMAO levels were determined by liquid chromatography tandem mass spectrometry.

Results

The age in HC was 57,5 [48; 63] (28% men), age in HF-pEF group was 67 [64; 74] years (52% men). The serum concentration of TMAO in HC was 3.72 uM, in HF-pEF was 5.24 uM. The group of HF-pEF had significantly higher levels of the marker, p=0,003. Bacterial communities of both groups were dominated by the Firmicutes and Bacteroidetes phyla. The most abundant genus in both groups were Bacteroides. The Shannon index, the Chao 1 estimator, and the Simpson index assessing α diversity were not significantly different between groups. However, Bacteroides, Alistipes, Pseudomonas, and Fusobacterium were enriched in the common core microbiota of HF-pEF patients, while Lachnospira, Roseburia, Eubacterium, Methanobrevibacter and Faecalibacterium were depleted. To note, Lactobacillus and Bifidobacterium were depleted in HF-pEF patients too.

TMAO levels in HC and HF-pEF groups

Conclusions

We have shown significant structural alterations of the intestinal microbiome and increased TMAO levels in HF-pEF patients' serum compared to HC. These findings may enable deeper understanding of the complex multifactorial pathogenesis of HF-pEF for the future development of personalized microbiome-based diagnostics and therapies for individuals at risk.

[Telemonitoring in patients with chronic heart failure]

Actuality. High risk of hospitalisation and death in patients with heart failure highlight the importance of developing methods to moni‑ tor weight, diuresis, heart rate and other parameters and provide the physicians with an ability to change the therapy immediately if needed. The aim of this work is an analysis of clinical trials which investigate telemonitoring in patients with heart failure. Discussion. The Cochrane meta-analysis is also discussed in this work. Main conclusions. Our analysis showed that there is no consistency among trials. Not all trials have demonstrated that telemonitoring can reduce the risk of death and heart failure hospitalisations. Potentials explanations are lack of compliance with systems which didn't include the direct contact between the patient and the caregivers, using parameters with low sensitivity in some of the methods and including of stable patients in some of the studies. It is also seeming that effect of telemonitoring is low in regions with existing programs to treat heart failure.

[Opportunities and Problems of Analysis of Mortality from Myocardial Infarction According to Medical Certificates of Death (on the Example of the Tula Region)]

AIM

to analyze the quality of completion medical certificates of death (MCD) of residents of the Tula region, in which in 2017 acute and subsequent myocardial infarction (MI) was listed as the underlying cause of death (UCD) or as multiple causes of death (MC).

MATERIALS AND METHODS

From the electronic database (DB) of MCD of residents of Tula region for 2017 we selected all MSD in which MI was written down irrespective of a section of MCD. A total of 689 MSD (43.8% men and 56.2% women) were analyzed.

RESULTS

Mean age of the deceased was 72.6±11.3 years (men 67.25±0.62; women 76.7±9.8; p&lt;0.001). Multimorbid pathology was registered in 31.5% of the deceased. In 77.9% of cases myocardial infarction was selected as the UCD and in 22.1% - as a complication of other diseases. Among registered MI complications were hemotamponade (24.5%), cardiogenic shock (3.6%), ventricular fibrillation (0.3%), heart failure (50.2%). Complications of MI were not listed in 3.9% of MCD. Analysis of MCD showed that their completion did not comply with established ICD-10 rules and recommendations of Ministry of Health of RF; all lines were filled out only in 1% of completed MCD. Also, problems of determining the initial cause of death when myocardial infarction occurred in the presence of multimorbid pathology were revealed.

CONCLUSION

Mortality analysis using solely UCD leads to decreasing mortality rates from MI, and unsatisfactory quality of filling the MCD decreases the ability to identify MC, that prevents the correction of priorities in the organization of medical care. The revealed problems of coding causes of death require urgent solutions from the professional community of cardiologists, pathologists, and the Ministry of Health.

[Quality management in biobank. World tendencies and experience of biobank of FSI «NMRC for preventive medicine» of the Ministry of healthcare of Russia.]

This paper provides several definitions of the term "biobank"; a list of standards developed by the International Organization for Standardization (ISO) applicable to the activities of biobanks; analyzes the legal and ethical requirements; the Russian legal framework in the field of biobanking, the best international practices and recommendations; describes the experience of the development and implementation of quality management systems according to ISO 9001 in Biobanks established in different countries, and the experience of the Bank of Biological Material of the National Medical Research Center for Preventive Medicine of the Ministry of Healthcare of Russia. The ISO 20387 Biobanking Standard, released in August 2018, combined the knowledge and experience of specialists from around the world and defined the general requirements that must be fulfilled by biobanks and repositories wishing to guarantee their customers the high quality of the preanalytical stage of scientific research, biological samples and associated data. In 2019, the Russian version of this standard is expected. Documents of the quality management system provide the reproducibility of activities on the main storage processes and facilitates the process of incorporating a new employee; conducting internal and external audits; Biobank knowledge management - continuous staff education. The introduction of an effective quality management system into biobank activity warrants the high quality of biological samples, the standardized pre-analytical stage, reliable, regulated long-term storage of biomaterial and related information for use in research purposes today and in future.

Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem. Features of Etiology, Clinical Manifestation and Prognosis

In addition to conventional risk factors in young patients with ischemic heart disease (IHD) numerous other risk factors including genetics play an important role in its causation. Molecular genetic testing is recommended for the detection of monogenic diseases with a high risk of developing IHD, such as familial hypercholesterolemia. In majority ofyoung patients, the first manifestation of IHD is an acute coronary syndrome. Young patients with IHD more often have normal coronary arteries or single-vessel coronary disease, and in up to 20% of them cause of myocardial ischemia is not related to atherosclerosis. In general, young patients with IHD have better prognosis. However, there are sex differences in IHD outcomes the prognosis of patients with premature IHD and reason for this is still unclear.

[Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem: Prevalence and Cardio-Vascular Risk Factors]

Ischemic heart disease (IHD) occurring at age less than 55 in men and less than 65 years in women is designated as premature IHD. However, in different studies these age limits vary from 35 years to 65 years. Among the population of working age in the Russian Federation mortality from IHD is several times higher than in the US and Europe. Patients with premature IHD differ from the elderly in structure of risk factors, clinical manifestations and prognosis. Smoking, obesity and family history of premature IHD are more common in young patients with IHD while diabetes and hypertension are less common.

[Gut microbiota and obesity: Pathogenetic relationships and ways to normalize the intestinal microflora]

The review demonstrates mechanisms in the relationship of obesity to gut microbiota, as well as possible therapeutic measures to normalize the intestinal microflora. There is evidence that the latter makes a great contribution to the pathogenesis of obesity and related diseases. Investigations have shown the role of the nature of consumed foods (fatty foods) in reducing the amount of bifidobacteria and lactobacilli, as well as the effects of bacterial lipopolysaccharides and metabolites from the intestinal microflora (trimethylamine-N-oxide, bile acids, etc.). The use of prebiotics, probiotics and ursodeoxycholic acid preparations and fecal transplantation are promising in correcting the microflora and in providing their positive effect on metabolic disturbances. Certain probiotic strains are effective in treating dyslipidemia, diabetes mellitus, obesity, and metabolic syndrome. Gut microbiota is impaired in obesity and contributes to the development of cardiovascular diseases. The control of the gut microbiota and the use of drugs altering the composition of the microflora may become a novel approach to reducing the risk of cardiovascular diseases.

Identification of Novel Candidate Markers of Type 2 Diabetes and Obesity in Russia by Exome Sequencing with a Limited Sample Size

Type 2 diabetes (T2D) and obesity are common chronic disorders with multifactorial etiology. In our study, we performed an exome sequencing analysis of 110 patients of Russian ethnicity together with a multi-perspective approach based on biologically meaningful filtering criteria to detect novel candidate variants and loci for T2D and obesity. We have identified several known single nucleotide polymorphisms (SNPs) as markers for obesity (rs11960429), T2D (rs9379084, rs1126930), and body mass index (BMI) (rs11553746, rs1956549 and rs7195386) (p < 0.05). We show that a method based on scoring of case-specific variants together with selection of protein-altering variants can allow for the interrogation of novel and known candidate markers of T2D and obesity in small samples. Using this method, we identified rs328 in LPL (p = 0.023), rs11863726 in HBQ1 (p = 8 × 10⁻⁵), rs112984085 in VAV3 (p = 4.8 × 10⁻⁴) for T2D and obesity, rs6271 in DBH (p = 0.043), rs62618693 in QSER1 (p = 0.021), rs61758785 in RAD51B (p = 1.7 × 10⁻⁴), rs34042554 in PCDHA1 (p = 1 × 10⁻⁴), and rs144183813 in PLEKHA5 (p = 1.7 × 10⁻⁴) for obesity; and rs9379084 in RREB1 (p = 0.042), rs2233984 in C6orf15 (p = 0.030), rs61737764 in ITGB6 (p = 0.035), rs17801742 in COL2A1 (p = 8.5 × 10⁻⁵), and rs685523 in ADAMTS13 (p = 1 × 10⁻⁶) for T2D as important susceptibility loci in Russian population. Our results demonstrate the effectiveness of whole exome sequencing (WES) technologies for searching for novel markers of multifactorial diseases in cohorts of limited size in poorly studied populations.

The role of the mLDL-induced activation of the complement system classical pathway and C3 expression stimulation in atherosclerosis

The role of modified low density lipoprotein in the activation of the classical pathway of the complement system and increasing expression C3 gene in human macrophages is described, role of these processes on the progression of atherosclerotic vascular lesions is considering.

Place of vitamin D in the prevention of premature aging and the development of age-associated diseases

There is an ongoing search for the molecular and biochemical mechanisms underlying the development of aging and age-associated diseases. At the same time there is growing evidence geroprotective properties of vitamin D. In this review, described in detail the possible mechanisms by which vitamin D affects differentiation, cell proliferation and apoptosis, and describes the potential benefits of this vitamin in the fight against aging and age-related diseases.

[Place of vitamin D in the prevention of premature aging and the development of age-associated diseases]

There is an ongoing search for the molecular and biochemical mechanisms underlying the development of aging and age-associated diseases. At the same time there is growing evidence geroprotective properties of vitamin D.In this review, described in detail the possible mechanisms by which vitamin D affects differentiation, cell proliferation and apoptosis, and describes the potential benefits of this vitamin in the fight against aging and age-related diseases.

Chronic Respiratory Diseases in the Regions of Northern Russia: Epidemiological Distinctions in the Results of a National Population Study

The aim of the study is to investigate the epidemiological situation regarding chronic respiratory diseases in populations that inhabit different climatic–geographical regions of Russia, and to develop targeted programs for prevention of these diseases. Methods: (1) a comparative analysis of the standardized mortality data in Russia and other selected regions of the Russian North using the European standard for respiratory diseases, in a population aged 25–64; and (2) data from a randomized cross-sectional epidemiological study, with subjects from three different climatic-geographical regions of Russia. Results: (1) the respiratory disease-related mortality rates in the majority of Russian Northern regions were much higher compared to the national average. Although death rates from chronic lower respiratory diseases were higher among the Northern regions and in the whole of Russia relative to the countries of European Union (EU), the cause of death in the populations of the Northern regions tend to be lower respiratory infections and pneumonia; and (2) despite the absence of any significant differences in the prevalence of smoking, the prevalence of chronic respiratory diseases (COPD) is significantly higher in Far North Yakutsk compared to the other two regions in this study—Chelyabinsk and Vologda. The status of hyperborean had the highest chance of a significant contribution to COPD and cardiorespiratory pathology among all other risk factors. The results revealed a need for effective targeted strategies for primary and secondary prevention of chronic respiratory diseases for the populations of the Northern regions of Russia. Conclusions: The revealed regional distinctions regarding the prevalence of, and mortality from, chronic respiratory diseases should be taken into consideration when designing integrated programs for chronic non-communicable disease prevention in these regions.

[THE MODE OF EVALUATION OF FUNCTIONAL ACTIVITY OF C3-CONVERTASE OF CLASSIC PATH OF ACTIVATION OF COMPLEMENT]

The technique of detection of stabilization of C3-convertase classical way of activation of system of complement inhuman blood serum. The technique comprises two stages and is based on applying a reaction of lysis of erythrocytes of sheep sensitized by antibodies using 0.8% human blood serum. Preliminary an incubation of two samples (experimental and control) is applied during 10 min. and then reaction of activation of complement is stopped by adding a buffer containing 10 mM of EDTA. In control sample degree of lysis of erythrocytes is established and experimental sample is additionally incubated during 30 min at 37oC and then degree of lysis is determined. The activity of C3-convertase is calculated as a difference between degree of lysis and in experimental and control samples. The difference more than 10% is considered as a pathological state conditioned by stabilization of C3-convertase of classical way of activation of system of complement. The studies were carried out concerning stabilization of C3-convertase of classical way of activation of compliment in 31 patients with abdominal obesity. It is demonstrated that in 87% of patients with abdominal obesity stabilization of C3-convertase was established.

[Evaluation of cardiovascular remodeling and epicardial fat thickness in patients with chronic heart failure and metabolic syndrome]

AIM

To estimate cardiac chamber sizes and epicardial fat (EF) thickness in patients with chronic heart failure (CHF) and metabolic syndrome (MS).

MATERIALS AND METHODS

The investigation enrolled 77 patients with CHF. The diagnosis of the latter was made on the basis of clinical symptoms and verified measuring N-terminal pro-brain natriuretic peptide levels in all the patients. A study group (SG) included 39 patients with CHF and MS. A control group comprised 38 CHF patients without MS. Clinical and biochemical blood tests and electrocardiography were performed in all the patients. Cardiac chamber sizes, myocardial wall thickness, and EF were estimated from echocardiographic findings. Fatty liver index (FLI) and nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) were calculated in all the patients.

RESULTS

All the patients had clinical signs and symptoms of CHF. There were 25 (32%) men among the 77 patients. The mean age was 63.9±10.3 years. The patients with CHF and MS showed pronounced myocardial remodeling, which was manifested as significantly higher increases in the sizes of cardiac chambers and in the thickness of their walls and as larger EF thickness (EFT) and larger myocardial mass. In SG, EFT was 3.39±1.82 mm (p=0.00001). This group exhibited correlations between EFT and FLI (r=0.52; p=0.004), glycated hemoglobin levels (r=0.41; p=0.016), E peak (r=-0.25; p=0.005), E/A ratio (r=0.25; p=0.041), left ventricular (LV) end-systolic size (r=0.25; p=0.035), LV myocardial mass (r=0.29; p=0.038), NFS (r=0.29; p=0.002), and body mass index (r=0.29; p=0.003).

CONCLUSION

The found correlations between EFT and the clinical and metabolic parameters of CHD and cardiovascular diseases allow EFT to be regarded as a new marker of risk for MS and cardiovascular diseases.