A significant number of epidemiological studies have shown that hyperuricemia is highly associated with the risk of developing cardiovascular disease, chronic kidney disease, and diabetes. In this connection, increased attention is required to monitor serum uric acid levels in patients, not only from a rheumatological point of view, but also with regard to reducing cardiovascular and renal risks. This article is a review of studies on the association of hyperuricemia with cardiovascular risk and a new consensus for the management of patients with hyperuricemia and high cardiovascular risk, published in december 2019 by a group of experts of the Russian Medical Society for Arterial Hypertension, which, among other things, includes a management algorithm of this category of patients.

The aim of our research work was to study asymmetric dimethylarginine (ADMA) level in a comparative aspect in patients with unstable angina (UA) and acute myocardial infarction (MI) with an analysis of the frequency of normodimethylargininemia (NDAN) and hyperdimethylargininemia (HDAN). In total 104 patients with acute coronary syndrome (ACS) and 20 somatically healthy individuals as a control group were included in the study. From 104 patients with ACS, 63 patients had acute MI, 41 patients had UA. From 41 patients with UA, there were 15 patients with first-time angina and 26 patients with progressive angina. Enzyme-linked immunosorbent assay was used to determine ADMA level. Statistica program version 12.0 was used to data processing. As a result of the study, it was found that the level of ADMA was statistically significantly higher in all patients with ACS compared to somatically healthy individuals. At the same time, the value of the ADMA level in patients with acute MI was statistically significantly higher than in patients with UA, among whom the ADMA level was statistically significantly higher in patients with progressive angina than in patients with first-time angina. Based on the analysis of the frequency of NDAN and HDAN, only 33 % of patients with first-time angina were diagnosed with NDAN. HDAN was detected in 100 % of patients with progressive angina and acute MI. The value of the ADMA level in patients with Q-wave MI was statistically significantly higher than in patients with non Q-wave MI, in patients with complicated MI it was statistically significantly higher than in patients with uncomplicated MI, and in patients with cardiogenic shock it was statistically significantly higher than in patients with pulmonary edema.

Aim. To develop a personalized algorithm for predicting the progression of atrial fibrillation and its complications in hypertension in combination with extracardial diseases. Methods. The observational cohort study observed 308 men aged 45–60 years with AF and AH in combination with extracardial pathology: diabetes mellitus (DM; n = 40), diffuse toxic goiter (TTZ; n = 42); hypothyroidism (GT; n = 59), abdominal obesity (AO; n = 64) and chronic obstructive pulmonary disease (COPD; n = 47). The comparison group consisted of 56 patients without extracardial pathology. Clinical, laboratory, anthropometric data, results of daily ECG monitoring and echocardiography were evaluated. All statistical calculations were performed in Rstudio program. Results. Found significant predictors of progression of atrial fibrillation: indicators of remodeling: galectin-3, which increase by 1 ng/l increases the risk of progression to 1.0030 (1.0006; 1.0050) times (p = 0.016); PL (p < 0.001), with an increase of 1 cm, the risk increases to 2.67 (1.58; 4.65) times; KDR (p = 0.025), with the increase of 1 cm decrease the chance of atrial fibrillation recurrence in 0.13 (0.02; 0.65) and LVMWI, where the increase LVMWI 1 g/m 2 increases the risk of progression of AF at 0.9 times; also, the inflammation index-with an increase in IL-6 by 1 PG/l, the risk increases by 0.6 times, and the vascular stiffness marker MMP-9 – an increase by 1 ng/ml increases the risk of progression by 0.16 times. It was determined that emergency hospitalization for the progression of CHF during the year in patients with atrial fibrillation was significantly more common in all clinical groups, except for patients with hypothyroidism. Statistically significant predictors of hospitalization for CHF progression were revealed: increase of LP size by 1 cm increases CHF risk by 5.04 (1.80; 16.10) times; an increase in NT-proBNP by 1 pg/l increases the risk of CHF by 1.01 (1.00; 1.02) times. The comparative assessment of the incidence of cardioembolism in these groups, although not showed a statistically significant difference, but in percentage terms was higher in patients with atrial fibrillation – 11.2 vs. 6.0 % in patients without atrial fibrillation, the relative risk of confidence interval – 3.736 (0.500; 26.900). Conclusion. The developed personalized algorithm can be used to assess the prognosis of progression of atrial fibrillation and the development of its complications in hypertension in combination with extracardial diseases

At present, there are no generally accepted normative values for blood pressure (BP) in athletes under exertion. Objective: to determine the normative parameters of blood pressure in young elite athletes in a test with dosed physical activity. 500 (229 girls and 271 boys) young elite athletes of 14–17 (15.8 ± 1.5) years old were examined, members of the youth teams of the Russian Federation, different in static and dynamic sports. The control group consisted of 36 healthy adolescents of the same age who are not involved in sports. All subjects underwent bicycle ergometry according to the PWC 170 protocol with an initial load of 1 W/kg, followed by an increase in load every 3 minutes by 25 W until a pulse of 170 bpm was reached or fatigue, blood pressure was measured manually according to the method of N. S. Korotkov at the end of each stage of the load. For young elite athletes, the maximum values of systolic blood pressure (SBP) on the load were significantly higher than for their peers who were not involved in sports (185 ± 20 vs 154 ± 15 mm Hg; p < 0.001). In a sample with dosed physical activity, the parameters of the SBP in young elite athletes can reach up to 230 mm Hg with an adequate increase in heart rate (heart rate ≥ 170 bpm.).

Research aim. The article is devoted to the research of the mechanisms of arterial hypertension development among patients with abdominal aortic atherosclerosis and formation of chronic lower limb ischemia (Leriche’s syndrome). Materials and methods. The presence of thrombotic occlusion of the extremity arteries and its level were evaluated in 129 cases of atherosclerotic aortic lesion complicated by acute thrombotic occlusion of the lower (112) and upper (17) extremities, according to physical data the absence of pulsation (or a sharp decrease in it) on the arteries during palpation, according to the results of ultrasound Doppler scanning of the limb arteries and according to multispiral computer angiography with contrasting. Uzdg was performed on a multi-functional ultrasound scanner MyLab 70 (Esaote, Italy), in in-mode. Echocardiography was performed on Acuson 128XP device (Acuson, USA) in two-dimensional and M-modal modes. Left ventricular systolic function was evaluated in B-mode using the Simpson method (1995). The glomerular filtration rate was calculated using the Cockcroft-Gault formula. The coagulogram was studied on the device ACL Elite Top (USA). Results. With the development of thrombotic occlusion of the lower extremity arteries, the character of the course of arterial hypertension worsens. Chronic arterial hypertension is detected in most patients with aortic atherosclerosis, complicated by thrombotic occlusion of the lower and upper limb arteries. More than 80 % of hypertension is characterized by systolic-diastolic type and only a small part (less than 20 %) shows isolated systolic character. Conclusions. Operative restoration of the main blood flow in the extremities has a positive effect on the course of hypertension in most patients.

Relevance. One of the main causes of death and disability in the world is thrombotic diseases, the effective means of prevention of which is the use of anticoagulants. However, their purpose is associated with a certain risk, including the development of gastrointestinal bleeding, which can be fatal. The search for ways to minimize the risks of gastrointestinal bleeding in patients taking new oral anticoagulants is an urgent task of clinical medicine. Aim. Analyze literature data to systematize data on risk factors, treatment options and prevention of gastrointestinal bleeding with the use of new oral anticoagulants in patients treated for pulmonary embolism. Materials and methods. A literature review of the data of domestic and foreign authors on the problem of pathogenesis, clinical manifestations, diagnosis, treatment and prevention of damage to the gastrointestinal tract during treatment of pulmonary embolism was conducted. Results. An attempt was made to systematize the literature data on risk factors, prevention and treatment of gastrointestinal bleeding, taking into account the individual characteristics of the patient, based on evidence. The description of their own clinical observation is provided. Conclusions. When prescribing therapy with new oral anticoagulants, it is necessary to consider benefits and risks, take into account the risk factors for gastrointestinal bleeding, keeping in mind the individual characteristics of the patient and work on their prevention.

Treatment of burns is a complex, multi-stage and financially costly process. Methods of treatment of patients with thermal trauma are currently continuing to improve: a multidisciplinary approach to treatment is being formed; burn centers have been established, where doctors of various specialties (surgeons, traumatologists, anesthesiologists, rehabilitologists, therapists, ophthalmologists and many others) participate in the treatment of patients. However, to date, the question of wound treatment in patients with deep burns at the stages of preparation for plastic closure and after autodermoplasty with a split perforated 1:4 graft remains open. It is known that extensive and deep burns are accompanied by the development of wound infection, which is one of the important factors that disrupt the epithelization of wounds. This results in lysis of the grafts and may require repeated surgery or long-term conservative treatment at the site of the operation.

The article presents the experience of successful surgical treatment of a patient with a severe burn injury using biological wound coatings with cadaveric skin grafts and dermal matrix afer wound debridement. Each of the presented biological coatings was evaluated on the basis of their clinical effectiveness (general condition of the patient, stage of the wound-healing process) and the results of microscopic examination of histological material during preparation of wounds for autotransplantation.

In order to include innovative technologies in clinical recommendations, confirmation of their clinical effectiveness in comprehensive treatment of burned patients is necessary. 1,696 case histories of patients with burns were audited, which are divided into two groups depending on peculiarities of treatment. The use of innovative treatment technologies for burned patients has reduced the incidence of burn disease complications and mortality. Introduction of innovative technologies in treating burned patients into broad clinical practice improves results of provision of specialized, high-tech medical care for victims of burns.

Objective. To present our clinical case of extracorporeal life support using a standard oxygenator in a patient undergoing cardiac surgery when standard cardiopulmonary resuscitation (CPR) turned out to be ineffective. Methods. The response to treatment of patient G. aged 49 years is presented here who initially underwent off-pump mammary coronary artery bypass grafting (1-CABG) with left internal thoracic artery to the anterior interventricular artery without any technical peculiarities. 8 hours after the surgery a cardiac arrest occurred with the patient in the intensive care unit (ICU). Resuscitation measures resulted in no response. CPB machine was connected as part of cardiopulmonary resuscitation complex (CPR). Standard oxygenator (Medtronic Affinity NT) equipped with a set of standard lines was used for a circulatory support. Result. At ICU emergency resternotomy was performed and CPB machine was connected as well. It took 26 minutes from the beginning of resuscitation to the extracorporeal circulation. CPB machine was connected centrally (ascending aorta to the right atrium). Against the ongoing extracorporeal life support the patient was transported to the x-ray operating theatre for emergency coronary bypass angiography during which pronounced native coronary artery spasm in all basins was diagnosed; intra-aortic balloon pump was used. The cardiac activity was restored. Reperfusion took 128 minutes. Extracorporeal circulation was stopped when 5 mcg/ kg/min. dopamine infusion and nitroglycerin used at a dose of 1 mcg/kg/min. ensured satisfactory hemodynamic parameters. The extracorporeal circulation lasted for 185 minutes. The patient spent three days at the ICU and was discharged on the 11th day after the surgery has been performed in a satisfactory condition with no neurologic impairment; at discharge the left ventricular ejection fraction (LVEF) by Simpson was 60 %. Conclusion. The extracorporeal life support as part of CPR in cardiac patients can contribute to the reduction of mortality for the described patient cohort.

The experience of clinical testing of the personal telemedicine system ‘Obereg’ for remote monitoring of patients at the intensive care units of leading Russian clinics is described. The high quality of communication with the remote receiving devices of doctors, the accuracy of measurements, resistance to interference from various hospital equipment and the absence of its own impact on such equipment were confirmed. There are significant advantages compared to stationary patient monitors, in particular, for intra and out-of-hospital transportation of patients.

The aim of the study is a comparative evaluation of the efficacy and safety of ultra-low-dose spinal analgesia, epidural and paravertebral analgesia to labor pain relief. Material and methods. Four groups of 40 women took part in the study: one group is 40 patients, the labor pain was relieved by epidural analgesia, The second group consisted of 40 women in labor, anesthesia was carried out with ultra-low-dose spinal analgesia, 3rd group is 40 women who were anesthetized with paravertebral analgesia.The control group is 40 patients without anesthesia. The parameters of central hemodynamics were monitored: heart rate, blood pressure, mean arterial pressure. The motor block was estimated on the Bromag escale. The dynamics of the opening of the cervix, the duration of the first and second stages of labor was estimated. Implications and negative influence of the anesthesia, the effect of analgesia on the fetus were also registered. Findings. Epidural analgesia showed high efficiency and safety, but the frequency of hypotension in this group was significantly higher than in other groups, an increase in the positivity of the exacerbation period was found. Ultra-low-dose spinal analgesia also had a sufficient analgesic effect in the first stage of labor. However, short-termeffect did not always provide effective analgesia of the second period of labor in comparison with other methods. In general the advantages of paravertebral analgesia in the form of a significant acceleration of cervical dilatation and a decrease in the time of delivery are revealed. There were no cases with score of ‘2’ of Bromagescale of a motor block with paravertebral analgesia, while in the epidural group and the ultra-low-dose spinal analgesia isolated cases with a score of ‘1’ and ‘2’ were encountered. Paravertebral analgesia does not result to hypotensionas against other neuro-axial methods of analgesia. Conclusion. Neuroaxialmethods provide a sufficient level of analgesia can reduce anomalies of labor and do not affect negatively the fetus. All presented methods of anesthesia have their place in obstetric anesthesiology. There is the possibility of choosing the most appropriate method of anesthesiain every obstetrical situation.