Резюме Цель исследования. Оценка приверженности к терапии и определение роли различных факторов, влияющих на приверженность пациентов к лечению в амбулаторных условиях, а также оценка клинической эффективности антагониста кальция фелодипина. Материалы и методы. Обследовали 5474 пациентов (мужчины и женщины) старше 18 лет с исходным уровнем офисного систолического артериального давления (АД) 140-179 мм рт. ст. и диастолического АД до 100 мм рт. ст. на фоне гипотензивной терапии или без нее, побывавших на приеме у участкового терапевта. Всем больным кроме общего клинического обследования, включавшего офисное измерение АД, проводили оценку ФР, сопутствующей терапии. Все больные самостоятельно оценивали свое самочувствие с использованием визуальной аналоговой шкалы (ВАШ), приверженность пациента к терапии оценивали с использованием теста Мориски-Грина. Обязательно регистрировали получение пациентом антигипертензивных препаратов в рамках системы дополнительного лекарственного обеспечения (ДЛО). Результаты. Среди амбулаторных больных артериальной гипертонией (АГ) и ишемической болезнью сердца (ИБС), обследованных в поликлиниках Москвы, более 60 % имеют низкую приверженность к приему назначенных препаратов. С высокой приверженностью к лечению ассоциируются такие факторы, как осложненное течение АГ при ее сочетании с ИБС, или сахарный диабет (СД), а также использование в терапии ингибиторов ангиотензинпревращающего фермента, антагонистов кальция, блокаторов рецепторов ангиотензина II. С низкой приверженностью к лечению достоверно ассоциированы мужской пол, пожилой возраст, наличие ФР развития сердечно-сосудистых осложнений и длительный анамнез АГ. Наличие препаратов в списке ДЛО при однофакторном анализе ассоциировано с высокой приверженностью к терапии. Включение в анализ таких дополнительных факторов, как ИБС, СД и наличие домашнего тонометра (многофакторный анализ), делает вклад ДЛО в высокую приверженность незначимым и недостоверным. Применение фелодипина в амбулаторных условиях позволяет не только достигнуть выраженного гипотензивного эффекта у больных АГ как в период подбора дозы, так и при последующем наблюдении, но и достоверно улучшить приверженность в группе пациентов с низкой приверженностью к лечению. Заключение. Необходимо регулярно проводить оценку возможной низкой приверженности к терапии с целью ее повышения при длительном амбулаторном наблюдении

Characteristics of cosmic-ray hadronic interactions in the l00_1017 eV range are studied by observing a total of 429 cosmic-ray families of visible energy greater than 100 TeV found in emulsion chamber experiments at high mountain altitudes, Chacaltaya (5200 m above sea level) and the Pamirs (4300 m above sea level). Extensive comparisons were made with simulated families based on models so far proposed, concentrating on the relation between the observed family flux and the behaviour of high-energy showers in the families, hadronic and electromagnetic components. It is concluded that there must be global change in characteristics of hadronic interactions at around l0b~eV deviating from those known in the accelerator energy range, specially in the forwardmost angular region of the collision. A detailed study of a new shower phenomenon of small-pT particle emissions, PT being of the order of 10 MeV/c, is carried out and its relation to the origin of huge "halo" phenomena associated with extremely high energy families is discussed as one of the possibilities. General characteristics of such super-families are surveyed.

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We have proposed an experiment on verification of the Reverse Cherenkov Radiation effect in a Left-Handed-Material-loaded waveguide. Applications of reverse Cherenkov radiation effect may range from novel higher-order-mode absorbers in microwave and millimeter-wave sources to improved particle detectors for satellite non-proliferation missions. The experimental configuration employs a circular waveguide filled with an artificial metamaterial with simultaneously negative permittivity and permeability, in which the electromagnetic wave with a frequency of 95 GHz will interact with an electron beam. We have demonstrated that for certain values of effective permittivity and permeability only the backward-propagating mode can be exited by the electron beam. In this presentation we will discuss the results of simulations and different manufacturing and assembling techniques for the metamaterial-loaded waveguide.

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Aim To study the oxidative modification of red blood cell Cu,Zn superoxide dismutase (SOD) in patients with ischemic heart disease (IHD) in vivo and in vitro to substantiate the use of a new oxidative stress marker.Material and methods Red blood cell Cu,Zn SOD was measured by depression of nitrotetrazolium blue reduction by the superoxide anion generated in xanthine oxidase xanthine oxidation. Red blood cell Cu,Zn SOD was measured immunochemically. The biochemical study was performed in the control group (patients with low extremity fracture without known history of cardiovascular diseases and hyperlipidemia) and in groups of patients with acute myocardial infarction, stable angina, and decompensated heart failure. For evaluation of oxidative stress intensity in IHD patients, an empirical SOD oxidative modification coefficient (OMCSOD) was proposed, which is a Cu,Zn SOD activity / Cu,Zn SOD content ratio.Results The red blood cell Cu,Zn SOD activity was significantly decreased in all IHD groups compared to the control group. Furthermore, OMCSOD was also considerably decreased in IHD patients, which warrants the use of this biochemical index as an oxidative stress marker.Conclusion It was shown that the Cu,Zn SOD modification was induced by interaction of the enzyme molecules with a natural dicarbonyl, malonic dialdehyde, and OMCSOD can be used for evaluation of oxidative stress intensity in IHD patients.

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The Paris climate agreement confirmed that climate change continues to pose a global concern and required all Parties to put forward their best efforts to protect public health. In the conditions of global warming, climate-induced risks gained importance as a public health hazard and confirmed the need to develop national action plans. Such plans shall be developed locally, taking into account the requirements of the National Action Plan for adaptation to health risks induced by changing climate. This manuscript presents the data on climate-dependent mortality. The global annual burden of excess deaths attributed to climate change is over 150,000 cases, which leads to a loss of 5.5 million years of productive life per year. Early warning systems have been adopted in many countries, with the goal to prevent heat-related deaths. If such a system were implemented in Moscow, eleven thousand excess deaths could have been avoided during the extremely hot summer of 2010. Heat watch warning systems are based on scientific data on heat thresholds. On the days with temperatures above such thresholds, climate-dependent mortality increases. Such thresholds have been established in the environmental epidemiology studies conducted in Moscow, Northern and Southern cities, the cities with continental and monsoon climates. The experience of implementation of early warning systems during extreme weather events was analyzed. The relative powers of bioclimatic indices as predictors of daily mortality rates during extreme weather events were compared. To prevent complications of cardiovascular diseases, a set of protective measures was proposed which included cardiology medications, recommendations on personal behavior and drinking habits during extreme heat, and other measures. The risks and examples of occurrence and northward propagation of climate-dependent infectious diseases such as Siberian anthrax, West Nile fever, Crimean-Congo hemorrhagic fever, and dirofilariasis, were described.