Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

CML), the accepting inhibitors tyrosine of kinases (TKI) I and the II generations (TKI1 and TKI2 respectively), and development of arterial hypertension.Material and methods. Examination of 137 patients with CML in the chronic phase (CP) is conducted, the median of age — 47 years. 24 of them were with for the first time the verified diagnosis of CML and earlier did not accept TKI, they have made group of control. Other patients accepted TKI: 39 patients — imatinib 400 mg/day, 36 — dasatinib 100 mg/day, 38 — nilotinib 800 mg/day) more than 6 months. In biochemical analysis of blood indicators of lipidic range were defined. Level detection of ET-1 and VEGF was made by means of enzyme immunoassay. To all patients measurement of the heart rate (HR) and the arterial blood pressure (ABP) on both hands at an interval of 2 minutes from previous was once taken.Results. In group of patients from CML accepting nilotinib authentically significant increase in levels of systolic and diastolic ABP (р<0,001) in comparison with group of control, with group of the patients accepting imatinib and dasatinib is noted. The most serious changes of lipidic range are noted at the patients accepting nilotinib. In all groups statistically significant increase in level of C-reactive protein, fibrinogen, homocysteine, endothelin-1 and VEGF in comparison with group of control is revealed. The most expressed changes are found in group of the patients accepting nilotinib, values of parameters of C-reactive protein, fibrinogen, homocysteine, endothelin-1 and VEGF are changed authentically (р<0,001) and statistically significantly differ in comparison with group for the first time of the revealed patients with CML and groups of reception of imatinib and dazatinib.Conclusion. As a result of the conducted research endothelium variation of a function at patients from CML accepting TKI1 and TKI2 is revealed. The above-stated indicators can be used as additional diagnostic criteria for assessment of risk of development of arterial hypertension in patients with CML at reception of TKI.

This work is devoted to the study of human blood protein fractions by Raman spectroscopy. Whole blood and blood plasma were used as the tested samples. For the pure Raman spectra analysis the autofluorescence background was subtracted by using of two mathematical approaches: polynomial approximation and baseline correction with asymmetric least squares. The study allowed for revealing the differences between the spectral features of blood plasma and whole blood plasma, which are changes in the relative Raman intensities of plasma and whole blood and appearance Raman bands 670 cm -1 , 750 cm -1 , 1120 cm -1 and 1550 cm -1 correspond to hemoglobin bonds in whole blood. The spectral features were used for total protein concentration measurement of plasma and whole blood. PLS regression method was utilized for spectral data analysis with different protein concentrations. The VIP-scores make it possible to determine the most informative spectral bands: 1002 cm -1 , 1227 cm -1 , 1400 cm -1 , 1630 cm -1 for proteins analysis.

The article is dedicated to contemporary views on the change of endothelial function in the patients with lymphoproliferative disorders prior to, and in the process of, chemotherapeutic treatment. Considering that possibilities of standard examination do not always help identifying subclinical endothelial dysfunction, it is necessary to use specific methods, in particular, to determine the levels of endothelin-1 and vascular endothelial growth factor to monitor endothelial function. The objective of this review is to identify problems and prospects for recognizing early subclinical changes of endothelial function in the patients with lymphoproliferative disorders before and after chemotherapy. Assessing presence and severity of endothelial dysfunction may be useful for determining subclinical stages of cardiovascular damage, stratifying the risk of the patients with confirmed cardiovascular disease, and reducing the likelihood of cardio- and endotheliotoxic effects in patients long after chemotherapy. That is why early detection and immediate therapy of cardiovascular toxicity is currently the most important task in the patients with lymphoproliferative disorders, receiving chemotherapy.

Introduction. Frequent bleeding with hemophilia significantly worsens the quality of life of patients. The pathogenesis of hemorrhage in hemophilia has not been studied enough, especially at the vascular level, so it is necessary to study microcirculation in this disease. The purpose of the study is to assess the mechanisms of regulation of blood tissue perfusion and the adaptive reserves of the microcirculation system in patients with hemophilia. Materials and methods. Total microcirculation was assessed by laser Doppler flowmetry in 44 patients with hemophilia A between the ages of 14 and 20 years. Severe form of the disease was in 59 % of patients, the average – in 32 %, light – in 9 % of patients. The control group included 26 healthy men aged 14 to 19 years. The sensors recorded blood flow in the index fingers on both sides. In 20 patients with hemophilia А, an occlusion test was performed. The results of the study. In patients with hemophilia, asymmetric changes in microcirculation parameters were detected when measured in the area of the index fingers. At rest in patients with hemophilia, the prevalence of vasospasm was revealed: a decrease in the perfusion index M, an increased blood bypass due to the predominance of myogenic tone. However, neurogenic tone indicators tended to decrease. During occlusive ischemia, vasospasm is slowed down in the first seconds after the onset of exposure to the stress factor. Conclusion. The study revealed a dysregulation of the vascular tone of the microvasculature in young hemophilia patients at rest and under the influence of a stress factor in the form of short-term ischemia. Therefore, with hemophilia from a young age, control of microcirculation is necessary for the timely prevention of both bleeding and cardiovascular pathology associated with vasospasm.

90Особенности нарушения сократительной способности миокарда у больных хроническим лимфолейкозом в процессе химиотерапии и их коррекция эналаприлом Давыдкин И. Л., Кузьмина Т. П., Золотовская И. А., Терешина О. В., Данилова О. Е., Хайретдинов Р. К., Рогозина Л. А.Цель. Оценка нарушений сократительной способности левого желудочка (ЛЖ) в процессе химиотерапии по схеме FCR (флударабин, циклофосфамид, ритуксимаб) у пациентов с хроническим лимфолейкозом (ХЛЛ) и эффективности их коррекции эналаприлом. Материал и методы. В исследование вошли 49 пациентов с впервые выявленным ХЛЛ стадии В по Вinet в сочетании со стабильной стенокардией напряжения (ССН) I-II функционального класса (ФК), артериальной гипертензией 1-2-й степени и фракцией выброса (ФВ) ЛЖ >50%, которые не принимали препараты из группы ингибиторов ангиотензинпревращающего фермента (иАПФ), не имели клинических признаков сердечной недостаточности (СН) и у всех показания к лечению по схеме FCR были до его начала. Пациенты прошли двухмерную эхокардиографию (ЭхоКГ) исходно, до начала полихимиотерапии (ПХТ) (период V 1 ) и после трех (84±5 дней) (V 2 ) и шести (168±7 дней) (V 3 ) курсов ПХТ. На V 2 пациенты были разделены на две группы. К лечению в основной группе была добавлена кардиопротективная терапия (эналаприл). Результаты. После третьего курса ПХТ отмечено относительное процентное снижение глобальной продольной деформации (Global Longitudinal Strain, GLS) в основной и контрольной группах -на 16, 16±0,80 и 16,2±0,79, соответственно (р=0,764), что является предиктором кардиотоксичности. При этом показатель ФВ ЛЖ (%) оставался в пределах нормального диапазона: 63,4 [65; 68] в основной группе и 63,9 [61,6; 67] в группе контроля (р=0,960). После шестого курса ПХТ показатели ФВ ЛЖ достоверно различались (р=0,002): в группе контроля у пяти пациентов (21%) зафиксировано развитие кардиотоксичности, которая отсутствовала в основной группе. Заключение. Клинически значимое снижение GLS является маркером субклинической сократительной дисфункции ЛЖ с прогнозируемым развитием кардиотоксичности у пациентов с ХЛЛ в процессе химиотерапевтического лечения по схеме FCR. Своевременное добавление к лечению эналаприла позволяет предотвратить развитие кардиотоксичности у таких пациентов. Доказана необходимость ранней оценки GLS во время курсов терапии по схеме FCR для выявления и предупреждения кардиотоксичности.Ключевые слова: хронический лимфолейкоз, субклиническая сократительная дисфункция левого желудочка, кардиотоксичность, химиотерапия, эналаприл.

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The review outlines current views on immune system in multiple myeloma (MM) and the basic pathogens inducing infectious complications in such patients. Although in recent years there has been considerable progress in studying molecular mechanisms of the MM development (pathogenesis), methods of its diagnosis, treatment, and prediction of outcomes, one of the main causes of death within this group of patients is infectious complications. In this context, it would be relevant to further study immune disorders and the spectrum of infectious pathogens common in the MM patient cohort. The study and correction of immunological status can contribute to improving the MM outcomes, which in turn will lead to increased life expectancy.