Цель. Оценить структурно-функциональное состояние сердца, перифериче-ских сосудов и кровотока, эндотелиальную дисфункцию и цитокиновый статус при аГ в сочетании с ХОбл в условиях комбинированной терапии препаратом ко-ренитек. Материал и методы. исследование, включающее специальные лаборатор-ные, функциональные и ультразвуковые методы, проведено у 37 больных аГ в сочетании с ХОбл. Результаты. Оценены клиническая симптоматика, параметры суточного про-филя артериального давления, структурно-функциональное состояние эндо-телия, периферических сосудов и сердца на модели аГ в сочетании с ХОбл в условиях 6-месячной комбинированной терапии препаратом ко-ренитек. заключение. комбинированная терапия препаратом ко-ренитек досто-верно позволяет нор мализовать артериальное давление, улучшить клиниче-скую симптоматику и показатели гемодинамики, клинико-функциональное состояние сердца и сосудов, кровоток и микроциркуляцию, снизить маркеры эндотелиальной дисфункции и системного воспаления у больных аГ в соче-тании с ХОбл. Российский кардиологический журнал 2014, 1 (105): 95-100Ключевые слова: артериальная гипертензия, хроническая обструктивная болезнь легких, ремоделирование сосудов и сердца, эндотелиальная дис-функция, системное воспаление, эффективность терапии. Шпагина л. а. -д. м.н., профессор, заведующая кафедрой госпитальной терапии и медицинской реабилитации, Шпагин и. с. -к. м.н., ассистент кафедры терапии, гематологии и трансфузиологии ФПк и ППВ, Поспе-лова т. и. -д. м.н., профессор, заведующая кафедрой терапии, гематологии и трансфузиологии ФПк и ППВ, Герасименко О. Н.* -д. м.н., профессор кафедры госпитальной терапии и медицинской реабилитации, сухате-рина Н. а. -аспирант кафедры госпитальной терапии и медицинской реаби-литации, аличева я. м. -аспирант кафедры госпитальной терапии и меди-цинской реабилитации.*автор, ответственный за переписку (Corresponding author): ongerasimenko@muzgkb2.ru, 5085@ngs.ru аГ -артериальная гипертензия, ВНОк -Всероссийское научное общество кардиологов, ДаД -диастолическое артериальное давление, Дим -диа-метр интима-медиа, ДП Ркк -реакция кожного кровотока в дыхательной пробе, е/а лЖ -отношение пик е/пик а над створками митрального клапана, е/а ПЖ -отношение пик е/пик а над створками трехстворчатого клапана, еОк -европейское общество кардиологов, имм лЖ -индекс массы мио-карда левого желудочка, имт -индекс массы тела, лДФ -лазерная доппле-ровская флоуметрия, лакк -лазерный анализатор капиллярного кровотока, лЖ -левый желудочек сердца, мОс 25 -максимальная объемная скорость воздуха на уровне выдоха 25% форсированной жизненной емкости легких, мОс 50 -максимальная объемная скорость воздуха на уровне выдоха 50% форсированной жизненной емкости легких, мОс 75 -максимальная объем-ная скорость воздуха на уровне выдоха 75% форсированной жизненной емко-сти легких, ОП Рк -окклюзионная проба резервного кровотока, ОФВ 1 -объем форсированного выдоха за 1 с, ПЖ -правый желудочек сердца, Пм -показатель базальной микроциркуляции, саД -систолическое артериальное давление, сДла -систолическое давление в лег...

BACKGROUND: Post-stroke cognitive impairments negatively affect the results of rehabilitation, worsening the outcomes of motor functions recovery, daily activity, and also increase the likelihood of recurrent stroke and premature death. Therapeutic physical factors contribute to the activation of the body's reserve capabilities and aim at correcting metabolic and vascular disorders, improving the functional status of the nervous system, which allows them to be used in a complex of rehabilitation measures. AIM: to substantiate the use of dynamic electric neurostimulation in the correction of cognitive impairment in patients in the early recovery period of ischemic stroke. MATERIALS AND METHODS: A prospective cohort study of 60 patients in the early recovery period of ischemic stroke, with mild and moderate cognitive impairment, at an average age of 62.44.5 years, divided by random sampling into 3 groups: group 1 (n=25), in addition to the basic rehabilitation complex, which included medication, sessions with a neuropsychologist, massage and physical exercise therapy, received a 15-day course of dynamic electric neurostimulation from the "Neurodance-PCM" device; group 2 (n=20) received the basic rehabilitation complex and procedures from the placebo device similar to procedures on "Neurodance-PCM"; group 3 (n=15) received only the basic rehabilitation treatment. All patients underwent an assessment of cognitive status using the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB) and the study of psychophysiological status on the psycho-physiological tester "NS-Psychotest", using the following tests: tapping test, the SchultePlatonov tables with red-black cells, test of simple visual-motor reaction, reaction to a moving object test. RESULTS: Over the two-week rehabilitation, it was found that the inclusion of dynamic electrical stimulation, in addition to the standard therapy of cognitive impairment in patients in the early recovery period of ischemic stroke, improves attention, memory, speech fluency, generalization functions, complicated choice reaction, increases the functions of visual attention and the speed of sensorimotor response, which was not noted in the comparison groups. CONCLUSIONS: The inclusion of dynamic electric neurostimulation in the rehabilitation complex of patients in the early recovery period of ischemic stroke with mild and moderate cognitive impairment may affect cognitive functions by stimulating the third block of the brain according to A.R. Luria and improving the neurodynamic support of higher mental functions.

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The study included men and women over 18 years of age with an established class II-IV HF and at least one hospitalization due to acute decompensated HF within 12-month follow-up.Results. The final analysis included 888 patients (men, 52,9%; women, 47,1%; mean age, 69 [61; 78] years). The preserved ejection fraction (EF) was detected in 47,86% of patients, mid-range — in 40,54%, reduced — in 11,6%. Only in 16% of patients, there was improved by 1 or more HF. Hypertension and coronary artery disease were predominant in etiology pattern of HF. Preserved EF was more often detected in women over 60 years of age, with HTN and obesity, as well as with HF with mid-range and reduced EF in men in the same age group. There was sufficient follow-up rate, but the extent examinations do not correspond to the recommended one. The prescription rate of renin-angiotensin-aldosterone system (RAAS) inhibitors corresponds to the recommended one, but there is a high frequency of prescribing angiotensin II receptor blockers (ARBs). The prescription rate of β-blockers and loop diuretics (mainly torasemide) increased in comparison with previous studies, while thiazide diuretics — decreased. In patients with reduced EF, the prescription rate of sacubitril/valsartan was only 14,7%, β-blockers — 83,3%, mineralocorticoid receptor antagonists (MCRA) — 72,5%. In patients with midrange EF, there was a sharp decrease in prescription rate of RAAS inhibitors, β-blockers, MCRA.Conclusion. The practical follow-up of patients with HF differs significantly from clinical guidelines. Due to inadequate pharmacotherapy, as well as insufficient noncompliance with the recommended extent of investigations, 1-year HF therapy does not lead to a pronounced improvement in the patients' class.

INTRODUCTION. Surgical treatment of colorectal malignancies, while increasing overall survival often determines the persistence ofthe pain syndrome, causing a decrease in the quality of life of patients. Pain-relieving medicines have side-effects and complications,which determines the search for and introduction of non-medicinal technologies. AIM. To evaluate the effectiveness of incorporating dynamic electroneurostimulation in the rehabilitation of patients after surgicaltreatment for colorectal cancer to correct pain syndrome, autonomic dysfunction and quality of life indices. MATERIAL AND METHODS. 60 male and female patients aged between 35 and 65 with a verified diagnosis of the colon and rectummalignant neoplasms after surgical treatment were examined in the conditions of the outpatient oncological care center at the StateMedical Institution “City Clinical Hospital No. 2” (Novosibirsk). They were divided into 2 groups: the 1st group (the main group, n=40)in addition to standard therapy received a 15-day course of dynamic electroneurostimulation (DENS) performed with «NEURODENSPCM» device, the 2nd group (the comparison group, n=32) received a standard treatment including chemotherapy, symptomaticpharmacotherapy and exercise therapy. The examination included assessment of pain syndrome using validated pain scales, thevegetative status, anxiety and depression, quality of life parameters. RESULTS AND DISCUSSION. The patients of the 1st group showed 1.2- and 2.4 times reduction of algias by the 5th and 15th day ofrehabilitation respectively. Upon completion of the rehabilitation the autonomic nervous system balance index (LF/HF) was adjustedby 4.8 and the centralization index by 6.0 times against the baseline, the anxiety and depression index on the HADS scale was reducedby 1.5 times, the quality of life on the SF-36 scale improved: physical functioning by 1.5 times, pain by 1.2 times, general health by 1.5times, which differed from the similar indicators in the 2nd group.Dynamic electroneurostimulation using NEURODENS-PCM device can have pain-relieving and vegetative-regulating effects due toactivation of antinociceptive brain structures and influence on suprasegmental parts of the autonomic nervous system. CONCLUSION. The inclusion of dynamic electroneurostimulation using «NEURODENS-PCM» device in the rehabilitation of patientsafter surgical treatment of malignant neoplasms in the colorectal region enables a faster relief of pain syndrome, adjustment of theneurovegetative regulation and the anxiety level, which contributes to improvement of the ' quality of life of patients.

Introduction. The high risk of infection of healthcare workers dictates the need to study their working conditions during the COVID-19 pandemic. The study aims to research the working conditions of medical workers during the COVID–19 pandemic in multidisciplinary medical and preventive organizations. Materials and methods. Analysis of working conditions of medical workers of medical and preventive organizations. The study design is a closed population (four medical institutions were randomly selected), a target group (doctors and nurses). The authors analyzed the staffing table and 16 reports on a special assessment of working conditions at 1,251 workplaces (1,845 medical workers, of which 787 doctors, 1,058 nurses). Statistical analysis included: standard methods of descriptive statistics, determination of relationships by logistic regression (odds ratios (OR) and 95% confidence intervals (OR CI)). p<0.05 was taken as the critical level of significance. Results. The largest number of ill medical workers provided assistance to patients without signs of COVID-19 both in hospitals (86.06% of doctors, 85.85% of nurses) and in outpatient polyclinic treatment and prevention organizations (90.31% of doctors, 92.05% of nurses). The probability of getting sick COVID-19 was maximum in an infectious diseases hospital (compared with emergency departments OR 2.049; 95% OR CI 1.194–4.608 and diagnostic and treatment units of medical institutions OR 3,057; 95% OR CI 1,876–4,98). The workplaces of medical workers who have undergone COVID-19 in infectious diseases hospitals and specialized teams are classified as harmful class 1–3 degrees, and workers are classified as high occupational risk groups according to SARS-CoV-2. The probability of getting sick with COVID-19 is significantly higher when in contact with pathogens of infectious diseases (class of working conditions 3.3 compared to 3.1 or 3.2). Conclusion. The workplaces of medical workers who have undergone COVID-19 in infectious diseases hospitals and specialized brigades are classified as harmful class of the first to third degree, and workers are classified as high occupational risk groups for COVID–19. Ethics. Scientists have conducted the study in compliance with the Ethical principles set out in the Helsinki Declaration of 1975 with amendments of 1983 and obtaining the informed consent of patients.