The article presents a clinical observation of the left atrial appendage thrombosis in a 51-year-old female patient with a paroxysmal form of nonvalvular atrial fibrillation which occurred despite long-term anticoagulant therapy with apixaban in a full dose (5 mg b.i.d.), and the patient’s management. The patient was admitted with recurrent symptomatic paroxysm for more than 48 hours, because of which, in accordance with the recommendations, transesophageal echocardiography was performed before an emergency rhythm restoration. Thrombus in the left atrial appendage 0.5×1.03 cm in size was detected. It was decided to refrain from the immediate restoration of the rhythm due to the very high risk of thromboembolic complications. In connection with the categorical refusal of the patient from warfarin, it was decided to replace apixaban with another direct oral anticoagulant – dabigatran 150 mg bid for a period of 4 weeks followed by performing a control transesophageal echocardiographic study. As a result, no thrombus was found on control echocardiography. The particularity of this observation is concomitant hypertrophic cardiomyopathy and diabetes mellitus type 1 in this patient.

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Ðàññìàòðèâàþòñÿ äàííûå êîíòðîëÿ ñîñòîÿíèÿ âîäíîé ýêîñèñòåìû, ïîëó÷åííûå ïðè ðå-ãèñòðàöèè èçìåíåíèé ïðîñòðàíñòâåííî-âðåìåííûṍ ïàðàìåòðîâ öåëûõ êëåòîê è èõ âíåøíèõ ñòðóêòóð ñ èñïîëüçîâàíèåì ñïåêòðîñêîïèè âíóòðåííåãî îòðàaeåíèÿ.  êà÷åñòâå áèîèíäèêàòîðà ïðèìåíÿåòñÿ äèàëèçíàÿ êóëüòóðà ìèêðîâîäîðîñëåé ñ êîíòðîëèðóåìîé "âíåøíåé ñðåäîé". Êëþ÷åâûå ñëîâà: ìèêðîîðãàíèçìû, äèàëèçíîå êóëüòèâèðîâàíèå, ñïåêòðîñêîïèÿ âíóòðåí-íåãî îòðàaeåíèÿ.Îñíîâíîé è äî ñèõ ïîð íå ðåøåííîé ïðîáëåìîé ïîääåðaeàíèÿ êà÷åñòâà ñðåäû è óïðàâëåíèÿ ïðèðîä-íûìè ðåñóðñàìè â öåëîì ÿâëÿåòñÿ ïðîáëåìà îòñóòñò-âèÿ ðåïðåçåíòàòèâíûõ ìåòîäîâ è ìåòîäîëîãèé îöåíêè ñîñòîÿíèÿ ñðåäû. Ìíîãîëåòíèé îïûò èñïîëüçîâàíèÿ íîðìàòèâîâ ÏÄÊ (ïðåäåëüíî äîïóñòèìûõ êîíöåíò-ðàöèè â ñðåäå íåêîòîðîãî íàáîðà âåùåñòâ) è êâîò íà âûáðîñû çàãðÿçíèòåëåé ïîêàçàë, ÷òî îíè íå ÿâëÿþò-ñÿ ðåàëüíîé ãðàíèöåé ìåaeäó îïàñíîñòüþ è áåçîïàñ-íîñòüþ, à ñëóaeàò ñêîðåå îáîçíà÷åíèåì íåêîòîðîãî óðîâíÿ ðèñêà, ðàçëè÷íîãî íå òîëüêî äëÿ îðãàíèçìîâ, ñîñòàâëÿþùèõ ýêîñèñòåìû, íî äàaeå äëÿ ðàçíûõ ãðóïï íàñåëåíèÿ [1]. Êàê ñëåäñòâèå â ñèñòåìå ìîíèòîðèí-ãà ïîâåðõíîñòíûõ ïðåñíûõ âîä íàáëþäàåòñÿ ïåðåõîä îò ÷èñòî õèìè÷åñêîãî êîíòðîëÿ ê áèîëîãè÷åñêîé êîí-öåïöèè -ïîìèìî íîðì ÏÄÊ â ñèñòåìå ýêîëîãè÷å-ñêîãî êîíòðîëÿ èñïîëüçóþòñÿ áèîòåñòû.Ïðè âñåì ðàçíîîáðàçèè ïîäõîäîâ ê ðåøåíèþ äàí-íîé ïðîáëåìû íè îäèí èç íèõ íå ïðèâåë ïîêà ê ðàç-ðàáîòêå êàêîãî-ëèáî ìåòîäà, êîòîðûé ìîaeíî áûëî áû áåçîãîâîðî÷íî ðåêîìåíäîâàòü äëÿ ïðàêòè÷åñêîãî èñ-ïîëüçîâàíèÿ [2,3]. Èìåííî ïîýòîìó â ñóùåñòâóþùèõ ñèñòåìàõ ýêîëîãè÷åñêîãî ìîíèòîðèíãà ïðèìåíÿþòñÿ ãëàâíûì îáðàçîì ýêñïåðòíûå îöåíêè êà÷åñòâà ïðè-ðîäíîé ñðåäû. Ìåòîäû, îñíîâàííûå íà àíàëèçå âè-äîâîãî ñîñòàâà, òðåáóþò ñåðüåçíûõ ïðåäâàðèòåëüíûõ èññëåäîâàíèé äëÿ óñòàíîâëåíèÿ ñîñòàâà ñîîáùåñòâà è åãî äèíàìèêè ïðè ðàçëè÷íûõ èçìåíåíèÿõ ñðåäû. Òàê, ïðè ïðîâåäåíèè ýêîëîãè÷åñêîãî ìîíèòîðèíãà ïðåñíûõ âîä îïðåäåëÿþò îáèëèå è âèäîâîé ñîñòàâ ïëàíêòîíà, ïåðèôèòîíà è çîîáåíòîñà, à ñîñòîÿíèå êàae-äîãî èç ýòèõ áèîòè÷åñêèõ èäåíòèôèêàòîðîâ îöåíè-âàåòñÿ ïóòåì ðàñ÷åòà. Áèîòè÷åñêèå îòíîøåíèÿ ìåaeäó ïîïóëÿöèÿìè â ñîîáùåñòâå, òàêèå êàê êîíêóðåíöèÿ, ìóòóàëèçì è äð., êàê ïðàâèëî, íå ó÷èòûâàþòñÿ.  êà-÷åñòâå âîçìîaeíîãî èíòåãðàëüíîãî ïîêàçàòåëÿ íîðìû èëè ïàòîëîãèè äëÿ ôóíêöèîíèðîâàíèÿ ýêîñèñòåì, ò.å. ñâîåîáðàçíîãî "ãðàäóñíèêà", ñ ïîìîùüþ êîòîðûõ ìîaeíî áûëî áû îòëè÷èòü ýêîëîãè÷åñêè áëàãîïîëó÷-íóþ ýêîñèñòåìó îò ýêîñèñòåìû, â êîòîðîé ïðîèçîø-ëè ñóùåñòâåííûå èçìåíåíèÿ, âûçâàííûå âíåøíèìè (â ïåðâóþ î÷åðåäü àíòðîïîãåííûìè) âîçäåéñòâèÿìè, ðàññìàòðèâàëèñü àíàëèç ðàíãîâûõ ðàñïðåäåëåíèé ÷èñ-ëåííîñòè èëè áèîìàññû ãðóïï aeèâûõ îðãàíèçìîâ; ãðàäàöèè ñîñòîÿíèÿ ýêîñèñòåì èëè ïîêàçàòåëè ïðî-äóêòèâíîñòè èõ âûñøèõ òðîôè÷åñêèõ çâåíüåâ [2][3][4].Îäíàêî àáñîëþòíûõ áèîëîãè÷åñêèõ âåëè÷èí, èìå-þùèõ îäèíàêîâûé ñìûñë äëÿ âñåõ ýêîñèñòåì íåçà-âèñèìî îò òèïà è ãåîãðàôè÷åñêîãî ïîëîaeåíèÿ ïî-ñëåäíèõ, íå ñóùåñòâóåò. Ðàâíûìè êîëè÷åñòâåííûìè õàðàêòåðèñòèêàìè (íàïðèìåð, îäíèì è òåì aeå çíà-÷åíèåì ïåðâè÷íîé ïðîäóêöèè) ìîãóò îáëàäàòü ýêî-ñèñòåìû, íàõîäÿùèåñÿ â ïðèíöèïèàëüíî ðàçëè÷íûõ ñîñòîÿíèÿõ. Òîëüêî îñíîâíûå êà÷åñòâåííûå ñîñòîÿ-íèÿ èíâàðèàíòíû äëÿ âñåõ áåç èñêëþ÷åí...

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