Coronary artery bypass grafting is one of the most common surgeries performed among all elective cardiac surgery operations. Starting from the first operations, thrombosis not only in the coronary arteries, but also in the venous system was the subject of attention. Over the past two decades it has become evident that the hypercoagulable state, or socalled thrombophilia is multifactorial, genetically determined disorder of the hemostatic system. This article provides an overview of studies on the role of genetic polymorphisms in the development of thrombosis after coronary artery bypass grafting.

For last few decades 'putative natriuretic hormone' have been considered as very important therapeutic target for developing novel therapies for cardiovascular diseases. The present review discusses the pathophysiological role of endogenous cardiotonic steroids with main focus on marinobufagenin (MBG). Recent studies has established that MBG plays a vital role in regulation of electrolyte homeostasis in humans and rodents. Additionally, it has been reported that elevated MBG plasma levels are associated with number of pathological states such as arterial hypertension, chronic kidney disease, preeclampsia and heart failure. It has been demonstrated that MBG-Na/K-ATPase interaction in kidneys regulates renal sodium excretion inducing natriuresis. Further, it has been reported that MBG-Na/K-ATPase interaction in vascular smooth muscle cells could induce vasoconstriction and cardiovascular fibrosis. Thus these facts have established MBG as a potential therapeutic target. Several therapies such as immunoneutralization of MBG with specific monoclonal antibodies and antagonism with aldosterone antagonists have already been proposed. Further studies providing understanding of pathophysiological implications of MBG and signaling pathways could contribute in establishing new therapies for cardiovascular diseases.

Introduction and purpose. Change of the «head-of-bed» position is a routine and simple method of correction of intracranial hypertension. There is still no consensus what exactly situation most effectively reduces intracranial pressure and doesn't compromise a cerebral blood flow. The purpose of the conducted research was the assessment influence of positioning on intracranial pressure and system hemodynamic at patients with a hemorrhagic stroke. Methods. 80 patients with a hemorrhagic stroke entered research. All of the patient carried out continuous monitoring of intracranial and system arterial pressure, transcranial doppler was daily carried out. To each patient was carried out «head-of-bed position» test (30°-0°-60°). Results. Despite various mechanism of hemorrhage in two studied groups in the first three days from the beginning of a disease similar tendencies to the progressing increase of intracranial pressure and decrease in mean arterial and cerebral perfusion pressure were observed. Only for the fifth days there were essential distinctions of the studied indicators. At consecutive «head-of-bed» changes are received the essential distinctions in the studied groups which aren't allowing to apply to them uniform algorithm of positioning. Conclusions. Positioning of patients with subarachnoid hemorrhages has no essential impact on the studied parameters. For patients with parenchymatous hemorrhages is preferable «head-of-bed» situation 30° and 60° the first and third day and 30° for the second and fifth day. Thus even short stay in horizontal position (0°) leads to the expressed growth of intracranial pressure and critical decrease in cerebral perfusion.

Introduction and purpose. Endothelial glycocalyx is a protective structure of the vascular bed and is damaged in early stages of cardiovascular diseases. Dark field microscopy can determine the depth of penetration of red blood cells in endothelial glycocalyx to estimate the perfusion boundary region (PBR). The aim of this study was to test and validate this method. Materials and methods. The study involved 38 healthy volunteers aged from 28 to 65 years (18 women and 20 men). The sidearm dark field microscopy of the mucosal microvessels in the sublingual area was used to determine the depth of penetration of red blood cells in endothelial glycocalyx to estimate PBR. Results end discussion. The results indicate good tolerability of the test by patients. Our data on the structure of microvessels were highly reproducible and did not depend on the sampling region within sublingual area and on time intervals between sampling. PBR value was not gender-dependent. Conclusion. The dark field microscopy method passed the first step of validation, showing a good feasibility and tolerability, as well as high reproducibility of measurements that are independent of the sampling region and time intervals between sampling.

The aim of the study - thermography-based analysis of lower limb vascular response to thermal impact in patients with trophic disorders, diabetes mellitus and peripheral atherosclerosis. Materials and methods. Thermal impact was carried out using the heating pad acting for 20 minutes. Control of temperature of back of the feet was performed by thermal imaging camera with a thermal sensitivity of 0.02°C. The study involved a group of 8 subjects without vascular disorders of the lower limbs (controls), and patient group of 8 subjects with trophic disorders due to the progression of diabetes and atherosclerosis (age of 67±8 years). All patients had type 2 diabetes and peripheral arterial disease with different levels and the degree of the main arterial occlusion. Intensity of trophic disorders changed from apical necrosis and trophic ulcers to gangrene of the foot. We calculated spectral amplitude parameters and temperature dynamics. Fourier transform was used to perform spectral analysis of temperature data. Results. Temperature response of limbs in patients with diabetes compared with healthy subjects was characterized by monotonous temperature variation without distinct oscillations; reduction in amplitude of oscillations within endothelial temperature range; relatively high average temperature difference between the left and right foot. In the group of healthy subjects reaction on thermal impact is not strictly two-stage, usually interpretable by theory as primary and secondary vasodilation. Conclusions. Decrease of temperature amplitude of endothelial range registered during thermal impact can be the sign of endothelial dysfunction in patients with diabetes and peripheral arterial disease. Spectral and temperature characteristics of reaction of limbs on thermal impact can be used to assess trophic disorders and compensation mechanisms of regulation of metabolic processes in the group of patients with diabetes mellitus.

Purpose. The aim of our study was to non-invasively investigate the parameters of coronary blood flow during exercise in patients with arterial hypertension. Materials and Methods. We enrolled 144 patients with arterial hypertension. All patients performed supine bicycle symptoms-limited tests. Throughout the exercise, the diastolic peaks of coronary flow velocity in left anterior descending artery (LAD) were measured. The values of diastolic velocity before and at maximal exercise, coronary flow velocity reserve (CFVR) and difference between peak and rest velocities were calculated offline. The control group consisted of 145 healthy persons. Results. The rest blood flow velocity in LAD was 33.0±8.4 cm/s, the peak velocity in LAD was 80.3±16.5 cm/s, difference of velocities was 48.2±13.9 cm/s, CFVR was 2.55±0.56. Women and men were comparable in velocity parameters during exercise test. There was no significant correlation between mass/index of left ventricle mass and velocity data in LAD. Hypertensive patients were comparable in investigated coronary artery flow parameters with healthy group. Conclusions. During supine bicycle tests, the patients with arterial hypertension have a similar coronary artery flow velocity profile with healthy persons.

Objective. To improve the results of acute myocardial infarction (AMI) treatment. Material and methods. We have analyzed 2 clinical cases of unfavorable course of AMI. Results. The middle aged patient who had ST segment elevation acute coronary syndrome received immediate full reperfusion therapy (thrombolysis and stenting). It was performed early in the course of the disease and demonstrated good angiographic result. Postoperatively there were no typical evolution of ECG signs of AMI. By the end of the first day we registered stent thrombosis with fatal outcome. Cause of death: acute left ventricular failure. The area of infarcted cardiac muscle was about 40 %, in the projection of the apex of the left ventricle the acute aneurysm was formed. Perhaps this situation has been associated with disorders of microcirculation in the infarcted area, which can be potentially neutralized by inhibitors 2b/3a receptors of platelets. This drug was given to this patient too late (during rethrombosis). In another observation (with the same circumstances) the inhibitor of IIb/IIIa GP receptors was given during the early postoperative period, what was followed by the natural course of AMI. Conclusion. These examples demonstrate the need of additional antiplatelet support (inhibitor IIb/IIIa GP receptors) in such clinical situations.

Introduction and aim. Chronic kidney disease (CKD) is one of the most common non-infectious diseases, in which arterial hypertension (AH) is progressing. The mechanisms of AH in CKD are complex and understudied. This research was conducted with the objective to investigate the mechanisms of microvascular tonus increase in the group of patients with the 5th stage of CKD who were treated with peritoneal dialysis. Materials and methods. Patients from dialysis department were included in the study (76 people). Blood flow in microvessels was measured by laser Doppler flowmetry (LDF). Results of LDF used for the calculation of neurogenic (HT), myogenic (MT) and endothelium-dependent tonus (EDT) microvessels. Cardiotonic steroid concentration in plasma was measured by competitive immunofluorescence using antibodies to ouabain and marinobufagenin. The activity of Na/K-ATPase was measured by spectrophotometry. Results and discussion. HT microvessels in patients with CKD was increased by 21.4±3,88 %, MT - 33.4±5,62 %, EDT 17.1±3.14 % compared with the control group. Endogenous ouabain (EO) concentration in plasma of patients with CKD was on average 0.311±0.032 nM/L, in the control - 0.296±0.031 nM/L. Marinobufagenin (MBG) concentration in the plasma of patients with CKD was 2.10; 0.89; 3.07 nM/L (median, 25th and 75th percentile), and in control - 0.347; 0.103; 0.427 nM/L. The activity of Na/K-ATPase in patients with CKD was 1.54±0.18 μmol Pi/mL/hr, vs. 3.07±0.44 μmol Pi/mL/h in the control. The correlation between the value of MT of microvascular and MBG concentration in blood plasma of patients with CKD was found (rs = 0.736). Conclusions. Our results show that high NT of microvessels of patients with CKD and is connected with increased activity of the central structures of the sympathetic nervous system, while increase of EDT is connected with endothelial dysfunction and increase of MT is connected with increasing concentration of MBG (not EO) in blood plasma. We believe that the MBG causes contraction of smooth muscle cells of blood vessels by activating signaling function of Na/K-ATPase.

Modeling septic shock by means of administration of living bacteria is a minimum invasive adequate model for reproduction of this pathologic process, however there is a few data on effectiveness of this model in rats on the basis of direct measurement of hemodynamic parameters. The goal of the study was to elaborate a simple and convenient model of septic shock by intravenous infusion of living bifidobacteria. Indexes of central hemodynamics evaluated by direct method were analyzed in the study as well as endothelial function of blood vessels assessed by measuring concentration of NO, vessels' endothelial growth factor-A and tissue plasminogen activator. Dysfunction of hemostasis was also estimated by measuring fibrinogen level and soluble complexes of fibrin monomer. Intravenous infusion of living bifidobacteria caused development of severe septic shock by 15th minute after administration with valid decrease of all systemic hemodynamics' parameters. Marked hemodynamic disturbancies combined with development of endothelial dysfunction and hemostatic mechanisms' increased activity. The present model is absolutely safe; it can be easily reproduced in a research or training laboratory and it can be used for fundamental research of septic shock, for pre-clinical tests of drugs as well as for educational purposes.