In the interests of practical healthcare, routine classifications should be modified as rarely as possible. At the same time changes should be discarded only on sufficient grounds, for example, when there are no obvious advantages of a new classification over the existing ones or they can no longer be modified by introducing fundamental changes and amendments. In this regard, the evolution of approaches to the classification of chronic heart failure (CHF) is prominent. It becomes particularly relevant due to the fact that currently experts of the Russian Society of Cardiology (RSC) are actively discussing a new draft classification of CHF. The authors of the lecture gave a brief historical insight and reviewed the main classifications of CHF used in North America, Europe, and Russia. The new classification of CHF proposed by RSC experts, which is actually a modified classification of North American colleagues, does not have obvious advantages over the currently used CHF classification in Russia (since 2002). The latter is based on the classification by Vasilenko – Strazhesko which is familiar to domestic internists, since it has become an indispensable part of their clinical practice and has stood the test of time. In addition, its underlying principles provide the potential for its flexible modification.

The lifestyle of people nowadays and poor diet are factors affecting the increasing incidence of digestive diseases in people all over the world. The search for new methods of early diagnosis of the disease is an urgent issue of modern medicine. In the last decade, much attention has been paid to various biological markers that can be used to assess the risk of disease development, the response to therapy, and the possible development of complications. Biomarkers in clinical medicine can be used as additional tools not only to improve early diagnosis of gastrointestinal diseases but also to assess the effectiveness of therapy.The aim of this lecture was to analyze and systematize biomarkers in various gastrointestinal diseases.

The authors analyzed the problem of diuretic resistance (DR) in patients with chronic heart failure (CHF). Most of the symptoms and signs of CHF are associated with hypervolemia and vascular congestion in the systemic and pulmonary circulation. The severity of the latter is the main factor which negatively affects the overall assessment of life satisfaction in patients with CHF. Since the patient, even at the incurable stage of CHF, primarily expects a rapid decrease in the severity of manifestations of decompensation from the prescribed therapy, achieving euvolemia is the essence of its short-term objective. Without diuretics, these immediate effects, according to which most CHF patients judge the qualifications of the doctor, are almost impossible to achieve. Unfortunately, apparently, not a single clinician was able to avoid disappointment in the effectiveness of CHF therapy associated with DR in their practice. As a rule, DR reflects the progressive course of CHF and is often associated with a poor prognosis. The review consistently covers the issues of terminology, diagnosis, pathogenesis, and prevention of DR, which aggravates CHF, and discusses measures aimed at restoring sensitivity to diuretics.

The authors of this article have analyzed the problem of diagnostic conclusion unification in patients with chronic heart failure (CHF). The root of this problematic situation in which practitioners find themselves is that, despite the large number of different regulatory documents, there is no consensus on what is considered correct and what is wrong when formulating a diagnostic conclusion in a patient with CHF. The many-faced syndrome is designated differently: CHF, congestive heart failure, chronic circulatory failure. There are difficulties in determining the stage of CHF in patients receiving optimal drug therapy or in those who are in a state of compensation after a successful surgical correction. When assessing the functional status in a patient with CHF, a distinct subjectivity should be taken into account in determining which limited physical activity is slight or, conversely, marked, as well as what kind of physical exertion is normal for the patient. This subjectivity naturally leads to low reproducibility of the assessment results of the CHF functional class in the same patient by different doctors. CHF should also be classified according to the value of a left ventricular ejection fraction. The diagnosis should also take into account the state characteristics of a diastolic function of the left ventricle (especially in patients with CHF and preserved left ventricular ejection fraction). The authors give examples of diagnostic conclusions, including cases of comorbid pathology.

The authors of the study analyze various definitions of chronic heart failure (CHF). CHF, having many faces, despite the consensus concerning the paradigm of its pathogenesis, is given different definitions, using both the syndromic and nosological approaches. Most authors share a view of CHF as the final stage (outcome or complication) of many diseases in which there is impairment of ventricular filling or ejection of blood, i.e. as a syndrome, and not an independent nosological form. Nevertheless, at the beginning of the XXI century leading Russian specialists in heart failure presented a reasoned point of view on CHF not only as the final stage of the cardiovascular continuum, complicating the course of a disease of the cardiovascular system, but also as an independent nosological form. This approach, which contradicts the standard rules for the formulation of the final clinical and pathological diagnoses, as well as the agreed positions of the International Statistical Classification of Diseases and Related Health Problems, has been the subject of reasonable criticism. Since the identification of the underlying cause of heart failure is crucial for therapeutic reasons, the only correct view is that of CHF as a syndrome, the detailed description of which in clinical diagnosis is an important intranosological characteristic that allows building the most effective differentiated therapy and accurately determining the prognosis of the disease.

ТЕРАПИЯ Особенности метаболического синдрома на фоне жировой болезни печени у женщин в перименопаузеИ.В.Костякова 1 , Л.С.Сотникова 2, 3 , Е.В.Белобородова 3 , В

In the literature review, modern views on the features of pathogenesis and diagnosis of pulmonary hypertension associated with portal hypertension and sarcoidosis of respiratory organs are presented. A variety of views is due to the lack of a convincing evidence base underlying the algorithm for diagnosis and treatment of this pathology. Pulmonary hypertension is one of the most complex cardiological problems and represents a pathological condition that is based on increasing resistance to blood flow in a small circle of blood circulation at any of site. Unlike the systemic arteries, there is no direct access to the pulmonary artery for measuring blood pressure by non-invasive methods, so the diagnosis of pulmonary hypertension in the early stages, before the formation of a lesion in the target organ, which is the right ventricle of the heart, is practically impossible. In actual clinical practice, pulmonary hypertension is at best diagnosed at the stage of latent right ventricular dysfunction, which is manifested by dilatation of its cavity and / or hypertrophy of its walls, at worst at the stage of right ventricular heart failure. At present, there has been a trend towards an improvement in the diagnosis of pulmonary hypertension (LH) in various diseases. This is the reason for the special interest in this interdisciplinary problem.

Taking into account the increase in the level of cardiovascular diseases in recent decades, the clinician faces the task of attempting to make the fastest possible diagnosis of the pathology at its earliest stages. That is why the aim of our work was to identify the main groups of biological markers, and to separate the role of each of them in the assessment of the risk of development, progression and possible complications of cardiovascular diseases. We have given the main working classification of markers of cardiovascular processes with the allocation of their main types, as well as the basic criteria for the “ideal” biological marker. Finally, an attempt was made to structure biomarkers depending on their molecular mechanisms of pathogenesis in the development of a particular pathology. All these data should help the clinician at the stage of early diagnosis of cardiovascular disease.

Aim: to study relationship between parameters of intracardiac hemodynamics assessed by Doppler echocardiography and functional activity of endothelium, hepatic blood flow and severity of portal hypertension in patients with cirrhosis of the liver (CL) of different etiology. Results. We found that changes of structural and functional parameters of the heart in LC depended on the stage of compensation of portal hypertension and were accompanied by rearrangement of parameters of intracardiac hemodynamics. Pulmonary arterial hypertension (PAH) was found in 11.1% of patients with LC. PAH was moderate and was more frequent in patients with end-stage disease (Child-Pugh class C) compared with those with initial stage of LC (21.4% and 6.3%, p<0.05, respectively). Conclusion. Disorders of vasoregulating endothelial function in patients with CL were related to parameters of cardiopulmonary hemodynamics and functional state of the right ventricle and were more pronounced in patients with PAH.

The aim of the work was to study somatopsychic manifestations in patients with chronic viral hepatitis (CVH). MMPI profiles, state and trait anxiety were assessed in 110 patients. Boundary psychic problems were evaluated using the Beck scale. It was shown that mean MMPI T-score in patients with CVH was above 50; half of them developed neurotic triad; hypochondria occurred in 37.3%, depression in 42.7%, and hysteria in 37.1%. The highest level of state anxiety was documented in patients with HCV infection and isolated HBCor At. The CVH-1b genotype was associated with enhanced occurrence of depression in patients having virus-positive blood for 1-5 years. The level of state and trait anxiety in them was lower than in patients with duration of viremia over 5 years.

Aim: to estimate quality of life (QL) indices in patients with chronic viral hepatitis (CVH) and their relationships to the clinical characteristics of the disease.Subjects and methods. One hundred and ten patients with chronic viral hepatitis (CVH), including 58 patients with chronic hepatitis C (CHC), 27 with chronic hepatitis B, and 25 with CHC + HBCor, were examined. The personality psychological profile, reaction and personality anxiety were evaluated; the Beck inventory was used to identify borderline mental disorders. The test developed by the Karelian Research Center, Russian Academy of Medical Sciences, modified by Ya. M. Rutgaizer, and the Nottingham Health Profile were applied to estimate QL indices.Results. Parameters characterizing the social and personality indices of life, such as qualitative performance of paid work, participation in social life, impossibility of adequate rest, and sexual life are most frequently influenced. The main indicators of worse QL were diminished vitality (vital energy), sleep disorders, and emergence of emotional reactions. This was largely seen in patients with active CVH infection and in those who had isolated HBcor antibodies.Conclusion.,QL is directly related to the duration of viral infection.

AIM:To study a relationship of the plasma activity of elastase-like and collagenase-like proteinases and their inhibitors to hepatic collagen metabolism and to detect the serum markers of fibrosis severity.SUBJECTS AND METHODS:Three hundred and fifty-nine patients with chronic liver diseases (CLD), including 118 patients with chronic viral hepatitis (CVH), 113 with CVH concurrent with alcoholic liver disease (ALD), 109 with ALD, and 19 with CLD in the presence of opiomania were examined. The activities of alpha1-proteinase inhibitor and alpha2-macroglobulin (alpha2-MG) were determined by the unified spectrophometric assay from the inhibition of N-benzoyl-arginine ethyl ester hydrolysis. The activity of elastase-like proteinases was determined by enzymatic assay from the hydrolysis of the synthetic substrate N-butyloxycarbonyl-L-alanine-para-nitrophenyl ester. That of collagenase-like proteinases was determined, by using a collagen type 1 substrate and expressed in terms of micromoles of the resultant hydroxyproline. The content of hydroxyproline was determined by a color reaction with demethylbenzaldehyde, a free, peptide- and protein-bound hydroxyproline; their fraction was obtained under various conditions of plasma protein isolation and hydrolysis. Plasma fibronectin levels were measured by solid-phase immunoassay. Liver biopsy specimens were morphologically studied in the majority of patients to determine the histological hepatitis activity index and the stage of fibrosis.RESULTS:Fibrois formation in the liver in its chronic diseases was attended by a significant reduction in the activity of collagenase-like proteinases hydrolyzing collagen and by the lower activity of alpha2-MG, an inhibitor limiting collagen formation.CONCLUSION:The identified changes make themselves evident just in early fibrosis, which suggests the rapid onset of imbalance in the mechanisms responsible for regulation of connective tissue synthesis and promotes intensified fibrosis formation.

The presented results show the structure of deteriorations of colloid stability of gall bile in the patients with chronic viral hepatitis C and in the patients with both chronic viral hepatitis C and alcohol abuse. The object of this study were 100 patients: 50 patients with chronic viral hepatitis C and 50 patients both with chronic viralhepatitis C and alcohol abuse. In results of fractious chromatic minutes duodenal intubationg with biochemical study of the composition of gall bile in the patients with chronic viral hepatitis С and patients with alcohol abuse. The degree of the change in the main biochemical factors in gall bile depended on etiology of a diseases. The data obtained should be taken into account in the treatment of patients with chronic viral hepatitis C and mixed etiology.

Summary. The presented results show the structure of deteriorations of colloid stability of gall bile in the patients with chronic viral hepatitis C and in the patients with both chronic viral hepatitis C and alcohol abuse. The object of this study were 100 patients: 50 patients with chronic viral hepatitis C and 50 patients both with chronic viralhepatitis C and alcohol abuse. In results of fractious chromatic minutes duodenal intubationg with biochemical study of the composition of gall bile in the patients with chronic viral hepatitis С and patients with alcohol abuse. The degree of the change in the main biochemical factors in gall bile depended on etiology of a diseases. The data obtained should be taken into account in the treatment of patients with chronic viral hepatitis C and mixed etiology.

Results of ultrasonic study of the liver and bile ways, radiologic study of the liver and biliary ways using hepatobilescintigraphy, fractured chromatic minute duodenal probing with biochemical investigation of the composition of gull bile in patient with chronic viral hepatitis С and with alcohol abuse are presented in the article. Change degree of main biochemical indices of gull bile is concluded to be depended on the disease etiology type.