The dominance of cardiovascular diseases in the structure of mortality and disability in developed countries as well as the increasing incidence of cardiovascular disorders led to development of conception of cardiovascular continuum based on the clinical evaluation of the risk factors for cardiovascular complications. In this regard studying of the initial stages of this process, i. e. childhood and adolescence, is of great interest. It is now apparent that childhood obesity may be regarded as a cardiovascular risk factor in adulthood. This fact also corresponds to the accumulated information on the cardiovascular disease in children and adolescents with obesity and its similarity with the changes found in adults. What also facilitates the importance of this issue is a steady worldwide increase of the percentage of infants with excess body weight, which may lead to possible increase in cardiovascular disease in the near future. The review covers early manifestations of cardiovascular disease in children with obesity, the development of endothelial dysfunction, remodeling of the artery wall and the progression of atherosclerotic lesions in the aorta and peripheral vessels. The review addresses the distinction of the hypertension development and course as well as the indication of cardiac remodeling and diagnostic criteria of left ventricular hypertrophy. The review provides directions in prevention and treatment of cardiovascular changes in children and adolescents with obesity.

Review of the most important scientific investigations in the field of pediatric endocrinology performing in the world is presented in the article. Modern data of molecular genetic, proteomic mechanisms of endocrine diseases in children and adolescents are discussed, along with the individual approaches of their diagnostics and treatment. Wide world experience of medical care of hypopituitarism, disorders of sex development, Cushing's disease and other endocrine disorders was analyzed and summarized in the paper. The prospective directions of development of pediatric endocrinology are considered and outlined.

Variables influencing gender development in humans are difficult to evaluate because it is usually impossible to tell apart the role of biological and social factors. While most studies of gender development and disorders of sex development have historically emphasized the importance of genes and hormones on gender identity and gender role, recently a significant role of socialization has become more evident. This article considers mechanisms underlying disorders of sexual development and brain sexual differentiation. Advanced concepts of disorders of sex development and sexual differentiation of the brain are discussed. Finally, the paper outlines the possible directions and targets for further investigation aimed at improving existing methods of health care for patients with disorders of sex development.

The article reviews some pleiotropic effects of vitamin D, shows that plasma level of 25 (OH)D is an indicator of organism supplement with vitamin D. Also some issues of vitamin D toxicity are discussed. Novel ideas about structure and functions of vitamin D-receptor, regulation of vitamin D-dependent genes expression are presented. Adipogenic activity of vitamin D, the role of its metabolites, vitamin D-connecting protein, fibroblast growth factor-23 inregulation of lipid, carbohydrate and energy metabolism are discussed. The paper summarizes the data from pilot and clinical studies of vitamin D deficiency and its influence on the development of insulin resistance, cardiovascular and kidney diseases. Possible ways of clinical use of vitamin D as a renoprotector and modulator of renin-angiotensin system are shown, along with the modulating effects of gene cluster associated with obesity (FTO) in children. Further investigations aimed at the practical recommendations development regarding the use of vitamin D in obesity and a metabolic syndrome in children are anticipated.

Objective. To assess the early electrocardiogram (ECG) changes induced by physical training in preadolescent professional football players.

Design and methods. Ninety-four highly trained male football players (mean age —12,85 ± 0,84 years) competing in the Serbian Football League (at least 7 training hours/week) and 47 age-matched healthy male controls were enrolled in the study. They were screened by ECG and echocardiography at a tertiary referral cardiocentre. The control group had sedentary life style (less than 2 training hours/week). Characteristic ECG intervals and ECG voltage were compared and reference range was given for preadolescent footballers.

Results. Highly significant differences between preadolescent athletes and sedentary controls were registered in all ECG parameters: P wave voltage (p < 0,001), S wave (V1 or V2 lead) voltage (p < 0,001), R wave (V5 and V6 lead) voltage (p < 0,001), ECD sum of the S1,2 + V5,6 (p < 0,001), T wave voltage (p < 0,001), QRS complex duration (p < 0,001), T wave duration (p < 0,001), QTc interval duration (p < 0,001) and R/T ratio (p < 0,001). No differences were registered in PQ interval duration between these two groups (p > 0,05). QTc interval duration in athletes was not very strongly, but indeed positively correlated with left atrium dilatation, left ventricular (LV) end-systolic and end-diastolic dimensions, LV myocardial index (LVMI), LVM/body surface area (BSA)1,5 and LVM/h2,7 indices. There was no correlation between QTc interval duration and LVM as well asLV wall thickness.

Conclusions.ECG changes are present in the early stage of athletes’ heart remodeling. QTc prolongation could be the early ECG marker of physiologicalLV remodeling in young preadolescent footballers.

Objective. To estimate central aortic blood pressure (BP) and index of augmentation in young people, taking into account the presence of risk factors (RF), during preventive medical examination.

Design and methods. Altogether 78 students of 3–4 years, aged 19–23 years old have been surveyed within the framework of the regular medical examinations, at the Center of Students’ Health, Stavropol State Medical University, as a part of the project “University is the territory of health”. Besides RF assessment, central aortic pressure was evaluated by oscillometric method (BPLab, “Peter Telegin”,Novosibirsk,Russia; Vasotens Office). In addition to common peripheral BP parameters, this technology provides measurements of systolic BP aortic (SYSао), diastolic BP aortic (DIAао), pulse BP aortic (PPао), average BP aortic (ABPао), left ventricular ejection duration (ED), augmentation index in aorta (AIxао), pulse pressure amplification (PPA) and subendocardial viability ratio (SEVR). Surveyed students were distributed into two groups: first group — without RF (control group), and second group — with RF (main group). For automatic tubulation of all parameters we used the operational system BPStat ® version 05.00.04 (“Petr Telegin”). For statistical data processing program “Statistica8” was used.

Results. At young age RF are associated with the increase of both peripheral and aortic BP, especially systolic and pulse ВР, as well as augmentation index of central ВР. In students RF are associated with the increase of aortic BP (isolated central or masked hypertension/prehypertensionwith the simultaneous increase of both peripheral and aortic BP). The frequency of isolated increase of peripheral BP among students with RF is similar to that in students without RF.

Conclusions. Thus, planimetric analysis of central pulse wave in young people allows to define various mechanisms leading to the early BP increase. These data enable differentiated premorbid diagnostics of hemodynamic status in young adults with cardiovascular RF. This approach will contribute to the more individualized preventive measures in young population.

Objective. To estimate the adherence and performance of health care standards (treatment and medicamental components) in patients with essential hypertension at different levels of medical care delivery. Design and methods. The analysis was carried out by evaluation of the ratio between actual implementation of medical procedures and prescriptions and the rate recommended by the standards according to primary medical documentation. Content analysis, analytical and statistical methods were applied. Results. Out of 46 (100 %) medical parameters 67 % were implemented in city hospitals, 70 % — in the District Hospital, 87 % — in regional and federal medical organizations with varying frequency. None of recommended medications was prescribed with a recommended frequency. Conclusions. Non-compliance with the standard recommendations for hypertensive patients is found at all levels of health care system, in particular, non-adherence with the prescription rate of recommended medications and frequency of medical procedures implementation.

Objective. Late detection and diagnostics of masked hypertension (MHTN) triggering cardiovascular continuum is still one of the key issues in healthcare system. Design and methods. We examined 309 midlife women (31–57 years old) working in institutions without specified factors of occupational hazards. We excluded patients with verified pathology, taking oral contraception or hormonotherapy. MHTN was verified based on the following criteria: combination of normal office blood pressure (BP) (≤ 140/90 mm Hg), positive breathhold test and elevated BP according to the results of 24-hour BP monitoring. Results and conclusions. MHTN was detected in 8,7 %. We defined clinical features of MHTN in examined population: absence of complaints and anamnesis of cardiovascular diseases, elevated mean haemodynamic pressure, and increased body mass index. Analysis of clinical and laboratory results showed no difference between mean parameters of lipid profile in the examined population, despite higher dyslipidemia rate among patients with hypertension and MHTN as compared to patients without hypertension (p < 0,05). The tendency towards elevation of fasting blood glucose and decreasing of glomerular filtration rate in patients with MHTN was not significantly different. Ten-year risk of fatal cardiovascular events (assessed by survival model based on Weibull function) in midlife working women with MHTN was comparable with women with manifest hypertension.

Preeclampsia (PE) is a serious complication of late pregnancy.

Objective. To study and to explore the possibilities of neutralization of cardiotonic steroids, to define the possible mechanisms of recovery activity Na/K-ATPase in pregnant women with PE for the prevention of vasospasm.

Design and methods. The study was carried out in two stages. Firstly, two groups of pregnant women were included. Control group consisted of 6 women with normal pregnancy with gestational age 37–40–3/7 weeks. The main group consisted of 7 women with PE with a comparable gestational age (mean systolic blood pressure 157 ±5 mm Hg, diastolic blood pressure 94 ±2 mm Hg, and urinary protein excretion 2,12 ± 0,46 g/day). At the second stage, 12 patients with PE (aged 29 ± 1 year, gestation 37,9 ± 0,6 weeks, blood pressure 159 ± 5 / 99 ±3 mm Hg) formed the main group. The control group included 11 healthy pregnant women comparable by gestational age. Venous blood samples were taken. Marinobufagenin level was determined by fluoroimmunoassay, spectrophotometry was used to assess the activity of erythrocyte Na/K-ATPase in the presence and absence of monoclonal antibody, DigiFab, magnesium sulfate.

Results. The level of marinobufagenin in pregnant women with preeclampsia was almost 2,5-fold higher than in control group (1,056 vs. 0,421 nM). The activity of erythrocyte Na/K-ATPase in pregnant women with preeclampsia was 1,47 ± 0,1716 and 2,65 ± 0,16 mcmol Fn/mL/h (p < 0,01), respectively. When incubated with monoclonal antibodies erythrocyte Na/K–ATPase activity was 2,41 mcmol Fn/mL/h. When incubated with DigiFab there was a 3,5-fold increase in PE marinobufagenin plasma levels (1,38 ± 0,40 vs. 0,38 ± 0,10 nmol/L, p < 0,01) and a reduction of the erythrocyte Na/K–ATPase activity compared to control group (1,16 ± 0,11 vs. 2,80 ± 0,2 mkmol Fn/ml/h, p < 0,01). Ex vivo, 1 ug/ml DigiFab restores the activity of Na/K–ATPase (1,72 ± 0,13 mkmol Fn/ml/h, p < 0,01) and3 mM magnesium sulfate amplifies DigiFab effect (2,3 ± 0,2 mkmol Fn/mL/h, p < 0,01).

Objective. To assess the epidemiology of overweight as the main risk factor for hypertension and its 18-year trends in Tyumen pupil population in order to develop basic preventive strategies.

Design and methods. Two single epidemiological studies were carried out in a population of pupils ofTyumen schools selected by the method of random numbers. The first study was conducted in 1986–1987 years using a standard questionnaire of World Health Organization (WHO) MONICA project. Altogether 3704 pupils aged 7–15 years (1836 boys and 1866 girls) were examined with 93 % response. The second study was carried out 18 years later (2005–2006 years) when 2640 pupils aged 7–17 years (1308 boys and 1332 girls) were examined with 87,7 % response. The following methods were used in both studies: assessment of blood pressure (BP) and Quetelet index for overweight detection (Quetelet index threshold for 7–9 years old ≥ 20,0 kg/m 2; for 10–14 years old ≥ 22,0 kg/m 2; for 15–17 years old ≥ 25,0 kg/m 2).

Results. The prevalence of overweight in the pupil population was 8,8 %: among boys — 9,2 %, among girls — 8,3 %. A tendency for increased overweight prevalence was found at second screening study as compared to the first one (9,3 vs. 8,5 %, respectively, р > 0,05). It was caused mainly by the increased overweight prevalence (9,3 vs. 7,6 % respectively, р < 0,05). The incidence of high BP in overweight pupils was significantly higher than in pupils with normal body weight (2,7-times higher in boys vs. 2,8-times higher in girls, р < 0,001). Moreover, in overweight pupils puberty progressed more rapidly. Pupils with excessive body weight complain of problems related to autonomic dysfunction 1,5–2 times more often than pupils with normal body weight.

Conclusions. Our study showed high prevalence of overweight in the population ofTyumen schoolchildren, a tendency for increasing overweight prevalence in boys nowadays, association between overweight, high BP, puberty and autonomic dysfunction.

Objective. Pulmonary hypertension is one of the typical complications of the congenital heart defects with pulmonary overload circulation. Hemodynamic status of the pulmonary circulation is critically important for the patients with univentricular heart anatomy and determines opportunities and results of the surgical treatment. Case report. We present a case report of superior vena cava syndrome feigning a thrombosis of the anastomosis in a patient after Glenn procedure. Clear clinical picture, hemodynamic instability of the patient and inability to exclude anastomosis dysfunction were an indication for re-operation. There were no signs of anastomosis dysfunction or thrombosis. This clinical situation was assessed as a manifestation of pulmonary hypertension (PH) feigning a thrombosis of the Glenn anastomosis. Applying of pulmonary vasodilation agents gave an opportunity to avoid a PH crisis and promoted stable postoperative period. Conclusions. In consideration of our clinical experience we believe that inclusion of computer tomography scan or magnetic resonance imaging into examination protocol is appropriate for the patients with high risk of PH crisis.

Obstructive sleep apnea syndrome in children represents a common and underestimated problem, in particular leading to the behavioral and emotional changes, and cognitive dysfunction. Based on the review of medical literature published between 1980 and 2014 (using the National Library of Medicine’s PUBMED database, Cochrane Database for Systematic Reviews and Russian index of science citation), there is a compelling evidence that sleep-disordered breathing is associated with neurocognitive problems in children. However, despite the available evidence, underlying mechanisms are not clear. The major factors leading to OSAS in children differ at different age, that is undoubtedly important for the management strategy. A correct and timely treatment of OSAS might prevent the development of irreversible changes, in particular neurocognitive characteristics that is one of priority problems of pediatrics and health care in general, because it can promote successful social adaptation of both children and adults.