It is well known that during last 10 years there is a significant growth in the number of patients with diabetes mellitus type 2. Early stages of glucose metabolism impairment such as glucose intolerance should be paid more attention. Diet and life style modification as well as acarbose (Glucobay) intake can result in glycemia normalization and prevent about one third of diabetes cases. Acarbose (Glucobay) can also improve coagulation factors, lipids, diminish oxidative stress, endothelial dysfunction, insulin and proinsulin level due to the decrease of postprandial glycemia and peripheral insulin resistance. As a consequence a reduction of patients' body mass index and cardiovascular risk is observed. We conclude that acarbose (Glucobay) must be administered oftener in patients with prediabetes and diabetes mellitus type 2 as monotherapy in case of postprandial hyperglycemia and as the second drug if normoglycemia is not achieved, as it can be combined with any hypoglycemic drug.

Clinical and genetic aspects of cardiomyopathies caused by cardiac troponin I mutations are observed. Apparent clinical heterogeneity with development of both hypertrophic and restrictive phenotypes and high risk of sudden death are presented.

It is well known that overweight as well as underweight is strongly associated with increased risk of development of many disorders, particularly cardiovascular pathology. The paper discloses the most appreciable problems of health associated with obesity and underweight. Pathophysiological mechanisms of development of the basic metabolic disturbances underlying obesity and diabetes mellitus, such as insulin resistance and dyslipoproteinemia, are described. The interaction of hereditary and environmental factors leading to adiposity is discussed in the light of the novel theories of development of adiposity, such as the hypothesis of a thrifty phenotype and "the selfish brain theory". Particular cases of obesity development in the absence of insulin resistance are described. The clinical phenomenon of paradoxical more favorable prognosis in patients with overweight in comparison with patients with normal weight and underweight (the obesity paradox) is discussed.

Objective. The study addresses the changes of Doppler spectra indices of intrarenal blood flow in diabetic patients with/without hypertension and the changes of intrarenal vascular resistance in hypertensive diabetic patients with/without microalbuminuria. Design and methods. 28 diabetic patients (Gr.D), 52 hypertensive patients (Gr.H), 208 diabetic hypertensive patients (Gr.HD) and 14 healthy people were included. Renal blood flow velocity profiles were detected by duplex scanning index in renal and arcuate intrarenal arteries and resistive index was calculated. 24-hour ambulatory blood pressure (BP) recordings were performed. Plasma glucose levels and serum insulin concentration were measured by radioimmune method. 24-hour urinary protein excretion was determined by standard laboratory method. Results. 34,1 % diabetic hypertensive patients, 13,3 % hypertensive patients (р = 0,0005) and 7,7 % diabetic patients (р = 0,0245) have microalbuminuria. Even normotensive diabetic patients show and increase in intrarenal vascular resistance. Patients in Gr.HD developed the increase in intrarenal vascular resistance and/or microalbuminuria earlier as compared to Gr.H. The elevated indices of intrarenal vascular resistance correlated positively with and hypertension duration of age, levels of HbA₁, triglycerides, total cholesterol and negatively with decrease in diastolic BP-day, diastolic BP-24h and duration of diastolic arterial hypertension during daytime at disproportional increase in systolic BP in patients having microalbuminuria.

Objective. To define the influence of social support on relative risk of hypertension development in general male population (men of 25-64 years old) during 20 years. Design and methods. Within the program WHO "MONICA-psychosocial" in 1988 and 1994, casual representative sample of males aged 25-64 years, inhabitants of one area of Novosibirsk was examined. During 20-years period the cohort was followed for the new cases of hypertension onset. Regression Cox model was applied for the estimation of relative risk of hypertension development. Results. Men with low ICC showed a two-fold increase of hypertension risk (p < 0,05) as compared to those with higher ICC during 5-year period. Males with low and average-1 SNI demonstrated 3-fold higher risk of hypertension development (p < 0,05) as compared to men with SNI higher than average-2. Conclusion. In men of 25-64 years old risk of hypertension is associated with low level of social support.

Objective. To assess predictive value of total cardiovascular risk (CV) factors for prognosis of stroke and heart attack in hypertension. Design and methods. 841 hypertensive patients (197 men, 644 women) 19-95 years old were examined. Results. It was established that total CV risk factors have different predictive values. The majority of factors were more valuable for prognosis of heart attack, but not for stroke.

Objective. To estimate efficiency of original enalapril Renitec in patients with low-renin hypertension (NR АH). Design and methods. 202 patients with NR АH were recruited. The mean systolic blood pressure (BP) was 196,6 ± 6,2 mmHg, diastolic BP - 112,4 ± 5,6 mmHg . Plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were estimated by radio-immune method in active patients. PRA was rated as normal if ranged 1,0-3,0 ng/ml/h, PA - 0,18-0,83 nmol/l (5-23 ng/dl or 50-230 pg/ml). Normal PA/PRA ratio was 5-23. Conclusion. 1) Nonstimulation renin criterion in the test with 20 mg/day enalapril (Renitec) intake is the impossibility of PRA increase more than 1,0 ng/ml/h, and angiotensindependent BP criterion is the decrease of PAC and/or PAC:PRA more than 20 % from the baseline level. 2) The primary task of NR АH treatment is the normalization of indicators of rennin-angitensin-aldosterone system and the achieving of target BP. Treatment should be started with monotherapy 20 mg/day enalapril (Renitec) intake. If PAC: PRA is normal but BP is still elevated a calcium blocker should be added. If PAC:PRA is abnormal after enalapril monotherapy then a low daily dose of spironalactone is added.

Less than 50 % Wistar male rats with intact baroreceptor reflex developed arterial hypertension 8 weeks after renal artery clipping in the model «two kidneys - one clip». Blood pressure level negatively correlated with initial magnitude of the baroreceptor reflex. At the same time all rats (100 %) with the damaged baroreceptor reflex developed hypertension after renal artery clipping. Thus, we conclude that baroreceptor reflex counteracts the development of vasorenal hypertension and it can take part in blood pressure long-term regulation.

Objective. To study the ryanodine (RyR) and dihydropyridine (DHPR) receptor physiological activity in cardiomyocytes of spontaneously hypertensive (SHR) and normotensive (WKY, Wistar) rats aged 0-6 weeks. Design and methods. The receptor activity was estimated by the elevation rate of intracellular Ca²⁺ concentration ([Ca²⁺]_i) in the cardiomyocyte culture (5 days): in response to 4-chloro-m-cresol (4-CmC) action for RyRs and to Bay K8644 (BayK) one - for DHPR. Results. In response to 4-CmC (2 mM), a drastic increase in the rate of [Ca²⁺]_i accumulation (2,9 ± 0,8 times) was registered in SHR myocytes cultivated for 3 and more weeks versus a decrease in the rates of Ca²⁺ release via the RyRs of Wistar and WKY rat cardiomyocytes. BayK (80 μM) also induced more sharp [Ca²⁺]_i elevation in SHR cardiomyocytes (3,4 ± 0,3-fold increase) as compared to age-matched Wistar (2,3 ± 0,2-fold increase) and WKY (1,2 ± 0,1-fold increase) ones. Conclusion. In SHR and WKY cardiomyocytes, as compared to normotensive Wistar rats, gradual growth of DHPR activity is observed, which follows by Ca²⁺-induced Ca²⁺ release (CICR) (3 weeks) and drastic activation of RyR in SHR myocytes at the end of prehypertensive period (6 weeks).

Results of long-term follow up of 38 patients with aortic valve replacement for secondary native infective endocarditis (IE) are analysed. In 71 % of cases IE occured in patients with congenital heart disease - bicuspid aortic valve, in 15,8 % with chronic rheumatic heart disease and in 13,2 % - with idiopathic aortic calcinosis. The most frequent complications in the early postoperative period were the following: small heart ejection syndrome (36,8 %), thromboembolic myocardial infarction (7,9 %), fever (55 %), caused by postcardiotomy syndrome in 15,8 %. Other reasons of the fever were IE activity (76,1 %), pneumonia (7,9 %), suppuration of the postoperative wound (0,2 %). 36 patients (94,7 %) have survived the hospital stage. The most frequent complications in the remote period of follow up were the valve-dependent ones (25 %). They occurred more often within the first three years, and, as a rule, reoperation was needed. In 6 patients they were the reason of a lethal outcome (16,7 %).

The generalized geometrical distribution (GGD) by means of the Bart's partial reference of functions was used for the analysis of the results of the post-cold-test performed on the radial artery in patients with vasospasm and in a control group. The association of GGD and the Galton-Watson's model (branching processes) allows interpreting the parameters of the radial artery post-cold-test recovery regarding rhythmic coordination of the circulatory system factors under cold exposure.

Оbjective. The paper addresses the relation between indices of blood pressure (BP) 24-hour monitoring and rehabilitation opportunities in patients with diabetes mellitus, as well as the value of quantity clinical-expert criteria in assessing the rehabilitation prognosis and therapy effectiveness. Design and methods. The research included 127 patients with diabetes mellitus. The following indices of the 24-hour BP monitoring were analyzed: mean BP, BP load indices, BP daily profile indices, BP variability and additional indices. Connection with adaptation was assessed by morphophysiological index (MPI) (Patent № 2344751, 27.01.2009)_. Results. The severity and the type of diabetes mellitus were associated with the area indices. Variability and area indices at night time were shown to be also significant? Based on the cluster analysis MPI was in the same group with pressure area at night as well as its connection with diabetes mellitus type was confirmed. Conclusion. BP variability, daily profile and load indices were the most important for the clinical expert diagnostics of diabetes mellitus. Decrease of daily variability and area indices at night time indicates vascular complications progression in patients with diabetes mellitus.

Objective. Type 1 Diabetes (T1D) is a multigeniс autoimmune disease. The study addresses the polymorphism association between PTPN22, TAF5L genes and T1D. Design and methods. 154 nuclear families, each having affected children with T1D and non-diabetic siblings were recruited. The control group included 200 healthy individuals. Single nucleotide polymorphism genotyping of PTPN22 gene ((-1123), 549, 620, 692, 757) and TAF5L gene (241, 375, 744, 1362) were investigated. Results. The increase of AA genotype frequency and the decrease of CC genotype frequency were observed in T1D affected group in 744 codone of the TAF5L gene. The decrease of allele G frequency and the increase of allele C frequency in genotype CC in promoter loci (-1123) of PTPN22 gene were observed in T1D affected group. Conclusion. These data provide a better understanding of mechanisms underlying development of diabetes mellitus and could potentially lead to novel approaches to its treatment.

Early exposure of cardiovascular risk factors and control of hypertension for prevention of cardiovascular events, first of all, myocardial infarction and cerebral stroke is one of the most important medical and social problems. A strong link has been appreved between cardiovascular disease development and blood pressure level, serum cholesterol, body mass index and smoking. The results of patients examination in hypertension prevention consulting rooms in St Petersburg outpatient's clinics, are presented.

Primary cardiac malignancy presents an unusual difficult surgical problem. Herein, we discuss the modern status of this problem and describe the case of favorable surgical management of a giant rabdomyosarcomas, located in the left atrium.