This review is devoted to anatomy of the radial artery, and its utilization as an access for interventional procedures. Also, the article depicts pathological mechanisms of the radial artery occlusion, ways of prevention and treatment of this complication.

Heart damage in case of sarcoidosis is associated with high risk of a sudden death; and its verification is very complicated due to lack of pathognomonic symptoms. In this article, we present a review of problems and abilities of cardiac sarcoidosis diagnosis, and main trends of its treatment.

Heartburn is one of the most widely spread symptoms particularly in population of economically developed Western countries. Traditionally it is considered to be related to activation of chemo- and mechanoreceptors of esophageal primary sensory neurons. Repeated stimulation may provoke visceral sensitization. Its development is facilitated by the stress hormone corticotropin-releasing factor. An attentive analysis of heartburn with an assessment of the provoking factors and effectiveness of drug therapy is required for differentiation of gastro-intestinal reflux disease and functional esophageal disease. The lack of response to proton pump inhibitors is an important criterion for suspicion on functional esophageal pathology although sensitization also plays an important role in genesis of heartburn in non-erosive reflux disease. In cases of refractory and «endoscopically negative heartburn», additional studies are justified: endoscopy with esophageal biopsies, 24h-pH-metry/pH-impedansometry, high-resolution manometry. Proton pump inhibitors, highly effective in reflux disease, may relieve heartburn only in some cases of functional heartburn and reflux hypersensitivity. In functional diseases medical therapy affecting visceral hypersensitivity may be used empirically.

The authors have studied the effect of lercanidipine on the functional status of radial artery used as conduit for CABG in patients with coronary artery stenosis. Endothelium-dependent vasodilation (ΔD) was evaluated preoperatively by using duplex ultrasound. Patients were divided into groups I and II with ΔD≥8% and ΔD<8%, respectively. Group II was divided into groups IIA (lercanidipine) and IIB (control). Mechanical force of isolated arterial segments was initially lower in group I. Preoperative treatment with lercanidipine (2.5–5 mg/kg for 5–7 days) led to a significant increase in endothelium-dependent vasodilation and decrease in tone of isolated arterial segments. Preoperative treatment with lercanidipine effectively preserved dilatational properties of arterial conduit.

Aim: to study the changes in heart rate variability (HRV) in patients with anxiety and depressive disorders who suffered acute coronary syndrome (ACS) and to determine the effects of antidepressant agomelatine on HRV and sleep quality during six-month follow up.
Material and Methods. The study included 54 people with ACS, anxiety, and depressive disorders. Patients were randomly assigned to two groups. Antidepressant agomelatine 25 mg/day was administered to patients of group 1 in addition to standard therapy for ACS; group 2 received placebo. Twenty four-hour Holter ECG monitoring, HRV study, mental status monitoring, and sleep quality assessment were performed during hospitalization and at six-month follow up.
Results. Patients of both groups had clinically significant anxiety, subclinical depression, and insomnia of varying severity. According to Holter monitoring data, all patients had decline in HRV parameters. After six months, anxiety and depression significantly improved in patients administered with agomelatine; these patients had sleep normalization and improved HRV. The comparison group did not have similar changes.
Conclusion. Additional administration of agomelatine 25 mg/day to patients with anxiety and depressive disorders after ACS resulted in improvement of mental status, heart rate variability, and sleep quality. Due to the absence of pro-arrhythmogenic effects, administration of agomelatine allows to correct anxiety-depressive disorders in patients with ACS.

The article is devoted to the evaluation of the results of clinical application of penetrating radiofrequency ablation techniques on atrial myocardium.
Material and Methods. A total of 298 patients with valvular heart disease complicated with atrial fibrillation were operated. All operations were performed under cardiopulmonary bypass and cardioplegia. The main group consisted of 198 patients who were operated using penetrating technique radiofrequency exposure. The control group consisted of 100 patients who underwent surgery with the use of «classical» monopolar radiofrequency-ablation technique. Both groups did not significantly differ in any parameter before surgery, but to increase confidence in the results, pseudo-randomization was performed using the Propensity score matching technique.

Results. Patients with previous heart surgery were excluded during the selection of candidates for the procedure because of the presence of adhesions in the pericardium that did not allow good visualization of the left atrium, sufficient to perform the procedure. Penetrating technique had significantly higher efficiency compared to the «classic» technique in the early and long-term postoperative periods. The efficiency was 93% in the early postoperative period and 88% in the long term. The efficacy of «classical» monopolar procedure was lower: 86 and 68%, respectively.

Background. Atrial fibrillation remains the most common sustained arrhythmia, with an expected increase in our aging population. In addition to the significant morbidity that is secondary to hemodynamic compromise and tachycardia-induced cardiomyopathy, stroke remains the most feared complication, with a 5-fold increased risk. New surgical approaches show promising results and perfect safety for treatment patients with different types of atrial fibrillation.
Subject: to describe surgical technique and to evaluate the short-term efficacy and safety of radiofrequency thoracoscopic ablation (Dallas Lesion Set) in patients with lone atrial fibrillation.
Material and Methods. Epicardial bipolar radiofrequency ablation was performed on the beating heart through a bilateral endoscopic approach in 127 consecutive patients with lone atrial fibrillation. This included isolation of the pulmonary veins using a clamp; isolation of the posterior left atrial wall, including a trigonal line to the aortic noncoronary sinus using a linear ablation device; and clip or resection of the left atrial appendage. Paroxismal atrial fibrillation was registered in 7% of patients; persistent and persistent long-standing atrial fibrillation was registered in 54 and 39% of patients respectively.
Results. Mean duration of atrial fibrillation was 60 (24; 120) months. Mean operation time was 146.7±29.1 minutes. Complications rates were 24% during the learning curve period and 3.9% beyond this period. Freedom from atrial fibrillation and others rhythm disturbances was achieved in 90.5% of patients at discharge. 

Conclusion. Endoscopic radiofrequency ablation on the beating heart demonstrated high success rates in patients with all types of atrial fibrillation. The rates of complications and procedure-related morbidity decreased at times beyond the learning curve period.

Objective. Main objective of this prospective randomized study was to assess safety and efficiency of the combined approach for the left atrial ablation in combination with and without reduction left atrioplasty in patients with mitral valve disease.

Material and Methods. The study was performed from September, 2014 to February, 2017. A total of 120 patients with mitral valve disease, permanent atrial fibrillation (AF), and left atriomegaly were enrolled in the study. Patients were randomized to two groups: group I comprised patients who received correction of mitral valve disease in combination with AF ablation and without reduction atrioplasty of the left atrium (MV+MAZE); group II (n=60) comprised patients with correction of mitral valve disease in combination with AF ablation and with reduction atrioplasty of the left atrium (MV+MAZE+AP). Patient characteristics did not differ between groups.
Results. There were no significant differences between groups in the early mortality rates (2 patients in group I versus 5 patients in group II, p=0.64); bleeding rates (total 5 cases including 2 patients in group I and 3 patients in group II, p=0.34), and the rates of AF recurrence in the early postoperative period. Permanent pacemakers were implanted in 8 patients (13.3%) of group I and in 4 patients (6.7%) of group II. Total long-term mortality was 4 patients including 1 and 3 patients in group I and II, respectively, which did not significantly differed. The rates of one-year freedom from AF were 84.8 and 86.2% in group I and II, respectively. No new onsets of atrial fibrillation were observed for 36 months in both groups. The rates of freedom from thromboembolic events during the time of observation were 88.6% in group I and 96.5% in group II. 

Conclusion. The left atrial reduction concomitant with the left atrial ablation and correction of mitral valve disease is safe and effective procedure. However, this procedure did not impact the rates of long-term freedom from AF.

Aim. Surgical septal myectomy is a standard treatment option for patients with hypertrophic obstructive cardiomyopathy. Subvalvular abnormalities of the mitral valve may play an important role in residual left ventricular outflow tract obstruction. This study aimed to evaluate the surgical outcomes of septal myectomy with subvalvular interventions.

Material and Methods. Between July, 2015 and December, 2016, 40 eligible patients underwent septal myectomy with subvalvular intervention. The peak gradient was 92.3±16.9 mm Hg. The mean septum thickness was 26.8±4.5 mm. Moderate or severe systolic anterior motion syndrome-mediated mitral regurgitation was observed in all patients.
Results. There was no residual mitral regurgitation. Residual systolic anterior motion syndrome was observed in 5%. The postoperative gradient was 8.7±4.5 mm Hg. At 12-month follow-up, all patients were alive. According to the New York Heart Association (NYHA) classification, 87.5 and 12.5% of patients had NYHA functional classes I and II, respectively. The prevalence rate of residual mitral regurgitation was 10%.
Conclusions. Concomitant subvalvular intervention during septal myectomy effectively eliminated left ventricular outflow tract obstruction and provided high freedom from residual mitral regurgitation one year after surgery.

In the course of the study, 124 case records of patients with epileptic seizures (cryptogenic epilepsy) were analyzed. Diagnosis was established based on a typical clinical presentation, anamnesis, electroencephalogram (EEG) dynamics, and/or video EEG monitoring in the 10-hour format. Group I comprised 36 patients with normal liquor-cranial indexes ranging from 1.6 to 3.6 with an average value of 2.1±0.2; these patients received standard multicomponent therapy during the hospitalization and at the outpatient-polyclinic stage. Group II comprised 42 patients who had liquor-cranial indexes below the lower limit of normal ranging from 0.8 to 1.2 with an average value of 1.0±0.1; these patients also received therapy for primary diagnosis according to standard therapy scheme, which was identical to that in group I. Patients of group III (main group, n=46) had liquor-cranial indexes below physiological norm (from 0.8 to 1.2 with an average value of 0.9±0.1) and received modified therapy. Two-year follow up study showed that more severe cognitive deficit developed in patients with low cerebrovascular indexes receiving standard therapy compared to patients with low cerebrovascular indexes who received modified therapy. The absence of significant differences between patients of group I and III suggest that timely correction of increased intracranial pressure allowed to prevent significant aggravation of pathopsychological characteristics, loss of short-term and long-term memory, and overall cognitive function decline.

Objective: to study clinical-biological features of affective disorders including their comorbidity with coronary artery disease and personality disorders and efficacy of psychopharmacotherapy in these patients.
Material and Methods. In the first group at a heart station 290 patients with chronic coronary artery disease and affective disorders (209 men and 81 women) were fully examined. The second group included 120 patients (40 men and 80 women) of a psychiatric hospital with affective disorder comorbid with personality disorders. The third group included the study of 29 patients with depressive disorders and a control group (n=21).
Results. Data on significant clinical-dynamic, biological and therapeutic features of affective disorders comorbid with coronary artery disease were obtained. It was revealed that presence of a comorbid personality disorder in the case of affective disorders causes the necessity to use a combined psychopharmacotherapy more frequently, worsens indicators of the efficacy of the psychopharmacotherapy of current episode of depression, and increases negative estimation of their social adaptation by these patients. Dysregulation of the processes of programmed cell death in patients with depressive disorders was found.
Conclusion. Obtained data testified to the high degree of comorbidity of affective disorders with coronary artery disease and personality disorders which worsened the prediction of the course and indicators of the efficacy of psychopharmacotherapy of these disorders. In patients with depressive disorders the specific weight of mononuclears of peripheral blood was increased in the state of apoptosis.

Evidence suggests that most myocardial infarctions result from ruptures of the atherosclerotic plaques that do not significantly compromise coronary lumen before the event. However, detection of nonsignificant coronary lesions in patients with suspected coronary artery disease without coronary angiography is challenging. We developed a calculator for nonobstructive coronary atherosclerosis based on patient gender, age, and the presence or absence of the echocardiographic signs of ascending aorta atherosclerosis and arterial hypertension. The calculator may be used for determining the probability of non-obstructive coronary atherosclerosis and for promoting compliance of patients to lipid-lowering therapy.

Aim: the aim of the study was to investigate the pleiotropic properties of the apoptotic enzyme caspase-3 and its associations with the synaptic plasticity of the hippocampus of albino rats in healthy animals and in rats after 20-min occlusion of the common carotid arteries.
Material and Methods. Total numerical density of neurons, ultrastructure of synapses, and area of immunohistochemically positive hippocampal synaptic terminals of CA1 stratum radiatum and stratum lucidum CA3 were studied by the methods of optical microscopy (hematoxylin and eosin stain), electron microscopy (uranyl acetate and lead citrate as contrast agents), immunohistochemistry (MAP2, synaptophysin, caspase-3, p53, and bcl-2), and morphometry in the brains of intact rats (n=5) and in animals after acute ischemia at day 1 (n=5), 3 (n=5), 7 (n=5), 14 (n=5), and 30 (n=25).
Results and Discussion. The study showed that 33.0% of pyramidal neurons in CA1 region and 17.4% of those in CA3 region underwent irreversible damage within 30 days of the post-ischemic period. Among the irreversibly damaged neurons, the cells with signs of coagulative-ischemic necrosis prevailed. In animals subject to ischemia, the relative area of synaptophysin-positive material initially decreased (at day 1) and then recovered (at days 3, 7). We found that caspase-3 colocalized with synaptophysin, which was especially evident in the giant synapses of the stratum lucidum of the hippocampal CA3 region. In the neurosomes of the hippocampal pyramidal cells, caspase-3 was not detected. However, this enzyme was found in the terminals of the axo-dendritic, axo-spine, and axo-somatic synapses. In the course of th e post-ischemic period, the most pronounced changes in the expression of caspase-3 were observed in the stratum radiatum of the CA1 field. Apoptosis regulatory proteins (p53, bcl-2) were detected in the individual neurons. In this regard, caspase-3 should be viewed in the context of its pleiotropy and involvement in the adaptation and recovery processes due to post-ischemic activation of neuroplasticity at the level of axons and synapses.
Conclusion. After acute ischemia caused by 20-min occlusion of the common carotid arteries, the activation of caspase-3 contributes to ischemic preconditioning and neuroprotection.

Aim: the aim of the study was to analyze the relationships of social, demographic and medical characteristics in patients with ischemic heart disease in case of high-technological medical care type profiled as «Cardiovascular surgery».
Material and Methods. The material of the study was database of patients hospitalized in Cardiology Research Institute, Tomsk NRMC (Tomsk, Russia). Methods of descriptive statistics and nonparametric methods for testing statistical hypotheses were used.
Results. As a result of the study, the differences in age- and sex-related structures, employment, and employability of patients were identified. Clinical diagnoses and durations of hospitalizing were analyzed depending on sex, age and type of high-technological medical care. Elucidation of these differences allowed us to identify two main models of patients with radical surgical correction of ischemic heart disease.
Conclusion. Elucidation of these differences allowed us to identify two main models of patients with radical surgical correction of ischemic heart disease. These models may be used for clinical and economic analysis of high-technological medical aid based on the method of modeling.

The aim of the work was to establish levels of social support in an open urban population for men aged 25–64 years.
Material and Methods. Cross-sectional epidemiological study was conducted in 1000 males using a representative sample formed by the method of «random numbers» taken from the electoral lists of the Central Administrative District of Tyumen, the response was 85.0%. Social support was evaluated using the Beckmann‑Sim test on the basis of the World Health Organization questionnaire «MONICA‑psychosocial».
The results of the study showed that in an open urban population in men aged 25–64 years and in certain age groups, a predominantly low and medium index of close contacts was established. Men of working age are dominated by the medium-high and average index of social ties; in the sixth decade of life, the low index of social ties reaches an absolute maximum, a high index of social ties-an absolute minimum.
Discussion. The scientific literature shows that people with high levels of social interaction have better health than those with low levels. Therefore, it is important to study the changes in the social support factor in the population as one of the protective social mechanisms that mitigate the negative consequences of stress. 
Conclusion. The patterns established in men of an open urban population according to the levels of social support are the scientific basis for planning socially-oriented preventive programs in medium-urbanized Siberian cities.

Accessibility of the country’s citizens to expensive, complex, innovative methods of treatment is provided by expanding the number of medical organizations of different levels providing these types of medical care. The most replicated methods of treatment included in the list of high-tech types of medical care are to be included in the list of the high-tech types of medical care, which is funded under the basic program of compulsory medical insurance, and then to clinical and statistical disease groups. Updating the list of existing methods of specialized, including high-tech, medical care provided free of charge within the framework of the State Guarantees Program is carried out in accordance with the Order of the Ministry of Health of Russian Federation of 01.08.2017 No. 484n «On approval of the order of the list of types of high-tech medical care».
The aim of the study is to assess the prospects for increasing the availability of high-tech types of medical care for patients who need intravitreal injections of angiogenesis inhibitors along the profile of «ophthalmology», an assessment of the possibilities and limitations on the expansion of the high-tech types of medical care of this profile.
Material and Methods. The study used the official statistics on the volume of cases of specialized, including high-tech medical care, for 2015–2017, the normative indicators of the Program of state guarantees for free medical care. Bibliographic, statistical, mathematical methods of scientific knowledge were used.
Results. The dynamics of the volumes of specialized medical aid in the profile of «ophthalmology» is estimated, including in the context of types of medical care and levels of medical organizations. On the basis of the Order of the Ministry of Health of Russian Federation from 01.08.2017 No. 484n «On the approval of the order of the list of types of high-tech medical care» developed and applied the algorithm of translation of the method of high-tech types of medical care from Section II of the List. The analysis of the prospects for the participation of private medical organizations in the provision of high-tech types of medical care since 2019 has been carried out.
Conclusions. The study made it possible to evaluate the prospects of expanding the accessibility of the high-tech types of medical care for patients who need intravitreal injections of angiogenesis inhibitors along the profile of «ophthalmology». None of the methods of high-tech types of medical care of Section II of Group No. 29 has objective prerequisites for translating these methods both in the high-tech types of medical care of Section I and in the diagnosis-related group.

The article presents the biography of the famous native scientist Valentina S. Lavrova and her contribution to the development of Russian pathophysiology. The author gives a brief review of her scientific, educational, medical, and social activities.