La práctica intertextual de F. M. Dostoievski y la novela “¿Qué hacer?” Por N.G. Chernyshevsky

The article deals with the phenomenon of intertext and intertextuality as a property of literary discourse as applied to the novels of F.M. Dostoevsky. The article identifies the intertextual transformations of the plot “What is to be done?” by N.G. Chernyshevsky, which became a pretext for the works of Dostoevsky. The article indicates the qualitative and quantitative presence of the other writers’ text in the novels of Dostoevsky. The conclusion is made about the polemical interaction “What is to be done?” with Dostoevsky’s novels.El artículo aborda el fenómeno del intertexto y la intertextualidad como una propiedad del discurso literario tal como se aplica a las novelas de F.M. Dostoievski. El artículo identifica las transformaciones intertextuales de la trama “¿Qué se debe hacer?” Por N.G. Chernyshevsky, que se convirtió en un pretexto para las obras de Dostoievski. El artículo indica la presencia cualitativa y cuantitativa del texto de los otros escritores en las novelas de Dostoievski. Se llega a la conclusión sobre la interacción polémica “¿Qué se debe hacer?” con las novelas de Dostoievski

Efficacy and safety of beta-blockers and prolonged bronchodilators in patients with heart failure with coronary artery disease and moderate to severe COPD

Abstract Purpose To compare clinical efficacy and safety of various treatment regimens with the inclusion of beta-blockers, RAAS antagonists (ACE inhibitors or ARBs), prolonged bronchodilators (LABA, LAMA) in heart failure patients with CAD and COPD. Methods 385 patients (292 men and 93 women), aged 66.3±4.1 years, with CHF classes II to III (NYHA) combined with moderate to severe COPD (GOLD) and with LVEF less than 45% were randomized into nine groups: enalapril + LAMA (control group), nebivolol + enalapril + LAMA, nebivolol + losartan + LAMA, nebivolol + losartan + LABA, nebivolol + losartan + LAMA/LABA, carvedilol + enalapril + LAMA, carvedilol + losartan + LAMA, carvedilol + losartan + LABA, carvedilol + losartan + LAMA/LABA. Patients of all groups received complex CHF treatment comprising diuretics, nitrates, cardiac glycosides (if necessary). Clinical examination, TTE, 6-minute walk test (6MWT), 24-hour electrocardiogram and blood pressure monitoring, respiratory function test were assessed at baseline and after 6 months of treatment. The quality of life was evaluated by MYHFQ, SGRQ and mMRC scale. Results After 6 months of therapy the improvement of clinical condition and quality of life were marked in all groups. At the end of observation period there was a significant improvement of patients clinical condition, quality of life, reduction of mean CHF FC and dyspnea severity, increase of exercise tolerance, slowing of progression of CHF and COPD, improvement of the parameters of intracardiac hemodynamics, structural and functional parameters of the left and right heart (a decrease in the size of the atria, LV volumes and internal dimension at end-diastole and end-systole, cardiac index, LVMMI, an increase of LVEF, a significant decrease in systemic vascular resistance and the pulmonary hypertension grade, significant improvement in systolic and diastolic function of the ventricles, regression of pathological remodeling of the heart, reduction of heart rate, duration and frequency of myocardial ischemia episodes (including its “silent” form). The best results were obtained in groups using a beta-blocker (nebivolol or carvedilol), a RAAS antagonist, and a combination of long-acting bronchodilators (indacaterol and tiotropium) – group 5 and 9. It is worth noting that beta-blockers, LABA and LAMA were well tolerated in all observation groups and serious adverse events were absent. Conclusions The appointment of 3-generation beta-blockers to patients with CHF on the background of CAD and COPD can significantly increase the effectiveness of treatment and does not cause a deterioration in spirometry in patients with such cardiopulmonary pathology. In our opinion, the most important point in the appointment of beta blockers to patients with moderate to severe COPD is low start dose and slow titration of the dose at the beginning of the therapy. It is advisable to include in the complex therapy of such patients a combination of LABA and LAMA as a basic bronchodilator support. Funding Acknowledgement Type of funding source: None </jats:sec

BRAIN NATRIURETIC PEPTIDE AS BIOCHEMICAL MARKER FOR STRUCTURAL AND FUNCTIONAL HEART DISORDERS IN ARTERIAL HYPERTENSION

Aim. Assessment of structural and functional condition of the left and right heart chambers related to the level of NT-proBNP and clinical signs of CHD in AH patients.Material and methods. Totally, 137 AH patients studied (45 men, 92 women) with sinus rhythm and EF LV ≥50%. All patients underwent standard investigations, 6-minute walking test, two-dimension EchoCG, transvalvular and tissue Dopplergraphy, treadmill-test, NT-proBNP concentration in plasma. Assessment of structural and functional heart condition was done in three defined groups according to NT-proBNP level (norm, “grey” zone, elevated NT-proBNP).Results. The level of NT-proBNP is related to the age, sex, therapy intake regularity and does not relate to body mass, BP level, heart rate. The relation revealed for NTproBNP level and diastolic dysfunction of the LV by the data of transmitral and tissue Doppler-graphy. Modified Tei index, obtained during impulse-wave tissue Dopplergraphy, was the most informative marker of LV dysfunction, relevant of NT-proBNP levels. The increase of NT-proBNP followed by significant increase of RV wall thickness. Evaluation of NT-proBNP together with EchoCG led to revelation of asympthomatic LV dysfunction in 13,1% of patients.Conclusion. Interpretation of NT-proBNP level in hypertensive must complex, taking into consideration clinical factors as risk factors, gender and age. Evaluation of NT-proBNP with echocardiography helps to identify groups of patients of higher cardiovascular risk and to optimize further treatment

RETINOL bINDING PROTEIN AS A MARKER OF CARDIOVASCULAR RISK IN ARTERIAL HYPERTENSION AND ObESITY

Aim.  To assess the influence of retinol-binding protein synthetized by adipose tissue, on clinical course and prognosis of arterial hypertension (AH).Material and methods. Totally, 168 patients included, with AH of 1-3 grade. Study protocol included general clinical investigation (at inclusion, in 1, 4 and 9 months) with analysis of complaints, anamnesis, physical examination, additional laboratory and instrumental methods. In 78 patients among the included, the level of retinolbinding protein RBP4 was measured in blood serum.Results. Increased level of RBP4 correlated significantly with the age, body mass index, duration of AH, raised level of uric acid, pulse wave velocity signs, endogenic nitrite. Only in the group with raised RBP4 there was stroke anamnesis noted, and obesity of III grade. Dynamics of the level of RBP4 during 9 months treatment, depending on cardiometabolic risk, showed some specifics: at inclusion, in the group with high cardiometabolic risk there was significantly increased RBP4 comparing to the groups of patients with low and moderate cardiometabolic risk.Conclusion. Increased level of retinol-binding protein is associated with higher cardiometabolic risk and adverse prognosis

SECONDARY MITOCHONDRIAL DYSFUNCTION IN ACUTE CORONARY SYNDROME

So-called “metabolic” direction has been developing intensively during last decades. Its aim is the theoretical and practical analysis of the role of metabolic disorders in initiation and progression of many diseases. The pathogenic peculiarities of acute coronary syndrome (ACS) which result in developing of secondary mitochondrial dysfunction are considered as a subject of this review. The methods of laboratory diagnosis of mitochondrial dysfunction and possibilities of its pharmaceutical correction in patients with ACS are reviewed.</p

INFLUENCE OF COMBINED ANTIHYPERTENSIVE AND ANTIDEPRESSANT THERAPY ON LEFT VENTRICULAR REMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION, ANXIETY AND DEPRESSION

Aim. To assess influence of combined antihypertensive (captopril or metoprolol) and antidepressant (thianeptin or sertralin) therapy on clinical status, blood pressure (BP) and myocardial function in patients with arterial hypertension (HT) and affective disorders (AD).Material and methods. 106 patients with HT were involved in the study. 64 patients (60,4%) had concomitant AD. All patients were divided into 3 groups. 46 patients with HT and AD were included in the 1-st group. They received metoprolol or captopril in combination with tianeptine or sertaline. The 2-nd group included 18 patients with HT and AD who received only antihypertensive therapy. The 3-rd group consisted of 42 patients with HT without AD. They also received only antihypertensive therapy.Results. After 6 month therapy patients of the 1-st and the 3-rd groups had more significant clinical improvement and BP reduction (according to 24- hour BP monitoring) as well as more farourable structural and functional changes of left ventricular in comparison with patients of the 2-nd group.Conclusion. In patients with HT and concomitant AD combined antihypertensive and antidepressant therapy result in favourable clinical changes, effectively reduce BP, improve left ventricular structure and function

Intertextual Practice of F. M. Dostoevsky and the Novel “What is to Be Done?” by N.G. Chernyshevsky

The article deals with the phenomenon of intertext and intertextuality as a property of literary discourse as applied to the novels of F.M. Dostoevsky. The article identifies the intertextual transformations of the plot “What is to be done?” by N.G. Chernyshevsky, which became a pretext for the works of Dostoevsky. The article indicates the qualitative and quantitative presence of the other writers' text in the novels of Dostoevsky. The conclusion is made about the polemical interaction “What is to be done?” with Dostoevsky's novels

La práctica intertextual de F. M. Dostoievski y la novela “¿Qué hacer?” Por N.G. Chernyshevsky

The article deals with the phenomenon of intertext and intertextuality as a property of literary discourse as applied to the novels of F.M. Dostoevsky. The article identifies the intertextual transformations of the plot “What is to be done?” by N.G. Chernyshevsky, which became a pretext for the works of Dostoevsky. The article indicates the qualitative and quantitative presence of the other writers’ text in the novels of Dostoevsky. The conclusion is made about the polemical interaction “What is to be done?” with Dostoevsky’s novels.El artículo aborda el fenómeno del intertexto y la intertextualidad como una propiedad del discurso literario tal como se aplica a las novelas de F.M. Dostoievski. El artículo identifica las transformaciones intertextuales de la trama “¿Qué se debe hacer?” Por N.G. Chernyshevsky, que se convirtió en un pretexto para las obras de Dostoievski. El artículo indica la presencia cualitativa y cuantitativa del texto de los otros escritores en las novelas de Dostoievski. Se llega a la conclusión sobre la interacción polémica “¿Qué se debe hacer?” con las novelas de Dostoievski