The use of nitrates and slow calcium channel blockers in the treatment of patients with ischemic heart disease and disorders of intraventricular conduction

Data are submitted on the condition of haemodynamics of greater and lesser circulation in patients with ischemic heart disease (IHD) presenting with the bundle-branch block. On the basis of the results from a combined clinical-instrumental investigation involving electro- and echocardiography the authors present the early objective quantitative criteria for the diagnosis of those haemodynamic shifts occurring in formation of the bundle-branch block. The blockade of the left bundle of His has a more pronounced effect on the greater circulation haemodynamics while that of the right one--on the lesser circulation. The authors give a comparative assessment of haemodynamic effects of a single dose of isosorbide dindtrate and nifedinin in the patients. Nitrosorbide and corinfar improve contractility of the left ventricle, decrease pulmonary hypertension and overloading of the right side of the heart.     

Expression of cytokine messenger RNA after heart transplantation: relationship with rejection and serum cytokines

Different groups of cytokines may initiate or inhibit the rejection process. We used the polymerase chain reaction to study the expression of cytokine mRNA for interleukin (IL)-2, -4, -6 and -10, tumor necrosis factor-alpha, and interferon-gamma in 187 biopsy specimens from 24 human cardiac transplant recipients 5-555 days after transplantation. Cytokine levels in the serum were also measured. Cytokine mRNA was detected in 38.5% of biopsy specimens. IL-10 mRNA was detected more frequently with mild or absent rejection (11.6% in grades 0 and 1 - vs. 1.4% in grades 2 and 3, P=0.01). Up to 90 days after transplantation, IL-2 mRNA was detected more frequently with moderate rejection (13% in grades 2 and 3 vs. 0% in grades 0 and 1, P=0.076), and IL-4 mRNA was detected more frequently with mild or absent rejection (16% in grades 0 and 1 - vs. 0% in grades 2 and 3, P=0.061). More than 90 days after transplantation, IL-2 mRNA was detected more frequently with mild or absent rejection (10% in grades 0 and 1 vs. 0% in grades 2 and 3, P=0.078). Serum IL-4 levels corresponding to biopsy specimens positive for IL-4 mRNA were higher than those corresponding to specimens negative for IL-4 mRNA (59 pg/ml vs. 32 pg/ml medians, P=0.028). Our results suggest that IL-10 and possibly IL-4 (T helper 2 cytokines) may suppress graft rejection, whereas IL-2 (T helper 1 cytokine) may promote cellular rejection. In addition, cytokine profiles may change with length of time after transplantation. The association of elevated serum levels of IL-4 with increased expression of intragraft IL-4 mRNA may suggest release of this cytokine from the graft into the circulation.     

Public health at the municipal level

The purposes of health protection and fortification in various sociums and conditions of attaining these purposes may differ at various levels (federal, regional and municipal) of the society organization. At the municipal level the fortification and protection of population health may be regarded as the chief idea, aim, and criterion of the optimal functioning and development of a socium of the given level, reflecting the measure of efficacy of providing the immediate vital activity of the population. The task of social management is as follows: the share of the national output, created by the socium, is to be distributed so that it were possible for this socium to permanently recreate and maintain at a certain qualitative level its labor resources--the major energy potential of the socium, and adequately provide and guarantee human rights as the main value of the society. A logistic model of the management structure ensuring population health at a municipal level is presented. For health control and for attaining this aim it is necessary to transfer the maximum of legal functions to the municipal level of society administration. It is desirable that every citizen, and not only administration, be involved in the reformation of the society as regards health protection, and that the citizens be personally interested in this process.     

Genetic variation in the interleukin 10 gene promoter and systemic lupus erythematosus

OBJECTIVE: To investigate interleukin 10 (IL-10) gene promoter polymorphisms in systemic lupus erythematosus (SLE) and its clinical subsets. METHODS: DNA from 76 Caucasian patients with SLE and 119 controls as genotyped for 3 defined dimorphic polymorphisms (G or A at position -1082, C or T at position -819, C or A at position -592) in the promoter region of the IL-10 gene, using the polymerase chain reaction to amplify the IL-10 gene promoter and oligonucleotide probes specific for each allelic sequence. The frequency of genotypes was compared between patients with SLE and controls, and between clinical subsets of patients with the disease. RESULTS: There was no significant change in the allele frequency of the three IL-10 gene promoter dimorphic polymorphisms in the SLE group compared with controls. However, when subgrouped according to autoantibody status and clinical features, IL-10 -1082*G, -819*C, and -592*C alleles were increased in patients possessing Ro autoantibodies and those with renal involvement. These alleles are in preferential allelic association, namely GCC, ACC, and ATA haplotypes, and the GCC haplotype was increased in these patient subgroups. CONCLUSION: Polymorphisms within the IL-10 gene promoter that are associated with high IL-10 levels may be important in the development of certain clinical features in SLE.     

Major stress protein Hsp70 interacts with NF-kB regulatory complex in human T-lymphoma cells

Utilization of psychiatric in-patient care among 537 new patients was studied in the Department of Psychiatry in Oulu, Finland, during a 3-year follow-up period. Hospitalization during the second and third years of the follow-up was predicted by hospitalization and number of emergency out-patient contacts during the first year of the study, diagnosis of functional psychosis or personality disorder, and previous in-patient care. In total, 5% of the cohort fulfilled our criteria for 'revolving-door' patients. The 'revolving-door' phenomenon was associated with in-patient care at the first contact with the psychiatric services and diagnosis of psychosis or personality disorder. In total, 2% of the cohort became long-stay hospital patients, and this was predicted by psychosis diagnosis. The clinical implications of these findings are that increased attention should be paid to the first assessment of new patients and to the interaction between psychiatric services and patients during the first year of care.