Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region.

Background. A steady population aging and high incidence of arterial hypertension (AH) lead to a stable increase in chronic heart failure (CHF). The rate of senile asthenia syndrome (SAS) rises in people aged over 80 years and becomes an independent factor of cardiovascular complications.
Objectives. The identification of risk factors (RF), comorbidity and clinical symptoms in elderly patients with CHF, AH and SAS.
Methods. The study covered 161 AH and CHF patients aged over 80 years. Cohort 1 contained “frailty” patients with AH, CHF and SAS, cohort 2 — “strong” patients with AH, CHF but no SAS. RF, concomitant pathology, clinical symptoms and six-minute walk test were evaluated in all patients. Statistical analyses were performed with Statistica 12.0.
Results. Cohort 1 had a higher incidence of atrial fibrillation (AF) (p = 0.001) and chronic kidney disease (CKD) (p = 0.036) compared to cohort 2. Frailty women revealed a higher AF incidence vs. frailty men (p = 0.0002). No-SAS patients had statistically significantly higher body mass index (BMI) (p = 0.047) and obese proportion (by 13.8%). Cohort 1 contained a significantly higher CHF FC III (functional class III), and cohort 2 — CHF FC II rate (p = 0.041). CHF FC III was significantly more frequent in frailty women, and CHF FC II — in frailty men (p = 0.018). Cohort 1 had higher clinical severity scores and a lower exercise tolerance compared to cohort 2 (p < 0.001).
Conclusion. Patients with CHF and SAS had a more frequent comorbidity with AF and CKD, greater number of comorbidities and a significantly higher CHF FC III rate, especially in women. Frailty patients showed a greater CHF severity and lower exercise tolerance compared to noSAS individuals.

Background. Masked arterial hypertension (MAH) is associated with asymptomatic injury of both heart and kidneys. Links between MAH and arterial stiffness are unclear, with debates ongoing on their mutual causative relation. Research into the arterial stiffness contribution to MAH development is a perspective area of cardiology.
Objectives. The MAH risk assessment as a condition of arterial stiffness in patients at cardiovascular risk (CVR) without a verified cardiovascular disease (CVD).
Methods. A single-stage screening observational study included a total of 92 CVR patients without a verified cardiovascular disease. The trial conducted general clinical examination, daily blood pressure monitoring (DBPM), volumetric sphygmoplethysmography with reading cardio-ankle vascular index (CAVI1), aortic and carotid artery pulse wave velocity (PWV), carotid-femoral PWV (CFV) and augmentation index.
Results. Patients were assigned in two cohorts by MAH presence, the primary MAH (58; 63.0%) and normal BP in DBPM (34; 37.0% patients) cohorts. The cohorts did not discord by age, major CVR factors, comorbidity or clinical profile. Men prevailed over women in the MAH cohort (p = 0.028). The cohorts had similar CFV, aortic PWV and augmentation index. Carotid PWV was higher in the MAH cohort both in mean values and elevation rate (p = 0.002 and p = 0.035, respectively). OR and HR were 3.29 and 2.35 (95% CI for OR 1.08–10.49, HR 1.05– 6.02), respectively. MAH was associated with increased CAVI1 for mean values and CAVI1 > 8 incidence rate (p = 0.010 and 0.049, respectively); OR 3.29 (95% CI 1.00–11.41), HR 2.46 (95% CI 1.00–7.10). Correlation analysis revealed a moderate direct dependence between the MAH presence and elevation rate of C-PWV (Q = 0.53) and CAVI1 > 8 (Q = 0.53).
Conclusion. The risk of MAH development in CVR patients is both gender and arterial stiffness-dependent. MAH development is associated with increased CAVI1 and carotid PWV.

Background. Secondary caries formation is a relevant issue due to poor long-term quality of composite fillings, with inherent subsequent chipping and cracking of the material. We developed a method to improve physical, mechanical and chemical properties of available composites based on thermal vibration imposed on unpolymerised composite in the formed tooth cavity directly prior to polymerisation.
Objectives. Effect assessment of thermal vibration exposure on bond strength in composite restorative polymer matrix in various composite brands.
Methods. The study used synchronous thermal analysis, including differential scanning calorimetry and thermogravimetry, to estimate and register thermal effects of physical and chemical processes within a temperature programme, as well as determine gaseous release, air contact and decomposition-related sample mass variation, thermal stability, reaction kinetics, polymer and inorganic filler component chemical composition, humidity and softening degree. The study covered 90 specimens 30 mg each prepared of three different composites.
Results. Synchronous thermal analysis revealed a statistically significant increase in polymer matrix bond strength in the composites Estelite Sigma Quick (Tokuyama Dental), Filtek Bulk Fill Posterior Restorative (3M Espe) and DentLight (VladMiVa) after thermal vibration exposure vs. classical polymerisation of same composites (p < 0.0001). The bond strength increased by 17.00, 22.51 and 11.31%, respectively.
Conclusion. The developed exposure method for altering the composite filling physical and chemical properties has been shown advantageous in a laboratory setting. Thermal vibration-pretreated composite fillings had a higher polymer matrix bond strength vs. same composites polymerised under standard conditions.
The pretreatment improves composite filling quality via directly affecting the material physical and mechanical properties of hardness and bending strength.

Background. The coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has swept across countries worldwide. Despite an unprecedented volume of research, few drug therapies have been proved effective. The lack of evidence-based strategies entailed many practical treatments. Hypercoagulability observed in COVID-19 patients has sparked a debate in the medical community on therapeutic value of anticoagulants.
Objectives. A review of up-to-date evidence supporting the therapeutic effect of unfractionated and low molecular-weight heparin as anticoagulant in treatment for COVID-19. Methods. Russian-language and foreign literature was mined in the RSCI, Scopus, PubMed, medRxiv and eLibrary databases for the years 2020–2021, with considering selected impactive publications within 1991–2019 as well. The query keywords were COVID-19, heparin [гепарин], hemostasis [гемостаз], thromboembolism [тромбоэмболия]. Peer-reviewed scientific journals received priority. Content and descriptive analytics were used as research tools.
Results. The review surveyed 84 literature sources, with 51 articles selected for downstream analysis. We highlight usage of heparin and its fractions in treatment for COVID-19 and preclinical evidence verifying the antiviral and anti-inflammatory properties of heparin and synthetic heparin-like drugs in COVID-19. The known and plausible side effects demanding additional prospective randomised controlled trials on anticoagulant application in COVID-19 are reviewed, with an assessment of oral direct-acting anticoagulant drug efficiency.
Conclusion. Drug-based therapies for haemostasis correction in COVID-19 are currently limited. The paucity of evidence warrants heparin usage as a safer therapy in acute COVID-19 compared to oral anticoagulants. However, the balance of its potential benefits vs. risks must be observed. The benefits and risk uncertainty in heparin treatment require randomised clinical trials and further studies to evaluate safety of direct-acting oral anticoagulants after the patient’s discharge in COVID-19.

Background. Pancreatic pseudocysts stand among current challenges in modern medicine. Their treatment uses variant instrumental techniques and implies a multispecialty approach. Trials in surgery and gastroenterology have aimed to identify an optimal strategy to tackle pancreatic pseudocysts for reducing complications and the recurrence rate, suggesting ultrasound-guided percutaneous, laparoscopic and flexible endoscopic drainage as promising treatment choices.
Objectives. A summarising review of diagnostic and therapeutic methods for pancreatic pseudocyst treatment and comparison of ultrasound-guided percutaneous vs. surgical and endoscopic drainage techniques.
Methods. The review examines the classification, epidemiology and methods for diagnosis and treatment of pancreatic pseudocysts. Only comparative full-text studies published within 2014–2021, as well as selected impactive publications within 2002–2013, have been included. The eLibrary, Elsevier and PubMed resources were queried for the article or journal title fields against the keywords (separate or combined) “pancreatic pseudocyst” [псевдокиста поджелудочной железы], “pseudocyst drainage” [дренирование псевдокисты], “surgical drainage” [хирургическое дренирование], “endoscopic drainage” [эндоскопическое дренирование], cystogastrostomy [цистогастростомия], gastrojejunostomy [гастроеюностомия], “duodenal-cystic anastomosis” [цистодуоденоанастомоз], “transpapillary drainage” [транспапиллярное дренирование], “transmural drainage and esophagogastroduodenoscopy” [трансмуральное дренирование и эзофагогастродуоденоскопия]. Records have been selected for topic-related scientific value.
Results. The review systematically surveys 68 scientific papers in the focus area and summarises the most common surgical methods for pancreatic pseudocyst treatment. Based on the main principle, the methods are classified into three categories, ultrasound-guided percutaneous drainage, surgical drainage and flexible endoscopic drainage. The major classifications and treatment techniques are highlighted for their advantages and disadvantages.
Conclusion. There exist no generally adopted strategy for pancreatic pseudocyst treatment in current clinical practice and no evidence on a particular method application in a large patient cohort. The publication survey identifies the techniques of percutaneous, surgical and endoscopic drainage with ultrasound control as highly effective overall among other surgical treatments.

Background. Adherence in cardiological patients is a leading challenge due to a high society burden imposed by cardiovascular diseases (CVDs) through morbidity, reduced life expectancy, disability and high mortality rates in population. Despite the availability of highly effective medicines and high-technology care, the success of CVD treatment remains insufficient. A particular focus should be placed on patients with previous coronary artery bypass grafting (CABG).
Objectives. A review of reasoning for non-adherence to medication and non-medication management in post-CABG patients and current methods influencing it.
Methods. Russian-language and foreign literature was mined in the eLibrary and PubMed databases with the query keywords “medication adherence” [приверженность терапии], “coronary artery disease” [ишемическая болезнь сердца], “coronary artery bypass surgery” [коронарное шунтирование], “coronary revascularisation” [вторичная профилактика после коронарного шунтирования]. The review included papers published within 2016–2020, as well as selected relevant publications from 2003–2015, to cover 52 sources irrespective of study design and language. Content and descriptive analyses were used as research tools.
Results. Coronary heart disease (CHD) poses an important health, social and economic problem worldwide as a leading cause of reduced life expectancy, disability and high mortality. Non-compliance with medication significantly bursts medical expenditures [1]. Coronary artery bypass grafting is used widely to treat multivessel coronary lesions both in stable and acute CHD. Secondary preventive techniques successfully preclude adverse post-CABG events, but adherence to post-CABG treatment is often low. The non-adherence rationale rarely links to a single factor but is rather complex and multifaceted. It includes social and economic reasons, systemic health care or personnel, therapy and patient-related factors. Methods are developing and refining to improve adherence to both non-medication and medication interventions.
Conclusion. Clinical trials to improve secondary prevention adherence in patients after coronary artery bypass grafting will allow a wider implementation of relevant methods in outpatient management of this patient category.

Background. Contemporary dental diagnosis should supplement clinical examination with instrumental diagnostic techniques. Raman spectroscopy has become widely adopted due to high spatial resolution, non-invasiveness, the lack of strict requirements and ease of sample preparation.
Objectives. A qualitative assessment of enamel mineral and organic composition dynamics using Raman spectroscopy.
Methods. Raman spectroscopy was used as primary research method. The trial bench consisted of a Shamrocksr-303i high-resolution digital spectrometer with built-in DV420A-OE cooled optical detector (spectral range 200–1200 nm), RPB-785 optic fibre scattering probe integrated with LuxxMaster LML-785.0RB-04 laser source with wavelength 785 nm.
Software spectrum processing was performed with Wolfram Mathematica 9. Spectra were denoised with a median filter (5 points), the approximating line (fifth order polynomial) of autofluorescent component was determined in 700–2200 cm-1 range using an iterative algorithm and then subtracted to receive isolated Raman spectra.
Linear discriminant analysis (LDA) of data was performed with the IBM SPSS Statistics package.
Results. The assay included 28 teeth, with 14 extracted for orthodontic indications and 14 — for chronic periodontitis. Spectral dental enamel dynamics has been established in periodontal disease and after the in-office bleaching procedure. The evidence obtained can be applicable in dental practice to verify patients at risk of periodontal disease by interpreting the tooth enamel spectral properties, as well as prior to in-office bleaching.
Conclusion. We demonstrate high efficiency of Raman spectroscopy for qualitative assessment of the mineral and organic enamel composition dynamics in various settings. Raman spectroscopy is confirmed effective and versatile in various aetiologies. It was successfully applied to diagnose periodontitis by changes in the organic and mineral enamel composition and evaluate enamel after in-office bleaching.

The article introduces the concept of health-saving and discusses the forms of activities aimed at preserving and improving health.
We discuss current issues and concerns in medicine and the routes of addressing them through innovations in medical practices. The emphasis is placed on health-saving technologies and their prospects in the subject area.