Репозиторий Университета

© Saint Petersburg Pasteur Institute. All rights reserved. The review is devoted to the analysis of pertussis incidence of children in the age group of 5-7, as well as strategies of DTP immunization with the help of the drugs in foreign countries. Mass vaccination against pertussis began in the middle of the 20th century, which contributed to a reduction in incidence and mortality rate from this infection. However, in the last decade, there has been an opposite tendency of increasing incidence of patients among children under school age, school age and adults. Atypical forms of the disease and complications due to ARVI, respiratory mycoplasmosis and cytomegalovirus infections are described in the review. Various strategies for the use of whole-cell and acellular pertussis vaccines as part of DTP drugs are described, as well as the epidemiological effect of introducing an additional booster dose of vaccine to children under school age. The expediency of revaccination of children aged 6-7 in Russia is argued, which can help to reduce the overall incidence of pertussis. The research materials related to the study of the properties of acellular anti-pertussis vaccine, such as immunogenicity and safety in comparison with whole-cell vaccine, are analyzed. The main drugs and their composition, which are used to vaccinate children against pertussis, are described in the review. It is assumed, that the increase in the incidence among children and teenagers, with the appearance of atypical forms of pertussis, is associated with a number of factors, such as the spread of new genotypes of Bordetella pertussis bacterium, emerged from mutations, as well as short duration of immunity after vaccination with acellular drugs, in comparison with whole-cell, and the use of more modern methods of detecting the pathogen. The mechanisms of the immune response due to different types of pertussis vaccines are also reviewed. It is concluded, that revaccination of children aged 6-7 with an additional fifth dose of an acellular vaccine against pertussis, as part of the DTaP instead of the Td drug, which is regulated in the National Calendar of preventive vaccinations, will have a favorable effect on the epidemic situation with pertussis infection in Russia.

© 2018 The Author(s). Blockchain as technology described to be used in closed Systems to conduct registers of official data in public healthcare. Also this technology had found its use in different other ways, for example it is education of medical staff, control of the contracts for healthcare ServiceS. And the role of Blockchain in CALS / PLM-technologies suggested.

© 2018 The Author(s). The article describes the processes of collecting and adapting the diagnostic information necessary for use in automated analysis of three-dimensional images and surgical navigation. The work is carried out on the basis of the NMRC Obstetrics, Gynecology And Perinatology named after V.I. Kulakov of the Ministry of Health of the Russian Federation with the financial support of the Ministry of Science and Education of the Russian Federation (Agreement dated 03.10.2016 No. 14.607.21.0162, unique identifier RFMEFI60716X0162) The work is devoted to the features of collection, segmentation and description of the results of preoperative radiological diagnostics of newborn patients with congenital urinary malformations such as hydronephrosis (HN), renal duplication with uretherohydronephrosis of the nonfunctional segment (UHN) or multicystic dysplastic kidney (MC). The goal of the work is the development of standards for the collection, classification and segmentation of various diagnostic information of congenital urinary malformations in newborns necessary to use in automated three-dimensional image analysis and surgical navigation. In order to expand the scope of application, it was decided to supplement the data bank with information from the patient's phenotypic chart, compiled by the clinical geneticist when examining the patient. According to the developed and implemented algorithms we collected and segmented 978 series of images belonging to 393 patients with urinary malformations and 452 series of normal urinary System. Available text descriptions of the series are reconstructed to the original developed standard. At present, using this data bank, a subSystem of neural network analysis and reconstruction of diagnostic images of newborn patients is being developed, as well as a surgical navigation System for performing endoscopic surgical manipulations on patients for congenital malformations of the urinal System.

© 2018 The Author(s). Medical drugs interactions and adverse drug reactions are one of the major problems in pharmacotherapy. At the Sechenov University (Russia, Moscow), digital System for drug prescription management is being developed. Artificial intelligence methods to the control of drug therapy will greatly enhance the ability of the automated control System to identify potential problems in drug therapy and provide recommendations for their elimination. Introduction of this System into commercial operation will make it possible to translate the civil circulation of medicines into a single information space and increase the effectiveness of the ongoing pharmacotherapy.

© 2018 Bentham Science Publishers. Gastrointestinal stromal tumours are the most common mesenchymal tumours of the gastrointestinal tract. Despite similar mutation pattern of activating mutations in KIT or PDGFRA receptors in 85% of cases, they demonstrate significantly heterogeneous clinical behaviour and pathological characteristics. This heterogeneity opens the question of the role of other factors and mechanisms of regulation in the development of GIST. Additional mutations in downstream effectors of GIST related signalling pathways or aberrant expression of non-coding RNAs may be additional contributing factors, the latter being increasingly recognized in carcinogenesis in general. Recently, a substantial progress has been achieved in understanding the functional roles of lncRNAs in GIST suggesting their potential employment as biomarkers and therapeutic targets in GIST. Moreover, some miRNAs have recently been found to be able to sensitize cells to imatinib, which could be an attractive option to overcome the resistance to the drug, which hampers the efficacy of GIST treatment. Therefore, the advantage can be taken of both coding and non-coding parts of the genome in order to significantly improve prognostication and help find personalized therapy for patients, depending on a subtype of GIST and personal characteristics.

© 2018 Ruslania. All Rights Reserved. One of the prevalent genetic causes of idiopathic male sterility is related to micro-deletions in AZF locus located in Y-chromosome. In total population, rate of such micro-deletions makes up to 1:4000. however, in infertile males their rate varies from 2% to 10%. In AZF locus three subregions are distinguished: AZFa, AZFb andAZFc. The loss of one or several subregions can result in disorder of spermatogenesis of various degree - from decreasing of its activity to Sertoli-cell syndrome manifested by azoospermia or oligospermia of severe degree. Therefore, implementation of genetic testing for presence of micro-deletions in AZF locus is a necessary test in case ofprognosis of male sterility and its treatment. The purpose of study is to develop and test a diagnostic system of detection of micro-deletions in subregions ofAZF locus using multiplex polymerase chain reaction in real-time. As a reference method a technique was implemented described in guidelines of the European Academy ofAndrology conjointly with European Molecular Genetics Quality Network. The technique testing specified analysis of 33 samples of DNA separated from blood of males with azoospermia and oligospermia ofsevere degree. No discordant results were received as compared with reference method. In 27 DNA samples the deletions were detected in AZF locus: 4 AZFa deletions (15%), 2 AZFb deletions (7%), 17 AZFc deletions (63%) and 6 combined deletions of AZFb+candu AZFa+b+c (22%). The proposed technique permits detect micro-deletions of subregions ofAZF locus.

© 2018 Russian Photodynamic Association. All rights reserved. Currently, reconstructive-plastic surgery is becoming the standard for surgical and combined treatment of breast cancer (BC) patients. With a one-stage reconstruction of the breast, the use of biological implants that can replace muscle autografts and, consequently, reduce trauma, blood loss and operation time, and also to avoid defects in the donor zones is becoming topical. From 2014 to 2017, 151 reconstructive operations on 121 patients with BC (average age 41.5 years) using synthetic and biological materials were carried out in P.Herzen Moscow Oncology Research Institute. 0 stage of BC TisN0M0 was diagnosed in 11 (9.1%) patients, I stage - in 52 (42.9%), IIA - in 41 (33.9%), IIB - in 9 (7.4%), IIIA - in 4 (3.3%), IIIB - in 2 (1.7%), IIIC - in 2 (1.7%). To strengthen the lower slope, a biological implant - Permacol acellular dermal matrix, was used in 34 cases. Cosmetic result was rated as excellent in 20 (58.9%) cases, good in 11 (32.3%), unsatisfactory in 3 (8,8%). Biological materials are an important addition to various options for breast reconstruction. The criterion for selecting the material for strengthening the lower slope of the breast with subcutaneous or cutaneous mastectomy for cancer with a one-stage reconstruction using a silicone endoprosthesis is the pinch-test value.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: This article is dedicated to analysis of use PET-CT with 18F-FDG for the last 10 years. Determining the presence of metastasis in regional lymph nodes and distant sites in endometrial cancer is an important diagnostic step aimed at the choice of treatment tactics and improvement of surgical treatment results. If the process is beyond the uterus itself, it significantly worsens the prognosis of survival. In addition, in these cases, it is necessary to change the treatment and surgical tactics. Determination of stage 1 and 2 of the process gives an optimistic prognosis for the survival of patients. Currently, ultrasound, magnetic resonance imaging and, to a much lesser extent, computed tomography are used to assess the prevalence of the process. The diagnostic value of these methods according to some authors does not exceed 66-73%. In this regard, it is justified to work on finding more reliable methods that will more accurately determine the presence of metastatic disease in, both regional lymph nodes and distant organs. One of such promising methods is the use of positron emission tomography combined with computed tomography (PET/CT), using as radiotracer 18 - fluorodeoxyglucose. This article is a review of the scientific literature on this problem over the past 10 years and is devoted to the evaluation of the diagnostic accuracy of PET/CT with 18F-FDG.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: This scientific review of the literature presents the most relevant discussions in the world community, aimed at improving the implementation of the diagnostic algorithm in patients with severe combined trauma. Materials and methods: The work deals with the main traumatic injuries of various anatomical zones, the criteria of the Advanced Trauma Life Support (ATLS) protocol and diagnostic methods aimed at detecting acute traumatic pathology. Conclusion: The authors consider unsolved issues, as well as the improvement of the multislice computed tomography (MSCT) algorithm in the "whole body" mode, to optimize diagnostic activities aimed at managing patients with severe combined trauma.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: Assessing the dynamics of vulnerability of atherosclerotic plaques in patients with angina pectoris on atorvastatin therapy (40 mg for 10-12 months) based on coronary computed tomography angiography (CCTA) data. Materials and methods: The study prospectively enrolled 74 patients with angina pectoris not medicated with statins. All patients underwent CCTA. 30 patients with vulnerability of atherosclerotic plaques were selected for further observation and atorvastatin was administered to them at dose of 40 mg. Repeated tomography scans were recorded 10-12 months later. Images were analyzed by "Vitrea" workstation in a blind manner. Statistical processing was performed on SPSS version 11.5 software (BioStat). Results: Statistically insignificant decrease in: total plaque volume (from 188.64 ± 35.8 to 184.96 ± 34.45 mm3), low-attenuation plaque (from 60.46 ± 12.87 to 57.06 ± 12.34 mm3), degree of stenosis (from 41.6 ± 3.16 to 40.65 ± 3.26%), spotty calcification (from 86.0 to 90%), remodeling index (from 1.25 [1,0;1,4] to 1.1 [1,0;1,4]), napkin-ring sign (from 69.76 to 60%), irregularity of the contour (from 79.1 to 65%). LDL levels decreased from 3.23 ± 0.33 to 2.76 ± 0.27 mmol/L. Statistically significant decrease of total cholesterol was from 5.75 ± 0.45 to 4.42 ± 0.57 mmol/L. The study also revealed statistically significant positive correlation between decrease of LDL levels and total plaque volume decrease (R=0.51, P=0.002), mainly because of lowattenuation components. Conclusion: We review our experience of using CCTA for noninvasive monitoring of vulnerability of atherosclerotic plaques in dynamics and show that atherosclerotic plaques stabilize on long-term atorvastatin treatment.

© Ruslania 2018. All rights reserved. According many publications, rate and severity of various diseases of oral cavity are significantly increasing in drug-dependent patients. One of drugs using in many countries as a substitution therapy is methadone. However, last research data testifies that negative effect of methadone on human organism in general is more expressed as compared with case of heroin. So, significance is acquired by those studies that testify pathological alterations in organs and systems of patients, including effect on oral cavity. The article presents the results of analysis if crystallography of biological fluids of drug-dependent patients using heroin and methadone. Te study established dependence of character ofgrowth of crystals from type of used drug.

© 2018, Media Sphera Publishing Group. All rights reserved. The robotic technologies every day exert an increasingly greater influence on the surgical technique, with the well documented clinical applicability in reconstructive plastic surgery and oncology. At the Department of plastic surgery of I.M. Sechenov First Moscow state medical university, we have gained an extensive experience with the surgical treatment of the patients requiring the major oral robotic intervention. A novel application has recently been documented for the purpose of robotic surgical assistance to the patients presenting with oncological pathology including cancer of the oropharyngeal wall at the early stages of development (T1N0M0). The objective of the present study was to develop and introduce into the clinical practice of the robot-assisted methods for the treatment of malignant neoplasms of the head and neck organs. A hybrid technique was applied, i.e. the combination of the robot-assisted trans-oral surgical intervention and the microsurgical radial flap mobilization to correct the postoperative defect following the extraction of the tumour. The combination of these methods provided the excellent clinical results and positive dynamics of the patients’ condition, with the swell apparent improvement of the quality of life. The early patient activation was due to the application of the minimally invasive transoral surgical technique, with the swallowing ability being reinstated within 14 days after the intervention by virtue of the proper flap function. All the patients successfully underwent the robot-assisted surgical manipulations without complications. The shorter rehabilitation time during the postoperative period in these patients made it possible to quicker initiate chemotherapy and radiotherapy. This significantly improved the patient’s quality of life and prognosis due to the combined approach to the treatment of head and neck oncology. It is concluded that the incorporation of the robotic assistance into the program of surgical treatment significantly increases the effectiveness of the treatment and makes possible the combined approach to the treatment of oncological patients with manageable tumours of the head and neck region.

© Ima-Press Publishing House. All rights reserved. Objective: to investigate the efficiency of treatment for acute and subacute dorsalgia, by providing information to patients and by using nonsteroidal anti-inflammatory drugs (NSAIDs) without conducting physical therapy, reflexotherapy, and manual therapy. Patients and methods. A total of 140 patients (87 women and 53 men; mean age 50.7±17.6 years) with acute and subacute back pain were followed up. Out of them 127 (91%) patients were found to have nonspecific (musculoskeletal) pain; 13 (9%) had discogenic radiculopathy. All the patients were informed of the benign nature of the disease, the high probability of its rapid resolution, the feasibility of abandoning prolonged bedrest, and the lack of need for physical therapy, reflexotherapy, massage, and manual therapy. To reduce pain, the patients received meloxicam 15 mg/day orally or intramuscularly or first 15 mg/day intramuscularly and then orally. The investigators assessed pain intensity with the numerical rating scale and functional activity restrictions with the Roland-Morris disability (RMD) questionnaire. Results. After treatment, the visual analogue scale pain intensity scores decreased from an average of 6.4 to 1.0; the RMD scores dropped from 6.8 to 1.4 (p<0.001). The duration of treatment averaged 11.0±4.4 days. Comparison of different meloxicam dosage regimens showed no significant differences; a positive result was noted in all cases. No adverse events were observed during treatment. Conclusion. The investigation has shown the high efficiency of management in patients with acute and subacute dorsalgia, by providing information to patients (an education conversation), by using meloxicam, and by applying a personalized approach (treatment for concomitant diseases and conditions). Refusing physiotherapy, massage, acupuncture, and manual therapy substantially reduces the cost of treatment in patients with acute dorsalgia.

© Ima-Press Publishing House. All rights reserved. Peripheral nervous system involvement may be a main manifestation of systemic amyloidosis or occur in the later stages of the disease in the presence of multiple organ pathology. Focal, multiple mononeuropathy, radiculopathy, polyneuropathy, autonomic nervous system dysfunction, and myopathy develop depending on the localization of amyloid deposits in the peripheral nervous system. The most characteristic symptom in systemic amyloidosis is sensorimotor polyneuropathy accompanied in most cases by the involvement of autonomic nerve fibers in the pathological process. In cases of systemic amyloidosis, peripheral nervous system involvement is progressive, leading to disability, which makes the early diagnosis of the disease and its neurological manifestations and subsequent pathogenetic therapy relevant.

© Ima-Press Publishing House. All rights reserved. Post-stroke cognitive impairment (PSCI) is often characterized by a complex prognosis of neurorehabilitation, insufficient restoration of the functional status of patients, and a high risk of recurrent strokes and disability, which determines considerable health care costs. Objective: to carry out a comparative pharmacoeconomic analysis of the use of actovegin (Takeda Pharmaceuticals, Switzerland) in Russian patients with PSCI. Patients and methods. The investigation was conducted using a modeling method to determine the cost-effectiveness of competing treatment strategies: standard patient management; standard patient management and use of actovegin. Data from the ARTEMIDA clinical trial were used. Results and discussion. The use of actovegin was economically justified, which was expressed in more preferable cost-effectiveness indicators. Also, the use of actovegin in patients significantly reduced the risk of post-stroke dementia and, accordingly, the cost of treatment in future periods. Conclusion. The findings data indicate the clinical and economic feasibility of using actovegin in patients with PSCI.

© Ima-Press Publishing House. All rights reserved. Interleukin 6 (IL-6) plays an important role in the pathogenesis of ischemic stroke (IS), exerting a modulating effect on a number of processes that determine the outcome of this disease. Objective: to investigate the peripheral blood levels of IL-6 in patients in the acute period of different IS pathogenetic subtypes and its effect on recovery rates. Patients and methods. The study enrolled 155 patients (74 men and 81 women; mean age, 63.8 years). A control group consisted of 28 people without IS. Pathogenetic subtype II was established in accordance with the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria on the basis of their clinical picture and the data of computed tomography or magnetic resonance imaging and ultrasonography of the main arteries of the head. The severity of a patient's condition and a focal neurological defect and the time course of clinical changes after stroke were determined using the National Institutes of Health Stroke Scale (NIHSS). An enzyme immunoassay (EIA) was used to measure IL-6 levels on days 1, 7, and 21 after onset of IS. An enzyme immunoassay (EIA) was used to measure IL-6 levels on days 1, 7, and 21 after onset of IS. Results. In the acute period of IS, there were significantly elevated levels of IL-6. The latter reached its highest values on day 7 in patients with the atherothrombotic pathogenetic subtype of IS. On day 7 of the study, the peak concentration of IL6 was typical for patients with all subtypes of IS, except for lacunar stroke. After its increase on day 1 of the study, the IL6 level in patients with lacunar stroke did not change significantly in all other periods. In acute IS, the concentration of IL-6 was significantly influenced by the following cardiovascular risk factors: hypercholesterolemia of days 1, 7 (p<0.01) and 21 (p<0.05), hypertension in day 1 (p<0.05), diabetes mellitus on days 1 and 7 (p<0.05), and coronary heart disease in all the study periods (p<0.01). The IL-6 concentration significantly correlated with the severity of neurological defect, but did not significantly affect the rate of recovery in the patient with acute IS. Conclusion. IL-6 was established to be of prognostic value for the outcome of acute IS on day 7. The rate of recovery can be used to identify targets for therapeutic intervention.

© 2018 Voprosy Sovremennoi Pediatrii - Current Pediatrics. All rights reserved. The article presents the modern knowledge of the structural and functional peculiarities of the skin in children. Information on the etiopathogenesis of a debut atopic dermatitis has been also given. The results of our own observations with an analysis of the clinical efficacy and safety of cosmetics based on highly purified lanolin and cotton extract in infants have been presented.

© 2011-2018 NSPU Bulletin. All rights reserved. Introduction. The authors investigate the problem of determining the epistemological foundations of pedagogical knowledge. The purpose of the article is to establish epistemological foundations of theoretical standard in pedagogical knowledge. Materials and Methods. The research employed a set of methods, including: a) an analysis of scientific literature on the topic of the article; b) a synthesis of generalized philosophical and scientific ideas, ideas of domain-specific research methodology of natural sciences and their influence on educational research methodology; c) clarifying the content of modern pedagogical knowledge, forms of its presentation to scientific and professional community, and methods of obtaining new pedagogical knowledge. Results. The article proposes an idea about such categories as dbjective subject reality "and Scientific-subject reality"unrepresented in theoretical education studies. The authors clarify the epistemological construct called theoretical standard of pedagogical knowledge" It consists of scientific-problem description of educational reality, fixing the difference between an educational event and a scientific fact, the subject of education and the idealized scientific object ofpedagogics, the correct nomination of problems and hypotheses and their epistemological verification. Conclusions. The authors conclude that the methodological concept of "theoretical standard of pedagogical knowledge" can become a reference point in the process of establishing pedagogics as epistemologically verified humanitarian knowledge.

© 2018, Silicea-Poligraf. All rights reserved. Aim. To evaluate the exact efficacy of the implantable cardioverter-defibrillators (ICD) and combination devices (CRT-D), and to evaluate their influence on the rate of sudden death and overall mortality in patients with the dilation cardiomyopathy syndrome (DCMP), and to clarify the selection criteria for implantation. Material and methods. Totally, 220 DCMP patients investigated: 66 (30%) of them (mean age 48,5±12,8 y. o., 47 males) underwent implantation of ICD (n=37) and CRT-D (n=29), 154 (70%) patients were in comparison group (mean age 47,1±12,4 y. o., 104 males). In 60 patients (93,9%) the devices were implanted for primary prevention of sudden cardiac death (SCD). Follow-up lasted for 16 [6; 37] months. As primary endpoints, the following parameters were used: “death+transplantation”, mortality, SCD, “SCD+shock” and “death+transplantation+proper shocks of the defibrillators”. Results. Mortality in all DCMP patients was 19,1%, “death+transplantation” — 21,4%, SCD — 2,7%. There were no significant differences by these values in patients with both devices (19,7%; 22,7% and 1,5%), ICD (21,6%; 24,3% and 2,7%), CRT-D (17,2%; 20,7; and 0) and patients with no devices (18,8%; 20,8% and 3,2%). Significantly higher rates by “SCD+shocks” (18,2% v 3,2%, p<0,001) and “death+transplantation+shocks” (36,4% vs 20,8%, p<0,05) in patients with the implanted devices witness for real impact of the defibrillators in equality of overall mortality and SCD parameters. Among the patients with implanted devices, the genetic and mixed (genetic and inflammatory) nature of DCMP predominated (62,1 v 35,7%, p<0,001), there was significantly lower EF (26,3±9,2 v 30,7±10,3%, p<0,01), its end value (31,1±11,0 v 39,2±13,5%, p<0,01), significantly higher end diastolic size of the left ventricle (EDS, LV, 6,8±0,8 v 6,5±0,8 cm, p<0,05) and the grade of mitral regurgitation. In patients with the devices, rate of proper shocks was 18,2%. In isolated myocarditis there were no shocks (35,3±9,1% v 26,8±9,3%, p<0,05), EDS significantly lower (6,2±0,6 cm v 6,9±0,9 cm, p<0,01), ECG signs of LV hypertrophy were more rare (16,7% v 56,3%, p<0,05), but more commonly — the low voltage of QRS (33,3% v 10,6%, p=0,53); there were no differences in the rates of cardiotropic drugs prescription. Main predictors of the shocks were genetic origin of DCMP (isolated or with myocarditis, 25/75%, comparing with 20/33% in patients with no shocks, p<0,01, HR 1,58, OR 10,93, sensitivity 94,1%, negative predictive value 99,2%), and sustained (HR 18,0, sensitivity 98,1%) and non-sustained ventricular tachycardia (HR 1,43, sensitivity and negative predictive value 100%), decrease of QRS voltage and absence of the signs of LV hypertrophy on ECG (negative predictive value 92,8% and 95,6%). Conclusion. In DCMP patients, implanting of ICD/CRT-D was performed with acknowledged additional criteria (genetic or mixed DCMP etiology, lower EF and worse response to treatment); due to more effective ICD therapy, the values of mortality, “death+transplantation” and SCD were not higher than in less severe patients with no such devices. Proper shocks developed in patients with significantly higher EF. As an independent SCD risk factor and a criteria for patients selection to defibrillator implantation, genetic origin of DCMP should be used, especially if comorbid with myocarditis. As the predictors for benign outcome — absence of non-sustained ventricular tachycardia, lower QRS voltage, signs of LV hypertrophy on ECG. An algorithm proposed of DCMP patients selection for ICD treatment.