Репозиторий Университета

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To improve the diagnosis of urolithiasis using the latest technique-dualenergy computed tomography (DECT). Materials and methods. A prospective study of a group of 91 (100%) patients was conducted at the department of radiology and urology at the Russian-Japanese Center in Sechenov University. All patients underwent a dual-energy CT scan to predict the chemical composition of urinary stones "in vivo". All patients underwent surgical treatment after diagnostics: distance lithotripsy (DLT), percutaneous nephrolithotripsy (PHNLT), contact ureterolithotripsy (CULT). All the stones after operations were subjected to physico-chemical analysis (X-ray phase analysis, infrared spectroscopy) in order to verify the composition. Further, the diagnostic value of the dual-energy computed tomography was assessed by comparing the DECT results with the physico-chemical analysis data. Results. Using DECT in the preoperative period, the following results were obtained: 40 patients had vevellit stones, 34 patients had Ca-containing stones without vevellit, 10 patients had stones with uric acid, in 7 patients stones were classified in the group of cystine/struvite. After verification studies in the postoperative period, the following urinary stone composition was determined: 42 stones-vevellit, 34 stones-Ca-containing stones without vevellit, 10 stones with uric acid, 5 stones-struvite stones. At the same time the following results were obtained incorrectly using DECT: 7 stones with vevellit from which 4 stones were postoperatively confermed to the group of Ca-containing stones without vevellit, 3 stones-struvite/cystine stones; 4 Ca-containing stones without vevellite were classified in the group of the vevellite; 2 struvite stones: 1 stone was incorrectly assigned to the group of uric acid, 1 stone-to the group of the vevellite; 1 stone uric acid was incorrectly assigned to the group of struvite stones. It should also be noted that 1 stone had a mixed composition (uric acid 70% + vevellit 23% + veddellite 7%), according to the results of DECT it was incorrectly assigned to the group of stones from uric acid, at the same time the prevailing component was determined correctly. Conclusions. In order to predict the chemical composition of the stone "in vivo" with a high degree of reliability DECT in the preoperative period can differentiate not only the urate and Ca-containing stones, but also separately identify the stones in which vevellit is the predominant component. The detailed differentiation of Ca-containing stones, as well as of more rare stones, such as struvite and cystine, requires further studies with more significant groups of stones.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To identify the possibilities of computed tomography in detection of the nature and severity of the thoracic aorta trauma. Materials and method. Results of computed tomography (CT) of 15 patients from 2006 to 2017 with severe combined blunt injuries and thoracic aorta injury who had been treated in N. V. Sklifosovsky Research Institute for Emergency Medicine were analyzed. The majority of the patients were male 73% (n=11), the average age was 41,3+ 7,6 (22-79) years. The cause of injury in 12 cases were motor vehicle accidents, in 2 cases-falling from a height of more than three meters, in one case - A fall from patient's own height. Results. In evaluating the severity of the aortic injuries the classification proposed by the American Association of Thoracic Surgeons in 2013 was used. In our study there were no patients with Grade I; Grade II-small pseudoaneurysm (less than 50% of the circumference of the aorta) was identified in 8 patients; Grade III-big pseudoaneurysm (more than 50% of the circumference of the aorta) was identified in 3 patients; Grade IV-complete aortic rupture was identified in 4 patients. Simultaneously with the thoracic aortic injury pulmonary contusion was found in 9 patients, in 8-multiple fractured ribs, in 1-fracture of the sternum. In 8 patients mediastinal hematoma was identified, hemopericardium was found in 3 patients. Hemothorax was found in 12 patients. Signs of craniocerebral trauma were found in 6 patients, spinal cord injury-in 3 patients, injuries of the musculoskeletal system-in 4 patients, abdominal parenchymal organ injury was found in 4 patients (in 3 of these cases-of the liver, in 1-of the kidney), in one case sings of the duodenal rupture were found, in another-left-sided diaphragmatic rupture, in 1 patient with thoracic aortic rupture, a pseudoaneurysm of the hepatic artery was also found. Discussion. Using the classification of the severity of the aortic injuries by the CT results in patients with stable hemodynamics enables the ability to determine the degree of aortic stability, to predict the risk of rupture and to choose the type of optimal surgical intervention (early or delayed). There is a possibility to perform endoprosthetic repair of the aorta and surgical intervention of other areas against the background of controlled hypotension in patients with simultaneous traumatic aortic injury and other combined injuries. Conclusion. It is advisable to perform a CT examination at once of several anatomical regions when examining patients with severe combined injuries. Evaluation of the mediastinum structures in patients with severe combined injuries should be performed on the basis of a computed tomography of the chest with mandatory intravenous administration of contrast media. It is necessary to perform multiplanar and three-dimensional volume rendering to allow better visualization of the extent of thoracic aortic injuries. Choosing a method of treatment in victims with thoracic aorta injury is based on the use of endoprosthetics as an effective and low-traumatic intervention that can be used simultaneously with other surgical methods of treatment.

The radiation has an antitumor effect and causes radiation reactions and damage to surrounding tissues within the framework of combined antitumor treatment of patients with cancer of maxillofacial region. It also has an irreversible effect on the production of saliva by large and small salivary glands, and this must be taken into account when planning radiation therapy for this group of patients.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. Purpose of the study is to have a detailed examination and investigation of the patient with all the required parameters. Material and methods. Revision knee replacement prosthesis making a difference in treatment outcome. Results. The result after the sleeve operation was uneventful and the patient had no complaints or pain even after a year of surgery. Conclusion. Long term complications are comparatively less when a proper prosthesis is selected for the particular patient operation.

The study objective was to determinate variations of stato-dynamical functional markers of postural balance system in the process of malocclusion treatment. Twenty patients aged from 14 to 30 years with class II malocclusion were recruited for this prospective study. All patients underwent electromyography of mm. temporalis and mm. maseter in rest and at maximal jaws pressure. Postural balance was evaluated by stabilometry platform and body's regions relationship was assessed by computer optical topography. Orthodontic interventions included using occlusal splint, dental straps or 'TwinForce' device. There were two diagnostic sessions: before and after one month of orthodontic treatment. The majority of patients after anterior dislocation of mandible demonstrated significant increase in unilateral masticatory muscles activity (р<0.05) which correlated with iliac crest position. According to computerized topography data superior iliac crest position was registered in opposite side with regard to muscle hypertonia. According to stabilometry data forward translation of the mandible resulted in retroversion of total pressure point projection (р<0.05). Asymmetric muscle working in the process of occlusal adjustment may provoke postural imbalance in distal body regions. It dictates postural system condition monitoring during orthodontic treatment.

© 2018 Media Sphera Publishing Group. All rights reserved. The relevance of the investigation is due to the need to optimize the system for the primary prevention of drug addiction and use because of its insufficient efficiency in the Russian Federation. This problem is manifested in the low awareness of the population, primarily young people, about the negative consequences of the use of narcotic drugs and psychotropic substances and about the high associated risk of their involvement in the use of narcotics, including new types of psychotropic substances (synthetic narcotics). In this connection, the aim of our investigation was to develop a method for determining the potential efficiency of measures for the primary prevention of drug addiction and use, by applying mathematical modeling. The Kermak - McKendrick epidemic model of the susceptible infected removed (SIR) - like type was used as a basis to build a drug use spread model that represented as transition of groups of individuals from one state to another in relation to drug use. This gave rise to a simulation model estimating the magnitude of a drug use reduction in the risk group in relation to the initial one if varying effective preventive measures were implemented. The drug abuse scenario in case of effective measures was analyzed. Enhancing the effectiveness of measures for primary prevention of drug addiction was shown to lead to a stronger rather than linear decline in the size of a group at risk for drug and in the number of drug users. This model may be used to prepare programs, strategies for the primary prevention of drug addiction to evaluate their potential effectiveness.

© 2018 Pirogov Russian National Research Medical University. All rights reserved. The health of the cervical spine (CS) and the functional state of the pectoral girdle are interdependent. Injuries to the pectoral girdle can be an underlying cause of CS pain, including cervicalgia. The aim of this study was to evaluate the condition of the cervical spine in patients with cervicalgia developed after a pectoral girdle injury using radiographic and physical examinations. The study included 400 patients complaining of cervicalgia. Pain intensity was evaluated on the visual analog scale (VAS); the impact of the condition on patients' lives was assessed using the Neck Disability Index (Russian language). During physical examinations, the general health of the spine was evaluated and abnormalities in the cervical spine were noted. All participants underwent a radiographic scan of the cervical spine in the lateral and anterior-posterior projections; 49.5% of patients underwent postural digital radiography to evaluate their CS sagittal profile. All patients received an MRI scan. Based on the results, we identified certain functional changes in the cervical spine which possibly caused cervicalgia. Structurally and functionally, the changes were divided into static and dynamic. We conclude that cervical spinal pain is a common problem among patients with previous pectoral girdle injury.

© Bionika Media Ltd. Objective. To carry out a systems analysis of the data available in the current literature on the pathogenesis, therapy, and prevention of vaginal infections caused by the pathogens of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC). Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed on this topic. Results. The paper highlights the main pathways of pathogenesis and the causes of recurrent vaginal coinfection. It describes methods for the treatment of women with BV and VVC and presents the optimal therapy and prevention schemes for recurrent vaginal infectious diseases, which have evidence-based effectiveness. Conclusion. The features of a microbial portrait and immune status predispose to recurrent BV and VVC, the presence of which results in coinfection. The cause of the latter is also repeated therapy for recurrent monoinfection. First-line therapy for BV is recognized to include metronidazole and clindamycin; the advantages of the latter are a wider spectrum of activity against the microorganisms that are difficult to identify. To treat coinfection and to prevent VVC in patients with BV, it is advisable to use fluconazole that also remains a first-line treatment option for vaginal infection caused by Candida albicans.

© 2018 Dynasty Publishing House. All rights reserved. The objective. To perform a budget impact analysis of a novel antiretroviral drug elsulfavirine (ESV) compared with currently used medical technologies. Materials and methods. The pharmacoeconomic model was based on the studies of efficacy and safety of two non-nucleoside reverse transcriptase inhibitors: ESV and rilpivirine (RPV) combined with standard basic tenofovir/ emtricitabine (TDF/FTC) therapy for 48 weeks. The studies were performed in similar clinical settings. The budget impact analysis assessed only direct medical costs of antiretroviral drugs within the chosen strategies of first-line antiretroviral therapy (ART). Results. It was shown that the treatment of ART-naive HIV patients with ESV is associated with 61,234.88 RUB less costs per patient in a 48-week course compared with RPV treatment. The analyzed values of cost effectiveness were lower for ESV strategy than for the strategy with the use of RPV. It makes ESV a more cost-efficient option within the developed model. Conclusion. The use of ESV is a preferable strategy of a first-line treatment of HIV. It is associated with less financial costs and more preferable cost effectiveness rate.

© Bionika Media Ltd. Objective. To determine a drug that is predominant in terms of pharmacoeconomic analysis for the treatment of infertility in patients with an insufficient ovarian response. Material and methods. An information search for publications on the appropriate topic of this study was conducted in the PubMed, Medlink, and Cochrane Library databases. A total of 134 articles and abstracts were found. Two publications on an open prospective randomized controlled trial by Ferraretti et al. (2004) and an open randomized trial by Carone et al. (2012) were selected for further analysis. These articles are unique in the contents and design of the study. Results. It was established that there was presently a limited number of studies available on the treatment of infertility in women with a suboptimal ovarian response, which had been conducted on a large sample of patients. An economic evaluation of the effectiveness of infertility treatment was made in patients with an insufficient ovarian response on the basis of effectiveness analysis, cost analysis, cost-effectiveness analysis, budget impact analysis, and sensitivity analysis. The compared alternatives were follitropin-alpha + lutropinñ alpha/ recombinant follicle-stimulating hormone (rFSH) + recombinant luteinizing hormone (rLH), follitropin-alpha/ rFSH, and menotropin/human menopausal gonadotropin (hMG). Conclusion. The results of pharmacoeconomic analysis have shown that follitropin-alpha + lutropin-alpha dominates in terms of cost-effectiveness analysis and leads to cost savings in the treatment of infertility in patients with a suboptimal ovarian response.

AIM: To develop predictive model for hepatic insufficiency in obstructive jaundice.MATERIAL AND METHODS: Obstructive jaundice was modeled by the author's method on 48 mini pigs, while morpho-functional features of erythrocytes were studied by using of INTEGRA Aura atomic force microscope (NT-MDT, Zelenograd, Russia). Histological specimens were stained with hematoxylin and eosin. Discriminant analysis was used to create predictive model for hepatic insufficiency.RESULTS: Mathematical model of hepatic insufficiency prediction has been developed. Sensitivity and specificity of this model were 94.1% and 74.2% respectively. Total percentage of correct predictions was 81.3%.CONCLUSION: Severe obstructive jaundice contributes erythrocyte's transformation from biconcave to dome-shaped followed by changes of its physical properties. Erythrocyte's volume and activity of cytolysis enzymes are the most informative to predict hepatic insufficiency. Our model allows us to diagnose this complication at early stages and to correct pre-, intra- and postoperative therapy.

AIM: To develop and justify optimal nutritional support in early phase of acute pancreatitis (AP).MATERIAL AND METHODS: 140 AP patients were enrolled. They were divided into groups depending on nutritional support: group I (n=70) - early enteral tube feeding (ETF) with balanced mixtures, group II (n=30) - early ETF with oligopeptide mixture, group III (n=40) - total parenteral nutrition (TPN). The subgroups were also isolated depending on medication: A - Octreotide, B - Quamatel, C - Octreotide + Quamatel. Pancreatic secretion was evaluated by using of course of disease, instrumental methods, APUD-system hormone levels (secretin, cholecystokinin, somatostatin, vasointestinal peptide).RESULTS: ETF was followed by pancreas enlargement despite ongoing therapy, while TPN led to gradual reduction of pancreatic size up to normal values. α-amylase level progressively decreased in all groups, however in patients who underwent ETF (I and II) mean values of the enzyme were significantly higher compared with TPN (group III). Secretin, cholecystokinin and vasointestinal peptide were increasing in most cases, while the level of somatostatin was below normal in all groups.CONCLUSION: Enteral tube feeding (balanced and oligopeptide mixtures) contributes to pancreatic secretion compared with TPN, but this negative impact is eliminated by antisecretory therapy. Dual medication (Octreotide + Quamatel) is more preferable than monotherapy (Octreotide or Quamatel).

AIM: To assess an efficacy of carotid arteries reconstruction in patients with internal carotid artery stenosis combined with tortuosity.MATERIAL AND METHODS: 86 patients with ICA tortuosity and stenosis were enrolled. All patients were divided into groups depending on type of surgery: group I - open carotid endarterectomy (CEA) followed by obligatory repair with synthetic patch (31 (36%) patients); group II - eversion CEA with ICA resection, redressation and reimplantation into own ostium (35 (40.7%) patients); group III - ICA replacement (20 (23.3%) patients). Synthetic prosthesis and autovein were used in 13 (65%) and 7 (35%) patients respectively. The study included patients with ICA stenosis ≥60% (any type of plaque) and any degree of cerebrovascular insufficiency or ICA stenosis <60% (plaque type I-III) with CVI grade II-IV combined with S- or C-tortuosity, bend or loop with blood flow velocity over 110 cm/s and its turbulence. Only 6 (7.0%) out of 86 patients had no clinical signs of CVI/previous stroke. Asymptomatic/symptomatic patients ratio was following in all groups: group I - 12 (38.7%)/19 (61.3%); group II - 29 (82.9%)/6 (17.1%); group III - 10 (50%)/10 (50%).RESULTS: Within 6-month follow-up 22 (70.9%) out of 31 patients were asymptomatic in group I, 30 (85.7%) (p=0.9475) out of 35 - in group II, 9 (45%) (p=0.9511) out of 20 patients - in group III and 1 (5%) patient developed thrombosis of the reconstruction zone followed by ischemic stroke. After 12 months following patients were asymptomatic: 22 (70.9%) in group I, 30 (85.7%) (p=0.9475) in group II and 9 (45%) patients (p=0.9511) in group III. After 1 year 4 (33.3%) out of 12 patients with CVI grade IV had partial regression of focal neurological symptoms.CONCLUSION: Surgery for ICA tortuosity combined with stenosis confirmed its efficacy and safety for both asymptomatic and symptomatic patients. Significantly better results were observed in eversion CEA compared with conventional procedure and ICA replacement.

© 2018, Kukes V.G., Nikolenko V.N., Pavlov C.S., Zharikova T.S., Marinin V.F., Gridin L.A. Currently there is an increased interest in medical anthropology, the study of constitutional features of the human body and their correlation with the manifestations of various diseases. Modern anthropometric techniques are increasingly used in scientific researches in clinical practice. This review article is devoted to the issues of interrelation between the type of the human constitution and manifestations of various diseases.

© 2017, Shatalov D.O., Kedik S.A., Panov A.V., Zhavoronok E.S., Aydakova A.V., Kovalenko A.V., Morozova O.A., Makeeva I.M., Dezhurko-Korol V.A. The present work is devoted to study of the antimicrobial activity of a new promising synthetic biocidal compound, branched oligohexamethylene guanidine hydrochloride. The studies were carried out using optional anaerobic bacteria Staphylococcus aureus and Klebsiella pneumoniae, as well as obligate anaerobic bacteria Actinomyces pyogenes, Actinomyces odontolyticus, Peptostreptococcus micros, Finegoldia magna, Veillonella parvula, Prevotella disiens and Fusobacterium nucleatum. It was shown that branched oligohexamethylene guanidine hydrochloride inhibits the growth of these bacteria, and facultative anaerobic bacteria are more sensitive to it. The assumptions about the mechanism of this activity of branched oligohexamethylene guanidine hydrochloride are made. The results of the study show that the substance can be recommended as a broad-spectrum biocide.

This article is dedicated to the memory of the outstanding Russian forensic doctor and literary figure professor D.E. Min on the occasion of his 200th birthday anniversary. The assignment of D.E. Min to the position of the head of Department of the State Medical Practice at the Emperor's Moscow University coincided with the large-scale judiciary reform carried out in the country at that time which envisaged, among other innovations, the practice of questioning of an expert in the court room. The new developments in the practical expert activities required the revision of the former approaches to the education and training of forensic medical experts. D.E. Min was the first to introduce the practice of public defense of expert judgements by the students of the Department as an indispensable component of their routine learning activities. He founded the museum of forensic medicine and pioneered the method for teaching the intravital forensic examination. D.E. Min initiated and supervised original research on mechanical asphyxia, forensic-medical toxicology, and traumatology. D.E. Min and his co-workers were frequently engaged by the agencies in charge of preliminary investigation to participate in forensic medical expertise associated with the inquiries into the most lurid criminal cases of those times. The scientist made the essential contribution to the development of forensic medicine in this country and the modernization of the academic process at the Department of the State Medical Practice that greatly promoted satisfaction of the basic requirements of practical forensic medical activities.

© 2018 Ima-Press Publishing House. All rights reserved. Idiopathic lobular panniculitis (ILP) (synonym: Weber-Christian panniculitis) is the least studied disease in the group of systemic connective tissue lesions and characterized by systemic damage to subcutaneous adipose tissue (SAT). There is no unified concept of the etiology and pathogenesis of ILP now. The literature contains almost no data on the diagnostic value of laboratory studies and therapeutic approaches, which served as the basis for this investigation. Objective: to investigate the relationship between the clinical presentation of ILP and immune inflammatory parameters in patients with this disease. Subjects and methods. Examinations were made in 67 patients (9 men and 58 women) aged 20 to 76 years with a verified diagnosis of ILP (median duration, 78.91 [48; 540] months), who were followed up at the V.A. Nasonova Research Institute of Rheumatology for the period 2007 to 2017. The determination of α1-antitrypsin titer, liver fractions, amylase, lipase, trypsin, ferritin, creatine phosphokinase, leptin, and tumor necrosis factor-α (TNFα), chest computed tomography, and induration morphological examination were done in addition to physical examination. Results and discussion. The disease was found in all age groups, but it accounted for more than half (57%) of cases at the most able-bodied age (45–60 years). Analysis of the clinical manifestations of ILP could identify its four types: nodular (n=30), plaque (n=10), infiltrative (n= 5), and mesenteric (n=12), which were characterized by typical clinical features. The observed group showed a significant increase in erythrocyte sedimentation rate (ESR) (p=0.01) and C-reactive protein (CRP) level (p < 0.0001). ESR correlated with tenderness on the visual analogue scale (VAS) (p<0.05; r=0.29), induration area (p<0.05; r=0.50), and rises in body temperature (p<0.05; r=0.68) and CRP level (p<0.05; r=0.68). The concentration of CRP correlated with tenderness on visual analog scale (p<0.05; r=0.46), induration area (p<0.05; r=0.61), node stage (p<0.05; r=0.41), and TNF-α concentrations (p<0.05; r=0.32). The latter showed a direct correlation with node stage (p<0.05; r=0.41) and leptin levels (p<0.05; r=0.28) and an inverse correlation with the number of nodes (p<0.05; r=-0.24). Leptin levels were increased in 35 (52.23%) patients and displayed a direct correlation with body mass index (p<0.05; r=0.46), induration area (p<0.05; r=0.31), CRP level (p<0.05; r=0.36) and an inverse correlation with the number of nodes (p≤0.05; r=-0.33). Morphological examination of skin and SAT biopsy specimens was performed in 65 (97.01%) patients. Pre- and retroperitoneal adipose tissues were biopsied in three of five patients without skin and SAT lesions; this was not done in the remaining patients because of access difficulties. ILP was verified in all cases. Therapy was performed using the essential drugs adopted in rheumatology practice. Their therapeutic effects were noted in 62.68% of cases; inefficiency and health deterioration were detected in 12 (17.91%) patients, which necessitated an increase in the dose of disease-modifying antirheumatic drugs. Seven patients were given the following biological agents: abatacept (n=2), adalimum-ab (n = 3), etanercept (n=1), and rituximab (n=1). Conclusion. There is an obvious need to expand knowledge about this pathology amongst physicians and to conduct further investigation in order to timely diagnose and search for the most effective treatment options for ILP.

© 2018 Ima-Press Publishing House. All rights reservbed. The socially significant problems in patients with prior stroke include post-stroke cognitive impairment (PCI), the prevalence of which is high (from 24 to 70%). The causes of disability in these patients are that the role of cognitive impairment is often underestimated and attention is paid only to motor defects. The pathogenesis of PCI may include not only vascular, but also neurodegenerative (due to Alzheimer's disease) mechanisms of brain damage. The diagnosis of early PCI is of great practical importance, as it is most effective to treat mild PCI. The paper considers current approaches to preventing and treating PCI. The authors give their own experience in treating a patient with moderate PCI.

© 2018 Ima-Press Publishing House. All rights reservbed. Dementia develops as a result of continuous long-term progression of less severe cognitive impairment (CI). Social and psychological methods (neurocognitive stimulation and neurocognitive training) are the mainstay of treatment for dementia. At the moment, there are no drugs both to cure dementia and to stop the degeneration of nerve tissue. Modern pharmacotherapy for dementia aims to maintain cognitive functions in the patient for as long as possible and to slow down disability, thus ensuring higher living standards. CI therapy most often consists of compensation for cognitive defect. Among the whole variety of pharmacological agents, the effective drugs to treat dementia are only two groups, such as acetylcholinesterase inhibitors and N-methyl-D-aspartate (NMDA) glutamate receptor antagonists. Atypical neuroleptics are employed for the treatment of psychotic disorders; antidepressants from a group of selective serotonin reuptake inhibitors are for depression. Cognitive behavioral therapy and cognitive stimulation deserve special attention. A high educational level and physical, social, and intellectual and activities can prevent dementia.