Репозиторий Университета

© 2018 Stolichnaya Izdatelskaya Kompaniya. Acute myocardial infarction (AMI) is one of the main causes of morbidity and mortality, both in the Russian Federation and around the world. Approximately, in up to 10% of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of coronary artery disease. These patients constitute an intriguing subgroup referred to as "Myocardial Infarction with Non-Obstructive Coronary Arteries" (MINOCA). MINOCA is a collective concept that unites many different pathologies, which determines the essential heterogeneity of the etiological factors. Coronary artery embolism is recognized as an important non-atherosclerotic cause of AMI. In turn, the most common underlying disease in those with coronary embolism is the atrial fibrillation. The advantages of reperfusion strategy and cardioprotective therapy in the treatment of obstructive arteriosclerosis are well studied, widely presented in the literature and supported by a strong evidence base, while the issues of diagnosis and treatment of patients with MINOCA are currently widely discussed We present two clinical cases of embolic myocardial infarction in patients with atrial fibrillation, diagnosed in our clinic in 2017..

© 2018 Russian Academy of Medical Sciences. All rights reserved. The aim of the study was to investigate the hepatoprotective activity of an aqueous extract of Caragana jubata (Pall.) Poir. Acute experimental hepatitis was induced by acetaminophen administration of 1000 mg/kg. Studies were conducted in white Wistar rats. The aqueous extract of C. jubata demonstrated the hepatoprotective effect, comparable to that of the reference preparation "Carcil". This was manifested by the normalization of biochemical blood parameters (ALT, AST, alkaline phosphatase, cholesterol, total bilirubin) and antioxidant activity of liver homogenates, determined by the method based on oxidation of luminol induced by 2,2-azo-bis-2-amidinopropane. Normalization of morphofunctional indices was also shown in a histological study of liver of rats that received aqueous extract from C. jubata.

© 2018 Media Sphera Publishing Group. All rights reserved. This article reflects the main stages of outpatient care formation in Moscow. It describes the most significant health care and health education reforms in different periods of Russian history. The article stresses the relevance of outpatient service modernization as a priority of Russian health care reform. The dominance of outpatient care and the introduction of a new three-level primary health care system into healthcare practice have demonstrated the optimal scheme of interaction of all Moscow medical institutions. The article shows the importance of consolidating the efforts of the Government of Moscow and Moscow medical universities, and the I.M. Sechenov First Moscow Medical University in particular, to solve the basic issues of prevention, early diagnosis, and treatment of diseases and to achieve the high quality of life in Muscovites.

© 2018 SPIE. In this work, tissue-engineered structures based on a matrix of protein conjugates, chitosan and carbon nanotubes were prepared and studied. Bovine serum albumin (BSA), bovine collagen (BCrossed D sign¡) were used. Two types of single-walled carbon nanotubes (SWCNTs) were used to form a strong internal scaffold in a protein-chitosan matrix under the action of laser radiation. Tissue-engineered structures were created by means of layered deposition and laser evaporation of the initial aqueous dispersion from SWCNT, BSA, BC and chitosan succinate. As sources of laser radiation, a continuous diode laser with a wavelength of 810 nm and a pulsed fiber laser with a wavelength of 1064 nm and frequency of 80 kHz were used. Studies of tissue-engineered structures were carried out using vibrational spectroscopy methods (IR and Raman). The changes in the frequencies and intensities of the corresponding absorption bands and Raman lines of the amide group oscillations were analyzed. IR spectra of tissue-engineered structures demonstrated a high degree of binding of organic (protein, chitosan) and inorganic (SWCNT) components. The structure and defectiveness of the carbon nanotube scaffold were investigated in the Raman spectra.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. An X-ray picture of tension pneumopericardium, as a transsternal transpericardial main bronchus stump occlusion complication, not previously seen after this sur-gery, is described. The clinical picture of a tension pneumopericardium and diag-nostic methods applied to determine this condition are reported. Successful elimination of complications in a somatically burdened patient was possible only due to rapid and accu-rate diagnostics of this condition.

© 2018 Russian Transplant Society. All rights reserved. Heart transplantation is the gold standard of treatment severe heart failure. Immunosuppressive therapy aimed at the prevention of acute allograft rejection is the cornerstone of post-transplant management. In addition to its direct effects, immunosuppressive therapy is also involved in the generation of a number of post-transplant morbidities that limit the long-term outcome of heart transplant recipients. Given these data it appears that the individual tailoring of immunosuppressive therapy is of paramount importance in determining the outcome of heart transplantation. The goal of immunosuppressive therapy is to prevent rejection of the transplanted heart, while minimizing drug-related effects, such as infection, malignancy, diabetes, hypertension, and renal insuffi ciency. This review aimed is to analyze the protocols for the appointment of immunosuppressive therapy in various groups of recipients after heart transplantation.

© 2018 All-Russian Public Organization Antihypertensive League. All rights reserved. The review discusses the role of blood pressure variability as a novel risk factor and its prognostic value in hypertension associated with the coronary artery disease. We discuss the modern approaches to calculation of blood pressure variability, its classification. The choice of antihypertensive drugs based on the blood pressure variability is discussed considering hypertension associated with coronary artery disease. We pay special attention to angiotensin enzyme converting inhibitors and calcium channel blockers, as well as their combinations. We present the evidence of the effects of perindopril and amlodipine and their fixed combination on the blood pressure variability and the decrease in cardiovascular risk in hypertension associated with coronary artery disease.

© 2018, Peter the Great St. Petersburg Polytechnic University. Layers of different materials, including nanocomposites, containing carbon nanotubes, with the tensoresistive properties are discussed. The investigated layers are divided into two groups: without (group I) and with carbon nanotubes (group II). A group-I material that is the most suitable for fabrication of a tensoresistor is the elastomer with microchannel, filled with a conductive liquid. In group II, these are the (0.2-10)-μm-thick layers consisting of the carboxymethylcellulose matrix, filled with multiwalled carbon nanotubes (∼5 wt.%). The investigated layers can be used as alternative tensoresistors for medical applications.

© 2018, Stolichnaya Izdatelskaya Kompaniya. The aim of the review is presenting the possibilities and perspectives of the third generation of thienopyridine P2Y12 receptor inhibitor prasugrel in the treatment of patients with acute coronary syndrome (ACS). The main pathogenetic stage of ACS is intracoronary thrombosis, which develops on the surface of a damaged atherosclerotic plaque. The use of acetylsalicylic acid with addition of the second antiplatelet agent, so-called dual antiplatelet therapy, is a standard component in the treatment of any type of ACS, regardless of reperfusion and the selected treatment strategy. Due to some limitations in the use of clopidogrel as the second component of dual antiplatelet therapy, the possibility of prasugrel or ticagrelor usage should be considered in patients with ACS with percutaneous coronary intervention (PCI). Prasugrel therapy is associated with better clinical outcomes as compared with clopidogrel therapy in moderate or high-risk patients who undergo PCI. Because of higher bleeding risk and the lack of clinical benefits in special subgroups of patients, prasugrel must not be used in patients with a stroke or transient ischemic attack in the past. If, after a thorough individual benefit-risk assessment a decision is in favor of prescribing prasugrel to the patient older than 75 years or with a small body weight the maintenance dose of prasugrel is to be reduced by half. Real clinical practice data has shown that with following these recommendations prasugrel demonstrates optimal efficacy, safety, and even more significant impact on the prognosis than this in clinical trials. Prasugrel is able to reduce significantly the incidence of cardiovascular events such as cardiovascular death, myocardial infarction and stroke in patients with ACS who undergo PCI.

© 2018 ABC-press Publishing House. All rights reserved. Background. The high recurrence rate after conventional transurethral resection (cTUR) for bladder cancer (BC) requires search for more effective methods of surgical treatment. Objective: to evaluate the feasibility, safety, and efficacy of cTUR versus thulium laser en bloc resection of bladder tumors using new fiber laser "Urolaz". Materials and methods. 129 patients, who underwent surgical treatment for BC between 2015-2017 in urological department of I.M. Sechenov First Moscow State Medical University were included in the study. The cTUR were performed for 58 patients, 71 patients underwent thulium laser en bloc resection of bladder tumors. Results. The presence of detrusor muscle in specimen was 58.62 % in cTUR group and 91.55 % in thulium laser en bloc resection group respectively. Obturator nerve reflex, bladder perforation, and bleeding in thulium laser en bloc resection group were absent, therefore immediate instillation of chemotherapy was made in all these cases. Recurrence rate after 12 and 18 months after surgery in the group of en bloc resection was statistically lower compared to the cTUR group. Conclusion. The results, obtained in our study shows that thulium en bloc resection using thulium fiber laser "Urolaz" is feasible, effective and safe procedure for patients with BC. Thulium en bloc resection has a number of advantages over the cTUR: Absence of obturator nerve reflex, high quality of specimen for pathological examination (presence of detrusor muscle in specimen was 91.55 %) and low recurrence rate.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The article presents the text of the authors' report at the plenary session of the XX Congress of Pediatricians of Russia (dated February 16, 2018) dedicated to the centenary of the Soviet state mother and child welfare system. The features of its formation and development were described. The most important achievements in the field of child health care were outlined. Attention is focused on the personalities of the first facilitators of pediatric healthcare in Soviet Russia. Authors summarise the findings resulting from the history of the Soviet pediatric service.

© Rational Pharmacotherapy in Cardiology 2018. The immediate and remote benefits of smoking cessation are considered. Within one year after quitting smoking the ischemic heart disease (IHD) risk will be 2 folds lower than the risk in smoking patient. Within 15 years the IHD risk declines to non-smoking population level. After 5-15 years after quitting smoking the risk of stroke also declines to non-smoker risk. Smoking cessation prior to cardio surgical intervention leads to reduction of complications incidence by 41%. Smoking cessation significantly reduces the risk of developing stable and unstable angina, acute myocardial infarction, cardiovascular death, transient ischemic attack, ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, peripheral arterial diseases, abdominal aortic aneurysm at any age, in both sexes in comparison to patients who continue to smoke. Smoking cessation is the most cost-effective strategy of cardiovascular disease prevention. Today, the most effective smoking cessation strategy is the identification of smokers and continuous advice on smoking cessation, and offer of the appropriate medication, primarily varenicline. The article contains data from a number of studies showing that varenicline is an effective and safe drug for tobacco dependence treatment, in particular, in patients with acute and chronic cardiovascular disease.

to investigate the myocardial expression of some structural proteins and markers of cellular proliferation and innate immunity for assessing their possible diagnostic and prognostic role in patients with chronic myocarditis. Subjects and methods. The investigation enrolled 23 patients (16 men; mean age, 52.0±12.4 years (range, 27 to 73) with various forms of noncoronarogenic myocardial injury who underwent right ventricular endomyocardial biopsy (n=4), intraoperative left ventricular biopsy (n=17) or autopsy (n=2). Prior to their morphological examination, the patients were divided into two groups: 1) 10 patients with dilated cardiomyopathy and presumptive myocarditis; 2) 13 patients with valvular heart disease, hypertrophic cardiomyopathy, myxoma, and chronic pulmonary thromboembolism, presumptively without myocarditis. Along with myocardial histological and immunohistochemical (IHC) examinations, the expression of vimentin, desmin, c-kit, Ki-67, and Toll-like receptors (TLR) 2 and 9 was determined. Polymerase chain reaction was used to identify whether herpes viruses of and parvovirus B19 genomes were present in the blood and myocardial samples; indirect ELISA was applied to estimate the blood level of antibodies against various cardiac antigens. Results. According to the histological findings, active/borderline lymphocytic myocarditis was diagnosed in all the patients (Group 1) and in 6 patients (Group 2) in conjunction with the underlying disease (only in 9 and 7 patients, respectively), viral genome was detected in the myocardium of 15 patients, including in 5 without morphological signs of myocarditis (parvovirus B19 (n=11), herpesvirus 6 (n=4), herpes simplex virus types 1 and 2 (n=1), Epstein-Barr virus (n=2), and cytomegalovirus (n=1)), and in the blood (n=4). A marked correlation was found between TLR2 and TLR9 expressions and the morphological pattern of active myocarditis in the absence of this correlation with the expression level of other studied markers. The expression level of TLR2 in patients with and without borderline myocarditis was 0 [0; 0,75] and in those with active myocarditis was 1.5 [1; 1,5] points; that of TLR9 was 2 [2; 2] and 4 [3; 4] points, respectively (p0.001). The expression of TLR2 and TLR9 in patients with borderline myocarditis was lower than in those without myocarditis (0 [0; 0] versus 0 [0; 1] and 2 [1,5; 2] versus 2 [2; 3] points), which can reflect cardiomyocyte destruction/depletion at later stages of the disease. There was also a close correlation between the expression level of TLR2 and that of TLR9 (r=0.824; p0.001) and with Ki-67 levels (r=-0.531 and r=-0.702; p0.01). There was also a correlation of the expression of the studied markers with viral persistence (desmin), the degree of myocardial dysfunction and cardiosclerosis (c-kit), which calls for further investigations. Conclusion. Determination of the myocardial expression level of TLR2 and TLR9 may serve as an immunohistochemical marker for myocarditis and preservation of its activity, which is especially valuable in patients with borderline forms. The marked expression of these markers for innate immunity may reflect both one of the mechanisms of genetic predisposition to myocarditis and its severe course and their secondary activation in the pathogenesis of the disease and is a potential target of therapy.

© 2018 Media Sphera Publishing Group. All rights reserved. The objective of the present study was the development of the diagnostic model for determining the human age based on the results of the comprehensive examination of the 230 thyroid cartilages (TC) obtained from the corpses of men and women of different age. TC were examined with the use of the anthropometric, X-ray, and histological methods. The anthropometric investigations confirmed the gender-related differences in the structure of human TC. Various characteristics of TC were shown to correlate with the age but these relationships were rather weak even if formally significant. The X-ray studies of TC have revealed the significant correlation of the relative amount of the bone tissue on the images with the age (r=0.8). Of the 27 parameters subjected to the morphometric evaluation, the following ones were shown to significantly correlates with the age: percentage of the bony (r=0,82) and cartilaginous (r=-0.8) tissue areas, average density of the adipose (r=0.76) and reticular (r=0.7) tissues, the maximum length of trabeculae (r=0.67), the width of the mature cartilage zone (r=0.54), the cortical plate thickness (r=0.5), and the mean number of immature chondrocytes in the field of vision (r=0.5). The comprehensive investigation into the structure of the human thyroid cartilage provided a basis for the development of the method for determining the human age with the use of the linear regression equations. It is concluded that the proposed method can be employed as an additional diagnostic tool for determining the human age for the purposes of forensic medical expertise and personality identification.

© 2018, Indian Journal of Public Health Research and Development. All rights reserved. Study design: randomized controlled before-and-after and in follow-up trial. Forty-six CAD patients volunteered to take part in the study: a group of 27 patients undertook an Intermittent Hypoxia (O2 at 10%) - Hyperoxia (O2 at 30%) Training (IHHT), while a control group (CTRL) of 19 patients was allocated to sham IHHT treatment (breathing via face mask by room air, O2 at 21%). Exercise performance, blood and metabolic profile, quality of life (MOS SF-36, Seattle Angina Questionnaire, SAQ) were measured before and after IHHT/sham IHHT in both groups; the intervention group was also assessed one month after completing the IHHT. The IHHT intervention group showed improved exercise capacity (+1,8 ml O2/min/kg, p=0,02), reduced resting systolic and diastolic blood pressures (151/85 before vs 130/73 after p<0,01), enhanced Left Ventricle Ejection Fraction (62,6±5,5% vs 58±6,2%, p<0,01), glycemia was significantly reduced only at 1-month follow-up (6,18±1,7 after vs 7,10±2,34 mmol/l at baseline, p=0,037). Frequency of angina as reason to stop exercising was significantly reduced after treatment and at 1-month follow-up. In CAD patients an Intermittent Hypoxia-Hyperoxia Training program is associated with improved exercise tolerance, risks factors profile and quality of life (SF-36, SAQ). IHHT has proved to be safe, well tolerable and easily applicable in cardiac patients.

© 2018 Ima-Press Publishing House. All rights reserved. The paper considers the modern concepts of the etiology and pathogenesis of psoriatic arthritis (PsA). The latter is currently indicated as a T-cell-mediated disease that is based on the activation of cellular immunity, followed by the hyperproduction and imbalance of key pro- A nd anti-inflammatory cytokines, such as tumor necrosis factor-α (TNF-α), interleukin-1â (IL-1â), IL-6, IL-12/23, and IL-17. The paper presents the basic principles of diagnosis and clinical manifestations of the disease and notes the importance of screening questionnaires, the use of which allows specialists to diagnose PsA early, by actively identifying articular complaints, the characteristic clinical and radiological signs of damage to the joint, spine, and entheses. It is pointed out that the key target of pharmacotherapy for PsA is to achieve remission or minimal activity of the main clinical manifestations of the disease, to slow down or prevent its radiographic progression, to increase the length and quality of life in patients, and to reduce the risk of comorbidities. The authors characterize the major groups of used drugs: Nonsteroidal anti-inflammatory drugs, conventional and targeted synthetic disease-modifying antirheumatic drugs, and biological drugs (inhibitors of TNF-α, IL-12/23, and IL-17). The key Treat-to-target principles of patient management are considered; it is noted that strict control over disease activity and treatment results provides suppression of all major clinical manifestations of PsA. The paper also shows the basic principles of the creation and further development of the All-Russian Registry of PsA patients, which makes it possible to optimize management decision-making on the provision of high-tech medical care and drugs for this cohort of patients.

© 2018 Tomsk State University. All Rights Reserved.  Sanguinarine is a benzophenanthridine alkaloid with antimicrobial, antiviral, antiparasitic, anti-inflammatory, antiplatelet, antiangiogenic, and antitumor activity. One of the important properties of sanguinarine is a pronounced ability to suppress thrombogenesis, tumor growth and metastasis. However, the low solubility of sanguinarine in biological fluids limits its medical use. The present research was devoted to the development of the liposomal form of sanguinarine and the study of its biological activity. We obtained liposomes with sanguinarine on the basis of lecithin and cholesterol by the method of hydration of a thin film with buffer, followed by sonication and extrusion through a polycarbonate membrane with a pore size of 100 nm. Purification of liposomal dispersion from a drug that was not included in the vesicles was performed by gel filtration chromatography. We studied the morphology of the obtained liposomal particles by scanning electron microscopy; particle size and zeta potential were determined by dynamic light scattering. The study of the dynamics of sanguinarine release was conducted using the method of dialysis; quantitative analysis of the released sanguinarine from liposomes was performed using reverse-phase HPLC. The cytotoxic activity (CTA) of liposomal preparation against tumor cells of human breast carcinoma MCF-7 line was determined by the MTT assay. The toxicity and biological effects of liposomal sanguinarine on the cultures of Paramecium caudatum Ehrenberg and Tetrahymena pyriformis WH1, as well as the study of the effect of the drug on the complement system, were evaluated using the automated video registration system “BioLaT” (Russia). According to electron microscopy data, the obtained liposomes were spherical nanosized particles (See Fig. 1). The mean size of the obtained liposomal particles with sanguinarine included in their composition, determined using the method of the dynamic light scattering, was 108.5±2.2 nm, and the zeta potential was –34.7±1.4 mV. The effectiveness of sanguinarine inclusion in liposomes was quite high and amounted to 72.8±4.8%. The study of the dynamics of sanguinarine release from liposomes in conditions close to physiological (pH 7.4; 37°C) showed that this process occurs at the highest rate in the first 2 h of incubation. Then, the process is prolonged (release of about 50% sanguinarine after 6 h of incubation, and about 93% after 70 h) (See Fig. 2). Liposomal sanguinarine showed dose-dependent cytotoxic activity against tumor cells of human carcinoma MCF-7 in the micromolar concentration range (Seе Fig. 3). The CTA of liposomal sanguinarine (IC 50 14.5 mM) was slightly lower than the activity of free sanguinarine (IC 50 9.4 mM), which can be explained by the prolonged release of sanguinarine from liposomes into the cell medium, as well as by the specificity of compartmentalization and intracellular release of the drug when it is absorbed by tumor cells by endocytosis. The prolonged release and the property of preferential accumulation of liposomes in tumor tissue can have a positive effect on therapeutic efficacy in the application of liposomal sanguinarine in vivo. The effect of liposomal sanguinarine on the survival of P. caudatum ciliates was dose-dependent (See Fig. 4). The minimum inhibitory concentration of liposomal sanguinarine was 0.49 mM. At concentrations from 0.245 mM and below, the drug did not cause cell death for 2 h; over the next 24 h, the death of the ciliates was neither observed. Thus, liposomal sanguinarine has a pronounced cytotoxic effect on P. caudatum, a representative of the protozoa, which can serve as the basis for the development of antiprotozoal drugs. To identify pathogenic Protozoa species spectrum vulnerable to the action of liposomal sanguinarine, additional research is required. We also assessed the influence of liposomal sanguinarine on the protective blood systems - coagulation and the complement system. The effect of liposomal sanguinarine on thrombus formation in vitro was evaluated in citrate plasma after its recalcification according to the time of the onset of thrombus formation and the resulting clot density (See Fig. 5). The clot size in plasma solutions with the addition of the drug was significantly smaller compared with the control. At the same time, liposomal sanguinarine induces the formation of a clot after 7 min of incubation, whereas in the control the formation of a clot begins only after 14 min of incubation. Thus, under the conditions of this experiment, liposomal sanguinarine had a pronounced stimulating effect on thrombus formation. Stimulation of thrombosis by liposomal sanguinarine can be caused both by direct activation of coagulation enzymes and by the induction of enzymatic reactions of the coagulation system, which can efficiently proceed on the surface of liposomal nanoparticles. The study of the effect of liposomal sanguinarine in a non-toxic concentration of 60 ng/ml on the functional activity of the complement system against T. pyriformis ciliates showed that the half-life of the ciliates as a target of the complement system in the medium containing serum and liposomal sanguinarine (T 50 21.7 min) reduced approximately twice compared with the control (T 50 41.6 min) (See Fig. 6). In the absence of serum in the samples, liposomal sanguinarine at a concentration of 60 ng/ml, on the contrary, had a stimulating effect on T. pyriformis growth - the value of the proliferation coefficient for native cells was 2.1±0.2, and for the treated cells it was 6.4±0.8. The obtained data may indicate the activating effect of liposomal sanguinarine with respect to the assembly of the membrane attack complex of the complement system on the surface of T. pyriformis cells, causing their death. This effect allows to envisage the prospect of using liposomal sanguinarine as an immunostimulating agent. Thus, the pronounced cytotoxic antitumor and antiprotozoal activity, demonstrated in experiments in vitro, makes it possible to consider liposomal sanguinarine as a promising antitumor and antiprotozoal agent. The detected effect of thrombosis stimulation by liposomal sanguinarine seems to be important when selecting the dose of the drug introduced into the bloodstream.

Previously, atherosclerosis was considered a disease accompanied exclusively by lipids accumulation. At present time success of fundamental and experimental science confirmed that atherosclerotic process is also associated with neovascularization and prolonged inflammatory response at all stages of atherogenesis from initial manifestations to thrombotic complications. The cause of atherosclerotic plaque instability is neovascularization, which is accompanied by intra-plaque hemorrhage and damage. Complications of carotid arteries atherosclerosis are strokes and transient ischemic attacks. The use of a wide range of diagnostic and pathohistological techniques is required for assessing this pathology. The most promising diagnostic technique is Contrast Enhanced Ultrasonography (CEUS) which allows to assess neovascularization degree in atherosclerotic plaque through the injection of a contrast agents.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Purpose. This case describes the role of radiology diagnostic methods in patients with congenital right transposition of the aortic arch. Due to the underestimation of radiology data, congenital right transposition of the aortic arch was not detected before surgery, which led to the selection of inadequate surgical access and technical difficulties that were successfully overcome.

© 2018 Izdatel'stvo Meditsina. There was performed a study of the diagnostic activity of sera with antibodies to Toxocara spp. and Echinococcus spp. in conditions of long storage at different temperature regimes. The use of cryoprotectants makes it possible to increase the safety of diagnostic sera by two times during prolonged storage at low temperatures.