Репозиторий Университета

© 2018 Bulletin of Siberian Medicine. All rights reserved. The aim of the investigation was to determine the characteristics of the immune response regulation for pulmonary tuberculosis (TB) and to analyze the role of regulatory T cells in the immunopathogenesis of TB with eosinophilia in the blood, depending on the clinical form of the disease and sensitivity of Micobacterium tuberculosis to anti-TB drugs. Materials and methods. 157 patients who were initially diagnosed with infiltrative and disseminated TB were examined. The material of the study was venous blood and culture of mononuclear leukocytes isolated from venous blood. The content of interleukin (IL) 4, IL-10 and transforming factor beta (TGFβ) in culture suspensions of mononuclear leukocytes in vitro and IL-5 in the blood was determined by enzyme-linked immunosorbent assay (ELISA) test. The expression of surface molecules CD4, CD20, CD25 and intracellular transcription factor Foxp3 by lymphocytes of the blood was evaluated by flow cytometry. The obtained results were analyzed by statistical methods. Results. It is shown that excessive generation of regulatory T cells in patients with TB is associated with eosinophilia of the blood and imbalance of immune response regulation mechanisms. In TB with eosinophilia, an increase in the number of Foxp3-positive regulatory T cells in the blood is combined with in vitro hypersecretion of anti-inflammatory cytokines TGFβ, IL-10, IL-4 and an increase in the content of CD20+ B lymphocytes and IL-5 in the blood. These changes are most pronounced in the disseminated form of TB in combination with drug resistance. Conclusion. Characteristics of immunoregulation at TB with blood eosinophilia are associated with activation of immunosuppression mechanisms and polarization of immune response towards Th2-dependent pathway.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The review presents a modern view on stress as a risk factor for the development of arterial hypertension (AH). A variety pathogenic mechanisms responsible for increase of blood pressure during stress exposure are described in detail. The importance of the sympathetic activation as a key link in the development of stress-induced AH and initiation of a cascade of pathophysiological reactions that realize their adverse effects at the level of the whole organism is underlined. Particular attention is paid to worksite AH as a variant of stress-induced hypertension due to its wide prevalence and association with an increased risk of cardiovascular complications, primarily myocardial infarction and stroke. Epidemiological data and results of recent metanalysis are presented, indicating the high significance of job strain as a risk factor for adverse cardiovascular events. The actual psychological stress reduction programs are described. Possibilities of using β-blockers in patients with stress-induced hypertension as drugs affecting the central pathogenetic trigger of this disease are considered. The advantages of using bisoprolol as a highly selective β-blocker are considered taking into account the available body of evidence for its effectiveness in patients with worksite AH, as well as its metabolic neutrality and target-organ protective properties.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The review illuminated actual issues of the diagnostic efficiency of computed tomography (CT) of the coronary arteries in the planning of the procedure percutaneous coronary intervention (PCI) in patients with chronic occlusion of coronary arteries (CTO). The results of researches of detection of predictors of unsuccessful recanalization according to traditional coronary angiography (CAG) and CT angiography were presented. The major CT characteristics of the CTO, which can supplement the coronary angiography data to predict outcomes of the PCI were discussed.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The article presents data of domestic and foreign authors on the relationship between occupational factors and arterial hypertension. The role of latent arterial hypertension, its frequency in the population, the lesion of the target organs and the prognosis in comparison with normotensive individuals, arterial hypertension of the "white coat" and stable arterial hypertension have been analyzed. Arterial hypertension in the workplace is a form of latent arterial hypertension. The authors review the influence of harmful production factors (physical, chemical), as well as psychosocial stress on the risk of developing arterial hypertension.The risk of developing hypertension in specified groups of workers has been analyzed separately. The place of production-related diseases in modern occupational pathology in the Russian Federation. A wider implementation of measures aimed at early diagnosis and prevention of arterial hypertension in workers is proposed.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Aim. To evaluate the presence and the severity of the complaints (headache, dizziness, memory loss, concentration of attention, sleep disturbances, decreased mood, increased anxiety), the state of cognitive functions, emotional status and quality of night sleep in treatmentnaïve middle-aged patients with mild to moderate EAH compared to healthy volunteers of the same age. Materials and methods. 103 treatment-naïve patients with EAH aged 40-59 years at the enrollment, who met the inclusion/exclusion criteria and provided written informed consent (46 men, mean age 53.6±0.8 years) and 50 healthy volunteers (17 men, mean age 51.5±1.0 years) with normal blood pressure (BP) level - control group - were enrolled to the study. Mean EAH duration was 2.9±5.7 years. Cognitive assessment included Montreal cognitive assessment, 10-words learning task, verbal fluency test, TMT, Stroop color and word test. Anxiety and depression were evaluated via Hamilton rating scales (HARS and HDRS). 24-hours ambulatory BP monitoring (ABPM) was performed according to European guidelines. Results. 70% of patients with EAH complained of memory disturbance, 68% - lack of attention, 22% - sleep disturbances, 12% - dizziness, 9% - headache. It took statistically significant more time for patients with EAH to perform on TMT B (p<0.05), they had significantly higher TMT B - TMT A difference score (p<0.01) and lower mean MoCA score (p<0.05). Patients with EAH had significantly higher mean score in Hamilton anxiety (2.1±3.7) and depression (1.1±2.4) rating scales compared to controls (0.3±0.9 points, p<0.01 and 0.1±0.5 points, p<0.001, respectively). Patients with EAH who complained of sleep disturbances had low sleep quality (8.7±2.8 points). Among patients with EAH who complained about headaches 66.6% had episodic migraine and chronic tension type headache (33.4%). Those patients had a substantial impact of headache on life and daily living according to HIT-6 (mean score - 57.5±6.1). Only 2 patients out of 12 with complains about dizziness had benign paroxysmal positional vertigo and Ménière's disease. Conclusion. Complaints about memory dysfunction, lack of attention, sleep disturbances, less common - dizziness and headaches, are most typical in patients with EAH on the early stages of the disease. They differ from healthy volunteers of the same age by having cognitive impairment and higher anxiety and depression scores. Patients with EAH who complained about sleep disturbances had low sleep quality. Headache in patients with EAH was due to episodic migraine and tension type headache which had a negative impact on life and daily living.

© Bionika Media Ltd. Background. Results of numerous studies have shown the advantages of fast increase in the volume of enteral nutrition (>25 ml/kg/day) in very premature infants in the early neonatal period with regard to the slow one (<25 ml/kg/day). Such tactics has demonstrated potential for decrease in postnatal growth retardation in the majority of infants with very low birth weight. Long-term outcomes of physical and psychomotor development are studied poorly. Objective. To assess the influence of enteral nutrition (EN) pace in the early neonatal period on physical and psychomotor development of extremely premature infants during first 12 corrected months. Materials and methods. The study dealt with extremely premature infants that were born at the age of up to 31 weeks of gestation and had body of up to 1,500 grams. The rate of EN increase was more than 25 ml/kg/day in group 1, in group two – less than 25 ml/kg/day. Physical development was assessed in different age periods according to centile curves, also routine neurological examination with assessment of psychomotor development (PMD) according to Griffiths R. mental development scale (1954) was carried out. Results. EN of more than 25 ml/kg/day in the early neonatal period contributes to higher indications of body mass, body length and head circumference, as well as fast pace of body mass gain from the moment of birth and after discharge, during first 12 corrected months of life. All this positively correlates with the results of PMD assessment. According to the results of the study, the number of studied infants that caught up with passport age in development already by 12}0.5 months of corrected age (CA) was definitely higher in the group, where scheme of EN with fast rate of increase was used in the early neonatal period. Conclusion. Scheme of EN with fast rate of increase in volume (>25 ml/kg/day) in the early neonatal period in very premature children that were born with body mass of up to 1,500 grams contributes to higher indicators of body mass, body length and head circumference, as well as fast pace of body mass gain from the moment of birth and after discharge, during first 12 corrected months of life. By 12 months of CA the percentage of infants, whose PMD corresponded to passport age, was definitely higher than in the group with fast increase in EN in the early neonatal period than in the group with slow increase (р=0.005). Thus the influence of increase rate of EN on PMD during first 12 months of CA is determined.

© Bionika Media Ltd. Aim. To estimate the effectiveness of the thrombin generation assay (TGA) in identifying high thrombogenic risk in pregnant women. Material and methods. The study comprised 30 healthy non-pregnant women (control group) and 32 women in the third trimester of pregnancy. Of the latter group, 22 women with complicated pregnancy comprised the study group while the remaining ten women made up the comparison group. After delivery, the patients in the study group were divided into subgroups with a favorable (n = 15) and adverse (n = 7) pregnancy outcomes. The state of the hemostatic system was examined using standard coagulation tests and TGA. Results. Thrombin generation assessed as endogenous thrombin potential (ETP), was statistically significantly higher in pregnant than in non-pregnant women (2300 ± 400 vs. 1700 ± 400, respectively, p <0.005). The patients with adverse pregnancy outcomes had statistically significantly higher ETP compared with women with favorable outcomes (2700 ± 600 vs. 2300 ± 300, respectively, p <0.005). Conclusion. TGA can be used to predict adverse pregnancy outcomes. Elevated ETP is associated with adverse pregnancy outcomes.

© 2018, Springer Nature Switzerland AG. The paper represents a novel approach for individual medical treatment in oncology, based on machine learning with transferring gene expression data, obtained on cell lines, onto individual cancer patients for drug efficiency prediction. We give a detailed analysis how to build drug response classifiers, on the example of three experimental pairs of data “kind of cancer/chosen drug for treatment”. The main hardness of the problem was the meager size of patient training data: it is many many hundred times smaller than a dimensionality of original feature space. The core feature of our transfer technique is to avoid extrapolation in the feature space when make any predictions of the clinical outcome of the treatment for a patient using gene expression data for cell lines. We can assure that there is no extrapolation by special selection of dimensions of the feature space, which provide sufficient number, say M, of cell line points both below and above any point that correspond to a patient. Additionally, in a manner that is a little similar to the k nearest neighbor (kNN) method, after the selection of feature subspace, we take into account only K cell line points that are closer to a patient’s point in the selected subspace. Having varied different feasible values of K and M, we showed that the predictor’s accuracy considered AUC, for all three cases of cancer-like diseases are equal or higher than 0.7.

© 2018 Society for Industrial and Applied Mathematics. We consider a vector-Laplace problem posed on a two-dimensional surface embedded in a three-dimensional domain, which results from the modeling of surface fluids based on exterior Cartesian differential operators. The main topic of this paper is the development and analysis of a finite element method for the discretization of this surface partial differential equation. We apply the trace finite element technique, in which finite element spaces on a background shape-regular tetrahedral mesh that is surface independent are used for discretization. In order to satisfy the constraint that the solution vector field is tangential to the surface we introduce a Lagrange multiplier. We show well-posedness of the resulting saddle point formulation. A discrete variant of this formulation is introduced which contains suitable stabilization terms and is based on trace finite element spaces. For this method we derive optimal discretization error bounds. Furthermore algebraic properties of the resulting discrete saddle point problem are studied. In particular an optimal Schur complement preconditioner is proposed. Results of a numerical experiment are included.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Cardiovascular diseases remain leading cause of high mortality in diabetes patients. The article is focused on the influence of diabetes on cardiovascular risks. The prevalence presented, as the significance of the main and additional risk factors of cardiovascular diseases in the development of macrovascular complications in diabetes. In the context of influence on cardiovascular risks, modern glucose lowering drugs are considered, the safety and efficacy properties. Advantages of dapagliflozin underscored, the novel oral drug of new generation, with safe and prominent antidiabetic effect and ability to correct the main factors of cardiovascular risk (obesity, hypertension).

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Aim. To evaluate the prevalence of arterial hypertension (AH) in heart transplant recipients, and its influence on the risk of adverse events, as the efficacy and safety of antihypertension medications (AHM). Material and methods. To the study, were consequently included all heart transplant recipients operated in the Shumakov Centre during the years 2013 to 2016 and survived 90 days after orthotopic heart transplantation. Results. Totally, 353 recipients included, with AH or AHM intake in anamnesis in 62 (17,6%). Within 90 days post surgery, AH that demanded for medication therapy was found in 151 (42,8%) patients. In posttransplant AH patients there were the following specific parameters in preoperational period: higher body mass index - 25,7±4,1 vs 24,9±4,4 (р=0,026), blood creatinine concentration - 100,6±62,6 vs 68,8±4,8 (р<0,001), donor heart posterior wall thickness - 11,9±0,8 vs 11,3±0,7 (р=0,034), creatinine concentration in 3 month after operation - 131,7±101,6 vs 94,1±46,5 (p<0,001). There was relation revealed, of AH development risk with anamnesis of AH and renal failure, as a necessity for renal replacement therapy within 30 days post surgery and episodes of acute antibody-mediated reaction on transplant. In the recipients taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) before operation, the survival rate free from adverse events was better than in those taking calcium channel blockers (CCB) (plog-rank=0,042). Conclusion. The results of the study point on high prevalence of AH in heart recipients. Presence of AH in anamnesis, renal failure, episodes of humoral, but not cellular, reaction to the transplant, and donor heart hypertrophy do significantly increase the probability of AH development after transplantation. Comparison revealed significant benefit of ACEi/ ARB versus CCB as antihypertension medications in either monotherapy or in combination with diuretics.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Although on the first glance, the prevention of arterial hypertension (AH) is effective since childhood and adolescence, further research is needed, as it is not well known how to make it effective. Aim. Based upon the analysis of 32-year long dynamics of various levels of blood pressure (BP), to define the efficacy of screening investigations in children. Material and methods. A 32-year long prospective, cohort study conducted, the observation of males beginning at age 11-12 y.o. In 32 years, among 1005 participants, 303 (30,1%) were investigated, and the cohort consisted finally of 290 persons. The assessment included: surveying, triple BP measurement, pulse count, body mass and height measurement, triceps skin folds thickness measurement, as scapular and abdominal, waist and hip circumference, total cholesterol measurement, as the high density, and level of triglycerides, electrocardiogram. Results. Among the males that at the age 12 were in the upper 20% (5th quintile) by systolic BP, in 32 years almost one quarter remained in the same quintile. The stability of raised BP the parameters influence such as body mass and skin fold thickness. Combination of raised systolic BP in high body mass in 13 y.o. adolescents does increase the risk of AH at 43 y.o. the same grade that does an isolated body mass increase - this witness on the decrease of baseline BP values role in hypertension developemnt with remaining role of body mass. The risk of AH development with the baseline age 15 y.o. was significantly higher in combination of overweight and AH. Conclusion. For AH prevention, even in childhood and adolescence it necessary to monitor closely those with raised systolic BP and overweight, and active prevention should start before the age 20 y.o.

© 2018, Dynasty Publishing House. All rights reserved. Chronic pancreatitis, being a complex multifactor clinico-genetic phenomenon, is a significant medical, social and economic problem. Study of pancreatitis remains a topical theme also for the paediatric cohort, especially taking into account practically similar morbidity rates in adults and children. The review presents information and analyzes main genetic risk factors of the development of pancreatitis. Mutations and polymorphisms of the CFTR, CTRC, SPINK1, CPA1, PRSS1, PRSS2 genes that are significant for functioning of the pancreas are discussed in detail. Examples of genetic variants associated with increased or decreased risks of developing disease are given. Special attention is paid to difficulties of interpreting the results of molecular-genetic testing associated with certain gene homology, presence of pseudogenes and disease cases conditioned by spontaneous mutation. Detection of genetic risk factors of chronic pancreatitis allows to early prevent the development of disease in the proband’s relatives, and also to take a more personalized approach to the patient’s treatment.

© 2018 Russian Transplant Society. All rights reserved. The article offers analysis of the problem status as well as World and Russian experience of donor organ recipients participation in sports and physical training. The connection of physical activity with the quality of life of patients after transplantation is reflected. The problems associated with organ donation in Russia and other countries and the importance of sports activities in promoting this problem are described. The analysis of foreign experience in the organization of sports games for people with transplanted organs, which indicates: the importance of research methods in admission to physical education and sports among recipients, the need for dosing and selection of physical activity, the involvement of a transplant doctor for individualization of rehabilitation programs. The personal experience of foreign athletes with transplanted organs, including the experience of the Russian recipient’s participation in the 21st world games 2017 is presented. Experience of carrying out sports activities for people with transplanted organs in Russia is also given.

© 2018 Stolichnaya Izdatelskaya Kompaniya. Статины в настоящее время являются наиболее широко применяемыми препаратами для лечения дислипидемии и наиболее эффективными лекарствами для снижения уровня холестерина липопротеинов низкой плотности и снижения риска сердечно-сосудистых и цереброваску- лярных событий. Считается, как правило, что статины хорошо переносятся, но предполагают потенциальную связь между статинами и ког- нитивными нарушениями у некоторых людей. Эта обзорная работа была проведена с учетом поиска информации о конкретной проблеме потенциального неблагоприятного влияния статинов на когнитивную сферу, целью которой было выявить рекомендации для медицинских работников по мониторингу и снижению риска потенциальных когнитивных нарушений при терапии статинами. Розувастатин, по-видимому, является более безопасным среди статинов с точки зрения влияния на когнитивную функцию. Перед началом терапии статинами нет не- обходимости в выявлении когнитивной дисфункции у пациентов, терапия статинами не сопровождается риском развития когнитивной дисфункции по данным когортных и рандомизированных исследований. При развитии когнитивной дисфункции на фоне терапии статинами необходимо доказать ее наличие и исключить другие возможные факторы ее возникновения, и оценить соотношение пользы/риска отмены терапии статинами. На основании индивидуальных особенностей пациента возможно уменьшить дозу принимаемого статина или прекратить прием препарата для оценки обратимости симптомов. В случае прекращения приема статина следует подумать об альтернативной замене на другой ингибитор ГМК-КоАредуктазы, предпочтительнее - препарат, меньше всего проникающий через гематоэнцефалический барьер, такой как розувастатин.

© 2011–2018 NSPU Bulletin All rights reserved Introduction. The problem of the article is addressed to clarify the question of how the content of practical pedagogical knowledge accumulated by the society can be understood from the point of view of an epistemologically correct theoretical scheme, to what extent this scheme itself is now formed in the methodology of pedagogy and what are the immediate prospects for such formation. The aim of the article is to reveal the epistemological coding of the modern state of educational theory as an object of research reflection and the prospects for its further formation. Materials and Methods. Among our research methods, we consider it possible to include: analysis of literature on the topic of the work, a theoretical substantive generalization, heuristic synthesis, the formulation of a hypothesis about the possible content and activity filling the field of reflection of researchers in the field of pedagogy, and a prospectus of further approaches to the study of the problem. Results. The modern initial stage of the theoretical interpretation of pedagogy is identified, the difficulties of which are explained by the polyphony of coding: the object of pedagogy, its fundamental foundations, the rules for deducing consequences from general provisions, the correct implementation of generalizations and analogies, and the methods for carrying out the experiment and identifying experimental confirmation of an experted theory. As the nearest stage in the solution of these problems, the authors design correct theoretical constructs of a restricted nature which must include the following aspects: identifying weak research development of several segments of pedagogical reality, raising hypotheses about the possibility of describing them from the point of view of the positively valuable educational outcome for the learner and the ways of achieving it, finding the criteria for its evaluation and implementing them in a diagnostic format. Conclusions. The presented variant of polyaspect reflection of the results of educational research based on the theoretical scheme covers both retrospective and prospective reflective forms; it also shows all the procedures traditionally indicated by psychologists: stopping, removing, fixing, reviewing, objectifying; allows educational researchers to evaluate their investigations according to scientific norms which achieve a theoretical status. All the theses of the problematic format presented in the article are a possible field of application for beginning researchers.

© 2018, Media Sphera Publishing Group. All rights reserved. This article was designed to report the results of scientific research and practical forensic medical work carried out jointly by the personnel of Department of Forensic Medicine of the Sechenovsky University and the Bureau of Forensic Medical Expertise of the Moscow Health Department during the last 5 years.

© 2018, Media Sphera Publishing Group. All rights reserved. We undertook the analysis of the archive data of forensic medical expertises of the non-identified corpses accumulated at the tanatological divisions of the Moscow Bureau of Forensic Medical Expertise for the period from 2012 till 2016. Special attention was given to sex and age composition of the deceased as well as the structure of mortality and the traces of ethyl alcohol, if any, present in the blood. It was shown that the majority of the unidentified bodies were those of the young men, with the main cause of the non-violent deaths being the cardiovascular pathology. Ethyl alcohol was found in the blood of 43% of the corpses. The analysis encompassed also the most frequently used methods for personality identification based on the data available from the medical-criminalistic department of the Bureau of Forensic Medical Expertise. The statistical treatment of the results of the study provided materials making it possible to envision the tendencies of the further development and improvement of the methods for personality identification for the purpose of forensic medical expertise and judicial practice.

© 2018, Media Sphera Publishing Group. All rights reserved. The present article deals with the problems pertaining to the forensic medical diagnostics of the HIV-associated pathological conditions taking into consideration the materials available from the Moscow City Centre for AIDS Prophylaxis and Control with special reference to the number and structure of the diagnosed HIV-associated diseases. We undertook the analysis of co-morbid HIV/AIDS causes of violent and sudden deaths documented at the Bureau of Forensic Medical Expertise of the Moscow Health Department during the period from 2013 till 2016. The study revealed the tendency toward a rise in the number of deaths from the HIV-associated infections including tuberculosis, pneumonias, chronic immunodeficiency conditions refractory to the treatment, and from malignant neoplasms. A peculiar feature of the aforementioned period was the increased age of the deceased subjects. In the cases of violent deaths, the HIV-associated conditions were diagnosed as the concomitant diseases, with the markedly predominant ones being acute drug and alcohol intoxication, injures, and attempts at suicide. The available results of the studies give evidence of the necessity and importance of the cooperative work of the specialists for the further improvement of forensic medical diagnostics and monitoring of HIV-associated conditions.

© 2018, Media Sphera Publishing Group. All rights reserved. The objective of the present study was the development and validation of the rapid reproducible method for the identification of ethyl glucuronide and ethyl sulfate allowing to store and transport the study specimens without the loss of the substances of interest by placing the samples on the paper. We have developed the validated technique for the detection and quantitative determination of ethyl glucuronide and ethyl sulfate in the cadaveric blood and urine by means of low-resolution tandem mass-spectroscopy with the use of deuterated derivatives of these substances as the internal standards. The low threshold for quantitative determination of both above substances is 50 ng/ml for the blood and 100 ng/ml for the urine. The method is characterized by the accuracy and precision with the coefficient of variation below 15% and the influence of the matrix with the coefficient of variation below 15%. The evaluation of stability of the two analytes in blood when stored in the dry condition on the paper carrier during 2 weeks showed that the coefficient of variation did not exceed 6.4%. The comparative study of ethyl glucuronide and ethyl sulfate in the samples of cadaveric blood and urine containing from 0 to 5.2% of ethyl alcohol was carried out. The methods for the transportation of the biological fluids and for the extraction of ethyl glucuronide and ethyl sulfate placed on the paper carrier (Whatman 903) have been proposed. The possibility has been demonstrated to use ethyl glucuronide and ethyl sulfate as the markers of the consumption of ethyl alcohol during one’s lifetime for the purpose of investigation of the putrifactive changes of the blood components.