Репозиторий Университета

© 2018, Media Sphera Publishing Group. All rights reserved. Inflammasomes are macromolecular complexes that contain many copies of receptors recognizing molecular patterns of pathogenic agents (PAMP) and damage-associated structures (DAMP), and also include molecules of adapter protein ASC and procaspase- 1. Activation of inflammasomes leads to the formation of active caspase-1 that, in turn, provides the maturation of pro-IL-1β and pro-IL-18 to IL-1β and IL-18. The latter cytokines play an important role in control of neuroinlfammation in the central nervous system contributing to the pathogenesis of a series of neurological, neurodegenerative and mental disorders. The review discusses the involvement of NLRP3 inflammasome and other their types in the development of the traumatic brain injury, ischemic and hemorrhagic stroke, brain tumors, CNS infections, Alzheimer’s and Parkinson’s diseases, epilepsy, amyotrophic lateral sclerosis, depressiver, and consequences of alcohol abuse. The elucidation of molecular mechanisms and signaling pathways controlled by inflammasomes will allow the development of new therapeutic measures for diseases, in which neuroinflammation plays a leading pathogenetic role.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. The key to successful treatment in patients with acute coronary syndrome is maximally early revascularization of the coronary arteries. Treatment of multifocal atherosclerosis with lesions of the coronary and peripheral arteries requires coordinated work of the multidisciplinary team of doctors. Critical ischemia of the lower limbs requires urgent revascularization in order to prevent limb amputation. However, it is not always possible to perform revascularization using specialists of the same profile – endovascular or surgical. The use of hybrid methods of treatment (surgical and endovascular) allows to significantly improve the prognosis in saving the limb. The article presents a clinical observation of successful multistep treatment of a patient with acute coronary syndrome in combination with critical ischemia of the lower limb. The first stage was performed by multiple stenting of the coronary arteries with bioabsorptive scaffolds; the second stage was the hybrid treatment – femoral-tibial bypass with simultaneous recanalization and angioplasty of the lower leg arteries with good postoperative and long-term outcome.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article covers the development of the problem of sudden cardiac death prevention with the implantable cardioverterdefibrillators from the moment of creation of these devices to our days. The current concept of primary prevention of sudden cardiac death, based on the severity of manifestation of heart failure and left ventricular dysfunction, is not effective enough. Its practical application is difficult because it requires mass application of implantable defibrillators, with low predictive accuracy of these criteria in terms of development of lifethreatening arrhythmias. The development of methods for visualizing the myocardium, allowing to assess the severity of myocardial fibrosis, as well as the possibilities of medical genetics, at the present stage, allows us to clarify indications for implantation of cardioverterdefibrillators and thereby significantly improve the concept of preventing sudden cardiac death with these instruments.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article deals with the modern tactics of pulmonary hypertension therapy, used in case of unsatisfactory clinical response to previous therapy. All classes of pathogenetic therapy of pulmonary hypertension are presented, as well as modern views on the risk stratification of annual mortality of patients. Switching to a more effective drug both within one group of pathogenetic PAHtherapy, and to drugs of other classes is discussed. The latest classification of pulmonary hypertension (Nice, 2018) is presented.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Purpose: to elucidate predictors of development of chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary artery thromboembolism (PTE). Material and methods. We included in this study 210 patients hospitalized with diagnosis of submassive and massive PTE from 2013 to 2017. In 1 to 3 years after initial hospitalization these patients were invited for control examination. According to results of this examination patients were divided into two groups: with (group 1, n=45) and without (group 2, n=165) signs of CTEPH. Severity of pulmonary artery vascular bed involvement was assessed by multislice computed tomography (MSCT) angiography and lung scintigraphy. For detection of thrombosis in the inferior vena cava system we used ultrasound angioscanning. Examination also included echocardiography. Results. In the process of mathematical analysis, the following risk factors for the development of CTEPH embolism were determined: duration of thrombotic history (group 1 - 13.70±2.05 days, group 2- 16.16±1.13 days, p=0.015), localization of venous thrombosis in the lower extremities (the most favorable - shin veins, popliteal, and common femoral veins, unfavorable - superficial femoral vein). The choice of the drug for thrombolytic and anticoagulant therapy: streptokinase and urokinase were significantly more effective than alteplase, rivaroxaban was superior to the combination of unfractionated or low molecular weight heparins with warfarin. Also, risk factors for the development of CTEPH were the initial degree of pulmonary hypertension and tricuspid insufficiency, as well as the positive dynamics of these indicators at the background of thrombolytic or anticoagulant therapy. Of concomitant diseases, significant risk factors for development of CTEPH were grade 3 hypertensive disease, diabetes mellitus, postinfarction cardiosclerosis. On the other hand, age, gender, degree of severity at the time of admission, presence of infarction pneumonia, surgical prevention of recurrent pulmonary embolism, number of pregnancies and deliveries, history of trauma and malignancies, cardiac arrhythmias produced no significant impact on the development of CTEPH.

© 2018 Russian Academy of Sciences. Wide circulation of HIV-infection/AIDS is a socially important problem for the majority of the countries of the world now. Against the background of the remaining high rates of infection spread beyond the borders of risk groups, a series of the negative phenomena aggravating an epidemiological situation on HIV-infection and other socially important diseases is observed (tuberculosis, hepatitises, etc.): depression of the general indicators of health of the population, urbanization, complicating of life rhythm, wide circulation of dependences on psychoactive agents, and, above all - serious transformation of institute of family, liberalization of sex behavior, of traditional family values. Now in representations of Russians the typical HIV-positive-a young childless and single man regardless of sexual orientation who is living in the large city, having an average special educations or being in process of its receiving whith level of income comparable to average one. The HIV-positive has been Infected as a result of a youth error (unprotected sexual contact or the intravenous use of drugs) and lives with this diagnosis several years, leads a risk-free life more often, at the same time usually hiding the diagnosis and separated from social communications. Existence of this diagnosis involves social trouble and the social not approved behavior, but if the disease affects the loved one, many Russians are potentially ready to give moral and psychological support (56%), financial support (including in purchase of drugs), the help in search of necessary experts and visit of the medical organizations (6,9%) and also to care for the HIV infected and their children (6%). According to authors, the widespread negative perception of people with "HIV-infection" diagnosis is in many respects caused by insufficient informing the population on HIV-infection/AIDS problems.

© 2018 Izdatel'stvo Meditsina. All rights reserved. NMDA receptor modulators are a new class of antidepressants with rapid onset of action and lasting antidepressant effect. These drugs increase BDNF level in CNS and adult hippocampal neurogenesis, which events are in common for both NMDA receptor modulators and classical antidepressants. However, unlike classical antidepressants, drugs of this new group produce no direct influence on the monoaminergic system, but regulate the neuroplasticity in the prefrontal cortex and hippocampus via modulation of the glutamatergic neurotransmission. Clinical tests of ketamine and rapastinel confirmed the rapid onset of action and the continuation of stable antidepressant effect (upon single administration per 7 days) for both usual and treatment-resistant forms of depression.

Lutein and zeaxanthin are carotenoid pigments that affect the function of the visual analyzer. They selectively accumulate in the yellow spot of the retina, form macular pigment and determine the density of the retina macula. Lutein and zeaxanthin slow down the progression of age-related macular degeneration, a leading cause of senior-age blindness. The main food sources of non-vitamin carotenoids are green leafy vegetables, zucchini, pumpkin, green peas, broccoli. The aim of the study is a retrospective assessment of the levels and sources of alimentary intake of lutein and zeaxanthin in young people and research of the effect of lutein and zeaxanthin in the diet on macula density. A specially designed questionnaire was used to quantify the content of lutein and zeaxanthin in the diet, reflecting the amount of consumption of the main sources of these carotenoids on the day preceding the survey. A non-invasive non-contact method of optical coherence tomography of the retina was used to determine the density of the macula. The study involved 96 students of Sechenov University at the age of 21-27 years. The study found that only 6.25% of the respondents had daily intake of lutein and zeaxanthin of 6 mg or more, 8.33% had 4.6-5.9 mg, 8.33% had 3.0-4.5 mg, in 18.75% - 1.5-2.9 mg, in 45.83% <1.4 mg 12.5% of respondents didn't include sources of lutein and zeaxanthin in the diet. The more common sources of lutein and zeaxanthin in the diet were eggs and fresh tomatoes. Retinal density indices corresponded to the age standards in the majority of the examined. In 8.3% surveyed the thickness of the retina was decreased, and 4.2% had higher thickness of the retina in comparison with the standards. Significant differences in the Central subfield thickness in men and women were revealed. There was no dependence of the levels of lutein and zeaxanthin coming from food sources on the retina thickness indicators.

The purpose of our study was to assess the efficiency of toothpaste 'Intensive strengthening of supersensitive teeth with nano-GAP' INNOVA and the suspension 'Liquid Enamel' INNOVA on the sensitivity of teeth with gingival recession. We examined 40 people aged 20-25 years. Each group consisted of 20 people: 10 women, 10 men. The first group (observations) used the paste and the suspension for 14 days, and the second group (comparisons) cleaned teeth only with a brush without a paste. Schiff aerial test was performed to assess the rate of hypersensitivity. As a result of the study, it was found that the combination of paste and liquid suspension with nano-hydroxyapatite for 14 days effectively reduced the hypersensitivity of the teeth with gingival recession that was shown by a statistically significant decrease in the Schiff index in the observation group. Thus, this combination is the method of choice in the treatment of hyperesthesia and can be used as an alternative substitute therapy.

© 2018, Silicea-Poligraf. All rights reserved. Pregnancy is a physiological condition that takes a defined period of time in a woman’s life. For nine months, the mother’s heart works under conditions of daily additional load, which is necessary to ensure placental blood flow. In this regard, structural and functional adaptation of the heart develops in a healthy woman with a normal pregnancy. A pregnant woman with some heart diseases is less likely to adapt. That leads to greater susceptibility to stress resulting in pathological changes of pregnancy. In addition, each pregnancy may develop new heart diseases, which in some cases may be relatively innocent, but in others — fatal. In this regard echocardiography (EchoCG) is a necessary procedure for assessing a woman’s health status that needs before bearing a fetus, during and after pregnancy.

© 2018 The Author(s). Background: Cornea protects the eye against natural and anthropogenic ultraviolet (UV) damage and mechanical injury. Corneal incisions produced by UV lasers in ophthalmic surgeries are often complicated by oxidative stress and inflammation, which delay wound healing and result in vision deterioration. This study trialed a novel approach to prevention and treatment of iatrogenic corneal injuries using SkQ1, a mitochondria-targeted antioxidant approved for therapy of polyethiological dry eye disease. Methods: Rabbit models of UV-induced and mechanical corneal damage were employed. The animals were premedicated or treated with conjunctival instillations of 7.5 μ M SkQ1. Corneal damage was assessed by fluorescein staining and histological analysis. Oxidative stress in cornea was monitored by measuring malondialdehyde (MDA) using thiobarbituric acid assay. Total antioxidant activity (AOA) was determined using hemoglobin/H2O2/luminol assay. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities were measured using colorimetric assays. Results: In both models corneas exhibited fluorescein-stained lesions, histologically manifesting as basal membrane denudation, apoptosis of keratocytes, and stromal edema, which were accompanied by oxidative stress as indicated by increase in lipid peroxidation and decline in AOA. The UV-induced lesions were more severe and long healing as corneal endothelium was involved and GPx and SOD were downregulated. The treatment inhibited loss of keratocytes and other cells, facilitated re-epithelialization and stromal remodeling, and reduced inflammatory infiltrations and edema thereby accelerating corneal healing approximately 2-fold. Meanwhile the premedication almost completely prevented development of UV-induced lesions. Both therapies reduced oxidative stress, but only premedication inhibited downregulation of the innate antioxidant activity of the cornea. Conclusions: SkQ1 efficiently prevents UV-induced corneal damage and enhances corneal wound healing after UV and mechanical impacts common to ocular surgery. Its therapeutic action can be attributed to suppression of mitochondrial oxidative stress, which in the first case embraces all corneal cells including epitheliocytes, while in the second case affects residual endothelial cells and stromal keratocytes actively working in wound healing. We suggest SkQ1 premedication to be used in ocular surgery for preventing iatrogenic complications in the cornea.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To test the main hypothesis that the deficit phenomena in schizophrenia act not in the «pure» form, but in the form of aggravating personality characteristics, forming so-called «common» syndromes with personality disorders (PD). Material and methods. The results of the psychopathological study (with the use of psychometric methods) of deficit disorders in a sample of 170 patients with schizophrenia and schizophrenia spectrum disorders (63 men, 107 women) are presented in relation to the abnormal structure of premorbid personality (PD of clusters A, B, C). An analysis of negative symptoms according to the comparability of defect to the profile of premorbid personality made it possible to distinguish three groups of deficit states associated with PD - «common syndromes»: defensive schizoidy by the type of deficit schizoid and expansive schizoidy by the type of «verschroben» (cluster A); pathological hysterical infantilism, malignant hysteria and defective erotomania (cluster B); pseudo-psychasthenia and pathological rationalism (cluster C). Results. It has been found that the symptomatology of «common syndromes» is subject to patterns reflecting the dichotomy of the basic defect. This pattern is valid not only for one single cluster of PD, but extends to all psychopathy- like disorders, regardless of their affiliation with a particular cluster. The pathocharacterological component of the «common syndromes» coexisting with the deficit symptom complexes is subject to the basic deficit component of the defect and is separated into polar dimensions (defensive-expansive) within specific clusters of PD, and then unified in accordance with the dichotomy of schizophrenic defect in categories with the predominance of emotional or apathoabulic disorders. Conclusion. ?sychopathy-like symptom complexes in the space of «common syndromes» can be qualified as a psychopathological construct secondary to basic deficit disorders, and their isolation as an independent entity of negative disorders appears to be unjustified.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. An analysis of typical medical errors in the diagnosis and treatment of compression neuropathy of the median nerve at the level of the wrist (carpal tunnel syndrome - CTS). Material and methods. Previous diagnoses and treatment of 85 patients with CTS (14 men and 71 women), aged from 36 to 84 years (middle age 62±10.6 years), who underwent surgery in our clinics were evaluated. Results. The wrong diagnosis was made in most of patients (60%). The osteochondrosi s of cervical spine (45.8%) and diabetic polyneuropathy (5.8%) were the most common mistaken diagnoses. Proper neurophysiological measurements using the Phalen’s test and Tinel’s sign were not performed in the majority of patients. Magnetic resonance imaging (MRI) of the cervical spine was often unreasonably made, the electroneuromyography was not used. Nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin B group were improperly prescribed to the patients diagnosed with CTS. Local corticosteroids injections were not prescribed to most of patients, immobilization of the wrist was not recommended at the early stage of disease and decompressive surgery at the advanced stage of disease. Clinical observation of the patient with long period of misdiagnosing is presented. Despite the long-standing history of CTS, surgical decompression led to regression of symptoms and complete professional rehabilitation. Conclusion. It is necessary to inform physicians about manifestations, diagnostic criteria and effective methods of treatment of CTS.

© 2018 Academic Research Publishing Group. The use of new information technologies in the educational process intensifies the need for analyzing the existing resources suitable for teaching students in conformity with professional standards. The objective of this study is to consider the significance of survey services in teaching students market research, to analyze the efficiency of survey services, to prove their positive impact on the learning process and to determine requirements for educational survey services. The materials of the study were students' reports on conducting consumer surveys using either paper or online questionnaires. The research is based on a pedagogical experiment to analyze the applicability of Internet resources in the educational process. The results of students' research were processed through the comparison of the data obtained. The authors of the article have developed the life cycle of educational survey services. Based on stages of the life cycle, the authors have determined desired functional characteristics of free survey services, which will simplify the task of selecting a suitable educational tool. It has been confirmed that the exclusive use of Internet technologies in teaching students market research cannot be sufficient, and they should be used in combination with basic approaches to a marketing theory. The conducted pedagogical experiment has proved the consistency of Internet technologies as an educational tool. The authors of the article have revealed that despite undeniable advantages of online survey services they also have significant shortcomings, which makes it impossible to completely replace classic methods of collecting market information from this moment on. The introduction of free survey services into the educational process increases teaching efficiency and develops professional competencies within the existing standards. Defining functional requirements of the above-mentioned life cycle, teachers can choose the best educational survey service taking into account the stages students will go through while using it. An extensive use of information technologies is essential to the formation of new teaching materials and the renewal of the existing ones based on the synthesis of the classical theory of marketing and innovations.

AIM: To identify correlation of carotid endarterectomy with neurocognitive function and psycho-emotional state changes. MATERIAL AND METHODS: There were 120 patients with internal carotid arteries (ICA) stenoses for the period from September 2013 to December 2016. The main group consisted of 100 patients undergoing carotid endarterectomy for internal carotid artery stenosis, control group - 20 patients who refused surgery in 2014-2016. Cognitive function and psycho-emotional state were assessed preoperatively, after 24 hours, 7 days and 3, 6 months postoperatively using the Mini Mental State Examination (MMSE), Frontal assessment battery (FAB), Information-Memory-Concentration Test, Clock Drawing Test and Schulte`s test, Luria Memory Words Test, Hospital Anxiety and Depression Scale (HADS) and Covi Anxiety Scale. RESULTS: Moderate preoperative cognitive impairment was observed in 39 (39%) patients of the main group. De novo postoperative cognitive dysfunction occurred in 65 patients on the 1st day after surgery (65%). Disturbances were noted after 1 week in 26%, after 3 months - in 15%, after 6 months - in 10% of patients. Improved status was noted in 31 (31%) patients of the main group within 1 day after surgery. Improved results were observed after 7 days in 52 (52%) patients, after 3 months - in 67 (67%), after 6 months - in 78 (78%) patients. Mean values of psycho-emotional testing in the main group were high before surgery and significantly decreased on the 1st day after operation. However, advanced anxiety and aggravation of depression occurred in 14% of patients (n=14) that affected cognitive sphere (p<0.01). Progressive cognitive impairment was noted in the control group. CONCLUSION: Carotid endarterectomy has a positive long-term effect on initially impaired neurocognitive functions (3 and 6 months) (p<0.05). There were no significant differences in cognitive testing data in subgroups of eversion and classical procedures (p>0.05). Early postoperative depressive disorders significantly increase the risk of postoperative cognitive dysfunction.

AIM: To determine significant predictors of long-term outcomes of surgery for portal cholangiocarcinoma. MATERIAL AND METHODS: Analysis included 49 out of 84 patients who were operated at the Vishnevsky Institute of Surgery in 2003-2016. Morphological examination (2011-2016) revealed great percentage of following positive variables: micro- (42.9%) and lymphovascular invasion (11.8%), positive resection margin (59.2%), perineural invasion (83.3%), depth of invasion - (83.3%), cells in surrounding fatty tissue (92.3%), invasion of entire thickness of bile ducts' walls (57.1%). Hemihepatectomy was carried out in 50 (59.5%) cases, advanced hemihepatectomy - in 16 (19%) patients. Left-sided hemihepatectomy (34.6%) was more common compared with right-sided hemihepatectomy (8.6%) for biliary confluence lesion (Bismuth-Corlette type IV). RESULTS: TNM stage (p=0.29), tumor localization Bismuth-Corlette type (p=0.10), regional lymph nodes metastases (p=0.77) do not significantly affect survival in univariate analysis. At the same time, TNM stage was significant factor if patients dividing into groups was considered (p=0.05). In regression analysis tumor cells differentiation (p=0.00028), positive resection margin (p=0.0034), perineural invasion and depth of invasion (p=0,00086) were significant predictors of survival. Multivariate analysis confirmed prognostic role of lymphovascular invasion alone (p=0.05). There was no correlation between survival and TNM stage (η=0.057), depth of invasion (η= -0.229) and lymphovascular invasion (η= -0.143645). There was significant reverse moderate correlation between survival and perineural invasion (η= - 0.468750), resection margin (η= -0.558) and tumor differentiation grade (η= -0.481). CONCLUSION: Significant predictors of long-term outcomes of surgery for portal cholangiocarcinoma are TNM stage, lymphovascular invasion, tumor cells differentiation, perineural invasion.

© 2018 Russian Association of Endocrinologists. The prevalence of cholelithiasis, its close pathogenetic connection with metabolic syndrome, high frequency of surgical intervention, significant economic losses put forward this comorbid pathology in a number of leading problems of modern clinical medicine. The factors associated with the metabolic syndrome not only increase the risk of developing cholelithiasis, but also form the basis of non-drug and drug therapy. Metabolic syndrome often determines the occurrence of three common and potentially life-Threatening complications of cholelithiasis: Acute cholecystitis, acute cholangitis and biliary pancreatitis. Therefore, the solution of this problem is associated with the need for early detection of additional risk factors for cholelithiasis, optimization of the early diagnostic and prognostic model of existing multi-organ pathology with the aim of reducing the progression of the disease and its complications. The data obtained in recent years on the human genome with metabolic syndrome and cholelithiasis make it possible to predict the development of comorbid pathology and to fully ensure the effectiveness of primary prevention.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Investigation's history and nomenclature's evolution of the IgA-vasculitis are presented in the article. Pathogenesis of the renal and skin damages is discussed in details, particularly abnormalities of the IgA-immunity and systemic endotoxemia. Relevant world's literature is cited.

The article reviews the literature on methods of evaluating the morphological and functional state of the eyelids in chronic blepharitis. Development of methods continues together with further research on the etiology and pathogenesis of the disease.