Репозиторий Университета

© 2018 Paediatrician Publishers, LLC. All rights reserved. At present, there is no reliable statistical data (morbidity, mortality, one-year mortality, etc.) that characterize the state of medical care for children with cancers in the Russian Federation seen in due to the lack of an universal electronic database of patients. Objective. Improve the reliability of statistical data. Methods. In the clinical practice of two pilot medical facilities, an electronic database of pediatric cancer patients was introduced which allows: keep patient records with a diagnosis, key dates, follow-up data; analyze the treatment received earlier and assess its quality; make a treatment plan; obtain information on the availability of beds and the number of patients in various medical facilities; perform medical consultations involving the of specialists of the third level medical institutions. Patient (or legal representatives of the patient), has access to the «private cabinet » which provides information on the treatment plan including a schedule for taking medicines, as well as routing possibilities. Results. In the period of 6 months (09.17-02.18), information on 75 patients who received treatment from 2017 to the present was put into the electronic database. Conclusion. The electronic database provides reliable statistical data, helps monitoring the quality of medical care and routing patients. This results in reducing the budget costs and improving the survival of patients.

© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Objectives. Certolizumab pegol (CZP) is a PEGylated antigen-binding fragment-fragment of a humanized mAb neutralizing TNF. It lacks Fc-fragment and has a very low potential to cross the placenta. We aimed to report the efficacy and safety of CZP in a case series of patients with refractory Takayasu arteritis (TA). Methods. Ten females of reproductive age (1835 years) with TA were treated with CZP (at a dose of 400 mg at weeks 0, 2 and 4 and at 200 mg every 2 weeks thereafter) for a median of 10 months (range 328). Prior to CZP administration all patients received glucocorticoids and ± MTX, CYC, AZA, HCQ, LEF or MMF. Six patients were previously treated with other biological anti-cytokine drugs. The National Institutes of Health criteria and the Indian Takayasu Clinical Activity Score 2010 were used to define disease activity. Results. All patients rapidly responded to treatment with CZP and were able to taper prednisone and MTX doses. Treatment with CZP resulted in a significant decrease in median serum CRP levels and normalization of Indian Takayasu Clinical Activity Score 2010 score in 9 of 10 patients. Remission of systemic vasculitis was achieved in all patients. Seven patients maintained remission for at least 4 months, while one patient developed relapse after 2 years of CZP treatment. Side effects included mild infections (n = 5). Conclusion. Our case series suggests that CZP may be an effective and steroid-sparing treatment option in patients with active TA even if they did not previously respond to other TNF inhibitors or tocilizumab.

Methotrexate is an antimetabolic drug with a myriad of serious side effects including nephrotoxicity, which presumably occurs due to oxidative tissue damage. Here, we evaluated the potential protective effect of lycopene, a potent antioxidant carotenoid, given in two different pharmaceutical forms in methotrexate-induced kidney damage in rats. Serum biochemical (urea and creatinine) and tissue oxidative damage markers and histopathological kidney changes were evaluated after systemic administration of both lycopene dissolved in corn oil and lycopene encapsulated in nanoliposomes. Similar to previous studies, single dose of methotrexate induced severe functional and morphological alterations of kidneys with cell desquamation, tubular vacuolation, and focal necrosis, which were followed by serum urea and creatinine increase and disturbances of tissue antioxidant status. Application of both forms of lycopene concomitantly with methotrexate ameliorated changes in serum urea and creatinine and oxidative damage markers and markedly reversed structural changes of kidney tissue. Moreover, animals that received lycopene in nanoliposome-encapsulated form showed higher degree of recovery than those treated with free lycopene form. The findings of this study indicate that treatment with nanoliposome-encapsulated lycopene comparing to lycopene in standard vehicle has an advantage as it more efficiently reduces methotrexate-induced kidney dysfunction.

© 2018 Carta, Mariani, Sambiagio, Chuchueva, Lecis, Gerosa and Puxeddu. The present study analyzed the results of the endoscopic approach to T1, T2 and selected T3 supraglottic carcinoma with the aim of reviewing functional and oncologic outcomes after different types of endoscopic supraglottic laryngectomies. This is a retrospective clinical study of 42 consecutive patients (mean age of 61.8 years, 33 males, 9 females) treated by the senior author for supraglottic squamous cell carcinoma with a transoral CO2 laser approach and reviewed from November 2010 to September 2017. Surgical procedures were classified according to the European Laryngological Society. In addition to the standardized transoral supraglottic laryngectomies, we introduced a modified type IVb by sparing the inferior third of the arytenoid if not directly involved in the tumor. Swallowing was evaluated with the Swallowing Performance Status Scale reported by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. Survival probabilities were estimated using Kaplan-Meier curves. Two type I, 2 type IIa, 2 type IIb, 3 type IIIa, 12 type IIIb, 13 type IVa, 3 type modified IVb, and 5 type IVb supraglottic laryngectomies were performed. Twenty-one patients (50%) underwent primary neck dissection. The pathologic TNM classification according to the 8th edition of the American Joint Committee on Cancer system was as follows: 9 pT1cN0, 2 pT1N0, 1 pT1N1, 7 pT2cN0, 1 rypT2cN0, 9 pT2N0, 4 pT2N1, 2 ypT2N1, 2 pT3cN0, 2 rypT3cN0, 1 pT3N1, and 2 pT3N2b. Mean follow-up was 3.4 years (range of 9 months to 6 years). According to the Kaplan-Meier analysis, 5-year disease-specific survival, local-relapse-free survival, nodal-relapse-free survival, overall laryngeal preservation and overall survival of patients without previous head and neck radiotherapy/open surgery were 100%, 95.2%, 87.8%, 100%, and 64.6%, respectively. Patients who underwent type I, IIa, and IIb resections (n = 6) started oral feeding the day after surgery, patients who underwent type III-IVb modified resections (n = 31) started oral feeding 3-4 days after surgery, and patients who underwent standard type 4b resections (n = 5) started oral feeding 7 days after surgery. Threemonths after surgery, patients without a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed significantly better swallowing compared to patients who underwent standard type IVb resection: grade 4-6 impairment of swallowing in 8 and 66.7% of cases, respectively (p = 0.006072); patients with a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed not statistically significant better swallowing compared to patients who underwent standard type IVb resection: grade 4-6 impairment of swallowing at 3 months in 16.7% and 50% of cases, respectively (p = 0.23568). Transoral CO2 laser supraglottic laryngectomy is an oncologic sound alternative to traditional open neck surgery and chemo-radiotherapy. Recovery of swallowing is significantly worsened after total resection of the arytenoid. Modified type IVb procedure leaving intact, when possible, the inferior third of the arytenoid and consequently the glottic competence, improves functional outcome.

© 2018, Media Sphera Publishing Group. All rights reserved. This article presents the materials devoted to the long-term history of collaboration between the Bureau of Forensic Medical Expertise of the Moscow Health Department and the Department of Forensic Medicine of the Sechenovsky University. Special attention is given to the contribution made by the Department of Forensic Medicine to the scientific and practical activities, methodological and staffing support first of the Moscow forensic medical services and thereafter of the Bureau of Forensic Medical Expertise operating under the auspices of the Moscow Health Department. Simultaneously, the influence of the work of the Moscow Bureau of Forensic Medical Expertise on the development and improvement of the scientific, methodological, and pedagogical activities of the Russia’s oldest Department of Forensic Medicine is overviewed. The personal contribution of the most prominent forensic medical experts and physicians of Moscow to medical science and practice is illustrated by concrete examples.

© 2018 Russian Academy of Medical Sciences. All Rights Reserved. Urolithiasis is a common urological problem. In most cases, this multifactorial pathology develops due to the combination of inherited low-penetrance gene variants and environment factors such as urinary tract infections and unbalanced diet. However, some cases are monogenic. These hereditary forms of urolithiasis manifest in childhood, and are characterized by multiple, bilateral and recurrent kidney stones and progress to chronic renal failure relatively early. Due to widening acceptance of exome and gene panel sequencing, substantially larger percentages of urolithiasis cases are now attributed to hereditary causes, up to 20% among patients of 18 years old or younger. Here we review genetic and biochemical mechanisms of urolithiasis, with an emphasis on its hereditary forms, including fermentopathies (primary hyperoxaluria, adenine phosphorobosyltransferase deficiency, phosphoribosyl-pyrophosphate-synthetase deficiency, xanthinuria, Lesch-Nihan syndrome) and these caused by membrane transport alterations (Dent's disease, familial hypomagnesia with hypercalciuria and nephrocalcinosis, hypophosphatemic urolithiasis, distal tubular acidosis, cystinuria, Bartter's syndrome). We suggest a comprehensive gene panel for NGS diagnostics of the hereditary urolithiasis. It is expected that accurate and timely diagnosis of hereditary forms of urolithiasis would enable the counselling of the carriers in affected families, and ensure personalized management of the patients with these conditions.

© 2018 Media Sphera Publishing Group. All rights reserved. The article provides review of possible mechanisms of inhibitor coagulopathies, in particular of acquired hemophilia A. This pathology is an extremely rare disease occurring in 1-2 cases in 1 million per year. In the present study we provide data for two clinical cases of hemophilia A in women. These cases had different development mechanisms, although both women have a newly discovered missense mutation His2026Arg in the VIII factor gene. The matter of main interest is the description of the disease development in the patient with an acquired idiopathic hemophilia A with a possible disease occurrence due to an asymmetric X-chromosome inactivation (lyonization). In this particular case lyonization led to the late manifestation of the hemophilia A carrier's state and development of severe form of the inhibitor-associated acquired hemophilia A. We also discuss therapeutic approaches to these forms of the disease, considering there are no concise protocols for case management due to an extreme rarity of the pathology. Acquainting the clinical personnel working it the different areas of medicine with suchlike inhibitor coagulopathies has a major practical importance.

© 2018 Dynasty Publishing House. All rights reserved. One of the most important tasks of clinical medicine is to stop bleeding as soon as possible. Despite the broad spectrum of modern haemostatic materials, the available local blood-stopping products are not without certain limitations and shortcomings when used in various clinical situations. The article discusses the potential of «Polygemostat», a Russian haemostatic for external and local use, which simultaneously has an antiseptic and wound-healing effect.

© 2018 Dynasty Publishing House. All rights reserved. Hepatocellular carcinoma (HCC) is rarely diagnosed during pregnancy, its fibrolamellar variant (FHCC) is a specific form that is more often diagnosed in young women and is rarely associated with cirrhosis or chronic infection with hepatitis B or C viruses. Making a diagnosis at early stages is complicated by the fact that the α-fetoprotein (AFP) level is usually not enhanced, and symptoms develop only at advanced stages of disease. A clinical case of FHCC in a 27-year-old woman is presented, diagnosed at the 30th week of pregnancy after persistent dragging and spastic pains in the epigastric region. US detected a tumour with sizes 110 × 81 × 89 mm and foci in the lungs. Variants of treating such patients depending on tumour characteristics, pregnancy period and family preferences are discussed.

© 2018 Russian Presidential Academy of National Economy and Public Administration. All rights reserved. This article uses oral history interviews to examine the memory of believers from Evangelical Christian-Baptist (ECB) churches regarding the requirements for women's external appearance as a reflection of their personal piety. While discussing believers' memory of the late Soviet period, the article demonstrates that these congregations focused almost exclusively on women. The conviction that believers were not to reflect the "outside world" in appearance was actually a double standard for women, since women's fashion choices have been much more dynamic than men's in the Soviet and post-Soviet periods. The article discusses the historical and social significance of the emphasis on women's appearance, arguing that both a high view of scripture and a nostalgia for the "Soviet past" perpetuated the patriarchal norms held by both men and women in ECB congregations. The authors then utilize a series of historical photographs from the 1940s to the 1970s to demonstrate the scope of the transformation of ECB believers' memory, which did not always accurately reflect late-Soviet reality. The authors conclude that the extensive changes in the social order in general and in women's fashion in particular in the post-Soviet period strengthened believers' impulse to isolate themselves from the immoral "outside world." By following the accepted norms for their external appearance, ECB women's appearance becomes a marker of their faith and a visible sign of their piety that is so highly prized by their community.

© Bionika Media Ltd. Endometriosis affects up to 15% of reproductive-aged women. Consideration of this nosological entity in a new aspect is impelled by the evidence that 0.5–1% of cases develops endometriosis-associated ovarian neoplasms that are more represented by the endometrioid and clear-cell subtypes of tumors. This category also includes seromucinous ovarian tumors (SMOTs). Objective. To investigate the morphological and immunohistochemical (IHC) features of SMOTs in reproductiveaged women, including pregnant ones. Subjects and methods. Ovarian tumor samples from 15 patients who had been operated on in 2012-2016 were analyzed comprehensively at the National Medical Research Center of Obstetrics, Gynecology, and Perinatology: IHC examination was conducted using the biomarkers of estrogen and progesterone receptors and Ki-67. Results. Borderline SMOTs were characterized by papillary growths on the inner surface (in one case) and on the outer surface, with an adhesive process with the serous surface of the corpus uteri (FIGO Stage 1c), and mixed epithelial structures; leukocyte infiltration was observed in 4 cases. The epithelium of seromucinous carcinoma (n = 1) was similar to that of serous, endocervical, and endometrial types at the same time. All the samples exhibited a low Ki-67 expression and high positive receptor immunoreactivity. Endometriosis diagnosed in nine women was accompanied by benign seromucinous cystadenomas (n = 4), borderline tumors (n = 4), and carcinoma (n = 1). Conclusion. Most of the examined SMOTs showed the areas, covered with the endometrioid epithelium, with adjacent endometrial stroma, which indicated the development of carcinoma in the presence of endometrioid cyst. The revealed facts suggest that endometriosis plays an etiological role in developing SMOTs. When detected, most neoplasms are localized (limited to ovarian tissue, FIGO stage 1a) and characterized by a favorable prognosis as a whole.

© 2018 Bentham Science Publishers. The burden of cardiovascular and metabolic diseases is increasing with every year. Although the management of these conditions has improved greatly over the years, it is still far from perfect. With all of this in mind, there is a need for new methods of prophylaxis and treatment. Coenzyme Q10 (CoQ10) is an essential compound of the human body. There is growing evidence that CoQ10 is tightly linked to cardiometabolic disorders. Its supplementation can be useful in a variety of chronic and acute disorders. This review analyses the role of CoQ10 in hypertension, ischemic heart disease, myocardial infarction, heart failure, viral myocarditis, cardiomyopathies, cardiac toxicity, dyslipidemia, obesity, type 2 diabetes mellitus, metabolic syndrome, cardiac procedures and resuscitation.

© 2018 Stavropol State Medical University. All rights reserved. Male fertility is based on complex intracellular signaling during spermatogenesis. Effect of Interleukin-1 (IL-1) and its homologues on spermatogenesis is actively studied. Nevertheless, its role in idiopathic infertility has not been sufficiently studied, especially in the phase of hypospermatogenesis. Aim: Evaluation of the expression of IL-1α, IL-1β and IL-1ra in human seminiferous tubules in idiopathic infertility. A retrospective study involved men (n=54) who complained of childlessness in a marriage for 2 years with the diagnosis of idiopathic infertility, established after a physical, medico-genetic, biochemical (hormone) and cytological (spermogram) analysis. The biopsy specimens obtained from the operation, as well as the autopsy material of men aged 22-35 years (n=10), were studied using the immunohistochemical method (antibodies: IL-1α, IL-1β and IL-1ra). At hypo-spermatogenesis, the maturation block, and Sertoli-cell syndrome, Leydig cells are marked to IL-1α, IL-1β labeling with a decrease in IL-1ra. Sertoli cells and germ cells show weak responses to IL-1α, IL-1β and their absence on IL-1ra. Thus, the different levels of expression of IL-1α, IL-1β and IL-1ra indicate that these cytokines control spermatogenesis and are one of the triggers in the formation of male infertility form-phases.

© 2018 Media Sphera Publishing Group. All rights reserved. The All-Russian physical culture-sports set «Ready for Labour and Defense» (RLD) is a system that is aimed at health improvement and patriotic education of the nation. This system consists of strength, speed, endurance, agility, and flexibility tests. Statutory requirements for each discipline have been developed taking into account the age and gender characteristics of an organism. The main aim of the RLD set is to improve the population's health; therefore much attention is focussed on the issues of medical support. The medical support of the RLD set can be arbitrarily divided into several stages: to make preliminary medical examination and to gain access to RLD tests; to check whether medical access is available and complies with the health status of their participant at the time of the tests; to render medical care when the RLD standards are fulfilled. This paper proposes to consider the stepwise medical support of the RLD set in accordance with actual normative legal acts.

© 2018, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved. Mechanical ventilation is associated with a number of complications that increase the cost of treatment and the hospital mortality rate. In 2004, the term «ventilator-induced diaphragm dysfunction» (VIDD) was proposed to explain one of the reasons for the failure of respiratory support. At present, this term is understood as a combination of atrophy and weakness of the contractile function of the diaphragm caused directly by a long-term mechanical lung ventilation. Oxidative stress, proteolysis, mitochondrial dysfunction, as well as passive overdistension of the diaphragm fibers contribute greatly to the pathogenesis of VIDD. Since 30—80% of patients in the ICU require mechanical respiratory support and even 6—8 hours of mechanical lung ventilation can contribute to the development of a significant weakness of the diaphragm, it can be concluded that the VIDD is an extremely urgent problem in most patients. Its typical clinical presentation is characterized by impaired breathing mechanics and unsuccessful attempts to switch the patient to the spontaneous breathing in the absence of other valid reasons for respiratory disorders. The sonography is the most informative and accessible diagnostic method, and preservation of spontaneous breathing activity and the use of the latest mechanical ventilation modes are considered a promising approach to prevention and correction of the disorders. The search for an optimal strategy for lung ventilation, development of diagnostic and physiotherapeutic methods, as well as the consolidation of the work of a multidisciplinary team of specialists (anesthesiologists and intensive care specialists, neurologists, pulmonologists, surgeons, etc.) can help in solving this serious problem. A review of 122 sources about the VIDD presented data on the background of the issue, the definition of the problem, etiology and pathogenesis, clinical manifestations, methods of diagnosis, the effect of drugs, prevention and therapy.

© 2018 SPIE. Laser radiation limiters can be made on the basis of working substances, which have strong nonlinear effects after reaching a certain critical value (threshold limiting). Thus, it becomes possible to obtain a high transmission for a safe beam and a sharply reduced transmission for a hazardous beam. To determine the nonlinear and linear optical properties of these materials there were carried out comprehensive spectroscopic studies, experiments by Z-scan methods with an open aperture and a fixed location of the limiter. Working substances was developed which is suspension of conjugates J-type phthalocyanine dimers Zn or Mg with single-walled carbon nanotubes (SWCNTs) in water. Created conjugates can be used not only for protecting eyes and light-sensitivity elements, but for forming three-dimensional tissueengineered structures. Using conjugates J-type phthalocyanine dimers Zn and Mg with SWCNTs will increase the optical absorption in the wavelength range of laser processing by reducing the thermal effect on other substances in the composition of this structure. The Nd:YAG laser was used as the laser radiation source for generating pulses of 16 ns duration at a wavelength of 532 nm with the linearly polarized laser beam in the horizontal plane and a shape of Gaussian type. The threshold of limiting, linear and nonlinear absorption coefficients were determined by output characteristic, that was obtained by fixed location of the limiter. Created working substances have values of the following order: linear absorption coefficient ∼ 3 cm-1 for layer of 0.2 cm thickness, low limiting threshold ∼ 1 MW·cm-2 and high value of the nonlinear absorption coefficient ∼ 550 cm GW-1. Knowing the nonlinear optical parameters, Z-scan data with an open aperture can be calculated for comparison with experimental data.

© 2018 Ima-Press Publishing House. All rights reserved. Certolizumab pegol (CZP) is the only pegylated biological agent (BA) that does not contain an Fc fragment, which minimizes its transplacental transfer. Takayasu arteritis mostly occurs in reproductive-aged women. Objective: to evaluate the efficacy and safety of CZP used to treat standard immunosuppressive therapy-resistant Takayasu arteritis. Subjects and methods. The retrospective study enrolled 6 female patients aged 18 to 35 years with Takayasu arteritis who received CZP. The median disease duration before BA usage was 66 months (24 to 204 months). The median duration of immunosuppressive therapy prior to CZP treatment was 92 months (14 to 132 months). All the female patients had taken glucocorticoids and methotrexate before and during CZP therapy. Only four patients had received two to five immunosuppressive drugs at different times prior to BA administration. Three patients had previously used other BAs. The disease activity was determined by the National Institute of Health (NIH) criteria. The Indian Takayasu Clinical Activity Score (ITAS2010) was used. The disease activity was recorded in all the patients prior to CZP therapy. Results and discussion. The median duration of CZP treatment was 17 months (6 to 24 months). The median erythrocyte sedimentation rate after CZP usage decreased from 22.5 to 10.5 mm/h; the median C-reactive protein level dropped from 7.8 to 0.39 mg/dl (p<0.05), the median daily dose of prednisolone was reduced from 20 to 8.75 mg (p<0.05). All the patients achieved complete remission an average of 4 months after starting CZP therapy. Three patients were still in remission after 12–24 months. One relapse of the disease was recorded following 24 months. ITAS2010 reduced from 1–4 to 0 in five patients and to 2 in one patient with recurrence. There was a good tolerance in five female patients. The adverse events were herpes labialis in two cases, community-acquired pneumonia in one case, and postoperative abscess in one case too. Conclusion. CZP in Takayasu arteritis was shown to be an effective drug for remission induction and maintenance. The presented results of the first experience in treating this disease with CZP are indicative of its promising further investigation as a steroid-sparing drug in patients with refractory vasculitis. One of the important advantages of CZP is its supposed high safety throughout pregnancy.

© 2018 Ima-Press Publishing House. All rights reserved. Objective: to determine the main factors associated with the development and manifestations of anxiety and depression spectrum disorders (ADSDs) in patients with Behcet’s disease (BD). Subjects and methods. This investigation was conducted within the framework of the interdisciplinary scientific program «Stress factors and mental disorders in rheumatic diseases». A total of 116 patients with BD were examined. Most of them were men (69.8%), whose mean age (M±σ) was 33.4±9.82 years; the median duration of BD was 120.0 [70.0; 192.0] months; 51.9% of the patients were natives of the North Caucasus. All the patients had a reliable diagnosis of BD according to the International Study Group for Behcet’s disease (ISGBD) criteria (1990). Disease activity was assessed using the Behcet’s Disease Current Activity Form (BDCAF); the subjective status of patients was evaluated using the visual analog scale (VAS) for general health assessment. ADSDs were diagnosed by a psychiatrist according to the ICD-10 during semi-structured interviews using the Hospital Anxiety and Depression Scale (HADS), the Hamilton Anxiety Rating Scale (HAM-A), and the Montgomery-Asberg Depression Rating Scale (MADRS). Clinical and psychological techniques were applied to assess cognitive functions (memory, attention, and logical thinking); stress levels were estimated by the 10-Item Perceived Stress Scale (PSS-10). Results and discussion. ADSDs were diagnosed in 91 (78.4%) patients with BD. The predominant RTDs were dys-thymia (39.6%) and recurrent depressive disorder (38.4%). Generalized anxiety disorder was found in only 7.69%, a single depressive episode was in 13.2%. Different degrees of cognitive impairment (CI) were observed in 91 (78.4%) patients. Multivariate analysis and linear regression were used to build a predictive model, from which it follows that ADSDs in patients with BD are primarily associated with sleep disorders (β=0.412), asthenia (β=0.149), CI (β=0.137), chronic stress (β=-0.010) and its severity (β=0.134), early childhood psychic trauma (ECPT) before the age 7 years (β=0.152), the development of ADSD before the onset of BD (β =0.160), older age of eye involvement in the pathological process (β=0.089), gastrointestinal tract (GIT) involvement within BD (β=0.096), high C-reactive protein (CRP) levels (β=0.177), and poor subjective status of patients (β=0.120) (area under the ROC-curve, 0.940). Conclusion. Chronic ADSDs are encountered with high frequency in patients with BD and frequently occur simultaneously with the latter or during its development. Their occurrence is favored to the greatest extent by ECPT and obvious chronic psychosocial stress preceding ADSDs. GIT involvement, late-onset ocular pathology, high CRP levels, and poor subjective status are common to patients with BD and ADSDs. Sleep disorders, asthenic syndrome, and CI are significant in the pattern of ADSDs.

© 2018 Ima-Press Publishing House. All rights reserved. Objective: to assess whether adalimumab (AD) can be gradually discontinued during continuous methotrexate (MTX) use in patients with early rheumatoid arthritis (ERA). Subjects and methods. Within the REMARCA (the Russian study of methotrexate and biological agents in early active arthritis) study, the investigators examined 20 patients (17 women and 3 men; median age, 51 [41.5; 56] years) with ERA (disease duration, 10 [5.5; 20] months; DAS28, 5.17 [4.37; 6.51]; 85% of the patients were seropositive for rheumatoid factor and 85% for anti-cyclic citrullinated peptide antibodies. Results and discussion. All the patients received subcutaneous MTX 25 mg/week. Twelve weeks after beginning therapy with MTX, due to its inefficiency, ADA was added according to the standard scheme. At week 24, the median DAS28 was 3.0 [1.65; 3.73]; 85% of the patients achieved remission or low disease activity. After 3 months of ADA therapy, high or moderate disease activity remained in 3 (15%) patients; median DAS28 was 4.4 [4.3; 6.1]; the drug was discontinued in them due to ineffective therapy. After 12-month follow-up, low DAS28 scores were observed in 5 (29.4%), DAS28 remission was in 12 (70.6%) of the 17 patients who continued ADA treatment; after 24 months, all the 17 patients were noted to have remission. After achieving sustained remission (≥ 6-month duration during ADA therapy), there was a carefully controlled reduction (titration) in the dose of ADA with its complete discontinuation, by maintaining remission at 36-month follow-up; the median DAS28 was 1.6 [1.4; 2.2]. During ADA treatment, one female patient developed pustular psoriasis and therefore the drug was discontinued at 24-month follow-up during the period of sustained remission. Other serious adverse events and tuberculosis cases were not recorded. Conclusion. Thus, the results of the study are indicative of the high clinical efficiency of the therapy. After ADA discontinuation, sustained remission can be maintained in patients with ERA and if they took biological agents early.

© 2018 Bentham Science Publishers. Background: This study discusses the crucial factors responsible for the progression of atherosclerotic cardiovascular disease (CVD). The interaction between the gut microbiota, heart and vessels in CVD pathogenesis is extremely complex and includes components such as direct bacterial translocation from the gut to vessels and metabolitemediated damage. To a greater extent, CVD seems to be entangled with a subtle immune system-to-microbiota interface. From among the most significant advances in recent years in this area, it is necessary to highlight the discovery of the pro-atherogenic effect of trimethylamine-N-oxide (TMAO) and changes in the activity of effector T-cells in the settings of dysbiosis. Currently, we are witnessing an explosive growth in interest in using the microbiota and interlinked cascades as a target for therapeutic interventions, including direct microbiome targeting, the attenuation of toxic metabolite-induced damage, the modulation of intestinal immunity, and downstream inhibition of systemic inflammatory pathways. Objective: In this brief review, modern strategies of microbiome-based therapies for the prevention and treatment of CVD are classified and discussed from the perspective of personalized medicine.