Репозиторий Университета

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

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

© 2018 Ima-Press Publishing House. All rights reservbed. CLIPPERS syndrome (Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids) is a recently described rare disease affecting the central nervous system. It is characterized by subacute development of symptoms of lesions predominantly in the brain stem and cerebellum, by specific magnetic resonance imaging (MRI) changes, perivascular lymphocytic infiltration in the brain substance and a good response to glucocorticoid (GC) therapy. The paper describes CLIPPERS syndrome in a patient who has been followed up in a clinic for 10 years. During this period, different variants of clinical diagnosis have been considered. The final diagnosis was made only when comparing the clinical course and manifestations of the disease, MRI data, as well as the reaction to GC therapy and its discontinuation. Literature data and diagnostic criteria of this disease are presented.

© 2018 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reservbed. The creation in the middle of the 20th century vaccines against poliomyelitis (PM) - inactivated vaccine (IPV) and live oral vaccine from Sabin strains (OPV) with various properties, advantages and disadvantages, but highly effective, made it possible to implement the idea of elimination of PM. Since 1988, the WHO Global Program of PM eradication has achieved remarkable success: the incidence of PM caused by wild poliovirus (PV) has been reduced by 10 thousand times, the number of endemic countries has been reduced to 3, the circulation of wild PV has been discontinued in 4 regions of the world the wild type 2 of PV has been eradicated, and wild type 3 of PV has not been detected for almost 5 years. Under conditions of a decrease in the incidence of PM caused by wild PV, the known negative properties of trivalent OPV made its further use problematic. These negative properties are: 1) the ability to cause post-vaccination complications and 2) the genetic instability of Sabin strains, especially PV of type 2, and their ability under certain conditions (primarily in conditions of low collective immunity to PV) to quickly restore neurovirulence, transforming into circulating vaccine-derived PV (VDPV), capable of causing incidents and outbreaks of PM. In order to reduce the risk associated primarily with type 2 PV, WHO proposed a global switch to the use of bivalent OPV from types 1 and 3, completed in 2016. In 2019, WHO plans to complete eradication of type 1 and 3 PVs, and in 2022 completely abandon the OPV. The precondition for the safety of such tactics is the maintenance of high collective immunity to PM. There are several threats to the security of this strategy. PVs can "silently" circulate in the human population for a long time without clinical manifestations of PM, which, with inadequate epidemiological surveillance can lead to the return of PM. The reintroduction of both wild PV and Sabin strains can occur from institutions that preserve / work with PV. The source of VDPV can be people with primary immunodeficiencies, which continuously excrete PV. It is necessary to maintain surveillance over the PM, expand additional types of surveillance for the PV, strict containment of all PVs. The only way to maintain collective immunity is immunization with trivalent IPV. The current global shortage of IPV poses a significant threat to the world's epidemiological well-being. The solution to the problem is the development of a new generation of safe and effective vaccines, improving the ways of introducing IPV, developing antiviral drugs.

© 2018 Ima-Press Publishing House. All rights reservbed. Sacroiliac joint (SIJ) dysfunction often causes nonspecific low back pain; the efficiency of its treatment is discussed to be exhibited by therapeutic blockades with anesthetics and glucocorticoids (GCs) or by SIJ radiofrequency denervation (RFD). Objective: to investigate the efficiency and safety of therapeutic blockades with anesthetics and GCs, or SIJ RFD in the combination therapy of chronic low back pain due to SIJ injury. Patients and methods. The investigation enrolled 51 patients (36 women and 15 men) aged 32 to 75 years (mean age, 56.4±2.1 years). Group 1 included 32 patients (mean age, 51.75±2.65 years) who used periarticular blockades with local anesthetics and GCs; Group 2 consisted of 19 patients (mean age, 64.1±2.8 years) who underwent SIJ RFD. Results and discussion. These treatments showed high efficiency and safety. Three months after a treatment cycle, there were reductions in the intensity of pain (by an average of 47%; p<0.0001) and in the degree of disability and improvements in the physical and psychological parameters of quality of life. There were no substantial differences in the health status of patients in the two groups treated with blockades with anesthetics and GCs or SIJ RFD. Conclusion. It has been shown that the incorporation of blockades with anesthetics and GCs or SIJ RFD into the treatment of patients with chronic low back pain can improve the results of therapy.

© 2018 Ima-Press Publishing House. All rights reservbed. Objective: to study of the individual aspects of the relationship and interaction of menstrual and generative function and depressive disorders in women. Patients and methods. 120 women aged 18-65 years with recurrent depressive disorder (RDD) who had experienced at least two depressive episodes (a study group) and 120 mentally healthy women of the same age (a control group) were clinically examined using a specially designed map with subsequent statistical processing of the findings. Results and discussion. In 71.7% of women, depression manifests itself during hormonal rearrangement periods (puberty, postpartum, and menopause). 65.0% of women with RDD have premenstrual syndrome (PMS), the pattern of which shows depressive symptoms. Depression affects menstrual function: the later onset and irregularity of menstruation, the earlier restoration of menstrual function after childbirth, and the earlier onset of premenopause, which has an adverse impact on generative function (a reduction in the number of pregnancies, births, and babies). Depression, the onset of which is observed during puberty, exerts the most malignant effect on menstrual and generative function. Overall, depressive patients are less socially and family-friendly than healthy women. Menstrual and generative function and adaptation minimally suffer in women with postmenopausal depression. Conclusion. The onset of depressive disorders is associated with the hormonal rearrangement periods. The presence of depressive symptoms in the pattern of PMS is a prognostic sign of future depression or indicates partial remission. At the same time, menstrual function is impaired in women suffering from RDD, which along with psychic manifestations of depression (a decrease in sexual drive and contacts, as well as anesthesia of feelings, etc.) leads to infertility.

© 2018 Media Sphera Publishing Group. All rights reserved. In the review, the mechanisms of podocytes damage underlying the development of proteinuria and progression of glomerulosclerosis in chronic glomerulonephritis are discussed in detail. The results of experimental and clinical studies are presented. Under the different immune and non-immune factors the podocytes form a stereotyped response to damage consisting in the reorganization of the actin cytoskeleton, foot process effacement, the detachment of podocytes from the glomerular basement membrane, and the appearance of specific podocyte proteins and whole cells (podocyturia) in the urine. Massive podocyturia in a limited proliferative capacity of podocytes leads to reduce their total count in the glomerulus (podocytopenia) and the development of glomerulosclerosis. The authors describe the line of markers of the podocyte injury and invasive and non-invasive methods of their assessment. In addition, the relationship of podocyturia level with proteinuria and renal dysfunction are discussed, the prospects of assessment the podocyte proteins in urine for assessing of glomerular damage severity and glomerulosclerosis risk are examined.

© 2018 Media Sphera Publishing Group. All rights reserved. Objective. To compare the frequency, clinical features and outcomes of renal involvement in ANCA-associated vasculitides (AAV) in patients with antibodies against proteinase-3 (pr3-ANCA) and myeloperoxidase (MPO-ANCA). Materials and methods. In our retrospective study we enrolled 264 patients, 94 males and 170 females, median age 53 [36; 62] years. Among them 157 were pr3-ANCA positive and 107 were MPO-ANCA positive. AAV was diagnosed according to ACR criteria and Chapel Hill consensus conference definition (2012). Median follow up was 44 [18; 93] months. We assessed baseline BVAS and VDI by the end of the follow up. Serum creatinine (sCr), estimated glomerular filtration rate (EGFR), hematuria and daily proteinuria were estimated. Diagnosis and stage of chronic kidney disease (CKD) and acute kidney injury (AKI) were established according to KDIGO guidelines (2012) and Scientific Society of Russian Nephrologists (2016). Results. Renal involvement was present in 181 (68.6%) patients, and its frequency was similar in pr3-ANCA and MPO-ANCA subgroups. Patients with MPO-ANCA developed rapidly progressive glomerulonephritis and hypertension significantly more often than patients with pr3-ANCA: 50.7% vs 35.6% (p=0.049) and 46.1% vs 29.8% (p=0.029) respectively. At disease onset, median sCr was significantly higher and EGFR was significantly lower in patients with MPO-ANCA (p<0.05). 1-year and 5-year renal survival rates were similar in pr3-ANCApositive (93.9% and 87.4% respectively) and MPO-ANCA positive patients (87.4% and 83.1% respectively). Median BVAS and VDI scores were significantly higher in pr3-ANCA subgroup. The number of patients who developed AAV relapse during 1-year follow up was also significantly higher in pr3-ANCA subgroup. The frequency of eye and ENT involvement was significantly higher in pr3-ANCA positive patients than in MPO-ANCA-positive patients. Conclusions: The frequency of extrarenal manifestations, clinical features of renal involvement and relapse rate are associated with AAV serotype.

© 2018 Media Sphera Publishing Group. All rights reserved. Obstetric atypical hemolytic uremic syndrome (aHUS) is one of the reasons for the development of acute kidney injury (AKI) and can determine the prognosis of both mother and child. Aim. Analysis of clinical manifestations, course and outcomes of obstetric aHUS. Materials and methods. 45 patients with aHUS development during pregnancy or immediately after childbirth were observed between 2011 and 2017, age from 16 to 42 years. Results and discussion. All patients had AKI (serum creatinine 521,5±388,0 μmol/l, oliguria or anuria that required initiation of hemodialysis). 93.3% pts had extrarenal manifestations of TMA with the development of multiple organ failure (MOF). The mean number of damage organs was 3,7±1,2. In all patients, the development of aHUS was preceded by obstetric complications, surgery, infection, etc. In the outcome: 53.4% women showed complete recovery of renal function, 11.1% developed CKD 4-5 stages, 35.5% had dialysis-dependent end-stage renal failure (ESDR). Maternal mortality was 23.9%. Perinatal mortality was 32.6%. The early start of eculizumab treatment (within 1-2 weeks from the onset of aHUS), compared with therapy start after 3 weeks, increased the chances of favorable outcome for mother in 5.33 times, and the chances for normalization of renal function in 48.7 times. Conclusion. Obstetric aHUS is characterized by the development of AKI in 100% of cases. In most patients, the obstetric aHUS occurs with the development of MOF. Timely diagnosis of aHUS and immediate treatment by eculizumab allows not only to save the life of patients, but also completely restore their health.

© 2018 Media Sphera Publishing Group. All rights reserved. Aim. To evaluate clinical features and outcomes of renal involvement in patients with microscopic polyangiitis (MPA). Materials and methods: We enrolled 99 patients with MPA, diagnosed in accordance with the algorithm of the European Medicines Evaluation Agency (EMEA) and the Chapel Hill consensus conference definition (2012). Serum creatinine (sCr), estimated glomerular filtration rate (EGFR), hematuria and proteinuria were estimated. Frequency of rapidly progressive renal failure (a twofold increase in the sCr level in ≤3 months) was regarded as the clinical equivalent of rapidly progressive glomerulonephritis (RPGN). Results and discussion. Renal involvement was present in 92 (92.9%) patients. RPGN developed in 51 (55,4%) patients. The most common features of kidney involvement were hematuria and subnephrotic proteinuria. Arterial hypertension was revealed in 32 (34.7%) patients and was associated with RPGN (p<0.004). End-stage renal disease (ESRD) developed in 11 (11.9%) patients. Despite effective induction therapy disease relapses occurred in 20 (21.1%) patients during the 1st year, including renal relapses in 12 (13.3%) cases. During 5-year follow up 34 (37.1%) patients developed disease relapses, including renal relapses in 22 (24.4%) patients. Conclusion. Renal involvement is one of the most common manifestations of MPA with a high frequency of RPGN. More than one third of patients develop disease relapses despite adequate therapy.

© 2018 Media Sphera Publishing Group. All rights reserved. Obesity, including morbid obesity, is a growing worldwide problem. The adverse effect of obesity on the kidneys is associated with the development of comorbid conditions, such as insulin resistance (IR), metabolic syndrome (MS), diabetes mellitus (DM), arterial hypertension (AH), which are the recognized risk factors of chronic kidney disease (ÑKD). Obesity also causes direct kidney damage with the development of non-immune focal segmental glomerulosclerosis. The leading pathophysiological mechanisms of kidney damage in obesity are intrarenal hemodynamic disorders with the formation of hyperfiltration and damaging effects of adipokines produced by adipose tissue. Bariatric surgery (BS) has taken a leading position in the treatment of morbid obesity, demonstrating its effectiveness not only in long-term weight loss, but also in the correction of IR, MS, DM, AH. Nephroprotective effect of significant and persistent weight loss is caused by the elimination of hyperfiltration and damaging effect of adipokines. Results of the observational studies of the immediate and long-term effects of BS have demonstrated positive renal outcomes, in particular, the decrease in albuminuria/proteinuria, the improvement or stabilization of glomerular filtration rate, the delay of end-stage renal failure development; surgical correction of body weight in dialysis patients with morbid obesity lets them realize subsequent kidney transplantation. Large, randomized prospective studies with a longer follow- up are needed; analysis of the long-term renal consequences of BS in obesity patients with pre-existing renal impairment, including dialysis patients, is required; stratification of the BS risk of renal complications (acute kidney damage, nephrolithiasis, nephrocalcinosis) and effective strategy for managing these risks need to be developed.

© 2018 Media Sphera Publishing Group. All rights reserved. According to modern ideas, chronic low-grade inflammation, which development is associated with uncontrolled activation of both innate and adaptive immunity, plays a fundamental role in all stages of the atherosclerotic process. The contribution of inflammation to the development of atherosclerotic vascular lesions attracts attention to the similarity of the mechanisms of immunopathogenesis of atherosclerosis and classic inflammatory rheumatic disease - rheumatoid arthritis. In the aspect of participation in the pathogenesis of atherosclerotic vascular lesions and as a promising therapeutic "target" of particular interest is interleukin-1β (IL-1β), which plays an important role in the development of many acute and chronic immunosuppressive diseases. The mechanisms of atherosclerosis associated with IL-1β determine the ability of cholesterol crystals and other "Pro-atherogenic" factors to induce the synthesis of IL-1β by activating NLRP3 inflammasome. The mechanisms of atherosclerosis associated with IL-1β determine the ability of cholesterol crystals and other "proatherogenic" factors to induce the synthesis of IL-1β by activating NLRP3 inflammasome. Convincing evidence for the role of inflammation in development of atherosclerosis in General and good prospects of anti-inflammatory therapy in particular obtained in a randomized placebo-controlled study called CANTOS (Canakinumab Anti-inflammatory Thrombosis Otcomes Study), which studied the effectiveness of treatment with monoclonal antibodies to IL-1β canakinumab (Novartis International AG) in patients with severe atherosclerotic vascular lesions as a new approach to secondary prevention of cardiovascular complications. The results of CÀNTOS research, as well as the experience gained in rheumatology in regard to cardiovascular effects of innovative antiinflammatory drugs, have great importance for the improvement of secondary prevention of atherosclerosis-related cardiovascular complications.

© 2018 Media Sphera Publishing Group. All rights reserved. Objectives: To study efficacy of treat-to-target (T2T) strategy in early peripheral psoriatic arthritis (EPsA) after one year of treatment. Methods: 44 (M/F - 18/26) DMARD-na?ve patients (pts) with active EPsA, according to the CASPAR criteria, mean age 37.5±11.3 years, PsA duration 7 [4; 24] months, psoriasis duration 36 [12; 84] months, disease activity index (DAS) 3.78 [3.18; 4.67], DAS28 4.33 [3.67; 4.8] study were included. At the baseline and every other 3 months for total 12 months of therapy all pts underwent standard clinical examination, tender joint count (TJC), swollen joint count (SJC), patient pain VAS, patient/physiciańs global disease activity VAS, enthesitis by Leeds Enthesial Index (LEI)+Plantar Fascia (PF), dactylitis, Psoriasis Area Severity Index (PASI), body surface area (BSA), Health Assessment Questionnaire (HAQ), DAS, DAS28-C-RP, C-RP (mg/l). The dose of MTX s/c was escalated by 5 mg every 2 weeks from 10 mg/wk to appropriate dose 20-25 mg/wk according to the drug intolerance. If pts does not achieve the lower disease activity (LDA), MDA or remission after 3 months of MTX subcutaneous (s/c) mono-therapy, then combination therapy of MTX+Adalimumab (ADA) by standard regime was continued up to one year. At 12 months of therapy the proportion of pts who attained LDA by DAS/DAS28 or remission by DAS<1.6/DAS28-C-RP<2.6 or MDA, ACR20/50/70, PASI75 and dynamics of HAQ, LEI+PF, dactylitis were calculated. Mean±SD, Me [Q25; Q75], %, Friedman (Fr.) ANOVA, U-test, Wilcoxon test were performed. All p<0.05 were considered to indicate statistical significance. Results: At one year of treatment according to T2T strategy significant improvements disease activity and physical health function related to quality of life was seen. By 12 months of therapy remission by DAS and MDA was reached 61.4%/65.9% of pts accordingly. By 12 months of therapy ACR20/50/70 was seen in 88%/77%/59% of pts. In pts with BSA≥3% (n=16) at baseline psoriasis improvements by PASI75 was seen in 88% of pts. In 55% of active EPsA pts MTX (s/c) mono-therapy was an effective treatment. Conclusions: One-year treatment according to T2T strategy significantly improves all PsA clinical domains - Arthritis, dactylitis, enthesitis, skin psoriasis and quality of life despite of type of treatment. It seems that T2T is a useful strategy in EPsA but additional research concerning its implementation in real practice are needed.

© 2018 Media Sphera Publishing Group. All rights reserved. A review deals with the problem of chronic kidney disease (CKD) from the position of a physician and cardiologist. The epidemiology of the disease was discussed both abroad and in Russia, including the most up-to-date data. In Russia CKD markers were detected in 49.4% of hypertensives. Authors describe risk factors and mechanisms of CKD at the most important pathogenetic conditions: hypertension, diabetes and obesity. The current classification and methods for calculating the glomerular filtration rate are given. The review disclose a paradigm of the renal continuum and its relation to cardiovascular diseases. It is well known fact that the final causes of the death of patients with CKD, as a rule, are cardiovascular complications. Based on the literature data, the necessity and expediency of screening for renal dysfunction is justified. In the example of use of an angiotensin receptor blocker II - irbesartan nephroprotective demonstrated possibilities of intervention in patients with renal dysfunction of varying severity.

© 2018 Media Sphera Publishing Group. All rights reserved. Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in adults and is classified as either primary (idiopatic) or secondary MN according to underlying etiology (the later result from some known disease such as systemic autoimmune diseases, infections, malignancies, drugs, etc). In recent years, phospholipase A2 receptor 1 (PLA2R) and thrombospondin type-1 domain-containing 7A (THSD7A) were identified as two major podocytic antigens involved in the pathogenesis of idiopatic MN (IMN). And the discovery of circulating antibodies specific for these target antigens has transformed the diagnostic workup and significally improved management of IMN. However why do such antibodies develop is not conclusively established. The role of underlying genetic factors is discussed. The review presents the results of recent studies, that have shown significant associations of specific genetic factors (particularly human leucocyte antigen class II and PLA2R1 genes) with IMN.

© 2018 ABC-press Publishing House. All rights reserved. Background. Pelvic floor muscle exercises are used as a first-line treatment for urinary incontinence after radical prostatectomy. Their efficacy is still being investigated. The use of biofeedback when teaching pelvic floor muscle exercises to patients increases the effectiveness of therapy. Objective: to assess the efficacy of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after laparoscopic and robot-assisted radical prostatectomy and to compare the results of teaching. Materials and methods. A total of 64 patients with urinary incontinence after nerve sparing prostatectomy underwent biofeedback-assisted pelvic floor muscle rehabilitation. Radical laparoscopic surgery was performed in 48 (75 %) patients, whereas robot-assisted surgery was performed in 16 (25 %) patients. The patients started their training 2 months postoperatively. We used two-channel electromyography with the Neurotrack ETS system (United Kingdom) to teach the patients isolated pelvic floor muscle contractions. After achieving a minimum activity of abdominal muscles during pelvic floor muscle contractions, the patients started exercises. Results. There was no significant difference in age between patients who underwent laparoscopic and robot-assisted radical prostatectomy (р = 0.79). Fifty-five patients (85.9%) acquired the skill of isolated pelvic floor muscle contractions and could perform training on their own. The remaining 9 patients (14.1 %) required regular support from healthcare professionals at an outpatient unit (1-2 biofeedback-assisted trainings per month). Thus, the type of surgery did not affect the process of training. The type of radical prostatectomy had no impact on the acquisition of the pelvic floor muscle contraction skill. Conclusion. The time for restoration of urinary continence by biofeedback-assisted pelvic floor muscle training did not vary between patients after laparoscopic and robot-assisted radical prostatectomy.

© 2018 ABC-press Publishing House. All rights reserved.  Background. There is a category of patients with renal masses, due to severe concomitant diseases, can not perform the operation or may be associated with a threat to life. In addition, many patients with small tumor sites are extremely concerned about their disease and are negative about the tactics of active observation and insist on treatment. These patients can be offered alternative methods of treatment of renal cell carcinoma (RCC), the leading of which is cryoablation. Objective: to evaluate the effectiveness and safety of percutaneous cryoablation of the kidney tumor under ultrasound control. Materials and methods. In the Urology Clinic of the I.M. Sechenov First Moscow State Medical University during the period from 2015 to 2017 performed 23 percutaneous cryoablation of RCC, 7 (men - 4, women - 3) of which were performed under local anesthesia. In 4 patients due to severe concomitant diseases, general anesthesia was associated with an extremely high risk. Three patients refused from dynamic observation and from traditional surgical treatment; preferred an alternative treatment in the form of a percutaneous cryoablation under local anesthesia. In 4 cases, the formations were located in the lower segment along the posterior surface of the kidney, in 3 - along the lateral surface in the middle segment. The size of the formations was not used 4 cm (T1a). The age of the patients was 62.3 years (51 to 83 years). Right-sided localization of the tumor was noted in 3 patients, left-sided - in 4. One patient had a single kidney. At the preoperative stage and 6 months after the operation, all patients underwent ultrasound with dopplerography, multislice computerized tomography with contrast, and computer 3D modeling, which helped to clearly assess the size of the tumor, clarify the prevalence of the tumor process and the spatial ratio of the internal surface of the tumor node to the elements of the bowl-and-pelvis system. In all the observations, the formations were located along the posterior or lateral surface of the kidney; in the lower or middle segment; without invasion of the sine. We used a 3 rd generation cryomash machine SeedNet gold (Galil Medical), cryoprobes IceSeed and IceRod. Intraoperative, immediately before cryoablation, a tumor biopsy was performed, the presence of RCC in all patients was confirmed morphologically. Results. According to the ultrasound examination with echodopplerography at 6 months after the operation, the size of the tumor node's formations decreased on average by 6-8 mm, while there was no blood flow in them. When multislice computerized tomography with 3D modeling was performed, the formation was reduced and the accumulation of the contrast preparation was completely absent or their accumulation gradient did not exceed 10 HU (initially it was about 200 HU). There were no intraoperative complications. In 1 observation, a postoperative hematoma measuring 7 × 3 cm was resolved conservatively and did not require surgical treatment. Conclusions. Percutaneous cryodestruction under local anesthesia using ultrasound guidance seems to be an effective and safe technique for treating patients with stage T1a RCC with localization in the posterior or lateral surface in the lower or middle segments without invasion of the renal sinus and surrounding tissues. It is planned to continue monitoring patients to assess the long-term effectiveness of cryoablation.

© 2018 Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved. The purpose of the study was to present data on polymixin-based antibiotics with activity against infections caused by multidrug-resistant Gram-negative bacteria, such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Material and methods. The review includes data from clinical as well as in vitro studies for the period 1998–2017. The search for relevant sources was carried out in the Medline, Cochrane Library, Elibrary and other databases. Results. The analysis of the data showed the presence of synergism and additive activity of polymyxin in combination with carbapenems, rifampicin and azithromycin. However, experimental data showed no direct positive correlation between combination of polymyxim and azithromycin/ rifampicin. In clinical studies, in hospital-acquired pneumonia, including ventilator-associated pneumonia, the clinical response rate of polymyxin B combined with other antibiotics ranged from 38 % to 88 %. High nephro- and neurotoxicity of polymyxin observed in previous studies can be explained by a lack of understanding of its toxicodynamics or the use of an incorrect dose. Conclusion. Polymyxin B in combination with other antibiotics is a promising treatment against infectious complications caused by multidrug resistant Gram-negative bacteria.

© 2018 Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved. Reconstruction of head and neck defects after surgery for cancer remains challenging. The choice of the reconstruction technique depends on the tumor size and localization, type of the defect, patient’s age, concomitant diseases, and disease prognosis. Surgeons have currently a broad range of material for reconstructive surgery, from free flaps to revascularized flaps. Microsurgical reconstruction has made a revolution in treatment of patients with complex head and neck defects. However, the use of this technique may not be advisable for some patients. The search for new techniques is needed to improve functional and aesthetic results and reduce traumatism without compromising oncologic outcomes. Thirty-six patients underwent surgery with reconstruction using the submental island flap, a new alternative in the reconstruction of various head and neck defects. The graft was taken after making a neck incision for neck lymph node dissection. A few patients develop total and marginal necrosis of the graft. Short- and long-term results showed no worsening of oncologic outcomes in the selected group of patients.

© 2018 Media Sphera Publishing Group. All rights reserved. The outcome of diseases accompanied or caused by mucostasis depends both on the restoration of drainage function of the airways and on the effectiveness of immune mechanisms against pathogens. N-acetylcysteine (NAC) is widely used as mucolytic and antioxidant remedy in clinical practice. In this regard, the data of the scientific literature on the direct and indirect effects of NAC on the mucosal immunity of the respiratory tract have been reviewed. NAC possesses pleiotropic immunomodulating properties, most of which contribute to the regression of clinical manifestations of acute and chronic inflammatory diseases of the respiratory tract. Biological and pharmacological effects of NAC include improvement in rheological properties of mucus, reduction of excess mucin production, restoration of mucociliary clearance and production of sIgA, suppression of excess production of IgE and IgG4, destruction of biofilms and inhibition of their formation, suppression of adhesion of pathogenic bacteria to epithelial cells, antioxidant activity, regulation of the production of pro-inflammatory and profibrotic cytokines. There was no convincing evidence that NAC is able to suppress any component of mucosal immunity. For final conclusions on this subject, further research are required.