Репозиторий Университета

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Aim: to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of followup in ambulatory elderly patients with chronic heart failure (CHF). Materials and methods. We conducted an open, prospective, nonrandomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II-IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean followup was 26.6±11.0 months. Results. Bendopnea was present in 38.8% patients. All these patients complained of shortness of breath during physical exertion and 45.2% of them had orthopnea. Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95% confidence interval [CI] 4.04-34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score) (OR 1.78, 95% CI 1.29-2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95% CI 1.07-1.52, p=0.007), coronary heart disease (OR 26.6, 95% CI 3.34-21.3, p=0.002), history of myocardial infarction (OR 13.9, 95% CI 4.2-46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95% CI 2.69-65.9, p=0.002), increased indexed LV endsystolic diameter (OR 8.2, 95% CI 1.9-34.1, p=0.004), left atrial size (OR 4.3, 95% CI 1,4-12.5, p=0.008), indexed LV endsystolic volume (OR 1.32, 95% CI 1.07-1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95% 1.03-1.45, p=0.002), high levels of NTproBNP (OR 1.0, 95% CI 1.0-1.002, p=0.055), creatinine (OR 1.04, 95% CI 1.02-1.07, p=0.001), uric acid (OR 1.006, 95% CI 1.002-1.011, p=0.004); hospitalizations (OR 7.61, 95% 2.04-28.4, p=0.003), and patient's mortality (OR 5.63, 95% CI 1.94-16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95% CI 1.04-2.8, p=0.033), increased left atrial size (OR 5.67, 95% CI 2.75-21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95% CI 1.04-2.80, p=0.050). During followup 51.6 and 12.2% of patients died among those with and without bendopnea, respectively (OR 4.22, 95% CI 1.85-9.9, p<0.001). Conclusion. Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.

© 2018 Russian Academy of Sciences. All rights reserved. The current theoretical and experimental data about the impact of the lipid A structure on interactions of lipopolysaccharide (LPS) with serum lipid-binding protein (LBP) are presented. LBP interacts more efficiently with the LPS lipid A from Rhizobium, Escherichia, and Neisseria spp. than with the LPS lipid from Francisella, Porphyromonas, Helicobacter, Chlamydophila, as well as with the lipid A synthetic analogue-compound E5564. It is shown that the lipid A hydrocarbon chain of 14 carbon atoms is most favorable, while that of 16 carbon atoms is ultimate for interaction of LBP with lipid A. A high content of unusually long chains and branched-chain acyl residues in lipid A will further complicate the interaction of LBP with LPS. The reviewed data provide a deeper insight into the mechanisms of the LPS delivery and cell activation accomplished by serum cationic proteins such as LBP. A direct relation between the efficiency of the LBP interaction with a particular lipid A of LPS and the development of the fulminant acute inflammation is proposed.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Succinate is an endogenous substrate of the human organism that participates in various redox processes, reactions of the Krebs cycle, and the mitochondrial oxidation chain. This universal intracellular metabolite plays an important role in the regulation of physiological, metabolic, and energy-producing processes. The article discusses the issues of neuroplasticity, the importance of correction of energy deficiency, oxidative stress and other pathophysiological processes, and maintenance of adequate functional activity of neuronal structures after cerebral circulation disorders. The problems of neuroprotective therapy in ischemic stroke, which is pathogenetically justified in all stages of restorative treatment after cerebrovascular accident, are considered. Cytoflavin is one of the most studied original cytoprotectors, which demonstrated safety, efficacy, and good tolerability. Results of numerous clinical trials revealed significant positive clinical and morphological dynamics of cytoflavin administration in patients after ischemic stroke.

© 2018 American Leather Chemists Association. All rights reserved. The regenerative potential of biodegradable collagen matrix (hemostatic sponge) for healing full-thickness rabbit conjunctival injury was studied. Results of histological investigation and scanning electron microscopy showed evidence of the progressive degradation of collagen matrix followed by granulation tissue formation from periphery to the center of the conjunctival wound. The ungrafted conjunctival defect was substituted with granulation tissue from the intact edges of wound to the center. Both matrix-grafted and ungrafted full-thickness conjunctival defects were covered completely with loose stroma and stratified squamous epithelium within 30 days. Thus, high regenerative potential of biodegradable collagen matrix (hemostatic sponge) implanted into the zone of injury for healing full-thickness defect of rabbit conjunctiva was established.

The prevalence of tooth caries and periodontitis in pregnant women has been studied; susceptibility of pregnant women to a high risk of development of dental pathology. Proven factors that modify the risk of tooth caries, periodontitis of mild and moderate severity in pregnancy are age over 30 years, repeated childbirth and pregnancy, complications of the gestational period, and for periodontitis, additionally - diseases of the digestive system, musculoskeletal system , anemia and metabolic-endocrine disorders.

© 2018 The Authors. Published by Elsevier B.V. Identification of genes variants (alleles) in organisms can become a time-consuming task due to great diversity. Polymorphism is also a feature of HLA, the main complex of human histocompatibility. Errors in sequencing can also cause incorrect determination of alleles. The authors of the paper propose a method for analyzing high-performance sequencing data, which allows observing high accuracy in the problem of genotyping HLA.

© 2018, Silicea-Poligraf. All rights reserved. Aim. To study the efficacy of plasmapheresis as the main type of pathogenic treatment or in combination with immunosuppressive therapy in patients with dilated cardiomyopathy (DCMP) and arrhythmias of immune-inflammatory nature. Material and methods. The main group included 20 patients with arrhythmic myocarditis (with premature supraventricular / ventricular contraction >3000/day, n=3/8, atrial fibrillation (AF) n=9) and 14 patients with DCMP syndrome (enddiastolic volume (EDV) left ventricle (LV) 6,3±0,6 cm, ejection fraction (EF) 33,5±8,1%). The inclusion criterion was an increase of at least 2 types of anti-cardiac antibodies titers ≥ twice. Myocarditis is diagnosed using myocardial biopsy, magnetic resonance imaging, multispiral computed tomography, scintigraphy, coronary angiography. We used a course of discrete plasmapheresis. The comparison group included 26 patients with an arrhythmic myocarditis and 19 with DCMP syndrome (EDV 6,6±0,8 cm, EF 32,6±7,3%), which plasmapheresis was not used. Dynamics was assessed at 6 and 12 months. Results. In groups of patients with arrhythmias and DCMP, a significant decrease in anti-cardiac antibodies titers was observed immediately after plasmapheresis and in control studies (p<0,05). In patients with arrhythmias, a health-promoting effect (a decrease in the number of premature contraction and a frequency of atrial fibrillation ≥75%) was observed in 65% of the main group and 58% of the comparison group. Predictor of plasmapheresis efficiency was a titer of specific antinuclear factor ≥1: 40 (sensitivity — 92,3%, specificity — 71,4%, AUC — 0,813, p<0,05). Methylprednisolone was prescribed to 45% of patients in the main group and 73% to patients in the comparison group (p>0,05) at a dose of 8 [4; 16] and 16 [10; 24] mg per day, respectively, p>0,05. In patients with DCMP in the main group, a significant increase in EF (p<0,05) (up to 41,4±8,2% and 46,3±12,7% vs 39,1±13,7% and 37,2±10,7% in the comparison group) and the distance of 6-minute walking test was obtained. A good effect (increase in EF by 10% or more) was noted in 50% of the main group and 32% of the comparison group. The predictor of plasmapheresis efficacy was systolic pressure in the pulmonary artery ≥28,5 mm Hg. (sensitivity — 100%, specificity — 71,4%, AUC — 0,893, p<0,05). In the main group, methylprednisolone was assigned to 43% of patients, in the comparison group — 89%, p<0,05. The average doses of methylprednisolone in the main group were significantly lower than in the comparison group (8 [8; 17,25] vs 16 [13; 28] mg per day, p<0,05). Conclusion. Positive clinical response to plasmapheresis was noted in 65% of patients with arrhythmias and in 50% of patients with DCMP of immune-inflammatory nature. In patients with different types of myocarditis, plasmapheresis increases the efficacy of antiarrhythmic and immunosuppressive therapy.

© 2018. Korean Academy of Periodontology. Purpose: The aim of this study was to evaluate the effects of various prophylactic treatments of titanium implants on bacterial biofilm formation, correlating surface modifications with the biofilms produced by Pseudomonas aeruginosa PAO1, Staphylococcus aureus, and bacteria isolated from saliva. Methods: Pure titanium disks were treated with various prophylactic procedures, and atomic force microscopy (AFM) was used to determine the degree to which surface roughness was modified. To evaluate antibiofilm activity, we used P. aeruginosa PAO1, S. aureus, and saliva-isolated Streptococcus spp., Bacteroides fragilis, and Staphylococcus epidermidis. Results: AFM showed that the surface roughness increased after using the air-polishing device and ultrasonic scaler, while a significant reduction was observed after using a curette or polishing with Detartrine ZTM (DZ) abrasive paste. In addition, we only observed a significant (P < 0.01) reduction in biofilm formation on the DZ-treated implant surfaces. Conclusion: In this study, both AFM and antibiofilm analyses indicated that using DZ abrasive paste could be considered as the prophylactic procedure of choice for managing peri-implant lesions and for therapy-resistant cases of periodontitis.

THE PURPOSE OF THE STUDY: determination of the optimal parameters of the action of various types of current, which have the most pronounced irritating effect on the receptor apparatus of the tooth pulp. The study involved 102 volunteers aged 19 to 72 years (53 females and 49 males). The study was conducted on 217 teeth: 86 molars, 25 premolars, 19 canines and 98 incisors. 137 (63%) teeth were intact, in 48 (22%) teeth caries were found, in 32 (15%) teeth there was pulpitis or teeth were depulpated. Electroexcitability of the teeth was determined with the help of various types of electric current: an impulse variable, an impulse constant and a sinusoidal variable. The optimal current for carrying out an electroodontodiagnosis proved to be sinusoidal variable current with a frequency of 50 Hz. This current does not cause polarization of tissues, it is easy to dose, it causes a clear, but not painful sensation, gives the smallest spread of the indicators during repeated studies. The obtained results allowed formulating requirements for electroodontodiagnosis devices.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To compare release parameters of various betahistine drugs in vitro using a comparative dissolution kinetics test. Material and methods. Objects of research are solid dosage forms (tablets) containing betahistine in a dose of 24 mg permitted for medical use in the Russian Federation. A method of comparative dissolution kinetics test was carried out as follows. The study was performed on a paddle stirrer at a speed of 50 rpm in three different pH dissolution media (pH 1.2, 4.5, 6.8), simulating the main sections of the digestive tract in which the active ingredient was decomposed, released and absorbed. This was performed in a quality controlled environment using a citrate buffer solution with pH 6.8. The time points for sampling the medium were 10 min, 15 min, 20 min and 30 min. Results. The results of betahistine release were significant (RSD<10%) for all time points, except the first time point (RSD<20%). Regardless of pH, there was a complete release (≥85% over 15 minutes, <10%) of betahistine from betaserc, 24 mg, tablets (manufactured by Mylan Laboratories SAS). The dissolution profiles of betahistine in other investigational drugs did not show complete drug release (parameter <85% in 15 minutes, <10%) in different pH media. Therefore, dissolution profiles of the studied drugs were not comparable to the reference profile. Conclusion. Starting from 10 minutes, the reference drug of betahistine (be taserc, 24 mg) has a consistently higher release at different pH levels (representing the various stages of gastric digestion), vs. other studied generic analogues showing significantly lower levels of betahistine release. None of the studied drugs were found to be equivalent in vitro.

© 2018 Authors. The present work presents a description of various cutting devices with an emphasis on skin surgery for the optimal choice of instruments in plastic surgery. Physical principles of work with a description of the biological role of an ultrasonic scalpel, various laser cutting devices, electrosurgical instruments, including radiofrequency electrosurgery, are described. Studies of recent years, including systematic reviews and meta-analyzes, are devoted to comparative analysis of various cutting and coagulating devices among themselves and in comparison with the mechanical metal scalpel.

© 2018 Media Sphera Publishing Group. All rights reserved. In this article we present problems of prognostic value of day-by-day blood pressure (BP) variability, its role in development and progression of damage of target organs in arterial hypertension, and impact on risk of cardiovascular, cerebral-vascular complications, and mortality. We also discuss methodological aspects of assessment of day-by-day BP variability. The article contains literature data on effects of antihypertensive therapy on variability of home BP, and consideration of evidence base of possibilities of the fixed amlo-dipine/perindopril combination for lowering day-by-day BP variability.

© 2018 Media Sphera Publishing Group. All rights reserved. Purpose: To assess effectiveness of algorithms of minimization of right ventricular pacing (MRVP) for prevention of progression of atrial fibrillation (AF), lowering of frequency of hospitalizations due to cardiovascular causes, and mortality in patients with sick sinus syndrome (SSS) and history of paroxysmal AF compared with standard compared with dual-chamber pacing (DDDR). Materials and methods. We included in this single-center prospective study 74 consecutive patients with indications to permanent DDDR pacing because of SSS combined with documented history of paroxysmal AF. Patients were randomized in the groups of DDDR pacing (n=3 6) and with activated algorithms of MRVP (n=38). Pacemaker check up was made after 6 months during I year after device implantation. Primary composite endpoint included development of persistent AF, hospitalization due to cardiovascular causes, and all cause death. Results. During follow-up there was no statistically significant difference in achievement of the primary endpoint (27.8 and 18.4% in groups of DDDR pacing and activated algorithms of MRVP respectively (relative risk 1.29% confidence interval 0.43 to 3.86; p=0.25). Rate of development of persistent AF in both groups was comparable (8.6 and 5.3% in DDDR and MRVP groups, re-spectively; p=0.47). Median AF burden was 6.0 (0;42) and 6.0 (0;42) min/day in DDDR and MRVP groups, respectively (p=0.67). Conclusion. Our study failed to demonstrate advantages of the use of algorithms of decreasing "unmotivated" right ventricular pacing over standard regimen of standard DDDR pacing in patients with SSS and history of paroxysmal AF.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. Background. Tumour necrosis factor alpha inhibitors are widely used in the treatment of juvenile idiopathic arthritis (JIA). To achieve maximum efficiency of genetically engineered biologic drugs, it is necessary to study predictors of the response to therapy. Objective. Our aim was to identify early predictors of the response to adalimumab therapy in patients with JIA without systemic manifestations. Methods. A prospective cohort study analysed treatment results of patients with JIA without systemic manifestations, who were prescribed adalimumab for the period from August 2008 to August 2014. We studied the relationship between baseline demographic indicators as well as baseline and registered after one month of treatment clinical and laboratory parameters and the best (remission according to the Wallace criteria) response to therapy after one year. Results. In the first year of therapy, 94 (43.9%) of 214 patients achieved remission according to the Wallace criteria. In a multivariate analysis, predictors of achieving remission after one year of adalimumab therapy were the improvement according to the ACR70 criterion after one month of therapy [odds ratio (OR) 3.3; 95% confidence interval (CI) 1.7-6.7], a history of uveitis (OR 1.86; 95% CI 1.03-3.33), a decrease in the number of joints with active arthritis after one month of therapy (OR 1.09; 95% CI 1.02-1.16). During therapy, injection reactions in the form of pain were observed in 36 (16.8%) of 214 patients, infectious diseases of ENT organs - in 85 (39.7%), of the respiratory tract - in 17 (7.9%), and tubinfection - in 13 (6.1%) children. Conclusion. The presence of uveitis, rapid reduction in the number of joints with active arthritis and a high level of response to treatment after one month of adalimumab therapy are predictors for achieving remission during the first year of treatment.

© 2018 Medical Radiology and Radiation Safety. All rights reserved. Introduction: The highest priority for modern clinical oncology is functionally-sparing and organ-conserving treatment. In Russia, breast cancer (BC), among all malignant tumors, accounted for 21.1 % of women in 2017. Oncoplastic radical resections (OPS-BCS = oncoplastic surgery – breast conserving surgery) have been widely used. This term means resection of the breast for cancer using plastic surgery to restore the shape of the breast, in most cases with one-stage correction of the contralateral breast. Purpose: It was the creation of various techniques of oncoplastic breast surgery, applicable for the appropriate localization of breast cancer and the evaluation of surgical, oncological and aesthetic results. Methods: From 2013 to 2017, in the P.A. Hertsen Moscow Oncology Research Center, organ-conserving surgery were performed in 570 patients with BC with an average age of 54.2. Stage 0 was diagnosed in 4.6 %, I – 5.9 %, IIA – 28.7 %, IIB – 6 %, IIIA – 5.1 %, IIIC – 3.3 %, IIIB – 0.2 %, IV – 0.2 %. Radical resection in the standard version was performed in 290 patients with breast cancer, oncoplastic breast surgery in various modifications – in 280. All patients after the organ-conserving surgical treatment received radiation therapy. Patients received chemotherapy, targeted therapy and hormone therapy according to the indications in depending the disease stage and the immunohistochemical type of the tumor. Results: After an urgent and planned morphological study positive margins of resection were revealed in 10 patients, which required reresection of the edges to a negative state of them in case of an urgent intraoperative response and mastectomy – in case of a planned response. Within 4 years, local recurrences were detected in 4 patients (0.7 %), which required a mastectomy with a one-stage reconstruction. In 1 patient (0.2 %), the disease progressed as metastases to the lung – in this case lobectomy and a necessary chemotherapy were conducted. Cosmetic results were defined as excellent in 70 % cases, good – 25 %, satisfactory – 5 %. Conclusion: If there are indications for organ-conserving treatment of breast cancer and the patient’s decision concerning this surgery, the patient should be offered methods of oncoplastic surgery for the prevention of psychological and emotional stress, effective rehabilitation, and a quick return to active social life.

Etiology, epidemiology and pathophysiology of anal fissure are examined in the article in order to determine the most optimal treatment strategy. The authors concluded that the most effective treatment is combined approach using both minimally invasive surgery and various medicines for anal spasm reduction.

© 2018, Bionika Media Ltd.. All rights reserved. Urinary disorders in women with recurrent urinary tract infections (UTI) are a serious problem that has not yet been solved despite that there are a large number of papers on this topic. Pregnant women who have experienced acute urinary tract infection and those who have been treated for asymptomatic bacteriuria should be followed up until delivery, by examining their urine to prove the efficiency of antibacterial therapy that can threaten their pregnancy. It is necessary to emphasize the importance of prevention, timely detection of signs of UTI in pregnant women and the correct choice of antibiotic therapy in the developed UTI.

© 2018, Media Sphera Publishing Group. All rights reserved. This article was designed as a comparative review of the literature publications pertaining to the two opposite approaches to the surgical treatment of varicose veins of the lower extremities based on the vein-sparing and radical principles. We compare classical phlebectomy (i.e. endovenous treatment of varicose veins including thermal obliteration) and the vein-savings treatment with the use of the methods for the hemodynamic correction of venous insufficiency, such as ASVAL, CHIVA, and short stripping with special reference to its location and extent. Also covered in the article is the issue of the appropriate length of great saphenous vein stripping. The authors emphasize that it should be based on the extent of reflux rather than on the desire to avoid saphenous nerve injury. It is maintained that either partial or complete preservation of the stem of the great saphenous vein (GSV) in addition to the endovenous obliteration techniques is an efficient and safe modification of the surgical intervention. Stripping is indicated when the endovasal intervention is either impossible or undesirable because of clinical, anatomical, and/or technical limitations. Short stripping in the absence of total reflux in the great saphenous vein is a safer procedure in comparison with the total extirpation of the venous stem.

© 2018, Media Sphera Publishing Group. All rights reserved. Over the past few decades, there has been growing concern among researchers about the health status of teachers due to their professional activities. Objective - to investigate the relationship of professional burnout (PB) in teachers towards their attitude to their own health and healthy lifestyle. Subject and methods. A total of 317 teachers (26 men and 291 women) were examined. The program encompassed a medical examination, rapid diagnosis of the stress level (L. Reeder), diagnosis of the level of emotional exhaustion (burnout) according to the questionnaire designed by V.V. Boiko, and a survey using the questionnaire that included a sociodemographic unit and questions about health attitudes. Results. Analysis of the teachers’ health self-assessment showed that 23% of women and 35% of men rated their health as good and very good; 70% of women and 62% of men regarded as satisfactory; and the remaining considered as bad. Health self-assessment decreased with higher levels of burnout. The results showed a low level of physical activity in the teachers, non-compliance with the work and rest regime, inability to manage their emotions and cope with stress, low competence in a balanced diet, and the presence of bad habits (smoking and alcohol). The number of alcohol abusers is growing in the group of women with higher PB. The women were statistically significantly ascertained to have a lower regular physical activity with a higher level of PB. Conclusion. The results show that PB has an adverse impact on health self-assessment, health attitudes, and healthy lifestyle behavior. In order to prevent PB, it is recommended that a package of preventive measures should be developed.

© 2018 Ismailova et al. Orbital decompression is a surgical procedure aimed at increasing the orbital volume and/or decreasing the volume of the orbital fat. The indications for orbital decompression are determined in the course of thorough eye examination. An important objective of examination of a patient with thyroid eye disease (TED) is determination of inflammation activity and severity. Orbital decompression is a surgical procedure that can be performed in both the active and non-active stages of the disease. However, the indications for the surgery in these cases are different. Optic neuropathy and severe corneal disease are threatening complications that may lead to permanent visual loss and generally occur in the presence of active orbital inflammation. If treatment with high-dose corticosteroids has proven ineffective, an urgent surgical procedure consisting of orbital decompression and, in case of involvement of the cornea, eyelid and corneal surgery has to be performed. Owing to significant progress in technology, improvement of methods and accumulated experience over the past decade, the indications for bone orbital decompression have extended compared to the time when this procedure was used only in patients with extremely severe TED. The most common complication of the orbital decompression is the development or deterioration of previously existing binocular diplopia and strabismus. In addition, other parameters may change as well, including the position of the globe, the eyelids, the angle of deviation of the eye, and intraocular pressure. Thus, bone orbital decompression is a major step of a comprehensive, often multistage, system of rehabilitation of patients with severe refractory TED.