Репозиторий Университета

© 2018 The Author(s). Blockchain as technology described to be used in closed Systems to conduct registers of official data in public healthcare. Also this technology had found its use in different other ways, for example it is education of medical staff, control of the contracts for healthcare ServiceS. And the role of Blockchain in CALS / PLM-technologies suggested.

© 2018 The Author(s). Medical drugs interactions and adverse drug reactions are one of the major problems in pharmacotherapy. At the Sechenov University (Russia, Moscow), digital System for drug prescription management is being developed. Artificial intelligence methods to the control of drug therapy will greatly enhance the ability of the automated control System to identify potential problems in drug therapy and provide recommendations for their elimination. Introduction of this System into commercial operation will make it possible to translate the civil circulation of medicines into a single information space and increase the effectiveness of the ongoing pharmacotherapy.

© 2018, Media Sphera Publishing Group. All rights reserved. Urothelial carcinoma is one of the most frequently diagnosed malignant tumors of the bladder and upper urinary tract, which ranks seventh in the pattern of cancer. Urothelial carcinoma of the renal pelvis is less common; but has a more aggressive clinical course and a worse prognosis than that of the bladder. This is due to the clinical and morphological features of this form of cancer, which, unlike bladder cancer, have not been studied enough. Objective — to comparatively analyze the morphological and immunophenotypic parameters of urothelial carcinomas of the renal pelvis and bladder. Subject and methods. Surgical specimens from 196 patients diagnosed with urothelial carcinoma of the renal pelvis and bladder were investigated. Paraffin sections were immunohistochemically examined using the standard protocol. Antibodies against CK5/6, CD138, CDX2 (≪Dako≫), CK7, CK14, CK20, CEA, CD10, CD117, EMA, E-Cadherin, HMWCK, p63, Uroplakin III, Vimentin (≪Novocastra≫), CD44, GATA-3, MUC1, MUC2, and MUC-5AC (≪Cell Marque≫) were used. Results. Most tumors (n=147 (75%)) were invasive. Of them, 65 (33%) cases had a histological structure of conventional urothelial cancer; and 3 (1.5%) had paradoxical differentiation. Divergent tumor zones were verified in 66 (34%) neoplasms; 4 (2%) cases showed an inverted growth pattern. Pseudosarcomatous stroma reaction in the invasion zones was verified in 9 (5%) cases. The tumor stage corresponded to pT2—pT4 in 128 (65%) tumors. Conclusion. Urothelial carcinomas of the renal pelvis and bladder show a broad spectrum of histological variants. The findings support that, unlike urothelial carcinomas of the bladder, the majority of primary urothelial carcinomas of the renal pelvis are high-grade and highly invasive.

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

© 2018 Media Sphera Publishing Group. All rights reserved. The article reflects the main positions of the latest Russian and pan-European clinical recommendations on the diagnosis and treatment of chronic pancreatitis (CP), devoted to the pharmacotherapy of this disease. The main objectives of pharmacotherapy for CP are to reduce or arrest pain abdominal syndrome and prevent or compensate for functional pancreatic insufficiency.

© Bionika Media Ltd. Objective. Evaluation method of therapy for pregnant women, with vulvovaginal candidiasis, with a combination of oral and intravaginal introduction polyene macrolide – natamycin. Subjects and methods. The results of treatment in 110 pregnant women, patients with invasive vulvovaginal 10-12 weeks gestation: group 1 (n = 55) therapy with natamycin intravaginal at a dose of 100 mg 1 times daily for 6 days; Group 2 (n = 55) had combined treatment natamicinum intravaginal at a dose of 100 mg 1 times daily for 6 days + natamicinum peroral at a dose of 100 mg 4 times daily for 10 days. Direct microscopy, measuring the pH of the vagina, cultural method was using. Results. Found that the combined intake of natamicinum (oral and intravaginal reception) increases the clinical efficacy of therapy vulvovaginal candidiasis in 1.7 ± 0.12, and microbiological -1.3 ± 0.1 times. Conclusion. Application of combined therapy antimycotics reasonable etiologically (simultaneous vaginal disinfection and colon) with polyene macrolides natamycin has the fewest side effects, absence of adverse effects on the fetus, and helps improve clinical microbiological efficacy of treatment in patients vulvovaginal invasive.

© 2018 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reservbed. The results of foreign and Russian author's researches about immunization of adult population are presented in article. The analysis of the vaccinal prevention state of infectious diseases in adults in different countries of the world (national guidance on adults immunization, coverage of preventive vaccinations, financing mechanisms) is given. The tasks of improving immunization in adult population of Russia are defined.

© 2018 Medical Education. All rights reserved. The aim of this study was to assess long-term effects of pneumococcal vaccination with 23-valent polysaccharide vaccine (PPV23) and 13-valent conjugate vaccine (PCV13) in patients with bronchial asthma. Methods. One hundred and three patients with mild to severe asthma were involved. They were randomly assigned to vaccination with PCV13, or PPV23, or PPV23 followed by PCV13, or vice versa. Clinical efficacy of vaccination was evaluated using number of asthma exacerbation a year before and 1 and 4 years after the vaccination; need in antibiotics a year before and 1 and 4 years after the vaccination; and number of hospitalizations due to asthma exacerbation a year before and 1 and 4 years after the vaccination. Results. In a year after vaccination, number of patients who had not experienced asthma exacerbation increased significantly in PPV23, PPV23/PCV13, and PCV13/PPV23 groups (p < 0.01 to p < 0.001). In 4 years after vaccination, number of patients without exacerbations increased significantly in PCV13/PPV23 group only (48.1%; p < 0.01). Number of patients who did not require hospitalization due to asthma exacerbation increased significantly in PCV13 group only (81.8%; p < 0.05). Conclusion. The authors proposed a hypothesis of impact of pneumococcal vaccines on immunopathogenesis of bronchial asthma. The authors consider vaccination against pneumococcus using PCV13 followed by PPV23 should be a part of the basic therapy of asthma.

© Olga V. Tereshkina, Elena N. Bobkova. The late 19th and the early 20th century showed the development of new scientific views and approaches to the understanding and treatment of mental illnesses. The need arose to create and introduce new medical institutions for the provision of assistance to the mental health patients. On the one hand, it was necessary to isolate the mental health patients who could pose a danger to themselves and others, and on the other hand, the institutions needed for this not only had to provide conditions generally approaching a regular life for the most of the patients, be effective for treatment and economically justified, but also had to follow a human mental health patients principle in their attitude towards the mental health patients. The therapeutic-labor (agricultural) psychiatric colony took up this role. One of the largest of them – the Spas-Petelinsky Psychiatric Colony – was opened in 1911 at the Tula provincial zemstvo district. Through the efforts of Kamenev, and under his leadership, a three-tier system for helping the mental health patients was created and successfully functioned in Tula and the Tula province. Several projects were developed by him. These projects – not big but still important – unfortunately were not carried out. The article focuses on Tula psychiatric establishments for medical and out-of-hospital care. In all Kamenev’s projects, in order to accelerate the implementation process and ensure maximum efficiency, there was a tendency to use various local resources, including sociocultural ones. Also, little-known information is provided on Kamenev’s Moscow activities after his departure from Tula. This article is a continuation of the authors’ research work devoted to the study of regional factors in Tula health care in the context of the reforms of the turn of the 19th and the 20th century.

© 2018 Media Sphera Publishing Group. All rights reserved. Objective - to evaluate the possible epidemiological and economic efficiency of pneumococcal vaccination in men with different chronic diseases. Material and methods. A prognostic (Markov) model was constructed based on the data available in the literature. The estimated efficiency of pneumococcal vaccination in reducing mortality, preventable diseases, and economic damage over a 5-year period was evaluated in able-bodied men. According to official statistics, the group at high risk for pneumonia in the Russian Federation includes 21,575,887 able-bodied men. The sources of data on the cost of the disease were governmental tariffs in the compulsory health insurance system in 2016 and those of vaccination cost were the results of competitive bidding for the procurement of 13-valent pneumococcal conjugate vaccine (PCV13). Results. The results of extrapolation of data from Russian and foreign studies in patients with chronic respiratory diseases, circulatory diseases, or diabetes mellitus showed a significant reduction in the risk of complications due to the underlying disease (RR=0.58; p<0.05), the number of hospitalizations (RR=0.02; p<0.05), and expected postvaccination mortality. The cost of vaccination in the assessed patient group was 25,869.5 million rubles. The use of PCV13 significantly reduces the number of exacerbations and, accordingly, hospitalizations, which saves about 14,359.9 million rubles in each subsequent year after vaccination. Thus, the total budget savings can reach 2,850.3 million rubles just during 2 years. A single dose of PCV13 will save at least 61,702 lives over 5 years. Conclusion. The results of this investigation suggest that pneumococcal vaccination has high epidemiological and clinical efficiency in able-bodied men with chronic diseases. This intervention reduces morbidity rates, the number of exacerbations and hospitalizations, as well as deaths in the vaccinated group, and it is a cost-effective investment in public health service.

© 2018 Human Stem Cell Institute. All rights reserved. Cell therapy is one of the most promising directions in the treatment of critical limb ischemia (CLI). In spite of certain advances achieved in this field in the last decades, which are related to application of bone marrow stem cells (BMSC), a large number of problems still remain unsolved. In this review, we discuss the BMSC biology, mechanisms of their therapeutic effect in the CLI treatment and results of the most notable BMSC-based clinical studies in detail.

© 2018, Nizhny Novgorod State Medical Academy. All rights reserved. Persistent bronchial inflammation in chronic obstructive pulmonary disease (COPD) is considered the cause of ventilation disorders and related contamination with conditionally pathogenic microorganisms; the latter can proceed and transform into a full infection, which can aggravate and exacerbate COPD. The aim of the study was to evaluate the relations between the oropharyngeal microbiota in patients with COPD and the clinical, functional, and prognostic parameters of the disease. Materials and Methods. 64 patients with COPD were included in the study; the participants were scheduled to visit our clinic on two occasions. In the first visit, their medical history was studied in detail and the major examination procedures were conducted. Those included an assessment of the respiratory function, the 6-minute walk test, the degree of dyspnea by the Medical Research Council scale, body plethysmography, the diffusion capacity of the lungs, and a chest CT scan. The second visit took place 12 months after the first one to assess the changes in the course of the disease. The result was considered negative if, in the second examination, the patient‘s condition was found more severe. Oropharyngeal samples of all patients were sequenced to identify the V3–V4 variable sites of the 16S rRNA gene. Results. It is found that the microbiological oropharyngeal patterns in COPD patients depend on the source of micro-aspiration. In addition, the changes in the oropharyngeal microbiota correlate with the severity and prognosis of the disease, as well as the patient phenotype. Based on the data obtained by sequencing parts of the 16S rRNA gene, the role of oropharyngeal microbiota in determining the course and prognosis of COPD has been elucidated. Conclusion. The presented clinical and functional characteristics associated with oropharyngeal microbiota indicate that microaspirations from other body compartments not only affect the composition of oropharyngeal microbiota in patients with COPD but also have an important prognostic significance.

© 2018, Media Sphera Publishing Group. All Rights Reserved. Objective. To present the clinical history, vaccination status, features of the clinical picture, composition of the cerebrospinal fluid (CSF), results of laboratory and instrumental examinations of a patient with vaccine-associated paralytic poliomyelitis (VAPP). Material and methods. In 2017, a child, aged 15 month, mistakenly vaccinated with the first dose of bivalent (types 1 & 3) polioviruses oral vaccine (OPV) was followed up. Results and conclusion. Clinical parameters of VAPP in the recipient of OPV are considered. Clinical features of disease caused by wild poliovirus and VAPP are compared. The disease was characterized by sudden onset, recurrence, short (2—4 days) period of progression of paresis, persistent residual effects, CSF protein-cell dissociation. It is emphasized that the occurrence of VAPP cases reflects primarily immunization defects.

© 2018 Ima-Press Publishing House. Objective: to compare the efficacy of methotrexate (MTX) and colchicine in patients with chronic arthritis in calcium pyrophosphate crystal deposition disease (CPPDD). Subjects and methods. Data from a controlled prospective cross-sectional study of 10 patients (8 women and 2 men) with chronic arthritis in CPPDD are presented. In the initial period of treatment, all the patients were given colchicine 1 mg/day for 3 months, followed by a wash-out period for 1 month and then subcutaneous MTX 20 mg/week for 3 months. The diagnosis of CPPDD was made if there were calcium pyrophosphate crystals in synovial fluid and signs of chondrocalcinosis, as evidenced by joint X-ray and/or ultrasonography. DAS44, the swollen joint count (SJC) and tender joint count (TJC), pain intensity on a visual analog scale (VAS), the Health Assessment Questionnaire (HAQ) index, and serum C-reactive protein (CRP) levels were determined in all the patients at baseline, 3 months after the beginning of treatment with colchicine, after a wash-out period, and 3 months after the beginning of MTX treatment. Results and discussion. At baseline, mean DAS44 value was 2.47}0.27; SJC and TJC were 2.0}0.6 and 2.4}1.1, respectively; pain intensity was 55.2}12.3 mm; serum CRP level-3.89}3.82 mg/l; HAQ-1.1}0.3. Three months after colchicine therapy initiation, mean DAS44 value decreased to 1.76}0.28 (p = 0.004), SJC-to 1.4}0.5 (p = 0.048), TJC-to 1.6}1.35 (p = 0.023), pain intensity-to 42.0}13.2 mm (p = 0.023), CRP level-to 3.13}2.85 mg/l (p = 0.75), HAQ-to 0.95}0.3 (p = 0.041). Good response was achieved in 7 patients after 3 months of colchicine therapy. After the wash-out period, the mean DAS44 value was 2.08}0.26; SJC and TJC-1.6}0.5 and 1.7}1.4, respectively; pain intensity-46.5}9.8 mm; CRP level-3.38}1.74 mg/l; HAQ-1.3}0.34. Following 3 months of MTX therapy, mean DAS44 value decreased to 1.39}0.45 (p = 0.027), SJC-to 0.7}0.5 (p = 0.023), TJC-to 0.6}0.5 (p = 0.007), pain intensity-to 26.0}18.97 mm (p = 0.045), CRP level-to 2.87}2.06 mg/l (p = 0.75), HAQ-to 0.8}0.6 (p = 0.045). Two of the 3 patients with an insufficient effect of colchicine achieved DAS44 remission after MTX treatment; two patients attained remission after therapy with colchicine and developed an exacerbation of the disease when this drug was replaced by MTX. Conclusion. MTX 20 mg/week is as effective as colchicine in most cases and can be the drug of choice in patients with chronic arthritis in CPPDD if colchicine therapy is ineffective.

© 2018, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved. The purpose of the study - to determine the feasibility of using the succinate-based antioxidant for the in vitro reduction of excessive methemoglobin to oxyhemoglobin in blood. Materials and Methods. Blood sampling was performed in five healthy donors in microvettes containing EDTA during prophylactic examinations. NaNO2 solution was added to blood samples in vitro in order to yield methemoglobin (MetHb). The complex drug containing the following active ingredients: succinic acid, inosine, riboflavin, nicotinamide, was used as an antioxidant. The absorption spectrum of red cell suspensions with different drug content Dl(λl) exper was measured with 1 nm increments. The non-linear regression method was used to calculate concentrations of hemoglobin derivatives in suspensions. Results. In our experiments, when methemoglobin reacted with drug the optical density of peaks typical for oxyhemoglobin increased and the spectral peak of methemoglobin decreased. The greater the concentration of drug, the more was the incubation time, the more efficient was the process of reduction of MetHb to HbO2. Conclusion. We proved experimentally that while the baseline concentration of MetHb was an average of 91-93%, addition of drug decreased its concentration to 25-7%. Without drug, due to autoreduction, the concentration of MetHb decreases only to 84%. The revealed effect provide a potential for practical applications in critical illness, during the storage of donor blood, in blood transfusions, and under the action of physico-chemical factors on blood.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Indomethacin, a non-steroid anti-inflammatory drug (NSAID), has been used in different spheres of medicine since the 1960s. It is successfully administered as an anti-inflammatory and pain-relieving medication in rheumatoid and other diseases. According to recent research, indomethacin may become a promising drug enhancing endogenous remyelination in patients with multiple sclerosis. Also, indomethacin affects cell proliferation and invasion, thus it is used to manage pancreatic cancer in patients with hyperglycemia. In addition, indomethacin can inhibit protein synthesis in colorectal carcinoma and other types of cancer cells. The article reviews modern indomethacin medications and the different dosage forms on the Russian pharmaceutical market. Indomethacin poor water solubility is one of the reasons for decreasing its biopharmaceutical characteristics. According to the conducted research, a prospective way to improve indomethacin solubility and bioavailability is the Solid Dispersion (SD) method. SDs are bi- or multicomponent systems consisting of the drug and the carrier. They are a highly dispersed solid phase of the drug or molecular-dispersed solid solutions with a partial formation of a variable composition complex and a carrier. The article provides a brief overview on different aspects of obtaining, investigating, and applying indomethacin SDs with various polymers.

© Bionika Media Ltd. Background. Fallopian tube cancer (FTC) is an extremely rare, difficult diagnostic malignant disease of the female reproductive system. The world literature describes single cases of FTC concurrent with tubal pregnancy. Description. The paper describes a clinical case of diagnosed FTC after surgical treatment for tubal pregnancy. Patient P., aged 34 years, who had complained of vaginal bleeding and tensive pain in the right iliac region, was admitted to the Bakhrushins Brothers City Clinical Hospital. After complete clinical and laboratory examinations diagnosed right ectopic pregnancy, emergency surgical treatment was performed as laparoscopy and rightsided tubectomy. The postoperative period was uncomplicated; the patient was discharged home in satisfactory condition. Histological examination revealed the growth of well-differentiated fallopian tube adenocarcinoma and confirmed the diagnosis of ectopic pregnancy. The diagnosis was verified by immunohistochemical study Conclusion. Preoperative diagnosis of FTC is extremely difficult; therefore the elaboration of a clear algorithm for the diagnosis and treatment of this condition is one of the important tasks in gynecologic oncology.

© Bionika Media Ltd. Background. Ovarian cancer develops from benign tumors in 80% of cases during long-term follow-up. According to the literature, the incidence of giant ovarian cystadenoma is extremely low. There are difficulties in verifying these ovarian tumors. Description. The paper describes a rare clinical case of a 54-year-old patient with giant ovarian cystadenoma. It depicts the patient’s clinical, medical history, laboratory, and instrumental data and demonstrates the technical complexities of surgery and the features of postoperative management. Conclusion. The early diagnosis and timely treatment of ovarian tumors will be able to avoid technically difficult surgical interventions and to minimize postoperative complications, which will substantially improve the prognosis of the disease. Such operations should be performed by a surgeon having extensive surgical experience and high qualification.

© 2018 Stavropol State Medical University. All Rights Reserved. The review presents the latest achievements in the field of complex adjuvant treatment of patients with portal cholangiocarcinoma. Modern data on the clinical efficacy and benefits of intraduct photodynamic therapy are presented.

© 2017 Izdatel'stvo Meditsina. All rights reserved. The enzyme-linked immunosorbent assay (ELISA) and the neutralization test (NT) are often used to determine the level of seropositive population and to evaluate the immunogenicity of vaccines. ELISA provides information on the total pool of antiviral antibodies, while NT allows the antiviral protection level of a person to be estimated. It is assumed that the 1: 100 titer in ELISA and the 1: 10 titer in NT are protective. Obviously, the ratio of the total pool and virus neutralizing antibodies can vary as a result of natural immunization or vaccination. In this study, two methods were used to study the blood serum samples taken in a group of inhabitants of the Sverdlovsk region aged from 1 to 60 years. The samples were collected before immunization and 30 days after two immunizations with inactivated vaccines against tick-borne encephalitis of different manufacturers. Immunizations were performed either according to a standard scheme (30-day interval between immunizations), or according to an emergency scheme (14-day interval). It was shown that the data on the presence of antiviral antibodies in protective titers obtained by ELISA and NT were consistent in more than 85% of cases. The discrepancies between the data are due, in the first place, to the difference in the sensitivities of the two methods. The proportion of seropositive people according to NT data is always greater than that according to the results of ELISA. Nevertheless, among 174 children, about 5% of recipients after a double immunization were seropositive according to ELISA, but did not have neutralizing antibodies in protective titers.