Репозиторий Университета

© 2018, Media Sphera Publishing Group. All rights reserved. Non-motor disturbances represented by sensory, affective, obsessive-compulsive disorders, cognitive dysfunction, sleep disturbances are often found in patients with dystonia and have a negative impact on their quality of life. The prevalence of sensory and affective disorders and sleep disturbances is above 50% in patients with cervical dystonia and is 25% in patients with blepharospasm, writing spasm; cognitive dysfunction is found in more than 25% of patients with focal dystonia. The relationship of nonmotor, in particular psychiatric disorders, with the impairment of social and everyday life and worsening of quality of life in whole was shown. Common pathophysiological mechanisms of non-motor disorders as well as approaches to treatment of these disorders are discussed. The authors present the results on the positive effect of botulinum toxin therapy that reduces cognitive dysfunction, sensory disorders and depressive syndrome. Non-medication treatment of non-motor disorders in patients with dystonia is considered.

© 2018, Media Sphera Publishing Group. All rights reserved. This article presents a review of Russian and foreign literature about the impact of arterial hypertension (AH) on the risk of cognitive impairment and dementia. Large studies have demonstrated the effect of blood pressure (BP) on the risk of vascular dementia and Alzheimer’s disease (AD) in elderly and oldest old people as well as a role of antihypertensive therapy. There is evidence of a negative effect of hypertension in middle age on cognitive functions in late-life. Observational studies as a whole have shown the positive effect of antihypertensive therapy on the prevention of cognitive function and dementia. However, there are a number of limitations that dictate the need for further research on this issue. The importance of the interdisciplinary approach to treatment of cognitive impairment by cardiologists and/or therapists, together with neurologists, as well as complex treatment regimens, including correction of risk factors and neuroprotective therapy, is highlighted.

The aim of the study was to provide a mathematical justification of the possibility of using 6.5 mm IRIS implants and to evaluate the results of orthopedic treatment in patients with partial loss of teeth. For the calculations was constructed of a composite three-dimensional computer models: the abutment screw-implant-bone. A total of 3 models were prepared: M1-implant in the spongy bone tissue, this model corresponds to the implantation on the HF when replacing one molar; M2-2 implants in the spongy bone tissue located at a distance of 4 mm connected via abutments, this model corresponds to the implantation of RF when replacing two molars; M3-implant in the cortical bone tissue, this model corresponds to the implantation of LF when replacing one molar. Loading of implants was carried out by occlusive force applied to its end surface. The results of the calculations showed that the equivalent stresses and limiting stresses of compression-tension are within the permissible values, which were obtained by us earlier in respect of the irregular implants and are consistent with the results of calculations for other systems of short implants. The clinical part of the work consisted in the treatment of 27 patients with partial loss of teeth, who had 41 iris evolution implants with a diameter of 5 mm, length of 6.5 mm after 3 years, there was a slow bone resorption in the cervical region not exceeding 0.35 mm, which corresponds to generally accepted international standards. During the first three years of operation there were no cases of loss of established implants. Thus, the data of mathematical modeling by finite element method and retrospective three-year analysis of prosthetics on IRIS evolution implants with length of 6.5 mm showed that the use of short implants in the recovery of upper and lower jaw molars is an effective method with a high success rate at long - term and resorption level of 0.34 mm.

© Bionika Media Ltd. Background. Results of numerous studies have shown the advantages of fast increase in the volume of enteral nutrition (>25 ml/kg/day) in very premature infants in the early neonatal period with regard to the slow one (<25 ml/kg/day). Such tactics has demonstrated potential for decrease in postnatal growth retardation in the majority of infants with very low birth weight. Long-term outcomes of physical and psychomotor development are studied poorly. Objective. To assess the influence of enteral nutrition (EN) pace in the early neonatal period on physical and psychomotor development of extremely premature infants during first 12 corrected months. Materials and methods. The study dealt with extremely premature infants that were born at the age of up to 31 weeks of gestation and had body of up to 1,500 grams. The rate of EN increase was more than 25 ml/kg/day in group 1, in group two – less than 25 ml/kg/day. Physical development was assessed in different age periods according to centile curves, also routine neurological examination with assessment of psychomotor development (PMD) according to Griffiths R. mental development scale (1954) was carried out. Results. EN of more than 25 ml/kg/day in the early neonatal period contributes to higher indications of body mass, body length and head circumference, as well as fast pace of body mass gain from the moment of birth and after discharge, during first 12 corrected months of life. All this positively correlates with the results of PMD assessment. According to the results of the study, the number of studied infants that caught up with passport age in development already by 12}0.5 months of corrected age (CA) was definitely higher in the group, where scheme of EN with fast rate of increase was used in the early neonatal period. Conclusion. Scheme of EN with fast rate of increase in volume (>25 ml/kg/day) in the early neonatal period in very premature children that were born with body mass of up to 1,500 grams contributes to higher indicators of body mass, body length and head circumference, as well as fast pace of body mass gain from the moment of birth and after discharge, during first 12 corrected months of life. By 12 months of CA the percentage of infants, whose PMD corresponded to passport age, was definitely higher than in the group with fast increase in EN in the early neonatal period than in the group with slow increase (р=0.005). Thus the influence of increase rate of EN on PMD during first 12 months of CA is determined.

© 2018 Society for Industrial and Applied Mathematics. We consider a vector-Laplace problem posed on a two-dimensional surface embedded in a three-dimensional domain, which results from the modeling of surface fluids based on exterior Cartesian differential operators. The main topic of this paper is the development and analysis of a finite element method for the discretization of this surface partial differential equation. We apply the trace finite element technique, in which finite element spaces on a background shape-regular tetrahedral mesh that is surface independent are used for discretization. In order to satisfy the constraint that the solution vector field is tangential to the surface we introduce a Lagrange multiplier. We show well-posedness of the resulting saddle point formulation. A discrete variant of this formulation is introduced which contains suitable stabilization terms and is based on trace finite element spaces. For this method we derive optimal discretization error bounds. Furthermore algebraic properties of the resulting discrete saddle point problem are studied. In particular an optimal Schur complement preconditioner is proposed. Results of a numerical experiment are included.

© 2018 Stolichnaya Izdatelskaya Kompaniya. Статины в настоящее время являются наиболее широко применяемыми препаратами для лечения дислипидемии и наиболее эффективными лекарствами для снижения уровня холестерина липопротеинов низкой плотности и снижения риска сердечно-сосудистых и цереброваску- лярных событий. Считается, как правило, что статины хорошо переносятся, но предполагают потенциальную связь между статинами и ког- нитивными нарушениями у некоторых людей. Эта обзорная работа была проведена с учетом поиска информации о конкретной проблеме потенциального неблагоприятного влияния статинов на когнитивную сферу, целью которой было выявить рекомендации для медицинских работников по мониторингу и снижению риска потенциальных когнитивных нарушений при терапии статинами. Розувастатин, по-видимому, является более безопасным среди статинов с точки зрения влияния на когнитивную функцию. Перед началом терапии статинами нет не- обходимости в выявлении когнитивной дисфункции у пациентов, терапия статинами не сопровождается риском развития когнитивной дисфункции по данным когортных и рандомизированных исследований. При развитии когнитивной дисфункции на фоне терапии статинами необходимо доказать ее наличие и исключить другие возможные факторы ее возникновения, и оценить соотношение пользы/риска отмены терапии статинами. На основании индивидуальных особенностей пациента возможно уменьшить дозу принимаемого статина или прекратить прием препарата для оценки обратимости симптомов. В случае прекращения приема статина следует подумать об альтернативной замене на другой ингибитор ГМК-КоАредуктазы, предпочтительнее - препарат, меньше всего проникающий через гематоэнцефалический барьер, такой как розувастатин.

© 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 Sfera. All rights reserved. Throughout the history of pediatric ophthalmology, pathophysiological state has always played an important role. It’s characterized by reduced central vision, often paired with disruption of binocular vision, which is interpreted as amblyopia. Central vision is necessary for social integration, so its disorders cause great quality of life changes in patients limiting their professional activities and complicating everyday life. Despite large number of proposed methods of treatment, amblyopia still remains a pressing problem and its prevalence has not changed significantly over the years.

© Bionika Media Ltd. Objective. To investigate the clinical efficacy of Elgyna in the medical treatment of human papillomavirus (HPV)- associated cervical intraepithelial neoplasias (CIN). Subject and methods. The results of antibacterial therapy prior to destructive treatment were comparatively analyzed in 53 patients with severe dysbiosis in HPV-associated CIN. A study group included 27 patients who took the combined drug Elgyna as one vaginal tablet twice daily (6 administrations); a comparison group of 27 patients received the combined drug Tergynan as one vaginal tablet twice daily (6 administrations). A control group comprised 20 women with the visually unchanged cervix. All the women underwent standard examinations and vaginal microbiocenosis estimation by RT-PCR assay using the Femoflor test. Results. The use of the combined drug Elgyna during medical treatment before destruction was found to normalize molecular biological parameters at the local level and contributes to a significant reduction in the time of epithelialization and a decline in the number of recurrences. Conclusion. HPV-associated cervical neoplasias are accompanied by the development of pronounced dysbiotic processes in the vagina with the predominant involvement of obligate anaerobes. Taking into account the properties of the combined drug Elgyna that provides a normalizing effect on the parameters of biocenosis in accelerating healing and in preventing a recurrence of the process, it is appropriate to prescribe the drug before destructive treatments.

© 2018 Ima-Press Publishing House. All rights reserved. We have considered it appropriate to publish this case due to the rarity of progressive myoclonus epilepsy; diagnostic difficulties, particularly in the early stages of the disease (the female patient has been long followed up for diagnosed juvenile myoclonic epilepsy); the relative role of a genetic study because it has not brought results in this case, and, finally, a problem with therapy, and a significant contribution to the achievement of certain success of currently available antiepileptic drugs, levetiracetam in particular.

© 2018 ABV-Press Publishing House. All rights reserved. Background. Memory and attention deficits are prevalent in the chronic pain population. There are multiple common mechanisms in chronic pain and cognitive impairment. However, the presence, prevalence and clinical burden of such impairment are frequently underestimated. Objective: to evaluate subjective and objective cognitive deficits in patients with chronic migraine (CM). Materials and methods. We recruited 53 subjects with CM and 22 gender- and age-matched controls with low-frequency episodic migraine (a maximum of 4 headache days per month) aged 18-59. All patients filled in the HADS (Hospital Anxiety and Depression Scale) anxiety and depression scale and Pittsburg Sleep Quality Inventory (PSQI). Cognitive function was assessed with Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT) and the Perceived Deficits Questionnaire (PDQ-20). Results. 56 % of patients with CM complained of memory problems. Decreased cognitive function was also observed during self-assessment using the PDQ-20 questionnaire. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learn ing rates. 44 % of subjects with CM scored lower than 26 points on MoCA. Most frequently we found impairments in attention (75 %), memory/delayed recall (50 %), language (50 %) and executive function (37 %). Depression and sleep quality correlated with only several parameters of cognitive tests. Conclusion. Subjective and objective cognitive deficits are prevalent in the CM population. Most often memory and attention are impaired. Cognitive complaints need to be carefully assessed, and treatment of such impairment may improve quality of life and decrease disability in CM.

© 2018 Media Sphera Publishing Group. All rights reserved. This article presents current views on the classification, diagnosis, treatment, and prevention of drug dependence caused by the co-use of several psychoactive substances (PASs). It describes the fundamental regularities of the development and course of the disease, the patterns of consumption, and the issues of laboratory diagnosis. Particular attention is paid to the clinical diagnosis of the most common patterns of use of various PASs. In order to make and propose the reader the most complete basis for evidencebased strategies for the treatment of various variants of polydrug abuse, the authors studied the results of investigations that enrolled patients using more than one PAS at least 1 month before the start of treatment. The section on therapy is presented as clinical recommendations, taking into account the levels of evidence and the grades of recommendations.

AIM: To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction.MATERIAL AND METHODS: The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience.RESULTS: It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.

© 2018 Ima-Press Publishing House. All rights reserved. Objective: to investigate the effect of various biological agents (BAs), including combined treatment with rituximab (RTM) and belimumab (BLM), on the activity of systemic lupus erythematosus (SLE) and to evaluate their efficacy and impact on some parameters of humoral immunity. Subjects and methods. BAs were prescribed to 54 patients with a reliable diagnosis of SLE with high and medium activity according to SLEDAI-2K; 40 of them received RTM, 7 – BLM; 7 – combined therapy with RTM and BLM. Clinical and laboratory examinations were made in all the patients at the time of their inclusion and then every 3 months during a year. The results were assessed using SLEDAI-2K, BILAG index, Lupus Erythematosus National Assessment (SELENA)-SLEDAI Flare index (SFI) (a moderate, severe exacerbation), and SLE Responder Index (SRI). Results and discussion. At 3, 6, and 12 months after start of therapy, the use of BAs in all the patients resulted in a disease activity reduction. It was statistically significant (p < 0.00001) in the RTM group; and no statistical analysis was carried out in the BLM and RTM+BLM groups due to the small numbers of patients. At the same time, there was a progressive decrease in the levels of anti-double-stranded DNA (ds-DNA) antibodies (Abs) and an increase in the concentration of the complement fractions C3 and C4 in the RTM and RTM+BLM groups (p < 0.05) at one-year follow-up. After 12 months of therapy with BAs, there was a decrease in IgG (p < 0.02) and IgM (p < 0.03) levels; but overall it remained within the reference ranges. Prior to therapy, irreversible organ damages were recorded in 23 (42.6%) of the 54 patients. The increased damage index at 12 month was observed only in patients receiving RTM, which is probably due to the use of higher-dose glucocorticoids. Conclusion. All three methods of therapy with BAs in SLE patients demonstrated good efficiency shown as a significant decrease in clinical and laboratory activity measures that were assessed by SLEDAI-2K and the levels of anti-ds-DNA and complement components C3 and C4. The decrease in immunoglobulin levels did not go beyond the reference values. Therapy with BLM and RTM+BLM allowed for managing patients with the low and average doses of oral glucocorticoids, which contributed to the reduction of not only the activity, but also risk of irreversible organ damages.

© 2018 Media Sphera Publishing Group. All rights reserved. Goodpasture's disease (anti-GBM disease) is a rare small vessels vasculitis characterized by the presence of autoantibodies directed against the glomerular basement membrane (GBM) and alveolar basement membrane. Common feature of anti-GBM disease is a combination of rapidly progressive glomerulonephritis and alveolar hemorrhage (pulmonary-renal syndrome). We present a case of atypical disease course in a young male patient who developed alveolar hemorrhage without renal failure. The only symptom of renal involvement was isolated hematuria. Plasmapheresis combined with immunosuppression (cyclophosphamide and corticosteroids) was effective. We present a review of state-of-art data on the pathogenesis and disease course of anti-GBM disease.

© 2018 Stolichnaya Izdatelskaya Kompaniya. The review focuses on the impairment of the carotid, coronary arteries and lower-extremity arterial disease. Systemic involvement of various vascular beds in atherogenesis is emphasized. Epidemiological characteristics of morbidity and mortality from the main clinical manifestations of atherosclerosis - ischemic stroke, ischemic heart disease and lower-extremity arterial disease are given. The current principles of drug therapy are considered from the point of view of improving the prognosis and eliminating ischemia. The basic positions of International and Russian clinical recommendations on the management of patients with the presence of certain clinical manifestations of atherosclerosis are discussed. Detailed administration schemes and the preferred doses of statins and antiplatelet agents depending on the localization of atherosclerotic lesion and the severity of stenosis are described. The target blood lipids levels in the treatment with statins are given. The advantages of statins as drugs that reduce the risk of cardiovascular complications are presented. Current data on the pattern of antiplatelet use, including acetylsalicylic acid, in individuals with clinical manifestations of atherosclerosis are given. The principal tactic of dual antiplatelet therapy and schemes of its use in patients undergoing percutaneous coronary intervention, coronary artery bypass surgery and in individuals with a history of acute coronary disorders are considered..

© 2018 Dynasty Publishing House. All rights reserved. The article presents a clinical case of a patient with genetically confirmed Alagille syndrome (ALGS) with marked delay of physical development that did not correspond to the severity of liver damage. Alagille syndrome (ALGS) is a rare hereditary disease with underlying hypoplasia of the intrahepatic bile ducts manifested by cholestasis syndrome in the first weeks of life. Developmental delay is characteristic for cholestatic diseases of the liver, including ALGS, which is conditioned by impaired absorption of fats and fat-soluble vitamins in the intestines. But growth delay and underweight in this syndrome often do not correlate with the severity of cholestatis syndrome, and causes of their development remain unstudied. Cholestatis syndrome was moderate, and clinical signs of liver cirrhosis were absent. Intense skin itching, greatly disturbing not only the baby's wake period but also sleep, along with marked height and weight deficit were indications for liver transplantation at the age of 4 years, after which a fast normalisation of the parameters of physical development was noted. This clinical case study permits to hypothesize that developmental delay in children with ALGS is conditioned by chronic cholestatic liver damage, irrespective of the severity of its clinical presentation.

© 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 Ima-Press Publishing House. Mental disorders (MDS) of the anxiety-depressive spectrum (ADS) and cognitive impairment (CI) substantially deteriorate the course and efficiency of therapy for rheumatoid arthritis (RA). There have been practically no studies on the impact of psychopharmacotherapy (PPT) for MDS on the efficacy of standard disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs). Objective: to investigate the impact of adequate PPT for MDS of ADS on the efficacy of DMARDs and BAs in patients with RA. Subjects and methods. The investigation included 128 patients (13% men and 87% women) with documented RA in accordance with the 1987 American College of Rheumatology (ACR) criteria. The patients' mean age was 47.4}0.9 years; the median duration of RA was 96 [48; 228] months. DAS28 averaged 5.34}0.17. 75.1% of the patients received DMARDs. The diagnosis of MDS was based on the ICD-10 codes, by applying a semi-structured interview and the Hospital Anxiety and Depression Scale. Changes in the pattern and severity of ADS were evaluated using the Hamilton Anxiety Scale and the Montgomery-Asberg Depression Rating Scale. Clinical and psychological procedures were used to diagnose CI. At baseline, ADS was detected in 123 (96.1%) patients: major depression in 41 (32.1%), minor depression in 53 (41.4%), and anxiety disorders in 29 (22.6%). CI was diagnosed in 88 (68.7%). PPT was offered to all the patients with MDS; 52 agreed to treatment and 71 refused. The following therapeutic groups were identified according to the performed therapy: 1) DMARDs (n = 39); 2) DMARDs + PPT (n = 43); 3) DMARDs + BAs (n = 32); 4) DMARDs + BAs + PPT (n = 9). The dynamics of MDS and the outcomes of RA were estimated in 112 (91.0%) and in 83 (67.5%) of the 123 patients at one-and five-year follow-ups, respectively. The efficiency of RA therapy was evaluated from the changes in DAS28 and SDAI. Results and discussion. One year later, the patients who had received the complete cycle of PPT and took DMARDs achieved a satisfactory effect twice more frequently (58.1 and 32.3%, respectively; relative risk (RR) = 0.53; 95% confidence interval (CI), 0.2-1.39; p = 0.024) and did not respond to therapy 3 times less often (21.0 and 58.1%, respectively; RR = 2.41; 95% CI, 0.87-6.71; p = 0.001) according to the EULAR criteria than those who had refused PPT. The patients with MDS who received DMARDs + PPT during one year were unresponsive to therapy significantly less frequently than those who received DMARDs and BAs without PPT (21 and 44.8%, respectively; RR = 0.6; 95% CI, 0.21-1.7; p = 0.029). After 5 years of follow-up, the probability of no response to RA therapy in MD patients who received only DMARDs was 3.6 times higher than in those who had PPT (66.7% and 10.4%, respectively; RR = 3.58; 95% CI 0.82-15.5; p < 0.001). The patients adequately treated with DMARDs and BAs for MDS according to the DAS28 showed 1.3-fold more frequently good and satisfactory results (100 and 76.2%, respectively; p = 0.14) than those who refused PPT, but these differences were not statistically significant because the DMARD+BA+PPT group was small. Five-year follow-up indicated that DAS28 remission was more common in the patients receiving DMARDs and PPT than in those who had DMARDs and no PPT (34.5 and 8.3%, respectively; RR = 1.79; 95% CI, 0.34-9.24; p = 0.024). DAS28 remission was somewhat more frequently observed among the patients receiving DMARDs, BAs, and PPT than among those taking DMARDs and BAs (33.3 19.0%, respectively; RR = 1.64; 95% CI, 0.28-9.57; p = 0.34), but these differences were insignificant. Remissions according to the 2011 ACR/EULAR criteria were achieved by only the patients having DMARDs and PPT (6.9% and 13.8% after 1 and 5 years, respectively). Conclusion. Adequate treatment of MDS in RA patients results in a significant increase in the efficiency of antirheumatic therapy.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Recently, development of medicine leads to the increase of the number and complexity of surgical interventions, explaining high significance of the risk assessments for post-surgical complications and probability of fatal outcome; this requires participation of internist in patients management with correction of therapy. The article is focused on the main scores and indexes utilized in clinical practice for prediction of possible complications, incl. cardial. A detailed description provided, for every calculator, features and limitations for usage and results interpretation.