Репозиторий Университета

© 2018 Izdatel'stvo Meditsina. All Rights Reserved. Subtle cognithe decline (SCD) is characterized by patients 'complai?Us about their memory and other cognirixe fimctions that do not make difficult professional or social acth'ity. Clinical neuivpsychological research reveals some changes, which does not fit defiiution of mild cognitive impairment. SCD as well as subjective cognithe degradation can predict more severe cognitive disorder, including dementia. The primary aim of the research was to analyze neuropsychological features of middle-aged and elder patients who sufferfrom SCD. PatietU groups were based on age, cardiovascular risk factor and the state of emotional condition. Material and methods. We analyzed the data of320patients, including 234 women and S6 men of45-59, 60-74, 75-S9 age groups. These results were compared to 104 healthy subjects of the same age groups. The research included clinical and neuropsychological evaluation of cognith'e fiinctions and emotional status. Results. The most significant differences between healthy subjects and the ones with SCD of various age groups were memory scores and executive functions as well as decline in Mini mental state examination and Frontal Assessme?it Battery. The dif-ferences in age connected cognitive status ofpatients with SCD and healthy ones were found. The comparison ofpatients with mild and subtle anxiety disorders with patie?its without emotional disorder of the same age has not revealed any significant differences. It was found that cardiovascular riskfactors influence frontal managing functions. C onclusion. The collected data confirm SCD specification amongpremild cognitive functions and decline show the peculiarities of age connected cognitive status as well as absence of negative connection between emotional disorder.

© 2018 Vysshee Obrazovanie v Rossii. All rights reserved. The article addresses the problem of epistemological basis of pedagogy and its research methods. This is particularly relevant in the light of the formation of theoretical framework in pedagogy. The following topical themes are discussed in the article: a) inductive, hypothetico-deductive and abductive reasoning in pedagogy, b) causal explanations of pedagogical phenomena, c) argumentation of pedagogical conclusions and consequences, including empirical, theoretical and contextual types of argumentation. The authors briefly touch upon the logical interpretation of “norm” and “evaluation” in pedagogy. The problems related to pedagogical theory constructing are identified including incompleteness of abductive model, insufficient evidence of all types of pedagogical argumentation and causal interpretation, and lack of clarity of the category “measure”.

© 2018 Ima-Press Publishing House. All Rights Reserved. Objective: to investigate the effectiveness of cognitive and motor training as an additional method to basic therapy in patients with Alzheimer's disease (AD) and vascular cognitive impairment (VCI). Patients and methods: The investigation enrolled 41 patients (15 women and 26 men; mean age. 73.59±6.3 years), including 32 patients with AD (mean age 74.94±5.15 years) and 9 patients with VCI (mean age, 72.31±4.98 years). Cognitive impairment (CI) corresponded to mild dementia in 15 patients (5 women and 10 men; mean age 74.6±2.8 years) and to moderate dementia in 29 (10 women and 19 men; mean age 72.1±3.2 years). The patients were randomly assigned to individual, group, and mixed (individual and then group) cognitive training groups. Quantitative scales were used to assess changes in CI and emotional and behavioral disorders after 1.5, 3, and 6 months of therapy. Results and discussion: During cognitive and motor training, all the groups showed a significant decrease in the severity of CI (p < 0.05), depression, anxiety, and apathy. The effectiveness of the training was further influenced by the severity of concomitant cardiovascular disease, the degree of apathy, adherence to the training, and the early initiation of basic symptomatic therapy. The greatest positive changes in anxiety and depressive disorders were noted in the patients receiving group cognitive and motor training. Conclusion: The results of the investigation allow group cognitive and motor training to be recommended as a mainstay in the therapy of patients with CI concurrent with emotional disorders.

© 2018 Izdatel'stvo Meditsina. All Rights Reserved. Subjective cognitive decline (SCD) is characterized by subjective complaints of patients about memory impairment and/or other cognitive functions accompanied by absence of significant changes during neuropsychological test. It is shown, that subjective cognitive decline may be a predictor of clinically significant cognitive disorder development to the extent of dementia. The primary aim of the research was the analyses of neuropsychological characteristics of patients with SCD depending on their age, gender, cardiovascular risk factors and their emotional affectivity. Materials and methods. The testing results of 150 patients (103 females, 47 males) aging from 45 to 59 and from 60 to 74 (66 patients) were analyzed in comparison with 92 healthy subjects of the same age. The research included clinical examination and application of scales and surveys, which estimate cognitive functions. Results. The most significant differences among healthy subjects were memory markers’ impairment as well as directory functions of the elder group. Patients with SCD additionally showed disorders of speech and constructive praxis deterioration. No significant differences in neuropsychological markers between SCD-positive and SCD-negative gender groups were not found. Comparison of patients with emotionally-affective disorder with healthy control of the same age did not reveal any significant difference. Either there was no influence of cardiovascular risk factors on neuropsychological testing indices. Conclusion. Analyses of possible age and gender factors accompanying emotionally-affective and cardiovascular changes that influence neuropsychological characteristics of patients with SCD showed the crucial meaning of age, being found in more indices of elderly people than the ones of the healthy group.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Urolithiasis (ICD) is one of one the most actual health problem in the world. The significant prevalence of urolithiasis in the population (at least 5% of the population in industrially developed countries) forces us to constantly investigate the etiology and pathogenesis, look for effective prevention mechanisms, improve diagnostic methods and develop new technologies for conservative and operative treatment. The relevance of urolithiasis in connection with global demographic shifts has become especially important in recent years. The constant displacement of the age pyramid of the developed countries society towards the proportion of elderly and senile populations leads to an increase in the ICD frequency. The development of endoscopic equipment, the creation of new contact lithotripotors improving the methods of nephrolithotripsy have made it possible to solve the problem of ICD. Currently, one of the topical issues is the choice of diagnostic method to predict and evaluate the effectiveness of treatment in patients with ICD. Studies have shown that urolithiasis directly affects intracellular hemodynamics. The change in renal blood flow in ICD patients depends on the nature of urodynamic disturbances, localization and size of the calculus, the duration of the disease, the presence of complications and the age of the patient. Therefore, evaluation of perfusion is necessary in studying of kidney function.

© 2018, Media Sfera. All rights reserved. Changes in ocular anatomy and topography that occur due to congenital development anomalies are often of complex, composite nature. Such pathologies are accompanied by not only refractive errors, but also changes in eye’s macrostructure. Careful analysis of the changes is necessary to better understand the clinical picture. Purpose - to study the specifics of structural and morphological changes of the eye in certain ocular congenital pathologies and in some orphan diseases using the results of three-dimensional ultrasound analysis and digital acoustic imaging. Material and methods. The study included 60 patients (119 eyes) with congenital ocular changes, some of which are registered as independent orphan diseases, as well as with systemic manifestations including congenital changes in eye membranes, lens and the vitreous body. The examination involved three-dimensional scanning followed by digital processing of the imaging data obtained using general medical ultrasound systems Voluson 730 Pro Kretz and Voluson E8. Results. Digital ultrasound technologies significantly expand the scope of data on eye morphology in various congenital changes obtainable in vivo. Conclusion. The advantage of this investigation method is the possibility to reliably detect congenital spatially complex morphological deformations in the eye tissues, which in some cases are impossible to observe with other methods.

© 2018, Dynasty Publishing House. All rights resvered. The work specifies the indications and conditions for surgical treatment of patients with uterine leiomyoma. The role and clinical significance of ulipristal acetate (UPA, Esmya) in a complex treatment of patients with uterine leiomyoma of varied localisation of nodules according to the FIGO classification have been determined. Special attention is paid to the problem of drug-induced liver injury (DILI) against the background of intake of Esmya. As has been shown, there no reasons to associate UPA with DILI, since (1) UPA does not pertain to the group of drugs associated with a risk for DILI; (2) no cases of DILI have been recorded in patients receiving UPA in a therapeutic dose (5 mg). Treatment with UPA should be administered with control of transaminases. If ALT or AST activity exceeds 2×upper limit of normal (ULN) either isolatedly or in combination with bilirubin >2 × ULN, the intake of Esmya is contraindicated.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To evaluate the incidence and prevalence of hepatitis C in Russia and estimate the impact of hepatitis C virus on liver cirrhosis, hepatocellular carcinoma and liver-related mortality before the implementation of the national program for the elimination of viral hepatitis. Materials and methods. We analyzed statistical data on the incidence of hepatitis C in Russia in 2001–2017, the incidence, prevalence and mortality rates from liver cirrhosis and malignant liver tumors in 2011–2015. An analysis of the incidence and prevalence of HCV was carried out in various age-sex groups. The structure of genotypes of the hepatitis C virus was determined in patients at different stages of liver fibrosis and with different levels of viral load. Results. In 2017, 50 798 cases of HCV were registered in Russia (34.6 per 100 thousand of the population). As of January 1, 2017, the total number of patients with chronic hepatitis C under medical observation was 591 830 (405 per 100 thousand population). The incidence rate of fibrosis and cirrhosis in Russia in 2015 was 12.7 per 100000 population (18640 cases), the total number of registered patients – 75.9 per 100 thousand population (110951 people). The incidence rate of malignant liver tumors in 2015 was 5.5 per 100 thousand population (8083 cases), the total number of patients on dispensary observation was 5.0 per 100 thousand population (7360 people). In 2015, the estimated number of deaths from liver cirrhosis and hepatocellular carcinoma in the outcome of chronic hepatitis C was 14 792 and 1635, respectively. Conclusion. Hepatitis C is the main cause of liver cirrhosis (excluding alcoholic etiology), hepatocellular carcinoma and liver-related mortality in Russia. To reduce the prevalence of HCV and mortality from liver cirrhosis and primary liver cancer, it is necessary to provide all patients with HCV with antiviral drugs.

Published by Oriental Scientific Publishing Company © 2018. The study assessed stress and brux activity among dental students during exam (stress) and non-examination (non-stress) periods. The study was initiated as a single group design with the total number of participants 36 (25 females and 11 males). All the participants were examined twice (once in a stress period and once in a non-stress period) according to “Clinical Functional Analysis”, which includes questions about students’ medical and dental history, as well as muscle palpation results. Two «BruxCheckers» (BCs) were applied, one for the upper jaw, the other for the lower jaw, two times for examination and non-examination periods. After the use, the «BCs» were photographed according to the research protocol and the abraded facets area on «BCs» was calculated in square millimeters. The research showed that during a stress period students may have headaches, cramps and pain in shoulder and neck muscles. The research also revealed that during the stress situation the abraded area shifts from frontal teeth to chewing teeth and brux episodes can occur more frequently and with a higher load. Chewing teeth (premolars in our study) are more adapted and more useful for such a condition. Accordingly, our students shifted their brux behavior from teeth 33 and 31 to teeth 15 and 24. Therefore, exams are a strong stress factor for dental students. In turn, prolongated stress can be an indicator of risk factor and have a negative effect for health of the craniomandibular system.

© 2018 Izdatel'stvo Meditsina. All rights reserved. NMDA receptor modulators are a new class of antidepressants with rapid onset of action and lasting antidepressant effect. These drugs increase BDNF level in CNS and adult hippocampal neurogenesis, which events are in common for both NMDA receptor modulators and classical antidepressants. However, unlike classical antidepressants, drugs of this new group produce no direct influence on the monoaminergic system, but regulate the neuroplasticity in the prefrontal cortex and hippocampus via modulation of the glutamatergic neurotransmission. Clinical tests of ketamine and rapastinel confirmed the rapid onset of action and the continuation of stable antidepressant effect (upon single administration per 7 days) for both usual and treatment-resistant forms of depression.

© 2019 American Psychiatric Association. All rights reserved. Abnormal mobility of the posterior membranous wall of the trachea and large bronchi is seen in many bronchopulmonary chronic inflammatory diseases. Currently, clear explanation of a mechanism of the expiratory tracheal stenosis (ETS) is absent. The advanced ETS is associated with severe ventilation abnormalities including asphyxia and syncope. The latter conditions are considered as indications for surgical treatment. Results of the surgical treatment are controversial and are not fully acceptable. For this reason, the surgical treatment for ETS is not routinely used and any successive case of such treatment is of great interest. Strict indications, such as life-threatening conditions or failure of optimal medical treatment, are required for surgical treatment of patients with tracheomalacia and ETS. Surgical treatment for tracheomalacia and ETS is contraindicated in the case of lobar bronchial lesion impeding stabilization the membranous part of the tracheobronchial tree.

© 2018, Media Sphera Publishing Group. All rights reserved. Psychogenic pain is one of the urgent problems of medicine. To date, pathogenetic mechanisms of development of pain syndrome are unclear, there is no uniform classification. Pain, developing in patients with a mental disorder without an organic damage to the nervous system, and pain, which is a complication of an already existing pain syndrome of neuropathic or nociceptive nature, should be considered separately. Treatment of psychogenic pain syndromes should be integrated with the mandatory use of methods aimed at modifying the patient’s lifestyle and attitude towards the illness.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. An analysis of typical medical errors in the diagnosis and treatment of compression neuropathy of the median nerve at the level of the wrist (carpal tunnel syndrome - CTS). Material and methods. Previous diagnoses and treatment of 85 patients with CTS (14 men and 71 women), aged from 36 to 84 years (middle age 62±10.6 years), who underwent surgery in our clinics were evaluated. Results. The wrong diagnosis was made in most of patients (60%). The osteochondrosi s of cervical spine (45.8%) and diabetic polyneuropathy (5.8%) were the most common mistaken diagnoses. Proper neurophysiological measurements using the Phalen’s test and Tinel’s sign were not performed in the majority of patients. Magnetic resonance imaging (MRI) of the cervical spine was often unreasonably made, the electroneuromyography was not used. Nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin B group were improperly prescribed to the patients diagnosed with CTS. Local corticosteroids injections were not prescribed to most of patients, immobilization of the wrist was not recommended at the early stage of disease and decompressive surgery at the advanced stage of disease. Clinical observation of the patient with long period of misdiagnosing is presented. Despite the long-standing history of CTS, surgical decompression led to regression of symptoms and complete professional rehabilitation. Conclusion. It is necessary to inform physicians about manifestations, diagnostic criteria and effective methods of treatment of CTS.

© 2018 Academic Research Publishing Group. The use of new information technologies in the educational process intensifies the need for analyzing the existing resources suitable for teaching students in conformity with professional standards. The objective of this study is to consider the significance of survey services in teaching students market research, to analyze the efficiency of survey services, to prove their positive impact on the learning process and to determine requirements for educational survey services. The materials of the study were students' reports on conducting consumer surveys using either paper or online questionnaires. The research is based on a pedagogical experiment to analyze the applicability of Internet resources in the educational process. The results of students' research were processed through the comparison of the data obtained. The authors of the article have developed the life cycle of educational survey services. Based on stages of the life cycle, the authors have determined desired functional characteristics of free survey services, which will simplify the task of selecting a suitable educational tool. It has been confirmed that the exclusive use of Internet technologies in teaching students market research cannot be sufficient, and they should be used in combination with basic approaches to a marketing theory. The conducted pedagogical experiment has proved the consistency of Internet technologies as an educational tool. The authors of the article have revealed that despite undeniable advantages of online survey services they also have significant shortcomings, which makes it impossible to completely replace classic methods of collecting market information from this moment on. The introduction of free survey services into the educational process increases teaching efficiency and develops professional competencies within the existing standards. Defining functional requirements of the above-mentioned life cycle, teachers can choose the best educational survey service taking into account the stages students will go through while using it. An extensive use of information technologies is essential to the formation of new teaching materials and the renewal of the existing ones based on the synthesis of the classical theory of marketing and innovations.

AIM: To determine significant predictors of long-term outcomes of surgery for portal cholangiocarcinoma. MATERIAL AND METHODS: Analysis included 49 out of 84 patients who were operated at the Vishnevsky Institute of Surgery in 2003-2016. Morphological examination (2011-2016) revealed great percentage of following positive variables: micro- (42.9%) and lymphovascular invasion (11.8%), positive resection margin (59.2%), perineural invasion (83.3%), depth of invasion - (83.3%), cells in surrounding fatty tissue (92.3%), invasion of entire thickness of bile ducts' walls (57.1%). Hemihepatectomy was carried out in 50 (59.5%) cases, advanced hemihepatectomy - in 16 (19%) patients. Left-sided hemihepatectomy (34.6%) was more common compared with right-sided hemihepatectomy (8.6%) for biliary confluence lesion (Bismuth-Corlette type IV). RESULTS: TNM stage (p=0.29), tumor localization Bismuth-Corlette type (p=0.10), regional lymph nodes metastases (p=0.77) do not significantly affect survival in univariate analysis. At the same time, TNM stage was significant factor if patients dividing into groups was considered (p=0.05). In regression analysis tumor cells differentiation (p=0.00028), positive resection margin (p=0.0034), perineural invasion and depth of invasion (p=0,00086) were significant predictors of survival. Multivariate analysis confirmed prognostic role of lymphovascular invasion alone (p=0.05). There was no correlation between survival and TNM stage (η=0.057), depth of invasion (η= -0.229) and lymphovascular invasion (η= -0.143645). There was significant reverse moderate correlation between survival and perineural invasion (η= - 0.468750), resection margin (η= -0.558) and tumor differentiation grade (η= -0.481). CONCLUSION: Significant predictors of long-term outcomes of surgery for portal cholangiocarcinoma are TNM stage, lymphovascular invasion, tumor cells differentiation, perineural invasion.

The article presents a clinical observation of ocular thrombotic microangiopathy in atypical hemolytic-uremic syndrome - a rare genetic disease characterized by systemic thrombosis caused by uncontrolled activation of alternative complement pathway. A typical manifestation of this ocular lesion in this disease is bilateral Purtscher-like retinopathy. Timely diagnostics of atypical hemolytic-uremic syndrome, including ophthalmologic examination, determines the early start of a highly effective pathogenetic therapy with complement inhibitor eculizumab.

© 2013-2018 Federal Scientific Center for Medical and Preventive Health Risk Management Technologies. Yessotoxin (YTX) is a polyether. There are more than 90 known derivatives of yessotoxin. YTX was excluded from diarrhea toxins group as it, unlike okadaic acid, doesn't cause diarrhea. YTX chemical structure is similar to that of brevetoxins and ciguatoxins that influence functioning of calcium-sodium pump and trans-membrane ion channels. So, YTX can exert influence on functioning of all the organs and systems in a body. YTX is known to promote apoptosis in the cerebral tissues. Average lethal dose LD50 for YTX and its analogues varied from 100 μg/kg to 500-750 μg/kg; the figures were obtained in various experiments performed on mice. Safe YTX level for acute impact (acute reference dose) amounts to 25 μM/kg of body weight. Nowadays toxicity parameters for YTX and some of its analogues are determined; its basic action mechanisms and a role it plays in promoting apoptosis are well-known. In spite of more and more data on biological effects produced by YTX on a warm-blooded organism, experts are still unable to describe its action mechanisms precisely. Our research goal was to examine YTX toxicity in experiments in vivo in doses that were lower than the detected acute reference dose. The experiment was performed on 72 male Wistar rats with initial body weight being equal to 100±10 g. Animals were given dry balanced feedstuffproduced by "Laboratortakorm" LLC (Russia) and had free access to it. We used YTX preparation produced by "National Research Council Canada" (Canada) in our experiment; the preparation was a methanol solution (YTX content was equal to 4.3 μmol). We determined mass of internal organs, biochemical and hematological blood parameters, apoptosis of brain cells, malonic dialdehyde level in the brain and reduced glutathione in the liver. We showed that YTX doses (2μM/kg, 8μM/kg and 12μM/kg) lower than ARfD=2μM/kg can exert toxic impacts on a warm-blooded organism. The obtain data prove it is necessary to additionally assess risks of an increase in maximum permissible YTX contents in shellfish from 1 mg/kg to 3.75 mg/kg.

© The authors team, 2018.All Rights Reserved. Purpose: to evaluate effectiveness of Oscillococcinum in the treatment of acute respiratory viral infections (ARVI) in children of different age groups. We observed 140 children from 1 to 14 years with mild to moderate-severe acute respiratory viral infection. 80 children (Group 1) were treated with Oscillococcinum, 60 children (Group 2) were treated symptomatically. Group 1 was divided into Subgroup 1А (40 children of 1-5 years old) and Subgroup 1B (40 children >5-14 years old). Group 2 was divided into Subgroup 2А (30 children of 1-5 years old) and Subgroup 2B (30 children >5-14 years old). The follow-up period was 7-10 days. Clinical efficacy was assessed by the severity of ARVI symptoms in scores from 0 to 2. All adverse events of the therapy were recorded. Also we evaluated disappearance of ARVI symptoms within 48 hours after the beginning of the therapy. Results: Oscillococcinum reduced the duration of ARVI in children of different age groups. During the first two days the symptoms of acute respiratory viral infection disappeared in 13 (16.3%) children of Group 1 receiving oscilococcinum and in 4 (6.7%) patients from Group 2 (OR = 2.7, 95 % CI 0.8-8.8, p <0.001). Conclusion: Oscillococcinum is an effective and safe drug to treat ARVI in children of different age groups.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To study the quality of life of feeding mothers and toe establish whether the adherence to breastfeeding influences physical and mental health of women. Patients and methods. We conducted a questionnaire survey of 151 mothers who had small infants. Their quality of life was studied with the help of the SF-36 questionnaire. Results. As we have found, the higher is the material wellbeing of the family, the less women adhere to breastfeeding (per capita income of the family of breastfeeding mothers are almost 2 times lower than in nonbreastfeeding women – 22500 ± 3.800 and 43958.33 ± 4.240 rubles, respectively, р < 0.05). Subjective perceptions of physical health (functioning), parameters of life activity (Vitality – VT) and subjective assessment of their health (General Health – GH) were similar in both breastfeeding and nonbreastfeeding mothers (VT 56.48 ± 3.77 and 58.33 ± 2.91; GH 68.52 ± 4.13 and 65.83 ± 1.95, р > 0.05). Irrespective of breastfeeding adherence, women after childbirth did not report of worsening of their health (50.93 ± 4.01 and 44.79 ± 2.61, respectively, р > 0.05). But in breastfeeding mothers parameters of the quality of life were demonstrative of a higher endurance (physical functioning 73.89 ± 1.66 and 85.22 ± 3.19, role functioning 52.78 ± 2.16 and 65.63 ± 3.73, р < 0.05). Breastfeeding mothers more rarely had difficulties in routine activities due to their physical condition and pain (bodily pain 73.89 ± 3.77 and131.35 ± 2.16, р < 0.05), physical and emotional condition did not interfere with communication and social activity (social functioning 67.13 ± 1.93 and 139.8 ± 6.92, р < 0.05, mental health 95.11 ± 7.18 and 58.17 ± 8.11, р < 0.05). They are less prone to depression and have higher values of the positive emotions parameter (role emotional functioning 64.08 ± 3.98 and 215.73 ± 12.67, р < 0.01). Conclusion. The results of the study can be used in programmes aimed at expanding breastfeeding.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To study the effectiveness of two-step treatment of female patients with cervical intraepithelial neoplasia (CIN) associated with papillomavirus infection (PVI). Patients and methods. 126 female patients of reproductive age were examined (mean age – 31.4 ± 2.1 years), in whom CIN was associated with papillomavirus infection (PVI). In all cases, cervical pathologies – low-grade squamous intraepithelial lesions (L-SIL) have been found. In all patients treatment included a surgical step (laser and plasma energy) and medication, which was employed in 101 (80.1%) patients (treatment group). 25 (19.9%) women comprised the control group, since they did not receive post-operative pathogenetic therapy. In the treatment group, patients received an immunostimulating and antiviral drug inosine pranobex (IP) – Isoprinosine. Results. The effectiveness of treatment was assessed after 60 and 120 days from the termination of complex therapy (treatment group), or surgical intervention (control group). After a 60-day period, complete elimination of virus was noted 97 (96%) patients of the treatment group and in 18 (72%) of the control group. After 120 days, PVI relapse was recorded in 3 women of the treatment group (3%) and in 4 (22%) – of the control group among patients with complete elimination of virus. Conclusion. The use of IP as monotherapy is an optimal solution ensuring minimal risks of relapses of pathological PVI. Preparations of pure IFN and their inductors do not always promote complete elimination of PVI owing to interferon resistance of HPV-infected patients.