Репозиторий Университета

© 2018 Medical Education. All rights reserved. The article provides a review on prevalence, phenotypes, endotypes, and the control of severe bronchial asthma. Severe asthma is a widespread, heterogeneous disease that affects 5 - 20% of patients with bronchial asthma. Prevalence of severe asthma in Russia significantly exceeds the official statistics data, therefore it is necessary to maintain a national register of patients with severe asthma. The conventional therapy for severe asthma is not always effective due to the uncontrolled course of the disease and eosinophilic airway inflammation. The identification of asthma phenotype/endotype is reasonable to develop a personalized approach to treatment. This approach allows to achieve better control of the disease and to minimize the risk of asthma exacerbations, fixed airway obstruction and adverse effects of the pharmacological therapy. The main changes in the Global Strategy for Asthma Management and Prevention (GINA, 2018) concerning severe asthma therapy are highlighted in this article. It is also emphasized that the use of monoclonal IL-5 and IgE-antibodies could contribute to successful treatment of patients with uncontrolled severe asthma. Currently, two immunobiological drugs have been registered in Russia, omalizumab (anti-IgE antibody) and reslizumab (anti-IL-5 antibody).

© 2018 ABV-Press Publishing House. All rights reserved. Modern anticancer therapy due to its intensity and molecular biology orientation allows achieving higher efficiency and theoretically reducing the incidence of complications. However, the increase in efficacy in the modern oncology really exists, but reducing complication frequency, unfortunately, is far from being solved. In many respects the problems of diagnosis, treatment and complications monitoring are associated with the impact on the complex physiological processes occurring in oncological patient. Timely implementation of modern and adequate programs for the prevention and treatment of these complications defines the concept of "supportive therapy", which provides at least half the effectiveness of antitumor treatment. To date, according to most studies, the most frequent complications of antitumor therapy are hematologic, in particular - anemia. In clinical practice, blood transfusions, recombinant human erythropoietins, hemopoiesis stimulating cofactors are used to correct this type of complications. The need for anemia treatment is determined by its negative impact on quality of life, as well as a negative prognostic impact on the life expectancy of cancer patients, because hypoxia of tumor tissue can be associated with resistance to chemo- and radiation therapy, the stimulation of genetic mutations and neoangiogenesis, which make it difficult to control of tumor growth. In numerous studies using multivariate analysis confirmed the association of low hemoglobin levels and/or tumor tissue hypoxia with worsening prognosis and overall survival in many types of tumors. The modern anemia treatment should not be determined only by increased in hemoglobin level, but should be considered as an active prophylaxis for its reducing. Recombinant forms of human erythropoietin and intravenous forms of iron preparations should be the most popular correction methods in everyday practice. The high cost of complex anemia therapy and the social significance of oncological diseases necessitate a pharmaco-economic analysis of registered in Russia erythropoietin preparations and the optimization of existing anemia treatment regimens in cancer patients in order to reduce the expenditures of the health budget. At present, an active import substitution program is underway in the Russian Federation to support the development of the Russian pharmaceutical industry and provide the population with more affordable medicines while maintaining its quality and efficiency. The need to address these issues, and the effective use of the domestic biological analogue epoetin alfa, served as an excuse for performing a comparative clinical and economic analysis. They were selected drugs that differ in pharmacokinetic properties: Eralfon® - analogue of epoetin alfa and Aranesp® - darbepoetin alfa. The treatment model of adults oncological patients with anemia receiving chemotherapy was created, which takes into account various therapies using erythropoietin preparations. The total therapy cost for an oncological patient with anemia is less when using short-acting erythropoietin - epoetin alfa - 131 609 rubles in comparison with the long-acting erythropoietin - darbepoetin alfa - 245 159.2 rubles, the difference was 113 550.2 rubles (-46 %) in favor of the epoetin alfa. According to pharmaco-economic analysis, the treatment of anemia with a Russian-produced drug epoetin alfa (Eralfon®) is preferred in comparison to darbepoetin alfa (Aranesp) in adult cancer patients with nonmyeloid malignancies in the Russian Federation, as it allows increasing the number of treated patients at a cost reduction.

© 2018 Media Sphera Publishing Group. All rights reserved. Objective. To clarify the association between HLA-DRB1 and TNFα (-308G>A) genes polymorphism and joint destruction/further progression during 12 months of the follow-up period (FUP) in patients with early (<6 months), active, predominantly antibodies to cyclic citrullinated peptide (ACCP) and rheumatoid factor (RF)-positive rheumatoid arthritis (RA) treated according to "Treat to target" strategy. Materials and Methods. The study included 85 patients with early RA and duration of symptoms <6 months. All patients were initially assigned to subcutaneous methotrexate (MTX) with rapid dose escalation to 20-25 mg/week. Combination MTX + biological therapy, mainly adalimumab, was used when MTX was ineffective. Joint destruction was assessed by Sharp-Van der Heijde modification scoring method at baseline and after 12 months FUP. Real time polymerase chain reaction (PCR-RT) was used for TNFα gene polymorphism (-308G>A) genotyping. Low resolution PCR-RT with subsequent sequence-based typing of ∗04 were performed to study HLA-DRB1 gene polymorphism. The HLA-DRB1∗01, ∗04:01, ∗04:04, ∗04:05, ∗04:08, ∗10 alleles were categorized as SE+ (Shared Epitope) alleles. Results. As for TNFα gene polymorphism, it was demonstrated that the number of narrowings and total Sharp score values were almost twice as high at baseline in GG genotype carriers as compared to GA genotype carriers (ρ<0,005, and ρ<0,004 respectively). Similar association was found after 12mo FUP. The progression of joint destruction, assessed as the change (Δ) in the number of erosions, joint space narrowings and the total score, was statistically significantly associated with HLA-DRB1∗(SE) genotypes: The carriers of SE (SE+/SE+) double-dose had more advanced progression as compared to (SE+/SE-)/(SE-/SE-) carriers (ρ<0,028, ρ<0,019, ρ<0,035 respectively). Conclusion. Our data suggest that HLA-DRB1 (SE+) gene and TNFα (-308G>A) polymorphisms are associated with the progression of radiographic joint destruction in early, active RA patients managed according to "Treat to target" stratagy.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. The article is focused on a broad evidence of antihypertension efficacy of perindopril and bisoprolol. The issues considered, of the drugs usage in patients with arterial hypertension, ischemic heart disease and chronic heart failure according to the international and local clinical guidelines. Special attention is paid for the influence of perindopril and bisoprolol on prognosis - the risk of cardiovascular complications from the evidence based medicine perspective. The data provided on a novel unique combination of these medications, and the benefits are accounted, as the mechanism of complimentary interaction; the results of randomized trials, clinical trials provided, that point on the high potential of this sort of combinational treatment.

© 2018, Slovenska Vzdelavacia Obstaravacia. All rights reserved. The approach to studying society in the postmodernist framework is relevant to understand postmodernist paradigm in contemporary philosophy. The rapid development of computerization and mass media in postmodern culture has been destroying the quality of human interaction with the surrounding environment and social reality, causes a feeling of losing touch with reality. This is due to the emergence of many virtual realities. The purpose of the article is to analyze the anthropological ideas in the philosophy of postmodernism. Postmodern anthropology is realized not only in the context of scientific revolution and internal form of culture but also as self-consciousness of modern civilization. Postmodernists prefer to discuss human beings as not whole self-contained individuals, units that may be broken down (divided), and call them ‘dividuals,’ beings or persons significantly distinct from their modern descendants, this being the best characteristic of the modern social state and contrasting to a Cartesian tradition. Methodologically the article is based on a systematic approach combining structural-functional, dialectical and hermeneutical methods. This approach allows us to reveal essential aspects of postmodern philosophy in their dialectical interrelation, to overcome constraints inherent in the heuristic potential of certain methodologies. The survey covers issues related both directly to the field of general theoretical postmodern philosophy and social sciences and makes a review on the researches on the human identity in the postmodern era. The analysis conducted made it possible to distinguish the main characteristics of postmodernism. The main intention of postmodernism considered is the crushing criticism of traditional values: humanism, rationalism, radicalism towards social structure and development, its rejection, denial of individuals' ability to be responsible for their actions, their inability to resist the power of supranational structures.

© 2018 Society for Industrial and Applied Mathematics. In this paper, we study a new numerical method for the solution of partial differential equations on evolving surfaces. The numerical method is built on the stabilized trace finite element method (TraceFEM) for the spatial discretization and finite differences for the time discretization. The TraceFEM uses a stationary background mesh, which can be chosen independent of time and the position of the surface. The stabilization ensures well-conditioning of the algebraic systems and defines a regular extension of the solution from the surface to its volumetric neighborhood. Having such an extension is essential for the numerical method to be well defined. The paper proves numerical stability and optimal order error estimates for the case of simplicial background meshes and finite element spaces of order m \geq 1. For the algebraic condition numbers of the resulting systems we prove estimates, which are independent of the position of the interface. The method allows that the surface and its evolution are given implicitly with the help of an indicator function. Results of numerical experiments for a set of 2D evolving surfaces are provided.

© Team of authors, 2018. The article describes the clinical case of subacute myocarditis in a child with an outcome in dilated cardiomyopathy, complicated with congestive heart failure. Difficulties in diagnosing the disease that manifested with cardiac arrhythmia are discussed. The main signs suggesting postmiocardic cardiomyopathy included a reduced deflection voltage and frequent ventricular extrasystoles with episodes of the ventricular tachycardia in the onset of the disease, left ventricular dilatation, a significant decrease in ejection fraction, increased activity of natriuretic peptide, findings of perfusion scintigraphy and magnetic resonance imaging. Medical therapy and implantation of a cardioverter defibrillator were ineffective. The child repeatedly suffered from syncopal conditions with circulatory arrest, which required resuscitation. Due to the ineffectiveness of drug therapy conducted in the leading federal centres, considering cardiac transplantation abroad was recommended.

© 2018, Dynasty Publishing House. The assessment of thrombosis and bleeding risks is one of the most important tasks of laboratory diagnostics of disorders in the hemostasis system. For this purpose the highly specialized tests are not always appropriate, because these assays are focused on specific markers or pathologies of individual links: the level of coagulation factors, the level of D-dimers, ADP- and serotonininduced platelet activation, effects of acetyl salicylic acid on aggregation. Nowadays, integral assays are the most promising approach, simulating hemostatic process in vivo - thromboelastography, thrombodynamics, thrombin generation. These tests are designed to specify the risk of thrombosis or bleeding with co-origin, as well as screening and monitoring of drug therapy. One of the approaches in the development of integral assays are flow systems where plasma or whole blood flow is formed over the hemostatic activator, and the growth of the thrombus is recorded on the video. There are commercially available samples of such devices, and some experience of its application in clinic. However, there are no uniform standards and clinical guidelines. This review describes examples of flow chambers exploitation for diagnosis, existing problems of its usage and the opportunities that it can provide to the clinicians.

© 2018 Dynasty Publishing House. All rights reserved. The objective. To study the level of knowledge of paediatricians on problems of antimicrobial therapy of respiratory tract infection with determination and analysis of the most common mistakes. Materials and methods. In 2016-2017, knowledge of antimicrobial therapy of respiratory tract infections in children was tested among 238 paediatricians in five cities (Yekaterinburg, Kirov, Novosibirsk, Surgut, Ufa). Testing included twenty stem questions composed according to modern clinical guidelines. Five answer choices were offered to each question, of which one or several were correct. Assessment of the results took into account both chosen and unchosen answers (maximally possible score was 100). The result of 91-100 scores was assessed as «excellent », 81-90 - «good», 71-80 - «satisfactory», 70 and less - «unsatisfactory». Results. The average score was 70.5. In different cities the average score was as follows: in Yekaterinburg - 71.7, in Kirov - 73.8, in Novosibirsk - 74, in Surgut - 69.3, in Ufa - 63.5. Only one physician's answers were assessed as «excellent» (0.42%), answers of 40 physicians were «good» (16.81%), 88 answers - «satisfactory» (36.97%) and 109 answers - «unsatisfactory» (45.8%). Conclusion. The study has shown insufficient knowledge of paediatrician on problems of antimicrobial therapy of respiratory tract infections. These data may be used in preparing educational programmes for physicians.

© 2018 SPIE. We have proposed a concept of monitoring ice ball formation in biological tissues during cryodestruction process via spatially-resolved detection of elastic light backscattering. For this purpose, we developed an experimental setup for study cryodestruction by using applicators based on sapphire shaped crystals with internal channels for optical irradiation of biotissues and detection of backscattered light. Due to the unique physical properties of sapphire, i.e. high thermal, mechanical, and chemical strength, high thermal conductivity and optical transparency, the sapphire cryoapplicators yield combination of the tissue cryodestruction with the optical control of tissue freezing. We have shown experimentally that using the proposed concept of applicator with several channels, it is possible to monitor changes of the ice ball during the cryodestruction process.

© 2018 Russian Transplant Society. All rights reserved. Aim: To develop an optimal surgical tactic for implantation of "AVK-N" system as a "bridge" to heart transplantation. Materials and methods. 17 patients were included. They were operated in the period from 2012 to October 2017 in Federal State Budgetary Institution V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs. A tiny implantable system Portable device for assisting cardiac circulation (AVK-N; Russia) was used for replacing the pumping function of the left ventricle. All patients were examined according to the program of potential recipients for heart transplantation, before the applying of prolonged mechanical circulatory support. Among the operated patients there were 16 (94.1%) men and 1 (5.9%) woman, the average age was 52.64 ± 10.56 (from 33 to 67 years). All patients had congestive heart failure III-IV functional class according to NYHA, refractory to optimal drug therapy. Heart failure was triggered by dilated cardiomyopathy in 12 (70,58%) cases, and by postinfarction systolic dysfunction of the left ventricle in 5 (29,42%). Implantation of AVK-N system was performed to potential recipients of the donor heart with terminal stage of CHF with a decrease in LV ejection fraction up to 10%. Results. As a result of this study there were developed several technological aspects facilitating the subsequent heart transplantation. Conclusion. Our experience in optimizing the surgical tactics of the "AVK-N" system implantation as a bridge to heart transplantation, demonstrated the possibility and safety of its active use in both patients with terminal heart failure on the waiting list of heart transplantation and patients having temporary contraindications to HTX.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Results of investigation of the analgesic activity of the natural recombinant peptide PT1, which specifically binds to P2X3 receptors, are presented. The test for hypersensitivity provoked by complete Freund's adjuvant (CFA) showed evidence of the analgesic activity of PT1 peptide in CD-I mice after single intravenous administration in a dose range of 0.01-1 mg/kg.

© 2018 Lippincott Williams and Wilkins. All rights reserved. The objective - of the present work was to develop the forensic medical criteria for the evaluation of the unfavourable outcomes of the roentgeno-endovascular operations (REVO) on the arteries of the lower extremities. The study included the analysis of the conclusions based on the results of the commission forensic medical examinations, attorney inquiry reports, query response, medical histories of the hospitalized patients who had undergone the roentgeno-endovascular operations on the arteries of the lower extremities. The criteria for the forensic medical evaluation of the unfavourable outcomes of the roentgeno-vascular operations on the arteries of the lower extremities have been proposed together with the indications for REVO, methods and tools for the performance of these surgical procedures. Particular attention was given to the identification of the signs and prognostics of the unfavourable outcomes of the roentgeno-endovascular operations (both intraoperatively and during the early postoperative period and the subsequent stay in the hospital) and to the risks of the development of the unfavourable outcomes of the surgical interventions following the technically adequate REVO. Special emphasis is placed on the cause-and-effect relationship between the actions or a failure to act on the part of an emergency physician and/or an attending surgeon/cardiovascular surgeon and the possibility of the unfavourable outcomes of the roentgeno-endovascular operations.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The article presents modern ideas about the treatment of systemic lupus erythematosus (SLE). The details of the management of patients with SLE during immunosuppressive and genetically engineered therapy is given. The article also reflects the aspects of rehabilitation, prevention of exacerbations, and follow-up care of children with SLE. The criteria for assessing the quality of medical care for children with SLE are presented. The detailed information on systemic lupus erythematosus for patients with SLE and their parents is outlined specifically.

© 2018, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved. Chronic wounds with impared wound healing that require prolong time for healing remain unsolved problem of modern medicine. Excessive oxidative stress plays an important role in the pathogenesis of chronic wounds caused by aging, diabetes and other pathologies. This review is aimed at the role of mitochondria in oxidative stress and to the future prospects for using the innovative mitochondria targeted antioxidants for treatment of impaired wounds. Recent studies in old mice and mice with type 2 diabetes showed that the mitochondrial antioxidant SkQ1 [10- (6'- plastoquinonyl) decyltriphenylphosphonium] stimulates healing of full-thickness dermal wounds. SkQ1 accelerates inflammatory stage of wound healing, maturation of granulation tissue, angiogenesis and epithelization of wounds. The anti-inflammatory effect of SkQ1 is possibly connected to decreased inflammatory activation of the vascular endothelium, which is typical for aging, diabetes and other pathologies. Local administration of SkQ1 also accelerates wound healing and provides strong anti-inflammatory effect in the model of acute aseptic inflammation. In addition, SkQ1 to stimulate apoptosis of neutrophils and suppresses their activation, as well as suppresses inflammatory activation of mast cells. In the wound model in vitro, SkQ1 accelerates movement of epithelial cells and fibroblasts into the «wound» and stimulates differentiation of human subcutaneous fibroblasts to myofibroblasts. Reviewed data suggest that SkQ1-based topical drugs have a great potential to treat wounds that exhibit impaired healing also in patients suffering from chronic critical illness.

© 2018, Slovenska Vzdelavacia Obstaravacia. All rights reserved. Inter-ethnic and inter-confessional peace is an essential factor for sustainable development, civil society, and preservation of statehood. The most significant challenges we face today, especially the last few years, are closely connected with an acute problem of avoiding ethnic and inter-confessional conflict risks, and erosion of national and civic identity as a result of globalization. Social philosophy approach to the understanding of national and civic identity is important because any identity is a social construct formed in social interaction, and the use of philosophical methods can provide the study involving all factors that influence this phenomenon: political, economic, social, psychological, and others. The purpose of this article is to study possible targets to prevent ethnic and confessional conflict risks and preserve the unique national and civic identity of each nation and each state. Methodological basis for the research comprises philosophical principles, including dialectic synthesis, the transformation of quantity into quality and vice versa, and dialectical contradictions; a philosophical principle of determinism; and a system activity approach. The leading theoretical method to study the problem is a content analysis of scientific papers relevant to the issue under consideration, and factors affecting and contributing to distortion of national and civic identities. The article discusses the definition of identity as the protean term self, self-identity of an individual, a particular group affiliation according to the person's nationality, religion, social status, profession, etc. The inadequate treatment and false interpretation of history, the absence of a national or patriotic idea that is able to unite the people, the insufficient role of the state, and enforcing unconventional views, norms and values have been considered as risks encouraging national and civic identity distortion. The risk of ethnic and religious conflicts occurs when there is a discrepancy between national and civic identities, or their distortion due to economic, political, social crises, or, as it sometimes happens, external influence.

© COPYRIGHT SPIE. Downloading of the abstract is permitted for personal use only. In this paper, we demonstrate instruments for laser radiation delivery based on sapphire capillary needles. Such sapphire irradiators (introducers) can be used for various medical applications, such as photodynamic therapy, laser hyperthermia, laser interstitial thermal therapy, and ablation of tumors of various organs. Unique properties of sapphire allow for effective redistribution of the heat, generated in biological tissues during their exposure to laser radiation. This leads to homogeneous distribution of the laser irradiation around the needle, and lower possibility of formation of the overheating focuses, as well as the following non-transparent thrombi.

© 2018 Frontiers in Bioscience. All Rights Reserved. We review the progression of aging as a sequential development of multiple syndromes analogous to other diseases. This generalized approach may allow practicing physicians to consider the signs of aging as manifestations of a poly-syndrome disease and facilitate prevention, diagnosis and treatment of common aging-related dysfunctions.

© 2018 Media Sfera. All rights reserved. Endocrine ophthalmopathy (EOP) is a severe chronic autoimmune disease associated with autoimmune thyroid pathology that leads to loss of sight, cosmetic defects and quality of life decrease. EOP is difficult to give prognosis for due to various factors affecting its course and outcome. Purpose - to develop a reliable and precise prognosis method for EOP activity and severity based on personalized combination of risk factors in specific patients by multidimensional linear regression modeling. Material and methods. A group of 139 patients (278 orbits) with newly diagnosed EOP associated with toxic diffuse goiter was observed during 1 year by an ophthalmologist and an endocrinologist; patient examination interval was 6 months. More than 250 indices were dynamically analyzed in the course of the study. Linear regression analysis was chosen as the research method; it allowed detection of linear dependencies between dependent and explanatory variables. Results. More than 600 various linear regression equations were derived that enabled prediction of EOP onset risk and development timeline, estimation of activity and/or severity of the disease, duration of active period in specific patients for the immediate and long-term outcome. From the derived models, the most reliable and safest for practical application were picked out. The present study introduces nine optimized models that can be used for patient follow-up since day one. Conclusion. The onset risk, progression and outcome of the disease can be determined by a combination of factors revealed in the study.

© 2018 Nutritec. All rights reserved. Research objective: studying of features of nutrition in elderly patients with removable stomatologic orthopedic constructions. 1388 patients aged from 60 up to 75 years which addressed in a city dental out-patient department were examined. Patients were divided into three groups: group 1 -The persons having only fixed stomatologic orthopedic constructions (n=419); group 2 -The persons having at least one partially removable stomatologic orthopedic construction and not havingfull-removable orthopedic constructions (n=512); group 3 -The persons having at least one full-removable stomatologic orthopedic construction (n=457). Patients were interviewed about nutrition features (frequency of consumption). Anthropometric researches were conducted. There were 2.2 and 1.3 fold more persons in group 3 with a concomitant increase in waist circumference and waist-hip ratio compared to groups 1 and 2 (p=0.0013). Persons from group 3 consumed meat significantly less often than patients in groups 1 and 2. A similar trend was observed for meat products, vegetables and fruits (p<0.05). Compared to patients in groups 1 and 2, patients from group 3 more often consumed cereals, potatoes, rice, pasta, as well as sauces, mayonnaises, margarines. AU examined elderly patients rarely consumed fish and seafood (76.0-89.9% persons consumed once a month and less often).