Репозиторий Университета

© 2018 Media Sphera Publishing Group. All rights reserved. At present, compelling evidence has been obtained that combined therapy of pulmonary arterial hypertension (PAH) with specific drugs can significantly slow progression of PAH. Therefore, in current guidelines combination therapy is already considered as standard treatment for a significant proportion of patients with moderately severe and severe forms of PAH. However, the quality of life and long-term prognosis of patients receiving combination therapy, should be the object of further research. The future research is absolutely necessary to identify the most optimal strategy of treatment of patients with PAH, such as initial combination therapy or rapid sequential combination therapy, double or triple combinations as well as exploring new signaling pathways PAH, which can become targets for new specific drugs PAH.

© 2018 Media Sphera Publishing Group. All rights reserved. Systemic vasculitis is a heterogeneous group of inflammatory diseases, which are classified according to the diameter of the affected vessels. The treatment of systemic vasculitis is no longer empirical, because of increasing number of randomized clinical trials in this field. In recent years, there was a trend to limit the cumulative dose of glucocorticosteroids and immunosuppressive drugs, partially through biological drugs usage. However, biologic therapy is not always superior to combination of glucocorticosteroids and cytotoxic drugs. The efficacy of different biologic drugs varies in patients with different forms of systemic vasculitis, which creates the ground for personalized therapy of these diseases. Another serious problem is the absence of strict criteria to immunosuppressive therapy intensification, especially in vasculitis, affecting large vessels, due to the lack of reliable laboratory markers of disease activity. The article reviews modern approaches to the treatment of some types of systemic vasculitis, including ANCA-associated vasculitides, giant cell arteritis, Takayasu`s arteritis and cryoglobulinemic vasculitis.

© 2018 Media Sphera Publishing Group. All rights reserved. Aim. Assessment of diagnostic significance of informativeness and security of ultrasonography with contrast enhancement drug SonoVue in the diagnosis of Crohn's disease (CD) and ulcerative colitis (UC). Materials and methods. The pilot conducted a prospective study which involved 15 patients with inflammatory bowel disease (IBD). All patients gave written consent to participate in the study and processing of personal data. The study included adult patients with an established diagnosis of UC and CD, with proven clinical activity of the disease. Activity was evaluated based on clinical and laboratory data on the scale of best (CDAI >150) for patients with CD and on a scale of Trulove-Witts (2-3 stage) and the Mayo index (DAI) for patients with UC. All the patients underwent colonoscopy with biopsy, ultrasound examination of abdominal cavity organs with the study of the vascularization of the intestinal wall (color Doppler, power Doppler, contrast study). Results. The use of contrast showed additional features in the instrumental evaluation of activity of inflammatory process, identification of complications and assessment of prognosis. Conclusion. The results of ultrasound of the bowel with contrast can be used to assess the activity and stage of disease in patients with UC or CD.

© 2018 Media Sphera Publishing Group. All rights reserved. The article presents a clinical observation of two patients with generalized sarcoidosis. The woman typical granulomatous changes in the lungs and lymph nodes combined with atrial fibrillation, kidney failure and hereditary thrombophilia, men with atherosclerotic coronary arteries, re-myocardial infarction, cholestasis, tubulointerstitial nephritis. The accession of systemic manifestations was accompanied by increase of level of angiotensin-converting enzyme in the blood serum, morphological examination of lung tissue in both cases there were high histological activity of vasculitis and granulomatous inflammation. Extrapulmonary symptoms regressed when conducting immuno-suppressive therapy. Discusses modern aspects of diagnosis of sarcoidosis in clinical practice.

© Russian Journal of Cardiology. Aim. To assess possibility and safety of intervalic hypoxic-hyperoxic training (HHT) as a method of cardioprotection and metabolic adaptation of myocardium for onpump coronary bypass surgery. Material and methods. Totally, 80 coronary heart disease patients included, hospitalized to the clinics of aortic and cardiosurgery of the University hospital of Sechenov University. All had indications for the operation — direct myocardial revascularization with bypass grafting. In 5 days before surgery, according to the scheme of preparation, the patients were randomized to two groups (main — with HHT, and controls; n=40). The rate of complications was evaluated, during the operation and in post-surgery period. The level of troponin I was measured before operation, in 2 and 24 hours after, as well as level of lactate in venous blood before and after operation. Results. The rate of intra- and early postsurgery complications in both groups did not differ significantly, though in the main there was tendency to decline of total rate of complications. In patients of HHT group median troponin I was significantly lower: 1,068 (0,388; 1,397) ng/L, when in controls — 1,980 (1,068; 3,239) ng/mL, р=0,012. Lactate level after HHT operation was significantly lower — 1,74 (1,23; 2,04) mM/L, comparing to the controls — 2,10 (1,80; 2,29) mM/L, р=0,04. Conclusion. The applicability and safety were demonstrated, of HHT as a method of cardioprotection in shunting of coronary arteries on-pump. Taken low number of participants, it is important to conduct broader investigation on this type of entrainment.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. A literature review provided, on the usage of various schemes of perioperational anticoagulation therapy (ACT) in atrial fibrillation patients undergoing scheduled surgery. It is noted that clinicians quite often pass through a situation when patients taking ACT require invasive investigations and surgery. Perioperational management of such category of patients is complicated as, on the one hand, the surgery under ACT is associated with intraoperational hemorrhagic complications, and, on the other hand, ACT cessation might increase the risk of thrombotic complications. The variants assessed, of different periprocedural ACT in patients taking vitamin K antagonists. It was found that as an alternative to continuous ACT recently, bridge therapy with low molecular weight heparins applied, aiming the decrease of the risk of bleeding in adequate thromboprophylaxis. The results of clinical trials provided on the assessment of bridge therapy in surgery. Risk stratification approaches presents for thromboembolic and hemorrhagic complications in surgery.

© 2018 Medical Education. All rights reserved.  Long-acting bronchodilators (long-acting β 2 -agonists (LABA), long-acting anticholinergics (LAMA) and their combinations) are the basic drugs for treatment of stable chronic obstructive pulmonary disease (COPD). Indacaterol/glycopyrronium (IND/GLY) is the first fixed LABA/LAMA combination acquired significant evidence of its efficacy for improvement lung function, symptoms, and quality of life, and decrease in the rate of acute exacerbations of COPD. The aim of this review was to reassess clinical efficacy of IND/GLY in treatment of COPD with regard to recent data and to outline the further role of this combination in therapy of COPD.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Aim. To evaluate a complex clinical efficacy, tolerability and safety of statin drugs - simvastatin, atorvastatin, rosuvastatin in patients with hyperlipidemia (HL). Material and methods. The assessment of clinical efficacy was done in 90 patients with HL and arterial hypertension of the grades 1 and 2, age 40-75 y.o.; some of them had coronary heart disease. Results. In 90 patients with cardiac pathology and HL, selected to 3 groups by 30 persons, the clinical efficacy of the listed statins was assessed. A significant hypolipidemic effect was noted as a decline of atherogenicity of the blood, with slight more prominent effect of rosuvastatin. Conclusion. The data makes it to conclude the simvastatin, atorvastatin and rosuvastatin are equally effective hypolipidemic drugs in HL type IIA and IIB patients. The time frame, type and grade of positive changes in lipid profile are almost the same, and in rosuvastatin just slightly more prominent.

© 2018 Meditsina Publishers. All rights reserved. The spread of a latent tuberculosis infection - 2.3 billion people - is of emergency importance for the global task of mankind - to eliminate tuberculosis as a common disease by 2035. For children, due to the limited use of the radiological diagnosis methods, the main methods today are the immunological tests for the detection of tuberculous infection. The most common used method is the tuberculin skin test (Mantoux test) due to its lack of specificity has significant drawbacks, especially in countries using mass BCG vaccination. Relatively new methods using specific recombinant MTB proteins, both in vitro tests and in new skin tests, allow to determine tuberculosis infection in latent or active form much more specifically, however, they are somewhat less sensitive, in comparison with the Mantoux test, which requires development of these methods with the introduction of new additional specific antigens. It is obvious that crucial task is the development of new methods for distinguishing active and latent tuberculosis infection or being able to predict progression from latent to active TB diseases both in children and in adult population. The article shows new diagnostic techniques of blood cells and plasma samples based on the use of flow cytometry with the detection of antigen-specific T-cells producing interferongamma and tumor necrosis factor alpha, T-cells specific markers, as well as using combinations of the identification of various protein factors that have the prospect to determining active tuberculosis infection signs. However, these methods are still time-consuming and expensive. Currently, some new promising approaches based on the using of new genetically engineered products are being developed to determine specific antibodies in the blood serum. With the development of accelerated methods for the analysis of the expression of specific genes in blood cells, this direction also has the prospect of introducing into healthcare practice.

© 2018 Techno-Press, Ltd. In order to prevent the phenomena of "microbiological genocide", unjustified and unfavorable violations in microecological systems, and, first of all, human microbiota during the implementation of the disinfection prevention of diseases, the necessity for the scientific justification and practical provision of sufficient antimicrobial selectivity of disinfecting effects, is substantiated in the article. It is necessary to decode and take into account the susceptibility of different microbe pathogens to various disinfectants in comparison with saprophyte, and even more so, useful microflora.

© 2018 Stolichnaya Izdatelskaya Kompaniya. Cardiovascular diseases occupy a leading position in morbidity, mortality and disability in most countries. Ischemic heart disease and stroke lead in the structure of mortality from cardiovascular diseases. The issues of lipid-lowering therapy with statins in the aspect of stroke prevention are discussed in the article. The main risk factors of atherosclerosis and their prevalence are presented. Topical standards for statin use, evidence-based medicine data obtained in randomized clinical trials, and evidence from actual clinical practice are covered. Possible promising areas of statin use for the prevention of acute cerebrovascular accident are also considered. Combination therapy together with other lipid-lowering drugs, as well as drugs of other pharmacological groups, the use of statins from earlier ages, the practical implementation of pleiotropic effects of statins can be attributed to the latter. The authors clearly demonstrate that the actual practice of using statins lags significantly behind the ideal, reflected in the recommendations and randomized clinical trials. Adherence to medical recommendations is one of the key factors in this. The main factors that can influence the increase of adherence of patients to taking statins and increase the effectiveness of their application in real clinical practice are presented..

© 2018 Stolichnaya Izdatelskaya Kompaniya. Hypertensive heart disease with biventricular cardiac failure is not common in clinical practice. This diagnosis requires an extensive diagnostic search. We present the clinical case of the male patient of 38 aged. He was admitted to the clinic with heart failure 3-4 NYHA class. EchoCG revealed symmetric hypertrophy of the left ventricle up to 18 mm without its dilatation, a decrease in ejection fraction up to 42%, restrictive hemodynamics, overload of the right chambers, severe pulmonary hypertension (60 mm Hg). The clinical status included persistent arterial hypertension (180-220 and 120-150 mm Hg), effusion in both pleural cavities and pericardium, ascites, renal failure. During examination (multispiral computed tomography, magnetic resonance imaging, scintigraphy with 131I-MIBG), bladder paraganglioma was diagnosed (normatenafrin 1468 μg/day). The resection of the tumor was performed, according to immunohistochemical research - neuroendocrine carcinoma, G1. After 3 months a partial regression of hypertension and cardiac failure was observed with the preservation of a high level of creatinine. The criteria and differential diagnosis of the hypertensive heart disease and the syndrome of primary myocardial hypertrophy, diagnostics of the urinary bladder paraganglioma, complex mechanisms of myocardial damage within the pheochromocytoma and its prognosis are discussed..

© 2018 Stolichnaya Izdatelskaya Kompaniya. Acute myocardial infarction (AMI) is one of the main causes of morbidity and mortality, both in the Russian Federation and around the world. Approximately, in up to 10% of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of coronary artery disease. These patients constitute an intriguing subgroup referred to as "Myocardial Infarction with Non-Obstructive Coronary Arteries" (MINOCA). MINOCA is a collective concept that unites many different pathologies, which determines the essential heterogeneity of the etiological factors. Coronary artery embolism is recognized as an important non-atherosclerotic cause of AMI. In turn, the most common underlying disease in those with coronary embolism is the atrial fibrillation. The advantages of reperfusion strategy and cardioprotective therapy in the treatment of obstructive arteriosclerosis are well studied, widely presented in the literature and supported by a strong evidence base, while the issues of diagnosis and treatment of patients with MINOCA are currently widely discussed We present two clinical cases of embolic myocardial infarction in patients with atrial fibrillation, diagnosed in our clinic in 2017..

© 2018 Ekaterina Vladimirovna Silina, Mukimdjon Ahmadzhonovich Sobirovz, Sergey Brankovich Bolevich and Aleksandrovich Stupin. The main aim of the study was to determine ways of improving the results of treating patients with ulcer bleeding of various nature and severity. It was provided by the system study of free radical processes and evaluation of the effectiveness of timely antioxidant therapy. Material and methods. The study included 153 patients aged 18-94 years with acute and chronic gastric and duodenal ulcers complicated by gastroduodenal bleeding. Patients were divided into two groups: group I (experimental group) included 62 patients who received antioxidative therapy with reamberin as a part of the basic therapy; and group II (control group) included 91 patients who received standard therapy. Various parameters of Free Radical Processes (FRP) were studied in dynamics in all patients. Results. We revealed the significance of oxidative stress on the first day of hospitalization in patients with gastrointestinal ulcerous bleeding of various character and severity. It was discovered mostly in severe patients with acute Gastroduodenal Ulcerous Bleeding (GDUB). In case of mild gastrointestinal ulcerous bleeding, oxidative stress disorders affected an oxygen stage of oxidative stress and represented themselves adaptive compensatory mechanisms. As the severity of the disease increased, intensification of an oxidant stress was manifested by a decrease in oxygen activity and an increase in lipid imbalance. Imbalance in free radical processes continued for a long time until discharge of patients from the hospital. The data obtained claimed to be the basis for recommendation to include antioxidant energy-conserving therapy in the complex of therapeutic measures in the earliest possible terms. We found out an efficacy of using succinic acid therapy with reamberin in patients with gastrointestinal bleeding. Positive effect of succinic acid on the markers of oxidative stress was confirmed by improvement in the disease pattern and success of the treatment.

© JPES. The relevance of the study is explained by the fact that despite the numerous available health-training programs for body weight loss, there is still need for development of new forms of physical training and ways of motivation. The objective of the present study is to evaluate the efficiency of dance therapy for body weight loss and improvement of physiological and functional state in young women with overweight. Materials and Methods. The study enrolled 82 students from Sechenov University with overweight and first-degree obesity. Forty two girls took exercises within individual health-training programs for 9 months. The programs were based on aerobic activity, including dance therapy. Forty students were engaged in physical training within the curriculum of the university. Before, during and after the training course the authors evaluated the components of body composition; functional state and psycho-emotional status. Results. The final tests showed significant excessive body weight loss in students in the main group due to fat mass reduction by 20%; increase of physical performance by 24.5%; self-confidence level growth by 24%. Conclusion: The results of the study confirmed that dance therapy is an effective type of physical training with high motivational component for excessive body weight loss in young women. This fact is proved by significant positive dynamics of the majority of morphofunctional and psychological parameters in students in the main. The materials of the article are of practical value for specialists in physical rehabilitation, general practice doctors, PT tutors and advisors on healthy way of life and public health.

© 2018 Dynasty Publishing House. All rights reserved. The objective. To offer a characteristic of phenotypes of atopic bronchial asthma (BA) in children according to the level physical health (LPH). Patients and methods. Our observation included 359 children aged 4 - 14 years with atopic BA. We performed a questionnaire survey among parents, studied medical histories and took anthropometric parameters. The parameters of respiratory, muscular and cardiovascular systems, and LPH according to the method by G.L.Apanasenko (1992) were determined. Results. Using multiple factor analysis with the principal component method we selected parameters that characterize the level of physical health in BA: values of external respiratory function - ERF (VC, FEV1), hand muscle strength (HMS), body mass index (BMI), vital index (VI), Robinson index (IRob), muscular endurance (ME). In BA with low LPH no patient has full control over disease. Overweight is recorded in 37.9% of them, lower ERF parameters in 33.3%, lower HMS in 87.9%, deviations on the part of the cardiovascular system in 80.3%. In BA with higher LPH, full control over diseases is observed in almost half of children (48.7%), harmonious physical development - in 87.1% of cases. Parameters of ERF, muscular and cardiovascular system corresponded to the norm in 92.3; 61.5 and 100% of patients, respectively. Children with BA with average LPH take the intermediate position between these two groups. Conclusion. Physical health should be regarded as a factor of retaining control over BA. Phenotype determination according to the level of physical health and degree of disease control permits to personify rehabilitation programmes for children with atopic bronchial asthma.

© 2018 Russian Academy of Medical Sciences. All rights reserved. The approach for the quick and efficient production of polyclonal antibodies to the target antigen alpha-synuclein has been proposed. Two methods have been employed to purify specific rabbit polyclonal antibodies against recombinant human alpha-synuclein, produced by subcutaneous immunization with complete Freund's adjuvant. It was shown that purification on CNBr-activated Sepharose with immobilized alpha-synuclein resulted in antibody preparation with rabbit serum histidine-rich glycoprotein as a contaminant. Two-stage antibody purification procedure first on Sepharose with immobilized protein G, and then on alpha-synuclein immobilized column helps to avoid contamination and to obtain homogenous antibody preparation. Antibodies recognize different conformations of alpha-synuclein and can be used in a variety of immunochemical approaches, including immunocytochemistry.

© 2018 Russian Academy of Medical Sciences. All rights reserved. The aim of the study was to investigate the hepatoprotective activity of an aqueous extract of Caragana jubata (Pall.) Poir. Acute experimental hepatitis was induced by acetaminophen administration of 1000 mg/kg. Studies were conducted in white Wistar rats. The aqueous extract of C. jubata demonstrated the hepatoprotective effect, comparable to that of the reference preparation "Carcil". This was manifested by the normalization of biochemical blood parameters (ALT, AST, alkaline phosphatase, cholesterol, total bilirubin) and antioxidant activity of liver homogenates, determined by the method based on oxidation of luminol induced by 2,2-azo-bis-2-amidinopropane. Normalization of morphofunctional indices was also shown in a histological study of liver of rats that received aqueous extract from C. jubata.

© 2018 Media Sfera. All rights reserved. The anterior capsular contraction syndrome (ACCS) in pseudophakic patients is known to be accompanied by postoperative opacity of anterior lens capsule (ALC) and partial or full closure of anterior capsulotomy opening. Purpose: to perform complex morphological assessment of ALC in patients with ACCS. Material and methods. The study involved complex analysis of ALC that was removed due to ACCS in the pseudophakic eye in the setting of diabetes mellitus and past vitreoretinal surgery. The following examination methods were used: light-optical microscopy of ALC samples in the form of polychrome-colored semifine sections using optical microscope Leica DM-2500 (Germany), scanning microscopy of ALC surface with EVO LS10 (Carl Zeiss, Germany) microscope, analysis of chemical element composition and its variation of the ALC sample with energy-dispersive spectrometer Oxford X-Max50 (Oxford, UK). Results. Light-optical microscopy showed altered state and plication of ALC induced by proliferation from inner surface of the fibrocellular tissue, which gradually thickens (up to 360 µm) towards center and causes reduction of anterior capsulotomy opening. Scanning electron microscopy revealed presence of tissue with uneven micro-relief and a porous three-dimensional structure uncharacteristic for capsule on the surface of ALC. Thickness of the fibrous deposition significantly exceeded the thickness of ALC. Evaluation of elemental composition of the fibrocellular tissue showed elevated concentration of sulfur and phosphorus, which indicates high activity of the regenerative process. In the observed case, the regenerative process was of substitute nature because an attempt to restore the lens was accompanied by formation of connective tissue structurally different from original. Conclusion. Complex assessment of an isolated ALC sample allowed revelation of the chain of pathological processes accompanying the development of ACCS.

© 2018 Media Sphera Publishing Group. All rights reserved. This article reflects the main stages of outpatient care formation in Moscow. It describes the most significant health care and health education reforms in different periods of Russian history. The article stresses the relevance of outpatient service modernization as a priority of Russian health care reform. The dominance of outpatient care and the introduction of a new three-level primary health care system into healthcare practice have demonstrated the optimal scheme of interaction of all Moscow medical institutions. The article shows the importance of consolidating the efforts of the Government of Moscow and Moscow medical universities, and the I.M. Sechenov First Moscow Medical University in particular, to solve the basic issues of prevention, early diagnosis, and treatment of diseases and to achieve the high quality of life in Muscovites.