Репозиторий Университета

© 2018, © 2018 Informa UK Limited, trading as Taylor  &  Francis Group. Background: Antiphospholipid antibodies (aPL) have a multifaceted effect on the hemostatic system, damaging all its protective links. Aim: To study the effect of APA on outcomes of assisted reproductive technologies (ART). Study design: We examined 267 women with infertility, who planned pregnancy using ART. They included 178 women with IVF failure (I group) and 89 women with pregnancy after the IVF program (II group). The comparison group consisted of 80 pregnant women after IVF (male factor); a control group included 80 pregnant women with physiological pregnancy. Results of study demonstrated a high frequency of aPL circulation in a group of women with IVF failures. Overall, the proportion of aPL among all 267 women who planned pregnancy with ART was 32.6%. Elevated levels of aPL in the structure of causes of IVF failures (group I) were observed in 42.1% of them. Among women whose pregnancy occurred with ART (II group) the rate of APA was 19.1%. In the comparison group, in 6.3% of cases, aPL circulation was observed. In the control group, the rate was 3.4%. Conclusion: Considering the high percentage of aPL circulation in the case of IVF failures, authors think that high titers of aPL are a temporary contraindication for IVF. Patients with a history of aPL circulation are required to receive anticoagulant therapy from the first days of the hormonal protocol. The drug of choice is a group of low molecular weight heparins (LMWH). An individual approach is extremely important with the possible identification of causes of IVF failures and selective therapy, which leads to a significant improvement in the outcomes of the IVF program.

© Russian Journal of Cardiology. Renin-angiotensin-aldosterone axis activation is an important mechanism of hypertension and its cardiovascular and renal complications. Angiotensin receptor blockers are considered among the first-choice antihypertensive drugs in Russia, European countries, and the USA. In addition to antihypertensive action, these drugs positively influence several components of the cardiovascular continuum and can be used for individualized management of high cardiovascular risk patients. The paper discusses the benefits of angiotensin receptor blockers use in patients with cardiovascular comorbidities. The paper includes a clinical case scenario revealing antihypertensive efficacy of telmisartan as an initial agent in a patient with high risk of cardiovascular events.

© 2018 Russian Association of Endocrinologists. All rights reserved. Significant number of patients with type 2 diabetes mellitus are obese. It is known that even glucose intolerance, as well as diabetes, can lead to vascular complications. At the same time, weight loss can reduce the risk of type 2 diabetes in obese and pre-diabetic patients. According to available data, a significant decrease in the incretin effect is observed in patients with type 2 diabetes and obese individuals. Thus, a decrease in the incretin effect leads to a violation of the insulin response to the intake of carbohydrates, and, consequently, an increase in the level of glucose in the blood. It was also found that the decrease in the incretin effect in patients with type 2 diabetes can be associated with a lower secretion of glucagon-like peptide-1. The interest is represented by groups of antidiabetic drugs capable of regulating glycemia by affecting the secretion of insulin and glucagon, depending on its level. Such drugs include glucagon-like peptide-1 receptor agonists. The article shows the advantage of prolonged action in patients with type 2 diabetes and obesity of the glucagon-like peptide 1 receptor agonists (albiglutide, dulaglutide, exenatide with slow release) dosing 1 time a week.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study the effect of сavinton comforte (CC) on the severity of cognitive impairment and motor awkwardness in patients with chronic brain ischemia (HIGM). Material and methods. There were 30 patients (8 men, 22 women) aged 50—65 years (61.6±4.9 years on average) with AHU with cognitive impairment. We used tests of MINI-Cog, Munsterberg, TMT), ADL). QC appointed 10 mg 3 times a day for 3 months. Results. Against the background of therapy, the improvement of constructive praxis and short-term memory, an increase in the speed of visual search and visual-motor function, an increase in the level of selectivity of attention, an improvement in the reproduction of visual images and perception, an increase in the speed of the motor task (drawing strokes). Conclusion. The obtained data can testify about the improvement of indicators of function of a small motility of brushes on the background of improvement of cognitive functions.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study the efficacy of various methods of non-drug therapy of diseases manifested by vertigo and dizziness in neurological practice. Material and methods. Referral and final diagnoses were compared after neurovestibular examination of 599 patients (177 men and 422 women), aged 25 to 79 years (mean age 55 years), with various causes of vertigo. Patients underwent vestibular rehabilitation, trainings on the stabiloplatform with biological feedback (biofeedback), repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Severity of dizziness on a Visual analogue scale of dizziness (VAS-d) and balance on stabilography before and after a course of vestibular rehabilitation was analyzed. Results. Before neurovestibular examination, the diagnoses of vertebrobasilar insufficiency (44%), hypertensive or atherosclerotic encephalopathy (35%), cervical spondyloarthrosis (8%), autonomic dystonia (11%)) are often considered mistakenly as the causes of vertigo and dizziness. After neurovestibular examination, the diagnoses were as follows: BPPV (39%), phobic postural vertigo (29%), Ménière’s disease (14%), vestibular neuritis (11%), multisensory dizziness in elderly (5%). The effectiveness of repositioning maneuvers in BPPV was 90,2% after the first session and 100% after the second session. After a course of vestibular exercises and trainings on the stabiloplatform with biofeedback, there was the marked improvement in indicators of stabilography and VAS-d in patients with vestibular neuritis, Meniere’s disease, phobic postural vertigo (p<0.05). Vestibular rehabilitation was most effective if started within the first month after vestibular neuritis. There was the high efficacy of complex rehabilitation, including vestibular exercises and trainings on stabilographic platform with biofeedback, in patients with Meniere’s disease. In the rehabilitation of patients with phobic postural vertigo, better results were achieved when vestibular exercises were combined with trainings on stabilographic platform with biofeedback and psychotherapy. Conclusion. The results demonstrated the low accuracy of diagnosis of diseases manifested by vertigo and dizziness and high efficacy of non-drug therapy in most cases, especially BPPV, vestibular neuritis, Meniere’s disease, postural phobic vertigo.

© 2018, Dynasty Publishing House. All rights reserved. The objective is to study the results of treatment of female patients with endometrial hyperplasia considering the 2014 WHO Classification and to make adjustments in tactics of conducting it, based on the individual approach. Patients and methods. Eighty-two (82) female patients at the age from 19 to 47 years (37.5 ± 2.6 years) were examined. Most of them (54/65,8%) were in the reproductive period. Methods of diagnosis: a) 2D and 3D transvaginal ultrasound scan with the use of color Doppler; b) video histeroscopia; C) histologic study of endometrial scratching or macropreparations, removed during the surgery. Results. It has been found in the analysis of the 2014 WHO Classification and Protocol RCOG & BSGE that when EH diagnosed for the first time in women of reproductive age after 3 months of taking NET, it is advisable to use estrogen-progestin products (COCP) for another 3 months with prolongation if necessary for further protection from unwanted pregnancy. The morphological picture of AEH should be carefully estimated, taking into account that in its simplest form total ablation of the endometrium is valid. Conclusion. No algorithm is able to cover all possible clinical situations and to adhere to individual approach in the choice of patient treatment tactics with endometrial hyperplasia.

© 2018, Dynasty Publishing House. All rights reserved. The article analyzes a favourable outcome of multiple pregnancy achieved after using assisted reproductive technologies and donor egg in a patient with recurrent pregnancy loss and combined thrombophilia.

© 2018, Dynasty Publishing House. All rights reserved. A clinical observation of the patient (26 years) is presented, for whom prolene (a non-absorbable monofilament suture material with a perfectly smooth surface) was used for the recovery of the wound in the uterus during Caesarean section. Numerous prolene sutures were hanging free in the uterine cavity and performed a peculiar function of intrauterine contraceptive. After excision of sutures by the resectoscope loop, fertility was restored.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To study the effectiveness, safety and tolerance of Viferon® (human recombinant interferon alpha-2b with antioxidants vitamins Е and С) as compared with standard therapy in complex treatment of mixed female urogenital infections during pregnancy and the effect of Viferon® on the formation of immunity in ontogenesis and during the early adaptation period of newborns. Patients and methods. The study included 70 women aged 18 to 40 years with mixed urogenital infections. The treatment group included 36 patients, who received etiotropic antimicrobial and antiviral therapy, underwent correction of immune status disorders and restoration of vaginal colonisation resistance. Along with standard therapy, patients of the treatment group received Viferon®, suppositories 500 000 IU, according to the schedule: 1 suppository 2 times/day every day for 10 days, then 1 suppository 2 times/day for 9 days with a 3-day interval. Aftre that, Viferon®, suppositories 150 000 IU 1 suppository 2 times daily every day for 5 days every 4 weeks until delivery. The control group comprised 34 patients who received standard therapy without interferon correction. All patients received standard therapy appropriate for their disease. Results. Among the patients receiving Viferon®, the development of placental insufficiency was recorded by 2 times more rarely. In the treatment group (Viferon®), fetal growth restriction (IUGR) was diagnosed only in 8.3%. In the control group, IUGR was found in 22% (OR + 2.65). In the treatment group, the incidence of fetal CMV infection was reduced by 16 timesd anf of herpesvirus infection type 2 – by 10 times. In the group of patients who did not use Viferon®, the share of newborns with CNS lesions amounted to 18.4%, whereas in the treatment group it approached 6.5% (OR –2.83). Inclusion of Viferon® in complex therapy resulted in a lower incidence of infectious lesions of the skin and mucous membranes of the newborn infants (amniotic fluid infection syndrome) by 5.8 times. Colclusion. The use of Viferon® (human recombinant interferon alpha-2b with antioxidants vitamins Е and С) suppositories in complex therapy in pregnant women with infection promotes a faster elimination of viruses, a significant decrease of the signs of threatened miscarriage, premature labour, risk for developing PI and IUGR, associated with inflammatory process (p < 0.05).

© Saint Petersburg Pasteur Institute. All rights reserved. Microfold cells (M cells) are specialized intestinal epithelial cells that initiate mucosal immune responses. These unique phagocytic epithelial cells are specialized for the transfer of a broad range of particulate antigens and microorganisms across the follicle-associated epithelium (FAE) into the gut-associated lymphoid tissue (GALT) by a process termed transcytosis. The molecular basis of antigen uptake by M cells has been gradually identified in the last decade. Active sampling of intestinal antigen initiates regulated immune responses that ensure intestinal homeostasis. The delivery of luminal substances across the intestinal epithelium to the immune system is a critical event in immune surveillance resulting in tolerance to dietary antigens and immunity to pathogens (e.g., bacteria, viruses, and parasites) and their toxins. Several specialized mechanisms transport luminal antigen across the gut epithelium. Discovery of M cell-specific receptors are of great interest, which could act as molecular tags for targeted delivery oral vaccine to M cells. Recent studies demonstrated that M cells utilize several receptors to recognize and transport specific luminal antigens. Vaccination through the mucosal immune system can induce effective systemic immune responses simultaneously with mucosal immunity. How this process is regulated is largely unknown. This review aims to show a new understanding of the factors that influence the development and function of M cells; to show the molecules expressed on M cells which appear to be used as immunosurveillance receptors to sample pathogenic microorganisms in the gut; to note how certain pathogens appear to exploit M cells to inject the host; and, finally, how this knowledge is used to specifically "target" antigens to M cells to attempt to improve the efficacy of mucosal vaccines. Recently, substantial progress has been made in our understanding of the factors that influence the development and function of M cells.

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Mathematical modeling of pharmacokinetic (PK) and pharmacodynamic (PD) parameters essential for establishing correct dosing regimens is an alternative to pharmacokinetic studies (PKS) adopted in the clinical setting. The aim of this work was to compare the values of PK parameters for vancomycin obtained in an actual PKS and through MM in postoperative patients with kidney injury. Our prospective study included 61 patients (47 males and 14 females aged 60.59 ± 12.23 years). During PKS, drug concentrations at steady state Сtrough and Cpeak were measured by high-performance liquid chromatography followed by the calculation of the area under the plasma concentration-time curve AUC24. For mathematical modeling, a single-compartment model was employed; PK parameters were estimated using R 3.4.0. The values of Ctrough measured 48 h after the onset of antibiotic therapy during PKS were significantly lower than those predicted by MM (р = 0.004). In a group of patients with acute kidney injury (AKI), AUC24 measured at the end of treatment was significantly higher than its value predicted by MM (р = 0.011). The probability of achieving the target AUC24 to MIC ratio of over 400 µg•h /ml is higher in the group of patients with Ctrough = 10–15 µg /ml. Our findings confirm that the use of MM in postoperative patients with renal dysfunction is limited and therapeutic drug monitoring should be used instead.

AIM: To evaluate the results of selective approach for splenic flexure mobilization (SFM) after total mesorectal excision with low colorectal anastomoses. MATERIAL AND METHODS: Clinical data were obtained from the multicenter RCT database comparing ileostomy and colostomy in patients with rectal cancer who underwent total mesorectal excision from 2012 to 2017. Our clinic policy is performing paraaortic lymph node dissection with 'low' inferior mesenteric artery ligation, left colic artery preservation and use of sigmoid colon for colorectal anastomosis. SFM was used only in cases of inability to apply above-mentioned procedure (selective approach for SFM). RESULTS: SFM was performed in 15 (13%) out of 115 patients. The most frequent reasons for SFM were sigmoid colon diverticulosis, impaired blood supply or inadequate length of sigmoid colon. There were no differences in intraoperative and postoperative complications between TME without SFM and TME with SFM. CONCLUSION: Selective SFM in TME followed by advanced paraaortic lymph node dissection and left colic artery preservation is safe and may be considered as a viable option to routine SFM in rectal cancer surgery.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: To develop a technique for conducting of complex radiology diagnostics in combination with dynamic MSCT-cystureterography in patients with reconstruction of the urogenital area and to study the possibilities of its application in clinical practice. Materials and methods: At the pre and postoperative stages 8 patients were examined by MSCT, from whom all men were presented with such acquired and congenital diseases of the urogenital area as followings: stricture or obliteration of the urethra, as well as hypoplasia of the penis. The age of the patients varied from 33 to 58 years with the average of 43.8 years. The studies were performed by a multispiral computer tomograph Toshiba Aquilion One. This 640-slice computer tomograph has 320 rows of detectors with 0.5 mm wide, which allows the detector to cover the scan zone at 16 cm by one rotation of the X-ray tube. Results: By studying the data obtained in five cases, hypoplasia of the penis was revealed. In three cases urethral obstruction was diagnosed, its cause and localization were determined. At the pre and postoperative stages the anatomy of the donor and recipient vessels was assessed, surgical intervention was planned, and the dynamic MSCT-cystureterography method allowed avoiding invasive examination of the urethra. The MSCT method with intravenous contrasting in combination with dynamic MSCT-cystureterography surpasses the standard X-ray examination, ultrasound method and endoscopic urethroscopy at terms of accuracy and informativeness. In addition, these methods are separated in time and in the implementation techniques and most of them are not physiological. Conclusions: Analyzing the obtained data, we can confidently state that MSCT with intravenous contrast showed its high informative value in the study of donor and recipient vessels, and the combination with dynamic MSCT-cystureterography in order to assess the patient's urethra further increases the informativeness and value of this study. The proven effectiveness of the developed method suggests that it can become routine in examining patients with diseases of the urogenital area.

© 2018 Russian Electronic Journal of Radiology.All right reserved. In plastic surgery we often have the need for soft tissue volume restoration of different localization, to close congenital or acquired defects as well as associated with agerelated changes in soft tissue. Autologous adipose tissue in many properties is the ideal filler for the correction of the body contour defects. However, despite its advantages, this minimally invasive technique has been secondary to more complex methods of reconstruction - flap transplantation. The main significant drawback of fat grafting is the unpredictable and ineffective survival of transplanted fat (20 to 60%, according to different authors). Currently, factors that can influence the degree of survival of adipose tissue and make it more predictable are being actively studied, in particular, the effect of Leucocyte and Platelet Rich Plasma (L-PRP). Purpose: To prove the stability of transplanted adipose tissue survival with the addition of L-PRP in breast surgery via multispiral computed tomography (MSCT) with the calculation of resorption rate of adipose tissue before transplantation in the early and in late postoperative stages. Materials and methods: In the period from 2013 to 2016, a total of 48 patients underwent surgery at the plastic surgery clinic in I.M. Sechenov First Moscow State Medical University. All patients complained of dissatisfactory appearance of the breast. Patients underwent breast lipofilling in order to correlate contour deformities. Monitoring of adipose autografts consisted of the following methods: MSCT was performed in 12 cases (5 patients after transplantation of pure adipose tissue and 7 patients after transplantation of adipose tissue enriched with L-PRP). Results: The study of the sample volumes and thickness of soft tissues after the transplantation was performed both with and without the addition of L-PRP. A steady increase in the soft tissue thickness in the breast region was revealed and an increase in volume was noted in the main group. At the same time, in patients of the control group three months after surgery a decrease in the volume and thickness of the breast soft tissues was revealed. Conclusions: The results of the study show that the improvement of breast contour after transplantation of adipose tissue both with and without the addition of L-PRP provides a steady increase in the thickness and volume of breast soft tissues. The average loss of adipose tissue after transplantation ranges from 11.62% to 17.13%. The results also confirm that MSCT is an adequate method of visualization of adipose autografts and volumetric changes in the late postoperative period.

© Ruslania 2018. All rights reserved. The patients with odontogenic phlegmon of maxillofacial area suffer from immune depression at the surgical stage of treatment that can unfavorably affect their rehabilitation. The study analyzes possibility of application of medication Dalargin in complex treatment ofpatients during post-operation period. The experimental study established components of immune system affected by medication. Thereupon, Dalargin was applied in clinical practice oftreatment ofpatients with course ofdisease ofaverage severity. The study proved immunomodulatory characteristics of Dalargin effecting various fractions of sub-populations of lymphocytes and manifesting by way of decreasing of initially high indices and increasing of initially low indices that is of great importance during treatment ofpatients with odontogenic hormones, especially in case ofsevere course of disease.

BACKGROUND: The relevance of this ensues from the fact that despite the numerous currently available health promotion training programs for the reduction of body weight, there is still the need for the development of the new forms of the efficacious physical training programs and the methods of motivation for compliance with them among the people of different age, sex and social status. AIM: The objective of the present study was to determine the role of motivational factors, including the assessment of the biological age, in the improvement of the effectiveness of the health promotion training programs for the reduction of the excess body weight. MATERIAL AND METHODS: A total of 82 students with overweight and first-degree obesity at the age from 17 to 21 years (average age 18.5±1.4 years) were examined. 42 girls included in the first (main) group spent 9 months performing health promotion training programs on an individual basis developed taking into consideration the motivational factors. The physical training programs included the aerobic exercise in the form of dance classes. 40 students in the control group were engaged in physical training envisaged by the academic curriculum of the university. The third group (the group of comparison) was comprised of 36 practically healthy girls having the normal body weight. We studied the components of the body composition with the use of bioimpedanceometry, evaluated the physical working capacity (the PWC-170 test) and the adaptive reserves of the body (heart rate variability test as proposed by R.M. Baevskyi, Garkavi test). In addition, the psycho-emotional status of the participants was estimated making use of the Lusher test and SAN. The biological age was determined by the original method based on the combination of the morphological and functional indices. RESULTS: The excess body weight in the students comprising group 1 was reduced by 10% on the average; simultaneously the physical working capacity among these students increased by an average of 24.5% while the level of emotional stability and self-esteem increased by 20% and 24%, respectively. We also documented a decrease in the initially increased biological age by 5 years on the average. The students included in group II did not experience any significant changes in the parameters of interest. CONCLUSION: The consideration of the motivational factors for the development of the training programs designed to promote the reduction of the excessive body weight significantly increases their effectiveness, as evidenced by the improvement of the morpho-functional and psychological characteristics in the students of the first group and its absence in their counterparts included in group II.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. Bolshaya Pirogovskaya ul. 2-4, Moscow, 119435 Russia Pericarditis is not enough researched and described in literature despite the emergence of a large quantity of up-to-date laboratory and instrumental methods of verification. The main problem is that pericarditis might be a sign of many infectious and non-infectious diseases. It is quite difficult to define the etiopathogenetic reason of process. The article presents a clinical observation of a 53 years old mail patient with paroxysms of atrial flutter, non-symptomatic febrile fever, arthralgia and signs of exudative pericarditis, which were manifested after the acute viral infection. The symptoms have been lasting for 8 months before the patient's hospitalization. In lab tests anemia, leucopenia, increase level of platelets and increase antinuclear antibody level were found. Several conceptions were considered: cancer with paraneoplastic syndrome, systemic disease, infectious process, myeloma, which were subsequently excluded. Due to the fact that pericardial effusion may often be associated with tuberculosis Diaskin test and T-SPOT were performed and they appeared to be positive. After several months of antituberculous treatment temperature normalized, atrial flutter episodes and arthralgia diminished. So empirically and laboratory tuberculous pericarditis with atypical manifestation was confirmed. The particularity of this observation is a nontypical clinical picture and the absence of a primary focus of infection. That is why the clinicians could not define the diagnosis rapidly.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. This article affects the problems of using NOAC in the most defenseless groups of patients with atrial fibrillation: those who have high bleeding and high thromboembolic risk and elderly. The focus is on comparison of effectiveness and safety of NOACs based on randomized clinical trials (RCT) and real-world data (RWD). The possible reasons for the different interpretation of the data of the RCT and the RWD are shown. Use of NOAC in reduced doses prescribing according to RCT and RWD are shown. Our own 13-month observation of patients 75 years and older with very high thromboembolic risk (CHA2DS2-VASc-4,5 points) on rivaroxaban therapy are presented. Good efficacy and safety of full and reduced doses of rivaroxaban were demonstrated: only 2 episodes of small bleedings and no large bleedings (ISTH criteria) were detected as well as no thromboembolic events. Thus, even difficult patients with AF and comorbidity may be safely and effectively treated with NOACs taking into consideration integrated approach and correction of modifiable risk factors.

© 2018 Voprosy Sovremennoi Pediatrii - Current Pediatrics. All rights reserved. The problem of dosing drugs at an early age is conditioned by specific metabolism of medicinal products (MP) in the child's body. Currently, there are a few clinical trials on the study of physiological characteristics in different periods of childhood and systematised data. It is still relevant to understand the characteristic differences that affect the bioavailability, distribution and excretion of MP, especially in children over one month of life. The results of such studies are necessary in order to formulate the recommendations for use of MP in children taking into account their age and compensate for the lack of data from direct clinical trials in pediatrics. The possibility of using a dose calculation method regarding the fat content of the body in different periods of childhood and the chemical properties of the substance has been discussed.