Репозиторий Университета

The article reviews the particularities of development and pathogenesis of secondary dry eye syndrome (DES) after refractive surgeries including a complex of problems related to changes in tear film content, damage of eye surface and neurotrophic epitheliopathy. Additionally, modern algorithms of treatment and prevention of secondary DES in patients after refractive surgeries are described. Despite the transient nature of the changes, excimer-laser surgery can lead to lasting deficiencies of eye surface in some patients. Therefore, intensive and early treatment of secondary DES during the early follow-up period after refractive surgery may significantly reduce risks of tear dysfunction and neurotrophic epitheliopathy development in the long term.

© 2018 Media Sphera Publishing Group.All Rights Reserved. In the modern clinic of internal diseases, the specific gravity of the infectious pathology, manifested by various clinical syndromes, is increasing. Infectious pathology is represented by diseases of the respiratory system, heart disease (infective endocarditis, cardioimplant infections, viral myocarditis), infectious arthropathies, extrahepatic manifestations of viral hepatitis, cytopenic syndromes, various manifestations of sepsis and some other conditions.In most cases, the diagnosis and management of such patients is the responsibility of the internist, who must be able to suspect the infection and carry out its verification. In the process of diagnostic search and management of patients, close interaction of the internist with a clinical microbiologist, clinical pharmacologist and other related specialists is necessary.

The article reviews the literature devoted to modern intraoperative methods of preventing cicatricial process at the site of dacryostoma after endonasal endoscopic dacryocystorhinostomy. Despite the constant improvement of the surgery technique, complications in the postoperative period still occur. They include the formation of granulation tissue at the sites of dacryostoma, synechiae in the nasal cavity, or narrowing of the dacryostoma, which ultimately leads to a relapse of the disease. The main prevention methods are construction of flaps from the medial wall of the lacrimal sac, from mucosa of the nasal cavity, and intubation of the dacryostoma with the lacrimal implant. They are used separately and in various combinations.

© 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.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To improve methods of surgical management of post-caesarean uterine scar defect and to justify the choice of an operative procedure depending on the clinical situation and condition of the deficient scar. Patients and methods. We examined 44 patients aged 24 to 42 years, diagnosed with «Defect of the uterine scar after caesarean section». A comparative analysis of two methods of metroplasty – abdominal and vaginal – was performed. For diagnosing the state of the scar we used: transvaginal ultrasound imaging in the 2D, 3D and high-sensitivity power Doppler modes, magnetic resonance imaging, hysteroscopy. Results. The advantage of the vaginal method was recorded by several characteristics (duration of surgery, volume of intraoperative blood loss, restoration of physical activity within the first 24 hours). But its application required a number of important conditions, among which a history of not more than two caesarean sections. Pregnancy occurred in 24 (54.5%) patients 9–26 months after surgery and ended with caesarean deliveries at term. Conclusion. Management of isthnocele per vaginalis is the least traumatic method among all known techniques. But at the slightest risk of complications associated with damage of the urinary tract, laparotomy should be used. Each patient with post-caesarean uterine scar defect needs an individual approach.

© 2018, Dynasty Publishing House. All rights reserved. The objective. Based on revealed changes in the parameters of the blood coagulation system and the functional state of the endothelium to propose pathogenetically justified therapeutic and diagnostic approaches ensuring a higher effectiveness of therapy of inflammatory bowel disease and prevention of complications. Patients and methods. We examined 78 children aged 3 to 15 years with newly diagnosed IBD, standard gastroenterological examination was performed to determine specificities of the coagulation system of IBD patients with administration of tests characterizing the state of all its components (number, size and aggregation of platelets, von Willebrand factor, international normalised ratio, activated partial thromboplastin time, thrombin time, fibrinogen, D-dimer, nitric oxide). Results. In the course of the study we found disorders in all components of the coagulation system. During exacerbation in children with ulcerative colitis and Crohn’s disease total concentrations of nitrates and nitrites in blood increase, in UC a reduced capability of the initial stage of thrombus formation with regard to the parameter «degree of platelet aggregation» can be found, which might account for frequent bleedings in this pathology. In CD, a significant decrease of platelet aggregation size was found, which is indicative of impaired functional properties of platelets. Investigating the coagulation component we found disorders of the final state of hemostasis – a prolonged time of fibrin clot formation resulting from prolonged TT, and also higher levels of D-Dimer, which is indicative of increased fibrinosysis processes. After alleviation of disease exacerbation the coagulation parameters only partially normalised: deviations in the platelet component remained. Conclusion. The processes of intestinal wall inflammation and disorders of the blood coagulation system in IBD exacerbation and in the course of its alleviation run parallel to each other. A developed clinical picture of IBD is accompanied by disorders of the initial (thrombus formation) and final (increased fibrinosysis) stages of blood clotting. A decreased degree and quality of platelet aggregation, increased fibrinosysis are evidently an important pathogenetic component of gastrointestinal bleeding.

© 2018, Dynasty Publishing House. All rights reserved. Literature data about biomechanical foundations of the development of foot pathologies in children and adolescents are analysed. The development and formation of anatomical structure of the foot as a flexible movable arch, and biomechanical specificities in human standing and walking are also considered. As has been noted, correct development and formation of the anatomical skeleton of the foot, its ligamentous-muscular apparatus and sole skin ensure its reliable functioning. As has been pointed out, understanding of the biomechanics of walking is extremely important for an orthopaedist when choosing a method of foot pathology correction, in particular, in rehabilitation of paediatric patients. The main functions of the foot have been specified – spring, balance, and propulsion. Most methods of diagnosing foot injury and disease, as a rule, are aimed at evaluating the spring function of the foot based on analysis of its anatomical structures. The conclusion has been made that the problem of correction and management of foot dysfunctions and pathologies should be solved as early as in childhood, which is possible only on the basis of complex consecutive implementation of a number of measures that include: diagnostics, choice of a way of correction, design and manufacturing of an individual orthosis (conservative method) or surgical treatment. Large-scale clinical testing of modern methods of podology and biomechanics in diagnosing and treatment of foot pathologies and correction of disorders of its stance function will contribute to progress in solving such a significant medico-social problem as foot disorders in childhood and adolescence.

© Saint Petersburg Pasteur Institute. All rights reserved. The aim of the present systematic literature review is to summarize data on the role of TLRs in maintaining homeostasis of the female genitals, in maintaining the physiological development of pregnancy, provision of anti-infective resistance in pregnant women with intrauterine infection. The review substantiates the importance of TLRs of female genitals as a necessary and determining factor in the reaction to various changes in the environment, and also responsible for changes in metabolic, structural, or energy, in the maintenance of anti-infective resistance and homeostasis. As universal regulators of vital activity of organism TLRs in conjunction with other receptors of innate immunity provide maintaining the general reactivity and anti-infective resistance at the physiological level. In physiologically developing pregnancy in a background of immunosuppression in response to pregnancy TLRs during contact with infectious and non-infectious pathogens stimulate the production of nonspecific adaptive immunity factors (defensins, cathelicidins, histatines, etc.), which together with the non-specific innate factors lysozyme, complement, properdin, etc. support anti-infective resistance of the female genitals at a high level at the beginning of the infectious process. Possible violations of the development of pregnancy may be accompanied by changes in the response of TLRs to infectious and non-infectious factors until hyper-reaction, excessive inflammation or apoptosis, which requires adequate management of pregnancy. Was established the significance of the influence of pathogens of infectious and noninfectious origin in intrauterine infection indirectly through TLRs in the homeostasis of the organism, on the formation of breaches in anti-infective resistance at the organism and community level the identification of new pathophysiological and immunological pathogenetic mechanisms of development of pathological processes. IUI is a penetration of microorganisms into the tissues of fetus and it's infection. The inhibition of the functional activity of TLRs is accompanied by the direct effect of the pathogen on the tissues, and during hyper-reaction of TLRs to pathogens revealed a pronounced inflammatory response in the fetus. The level of expression of TLRs correlates directly with the severity of the process that can be considered as early markers of infection. Depending on the nature of the pathogen an increased expression of one or the other TLRs is observed. Explained the lack of symptoms, the possibility of atypical manifestations, the asymptomatic course of infection.

AIM: To investigate the role of video-assisted subtotal esophageal resection in treatment of patients with benign esophageal diseases. MATERIAL AND METHODS: Fifty-one patients with benign esophageal diseases have undergone subtotal esophageal resection in our department for the period 2010-2017. Thoracoscopic technique was applied in 25 cases, open approach - in 26 patients. Total surgery time, thoracoscopic stage duration, length of hospital-stay (LOS), ICU-stay, Clavien-Dindo morbidity rates with separate registration of respiratory complications, mortality have been considered. RESULTS: Groups were similar in terms of age, gender, ASA status. Thoracoscopic stage duration gradually decreased from 175 to 65 min with average time of 102 (75; 123) min. Total surgery time was 390 (270; 495) min in group 1 and 465 (341; 561) min in the control group (р=0.035). Mean ICU-stay decreased up to 2 (1.25; 3.75) days compared with the control group (5 (3.92; 5.85) days, р<0.0001). Conversion rate was 8%. In the main group complications Clavien-Dindo grade 2 were detected in 10 (40%) patients compared with 20 (69%) cases in the control group (р=0.009). Respiratory complications occurred in 5 patients in group 1 and in 13 cases of the control group (р=0.039). Mortality was absent. CONCLUSION: Thoracoscopic subtotal esophageal resection may be advisable alternative to open surgery for patients with benign esophageal diseases due to lower postoperative morbidity and earlier rehabilitation followed by improved outcomes.

© 2018 Tuberculosis and Lung Diseases. All rights reserved. The article presents the review of latest studies devoted to assessment of the eosinophilic inflammation in chronic obstructive pulmonary disease (COPD) and opportunities for differential therapy of stable COPD and COPD therapy during exacerbation. Currently, there is no final definition what threshold blood level of eosinophils can be used for decision making in clinical practice. The only thing found out was that the high blood level of eosinophils could be a predictor of the risk of frequent exacerbations and the effectiveness of treatment with glucocorticosteroids.

© 2018 Russian Electronic Journal of Radiology.All right reserved. The literature data which demonstrate the possibilities of using computed tomography (CT) with contrast agents for the analysis of the deceased patients' bodies are presented. It is shown that postmortem CT angiography significantly expands the possibility of so-called noninvasive autopsy. The information on the features of the use of different types of con-trast agents as well as the main methods of postmortem CT angiography are presented. The use of targeted postmortem CT angiography allows to study the features of blood supply and to identify pathological changes in blood vessels of certain organs, in particular, coronary heart disease and cerebrovascular lesions. CT angiography of the whole body, especially multiphase postmortem CT angiography, allows to visualization of the cardiovascular system as a whole. The use of CT angiography is most effective for determining the source and volume of internal bleeding, the severity of thrombosis and the degree of stenosis of blood vessels, the type and prevalence of vascular malformations. We noted the complexity of the application and possible artifacts of postmortem CT angiography. It was concluded that postmortem CT angiography can be used to analyze of the bodies and clarify the tanatogenesis of deceased patients. We accented that postmortem CT angiography cannot fully replace the traditional autopsy despite its high specificity and sensitivity with regard to visualization of fatal bleeding.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: In recent years, whole-body MRI have been increasingly used in the field of oncological radiology owing to its advantages such as: yield of high-quality diagnostic information in relatively short scan time, lack of radioisotope or intravenous contrast use, and comparingly low examination cost in contrast to traditional nuclear medicine techniques. Aim of this article is to bring the overview of whole-body MRI as a technique and current applications of its use in oncological radiology.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. Obesity is one of the leading and the most serious risk factors of cardiovascular diseases. Overweight provokes many metabolic and hemodynamic disorders. About 30% of inhabitants of the planet have overweight and prevalence of obesity increases by 10% every 10 years according to the WHO data. The probability of arterial hypertension in obese patients is 50% higher than in people with normal body mass. Framingham study showed that obesity is an independent, significant risk factor of ischemic heart disease, myocardial infarction, cerebral stroke and diabetes mellitus. The most dangerous is the central obesity with the preferential fat deposition in the abdomen. Combination of visceral obesity, violation of carbohydrate and lipid metabolism, arterial hypertension, and close pathogenic relationship between these factors underlie the isolated symptom complex known as metabolic syndrome. J. Vague was the first to describe relationship between abdominal obesity with cardiovascular disease and mortality in 1947. In our country G.F. Lang noticed common combination of arterial hypertension with obesity, lipid and carbohydrate metabolism disorders. Thus, metabolic syndrome significantly increases risk and severity of cardiovascular disease. Within last decades criteria of metabolic syndrome stays constant. The factors of insulin resistance and endothelial dysfunction as stages of the pathogenesis of the metabolic syndrome have been studied in detail. The mechanisms of insulin resistance and endothelial dysfunction are discussed in detail in this article as well as inflammatory markers and the significance of highly sensitive C-reactive protein.

© Ima-Press Publishing House. All rights reserved. Objective: to study the clinical features of depression in women compared with men. Patients and methods. 120 women aged 18-65 years with recurrent depressive disorder (RDD; ICI-10 F33) (a study group) and 67 men of the same age with RDD (a control group) were clinically examined using a specially designed schedule and the Montgomery-Asberg Depression Scale. Results. The clinical picture and the course of RDD have gender differences. The earlier onset of the disease in women with a large number of depressive attacks and lower quality remissions is due to the relationship and mutual influence of menstrual and reproductive function and depression. Such typical symptoms of endogenous depression, as slow thinking, anhedony, decreased sleep duration and early morning awakenings, as well as diurnal swings of mood with its deterioration in the morning, were characteristic for most women and men. The pattern of depression in women is more commonly characterized by anxiety; ideas of self-accusation; suicidal thoughts; avoidance of contacts with others; weakness; fatigue; decreased or increased appetite; sleep onset insomnia; lack of sleep feeling. That in men is more often marked by symptoms, such as melancholy; motor retardation; decreased motivation; somatic symptoms of depression (tachycardia, constipation); comorbid panic attacks; and concomitant diseases of the cardiovascular, respiratory and genitourinary systems. Men more frequently abuse alcohol and other psychoactive substances. Conclusion. The revealed features of depression in women and men will be able to more accurately diagnose and to prescribe adequate therapy.

© 2018 Voprosy Sovremennoi Pediatrii - Current Pediatrics. All rights reserved. Background. Infections are the main cause of death for patients with autoimmune rheumatic diseases. In adult patients with rheumatoid arthritis (RA), mortality caused by respiratory infections is 2-5 times higher than in the population. One of the frequent infectious complications in the course of treatment with tocilizumab, the first-choice drug for treating systemic juvenile idiopathic arthritis (sJIA), is pneumonia characterized by a poor clinical picture, normal values of laboratory indices of the disease activity (ESR, C-reactive protein) with pronounced changes in the lungs revealed by computed tomography. In case of acute respiratory infection in children with systemic JIA, immunosuppressants and genetically engineered biological preparations (GEBP) are discontinued. This often leads to an exacerbation of the underlying disease and the progression of a pathological process. At present, vaccination against pneumococcal infection in Russia is not included in the standard for managing patients with rheumatic diseases. Studies of the safety and efficacy of vaccination with 13-valent pneumococcal conjugate vaccine (PCV) in patients with sJIA receiving genetically engineered biological preparations were not conducted. Clinical Case Description. The article shares the experience of vaccination of a girl aged 9 years with a 13-valent PCV that was conducted in the course of a scientific investigation, which studied the efficacy and safety of vaccination of children with systemic JIA prior to prescription of GEBP tocilizumab. Vaccination did not cause a deterioration in the course of the main disease (1 month), led to a reduction in the incidence of acute respiratory infections (from 4 to 1 time within 6 months before and after vaccination), and discontinuation of antibacterial drugs within 6 months after vaccination. Conclusion. The safety of a 13-valent PCV in a child with sJIA and a decrease of the incidence of respiratory diseases after vaccination, their complications, and the use of antibacterial drugs have been shown.

© 2018 Ophthalmology Publishing Group. All rights reserved. Purpose: creation of working classification of morphologic variations of postoperative lens capsule opacity after Micro-Invasive cataract surgery. Material and methods: Morphologic study of the lens capsule (LC) has been conducted on 4 artiphakic cadaveric eyes. A specimen of an isolated anterior lens capsule, obtained during the repeated operation with changes characteristic for anterior capsular contraction syndrome has been studied too. The obtained specimens have been researched with the method of semithin sections. Results: The analysis of the morphologic cadaveric LC specimens revealed the polymorphism of secondary cataract (SC). Besides well known "classic" SC forms, which were caused by fibroplasias processes or pseudo-regeneration a new type of postoperative LC opacity not represented in the available literature before has been revealed. The given variant of opacities was called "pseudo-hyaloid" form and characterized by the absence of clear LC borders, changes of its normal structure, the appearance of loose fibrillar structure with microslit spaces and exfoliations, that possibly was the consequence of acustic cavitation, arising in the result of ultrasonic effect. As a result the LC lost characteristic for it the role of the dense bed and made impossible adhesion and migration on its changed surface the proliferative fibrocellular elements characteristic for "classic" SC forms. The microscopy results of the isolated anterior LC specimen in the area of capsulotomic aperture showed the presence of altered abundant loose fibrillar tissue with microporous structure and expressed forming of folds. Making layers of fibrous tissue exceeded the thickness of the normal anterior LC in 10 and more times and considerably reduced the diameter of capsulotomic aperture. Conclusion: The variety of postoperative LC opacities confirmed by the results of morphologic studies afforded to suggest a new working classification in which all possible morphologic variants and the stages of the secondary pathologic changes forming of anterior LC. The suggested classification is convenient for the understanding and must promote to make a right algorithm in the choice of optimal and safe technology of laser reconstructive interventions.

© ABC-press Publishing House. All rights reserved. Objectives to enhance the morphological diagnostic complex in order to predict postoperative outcomes in a more accurate way and to optimize patients with non-muscular invasive bladder cancer treatment. Materials and methods. The study included 34 patients from 25 to 71 years old underwent laser en-block resection, the most of them were males - 28. In 9 cases multiple carcinomas (2 or more) were found. Huge tumors (2 cm or more in one dimension) were resected in 6 patients. Results. The major part of tumors removed (n = 22) histologically appeared to be papillary urothelial carcinomas with low grade of malignancy and PUNLMP; in 6 cases G2 was verified, one tumor with high malignancy potention - G3. In 3 patients intramuscular invasion was found (invasive carcinoma T2) excluding them from the study. Discussion. Laser en-block resection of non-muscle-invasive bladder cancer appears to be the most optimal approach in operative treatment that provides representative histological material. For correct morphological estimate we recommend either to expand the resection zone to 1 cm which allows to remove circular resection margin or to take extra pinch biopsy from tumor crater (vertical margin). In 3 patients from our study positive circular margin was revealed histologically whereas foci of perineural and perivascular invasion were found in one case. A new subgrading of stage T1 depending on intramuscular invasion depth was suggested whereas the main criteria is the muscularis mucosae involvement. Conclusion. Morphological estimate of circular resection margin provides an ability to predict postoperative outcomes and correct the treatment in one or another way. Subgrading for T1-stage tumors is recommended for following correct postoperative prognosis and possibility of tumor recurrence.

© 2018, Media Sphera Publishing Group. All rights reserved. Pectus excavatum (PE) and pectus carinatum (PC) in children are the most common congenital deformities that cause complications in the thoracic organs; however, the role of chondrocytes and cartilage canals in the pathogenesis of these conditions remains unexplored. Objective — to investigate qualitative and quantitative changes of cartilage lacunae and canals in the costal cartilages in children with PE and PC compared to those with normal chests. Subject and methods. Costal cartilages were investigated in 10 children with normal chests (a control group), in 12 children with PE, and in 12 children with PC. Tissue fragments were fixed in 10% neutral formalin and embedded in compacted paraffin. Sections were stained with hematoxylin and eosin. Slides were examined by light microscopy. Cartilage lacunae, hyper-and hypolacunar zones, and cartilage canals were morphometrically examined, followed by statistical data analysis. Results. There was a significant decrease in the number of cartilage lacunae and in the frequency of hyperlacunar zones and an increase in that of hypolacunar zones in the PE and PC groups. There were no significant differences in these parameters between the PE and PC groups; however, there was a tendency to the smallest number of cartilage lacunae and canals in the PC group and that to the preponderance of empty lacunae in the PE group. Only the PC group showed also negative correlations between the proportions of empty lacunae and the age of children. Conclusion. The pathogenesis of PE and PC in children is related to the impaired trophism of costal cartilages due to the smaller number of cartilage channels containing vessels and lacunae with chondrocytes. The development of PE and PC is associated with specific costal cartilage morphological changes that suggest that PE and PC are different manifestations of the same disease, namely connective tissue dysplasia.

© 2018, Media Sphera Publishing Group. All rights reserved. The paper describes the procedure to prepare endothelial cell monolayer samples from the vascular intima, which is suitable for studying various morphological processes. To obtain high-quality multicellular specimens, it is recommended to preliminarily remove excess tissue from the outside of the vessel and to free the intima; ways to dry the surface and to separate endothelial cells are examined. The paper gives the figures of specimens stained by the Romanowsky-Giemsa method and identifies factor VIII, an endothelial marker, and Chlamydia pneumoniae inclusions in the cytoplasm of endothelial cells.

Research objective was assessment of a possibility of primary diagnosis of viruses Epstein-Burr, a cytomegalovirus, a virus of herpes of the 6th type in oral liquid and also influences of herpes infection on development and the clinical course of precancer diseases of the oral mucosa and the red border of lips (RBL). Profound clinic-immunological examination is conducted to 60 patients: the first group are have made 20 patients with an erosive and ulcer form of the lichen planus, the second - 20 people with an erosive form of a leukoplakia, a third - 20 people without diseases of the oral mucosa. As a result of work detection herpes infection is revealed high (90%). The combined infection with a virus Epstein-Burr and a virus of herpes of the 6th type was observed more than at a half of patients. The imbalance of factors of local immunity of the oral cavity in the form of increase in the IgG profile, decrease in concentration of IGA, lysozyme, and increase in an indicator of Ksb three times in comparison with norm and also substantial increase of level of pro-inflammatory cytokin IL 1β and FNO-α is found in patients with precancer diseases of the oral mucosa. Characteristic clinical feature of the precancer diseases associated with latent herpes infection is the long, recidivous current, persistent to traditional therapy. The research of oral liquid and blood on herpes viruses and consultation of the infectiologist is recommended to all patients with precancer diseases.