Репозиторий Университета

© 2018 Authors. The present work presents a description of various cutting devices with an emphasis on skin surgery for the optimal choice of instruments in plastic surgery. Physical principles of work with a description of the biological role of an ultrasonic scalpel, various laser cutting devices, electrosurgical instruments, including radiofrequency electrosurgery, are described. Studies of recent years, including systematic reviews and meta-analyzes, are devoted to comparative analysis of various cutting and coagulating devices among themselves and in comparison with the mechanical metal scalpel.

© 2018 Media Sphera Publishing Group. All rights reserved. In this article we present problems of prognostic value of day-by-day blood pressure (BP) variability, its role in development and progression of damage of target organs in arterial hypertension, and impact on risk of cardiovascular, cerebral-vascular complications, and mortality. We also discuss methodological aspects of assessment of day-by-day BP variability. The article contains literature data on effects of antihypertensive therapy on variability of home BP, and consideration of evidence base of possibilities of the fixed amlo-dipine/perindopril combination for lowering day-by-day BP variability.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. Background. Tumour necrosis factor alpha inhibitors are widely used in the treatment of juvenile idiopathic arthritis (JIA). To achieve maximum efficiency of genetically engineered biologic drugs, it is necessary to study predictors of the response to therapy. Objective. Our aim was to identify early predictors of the response to adalimumab therapy in patients with JIA without systemic manifestations. Methods. A prospective cohort study analysed treatment results of patients with JIA without systemic manifestations, who were prescribed adalimumab for the period from August 2008 to August 2014. We studied the relationship between baseline demographic indicators as well as baseline and registered after one month of treatment clinical and laboratory parameters and the best (remission according to the Wallace criteria) response to therapy after one year. Results. In the first year of therapy, 94 (43.9%) of 214 patients achieved remission according to the Wallace criteria. In a multivariate analysis, predictors of achieving remission after one year of adalimumab therapy were the improvement according to the ACR70 criterion after one month of therapy [odds ratio (OR) 3.3; 95% confidence interval (CI) 1.7-6.7], a history of uveitis (OR 1.86; 95% CI 1.03-3.33), a decrease in the number of joints with active arthritis after one month of therapy (OR 1.09; 95% CI 1.02-1.16). During therapy, injection reactions in the form of pain were observed in 36 (16.8%) of 214 patients, infectious diseases of ENT organs - in 85 (39.7%), of the respiratory tract - in 17 (7.9%), and tubinfection - in 13 (6.1%) children. Conclusion. The presence of uveitis, rapid reduction in the number of joints with active arthritis and a high level of response to treatment after one month of adalimumab therapy are predictors for achieving remission during the first year of treatment.

© 2018 Medical Radiology and Radiation Safety. All rights reserved. Introduction: The highest priority for modern clinical oncology is functionally-sparing and organ-conserving treatment. In Russia, breast cancer (BC), among all malignant tumors, accounted for 21.1 % of women in 2017. Oncoplastic radical resections (OPS-BCS = oncoplastic surgery – breast conserving surgery) have been widely used. This term means resection of the breast for cancer using plastic surgery to restore the shape of the breast, in most cases with one-stage correction of the contralateral breast. Purpose: It was the creation of various techniques of oncoplastic breast surgery, applicable for the appropriate localization of breast cancer and the evaluation of surgical, oncological and aesthetic results. Methods: From 2013 to 2017, in the P.A. Hertsen Moscow Oncology Research Center, organ-conserving surgery were performed in 570 patients with BC with an average age of 54.2. Stage 0 was diagnosed in 4.6 %, I – 5.9 %, IIA – 28.7 %, IIB – 6 %, IIIA – 5.1 %, IIIC – 3.3 %, IIIB – 0.2 %, IV – 0.2 %. Radical resection in the standard version was performed in 290 patients with breast cancer, oncoplastic breast surgery in various modifications – in 280. All patients after the organ-conserving surgical treatment received radiation therapy. Patients received chemotherapy, targeted therapy and hormone therapy according to the indications in depending the disease stage and the immunohistochemical type of the tumor. Results: After an urgent and planned morphological study positive margins of resection were revealed in 10 patients, which required reresection of the edges to a negative state of them in case of an urgent intraoperative response and mastectomy – in case of a planned response. Within 4 years, local recurrences were detected in 4 patients (0.7 %), which required a mastectomy with a one-stage reconstruction. In 1 patient (0.2 %), the disease progressed as metastases to the lung – in this case lobectomy and a necessary chemotherapy were conducted. Cosmetic results were defined as excellent in 70 % cases, good – 25 %, satisfactory – 5 %. Conclusion: If there are indications for organ-conserving treatment of breast cancer and the patient’s decision concerning this surgery, the patient should be offered methods of oncoplastic surgery for the prevention of psychological and emotional stress, effective rehabilitation, and a quick return to active social life.

Etiology, epidemiology and pathophysiology of anal fissure are examined in the article in order to determine the most optimal treatment strategy. The authors concluded that the most effective treatment is combined approach using both minimally invasive surgery and various medicines for anal spasm reduction.

© 2018, Media Sphera Publishing Group. All rights reserved. This article was designed as a comparative review of the literature publications pertaining to the two opposite approaches to the surgical treatment of varicose veins of the lower extremities based on the vein-sparing and radical principles. We compare classical phlebectomy (i.e. endovenous treatment of varicose veins including thermal obliteration) and the vein-savings treatment with the use of the methods for the hemodynamic correction of venous insufficiency, such as ASVAL, CHIVA, and short stripping with special reference to its location and extent. Also covered in the article is the issue of the appropriate length of great saphenous vein stripping. The authors emphasize that it should be based on the extent of reflux rather than on the desire to avoid saphenous nerve injury. It is maintained that either partial or complete preservation of the stem of the great saphenous vein (GSV) in addition to the endovenous obliteration techniques is an efficient and safe modification of the surgical intervention. Stripping is indicated when the endovasal intervention is either impossible or undesirable because of clinical, anatomical, and/or technical limitations. Short stripping in the absence of total reflux in the great saphenous vein is a safer procedure in comparison with the total extirpation of the venous stem.

© 2018 Ismailova et al. Orbital decompression is a surgical procedure aimed at increasing the orbital volume and/or decreasing the volume of the orbital fat. The indications for orbital decompression are determined in the course of thorough eye examination. An important objective of examination of a patient with thyroid eye disease (TED) is determination of inflammation activity and severity. Orbital decompression is a surgical procedure that can be performed in both the active and non-active stages of the disease. However, the indications for the surgery in these cases are different. Optic neuropathy and severe corneal disease are threatening complications that may lead to permanent visual loss and generally occur in the presence of active orbital inflammation. If treatment with high-dose corticosteroids has proven ineffective, an urgent surgical procedure consisting of orbital decompression and, in case of involvement of the cornea, eyelid and corneal surgery has to be performed. Owing to significant progress in technology, improvement of methods and accumulated experience over the past decade, the indications for bone orbital decompression have extended compared to the time when this procedure was used only in patients with extremely severe TED. The most common complication of the orbital decompression is the development or deterioration of previously existing binocular diplopia and strabismus. In addition, other parameters may change as well, including the position of the globe, the eyelids, the angle of deviation of the eye, and intraocular pressure. Thus, bone orbital decompression is a major step of a comprehensive, often multistage, system of rehabilitation of patients with severe refractory TED.

© 2018 Media Sphera Publishing Group.All Rights Reserved. In the article we present three clinical observations demonstrating that HCV infection in patients with remission of Wilson disease causes an recrudescence of the disease, in one of the observations - decompensation of liver cirrhosis. In this study we first describe on the successful treatment of HCV infection with direct antiviral drugs in patients with Wilson disease. Establishment of all factors of liver damage and successful treatment (elimination of the virus, adequate lifelong medical treatment) allow to expect a favorable prognosis in patients with a combination of Wilson disease and HCV infection.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Aim. To study the oxidative damage of biopolymers (proteins and nucleic acids) in blood of patients with type 2 diabetes mellitus (DM). Materials and methods. In the blood of 50 patients with DM and 25 patients without disorders of carbohydrate metabolism were estimated: the level of oxidized low-density lipoprotein (oxLDL) by immunochemical method, the content of SH-groups in plasma proteins, the activity of Cu, Zn-superoxide dismutase (SOD) in erythrocytes, the length of telomere in leukocyte DNA, the level of 8-hydroxy-2'-deoxy-gunosine (8-oxo-dG) in plasma and urine. Results and discussion. It is shown that in DM patients the level of oxLDL increases and the content of SH-groups in proteins and peptides of the blood plasma decreases, which indicates the development of oxidative stress. In addition, a carbonyl-dependent modification of erythrocyte SOD was detected in DM patients, as well as oxidative DNA destruction (decrease in telomere length in leukocytes and an increase in the level of 8-oxo-dG in blood plasma and urine). Conclusion. On the basis of the definition of a complex of correct indicators, a multiple oxidative modification of biopolymers of blood (proteins and DNA) was detected in patients with DM.

© 2018, Media Sfera. All rights reserved. The article describes a newly developed and tested diffractive optical element (DOE) that converts non-uniform radiation of the laser output into a homogeneous ring. The Gerchberg-Saxton algorithm is shown to be well suited for achieving annular intensity distribution. Testing this ring transducer on threshold-plasticity cornea demonstrated the reversibility of axisymmetric changes in the cornea. Atomic-Force microscopy of the area of maximum stresses in the corneal periphery showed no significant changes in the structure of the cornea when irradiated in the selected mode. Measurement of Young’s modulus of the corneal surface areas after their irradiation also revealed no changes in the elastic properties, while examination of the corneal structure demonstrated the absence of significant structural changes in irradiated samples compared with intact ones.

© 2018 Russian Association of Endocrinologists. All rights reserved. In recent years, a large amount of data has been accumulated on the relationship between cognitive impairment, dementia and diabetes mellitus. This article presents an overview of modern literature, including the definition of cognitive functions, the modern classification of cognitive impairment, pathogenetic mechanisms of diabetes mellitus influence on the development of cognitive impairment and dementia (neurogenesis, integrity of the blood-brain barrier, systemic inflammatory reactions, hyper- And hypoglycemia, insulin resistance, vascular dysfunction of the microvasculature and increase in glucocorticosteroids). The influence of anti-diabetic medications on cognitive functions has been examined in detail: insulin preparations, oral hypoglycemic agents of the biguanide group (metformin), thiazolidinediones (rosiglitazone and pioglitazone), sulfonylurea derivatives (glycazide, glipizide), a-glucosidase (acarbose) inhibitors, incretin-directed therapy (receptor agonists glucan-like peptide (exenatide and liraglutide) and inhibitors of dipeptidylpeptidase type 4 (sitagliptin, vildagliptin and alogliptin)), sodium glucose inhibitors cotransporter type 2. The data demonstrating a multidirectional effect on the cognitive functions of various antidiabetic drugs is presented, the possible influence on the rate of progression of cognitive impairment and the risk of dementia of intensive control of plasma glucose level in comparison with the standard decrease in patients with type 2 diabetes is analyzed.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The article discusses the problem of the role of pets as a source of zoonotic infections, representing a hidden threat to modern society. Since the content is now very popular at home, both traditional and exotic animals, it is necessary to develop an interdisciplinary program to control the spread of zoonotic infections and the risks of their infection with people. Since the problem lies in the intersection of several disciplines, joint efforts of doctors, veterinarians, health organizers and laboratory specialists are necessary.

© 2018 Ima-Press Publishing House.All right reserved. Objective: to study changes of acute-phase reactants (erythrocyte sedimentation rate – ESR, C-reactive protein – CRP), autoantibodies (IgM/IgA rheumatoid factors – RF, anti-citrullinated protein antibodies), immunoglobulin classes G, M, and A, and CD19+ B-lymphocytes in patients with rheumatoid arthritis (RA) 12 and 24 weeks after initiation of therapy with a rituximab (RTM) biosimilar at a total dose of 1200 mg. Subjects and methods. Examinations were made in 20 patients with a reliable diagnosis of RA (including 18 women; median age, 61.5 [54; 66.5] years; disease duration, 39.5 [20; 84] years; DAS28, 5.6 [4.9; 6.8]). All the patients received two intravenous infusions of RTM (Acellbia®) 600 mg at a 2-week interval during therapy with methotrexate, nonsteroidal anti-inflammatory drugs, and glucocorticoids. Clinical and laboratory parameters were analyzed immediately before therapy and then 12 and 24 weeks after the first infusion of the drug. Results and discussion. DAS28, ESR, and CRP level in respondents significantly decreased 12 and 24 weeks after RTM administration. The serum IgM RF concentration in the respondents was found to be significantly reduced at weeks 12 and 24 and amounted to 79.7 and 87.1% of baseline, respectively. The IgA RF level significantly decreased by 72 and 85% of baseline at weeks 12 and 24 of RTM therapy, respectively, in patients with a good response, and by 59.7 and 67.5% at weeks 12 and 24 in patients with a satisfactory response. The serum concentration of anti-cyclic citrullinated peptide antibodies in the respondents remained high throughout the follow-up. All the patients achieved CD19+ B-cell depletion at week 12 of therapy (absolute levels, 0); there was an increase in the level of CD19+ B-lymphocytes at week 24 (0.0030 [0.0003; 0.0270] 109/l). In both in the good and satisfactory response groups, the mean immunoglobulin levels remained within normal limits. Conclusion. The analysis of the efficiency of two infusions of the RTM biosimilar at a total dose of 1200 mg following 24 weeks of therapy initiation suggests that the drug is able to cause reductions in disease activity, laboratory signs of inflammatory activity, autoantibody concentrations, and complete B-lymphocyte depletion.

© 2018 Ima-Press Publishing House.All right reserved. Impaired B-cell immunological tolerance plays a central role in the pathogenesis of autoimmune rheumatic diseases and autoimmune diseases of another nature. B-cells link innate and acquired immunity: they express Toll-like receptors that respond to danger signals; act as antigen-presenting cells; induce an antigen-specific immune response; determine the development of immunological memory; and synthesize a wide range of cytokines that regulate (stimulate or suppress) an immune response and inflammation. In autoimmune diseases, there are metabolic and B-cellular signaling disturbances that lead to defects in B-regulatory, T-regulatory, follicular T-helper, and dendritic cells. B-cells synthesize organ-nonspecific and organ-specific autoantibodies that are biomarkers for autoimmune diseases and play an important role in their immunopathogenesis. Anti-B-cell therapy that causes B-cell depletion in blood and target organs is effective in a wide range of autoimmune diseases. Its efficiency is determined by various mechanisms, such as suppression of pathogenic autoantibody synthesis; modulation of the function of B-cells (antigen presentation, cytokine synthesis, and costimulation), T-lymphocytes and dendritic cells. Further study of a strategy for targeted anti-B-cell therapy, mechanisms of action, and new targets is important for the progress of modern rheumatology to improve the treatment strategy of autoimmune rheumatic diseases.

© 2018 Copyright SPIE. The paper presents the results of the studies of influence of optical radiation with wavelengths of 520 and 780 nm on human glial cells (U251) at the range of exposure times ∼ 1-15 min. It was found that after the first minute of irradiation at the wavelength of 780 nm, the relative number of apoptotic cells significantly increased. The result corroborates the concept of biological hazard of optical radiation for tumor cells, and suggests that the approach has a great potential in clinical application for the treatment of human glioma.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study cognitive functions, anxiety and depression levels, 24-hour blood pressure (BP) profile, cerebral blood flow (CBF) perfusion in treatment-naive middle-aged patients with uncomplicated essential arterial hypertension (EAH) depending on the white matter hyperintensities (WMH) burden. Material and methods. Forty-one hypertensive patients (mean age 46.2±4.6 years) and 41 healthy volunteers (mean age 50.3±6.7 years) were enrolled to the study. All subjects underwent brain MRI (MAGNETOM Skyra 3.0T, T1, T2 FSE, T2 FLAIR, T1 MPRAGE, ASL), Montreal cognitive assessment (MoCA), 10-word learning task, verbal fluency test, trail making test, Stroop color and word test, anxiety and depression assessment with Hamilton rating scales, 24-hour blood pressure monitoring (ABPM). Results. WMH were found in 22 (53.7%) hypertensive patients and in 3 (7.3%) healthy volunteers (p=0.0002). Hypertensive patients had the significantly lower CBF compared to controls (p<0.001). Conclusion. WMH were identified in treatment-naive middle-aged patients with uncomplicated mild to moderate EAH. There was an association between WMH and lower CBF in the cortical plate of frontal lobes, SBP variability and worse cognition. Cerebral hypoperfusion can cause cognitive impairment even in the earliest stages of EAH, which increases due to emotional disorders.

© 2018 Ruslania. All Rights Reserved. One of the prevalent genetic causes of idiopathic male sterility is related to micro-deletions in AZF locus located in Y-chromosome. In total population, rate of such micro-deletions makes up to 1:4000. however, in infertile males their rate varies from 2% to 10%. In AZF locus three subregions are distinguished: AZFa, AZFb andAZFc. The loss of one or several subregions can result in disorder of spermatogenesis of various degree - from decreasing of its activity to Sertoli-cell syndrome manifested by azoospermia or oligospermia of severe degree. Therefore, implementation of genetic testing for presence of micro-deletions in AZF locus is a necessary test in case ofprognosis of male sterility and its treatment. The purpose of study is to develop and test a diagnostic system of detection of micro-deletions in subregions ofAZF locus using multiplex polymerase chain reaction in real-time. As a reference method a technique was implemented described in guidelines of the European Academy ofAndrology conjointly with European Molecular Genetics Quality Network. The technique testing specified analysis of 33 samples of DNA separated from blood of males with azoospermia and oligospermia ofsevere degree. No discordant results were received as compared with reference method. In 27 DNA samples the deletions were detected in AZF locus: 4 AZFa deletions (15%), 2 AZFb deletions (7%), 17 AZFc deletions (63%) and 6 combined deletions of AZFb+candu AZFa+b+c (22%). The proposed technique permits detect micro-deletions of subregions ofAZF locus.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: This article is dedicated to analysis of use PET-CT with 18F-FDG for the last 10 years. Determining the presence of metastasis in regional lymph nodes and distant sites in endometrial cancer is an important diagnostic step aimed at the choice of treatment tactics and improvement of surgical treatment results. If the process is beyond the uterus itself, it significantly worsens the prognosis of survival. In addition, in these cases, it is necessary to change the treatment and surgical tactics. Determination of stage 1 and 2 of the process gives an optimistic prognosis for the survival of patients. Currently, ultrasound, magnetic resonance imaging and, to a much lesser extent, computed tomography are used to assess the prevalence of the process. The diagnostic value of these methods according to some authors does not exceed 66-73%. In this regard, it is justified to work on finding more reliable methods that will more accurately determine the presence of metastatic disease in, both regional lymph nodes and distant organs. One of such promising methods is the use of positron emission tomography combined with computed tomography (PET/CT), using as radiotracer 18 - fluorodeoxyglucose. This article is a review of the scientific literature on this problem over the past 10 years and is devoted to the evaluation of the diagnostic accuracy of PET/CT with 18F-FDG.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: This scientific review of the literature presents the most relevant discussions in the world community, aimed at improving the implementation of the diagnostic algorithm in patients with severe combined trauma. Materials and methods: The work deals with the main traumatic injuries of various anatomical zones, the criteria of the Advanced Trauma Life Support (ATLS) protocol and diagnostic methods aimed at detecting acute traumatic pathology. Conclusion: The authors consider unsolved issues, as well as the improvement of the multislice computed tomography (MSCT) algorithm in the "whole body" mode, to optimize diagnostic activities aimed at managing patients with severe combined trauma.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: Assessing the dynamics of vulnerability of atherosclerotic plaques in patients with angina pectoris on atorvastatin therapy (40 mg for 10-12 months) based on coronary computed tomography angiography (CCTA) data. Materials and methods: The study prospectively enrolled 74 patients with angina pectoris not medicated with statins. All patients underwent CCTA. 30 patients with vulnerability of atherosclerotic plaques were selected for further observation and atorvastatin was administered to them at dose of 40 mg. Repeated tomography scans were recorded 10-12 months later. Images were analyzed by "Vitrea" workstation in a blind manner. Statistical processing was performed on SPSS version 11.5 software (BioStat). Results: Statistically insignificant decrease in: total plaque volume (from 188.64 ± 35.8 to 184.96 ± 34.45 mm3), low-attenuation plaque (from 60.46 ± 12.87 to 57.06 ± 12.34 mm3), degree of stenosis (from 41.6 ± 3.16 to 40.65 ± 3.26%), spotty calcification (from 86.0 to 90%), remodeling index (from 1.25 [1,0;1,4] to 1.1 [1,0;1,4]), napkin-ring sign (from 69.76 to 60%), irregularity of the contour (from 79.1 to 65%). LDL levels decreased from 3.23 ± 0.33 to 2.76 ± 0.27 mmol/L. Statistically significant decrease of total cholesterol was from 5.75 ± 0.45 to 4.42 ± 0.57 mmol/L. The study also revealed statistically significant positive correlation between decrease of LDL levels and total plaque volume decrease (R=0.51, P=0.002), mainly because of lowattenuation components. Conclusion: We review our experience of using CCTA for noninvasive monitoring of vulnerability of atherosclerotic plaques in dynamics and show that atherosclerotic plaques stabilize on long-term atorvastatin treatment.