Репозиторий Университета

© 2018 ABC-press Publishing House. All rights reserved. The objective is to perform comparative analysis of intra- and postoperative complications of retroperitoneoscopic radical nephrectomy (RRN) and laparoscopic radical nephrectomy (LRN) for large tumors. Materials and methods. The study includes examination and treatment data for 108 patients with stage T1–3a renal cell carcinoma. Results and conclusion. A number of advantages of RRN compared to LRN were demonstrated associated with shorter surgery duration with fast processing of the renal pedicle, lower blood loss, lower use of analgesics in the postoperative period, shorter duration of hospitalization, and quick recovery after the surgery. The rate of intra- and postoperative complications for RRN was 19.2 and 17.3 %, for LRN – 33.9 and 37.5 %, respectively. Complications associated with abdominal organs were absent for RRN. After LRN, the rate of serious complications was significantly higher than after RRN.

The modern model of inpatient surgical care of private and optimized state/govermental medical institutions allows us to change the paradigm of nosological attachment of the hospital bed to one profile of specialists for an adaptive model, when the wards can be reassigned depending on the needs of the hospital. In such multidisciplinary medical centers with mixed hospital beds without a nominal distinction in the nosological departments, a new therapeutic service is being developed - hospitalists, which provide a consistent curation of hospitalized patients, compensation of chronic therapeutic illnesses with patient's preparation for surgical interventions. Our work describes the experience of Fast Track recovery program with the active participation of a hospitalist in a surgical team, which is a new experience in the practice of Russian colorectal surgery.

AIM: To evaluate bile ducts injuries and effect of biliary decompression technique on the outcomes of reconstructive surgery. MATERIAL AND METHODS: There were 21 patients with biliary injury during cholecystectomy, 20 patients with cholelithiasis, and 1 patient after surgery for perforated duodenal ulcer. Their age was 22-81 years (mean 54.3 years). Primary surgery through median laparotomy was followed by biliary injury in 12 patients, laparoscopic cholecystectomy - in 6 patients, open laparoscopy - in 3 patients. Patients were divided into 2 groups. In group 1 (n=11) biliary injury was diagnosed intraoperatively, in group 2 (n=10) - in 2-11 days after primary procedure. According to European Association for Endoscopic Surgery (EAES) 2013 classification biliary injury type 1 was found in 5 patients, type 2 - in 9 cases, high damage involving confluence (type 3) - in 1 patient, type 4 - in 1 patient, and type 6 - in 5 patients. Endoscopic retrograde cholangiopancreatography in 3 patients revealed that biliary drainage output after laparoscopic cholecystectomy was caused by cystic duct clipping failure, endoscopic papillosphincterotomy was successfully used for biliary drainage output (type 6). In 3 patients operated through median laparotomy biliary excretion cessation was observed after 2-3 days that indicated damage of aberrant bile ducts. RESULTS: Bile outflow into gastrointestinal tract was restored in 11 out of 16 patients with iatrogenic biliary injury types 1-4, external biliary drainage was used in 4 patients due to their severe condition and abdominal inflammatory changes. Biliary fistulae occurred in 5 out of 8 patients in both groups after primary reconstructive surgery. Biliary stricture was observed in 3 cases due to external biliary drainage failure followed by peritonitis. 7 patients underwent reconstructive surgery with positive result. Mortality was absent. In 1 patient with biliary fistula outcome is unknown. CONCLUSION: Transumbilical biliary drainage is optimal during reconstructive surgery.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Aim. To evaluate cost effectiveness of coronary endovascular treatment in patients with stable IHD during “one-night” hospitalization. Materials and methods. Using the cost-minimization analysis direct medical cost of coronary endovascular treatment in patients with stable IHD during the “one-night” hospitalization was compared with the “classic” hospitalization. Results. The most cost-effective strategy for hospitalization of patients for transcutaneous coronary intervention (TCI) with stenting was the “one-night” hospitalization. Differences in direct medical costs (DMC) were statistically significant (p=0.01) in favor of the patient group hospitalized for one night. Conclusion. The “one-night” hospitalization plan for patients with stable IHD to undergo TCI with stenting increases the cost-effectiveness due to the decreased number of days of stay in the hospital and the associated decrease in cost of in-patient maintenance, which resultes in considerable financial savings (∆ between the hospitalization plans was 21.2% in favor of the “one-might” hospitalization). This ∆ indicates high cost effectiveness of the selected approach.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article discusses various mechanisms of developmentt and progression of arterial hypertension in young and middle aged adults. It emphasizes the predominant role of hypersympathicotonia in the development of the disease in this category of patients. Various mechanisms are considered, by means of which the increase of activity of the sympathetic nervous system leads to elevation of arterial pressure and potentiates early damage of target organs, first of all, damage of the heart. The data of numerous studies demonstrating pronounced cardioprotective effects of a highly selective representative of the class of β-blockers bisoprolol in young and middle aged hypertensive patients are presented.

The article reviews the phenomenology of sleep and wakefulness disorders in Parkinson's disease and Alzheimer's disease. Degeneration of sleep and wakefulness centers, secondary effect of other symptoms of diseases and side-effects of drug therapy lead to a widespread prevalence of sleep and wakefulness disturbances in these patients. Along with the review of actual literature concerning mechanisms of development and clinical features of these disorders, the authors discuss principal methods for their treatment.

© 2018, Dynasty Publishing House. All rights reserved. The objective. Assessment of the practice of breastfeeding support in a department of neonatal and premature infant pathology of the Tambov Regional Children’s Clinical Hospital (TRCCH) after 3–4 years of becoming a WHO/UNICEF Baby Friendly Hospital. Patients and methods. Mothers were questioned using specially designed questionnaires at their admission to the department and at discharge from hospital. Overall, 356 mothers were questioned at admission and 327 at discharge. The results were processed on the SPSS.19 statistical programme. Frequency distribution, mean values (± standard deviation) and Student’s t-coefficient were determined. Results. The practice of supporting breastfeeding in the department consisted in observance of the 10 steps of successful breastfeeding: mother and infant remaining together (98.2%), breastfeeding on an infant’s demand (91.3%), breastfeeding at night (98.6%), breast milk extraction for infant feeding and lactation stimulation (88.6%), informing mothers about the benefits and technique of breastfeeding (90.5%). The percentage of breastfed infants significantly increased by the time of discharge from the department – to 89.4% (at admission – 71.9%; p < 0.0001), among them exclusively breastfed infants – to 66.5% (at admission – 45.3%; p < 0.0001). Conclusion. The practice of breastfeeding based on current international recommendations is successfully supported in the neonatal department of TRCCH. Nevertheless, breastfeeding parameters might be considerably improved due to attainment of continuity in the work of maternity clinics and TRCCH and optimization of the practices of breast milk extraction, storage and use in the department.

© 2018 Institute of Europe Russian Academy of Sciences. All Rights Reserved. Introduction. In the modern world, volunteering is one of the most effective ways for successful social development and improvement of the quality of human life. By the Decree of the President of Russia Vladimir Putin, the year of 2018 has been declared the Year of Volunteer in the Russian Federation. Voluntary activity has a positive impact not only on people who are provided with help but also on volunteers. Volunteering is beneficial for the formation and strengthening of moral position and citizenship, development of philanthropy, responsiveness, sense of justice, leadership skills. Besides, youth volunteering abroad has long been used as an important element of preparation to perform professional duties. Participating in the professionally focused volunteering, the student has an opportunity to gain professional experience, to check the correctness of own professional self-determination and career aptitude. Similar volunteer service is especially relevant for representatives of the “caring” professions - teachers, social workers, psychologists and doctors, i.e. people who have to be a priori ready for pro-social activity and have such qualities as goodwill, communicability and conscientiousness. The aim of the paper is to study the dynamics of the psychological characteristics of future health-care professionals regularly participating in professionally-oriented volunteer activities. Methodology and research methods. The research is based on competency-based and activity approaches to education. Also, research methodology involves the key provisions of the concept of a humanization of the pedagogical process of the higher education institution, and the basic principles of volunteers' activity declared in documents of the “United Nations Volunteers” (UNV) programme. The survey among students was the main method of information collection. Psycho-diagnostic tools involved: the assessment technique for communicative and organizing tendencies of an individual (V. V. Sinyavsky, V. A. Fedoroshin); the questionnaire for assessing the development level of empathic tendencies (A. Megrabyan, N. Epstein); the methodology for studying of valuable orientations of the individual (M. Rokich); the questionnaire “Motivation of Assistance” (S. K. Nartov-Bochaver). To objectify the data obtained, the Mann-Whitney U Test statistical technique was applied to reveal a difference in values of the parameter between small selections. Results and scientific novelty. The volunteer team was organized at the Department of Psychology of Health and Correctional Psychology of the Kursk State Medical University. This team is engaged in volunteering at the boarding school for children with disabilities. The authors came to the conclusion that the real directions of quasi-professional voluntary student unionism substantially correspond to the abilities and skills required of future health professionals. The authors analyzed the two-year dynamics of changes in students' psychological characteristics and professional competencies under the influence of their constant involvement in the volunteer movement. The key personality traits of an experienced student volunteer were designated: orientation towards humanistic values; motivation and readiness of providing assistance to needy people; well-developed communicative abilities and empathy. It has been established empirically that the level of development of these professionally important qualities among the student volunteers is initially above, compared with fellow students who were not involved in volunteering. Also, the level mentioned above continues to evolve actively due to the performance of the professionally focused and socially important volunteer mission. Practical significance. Results of the undertaken research prove convincingly that inclusion in the pedagogical process of higher education institution of professional volunteering as one of the priority activities contributes to the spiritual-moral education of students, the formation of professional and general humanistic outlook. In addition, student volunteering allows future graduates to find the necessary experience in the chosen field of employment.

© 2018, Silicea-Poligraf. All rights reserved. Aim. Study of efficacy and safety of taurin in management of stable angina patients with postinfarction cardiosclerosis. Material and methods. Totally, 95 postinfarction cardiosclerosis patients included, with stable angina of II and III functional class. The patients that were included, had refused revascularization. To the main group, 48 were included with added taurin (Dibicor, “PIK-Pharma”, Russia, 750 mg daily), and to comparison group — 47 patients that were taking standard treatment and placebo. Treatment duration 3 months. Results. Clinical efficacy of taurin in postinfarction cardiosclerosis and stable angina is confirmed by significant improvement of the following parameters: subjective state (decreased fatigue, less complaints on palpitation, less severity of dyspnea and rarer angina attacks), of the life quality parameters by Seattle questionnaire; echocardiographic parameters, normalized cardiac rhythm. Postive changes achieved on the basis therapy with taurin, remained for 3 months after drug discontinuation. Conclusion. Positive influence of taurin on clinical and instrumental parameters of patients make it to recommend its prescription for stable angina treatment in postinfarction cardiosclerosis patients.

© 2018, Silicea-Poligraf. All rights reserved. Aim. Assessment of prognostic significance of endothelial dysfunction markers: stable metabolites of nitric oxide (NOx), von Willebrand factor (vWF), endothelin-1 (E1), homocysteine and tissue plasminogen activator (tPA) in essential hypertension (EAH) patients not taking antihypertension therapy systematically. Material and methods. Totally, 12 EAH patients investigated (45 males, 79 females) (mean age 51,4±6,5 y.o., mean duration of AH 7,9±7,3 y.). Concentration of NOx in plasma was measured by spectrophotometry, and of vWF, homocysteine, E1 and tPA — by immune enzyme assay. Results. By the increase of SCORE risk level, there was significant increase of concentrations of NOx, E1, homocysteine and vWF in EAH patients (p<0,05), there were no changes in tPA levels (p>0,05). In 8 (8±1,1) years after baseline assessment, 115 patients were assessed second time. Of those 13 (11,3%) had cardiovascular events (CVE) and 5 (4,3%) died. By single factorial regression, the rate of CVE in EAH patients relate to homocystein level (р=0,01), NOx (р=0,001) and vWF (р=0,001). By multifactorial analysis, prognostic statistical significance is found for NOx (relative risk (RR) =3,8, р=0,006) and vWF (RR =3,5, р=0,005). In ROC-analysis there were found threshold levels of NOx (>46,6 mcM/L, AUC =0,863) and vWF (>1,68 mg/dL, AUC =0,738), the increase of which is followed by CVE development risk for the levels of NOx >46,6 mcM/L 3,8 times (sensitivity 81,9% and specificity 65,8%), vWF >1,68 mg/dL — 3,5 times (sensitivity 74,3% and specificity 62,7%). Combination of the parameters point on the risk increase up to 6,5 times (р=0,00007). Conclusion. NOx with the threshold of >46,6 mcM/L (RR =3,8) and vWF >1,68 mg/dL (RR =3,5) do show independent prognostic value for 5-year CVE risk assessment in EAH patients that can be applied as an additional method for risk stratification to estimate a group for more aggressive therapy and CVE prevention.

© 2018 Media Sphera Publishing Group.All right reserved. Aim: to assess the state of vascular bed, parenchyma, and perfusion of lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using the method of subtraction computed tomography (CT). Methods. CT pulmonary angiography (CTPA) was performed in 45 patients with verified CTEPH (18 men, 27 women, age 26-79 years) by CT scanner using the "Lung subtraction" standard protocol. Parameters analyzed were characteristics of the state of main pulmonary artery (MPA) and the right ventricle (RV), and calculated CT angiographic (CTA) obstruction and perfusion defect scores. Results. Significant correlation was found between CTA obstruction score and perfusion defect score (r=0.34, p=0.02). Mean pulmonary arterial pressure (mPAP) correlated with MPA diameter (r=0.4, p=0.02), RV wall thickness (r=0.6, p=0.0003) and the ratio of MPA diameter to ascending aortic diameter (r=0.5, p=0.002). Significant correlation was also found between RV wall thickness and pulmonary vascular resistance (PVR) (r=0.4, p=0.04). Neither CTA obstruction score nor perfusion defect score correlated with PVR and mPAP. The data of CT did not correlate with results of 6-minute walk test. Conclusion. In patients with CTEPH subtraction CTPA allows carrying out complex diagnostics of the state of vascular bed, parenchyma and perfusion of the lungs.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved.  Aim: to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect. Materials and methods. Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6%) the procedure of endovascular repair of secondary ASD was combined with performed at same session coronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9. Results. At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100%. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm 3 , right ventricular volume - from 45.2±5.1 to 33.4±3.8 cm 3 , systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiog-raphy good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W. Conclusion. Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Until today, there are no universally accepted methods for detection of unstable atherosclerotic plaques, even though many recent studies were devoted to this issue. In this article we present modern possibilities of computed tomography in visualization of atherosclerotic coronary lesion, including the detection of unstable lesions, whot in turn, can help in diagnosing subclinical exacerbation of ischemic heart disease and in the stratification of risks of acute coronary events.

© 2018 Stavropol State Medical University. All Rights Reserved. The aim of the study was to assess clinical value of galectin-3 levels evaluation in patients with heart failure. The study results demonstrated decrease of plasma galectin-3 levels after pharmacotherapy. The decrease of galectin-3 levels was accompanied by clinical improvement in patients with heart failure. Thus, galectin-3 can be used as an additional biomarker for HF diagnostics and pharmacotherapy monitoring in patients with heart failure.

© 2018 Stavropol State Medical University. All Rights Reserved. 57 men and 43 women, aged 22.0±4.2 years were examined to determine the clinical and prognostic value of matrix metalloproteinases in heart remodeling in CTD. Serum concentrations of MMP-1, MMP-9, TIMP-1 were determined by ELI-SA («Cloud-Clone Corp.», China). Imbalance of MMP-1, MMP-9 and their inhibitor - TIMP-1 was revealed in patients with CTD. Significant increase in MMP-1 level was registered in cases of MVP with myxomatous degeneration and mitral regurgitation of II degree. Risk of cardiac remodeling progression at three-year follow-up increases in cases of elevated of MMP-1/TIMP-1 coefficient. Identified changes in the MMPs system in patients with CTD may be used as additional criteria of severity and determination of probability of progression of heart connective tissue structures remodeling.

© 2018 Vysshee Obrazovanie v Rossii. All rights reserved. The article addresses the problem of epistemological basis of pedagogy and its research methods. This is particularly relevant in the light of the formation of theoretical framework in pedagogy. The following topical themes are discussed in the article: a) inductive, hypothetico-deductive and abductive reasoning in pedagogy, b) causal explanations of pedagogical phenomena, c) argumentation of pedagogical conclusions and consequences, including empirical, theoretical and contextual types of argumentation. The authors briefly touch upon the logical interpretation of “norm” and “evaluation” in pedagogy. The problems related to pedagogical theory constructing are identified including incompleteness of abductive model, insufficient evidence of all types of pedagogical argumentation and causal interpretation, and lack of clarity of the category “measure”.

© 2018 Ima-Press Publishing House. All Rights Reserved. Based on the data available in the literature, the author has first systematized in detail the main stages of the design and clinical introduction of serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants. Theoretical prerequisites for their emergence are described. The evaluation of the efficiency of depression therapy with drugs of this group in clinical trials and post-marketing studies is analyzed in the historical context. The reasons for temporary restrictions on their wide use are considered. There are data on the design of novel representatives of SNRI antidepressants.

© 2018 Ima-Press Publishing House. All Rights Reserved. Objective: to investigate the effectiveness of cognitive and motor training as an additional method to basic therapy in patients with Alzheimer's disease (AD) and vascular cognitive impairment (VCI). Patients and methods: The investigation enrolled 41 patients (15 women and 26 men; mean age. 73.59±6.3 years), including 32 patients with AD (mean age 74.94±5.15 years) and 9 patients with VCI (mean age, 72.31±4.98 years). Cognitive impairment (CI) corresponded to mild dementia in 15 patients (5 women and 10 men; mean age 74.6±2.8 years) and to moderate dementia in 29 (10 women and 19 men; mean age 72.1±3.2 years). The patients were randomly assigned to individual, group, and mixed (individual and then group) cognitive training groups. Quantitative scales were used to assess changes in CI and emotional and behavioral disorders after 1.5, 3, and 6 months of therapy. Results and discussion: During cognitive and motor training, all the groups showed a significant decrease in the severity of CI (p < 0.05), depression, anxiety, and apathy. The effectiveness of the training was further influenced by the severity of concomitant cardiovascular disease, the degree of apathy, adherence to the training, and the early initiation of basic symptomatic therapy. The greatest positive changes in anxiety and depressive disorders were noted in the patients receiving group cognitive and motor training. Conclusion: The results of the investigation allow group cognitive and motor training to be recommended as a mainstay in the therapy of patients with CI concurrent with emotional disorders.

© 2018 Izdatel'stvo Meditsina. All Rights Reserved. Subjective cognitive decline (SCD) is characterized by subjective complaints of patients about memory impairment and/or other cognitive functions accompanied by absence of significant changes during neuropsychological test. It is shown, that subjective cognitive decline may be a predictor of clinically significant cognitive disorder development to the extent of dementia. The primary aim of the research was the analyses of neuropsychological characteristics of patients with SCD depending on their age, gender, cardiovascular risk factors and their emotional affectivity. Materials and methods. The testing results of 150 patients (103 females, 47 males) aging from 45 to 59 and from 60 to 74 (66 patients) were analyzed in comparison with 92 healthy subjects of the same age. The research included clinical examination and application of scales and surveys, which estimate cognitive functions. Results. The most significant differences among healthy subjects were memory markers’ impairment as well as directory functions of the elder group. Patients with SCD additionally showed disorders of speech and constructive praxis deterioration. No significant differences in neuropsychological markers between SCD-positive and SCD-negative gender groups were not found. Comparison of patients with emotionally-affective disorder with healthy control of the same age did not reveal any significant difference. Either there was no influence of cardiovascular risk factors on neuropsychological testing indices. Conclusion. Analyses of possible age and gender factors accompanying emotionally-affective and cardiovascular changes that influence neuropsychological characteristics of patients with SCD showed the crucial meaning of age, being found in more indices of elderly people than the ones of the healthy group.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. To reveal the important clinical and radiologic characteristics of bony defects developing near vertical root fractures according to cone-beam computed tomography findings, which can be used for the diagnosis and differential diagnosis of root fractures. Material and methods. Eighty clinical cases suggestive for vertical root fractures were analyzed in the study. Teeth with vertical root fractures confirmed after extraction (n = 65) were divided according to tooth group and fracture propagation pattern as well as associated bone resorption according to cone-beam computed tomography. Clinical and radiographic features of vertical root fractures were compared with the mimicking conditions to reveal the differences. Results. From 80 teeth 65 were fractured; the conditions mimicking vertical root fractures included chronic periodontitis (2 cases), periapical pathology (13 cases), strip perforations (5 cases), and accessory canals (3 cases). The characteristic combination of clinical and radiographic features of vertical root fractures included a deep narrow periodontal pocket (52,3%), dehiscence-like defect of the buccal cortical plate with no or a lesser extent of periodontal destruction reflection on the other sites of the dentition and at the proximal surface(s) of the fractured root. Discussion: The differential diagnosis of vertical root fractures is a challenging task. The detection of fracture with cone-beam computed tomography is not always possible. However, this method may be used for the diagnosis of fractures by ascertaining the form and location of the bony defect. Conclusions. The analyses of characteristic features of the bony defect in conjunction with clinical findings allowed for diagnosis of vertical root fractures.