Репозиторий Университета

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. Echocardiographic parameters were assessed in patients with non-ST segment elevation acute coronary syndrome, who underwent emergency percutaneous coronary intervention followed by various outpatient physical cardiac rehabilitation programs. The patients underwent physical rehabilitation for 3 months under conditions of diagnostic centre in the rehabilitation unit according to the standard program including in treadmill or bicycle exercise in the exercise therapy room or with Nordic walking in the main training block. After rehabilitation course, the left ventricular mass index significantly decreased and systolic volume and left ventricular ejection fraction significantly increased in both groups. Nordic walking training for 3 months non-ST segment elevation acute coronary syndrome induced similar positive shifts in the parameters of intracardiac hemodynamics, as standard treadmill or bicycle training program, which allows considering it as an alternative cardiac rehabilitation method.

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. Polyphenolic compounds (flavonoids) of lyophilized aqueous extracts from Caragana jubata (Pall.) Poir. raw material from 2010 and 2015 were studied using modern HPLC-DAD-MS. Primarily mono- and diglycosides of O-hydroxylated (myricetin, quercetin, kaempferol) and O-methylated flavonols (isorhamnetin, laricitrin, syringetin) were identified. Long-term storage of dried raw material under standard conditions had little effect on the quantitative content of polyphenolic compounds. Acute toxicity studies of C. jubata extract showed no toxicity.

© 2017 The Authors. Diabetes, Obesity and Metabolism published by John Wiley  &  Sons Ltd. Aim: To investigate determinants of change in glycated haemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM) at 6 months after initiating uninterrupted second-line glucose-lowering therapies. Materials and Methods: This cohort study utilized retrospective data from 10 256 patients with T2DM who initiated second-line glucose-lowering therapy (switch from or add-on to metformin) between 2011 and 2014 in Germany and the UK. Effects of pre-specified patient characteristics on 6-month HbA1c changes were assessed using analysis of covariance. Results: Patients had a mean (standard error [SE]) baseline HbA1c of 8.68% (0.02); 28.5% of patients discontinued metformin and switched to an alternative therapy and the remainder initiated add-on therapy. Mean (SE) unadjusted 6-month HbA1c change was −1.27% (0.02). When adjusted for baseline HbA1c, 6-month changes depended markedly on the magnitude of the baseline HbA1c (HbA1c <9%, −0.45% per unit increase in HbA1c; HbA1c ≥9%, −0.87% per unit increase in HbA1c). Adjusted mean 6-month HbA1c reductions showed slight treatment differences (range, 0.92–1.09%; P <.001). Greater reductions in HbA1c were associated with second-line treatment initiation within 6 months of T2DM diagnosis (1.36% vs 1.03% [P <.001]) and advanced age (≥70 years, 1.13%; <70 years, 1.02% [P <.001]). Conclusions: Many patients with T2DM have very high HbA1c levels when initiating second-line therapy, indicating the need for earlier treatment intensification. Patient-specific factors merit consideration when making treatment decisions.

© Copyright 2018, Mary Ann Liebert, Inc., publishers 2018. Aim: To compare a program based on intermittent hypoxia-hyperoxia training (IHHT) consisting of breathing hypoxic-hyperoxic gas mixtures while resting to a standard exercise-based rehabilitation program with respect to cardiorespiratory fitness (CRF) in older, comorbid cardiac outpatients. Materials and Methods: Thirty-two cardiac patients with comorbidities were randomly allocated to IHHT and control (CTRL) groups. IHHT completed a 5-week program of exposure to hypoxia-hyperoxia while resting, CTRL completed an 8-week tailored exercise program, and participants in the CTRL were also exposed to sham hypoxia exposure. CRF and relevant hematological biomarkers were measured at baseline and after treatment in both groups. Results: After intervention, CRF in the IHHT group was not significantly different (n = 15, 19.9 ± 6.1 mlO2 minutes-1 kg-1) compared with the CTRL group (n = 14, 20.6 ± 4.9 mlO2 minutes-1 kg-1). CRF in IHHT increased significantly from baseline (6.05 ± 1.6 mlO2 minutes-1 kg-1), while no difference was found in CTRL. Systolic and diastolic blood pressures were not significantly different between groups after treatment. Hemoglobin content was not significantly different between groups. Erythrocytes and reticulocytes did not change pre/post interventions in both experimental groups. Conclusions: IHHT is safe in patients with cardiac conditions and common comorbidities and it might be a suitable option for older patients who cannot exercise. A 5-week IHHT is as effective as an 8-week exercise program in improving CRF, without hematological changes. Further studies are needed to clarify the nonhematological adaptations to short, repeated exposure to normobaric hypoxia-hyperoxia.

© 2017 Elsevier B.V. The need for investigating alcohol abuse by means of objective tools is worldwide accepted. Among the currently available biomarkers of chronic alcohol abuse, carbohydrate-deficient transferrin (CDT) is one of the most used indicator, mainly because of its high specificity. However, some CDT analytical and interpretation aspects are still under discussion, as witnessed by numerous research papers and reviews. The present article presents a critical review of the literature on CDT appeared in the period from 2007 to 2017 (included). The article is organized in the following sections: (1) introduction, (2) pre-analytical aspects (3) analytical aspects (4) diagnostic aspects (5) concluding remarks. As many as 139 papers appeared in the international literature and retrieved by the search engines PubMed, Web of Science and Scopus are quoted.

© 2017 Informa UK Limited, trading as Taylor  &  Francis Group. Background: Knowledge of effectiveness and safety of the nonbiologic, nonantihistamine treatments used for chronic urticaria is important as in some cases the principal guideline-recommended drug; omalizumab, has limited effect, side effects or is too expensive or unavailable. Herein, we systematically review the evidence for the use of the nonbiologic treatments in antihistamine-refractory chronic urticaria. Methods: We performed a systematic review of the literature using PubMed and Webofscience and identified studies that reported use of one or more of the nonbiological, nonantihistamine treatment options for chronic urticaria. The studies were evaluated based on study design, number of patients, effect of treatment and safety. Results: We identified 118 studies or case series with 13 different treatments (azathioprine, chloroquine, colchicine, cyclosporine, dapsone, intravenous immunoglobulin (IVIG), methotrexate, montelukast, mycophenolate mofetil, plasmapheresis, sulfasalazine, tranexamic acid and ultraviolet light (UV) A, UVB) totaling 1682 patients. There was a paucity of controlled trials for most of the treatments reviewed albeit the strongest evidence in favor of a beneficial effect in chronic urticaria was, apart from montelukast and cyclosporine, seen for UV therapy and dapsone followed by IVIG. Conclusion: The treatment options reviewed should be seen as potential alternatives in treatment-resistant chronic urticaria where guideline-based selections have failed. However, larger controlled trials are warranted to advance the level of evidence, possibly supporting some treatments’ future recommendation in selected patients.

© EV Arsentyev,. The article deals with the main turning points in the life and work of N.A. Semashko, the first People’s Commissar of Health of the RSFSR, from 1920 to 1925. The authors of the article proceed from the fact that the historical and biographical data available about Semashko are interpreted according to ideologically tinted stereotypes that were formed in the Soviet historiographic school. Based on various sources (mainly documents from the State Archives of the Russian Federation and Semashko’s family archive), as well as critical analysis of data from literature, an attempt was made to give an ideologically neutral assessment of the participation of Semashko in the organization of the sanatorium and resort sector in the RSFSR and the assistance provided to Soviet Russia from foreign public organizations. New facts were discovered about Semashko’s life, which in particular made it possible to clarify his role in helping medical personnel in Crimea during political repressions there (after the Bolsheviks established power on the peninsula). The authors of the article point out that despite the difficulties that existed at that time, in many respects, it was only due to Semashko’s authority and organizational abilities that the famous Soviet All-Russia health resort was established in Crimea. While work was carried out on the archives, data were found on the supply of humanitarian aid to the People’s Commissar of Health by US public organizations, sympathizing with Soviet Russia in the first half of the 1920s. It is concluded that the formation of Semashko’s scientific biography, which assumes an objective assessment, in particular, concerning his contribution to the organization of medical care, will make it possible in general to move on to an objective analysis of the features of the Soviet health care system and the transformation of the Soviet model (the Semashko model) into the modern Russian model of health care.

© SD Batoev. The current continuing outflow of valuable production forces and intellectual resources from Transbaikal has a negative impact on the socio-economic development of this border area. A retrospective analysis of the health care system provided to the Russian population living in remote areas demonstrates that not all formative stages of the health care system in Transbaikal were completed without problems. The Russian Empire implemented a state policy on the demographic and socio-cultural integration of Transbaikal for the purpose of rational economic development, effective consolidation of the territory and provision of border security. The pre-revolutionary government, facing significant financial shortages and an unfavorable socio-economic and political situation from the mid 18th century, carried out continuous work to create the foundations for the Transbaikal public health system. However, social issues were not a priority with regard to all population groups living on the outskirts of the Russian Empire, therefore many projects and decisions were implemented with significant delays or in a reduced format. In addition, it is necessary to take into account an objective point restraining the introduction of the central authorities’ solution: a new type of medical care was being promoted, to which the indigenous and newly arrived people of Transbaikal had to grow accustomed. At the same time, by the beginning of the 20th century, the heterogeneous population of Transbaikal, which traditionally used folk methods as well as Tibetan medicine, gradually began to understand the advantages of official medicine and science-based hygiene for improving and preserving human potential, which is the basis of the physical and intellectual development of any nation, and to master their leading principles. From the beginning of November 1920, under the conditions found in the Far Eastern Republic, measures were taken for the first time to organize free and preventive medicine for all population groups on the territory of Transbaikal, which marked the beginning of positive changes in the sphere of health care in terms of ensuring the real availability of medical care. Thus, the long process if creating a treatment and prevention system in pre-revolutionary Transbaikal took place within the framework of the all-Russian model of state medical care. It was continuous in nature and had a number of significant differences from the health care system established in European Russia.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To specify the frequency and species composition of vaginal bacterial carriage in pregnant women at the term of gestation 35–37 wks. Patients and methods. We examined 800 pregnant women, who were followed-up on an outpatient basis at terms of gestation 35–37 wks. Cultural examination of the content of the posterior vaginal fornix was performed. Species identification of microorganisms was performed by the method of direct protein profiling with the help of MALDI-TOF mass spectrometry, FLEX series, Bruker Daltonic GmbH, Germany. Results. The growth of flora was obtained in 761 patients (95%). Bacterial vaginosis (n = 71), Candida vulvovaginitis (n = 83) were diagnosed in 154 patients (19%). Lactobacillus spp. were found in 80% (n = 637) of examined women, of them in 161 (20%) in monoculture. Bacterial carriage was diagnosed in 55.8% of cases. The prevalence of Enterococcus faecalis, Escherichia coli, Streptococcus agalactiae, Staphylococcus epidermidis and Staphylococcus haemoliticus was noted. They were much more rarely detected in monoculture: E. faecalis (1%), S. agalactiae (0.1%), S. epidermidis (0.1%), Candida albicans (0.1%). In 39 (5%) patients, no growth of flora was found. In 17 patients we found extended-spectrum B-lactamase-producing bacteria: E. coli (n = 15), Klebsiella pneumoniae (n = 2). Conclusion. Taking into account a high prevalence of vaginal bacterial carriage in pregnant women in the 3rd trimester, it might be expedient to consider inclusion of microbiological examination of vaginal discharge in the basic spectrum of antenatal observation and screening examination of pregnant in the Russian Federation.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To determine vitamin D status in children with rheumatic disease who live on the territory of Russia. Patients and methods. A pilot study was conducted that included 52 children (35 girls and 17 boys) aged 5 to 17 years (11.88 ± 0.48 years), among them 29 children with systemic connective tissue disorders (SCTD) and 23 children with juvenile idiopathic arthritis (JIA). All patients underwent complex clinical-laboratory and instrumental examination in order to confirm the diagnosis and assess the patients’ health. Vitamin D status was assessed by 25(ОН)D serum levels using the method of chemiluminescence immunoassay. Results. Sufficient levels of 25(ОН)D (>30 ng/l) were found only in 5 (9.5%) children, vitamin D insufficiency (25(ОН)D 21–30 ng/l) was observed in 6 (11.5%) children, deficiency (25(ОН) <20 ng/l) in 41 (79.0%) children, among them in 7 (13.4%) it was severe (25(OH)D <10 ng/l), in spite of a long-term intake of low-doses of cholecalciferol (100–400 U/day) by 40 (76.9%) patients. Average levels of 25(ОН)D in patients with SCTD were significantly higher than in patients with JIA (20.86 ± 2.15 ng/l vs. 14.98 ± 0.91 ng/l, p = 0.0151), deficiency was more rarely found in these patients (69.0% vs. 91.3%), which was to a certain degree conditioned by more intensive vitamin D therapy. Conclusion. Insufficiency/deficiency of vitamin D is noted in an overwhelming majority of children with RD. Standard therapy with low doses of cholecalciferon offered to patients with RD is not sufficient for obtaining optimal 25(ОН)D levels and needs correction.

© 2018 Media Sphera Publishing Group.All rights reserved.  Contribution of diseases of the circulatory system to total mortality of the population remains high. Therefore it is necessary to study factors with most substantial impact on regional morbidity and mortality for elaboration of targeted programs of preventive measures aimed at definite population groups. Purpose of this study was to perform analysis of differences of mortality from cardiovascular diseases (VVD) of Moscow region inhabitants of various gender and age. Materials and methods. Data on 2016 mortality of Federal Service of State Statistics (Rosstat) and territorial service of state statistics of the Moscow Region were used in this analysis. Analysis was conducted for men and women divided in age groups ≤50, 50-59, 60-69, and ≥50 years. Diseases were classified in accordance with 10 th Revision of International Statistical Classification of Diseases (ICD10). Results. Population of the Moscow Region territory on January 1, 2016, amounted 7 318 647 (men 46.2, women 53.8%, persons of working age 58.9%). Contribution in the mortality structure of chronic ischemic heart disease (IHD) and cerebro-vascular diseases in women was greater than in men (80 vs. 68%, respectively, р<0.0001). Contribution of acute IHD, IHD unrelated heart diseases, and vascular diseases in men was significantly greater than in women (30 vs. 18%, respectively, р<0.0001). In the age group over working age mortality indexes were substantially higher compared with those in working age. In men these indexes became 10-20 times while in women - 30-130 times higher. Conclusion. Despite positive dynamics of mortality from diseases of the circulatory system (45.3% lowering from 2008 to 2016) it is necessary to strengthen efforts directed to correction risk factors of IHD and implementation of timely diagnostics and correction of IHD unrelated diseases.

© 2018 American Leather Chemists Association. All rights reserved. Classification, mechanism of action, features of pharmacodynamics and pharmacokinetics, and indications for use of chondroprotectors (drugs promoting the regeneration of cartilage tissue) are presented. Comparative analysis of experimental and clinical studies of main representatives of this group of drug has been performed.

For the purpose of studying the possibility of labor functions development for public health and healthcare during training in the educational organizations the comparative analysis of provisions of the professional standard with the materials stated in textbooks and national manuals of the corresponding profile was carried out. It was found that in the development of Federal state educational standards of higher education in dentistry (specialization level), updating educational methodological publications on dentistry and public health, the formation of a unified database of evaluation tools for accreditation of specialists and obtaining or confirming qualification categories, it is necessary to take into account the content of labor functions of the professional standard in each discipline.

© 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, 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.

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 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.

The purpose of the study was to assess the impact of toothpastes containing hydroxyapatite and fluoride on enamel caries resistance and remineralization rate. Study groups comprised 160 patients divided in 2 groups of 80 patients: 40 - at the age of 15-17 and 40 at the age of 18-25 who have been using toothpastes with hydroxyapatite and fluoride during 1 year. The plaque determination was carried out with the use of OHI-S and Turesky indexes. Litmus test pieces were used to determine oral fluid pH. The clinical determination of enamel remineralization rate, dynamics of acid resistance of enamel were carried out. Oral hygiene at baseline examination was poor in both groups. After oral hygiene training, there was a tendency towards indexes decrease more pronounced in the 18-25 age group regardless of the composition of the toothpastes used. Mean baseline oral fluid pH in the observation group was 6.5±0.4, in the comparison group - 6.8±0.4. By the end of the trial there was a tendency towards the increase of the oral fluid pH, which were 7.3±0.3 and 7.7±0.3, respectively. The enamel acid resistance of the patients of the observation group was significantly higher (p>0.05) compared with the group of patients using fluoride toothpaste, as well as the proportion of patients in whom the enamel recovery occurred within 24 hours (47.5% vs. 22.5%, respectively).

© 2018 All-Russian Public Organization Antihypertensive League. All Rights Reserved. The article presents current knowledge of pro-and antihypertensive mechanisms involved in the development of hypertension (HTN), and antihypertensive management strategies. Particular attention is paid to the angiotensin converting enzyme inhibitor lisinopril and thiazide-like diuretic indapamide. The mechanisms and effects are described. The paper discusses the results of multicenter randomized clinical trials, and the antihypertensive effects of lisinopril and indapamide and their impact on myocardial hypertrophy in hypertensive patients. The potential advantages of fixed combination of lisinopril and indapamide in the treatment of patients with HTN are also discussed.