Репозиторий Университета

The publication presents the definition of key terms in pricing, sets out pricing methods, lists the current legal documents on cost indicators in health care. Methodical approaches to the calculation of remuneration, as one of the components of the cost of medical care, involve the use of labor standards of medical workers, differentiated by their participation in the therapeutic and diagnostic process. The analysis of the regulatory framework for labor in health made the need for its revision.

The article describes the principles of choosing parameters to be included into account registry of mandatory medical insurance system in 2019. The parameters should be applied for retrospective analysis of anti-neoplasm treatment of solid tumors in adults for accordance with clinical recommendations. It is proposed to extend account registries of mandatory medical insurance system with additional 13 parameters, reflecting both tumor type and course of disease and stages of medical care as well.

© 2019, Pediatria Ltd. All rights reserved. Pyelonephritis treatment in children with neurogenic bladder (NB) has a number of peculiarities, which include incomplete bladder emptying after self-urination and causing difficulties in determining treatment tactics for primary care pediatricians. Residual urine is a risk factor for development and relapse of chronic pyelonephritis, and urinary incontinence is also a medical and social problem. The article presents an example of observing an 8-year-old girl after 2 years of ineffective treatment for chronic pyelonephritis with mistakes in primary diagnosis. It provides the analysis of 3 months treatment and examination of the child with NB, including monitoring of urination functional productivity. The scheme of combined correction of inflammatory process and urinary tract dysfunction is presented. A systematic step-by-step approach to diagnosis and treatment of recurrent pyelonephritis in children with NB allows to increase therapy efficacy and improve patient's quality of life. The presented clinical case differs because bladder dysfunction manifested itself at the age of 8 years with an increase of bladder residual volume. Peculiarity of pathogenetic mechanisms of this pathology development in the described observation is a combination of delayed mature urination formation and manifestation of acute pyelonephritis, which required a non-standard approach to diagnosis and treatment.

© 2019, Pediatria Ltd. All rights reserved. Objective of the research: To study the effect of different temperature conditions and shelf life of expressed mother and donor breast milk (BM) on its microbiological safety. Materials and methods: N open prospective study was performed, which included 120 lactating women. BM samples were microbiologically evaluated under various storage conditions. Seeding of biological material was performed by a semi-quantitative method. Species identification of the obtained microorganisms was performed using a MALDI-TOF-MS Biotyper MicroFlex mass spectrometer and a VITEK bacteriological analyzer. Results: In 66% of women, samples of expressed BM showed an increase (103–105 CFU/ml) of conditionally pathogenic bacteria (CPB) with a predominance of S. epidermidis (55%). None of the samples of the expressed BM stored for 3 hours at room temperature (t° + 23°C) during the day in the refrigerator (t° + 4–6°C) and for 1 month in the freezer (t ° –18°C), the growth of CPB was not recorded. However, a decrease in the growth of bacteria total number was revealed, including S. epidermidis, when storing expressed milk for 24 hours at t° + 4–6°С and for 1 month at t° –18°С. It was found that BM pasteurization leads to a significant decrease in the number of CPB. The study revealed no increase in the total number of bacteria during storage of donor milk at t° –18°C for both 1 and 3 months.

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. The hemocompatibility of Sputnik rotary blood pumps of the first and second generation (Sputnik-1 and Sputnik-2) was studied using numerical simulation. The influence of the flow geometry on scalar shear stresses (SSS), the residence time, and the volume of recirculation zones was determined. Volume fractions of SSS were obtained for the threshold stress levels of 9, 50, and 150 Pa at a fixed pump speed of 8000 rpm (mean flow rate, 4.5 L/min; pressure, 80 mm Hg). At all selected threshold stress levels, the elevated SSS volumes for the first-generation rotor pump were found to exceed those for the second-generation pump. Thus, the latter has a lesser effect on blood cells. The average residence time was found to be 39 and 29 ms for the Sputnik-1 and Sputnik-2 pumps, respectively; the respective recirculation zone volumes were 4.36 and 1.72 mL. The lesser volume of recirculation zones for the second-generation rotor pump reduces the probability of formation of stagnation zones and, therefore, the probability of clotting. The simulation results showed that upgrading the design of the Sputnik rotor pump had a positive effect on its hemocompatibility.

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. We present here the results obtained during the development of an experimental apparatus for transmyocardial laser revascularization based on an Nd:YAG laser. Use of laser irradiation with a wavelength of 1.44 μm was shown to be effective in producing targeted angiogenesis in transmyocardial laser revascularization in experimental studies using a model of ischemic myocardium. The optimum regimes for pulsed Nd:YAG laser irradiation of the myocardium with thermal tissue damage were established. Morphological changes in the transmyocardial laser channels in pig myocardium were studied. The objective of the experiments was to confirm the efficacy of using this apparatus for transmyocardial laser revascularization with an Nd:YAG laser for the treatment of patients with diffuse lesions to the coronary arteries.

© 2019 Institution of Chemical Engineers Enabling technologies have led to the design of new extraction protocols for naturally occurring compounds that are fast, sustainable and have low energy demands. Ultrasound-assisted extraction (UAE) and microwave-assisted extraction (MAE) have been used, in this study, for the recovery of valuable nutraceuticals and primary metabolites from pumpkin seeds (Curcubita sp.) and have been compared with conventional methods. In order to optimise extraction parameters and conditions, we have compared yields, total phenolic content, antioxidant activity, as well as fatty-acid and lipid profiles. The best yield, in both lipophilic and hydrophilic compounds, was achieved under UAE with a ternary solvent mixture (hexane/ethanol/water - 30:49:21). However, the highest phenolic content and antioxidant capacity were obtained using MAE under subcritical conditions with good extraction yields. The oil composition, as obtained using GC-FID analyses, showed a prevalence for unsaturated fatty acids; mainly linoleic and oleic acids. The use of UAE with ternary mixtures presented the highest lipid content and a slightly higher percentage of unsaturated compounds. Preliminary tests to verify the scalability of UAE with a ternary mixture showed that the extraction performance was maintained when using larger volumes (factor 10). This study will pave the road for the potential exploitation of UAE as a fast and efficient procedure for the simultaneous recovery of lipophilic and hydrophilic compounds from pumpkin seeds.

© 2019, Pleiades Publishing, Ltd. Preterm birth is not only medical, but also a social problem. The global goal of medicine is prevention of preterm labor and identification of risk factors leading to preterm birth. The objective of our study was to find the association between polymorphic markers in the cytokine IL-β, TNF-α, IL-1Ra, and IL-4 genes and development of preterm labor. The prospective study was conducted in 108 pregnant women with the risk of preterm birth. The main group consisted of 66 women whose pregnancy ended with preterm delivery despite the ongoing therapy. The comparison group included 42 women with the full-term delivery. The dominant T allele of the cytokine IL-1β gene polymorphism rs1143634 (3953C→T) was 7.6 times more common in women with preterm delivery vs. the comparison group (36.4 and 4.8%, respectively; RR, 1.802; 95% CI, 1.420–2.288; p < 0.05); its homozygous form was detected only in women with preterm delivery at the very early gestation age (less than 26 weeks). The dominant proinflammatory allele 2R of the IL-1 receptor antagonist gene (IL-1Ra) was 1.5 times more common in women with preterm delivery than in the comparison group (63.6 and 42.8%, respectively; RR, 1.400; 95% CI, 1.009–1.943; p < 0.05), which makes the 2R allele the risk factor for preterm birth. The 2R/2R and 2R/4R genotypes led to a very early and early preterm delivery, respectively. The combination of three or four proinflammatory genotypes was detected only in women with a very early preterm delivery, which confirms that the combination of several proinflammatory genotypes is an extremely unfavorable factor for the full-term pregnancy. Identification of genetic polymorphisms in the interleukin genes at the periconceptional stage will help to prevent the risk of preterm delivery, which will reduce the incidence of preterm births, as well as perinatal morbidity and mortality.

© 2019, Pleiades Publishing, Ltd. Abstract: It is shown that the efficacy of the photosensitized oxidation of organic substrates in aqueous media (with the oxidation of tryptophan being used as an example) does not depend on adding biologically active dinitrosyl iron complexes (DNICs) with thiol-containing ligands to the reaction medium if it contains Pluronic F127, a poly(ethylene oxide)–poly(propylene oxide)– poly(ethylene oxide) triblock copolymer, at concentrations higher than the critical micelle concentration. Photosensitizer molecules are localized in Pluronic micelles and are shielded from the damaging impact of NO• radicals that form upon the photodegradation of DNIC molecules. Photodynamic therapy (PDT) sessions (the photoinduced necrosis and apoptosis of cells in pathologically altered tissues and the simultaneous initiation of regeneration and repair of the treated tissues due to the photodecomposition of DNIC molecules) thus become fundamentally possible.

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. Acid-sensing ion channel (ASIC) channels belong to the family of ligand-gated ion channels known as acid-sensing (proton-gated) ion channels. Only a few activators of ASICs are known. These are exogenous and endogenous molecules that cause a persistent, slowly desensitized current, different from an acid-induced current. Here we describe a novel endogenous agonist of ASICs-peptide nocistatin produced by neuronal cells and neutrophils as a part of prepronociceptin precursor protein. The rat nocistatin evoked currents in X. laevis oocytes expressing rat ASIC1a, ASIC1b, ASIC2a, and ASIC3 that were very similar in kinetic parameters to the proton-gated response. Detailed characterization of nocistatin action on rASIC1a revealed a proton-like dose-dependence of activation, which was accompanied by a dose-dependent decrease in the sensitivity of the channel to the protons. The toxin mambalgin-2, antagonist of ASIC1a, inhibited nocistatin-induced current, therefore the close similarity of mechanisms for ASIC1a activation by peptide and protons could be suggested. Thus, nocistatin is the first endogenous direct agonist of ASICs. This data could give a key to understanding ASICs activation regulation in the nervous system and also could be used to develop new drugs to treat pathological processes associated with ASICs activation, such as neurodegeneration, inflammation, and pain.

© 2019 Elsevier Ltd Normal pregnancy is associated with an increasing state of activation of the haemostatic system. This activation state is excessive in women with placenta-mediated pregnancy complications (PMPCs), including preeclampsia (PE). Platelet activation plays a crucial pathophysiological role in PE. The very early activation of coagulation in the intervillous space is mandatory for placental growth and morphogenesis but its excesses and/or inadequate control may participate to the emergence of the trophoblastic phenotype of PE. Extracellular vesicles, of endothelial but also of trophoblastic origin, can favour key cellular reactions of preeclampsia, acting as proactive cofactors. The understanding of this intricate relationship between haemostasis activation and PMPCs may provide interesting keys for new pathophysiological therapeutic developments.

© 2019, Chinese Chemical Society Institute of Chemistry, Chinese Academy of Sciences Springer-Verlag GmbH Germany, part of Springer Nature. The cationic polymerization of C4 mixed feed and isobutylene co-initiated by AlCl3×OiPt2, iBuAlCl2×nOiPr2, and [emim]Cl-FeCl3×nOiPr2 ([emim]Cl: 1-ethyl-3-methylimidazolium chloride) has been investigated. AlCl3×OiPr2 co-initiated cationic polymerization of C4 mixed feed proceeds at a lower rate than polymerization of isobutylene affording polymers with higher molecular weight. Complexes of iBuAlCl2 with diisopropyl ether of different compositions are more suitable co-initiators than AlCl3×OiPr2 for the synthesis of highly reactive polyisobutylene (HR PIB) from C4 mixed feed due to their higher activity in the polymerization as well as possibility to prepare polyisobutylenes with lower molecular weight and higher content of exo-olefin end groups. However, iBuAlCl2 needs activating via addition of external water (initiator) and/or interaction with salts hydrates in order to increase the reaction rate and the saturated monomer conversion. [Emim]Cl-FeCl3/iPr2O is a quite promising catalyst for the preparation of HR PIB with high exo-olefin end group content (> 80%) and relatively low polydispersity (Mw/Mn < 2.8) via cationic polymerization of C4 mixed feed. The sonication of reaction mixture in case of using [emim]Cl-FeCl3 allowed increasing the reaction rate and decreasing the molecular weight.

© 2019 Background: The aim of this meta-analysis was to determine whether transanal total mesorectal excision (taTME) improves histopathology metrics and/or complication rates when compared to robotic total mesorectal excision (R-TME) of resectable rectal cancer. Methods: MEDLINE, Pubmed, Cochrane Library, and Scopus were systematically searched by two independent researchers. Six observational studies totaling 1,572 patients (811 taTME; 761 R-TME) were included after screening 14 potentially eligible records. Mantel-Haenszel method using odds ratios with 95% confidence intervals (OR (95%CI)) and inverse variance with mean difference with 95% confidence intervals (MD (95%CI)) as an effect measure for dichotomous and continuous variables, respectively, was employed for meta-analysis. Statistical heterogeneity among effect estimates was evaluated using I2 and Tau2. Results: Circumferential resection margin (CRM) involvement rates (3.8% taTME; 5.3% R-TME) did not differ [OR (95%CI) = 0.86 (0.35, 2.15); p = 0.75] with low among-study heterogeneity (I2 = 21%). Complication rates (35.4% taTME; 32.3% R-TME) did not differ [OR (95%CI) = 0.92 (0.64, 1.32); p = 0.65], although with moderate among-study heterogeneity (I2 = 40%). CRM involvement [OR (95%CI) = 0.76 (0.40, 1.43); p = 0.40] and complication rates [OR (95%CI) = 0.84 (0.59, 1.21); p = 0.35] did not significantly differ in subgroup meta-analysis including mid- and low rectal cancer. Distal resection margin (mm) did not significantly differ between the interventions [MD (95%CI) = −0.41 (−1.29, 0.47); p = 0.37]. Conclusions: This meta-analysis found that taTME of rectal cancer does not improve histopathology metrics and complication rates when compared to R-TME.

© 2019, International League of Associations for Rheumatology (ILAR). Introduction: Long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs; eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) have been reported to reduce platelet aggregation. Our aim was to prospectively assess the potential influence of different supplementation omega-3 PUFA on the antiplatelet effects in rheumatoid arthritis (RA) patients. Methods: The study included 60 patients with RA at the Department of Rheumatology, Clinical Center Kragujevac. Patients were divided into three groups depending on who used concentrated fish oil only or concentrated fish oil in combination with evening primrose oil or control group without supplementation in a period of 3 months. Platelet aggregation was measured using the multiplate analyzer and expressed through the value of adenosine diphosphate (ADP) test, aranchidonic acid–induced aggregation (ASPI) test, thrombin receptor–activating peptide (TRAP) test (to assess baseline platelet aggregation), and the ratio of ADP/TRAP and ASPI/TRAP representing the degree of inhibition of platelet aggregation compared to the basal value. The platelet function analysis in whole blood was performed 18–24 h before starting supplementation and after 90 days. Considerations were taken in the representation of demographic, clinical characteristics, and laboratory parameters between the groups. Results: Patients who used concentrated fish oil only had a significantly lower value of the ratio of ADP/TRAP (0.68 ± 0.20) compared to patients without supplementation (0.83 ± 0.12; p = 0.008), while there was no statistically significant difference in values of other laboratory parameters of platelet function between other groups. Conclusions: Co-administration of supplementation-concentrated fish oil may reduce platelet aggregation in adults with RA. Key Points: • Omega-3 PUFAs are essential for health and are known to possess anti-inflammatory properties, improving cardiovascular health as well as benefiting inflammatory diseases. • In this paper, we report on anti-aggregation effects n-3 PUFAs and ɤ-linolenic acid in RA. • The risk of cardiovascular morbidity and mortality is increased in RA, and dietary supplementation of n-3 PUFA may have preventive potential for the cardiovascular management in rheumatoid arthritis.

The acute stroke is one of leading causes of mortality and disability both in Russia Federation and worldwide. The specialized vascular centers and units proved to be effective in improving diagnostics, treatment and functional outcome inpatients in various countries. The purpose of article is to evaluate efficacy of regional vascular center (RVC) in Tyumen. The functioning of RVC in 2011-2017 was assessed using purposefully developed and implemented score card of medical care quality assessment in vascular centers. The epidemiological data for 2007-2017 was obtained from statistical materials of the Department of Health of Tyumen oblast. The epidemiological parameters were calculated both in absolute units by simple summing up of cases of illness and in relative units per number of population. It was established that all diagnostic and treatment procedures in RVC were implemented according actual medical standards. The significant increase of the percentage of patients hospitalized during first three hours after the onset of stroke symptoms was established. The patients receiving thrombolytic therapy was observed, with an improvement of functional status of patients upon discharge. The significant improvement of early diagnosis of cerebrovascular diseases (CVD) in the service area of RVC was demonstrated. The development and implementation of the plan of a regional vascular center placement and stroke patient routing enabled optimization of medical care accessibility to this group of patients and increased identification of CVD.

© 2019, Pleiades Publishing, Inc. Abstract: Angiomyolipoma (AML) is one of the most frequent and, at the same time, AML molecular genetics is one of the least studied among benign tumors. We performed deep sequencing of 409 genes involved in oncogenesis in tumor samples and peripheral blood of patients with sporadic AML of the kidney. We recorded mutations in the TSC2 gene in 65% of samples, which is consistent with international results. As a result of our work, we uncovered mutations in the SETD2, PDGFRA, STK36, SYNE1, PIK3CD, NF1, TOP1, and ITGB3 genes in sporadic renal AML for the first time. In two samples, we were able to clarify the clinical and morphological diagnosis by finding mutations in the genes in tumors lacking TSC2 gene lesions. Mutations in MET and CDC73 are also causative for other types of renal tumors: papillary renal cell carcinoma and CDC73-related disorders, respectively. The latter disease is accompanied by kidney cysts and hamartomas. The obtained results demonstrate a promising potential of mutational profiling of sporadic renal angiomyolipoma (sAML). Genotyping of sAML is particularly important for clarification of the clinical diagnosis in ambiguous cases, as well as for a more in-depth understanding of AML molecular genetics and etiopathogenesis, and for the identification of new molecular targets for personalized AML therapies.

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. We studied the sensitivity of domestic proprietary human and animal cell lines from the collection of M. P. Chumakov Federal Scientific Center for Research and Development of Immuneand-Biological Products to infection with different enterovirus 71 strains. A cell system based on domestic proprietary permanent cell line 4647 was for the first time used for reproduction of four enterovirus 71 strains (BrCr, 42266, 42934, and 43374). It was shown that strain 4647 is the optimal cell substrate for enterovirus 71 reproduction. The titers of enterovirus 71 for all four strains considerably (by 2 lgTCID50/ml and more) increased during sequential passages in permanent cell line 4647. The prospects of using permanent cell line 4647 for creation of diagnostic and preventive preparations against 71 was demonstrated.

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. We studied the effect of LPS on the state of stress-marker organs in rats at various periods after a single exposure to long-term stress on the model of 24-h immobilization. The animals were intraperitoneally injected with LPS in a dose of 100 μg/kg immediately after the negative emotiogenic exposure. Changes in physiological parameters were evaluated 3 h, 1 day, and 8 days after immune stimulation. Acute stress was accompanied by a decrease in the weight of the thymus during all stages of the post-stress period. An increase in the relative weight of theadrenal glands in animals under these conditions was observed only on day 8 after restraint stress. The induction of immune reactions due to systemic treatment with LPS was shown to prevent involution of the spleen in the late stage after a single exposure to long-term stress (day 8). Hypertrophy of the adrenal glands, which serves as one of the typical reactions of mammals to negative emotiogenic factors, was not revealed during the post-stress period after antigenic stimulation. These data hold much promise for the development of new approaches to the use of immunoactive substances to prevent or reduce the severity of physiological changes after emotiogenic loads.