Репозиторий Университета

© 2018 Ima-Press Publishing House. All rights reserved. Toxic epidermal necrolysis (TEN) has been long believed to be the most severe manifestation of drug allergy. However, cutaneous changes as TEN in systemic lupus erythematosus (SLE) were first described in the late 1970s. As of now, the English-language literature published reports of 30 cases of such lesions in SLE. This paper describes a clinical case of TEN as a direct manifestation of SLE; the positive experience has been first depicted in using not only intravenous immunoglobulin, but also rituximab with a good therapeutic effect in Russian clinical practice.

© AA Yaroshenko, NP Shok. The lessons learned from the last wars of the second half of the 19th to early 20th centuries influenced the organization of the troop command and control. The latest inventions, mass outbreaks of infectious diseases among the troops and the population of countries at war, as well as a number of other factors, led to changes in army management mechanisms. Given the experience gained from initial hostilities, the Russian government decided to review its approach to medical support for the field army and the organization of the medical supply system for troops. This was due to the unsatisfactory state of the Russian military-indus-trial complex at the beginning of World War I. At the beginning of the war, Russia was forced to seek help from France, Britain, the United States, and Japan, and to take urgent measures to expand its own production of medical equipment. Emergency measures were taken to facilitate the production of medical equipment on the territory of the Russian Empire. During the reign of Nicholas II, in June 1915, a Special council was set up. The council oversaw the activities of industrial enterprises that produced war supplies, distributed military orders between Russian and foreign factories and facilitated the opening of new ones. The Special council entrusted the provision of medical supplies for the Russian army to the Commission for the Revision of Sanitary and Medical Supply Standards, which was established on October 24, 1915. As a result of the work of the commission during the war, the medical support system for the troops was improved, production of domestic versions of medical equipment was established, the procedure for dispensing medical supplies was simplified, and standards were increased.

© 2018 Ima-Press Publishing House. All rights reserved. Objective: to evaluate the clinical efficacy of the rituximab biosimilar Acellbia® at a dose of 600 mg intravenously at a 2-week interval in patients with active rheumatoid arthritis (RA) 12 and 24 weeks after initiation of treatment. Subjects and methods. Examinations were made in 20 active seropositive RA patients who had not been previously treated with biological agents (BAs), but received two infusions of the rituximab biosimilar Acellbia® at a dose of 600 mg intravenously at a 2-week interval during stable therapy with methotrexate (MT) and glucocorticoids (GCs). The European League Against Rheumatism (EULAR) response criteria (Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index) and the American College of Rheumatology (ACR) criteria were used to evaluate the efficiency of Acellbia® therapy. Disease remission was identified by DAS28 and 2011 ACR/EULAR criteria. The safety profile (the frequency of all reported adverse events) corresponds to the data on the safety of rituximab (MabThera®). Results and discussion. At the time of inclusion, median DAS28 was 5.6 [4.9; 6.8], SDAI - 27.1 [23.0; 39.9], and CDAI - 26.6 [22.2; 37.0]. At week 12 after initiation of Acellbia® therapy, they decreased to 4.2 [3.24; 4.75], 14.4 [8.5; 20.7], and 13.2 [7.9; 19.0] respectively, which remained at 24-week follow-up (p<0.01). At week 12, the frequencies of ACR 20%, 50%, 70% improvements were 70, 55, and 5%; at week 24, these were 75, 45, and 15%, respectively. A good or moderate EULAR response at week 24 was observed in 25 and 60% of patients, respectively. At week 24, DAS28, SDAI, and CDAI remissions were achieved by 4 (20%), 2 (10%), and 1 (5%); low disease activity - by 4 (20%), 5 (25%), and 6 (30%) patients, respectively; high disease activity as measured by SDAI and CDAI remained in 3 (15%) patients. Two patients (10%) met the 2011 ACR/EULAR remission criteria at 24 weeks. Conclusion. The rituximab biosimilar Acellbia® 600 mg used in patients with active seropositive RA is clinically effective and comparable in the safety profile as shown in investigations of the brand-name MabThera® (F. Hoffman-La Roche Ltd., Switzerland) at a low dose (500 mg), as well as the first BA.

Social media opens great opportunities in doctors' practice, education and communication with patients. The information is published easily and instantly, just by 'click', but sometimes it's not enough time for the author to think over issues of ethics, compliance with the professional standard, the validity of statements and their reliability. On the other hand, the capabilities of the Internet can detect any publication even after its removal. Currently there are no official guidelines regulating the rules of doctor's behavior in social media in Russia. In this article we will discuss what to keep in mind while using these new opportunities effectively and safely.

© 2018 Russian Transplant Society. All Rights Reserved. HCV infection is one of the most common causes leading to the development of terminal liver diseases – cirrhosis and hepatocellular carcinoma, the main treatment for which is orthotopic liver transplantation. However, with continued virus replication, 100% reinfection occurs, which leads to the rapid progression of cirrhosis of the graft and the loss of its function. Standard interferon-containing therapy is ineffective for HCV infection, especially genotype 1, both before and after transplantation, and also has a wide range of adverse events. The article presents the successful experience of treating the recurrence of HCV infection 1 genotype in a patient who underwent liver transplantation and several courses of ineffective antiviral therapy.

© 2018 Russian Transplant Society. All Rights Reserved. Aim. To study the efficacy and safety of the use of paritaprevir, ritonavir, ombitasvir and dasabuvir in combination or without ribavirin in liver recipients with recurrence of HCV 1 genotype after transplantation. Materials and methods. The study included 46 patients after orthotopic liver transplantation with recurrence of HCV 1 genotype. 37 patients completed a 24-week course of antiviral therapy, including paritaprevir, ritonavir, ombitasvir and dasabuvir in combination or without ribavirin. The effectiveness of the therapy was calculated as the proportion of patients who achieved aviremia 12 weeks after the end of the course of treatment. The safety of therapy was assessed by the number of adverse events that occurred during the course of antiviral therapy. Results. A sustained virologic response at 12 weeks after the end of the course of antiviral therapy, including paritaprevir, ritonavir, ombitasvir and dasabuvir, reached 100% of the recipients of the liver. Reduction in the intensity of cytolytic and cholestatic syndromes was noted at week 4 of therapy. Adverse events were recorded in 56.7% of the subjects, mostly they were not severe and were stopped on their own. Acute cellular rejection of the transplant developed in 1 patient (2.7%). There have been no cases of irreversible liver transplant dysfunction or death of the recipient. The conclusion. The use of paritaprevir, ritonavir, ombitasvir and dasabuvir is safe and effective in the treatment of relapse of HCV infection of 1 genotype after liver transplantation.

© 2018 Silina et al. Aim: The purpose of this study was to examine the role of free radical oxygen and peroxide-lipid processes along with conducting the study of blood flow level and oxygen saturation of facial tissues in patients of different ages with varying degrees of involutional changes in the skin of the face and neck. Materials and methods: One hundred and fifty-three people (84.3% women and 15.7% men) aged from 26 to 78 years with varying degrees of involutional changes in facial skin were examined. The clinical and laboratory evaluation was carried out dynamically and included various indicators of free radical processes, objective and subjective clinical visualization, and laser Doppler flowmetry (LDF) of the facial skin and transcutaneous oximetry (TcpO2) performed at 10 points on the face. To assess the state of free radical processes, the authors investigated the basal indicator of chemiluminescence intensity (ICb), the intensity of chemiluminescence stimulated (ICs) by zymosan, the activity coefficient (AC) of chemiluminescence, antiperoxide activity of plasma, and malondialdehyde (MDA). Results: With aging, the imbalance of the oxygen constituents of free radical processes grows with the increase in ROS. Proportional to age, the ICs increased 2.1 times on average in people older than 55 years compared to that in people younger than 30 years and ICb decreased by 1.8 times. As a result, the AC increased by 5.6 times. This correlates with involuntary skin changes and with regression of microcirculation and TcpO2. According to LDF, it was established that average total blood flow in people younger than 30 years and people older than 55 years was 8.1 and 6.4 mL/min, respectively The difference between the indicators of TcpO2 in people younger than 30 years and people older than 55 years was 1.6 times (average 56 vs 35 mm Hg). The stability of the indicators of the peroxide-lipid link of oxidative stress in different age groups demonstrated that the activation of ROS formation in mitochondria is not a cause but a consequence of microcirculation and metabolic processes in the face and neck and aging in general. Conclusion: The tissue metabolism and microcirculation parameters naturally regress with aging, which is associated with the increase of ROS. The excess of species leads to the intensification of peroxide processes. This, in turn, is reflected in the aesthetic appearance manifested by aging.

© 2018 Stavropol State Medical University. All Rights Reserved. The cytological picture of oral tissues in experimental animals was studied when creating a cariogenic model with a formed artificial defect of hard tissues (Black class V), filled with a restorer filling material Restavrin coated with Easy Glaze sealant and without it. The intensification of the formation of plaque and the manifestation of the inflammatory process in a group of animals with defects, but without coating with sealant was revealed by the 30th day of observation. By this time of the experiment, the number of segmented neutrophils and desquamated epithelium cells sharply increased while the ratio of dead to live cells increased, which increases the degree of cariogenic danger and intensity of inflammation in the area of buccal epithelium, gums and periodontium. A mandatory coating of a photo-composite restoration with a sealant is recommended, which serves as a barrier that protects the filling material from the influence of exogenous factors, preserves the aesthetic and mechanical qualities of composite restorations.

© 2018 Ima-Press Publishing House. All Rights Reserved. Up to 15% of patients with secondary brain tumors of unknown primary are admitted to a neurosurgery department. Identification of a primary tumor site on the basis of surgical material immunophenotyping in routine clinical practice has a significant potential; however, this requires systematization. Objective: to detect the primary focus of brain carcinoma. Patients and methods: Surgical specimens from 7 patients with brain tumor of unknown primary were investigated using light optical microscopy and an immunohistochemical (IHC) panel including EMA, CK AE1/3, CK7, CK5/6, GFAP, S-100, Vimentin, p63, TTF-1, Uroplakin III (UPIII), CDX2, and Her2/neu. Results and discussion: A study using the IHC panel made it possible to obtain the following tumor phenotypes in the patients: CK5/6+, p63+, CK7+, UPIII+ (urothelial cancer) (n=3); CK5/6-, CK7+, TTF-1+, CDX2- (lung adenocarcinoma) (n=2); CK5/6+, p63+, CK7-, UPIII, TTF-1- (squamous cell carcinoma) (n=1), and CK5/6-, CK7+, TTF-1-, CDX2-, Her2/neu+ (breast cancer) (n=1). Evidence of the primary focus of the tumors was subsequently confirmed by instrumental techniques in all cases when cancer of the breast, lung and urinary system was directly sought. The findings were used to elaborate an algorithm for the differential diagnostic immunophenotyping of brain metastases. Conclusion: The primary focus of brain carcinoma was detected in all cases on the proposed IHC panel. The systematized algorithm for differential diagnostic immunophenotyping can be used in clinical practice.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. To determine the role of MSCT in the development of pneumoconiosis. Materials and methods. A total of 109 patients with the pneumoconiosis: silicosis and pneumoconiosis from mixed dust were examined at the Clinical IRIOH (Moscow) and the Orenburg Regional Clinical Hospital №2 (Orenburg). Patients underwent complex clinical and laboratory research, external respiration function examination, bronchos-copy and radiation examination. Results. Concomitant pulmonary tuberculosis was detected in 11%. Dissemination and interstitial changes were determined. Foci were located chaotically, perilymphatically. At the time of the initial study, the fusion of foci was 67.5%, with a dynamic study - in 100%. Interstitial changes were characterized by thickening of intra-lobular and interlobular interstitium. 19 patients had fibrous conglomerates, which were heterogeneous due to the presence of calcifications, necrosis and sometimes destruction cavities, which were later replaced by fibrotic changes. 57 patients were observed in dynamics during 3-19 years. 44 patients had a negative dynamics. There was no connection with the experience in the conditions of the impact of aerosol and profession. A great influence was exerted by the dispersion of dust and the concentration of silicon dioxide in it. Progression was characterized by an increase in the number of foci, their size, fusion and formation of fibrosis areas, an increase in the thickness of interstitium. Conclusions. Pneumoconiosis has progression even in the post-contact period. The growth of fibrotic changes led to emphysema of the lungs and respiratory failure. The dust dispersion affects the character of the progression.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The main objective of laboratory diagnosis of a diphtheria is identification of the causative agent by means of the minimum quantity of diagnostic tests for obtaining the authentic answer in the most short time. One of the major stages is capture and delivery of pathological material on which the efficiency of carrying out and timeliness of issue of the final answer depends. Considering emergence in the market of commercial liquid transport mediums, assessment of their efficiency for diagnosis of diphtheria is advisable. In the real work the pilot studies allowing to predict efficiency of use of the commercial transport liquid medium £-Transwab® with the liquid medium of Ames in two systems - with the standard applicator (system 1) and with the thin extended tampon for sampling from narrow cavities - urethral and nazofarengialny are conducted (system 2). In a research used a control toxigenic strain of Corynebacterium diphtheriae of a biovar of gravis No. 665. In an experiment "imitated" operating conditions of the medical organizations for storage of tampons with pathological material on diphtheria before their transportation in laboratory - on a table at the room temperature (6 and 20 hours), in the refrigerator (6 and 20 hours), in the thermostat (6 and 20 hours). After an incubation all tampons sowed the environment for primary crops ofpathological material on a blood tellurite agar.. Accounting of results was carried out in 24 and 48 hours of growth. It is established that the commercial transport liquid medium ofAmes can be usedfor capture of pathological material on diphtheria in the second half of the working day at storage in the conditions of the refrigerator. At the same time, it is necessary to consider a tampon form as the best results on a identification of the causative agent of diphtheria have been received when using a universal tampon.

© 2018 S. Karger AG.All right reserved. Objective: to estimate the state and the rate of bone metabolism in women with chronic kidney disease (CKD) 1-3 stages during pregnancy. Materialsandmethods:observational cross-sectional and prospective study included 137 pregnant women. CKD 1-3 stage had 85 of them: 64 with CKD 1-2 stage, 21 with CKD 3 stage. Median age 29 years, second and third trimester (42 and 37, respectively). The comparison group consisted of 52 pregnant women with of the same age and gestational age without CKD. Dynamic examination was carried out in 18 cases with CKD 1-3 stage. Ionized, total calcium and inorganic phosphorus, 25-OH vitamin D, parathyroid hormone (PTH), the activity of total alkaline phosphatase (ALP), osteocalcin (OC), N-terminal propeptid of type 1 procollagen (P1NP) and β-isomer of C-terminal telopeptide of type I collagen (β-CTX) were determined. Results: serum calcium, phosphorus and PTH levels in all the examined pregnant women were within their normal range. In pregnant with CKD 3 stage, a deficiency of vitamin D was more significant (р0.02) compared to pregnant women without CKD and pregnant with CKD 1-2 stage. The levels OC and P1NP and β-CTX in pregnant with CKD 3 stage were higher than in the control group and pregnant women with CKD 1-2 stage. It was also higher in pregnant women with CKD 1-3 stages in the third trimester in comparison with the second one, although remained within the limits of reference values. Significant direct correlations were found between serum concentrations of P1NP and OC (r=0.575, р0.001), P1NP and ALP (r=0.415, р=0.001), OC and ALP (r=0.276, р=0, 02) and vitamin D and PTH (r=0.235, р=0.04). A significant inverse correlation was found between the blood levels of vitamin D and P1NP (r=-0.344, р=0.002). Conclusions: the peculiarities of bone metabolism in pregnant with CKD of 3 stage are manifested by the vitamin D deficiency and the acceleration of bone formation and resorption to a greater extent in the third trimester.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Aim of the study. To compare the effects of tranexamic acid (TXA), factor XIII concentrate (FXIII) and fibrinogen concentrate on clot formation and fibrinolytic resistance in the in vitro model of hyperfibrinolysis induced by tissue-(tPA) vs urokinase-type (uPA) plasminogen activators. Materials and methods. Citrated whole blood from 28 adult healthy volunteers was supplemented with 10 μg/ mL TXA, 2 lU/mL FXIII, or 3 mg/mL fibrinogen concentrate. Hyperfibrinolysis was induced by spiking the blood with PA or uPA at their half-maximal effective concentrations (90 and 33 lU/mL, respectively). Clotting was induced by recalcification and addition of tissue factor and monitored using rotation thromboelastometry. Results. The use of TXA increased maximal clot firmness in the presence of tPA and markedly inhibited clot lysis in the presence of any of the plasminogen activators. Supplementation of blood with FXIII significantly increased clot firmness and improved fibrinolytic resistance in the presence of either PA or uPA. Supplementation with fibrinogen concentrate elicited a strikingly different effect on clot formation and lysis depending on the type of plasminogen activator. In the presence of tPA, fibrinogen concentrate significantly increased clot firmness and attenuated clot lysis. In contrast, in the presence of uPA, the use of fibrinogen markedly reduced clot firmness and promoted clot lysis. Similar effects of fibrinogen concentrate were observed in platelet-rich and microparticles-free plasma. Conclusion. In hyperfibrinolysis, effect of the hemostatic drugs significantly depends on the type of plasminogen activator used. Therefore, mechanisms of hyperfibrinolysis should be taken into consideration while administering hemostatic drugs.

© 2018 Izdatel'stvo Meditsina. There was performed a study of the diagnostic activity of sera with antibodies to Toxocara spp. and Echinococcus spp. in conditions of long storage at different temperature regimes. The use of cryoprotectants makes it possible to increase the safety of diagnostic sera by two times during prolonged storage at low temperatures.

© 2018 Ruslania. All rights reserved. This literature review is devoted to modem notions about molecular mechanism of action of the selective modulators of progesterone receptors. The superfamily of nuclear receptors represents ligand-activated transcription factors and includes receptors for steroid hormones, lipophilic vitamins, sterols, and bile acids. These receptors serve as targets for creating numerous drugs. As a result, a new class of compounds (ligands) appeared exhibiting agonistic/partial agonistic/antagonistic functional activities depending on the context (tissue or gene target). This class of ligands is called selective modulators of nuclear receptors. Initially, mifepristone was developed as the progesterone receptor antagonist, but further it demonstrated the properties of a selective modulator of progesterone receptor and became the ancestor of this group. At present, the development of new selective modulators of progesterone receptor is aimed at obtaining higher selectivity with respect to progesterone receptors and decreasing the anti-androgenic and anti-glucocorticoid properties. Unfortunately, most of the subsequent selective modulators of progesterone receptors exhibited hepatotoxicity, which limited their wide introduction into clinical practice.

© 2018, Dynasty Publishing House. All rights reserved. The article presents non-pharmaceutical methods of rehabilitation of children with acute respiratory infections (ARI) used at a hospital, polyclinic (rehabilitation centre), medical resort. Specificities of administering medical exercise therapy, massage, inhalation therapy, balneo-halotherapy and other methods at different stages of rehabilitation are discussed. The authors analyse the results of research works that are demonstrative of the necessity of including in rehabilitation programmes for children with ARI of the drug levocarnitine that enhances their effectiveness. Administration of levocarnitine in doses of 50 to 100 mg/kg/day 2 times daily, as 1–1.5-month courses, prevents the development of repeat episodes of acute respiratory viral infections in children and reduces their duration, restoring the activity of immune cells. Also, recommendations are given to physicians about the use of Elcar® in children who fall ill frequently and for prevention of respiratory infections. physicians about the use of Elcar in children who fall ill frequently and for prevention of respiratory infections.

© 2018 Ruslania. All rights reserved. This review summarizes the published literature devoted to the analysis of diagnostic role of microRNAs in cardiovascular disease. MicroRNAs are a class of small non-coding RNAs that regulate gene expression and affect various cellular functions. Modern methods for the detection ofmicroRNA are described. The data of variations in their concentration in ischemic heart disease, heart failure and other diseases are analyzed. At present, the accumulation of clinical data on the role of these biomarkers will allow to determine the diagnostic and prognostic significance of microRNAs (microRNA sets) in cardiovascular diseases.

© 2018, Dynasty Publishing House. All rights reserved. We analysed the association between levels of various cytokines and specificities of the clinical course and severity of toxic syndrome in pregnant women with influenza А(H1N1)pdm09, complicated by pneumonia. Cytokines reduce the sensitivity of the warm receptors and increase that of the cold receptors, which is regarded by patients as episodes of chills. According to correlation analysis data, IL-6 has the largest direct correlation with the persistence of fever, whereas interrelations between other cytokines and persistence of higher temperature proved to be less significant. It is noteworthy that elevated IL-6 levels lead to impairment of sleep architecture, which contributes to increased and persistent weakness, drowsiness. As has been shown, persistence of cough is to a significant degree determined by correlations between the levels of such cytokines, as TNF-α, IL-4 and IL-8. We assessed correlations between individual signs of systemic inflammatory response syndrome (SIRS) and cytokine levels. In diagnosing SIRS according to procalcitonin levels in viral-bacterial pneumonia 3 significant correlations were found (association with IL-8 – 0.72, TNF-α – 0.76 and IL-6 – 0.66). In pregnant women with pneumonia, generalised inflammatory process and a subsequent development of SIRS lower levels of the anti-inflammatory cytokine IL-4 have been found. A quantitative correlational approach to assessment of cytokine interrelationships has been proposed, permitting to differentiate between uncomplicated and complicated forms of influenza.

© 2018 Russian Academy of Medical Sciences. All Rights Reserved. Cancer immunotherapy represents a promising and rapidly developing approach for the treatment of oncological diseases. Among the methods of personalized adjuvant immunotherapy, neoantigenic peptide-based drugs have demonstrated substantial efficiency. These drugs are designed to target mutant proteins arising from somatic alterations in the genome of tumor cells and thus stimulate immune response against tumor tissues. The methods of individual screening for potentially immunogenic mutations are mostly based on next-generation exome sequencing of tumor samples, which is a complex and costly procedure for clinical application. Targeted gene sequencing panels limited to a certain set of genes represent a reasonable alternative to WES. Targeted sequencing is also more efficient when there is a low amount of the sample DNA available. We have estimated the potential efficiency of targeted oncological panels in terms of somatic neoantigen profiling in colorectal cancer (colon and rectal adenocarcinoma). The clinical practice of identification of frequent somatic variants does not provide enough data for designing an efficient personalized drug when applied to low and medium mutated cancers such as colorectal cancer. Our analysis of 11 commercially available panels containing different number of genes has shown that neither the larger size of a panel nor its initial customization for colorectal cancer provides a significantly better estimation of an individual somatic mutation profile. The optimal approach is to use the general-purpose medium-sized cancer panels (2300-11200 amplicons and/or 150-600 genes). These panels allow to detect a sufficient number of immunogenic epitopes (>3) per patient for over 30-50% of patients.

© 2018. Korean Academy of Periodontology. Purpose: The aim of this study was to evaluate the effects of various prophylactic treatments of titanium implants on bacterial biofilm formation, correlating surface modifications with the biofilms produced by Pseudomonas aeruginosa PAO1, Staphylococcus aureus, and bacteria isolated from saliva. Methods: Pure titanium disks were treated with various prophylactic procedures, and atomic force microscopy (AFM) was used to determine the degree to which surface roughness was modified. To evaluate antibiofilm activity, we used P. aeruginosa PAO1, S. aureus, and saliva-isolated Streptococcus spp., Bacteroides fragilis, and Staphylococcus epidermidis. Results: AFM showed that the surface roughness increased after using the air-polishing device and ultrasonic scaler, while a significant reduction was observed after using a curette or polishing with Detartrine ZTM (DZ) abrasive paste. In addition, we only observed a significant (P < 0.01) reduction in biofilm formation on the DZ-treated implant surfaces. Conclusion: In this study, both AFM and antibiofilm analyses indicated that using DZ abrasive paste could be considered as the prophylactic procedure of choice for managing peri-implant lesions and for therapy-resistant cases of periodontitis.