Репозиторий Университета

© 2018, Media Sphera Publishing Group. All rights reserved. The robotic technologies every day exert an increasingly greater influence on the surgical technique, with the well documented clinical applicability in reconstructive plastic surgery and oncology. At the Department of plastic surgery of I.M. Sechenov First Moscow state medical university, we have gained an extensive experience with the surgical treatment of the patients requiring the major oral robotic intervention. A novel application has recently been documented for the purpose of robotic surgical assistance to the patients presenting with oncological pathology including cancer of the oropharyngeal wall at the early stages of development (T1N0M0). The objective of the present study was to develop and introduce into the clinical practice of the robot-assisted methods for the treatment of malignant neoplasms of the head and neck organs. A hybrid technique was applied, i.e. the combination of the robot-assisted trans-oral surgical intervention and the microsurgical radial flap mobilization to correct the postoperative defect following the extraction of the tumour. The combination of these methods provided the excellent clinical results and positive dynamics of the patients’ condition, with the swell apparent improvement of the quality of life. The early patient activation was due to the application of the minimally invasive transoral surgical technique, with the swallowing ability being reinstated within 14 days after the intervention by virtue of the proper flap function. All the patients successfully underwent the robot-assisted surgical manipulations without complications. The shorter rehabilitation time during the postoperative period in these patients made it possible to quicker initiate chemotherapy and radiotherapy. This significantly improved the patient’s quality of life and prognosis due to the combined approach to the treatment of head and neck oncology. It is concluded that the incorporation of the robotic assistance into the program of surgical treatment significantly increases the effectiveness of the treatment and makes possible the combined approach to the treatment of oncological patients with manageable tumours of the head and neck region.

© 2011-2018 NSPU Bulletin. All rights reserved. Introduction. The authors investigate the problem of determining the epistemological foundations of pedagogical knowledge. The purpose of the article is to establish epistemological foundations of theoretical standard in pedagogical knowledge. Materials and Methods. The research employed a set of methods, including: a) an analysis of scientific literature on the topic of the article; b) a synthesis of generalized philosophical and scientific ideas, ideas of domain-specific research methodology of natural sciences and their influence on educational research methodology; c) clarifying the content of modern pedagogical knowledge, forms of its presentation to scientific and professional community, and methods of obtaining new pedagogical knowledge. Results. The article proposes an idea about such categories as dbjective subject reality "and Scientific-subject reality"unrepresented in theoretical education studies. The authors clarify the epistemological construct called theoretical standard of pedagogical knowledge" It consists of scientific-problem description of educational reality, fixing the difference between an educational event and a scientific fact, the subject of education and the idealized scientific object ofpedagogics, the correct nomination of problems and hypotheses and their epistemological verification. Conclusions. The authors conclude that the methodological concept of "theoretical standard of pedagogical knowledge" can become a reference point in the process of establishing pedagogics as epistemologically verified humanitarian knowledge.

© 2011-2018 Research Institute of Mechanics of Moscow State University. All rights reserved. Aim. To carry out a comparative analysis of self-rated health, medical activity, and satisfaction with the quality of medical care in public health institutions by residents of rural settlements of the Untsukul district, Republic of Dagestan. Methods. The study was conducted by the method of questioning 2643 respondents, among them 1453 women and 1181 men. Results. According to the results of the survey, the majority of the interviewed residents of Untsukul district (68.2%) are satisfied with their health. Medical activity of the population at the time of the study was 60.6%. As to respondents who applied to the medical institutions of the Untsukul district during this period, 13.5% are not satisfied with the quality of medical care in public health institutions, 23.5% are fully satisfied, 30% are not fully satisfied. Conclusion. A social survey in the form of a questionnaire is one of the most effective methods of obtaining information about the self-rated health of the population. Timely analysis of medical activity of the population, its satisfaction with the quality of medical care will improve the efficiency of the health system.

© 2018, Bionika Media Ltd. All rights reserved. Relative and absolute hyperestrogenism and a change in the estradiol/progesterone (E2/P) ratio are of great importance in the pathogenesis of fibrocystic breast disease, which justifies the choice of progesterones for pathogenetic therapy. Transdermal progesterone gel is recommended in accordance with the instruction for medical use as monotherapy for this disease. Clinical findings show that the transdermal administration of progesterone is effective in reducing not only mastalgia, but also the number of cysts. A survey of physicians has demonstrated that unregistered drugs for this indication are used to treat fibrocystic breast disease. If there are indications, pharmacotherapy should be performed strictly in accordance with the instruction for medical use, which always contains information regarding what specific benign breast disease is treated with this drug, whether it is used as alone or as part of standard combination therapy, and which specific symptom should be eliminated if the drug is used symptomatically.

© 2018 National Research University Higher School of Economics. All rights reserved. The aim of this study was to identify predictors of poor outcomes in patients hospitalized for severe acute exacerbation of COPD (AECOPD). Methods. This retrospective, observational cohort study was conducted in Pulmonology Department of a city hospital in 2015 - 2016 and involved patients hospitalized for severe AECOPD. Patients were divided according to outcomes. Poor outcomes included at least one of the followings: the need in invasive (IMV) or non-invasive (NIV) ventilation, admission to ICU, in-hospital death and COPD-related readmission during 2 months. Demographic, clinical, laboratory parameters, pulmonary function tests and blood gas analysis were analyzed; different multidimensional prognostic scores were also evaluated and compared. Results. Of 121 patients included, a poor outcome had occurred in 45 patients (37%). Among them, NIV was required in 21 (17%), IMV in 8 (6%), and admission to ICU in 16 patients (13%); death was registered in 6 patients (5%) and readmission in 27 (22%) of the patients. Patients with poor outcomes were admitted more frequently by ambulance (62% vs 40%; p = 0.003), more often were admitted to a hospital for AECOPD in the previous year (69% vs 45%; p = 0.0006), and had lower pH (p = 0.001), lower PaO2 (p = 0.001), higher PaCO2 (p = 0.001), and a worse score on several prognostic scales such as APACHE II (13.9 ± 5.4 vs 7.8 ± 3.6; p = 0.001), DECAF (2.4 ± 0.6 vs 1.5 ± 0.6; p = 0.001), BODEx (5.6 ± 1.8 vs 3.9 ± 1.1; p = 0.001), DOSE (2.9 ± 1.5 vs 2.2 ± 1.2; p = 0.029), and ADO (4.9 ± 1.5 vs 4.3 ± 1.3; p = 0.015) at admission. They more frequently received O2 therapy (87% vs 46%; p = 0.001) and had longer hospital stay (19.2 ± 6.2 days vs 12.5 ± 1.8 days; p = 0.001). Conclusions. Hypercapnia, hypoxemia and worse prognostic scores on admission predicted poor outcome in patients hospitalized for AECOPD during the previous year.

© 2018, Media Sphera Publishing Group. All rights reserved. The paper describes a case of essential cryoglobulinemia unassociated with hepatitis B and C viruses. The morphological substrate of the disease was exclusively proliferative endothrombovasculitis without destructive changes in the walls of affected vessels. In addition, in the late stage of the disease, there was its unusual manifestation associated with inflammation of the mesentery arteriolar walls and with the formation of occlusive blood clots in their lumens, which led to severe abdominal diseases. The female patient showed a mosaic involvement of the loops of the bowel in the necrotic process as its separate segments, which was associated with damage to a large number of small vessels. The feature of the case is a set of 4 risk factors for a fatal disease outcome, such as age over 65 years, pulmonary, renal, and intestinal lesions.

© 2018, Media Sphera Publishing Group. All rights reserved. Non-motor disturbances represented by sensory, affective, obsessive-compulsive disorders, cognitive dysfunction, sleep disturbances are often found in patients with dystonia and have a negative impact on their quality of life. The prevalence of sensory and affective disorders and sleep disturbances is above 50% in patients with cervical dystonia and is 25% in patients with blepharospasm, writing spasm; cognitive dysfunction is found in more than 25% of patients with focal dystonia. The relationship of nonmotor, in particular psychiatric disorders, with the impairment of social and everyday life and worsening of quality of life in whole was shown. Common pathophysiological mechanisms of non-motor disorders as well as approaches to treatment of these disorders are discussed. The authors present the results on the positive effect of botulinum toxin therapy that reduces cognitive dysfunction, sensory disorders and depressive syndrome. Non-medication treatment of non-motor disorders in patients with dystonia is considered.

© 2018, Media Sphera Publishing Group. All rights reserved. This article presents a review of Russian and foreign literature about the impact of arterial hypertension (AH) on the risk of cognitive impairment and dementia. Large studies have demonstrated the effect of blood pressure (BP) on the risk of vascular dementia and Alzheimer’s disease (AD) in elderly and oldest old people as well as a role of antihypertensive therapy. There is evidence of a negative effect of hypertension in middle age on cognitive functions in late-life. Observational studies as a whole have shown the positive effect of antihypertensive therapy on the prevention of cognitive function and dementia. However, there are a number of limitations that dictate the need for further research on this issue. The importance of the interdisciplinary approach to treatment of cognitive impairment by cardiologists and/or therapists, together with neurologists, as well as complex treatment regimens, including correction of risk factors and neuroprotective therapy, is highlighted.

© 2018, Media Sphera Publishing Group. All rights reserved. The development of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is associated with the hyperergic reaction of the human immune system. The development of autoimmune inflammation is preceded by contact with internal or external trigger factors (adjuvants) of immune disorders. ASIA is associated with an individual genetic predisposition that is probably associated with the carriage of HLA-DRB1*01 or HLA-DRB4. The paper presents five possible options for the impact of adjuvants in the pathogenesis of autoimmune disorders. It gives diagnostic criteria for the syndrome, as well as its clinical, laboratory and morphological manifestations. Emphasis is laid on the importance of morphological changes in the diagnosis of autoimmune disorders. The spectrum of morphological changes in ASIA is extensive. The tissues show signs of immune inflammation, such as lymphohistiocytic infiltration, granulomatous inflammation, and scleroderma-like changes. The characteristic feature is the regression of clinical, laboratory, and morphological manifestations after adjuvant removal.

© 2018, Media Sphera Publishing Group. All rights reserved. Solid pseudopapillary tumor is a low-grade malignant neoplasm of the pancreas. The clinical manifestations are variable, ranging from an asymptomatic course to cases with severe symptoms that dramatically impair the patients’ status. The paper describes the rare case of a solid pseudopapillary tumor in a 34-year-old woman, which was accompanied by difficulties in the interpretation of clinical data and morphological patterns.

© 2018 Ima-Press Publishing House. All right reserved. In accordance with international and Russian guidelines for the management of patients with rheumatoid arthritis (RA), after its diagnosis, a synthetic disease-modifying antirheumatic drug is prescribed, among these drugs, methotrexate is anchor and, when the latter is impossible to use, leflunomide is commonly administered. Objective: to evaluate the efficacy and safety of a leflunomide generic (Elafra) during a multicenter follow-up. Subjects and methods. The investigation enrolled 347 patients aged over 18 years who met the 2010 ACR/EULAR criteria for RA, had its duration of less and more than 2 years, signed informed consent, and followed up in 29 centers of Russia. Elafra was prescribed at a saturating dose of 100 mg for the first 3 days, then 20 mg/day. There might be a temporary two-fold reduction in the dose when adverse events (AE) occurred. The patients were examined before and 4, 12 and 24 weeks after beginning leflunomide treatment. The treatment efficiency was evaluated with DAS28 and CDAI and by the physician global assessment. Results and discussion. The patients were divided into two groups: 1) 125 patients with RA of less than 2 years' duration and 2) 222 patients with RA of more than 2 years' duration. The mean age of patients in Group 1 was 48.7±12.9 years; that in Group 2 was 52.5±11.95 years; the mean disease duration was 11.9±7.8 and 90.99±54.28 months, respectively. During 24-week treatment, there was a highly significant decrease in all assessed clinical, laboratory parameters and indices of RA activity in both groups. At 4 weeks of treatment, the effect was observed in 91.8% of the patients in Group 1 and in 84.6% in Group 2, whereas at 12 weeks the effect was noted in almost all patients (99.1% and 96.9% in Groups 1 and 2, respectively). The highest rate of AE during Elafra therapy was recorded in the early periods: at 4 weeks, AE were noted in 6.5% of the patients in Group 1 and in 9.9% in Group 2, without needing to discontinue the drug. Treatment continuation decreased the rate of AE. Because of its intolerance, Elafra was discontinued due to in one case in Group 1 (diarrhea at 24 weeks of treatment) and in 6 cases in Group 2 (at 12 and 24 weeks of treatment). Conclusion. Treatment with leflunomide (Elafra) leads to the rapid development of its effect in early and late RA in most patients and is characterized by a good tolerability.

© 2018 National Academy of Pediatric Science and Innovation. All rights reserved. Solid tumors in children occupy the second place in the structure of morbidity, yielding to hemoblastosis. Among solid tumors, approximately 5% are bone sarcomas: osteosarcoma (3%) and Ewing's sarcoma (2%). Atypicality of the course of these diseases makes it difficult to diagnose them early. The article describes a series of clinical observations of patients with bone sarcomas, which illustrate the complexity of diagnosing diseases of this group.

© 2018 Bulletin of Siberian Medicine. All rights reserved. The aim of the investigation was to determine the characteristics of the immune response regulation for pulmonary tuberculosis (TB) and to analyze the role of regulatory T cells in the immunopathogenesis of TB with eosinophilia in the blood, depending on the clinical form of the disease and sensitivity of Micobacterium tuberculosis to anti-TB drugs. Materials and methods. 157 patients who were initially diagnosed with infiltrative and disseminated TB were examined. The material of the study was venous blood and culture of mononuclear leukocytes isolated from venous blood. The content of interleukin (IL) 4, IL-10 and transforming factor beta (TGFβ) in culture suspensions of mononuclear leukocytes in vitro and IL-5 in the blood was determined by enzyme-linked immunosorbent assay (ELISA) test. The expression of surface molecules CD4, CD20, CD25 and intracellular transcription factor Foxp3 by lymphocytes of the blood was evaluated by flow cytometry. The obtained results were analyzed by statistical methods. Results. It is shown that excessive generation of regulatory T cells in patients with TB is associated with eosinophilia of the blood and imbalance of immune response regulation mechanisms. In TB with eosinophilia, an increase in the number of Foxp3-positive regulatory T cells in the blood is combined with in vitro hypersecretion of anti-inflammatory cytokines TGFβ, IL-10, IL-4 and an increase in the content of CD20+ B lymphocytes and IL-5 in the blood. These changes are most pronounced in the disseminated form of TB in combination with drug resistance. Conclusion. Characteristics of immunoregulation at TB with blood eosinophilia are associated with activation of immunosuppression mechanisms and polarization of immune response towards Th2-dependent pathway.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The article presents data of domestic and foreign authors on the relationship between occupational factors and arterial hypertension. The role of latent arterial hypertension, its frequency in the population, the lesion of the target organs and the prognosis in comparison with normotensive individuals, arterial hypertension of the "white coat" and stable arterial hypertension have been analyzed. Arterial hypertension in the workplace is a form of latent arterial hypertension. The authors review the influence of harmful production factors (physical, chemical), as well as psychosocial stress on the risk of developing arterial hypertension.The risk of developing hypertension in specified groups of workers has been analyzed separately. The place of production-related diseases in modern occupational pathology in the Russian Federation. A wider implementation of measures aimed at early diagnosis and prevention of arterial hypertension in workers is proposed.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Aim. To evaluate the presence and the severity of the complaints (headache, dizziness, memory loss, concentration of attention, sleep disturbances, decreased mood, increased anxiety), the state of cognitive functions, emotional status and quality of night sleep in treatmentnaïve middle-aged patients with mild to moderate EAH compared to healthy volunteers of the same age. Materials and methods. 103 treatment-naïve patients with EAH aged 40-59 years at the enrollment, who met the inclusion/exclusion criteria and provided written informed consent (46 men, mean age 53.6±0.8 years) and 50 healthy volunteers (17 men, mean age 51.5±1.0 years) with normal blood pressure (BP) level - control group - were enrolled to the study. Mean EAH duration was 2.9±5.7 years. Cognitive assessment included Montreal cognitive assessment, 10-words learning task, verbal fluency test, TMT, Stroop color and word test. Anxiety and depression were evaluated via Hamilton rating scales (HARS and HDRS). 24-hours ambulatory BP monitoring (ABPM) was performed according to European guidelines. Results. 70% of patients with EAH complained of memory disturbance, 68% - lack of attention, 22% - sleep disturbances, 12% - dizziness, 9% - headache. It took statistically significant more time for patients with EAH to perform on TMT B (p<0.05), they had significantly higher TMT B - TMT A difference score (p<0.01) and lower mean MoCA score (p<0.05). Patients with EAH had significantly higher mean score in Hamilton anxiety (2.1±3.7) and depression (1.1±2.4) rating scales compared to controls (0.3±0.9 points, p<0.01 and 0.1±0.5 points, p<0.001, respectively). Patients with EAH who complained of sleep disturbances had low sleep quality (8.7±2.8 points). Among patients with EAH who complained about headaches 66.6% had episodic migraine and chronic tension type headache (33.4%). Those patients had a substantial impact of headache on life and daily living according to HIT-6 (mean score - 57.5±6.1). Only 2 patients out of 12 with complains about dizziness had benign paroxysmal positional vertigo and Ménière's disease. Conclusion. Complaints about memory dysfunction, lack of attention, sleep disturbances, less common - dizziness and headaches, are most typical in patients with EAH on the early stages of the disease. They differ from healthy volunteers of the same age by having cognitive impairment and higher anxiety and depression scores. Patients with EAH who complained about sleep disturbances had low sleep quality. Headache in patients with EAH was due to episodic migraine and tension type headache which had a negative impact on life and daily living.

© 2018, Dynasty Publishing House. All rights reserved. Chronic pancreatitis, being a complex multifactor clinico-genetic phenomenon, is a significant medical, social and economic problem. Study of pancreatitis remains a topical theme also for the paediatric cohort, especially taking into account practically similar morbidity rates in adults and children. The review presents information and analyzes main genetic risk factors of the development of pancreatitis. Mutations and polymorphisms of the CFTR, CTRC, SPINK1, CPA1, PRSS1, PRSS2 genes that are significant for functioning of the pancreas are discussed in detail. Examples of genetic variants associated with increased or decreased risks of developing disease are given. Special attention is paid to difficulties of interpreting the results of molecular-genetic testing associated with certain gene homology, presence of pseudogenes and disease cases conditioned by spontaneous mutation. Detection of genetic risk factors of chronic pancreatitis allows to early prevent the development of disease in the proband’s relatives, and also to take a more personalized approach to the patient’s treatment.

© 2011–2018 NSPU Bulletin All rights reserved Introduction. The problem of the article is addressed to clarify the question of how the content of practical pedagogical knowledge accumulated by the society can be understood from the point of view of an epistemologically correct theoretical scheme, to what extent this scheme itself is now formed in the methodology of pedagogy and what are the immediate prospects for such formation. The aim of the article is to reveal the epistemological coding of the modern state of educational theory as an object of research reflection and the prospects for its further formation. Materials and Methods. Among our research methods, we consider it possible to include: analysis of literature on the topic of the work, a theoretical substantive generalization, heuristic synthesis, the formulation of a hypothesis about the possible content and activity filling the field of reflection of researchers in the field of pedagogy, and a prospectus of further approaches to the study of the problem. Results. The modern initial stage of the theoretical interpretation of pedagogy is identified, the difficulties of which are explained by the polyphony of coding: the object of pedagogy, its fundamental foundations, the rules for deducing consequences from general provisions, the correct implementation of generalizations and analogies, and the methods for carrying out the experiment and identifying experimental confirmation of an experted theory. As the nearest stage in the solution of these problems, the authors design correct theoretical constructs of a restricted nature which must include the following aspects: identifying weak research development of several segments of pedagogical reality, raising hypotheses about the possibility of describing them from the point of view of the positively valuable educational outcome for the learner and the ways of achieving it, finding the criteria for its evaluation and implementing them in a diagnostic format. Conclusions. The presented variant of polyaspect reflection of the results of educational research based on the theoretical scheme covers both retrospective and prospective reflective forms; it also shows all the procedures traditionally indicated by psychologists: stopping, removing, fixing, reviewing, objectifying; allows educational researchers to evaluate their investigations according to scientific norms which achieve a theoretical status. All the theses of the problematic format presented in the article are a possible field of application for beginning researchers.

© 2018, Media Sphera Publishing Group. All rights reserved. This article was designed to report the results of scientific research and practical forensic medical work carried out jointly by the personnel of Department of Forensic Medicine of the Sechenovsky University and the Bureau of Forensic Medical Expertise of the Moscow Health Department during the last 5 years.

© 2018, Media Sphera Publishing Group. All rights reserved. We undertook the analysis of the archive data of forensic medical expertises of the non-identified corpses accumulated at the tanatological divisions of the Moscow Bureau of Forensic Medical Expertise for the period from 2012 till 2016. Special attention was given to sex and age composition of the deceased as well as the structure of mortality and the traces of ethyl alcohol, if any, present in the blood. It was shown that the majority of the unidentified bodies were those of the young men, with the main cause of the non-violent deaths being the cardiovascular pathology. Ethyl alcohol was found in the blood of 43% of the corpses. The analysis encompassed also the most frequently used methods for personality identification based on the data available from the medical-criminalistic department of the Bureau of Forensic Medical Expertise. The statistical treatment of the results of the study provided materials making it possible to envision the tendencies of the further development and improvement of the methods for personality identification for the purpose of forensic medical expertise and judicial practice.

© 2018, Media Sphera Publishing Group. All rights reserved. The present article deals with the problems pertaining to the forensic medical diagnostics of the HIV-associated pathological conditions taking into consideration the materials available from the Moscow City Centre for AIDS Prophylaxis and Control with special reference to the number and structure of the diagnosed HIV-associated diseases. We undertook the analysis of co-morbid HIV/AIDS causes of violent and sudden deaths documented at the Bureau of Forensic Medical Expertise of the Moscow Health Department during the period from 2013 till 2016. The study revealed the tendency toward a rise in the number of deaths from the HIV-associated infections including tuberculosis, pneumonias, chronic immunodeficiency conditions refractory to the treatment, and from malignant neoplasms. A peculiar feature of the aforementioned period was the increased age of the deceased subjects. In the cases of violent deaths, the HIV-associated conditions were diagnosed as the concomitant diseases, with the markedly predominant ones being acute drug and alcohol intoxication, injures, and attempts at suicide. The available results of the studies give evidence of the necessity and importance of the cooperative work of the specialists for the further improvement of forensic medical diagnostics and monitoring of HIV-associated conditions.