Opportunities of early treatment of acute respiratory viral infection in children
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01.01.2018 |
Gеppe N.
Krylova N.
Eliseeva T.
Tyurina E.
Yablokova E.
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Rossiyskiy Vestnik Perinatologii i Pediatrii |
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© The authors team, 2018.All Rights Reserved. Purpose: to evaluate effectiveness of Oscillococcinum in the treatment of acute respiratory viral infections (ARVI) in children of different age groups. We observed 140 children from 1 to 14 years with mild to moderate-severe acute respiratory viral infection. 80 children (Group 1) were treated with Oscillococcinum, 60 children (Group 2) were treated symptomatically. Group 1 was divided into Subgroup 1А (40 children of 1-5 years old) and Subgroup 1B (40 children >5-14 years old). Group 2 was divided into Subgroup 2А (30 children of 1-5 years old) and Subgroup 2B (30 children >5-14 years old). The follow-up period was 7-10 days. Clinical efficacy was assessed by the severity of ARVI symptoms in scores from 0 to 2. All adverse events of the therapy were recorded. Also we evaluated disappearance of ARVI symptoms within 48 hours after the beginning of the therapy. Results: Oscillococcinum reduced the duration of ARVI in children of different age groups. During the first two days the symptoms of acute respiratory viral infection disappeared in 13 (16.3%) children of Group 1 receiving oscilococcinum and in 4 (6.7%) patients from Group 2 (OR = 2.7, 95 % CI 0.8-8.8, p <0.001). Conclusion: Oscillococcinum is an effective and safe drug to treat ARVI in children of different age groups.
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Experience of vaccination of a patient with systemic juvenile idiopathic arthritis (sJIA) with a 13-valent pneumococcal conjugate vaccine, prior to the appointment of therapy with tocilizumab, an anti-IL-6-receptor monoclonal antibody
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01.01.2018 |
Vankova D.
Alekseeva E.
Soloshenko M.
Dvoriakovskaia T.
Isaeva K.
Denisova R.
Mamutova A.
Rudnitskaya M.
Mayansky N.
Tkachenko N.
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Voprosy Sovremennoi Pediatrii - Current Pediatrics |
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© 2018 Voprosy Sovremennoi Pediatrii - Current Pediatrics. All rights reserved. Background. Infections are the main cause of death for patients with autoimmune rheumatic diseases. In adult patients with rheumatoid arthritis (RA), mortality caused by respiratory infections is 2-5 times higher than in the population. One of the frequent infectious complications in the course of treatment with tocilizumab, the first-choice drug for treating systemic juvenile idiopathic arthritis (sJIA), is pneumonia characterized by a poor clinical picture, normal values of laboratory indices of the disease activity (ESR, C-reactive protein) with pronounced changes in the lungs revealed by computed tomography. In case of acute respiratory infection in children with systemic JIA, immunosuppressants and genetically engineered biological preparations (GEBP) are discontinued. This often leads to an exacerbation of the underlying disease and the progression of a pathological process. At present, vaccination against pneumococcal infection in Russia is not included in the standard for managing patients with rheumatic diseases. Studies of the safety and efficacy of vaccination with 13-valent pneumococcal conjugate vaccine (PCV) in patients with sJIA receiving genetically engineered biological preparations were not conducted. Clinical Case Description. The article shares the experience of vaccination of a girl aged 9 years with a 13-valent PCV that was conducted in the course of a scientific investigation, which studied the efficacy and safety of vaccination of children with systemic JIA prior to prescription of GEBP tocilizumab. Vaccination did not cause a deterioration in the course of the main disease (1 month), led to a reduction in the incidence of acute respiratory infections (from 4 to 1 time within 6 months before and after vaccination), and discontinuation of antibacterial drugs within 6 months after vaccination. Conclusion. The safety of a 13-valent PCV in a child with sJIA and a decrease of the incidence of respiratory diseases after vaccination, their complications, and the use of antibacterial drugs have been shown.
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Laser en-bloc resection of non-muscle-invasive bladder cancer: Clinical and morphological specificities
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01.01.2018 |
Severgina L.
Sorokin N.
Dymov A.
Tsarichenko D.
Enikeev D.
Kislyakov D.
Rapoport L.
Korovin I.
Korolev D.
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Onkourologiya |
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© ABC-press Publishing House. All rights reserved. Objectives to enhance the morphological diagnostic complex in order to predict postoperative outcomes in a more accurate way and to optimize patients with non-muscular invasive bladder cancer treatment. Materials and methods. The study included 34 patients from 25 to 71 years old underwent laser en-block resection, the most of them were males - 28. In 9 cases multiple carcinomas (2 or more) were found. Huge tumors (2 cm or more in one dimension) were resected in 6 patients. Results. The major part of tumors removed (n = 22) histologically appeared to be papillary urothelial carcinomas with low grade of malignancy and PUNLMP; in 6 cases G2 was verified, one tumor with high malignancy potention - G3. In 3 patients intramuscular invasion was found (invasive carcinoma T2) excluding them from the study. Discussion. Laser en-block resection of non-muscle-invasive bladder cancer appears to be the most optimal approach in operative treatment that provides representative histological material. For correct morphological estimate we recommend either to expand the resection zone to 1 cm which allows to remove circular resection margin or to take extra pinch biopsy from tumor crater (vertical margin). In 3 patients from our study positive circular margin was revealed histologically whereas foci of perineural and perivascular invasion were found in one case. A new subgrading of stage T1 depending on intramuscular invasion depth was suggested whereas the main criteria is the muscularis mucosae involvement. Conclusion. Morphological estimate of circular resection margin provides an ability to predict postoperative outcomes and correct the treatment in one or another way. Subgrading for T1-stage tumors is recommended for following correct postoperative prognosis and possibility of tumor recurrence.
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Chronic diseases, precancer, and cancer of the lung, which are associated with pathology of the club cells of respiratory and terminal bronchioles
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01.01.2018 |
Demura S.
Kogan E.
Goryachkina V.
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Arkhiv Patologii |
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© 2018, Media Sphera Publishing Group. All rights reserved. The review of the literature deals with the participation of Clara cells now called club cells (CCs) of the epithelium in the respiratory and terminal bronchioles in the pathogenesis and morphogenesis of chronic inflammatory diseases, precancer, and cancer of the lung, which develop in the respiratory segments. The review summarizes data on the histophysiology of CCs and their participation in the pathogenesis and morphogenesis of chronic interstitial lung diseases, pneumoconiosis, chronic obstructive diseases, adenomatosis, and adenocarcinoma of the lung. In this area, there is a bronchioloalveolar junction area (BAJA), one of the most important stem cell niches. CCs are located in the BAJA; they are progenitor tissue stem cells and play an important role in the regeneration of the epithelium of the respiratory bronchioles and alveoli. Pathology of CCs in the BAJA leads to the maintenance of chronic inflammation, to the destruction of the lung elastic frame, and to impaired epithelial regeneration, interstitial fibrosis, and adenomatosis. In this case, decompensated inflammation, pathological regeneration, and fibrosis develop, which, along with the action of carcinogenic agents, can contribute to the accumulation of mutations and epigenetic rearrangements in the CCs, which subsequently results in atypical adenomatous hyperplasia and adenocarcinoma of the lung.
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Immunochemical and protective properties of Conjugated Capsular polysaccharide of Streptococcus pneumoniae Serotype 9N
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01.01.2018 |
Nuriev R.
Galvidis I.
Yastrebova N.
Burkin M.
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Biotekhnologiya |
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© 2018. Conjugates of Streptococcus pneumoniae type 9N capsular polysaccharide with tetanus toxoid have been prepared. Their interactions with specific antibodies to tetanus toxoid and polysaccharide 9N were assessed, which permitted to select a conjugate with the optimal ratio of the polysaccharide and carrier protein (3:4). The parameters of the efficient adsorption of tetanus toxoid and polysaccharide on aluminum hydroxide for the following in vivo experiments were determined using the quantitative ELISA; in particular, the optimum ratio of the conjugate and adjuvant was proved be ≤ 1:1 (w/w). The repetitive immunization with the selected conjugate adsorbed on aluminum hydroxide increased the anti-PS antibody titers up to 70400 (p < 0,001) which is 140-fold higher as compared to the antigen unconjugated form. The investigation of the antibody protection from Streptococcus pneumoniae 9N after the intranasal challenge of wild-type mice revealed that the titer of the bacterial contamination in the immunized mouse lung tissue was 10-fold lower than that in non-immune mice 72 h after the contamination (p > 0,05).
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Barrier drugs with prolonged release in dental practice
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01.01.2018 |
Romanova Y.
Makeeva M.
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Stomatologiia |
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Pathological lesions associated with multiple causes (infections, physical, chemical and thermal agents) of oral mucosa are equally widespread in all spheres of dental practice. The actual importance of pharmaceutical therapy of lesions of oral mucosa is associated with the lack of reliable traditional topical drugs - ointments, gels, pastes, lacquers, discs - caused by their little efficiency associated with poor maintaining of permanent concentration, short contact period, discomfort and long-term treatment. All the mentioned facts caused the development of various pharmaceutical forms with prolonged activity with improved adhesion to oral mucosa, prolonged saving of useful properties and protecting the lesion from oral infection and external influences and reducing the intensity of painful sensations during mastication and mimics. These drugs form the group of barrier drugs and drugs with prolonged release of medicine of the wide specter. During all the time of existence this group of drugs has undergone and is still undergoing several changes targeted on improvement of adhesion and maintaining of constant concentration of medicine in the lesion and extension of indications for use. The development of new pharmaceutical forms is still continuing.
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New criteria of radical surgery and long-term outcomes of hilar cholangiocarcinoma management
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01.01.2018 |
Kovalenko Y.
Vishnevsky V.
Chzhao A.
Zharikov Y.
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Khirurgiia |
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1 |
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AIM: To develop new criteria of radical surgery for hilar cholangiocarcinoma (HCC). MATERIAL AND METHODS: There were 165 HCC patients who underwent surgery in 1986-2016 at the Vishnevsky Institute of Surgery. TNM stage distribution: stage I - 4 (2.4%), II - 45 (27.3%) (29 of them are referred to the 1st period of work), IIIA - 23 (13.9%), IIIB - 41 (24.8%), IVA - 35 (21.2%), IVB - 17 (10.3%). 80 (48%) patients underwent hemihepatectomy, 17 (10%) - advanced hemihepatectomy, 16 (10%) - minor liver resection with common bile duct repair, 52 (32%) - common bile duct repair resection. Kaplan-Meier survival analysis was performed. Cox proportional hazard model was applied to access relationship between survival and prognostic factors. Log-rank test was used to compare both survival curves. RESULTS: R0-resection as followed by 5-year survival rate near 32%. Microvascular invasion was observed in 42.9%, lymphovascular invasion - in 88.2%, positive resection margin - in 59.2%, perineural invasion - in 83.3%, cells in surrounding fatty tissue were revealed in 92.3%. Resection may be considered radical (R0) if all variables are absent, 5-7 negative factors are followed by conditionally radical procedure (R+number of positive factors). Long-term outcomes and significance of new criteria were accessed (p=0.004). CONCLUSION: New criteria of radical procedure are presented. The last reflects the concept of dependence of 'pure' surgical edge from not only presence or absence of tumor cells in cut-off plane but also from important morphological features of tumor.
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Conversion to everolimus to preserve kidney function in a heart transplant recipient, a personalized approach of immunosuppressive therapy
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01.01.2018 |
Koloskova N.
Nikitina
Zakharevich V.
Muminov I.
Cvan V.
Poptsov V.
Ahmadzai R.
Izotov D.
Shevchenko A.
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Vestnik Transplantologii i Iskusstvennykh Organov |
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© 2018 Russian Transplant Society. All rights reserved. Heart transplantation is the «gold standard» of treatment severe heart failure. Patient survival after heart transplantation has improved dramatically since the availability of calcineurin inhibitor (CNIs). However, nephrotoxicity of CNIs has been largely responsible for the progressive development of renal dysfunction and reduces long-term patient survival. Use mTOR inhibitor in immunosuppressive therapy may improve renal function when everolimus is administered associated with a progressive reduction of CNIs. The purpose of our report is to demonstrate the successful case of conversion of the recipient after heart transplantation to everolimus and to evaluate the effectiveness of this drug during the observation year after heart transplantation.
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Perspective clinical application of modern anti-fibrotic therapies in dacryology
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01.01.2018 |
Rein D.
At'Kova E.
Ramenskaya G.
Yartsev V.
Root A.
Zhukov O.
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Eksperimental'naya i Klinicheskaya Farmakologiya |
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© 2018 Izdatel'stvo Meditsina. All rights reserved. The main reason of surgical treatment failure in cases of chronic dacryocystitis concurrent with nasolacrimal duct obliteration is scarring of the newly created ostium. This outcome is caused by the continued activity of myofibroblasts that leads to the formation of a rough scar. Mitomycin C is currently considered to be the most preferred anti-fibrotic drug. Nonetheless, contradictory evidence of the drug efficiency stimulates further research for finding alternative anti-fibro-tic therapeutics. Recently, several advances were made in developing new anti-fibrotic drugs, including monoclonal antibodies, small RNA molecules, and other gene therapy formulations, nanoparticles and small-molecule therapeutics. This review article aims to provide up-to-date information on the efficacy of mentioned agents and on prospects of their use in dacryology.
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A new approach for split renal function evaluation of glomerular filtration rate, perfusion and plasma flow by numerical analysis of 3D MSCT-based models
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01.01.2018 |
Alyaev Y.
Khokhlachev S.
Fiev D.
Borisov V.
Proskura A.
Iurova M.
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Russian Electronic Journal of Radiology |
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© 2018 Russian Electronic Journal of Radiology. All rights reserved. Introduction. Instrumental methods of examination may alter the course of treatment and patients' management. Several studies have shown that interobserver variability in values obtained with renal scintigraphy (RS) can be as high as 10%, however, RS remains the standard investigation for the assessment of split renal function. Objective. This paper aims to present how numerical analysis of abdominal MSCT results can be used to evaluate split renal function. Materials and methods. A prospective study was launched in a Research Institute for Uronephrology and Reproductive Health from November, 2015 to May, 2017. 88 patients were enrolled into the study (2 with hydronephrosis, 10 with hypertensive kidney disease, 5 with stone kidney disease, 2 with kidney anomalies, 69 with renal tumors). Comparison made between renal scintigraphy data and 3D MSCT-based models. Results. CT-based methods for the calculation of split renal function with 3D-models showed correlation with renal scintigraphy (p<0.004). Conclusion. A new approach for split kidney function assessment based on contrast-enhanced CT with 3D-models and mathematical analysis allows for both acquiring detailed data on clinical anatomy and evaluation of renal function to promote preoperative decision-making. It showed strong correlation with no significant difference in comparison with RS in terms of glomerular filtration rate, perfusion and plasma flow.
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Apoptosis in seminiferous tubules of human in normal and in idiopathic infertility
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01.01.2018 |
Demyashkin G.
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Tsitologiya |
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1 |
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© 2018 Sankt Peterburg. All rights reserved. The purpose of this study was to assess the level of apoptosis in cells of human seminiferous tubules in normal and pathological spermatogenesis by revealing the proportion of immunostaining cells for caspase-9 and -3 and by comparing the expression of pro-apoptotic (BAK and BAX) and anti-apoptotic genes (BCL2 and BCLW). A retrospective study involved men (n = 42) who complained of childlessness in marriage for 2 years with a diagnosis of idiopathic infertility, established after physical, genetic, biochemical (hormones) and cytological (spermogram) analyzis. The biopsies of the testes as well as the autopsy material of men 22—35 (n = 10), 64—75 (n = 10) and 75—90 (n = 10) years were studied using the immunohistochemical method (caspase-9 and -3) and PCR-RT. The marking level for caspase-9 in spermatogonies with normal spermatogenesis is approximately at the same level (the proportion of stained spermatogonies is 39.5 0.33 % in young men, 35.6 0.44 % in the elderly, and 32.2 0.28 % in man of senile age), and increases when the maturation is blocked and in the case of focal variant of Sertoli-cell-only syndrome (64.3 0.39 and 72.0 0.41 %, respectively). When using antibodies to caspase-3, the percentage of immunopositive spermatogonia in normal spermatogenesis was 60.1 0.44 % in young men, 78.2 1.2 % in the elderly, and 87.3 0.9 % in men of senille age, and with idiopathic infertility, a sharp increase in the proportion of labeled spermatogonia was observed (an average of 91.4 1.1 %). In the case of hypospermatogenesis and the blocking of maturation, a significant increase in the relative level of expression of the proapoptotic genes of the internal pathway of apoptosis of BAX and BAK was observed against the background of a decrease in the expression of the anti-apoptotic genes BCL2 and BCLW, compared to men of the same age but with normal spermatogenesis. Based on the results, we can conclude that in the elderly’s testes the receptor-mediated pathway of apoptosis predominates over the mitochondrial (internal) pathway. In the idiopathic form of male infertility the internal pathway of apoptosis is dominant. An increase in the activity of apoptosis markers can be associated with impaired maturation of the germ cells in the meiosis block and with the depletion of the germ cell pool in Sertoli-cell-only syndrome.
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Computed tomography of thoracic aorta trauma in patients with severe combined blunt injuries
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01.01.2018 |
Popova I.
Vladimirova E.
Kokov L.
Sharifullin F.
Muslimov R.
Tarabrin E.
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Russian Electronic Journal of Radiology |
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© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To identify the possibilities of computed tomography in detection of the nature and severity of the thoracic aorta trauma. Materials and method. Results of computed tomography (CT) of 15 patients from 2006 to 2017 with severe combined blunt injuries and thoracic aorta injury who had been treated in N. V. Sklifosovsky Research Institute for Emergency Medicine were analyzed. The majority of the patients were male 73% (n=11), the average age was 41,3+ 7,6 (22-79) years. The cause of injury in 12 cases were motor vehicle accidents, in 2 cases-falling from a height of more than three meters, in one case - A fall from patient's own height. Results. In evaluating the severity of the aortic injuries the classification proposed by the American Association of Thoracic Surgeons in 2013 was used. In our study there were no patients with Grade I; Grade II-small pseudoaneurysm (less than 50% of the circumference of the aorta) was identified in 8 patients; Grade III-big pseudoaneurysm (more than 50% of the circumference of the aorta) was identified in 3 patients; Grade IV-complete aortic rupture was identified in 4 patients. Simultaneously with the thoracic aortic injury pulmonary contusion was found in 9 patients, in 8-multiple fractured ribs, in 1-fracture of the sternum. In 8 patients mediastinal hematoma was identified, hemopericardium was found in 3 patients. Hemothorax was found in 12 patients. Signs of craniocerebral trauma were found in 6 patients, spinal cord injury-in 3 patients, injuries of the musculoskeletal system-in 4 patients, abdominal parenchymal organ injury was found in 4 patients (in 3 of these cases-of the liver, in 1-of the kidney), in one case sings of the duodenal rupture were found, in another-left-sided diaphragmatic rupture, in 1 patient with thoracic aortic rupture, a pseudoaneurysm of the hepatic artery was also found. Discussion. Using the classification of the severity of the aortic injuries by the CT results in patients with stable hemodynamics enables the ability to determine the degree of aortic stability, to predict the risk of rupture and to choose the type of optimal surgical intervention (early or delayed). There is a possibility to perform endoprosthetic repair of the aorta and surgical intervention of other areas against the background of controlled hypotension in patients with simultaneous traumatic aortic injury and other combined injuries. Conclusion. It is advisable to perform a CT examination at once of several anatomical regions when examining patients with severe combined injuries. Evaluation of the mediastinum structures in patients with severe combined injuries should be performed on the basis of a computed tomography of the chest with mandatory intravenous administration of contrast media. It is necessary to perform multiplanar and three-dimensional volume rendering to allow better visualization of the extent of thoracic aortic injuries. Choosing a method of treatment in victims with thoracic aorta injury is based on the use of endoprosthetics as an effective and low-traumatic intervention that can be used simultaneously with other surgical methods of treatment.
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Bacterial vaginosis and vulvovaginal candidiasis
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01.01.2018 |
Kuznetsova I.
Chilova R.
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Akusherstvo i Ginekologiya (Russian Federation) |
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© Bionika Media Ltd. Objective. To carry out a systems analysis of the data available in the current literature on the pathogenesis, therapy, and prevention of vaginal infections caused by the pathogens of bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC). Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed on this topic. Results. The paper highlights the main pathways of pathogenesis and the causes of recurrent vaginal coinfection. It describes methods for the treatment of women with BV and VVC and presents the optimal therapy and prevention schemes for recurrent vaginal infectious diseases, which have evidence-based effectiveness. Conclusion. The features of a microbial portrait and immune status predispose to recurrent BV and VVC, the presence of which results in coinfection. The cause of the latter is also repeated therapy for recurrent monoinfection. First-line therapy for BV is recognized to include metronidazole and clindamycin; the advantages of the latter are a wider spectrum of activity against the microorganisms that are difficult to identify. To treat coinfection and to prevent VVC in patients with BV, it is advisable to use fluconazole that also remains a first-line treatment option for vaginal infection caused by Candida albicans.
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Predictors of hepatic insufficiency in obstructive jaundice
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01.01.2018 |
Vinnik Y.
Pakhomova R.
Kochetova L.
Voronova E.
Kozlov V.
Kirichenko A.
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Khirurgiia |
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AIM: To develop predictive model for hepatic insufficiency in obstructive jaundice.MATERIAL AND METHODS: Obstructive jaundice was modeled by the author's method on 48 mini pigs, while morpho-functional features of erythrocytes were studied by using of INTEGRA Aura atomic force microscope (NT-MDT, Zelenograd, Russia). Histological specimens were stained with hematoxylin and eosin. Discriminant analysis was used to create predictive model for hepatic insufficiency.RESULTS: Mathematical model of hepatic insufficiency prediction has been developed. Sensitivity and specificity of this model were 94.1% and 74.2% respectively. Total percentage of correct predictions was 81.3%.CONCLUSION: Severe obstructive jaundice contributes erythrocyte's transformation from biconcave to dome-shaped followed by changes of its physical properties. Erythrocyte's volume and activity of cytolysis enzymes are the most informative to predict hepatic insufficiency. Our model allows us to diagnose this complication at early stages and to correct pre-, intra- and postoperative therapy.
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The correlation of somatotype of person with the development and course of various diseases: Results of Russian research
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01.01.2018 |
Kukes V.
Nikolenko V.
Pavlov C.
Zharikova T.
Marinin V.
Gridin L.
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Russian Open Medical Journal |
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© 2018, Kukes V.G., Nikolenko V.N., Pavlov C.S., Zharikova T.S., Marinin V.F., Gridin L.A. Currently there is an increased interest in medical anthropology, the study of constitutional features of the human body and their correlation with the manifestations of various diseases. Modern anthropometric techniques are increasingly used in scientific researches in clinical practice. This review article is devoted to the issues of interrelation between the type of the human constitution and manifestations of various diseases.
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On the occasion of the 200th birthday anniversary of D.E. Min
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01.01.2018 |
Pigolkin Y.
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Sudebno-meditsinskaia ekspertiza |
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This article is dedicated to the memory of the outstanding Russian forensic doctor and literary figure professor D.E. Min on the occasion of his 200th birthday anniversary. The assignment of D.E. Min to the position of the head of Department of the State Medical Practice at the Emperor's Moscow University coincided with the large-scale judiciary reform carried out in the country at that time which envisaged, among other innovations, the practice of questioning of an expert in the court room. The new developments in the practical expert activities required the revision of the former approaches to the education and training of forensic medical experts. D.E. Min was the first to introduce the practice of public defense of expert judgements by the students of the Department as an indispensable component of their routine learning activities. He founded the museum of forensic medicine and pioneered the method for teaching the intravital forensic examination. D.E. Min initiated and supervised original research on mechanical asphyxia, forensic-medical toxicology, and traumatology. D.E. Min and his co-workers were frequently engaged by the agencies in charge of preliminary investigation to participate in forensic medical expertise associated with the inquiries into the most lurid criminal cases of those times. The scientist made the essential contribution to the development of forensic medicine in this country and the modernization of the academic process at the Department of the State Medical Practice that greatly promoted satisfaction of the basic requirements of practical forensic medical activities.
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CLIPPERS syndrome
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01.01.2018 |
Schmidt T.
Pronin I.
Kazantsev K.
Voskresenskaya O.
Damulin I.
Aleksandrov A.
Yakhno N.
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Nevrologiya, Neiropsikhiatriya, Psikhosomatika |
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© 2018 Ima-Press Publishing House. All rights reservbed. CLIPPERS syndrome (Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids) is a recently described rare disease affecting the central nervous system. It is characterized by subacute development of symptoms of lesions predominantly in the brain stem and cerebellum, by specific magnetic resonance imaging (MRI) changes, perivascular lymphocytic infiltration in the brain substance and a good response to glucocorticoid (GC) therapy. The paper describes CLIPPERS syndrome in a patient who has been followed up in a clinic for 10 years. During this period, different variants of clinical diagnosis have been considered. The final diagnosis was made only when comparing the clinical course and manifestations of the disease, MRI data, as well as the reaction to GC therapy and its discontinuation. Literature data and diagnostic criteria of this disease are presented.
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Poliomyelitis in modern conditions: Achievements and prospects
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01.01.2018 |
Ivanova O.
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Jurnal Infektologii |
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© 2018 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reservbed. The creation in the middle of the 20th century vaccines against poliomyelitis (PM) - inactivated vaccine (IPV) and live oral vaccine from Sabin strains (OPV) with various properties, advantages and disadvantages, but highly effective, made it possible to implement the idea of elimination of PM. Since 1988, the WHO Global Program of PM eradication has achieved remarkable success: the incidence of PM caused by wild poliovirus (PV) has been reduced by 10 thousand times, the number of endemic countries has been reduced to 3, the circulation of wild PV has been discontinued in 4 regions of the world the wild type 2 of PV has been eradicated, and wild type 3 of PV has not been detected for almost 5 years. Under conditions of a decrease in the incidence of PM caused by wild PV, the known negative properties of trivalent OPV made its further use problematic. These negative properties are: 1) the ability to cause post-vaccination complications and 2) the genetic instability of Sabin strains, especially PV of type 2, and their ability under certain conditions (primarily in conditions of low collective immunity to PV) to quickly restore neurovirulence, transforming into circulating vaccine-derived PV (VDPV), capable of causing incidents and outbreaks of PM. In order to reduce the risk associated primarily with type 2 PV, WHO proposed a global switch to the use of bivalent OPV from types 1 and 3, completed in 2016. In 2019, WHO plans to complete eradication of type 1 and 3 PVs, and in 2022 completely abandon the OPV. The precondition for the safety of such tactics is the maintenance of high collective immunity to PM. There are several threats to the security of this strategy. PVs can "silently" circulate in the human population for a long time without clinical manifestations of PM, which, with inadequate epidemiological surveillance can lead to the return of PM. The reintroduction of both wild PV and Sabin strains can occur from institutions that preserve / work with PV. The source of VDPV can be people with primary immunodeficiencies, which continuously excrete PV. It is necessary to maintain surveillance over the PM, expand additional types of surveillance for the PV, strict containment of all PVs. The only way to maintain collective immunity is immunization with trivalent IPV. The current global shortage of IPV poses a significant threat to the world's epidemiological well-being. The solution to the problem is the development of a new generation of safe and effective vaccines, improving the ways of introducing IPV, developing antiviral drugs.
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Polymixin in oncology clinical practice
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01.01.2018 |
Dmitrieva N.
Petukhova I.
Grigorievskaya Z.
Bagirova N.
Tereshchenko I.
Grigorievsky E.
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Siberian Journal of Oncology |
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© 2018 Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved. The purpose of the study was to present data on polymixin-based antibiotics with activity against infections caused by multidrug-resistant Gram-negative bacteria, such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Material and methods. The review includes data from clinical as well as in vitro studies for the period 1998–2017. The search for relevant sources was carried out in the Medline, Cochrane Library, Elibrary and other databases. Results. The analysis of the data showed the presence of synergism and additive activity of polymyxin in combination with carbapenems, rifampicin and azithromycin. However, experimental data showed no direct positive correlation between combination of polymyxim and azithromycin/ rifampicin. In clinical studies, in hospital-acquired pneumonia, including ventilator-associated pneumonia, the clinical response rate of polymyxin B combined with other antibiotics ranged from 38 % to 88 %. High nephro- and neurotoxicity of polymyxin observed in previous studies can be explained by a lack of understanding of its toxicodynamics or the use of an incorrect dose. Conclusion. Polymyxin B in combination with other antibiotics is a promising treatment against infectious complications caused by multidrug resistant Gram-negative bacteria.
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The use of the submental flap in reconstruction of head and neck defects
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01.01.2018 |
Saprina O.
Azizyan R.
Brzhezovsky V.
Mudunov A.
Romanov I.
Allakhverdiyeva G.
Alieva S.
Lomaya M.
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Siberian Journal of Oncology |
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© 2018 Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved. Reconstruction of head and neck defects after surgery for cancer remains challenging. The choice of the reconstruction technique depends on the tumor size and localization, type of the defect, patient’s age, concomitant diseases, and disease prognosis. Surgeons have currently a broad range of material for reconstructive surgery, from free flaps to revascularized flaps. Microsurgical reconstruction has made a revolution in treatment of patients with complex head and neck defects. However, the use of this technique may not be advisable for some patients. The search for new techniques is needed to improve functional and aesthetic results and reduce traumatism without compromising oncologic outcomes. Thirty-six patients underwent surgery with reconstruction using the submental island flap, a new alternative in the reconstruction of various head and neck defects. The graft was taken after making a neck incision for neck lymph node dissection. A few patients develop total and marginal necrosis of the graft. Short- and long-term results showed no worsening of oncologic outcomes in the selected group of patients.
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