Репозиторий Университета

© 2018, Media Sphera Publishing Group. All Rights Reserved. Objective. To present the clinical history, vaccination status, features of the clinical picture, composition of the cerebrospinal fluid (CSF), results of laboratory and instrumental examinations of a patient with vaccine-associated paralytic poliomyelitis (VAPP). Material and methods. In 2017, a child, aged 15 month, mistakenly vaccinated with the first dose of bivalent (types 1 & 3) polioviruses oral vaccine (OPV) was followed up. Results and conclusion. Clinical parameters of VAPP in the recipient of OPV are considered. Clinical features of disease caused by wild poliovirus and VAPP are compared. The disease was characterized by sudden onset, recurrence, short (2—4 days) period of progression of paresis, persistent residual effects, CSF protein-cell dissociation. It is emphasized that the occurrence of VAPP cases reflects primarily immunization defects.

© Bionika Media Ltd. Objective. To present an analysis of the data available in the literature on the role of extracellular fetal DNA (fDNA) in predicting the great obstetric syndromes. Material and methods. Literature sources published in databases, such as Pubmed and Scopus, were sought. Results. There is evidence indicating that increased maternal blood DNA levels can be used as a predictive marker for pregnancy complications, such as preeclampsia, preterm birth, and fetal growth retardation. The most likely mechanism for increasing maternal blood fDNA is the strengthening of apoptotic, necrotic, and inflammatory processes in the placenta. However, not all studies confirm that there is a relationship between the development of the great obstetric syndromes and higher fDNA concentrations. Conceivably, the contradictions are due to the use of a number of procedures to determine fDNA, which limit sampling by sex and rhesus factor. Also, there is no consensus on the time when its concentration starts to increase; the influence of confounding factors has not been investigated. Conclusion. Maternal blood extracellular fDNA is a promising marker for predicting the great obstetric syndromes. There is a need for further investigations, by using the procedures that do not limit sampling and by taking into account the factors that influence the maternal blood concentration of extracellular fDNA.

© Bionika Media Ltd. Objective. To study the features of sexual functioning and the psychopathological pattern of sexual dysfunctions in women with infertility in assisted reproductive technology programs to elaborate treatment and rehabilitation measures and to improve quality of life in a couple. Subjects and methods. An open-label continuous comparative cross-sectional study of sexual functioning and psychopathological and personality characteristics was conducted in 589 women visiting the V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, for infertility. Clinical, psychopathological, clinicosexological, and psychometric studies were used. Results. 58.9% of the examined patients were found to have non-psychotic mental disorders, among them there was a predominance of anxiety disorders (28.0%); 18.34% had sexual dysfunctions, among which a libido disorder was prevalent (25.0%). There was a high comorbidity of sexual dysfunctions and borderline mental disorders (100.0%). The personal and psychopathological characteristics were revealed in patients with sexual dysfunction (p < 0.05). Conclusion. The studied features of the psychopathological pattern of sexual dysfunctions in infertile women are needed to elaborate differentiated tactics for the treatment and rehabilitation measures and to improve quality of life in a married couple.

© Bionika Media Ltd. Different factors caused by both equipment and the course of surgery (conditions under which the operation is performed, the location of incision, the characteristics of suture material, the type of surgical suture, and the amount of blood loss), by the course of the postoperative period, and the peculiarities of repair of damaged tissues influence wound healing of the uterus during cesarean section. Objective. To establish the value of premature amniorrhea and uterine inertia as predictors of impaired myometrial repair after cesarean section, by using clinical and morphological analyses. Subjects and methods. The investigation enrolled 129 patients who had given birth via cesarean section. Of them, 44 patients had delivery before birth activity, 85 during the first stage of labor. 49 and 80 women delivered before and after amniorrhea, respectively. During cesarean section, uterine tissue was taken from the upper edge of the wound after uterine incision. The myometrial biopsy specimens obtained during cesarean section were morphologically and immunohistochemically examined. The patients were divided into 4 groups according to the level of birth activity and the preservation of amniotic fluid at the time of cesarean section. Group 1 included patients with regular labor activity and amniorrhea at the time of caesarean section; Group 2 consisted of those with labor activity in the presence of whole amniotic fluid; Group 3 comprised those without birth activity in the presence of whole amniotic fluid; Group 4 included patients with premature amniorrhea without uterine contractions. 36 cases (9 in each group) were selected by random sampling for morphological and immunohistochemical examinations. The biopsy specimens were fixed in 10% neutral formalin and embedded in paraffin. The serial paraffin-embedded sections underwent histological examination and immunohistochemical tests for the following markers: TGF-β, VEGF, MMP2, TIMP1, types I and III collagen, TNF, and PDGF. Results. The morphological and immunohistochemical analyses revealed the most pronounced signs of myometrial damage during cesarean section in Group 4 patients having premature amniorrhea without uterine contractions. There were decreased VEGF, PDGF, MMP2, and TIMP levels and simultaneously increased TNF-α expression in leiomyocytes, vascular endothelium, and myometrial stromal cells. The findings may indicate the relatively lower reparative potential of the myometrium and the increased readiness for an inflammatory response in the group of women undergoing cesarean section in the presence of premature amniorrhea without uterine contractions. Conclusion. Clinical, morphological, and immunohistochemical analyses have revealed differences in the myometrial status in relation to typical clinical factors, such as amniorrhea and birth activity. Wound healing occurs under the influence of growth factors and the ratio of expression levels for growth factors can vary in different pathological conditions. The reduced expression of VEGF, MMP2, TIMP, and PDGF and the increased expression of TNF in the group having amniorrhea without uterine contractions (P-B+) suggest that there are pronounced inflammatory processes and impaired myometrial repair with the longer latency period in the absence of labor activity, which may refer these women to a group at risk for incompetent scar formation.

© 2018 Irina Nikolaevna Dominova, Vitaly Anvarovich Kasymov, Ekaterina Vladimirovna Silina, Victor Aleksandrovich Stupin, Natalia Nikolaevna Shusharina and Maksim Vladimirovich Patrushev. A fragment of the research project devoted to the development of genetic control of exocytosis is presented in the work, which can further ensure the success of targeted therapy of various diseases, including neurodegenerative ones. For the purpose of specific transfection of intracellular cascades in astrocytes in vivo, we have developed an experimental sample of the reagent kit. The latter represents lentiviral genetic construction LVV-GFAP-Case12. The results of testing of experimental samples of the reagent kit for specific transfection of astroglial cells are presented with the purpose of targeted control of intracellular cascades in vivo on acute slices of different parts of the brain in adult Wistar rats. We selected regions of interest with cells expressing calcium indicator Case12 and responsible for ATP application by >2-fold amplification of fluorescence. We have developed instructions for using the reagent kit for specific transfection of astroglial cells with the purpose of targeted control of intracellular cascades.

© 2018 Ima-Press Publishing House. Objective: to compare the efficacy of methotrexate (MTX) and colchicine in patients with chronic arthritis in calcium pyrophosphate crystal deposition disease (CPPDD). Subjects and methods. Data from a controlled prospective cross-sectional study of 10 patients (8 women and 2 men) with chronic arthritis in CPPDD are presented. In the initial period of treatment, all the patients were given colchicine 1 mg/day for 3 months, followed by a wash-out period for 1 month and then subcutaneous MTX 20 mg/week for 3 months. The diagnosis of CPPDD was made if there were calcium pyrophosphate crystals in synovial fluid and signs of chondrocalcinosis, as evidenced by joint X-ray and/or ultrasonography. DAS44, the swollen joint count (SJC) and tender joint count (TJC), pain intensity on a visual analog scale (VAS), the Health Assessment Questionnaire (HAQ) index, and serum C-reactive protein (CRP) levels were determined in all the patients at baseline, 3 months after the beginning of treatment with colchicine, after a wash-out period, and 3 months after the beginning of MTX treatment. Results and discussion. At baseline, mean DAS44 value was 2.47}0.27; SJC and TJC were 2.0}0.6 and 2.4}1.1, respectively; pain intensity was 55.2}12.3 mm; serum CRP level-3.89}3.82 mg/l; HAQ-1.1}0.3. Three months after colchicine therapy initiation, mean DAS44 value decreased to 1.76}0.28 (p = 0.004), SJC-to 1.4}0.5 (p = 0.048), TJC-to 1.6}1.35 (p = 0.023), pain intensity-to 42.0}13.2 mm (p = 0.023), CRP level-to 3.13}2.85 mg/l (p = 0.75), HAQ-to 0.95}0.3 (p = 0.041). Good response was achieved in 7 patients after 3 months of colchicine therapy. After the wash-out period, the mean DAS44 value was 2.08}0.26; SJC and TJC-1.6}0.5 and 1.7}1.4, respectively; pain intensity-46.5}9.8 mm; CRP level-3.38}1.74 mg/l; HAQ-1.3}0.34. Following 3 months of MTX therapy, mean DAS44 value decreased to 1.39}0.45 (p = 0.027), SJC-to 0.7}0.5 (p = 0.023), TJC-to 0.6}0.5 (p = 0.007), pain intensity-to 26.0}18.97 mm (p = 0.045), CRP level-to 2.87}2.06 mg/l (p = 0.75), HAQ-to 0.8}0.6 (p = 0.045). Two of the 3 patients with an insufficient effect of colchicine achieved DAS44 remission after MTX treatment; two patients attained remission after therapy with colchicine and developed an exacerbation of the disease when this drug was replaced by MTX. Conclusion. MTX 20 mg/week is as effective as colchicine in most cases and can be the drug of choice in patients with chronic arthritis in CPPDD if colchicine therapy is ineffective.

© 2018, Peter the Great St. Petersburg Polytechnic University. The magnetomodulation differential weak magnetic-field sensor, based on the Bi-2223 high-temperature superconducting ceramics has been investigated. The high magnetic-field resolution (∼20 pT) and wide measurement range (125-140 dB) have been obtained. The possibility of using this sensor for noninvasive control of magnetic particles or implanted medical electronic devices in biological objects at a distance of up to 30 mm from the skin surface is discussed.

© 2018 Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved. background. Adrenocortical cancer (ACC) is a rare malignancy of the adrenal cortex. Therapeutic options for advanced ACC are limited. It is necessary to study new and more effective drug combinations and tumor biological targets. the purpose of the study was to determine the expression of somatostatin receptor subtypes 2A and (SSTR 2A and SSTR 5) using immunohistochemical (IHC) analysis of tumor tissue samples in patients with ACC, as well as to study the feasibility of using prolonged analogues of somatostatin in the treatment of advanced ACC. material and methods. The expression of SSTR 2A and SSTR 5 was analyzed using imunohistochemistry of tumor tissue samples from 20 patients with advanced ACC. results. The negative (0) IHC status of SSTR 2A and SSTR 5 was determined in 10 patients (50 %). A different staining intensity of SSTR 2A and SSTR 5 expression was found in tumor cells of 10 patients (50 %). The low SSTR expression was associated with low membrane immunoreactivity and high SSTR expression was associated with moderate and strong immunoreactivity. High level of somatostatin receptor expression was detected in 7 patients (35 %). Conclusion. The detection of SSTR 2A and SSTR 5 expression in tumor tissue of patients with advanced ACC, as well as the study of feasibility of using prolonged somatostatin analogs are promising in the treatment of patients with high receptor expression, however, further research is required.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Aim. To analyze the specifics of comorbidity forming and age-related correlations of the risk factors (RF) distribution in arterial hypertension (AH) patients living in rural areas. Material and methods. In 2015-2017 a retrospective analysis of 2500 patients database was done at two general practitioners offices in Konakovsky District of Tverskaya Oblast. Of those, 350 were selected (14%) at the age 44-53 (164 males, 186 females) among the charts containing most complete data on the dispanserization. Additionally, surveying of the group was done for more detailed retrospective analysis of comorbidity and RF existence during lifetime of 25-35 years. Results. In the structure of comorbidity AH predominates, which has been diagnosed in 50,86%of patients; mostly it is diagnosed at the age 44-53 (81,06%). After AH, 2nd place is held by dorsopathies (24%), 3rd - gastrointestinal disorders (12%). For chronic pulmonary obstructive disease and cerebrovascular disease - it is less than 3%. 96,1%of men with AH are smokers at the age 18 to 53 y. o. By the age 53, in 40,26%of men and 36,63%of women there is bodyweight increase; and raised cholesterol - in 48,05%and 22,77%, respectively. Conclusion. In rural areas inhabitants, the formation of comorbidity is ongoing mostly at age 44-53 y. o. Of the specifics of comorbidity in these patients, there is often combination of AH with dorsopathies, and quite rare - with chronic obstructive lung disease or cerebrovascular diseases. The observed at the age 34-43 "diagnostic gap" points on the necessity for attention to this exact age strata with the aim of ontime diagnostics and early stages of diseases reveal. The structure of RF during the lifetime is not homogenic and is the highest at the age of comorbidity forming (except smoking and professional harms). All the considered RF are more prominent in men than in women.

© 2018 Ima-Press Publishing House. Mental disorders (MDS) of the anxiety-depressive spectrum (ADS) and cognitive impairment (CI) substantially deteriorate the course and efficiency of therapy for rheumatoid arthritis (RA). There have been practically no studies on the impact of psychopharmacotherapy (PPT) for MDS on the efficacy of standard disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs). Objective: to investigate the impact of adequate PPT for MDS of ADS on the efficacy of DMARDs and BAs in patients with RA. Subjects and methods. The investigation included 128 patients (13% men and 87% women) with documented RA in accordance with the 1987 American College of Rheumatology (ACR) criteria. The patients' mean age was 47.4}0.9 years; the median duration of RA was 96 [48; 228] months. DAS28 averaged 5.34}0.17. 75.1% of the patients received DMARDs. The diagnosis of MDS was based on the ICD-10 codes, by applying a semi-structured interview and the Hospital Anxiety and Depression Scale. Changes in the pattern and severity of ADS were evaluated using the Hamilton Anxiety Scale and the Montgomery-Asberg Depression Rating Scale. Clinical and psychological procedures were used to diagnose CI. At baseline, ADS was detected in 123 (96.1%) patients: major depression in 41 (32.1%), minor depression in 53 (41.4%), and anxiety disorders in 29 (22.6%). CI was diagnosed in 88 (68.7%). PPT was offered to all the patients with MDS; 52 agreed to treatment and 71 refused. The following therapeutic groups were identified according to the performed therapy: 1) DMARDs (n = 39); 2) DMARDs + PPT (n = 43); 3) DMARDs + BAs (n = 32); 4) DMARDs + BAs + PPT (n = 9). The dynamics of MDS and the outcomes of RA were estimated in 112 (91.0%) and in 83 (67.5%) of the 123 patients at one-and five-year follow-ups, respectively. The efficiency of RA therapy was evaluated from the changes in DAS28 and SDAI. Results and discussion. One year later, the patients who had received the complete cycle of PPT and took DMARDs achieved a satisfactory effect twice more frequently (58.1 and 32.3%, respectively; relative risk (RR) = 0.53; 95% confidence interval (CI), 0.2-1.39; p = 0.024) and did not respond to therapy 3 times less often (21.0 and 58.1%, respectively; RR = 2.41; 95% CI, 0.87-6.71; p = 0.001) according to the EULAR criteria than those who had refused PPT. The patients with MDS who received DMARDs + PPT during one year were unresponsive to therapy significantly less frequently than those who received DMARDs and BAs without PPT (21 and 44.8%, respectively; RR = 0.6; 95% CI, 0.21-1.7; p = 0.029). After 5 years of follow-up, the probability of no response to RA therapy in MD patients who received only DMARDs was 3.6 times higher than in those who had PPT (66.7% and 10.4%, respectively; RR = 3.58; 95% CI 0.82-15.5; p < 0.001). The patients adequately treated with DMARDs and BAs for MDS according to the DAS28 showed 1.3-fold more frequently good and satisfactory results (100 and 76.2%, respectively; p = 0.14) than those who refused PPT, but these differences were not statistically significant because the DMARD+BA+PPT group was small. Five-year follow-up indicated that DAS28 remission was more common in the patients receiving DMARDs and PPT than in those who had DMARDs and no PPT (34.5 and 8.3%, respectively; RR = 1.79; 95% CI, 0.34-9.24; p = 0.024). DAS28 remission was somewhat more frequently observed among the patients receiving DMARDs, BAs, and PPT than among those taking DMARDs and BAs (33.3 19.0%, respectively; RR = 1.64; 95% CI, 0.28-9.57; p = 0.34), but these differences were insignificant. Remissions according to the 2011 ACR/EULAR criteria were achieved by only the patients having DMARDs and PPT (6.9% and 13.8% after 1 and 5 years, respectively). Conclusion. Adequate treatment of MDS in RA patients results in a significant increase in the efficiency of antirheumatic therapy.

© 2018 Ima-Press Publishing House. Giant cell arteritis (GCA), formerly known as Horton's disease, is among the most common diseases from a group of systemic vasculitides; its clinical significance is complemented with the potential involvement of the coronary arteries, aorta, and cranial arteries with development of ischemic optic neuropathy if there is no timely treatment that results in rapid and irreversible visual loss. The elderly age of patients is one of the key aspects of GCA. Therefore, the disease is often accompanied by various comorbidities that have considerable impact on the choice of a treatment regimen and limit the use of standard therapy with glucocorticoids (GCs). The complications due to GC treatment can be competitive in severity with GCA, especially in elderly multimorbid patients. Progress in rheumatology due to the introduction of biological agents (BAs) has created the preconditions for the development of a new area of pharmacotherapy for GCA associated with interleukin 6 (IL6) inhibition using tocilizumab (TCZ). According to the results of two randomized placebocontrolled trials (RPCTs), which were published in 2016, the rate of remission with TCZ treatment was significantly higher in patients with GCA than that in the placebo group (p = 0.03-0.0001), as is relapse-free survival after 52 weeks of TCZ treatment (85 and 20%, respectively; p = 0.001), the incidence of serious adverse events (AE) was 14-35%. In 2017, the results of Phase III GiACTA RPCT became the basis for approval of the use of TCZ for the treatment of GCA in the United States and Europe. The authors present their own results of a small prospective study of TCZ in 7 patients with active GCA with severe comorbidity, including multimorbidity, that potentially increases the risk for AE due to GC therapy. The mean age of the patients was 71.3}7.6 years; among them there was one man and 6 women. The administration of TCZ in a monthly dose of 2.3-8.8 mg/kg for 1-10 months with a cumulative dose of 10-58.1 mg/kg could reduce the mean daily dose of prednisolone to 15 (5-32.5) mg, thereby preventing the development or progression of AE, and all the 7 patients could rather rapidly achieve GCA remission. A recurrence after therapy discontinuation was noted in one patient. TCZ treatment was accompanied by serious AE (purulent elbow bursitis); and other two patients had AE a few months after TCZ discontinuation. There were no fatal outcomes. Thus, the presented results suggest that the use of IL6 inhibitors in patients with GCA, including those with severe comorbidity, can be regarded as a potentially effective innovative (off-label) treatment strategy with an acceptable safety profile. The further expansion of an evidence base and the clarification of the medical and economic aspects of TCZ treatment in some groups of GCA will help justify the choice of BAs.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Recently, development of medicine leads to the increase of the number and complexity of surgical interventions, explaining high significance of the risk assessments for post-surgical complications and probability of fatal outcome; this requires participation of internist in patients management with correction of therapy. The article is focused on the main scores and indexes utilized in clinical practice for prediction of possible complications, incl. cardial. A detailed description provided, for every calculator, features and limitations for usage and results interpretation.

© 2018 Dynasty Publishing House. All rights reserved. A clinical case of a patient, 34-35 weeks pregnant with melanoma stage V (tumour growing into fatty tissues), complicated by severe paraneoplastic symptoms including secondary thrombophilia, marantic endocarditis, disseminated arterial thrombosis. A lethal outcome was stated 8 months after preterm delivery due to thromboembolism and severe multiple organ failure.

© 2018 Dynasty Publishing House. All rights reserved. The objective: to study the diagnostic efficiency and to establish normative values of stiffness of ovaries in healthy women of reproductive age, using multiparametric ultrasound (MPUS), advanced with the 2DSWE mode. Patients and methods: In order to establish stiffness of structures of normal ovaries, MPUS with measurement of Jung's modulus in kPa of right and left ovary were held in 25 healthy women of reproductive age between the 5th-7thday of menstrual cycle. For more precise quantitative parameter of Jung's modulus, measurements were repeated at least in two menstrual cycles in every woman. Results: At ovarian MPUS with the 2DSWE technology, determination of stiffness of ovaries in healthy women of reproductive age was carried out at the average volume of ovary 4,9 ± 0,5 cm3(minimum is 3.7 cm3maximum of 6.9 cm3). In addition, in healthy women of reproductive age, quantitative indicators of Jung's modulus of stiffness of structures of ovary (2,5 - 97,5 percentile - 95% interval) were as follows: median Emean is 8.7 kPa (2,1 - 16,9), the SD of 2.6 kPa (0,7 - 4,1). Qualitative analysis of color elastomers obtained showed a uniform homogeneous blue background of intact ovaries in all cases of the study. Conclusion: When extending the algorithm of MPUS with the 2DSWE technology, the effectiveness of the method in the study of normative values of Jung's modulus of stiffness of ovaries in healthy women of reproductive age was 100%.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To study M-CSF levels in venous blood and CSF1R gene polymorphism in women with tuboperitoneal infertility, who enter an IVF programme, and to assess their prognostic role. Patients and methods: The examination included 120 women, who were divided into two groups: 40 women with effective IVF (group I) and 80 women with ineffective IVF (group II). M-CSF serum levels were determined by ELISA method, the polymorphic marker rs386693509 of the c-fms gene UTR-3 region was examined by PCR method with subsequent Sanger sequencing. Results: Based on OR calculation, prognostically significant concentrations of M-CSF and c-fms genotype were found for diagnosing the development of pregnancy (95% CI = [1.934-11.116], p = 0.0021; 95% CI = [5.92-37.73], p = 0.0001, respectively). In women with effective IVF, weak correlation was found between M-CSF and the number of oocytes recovered by transvaginal puncture (TVP) (r = 0.3321, p = 0.0363). conclusion. The results of this work confirm a significant role of M-CSF in realisation of female reproductive function. The study has shown that serum M-CSF concentrations and polymorphism of its c-fms gene receptor have a predictive significance for pregnancy due to IVF procedure at the preconceptive stage. The obtained data contribute to our knowledge of the contribution of cytokines and gene polymorphisms to the development of an IVF pregnancy.

© 2018, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved. The purpose of the study - to determine the feasibility of using the succinate-based antioxidant for the in vitro reduction of excessive methemoglobin to oxyhemoglobin in blood. Materials and Methods. Blood sampling was performed in five healthy donors in microvettes containing EDTA during prophylactic examinations. NaNO2 solution was added to blood samples in vitro in order to yield methemoglobin (MetHb). The complex drug containing the following active ingredients: succinic acid, inosine, riboflavin, nicotinamide, was used as an antioxidant. The absorption spectrum of red cell suspensions with different drug content Dl(λl) exper was measured with 1 nm increments. The non-linear regression method was used to calculate concentrations of hemoglobin derivatives in suspensions. Results. In our experiments, when methemoglobin reacted with drug the optical density of peaks typical for oxyhemoglobin increased and the spectral peak of methemoglobin decreased. The greater the concentration of drug, the more was the incubation time, the more efficient was the process of reduction of MetHb to HbO2. Conclusion. We proved experimentally that while the baseline concentration of MetHb was an average of 91-93%, addition of drug decreased its concentration to 25-7%. Without drug, due to autoreduction, the concentration of MetHb decreases only to 84%. The revealed effect provide a potential for practical applications in critical illness, during the storage of donor blood, in blood transfusions, and under the action of physico-chemical factors on blood.

© Russian Association of Endocrinologists, 2018. BACKGROUND. Intensive glycaemic control in patients with type 1 diabetes may lead to hypoglycaemia and thus increase the risk of cardiovascular and cerebrovascular events. Platelet activation and/or decreased activity of physiological anticoagulants during hypoglycaemia may play a role in the development of cardiovascular or cerebrovascular complications. AIMS. To investigate induced platelet activity, the activity of physiological anticoagulants, and the von Wil-lebrand factor in patients with type 1 diabetes with the hyperinsulinaemic-hypoglycaemic clamp. MATERIALS AND METHODS. We examined 11 patients with type 1 diabetes without macro- and micro-vascular complications (6 males, 5 females, mean age 23.7 ± 5.6 years, A1C 9.7 ± 2.3%). Induced platelet aggregation, physiological anticoagulants (Protein S, Protein C, AT III) and the von Willebrand factor were studied at hyperglycaemic, euglycaemic, and hypoglycaemic stages during use of a hyperinsulinaemic (1 mU/kg/min) hypoglycaemic clamp. RESULTS. Platelet aggregation to all agonists increased significantly during the hypoglycaemic stage, compared with the euglycaemic or hyperglycaemic stages. There was no difference in platelet aggregation between the euglycaemic and hyperglycaemic stages. Platelet aggregation to all agonists increased during the hypoglycaemic stage compared with the hyperglycaemic period: thrombin-23.9%, ADP-30.6%, arachidonic acid-30.9%, collagen-69.4% and ristocetin-70.8%. During hypoglycaemia aggregation to ADP, arachidonic acid and collagen remained within normal limits (upper quartile); aggregation to thrombin was significantly above normal limits and aggregation to ristocetin remained significantly below lower limits. Protein S activity was significantly increased during hypoglycaemia compared with euglycaemia (p = 0.046) and hyperglycaemia (p = 0.046). Antithrombin-III activity decreased significantly at the euglycaemic and hypoglycaemic stages, compared with the hyperglycaemic period, but still remained significantly elevated above the upper threshold. Protein C and vWf activity did not change significantly. CONCLUSIONS. In patients with type 1 diabetes platelet aggregation and protein S activity increases significantly at the hypoglycaemic stage of the hyperinsulinaemic-hypoglycaemic clamp. Platelet activation is directly caused by hypoglycaemia and not by decreasing glucose levels. Increased protein S activity is a compensatory response to platelet activation.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Indomethacin, a non-steroid anti-inflammatory drug (NSAID), has been used in different spheres of medicine since the 1960s. It is successfully administered as an anti-inflammatory and pain-relieving medication in rheumatoid and other diseases. According to recent research, indomethacin may become a promising drug enhancing endogenous remyelination in patients with multiple sclerosis. Also, indomethacin affects cell proliferation and invasion, thus it is used to manage pancreatic cancer in patients with hyperglycemia. In addition, indomethacin can inhibit protein synthesis in colorectal carcinoma and other types of cancer cells. The article reviews modern indomethacin medications and the different dosage forms on the Russian pharmaceutical market. Indomethacin poor water solubility is one of the reasons for decreasing its biopharmaceutical characteristics. According to the conducted research, a prospective way to improve indomethacin solubility and bioavailability is the Solid Dispersion (SD) method. SDs are bi- or multicomponent systems consisting of the drug and the carrier. They are a highly dispersed solid phase of the drug or molecular-dispersed solid solutions with a partial formation of a variable composition complex and a carrier. The article provides a brief overview on different aspects of obtaining, investigating, and applying indomethacin SDs with various polymers.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The problem of childbearing in patients with myasthenia gravis (MG) is extremely important, since the disease most often affects women in the reproductive period. Has not yet been determined neither the prognostic criteria for myasthenia exacerbation during pregnancy, nor the predictors for the development of the transient neonatal myasthenia gravis (TNM). The article analyzes the literature data from the first descriptions of pregnancy in patients with myasthenia and TNM until the present days. The evolution of the concept of the role of a high titer of antibodies to acetylcholine receptors (anti-AChR Ab) in the development of exacerbations of MG in the mother and TNM in her newborn is shown. The role of Ab against γ-subunits of AChR in the development of arthrogryposis and THM is discussed. The importance of planning the pregnancy in myasthenic mothers is emphasized. These observations show that the same woman has either a favorable course of MG with the birth of a healthy child, or has a severe exacerbation until the postpartum myasthenic crisis with the birth of baby with TNM depending on quality of remission before pregnancy. Based on the literature data and own experience, the indisputable role of thymectomy in the prevention of exacerbations of MG and TNM is shown. Own observation of cases of TNM demonstrates the crucial role of neostigmine test in the recognizing of «floppy baby» syndrome. For the first time in Russia, a study of anti-fetal/anti-adult AChR Ab ratio in the umbilical cord blood was conducted. For the first time in the world, a unique case of the birth of a healthy child in a couple of patients with juvenile MG is presented. The husband suffering of the severe refractory MG with elevated titre of anti-AChR Ab up to 20.8 nmol/l and a lot of congenital stigmas of dysembryogenesis. The wife had a mild course of MG. She was carefully prepared for pregnancy by thymectomy and glucocorticoid-therapy and had a stable condition for more than 10 years at the time of pregnancy. The titer of anti-AChR Ab was relatively low (9.0 nmol/L), however, the pool of anti-AChR Ab in the umbilical cord blood mainly contained anti-fetal AChR AB (92%). This example shows that it is the quality of remission of the mother's MG at the time of pregnancy determines the course of the disease during pregnancy and the risks of TNM. This case allows us to consider genetic factors as secondary and once again emphasizes the autoimmune nature of myasthenia gravis.

© 2018 Ima-Press Publishing House. All rights reserved. Chronic cerebral ischemia (CCI) is one of the most common diagnoses in middle-aged and elderly patients in the practice of an outpatient neurologist. Unfortunately, the diagnosis of CCI in these patients is often established only on the basis of complaints of headache, dizziness, instability during walking, and lower mood. At the same time, other diseases that cause these symptoms are not diagnosed, patients do not receive treatment, which considerably worsens quality of life and leads to anxiety and depression. A variety of diseases, such as headache, peripheral vestibular vertigo, depression, Alzheimer's disease, and Parkinson's syndrome, are frequently hidden under the diagnosis of CCI. The leading neurological syndrome in CCI is cognitive impairment that can be both moderate and reach the level of dementia. Approximately 40% of patients with chronic cerebrovascular disease complain of headache that is usually caused by mixed primary headache. The management tactics for a CCI patient suffering from headache is aimed at treating primary headache, modifying vascular risk factors, and managing cognitive impairment. The paper discusses the use of choline alphoscerate in patients diagnosed with CCI.