Репозиторий Университета

© 2018, Media Sphera Publishing Group. All rights reserved. Differential diagnosis of migraine, can be difficult, especially of migraine with aura. On the one hand, some diseases can produce symptoms similar to migraine (cerebral aneurysm before rupture, reversible cerebral vasoconstriction syndrome). On the other hand, migraine with aura and some other disorders are conditions that have common pathophysiological mechanisms (e.g., CADASIL and MELAS syndrome, antiphospholipid syndrome). Thirdly, clinical presentations of migraine are often difficult to distinguish from features of other headache conditions (migraine with aura - transient ischemic attack, migraine with visual aura - occipital epilepsy). The author discusses the differential diagnosis of acute headache, especially thunderclap headache, and main strategies of effective treatment of migraine attacks.

© Bionika Media Ltd. Objective. To carry out a systematic analysis of the data available in the literature on the use of combined oral contraceptives (COCs) by adolescent girls and young women. Material and methods. Foreign and Russian articles published in the past 15 years were sought in the international citation database Pubmed for their analysis. Results. The paper highlights the factors influencing adherence to COC use in adolescent girls and young women (a fear of complications and side effects, the lack of responsibility in young women, a low level of awareness of the benefits and risks of hormonal contraception). It is shown that after adequate medical consultation, the use of COC by adolescent girls and young women can offer additional health and quality of life benefits. Conclusion. The correct choice of a dosage regimen and hormonal components in the composition of COCs is a guarantee for adherence to contraception in young female users. COCs containing drospirenone and a microdose of ethinyl estradiol (a 24/4 regimen) are one of the most attractive combinations for most adolescent girls and young women today.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article discusses various mechanisms of developmentt and progression of arterial hypertension in young and middle aged adults. It emphasizes the predominant role of hypersympathicotonia in the development of the disease in this category of patients. Various mechanisms are considered, by means of which the increase of activity of the sympathetic nervous system leads to elevation of arterial pressure and potentiates early damage of target organs, first of all, damage of the heart. The data of numerous studies demonstrating pronounced cardioprotective effects of a highly selective representative of the class of β-blockers bisoprolol in young and middle aged hypertensive patients are presented.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. The incidence of hip osteoarthritis and degenerative lumbar spine stenosis increases with the lifespan. The combination of these two conditions is not rare and is known as “hip-spine syndrome” in literature. Due to the similarity of symptoms the main problem is to determine the primary pain generator. Solving this diagnostic problem can lead to proper treatment, surgical or other. Purpose. To provide the literature review of the hip-spine syndrome. Materials and methods. We analyzed articles published on https://www.ncbi.nlm.nih.gov/pubmed during 2004-2018 searching for keywords: «radiographic and clinical hip osteoarthritis» - 1141 results, «lumbar spine stenosis and MRI canal» - 521 results and «hip-spine syndrome» - 35 results, 54 items were chosen due to the objective. Results. Primary source of pain for patients with hip-spine syndrome often remains unclear. The existing diagnostic algorithms are imperfect, about 25% of patients do not feel relief of pain after spine surgery or total hip arthroplasty. Mandatory x-ray examination in case of unknown source of pain is important and can show changes in hip and lumbar spine. That can help to change the way of search for pain generator Conclusion. It is necessary to create new diagnostic algorithms that will be harmless for patients and will be with maximum value for surgeons.

© 2018, SPb RAACI. The aim of this prospective randomized clinical study was to investigate the role of preoperative carbohydrate admnistration in surgery-induced metabolic, immune and inflammatory reactions after thoracoabdominal operations. At the Surgical department I (B.V. Petrovsky National Research Center of Surgery), we investigated a modulatory role of carbohydrate preload upon surgical stress observed after major thoracoabdominal operations (thoracoscopic and open esophagectomy, retrosternal colonic esophagoplasty) followed by the enhanced recovery protocol. The study was performed in 2014-2017, it included 30 patients, divided into 2 groups. Group A patients (n = 16) received carbohydrates preload (12.5% maltodextrin solution per os or enterally). In patients with dysphagia, the 12.5% dextrose solution was used intravenously in equal volumes. Group B patients didn’t receive any additional preload with carbohydrates. The groups were age- and gender-matched, similar for disease and surgery types. Glucose and insulin levels (with HOMA insulin resistance index, HOMA-IR) were measured before surgery and on day +1, interleukin levels (IL-6, IL-10, IL-8) and index IL-8/IL-10 were assessed before surgery, and on days +1 and +5 after surgery. Cell-mediated immunity was investigated before surgery and on day +5. The stress-induced hyperglycemia (> 7.8 mmol/L) was detected more frequently in group B (50%), than in group A (6%), p = 0.012. Insulin resistance measured by HOMA-IR in group B was detected in 71% of patients and in 25% patients of group A only, p = 0.027. Individual analysis of immune response demonstrated that a trend for immune recovery was detected by the day +5 post-op in the group A. Postoperative levels of IL-6 and IL-10 were lower on day +1 and +5 in group A. Morbidity rates and the terms of hospitalization were similar in both groups. Local postsurgical infections in group A were developed in 6% of the patients vs 35.6% in group B (p = 0.072). In conclusion, a complex study of surgical stress, i.e., metabolic, immune and inflammatory reactions after esophageal surgery has shown that the carbohydrate preload decreased the incidence of postoperative insulin resistance and stress-induced hyperglycemia, being accompanied by lower release of proinflammatory cytokines and provides positive effects upon the patient’s immune system.

© 2018 Izdatel'stvo Meditsina. All Rights Reserved. Introduction. Now radio lines of the management of explosions find more and more broad application for the execution of acts of terrorism. The special technical means which are powerful sources of EMP in the range of frequencies of 0.02 – 6.00 GHz by which workers in the course of their production and operation and also the population which has appeared in a radiation zone can be affected, are developed for the suppression of radio-frequency signals of control of explosive devices. Aim of the study. Scientific justification and development of hygienic requirements for the safe use of systems of suppression of radio lines of control of explosive devices (SS RCED). Material and methods. The calculation methods for determining the EMF intensities created by different types of SS RCED (1500 calculations) were used, more than 250 measurements were carried out at different distances from 5 types of SS RCED in the open area and in the offices. Results. Hygienic investigations have allowed to point out 5 categories of the irradiated contingents for which hygienic regulations of EMP on the basis of the analysis of the standard and methodical documents acting in the Russian Federation have been proved. Calculations and natural measurements of the EMP levels from various types of SS RCED in rooms and in the open territory are taken. The technique of forecasting of conditions of radiation taking into account their technical characteristics (range of frequencies, power, etc.), the time of the exposure and distances from sources is offered. The algorithm of carrying out a hygienic assessment of conditions of radiation of personnel and population from SS RCED and a complex of preventive actions are developed. Discussion. Protection of workers by production, service, and operation of SS RCED, has to be carried out by restriction of the time of the impact of EMP taking into account power expositions at different distances from a source, and the population - by determination of safe zones of stay taking into account categories of the irradiated contingents. The technical actions including the organization of remote control of SS RCED and application of means collective (shielding) and/or individual protection are offered. Conclusion. The conducted complex research allowed justifying hygienic requirements for the production and operation of SS RCED and developing the project of SanPiN 2.1.8/2.2.4.xxxx-18 «Sanitary rules and standards of safe use of systems of suppression of radio lines of management of explosive devices of the range of frequencies of 0,02–6,00 GHz».

© 2018 Universiteit Gent. All Rights Reserved. Due to the recent introduction of golimumab into paediatric rheumatology practice, an overview of the clinical studies of this tumour necrosis factor alpha inhibitor, most of which were conducted with adult patients with rheumatic diseases, has been presented. Clinical laboratory effects and tolerability of golimumab in the form of subcutaneous injections have been analysed for rheumatoid arthritis, psoriatic arthritis, and spondylitis. Evaluation of the efficacy and tolerability of golimumab in long-term observational studies (up to 5 years) has been discussed.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article deals with the modern tactics of pulmonary hypertension therapy, used in case of unsatisfactory clinical response to previous therapy. All classes of pathogenetic therapy of pulmonary hypertension are presented, as well as modern views on the risk stratification of annual mortality of patients. Switching to a more effective drug both within one group of pathogenetic PAHtherapy, and to drugs of other classes is discussed. The latest classification of pulmonary hypertension (Nice, 2018) is presented.

© 2018, Media Sphera Publishing Group. All rights reserved. The diagnosis of head injury should be based on certain principles. Each of them is important and has its own history. The authors summarize the experience of treatment of head injury using clinical and neuroimaging methods at the NN Burdenko Neurosurgery Institute (now the NN Burdenko National Research Center for Neurosurgery) for more than 30 years. The following principles of diagnosis of head injury were suggested and tested in clinical practice: severity of patient’s state; clinical syndromes; topical diagnosis; neuroimaging; phasicity; age-related approach; data synthesis; sufficiency; individual approach. Taken together, these principles provide complete personalized diagnosis and prognosis which allow choosing an optimal management of the patient. The strategy for better diagnosis, prognosis and treatment of head injury is the combined use of clinical, neuroimaging and ethical approaches.

Liver resection remains the method of choice for treatment of colorectal liver metastases with good long-term results. Regional lymph nodes involvement is significant negative prognostic factor. Moreover, it has been considered as a contraindication for liver resection for a long time. The role of lymphadenectomy remains controversial. Current state of this problem is reviewed in the article. Liver regional lymph nodes involvement takes place in 10-20% of cases. PET/CT is the most sensitive method of preoperative diagnosis. Involvement of liver regional lymph nodes is currently not absolute contraindication for liver resection. Routine lymphadenectomy does not make sense, and, perhaps, is justified only within scientific trials for more accurate disease staging. Indications for lymphadenectomy are suspicious changes of lymph nodes revealed by preoperative visualization methods or by intraoperative exploration. Modern chemotherapy regimens allow to reconsider the prognostic importance of liver regional lymph node metastases and to extend indications for liver resections.

One of the most common and potentially threatening manifestations of granulomatosis with polyangiitis (GPA) is orbital lesion. PURPOSE: To study the clinical course and prognosis of orbital lesions of various localization in GPA patients. Material and me-thods. The study included 226 patients with GPA, 74 of them with orbital lesion. Ophthalmic examination consisted of visual acuity test, biomicroscopy, ophthalmoscopy, exophthalmometry and ocular mobility test. Visualization was done using multislice computed tomography and/or magnetic resonance tomography and/or ultrasound examination. RESULTS: Among the patients of the study group, in 35.1% the lesion was limited to dacryoadenitis, in 4.0% of patients - to myositis, and 70.8% had extensive inflammatory orbital masses. Patients with orbital masses had systemic disease in 51.1%, compared to 7.7% in dacryoadenitis (p=0.00). Clinical progression in patients with orbital masses was characterized by severe exophthalmos, periorbital swelling and hyperemia. Patients with dacryoadenitis, on the contrary, had only mild symptoms. Patients with orbital masses had unfavorable prognosis. There were only three patients with myositis in the study group, so the data on them is limited; their clinical symptoms included light periorbital swelling, exophthalmos, strabismus, painful binocular diplopia and eye movement restriction. The disease was recurring in two cases. CONCLUSION: Patients with orbital involvement in GPA may have different course of the disease depending on the localization of inflammation.

© Springer Nature Switzerland AG 2018. Video games are often seen as a reason for numerous psychological changes, both positive and negative, in players. For instance, many authors believe that video games push children and adults towards risky behaviors and impulsivity. The study aimed to analyze both theoretical and empirical evidences of that sort, as well as to investigate parameters of personal and cognitive impulsivity and risk-readiness in adult video gamers. The sample of gamers included 223 participants, all from Russia. Impulsivity and related personal traits were measured with Eysencks’ Impulsiveness Scale (I-7) and Kornilova’s Personal Risk Factors Questionnaire. Impulsivity as cognitive style was measured by Kagan’s MFFT. No evidence of high impulsivity was found, though video game players, who played more than 12 h per week turned out to be more venturesome, compared to less active gamers. Sex-related differences were investigated: female gamers scored lower in empathy, while male gamers showed higher venturesomeness. In a cognitive style study, video gamers were more accurate compared to non-gamers, and thus showed no tendency for impulsivity. The results are contrasted to the published data, when applicable.

© Saint Petersburg Pasteur Institute. All rights reserved. The aim of the present systematic literature review is to summarize data on the role of TLRs in maintaining homeostasis of the female genitals, in maintaining the physiological development of pregnancy, provision of anti-infective resistance in pregnant women with intrauterine infection. The review substantiates the importance of TLRs of female genitals as a necessary and determining factor in the reaction to various changes in the environment, and also responsible for changes in metabolic, structural, or energy, in the maintenance of anti-infective resistance and homeostasis. As universal regulators of vital activity of organism TLRs in conjunction with other receptors of innate immunity provide maintaining the general reactivity and anti-infective resistance at the physiological level. In physiologically developing pregnancy in a background of immunosuppression in response to pregnancy TLRs during contact with infectious and non-infectious pathogens stimulate the production of nonspecific adaptive immunity factors (defensins, cathelicidins, histatines, etc.), which together with the non-specific innate factors lysozyme, complement, properdin, etc. support anti-infective resistance of the female genitals at a high level at the beginning of the infectious process. Possible violations of the development of pregnancy may be accompanied by changes in the response of TLRs to infectious and non-infectious factors until hyper-reaction, excessive inflammation or apoptosis, which requires adequate management of pregnancy. Was established the significance of the influence of pathogens of infectious and noninfectious origin in intrauterine infection indirectly through TLRs in the homeostasis of the organism, on the formation of breaches in anti-infective resistance at the organism and community level the identification of new pathophysiological and immunological pathogenetic mechanisms of development of pathological processes. IUI is a penetration of microorganisms into the tissues of fetus and it's infection. The inhibition of the functional activity of TLRs is accompanied by the direct effect of the pathogen on the tissues, and during hyper-reaction of TLRs to pathogens revealed a pronounced inflammatory response in the fetus. The level of expression of TLRs correlates directly with the severity of the process that can be considered as early markers of infection. Depending on the nature of the pathogen an increased expression of one or the other TLRs is observed. Explained the lack of symptoms, the possibility of atypical manifestations, the asymptomatic course of infection.

© 2018 Russian Electronic Journal of Radiology.All right reserved. This article presents the clinical case of an extragastric large gastrointestinal stromal tumor combined with osteomyelofibrosis. It made great differential diagnostic difficulties with regard to the tumor location. Modern radiology methods are described, which allow to reveal and establish the organogenesis of the tumor as well as its histological characteristics.

© Ima-Press Publishing House. All rights reserved. Surgical treatment as accelerated functional recovery for discogenic radiculopathy has been proven to have advantages over medical treatment, the efficiency of which remains debatable. Objective: to investigate the efficiency of combination conservative treatment in patients with discogenic lumbosacral radiculopathy. Patients and methods. Thirty patients (12 men and 18 women; mean age, 39.5±2.2 years) with discogenic lumbosacral radiculopathy confirmed by magnetic resonance imaging were followed up. All the patients underwent combination conservative treatment (epidural glucocorticoid administration, analgesic therapy, and motor mode correction). They were surveyed using questionnaires (numeric pain rating scale (NPRS), Oswestry disability index, Hospital Anxiety and Depression Scale, the 12-Item Short Form (SF-12) of Quality of Life (QoL) Questionnaire on admission to the clinic, at 7-14 days after treatment (pain intensity and functional status), and in the long-term period (at 3, 6 and 12 months) after discharge. At baseline, the patients were severely disabled due to pain syndrome. The average Oswestry index was 57.9±3.7%, the back and leg pain intensity scores were 6.5±0.6 and 6.9±0.5, respectively, as evidenced by NPRC. The majority of patients were found to have the combined musculoskeletal sources of pain, such as a myofascial component in 56.7% and sacroiliac joint dysfunction in 43.3%. In these cases, nonsteroidal anti-inflammatory drugs and muscle relaxants were additionally used. Results. The conservative treatment resulted in a statistically significant clinical improvement with a preserved positive effect in the long term: at 1 year, the average Oswestry index was equal to 16.6±3.9%, the back and leg pain intensity scores were 1.7±0.5 and 1.6±0.5, respectively, as shown by NPRC (p<0.001 vs baseline). Within a year, only one female patient required surgical treatment; regression of large extrusions and sequesters, the average initial size of which reached 11.1 mm, was observed in 9 cases. Conclusion. The findings reflect the efficiency of conservative treatment and the expediency of detecting mixed musculoskeletal disorders and their correction in discogenic radiculopathy.

© 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.

© 2018 by the authors; licensee Modestum Ltd., UK. Objective: Prolongation of the QT interval in patients with coronary heart disease (CAD) is a risk factor of polymorphic ventricular tachycardia (PVT) and as consequence, the sudden death. Drug-drug interactions (DDI) on metabolic rate involving cytochrome P-450 (CYP) is the one of the major cause of Long QT Syndrome (LQTS). The aim of the present study was to improve the safety of combined pharmacotherapy when using drugs that affect the QT interval. Method and Results: Medication occurrence of potential dangerous combination of medicines that are affected on QT interval duration in patients with CAD are researched (outpatient medical records (patient history) analysis). Clinical relevance of DDI, which are associated with changes in CYP enzyme activity, categorized by drugs.com Medication Guide. Finding potential dangerous combination of medicines that are affected on QT interval duration were administered to patients with CAD in 3.6% cases in outpatient clinical practice. The most often prescribed combination of drugs is amiodarone and torasemide (13.3% evidence of all concomitant administration that are leading to QT prolongation). The potential mechanism of Amiodarone and Torasemide interaction on metabolic rate that are leading to QT prolongation are competitive substrates CYP 2C8 and a result of inhibited CYP 2C9 by amiodarone. Conclusion: Ability to predict the prolongation of the QT interval caused by DDI on metabolic rate make possible to improve the safety concomitant administration to patients with CAD.

© 2018 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved. The development of mesenteric lymphadenitis is typical for patients with HIV infection at the stage of secondary diseases. The purpose of our study is to decipher the etiology of lymphadenitis in patients with HIV infection at the stage of secondary diseases. The analysis of disease histories of 113 HIV infection patients at the stage of secondary diseases with the use of statistical processing was carried out. The article presents examples that characterize the polymorphism of clinical variants of the development of mesadenitis in HIV-infected patients with stage 4B, which has developed as a result of the influence of various etiological factors.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The aim of the study was to evaluate the effect of the duration of training on the use of personal respiratory protective equipment on indices of pulmonary gas exchange. Simulation of conditions for the use of personal respiratory protective equipment was carried out at the inspiratory resistance of 40, 60, 70 and 80% Pmmax. The study included 38 healthy male subjects aged 20 to 36 years. According to the results of the study, under the use of personal protective equipment for the respiratory system, preliminary training was shown to be essential. In the subjects without preliminary training, the use of personal protective equipment was followed by a weak change in the nature of the respiratory pattern. After the preliminary training subjects had an adaptive rearrangement of the respiratory pattern, consisted of the decline in breathing movements as the respiratory resistance increased. Preliminary training to the exposure of additional resistance to breathing, altered pulmonary gas exchange and acid-base state of blood. The trained subjects had higher pCO2 blood values and lower values of pO2. They showed a greater deficit of buffer bases of plasma compared to untrained ones. This fact testified the preliminary training for the use of personal respiratory protective equipment (long-term adaptation) changed the gas composition and acid-base state of the blood to be a more economical mode of the discharge of buffer systems. On the basis of the data obtained, the preliminary training for increased respiratory resistance was suggested to be advisable before the using personal respiratory protective equipment.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Okadaic acid (OA) is relating to the number of seafood toxins causing diarrhea. At the present time, there was determined the toxicity index of OA; the main target molecules of its action, its role as a promoter of tumor processes and apoptosis have been investigated. However, in the available literature, data on the toxicokinetics of OA and molecular biomarkers of its action for warm-blooded animals are practically absent. The purpose of this work was to determine biomarkers of toxicity of OA in experiments in vivo and ex vivo. The experiment was performed on 74 male Wistar rats with an initial body weight of 100 ± 10 g. In the work, there was used a solution of OA in methanol, produced by “FermentecLtd.” (Israel). Prior to the studies, methanol was removed from the preparation. To obtain working dilutions of the toxin, aliquots of the alcoholic OA solution with a concentration of 10 ppm were diluted with a sterile solution of 0.15M NaCl to obtain solutions with a concentration of OA of 50, 100 and 150 ppb. These solutions were administered to the rats in doses of 1 ml/kg of body weight intraperitoneally. The animals of the control groups were injected with NaCl solution. Excretion of animals from the experiment was carried out 6, 24 and 168 hours after the administration of OA preparations by decapitation under ether anesthesia. The mass of internal organs, biochemical and hematological blood indices, the activity of glutathione peroxidase, non-protein thiols in the liver, cytokine levels of IFN-, IL-10, IL-17A in blood plasma and liver cell lysates, liver cell apoptosis, malonic dialdehyde level in the liver were analyzed. Studies have shown minimal manifestations of toxic effects of OA in case of intraperitoneal administration (shifts in the ratio of neutrophils and lymphocytes, increased activity of AST, changes in the activity of glutathione peroxidase) to be observed even at a dose of 50 μg/kg of body weight. Taking into account the safety factor of 3, the ARfD level of OA should be revised and accepted to be equal to 0.27 μg/kg of body weight. The data obtained indicate the need for additional risk assessments of this toxin for the health of consumers and, possibly, a revision of the established values of the safe content of this toxin in mollusks. For the first time, there was shown the possibility of using the following marker of toxic action of OA: non-protein thiols, the activity of glutathione peroxidase, and the content of malonic dialdehyde in the liver.