Репозиторий Университета

© 2018 Russian Transplant Society. All rights reserved. The method of mechanical circulation support using non-pulsating flow pumps, built on the principle of rotary (centrifugal and axial) pumps, took the leading direction (94%) in the world clinical practice for the treatment of the patients with terminal heart failure. Despite this, the clinic application of these pumps in a number of cases faced with the numbers of negative problems associated with this technology. This is stimulated of a new direction of principles for a control of the rotary pumps, based on the modulation of the speed pumps. The article analyzes the negative factors of the clinical application of non-pulsating flow pumps and gives an overview of the methods the optimization of the control pump based on the modulation of the output flow.

© 2018 BMSTU. We studied the dependence of the rate of dissolution of d-elements oxides (cobalt and copper oxides) in acidic media with EDTA additives from different factors. Increase in EDTA concentration enhances the cobalt and copper oxides dissolution, while the copper oxide dissolution is inhibited. Within the research we determined the orders by hydrogen ions and EDTA: For cobalt oxide it is 0.5 ± 0.1; for copper oxide it is nH=0,6, and by EDTA it is∼-0.6. The peculiarity of the studied kinetics in EDTA is that the rate of cobalt oxides dissolution passes through a maximum at pH =-1, for copper oxide in the presence of chelating agent EDTA the dissolution rate first decreases, and then it increases at pH from 5 to 8. The activation energy of the process is Ea (H2SO4) = = 70 kJ/mol, Ea (EDTA) = 60 kJ/mol, for copper oxide the activation energy is 73 ± 0.5 kJ/mol. The simulation of the processes showed that the surface particle, which determines the rate of dissolution is eOH+ in mineral acids, and in the chelating agent it is HY.

© 2018, Nizhny Novgorod State Medical Academy. All rights reserved. Persistent bronchial inflammation in chronic obstructive pulmonary disease (COPD) is considered the cause of ventilation disorders and related contamination with conditionally pathogenic microorganisms; the latter can proceed and transform into a full infection, which can aggravate and exacerbate COPD. The aim of the study was to evaluate the relations between the oropharyngeal microbiota in patients with COPD and the clinical, functional, and prognostic parameters of the disease. Materials and Methods. 64 patients with COPD were included in the study; the participants were scheduled to visit our clinic on two occasions. In the first visit, their medical history was studied in detail and the major examination procedures were conducted. Those included an assessment of the respiratory function, the 6-minute walk test, the degree of dyspnea by the Medical Research Council scale, body plethysmography, the diffusion capacity of the lungs, and a chest CT scan. The second visit took place 12 months after the first one to assess the changes in the course of the disease. The result was considered negative if, in the second examination, the patient‘s condition was found more severe. Oropharyngeal samples of all patients were sequenced to identify the V3–V4 variable sites of the 16S rRNA gene. Results. It is found that the microbiological oropharyngeal patterns in COPD patients depend on the source of micro-aspiration. In addition, the changes in the oropharyngeal microbiota correlate with the severity and prognosis of the disease, as well as the patient phenotype. Based on the data obtained by sequencing parts of the 16S rRNA gene, the role of oropharyngeal microbiota in determining the course and prognosis of COPD has been elucidated. Conclusion. The presented clinical and functional characteristics associated with oropharyngeal microbiota indicate that microaspirations from other body compartments not only affect the composition of oropharyngeal microbiota in patients with COPD but also have an important prognostic significance.

© 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. 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 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 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.

© 2018 Ima-Press Publishing House. All rights reserved. Cognitive impairment (CI) is a basis for the clinical presentation of chronic cerebral ischemia (CCI). However, the role of the mechanisms of inflammation and angiogenesis in the origin of CI is unclear, as is its relationship to the number and localization of foci during a neuroimaging examination. Objective: to investigate the relationship between the presence of CI, focal brain tissue changes, and the plasma and serum levels of vascular endothelial growth factor (VEGF) and monocyte chemoattractant protein-1 (MCP-1) in patients with CCI. Patients and methods. Examinations were made in 59 patients with CCI and in 20 apparently healthy individuals. The investigators evaluated the cognitive status using the Mini-Mental State Examination (MMSE) and the clock drawing test), performed brain magnetic resonance imaging (MRI), duplex scanning of cerebral vessels, and determined laboratory indicators: the serum levels of MCP-1 and C-reactive protein, and the serum and plasma concentrations of VEGF. Results. The patients with CI were found to have higher values of inflammatory markers, lower serum and plasma concentrations of angiogenic factors, and a greater number of focal changes on MRI than those without CI (5.06±0.23 and 2.36±0.3 scores, respectively; p(0.05). Imbalance of angiogenic and antiangiogenic factors can cause disease progression and moderate vascular CI in patients with CCI.

© 2018, Bionika Media Ltd. All rights reserved. Background. Hatching from the zona pellucida is one of the most important stages of human preimplantation embryo development and spontaneous hatching inability is one of the causes of implantation failure in assisted reproductive technology (ART) cycles. The use of mechanical integrity disorders or complete destruction of the zona pellucida (assisted hatching) can be an effective way to enhance the effectiveness of infertility treatment programs using ART techniques. Objective. To assess the results of ART programs depending on the performance and type of assisted hatching. Material and methods. The prospective cohort investigation enrolled 309 patients treated for infertility with in vitro fertilization (IVF). According to the type and performance of assisted blastocyst hatching, the patients were divided into 3 groups: 1) 106 patients undergoing laser hatching with partial removal of the zona pellucida; 2) 103 patients having pronase hatching with complete removal of the zona pellucida; 3) 100 patients with no assisted blastocyst hatching. The degree of maturity and the quality of oocytes and embryos were assessed; hatching was monitored using light microscopy. Results. The pregnancy rates were noted to be statistically higher in Group 1 than in Groups 2 and 3; the multiple pregnancy rates were significantly lower in Group 1. Conclusion. Complete zona pellucida removal is a new approach to assisted hatching, in which, firstly, there is no mechanical separation of the cells forming the embryo, and, secondly, there is a rapid contact with endometrial cells during implantation. This contributes to the reduction of the risk of monozygotic pregnancies during the transfer of one morphologically normal blastocyst, by enhancing the effectiveness of ART programs.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. Background. There are limited data on the efficacy of long-term enzyme replacement therapy (ERT) in children with mucopolysaccharidosis (MPS). Objective. Our aim was to study the efficacy and safety of long-term ERT in children with MPS type I, II and VI. Methods. We analyzed the results of ERT with laronidase, idursulfase and galsulfase in children with MPS type I, II and VI admitted to the federal research center from January 2007 to November 2016. The response rate was assessed by the level of normalized urinary excretion of glycosaminoglycans (GAGs) (the ratio of GAGs concentration to urine creatinine) recalculated in percent (%) exceedance of the upper limit of normal for the corresponding age. Data on the administered therapy and its results, including adverse events, is extracted from the medical records of in-patients. Results. The results of treatment (intravenous infusions, intervals between administrations from 4 to 10 days) were studied in 33 children (5 of them were girls) with MPS type I (n =4; laronidase at a dose of 0.58 mg/kg), II (n =26; idursulfase at a dose of 0.5 mg/kg), and VI (n =3; galsulfase at a dose of 1 mg/kg). A decrease in the normalized urinary excretion of GAGs from 376% (172; 791) to 54% (0; 146) exceedance of the upper limit of normal for the age (p <0.001) was noted in the course of ERT lasting (median) 27 (14; 41) months. A decrease in the normalized GAGs excretion below the upper limit of normal for the age was established in 12/33 (36%) patients. ERT-associated adverse events were identified in 12 patients; one case required a two-fold therapy interruption. The development of nephrotic syndrome in the course of ERT in patients with severe MPS II was first described. Conclusion. Long-term ERT in children with MPS type I, II and VI is characterized by acceptable efficacy and safety.

© 2018, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.  Modifiers of membranes cause local defects on the cell surface. Measurement of the rigidity at the sites of local defects can provide further information about the structure of defects and mechanical properties of altered membranes. The purpose of the study: a step-by-step study of the process of a nonlinear deformation of red blood cells membranes under the effect of modifiers of different physico-chemical nature. Materials and methods. The membrane deformation of a viscoelastic composite erythrocyte construction inside a cell was studied by the atomic force spectroscopy. Nonlinear deformations formed under the effect of hemin, Zn 2+ ions, and verapamil were studied. Results. The process of elastic deformation of the membrane with the indentation of a probe at the sites of local defects caused by modifiers was demonstrated. The probe was inserted during the same step of the piezo scanner Δz displacement; the probe indentation occured at the different discrete values of Δh, which are the functions of the membrane structure. At the sites of domains, under the effect of the hemin, tension areas and plasticity areas appeared. A mathematical model of probe indentation at the site of membrane defects is presented. Conclusion. The molecular mechanisms of various types of nonlinear deformations occurring under the effect of toxins are discussed. The results of the study may be of interest both for fundamental researchers of the blood cell properties and for practical reanimatology and rehabilitology.

© 2018 Media Sphera Publishing Group. All Rights Reserved. The characteristics of mortality in the Russian Federation are that the greatest years of potential life lost are due to deaths among 50-60-year-old men. Objective - to investigate the characteristics of nutrition patterns in a sample of 41-44-year-old Moscow residents with overweight and obesity, by taking into account the role and significance of overweight in the development of cardiovascular diseases and events. Material and methods. Actual nutrition was evaluated according to the special computer program 1C. Value of Nutrition through a 24-hour dietary recall, by applying a special food atlas. A constructed mathematical model and tables of the chemical composition of nutrients were used to obtain information about the energy value of a diet and the pattern of nutrition. Results. A total of 301 men aged 41-44 years were examined. 38.3% of them were overweight. 29% of the men were found to be obese; 83 (28.6%) men had abdominal overweight. Comparative analysis showed that overweight and obese persons consumed statistically significantly more protein and total fat than normal weight ones and people with abdominal obesity ate more saturated fats and cholesterol. There was a paradoxical decrease in the intake of simple and complex carbohydrates with increases in both weight and waist circumference. Conclusion. The findings can be used to improve methods for nutrition assessment and differentiated technology for overweight correction in primary health care facilities.