Репозиторий Университета

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. The article is focused on the issues of clinical efficacy of telmisartan - angiotensin II type 1 receptor blocker from the perspective of its influence on cardiovascular risk in systemic hypertension patients. The results presented, of a variety of studies, witnessing potent antihypertensive and protective properties of telmisartan. The opportunities described, for usage of the drug in high risk patients, its efficacy in cardio- and nephroprotection. Special attention is paid for an exclusive property of telmisartan to be an agonist of PPAR γ-receptors, hence to correct glucose and lipid metabolism in patients with metabolic syndrome and diabetes.

© 2018 Media Sfera. All Rights Reserved. Purpose: to assess the neurophysiological effect and clinical effectiveness of transcranial direct current stimulation in combination with drug therapy in amblyopic children. Material and methods. The study involved 32 healthy children in the age of 5-12 years and 97 patients of the same age with refractive strabismic amblyopia. All study subjects underwent standard examination including ophthalmological (visometry, refractometry in normal conditions and in cycloplegia, biomicroscopy, ophthalmoscopy, type of vision), neurophysiological methods (determination of retinal electric sensitivity threshold, electric lability of optic nerve, amplitude and latency period of visual evoked potentials, electroencephalogram wave amplitudes, localization of peak electrical activity area of the cerebral cortex), assessment of neuropsychic development and estimation of mental development coefficient with age tests. Results. Dynamics of neurophysiological parameters shows that healthy children develop fully functional retina, visual cortex and cortical-subcortical connections by 12 years. Children with refractive strabismic amblyopia in all age groups show statistically significant (p<0.05) deterioration of neurophysiological parameters of the visual analyzer, retardation of corticalsubcortical connections formation and lower electrical activity of the cerebral cortex. Amblyopic children show lower coefficients of mental development accompanied by intellectual deficiency and deterioration of learning ability. Proposed treatment method improved neurophysiological parameters of the visual analyzer in 83.5% of cases and increased visual acuity in 81.4% of cases. Improvement of psychological development resulted in better logical thinking, memory reinforcement and better adaptation to school educational environment in 86.6% of children.

© 2018 Media Sphera Publishing Group. All rights reserved. The objective of the present study was to determine the biological age of the unrecognized individuals based on the analysis of CT-scanograms of the skull and the craniovertebral region in the sagittal projection. We investigated the structure of the spongy substance of the clinoid plate of the sella turcica and the clivus of the cranium, involution of the vertebrae configuration in the medial atlantoaxial articulation, frontal and sphenoidal sinuses. A total of 80 skulls of Caucasoid individuals at the age ranging from 4 to 84 years belonging to an Eastern Slavonic population (free from the pathological lesions in the above cranial structures) were available for the examination. The results of the multifactorial analysis gave evidence of the possibility to estimate the age of individual subjects based on the comprehensive aggregate qualitative and quantitative characteristic in the framework of the linear regression model by making use of the age-related changes in the frontal and sphenoidal sinuses, the sella turcica and the clivus of the cranium, the first and the second cervical vertebrae with an accuracy to within 6 years. It is concluded that the application of the systems for the automated statistical analysis of the images for the purposes of forensic medical expertise would allow to obtain the results of great practical and scientific value.

© 2018 Media Sphera Publishing Group. All rights reserved. The objective of the present study was to elucidate the characteristic features of the injuries inflicted to the victims of a road traffic accident inside the passenger compartment of a moving car equipped with the modern personal safety systems. The materials available for the present work included the lesions documented in 210 drivers and 150 occupants of the car passenger compartments. Both comparative, morphometric and statistical methods were used to analyze the data obtained. The morphometric analysis included identification of the form of the injury, such as extravasation, wounds, fractures, and lesions of the internal organs (e.g. hemorrhages, ruptures, etc.), their number and localization. Special attention was given to the specific features of the injuries to the occupants of the cars equipped with the modern personal safety systems. The study has demonstrated that the form, frequency, and localization of the injuries inflicted to the victims of a road traffic accident inside the passenger car compartment (including the drivers and other occupants) can be used for determining the positions of the victims at the moment of the accident.

© 2018 Media Sphera Publishing Group. All rights reserved. This article presents an overview of the literature publications concerning pathological changes in the cerebral blood vessels and the factors underlying the development of hemorrhagic complications leading to sudden death of young people. The special emphasis is placed on the most important causes behind the changes in the vascular wall (including the congenital ones) responsible for the high risk of rupture of the intracerebral vessels associated with the development of hemorrhagic complications.

© Bionika Media Ltd. Background. Fallopian tube cancer (FTC) is an extremely rare, difficult diagnostic malignant disease of the female reproductive system. The world literature describes single cases of FTC concurrent with tubal pregnancy. Description. The paper describes a clinical case of diagnosed FTC after surgical treatment for tubal pregnancy. Patient P., aged 34 years, who had complained of vaginal bleeding and tensive pain in the right iliac region, was admitted to the Bakhrushins Brothers City Clinical Hospital. After complete clinical and laboratory examinations diagnosed right ectopic pregnancy, emergency surgical treatment was performed as laparoscopy and rightsided tubectomy. The postoperative period was uncomplicated; the patient was discharged home in satisfactory condition. Histological examination revealed the growth of well-differentiated fallopian tube adenocarcinoma and confirmed the diagnosis of ectopic pregnancy. The diagnosis was verified by immunohistochemical study Conclusion. Preoperative diagnosis of FTC is extremely difficult; therefore the elaboration of a clear algorithm for the diagnosis and treatment of this condition is one of the important tasks in gynecologic oncology.

© Bionika Media Ltd. Background. Ovarian cancer develops from benign tumors in 80% of cases during long-term follow-up. According to the literature, the incidence of giant ovarian cystadenoma is extremely low. There are difficulties in verifying these ovarian tumors. Description. The paper describes a rare clinical case of a 54-year-old patient with giant ovarian cystadenoma. It depicts the patient’s clinical, medical history, laboratory, and instrumental data and demonstrates the technical complexities of surgery and the features of postoperative management. Conclusion. The early diagnosis and timely treatment of ovarian tumors will be able to avoid technically difficult surgical interventions and to minimize postoperative complications, which will substantially improve the prognosis of the disease. Such operations should be performed by a surgeon having extensive surgical experience and high qualification.

© 2018 ABV-Press Publishing House. All rights reserved. Early childhood autism, or autism spectrum disorders, is an extremely heterogeneous group of conditions that share similar symptoms of dysontogenesis. Epilepsy is the most significant comorbidity in autism. The present article covers various aspects of comorbidity between epilepsy and autism, described in the literature over the last 50 years. This review aims to analyze the development of epilepsy and autism during ontogenesis and to identify causal relationships between these diseases, considering the information on the two age peaks for epilepsy onset in patients with autism.

© SN Puzin et al. In this article, we are looking at the stages of reorganisation of medical expert commissions into workplace health expert committees (WHEC). Classification of disability, according to which a disabled person could be assigned to one of three groups, is proposed. This classification regulated the criteria for the establishment of each group in accordance with the indications for employment. The Regulation on the WHEC, approved in 1942, practically became fundamental for all subsequent regulatory documents on the activities of the WHEC. According to this Regulation, the WHEC was able to grant certificates stating that the disability is related to being at the front. A new category of people with disabilities was created – the veterans of the Eastern Front of World War II. The Regulation on the WHEC, introduced in 1948, expanded the functions and powers of these services. The categories of people who had to be assessed by the WHEC were determined. Since 1955, the inpatient examination and the work of specialised (tubercular and psychiatric) WHEC have been organised. During 1956–1984 WHEC received the authority to set the time of the onset of disability to address the issue of pension benefits for people previously recognised as being disabled. The dates for the re-examination of people with disabilities were established. In 1956, a new Regulation on the WHEC was introduced. According to this document, as recommended by the WHEC, it was possible, in the absence of medical contraindications, for people with disabilities of all three groups to continue working, but under different conditions. During 1940–1960s, a new directive appeared – medical rehabilitation, the basic principle of which was specialised assistance to people with amputations, severe injuries of the skull, brain, spinal cord, and vertebral column. A foundation for the specialisation and improvement of expert doctors was created. The development of the state service of medical and social expertise was carried out in accordance with the new approaches of the World Health Organisation to the definition of disability, based upon the clinical and expert diagnosis of functional disorders and activity limitations.

© 2018 Istituto Superiore di Sanita. All Rights Reserved. Parkinson disease is one of the common age-related motor neurodegenerative diseases, in which dopamine neurons degeneration is considered to be pathognomic for the development of motor disfunction. Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family, which is considered to be a key regulator of neuronal plasticity. BDNF, being a large molecule, does not pass through the blood-brain barrier (BBB). Synthetic polymer nanoparticles (NP), covered by surfactant, provide the phenomenon of “Trojan hoarse” and enable BDNF to penetrate into the brain tissue. For modelling of parkinsonism we used an intraperitoneal (i.p.) injection of neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) which was injected to the C57BL/6 mice with subsequest treatment with normal saline (group 1), BDNF (group 2), nanoparticulate BDNF (group 3) and surfactant-coated nanoparticulate BDNF (group 4). After 90 min, 24 hours, 72 hours and 7 days manifestations of parkinsonism were evaluated using behavioural tests of open field, rota-rod, assessment of the tremor, length of the body and pace. At the end of experiment the brain was sampled for histological evaluation of changes in the striatum and midbrain and concentration of BDNF in the brain tissues. The results of the experiments demonstrated that nanoparticulate BDNF covered with surfactant significanltly reduced rigidity of the skeletal muscles, oligokinesia and tremor, and also significantly increased BDNF concentration in the brain tissues.

© 2018 Russian Academy of Sciences.All rights reserved. In this study we investigated factors which predict attitudes toward different forms of Russian participation in Syrian conflict. Russian residents (N = 595) filled out the scales for belief in a just world, nationalism, patriotism, general military attitudes and attitudes towards different forms of Russian involvement in Syrian conflict. The results of the study have shown that just world belief predicts differ-ent forms of national identity-patriotism and nationalism. Patriotism, but not nationalism, is negatively correlated with general military attitudes. General military attitudes, in turn, are positively correlated with attitudes towards Russian military involvement in the conflict, but negatively correlated with the peaceful participation. The article contains new data on the links between national identity and the atti-tude toward war. Proposed assumptions about what the results may be related to. The main prospects for the development of this area of research are outlined.

© 2018 Russian Transplant Society. All Rights Reserved. Blood level of transforming growth factor beta 1 (TGF-β1) is associated with liver function and immune homeostasis, which suggests it as a potential biomarker for immunosuppressant tacrolimus dose requirement at liver transplantation (LT). Aim. To evaluate diagnostic efficacy of TGF-β1 blood level at determination of individual tacrolimus dose requirement in children at LT. Materials and methods. 89 children with end stage liver disease aged from 3 to 73 months were examined. Children underwent living related LT, then the recipients received 2–3 component immunosuppressive therapy, including tacrolimus. Blood concentration of tacrolimus and TGF-β1 was measured by ELISA. Results. TGF-β1 blood level in children before LT was significantly lower than in healthy children: 3.7 (1.3–8.4) and 19.3 (12.6–25.5) ng/ml, p = 0.001. A month after LT, its concentration increased to 8.1 (1.8–15.3) ng/ml (p = 0.02). A year after LT, the cytokine level remained higher than before transplantation: 6.6 (1.9–12.6) ng/ml, p = 0.01. TGF-β1 level did not correlate with tacrolimus blood concentration, determined 12 hours after the last administration of the drug, neither a month, nor a year after transplantation. At the same time, the cytokine level one month after LT was associated with a tacrolimus daily dose one year after the operation (r = –0.23, p = 0.04). In the recipients, who received smaller daily doses (0.4–2.5 mg) of tacrolimus, TGF-β1 level was higher than in those receiving large doses (3.0–6.0 mg) of the drug: 9.1 (2.6–16.2) ng/ml vs. 4.2 (1.3–9.2) ng/ ml, p = 0.04. Evaluation of diagnostic efficacy of the TGF-β1 level as a test for the detection of tacrolimus dose requirement showed that the area under the ROC curve (AUC) was 0.66 ± 0.07; 95% CI [0.53–0.79], the sensitivity and specificity of the test were 60 and 74% at threshold value 6.7 ng/ml. Relative risk of higher tacrolimus dose requirement was 3.14 ± 0.48; 95% CI [1.24–7.96]. Conclusion. TGF-β1 blood level in one month after LT less than 6.7 ng/ml is 3 times higher risk factor of tacrolimus dose requirement more than 3.0 mg per day. The likehood of the test is 66%, the sensitivity and specificity – 60 and 74%.

© 2018 Russian Transplant Society. All Rights Reserved. Lung transplantation (LT) for idiopathic pulmonary arterial hypertension (IPAH) now is the only radical treatment of this disease. Aim: to analyze own experience of performing LT in patients with IPAH. Materials and methods. 8 adult IPAH patients, who underwent LT between 2014 and october 2018, were included. In 7 of 8 patients undergoing bilateral lung transplantation on intraoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) with prolongation into the postoperative period. Results. VA ECMO support was prolonged into postoperative period 6 and 7 days respectively in 2 (25,0%) patients and 3 days in 6 (75,0%) patients. Hospital mortality in IPAH patients was 1. Conclusions. Own experience demonstrates that LT is an effective method of treatment in patients with IPAH. Hospital, 1- and 3-year survival rates for the patient collective were 87.5, 75.0 and 75.0% respectively.

© 2018 National Research University Higher School of Economics. All Rights Reserved. The aim: to analyze the waiting list for heart transplantation from 2010 to 2017 and to characterize recipients with chronic heart failure III–IV NYHA Class. Methods. The study comprised 997 patients (139 [14%] females and 858 [86%] males) included in the waiting list for heart transplantation the period from January 2010 to December 2017. The average age of patients on the waiting list was 49.0 ± 12.0 (from 10 to 78 years). Before making a decision on inclusion in the waiting list, all patients underwent clinical and instrumental examination, including general clinical studies, echocardiography, measurement of central hemodynamic parameters using a Swan–Gans catheter, computer and/or magnetic resonance imaging of the chest, abdominal and brain. Results. Heart transplantation was performed on 728 patients (99 females – 13.6% and 629 males – 86.4%) including 18 children aged 12 to 17 years (14.18 ± 2.07 years). Mortality in the waiting list in 2010 was 16.1%, compared with 3.2% in 2017.

© 2018 Russian Transplant Society. All Rights Reserved. Aim. To study the effect of ACE inhibitors (ACEI) in heart recipients on the prognosis and myocardial remodeling. Materials and methods. Three hundred and eighty-six patients who received orthotopic heart transplantation (HT) were consequently enrolled to the study from February 2009 to November 2016. Results. Thirty days after the HT, ACEIs were assigned to 141 recipients. Arterial hypertension was diagnosed in all cardiac recipients who received ACEI and among 48 patients (19.5%) from non-ACEI group. Patients receiving ACEI had significantly better event-free survival than control group (p = 0.045) during the follow-up for 1361,6 ± 36,9 days. Left ventricle (LV) end-diastolic dimension did not change over the time in both groups, whereas LV posterior wall thickness in non-ACEI group significantly increased from 1.35 ± 0.03 cm to 1,23 ± 0.05 cm (p < 0.05). Conclusion. Cardiac recipients who received ACE inhibitors had better survival and less transplant left ventricle progression, that could reflect beneficial effects of renin-aldosterone-angiotensin system inhibition after heart transplantation.

© 2018 Stavropol State Medical University. All Rights Reserved. The review presents the latest achievements in the field of complex adjuvant treatment of patients with portal cholangiocarcinoma. Modern data on the clinical efficacy and benefits of intraduct photodynamic therapy are presented.

© 2018 Sychev et al. Background: Non-vitamin K oral anticoagulants (NOACs) are commonly used for prophylaxis of venous thromboembolism (VTE) in orthopedic patients. Despite known safety and high potency of NOACs, potential interactions of NOACs with genetic polymorphisms are poorly understood. Dabigatran etexilate is one of the most commonly prescribed direct thrombin inhibitors for the prevention of VTE. The objectives of this study were to assess the effect of ABCB1 (rs1045642 and rs4148738) and CES1 (rs2244613) polymorphisms on dabigatran pharmacokinetics in patients after total knee arthroplasty. Patients and methods: A total of 60 patients, aged 37–81 years, who underwent surgery for knee replacement have been included in the study. VTE prophylaxis was conducted via administration of dabigatran etexilate 220 mg once daily. Genotyping for carrier state of polymorphic variants such as rs1045642 and rs4148738 of the ABCB1 gene and rs2244613 of the CES1 gene was carried out using real-time polymerase chain reaction (PCR). We also measured the peak and trough concentrations of plasma dabigatran by using high-performance liquid chromatography (HPLC). Results: Our study revealed that TT genotype of rs1045642 polymorphism of the ABCB1 gene was associated with higher dabigatran equilibrium peak concentrations and the higher risk of bleeding than the presence of CC genotype (p<0.008). There was no statistically significant genotype-dependent difference in the trough concentrations between rs1045642 and rs4148738 of the ABCB1 gene and rs2244613 of the CES1 gene. Conclusion: Our findings indicate that the polymorphisms of ABCB1 rs1045642 may have a prominent contribution to the safety of dabigatran in patients after knee surgery. Moreover, TT genotype may be associated with the higher risk of hemorrhagic complications in this population. There were no influence of polymorphism of ABCB1 rs4148738 and CES1 rs2244613 on dabigatran peak and through concentrations. Larger studies are needed to confirm our observations.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To estimate a clinical picture of the pertussis-like illnesses caused by Bordetella holmesii. Patients and methods. The research is conducted in Infectious diseases clinical hospital No 1 of the Moscow Department of Healthcare. Under observation there were 7 children (from 1 month to 15 years). Examination is conducted by means of PCR-RT with the primers the IS481, ptxA, IS1001 and hIS1001 for identification of fragments of genomes of B. holmesii, B. pertussis and B. parapertussis, and by means of the AmplySens® Bordetella Multi-FL test system for identification of B. pertussis, B. parapertussis and B. bronchiseptica DNA. Results. At 6 children the disease proceeded an easy form, from them in five children in clinical samples DNA of B. holmesii also is found in one child – B. holmesii and B. parapertussis DNA; at 1 child (1 month) the disease proceeded in a medium-weight form, and B. holmesii and DNA of B. pertussis is found in him in a sample. In a clinical picture of the pertussis-like illnesses caused by B. holmesii at all children the symptoms characteristic of the course of the whooping cough caused by B. pertussis were observed: whooping cough, with office of a transparent phlegm, with hyperaemia of the person. But the disease proceeded in easier form, the health of the child didn't suffer, respiratory frustration weren't observed, duration of a disease was much shorter. Conclusion. The research demonstrates circulation of B. holmesii in the territory of the Russian Federation. At allocation of B. holmesii pertussis-like symptoms are noted, however easier current including at children of early age is registered.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Steady increase in the prevalence of chronic kidney disease (CKD) is a serious public health problem, since CKD potentially leads to the development of end-stage renal disease (ESRD) that requires high-cost replacement therapy and is closely associated with increased risk of developing cardiovascular diseases (CVD), which are the cause of death in most patients. Progression of renal dysfunction and development of CVD are significantly affected by hyper- and dyslipidemia. This review contains results of studies evaluating the effect of hypolipidemic therapy on reduction of cardiovascular risk and slowdown of renal dysfunction in patients with CKD at pre-dialysis and dialysis stages of renal failure, as well as in patients with kidney transplant. In addition, recommendations on nutrition and new therapeutic approaches to lipid-lowering therapy in patients with CKD, as well as prospects for the usage of new hypolipidemic drugs are also presented.

© 2018 Izdatel'stvo Meditsina. All Rights Reserved. Introduction. Alzheimer's disease (AD) is the most common neurodegenerathe disease in the population. Often, patients with AD have a combined brain lesion of vascular etiology (cerebral microangiopathy). Arterial blood spin labeling (ASL - Arterial spin labeling) is one of the most modem and promising methods for quantifying cerebral perfusion in patients with AD. Objective. To assess regional cerebral blood flow (CBF) using the ASL method in patients with AD with chronic cerebral ischemia - cerebral microangiopathy (CMA) and without it. Material and methods. A group of 20patients (mean age 66 ± 10 years), consisting of 11 patients with AD without CAIA and 9patients with AD with CMA, was examined. The study was conducted on a Siemens Magnetom Skyra magnetic resonance imaging scanner with a magnetic field induction of3T. The examination protocol included an impulse sequence of arterial blood spin labeling. Using the software for postprocessing data processing Olea Medical Sphere 3.0, the indicators of regional cerebral blood flow in various parts of the gray matter of the brain were measured in a manual mode. A neuro-psychological study was performed, confirming a presence of mild to moderate dementia in all patients. Results. A decrease of CBF was revealed in AD patients with CAIA in comparison with AD patients without CMA. The lowest CBF were found in the upper temporal; middle temporal; occipital-temporal; upper frontal and angular gyrus. No correlation was found between CBF measures and neuropsychological results. C onclusion. ASL is a sensitive method in assessing cerebral perfusion in AD patients.