Репозиторий Университета

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Some pathologic processes compromise renal function and as result worsen glomerular filtration rate (GFR). The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation was developed in an effort to create a more correct formula to estimate GFR, however, it is not able to assess split renal function. Objective. This paper aims to present how numerical analysis of abdominal multispiral computed tomography (MSCT) results correlate with data of CKD-EPI equation. Materials and methods. In this Institutional prospective cohort study, MSCT scans of 16 patients undergoing multiphasic renal protocol with 3D-reconstruction and numerical estimation were reviewed. Comparison was made by means of Pearson coefficient and Youden index. Results. MSCT-based methods for the calculation of split renal function with 3Dmodels showed strong correlation with CKD-EPI (p<0.001). Conclusion. Data received using the 3D-MSCT in comparison with CKD-EPI equation are equally accurate with low bias in GFR-assessment. However new approach has great advantages, because allows for both acquiring detailed data on clinical anatomy and evaluation of renal function, that made it not only precise but also more informative for decision-making in clinical practice. Such application of high-tech imaging method applied to the field of radiology may alter the course of patients' management when pathologic process is just beginning to correct premorbid conditions.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Mainly, intracoronary thrombosis is the cause of acute coronary syndrome. The structure of the atherosclerotic plaque plays an important role in the development of the mechanism of intracoronary thrombosis. Currently, there are various radiological methods for diagnosis of atherosclerotic plaques of the coronary arteries. The current review reveals the theme of "indirect" signs of instability of atherosclerotic plaques, their combinations and occurrence, detected by computed tomography. Retrospective studies have shown the feasibility of these signs of plaques in the assessment of the prognosis of acute coronary events. The review compares the results of computed tomography (CT) and intravascular ultrasound, which is the gold standard in the diagnosis of atherosclerotic plaque morphology.

© 2018 Dynasty Publishing House. All rights reserved. Replication of Francisella and Shigella in cytosole of host cell is correlated with their ability to escape from phagosome (containing bacteria vacuole) and to modulate innate immunity of host. Francisella T6CC and some undeterminated products of pathogenicity island's genes take part in such processes. Shigella T3CC and autotransporter protein IscA provide this processes together with spreading bacteria intra colonic epithelium.

© Bionika Media Ltd. The paper presents current generalized data on the immunological aspects of preeclampsia development and progression and emphasizes the role of immunological maladaptation of the mother to pregnancy with the participation of key factors of the immune system in response to the formation of a semi-allogenic fetus and placenta. The results of recent studies allow us to take a fresh look at therapeutic approaches to managing patients with preeclampsia, by taking into account targeted exposure methods against the most important component of its pathogenesis, in particular to prevent excessive activation of the complement system.

RESULTS: There were no any complications after proximal debranching and aortic stenting. Abdominal debranching was followed by lethal outcome in 3 (13.0%) patients and early postoperative occlusion of the prosthesis brunch in 3 out of 87 cases.CONCLUSION: Staged approach for hybrid surgical treatment is optimal solution, especially in high risk patients. In our opinion no necessity for cardiopulmonary bypass is the main advantage of this technique.AIM: To generalize our experience of step-by-step hybrid thoracoabdominal aortic replacement.MATERIAL AND METHODS: Twenty-three patients were enrolled who underwent staged hybrid treatment of thoracoabdominal aortic aneurysm. There were 5 (21.7%) women and 18 (78.3%) men aged 61.4±8.3 years (37-74 years). The first stage was proximal debranching, the second - distal (abdominal) procedure and the third - stenting of the thoracoabdominal aorta.

© N.N. IVANETS E.N. EFREMOVA, 2018. Objective. To explore psychopathological features of affective disorders in the structure of schizotypal disorder. Material and methods. The study included 102 patients with schizotypal disorder, aged from 18 to 60 years. Assessment was done using clinical/ psychopathological method and psychometric scales — Calgary depression scale in patients with schizophrenia (CDSS), General Clinical Impression scale (CGI), Yang’s mania scale (YMRS). Results and conclusion. Affective disorders are noted in the majority of inpatients with schizotypal disorder. They are represented by depressive disorders of variable severity, and mixed depressive states. A group of patients with schizotypal disorder was identified in whom the symptoms of the affective disorder constituted the main clinical picture of the disease, whereas concomitant neurosis-like disorders were formed solely during the exacerbation of depression, correlated with its severity and reduced on antidepressant therapy along with depressive symptoms. Observed reversibility of productive disorders allowed us to consider the dynamic of these states as similar to the atypical affective phase, and the natural course of the disorder as close to the paroxysmal type in the form of distinct depressive phases. In patients with persistent neurosis-like disorders, affective disorders accompanied axial symptoms of the disease and made a large impact on the structure of the exacerbation of the endogenous process. A reduction of depressive symptoms in these patients was accompanied by a decrease in the intensity of axial symptoms of the disease, however the complete reduction of axial symptoms and remission was not observed.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The right drug at the right dose administered to a patient in time is the goal which all medical specialists aim at when prescribing medicines to patients. Pregnancy is a condition when the principle of personalized pharmacotherapy is especially relevant. Due to the developing fetus and the occurring changes in the maternal organism, the selection of drug therapy during pregnancy is especially difficult for a clinician. This issue is tightly intertwined with clinical pharmacogenetics since the genetic code of a woman that determines the activity of the liver cytochrome, the fetus-placental barrier, and renal clearance contributes to the peculiarities of the drug metabolism during pregnancy. Additional data provides the opportunities to form therapeutic models and to determine the ways of personifying pharmacotherapy in pregnancy. The purpose of this review is to summarize the available data on the pharmacogenetics of antihypertensive drugs used during pregnancy.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Introduction of amendments to the registration dossier is the responsibility of the marketing application holder (MAH). Increased knowledge on pharmaceuticals, its manufacturing and control processes can reduce the number of documents submitted to the regulatory authorities. The existing requirements establishing the procedure for the introduction of amendments differ in terms of change classification, period of notification of regulatory authorities, ways of conformity validation of pharmaceutical properties, etc. ICH proposed draft guideline Q12 «Technical and Regulatory Considerations for Pharmaceutical Product Lifecycle Management» which covers the problem of harmonization of regulatory approaches to the changes provided in the «Quality» section of CTD during the commercial phase of drug life cycle. The new guideline can be considered as the continuation and elaboration of previous ICH documents. The article provides explanations on the main provisions and regulatory mechanisms introduced by the draft guideline ICH Q12: categorization of post-approval changes, established conditions, post-approval change management protocol, and drug product lifecycle management.

© 2018 Media Sphera Publishing Group. All rights reserved. Aim of the study was to explore the role of the FGF-23/sKlotho/sclerostin ratio disturbance in the determining of cardiovascular risk in end stage renal disease (ESRD) patients, receiving treatment with regular hemodialysis (ÍD) or hemodiafiltration (ÍDF) online in Russia. Materials and methods. 42 patients with ESRD, at the age of 18-55 years, treated with HD or HDF on line for at least 6 months, were examined. 22 (52.3%) patients received traditional HD, the remaining 20 (47.7%) - HDF online. In all the patients, in addition to a general examination, the serum levels of FGF-23, sKlotho, sclerostine (by ELISA), their associations with cardiovascular risk factors (left ventricular hypertrophy (LVH), acute coronary syndrome (ACS), serum troponin I levels) with the numbers of techniques (ECG; Eho-CGF (with calculation of left ventricular myocardium mass index (LVMMI), as well as the relative thickness of the walls of the left ventricle (RWT); sphygmography (central (aortal) blood pressure (CBP), subendocardial blood flow (SBF) - by Sphygmocor), and the effect of regular HD and HDF on serum levels of the studied markers, were assessed. Results and discussion. An independent effect of FGF-23 on the risk of LVH, as well as on the increase of serum troponin I in the studied ESRD patients [β=3.576 p<0.01, and β=1.115, p<0.05, respectively] was found. Serum Klotho was the factor most associated with the CBP [β=-0.023; p<0.001]. The increased serum sclerostin was correlated with a lower incidence of both reduced SBF [r=0.492; p<0.05], symptoms of coronary heart disease [r=-0.449; p<0.05] and rhythm disturbances [r=-0.446; p<0.05]. In addition, in HD patients higher FGF-23 and lower Klotho and sclerostine serum levels were associated with: inadequate dialysis syndrome (Kt/V <1.1; r=0.463; p<0.05), chronic inflammation (C-reactive protein >10 mg/L; r=0.612; p<0.01), and with a decrease in serum albumin level (<35 g/l; r=0.459; p<0.05). The FGF-23/sKlotho/sclerostin ratio disturbance was more pronounced in patients treated with traditional HD then HDF online. A direct correlation (r=0.445; p<0.05) was established between FGF-23 serum levels and serum phosphorus, which was more pronounced in HD patients (r=0.545; p<0.01). Conclusion. In HD and HDF ESRD patients, higher serum FGF-23 and lower sKlotho and sclerostin levels were associated with a chronic inflammation, malnutrition, secondary hyperparathyroidism, and may considered as predictors of cardiovascular complications such as LVH, ACS, rhythm disturbances, persisting of subincreased serum troponin I.

© 2018 Media Sphera Publishing Group. All rights reserved. The study demonstrated the results of the comparative analysis of various types of renal replacement therapy effects on the quality of life patients with terminal stage of chronic kidney disease on the basis of standardized questionnaires. It has been shown that the quality of life is significantly improved after a kidney transplantation. At the same time, it has also been found that the introduction of home dialysis, epoetins, active metabolites of Vitamin D, calcimimetics in the clinic care expanded the opportunities for the labor rehabilitation of the dialysis patients and made their quality of life comparable with the same of the kidney transplant recipients.

© 2018 Media Sphera Publishing Group. All rights reserved. The role of modified low density lipoprotein in the activation of the classical pathway of the complement system and increasing expression C3 gene in human macrophages is described, role of these processes on the progression of atherosclerotic vascular lesions is considering.

© 2018 Media Sphera Publishing Group. All rights reserved. Pharmacotherapy of resistant arterial hypertension represents a serious problem, because today there are no clear algorithms of action in this clinical situation. The review discusses the key works in which the authors propose a solution to this problem. The variants of a differentiated approach to treatment based on hemodynamic type, plasma renin activity, as well as a number of empirical strategies, including the predominant use of mineralocorticoid receptor antagonists, are discussed.

© 2018 Media Sphera Publishing Group. All rights reserved. The exact cause of the development of anxiety disorders (AD) in present time has not been fully established and is a subject of debate in many countries. Interest in studying the mechanisms of action of proteins of S100 group, in particular, neurospecific protein S100b, is caused by its participation in processes of integrative activity of brain/neuron and development of diseases of nervous system. The functions of S100 proteins determine their influence on synaptic plasticity and participation in the regulation of stress-realizing and stress-limiting systems, the imbalance of which (primarily, the insufficiency of the GABA-ergic system) is the neurobiological basis of the majority of anxiety-depressive pathologies. Preparations regulating the activity of S100 protein have a distinct clinical anti-anxiety effect and additionally contribute to the restoration of neuronal plasticity processes.

© 2018 I M Sechenov First Moscow University (Sechenov University), Moscow, Russian Federation We report a fatal case of human babesiosis caused by bovine pathogen Babesia divergens in Russia. Falciparum malaria was falsely diagnosed due to the presence of small ring forms in the blood smear. Laboratory diagnosis can distinguish between babesiosis and malaria according to the examination of stained blood smears.

© 2018 Stolichnaya Izdatelskaya Kompaniya. Aim. To study the changes in the stiffness of the arterial wall, vasomotor function of the endothelium, and appearance of new cases of atrial fibrillation (AF) in patients with arterial hypertension with long-term treatment with lisinopril. Material and method. 66 hypertensive patients with cardiac sinus rhythm at the age of 48-64 years (mean age 58.4±4.2 years) were included into the study. They were randomized into 2 groups: patients of group 1 (n=35) were prescribed lisinopril or a combination of lisinopril with hydrochlorothiazide over the 5-year follow-up; patients of group 2 (control) did not receive angiotensin converting enzyme inhibitors or angiotensin II receptor blockers. The follow-up duration was from September 2010 until June 2016. It included telephone calls once every 3 months and annual clinical, instrumental and laboratory examination. The new-onset AF was identified by the 24-hour Holter ECG monitoring results and by patient symptom diaries. Results. New-onset AF was registered in 2 patients (6%) in the lisinopril group and in 4 patients (13%) from the control group (p=0.001) over the 5-year follow-up. Lisinopril significantly reduced AF incidence in hypertensive patients. The patients on lisinopril were found to have no significant changes in the left ventricular mass index and left atrial size according to echocardiography done after the 5-year follow-up whereas in the patients of control group both parameters increased significantly. Lisinopril contributed to the maintenance of endothelial vasodilator function and prevented increase in arterial wall stiffness. Conclusion. Long term lisinopril treatment was found to significantly reduce the AF incidence in hypertensive patients over the 5-year follow-up. Lisinopril demonstrated organoprotective properties throughout the cardiovascular disease continuum and can be recommended for primary prevention of arrhythmia in hypertensive patients..

© 2018 Stolichnaya Izdatelskaya Kompaniya. Aim. To study the erythrocyte electric charge (EEC) in patients with metabolic syndrome (MS). Material and methods. 112 patients (mean age 61.4±7.2 years) with MS (average duration of MS 8.7±5.2 years) were examined. Control group consisted of healthy volunteers (n=25) of similar age. The level of EEC was detected by the method of adsorption of a positive cationic dye (cationic blue O) on the surface of the erythrocyte plasma membrane up to the complete neutralization of their negative charge, followed by photometry of the solution and calculation of the number of charges on the erythrocyte cell surface. The results of the study were processed by Statistica 10.0 software. Results. Hypertension was found in 73% of patients with MS, hyperglycemia - in 39%, diabetes - in 36%, dyslipidemia - in 80% of patients. The EEC in MS patients (1.59±0.05×107) was lower than this in the control group (1.65±0.03×107; p < 0.05). With MS duration more than 5 years, the EEC was significantly lower in comparison with control group (p < 0.05). In patients with obesity II-III degrees as well as dyslipidemia the EEC values were significantly lower vs control group (p < 0.05). In patients with MS, a significant negative correlation of EEC with total cholesterol (r=-0.51, p < 0.05) and triglycerides (r=-0.51, p < 0.05) levels were revealed. Conclusion. In patients with MS with increase in the MS duration, degree of obesity and lipid metabolism disorders, significantly lower values of EEC were observed..

© 2018 Stolichnaya Izdatelskaya Kompaniya. The article presents a clinical observation of the left atrial appendage thrombosis in a 51-year-old female patient with a paroxysmal form of nonvalvular atrial fibrillation which occurred despite long-term anticoagulant therapy with apixaban in a full dose (5 mg b.i.d.), and the patient's management. The patient was admitted with recurrent symptomatic paroxysm for more than 48 hours, because of which, in accordance with the recommendations, transesophageal echocardiography was performed before an emergency rhythm restoration. Thrombus in the left atrial appendage 0.5×1.03 cm in size was detected. It was decided to refrain from the immediate restoration of the rhythm due to the very high risk of thromboembolic complications. In connection with the categorical refusal of the patient from warfarin, it was decided to replace apixaban with another direct oral anticoagulant - dabigatran 150 mg bid for a period of 4 weeks followed by performing a control transesophageal echocardiographic study. As a result, no thrombus was found on control echocardiography. The particularity of this observation is concomitant hypertrophic cardiomyopathy and diabetes mellitus type 1 in this patient..

© Ivan M. Chizh, Igor V. Karpenko, Maria S. Sergeeva, Ilya V. Fedoseikin. The article covers a little-known episode from World War I, concerning the work of one of the foreign detachments (hospitals) in the Russian Tsarist army. The large-scale sanitary losses and epidemics of infectious diseases, which accompanied the war, required special efforts from the medical service of the Russian army. The Russian Red Cross Society (RRCS), which had monopoly rights to organize medical care during the war, did not cope with the problems that arose. In connection with this, the international community, primarily the medical personnel of neutral and allied states, in particular, England and America, played a big role in the provision of medical care to the wounded Russian army. The activities of foreign doctors, nurses and hospitals were carried out under the auspices of the RRCS in the framework of the humanitarian assistance that allies provided to Russia during World War I. Based on archival documents and materials from RRCS periodicals for 1914–1917, the activities of the medical unit of the North American United States in the Caucasian theater of military operations and the American hospital organized by it on the territory of Persia (the town of Khoy) are investigated. The materials under review single out a number of problems in the provision of medical assistance to the troops of the Caucasian Front, requiring special urgency and unprecedented work from the American specialists in Khoy. Throughout the period under review, anti-epidemic, clinical, evacuation and charitable activities predominated the detachment’s work. Doctors and nurses of the detachment risked their lives in performing their duties during typhus epidemics. It is noted that in addition to American doctors and nurses, Russian doctors and nurses worked at the hospital.

© Nikolay N. Krylov, Aftandil V. Alekberzade, Elena A. Piatenko. The eponym is a part of the nomenclature of medicine. In 1848, R. Virchow described the enlarged left supraclavicular lymph node (Virchow's node), which he uncovered by physical examination. He believed that such lymphadenopathy occurs in cases of stomach cancer (less often – with lung cancer), when the metastatic process spreads up the thoracic duct to the left supraclavicular fossa. He described the pathogenesis of this trait and proved its malignant nature. Russian authors, apparently, borrowed this eponym from German textbooks on medicine. In 1886, Troisier added to Virchow’s insights and presented a detailed substantiation for the increase in the size of the left supraclavicular lymph node. Troisier described its typical location above the middle third of the clavicle behind the clavicular portion of the sternocleidomastoid muscle. He considered this enlargement as a direct sign of the existence of a neoplasm in the abdominal cavity or in the pelvic cavity, breast cancer, tuberculosis, and syphilis. In his opinion, identifying a diseased lymph node by physical examination does not indicate the exact location of the primary focus of the tumor, but will direct the diagnostic search in the right direction. Palpable lymph nodes in the supraclavicular fossa (Troisier-Virchow), as a rule, indicate a malignant nature. If the lymph node enlargement is due to tumor emboli in cases of stomach cancer, it should be referred to as Virchow’s metastasis. Troisier’s symptom can be detected due to the metastasizing of cancer of other abdominal organs and the small pelvis, lung, breast, esophagus and tuberculosis lesions.

© Sergey D. Batoev. The government’s incorporation of the vast territory of the Transbaikal region did not initially involve broad socio-economic development of this region. Gradually, it became clearly understood that for the successful development of the economically advantageous territory it was necessary to solve a number of issues related to the organization of public health care, in particular for women and children. Military and economic measures alone would not ensure the social wellbeing of both the indigenous population and Transbaikal’s new arrivals. The indigenous population,s traditional way of life, the confessional differences between those living in the territory and the severe climatic and geographic conditions slowed the spread of public medicine in this region. The constant shortage of qualified medical personnel, the small number of medical institutions and serious financial difficulties exacerbated the difficult situation. The first measures taken in the social policy field concerned the foundation of the Irkutsk Order of Public Charity in March 1784, but they were not successful in any serious way. State medical care remained inaccessible, therefore the population continued to mainly use folk and Tibetan medicine methods. A definite turning point was observed in the middle of the 19th century. It was then that the first children’s shelters, and the first obstetric institutions for female prisoners appeared. However, it was only at the beginning of the 20th century that obstetric and gynecological hospital beds were introduced in the city hospital in the regional center in Chita. The author of the article notes that for two centuries, during which the territory of Transbaikal was part of the Russian Empire, there were some positive changes in the provision of medical care, including medical care for women and children. Significant financial investment and highly qualified personnel were required for the development of medicine in pre-revolutionary Transbaikal. Attempts by society, including medical organizations, to influence the existing system of medical care without a legislative base and corresponding government support were doomed to failure. There was a need for a radical transformation of health care, including in the field of women’s and children’s health.