Репозиторий Университета

© 2018 State Research Center, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. All rights reserved. Purpose: To increase the effectiveness and quality of surgery treatment for patients with early stages of breast cancer. Material and methods: Since 2016, 25 patients with breast cancer were examined and went through surgery. A lymphotropic colloidal radiopharmaceutical labeled with 99mTc was used; it was administered (150 MBq) the day before the operation. 20 patients received this injection intradermally into periareolar zone, 4 patients received it peritumourally (under control of ultrasound), 1 - paratumorally. Lymphoscintigraphy was performed 3 hours after injection, the images were acquired using dualhead gamma camera Symbia E (Siemens, Germany). A static multiplanar imaging (scintigraphy) (anterior, posterior, lateral projections) was performed for the sentinel nodes (SN) mapping. 25 planar examinations were performed. In 3 cases additional SPECT/CT study was performed using a hybrid SPECT/CT Symbia T2 (Siemens, Germany). Surgical intervention was done on the next day after scintigraphy. During the surgery the handheld gamma probe NEO 2000 (Johnson & Johnson, USA) was used to localize radioactivity. The lymph nodes with the highest count (hot lymph nodes) were removed and sent for immediate histological examination. The results of immediate histological examination were evaluated again during next studies of gross specimen and slides. Results: During scintigraphy studies planar and SPECT/CT, 26 SN were detected in 20 women (80 %). In 15 patients only one SN lymph node was found, in 4 patients - 2, and in one case 3 SN were found. Intraoperative search of SN and immediate histological examination was conducted in 22 cases, 33 SN were found, while during planar scintigraphy only 26. In three cases, after histological examination (after obtaining examination results), patient surveillance was changed, these patients did not undergo through intraoperative radiometry and a decision was to conduct a onestage mastectomy with regional lymphadenectomy. 10 out of 22 patients which underwent intraoperative radiometry and sentinel node biopsy, with immediate histological examination had metastases in the removed nodes, therefore lymphadenectomy had been performed. In the rest 12 patients after immediate histological examination of SN no evidence of tumor growth was found, thus lymphadenectomy was not performed. In case of three patients which did not undergo through intraoperative radiometry, lymphadenectomy was performed and after histological examination only two patients had tumorinvolved SN, and one patient was clear. All intraoperative results were confirmed with next followup histological examinations. In 5 out of 25 patients (20 %) sentinel nodes were not founded. In these 5 cases during follow up period metastases were found in regional lymph nodes, and one patient had tumor emboli in lymphatic vessels, this considered being the cause of negative scintigraphy result. In 12 cases out of 25 (48 %) it was possible to minimize surgical management, and 13 (52 %) undergo lymphadenectomy. Conclusion: 1) The integration of SPECT/CT method of sentinel nodes search allows to plan an optimal surgical management, and can positively affect the longterm followup result of treatment of patients with breast cancer, and improve the quality of life. 2) The sensitivity and positive prognostic value (PPV) of planar scintigraphy and intraoperative radiometry of searching for SN are 80, 100 and 73.3, 100 %, respectively. 3) Thanks to the method of lymphoscintigraphy, 12 (48 %) of 25 women it was possible to minimize surgical management without lymphadenectomy.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Spinal cord injury (SCI) is a devastating condition that affects mostly young and active individuals but also impacts their family members and results in significant challenges for medical care and social integration. In addition to obvious motor impairment (tetraplegia/paraplegia), these individuals also suffer from a variety of less obvious but devastating autonomic nervous system dysfunctions that negatively impact their health and affect various aspects of daily living. Physical training and sports are essential components of rehabilitation and leaser activities for people with disabilities. Number of individuals with SCI who run an active lifestyle is increasing. Physical activity puts an additional stress on various organs and body systems. The presented manuscript describes in detail cardiovascular dysfunctions in physically active individuals with a SCI, including those engaged in Paralympic sports: low resting blood pressure, orthostatic hypotension, arrhythmias, and the phenomenon of «autonomic dysreflexia». We also address issues related to self-induced episodes of autonomic dysreflexia in order to improve athletic performance ― a phenomenon known as «boosting». Boosting may improve sports performance in short term but is associated with the risk of serious cardiovascular disorders and even sudden death. This practice is considered as anti-doping rule violation by the International Paralympic Committee and thus prohibited. Understanding of the changes occurring in the body of a physically active individual after SCI is necessary for general practitioners, neurologists, rehabilitation specialists, sports medicine physicians, as well as for specialists of adapted physical education and sports.

© 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. Anthropogenic physical, chemical, and biological impacts of objects on living organisms in the environment lead to profound structural and functional disorders primarily in the evolutionary current microbiocenosеs of a human. This is often accompanied by a deterioration in his health, an increase in the risk of infectious, chronic metabolic and mental diseases, which eventually can put a question for not only the preservation on our planet but also the entire existing diversity of living organisms. The development of cryobiotechnology and the creation of cryobanks of different directions is a common global trend in the development of Biological, Medical, Agricultural and Environmental Sciences. The advantage of the proposed technique of cryopreservation of symbiotic microbial associations is the storage of the biomaterials taken from the people will be carried out in an atmosphere of liquid nitrogen (-196°C) for the long-term storage. Fundamental and applied research on cryopreservation of microbiota of different human biotopes has a social orientation because they are directly related to human ecology and health of the nation.

© 2018 Stolichnaya Izdatelskaya Kompaniya. Синдром такоцубо - это остро развивающаяся и, как правило, обратимая дисфункция миокарда левого желудочка. Наиболее часто синдром такоцубо проявляется локальной гипокинезией апикальных сегментов миокарда левого желудочка в ответ на эмоциональные или физические триггеры. Синдром такоцубо составляет около 2% от всех госпитализаций с подозрением на острый коронарный синдром. Диагностика синдрома такоцубо остается затруднительной. Клиническая картина острой фазы синдрома такоцубо зачастую не отличима от симптомов острого коронарного синдрома с подъемом или без подъема сегмента ST. Заболевание также сопровождается повышением маркеров по- вреждения миокарда, которое, однако, отличается от такового у пациентов с инфарктом миокарда с подъемом сегмента ST. Наиболее рас- пространенными для постановки диагноза являются модифицированные критерии клиники Mayo. Патогенез заболевания также мало изучен и представлен различными теориями, в которых главную роль играют катехоламины и их воздействие на миокард. На основании описанных семейных случаев синдрома такоцубо нельзя исключить генетическую предрасположенность к развитию заболевания. Несмотря на обратимую дисфункцию миокарда, почти в половине случаев синдром такоцубо осложняется развитием острой сердечной недостаточности, а госпитальная летальность сопоставима с таковой при инфаркте миокарда с подъемом сегмента ST. Вопрос о лечении синдрома такоцубо на сегодняшний день малоизучен. Проспективных клинических исследований каких-либо препаратов не проводилось. Считается, что тактика ведения пациентов с синдромом такоцубо, госпитализированных с подозрением на острый коронарный синдром, должна соответ- ствовать протоколу ведения больных с инфарктом миокарда, пока острая коронарная патология не исключена. На сегодняшний день забо- левание требует дальнейшего изучения.

© 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.

© 2018 Stolichnaya Izdatelskaya Kompaniya. Цель. Изучить влияние ожирения в детском и зрелом возрасте на показатели артериальной жесткости, центрального аортального давления в популяционной выборке мужчин 42-43 лет. Материал и методы. Представленное исследование является частью 32-летнего проспективного, когортного наблюдения за лицами мужского пола, начиная с детского возраста (11-12 лет). Через 32 года обследованы 303 (30,1%) представителя исходной популяционной выборки - 1005 человек. В анализ включены 290 человек. Средний возраст мужчин на момент настоящего обследования составил 42,9 лет. Обследование включало опрос по стандартной анкете, измерение антропометрических показателей, артериального давления (АД), подсчет пульса. Измерение жесткости артериальной стенки и центрального давления проводилось методом аппланационной тонометрии. Результаты. Согласно нашим данным из 290 мужчин в возрасте 43 лет только 95 (32,8%) имеют нормальную массу тела (МТ), у 111 (38,3%) выявлена избыточная МТ (ИМТ), а у 84 (28,9%) - ожирение (ОЖ). Мужчины с ОЖ и ИМТ во взрослом возрасте имели статистически значимую ИМТ уже в детском возрасте. Центральное аортальное АД (ЦАД) как суррогатный показатель жесткости сосудов было статистически значимо выше в группах с ОЖ и ИМТ. Корреляционный анализ выявил статистически значимую положительную взаимосвязь между показа- телями, характеризующими ОЖ в детском возрасте (индекс Кетле, толщина кожных складок), и уровнем АД в детском возрасте. Имеется по- ложительная корреляция между толщиной кожных складок в детстве с ЦАД во взрослом возрасте, а также слабая положительная связь между периферическим систолическим АД (пСАД) в детстве и центральным систолическим АД (цСАД) во взрослом возрасте. Из потенци- альных предикторов, оцененных в возрасте 12 лет и включенных в регрессионную модель, только толщина кожной складки под лопаткой (КСЛ) оказывает влияние на значение цСАД в возрасте 43 лет. С увеличением толщины КСЛ в детском возрасте на 1 мм связано повышение цСАД во взрослом состоянии на 0,4 мм.рт.ст. Среди предикторов, оцененных во взрослом возрасте, статистически значимое влияние на уровень цСАД оказывают пСАД, периферическое диастолическое АД (пДАД) и индекс Кетле. На значение центрального диастолического АД (цДАД) в возрасте 43 лет оказывает влияние толщина кожной складки на животе в 12-летнем возрасте. Среди потенциальных предикторов, оцененных во взрослом возрасте, статистически значимое влияние на уровень цДАД оказывают пДАД, показатели ожирения. Заключение. Во взрослом возрасте центральное аортальное давление максимально зависит от повышения периферического АД и показа- телей, характеризующих ожирение. Из детских предикторов (12-летнего возраста) значение имело только ожирение.

© 2018 Stolichnaya Izdatelskaya Kompaniya. В последние годы наблюдается очевидная тенденция увеличения в популяции числа пожилых больных. Эти пациенты в большинстве случаев страдают несколькими коморбидными заболеваниями, что значительно утяжеляет прогноз и усложняет тактику ведения. Представлен клинический случай пожилой пациентки, длительное время страдающей сахарным диабетом 2 типа, получающей инсулинотерапию, нахо- дящейся на программном гемодиализе из-за терминальной хронической почечной недостаточности, а также имеющей постоянную форму фибрилляции предсердий. Пациентка была госпитализирована в ГКБ №1 им Н.И. Пирогова по поводу острого повторного инфаркта миокарда. Проведено экстренное чрескожное коронарное вмешательство, стентирование инфаркт-зависимой артерии стентом с лекарст- венным покрытием. Послеоперационный период осложнился развитием острой кровопотери на фоне кровотечения из верхних отделов желудочно-кишечного тракта, тяжелой анемии сочетанного генеза (постгеморрагической, нефрогенной), что потребовало от врачей принятия нестандартных решений по выбору антитромботической терапии. Данный клинический случай иллюстрирует сложности ведения пожилых полиморбидных пациентов в реальной клинической практике, и спорные вопросы, возникающие при назначении им антитромботической терапии, особенно, после развившегося кровотечения. Рекомендательные документы не могут дать ответ на все вопросы, которые ставит перед врачом повседневная практика. В каждом конкретном случае возобновление антитромботической терапии и ее оптимальный выбор для пожилого полиморбидного пациента с развившимся кровотечением является предметом дискуссии, и представляет для лечащего врача настоящий вызов.

© 2018 GEOTAR-Media Publishing Group. Yessotoxin and its derivatives (about 90) are isolated from algae belonging to the species Protoceratium reticulatum, Gonyaulax cf. Spinifera, Lingulodinium polyedrum and from invertebrate organisms that feed on these algae. Previously yessotoxin have been associated with the group of diarrheal toxins. Later studies of the possible impact of yessotoxin on the activity of alkaline phosphatase allowed to exclude them from this group. Yessotoxin causes a violation of calcium entry in the cells, which, in turn, effects the calcium-calmodulin system and thus influences into homeostasis of the organism as a whole. It was shown that yessotoxin induces a biphasic change in the concentration of adenosine monophosphate, an initial increase with a subsequent relative decrease, within some minutes after adding the toxin to the lymphocytes cell culture. Yessotoxin has effects on immune system; which is manifested in an increase of cytokines level, by inducing the expression of the genes encoding them. Yessotoxin have impact into processes of cell adhesion via E-cadherin and, thus, could be an important factor in the development of Alzheimer's disease. It has been established that yessotoxin caused the development of apoptosis. In those cases all three mechanisms of cell death took place - apoptosis, paraptosis and autophagy. Yessotoxin's acute toxicity doses according to different data are from 100 to 500-750 μg per 1kg of body weight. Yessotoxin's acute reference dose (ARfD) - 25 μg/kg of body weight per day. The results of the analysis of yessotoxin level in shellfish meat showed that none of the studied samples contained more than 3.75 mg yessotoxin equivalents/kg shellfish meat. This level has been adopted by the European Union as the maximum acceptable level of yessotoxin in shellfish meat (EU Regulation N 786/2013). Presented data on the mechanism of action, toxicity and prevalence of yessotoxins make it necessary to establish regulations of their content in seafood, placed on the markets of the Eurasian Economic Union.

© 2018, Media Sphera Publishing Group. All rights reserved. Arterial aneurysms of the A2 segment are very rare (<1%) peripheral aneurysms of the anterior cerebral artery (ACA) territory. Usually, these are saccular aneurysms; there are single reports of fusiform aneurysms of this location. Surgical treatment of these aneurysms involves both microsurgical and endovascular interventions. In the presented case, we used deconstructive surgery (proximal clipping of the aneurysm) with intraoperative awakening of the patient, which verified sufficient collateral blood flow. In the case of focal deficit development, we planned to simultaneously perform an interarterial anastomosis between the A3 segments of the right and left ACAs.

© 2018, Media Sphera Publishing Group. All rights reserved. Aim — the study purpose was to analyze the efficacy of intra-arterial administration of verapamil (IAV) in the treatment of angiospasm in SAH patients and to determine optimal parameters of the procedure. A number of studies demonstrated the efficacy of intra-arterial administration of vasodilators, in particular verapamil, in the treatment of angiospasm after aneurysmal SAH, which served the basis for inclusion of this method in the recommended protocol for treatment of SAH patients [1―7]. Material and methods. We analyzed the efficacy of IAV in 35 patients in the acute period of SAH, with 77.2% of the patients having a Hunt-Hess score of III―V. The inclusion criteria were as follows: IAV within two weeks after SAH; excluded aneurysm; verapamil dose per administration of at least 15 mg; follow-up for at least three months. Efficacy endpoints were as follows: changes in spasm according to angiography and transcranial dopplerography (TCDG); development of ischemic lesions; clinical outcome according to the modified Rankin scale. Results. A total of 76 IAV procedures were performed. The verapamil dose per procedure was 36.7±9.7 mg, on average; the number of procedures varied from 1 to 5. One arterial territory was treated in 12 cases, two arterial territories were treated in 48 cases, and three arterial territories were treated in 15 cases. Typical adverse reactions included decreased blood pressure, a reduced heart rate, and elevated ICP. In all cases, TCDG revealed signs of reduced angiospasm ― a 20―40% decrease in the LBFV in the M1 MCA. Four (11.4%) patients died; of these, only one died due to angiospasm progression. On examination at 3 months or more after discharge, favorable outcomes were observed in 74.3% of cases. Conclusion. IAV is associated with a low risk of significant complications. IAV should be performed under control of systemic hemodynamics and ICP. The indications for IAV include signs of moderate worsening or severe angiospasm according to TCDG and/or angiography. The IAV procedure may be performed every day. Further clarification of the IAV procedure and evaluation of clinical outcomes under prospective study conditions are required.

© 2018 Media Sphera Publishing Group. All rights reserved. The review analyzes the main etiological and pathogenetic mechanisms of the development of NSAID-enteropathy. Particular attention is paid to the role of intestinal microbiota in the manifestation and progression of NSAID-enteropathy. The special role of probiotics in the prevention and treatment of NSAIDs enteropathy is considered.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The main reason of surgical treatment failure in cases of chronic dacryocystitis concurrent with nasolacrimal duct obliteration is scarring of the newly created ostium. This outcome is caused by the continued activity of myofibroblasts that leads to the formation of a rough scar. Mitomycin C is currently considered to be the most preferred anti-fibrotic drug. Nonetheless, contradictory evidence of the drug efficiency stimulates further research for finding alternative anti-fibro-tic therapeutics. Recently, several advances were made in developing new anti-fibrotic drugs, including monoclonal antibodies, small RNA molecules, and other gene therapy formulations, nanoparticles and small-molecule therapeutics. This review article aims to provide up-to-date information on the efficacy of mentioned agents and on prospects of their use in dacryology.

© 2018 Journal of Pharmaceutical Negative Results. Objective: The objective was to compare the complex formation of flavones (luteolin, apigenin), flavonols (morin, quercetin, and rutin), flavanones (naringenin), flavanonols (dihydroquercetin), caffeic, and ferulic acids with aluminum ion using two spectrophotometric methods and the application of these methods to estimate the flavonoid content in the angionorm herbal product. Materials and Methods: Method 1 included direct complex formation with aluminum chloride, and Method 2 involved preliminary nitrozation and subsequent complex formation of nitroso-derivatives with aluminum chloride. 2,4-dinitrophenylhydrazine method was also tested. Results: The conjugation system increase in the chromophore structure of nitroso derivatives is reflected by the hyperchromic effect of all substances (from 1.4 to 4-fold). The largest bathochromic shift of nitroso derivatives was seen for rutin, luteolin, and dihydroquercetin (to 510-530 nm). The total flavonoids estimation in the extract of the four herbs mixture, which constitute angionorm preparation active ingredient, depends on the chosen reference substance (3.49% calculated as luteolin when measured by Method 1 or 8.71% by Method 2; 7.97% calculated as dihydroquercetin when measured by Method 1 and 4.14% by Method 2. Conclusion: The complex formation according to Methods 1 and 2 does not allow the identification of the selective spectral regions typical for the certain flavonoids subgroups and hydroxycinnamic acids. Neither method of complex formation is suitable for the assay of total flavonoids in unknown samples or for the flavonoid content comparison in the different herbal material.

© 2018 Izdatel'stvo Meditsina. All rights reserved. This review article considers the modern notions about glucocorticoid hormones. Particular attention is paid to their molecular mechanisms of action, with emphasis on the importance of studying new compounds of the group of selective modulators of glucocorticoid receptors.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To establish the character of haemodynamic disorders in the fetoplacental complex taking into account blood rheological properties, severity of systemic inflammatory response syndrome and to offer a pathogenetic rationale for terms that would be optimal for treatment of placental dysfunction in pregnant women with influenza. Patients and methods: 114 pregnant women with influenza were examined, of them 35 with moderate, 79 with severe flu. In order to rule out the variability of parameters reflecting the state of the fetoplacental complex all women were at comparable terms of gestation (20-30 wks). Results: We have found a relation between the severity of influenza, increased blood viscosity and the development of haemodynamic disorders in the fetoplacental complex. In moderate flu, fetoplacental blood circulation practically does not suffer. Resistivity index (RI), pulsatility index (PI) and systolic/diastolic (S/D) ratio remain within control values. In severe influenza, blood viscosity significantly increases and uteroplacental blood flow exhibits significant impairment. Against the background of increased blood viscosity on the average by 15-20%, taking into account the shear rate, RI, PI and S/D ratio values increase by 25-30%, which is indicative of the signs of impaired blood circulation. In increased blood viscosity at low shear rates it is uteroplacental blood flow that suffers predominantly, without involving fetoplacental one. Conclusion: In severe influenza, the contingency of placental hemodynamics on the maternal and fetal sides is impaired, and increased blood viscosity is to a great extent the cause of these disorders.

© 2018 Dynasty Publishing House. All rights reserved. The objective: The purpose of the study is to establish the role of infection with herpes simplex viruses type I and II in the pathogenesis of urogenital infection in pregnant women. Patients and methods: 89 patients of I, II trimester gestation, aged 18 to 35 years (average age of 27.5 ± 5.6 years) were examined. The design of the research and the methodology of verification of the UGI pathogens of pregnant women are presented in previously published materials. The establishment of character of pregnancy course (urgent delivery, premature birth, termination of pregnancy and mis-carriage), the presence or absence of infection and/or clinical manifestations of infectious and inflam-matory diseases, as well as evaluating the gene expression of TLR-2, TLR-3, TLR-4, TLR-8 (in relative units - RU) was conducted according to manuals. Results: It is established, that in UGI in pregnant combined viral-bacterial infection is registered. Viral component of UGI pathogens in pregnant women is presented by the association of viruses from the Herpesviridae family - herpes simplex viruses, Cytomega-lovirus, Epstein-Bar virus. Against the background of polyfactorial mechanisms of the pathogenesis of abortion, extra maximum activation of gene expression of TLR (22-23 RU or more) additional external factors, for example, infections can be an aggravating pathogenetic factor of miscarriage. Reduced expression of genes of TLR2, TLR4, TLR3 and TLR8 in the mucous membrane of the cervical canal in UGI of pregnant women in infection with herpes simplex virus due to the oppressive effect of pregnancy on the reaction of TLR, combined with the immunodepressive effect of the virus itself. With the violation of cellular part of immuno-logical reactivity of the body under the influence of adverse endogenous and exogenous factors on the process of pregnancy is activated the infectious process caused by the bacte-rial-viral pathogens association, which is accompanied by hyper reaction and increased reaction from the expression of genes of TLR, determines the pathological development of pregnancy. It is established that in the UGI of pregnant gene expression levels of TLR2-21.2 and above, TLR4-23.0 and above, TLR8 - 26.0 and above (the level of gene expression of TLR8 above 28 is the predictor of the onset of abortion and miscarriage) testify to the acute infectious process with the clinical manifestations of the UGI, and also indicates the possible interruption of pregnancy and miscarriage; levels of gene expression of TLR2 below 21.2, TLR4 below 23.0, TLR8 below 26.0, in-dicated a decrease in the severity of the infectious process and its chronicity, as well as the possibility of direct microbial damage to the tissues of UGT, placenta, and fetus. Conclusion: Verified in preg-nant women in 61% of cases clinical manifestations of the infectious process are necessarily associated with the verification of the association of herpes simplex viruses I and II type - triggers of infectious process deterioration, determining the prognosis and outcome of the development of the UGI in preg-nant.

© 2018 Blackwell Publishing Ltd. All rights reserved. AIMS: On the basis of echocardiography to evaluate the thickness of epicardial fat (TEF) in patients with metabolic syndrome (MS) and to establish a connection with the main indicators of laboratory and instrumental methods of research. MATERIALS AND METHODS: The study included 76 patients, 43 patients with MS and 33 without MS.The average age of patients in the MS group at the time of inclusion in the study was 62.7±10.3 years in the control group (without MS) - 60±14.7 years. All patients underwent a comprehensive examination that included the collection of complaints, study of history, physical examination, anthropometric measurements, laboratory (including the study of the levels of caspase - 8, leptin in blood plasma enzyme-linked immunosorbent assay using kits «Platinum ELISA») and instrumental examination (echocardiography, ultrasound examination of organs of small pelvis). TEF was determined using transthoracic echocardiography on the machine Acuson Sequoia 512. RESULTS: According transthoracic echocardiography was significantly higher in the group of patients with MS and was 4.67±1.7 mm, as compared to 2.66+1.15 mm in the control group (p<0.001). Identified moderate and strong correlation between TEF and weight of the patients, waist circumference, ratio of waist circumference to hip circumference, body mass index, glucose levels in the blood plasma, the presence of diabetes mellitus type 2, ultrasonic signs of steatosis of the liver and pancreas, increased aminotransferases, the level of caspase-8 concentration in plasma leptin. Patients the MS group with increased TEF increases the risk of developing hypertension, ischemic heart disease, left ventricular hypertrophy, diastolic dysfunction of the left ventricle type 2, level of caspase-8 and concentration in plasma leptin. CONCLUSION: Based on the obtained data, the measurement of TEF is justified in patients with MS in everyday clinical practice. The correlations between theTEF and the clinical and metabolic parameters of the CVD and MS make it possible to consider the TEF as a new marker of the risk of developing MS and cardiovascular diseases.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. A calcium deficiency is detected in more than 80% of children. This is the result of inadequate consumption of milk and dairy products which are the main food sources of calcium. There is a correlation between deficiency of calcium intake with food in childhood and the risk of osteopenia and osteoporosis in subsequent life periods. With insufficient exogenous intake of calcium, its concentration in the blood decreases which stimulates bone resorption. The factors that further limit the consumption of dairy products are lactase deficiency and cow's milk protein allergy. In order to ensure the intake of the necessary amount of calcium, it is advisable to use vitaminmineral complexes in children that contain not only a sufficient amount of calcium and Vitamin D but also other micronutrients required for bone formation.