Репозиторий Университета

© 2018 Stolichnaya Izdatelskaya Kompaniya. Hypertensive heart disease with biventricular cardiac failure is not common in clinical practice. This diagnosis requires an extensive diagnostic search. We present the clinical case of the male patient of 38 aged. He was admitted to the clinic with heart failure 3-4 NYHA class. EchoCG revealed symmetric hypertrophy of the left ventricle up to 18 mm without its dilatation, a decrease in ejection fraction up to 42%, restrictive hemodynamics, overload of the right chambers, severe pulmonary hypertension (60 mm Hg). The clinical status included persistent arterial hypertension (180-220 and 120-150 mm Hg), effusion in both pleural cavities and pericardium, ascites, renal failure. During examination (multispiral computed tomography, magnetic resonance imaging, scintigraphy with 131I-MIBG), bladder paraganglioma was diagnosed (normatenafrin 1468 μg/day). The resection of the tumor was performed, according to immunohistochemical research - neuroendocrine carcinoma, G1. After 3 months a partial regression of hypertension and cardiac failure was observed with the preservation of a high level of creatinine. The criteria and differential diagnosis of the hypertensive heart disease and the syndrome of primary myocardial hypertrophy, diagnostics of the urinary bladder paraganglioma, complex mechanisms of myocardial damage within the pheochromocytoma and its prognosis are discussed..

© 2018 Stolichnaya Izdatelskaya Kompaniya. Acute myocardial infarction (AMI) is one of the main causes of morbidity and mortality, both in the Russian Federation and around the world. Approximately, in up to 10% of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of coronary artery disease. These patients constitute an intriguing subgroup referred to as "Myocardial Infarction with Non-Obstructive Coronary Arteries" (MINOCA). MINOCA is a collective concept that unites many different pathologies, which determines the essential heterogeneity of the etiological factors. Coronary artery embolism is recognized as an important non-atherosclerotic cause of AMI. In turn, the most common underlying disease in those with coronary embolism is the atrial fibrillation. The advantages of reperfusion strategy and cardioprotective therapy in the treatment of obstructive arteriosclerosis are well studied, widely presented in the literature and supported by a strong evidence base, while the issues of diagnosis and treatment of patients with MINOCA are currently widely discussed We present two clinical cases of embolic myocardial infarction in patients with atrial fibrillation, diagnosed in our clinic in 2017..

© 2018 Ekaterina Vladimirovna Silina, Mukimdjon Ahmadzhonovich Sobirovz, Sergey Brankovich Bolevich and Aleksandrovich Stupin. The main aim of the study was to determine ways of improving the results of treating patients with ulcer bleeding of various nature and severity. It was provided by the system study of free radical processes and evaluation of the effectiveness of timely antioxidant therapy. Material and methods. The study included 153 patients aged 18-94 years with acute and chronic gastric and duodenal ulcers complicated by gastroduodenal bleeding. Patients were divided into two groups: group I (experimental group) included 62 patients who received antioxidative therapy with reamberin as a part of the basic therapy; and group II (control group) included 91 patients who received standard therapy. Various parameters of Free Radical Processes (FRP) were studied in dynamics in all patients. Results. We revealed the significance of oxidative stress on the first day of hospitalization in patients with gastrointestinal ulcerous bleeding of various character and severity. It was discovered mostly in severe patients with acute Gastroduodenal Ulcerous Bleeding (GDUB). In case of mild gastrointestinal ulcerous bleeding, oxidative stress disorders affected an oxygen stage of oxidative stress and represented themselves adaptive compensatory mechanisms. As the severity of the disease increased, intensification of an oxidant stress was manifested by a decrease in oxygen activity and an increase in lipid imbalance. Imbalance in free radical processes continued for a long time until discharge of patients from the hospital. The data obtained claimed to be the basis for recommendation to include antioxidant energy-conserving therapy in the complex of therapeutic measures in the earliest possible terms. We found out an efficacy of using succinic acid therapy with reamberin in patients with gastrointestinal bleeding. Positive effect of succinic acid on the markers of oxidative stress was confirmed by improvement in the disease pattern and success of the treatment.

© JPES. The relevance of the study is explained by the fact that despite the numerous available health-training programs for body weight loss, there is still need for development of new forms of physical training and ways of motivation. The objective of the present study is to evaluate the efficiency of dance therapy for body weight loss and improvement of physiological and functional state in young women with overweight. Materials and Methods. The study enrolled 82 students from Sechenov University with overweight and first-degree obesity. Forty two girls took exercises within individual health-training programs for 9 months. The programs were based on aerobic activity, including dance therapy. Forty students were engaged in physical training within the curriculum of the university. Before, during and after the training course the authors evaluated the components of body composition; functional state and psycho-emotional status. Results. The final tests showed significant excessive body weight loss in students in the main group due to fat mass reduction by 20%; increase of physical performance by 24.5%; self-confidence level growth by 24%. Conclusion: The results of the study confirmed that dance therapy is an effective type of physical training with high motivational component for excessive body weight loss in young women. This fact is proved by significant positive dynamics of the majority of morphofunctional and psychological parameters in students in the main. The materials of the article are of practical value for specialists in physical rehabilitation, general practice doctors, PT tutors and advisors on healthy way of life and public health.

© 2018 Dynasty Publishing House. All rights reserved. The objective. To offer a characteristic of phenotypes of atopic bronchial asthma (BA) in children according to the level physical health (LPH). Patients and methods. Our observation included 359 children aged 4 - 14 years with atopic BA. We performed a questionnaire survey among parents, studied medical histories and took anthropometric parameters. The parameters of respiratory, muscular and cardiovascular systems, and LPH according to the method by G.L.Apanasenko (1992) were determined. Results. Using multiple factor analysis with the principal component method we selected parameters that characterize the level of physical health in BA: values of external respiratory function - ERF (VC, FEV1), hand muscle strength (HMS), body mass index (BMI), vital index (VI), Robinson index (IRob), muscular endurance (ME). In BA with low LPH no patient has full control over disease. Overweight is recorded in 37.9% of them, lower ERF parameters in 33.3%, lower HMS in 87.9%, deviations on the part of the cardiovascular system in 80.3%. In BA with higher LPH, full control over diseases is observed in almost half of children (48.7%), harmonious physical development - in 87.1% of cases. Parameters of ERF, muscular and cardiovascular system corresponded to the norm in 92.3; 61.5 and 100% of patients, respectively. Children with BA with average LPH take the intermediate position between these two groups. Conclusion. Physical health should be regarded as a factor of retaining control over BA. Phenotype determination according to the level of physical health and degree of disease control permits to personify rehabilitation programmes for children with atopic bronchial asthma.

© 2018 Russian Academy of Medical Sciences. All rights reserved. The aim of the study was to investigate the hepatoprotective activity of an aqueous extract of Caragana jubata (Pall.) Poir. Acute experimental hepatitis was induced by acetaminophen administration of 1000 mg/kg. Studies were conducted in white Wistar rats. The aqueous extract of C. jubata demonstrated the hepatoprotective effect, comparable to that of the reference preparation "Carcil". This was manifested by the normalization of biochemical blood parameters (ALT, AST, alkaline phosphatase, cholesterol, total bilirubin) and antioxidant activity of liver homogenates, determined by the method based on oxidation of luminol induced by 2,2-azo-bis-2-amidinopropane. Normalization of morphofunctional indices was also shown in a histological study of liver of rats that received aqueous extract from C. jubata.

© 2018 Media Sfera. All rights reserved. The anterior capsular contraction syndrome (ACCS) in pseudophakic patients is known to be accompanied by postoperative opacity of anterior lens capsule (ALC) and partial or full closure of anterior capsulotomy opening. Purpose: to perform complex morphological assessment of ALC in patients with ACCS. Material and methods. The study involved complex analysis of ALC that was removed due to ACCS in the pseudophakic eye in the setting of diabetes mellitus and past vitreoretinal surgery. The following examination methods were used: light-optical microscopy of ALC samples in the form of polychrome-colored semifine sections using optical microscope Leica DM-2500 (Germany), scanning microscopy of ALC surface with EVO LS10 (Carl Zeiss, Germany) microscope, analysis of chemical element composition and its variation of the ALC sample with energy-dispersive spectrometer Oxford X-Max50 (Oxford, UK). Results. Light-optical microscopy showed altered state and plication of ALC induced by proliferation from inner surface of the fibrocellular tissue, which gradually thickens (up to 360 µm) towards center and causes reduction of anterior capsulotomy opening. Scanning electron microscopy revealed presence of tissue with uneven micro-relief and a porous three-dimensional structure uncharacteristic for capsule on the surface of ALC. Thickness of the fibrous deposition significantly exceeded the thickness of ALC. Evaluation of elemental composition of the fibrocellular tissue showed elevated concentration of sulfur and phosphorus, which indicates high activity of the regenerative process. In the observed case, the regenerative process was of substitute nature because an attempt to restore the lens was accompanied by formation of connective tissue structurally different from original. Conclusion. Complex assessment of an isolated ALC sample allowed revelation of the chain of pathological processes accompanying the development of ACCS.

© 2018 Media Sphera Publishing Group. All rights reserved. This article reflects the main stages of outpatient care formation in Moscow. It describes the most significant health care and health education reforms in different periods of Russian history. The article stresses the relevance of outpatient service modernization as a priority of Russian health care reform. The dominance of outpatient care and the introduction of a new three-level primary health care system into healthcare practice have demonstrated the optimal scheme of interaction of all Moscow medical institutions. The article shows the importance of consolidating the efforts of the Government of Moscow and Moscow medical universities, and the I.M. Sechenov First Moscow Medical University in particular, to solve the basic issues of prevention, early diagnosis, and treatment of diseases and to achieve the high quality of life in Muscovites.

© 2018 Nutritec. All rights reserved. The results of assessing the sufficiency offolic acid of the residents of the Moscow region have been presented depending on rs1801133 MTHFRgene polymorphism and rs9939609 FTO gene polymorphism. A total of 326 people were examined, including 74 men and 252 women aged 20 to 65 years. The results of determining the level of folic acid in blood serum showed insufficiency of this vitamin among the population of the Moscow region of the Russian Federation. The expressed vitamin deficit (level <3,0 ng/ml) was detected in 24.2% of the surveyed residents, in 22.8% folic acid level was at the lower bound of the norm (3.0-4.5 ng/ml). The results of genotyping showed a statistically significant association of low folic acid level with rs1801133 MTHFR gene polymorphism in carriers of A allele of rs9939609 FTO gene polymorphism both in the homozygous state (genotype AA) and in the heterozygous (genotype AT) state, OR=4.26; CI (1.40-12.9), p=0.008, as well as with rs9939609 FTO gene polymorphism in carriers of the T allele of rs1801133 MTHFR gene polymorphism both in the homozygous (genotype TT) and heterozygous (CTgenotype) state, OR-3.29; CI (1.07-10.1), p=0.03. In carriers of 3 alleles of risk offolic acid deficiency [rs9939609 FTO gene polymorphism and rs1801133 MTHFR gene polymorphism (genotypes CT/AA and TT/AT)] blood serum level of folic acid was below the norm, that indicated folate deficiency in this category of persons.

© 2018 SPIE. A reliable connection of dissected biological tissues is a popular problem in modern surgery. In the last decade, two methods of biological tissues connection using laser radiation have been actively developed: laser-assisted vascular repair (LAVR) and anastomosis (LAVA). These methods make it possible to obtain a weld impenetrable for blood and other biological fluids immediately after the welding. A solder is applied to a welding area. The main characteristic of the weld at LAVA is the tensile strength. A weld should be flexible enough to withstand repeated cycles of alternation of diastolic and systolic pressures. Single-walled and multi-walled carbon nanotubes (SWCNTs and MWCNTs respectively) are used to increase the weld tensile strength. They form a spatial bovine serum albumin (BSA)- nanocarbon scaffold under an action of laser radiation. It in real time varies the power of laser radiation (in the range 0.2- 5 W), which is necessary to stabilize the welding temperature (∼57C). In the present work new compositions of laser solder are proposed and the scheme of the installation for LAVR are offered. The proposed solder is based on an aqueous dispersion of BSA, MWCNTs and SWCNTs, ICG and collagen. The using of the chromophore ICG is due to its absorption maximum corresponding to the wavelength of the diode laser used (∼ 810 nm). The tensile strength was 0.8±0.3 MPa.

© 2018 SPIE. In this work, tissue-engineered structures based on a matrix of protein conjugates, chitosan and carbon nanotubes were prepared and studied. Bovine serum albumin (BSA), bovine collagen (BCrossed D sign¡) were used. Two types of single-walled carbon nanotubes (SWCNTs) were used to form a strong internal scaffold in a protein-chitosan matrix under the action of laser radiation. Tissue-engineered structures were created by means of layered deposition and laser evaporation of the initial aqueous dispersion from SWCNT, BSA, BC and chitosan succinate. As sources of laser radiation, a continuous diode laser with a wavelength of 810 nm and a pulsed fiber laser with a wavelength of 1064 nm and frequency of 80 kHz were used. Studies of tissue-engineered structures were carried out using vibrational spectroscopy methods (IR and Raman). The changes in the frequencies and intensities of the corresponding absorption bands and Raman lines of the amide group oscillations were analyzed. IR spectra of tissue-engineered structures demonstrated a high degree of binding of organic (protein, chitosan) and inorganic (SWCNT) components. The structure and defectiveness of the carbon nanotube scaffold were investigated in the Raman spectra.

© 2018 Media Sphera Publishing Group. All rights reserved. Ependymoma is a central nervous system tumor that grows from ependymal cells lining the cerebral ventricles, central canal of the spinal cord, and filum terminale. Regardless of the histological type of ependymomas, they rarely have exophytic growth. Because of an extremely low occurrence rate of this phenomenon, we present two clinical cases of patients with classical intramedullary ependymomas (Grade II) having an extramedullary component. Material and methods. The paper presents two clinical cases of patients with intramedullary-extramedullary ependymomas of the spinal cord. The surgical technique is described. After surgical treatment, the performance status of patients remained unchanged. Conclusion. Radical removal of complex ependymomas provides conditions for long-term disease-free survival and further neurological recovery.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To assess the possibilities of functional multispiral computed tomography (fMSCT) in orbital tumors. Materials and methods. The patient M, 55 years old, was admitted to ENT doctor with complaints of difficulty in nasal breathing and nasal discharge. After clinical and in-strumental examination, orbital tumor in the posterior part near the oculomotor muscle and optic nerve was found. To clarify the state of the optic nerve and its involvement in the pro-cess, the patient was referred by an ophthalmologist to an additional orbit examination us-ing functional MSCT. Functional MSCT was performed on a multispiral computer tomograph Toshiba Aq-uilion One 640, with slice thickness 0.5 mm, in the soft-tissue mode. During the study, the patient made eye movements from the central position upwards, then down, to the right, to the left, with a return to the central position. The time of functional eye movement study was 7 seconds. Results. During the functional MSCT the optic nerves were symmetrical: the left and right optic nerves with distinct smooth contours have a smooth course and differentiated to the orbital apexes. The movements of the optic nerves were symmetrical, in full volume. Taking into account the results of FMSCT, the tactics of conducting and surgical treatment of the patient was changed due to the lack of connection between the orbit tumor and optic nerve. The patient underwent surgical treatment and removal of left orbit tumor. Histologi-cal examination revealed cavernous hemangioma. Conclusion. Functional MSCT is a new promising method in examining patients with neoplasm of orbit. There is an opportunity to obtain additional diagnostic information on the relationship between orbital bone and soft tissue structures with neoplasms within the preoperative planning and postoperative control.

© 2018 GEOTAR Media. All rights reserved. A monocenter randomized comparative study, based on 96 patients with inguinal hernia, was undertaken. All patients were divided into two groups according to the type of mesh prosthesis that was used in hernioplasty with the Lichtenstein technique: lightweight polyester monofilament mesh Parietex™ and standard monofilament polypropylene mesh Parietene™ (both Covidien, USA). We found out that during early postoperative period the intensity of pain syndrome and local tissue reactions do not fundamentally depend on the type of applied mesh prosthesis. It was concluded that in prosthetic hernioplasty the use of lightweight synthetic materials in stead of standard polypropylene mesh prosthesis leads to a significant reduction of pain intensity and duration, sense of discomfort, minimal limitation of patient activity during a long-term postoperative period.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Comparison of materials used in dental practice for the protection of patients with cancer of maxillofacial region from radiation was compared. Literature has been sought in the SCOPUS, Web of Science, Pubmed, Russian Science Citation Index database. The devices for the prevention of radiation reactions and damage of the oral mucosa, teeth, jaws, salivary glands are made of materials that have low absorption of radiation and have a toxic effect on the structure of oral cavity. It is not enough to protect patients with cancer of maxillofacial region during radiotherapy.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. An X-ray picture of tension pneumopericardium, as a transsternal transpericardial main bronchus stump occlusion complication, not previously seen after this sur-gery, is described. The clinical picture of a tension pneumopericardium and diag-nostic methods applied to determine this condition are reported. Successful elimination of complications in a somatically burdened patient was possible only due to rapid and accu-rate diagnostics of this condition.

© 2018 GEOTAR Media. All rights reserved. We created and tested an experimental model of spontaneous rupture of the esophagus (SRE). The 1st group consisted of live animals (n=5), the 2nd group consisted of dead animals (n=5). In all experiments rupture of the esophageal wall was performed, which with this method of modeling occurred in the lower third of the esophagus in mediamagnatom segment on the left side. The length of the gap ranged from 2.5 to 4.0 cm, the pressure difference of the gap between dead and live animals amounted to 0.2 bar - it means direct influence of the tone of the surrounding tissues and structures on spontaneous rupture of the esophagus. The level of intraluminal pressure wall rupture of the esophagus in live animals is much higher than physiological intraluminal pressure that occurs during vomiting (0.15 to 0.20 bar) and in vivo is not observed. Within experiment we created models of the intraorgan hypertension of the esophagus and stomach, defined intraluminal pressure wall rupture of the esophagus (1.3 bar) and stomach (0.5 bar), and the ratio of the received data with the level of hypertension in the lumen of the esophagus and stomach during vomiting. It is shown that intraluminal pressure that occurs while vomittting, can result in Mallory-Weiss syndrome, however, it is impossible to break the wall of the esophagus at this pressure. SRE is most likely a variant of mechanical damage to the esophagus caused by discoordination of muscle contractions that occur during vomiting.

© 2018 Russian Transplant Society. All rights reserved. Heart transplantation is the gold standard of treatment severe heart failure. Immunosuppressive therapy aimed at the prevention of acute allograft rejection is the cornerstone of post-transplant management. In addition to its direct effects, immunosuppressive therapy is also involved in the generation of a number of post-transplant morbidities that limit the long-term outcome of heart transplant recipients. Given these data it appears that the individual tailoring of immunosuppressive therapy is of paramount importance in determining the outcome of heart transplantation. The goal of immunosuppressive therapy is to prevent rejection of the transplanted heart, while minimizing drug-related effects, such as infection, malignancy, diabetes, hypertension, and renal insuffi ciency. This review aimed is to analyze the protocols for the appointment of immunosuppressive therapy in various groups of recipients after heart transplantation.

© 2018 GEOTAR Media. All rights reserved. The purpose of the study is to develop an accessible method of dynamic control of patients with mechanical jaundice for a practical doctor. Data from 258 medical histories of patients with mechanical jaundice were studied. To solve this problem we used a method for calculating the severity level using a universal statistical program StatSoft Statistica for OS Windows. A mathematical relationship between a degree of possibility of a fatal outcome and the nine significant parameters was developed. As a result of the calculations, such factors as disease duration (days), blood bilirubin, body temperature, blood leucocytosis, pulse rate, patient age, blood creatinine, blood lymphocytes, respiratory rate appeared to be significant parameters in calculating the severity of mechanical jaundice of a particular patient. At the second stage, a multivariate regression analysis was performed, used to assess the degree of influence of various factors on the resulting indicator. A statistical dependence was found on the basis of which a formula combining 9 significant parameters was developed to determine the severity level of a patient based on the degree of influence of each of these factors on the resulting parameter: G = 0,002 (d×b) + 1,2 (t - 36,6) + 0,001 (p×v) + 0,322 (L/1000 - 5) + + 0,22 (16 - Lim) + 0,0085 (K - 60) + 0,165 (Di - 20). The formula took into account the stochastic dependence of the resulting parameter on the factors influencing it. When calculating a correlation analysis was conducted aimed at establishing a stochastic relationship between the parameters and estimating the tightness of the connection between the factors and the resulting index. This method of calculating the severity level can be applied by any surgeon and can accurately monitor the minimum changes in the patient's condition, as well as the effect of individual elements of treatment on the state of the disease.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. The purpose of this clinical observation was to demonstrate an interesting and obvi-ous case of discrepancies in the clinical and radiological and morphological pat-terns of intrathoracic lymph nodes tuberculosis. Correct diagnosis is the key to a correct choice of further treatment of this patient, therefore, it is necessary to keep in mind possible variations and difficulties in establishing the stage of intrathoracic lymph nodes tuberculosis.