Репозиторий Университета

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: To develop a technique for conducting of complex radiology diagnostics in combination with dynamic MSCT-cystureterography in patients with reconstruction of the urogenital area and to study the possibilities of its application in clinical practice. Materials and methods: At the pre and postoperative stages 8 patients were examined by MSCT, from whom all men were presented with such acquired and congenital diseases of the urogenital area as followings: stricture or obliteration of the urethra, as well as hypoplasia of the penis. The age of the patients varied from 33 to 58 years with the average of 43.8 years. The studies were performed by a multispiral computer tomograph Toshiba Aquilion One. This 640-slice computer tomograph has 320 rows of detectors with 0.5 mm wide, which allows the detector to cover the scan zone at 16 cm by one rotation of the X-ray tube. Results: By studying the data obtained in five cases, hypoplasia of the penis was revealed. In three cases urethral obstruction was diagnosed, its cause and localization were determined. At the pre and postoperative stages the anatomy of the donor and recipient vessels was assessed, surgical intervention was planned, and the dynamic MSCT-cystureterography method allowed avoiding invasive examination of the urethra. The MSCT method with intravenous contrasting in combination with dynamic MSCT-cystureterography surpasses the standard X-ray examination, ultrasound method and endoscopic urethroscopy at terms of accuracy and informativeness. In addition, these methods are separated in time and in the implementation techniques and most of them are not physiological. Conclusions: Analyzing the obtained data, we can confidently state that MSCT with intravenous contrast showed its high informative value in the study of donor and recipient vessels, and the combination with dynamic MSCT-cystureterography in order to assess the patient's urethra further increases the informativeness and value of this study. The proven effectiveness of the developed method suggests that it can become routine in examining patients with diseases of the urogenital area.

© 2018 Izdatel'stvo Meditsina. All rights reserved. This article provides a short history of the creation of hypnotics, examines their mechanisms of action, and conducts a comparative analysis of the main groups of hypnotics such as barbiturates, benzodiazepines, "nonbenzodiazepine" benzodiazepine receptor agonists, melatonin receptor agonists, orexin receptor antagonists, histamine H1-receptor antagonists.

The objective of the research was to elaborate experimental-theoretical and clinic-bacteriological rationale for the application of laser diagnostic for identification of main pathogens of purulent-inflammatory processes in maxillofacial area. For germs identification by giant Raman scattering effect SERS-substrate with nano silver metallic balls, reference strains (Ps. aeruginosa 27853 and S. aureus 25923) and clinical cultures of Staphylococcus, Bacillus and Escherichia coli were used. Using an example of purulent inflammation pathogens we considered that each of bacterial species is characterized by individual spectral lines of Raman scattering, which allows to identify them in short term (1-2 min). Moreover the proposed method is highly sensitive (105-106 CFU/ml). Creation of germs library and device portability makes use of laser diagnostic for express-indication purulent infections possible directly in clinical conditions. Thus, analytical capability, quick result, high sensitivity and peculiarity, economical effectiveness due to lack of necessity to use growth medium and to transport it to microbiological lab gives an opportunity to consider laser diagnostic as a perspective universal express-method of clinical microbiology.

© 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 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 Dynasty Publishing House. All rights reserved. The objective: To study the effectiveness and long-term outcomes of sclerotherapy for ovarian endometriomas and to substantiate the conditions and indications for minimally invasive intervention. Patients and methods: We analysed 124 interventions performed by the technique of aspiration (sclerosing) therapy of endometrioid ovarian cysts. The patients' age varied from 18 to 42 years, averaging 26.4 ± 4.2 years. The mean diameter of ovarian endomeriomas varied from 25 to 65 mm. In 84 (67.7%) of observations, pathological process was unilateral, in 72.3% - bilateral. 43 (34.6%) women had disease recurrence after previously performed cystectomy, in 28 (22.6%) endometrioid cysts were located in the only ovary and in 7 (5.6%) patients ultrasonography found that the ovary contralateral to endometrioid tumour was sharply decreased and its sections lacked the signs of antral follicles after preceding cystectomy. In fact, in 35 (28.2%) patients endometrioma was diagnosed in the only ovary. All patients after aspiration therapy of endometriomas received dienogest (2 mg) + ethinylestradiol (0.03 mg) (Siluette®, «Gedeon Richter»). Results: The recurrence rate of endometriomas during the first 12 months of follow-up was 38.7%, during the first 3 months of follow-up this parameter did not exceed 9.7%. Within 7-12 months after intervention spontaneous pregnancy occurred in 36.3% (46) of women, ending with childbirth in all cases (with the use of contraception 25 patients - 46%). Conclusion: Sclerotherapy of ovarian endometriomas with ultrasound monitoring of intervention is a minimally invasive method of treating women of reproductive age, ensuring preservation of ovarian reserve. It is not a monotherapy, its outcome is in many respects determined by the adequacy of postoperative hormonal treatment.

© 2018 Dynasty Publishing House. All rights reserved. Objective: Development and justification of a differentiated approach to diagnosis and treatment of ectopic extratubal pregnancies. Patients and methods: 37 patients with histologically verified diagnosis «Ectopic pregnancy» were examined, in whom the ovum was located outside the uterine tubes. In 26 cases it was cervical pregnancy, in 8 - ovarian pregnancy, and 3 pregnancies within a caesarean scar. Diagnostic and treatment methods: 2D- and 3D-transvaginal echography, including power Doppler sonography; hCG testing in blood and urine, laparoscopy, hysteroresectoscopy. Results: A system of examining and treating patients with rare ectopic pregnancies has been developed, in which step-by-step measures for optimization of diagnostic and therapeutic processes are presented. The main attention is paid to organ-sparing technologies, including metroplasty and intrauterine surgery in caesarean scar ectopic pregnancy, and also intrauterine surgery in cervical pregnancy. Conclusion: The presented system permits to optimize diagnosis and treatment of patients with ectopic extratubal pregnancies with preservation of the reproductive function.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The article discusses issues related to the long-term administration of macrolide antibiotics for a bronchoectatic disorder of the pulmonary system in children. The relevant information about the results of long-term intake of macrolides in adults and children, the effective dose titration, possible toxic effects of therapy, including the development of cardiotoxic effect and ways to prevent it, has been enlightened in detail. It has been noted that a limited number of clinical studies involving children determine the need for studying the possibility to extrapolate adult treatment.

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Perioperative antimicrobial prophylaxis (PAP) involves administration of antimicrobial agents (AMA) to patients undergoing a surgical intervention and aims to reduce the risk of postoperative infectious complications, especially at surgical sites. In the present work we assess efficiency and safety of AMA used for prevention of postoperative infectious complications. In the course of our study we pre-analyzed 576 medical histories of post-op patients aged 18 to 87 years (mean age M ± SD was 57.4 ± 14.5 years), of which 347 (60.2%) were male and 229 (39.8%) female. Only 481 histories were selected for final analysis. We assessed the choice of antibacterial therapy, the frequency of adverse reactions (AR) and infectious complications and the type of the latter. PAP regimens were consistent with the official guidelines in 207 (43.04%) cases. PAP recommendations were ignored in 274 cases (56.96%), and the timing was wrong in 364 cases (75.7%). Incorrect dosages were administered in 225 cases (46.8%). We also discovered an association between irrational PAP regimens and 1) the length of patient's stay in the intensive care unit (p = 0.003 and p < 0.005), 2) the frequency of reoperations associated with infection (p = 0.001), 3) mortality rates (p = 0.002), and 4) isolation of strains with multidrug resistance (p = 0.016). We conclude that PAP regimens for the inpatients of surgical wards are often compromised by failure to comply with the official guidelines, wrong timing and incorrect dosage, which negatively affects hospital statistics.

© 2018 Copyright O. Zolnikova et al. We have reviewed the currently published results on a role of the gut microflora in a prevention of acute respiratory infections. The main biological properties of probiotic bacteria are presented in a context of their modulating activity on an inflammatory immune response. Available data on the reduction of a possible risk, duration, and severity of respiratory infection symptoms during a probiotic medication intake were analyzed. Potential antiviral probiotic mechanisms have been reviewed and discussed.

© 2018 Stavropol State Medical University. All rights reserved. The reactivity of T-cells in a screening cell migration test (SCMT) in vitro in patients with recurrent erysipelas and healthy individuals to immunomodulatory drugs - Derinat, Roncoleukin, Gamma-plant, Leikinferon - have been studied. Significant differences in migratory activity of leucocytes (MAL) in respond to a variety of immunomodulators, depending on their concentration, have been determined. It is assumed that the acceleration of MAL to certain concentrations of studied immunomodulators can be interpreted as an indicator of the "SOS" response, and the introduction of immunomodulators in this period may have a disadvantageous effect on inflammation and the formation of immune response.

© 2018 Ima-Press Publishing House. All Rights Reserved. Objective: to investigate the effectiveness of cognitive and motor training as an additional method to basic therapy in patients with Alzheimer's disease (AD) and vascular cognitive impairment (VCI). Patients and methods: The investigation enrolled 41 patients (15 women and 26 men; mean age. 73.59±6.3 years), including 32 patients with AD (mean age 74.94±5.15 years) and 9 patients with VCI (mean age, 72.31±4.98 years). Cognitive impairment (CI) corresponded to mild dementia in 15 patients (5 women and 10 men; mean age 74.6±2.8 years) and to moderate dementia in 29 (10 women and 19 men; mean age 72.1±3.2 years). The patients were randomly assigned to individual, group, and mixed (individual and then group) cognitive training groups. Quantitative scales were used to assess changes in CI and emotional and behavioral disorders after 1.5, 3, and 6 months of therapy. Results and discussion: During cognitive and motor training, all the groups showed a significant decrease in the severity of CI (p < 0.05), depression, anxiety, and apathy. The effectiveness of the training was further influenced by the severity of concomitant cardiovascular disease, the degree of apathy, adherence to the training, and the early initiation of basic symptomatic therapy. The greatest positive changes in anxiety and depressive disorders were noted in the patients receiving group cognitive and motor training. Conclusion: The results of the investigation allow group cognitive and motor training to be recommended as a mainstay in the therapy of patients with CI concurrent with emotional disorders.

© 2018 Ima-Press Publishing House. All Rights Reserved. The recently discovered glymphatic system (GS) ensures the efficient clearance of interstitialfluid and soluble compounds from the central nervous system into cerebrospinal fluid (CSF), which compensates for the lack of conventional lymphatic vessels in the brain parenchyma. This unique anatomical and physiological phenomenon had been unknown until 2012. GS lacks inherent proper vessels P the cuirent of CSF and interstitial fluid is carried out directly inside the arterial walls (the perivascular pathway) or near the walls of the cerebral arteries and veins (the paravascular pathway). Current biorheological technologies could establish a special role of aquaporin-4 in the filtration of CSF and interstitial fluid. The close link between GS and the CSF circulatoiy system allows the established views on fluid dynamics within the brain to be reconsidered. The discoveiy ofGS can contribute to our understanding of the pathogenesis of increased intracranial pressure and neurodegenerative diseases, as well as to the elaboration of new therapeutic approaches to their treatment.

© 2018, SPb RAACI. The aim of this prospective randomized clinical study was to investigate the role of preoperative carbohydrate admnistration in surgery-induced metabolic, immune and inflammatory reactions after thoracoabdominal operations. At the Surgical department I (B.V. Petrovsky National Research Center of Surgery), we investigated a modulatory role of carbohydrate preload upon surgical stress observed after major thoracoabdominal operations (thoracoscopic and open esophagectomy, retrosternal colonic esophagoplasty) followed by the enhanced recovery protocol. The study was performed in 2014-2017, it included 30 patients, divided into 2 groups. Group A patients (n = 16) received carbohydrates preload (12.5% maltodextrin solution per os or enterally). In patients with dysphagia, the 12.5% dextrose solution was used intravenously in equal volumes. Group B patients didn’t receive any additional preload with carbohydrates. The groups were age- and gender-matched, similar for disease and surgery types. Glucose and insulin levels (with HOMA insulin resistance index, HOMA-IR) were measured before surgery and on day +1, interleukin levels (IL-6, IL-10, IL-8) and index IL-8/IL-10 were assessed before surgery, and on days +1 and +5 after surgery. Cell-mediated immunity was investigated before surgery and on day +5. The stress-induced hyperglycemia (> 7.8 mmol/L) was detected more frequently in group B (50%), than in group A (6%), p = 0.012. Insulin resistance measured by HOMA-IR in group B was detected in 71% of patients and in 25% patients of group A only, p = 0.027. Individual analysis of immune response demonstrated that a trend for immune recovery was detected by the day +5 post-op in the group A. Postoperative levels of IL-6 and IL-10 were lower on day +1 and +5 in group A. Morbidity rates and the terms of hospitalization were similar in both groups. Local postsurgical infections in group A were developed in 6% of the patients vs 35.6% in group B (p = 0.072). In conclusion, a complex study of surgical stress, i.e., metabolic, immune and inflammatory reactions after esophageal surgery has shown that the carbohydrate preload decreased the incidence of postoperative insulin resistance and stress-induced hyperglycemia, being accompanied by lower release of proinflammatory cytokines and provides positive effects upon the patient’s immune system.

© 2018, Dynasty Publishing House. All rights reserved. Bronchial obstruction, developing in children of preschool age against the background of acute respiratory infection, is characterised by a high prevalence, heterogeneity of clinical signs, difficulties of differential diagnosis, and a tendency to recurrence. Treatment of an acute episode of bronchial obstruction in acute respiratory infection is pathogenetic, since it is aimed at alleviation of bronchial spasm, oedema and mucus hypersecretion, and also at elimination of respiratory failure and hypoxia, if present. Therapy should be started as soon as possible, at the appearance of the first clinical and physical signs of bronchial obstruction. Drugs of choice for stopping bronchial obstruction are short-acting (4–6 h) β2-agonists: fenoterol, salbutamol.

© 2018, Dynasty Publishing House. All rights resvered. The work specifies the indications and conditions for surgical treatment of patients with uterine leiomyoma. The role and clinical significance of ulipristal acetate (UPA, Esmya) in a complex treatment of patients with uterine leiomyoma of varied localisation of nodules according to the FIGO classification have been determined. Special attention is paid to the problem of drug-induced liver injury (DILI) against the background of intake of Esmya. As has been shown, there no reasons to associate UPA with DILI, since (1) UPA does not pertain to the group of drugs associated with a risk for DILI; (2) no cases of DILI have been recorded in patients receiving UPA in a therapeutic dose (5 mg). Treatment with UPA should be administered with control of transaminases. If ALT or AST activity exceeds 2×upper limit of normal (ULN) either isolatedly or in combination with bilirubin >2 × ULN, the intake of Esmya is contraindicated.

© 2018 Media Sphera Publishing Group. All rights reserved. Àim. To compare the efficacy of prophylactic administration of mineral-vitamin complexes "Feroglobin-B12" and "Complivit iron" with different degrees of Fe valence. Materials and methods. 120 female subjects were examined. To determine the quality of life, the SF-36 questionnaire was used. The presence of anxiety was determined on the Spielberger-Khanin Alarm Scale. 30 women with a deficit of Fe were divided into 2 groups of 15 people each. The first group received "Ferroglobin-B12", the second – "Complivit iron" for a month. Results. In a month after the initiation of preventive therapy in women of the 1 group the content of Fe serum was normalized. In the second group, its concentration approached the control values. The difference in Fe content in the 1 and 2 groups was of a reliable nature. Conclusion. The intake of "Ferroglobin-B12" was not accompanied by side effects, and performance indicators, social activity and mental health reached control values, unlike the group of patients taking Complivit iron.

© 2019 American Psychiatric Association. All rights reserved. Abnormal mobility of the posterior membranous wall of the trachea and large bronchi is seen in many bronchopulmonary chronic inflammatory diseases. Currently, clear explanation of a mechanism of the expiratory tracheal stenosis (ETS) is absent. The advanced ETS is associated with severe ventilation abnormalities including asphyxia and syncope. The latter conditions are considered as indications for surgical treatment. Results of the surgical treatment are controversial and are not fully acceptable. For this reason, the surgical treatment for ETS is not routinely used and any successive case of such treatment is of great interest. Strict indications, such as life-threatening conditions or failure of optimal medical treatment, are required for surgical treatment of patients with tracheomalacia and ETS. Surgical treatment for tracheomalacia and ETS is contraindicated in the case of lobar bronchial lesion impeding stabilization the membranous part of the tracheobronchial tree.

© 2018 Izdatel'stvo Meditsina. All Rights Reserved. Nerve damage is a common severe trauma caused by a complete or partial disruption of the integrity of the nerve trunk and appropriate dissociation of the CNS and denervated tissue. «Golden standard» in the treatment of extensive injuries of peripheral nerves is the use of autografts of nerve fibers, but when they are used, pathological disturbances appear in the donor zone and the results of surgical treatment are not always satisfactory. Currently, an alternative to the traditional method is the use of nerve conduits (conductors) for directed regeneration of axons. In this work, the results of the application of nerve conductors from various materials and with various biologically active components in preclinical and clinical studies, as well as conduits used in clinical practice, were analyzed. The efficiency of regeneration was compared, on the basis of the analysis the conductor most suitable for successful nerve regeneration was selected, including approaches for creating innervated tissue engineered constructs. In this work, we have collected research on nerve conductors from various materials with various prescribed properties using certain factors used to treat damage to the peripheral nervous system, showing all the advantages and disadvantages of their use, which makes it possible to develop and create a conduit that meets all the requirements of modern regenerative medicine.

AIM: To identify correlation of carotid endarterectomy with neurocognitive function and psycho-emotional state changes. MATERIAL AND METHODS: There were 120 patients with internal carotid arteries (ICA) stenoses for the period from September 2013 to December 2016. The main group consisted of 100 patients undergoing carotid endarterectomy for internal carotid artery stenosis, control group - 20 patients who refused surgery in 2014-2016. Cognitive function and psycho-emotional state were assessed preoperatively, after 24 hours, 7 days and 3, 6 months postoperatively using the Mini Mental State Examination (MMSE), Frontal assessment battery (FAB), Information-Memory-Concentration Test, Clock Drawing Test and Schulte`s test, Luria Memory Words Test, Hospital Anxiety and Depression Scale (HADS) and Covi Anxiety Scale. RESULTS: Moderate preoperative cognitive impairment was observed in 39 (39%) patients of the main group. De novo postoperative cognitive dysfunction occurred in 65 patients on the 1st day after surgery (65%). Disturbances were noted after 1 week in 26%, after 3 months - in 15%, after 6 months - in 10% of patients. Improved status was noted in 31 (31%) patients of the main group within 1 day after surgery. Improved results were observed after 7 days in 52 (52%) patients, after 3 months - in 67 (67%), after 6 months - in 78 (78%) patients. Mean values of psycho-emotional testing in the main group were high before surgery and significantly decreased on the 1st day after operation. However, advanced anxiety and aggravation of depression occurred in 14% of patients (n=14) that affected cognitive sphere (p<0.01). Progressive cognitive impairment was noted in the control group. CONCLUSION: Carotid endarterectomy has a positive long-term effect on initially impaired neurocognitive functions (3 and 6 months) (p<0.05). There were no significant differences in cognitive testing data in subgroups of eversion and classical procedures (p>0.05). Early postoperative depressive disorders significantly increase the risk of postoperative cognitive dysfunction.