Репозиторий Университета

© 2018, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.  Modifiers of membranes cause local defects on the cell surface. Measurement of the rigidity at the sites of local defects can provide further information about the structure of defects and mechanical properties of altered membranes. The purpose of the study: a step-by-step study of the process of a nonlinear deformation of red blood cells membranes under the effect of modifiers of different physico-chemical nature. Materials and methods. The membrane deformation of a viscoelastic composite erythrocyte construction inside a cell was studied by the atomic force spectroscopy. Nonlinear deformations formed under the effect of hemin, Zn 2+ ions, and verapamil were studied. Results. The process of elastic deformation of the membrane with the indentation of a probe at the sites of local defects caused by modifiers was demonstrated. The probe was inserted during the same step of the piezo scanner Δz displacement; the probe indentation occured at the different discrete values of Δh, which are the functions of the membrane structure. At the sites of domains, under the effect of the hemin, tension areas and plasticity areas appeared. A mathematical model of probe indentation at the site of membrane defects is presented. Conclusion. The molecular mechanisms of various types of nonlinear deformations occurring under the effect of toxins are discussed. The results of the study may be of interest both for fundamental researchers of the blood cell properties and for practical reanimatology and rehabilitology.

The paper deals with the mechanisms of a T-cell immune response, which depends on the balance between costimula-tory and coinhibitory signals that have been called as immune checkpoints (ICP). The imbalance of T-cell activation within ICTs (CTLA4/CD28 and PD1/PD1L) is considered to be a fundamental mechanism not only of autoimmune disease, but also impaired antitumor immunity underlying the development of malignant tumors. The use of monoclonal antibodies against negative regulatory ICTs (CTLA4, PD1, and PD1L) is a major achievement in the treatment of malignant neoplasms in the early 21st century. However, since CTLA4 and PD1 control the activation of auto-reactive T cells, the inhibition of these ICTs is associated with the development of autoimmune disease that is defined as immune-mediated adverse even. The paper considers the clinical manifestations of IMAR, primarily rheumatic ones and discusses the prospects of pharmacotherapy from the standpoint of achievements of modern rheumatology.

© 2018, Polish Urological Association. All rights reserved. Introduction In order to investigate the efficacy and safety of Afalaza in men with benign prostatic hyperplasia (BPH) at risk of progression, this multicenter, double-blind, placebo-controlled, randomized clinical trial was performed. Derived by technological treatment of antibodies to prostate-specific antigen (PSA) and endothelial nitric oxide synthase (eNOs), Afalaza was previously proved to modulate its molecular targets. The mechanism of action of the drug is associated with the modulating effect of the antibiodies (RA-Abs) on the molecular targets (PSA and eNOS) by way of conformational changes. Material and methods A total of 249 patients aged 45–60 years with BPH and moderate lower urinary tract symptoms (LUTS), total prostate volume (TPV) ≥30 cm3, Qmax 10–15 ml/s, and serum PSA<4 ng/ml were randomly assigned to receive either Afalaza (n = 125) or placebo (n = 124) for 12 months. Changes in BPH/LUTS symptoms (according to the International Prostate Symptom Score), Qmax, TPV, PSA, BPH clinical progression, occurrence of acure urinary retention (AUR) events or BPH-related surgery were estimated as the study endpoints. Results IPSS mean change was-3.7 ±3.0 (95% CI-4.3 to-3.2) after 12 months of Afalaza (vs.-2.9 ±2.4; 95% CI-3.3 to-2.4 in placebo; р = 0.02). Qmax growth was 2.5 ±4.3 ml/s (vs. 1.4 ±3.3 in placebo; p = 0.049), TPV reduced by 11.8 ±16.0% (vs. 6.5 ±14.7%; p = 0.01, and PSA remained unchanged. Afalaza therapy resulted in a significant decrease in the total sum of BPH progression symptoms (p = 0.01). The maximum effect of Afalaza was registered after 12 months without a tendency to form a ‘plateau’. During the study, no patients experienced AUR or BPH-related surgery. Conclusions A 12-month course of Afalaza therapy is effective and safe for patients with BPH. The results of end points measurements revealed asignificant advantage of Afalaza compared to placebo in the overall symptoms benefit and a decline in the risk of BPH progression. ClinicalTrials.gov: NCT01716104.

© 2018 Media Sphera Publishing Group. All rights reserved. Chronic obstructive pulmonary disease (COPD) and its exacerbations remain an important problem of clinical medicine. Aim. To assess the quality of medical care provided in large Russian hospitals to patients with COPD exacerbation. Materials and methods. The study included patients with acute exacerbations of COPD hospitalized into three large clinical hospitals in Moscow. The diagnosis of "COPD exacerbation" was established in accordance with current clinical recommendations. We collected the data about patients’ demography, clinical signs and symptoms, blood gas analysis, chest radiography, drug therapy, oxygen therapy and respiratory support. The follow-up period was 90 days. The obtained data were compared with the data of patients from the multicenter study "European COPD Audit". Results and discussion. The leading clinical symptoms in COPD exacerbation were dyspnea (95.4%) and sputum production (60.7%). The majority of patients with COPD received short-acting β2-agonists (77.4%), systemic steroids (85.1%), antibiotics (79.0%) and theophyllines (48.1%). Noninvasive ventilation was performed in 8.6% of patients, oxygen therapy – in 23,8% of patients, pulmonary rehabilitation – in only 6,2% of patients. Chest radiography was performed in 97.9% of patients, pulmonary function tests – in 79.8%, blood gases analysis – in 19.3% of patients. The mean duration of hospitalization was 18.2±3.9 days, repeated hospitalization within 90 days occurs in 36.2% of patients. In-hospital mortality was 3.3%. Conclusion. Based on the results of the study practical recommendations for improving the quality of medical care in acute exacerbations of COPD are proposed.

© 2018, Bionika Media Ltd.. All rights reserved. The authors have established a relationship between intraepithelial cervical lesions and vaginal biocenotic disorders in pregnant women with human papillomavirus (HPV) infection and determined their management tactics. The HPV–positive pregnant women have a high incidence of vaginal dysbiosis (38.7%) that is, in most of them, characterized by co–infection (65%), mainly by anaerobic and aerobic infections (44.1%). High-rate HPV in the pregnant women is associated with bacterial vaginosis, mixed dysbiosis, and their recurrences and with the frequency of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) in the presence of an inflammatory response. Restoring the normal microflora contributes to the disappearance of the inflammatory response and to the reduction of ASCUS. Therapy for dysbiosis does not change the rate of LSIL at 3-month follow-up.

© Bionika Media Ltd. Antiphospholipid syndrome (APS) is a systemic process that affects all organs and tissues of the body and diagnosed upon fulfilment of clinical and biological criteria. The currently accepted clinical morbidities affect two organs: the vascular tree, leading to thrombotic manifestations, and the utero-placental unit, leading to pregnancy complications. Obstetric APS (oAPS) is an autoimmune disease leading to the synthesis of autoantibodies directly capable of activating key cells of vascular and/or placental pathophysiology. During pregnancy, placenta serves as the most important organ. Violations of the placenta function due to endothelial dysfunction, ischemia, and placenta microthrombosis are responsible for the development of obstetric complications: pre-eclampsia, HELLP-syndrome, placental abruption.This manuscript describes a data of a different clinical experience in the field of APS. APA directly or indirectly affects the implantation process and early embryonic stages. The thorough systematic review on histopathology in the placenta of oAPS women found, on the sincytiotrophoblast (sTB) side, a decreased trophoblast (TB) proliferation, increased TB death rates, a decreased syncytialisation process, an increased sTB death rate with increased cell debris, and areas of sTB denudation and of fibrin deposition. Experimental in vitro data confirmed that ab2GP1 Abs decrease fusion of TB cells, thus inhibiting sTB formation. Reduced eTB invasion was associated with decreased placenta anchorage, reduced transformation of maternal spiral arteries and reduced maternal flow to the placenta, mirroring the conditions in placenta-mediated late pregnancy complications such as preeclampsia.Our studies and over 20 years of clinical experience indicate the presence of etiopathogenetic relation between APS and obstetric complications and the high efficacy of prophylaxis with anticoagulants when it starts early, since the period of preconception.

© Ima-Press Publishing House. All rights reserved. Objective: to investigate the effect of indapamide/perindopril fixed-dose combination (FC) on 24-hour blood pressure (BP) and cognitive functions in antihypertensive treatment-naive middle-aged patients with uncomplicated grade 1-2 essential arterial hypertension (EAH). Patients and methods. The open prospective study enrolled 25 patients (9 men and 16 women) aged 40-59 years with a diastolic BP of 90-109 mm Hg and/or a systolic BP of 140-179 mm Hg, as evidenced by routine measurements. As starting antihypertensive therapy, the patients received indapamide 1.25/perindopril 5 mg FC once daily in the morning; if necessary, after 2 weeks (if the routine blood pressure was ≥140/90 mm Hg) they took indapamide 2.5/perindopril 10 mg once daily in the morning. The follow-up period was 14-16 weeks. Before and at the end of the follow-up, the patients underwent 24-hour ambulatory BP monitoring (ABPM) and evaluation of cognitive functions using the Montreal Cognitive Assessment (MoCA), ten-words test (immediate and delayed word recall), verbal association test (literal and categorical associations), number connecting test (Trail making test (TMT), part A and numbers and letters connecting test (TMT) part B), and Stroop test. Results. At the end of the follow-up period, treatment with indapamide/perindopril fixed-dose combination showed a statistically significant reduction in BPs, as evidenced by routine measurements and ABPM (during 24-hour, and awake and sleep periods); a statistically significant cognitive improvement: an increase in the number of the so-called words in the ten-words test during both immediate (from 5.5±1.6 6.5±1.5 words; p=0.02 vs baseline) and delayed (from 6.2±1.7 to 7.4±1.4 words; p=vs baseline) recalls, a decrease in the performance time of TMT-B (from 112.6±42.5 to 90.4±28.4 sec; p=0.02) and Stroop test Part 3 (from 135.5±50.1 to 112.6±19.6 sec; p=0.02), and a larger number of called words in the categorical associations test (from 6.5±2.4 to 8.1±2.9 words; p=0.02). Conclusion. The results obtained indicate that in treatment-naive middle-aged patients with EAH, indapamide/perindopril fixed-dose combination assures an effective reduction in BPs, as evidenced by routine measurements and ABPM, also improves cognitive functions, particularly attention, information processing speed, semantic memory, cognitive flexibility, and short-term and long-term memory.

© 2018 Media Sphera Publishing Group. All rights reserved. The article provides review of possible mechanisms of inhibitor coagulopathies, in particular of acquired hemophilia A. This pathology is an extremely rare disease occurring in 1-2 cases in 1 million per year. In the present study we provide data for two clinical cases of hemophilia A in women. These cases had different development mechanisms, although both women have a newly discovered missense mutation His2026Arg in the VIII factor gene. The matter of main interest is the description of the disease development in the patient with an acquired idiopathic hemophilia A with a possible disease occurrence due to an asymmetric X-chromosome inactivation (lyonization). In this particular case lyonization led to the late manifestation of the hemophilia A carrier's state and development of severe form of the inhibitor-associated acquired hemophilia A. We also discuss therapeutic approaches to these forms of the disease, considering there are no concise protocols for case management due to an extreme rarity of the pathology. Acquainting the clinical personnel working it the different areas of medicine with suchlike inhibitor coagulopathies has a major practical importance.

© 2018 Ima-Press Publishing House. All rights reserved. Objective: to determine the main factors associated with the development and manifestations of anxiety and depression spectrum disorders (ADSDs) in patients with Behcet’s disease (BD). Subjects and methods. This investigation was conducted within the framework of the interdisciplinary scientific program «Stress factors and mental disorders in rheumatic diseases». A total of 116 patients with BD were examined. Most of them were men (69.8%), whose mean age (M±σ) was 33.4±9.82 years; the median duration of BD was 120.0 [70.0; 192.0] months; 51.9% of the patients were natives of the North Caucasus. All the patients had a reliable diagnosis of BD according to the International Study Group for Behcet’s disease (ISGBD) criteria (1990). Disease activity was assessed using the Behcet’s Disease Current Activity Form (BDCAF); the subjective status of patients was evaluated using the visual analog scale (VAS) for general health assessment. ADSDs were diagnosed by a psychiatrist according to the ICD-10 during semi-structured interviews using the Hospital Anxiety and Depression Scale (HADS), the Hamilton Anxiety Rating Scale (HAM-A), and the Montgomery-Asberg Depression Rating Scale (MADRS). Clinical and psychological techniques were applied to assess cognitive functions (memory, attention, and logical thinking); stress levels were estimated by the 10-Item Perceived Stress Scale (PSS-10). Results and discussion. ADSDs were diagnosed in 91 (78.4%) patients with BD. The predominant RTDs were dys-thymia (39.6%) and recurrent depressive disorder (38.4%). Generalized anxiety disorder was found in only 7.69%, a single depressive episode was in 13.2%. Different degrees of cognitive impairment (CI) were observed in 91 (78.4%) patients. Multivariate analysis and linear regression were used to build a predictive model, from which it follows that ADSDs in patients with BD are primarily associated with sleep disorders (β=0.412), asthenia (β=0.149), CI (β=0.137), chronic stress (β=-0.010) and its severity (β=0.134), early childhood psychic trauma (ECPT) before the age 7 years (β=0.152), the development of ADSD before the onset of BD (β =0.160), older age of eye involvement in the pathological process (β=0.089), gastrointestinal tract (GIT) involvement within BD (β=0.096), high C-reactive protein (CRP) levels (β=0.177), and poor subjective status of patients (β=0.120) (area under the ROC-curve, 0.940). Conclusion. Chronic ADSDs are encountered with high frequency in patients with BD and frequently occur simultaneously with the latter or during its development. Their occurrence is favored to the greatest extent by ECPT and obvious chronic psychosocial stress preceding ADSDs. GIT involvement, late-onset ocular pathology, high CRP levels, and poor subjective status are common to patients with BD and ADSDs. Sleep disorders, asthenic syndrome, and CI are significant in the pattern of ADSDs.

© 2018 Stolichnaya Izdatelskaya Kompaniya. In the article, with regard to current clinical recommendations, the place of combined antihypertensive therapy, especially triple drugs regimens, is considered in the treatment of patients with arterial hypertension. Special focus is given to the body of evidence for the efficacy of valsartan and amlodipine, as the reference drug of angiotensin II receptor blockers and calcium channel blockers, respectively. Not only their high antihypertensive properties are demonstrated, but also a favorable effect on target-organ protection and prognosis is described. In particular, the possibilities of valsartan in reducing the severity of left ventricular hypertrophy and microalbuminuria are described, and its unique properties in the class of sartans that allow the use of this drug in patients with ischemic heart disease and chronic heart failure are emphasized. Data on the antiatherosclerotic effects of amlodipine and its proven ability to reduce cardiovascular risk are presented. Current data are presented about their use in a fixed-dose combination with hydrochlorothiazide, including real clinical practice settings. The evidence base of high clinical efficacy, safety and metabolic neutrality of the triple combination of antihypertensive drugs valsartan, amlodipine and hydrochorothiazide is presented. The issues of increasing adherence of patients to treatment when prescribing fixed-dose combinations are considered. An algorithm for the selection of antihypertensive drugs in the form of monotherapy and combination therapy of two or three drugs depending on the clinical situation (the presence of certain target-organs damages and associated clinical conditions, primarily ischemic heart disease, atherosclerosis of carotid arteries and chronic heart failure) and the severity of the additional risk of cardiovascular complications..

© 2018 Nutritec. All rights reserved. Specialized sports nutrition is one of the most important factors in the extension of the functional potential of athletes, providing adaptive resistance to physical stress, which determines the high physical performance and prolongs athletic longevity of the athletes. The study involved 30 skiers-racers (the average age of 19.5±1.8 years). 12 skiers of the main group within 21 days consumed a specialized food product, obtained on the basis of fermented milk whey containing amino acids, several vitamins, minerals and trace elements, live culture of lactic acid bacteria: L. lactis, L. thermophilus, L. bulgaricus (1.2 × 10s CFU/cm3). The control group consisted of 18 skiers, those taking the placebo (food starch of the same consistency). After a course of product intake, blood level of hemoglobin increased by 6%, of leukocytes - by 10% due to an increase in the number of granulocytes by 32%, and segmented neutrophils by 16% (p<0.05), there was a tendency to increase the number of red blood cells by 7% with a significant decrease in lymphocyte count by 19%. Erythrocyte sedimentation rate in blood of the skiers from the comparison group increased by 41% (p<0.05), while in the athletes of the main group it decreased by 16% (p>0.05). After product intake it has been established by the method of laser Dopplerflowmetry that there was a tendency to increase blood perfusion by 15%, a statistically reliable increase in the flux by 53%, which is based on the improvement of the internal mechanisms of microcirculation regulation. According to the mathematical analysis of cardiac rhythm, centralization of regulation decreased while the activity of an autonomous mechanism for controlling the work of the heart increased. The revealed functional changes ensured an increase of absolute (by 31%, p<0.05) and relative (by 33%, p<0.05) physical performance and aerobic endurance of skiers, contributed to the improvement of short-Term memory. The conclusion is made about the expediency of the intake of the specialized food product to enhance the adaptive capacity of athletes under the influence of systematic physical loads.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. Background. Cystic fibrosis is a hereditary disease that occurs as a result of mutations in the regulator gene of chloride ion transmembrane transport (CFTR). Finding mutations in the CFTR gene is necessary for identification of the clinical features of cystic fibrosis. Objective. Our aim was to identify genotype-phenotype correlations between mutations of the first class of pathogenicity and clinical manifestations of cystic fibrosis based on studying the prevalence and structure of CFTR gene mutations. Methods. The study included children under 18 years with cystic fibrosis admitted to hospital between 2013 and 2017. Biallelic mutations in the CFTR gene were the non-inclusion criterion. The CFTR gene variants were analyzed by next-generation sequencing method. Results. In 125 patients with cystic fibrosis, 59 different variants of the CFTR gene were detected, 11 of them not previously described. The most common was the deletion c.1521-1523del found in 98 (39.2%) of the 250 analyzed CFTR gene alleles and the deletion c.1545-1546del found in 22/250 (8.8%) alleles. It has been shown that the mutation c.1545-1546del, p.Y515∗ was more often found in children of the Chechen nation-odds ratio (OR) 139 (95% confidence interval 15-1,257). It has been established that meconium ileus, pancreatic deficiency and cirrhosis are more common in patients with mutations of the first category of pathogenicity: OR 3.9 (95% CI 1.0-15.0), 4.4 (95% CI 1.8-11.1), and 351 (95% CI 17.5-7,046), respectively. The association of CFTR gene mutations with the development of bronchiectases and polypous pancinusitis has not been found. Conclusion. Correlations between the genotype and clinical manifestations of cystic fibrosis in Russian children with CFTR gene mutations of the first class of pathogenicity have been established.

© 2018 Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved. We studied capabilities of the Bruker Microflex MALDI-TOF device for species identification of anaerobic gramnegative cocci isolated from clinical specimens of cancer patients. Seventy clinical isolates of Veillonella spp. and one Acidaminococcus spp were analyzed. All isolates were identified to the species level with a scores greater than 1.9. The most common species were V. parvula (37 strains), followed by V. dispar (16), V. atypica (16) and V. denticariosi (1). Susceptibilities of the isolates were determined by the E-test methodology. All Veillonella isolates were susceptible to imipenem, whereas high resistance rates were observed for penicillin G, amoxicillin/clavulanate and metronidazole. The proportion of resistant isolates of V. parvula, V. dispar and V. atypica to penicillin was 86 %, 85 % and 100 %, respectively. The resistance to amoxicillin/clavulanate was observed in 28.6 % of V. parvula isolates, 23.1 % of V. dispar isolates and in 6.7 % of V. atypica isolates. Resistance to metronidazole (MIC = 8 μg/ml) of V. parvula, V. dispar and V. atypica was 88.6 %, 53.8 % and 40 %, respectively.

© 2018 Media Sphera Publishing Group. All rights reserved. The objective of the present study was to develop the diagnostic criteria for determining the positions of the participants of a road traffic accident inside the passenger car compartment based on the analysis of the characteristic features of vertebral lesions in the victims. The archival documents of forensic medical expertises were used to analyze the specific characteristics of fractured cervical vertebra in the victims of the accident inside the passenger car compartments including the drivers (n=92), the occupants of the forward (n=43) and rear (n=37) seats of the car. Localization and mechanisms behind the formation of vertebral lesions in the cervical part of the spinal column associated with the intra-compartment injury is of primary importance for the diagnostic purposes. The character of an injury to the cervical region gives evidence of the position of the driver and the occupants of the car inside the passenge r compartment at the moment of the accident. Injuries to the cervical, thoracic, and/or sacral vertebrae may be indicative of the seat (either driver's, forward or rear) occupied by the victim(s). The fractures of the sacral part of the vertebral column are of negligible value for the differential diagnostics between the positions of the driver and/or other victims because they equally frequently occur in the drivers and occupants of both the forward and rear seats. Nevertheless, the proposed criteria made it possible to construct the mathematical model in the form of the logistic regression equations and to use them for making the probabilistic predictions as regards the positions of the participants of a road traffic accident inside the passenger car compartment based on the selected combination of pathomorphological characteristics in the victims.

© Pushkareva M.V., Shevyreva M.P., Goncharuk N.N., May I.V., Andrishunas A.M., 2018. The article contains information on hazardous chemical wastes, reasons that cause their occurrence and accumulation in the environment as well as issues related to accumulation of persistent organic pollutants (POPs) in the environmental objects. The authors outline specific features of POPs and their possible influence on the environment and a human body; they also dwell on priority activities accomplished in the RF in relation to POPs after Stockholm Convention on Persistent Organic Pollution was ratified. Provisions of international law in the sphere of providing chemical safety are being consolidated now and operating bodies of Basel, Rotterdam, and Stockholm Conventions interact with each other in order to fix concentrations for chemicals which are persistent organic pollutants and to determine their low contents in wastes. The European Union countries and Canada have submitted their proposals on concentrations of 21 various chemicals in wastes for consideration by all the concerned parties. Scientific validity of the proposed concentrations has been analyzed; the analysis results are given in the article. Given the hazards caused by chemicals wastes that contain POPs for people and the environment, the authors suppose that additional research should be performed on substantiation of POPs safe concentrations in wastes. Taking into account national security and common provisions of international laws related to solving global, national, and regional tasks, the authors note that it is necessary to update legislation on state regulation in the sphere of providing chemical safety; they also give grounds and outline conceptual approaches to creation of the Federal Law "On chemical safety". The article gives a basic idea of this law; its purpose; an object of its regulation; people or economic entities whose activities are subject to its force; a place this law, when passed, is going to have in the RF federal legislation and a system of international agreements that are ratified by the RF. It should be noted that when the Federal Law "On chemical safety" is adopted, it will allow to reduce negative effects produced by hazardous chemical wastes on population and the environment and will have both medical and social-economic outcomes.

© 2018, © 2018 Informa UK Limited, trading as Taylor  &  Francis Group. Introduction: Prenatal atrioventricular septal defect (AVSD) on frequent occasions coexists with other cardiac or extracardiac abnormalities or malformation which may change the prognosis and the management with the fetus and the newborn. The aim of the research was to assess the prognosis and the outcome of prenatally diagnosed AVSD based on the classification which also includes coexisting extracardiac abnormalities and malformations as well as its influence on the prenatal consultation. Methods: It was a retrospective analysis of 113 patients with prenatally diagnosed AVSD. The group was selected out of 871 patients with CHD. Out of 113 fetuses with AVSD we exclude those in whom AVSD was coexistent with other cardiac malformations (n = 41). Extracardiac abnormalities [ECA] were defined as problems which do not require surgical intervention after delivery, they were usually markers of a genetic syndrome. Extracardiac malformations [ECM] were defined as problems requiring surgical interventions after delivery or lethal malformations. All 72 fetuses with an isolated AVSD were classified to one of the three groups: (1) Simple AVSD–(sAVSD)–a fetus with isolated AVSD without coexisting ECA and ECM (n = 6), (2) sAVSD + ECA–a fetus with isolated AVSD, with coexisting ECA (n = 28), (3) sAVSD + ECM–a fetus with isolated AVSD, with coexisting ECM (n = 38). Results: The pregnancy from the groups sAVSD + ECM were, in fact, more often referred to the prenatal cardiology centers on account of the existing ECM (p=.03). There were no differences between the two subgroups in regard to: the mean age of the pregnancy, the mean age of the fetus at the time of diagnosis and during diagnostic testing at the referral center, the gender of the fetus. An increased nuchal translucency (NT) was most often found in fetuses from the group AVSD + ECA (n = 13/23), which was connected with more frequent occurrence of abnormal karyotype (p=.048). The trisomy 21 more frequently referred to pregnancy with sAVSD + ECA than those with sAVSD + ECM (p=.0006). In the group sAVSD + ECM there was the highest number of fetuses small for the gestational age detected −48.65% (p=.01). Most often premature deliveries were found in the group sAVSD + ECM (72.73%). The duration of gestation in the group sAVSD + ECM turned out to be much shorter than that in the group with the isolated sAVSD (p=.01) and sAVSD + ECA (p=.03). The lowest Apgar score was in the newborns from the group sAVSD + ECM (p=.002). Longer period of gestation was connected with the higher score on Apgar scale (R = 0.541; p=.001). The average delivery weight of the newborns was the lowest in the group sAVSD + ECM (p=.04). sAVSD + ECM was connected with the significantly higher death rate than the isolated sAVSD (p=.0047) or sAVSD + ECA (p<.00001). The fatality rate of the newborns/ fetuses from the pregnancies lasting less than 37 weeks turned out to be much higher than in the case of the remaining pregnancies (sAVSD p=.002). Conclusions: (1) The majority of fetuses with AVSD remained the patients of just obstetricians and prenatal cardiologists because of highly heterogeneous of the coexisting malformations and abnormalities and since they perish in the period of fetal or neonatal life usually they are not seen by the pediatricians or cardiac surgeons. (2) The classification of the AVSD in fetus to a particular group of the prognostic classification of the fetal heart defects helps to plan perinatal management and supplies information regarding the prognosis. (3) The highest mortality rate was in a group of AVSD + ECM, probably due to shorter time of pregnancy duration, fetuses grow restriction and low Apgar score in 1 minute of life.

© 2018, Modestum Ltd.. All rights reserved. Objective: The relevance of this study is due to the mass accreditation of health professionals that is developing in Russia, which requires innovative measurement tools and opens new opportunities for a well-founded cross-analysis of specialists’ professional readiness quality. Purpose of the study: The purpose of this article is to present approved methodical approaches to the transformation of accreditation data into a format suitable for secondary analysis of medical schools graduates quality based on the requirements of Professional Standards. Method: The leading methods of secondary data analysis are: a) codification of indicators in the primary data accumulation array; b) statistical processing of study results (evaluation of the relationships between the arrays of primary data accumulation and instrumental data, the correlation of test scores obtained by accreditation results with the labor functions of Professional Standards); c) the creation of representative samples for data analysis. The implementation of methods is carried out in the mode of working with arrays of big data, which also uses the method of cross-analysis to identify additional factors that affect to specialists’ professional readiness quality. Results: As a results of the research, there were: 1) approaches to the codification of data in the array and their secondary analysis were developed; 2) three samples were constructed with an estimation of representativeness for different strata, including subjects, assignments and corresponding labor functions; 3) the matrix of primary data in the specialty “Pediatrics” was verified using the example of the results of students from 50 medical universities in Russia. Conclusion: Approbation of methods of secondary data analysis conducted on representative samples of the subjects showed the effectiveness of the developed approaches that should be used when analyzing large data sets in the procedures of certification or accreditation. The materials of the article can be useful for specialists in the field of assessing the quality of education or assessing the professional readiness of health professionals, managers, professors and pedagogical staff of medical schools, specialists of centers for independent assessment of qualifications.

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: To analyze and organize the basic techniques to reduce radiation exposure to patients with computed tomography (CT) scan of the head, chest, abdomen and pelvis. Materials and methods: The analysis of publications was carried out on the databases Scopus, Web of Science, MedLine and RINC. Results: The variants of the use of CT of the head, chest, heart, abdominal and pelvic organs in multidisciplinary institutions with different methods of reducing the dose burden on patients have been analyzed. Conclusion: The factors used to reduce the dose for CT can be systematized in three main ways: 1) methods that depend on the attending physician, radiologist and CT staff; 2) parameters of the research protocol; 3) features of CT-devices and software. Considering the factors reducing the radiation dose of patients in support of the need for CT examination, choice of parameters of the CT protocol, CT devices and software allows to significantly reduce the radiation burden on patients (by 10-78%) without compromising the quality of CT images. The development of methods to reduce the dose of irradiation of patients is extremely urgent, especially in screening, multiple CT studies and CT with contrast.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. The urgency of the problem of orthostatic hypotension (OH) has increased in recent years. It was due to the high prevalence and its adverse effect on the prognosis and quality of life of patients, especially the elderly and oldest old. The purpose of this review was to summarize the contemporary domestic and foreign literature data about disease. The article presents an updated definition of OH, modern classification, pathophysiology, feature of the course of OH in the elderly, recommendations for diagnosis and treatment. Particular attention is paid to reviewing the results of scientific research on the influence of OH on the risk of developing coronary and cerebrovascular events and overall mortality. OH is one of the forms of orthostatic tolerance and diagnostic criteria were determined by the 2011 Consensus as a sustained fall of systolic blood pressure by at least 20 mm Hg and/or a diastolic blood pressure by 10 mm Hg within 3 min of standing. The prevalence of OH ranges depending on the age of the patients and the presence of a number of concomitant diseases: from 6% in healthy people without arterial hypertension up to 50% or more in people older than 75 years with a comorbid pathology. OH is an independent predictor of overall mortality and adverse cardiovascular events. OH is associated with an increased risk of serious adverse cerebrovascular and coronary events, and may also contribute to cognitive impairment and the development of dementia. For today, we have three clinical options OH: classical, early and delayed OH. In addition, OH is classified based on etiology-primary and secondary; and pathophysiological principle-neurogenic OH and not a neurogenic OH (or functional). The algorithm for identifying patients with a high risk of development of OH and diagnostic methods are also presented. Non-medicamentous and medicamentous methods of OH treatment are considered.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article describes the definition of dementia, its diagnostic criteria, classification. Differences in the pathogenesis and clinical manifestations of different types of dementia are considered. The issues of interrelation of arterial hypertension and the risk of development of cognitive disorders and dementia in old and very old people are discussed in detail. Data on the effect of antihypertensive drugs of different groups on the risk of dementia and the state of cognitive functions are presented. The evidence base of dihydropyridine calcium antagonist amlodipine and thiazide-like diuretic indapamide-retard is discussed with respect to the prevention of dementia and cognitive decline and their beneficial effect on cognitive function in patients with arterial hypertension.