Репозиторий Университета

© 2021 Elsevier Ltd Objectives: Metabolic syndrome (MetS) and its components (high blood pressure, BMI≥30, altered fasting glucose, low HDL cholesterol and high triglycerides) may undermine early perioperative outcomes after radical prostatectomy (RP). We tested this hypothesis. Materials & methods: Within the National Inpatient Sample database (2008–2015) we identified RP patients. The effect of MetS was tested in four separate univariable analyses, as well as in multivariable regression models predicting: 1) overall complications, 2) length of stay, 3) total hospital charges and 4) non-home based discharge. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. Results: Of 91,618 patients: 1) 50.2% had high blood pressure, 2) 8.0% had BMI≥30, 3) 13.0% had altered fasting glucose, 4) 22.8% had high triglycerides and 5) 0.03% had low HDL cholesterol. Respectively, one vs. two vs. three vs. four MetS components were recorded in 36.2% vs. 19.0% vs. 5.5% vs. 0.8% patients. Of all patients, 6.3% exhibited ≥3 components and qualified for MetS diagnosis. The rates of MetS increased over time (EAPC:+9.8%; p < 0.001). All four tested MetS components (high blood pressure, BMI≥30, altered fasting glucose and high triglycerides) achieved independent predictor status in all four examined endpoints. Moreover, a highly statistically significant dose-response was also confirmed for all four tested endpoints. Conclusion: MetS and its components consistently and strongly predict early adverse outcomes after RP. Moreover, the strength of the effect was directly proportional to the number of MetS components exhibited by each individual patient, even if formal MetS diagnosis of ≥3 components has not been met.

© 2020 Elsevier Ltd Objectives: To test contemporary rates and predictors of open conversion at minimally invasive partial nephrectomy (MIPN: laparoscopic or robotic partial nephrectomy). Materials and methods: Within the National Inpatient Sample database (2008–2015) we identified all MIPN patients and patients that underwent open conversion at MIPN. First, estimated annual percentage changes (EAPC) tested temporal trends of open conversion. Second, univariable and multivariable logistic regression models predicted open conversion at MIPN. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. Results: Of 7649 MIPN patients, 287 (3.8%) underwent open conversion. The rates of open conversion decreased over time (from 12 to 2.4%; EAPC: 24.8%; p = 0.004). In multivariable logistic regression models predicting open conversion, patient obesity achieved independent predictor status (OR:1.80; p < 0.001). Moreover, compared to high volume hospitals, medium volume (OR:1.48; p = 0.02) and low volume hospitals (OR:2.11; p < 0.001) were associated with higher rates of open conversion. Last but not least, when the effect of obesity was tested according to hospital volume, the rates of open conversion ranged from 2.2 (non obese patients treated at high volume hospitals) to 9.8% (obese patients treated at low volume hospitals). Conclusion: Overall contemporary (2008–2015) rate of open conversion at MIPN was 3.8% and it was strongly associated with patient obesity and hospital surgical volume. In consequence, these two parameters should be taken into account during preoperative patients counselling, as well as in clinical and administrative decision making.

© 2019 The Authors Background: The aim was to estimate the prevalence of harmful alcohol use in relation to socio-demographic characteristics among acutely ill medical patients, and examine identification measures of alcohol use, including the alcohol biomarker phosphatidylethanol 16:0/18:1 (PEth). Methods: A cross-sectional study, lasting one year at one hospital in Oslo, Norway and one in Moscow, Russia recruiting acute medically ill patients (≥ 18 years), able to give informed consent. Self-reported data on socio-demographics, mental distress (Symptom Check List-5), alcohol use (Alcohol Use Disorder Identification Test-4 (AUDIT-4) and alcohol consumption past 24 h were collected. PEth and alcohol concentration were measured in whole blood. Results: Of 5883 participating patients, 19.2% in Moscow and 21.1% in Oslo were harmful alcohol users, measured by AUDIT-4, while the prevalence of PEth-positive patients was lower: 11.4% in Oslo, 14.3% in Moscow. Men in Moscow were more likely to be harmful users by AUDIT-4 and PEth compared to men in Oslo, except of those being ≥ 71 years. Women in Oslo were more likely to be harmful users compared to those in Moscow by AUDIT-4, but not by PEth for those aged < 61 years. Conclusions: The prevalence of harmful alcohol use was high at both study sites. The prevalence of harmful alcohol use was lower when assessed by PEth compared to AUDIT-4. Thus, self-reporting was the most sensitive measure in revealing harmful alcohol use among all groups except for women in Moscow. Hence, screening and identification with objective biomarkers and self-reporting might be a method for early intervention.

© 2019, Spandidos Publications. All rights reserved. Adiponectin, endothelin and nitric oxide (NO) are major regulators of vascular function. An imbal-ance of vasoactive factors contributes to the onset and progression of atherosclerosis. Various single nucleotide polymorphisms (SNPs) are considered to be risk factors for coronary heart disease. However, the molecular mechanisms of their associations with the components of endothelial dysfunction are poorly understood. In the present study, rs17366743, rs17300539, rs266729, rs182052 and rs2241766 SNPs of the adiponectin (ADIPOQ) gene and rs2070699, rs1800542 and rs1800543 SNPs of the endothelin-1 (EDN1) gene were genotyped in 477 patients with coronary heart disease who were subjected to coronary angiography, in order to determine the presence or absence of coronary atherosclerosis. The serum levels of adiponectin, endothelin and stable metabolites of NO, (nitrate and nitrite NOx), were assayed and their associations with the SNP genotypes and coronary lesions were calculated. The results indicated that rs17366743 of the ADIPOQ gene and rs2070699 and rs1800543 of the EDN1 gene were associated with the levels of NOx in women, which in turn was associated with cardiovascular mortality. In men, rs182052 and rs266729 of the ADIPOQ gene were associated with adiponectin levels, whereas rs17366743 of the ADIPOQ gene was associated with endothelin levels. Additionally, these SNPs were indirectly associated with the prevalence of coronary lesions in men. Therefore, the tested SNPs can be considered potential risk factors that lead to imbalance of vasoactive mediators in a gender-specific manner and contribute to the development of clinical manifestations of atherosclerosis.

© 2018 John Wiley  &  Sons A/S. Published by John Wiley  &  Sons Ltd Background: The essential physical role, visibility and social importance of the hands place a major psychological burden on patients with hand eczema. Objectives: The aim of this study was to identify the psychological, social and clinical characteristics of patients with hand eczema, in particular the prevalences of depression, anxiety, suicidal ideation, and comorbidities. Materials and methods: Data on patients with hand eczema were analysed from a large European multicentre study conducted with dermatology outpatients from 13 countries. Groups of patients and controls were compared to analyse the psychological burden of hand eczema. Results: Female patients with hand eczema had higher Hospital Anxiety and Depression Scale (HADS) scores for anxiety (n = 86, median = 7.0) than controls (n = 900, median = 5.0, P =.02), and for depression (median = 4.0) than controls (3.0, P <.001). Patients with high suicidal ideation, with low socioeconomic status and who were widowed or divorced were more likely to fulfil the HADS criteria for anxiety [odds ratio (OR) > 1, P =.038, P <.001, and P <.001, respectively]. The median Dermatology Life Quality Index score was 7.0 (n = 68). Discussion: This study identifies a specific psychological burden experienced by hand eczema patients, highlighting the need for focused psychosocial interventions. Physicians in particular should be aware of the need to identify anxiety and depression in female patients.

© Copyright 2018, Mary Ann Liebert, Inc., publishers 2018. Aim: To compare a program based on intermittent hypoxia-hyperoxia training (IHHT) consisting of breathing hypoxic-hyperoxic gas mixtures while resting to a standard exercise-based rehabilitation program with respect to cardiorespiratory fitness (CRF) in older, comorbid cardiac outpatients. Materials and Methods: Thirty-two cardiac patients with comorbidities were randomly allocated to IHHT and control (CTRL) groups. IHHT completed a 5-week program of exposure to hypoxia-hyperoxia while resting, CTRL completed an 8-week tailored exercise program, and participants in the CTRL were also exposed to sham hypoxia exposure. CRF and relevant hematological biomarkers were measured at baseline and after treatment in both groups. Results: After intervention, CRF in the IHHT group was not significantly different (n = 15, 19.9 ± 6.1 mlO2 minutes-1 kg-1) compared with the CTRL group (n = 14, 20.6 ± 4.9 mlO2 minutes-1 kg-1). CRF in IHHT increased significantly from baseline (6.05 ± 1.6 mlO2 minutes-1 kg-1), while no difference was found in CTRL. Systolic and diastolic blood pressures were not significantly different between groups after treatment. Hemoglobin content was not significantly different between groups. Erythrocytes and reticulocytes did not change pre/post interventions in both experimental groups. Conclusions: IHHT is safe in patients with cardiac conditions and common comorbidities and it might be a suitable option for older patients who cannot exercise. A 5-week IHHT is as effective as an 8-week exercise program in improving CRF, without hematological changes. Further studies are needed to clarify the nonhematological adaptations to short, repeated exposure to normobaric hypoxia-hyperoxia.

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Mathematical modeling of pharmacokinetic (PK) and pharmacodynamic (PD) parameters essential for establishing correct dosing regimens is an alternative to pharmacokinetic studies (PKS) adopted in the clinical setting. The aim of this work was to compare the values of PK parameters for vancomycin obtained in an actual PKS and through MM in postoperative patients with kidney injury. Our prospective study included 61 patients (47 males and 14 females aged 60.59 ± 12.23 years). During PKS, drug concentrations at steady state Сtrough and Cpeak were measured by high-performance liquid chromatography followed by the calculation of the area under the plasma concentration-time curve AUC24. For mathematical modeling, a single-compartment model was employed; PK parameters were estimated using R 3.4.0. The values of Ctrough measured 48 h after the onset of antibiotic therapy during PKS were significantly lower than those predicted by MM (р = 0.004). In a group of patients with acute kidney injury (AKI), AUC24 measured at the end of treatment was significantly higher than its value predicted by MM (р = 0.011). The probability of achieving the target AUC24 to MIC ratio of over 400 µg•h /ml is higher in the group of patients with Ctrough = 10–15 µg /ml. Our findings confirm that the use of MM in postoperative patients with renal dysfunction is limited and therapeutic drug monitoring should be used instead.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. This article affects the problems of using NOAC in the most defenseless groups of patients with atrial fibrillation: those who have high bleeding and high thromboembolic risk and elderly. The focus is on comparison of effectiveness and safety of NOACs based on randomized clinical trials (RCT) and real-world data (RWD). The possible reasons for the different interpretation of the data of the RCT and the RWD are shown. Use of NOAC in reduced doses prescribing according to RCT and RWD are shown. Our own 13-month observation of patients 75 years and older with very high thromboembolic risk (CHA2DS2-VASc-4,5 points) on rivaroxaban therapy are presented. Good efficacy and safety of full and reduced doses of rivaroxaban were demonstrated: only 2 episodes of small bleedings and no large bleedings (ISTH criteria) were detected as well as no thromboembolic events. Thus, even difficult patients with AF and comorbidity may be safely and effectively treated with NOACs taking into consideration integrated approach and correction of modifiable risk factors.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Is this paper discuss problems of selection of anticoagulant therapy in elderly patients with atrial fibrillation, use of unreasonably low doses of anticoagulants, their risks and adherence to therapy is discussed in the paper.

© 2018 Tomsk National Research Medical Center of the Russian Academy of Sciences. All rights reserved. The purpose of the study was to present data on polymixin-based antibiotics with activity against infections caused by multidrug-resistant Gram-negative bacteria, such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Material and methods. The review includes data from clinical as well as in vitro studies for the period 1998–2017. The search for relevant sources was carried out in the Medline, Cochrane Library, Elibrary and other databases. Results. The analysis of the data showed the presence of synergism and additive activity of polymyxin in combination with carbapenems, rifampicin and azithromycin. However, experimental data showed no direct positive correlation between combination of polymyxim and azithromycin/ rifampicin. In clinical studies, in hospital-acquired pneumonia, including ventilator-associated pneumonia, the clinical response rate of polymyxin B combined with other antibiotics ranged from 38 % to 88 %. High nephro- and neurotoxicity of polymyxin observed in previous studies can be explained by a lack of understanding of its toxicodynamics or the use of an incorrect dose. Conclusion. Polymyxin B in combination with other antibiotics is a promising treatment against infectious complications caused by multidrug resistant Gram-negative bacteria.

© 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 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.

© Bionika Media Ltd. Objective. To carry out a systematic analysis of the data available in the current literature on the modern view on Trousseau’s syndrome Material and methods. The review included the data of foreign and Russian articles published in the past 10 years and found in e-Library and PubMed on this topic. Results. This paper provides a pathogenetic explanation for the increased thrombotic potential in cancer patients, which underlies tumor growth and metastasis. In addition to direct thrombotic events, the paper also describes hemorrhagic complications resulting from systemic coagulopathy, including disseminated intravascular coagulation, hemolytic thrombotic microangiopathy, and excessive fibrinolysis. Conclusion. At present, any manifestation of thrombohemorrhagic complications in patients with malignant tumors can be classified as a paraneoplastic syndrome (Trousseau’s syndrome). In addition to Virchow’s classic triad, hyperproduction of tissue factor (TF), the main initiator of the extrinsic coagulation pathway, underlies the pathophysiology of Trousseau’s syndrome. At the same time, the substantial release of microparticles from TF-bearing tumor cells is critical not only for clot formation, but also for the progression of tumor growth.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Aim: to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of followup in ambulatory elderly patients with chronic heart failure (CHF). Materials and methods. We conducted an open, prospective, nonrandomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II-IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean followup was 26.6±11.0 months. Results. Bendopnea was present in 38.8% patients. All these patients complained of shortness of breath during physical exertion and 45.2% of them had orthopnea. Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95% confidence interval [CI] 4.04-34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score) (OR 1.78, 95% CI 1.29-2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95% CI 1.07-1.52, p=0.007), coronary heart disease (OR 26.6, 95% CI 3.34-21.3, p=0.002), history of myocardial infarction (OR 13.9, 95% CI 4.2-46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95% CI 2.69-65.9, p=0.002), increased indexed LV endsystolic diameter (OR 8.2, 95% CI 1.9-34.1, p=0.004), left atrial size (OR 4.3, 95% CI 1,4-12.5, p=0.008), indexed LV endsystolic volume (OR 1.32, 95% CI 1.07-1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95% 1.03-1.45, p=0.002), high levels of NTproBNP (OR 1.0, 95% CI 1.0-1.002, p=0.055), creatinine (OR 1.04, 95% CI 1.02-1.07, p=0.001), uric acid (OR 1.006, 95% CI 1.002-1.011, p=0.004); hospitalizations (OR 7.61, 95% 2.04-28.4, p=0.003), and patient's mortality (OR 5.63, 95% CI 1.94-16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95% CI 1.04-2.8, p=0.033), increased left atrial size (OR 5.67, 95% CI 2.75-21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95% CI 1.04-2.80, p=0.050). During followup 51.6 and 12.2% of patients died among those with and without bendopnea, respectively (OR 4.22, 95% CI 1.85-9.9, p<0.001). Conclusion. Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.

© 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 analysis of publications devoted to the Russian Consensus on the Diagnostic and Treatment of Autoimmune Hepatitis (AIH), which was considered at the 43rd annual Scientific Session of the CNIIG From Traditions to Innovation (March 4, 2017) is carried out. The presence of clear algorithms and recommendations for the diagnosis and treatment of AIH significantly help the doctor in real clinical practice, but do not exclude a personified approach to the patient.