Репозиторий Университета

Purpose: To assess the clinical and radiographic success rate of microsurgical endodontic treatment of upper molar teeth in relationship with the maxillary sinus, with 12 months follow-up. Methods: Patients treated with microsurgical endodontic treatment of upper molar teeth in the period between 2017 and 2019 were recruited from two dental clinics according to specific selection criteria. The outcomes were determined based on clinical and radiographic results taken three, six and 12 months post-operatively, compared with those taken immediately before and after surgery. Clinical and radiographic outcomes were recorded. The distance between the most apical part of the root and of the lesion to the maxillary sinus was measured on CBCT images before the surgery. Patient-related outcomes were recorded. Results: Out of 35 patients evaluated, 21 were selected according with the selection criteria for a total of 27 roots and 29 canals treated. After 12 months, 18 patients showed a complete healing whereas three demonstrated incomplete healing. Consequently, the success rate in this study was 85.7% after one year. In 28.5% (6 patients) there was a perforation of the Schneiderian membrane that didn’t seem to affect the outcome. All patients kept the molar one year later. The pain level decreased significantly over the time during the first week after surgery. Conclusion: Microsurgical Endodontic treatment of the upper molar teeth should be considered a valid and predictable treatment option even in case of Schneiderian membrane perforation. Future clinical studies with a larger sample size are needed to compare the results obtained.

Purpose: To assess the clinical and radiographic success rate of microsurgical endodontic treatment of upper molar teeth in relationship with the maxillary sinus, with 12 months follow-up. Methods: Patients treated with microsurgical endodontic treatment of upper molar teeth in the period between 2017 and 2019 were recruited from two dental clinics according to specific selection criteria. The outcomes were determined based on clinical and radiographic results taken three, six and 12 months post-operatively, compared with those taken immediately before and after surgery. Clinical and radiographic outcomes were recorded. The distance between the most apical part of the root and of the lesion to the maxillary sinus was measured on CBCT images before the surgery. Patient-related outcomes were recorded. Results: Out of 35 patients evaluated, 21 were selected according with the selection criteria for a total of 27 roots and 29 canals treated. After 12 months, 18 patients showed a complete healing whereas three demonstrated incomplete healing. Consequently, the success rate in this study was 85.7% after one year. In 28.5% (6 patients) there was a perforation of the Schneiderian membrane that didn’t seem to affect the outcome. All patients kept the molar one year later. The pain level decreased significantly over the time during the first week after surgery. Conclusion: Microsurgical Endodontic treatment of the upper molar teeth should be considered a valid and predictable treatment option even in case of Schneiderian membrane perforation. Future clinical studies with a larger sample size are needed to compare the results obtained.

© 2019, The Author(s). Background: In recent years, joint replacement surgery has gradually progressed towards the fast-track model, and early rehabilitation immediately after surgery is regarded fundamental for optimal recovery of function: the aim of the present study is to describe the efficacy in perioperative management of pain in patients undergoing total hip replacement surgery and treated with tapentadol or oxycodone/naloxone in combination with ketoprofene. Methods: Single-center retrospective study on patients with moderate-severe pain, referred to total hip replacement. Patients received either tapentadol (100 mg/twice-daily post-surgery – treatment group) or oxycodone/naloxone (10 mg/5 mg post-surgery – control group) plus ketoprofen 100 mg/ twice daily. Supplemental analgesia (paracetamol 1 g or morphine 0,1 mg/kg sc) was provided if needed. Pain at rest and pain during movement were evaluated on a daily basis for 4 days post-op, after which patients were usually discharged. All adverse events were reported and compared between the two groups. Results: 106 patients were analyzed in the tapentadol group and compared to 105 patients treated with oxycodone/naloxone. Both pain intensity at rest and upon movement were significantly lower in the tapentadol group at all follow-up times (p < 0.001). Throughout T1-T4, supplemental analgesia was needed by significantly less tapentadol patients compared to the control group. Similarly, regarding side effects, a significantly higher occurrence of post-op nausea, vomit, itching and constipation was observed in the control group (p < 0.001 in all cases). Conclusion: Results from the present study support the use of tapentadol in combination with ketoprofen for the management of moderate-severe pain in the setting of major orthopedic surgery, given its effectiveness in reducing pain intensity, and its satisfactory tolerance.

© 2019 John Wiley  &  Sons Ltd Aims and objectives: To examine how nurses' knowledge of behaviours indicating pain in mechanically ventilated patients and self-perceived collaboration between nurses and physicians affects the adequacy of departmental pain management. Background: Pain management is a vital factor of medical treatment in a hospital setting. Inadequate pain management requires attention both from a patient-focused perspective and from a departmental one. It would be particularly troubling in the case of inadequate pain management of mechanically ventilated patients. Design: The study utilised a cross-sectional design. The instruments developed were validated by a focus group of 25 pain management nurses, who reviewed the questionnaire for face validity, feasibility and comprehensibility, and who did not participate in the study. The questionnaire was revised, readjusted and formulated based on their responses and comments. Methods: A self-administered questionnaire administered in Israel with a convenience sample of 187 registered nurses (RN) from internal medicine and surgical departments and ICUs. Data were collected during February–May 2015. The “STROBE” EQUATOR checklist was used. Results: Nurses working in the ICU scored significantly higher on knowledge of behaviours indicating pain in mechanically ventilated patients and on self-perceived collaboration between nurses and physicians. Self-perceived collaboration between physicians and nurses was positively correlated with perceived departmental pain treatment adequacy. Self-perceived collaboration between nurses and physicians, knowledge of behaviours indicating pain in mechanically ventilated patients and seniority (with a borderline significance) explained 27% of the variance of perceived departmental pain management. Conclusion: Nurses' knowledge of behaviours indicating pain in mechanically ventilated patients, as well as self-perceived collaboration between nurses and physicians, promotes reported adequate pain management. Relevance to clinical practice: Pain management would benefit from being conducted as a well-performed interprofessional self-perceived collaborative practice. Knowledgeable nurses tend to critically assess the level of departmental pain management.

© 2018 The Author(s). Background: To enrich the hitherto insufficient understanding regarding the mechanisms of action of transcranial direct current stimulation (tDCS) in pain disorders, we investigated its modulating effects on cerebral pain processing using functional magnetic resonance imaging (fMRI). Methods: Thirteen right-handed healthy participants received 20 min of 1.5 mA tDCS applied over the primary motor cortex thrice and under three different stimulation pattern (1.anodal-tDCS, 2.cathodal-tDCS, and 3.sham-tDCS) in a blinded cross-over design. After tDCS neural response to electric trigeminal-nociceptive stimulation was investigated using a block designed fMRI. Results: Pain stimulation showed a distinct activation pattern within well-established brain regions associated with pain processing. Following anodal tDCS increased activation was detected in the thalamus, basal ganglia, amygdala, cingulate, precentral, postcentral, and dorsolateral prefrontal cortex, while cathodal t-DCS showed decreased response in these areas (pFWE < 0.05). Interestingly the observed effect was reversed in both control conditions (visual- and motor-stimulation). Behavioral data remained unchanged irrespective of the tDCS stimulation mode. Conclusions: This study demonstrates polarity-specific modulation of cerebral pain processing, in reconfirmation of previous electrophysiological data. Anodal tDCS leads to an activation of the central pain-network while cathodal tDCS does not. Results contribute to a network-based understanding of tDCS's impact on cerebral pain-processing.

© 2018 Ima-Press Publishing House. All Rights Reserved. Information about a favorable prognosis for a patient, recommendations for activities, and optimal pharmacotherapy are a mainstay in the effective treatment of acute nonspecific low back pain (NLBP). Standard pharmacotherapy for acute NLBP includes nonsteroidal anti-inflam-matory drugs (NSAIDs). However, the longer their administration and larger doses, the higher the risk of side effects are. NSAIDs are contraindicated in some cases. In this connection, it has become necessary to search for new opportunities for the pharmacotherapy of acute NLBP. The results of experimental studies have demonstrated the analgesic and anti-inflammatory effects of high-dose B vitamins. Clinical trials have confirmed the efficacy of Vitamin B complex (thiamine, pyridoxine, and cyanocoba lamin) in the treatment of acute NLBP. The paper considers the practical significance of concomitant administration ofB vitamins and NSAIDs in NLBP and notes the efficacy of milgamma used both alone and in combination with NSAIDs in the treatment of acute NLBP.

The aim of the study was to prove the anatomical and clinical effectiveness of the modified anesthesia of mental nerve. The effectiveness of conductive anesthesia near the mental foramen was objectively evaluated using the electric pulp test (EPT) in 100 volunteers of both sexes, aged 35-43 years. Wet anterior mandible preparations obtained from 350 cadavers aged 18-74 years were also studied. EPT value after local mental anesthesia conducted according to Malamed C. using 4% articain solution of local anesthetic with vasoconstrictor concentration of 1:200.000 after 2 minutes was 93±0.82 mA, after 4 minutes - 188±1.26 mA. Yield variability indicators of intraosseous mental nerve anesthesia was slightly higher varying from 94.11 mA to 96.61 mA after 2 minutes and from 197.4 to 199.92 mA after 4 minutes survey. The study showed the efficiency and predictability of intraosseous anesthesia of the mental nerve.

© 2018, Media Sphera Publishing Group. All rights reserved. Psychogenic pain is one of the urgent problems of medicine. To date, pathogenetic mechanisms of development of pain syndrome are unclear, there is no uniform classification. Pain, developing in patients with a mental disorder without an organic damage to the nervous system, and pain, which is a complication of an already existing pain syndrome of neuropathic or nociceptive nature, should be considered separately. Treatment of psychogenic pain syndromes should be integrated with the mandatory use of methods aimed at modifying the patient’s lifestyle and attitude towards the illness.

© Ima-Press Publishing House. All rights reserved. Placebos are drugs, devices, or other treatments that are physically and pharmacologically inert. The placebo effects are therapeutic responses to the context of the treatment process. They are mediated by factors, such as training of a patient, his/her expectations associated with treatment, as well as social conditions, the features of cognitive functioning, etc. and can affect the clinical and physiological responses caused by the health status. The analgesic effects of placebo in different types of pain syndromes reach 25-80%. The formation of placebo analgesia involves the brain structures that belong to the pain matrix and are implicated in the basic processes of perception, in the mechanisms of pain modulation, and in a number of other cognitive and affective processes, as well as in the emotional reactions not caused by pain. A deeper understanding of the mechanisms of action of placebo analgesia can optimize the strategy of current pain therapy.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. Evaluation of the morbidity structure and demonstration CT-semiotics of the main diseases in patients with nontraumatic acute abdomen. Materials and methods. 905 studies of the abdomen performed in 2016 in the State Clinical Hospital named after S.P. Botkin in patients with acute abdomen. The studies were conducted natively, with contrasting per os, with intravenous enhancement, depending on the expected pathology. Results. The most common causes of acute abdomen were: acute intestinal obstruction (27%), pancreatitis (9%), urolithiasis and its complications (8%), oncology directly and its complications (7%), inflammatory changes in the gallbladder and diliary ducts (4%), inflammatory changes in the kidneys (3%). Also significant weight in the structure of morbidity was perforation of the bowel (2.5%), mesenteric thrombosis (2%), extraorganic inflammatory changes (2%). Only 5% of cases failed to reliably detect signs of a pathological process in the presence of a clinical picture. The main characteristics of the risk group for the emergence of acute abdominal pathology, such as the age of 32-67 years, the male sex, are revealed. A more detailed analysis of risk factors within the statistically most significant nosological groups was also carried out. The diagnostic efficiency index of multislice computed tomography (CT) for the above diseases varied from 95% to 97%, the sensitivity and specificity of the method depending on the disease were 95-97.8% and 93.2-97%, respectively, p> 0.05. Conclusions. CT allows to determine the nature of the disease quite accurately in emergency medical care in patients with nontraumatic urgent abdominal pathology. The identification of a risk group in the structure of acute nontraumatic abdominal pathology facilitates early diagnosis and timely treatment.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. Purpose of the study is to have a detailed examination and investigation of the patient with all the required parameters. Material and methods. Revision knee replacement prosthesis making a difference in treatment outcome. Results. The result after the sleeve operation was uneventful and the patient had no complaints or pain even after a year of surgery. Conclusion. Long term complications are comparatively less when a proper prosthesis is selected for the particular patient operation.

© 2018 Ima-Press Publishing House. All rights reservbed. Sacroiliac joint (SIJ) dysfunction often causes nonspecific low back pain; the efficiency of its treatment is discussed to be exhibited by therapeutic blockades with anesthetics and glucocorticoids (GCs) or by SIJ radiofrequency denervation (RFD). Objective: to investigate the efficiency and safety of therapeutic blockades with anesthetics and GCs, or SIJ RFD in the combination therapy of chronic low back pain due to SIJ injury. Patients and methods. The investigation enrolled 51 patients (36 women and 15 men) aged 32 to 75 years (mean age, 56.4±2.1 years). Group 1 included 32 patients (mean age, 51.75±2.65 years) who used periarticular blockades with local anesthetics and GCs; Group 2 consisted of 19 patients (mean age, 64.1±2.8 years) who underwent SIJ RFD. Results and discussion. These treatments showed high efficiency and safety. Three months after a treatment cycle, there were reductions in the intensity of pain (by an average of 47%; p<0.0001) and in the degree of disability and improvements in the physical and psychological parameters of quality of life. There were no substantial differences in the health status of patients in the two groups treated with blockades with anesthetics and GCs or SIJ RFD. Conclusion. It has been shown that the incorporation of blockades with anesthetics and GCs or SIJ RFD into the treatment of patients with chronic low back pain can improve the results of therapy.

© 2018, Media Sphera Publishing Group. All Rights Reserved. Authors present a case-report of a 36-year-old patient with pain syndrome in the face region (craniomandibular dysfunction with occlusive disorders) involving pericranial muscles and shoulder girdle muscles. Thioctic acid was prescribed as a basic therapy, and relaxation tire, mimic gymnastics, post-isometric relaxation, vitamin and mineral complex were additionally used. Thioctic acid was prescribed according to the following scheme: stage I — intravenous injections of thioctic acid (600 mg/daily, 5 procedures, every other day); stage II — oral administration of the drug in the dose of 600 mg/daily for 3 months. A significant reduction of pain syndrome and the palpable tension of muscles were noted; the symmetric even muscle tone was revealed. This case-report demonstrates the high efficacy of thioctic acid in treatment of patients with craniomandibular disorders using the 2-stage scheme. There was a significant improvement of quality of life of the patients due to the additional use of vitamin and mineral complex and medical tools (relaxation tire) for treatment at all stages of pain formation.

© 2018 ABV-Press Publishing House. All rights reserved. Background. Patients with the chronic migraine frequently present with memory and attention complaints. However, the prevalence and phenotype of such impairment in chronic migraine have not been studied. Objective-to evaluate the prevalence of the objective cognitive deficit in patients with chronic migraine and factors underlying its etiology. Materials and methods. We recruited 62 subjects with chronic migraine and 36 gender-and age-matched controls with low-frequency episodic migraine (not more, then 4 headache days per month) aged 18-59. All patients filled in the Hospital Anxiety and Depres sion Scale (HADS) and Sheehan Disability Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20). Results. In this study 58 % of patients with chronic migraine complained of memory loss. Cognitive impairment was also found with PDQ-20. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learning rate. In 40 % of subjects with chronic migraine scored lower than 26 points on MoCA. Patients with chronic migraine more frequently had lower DSST rates as compared to episodic migraine (odds ratio 5.07 (95 % confidence interval-1.59-16.17); p = 0.003). Depression and anxiety did not correlate with performance on cognitive tests. Chronic migraine (frequent headache) and longer headache history, but not depression, anxiety or medication overuse were independent predictors of cognitive impairment. Conclusion. Subjective and objective cognitive deficits are prevalent in the chronic migraine population. Most often memory and attention are impaired. Longer headache history and presence of chronic migraine are independent risk factors for cognitive impairment in patients with chronic migraine.

© 2018 Ima-Press Publishing House. All Rights Reserved. This review provides information on prospects for using the antidepressant agomelatine in neurological practice. The drug has a unique receptor profile, being a melatonin receptor type 1 and 2 agonist and a serotonin receptor subtype 2C antagonist. Due to this and in addition to antidepressant action, the drug has a number of other effects, such as analgesic, anti-apathetic, anti-asthenic, procognitive, anxiolytic, and sleep-normalizing ones, which are of great importance in the treatment of neurological diseases. There are clinical and experimental data that prove the high efficiency and safety of agomelatin in the follow-up of patients with post-stroke depression, Parkinson's disease, Alzheimer's disease, Pick's disease, Huntington's disease, chronic fatigue syndrome, and pain syndromes.

© ABV-Press Publishing House. All rights reserved. Over a half of chronic pain (CP) patients present with cognitive complaints, which increase their disability and impact quality of life. The paper reviews objective impairments in memory, attention, processing speed and executive function demonstrated in the CP population. The paper also reviews common pathology underlying cognitive impairment and CP: neuroplasticity in the shared brain areas, neurotransmitter and other molecular mechanisms. Common mechanisms in CP and depression precipitating cognitive impairment are also discussed. The paper also compares the potential of different antidepressants to improve cognitive functions in depression and CP.

© Ima-Press Publishing House. All rights reserved. Objective: to investigate the efficiency of treatment for acute and subacute dorsalgia, by providing information to patients and by using nonsteroidal anti-inflammatory drugs (NSAIDs) without conducting physical therapy, reflexotherapy, and manual therapy. Patients and methods. A total of 140 patients (87 women and 53 men; mean age 50.7±17.6 years) with acute and subacute back pain were followed up. Out of them 127 (91%) patients were found to have nonspecific (musculoskeletal) pain; 13 (9%) had discogenic radiculopathy. All the patients were informed of the benign nature of the disease, the high probability of its rapid resolution, the feasibility of abandoning prolonged bedrest, and the lack of need for physical therapy, reflexotherapy, massage, and manual therapy. To reduce pain, the patients received meloxicam 15 mg/day orally or intramuscularly or first 15 mg/day intramuscularly and then orally. The investigators assessed pain intensity with the numerical rating scale and functional activity restrictions with the Roland-Morris disability (RMD) questionnaire. Results. After treatment, the visual analogue scale pain intensity scores decreased from an average of 6.4 to 1.0; the RMD scores dropped from 6.8 to 1.4 (p<0.001). The duration of treatment averaged 11.0±4.4 days. Comparison of different meloxicam dosage regimens showed no significant differences; a positive result was noted in all cases. No adverse events were observed during treatment. Conclusion. The investigation has shown the high efficiency of management in patients with acute and subacute dorsalgia, by providing information to patients (an education conversation), by using meloxicam, and by applying a personalized approach (treatment for concomitant diseases and conditions). Refusing physiotherapy, massage, acupuncture, and manual therapy substantially reduces the cost of treatment in patients with acute dorsalgia.

© 2018 Media Sphera Publishing Group. All rights reserved. The article reflects the main positions of the latest Russian and pan-European clinical recommendations on the diagnosis and treatment of chronic pancreatitis (CP), devoted to the pharmacotherapy of this disease. The main objectives of pharmacotherapy for CP are to reduce or arrest pain abdominal syndrome and prevent or compensate for functional pancreatic insufficiency.

© 2018, Peter the Great St. Petersburg Polytechnic University. Nanocomposite layers consisting of an acrylic paint and single-walled carbon nanotubes (∼1.5 wt.%) have been investigated. The investigated samples had a disk shape with a diameter of 20-30 mm and a thickness of 2-50 μm. After exposure in water for 350 h, the layer mass remained almost invariable (a mass loss of ≤ 1.5%) and the layer samples exhibited high adhesion to glass substrates and a conductivity of ∼ 40 S/m. The layers consisting of the nanotubes and acrylic paint exfoliated from the substrates for ∼1 h. After heat treatment at a temperature of 140 °C, all the layers exhibited a semiconductor-type temperature dependence of the resistance. The prospects of using these layers in various medical products, e.g. implants for wireless energy transmission, have been discussed.

© 2018, Media Sphera Publishing Group. All rights reserved. A systematic review summarizes the results of studies on the efficacy of myorelaxants (tolperisone, tizanidine, thiocolchicoside or baclofen) in the treatment of acute nonspecific low back pain published up to Dec. 2017. The authors conclude that there are enough data to confirm the efficacy of myorelaxants in treatment of nonspecific low back pain, myorelaxants are recommended as monotherapy or in combination with analgesics or NSAID, the nonsedative drugs tolperisone or thiocolchicoside should be preferred.