Репозиторий Университета

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. We created an anisotropic material based on collagen sponge and reactive polylactide structured by laser photopolymerization. The combination of collagen with reactive polylactide improves the resistance of the formed matrices to biodegradation in comparison with collagen sponge, while the existence of sites with different mechanical characteristics and cell affinity on the matrix provides directed cell growth during their culturing. It was shown that reinforcement of the collagen sponges 7-fold increased the mean Young’s modulus for the hybrid matrix without affecting its cytotoxicity. The developed matrix provides cell adhesion and proliferation along reinforcement lines and can be used for fabrication of tissue engineering constructs.

© 2018, Pediatria Ltd. All rights reserved. The article presents results of the study of glutathione-S-transferase GSTM1 and GSTT1 genes polymorphism in children with an isolated form of esophageal atresia (EA) with tracheoesophageal fistula and without fistula. Study materials and methods: 130 children were examined, including 39 children with EA and 91 children without EA, whose mothers did not consume tobacco or alcohol during pregnancy. All children belong to the Russian ethnic group. Samples of DNA for further analysis were obtained from buccal epithelial cells. Typing of allelic polymorphism of GSTM1 and GSTT1 genes was performed by Real-time PCR and quantitative PCR. Results: in children with an isolated EA the study revealed a statistically significant increase in the frequency of heterozygous genotypes (+/del) for GSTM1 in comparison with the frequency estimate in the control group (χ2=6,74 df=1, p<0,001). Conclusion: the association of EA with the heterozygous genotype of GSTM1 gene was first established, which may indicate a higher risk of pathology development for carriers of this genotype. The authors believe that EA formation depends on the cumulative effect of mother and newborn genotypes, leading to a decrease in GSTM1 enzyme catalytic activity. To determine the hereditary predisposition to EA development in a fetus it is reasonable to determine the glutathione-S-transferase genes polymorphisms in pregnant women who smoke and consume alcohol, as well as pregnant women living in ecologically unfavorable regions.

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. An HPLC-MS/MS method for determining dabigatran in human blood serum was developed. Samples were prepared by precipitation of proteins using MeOH followed by centrifugation and dilution with deionized H2O. The developed method had a simple sample-preparation procedure, short analysis time, and wide analytical range (from 1 to 1,000 ng/mL). This method was suitable for routine bioanalytical studies, in particular, therapeutic drug monitoring.

© Springer Science+Business Media, LLC 2017.  Sandwich enzyme-linked immunosorbent assay (ELISA) of sulfonamides based on double-competitive interaction between haptenized protein as a captured antigen and analyte for binding to immobilized and enzyme-labeled antibodies was developed. This experimental assay format was examined in analytical properties and matrix effect resistance in comparison with usual ones: indirect, direct antigen-coated and antibody-coated ELISAs. All four assay formats were designed on the basis of interactions between the previously prepared monoclonal antibody and immunizing hapten, 4-(4-(4-aminophenylsulfonamido) phenyl)butanoic acid, providing the uniform output optical signal for correct comparison of each assay characteristic. The sensitivity (IC 50 ) of the developed competitive sandwich assay was rather below 100 ng/ml for 11 sulfonamides which was suitable for their determination in milk, muscles and animal sera at established maximum residue limit concentration. Comparative examination did not reveal changes in assay specificity, and advantages in sensitivity, matrix effect resistance, and procedure duration before commonly used assay formats. Moreover, new design of assay was shown to be three-fold more consumable in antibody reagents in comparison with direct assay formats.

© 2018 Tkacheva et al. Background: Geriatric syndromes (GSs) are common in older adults and have a significant effect on their quality of life, disability, and use of health care resources. Few studies have assessed the prevalence of GSs in Russia. The aim of this study is to assess the prevalence of GSs among older adults living in the community in Moscow. Methods: A cross-sectional study was conducted in four community clinics in Moscow. A total of 1,220 patients completed a screening questionnaire, and 356 of them also underwent a comprehensive geriatric assessment (CGA). Results: The mean age of the 1,220 participants was 74.9±6.1 years; 75.5% were women. Based on the questionnaire, 58.3% reported visual or hearing impairment, 58.2% cognitive impairment, 46% mood disorder, 42% difficulty walking, 28.3% urinary incontinence, 21.3% traumatic falls (over the previous year), and 12.2% weight loss. The mean number of GSs per patient was 2.9±1.5. Based on CGA, a decline in Instrumental Activity of Daily Living score was identified in 34.8% of the patients, a risk of malnutrition (Mini-Nutritional Assessment score, 17–23.5) in 25.8%, probable cognitive impairment (Mini-Mental State Examination score <25) in 8.6%, and symptoms of depression (15-item Geriatric Depression Scale score >5) in 36.2%. On the whole, patients demonstrated good mobility (average walking speed, 1±0.2 m/s) and hand grip strength (23.9±6.4 kg in women and 39.1±8.3 kg in men), but poor balance (only 39.4% were able to maintain their balance on one leg for 10 s or more). Conclusion: The results of this study demonstrate a high prevalence of GSs among community-dwelling people aged 65 years and older in Moscow. The results provide a better understanding of the needs of older adults in Russia and can facilitate planning for medical and social assistance for this population.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. In the clinical practice a physician quite often is at a loss due to “freedom of choice” granted by availability of direct oral anticoagulants (DOAC). If a patient with nonvalvular atrial fibrillation (AF) has indications for therapy with anticoagulants which DOAC should be preferred? What are benefits for a patient with ischemic heart disease and AF when definite NOAC is chosen and what are risks inherent of this choice? Answers to such questions are given in this paper.

AIM: Efficiency assessment of Granulotec (PD) endodontic sealer for root canal permanent obturation in patients with apical granuloma basing on clinical and radiological data. MATERIAL AND METHODS: Endodontic treatment of 35 teeth with apical granuloma was performed in 22 patients with root canal obturation by means of lateral condensation with Granulotec sealer. Bone remodeling in periapical area has been estimated in 1, 3, 6 and 8 months with PAI index. RESULTS: Endodontic post-operative pain has been observed in 5 (14.3%) cases of 35, pain duration varied 1 to 5 days, NSAIDs use hasn't been required. During observation period 2 teeth have been excluded from the test group (one case of periapical abscess with sinus tract and one case periapical abscess without sinus tract). In the end of observation period complete bone remodeling was observed in 30 cases, the periapical lesion size significant reduction was achieved in 2 cases, periapical lesion stabilization - in 1 case. The overall success rate was 91.4%. The mean PAI value decreased from 4.2±0.2 to 1.4±0.2. CONCLUSION: The Granulotec (PD) use for one visit chronic apical periodontitis treatment allows achieving positive results with low complications risk.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The paediatric patient is considered to be a child. However, when it comes to communication with a patient, his consent, implementation of appointments, then the party of interaction is supposed to be an adult. In this regard, the paediatric patient is represented by a child-adult alliance, which allows us to speak of a 'complex patient'. At the same time, his personal agency (the ability to independently formulate a complaint, accept appointments and achieve compliance) changes with the age of a child, coming to him from an adult. This determines the efficacy of screening as well as the main tactics of interaction between the doctor and the patient, explanation, and compliance. Based on the theory of periodization of the personality development, answers are given to the questions: who, a child or an adult, formulates a complaint, who accepts the explanation and who is the subject to compliance? It has been shown that in early childhood (up to 3 years) the patient's subjectivity in the formulation of a complaint and a picture of the disease, the perception of prescriptions and adherence to compliance is provided by the parent. During the pre-school (3-7 years) and primary school (7-11 years) periods, the picture is mosaic: the doctor compares the opinion of the parent and his child to get a picture of the disease, he gives prescriptions to the parent and/or to the child, so both of them can be a subject to compliance. And only in adolescence (12-17 years) a child can be almost a completely independent subject in all aspects of interaction in the doctor-patient system.

AIM: To analyze long-term outcomes of tracheal transplantation. MATERIAL AND METHODS: There were 1128 patients with cicatricial tracheal stenosis who have been operated at the Petrovsky Russian Research Center for Surgery and the Sechenov First Moscow State Medical University for the period 1963-2015. RESULTS: Operations have become safer. Postoperative morbidity and mortality reduced from 41.4% (1963-1980) to 5.6% (2001-2015) and from 21.9% (1963-1980) to 0.5% (2001-2015), respectively. Tracheal transplantation was performed in 2 cases and fundamentally different tracheal structures were applied. Donor thyreotracheal complex with restored blood supply through thyroid vessels was used in the first case (2006). Perennial experimental trials preceded clinical application of this technique. In the second case (2010) we applied scientific results of foreign colleagues (cellular technologies and methods of regenerative medicine to create artificial trachea). Patients are still alive after 12 and 8 years, respectively. Restoration of blood supply of donor trachea is possible through thyroid collaterals. This technique is successful in long-term period. Tissue-engineered trachea cannot be considered true trachea due to no all tracheal components. However, such trachea provides air-conducting, evacuation and protective functions. Tracheomalacia requires further researches as one of the main problems of tracheal transplantation.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. Bolshaya Pirogovskaya ul. 2-4, Moscow, 119435 Russia Pericarditis is not enough researched and described in literature despite the emergence of a large quantity of up-to-date laboratory and instrumental methods of verification. The main problem is that pericarditis might be a sign of many infectious and non-infectious diseases. It is quite difficult to define the etiopathogenetic reason of process. The article presents a clinical observation of a 53 years old mail patient with paroxysms of atrial flutter, non-symptomatic febrile fever, arthralgia and signs of exudative pericarditis, which were manifested after the acute viral infection. The symptoms have been lasting for 8 months before the patient's hospitalization. In lab tests anemia, leucopenia, increase level of platelets and increase antinuclear antibody level were found. Several conceptions were considered: cancer with paraneoplastic syndrome, systemic disease, infectious process, myeloma, which were subsequently excluded. Due to the fact that pericardial effusion may often be associated with tuberculosis Diaskin test and T-SPOT were performed and they appeared to be positive. After several months of antituberculous treatment temperature normalized, atrial flutter episodes and arthralgia diminished. So empirically and laboratory tuberculous pericarditis with atypical manifestation was confirmed. The particularity of this observation is a nontypical clinical picture and the absence of a primary focus of infection. That is why the clinicians could not define the diagnosis rapidly.

© 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 Stolichnaya Izdatelskaya Kompaniya. Aim. To study the changes in the stiffness of the arterial wall, vasomotor function of the endothelium, and appearance of new cases of atrial fibrillation (AF) in patients with arterial hypertension with long-term treatment with lisinopril. Material and method. 66 hypertensive patients with cardiac sinus rhythm at the age of 48-64 years (mean age 58.4±4.2 years) were included into the study. They were randomized into 2 groups: patients of group 1 (n=35) were prescribed lisinopril or a combination of lisinopril with hydrochlorothiazide over the 5-year follow-up; patients of group 2 (control) did not receive angiotensin converting enzyme inhibitors or angiotensin II receptor blockers. The follow-up duration was from September 2010 until June 2016. It included telephone calls once every 3 months and annual clinical, instrumental and laboratory examination. The new-onset AF was identified by the 24-hour Holter ECG monitoring results and by patient symptom diaries. Results. New-onset AF was registered in 2 patients (6%) in the lisinopril group and in 4 patients (13%) from the control group (p=0.001) over the 5-year follow-up. Lisinopril significantly reduced AF incidence in hypertensive patients. The patients on lisinopril were found to have no significant changes in the left ventricular mass index and left atrial size according to echocardiography done after the 5-year follow-up whereas in the patients of control group both parameters increased significantly. Lisinopril contributed to the maintenance of endothelial vasodilator function and prevented increase in arterial wall stiffness. Conclusion. Long term lisinopril treatment was found to significantly reduce the AF incidence in hypertensive patients over the 5-year follow-up. Lisinopril demonstrated organoprotective properties throughout the cardiovascular disease continuum and can be recommended for primary prevention of arrhythmia in hypertensive patients..

© 2018 Stolichnaya Izdatelskaya Kompaniya. The article presents a clinical observation of the left atrial appendage thrombosis in a 51-year-old female patient with a paroxysmal form of nonvalvular atrial fibrillation which occurred despite long-term anticoagulant therapy with apixaban in a full dose (5 mg b.i.d.), and the patient's management. The patient was admitted with recurrent symptomatic paroxysm for more than 48 hours, because of which, in accordance with the recommendations, transesophageal echocardiography was performed before an emergency rhythm restoration. Thrombus in the left atrial appendage 0.5×1.03 cm in size was detected. It was decided to refrain from the immediate restoration of the rhythm due to the very high risk of thromboembolic complications. In connection with the categorical refusal of the patient from warfarin, it was decided to replace apixaban with another direct oral anticoagulant - dabigatran 150 mg bid for a period of 4 weeks followed by performing a control transesophageal echocardiographic study. As a result, no thrombus was found on control echocardiography. The particularity of this observation is concomitant hypertrophic cardiomyopathy and diabetes mellitus type 1 in this patient..

© 2018 National Academy of Pediatric Science and Innovation. All rights reserved. Relevance. Statistical indicators are the basis for planning of the organization of medical care for children with cancer, as well as analysis of the effectiveness of medical care. Materials and methods. The authors have analyzed operational reports for 2017 of the executive authorities in the field of health care of 18 objects of the Russian Federation being part of the Central Federal District. Results. There 9 pediatric oncology departments, there are 464 children’s oncological beds, the bed occupancy per year is 319.3. There are 91 doctors providing medical care to children with cancer, 64 (70.3%) of the doctors have a certificate of pediatric oncologist. In 11 subjects there are no Departments for Pediatric Oncology. There are 821 primary patients with malignant neoplasms. There are 156 deceased patients, 66 of them were diagnosed in 2017. 52 (6.3%) patients are revealed actively. There were 12 (per 100 thousand for the age group of 0–17 years) cases of incidence of malignant neoplasms, mortality is 2.3 (per 100 thousand for the age group of 0–17 years), one-year mortality is 8%. The average time taken to diagnose and to verify the diagnosis before the beginning of treatment remains unknown. Conclusion. Operational reports contain non-matching indicators, thus, the information is not completely reliable. Incidence rates are significantly lower than those in countries with high reliability of statistical data. The percentage of patients identified actively remains extremely low. In order to eliminate the noted defects, it is necessary to introduce a single database of children with cancer in the Russian Federation.

Copyright: © 2018 Sapelnikov et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 License. Mitral valve disease, including dysfunction of the mitral valve, is often accompanied by atrial fibrillation. Among the patients with prosthetic mitral valves, atrial fibrillation occurs in 30-50% cases. Development of atrial arrhythmias and incisional tachycardia in the early and late postoperative periods can significantly influence patients' rehabilitation and prognosis. Our clinical case describes a patient with a mechanical mitral valve and incisional tachycardia, which led to progression of heart failure and reduced left ventricular systolic function. The patient underwent catheter ablation with non-invasive myocardium mapping. The case reveals the potentials of treatment of incisional tachycardia and atrial fibrillation, which do not respond to drug therapy. Modern methods of visualization enable the cardiac surgeons to reduce possible intraoperative risks and development of complications in this group of patients.

© 2018 Paediatrician Publishers, LLC. All Rights Reserved. Background. Improving the quality of medical care is based on a coordinated policy at the federal, regional and municipal levels in the field of health. The implementation of this goal is based on a regular assessment of the current state of the healthcare system in the Russian Federation. Objective. Our aim was to analyse of the main indicators characterizing medical care for children with cancer in the South Federal District. Methods. The operative reports for 2017 of the executive authorities in the sphere of health protection of 8 subjects of the Russian Federation that are part of the South Federal District of the Russian Federation have been analyzed. Results. The number of children were 3 216 797 people (aged 0-17 years), the number of children's oncological beds is 272 (0.8 per 10 thousand children aged 0-17 years), the average number of days of berth employment in the year is 289.9 bed days. In 4 (50%) subjects of the department of pediatric oncology are absent, in 1 (12.5%) - there are no children's oncological beds. The number of doctors providing medical care to children with cancer is 50, of them 42 (84%, 0.1 per 10 thousand children aged 0-17 years) have a certificate of a pediatric oncologist. In 2 (25%) subjects, there are no pediatric oncologists. Incidence of malignant tumors was 13.9 (per 100,000 children aged 0-17 years), prevalence was 86.5 (per 100,000 children aged 0-17 years), mortality was 2.5 (per 100,000 children aged 0-17 years), a one-year mortality rate of 4.7%. 8% of patients were actively detected. 104 (23.2%) of primary patients were sent to medical organizations of federal subordination, 4 (0.9%) of primary patients left the territory of the Russian Federation. Conclusion. The analysis revealed a number of defects: incorrect information contained in the reports, low incidence (detectability) of patients, including during planned preventive examinations, staff shortages and non-rational use of bed facilities.

© 2018 University of Rijeka, Faculty of Medicine. All Rights Reserved. Background. The analysis of the quality of medical care for children with cancer is based on statistical data. Evaluation of the results is also the basis of the strategy for the development of medical care for this category of patients. Objective. Our aim was to analysie the main indicators characterizing medical care for children with cancer in the North-Caucasian, Volga, Urals, Siberian and Far Eastern Federal Districts. Methods. In ecological study the operative reports for 2017 of the executive authorities in the sphere of health protection of 44/48 (91.6%) subjects of the Russian Federation that are part of the listed above federal districts have been analyzed (Chuvash Republic, Irkutsk Region, Republic of Sakha (Yakutia) and Khabarovsk Territory did not provide data). Results. The number of children's population was 15 555 306 people (0-17 years), the number of children's oncological beds - 1166 (0.7 per 10 thousand 0-17 years), the average number of days of berth employment in the year - 324.6 bed days. In 13 (29.5%) subjects of the department of pediatric oncology are absent, in 6 (13.6%) - there are no children's oncological beds. The number of doctors providing medical care to children with cancer is 213, of which 132 (62%; 0.08 for 10 thousand 0-17 years) have a certificate of a pediatric oncologist. In 6 (13.6%) subjects there are no doctors-children oncologists (6 more (13.6%) subjects did not provide data). The incidence of malignant neoplasms was 13.1 (per 100.000 0-17 years), the prevalence of 93.1 (per 100.000 0-17 years), mortality rate 2.5 (per 100.000 0-17 years), one-year lethality - 6.8%. 10.1% of patients were actively detected. 781 (38.3%) of primary patients were sent to medical organizations for federal subordination, 39 (1.9%) of primary patients left the territory of the Russian Federation. Conclusion. Obvious accounting defects (low incidence rate) and lack of reliable follow-up data (estimation of mortality levels is difficult) are eliminated by introducing electronic accounting systems. For reliable estimation of the level of provision of the population with children's cancer beds and the percentage of patients sent for treatment in medical organizations of federal subordination, audit of patients' illnesses is necessary. The traditional problems - the deficiency of doctors and children's oncologists and a low percentage of patients identified actively - must be addressed through the reform of the training program for medical personnel.

© 2018 Media Sphera Publishing Group.All right reserved. Aim. To estimate association between disorders of salt-water homeostasis on admision and the remote one-year prognosis for patients hospitalized with decompensated CHF NYHA FC III-IV. Materials and methods. This prospective study was based on clinical amnestic data and results of one-year follow-up of 111 consecutive patients admitted for decompensation of CHF to the State Clinical Hospital No. 24 in January 2015-February 2016. Results. The relative risk of death within one year for patients hospitalized for decompensated CHF with disorders of water and salt homeostasis increased 1.43 times by the end of one-year follow-up compared to patients with normal blood levels of sodium and potassium on admission (RR=1.43; 95 % CI: 1.10-1.87; p<0.01). Furthermore, the relative risk of death within one year was significantly increased 1.4 times in the subgroup of patients with hypernatremia (RR=1.41; 95 % CI: 0.99-2.01; p<0.05, respectively) and 1.4 and 2.3 times in subgroups with hypo-/hyperkalemia respectively (RR=1.39; 95 % CI: 0.93-2.07; p<0.05 and RR=2.23; 95 % CI: 1.04-4.78; p<0.01) compared to patients with normal blood levels of sodium and potassium on admission. Conclusion. Disturbed water and salt homeostasis on admission of patients hospitalized for decompensated NYHA FC III-IV CHF is a predictor for an unfavorable remote prognosis.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved.  Aim: to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect. Materials and methods. Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6%) the procedure of endovascular repair of secondary ASD was combined with performed at same session coronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9. Results. At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100%. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm 3 , right ventricular volume - from 45.2±5.1 to 33.4±3.8 cm 3 , systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiog-raphy good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W. Conclusion. Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.