Репозиторий Университета

© 2018 Stolichnaya Izdatelskaya Kompaniya. The choice of anticoagulant therapy in patients with atrial fibrillation (AF) and concomitant diseases - coronary heart disease (CHD), including acute coronary syndrome (ACS) in history, peripheral arterial disease (PAD), is discussed in the article. The overall mortality and incidence of myocardial infarction in patients with CHD and AF is higher than in patients with AF without CHD. Patients with AF and PAD compared to patients with AF without PAD have higher risks both stroke and systemic embolism. The prescription of triple antithrombotic therapy is necessary for patients with a combination of AF and CHD who underwent percutaneous coronary interventions (in ACS or elective surgery). The possibility of prescription and duration, the choice of specific drugs and their doses should be determined individually, based on the risks of ischemic events associated with stenting, the risk of ischemic stroke and bleeding. Use of new oral anticoagulants (NOAC) instead of vitamin K antagonists (eg, warfarin), low doses of NOAC, studied in trials and proven efficacy in the prevention of stroke/systemic embolism, the use of clopidogrel as a drug of choice from the P2Y12 inhibitor group, the use of low doses of acetylsalicylic acid (ASA), the routine administration of drugs from the proton pump inhibitor group is recommended to minimize the risk of bleeding. The data of subanalysis of the ARISTOTEL randomized clinical trial, indicating a high profile of efficacy and safety of apixaban in patients with AF, depending on the presence of CHD, PAD, concomitant use of ASA, are also presented in the article. The benefits of apixaban over warfarin for reducing the risk of stroke/systemic embolism, total mortality and the risk of bleeding in a subgroup of CHD patients are just as obvious as in the general population of the ARISTOTLE study, and in the subgroup of patients without CHD. Treatment with apixaban, both in the subgroup of patients taking ASA, and a subgroup of patients without ASA, is accompanied by a lower risk of strokes and systemic embolism and a lower incidence of major bleeding. The risk of stroke or systemic embolism was similar in patients with AF and PAD randomized to the apixaban group or to the warfarin group, as well as in patients with AF without PAD. Patients with AF and PAD who received apixaban or warfarin had a similar incidence of major bleeding or clinically significant minor bleeding..

© Olga V. Tereshkina, Elena N. Bobkova. The late 19th and the early 20th century showed the development of new scientific views and approaches to the understanding and treatment of mental illnesses. The need arose to create and introduce new medical institutions for the provision of assistance to the mental health patients. On the one hand, it was necessary to isolate the mental health patients who could pose a danger to themselves and others, and on the other hand, the institutions needed for this not only had to provide conditions generally approaching a regular life for the most of the patients, be effective for treatment and economically justified, but also had to follow a human mental health patients principle in their attitude towards the mental health patients. The therapeutic-labor (agricultural) psychiatric colony took up this role. One of the largest of them – the Spas-Petelinsky Psychiatric Colony – was opened in 1911 at the Tula provincial zemstvo district. Through the efforts of Kamenev, and under his leadership, a three-tier system for helping the mental health patients was created and successfully functioned in Tula and the Tula province. Several projects were developed by him. These projects – not big but still important – unfortunately were not carried out. The article focuses on Tula psychiatric establishments for medical and out-of-hospital care. In all Kamenev’s projects, in order to accelerate the implementation process and ensure maximum efficiency, there was a tendency to use various local resources, including sociocultural ones. Also, little-known information is provided on Kamenev’s Moscow activities after his departure from Tula. This article is a continuation of the authors’ research work devoted to the study of regional factors in Tula health care in the context of the reforms of the turn of the 19th and the 20th century.

© 2018 Russian Academy of Sciences.All rights reserved. In this study we investigated factors which predict attitudes toward different forms of Russian participation in Syrian conflict. Russian residents (N = 595) filled out the scales for belief in a just world, nationalism, patriotism, general military attitudes and attitudes towards different forms of Russian involvement in Syrian conflict. The results of the study have shown that just world belief predicts differ-ent forms of national identity-patriotism and nationalism. Patriotism, but not nationalism, is negatively correlated with general military attitudes. General military attitudes, in turn, are positively correlated with attitudes towards Russian military involvement in the conflict, but negatively correlated with the peaceful participation. The article contains new data on the links between national identity and the atti-tude toward war. Proposed assumptions about what the results may be related to. The main prospects for the development of this area of research are outlined.

© 2018 Russian Transplant Society. All Rights Reserved. Blood level of transforming growth factor beta 1 (TGF-β1) is associated with liver function and immune homeostasis, which suggests it as a potential biomarker for immunosuppressant tacrolimus dose requirement at liver transplantation (LT). Aim. To evaluate diagnostic efficacy of TGF-β1 blood level at determination of individual tacrolimus dose requirement in children at LT. Materials and methods. 89 children with end stage liver disease aged from 3 to 73 months were examined. Children underwent living related LT, then the recipients received 2–3 component immunosuppressive therapy, including tacrolimus. Blood concentration of tacrolimus and TGF-β1 was measured by ELISA. Results. TGF-β1 blood level in children before LT was significantly lower than in healthy children: 3.7 (1.3–8.4) and 19.3 (12.6–25.5) ng/ml, p = 0.001. A month after LT, its concentration increased to 8.1 (1.8–15.3) ng/ml (p = 0.02). A year after LT, the cytokine level remained higher than before transplantation: 6.6 (1.9–12.6) ng/ml, p = 0.01. TGF-β1 level did not correlate with tacrolimus blood concentration, determined 12 hours after the last administration of the drug, neither a month, nor a year after transplantation. At the same time, the cytokine level one month after LT was associated with a tacrolimus daily dose one year after the operation (r = –0.23, p = 0.04). In the recipients, who received smaller daily doses (0.4–2.5 mg) of tacrolimus, TGF-β1 level was higher than in those receiving large doses (3.0–6.0 mg) of the drug: 9.1 (2.6–16.2) ng/ml vs. 4.2 (1.3–9.2) ng/ ml, p = 0.04. Evaluation of diagnostic efficacy of the TGF-β1 level as a test for the detection of tacrolimus dose requirement showed that the area under the ROC curve (AUC) was 0.66 ± 0.07; 95% CI [0.53–0.79], the sensitivity and specificity of the test were 60 and 74% at threshold value 6.7 ng/ml. Relative risk of higher tacrolimus dose requirement was 3.14 ± 0.48; 95% CI [1.24–7.96]. Conclusion. TGF-β1 blood level in one month after LT less than 6.7 ng/ml is 3 times higher risk factor of tacrolimus dose requirement more than 3.0 mg per day. The likehood of the test is 66%, the sensitivity and specificity – 60 and 74%.

© 2018 Sychev et al. Background: Non-vitamin K oral anticoagulants (NOACs) are commonly used for prophylaxis of venous thromboembolism (VTE) in orthopedic patients. Despite known safety and high potency of NOACs, potential interactions of NOACs with genetic polymorphisms are poorly understood. Dabigatran etexilate is one of the most commonly prescribed direct thrombin inhibitors for the prevention of VTE. The objectives of this study were to assess the effect of ABCB1 (rs1045642 and rs4148738) and CES1 (rs2244613) polymorphisms on dabigatran pharmacokinetics in patients after total knee arthroplasty. Patients and methods: A total of 60 patients, aged 37–81 years, who underwent surgery for knee replacement have been included in the study. VTE prophylaxis was conducted via administration of dabigatran etexilate 220 mg once daily. Genotyping for carrier state of polymorphic variants such as rs1045642 and rs4148738 of the ABCB1 gene and rs2244613 of the CES1 gene was carried out using real-time polymerase chain reaction (PCR). We also measured the peak and trough concentrations of plasma dabigatran by using high-performance liquid chromatography (HPLC). Results: Our study revealed that TT genotype of rs1045642 polymorphism of the ABCB1 gene was associated with higher dabigatran equilibrium peak concentrations and the higher risk of bleeding than the presence of CC genotype (p<0.008). There was no statistically significant genotype-dependent difference in the trough concentrations between rs1045642 and rs4148738 of the ABCB1 gene and rs2244613 of the CES1 gene. Conclusion: Our findings indicate that the polymorphisms of ABCB1 rs1045642 may have a prominent contribution to the safety of dabigatran in patients after knee surgery. Moreover, TT genotype may be associated with the higher risk of hemorrhagic complications in this population. There were no influence of polymorphism of ABCB1 rs4148738 and CES1 rs2244613 on dabigatran peak and through concentrations. Larger studies are needed to confirm our observations.

© 2018 Onkopediatria. All rights reserved. Background. Analysis of medical care delivery for children with cancer in armed conflict is highly important because the high-tech treatment in this context is extraordinary difficult and challenging task. Objective. Our aim was to analyze the morbidity and mortality rates in children with malignant tumors, to assess the pediatric patient capacity and medical service density in the Donetsk People's Republic. Methods. The ecological study was conducted where the units of analysis were represented by the aggregated data of the Republican Cancer Registry on the number of primary and secondary patients with malignant and benign tumors, the deceased patients in the DNR in 2014-2017, pediatric patient capacity, and medical service density. Results. The number of pediatric patient capacity for children with cancer was 10 (0.27 per 10,000 children aged 0-17), pediatric patient capacity for children with hematological disorders - 40 (1.37 per 10,000 children aged 0-17). The treatment of children with cancer was performed by 5 healthcare providers: 1 pediatric oncologist (0.02 per 10,000 children aged 0-17), 3 hematologists (0.08 per 10,000 pediatric population aged 0-17), and 1 practitioner who did not have a specialist certificate in oncology. Morbidity rate for malignant neoplasms from 2014 to 2017 decreased by 25% (in 2014 - 9.6 per 10,000 children aged 0-17; in 2017 - 7.2). In the morbidity structure, the incidence proportion of hemoblastoses was 68.4%, brain tumors - 2.6%, other solid tumors - 29%. The death rate due to malignant neoplasms decreased by 37% (in 2014 - 2.7; in 2017 - 1.7). Conclusion. Low levels of the incidence rate and pattern of morbidity indicate defects in the identification and recording of patients. This explains the performance of the bed: low average bed occupancy per year and low turnover. For a reliable analysis of mortality statistical data is not available: in 2014-2015 only the number of in-hospital deceased patients is presented. Limited data is due to the lack of reliable patient catamnesis which is explained by the high rate of population migration.

© 2018 Media Sphera Publishing Group. All rights reserved. This article presents an overview of data of Russian and foreign literature on possible associations between cognitive impairment and atrial fibrillation (AF). It includes modern classification of cognitive impairment, mechanisms of the effect of AF on cognitive functions and development of dementia, recommendations for the prevention of cognitive impairment in patients with AF. Special attention is paid to the assessment of cognitive status, and safe anticoagulant therapy, which is a priority in the prevention of cognitive impairment in patients with AF. Analysis of literature showed greater efficacy and safety of drugs from the group of Non-Vitamin K Antagonist Oral Anticoagulants (NOAC), rivaroxaban in particular, in comparison with warfarin. Drugs from the NOAC group can be recommended for prevention stroke, cognitive impairment and dementia in elderly patients with AF.

© 2018 Paediatrician Publishers, LLC. All rights reserved. At present, there is no reliable statistical data (morbidity, mortality, one-year mortality, etc.) that characterize the state of medical care for children with cancers in the Russian Federation seen in due to the lack of an universal electronic database of patients. Objective. Improve the reliability of statistical data. Methods. In the clinical practice of two pilot medical facilities, an electronic database of pediatric cancer patients was introduced which allows: keep patient records with a diagnosis, key dates, follow-up data; analyze the treatment received earlier and assess its quality; make a treatment plan; obtain information on the availability of beds and the number of patients in various medical facilities; perform medical consultations involving the of specialists of the third level medical institutions. Patient (or legal representatives of the patient), has access to the «private cabinet » which provides information on the treatment plan including a schedule for taking medicines, as well as routing possibilities. Results. In the period of 6 months (09.17-02.18), information on 75 patients who received treatment from 2017 to the present was put into the electronic database. Conclusion. The electronic database provides reliable statistical data, helps monitoring the quality of medical care and routing patients. This results in reducing the budget costs and improving the survival of patients.

© 2018 Kryukov et al. Introduction: Difficulties in non-vitamin K anticoagulant (NOAC) administration in acute stroke can be associated with changes in pharmacokinetic parameters of NOAC such as biotransformation, distribution, and excretion. Therefore, obtaining data on pharmacokinetics of NOAC and factors that affect it may help develop algorithms for personalized use of this drug class in patients with acute cardioembolic stroke. Patients and methods: Pharmacokinetics of apixaban in patients with acute stroke was studied earlier by Kryukov et al. The present study enrolled 17 patients with cardioembolic stroke, who received 5 mg of apixaban. In order to evaluate the pharmacokinetic parameters of apixaban, venous blood samples were collected before taking 5 mg of apixaban (point 0) and 1, 2, 3, 4, 10, and 12 hours after drug intake. Blood samples were centrifuged at 3000 rpm for 15 minutes. Separate plasma was aliquoted in Eppendorf tubes and frozen at —70°C until analysis. High-performance liquid chromatography mass spectrometry analysis was used to determine apixaban plasma concentration. Genotyping was performed by real-time polymerase chain reaction. CYP3A isoenzyme group activity was evaluated by determining urinary concentration of endogenous substrate of the enzyme and its metabolite (6-β-hydroxycortisol to cortisol ratio). Statistical analysis was performed using SPSS Statistics version 20.0. The protocol of this study was reviewed and approved by the ethics committee; patients or their representatives signed an informed consent. Results: ABCB1 (rs1045642 and rs4148738) gene polymorphisms do not affect the pharmacokinetics of apixaban as well as CYP3A5 (rs776746) gene polymorphisms. Apixaban pharmacokinetics in groups with different genotypes did not differ statistically significantly. Correlation analysis showed no statistically significant relationship between pharmacokinetic parameters of apixaban and the metabolic activity of CYP3A. Conclusion: Questions such as depending on genotyping results for apixaban dosing and implementation of express genotyping in clinical practice remain open for NOACs. Large population studies are required to clarify the clinical significance of genotyping for this drug class.

© 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 Paediatrician Publishers, LLC. All rights reserved. Background: Moscow and St. Petersburg are cities of federal significance with the largest number of children and consequently a large number of primary patients identified annually. Objective: Our aim was to analyze the main indicators characterizing the delivery of medical care for children with cancer in cities of federal significance. Methods: The operative reports for 2013–2017 of the Department of Health of Moscow, the Ministry of Health of the Moscow Region, the Health Committee of the Government of St. Petersburg, and the Health Committee of the Leningrad Region were analyzed. Results. In 2013–2017 in the Russian Federation, 18 090 primary patients were identified, 2734 (15.1%) of them in the analyzed subjects: in Moscow — 1315 (7.3%), in the Moscow Region — 492 (2.7%), in St. Petersburg — 697 (3.9%), in the Leningrad Region — 230 (1.3%). For 5 years, the number of primary patients increased in Moscow by 18.1%, in St. Petersburg — by 36%, in the Leningrad Region — by 2.5%. In the Moscow Region, the number of primary patients decreased by 2.3%. The incidence in Moscow increased by 5.3% (from 11.3 per 100 000 of children aged 0–17 in 2013 to 11.9 in 2017), in St. Petersburg — by 18.1% (from 14.9 in 2013 to 17.6 in 2017). The incidence in the Moscow Region fell by 20% (from 11.8 in 2013 to 9.4 in 2017), in the Leningrad Region by 4.9% (from 14.4 in 2013 to 13.7 in 2017). Mortality in 2016–2017 in Moscow decreased by 37.5% (from 6.4 per 100 thousand children’s population 0–17 years to 4), in the Moscow Region — by 50% (from 2 to 1), in St. Petersburg increased by 50% (from 2 to 3), in the Leningrad Region — by 12.5% (from 2.4 to 2.7). The one-year mortality rate in Moscow increased by 3.7% (from 8.3% in 2016 to 12% in 2017), in the Moscow Region — by 3.5% (from 5.4 to 8.9% %), in St. Petersburg — by 3.9% (from 2.5 to 6.4%). In the Leningrad Region, the one-year mortality rate decreased from 6.5% in 2016 to 0 in 2017. The number of pediatric oncological beds did not change in the Moscow Region (0.4 per 10,000 children aged 0–17 years), St. Petersburg (0.9), and the Leningrad Region (0). In Moscow and St. Petersburg patients were not identified actively in 2016–2017; in the Moscow Region, their percentage decreased from 34.2 to 7.3, in the Leningrad Region — from 8.7 to 0. In Moscow, the number of pediatric oncological beds increased by 50% (from 0.6 to 0.9). The number of oncologists increased in the Moscow Region from 0.009 per 10 000 children aged 0–17 years to 0.06 (66.7%), in St. Petersburg from 0.09 to 0.12 (+33.3%), in the Leningrad Region — from 0 to 0.03. In Moscow, the number of pediatric oncologists decreased from 0.13 to 0.11 (-15.3%). Conclusion: Defects of statistical data were revealed. Patients were not identified during routine preventive examinations which indicate a low oncologic alertness of district pediatric physicians. Delivery of medical care for children with cancer and the statistical data accumulation procedures should be improved.

© 2018 Stavropol State Medical University. All rights reserved. The review presents data on the relationship of intestinal dysbiosis with irritable bowel syndrome (IBS) and the possibility of modulation of the intestinal microbiota (MB) in IBS therapy. It is shown that imbalance of MB caused by the influence of diet, antibiotics or other exogenous factors leads to gastrointestinal disorders, in particular, to the development of IBS. The data are presented that the modulation of MB with the help of prebiotics, antibiotics, probiotics and fecal microbiota transplantation has a positive therapeutic effect in patients with IBS.

© The Author(s) 2018. Objective: Chondrospheres represent a variant of tissue spheroids biofabricated from chondrocytes. They are already being used in clinical trials for cartilage repair; however, their biomechanical properties have not been systematically investigated yet. The aim of our study was to characterize chondrospheres in long-term in vitro culture conditions for morphometric changes, biomechanical integrity, and their fusion and spreading kinetics. Results: It has been demonstrated that the increase in chondrospheres secant modulus of elasticity is strongly associated with the synthesis and accumulation of extracellular matrix. Additionally, significant interplay has been found between biomechanical properties of tissue spheroids and their fusion kinetics in contrast to their spreading kinetics. Conclusions: Extracellular matrix is one of the main structural determinants of chondrospheres biomechanical properties during chondrogenic maturation in vitro. The estimation of tissue spheroids’ physical behavior in vitro prior to operative treatment can be used to predict and potentially control fusogenic self-assembly process after implantation in vivo.

© 2018, Nizhny Novgorod State Medical Academy. All rights reserved. The aim of this study was to modify the chemical structure and to optimize the composition of the fibrin gel for effective cell encapsulation. Materials and Methods. We prepared PEGylated fibrin gels using different fibrinogen concentrations (25–50 mg/ml) and PEG-fibrinogen molar ratio 10:1 and 5:1 and characterized them via Fourier transform infrared spectroscopy and differential scanning calorimetry. Within the gels, we encapsulated primary culture of fibroblasts and analyzed using light and laser confocal microscopy. Results. PEGylation of fibrinogen allowed us to achieve the gel transparency and preserve its biocompatibility. We revealed that the gel prepared from PEGylated 5:1 fibrinogen (25 mg/ml) provided the most favorable microenvironment for spreading, growth, and proliferation of fibroblasts. This PEG-fibrin gel can be used for encapsulation of different cell types that is essential for various approaches in tissue engineering and diagnostic systems.

© 2018, Nizhny Novgorod State Medical Academy. All rights reserved. The aim of the study was to demonstrate a good diagnostic potential of atomic force microscopy (AFM) in tracking morphological changes in the extracellular matrix (ECM) of connective tissue due to pathological processes. Here we summarize our experience in AFM application in a number of biomedical studies on the connective tissue disease, both for the research and clinical purposes. Materials and Methods. Depending on the project application (experimental or clinical), the tissue specimens were harvested either from animals, or from patients in the course of their surgical treatment, or post mortem. AFM images of fixed tissue slices on glass slides were acquired with a Solver P47 AFM instrument (NT-MDT, Russia), in the semi-contact mode. For mechanical properties mapping, the images were acquired on air in the PeakForce Quantitative Nanomechanical Mapping mode (PeakForce QNM®), using a MultiMode 8 atomic force microscope (Bruker, USA). The regions of interest for scanning were selected in accordance with the histological assignments for the same sample, based on the view of a sample in the built-in optical microscope of the AFM instrument setup. To quantify the changes in the ECM morphology visualized by AFM imaging, we applied flicker-noise spectroscopy parameterization. Results. AFM has been shown to reveal visible deviations from the normal morphology of the ECM in diseased tissues. We found that AFM and related techniques are capable of tracking disease-related changes at different levels of collagen organization in the ECM. At the microscale, AFM may detect loosening and disorganization of collagen fibers (e.g., in a dysplastic process), or the opposite process of their packing into tight parallel bundles in a fibrotic process. AFM may also monitor the ratio between collagen and non-fibrous material of the ECM, for example, in inflammatory and neoplastic processes. At the level of collagen fibrils, AFM may reveal early signs of the matrix destruction and remodeling not visible at the microscopic level. The flicker-noise spectroscopy parameters provide quantification of the morphological changes visualized by AFM. The PeakForce QNM® and nanoindentation studies give a further insight into the state of ECM via tracking changes in the local mechanical and adhesive properties. All our AFM studies appeared in a good agreement with the histological findings and generally had a superior sensitivity to pathology-related ECM rearrangements. Conclusion. AFM may serve as a valuable complementary diagnostic tool for tracking pathological changes in the connective tissue.

© 2018 by the MediaSphere. The materials of the National Consensus reflect the modern domestic and international experience on this issue. Before conducting a specialized endocrinological examination of a short child, all other causes of short stature should be excluded: severe somatic diseases in a state of decompensation that can affect growth velocity, congenital systemic skeletal diseases, syndromic short stature (all girls with growth retardation require a mandatory study of karyotype, depending on the presence or absence of phenotypic signs of Turner syndrome), endocrine diseases in decompensation. A specialized examination of the state of GH-IGF-I axis is carried out when the proportionally folded child has pronounced short stature: if the child's height is < –2.0 SDS, if the difference between the child's height SDS and child's midparental height SDS exceeds 1.5 SDS and/or a low growth velocity. The consensus reflects clear criteria for the diagnosis of GH-deficiency, central hypothyroidism, central hypocorticosolism, central hypogonadism, diabetes insipidus, hypoprolactinemia, and also the criteria for their compensation. The dose of somatropin with GH-deficiency in children and adolescents is 0.025–0.033 mg/kg/day. With total somatotropic insufficiency, especially in young children, it is advisable to start therapy with somatropin from lower doses: 25–50% of the substitution, gradually increasing it within 3–6 months to optimal. In children with a growth deficit when entering puberty, the dose may be increased to 0.045–0.05 mg/kg/day. With the development of side effects, the dose of somatropin can be reduced (by 30–50%), or temporarily canceled (depending on the severity of the clinical picture) until the complete disappearance of undesirable symptoms. With swelling of the optic nerve, treatment is temporarily stopped until the picture of the fundus of the eye fully normalizes. If therapy has been temporarily discontinued, treatment is resumed in smaller doses (50% of the initial) with a gradual (within 1–3 months) return to the optimum. GH treatment at pediatric doses not continue beyond attainment of a growth velocity below 2–2.5 cm/year, closure of the epiphy-seal growth zones, or earlier, when: the achievement of genetically predicted height, but not more than 170 cm in girls, 180 cm in boys, the patient's desire and his parents / legal representatives satisfied with the achieved result of the final height. Re-evaluation of the somatotropic axis is carried out after reaching the adult height, after 1–3 months GH therapy will be discontinued. Patients with isolated GH-deficiency or patients with 1 (besides GH) pituitary hormone deficiencies in the presence of a normal IGF-1 level (against the background of somatropin withdrawal) and not having molecular genetic confirmation of the diagnosis need re- evaluation. Patients with two or more (besides GH) pituitary hormone deficiencies, acquired hypothalamic-pituitary lesions due to operations on the pituitary and irradiation of the hypothalamic-pituitary area (if the IGF-1 level is low against somatropin withdrawal), specific pituitary/ hypothalamic structural defect on MRI, gene defects of the GH-IGF-I system do not need re- evaluation. If GH deficiency is confirmed, treatment with somatropin is resumed at metabolic doses of 0.01—0.003 mg/kg/day under the control of the IGF-I level in the blood (measurement 1 time in 6 months), the indicator should not exceed the upper limit of the reference value for the corresponding age and floor.

© 2018 Russian Association of Endocrinologists. All rights reserved. The presented paper is a third revision of the clinical recommendations for the treatment of morbid obesity in adults. Morbid obesity is a condition with body mass index (BMI) ≥40 kg / m2 or a BMI ≥35 kg / m2 in the presence of serious complications associated with obesity. The recommendations provide data on the prevalence of obesity, its etiology and pathogenesis, as well as on associated complications. The necessary methods for laboratory and instrumental diagnosis of obesity are described in detail. In this revision of the recommendations, the staging of prescribing conservative and surgical methods for the treatment of obesity are determined. For the first time, a group of patients with obesity and type 2 diabetes mellitus is selected, in whom metabolic surgery allows a long-term improvement in the control of glycemia or remission of diabetes mellitus.

Бронхиальная астма - мультифакторное заболевание, в основе которого лежат генетическая предрасположенность и агрессивное воздействие различных аллергенов. Заболевание сопровождается такими симптомами, как кашель, дистанционные свистящие хрипы, одышка. Однако данные симптомы сопровождают и бронхообструктивный синдром (БОС), который наблюдается у детей в возрасте 5 лет и младше в связи с инфекциями верхних дыхательных путей, которые часто встречаются в этой возрастной группе. При оказании помощи ребенку с бронхиальной обструкцией необходимо оценить тяжесть БОС до лечения. В педиатрии для купирования остро возникающих нарушений бронхиальной проходимости используют ß2-агонисты, антихолинергические препараты и их комбинацию.

Бронхиальная астма - мультифакторное заболевание, в основе которого лежат генетическая предрасположенность и агрессивное воздействие различных аллергенов. Заболевание сопровождается такими симптомами, как кашель, дистанционные свистящие хрипы, одышка. Однако данные симптомы сопровождают и бронхообструктивный синдром (БОС), который наблюдается у детей в возрасте 5 лет и младше в связи с инфекциями верхних дыхательных путей, которые часто встречаются в этой возрастной группе. При оказании помощи ребенку с бронхиальной обструкцией необходимо оценить тяжесть БОС до лечения. В педиатрии для купирования остро возникающих нарушений бронхиальной проходимости используют ß2-агонисты, антихолинергические препараты и их комбинацию.