bluuebunny/crossref_metadata_2025 huggingface dataset:
Selecting an optimal model of uterine damage for preclinical studies
Authors: Денисова Ю.В. , Мандра Е.В. , Люндуп А.В. , Александров Л.С. , Ищенко А.И. , Никонов А.П.
Published: June 2020

Проведение доклинических исследований для оценки безопасности и эффективности лекарственного средства является необходимым условием для его регистрации и внедрения в клиническую практику. Успех данных исследований во многом зависит от выбора животного и способа моделирования определенной патологии. В представленном обзоре методов анализируются данные по моделированию гинекологической патологии на лабораторных животных. В частности, рассмотрены методы воздействия, позволяющие моделировать синдром Ашермана, эндометриоз и хронический эндометрит. Поиск исследований производился в электронной библиотеке PubMed и базe клинических исследований Clinical Trials. В работе приводится характеристика использующихся хирургических вмешательств, физических, химических и инфекционных методов нарушения целостности матки и формирования в органе воспалительного и спаечного процессов. Рассматривается возможность моделирования эндометриоза при помощи стрессового воздействия. Оценена эффективность применения данных стратегий и возможность их дальнейшего использования. Анализ литературы показал, что наиболее оптимальным вариантом для моделирования повреждения матки считается использование крыс-самок в возрасте от 5 до 8 нед. Наиболее воспроизводимым способом имитации патоморфологических механизмов внутриматочной адгезии является повреждение эндометрия 95-процентным этанолом. Наиболее универсальным способом моделирования хронического эндометрита считается подшивание участков эндометрия к париетальной брюшине передней брюшной стенки.

Preclinical studies are performed to assess safety and efficacy of a drug. They are a prerequisite for drug registration and implementation. Success of these studies depends on the choice of the animal and the method of modeling the pathology. This review focuses on modeling gynecological pathologies in preclinical studies. Specifically, the authors addressed experimental impacts for modeling Asherman’s syndrome, endometriosis, and chronic endometritis. The search for literature was conducted in PubMed and Clinical Trials databases. The review describes surgical interventions, physical, chemical, and infectious methods for affecting the uterus integrity and induction of inflammatory and adhesive processes in this organ. A possibility of modeling endometriosis by stress exposures is considered. Effectiveness of these strategies and prospects for their future use were evaluated. According to the analysis of reports the most suitable animal for modeling the uterine damage is 4-8-week-old female rats. The most reproducible way to activate mechanisms of pathomorphological intrauterine adhesion is chemical injury of the endometrium with 95% ethanol. The best approach in modeling chronic endometritis is endometrial and parietal peritoneum stitching.
Endotoxin in the pathogenesis of HIV infection
Authors: Хасанова Г.Р. , Анохин В.А. , Биккинина О.И. , Яковлев М.Ю.
Published: June 2020

Механизм прогрессирования иммуносупрессии при ВИЧ-инфекции не может быть сведен лишь к гибели CD4+ лимфоцитов вследствие репликации в них вируса. Полученные в результате многочисленных исследований данные свидетельствуют о важной роли избыточной активации иммунной системы в патогенезе заболевания. В качестве одного из факторов, поддерживающих активацию иммунной системы и развитие у ВИЧ-инфицированных разной степени проявлений системного воспалительного ответа, рассматривается эндотоксин (ЭТ) грамотрицательных бактерий. Роль эндотоксина в этом процессе подтверждается высокими показателями эндотоксина и растворимого рецептора CD14 в крови, а также изменениями уровня эндотоксин-связывающих антител у большей части больных с ВИЧ-инфекцией, находящихся на разных стадиях заболевания. Поступлению избыточных количеств эндотоксина в кровоток способствует повреждение кишечной стенки, характерное для течения ВИЧ-инфекции с самого начала заболевания, наблюдающееся в течение всей жизни пациента, и не купирующееся полностью на фоне антиретровирусной терапии (АРВТ). Определенный вклад в микробную транслокацию могут вносить и нарушения микробиоценоза кишечника, так же весьма характерные для течения ВИЧ-инфекции. Продолжение исследований в данном направлении позволит разработать методы патогенетической терапии, которые в сочетании с АРВТ смогут повысить эффективность лечебных мероприятий и увеличить продолжительность жизни пациентов.

The mechanism of immunosuppression progression in HIV infection cannot be reduced only to destruction of CD4+ lymphocytes due to the virus replication. Multiple studies have stressed an important role of immune system overactivation in the pathogenesis of the disease. Endotoxin of gram-negative bacteria is considered as one of the factors supporting the immune system activation and manifestations of the systemic inflammatory response of different severity in HIV-infected people. This fact is confirmed by high levels of endotoxin and soluble CD14 receptor as well as by changes in endotoxin-binding antibody titers in a vast majority of patients with HIV infection at different stages of the disease. Excessive amounts of endotoxin release into the blood due to damage of the intestinal wall, which is typical for the course of HIV infection from the disease onset throughout the patient’s life and cannot be completely reversed by antiretroviral therapy (ART). Disorders of the intestinal microbiocenosis, which are also very typical for the HIV infection, can also contribute to the microbial translocation. Further studies in this direction will allow developing methods for pathogenetic therapy, which in combination with ART would increase the effectiveness of therapeutic measures and prolong the life expectancy of patients.
Molecular Characterization of the Surface Excess Charge Layer in Droplets
Authors: Kwan Victor , Consta Styliani
Published: June 2020

Charged droplets play a central role in native mass spectrometry, atmospheric aerosols and in serving as micro-reactors for accelerating chemical reactions. The surface excess charge layer (SECL) in droplets has often been associated with distinct chemistry. Using molecular simulations for droplets with Na+ and Cl- ions we have found that this layer is ≈ 1.5−1.7 nm thick and depending on the droplet size it includes 33%-55% of the total number of ions. Here, we examine the eﬀect of droplet size and nature of ions in the structure of SECL by using molecular dynamics. We ﬁnd that in the presence of simple ions the thickness of the surface excess charge layer is invariant not only with respect to droplet size but also with respect to the nature of the simple ions and it is not sensitive to ﬁne details of different force ﬁelds used in our simulations. In the presence of macroions the SECL may extend to 2.0. nm. For the same droplet size, iodide and model H3O+ ions show considerably higher concentration than the sodium and chloride ions. In nano-drops, the SECL does not have the highest concentration of ions. We identify the maximum ion concentration region that may overlap with SECL in nano-drops. We also ﬁnd that the differences in the average water dipole orientation in the presence of cations and anions in this layer are reﬂected in the charge distributions. Within the surface charge layer, the number of hydrogen bonds reduces gradually relative to the droplet interior where the number of hydrogen bonds is on the average 2.9 for droplets of diameter < 4 nm and 3.5 for larger droplets. The decrease in the number of hydrogen bonds from the interior to the surface is less pronounced in larger droplets. In droplets with diameter < 4 nm and high concentration of ions the charge of the ions is not compensated only by the solvent polarization charge but by the total charge that also includes the other free charge. This ﬁnding shows exceptions to the commonly made assumption that the solvent compensates the charge of the ions in solvents with very high dielectric constant. The study provides molecular insight into the bi-layer droplet structure assumed in the equilibrium partitioning model (EPM) of C. Enke and assesses critical assumptions of the Iribarne-Thomson model for the ion-evaporation mechanism. We suggest the extension of the bi-layer droplet structure in EPM to include the maximum ion concentration region that may not coincide with SECL in nanodrops. We compute the ion concentrations in SECL, which are those that should enter the kinetic equation in the ion-evaporation mechanism, instead of the overall drop ion concentration that has been used thus far.
Levenshtein Augmentation Improves Performance of SMILES Based Deep-Learning Synthesis Prediction
Authors: Sumner Dean , He Jiazhen , Thakkar Amol , Engkvist Ola , Bjerrum Esben Jannik
Published: June 2020

SMILES randomization, a form of data augmentation, has previously been shown to increase the performance of deep learning models compared to non-augmented baselines. Here, we propose a novel data augmentation method we call “Levenshtein augmentation” which considers local SMILES sub-sequence similarity between reactants and their respective products when creating training pairs. The performance of Levenshtein augmentation was tested using two state of the art models - transformer and sequence-to-sequence based recurrent neural networks with attention. Levenshtein augmentation demonstrated an increase performance over non-augmented, and conventionally SMILES randomization augmented data when used for training of baseline models. Furthermore, Levenshtein augmentation seemingly results in what we define as attentional gain – an enhancement in the pattern recognition capabilities of the underlying network to molecular motifs.
Photoinduced Aerobic Iodoarene-Catalyzed Spirocyclization of N-Oxy-Amides to N-Fused Spirolactams
Authors: Habert Loïc , Cariou Kevin
Published: June 2020

Using the spiro-cyclization of amides as a model reaction we have demonstrated that aerobic iodoarene catalysis can be enabled by relying on a pyrylium photocatalyst under blue light irradiation. This unprecedented dual organocatalytic system allows the use of low catalytic loading of both catalysts under very mild operating conditions.
Differences in the Performance of Allyl Based Palladium Precatalysts for Suzuki-Miyaura Reactions
Authors: Espinosa Matthew R. , Doppiu Angelino , Hazari Nilay
Published: June 2020

We evaluate the activity of different allyl-based precatalysts in Suzuki-Miyaura reactions as the ancillary ligand (NHC or phosphine), reaction conditions, and substrates are varied. In some cases, we connect relative activity to both the mechanism of activation and the prevalence of the formation of inactive palladium(I) dimers.
Deep Learning for Variational Multi-Scale Molecular Modeling
Authors: Zhang Jun , Lei Yaokun , Yang Yi Isaac , Gao Yi Qin
Published: June 2020

Molecular simulations are widely applied in the study of chemical and bio-physical systems. However, the

accessible timescales of atomistic simulations are limited, and extracting equilibrium properties of systems

containing rare events remains challenging. Two distinct strategies are usually adopted in this regard: either

sticking to the atomistic level and performing enhanced sampling, or trading details for speed by leveraging

coarse-grained models. Although both strategies are promising, either of them, if adopted individually,

exhibits severe limitations. In this paper we propose a machine-learning approach to ally both strategies so

that simulations on different scales can benefit mutually from their cross-talks: Accurate coarse-grained (CG)

models can be inferred from the fine-grained (FG) simulations through deep generative learning; In turn, FG

simulations can be boosted by the guidance of CG models via deep reinforcement learning. Our method

defines a variational and adaptive training objective which allows end-to-end training of parametric

molecular models using deep neural networks. Through multiple experiments, we show that our method is

efficient and flexible, and performs well on challenging chemical and bio-molecular systems.
Helminths detection with video capsule endoscopy
Authors: Akopova A O , Mikcheeva O M , Shcherbakov P L , Parfenov A I
Published: June 2020

The article describes clinical observations of helminthiasis detection in 18 of 208 patients during video capsule endoscopy (VCE). Indications for the appointment of VCE were complex clinical situations associated with the search for inflammatory diseases of the small intestine and sources of small intestine bleeding. Because of the high cost of VCE the diagnosis of parasitic diseases should be based on laboratory techniques in clinical practice. Only in case of anemia of unknown etiology VCE demonstrates high efficiency.
Analysis of the impact of vaccination of pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with diabetes
Authors: Ignatova G L , Blinova E V , Antonov V N , Grebneva I V
Published: June 2020

Aim. The article presents data on the evaluation of the clinical efficacy of using a conjugated pneumococcal vaccine in patients with COPD in combination with 2-type diabetes during a 3-year follow - up period. Materials and methods. The study included 309 patients with an isolated course of COPD and in combination with diabetes. The main parameters for evaluating the effectiveness were: the dynamics of clinical symptoms - shortness of breath on the mMRC scale, CAT test, FEV1, the number of exacerbations, hospitalizations, the number of pneumonia, the state of carbohydrate metabolism (HbA1c) and the lipid profile. For vaccine prevention 13-valent conjugated pneumococcal vaccine Prevenar-13 was used. Results and conclusions. The use of PСV13 helps to reduce the severity of respiratory symptoms, reduce the number and duration of exacerbations of COPD, reduce the number of pneumonia. Both in isolated course of COPD and in combination with diabetes. Vaccination PCV13 in patients with comorbid course contributes to the compensation of carbohydrate metabolism and improve the lipid profile.
Antiviral therapy of chronic hepatitis C: 30 years success story
Authors: Abdurakhmanov D T , Rozina T P , Nikulkina E N , Burnevich E Z , Tanashuk E L , Severov M V , Filatova A L , Milovanova S Yu , Karpov V V , Moiseev S V
Published: June 2020

Exactly 30 years ago, hepatitis C virus was identified. Over the years, tremendous success has been achieved in the treatment of hepatitis C, which is currently considered to be an almost completely curable disease. The review presents the main stages in the development of hepatitis C antiviral therapy, the efficacy of various treatment regimens. The greatest progress in treatment was noted over the past 5 years when drugs with direct antiviral action appeared and began to be widely used, including in Russia, which ensure the elimination of the virus in 90-95% of cases.
Psychosocial factors and coronary heart disease
Authors: Kubareva M I , Ibatov A D
Published: June 2020

Article is devoted to a research of interrelation of psychosocial factors and courses of coronary heart disease (CHD). The anxiety, a depression, social isolation of patients with CHD is considered. Need of identification of psychosocial factors at patients with CHD for the purpose of their correction and improvement of the forecast of sick CHD and quality of their life is shown.
Diabetes mellitus and chronic liver diseases. Literature review (part 2): treatment features
Authors: Kalmykova Z A , Kononenko I V , Mayorov A Yu
Published: June 2020

Diabetes mellitus (DM) and chronic liver disease (CLD) are pathological conditions associated with each other and reaching epidemic proportions. There is a strong pathogenetic relationship of carbohydrate metabolism disorders and a number of CLD. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various CLD, leading to steatosis, insulin resistance (IR), impaired glucose tolerance and the development of DM are described. Effective glycemic control can have a beneficial effect on the treatment of these patients, and, conversely, there is evidence of a positive effect of CLD therapy on carbohydrate metabolism. This review discusses the correction of carbohydrate metabolism in patients with CLD, the main groups of modern hypoglycemic drugs, mechanisms of their action, the impact on the physiology of the liver, the possibility of using each of these pharmacological groups in patients with impaired liver function. The modern approaches and possibilities of drug effects on the process of fibrogenesis in CLD, the effect of these drugs on carbohydrate metabolism are listed.
Heart - type fatty acid binding protein in prognosis of ischemic stroke at the hospital stage
Authors: Lyang O V , Kochetov A G , Zhirova I A , Novozhenova Yu V , Ivoylov O O , Stakhovskaya L V
Published: June 2020

Heart - type fatty acid binding protein (h-FABP), in addition to myocardium, is also contained in the brain cells. The blood concentration of h-FABP in cerebral ischemia can be a marker of ischemic stroke course. Aim. To investigate the importance of h-FABP in the prognosis of ischemic stroke (IS). Materials and methods. The study included 302 patients in the acute period of ischemic stroke. All patients were determined the concentration of h-FABP in the serum 1 day by enzyme immunoassay. SPSS and Microsoft Excel software were used for statistical data processing. Results. The most frequent adverse events at the hospital stage were lethal outcome (LO), thrombotic complications and pneumonia. Statistically significant differences in the level of h-FABP between the groups of presence and absence of LO were revealed both by confidence intervals of Central values and by statistical criteria. The ROC analysis values of h-FABP in the presence of the LO confirmed its predictive value, area under the curve amounted to 0.776±0.061 (0.655-0.896), p
Evolution of pathogenetic therapy of pulmonary arterial hypertension
Authors: Chazova I E , Yarovoy S Yu , Danilov N M
Published: June 2020

Pulmonary arterial hypertension (PAH) is a severe, disabling disease characterized by an increase pressure in the pulmonary artery (PA), an increase pressure in the right atrium, and a decrease of the cardiac output. It combines several diseases: idiopathic pulmonary hypertension, inherited pulmonary hypertension, PAH induced by medication and toxins, PAH associated with systemic diseases of connective tissue, HIV infection, portal hypertension, congenital heart defects, schistosomiasis. In the absence of treatment, PAH quickly leads to insufficiency of the right heart and premature death. An effective PAH therapy did not exist for a long time. However, in 1987 there was established a positive effect of taking large doses of calcium channel blockers in patients, who “responded” to their prescription in the short term, and in recently several groups of specific drugs have been developed and approved for the treatment of this pathology: prostacyclin analogues and prostacyclin receptors agonists, endothelin receptor antagonists, phosphodiesterase type 5 inhibitors and soluble guanylate cyclase stimulators. Modern studies of treatment of PAH are based on the latest data of the molecular transmission mechanisms of intracellular and intercellular signals, the action of hormones and tissue enzymes. The available results of these studies allow to suggest the inclusion to clinical guidelines several new drugs for the pathogenetic treatment of PAH in the near future: receptor tyrosine kinase inhibitors, Rho - kinase inhibitors, immunosuppressants and type 2 activin receptor agonists, protein kinase C inhibitors, aromatase inhibitors and estrogen receptor antagonists, poly-(ADP-ribose)-polymerase inhibitors and bromodomain protein 4, elastase inhibitors. Some of the drugs have already passed the III phase of clinical trials (imatinib), others are at the preclinical stage or at the I-II phase tests (olaparib, enzastaurin, elafin).
Do the patients with peripheral atherosclerosis need to a medical therapy before the revascularization?
Authors: Barbarash O L , Kashtalap V V
Published: June 2020

In the review article are provided the approaches to the therapy for improvement of prognosis in patients with peripheral and multifocal atherosclerosis which are available now; some limitations and a real situation are designated for the antithrombotic therapy in this category of patients. According to the clinical trial COMPASS the prospects of wide use of a combination of acetylsalicylic acid and a rivaroxsaban of 2.5 mg 2 times a day in the patients with chronic coronary heart disease and/or symptom peripheral atherosclerosis are designated.
Systemic manifestations of inflammatory bowel diseases
Authors: Parfenov A. I. , Kagramanova A. V. , Knyazev O. V.
Published: June 2020

The article is devoted to the current data regarding the pathogenesis, classification and frequency of extraintestinal manifestations (EIMs) in inflammatory bowel diseases. We discuss two distinct theories of EIMs pathogenesis. First, EIMs arise from an extension of antigen-specific immune responses from the intestine to non-intestinal sites. Second, EIMs are independent inflammatory events initiated or perpetuated by the presence of IBD or by shared genetic or environmental risk factors in the host. These mechanisms are not mutually exclusive and may contribute to varying degrees in different EIMs. Early diagnosis of EIMs contributes to prevention disability and enhancement of quality of life of IBD patients. It is concluded that treatment of extraintestinal manifestations should be carried out taking into account the course of the IBD and the multidisciplinary approach, which requires close cooperation of doctors of various specialties. Assessment of prognostic markers and predictors for EIM in IBD will be part of a future investigation.
Surfactant proteins A and D: role in the pathogenesis of community-acquired pneumonia and possible predictive perspectives
Authors: Kharlamovа O. S. , Nikolaev K. Yu. , Ragino Yu. I. , Voevoda M. I.
Published: June 2020

Community-acquired pneumonia is one of the most common infectious diseases and remains one of the leading causes of death in this group of diseases. Studies of community-acquired pneumonia are extremely relevant for modern clinical practice. One of the important role in the pathogenesis of bacterial, viral, fungal invasion in the system of a human lung system belongs to the pulmonary surfactant, in particular, its proteins SP-A and SP-D. This article reviews the well-known mechanisms of important biological properties of immunomodulatory activity of the proteins SP-A and SP-D in response to microbial infection in the lungs. The mechanisms of participation of surfactant proteins SP-A and SP-D in the cascade of reactions that lead to severe life-threatening complications in community-acquired pneumonia are considered. The use of serum levels of surfactant proteins SP-A and SP-D can help finding new diagnostic and prognostic approaches in patients with community-acquired pneumonia.
Differential diagnosis of idiopathic pulmonary fibrosis
Authors: Shmelev E. I. , Ergeshov A. E. , Gergert V. Ya.
Published: June 2020

The review is devoted to the urgent problem of modern pulmonology: the differential diagnosis of idiopathic pulmonary fibrosis (ILF). ILF occupies a special place among many interstitial lung diseases for a number of reasons: 1) it is a deadly disease; 2) early diagnosis and adequate antifibrotic therapy significantly extend the life expectancy of patients; 3) anti-inflammatory drugs (corticosteroids) and cytostatics with ILF that are widely used in other forms of interstitial lung diseases are ineffective and accelerate the progression of the process; 4) the commonality of the main clinical signs (increasing respiratory failure) of various interstitial lung diseases. The list of respiratory diseases with which ILF should be differentiated is huge, and if with diffuse lung lesions of a known nature (disseminated pulmonary tuberculosis, pneumoconiosis, etc.) with a certain experience/qualification, the diagnosis is relatively simple, then the isolation of ILF from the group of idiopathic interstitial pneumonias always represents certain difficulties. The main methods used in the diagnosis of ILF are summarized taking into account current international and national recommendations.
Comparative analysis of the strength of the respiratory muscles in community-acquired pneumonia with different severity of endogenous intoxication
Authors: Geltser B. I. , Dej A. A. , Titorenko I. N. , Kotelnikov V. N.
Published: June 2020

Aim. To assess the strength of the respiratory muscles in patients with community-acquired pneumonia (CAP) with varying severity of endogenous intoxication.
Materials and methods. In the hospital, 78 men aged 1826 years with CAP were examined. СAP was diagnosed in 56 (72%) patients, severe CAP in 22 (28%). The severity of endogenous intoxication was verified using intoxication indices: hematological index of intoxication (HII), leukocyte index of intoxication (LII), nuclear index of intoxication (NII) and Krebs index. Middleweight molecules (MWM) was determined by spectrophotometry in the serum and the concentration of interleukin (IL)-10 and tumor necrosis factor  (TNF-) by ELISA. The strength of the respiratory muscles was measured on the device Micro RPM (Care Fusion, Great Britain). The maximum expiratory pressure (МЕР), inspiratory pressure (MIP) in the oral cavity, the Maximal Rate of Pressure Development (MRPD) during inhalation (MRPDin) and exhalation (MRPDex), and intranasal test (SNIP) were determined. Statistical processing was performed using descriptive statistics, MannWhitney test, correlation and cluster analysis.
Results. Three clusters of endogenous intoxication corresponding to mild, moderate and severe degree were identified. The first cluster was represented only by patients with mild CAP, the second-mild CAP and severe CAP, and the third severe CAP. Dysfunction of the expiratory respiratory muscles prevailed during the height of the disease in patients with the first cluster, and in the second and third inspiratory, including the diaphragm. The level of actually measured values of MIP and SNIP was 68% and 58% of those due to severe endogenous intoxication. Significant negative correlations were established LII, HII, MWM, TNF-, IL-10 с MEP, MRPDex, MIP и SNIP. Respiratory muscle dysfunction remained only expiratory respiratory muscles in convalescents of the first cluster, and expiratory and inspiratory muscles of the second and third cluster.
Conclusion. The development of respiratory muscle dysfunction in CAP is associated with the influence of endogenous intoxication factors. The results can be used in personalized programs of rehabilitation.
Drug-induced interstitial lung disease: approaches to diagnostics and treatment
Authors: Anaev E. Kh.
Published: June 2020

Drug-induced interstitial lung disease (D-ILD) can be caused by various drugs, including antibiotics, amiodarone, antitumor, rheumatological and non-steroidal anti-inflammatory drugs. D-ILD includes hypersensitivity reactions, organizing and non-specific interstitial pneumonia, eosinophilic lung diseases, diffuse alveolar damage and alveolar hypoventilation. To exclude other causes of pulmonary diseases, an assessment of the medical history, physical data and examination results, which may include chest X-ray/multispiral computed tomography (MSCT), lung function tests, and bronchoscopy with bronchoalveolar lavage, are necessary. Diagnosis of D-ILD is difficult due to the heterogeneity of clinical, radiological and histological data. The X-ray pathological phenotype of D-ILD is different; a specific MSCT pattern has not been identified. Treatment includes drug withdrawal and, in some cases, glucocorticoid therapy, although there are no prospective studies on their effect on the outcome of the disease. This article provides various drugs that cause ILD, approaches to their diagnosis and treatment.
Fatal severe community-acquired pneumonia: risk factors, clinical characteristics and medical errors of hospital patients
Authors: Postnikova L. B. , Klimkin P. F. , Boldina M. V. , Gudim A. L. , Kubysheva N. I.
Published: June 2020

Community-acquired pneumonia (CAP) is the most common disease and potentially life-threatening infection in the worldwide. In the Nizhny Novgorod region, no analysis of the causes of mortality and medical errors of severe CAP patients.
Aim. To analyze the patients structure who died severe CAP in hospitals of the Nizhny Novgorod region, to identify the leading risk factors, to assess the clinical characteristics of fatal severe CAP and medical errors according to medical records of patients from 20152016.
Materials and methods. This was a retrospective study of medical records of 139 patients with fatal severe CAP from medical organizations of the Nizhny Novgorod region. The 72 patients died in 2015. The mortality rate from pneumonia was 67 cases in 2016.
Results. The key predictors of the fatal severe CAP in patients of the Nizhny Novgorod region identified: socio-demographic status (men of working age, unemployed, smoking, alcohol and drug dependence), late treatment and hospitalization, tachypnea, hypotension, tachycardia, confusion, leukocytosis or leukopenia, thrombocytopenia, anemia, hyperglycemia, bilateral lung damage, pleural effusion, acute respiratory failure. The leading medical errors in fatal CAP were incorrect assessment of the severity of the patients condition, untimely CAP, non-monitoring of SpO2 on the first day of hospitalization, late transfer of patients to the intensive care unit, there was no influenza therapy, inadequate starting antibacterial therapy.
Conclusion. The main ways to avoid or minimize medical errors and reduce the mortality of patients with TVP is strict adherence to clinical recommendations, active preventive measures, diagnosis and treatment of chronic diseases.
The study of myocardial perfusion by cardiac volumetric computed tomography, combined with adenosine triphosphate test, in a patient with painless myocardial ischemia and atherosclerosis of the coronary arteries
Authors: Soboleva G. N. , Gaman S. A. , Ternovoy S. K. , Karpov Yu. A. , Minasyan A. A. , Shariya M. A. , Shitov V. N. , Mironov V. M.
Published: June 2020

The presented clinical observation demonstrates the diagnostic capabilities of cardiac volumetric computed tomography (CT) with a pharmacological test by a vasodilator adenosine triphosphate (ATP) in the simultaneous assessment of coronary anatomy and changes in left ventricular myocardial perfusion (LV) in a patient with painless myocardial ischemia and coronary atherosclerosis. A 68-year-old patient with coronary heart disease (CHD) and atherosclerotic changes in the coronary arteries underwent cardiac volumetric CT in combination with a ATP pharmacological test. The study was performed on a Aquilion ONE 640 Vision Edition computer tomograph (Toshiba, Japan). Assessment of LV myocardial perfusion was carried out in comparison with other clinical, laboratory and instrumental examination methods. The results of clinical and instrumental examination of a patient with a low pre-test probability of coronary heart disease are presented. From the standpoint of modern recommendations on stable coronary heart disease, false-negative results of single-photon emission computed tomography of the heart and stress-echocardiography are discussed. Clinical observation demonstrates the feasibility of diagnosing LV myocardial ischemia by cardiac volumetric CT combined with ATP pharmacological test, confirmed by an invasive determination of the fractional flow reserve. The given clinical example represents the advantage of cardiac volumetric CT, combined with the ATP pharmacological test, as a method for visualizing LV myocardial perfusion in detecting myocardial ischemia.
The molecular marker of the preconditioning phenomenon HIF1α is a new pathway for early detection of visceral hypoxic conditions
Authors: Cherkashin D. V. , Lyubimov A. V.
Published: June 2020

Improvement and development of technologies for laboratory and instrumental examination of patients in recent years have greatly facilitated the diagnosis of ischemic myocardial damage. However, a decrease in the rating of cardiovascular diseases is not expected in the short term. This is due to an increase in the life expectancy of the population, general aging of the population and improving diagnostic capabilities and the provision of medical care. The time for verification of the diagnosis of ischemic disease, simplified the decision on treatment tactics were significantly reduced by introduction of X-ray contrast visualization examination methods such as angiography, quantitative and qualitative laboratory tests, development of diagnostic criteria based on the results of ultrasound and electrophysiological examination methods. Unfortunately, all these techniques are secondary in nature and are applied, when organ damage is for the most part already irreversible. Full restoration of organs is possible only if the patient is successfully evacuated to the hospital and there are specialists of the appropriate level of experiebce, X-ray surgical equipment with suitable supplies or pharmacological agents, usefull for quickly restoration the patency of the great vessels and normal blood flow. A large number of studies appear on the phenomenon of preconditioning at the present stage of development of fundamental medical science. The purpose of this article is to reveal the possibilities of using molecular markers of the phenomenon of preconditioning in the framework of the early detection of hypoxic conditions, the assessment of their diagnostic use in the clinic and the prevention of hypoxia-associated diseases.
Evaluation of the effectiveness of ultrasound shear elastography and liver steatometry
Authors: Tarasova O. I. , Kuhareva E. I. , Krasnitskaya S. K. , Mazurchik N. V. , Ngameni M. Ya. , Malinina N. A. , Zykin B. I. , Ogurtsov P. P.
Published: June 2020

Detection of liver fibrosis and steatosis at early stages is a difficult task for clinical practice, due to the lack of early signs in routine radiation diagnostics.
Aim. To evaluate the efficacy of ultrasound shear elastography and ultrasound steatometry of the liver with the use of domestic ultrasonic diagnostic system Angiodin-Sono/N-Ultra.
Materials and methods. 264 people held ultrasound elastography and ultrasound steatometry. 38 patients underwent percutaneous puncture liver biopsy and subsequent pathophysiological examination.
Results. High correlation of fibrosis obtained at the Angiodin-Sono/N-Ultra and the leading ultrasonic systems with shear elastography was revealed. Cross-sectional comparative analysis of elasticity with the results of liver steatometry was conducted.
Conclusions. Results obtained in all groups correlate with the data obtained in studies on Fibroscan. When working with system Angiodin we got a simultaneous comparative analysis of elasticity with the results of liver steatosis. Results appear to be much more stable and compact than those obtained in studies on the Fibroscan. A new diagnostic criterion was revealed the phenomenon of independence of fibrosis and steatosis indices.
Laboratory diagnostics in medicine
Authors: Kochetov A. G. , Lyang O. V. , Zhirova I. A. , Ivoilov O. O.
Published: June 2020

The development of clinical laboratory diagnostics is in line with the evidence-based medicine, which requires that clinical decisions have to be based on diagnostic methods with proven informativity. This creates a request for the scientific validity of the use of laboratory researches and application of probabilistic interpretation tools corresponding to the tasks. The concept of indefiniteness (analytical, biological and clinical) is at the heart of interpretation of laboratory results. The inclusion of laboratory research in clinical guidelines, the choice and appointment of this research to the patient should not be made from the position of ideas about increasing or decreasing the laboratory index in the disease, but on the basis of its scientifically proven characteristics as a laboratory biomarker sensitivity, specificity, predictive value, as well as the relationship with certain clinical events, outcomes, risks. These characteristics are probabilistic and can be defined.
Comparison of myocardial contrast stress-echocardiography and standard stress-echocardiography in detecting myocardial ischemia in patients with different severity of coronary artery stenoses
Authors: Atabaeva L. S. , Saidova M. A. , Shitov V. N. , Staroverov I. I.
Published: June 2020

Aim. To compare diagnostic value between standard stress-echocardiography and myocardial contrast stress echocardiography in detection of myocardial ischemia in patients with different severity of coronary artery stenoses.
Materials and methods. Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (5075%) and 33 over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed.
Results. Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (5075%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively
Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.
Clinicopatological variants and risk factors for chronic kidney disease in rheumatoid arthritis
Authors: Chebotareva N. V. , Gulyaev S. V. , Androsova T. V. , Popova E. N. , Gurova D. V. , Novikov P. I. , Milovanova L. Yu. , Moiseev S. V.
Published: June 2020

Recent studies have shown a high risk of chronic kidney disease and associated cardiovascular complications in patients with rheumatoid arthritis (RA), which determines the prognosis. However, the prevalence of chronic kidney disease (CKD) in RA has not been established in the Russians. Aim. Study was to examine the prevalence, risk factors and histological variants of CKD in RA. Materials and methods. 180 patients with rheumatoid arthritis were observed in the Tareev clinic of nephrology, for the period from 2014 to 2019 years. Age, gender, duration of RA, drug therapy, ESR, CRP, DAS28, renal function, proteinuria, histological variants were analyzed. Of the common population risk factors for CKD arterial hypertension, weight index, serum lipids and glucose levels were also assessed. Results. The prevalence of CKD in RA was 19.7%. Age, presence and stage of arterial hypertension, an increase in body mass index, as well as high rates of disease activity ESR, CRP, DAS28 score and duration of RA were risk factors of CKD in RA. Age, duration of the disease, stage of AH and hypercholesterolemia were risk factors in multifactorial regression analysis. Amyloidosis was the most common histologic pattern (50.0%), followed by chronic glomerulonephritis (30.4%) and tubulo-interstitial nephritis (19.6%). Among chronic glomerulonephritis mesangial glomerulonephritis was the most frequent. Renal amyloidosis was associated with a duration of RA, presence of systemic symptoms and CRP level. An isolated decrease in GFR of less than 60 ml/min was detected in 31 (36.0%) out of 86 patients. Сonclusion. The risk factors for CKD in patients with RA are activity and duration of the disease In addition to common population factors. Amyloidosis was the most common histologic pattern associated with duration of RA and inflammatory proteins levels.
Control of pain in the early post-traumatic period in the outpatient practice. Results of the multi-center observational study RAPTOR (Rational Analgesia PostTraumatic: an Observational Research)
Authors: Karateev A. E. , Lila A. M. , Zagorodnii N. V. , Amirdzhanova V. N. , Pogozheva E. Lu. , Filatova E. S. , Nesterenko V. A.
Published: June 2020

Aim. Evaluate the frequency, nature and course of PTP, as well as the effectiveness and safety of NSAIDs in PTP in real clinical practice.
Materials and methods. The assessment of the condition and need for NSAIDs (original meloxicam) in 1115 outpatient patients who suffered a fracture of the radius (32.2%), injury to the knee (35.2%) or ligaments of the ankle (32.6%); women/men 51.5 and 48.5%, average age 46.915.5 years. We evaluated the dynamics of pain intensity (on a numerical rating scale NRS 010) at rest and during movement, the preservation of moderate and severe pain, as well as the development of adverse drugs reactions (ADR) to NSAIDs 48 weeks after injury.
Results. The average intensity of pain during movement decreased from 7.031.66 to 2.211.38 (p0.001), at rest from 4.462.07 to 0.710.989 (p0.001). The number of people with pain severity 4 in the NRS in 48 weeks after the radius fracture, injury of the knee and ligaments of ankle was 21.0, 16.9 and 11.9%, with moderate or severe impairment of the injured limb 40.4, 26.2 and 16.3%, respectively. The need for taking NSAIDs up to 7 days was noted in 43.3%, 714 days-in 41.8%, more than 2 weeks or constantly in 14.9% of patients. Weak or moderate ADR were observed in 20.8% of patients, mainly dyspepsia and hypertension. Discontinuation of NSAIDs due to ADR was required in only 2.6% of patients. Pain retention 4 in NRS was associated with initially expressed pain (7 in NRS) OR 2.75 (95% CI 0.834.13; p0.001) and the presence of osteoarthritis of knee and/or hip OR 1.56 (95% CI 1.032.34; p=0.039).
Conclusion. PTP decreases rapidly in most patients after a radius fracture, injury of the knee, and ankle ligament injury while taking the original meloxicam. However, in a significant part of patients, moderate or severe PTP persists after 48 weeks, which requires prolonged analgesic therapy and active rehabilitation.
Renal experiences of bariatric surgery in patients with type 2 diabetes mellitus
Authors: Larina I I , Severina A S , Shamkhalova M S , Shestakova M V
Published: June 2020

The review addresses the questions of the literature devoted to the problem of the influence of bariatric surgery on the course of diabetic nephropathy in patients with diabetes mellitus type 2 after achieving a surgically induced remission. This approach was shown to have positive aspects, such as decrease in creatinine, decrease in albuminuria, an increase in GFR, normalization of glycemia and blood pressure, "incretin effect"’s influence on the kidneys. Descriptions of the currently expected pathogenetic mechanisms involved in achieving the observed improvement in microvascular complications of diabetes, namely diabetic kidney disease, are also described in details.
The prevalence of abdominal obesity and the association with socioeconomic status in Regions of the Russian Federation, the results of the epidemiological study - ESSE-RF
Authors: Zhernakova Yu V , Zheleznova E A , Chazova I E , Oshchepkova E V , Dolgusheva Yu A , Yarovaya E B , Blinova N V , Orlovsky A A , Konosova I D , Shalnova S A , Rotar’ O P , Konradi A O , Shlyakhto E V , Boytsov S A
Published: June 2020

Abdominal obesity (AO) is a predictor of cardiovascular disease and diabetes mellitus type 2. The assessment of the disease prevalence and the study of socioeconomic status of people with this phenotype of obesity are necessary to develop effective mechanisms to combat this risk factor in the population. The aim of the study is to determine the prevalence of AO in the population and to assess the association with socioeconomic factors according to the data of the ESSE-RF study (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation). Materials and methods. The object of the study is a random population sample of men and women aged 25-64 years from 13 regions of the Russian Federation (n=21 817). Abdominal obesity in men was defined as waist circumference (WC) >94 cm, and in women - WC >80 cm. Body mass index (BMI) >30.0 kg/m2 was adopted as the criterion of common obesity. Results and discussion. The prevalence of AO in Russia was 55% (61.8% in women and 44% in men), while the percent of people with obesity, defined by BMI was significantly lower (33.4%). The number of examined patients with AO increased with age among both men and women (p
The association between the development of autoimmune polyglandular syndrome in adults and polymorphism of HLA class II genes and the predisposition to the development of chronic adrenal insufficiency in the context of these syndromes
Authors: Larina A A , Troshina E A , Ivanova O N
Published: June 2020

Aim: to consider association of chronic adrenal insufficiency in patients with APS of adults with polymorphism of class II HLA genes, CTLA-4 and PTPN-22. Materials and methods. The case-control study involved 78 patients with APS 2, 3, 4 types and 109 healthy subjects). Alleles of the HLA class II genes, CTLA-4 and PTPN-22 were identified by the multiprimer allele-specific PCR method. The statistical analysis was carried out using the exact two-sided Fisher test. The association of the chronic adrenal insufficiency in patients with APS was determined by the value of the odds ratio (OR - odd's ratio), the value of 95% confidence interval (95% CI - confidence interval). Results and discussion. Haplotypes DR3-DQ2 (OR = 4.06), DR4-DQ8 (OR = 5.78), genotype DR3/DR4 (OR = 19.7), DQA1 * 0301 allele (OR = 4.27), as well as genotype DQA1 * 0301 / DQA1 * 0501 (OR = 13.89) predispose to the development of APS of adults compared to the control group. APS patients were divided into two groups according to the presence of chronic adrenal insufficiency (APS 2 and 4 types - in one group and type 3 APS in the other group). Haplotype DR3-DQ2 (DRB1 * 17-DQA1 * 0501 -DQB1 * 0201) (OR = 2.6), as well as the genotype DR3/DR4 (OR = 4.28) found the strongest association with the development of adrenal insufficiency in patients with APS of adults. Protective haplotypes DRB1 * 01-DQA1 * 0101-DQB1 * 0501 (p
Association between polymorphic markers in candidate genes and the risk of manifestationof endocrine ophthalmopathy in patients with Graves’ disease
Authors: Petunina N A , Martirosian N S , Trukhina L V , Saakyan S V , Panteleeva O G , Burdennyy A M , Nosikov V V
Published: June 2020

Aim. To analyze the association between the polymorphic markers in CTLA4, TNF, IL10 and IL16 genes and the risk of manifestation of endocrine ophthalmopathy (EO) in patients with Graves’ disease (GD). Materials and methods. Case-control study included 248 patients with GD. Using polymerase chain reaction we studied the distribution of alleles and genotypes of polymorphic markers such as A60G (rs3087243) in CTLA4 gene, G(-308)A (rs1800629) in TNF gene, G(-1082)A (rs1800896) in IL10 gene, T3249C (rs4778641) in IL16 gene among 141 patients with Graves’ disease and EO and 107 patients with GD without EO. Results and discussion. The frequencies of A alleles and the AA genotypes were significantly increased and the frequencies of G alleles and the GG genotype polymorphic markers rs3087243 of CTLA4 gene and rs1800896 of IL10 gene, as well as the GG genotype polymorphic marker rs1800629 of TNF gene were reduced in patients with GD and EO. The polymorphism in CTLA4 gene was also associated with the activity and the severity of EO. The comparative analysis of the allele and genotype frequency distribution of polymorphic markers of IL16 gene did not show the significant difference. Conclusion. The risk of manifestation and the development of EO in patients with Graves’ disease can be caused by not only environmental, but also genetic risk factors.