bluuebunny/crossref_metadata_2025 huggingface dataset:
PUBIC SYMPHYSIS DIASTASIS IN PREGNANCY AND DELIVERY (REVIEW)
Authors: Petrushin A. L. , Pryaluchina A. V.
Published: October 2018

Purpose of the study — to generalize and arrange the data published in scientific literature and to present current views on epidemiology, diagnostics and treatment options for pubic symphysis diastasis during pregnancy and delivery. Semeiotic separation wider than 10 mm is considered pubic symphysis diastasis during pregnancy and delivery. Diastasis above 14-25 mm might be associated with ruptures of sacroiliac joints. Frequency of such pathology is reported in the range from 0,03 to 2,8%. Key risk factors of this pathology include multiparity and repeated labor. Symptoms of pubic separation include pain and signs of pelvic instability manifesting immediately after delivery or within a short period of time after the delivery. AP roentgenography is the principal diagnostics method however lately ultrasound exam is done more frequently. Conservative option prevails in treatment of pubic symphysis diastasis. Surgical procedures are recommended in case of separation above 30-50 mm, ruptures of sacroiliac joints, open lesions, failed conservative treatment and urological dysfunction. In such cases preferred option is the internal fixation by plate and screws. Some authors use external fixation. Late-term outcomes of both methods do not demonstrate significant differences. Pain regress after the surgery is observed within 3 weeks to 6 months postoperatively, walking with partial load is restored in 5-14 days, full load on the lower limbs is possible 6 months postoperatively. Indications for removal of implants after internal fixation are not clearly defined. Following surgical treatment of pubic symphysis diastasis the majority of authors incline to subsequent operative delivery.
COMMENT
Authors: Sereda A. P.
Published: October 2018

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CONSTRAINED LINERS AND DUAL MOBILITY SYSTEMS FOR PREVENTION OF INSTABILITY IN REVISION HIP ARTHROPLASTY
Authors: Efimov N. N. , Stafeev D. V. , Lasunskii S. A. , Mashkov V. M. , Parfeev D. G. , Shubnyakov I. I. , Tikhilov R. M.
Published: October 2018

Purpose. Instability is a challenging complication of revision hip arthroplasty and a frequent cause of repeat revisions. Constrained liners and dual mobility systems have gained major attention among the options of dislocation prophylaxis. The aim of this study is to compare the outcomes of revision hip arthroplasy with use of constrained liners and dual mobility systems. Materials and Methods. We used DePuy Duraloc (inner diameter 28 mm) and Zimmer Trilogy (inner diameter 32 mm) systems in the constrained liners group (N 78, mean follow-up — 66.2 month, 54-82), Serf Novae and Biomet Avantage systems in the dual mobility group (N 58, mean follow-up — 17.8 month, 10-41). The two groups were comparable in age, sex and different potential dislocation risk factors, however, dual mobility cups were used more frequently in revisions due to unreduced and recurrent dislocations and in patients with the history of instability following total hip arthroplasty. There were also differences in the structure of primary diagnosis. Results. We observed 14 (17.9%) dislocations, 10 (12.8%) of which occurred within 2 years after surgery, and also 3 (3.8%) cases of aseptic loosening of the acetabular component, 4 (5.1%) cases of locking mechanism damage without dislocation and 8 (10.3%) cases of deep infection in the constrained liners group. In the dual mobility group we observed 3 (5.17%) large articulation dislocations, 1 (1.7%) case of aseptic loosening of the acetabular component and 4 (6.9%) cases of deep infection. The difference in dislocation rates in two groups was significant (p0.05). The analysis of the constrained liners group revealed an increased risk of dislocation in cases when a constrained system was implanted into a retained acetabular component compared to cases with acetabular shell revision (p0.01; RR = 7.2, 95% CI: 2.05-25.26), as well as a trend for increased risk of dislocation in cases when DePuy Duraloc liners (inner diameter 28 mm) were used compared to Zimmer Trilogy (inner diameter 32 mm) (p = 0.07; RR = 4.97, 95% CI: 1.03-24.04). Conclusion. Dual mobility systems proved to be more effective than constrained liners in revision hip arthroplasty although being used more frequently as a treatment rather than prophylaxis of instability. Constrained liners bear a higher risk of dislocations when implanted into retained acetabular components and when used with heads of lesser diameter.
OUTCOME OF PERIPROSTHETIC FEMORAL FRACTURES IN HIP ARTHROPLASTY
Authors: Korytkin A. A. , El Moudni Y. M. , Kovaldov K. A. , Novikova Y. S. , Belousov B. Yu.
Published: October 2018

Periprosthetic fractures are one of the main reasons for revision surgery according to the data of large joint replacement registers. Treatment of patients with periprosthetic fractures is associated with a big number of complications and still keeps its relevance. Purpose of the study is to evaluate treatment outcome of patients with periprosthetic femoral fractures in hip replacement. Material and Methods. The authors performed a retrospective analysis of medical histories of 76 patients who underwent treatment of periprosthetic femoral fractures. The patients were divided into groups by the Unified Classification System (UCS). Follow up period was from 6 to 124 months (mean of 34.90±28.81). Results. 3 cases (3.9%) of periprosthetic femoral fractures were the complications after primary hip arthroplasty and occurred intraoperatively, 75 cases (96.1%) were complications after revision surgery; 56 cases (71.8%) were reported with uncemented and 22 cases (28.2%) with cemented femoral components. In 30 cases (38.5%) fractures had a iatrogenic nature and occurred intraoperatively, in 48 cases (61.5%) — occurred due to high- and low energy trauma. Type B fractures were observed most often — in 53 cases (68%). Conservative treatment, fixation by cerclage or by plate and screws has proven to be the least effective operative options. In the group of patients with extended osteotomy of the greater trochanter the healing was achieved in 90.5% of cases, while in the group without osteotomy — in 75% of cases. Low healing rate of periprosthetic fractures was observed for A and B1 type fractures (65% and 66.7% respectively). Follow up of patients with B2, B3 and C type fractures demonstrated consolidation in more than 80% of cases. Various complications were reported in 17 cases (21.8%). Conclusion. Effective treatment of patients with periprosthetic femoral fractures was associated with extended osteotomy of the greater trochanter (γ = 0.51; p = 0.032), absence of complications in postoperative period (R = 0.55; p = 0.00001), B2, B3 and C fracture types (γ = 0.40; p = 0.02) and use of revision uncemented femoral components with distal fixation (γ = 0.35; p = 0.018). In the authors opinion use of sutures or cerclage wires are not effective in cases of trochanteric fractures and stable femoral components; it would be preferable to perform internal fixation by a plate with hooks such as Dall-Miles. In case of doubts in regard of stem stability the revision should rather stipulate use of uncemented femoral components, in particular long stems with distal fixation.
PATIENT SATISFACTION FOLLOWING TOTAL HIP REPLACEMENT: PREDICTORS OF SUCCESS
Authors: Cherkasov M. A. , Tikhilov R. M. , Shubnyakov I. I. , Kovalenko A. N. , Mugutdinov Z. A.
Published: October 2018

Background. Total hip arthroplasty (THA) is reliable and successful intervention in terms of relieving pain and improving joint function. Between 7% and 16% of patients are dissatisfied after THA. To assess predictors and postoperative determinants of satisfaction 3 and 12 months after THA. Material and Methods. During our research from 2015 to 2017 prospectively 1015 patients were interviewed using patient related outcome measures (a questionnaire of functional outcome (Oxford Hip Score, Harris Hip Score), health-related quality of life (EQ-5D)) preoperatively, 3 and 12 months postoperatively. Satisfaction was assessed using Visual Analogue Scale (VAS). Also Univariate and multivariate analyses were performed. Results. A female gender, absence of interventions on the operated joint in history were preoperative predictors of satisfaction. The main postoperative determinant of satisfaction was the fulfillment of patient’s expectations, improve physical function, quality of life, relief of pain. Conclusion. To improve patient satisfaction after THA, patients’ expectations and their fulfillment need to be carefully addressed. Patients with a history of interventions on the operated joint with low physical function or quality of life, high level of pain should be identified and specifically informed on expected surgical outcome
SACROILIAC JOINT PATHOLOGY IN ELDERLY PATIENTS WITH LOW BACK PAIN (OBSERVATION PROGRAM “IOLANTA”)
Authors: Kotelnikov G. P. , Zolotovskaia I. A. , Davydkin I. L. , Poverennova I. E. , Dolgushkin D. A.
Published: October 2018

Pain in the lower back is one of the frequent reasons for seeking medical help among people over 60 years of age. The study of this problem is of interest to specialists of various profiles, including neurologists, rheumatologists, orthopedic surgeons and therapists. Purpose — to determine prevalence rate of sacroiliac joint pathology in elderly patients with low back pain (LBP) in conjunction with evaluation of clinical significance of bone resorption and cytokines markers. Materials and Methods.The study was conducted with consecutive inclusion of patients (n = 259) with mean age of 65.5 year old [62.5; 69.5] who addressed the hospital for the first time in calendar year with complaints for low back pain. The authors performed MRI examination of lumbar-sacral spine and sacroiliac joint, assessed transforming growth factor β1 (TGF β1), interleukin (IL) 1β and IL-6, Beta-Crosslaps (β-CrossLaps) criteria, P1NP (N-terminal propeptide of procollagen type I) concentration and deoxypyridinoline (DPD) level. Results. 39.4% of patients older 60 years with low back pain on MRI demonstrated changes in sacroiliac joints with statistically significant higher (p = 0.037) pain level as compared to patients without pathology of sacroiliac joint, as well as higher values of TGF-β1 (p = 0.033), IL-1β (p = 0.028), IL-6 (p = 0.041), β-CrossLaps (p = 0.028), P1NP (p = 0.037) and DPD (p = 0.002). Conclusion. Reported alterations in sacroiliac joint conditioned by degenerative and dystrophic processes are associated with distinctive signs of osteoarthrosis and confirm non-specific inflammation active with bone resorption in patients with low back pain.
ЕFFECTIVENESS OF FOUR-ROD FIXATION FOR PEDICLE SUBTRACTION SPINAL OSTEOTOMY
Authors: Panteleyev A. A. , Mironov S. P. , Buhtin K. M. , Sazhnev M. L. , Kazmin A. I. , Pereverzev V. S. , Kolesov S. V.
Published: October 2018

Introduction. Pedicle subtraction osteotomy (PSO) provides for significant segmental correction of the sagittal balance of the spine. At the same time, the technique is associated with a high risk of complications, with rod fracture at the osteotomy site being the most common. The purpose of this study — to assess the effectiveness of four-rod fixation compared to literature data on standard two-rod fixation in patients undergoing PSO. Materials and Methods. The study is a retrospective analysis of 47 consecutive patients with rigid spinal deformities, who underwent pedicle subtraction osteotomy at the lumbar level. The average age of the patients (33 females and 14 males) was 59.7 years. In all cases spinal fixation carried out using a four-rod construct with additional short rods at the osteotomy site. The minimal postoperative follow-up was 2 years. A detailed analysis of the radiographic data was carried out with calculation of the global sagittal balance and spinopelvic parameters. A detailed assessment of complications in the early and late postoperative periods was also performed. After an exhaustive review of literature, a comparative analysis was made of the four-rod fixation technique with current literature data on the frequency of complications (in particular, rod fractures in the osteotomy zone) after two-rod fixation. Results. In all cases the osteotomy was performed at one level, most often at L3 (49%). The average length of fixation was 9.8 segments. The average angle of segmental correction was 27.1°. In most cases, it was possible to achieve adequate correction of spinopelvic parameters. Among complications, bone resorption around screws was most prevalent (23.4% of cases). Proximal junctional kyphosis occurred in 12.8% of cases, neurologic deficit — in 14.9% of cases, infectious complications — in 10.6% cases. Asymptomatic pseudarthrosis, confirmed by CT data, was observed in 12.8% of patients. Rod fracture at the PSO site and adjacent segments was not observed in any of the cases. Rod fractures of other localization were observed in 10.6% of patients. Conclusion. According to the literature, the frequency of rod fractures at the osteotomy site is the most frequent complication of PSO. The results of this study showed that four-rod fixation in PSO significantly reduces the incidence of pseudarthrosis and rod fracture rate in the long-term follow-up and provides greater control over the process of osteotomy closure.
CLINICAL AND ROENTGENOLOGICAL CRITERIA OF SPINE-PELVIS RATIOS IN CHILDREN WITH DYSPLASTIC FEMUR SUBLUXATION
Authors: Bortulev P. I. , Vissarionov S. V. , Baskov V. E. , Ovechkina A. V. , Barsukov D. B. , Pozdnikin I. Y.
Published: October 2018

Aim of the study — to identify clinical and roentgenological criteria of the sagittal profile status of spine-pelvis segment in children with dysplastic femur subluxation.Material and Methods. The present study included 40 female patients (50 hip joints) aged from 12 to 17 years (14.7±1.58) with unilateral and bilateral hip joint instability due to dysplasia. Children were divided into two groups – the first group included 30 patients (30 hip joints) with unilateral femur subluxation, the second group – 10 patients (20 hip joints) with bilateral femur subluxation. All patients underwent a standard orthopaedic clinical examination using a specialized scale to objectify complaints. All patients underwent X-ray examination of hip joints in AP and Lauenstein projections, CT scanning as well as lateral panoramic roentgenography of C1-S1 including femoral bones in standing position of the patient.Results. The authors observed a strong positive correlation between sacrum inclination and lumbar lordosis curvature, antetorsion angle of proximal femur and sacrum inclination angle, severity of pain syndrome during impingement test and sacrum tilt: Pearson correlation coefficient was 0.71, 0.81 and 0.88 respectively. The authors reported in all patients a thoracic normokyphosis and lumbar hyperlordosis with excessive pelvis anteversion. Global sagittal disbalance was observed in all patients.Conclusion. Apart from typical anatomical and roentgenological changes in pelvic and femoral componentsof the joint the children with dysplastic femur subluxation are characterized by excessive pelvic anteversion. Criteria of above parameters are identical and do not depend on the number of joints involved into the pathological process. Cranial dislocation of femoral head results to abnormalities of sagittal spine-pelvis ratios. Pathological process in hip joints and abnormality of spine-pelvis ratios results in negative changes of sagittal spine profile in the form of hyperlordosis, of physiological criteria of thoracic kyphosis and of the global sagittal disbalance. All of the above leads to overload of spinal motion segments and development of spine degenerative and dystrophic changes at early age.
THORACIC AND LUMBAR HEMIVERTEBRA EXCISION IN PEDIATRIC PATIENTS: HOW DOES THE OPERATION TECHNIQUE INFLUENCE ON OUTCOMES? (СOHORT ANALYSIS AND LITERATURE REVIEW)
Authors: Mushkin A. Yu. , Naumov D. G. , Umenushkina E. Yu.
Published: October 2018

Purpose of the study — to study impact of hemi-vertebrae extirpation technique in mono-segmental reconstruction on the surgical trauma.Material and Methods. 34 patients underwent 36 mono-segmental extirpations of hemi-vertebrae followed by a posterior fixation during a single center four years cohort study. Mean age of children at the moment of procedure was 4 years and 3 months (min — 1 year, max — 14 years). The authors studied impact of pathology level, surgical approach, type of bony structures removal technique and age of the patients on the time of procedure and volume of blood loss. Results. Extirpation of thoracic hemi-vertebrae was characterized by a lengthier procedure and greater blood loss in contrast to lumbar hemi-vertebrae. Patients were divided into three groups depending on extirpation technique: 1)  extirpation from two approaches using a high-speed burr; 2) from a single dorsal approach using the same extirpation technique; 3) from dorsal approach using ultrasonic bone scalpel. Surgery time was 208±72 min in the first group, 187±54 min in the second group, and 170±30 min in the third group; blood loss volume was 181±39, 181±53, 132±73 ml respectively in the groups, or 11.5±4.3%, 9.4±2.8% and 9.6±5.2% of total blood volume, respectively.Conclusion. Surgical approach and hemi-vertebrae extirpation technique in children have a varying impact on surgery time and intraoperative blood loss, and the least values were reported for posterior approach using ultrasonic bone scalpel.
TRAUMATOLOGY AND ORTHOPEDICS RESEARCH SPECIALITY IN 2017: DISSERTATIONS ANALYSIS
Authors: Reshetov I. V. , Tikhilov R. M. , Kochish A. Yu. , Shubnyakov I. I.
Published: October 2018

The authors present a short analysis of autoabstracts of all theses in traumatology and orthopedics speciality (14.01.15), 10 doctoral and 59 candidate theses, that were defended at 11 dedicated dissertation boards starting mid of October 2016 until mid of October 2017 and underwent expert reviews during 2017 in expert council of the Higher certifying commission on surgical science.The absolute majority of 26 papers in traumatology (16 candidate and 5 doctoral theses) were dedicated to treatment of patients with different fractures and another 5 candidate theses examined issues of arthroscopic procedures in case of a trauma. 25 dissertations in orthopedics mainly reviewed aspects of large joints replacement (6 candidate and 3 doctoral these) and treatment of periprosthetic infection (4 candidate theses). Spine pathologies (5 candidate theses) and oncology orthopedics (2 candidate theses) prevailed among dissertation topics on paediatric orthopedics. The only doctoral thesis on paediatric orthopaedics was dedicated to clubfoot.In accordance with recommended criteria of clinical Orthopaedics and Related Research journal 40 (67,8%) candidate theses and 2 (20%) doctoral theses corresponded to evidence level III, 17 (28,8%) candidate and 8 (80%) doctoral theses were classified as evidence level IV and only 2 candidate theses (3,4%) formally corresponded to evidence level II.
TRANSPATELLAR RECONSTRUCTION OF MEDIAL PATELLOFEMORAL LIGAMENT BY SEMITENDINOUS TENDON AUTOGRAFT
Authors: Korolev A. V. , Magnitskaya N. E. , Ryazantsev M. S. , Sinitskiy M. A. , Kadantsev P. M. , Afanas’yev A. P. , Il’in D. O.
Published: October 2018

Purpose of the study — to evaluate surgical treatment outcomes of the patients with chronical patella instability who underwent double bundle transpatellar reconstruction of medial patella-femoral ligament (MPFL) by a semitendinous tendon autograft. Material and methods. 26 patients with minimal 12 months follow up were included into the study. In all cases semitendinous tendon autograft was inserted through a vertical tunnel in the patella, formed in a loop, and fixed in femoral tunnel by a biodegradable screw. Preoperative MRIs were used to evaluate trochlear dysplasia type by D. Dejour classification, tibial tubercle to trochlear groove distance (TT-TG) and Insall-Salvati ratio. Postoperative x-rays were used to measure femoral tunnel angle (FTA), postoperative MRIs — to measure diameter of patella tunnel (d_Pat), distance from tunnel to medial border of patella (MPM) and diameter of tunnel in medial femoral condyle (d_Fem). Functional outcomes were evaluated by Kujala Score, Lysholm and IKDC, also the authors assessed the level of sports activity prior to and after the surgery. Results. Age median of the patients at the moment of procedure was 22 years. MRI data prior to surgery reported that the majority of patients suffered from B type of trochlear dysplasia, median TT-TG distance was 14.6 mm, median Insall-Salvati ratio was 1.1 mm. Postoperative x-rays and MRIs demonstrated median FTA of 18°, d_Pat median — 5.4 mm, MPM median — 7.0 mm, d_Fem median — 8.2 mm, no implant migrations were observed. Subjective assessment scores demonstrated excellent outcomes: Kujala Score — 96, IKDC — 87.4, Lysholm — 91. No secondary dislocations during follow up were reported, 48% of patients returned to sports on the pre-surgery or higher level, 52% of patients returned to sports with decreased activity. Conclusion. Transpatellar reconstruction of MPFL by semitendinous tendon autograft proved to be the efficient treatment method of chronical patella instability.
Diferencias en morfometría y germinación de semillas de Croton guatemalensis (Euphorbiaceae), procedentes de poblaciones silvestres de la Selva Zoque, Chiapas, México
Authors: Pozo-Gómez Dulce María , Orantes-García Carolina , Rioja-Paradela Tamara Mila , Moreno-Moreno Rubén Antonio , Farrera-Sarmiento Oscar
Published: October 2018

Antecedentes y Objetivos: Croton guatemalensis es una especie nativa que tiene diversos usos locales y juega un papel importante en la medicina tradicional de los habitantes de las comunidades campesinas de la Selva Zoque, Chiapas, México. Actualmente, la especie se encuentra protegida por la NOM-059-SEMARNAT-2010 bajo “Protección Especial”. El presente trabajo tuvo como objetivos evaluar la morfometría, viabilidad, sanidad y germinación de semillas recolectadas en poblaciones silvestres de cuatro Áreas Naturales Protegidas de la Selva Zoque, Chiapas, así como generar información básica que permita desarrollar en un futuro programas o proyectos locales de conservación, restauración y manejo forestal de la especie, para así contribuir a disminuir el impacto sobre las poblaciones silvestres.Métodos: De noviembre 2016 a octubre 2017 se recolectó material vegetal para corroborar la identificación taxonómica de Croton guatemalensis, y frutos y semillas para determinar, bajo un diseño al azar, el tamaño (longitud × grosor), peso, porcentaje de viabilidad, sanidad y germinación de las semillas. Debido a la anormalidad de los datos resultantes, la comparación y determinación de las diferencias estadísticas entre zonas se realizó mediante los análisis de Kruskal-Wallis y Mann-Whitney, por el software R 3.24.Resultados clave: Los resultados indican que existen diferencias estadísticamente significativas entre las cuatro zonas de recolecta. Los resultados más contrastantes se presentaron en la Zona Sujeta a Conservación Ecológica La Pera y Zona Protectora Forestal Vedada Villa de Allende. En la primera, las semillas presentaron mayor tamaño (5.13±0.06 × 3.26±0.06 mm), alto porcentaje de sanidad, viabilidad y germinación final (98±2.16, 98±2.30, 98±3.84%, respectivamente), mientras que en la segunda, las semillas fueron más pequeñas (4.63±0.09 × 2.69±0.08 mm), obtuvieron 68±6.65% de sanidad, 19±5.03% de viabilidad y 6±3.84% de germinación final.Conclusión: El presente estudio aporta información reproductiva fundamental para la generación de estrategias de conservación, restauración y manejo forestal de Croton guatemalensis.
COMPARISON BETWEEN THE EFFECT OF ADDITION OF NANO-CALCIUM CARBONATE AND NANO-KAOLINE ON DEVELOPING THE PROPERTIES OF REINFORCED CONCRETE
Authors: Saaid I Zaki , Osama A Hodhod , Omar F Eid
Published: October 2018

Данное исследование было проведено с целью установления влияния действия некоторых наноматериалов на свойства бетона, экспериментальная часть включала использование наночастиц карбоната кальция (CaCO3) и нанокаолина (К) в различных концентрациях. Нанокарбонат кальция вводили в состав в концентрации 1, 2, 3, 4 и 5 %, частично заменяя цемент. Количество нанокаолина составляло 5, 6, 7, 8, 9, 10 %. Результаты экспериментального исследования показали, что при введении этих материалов подвижность бетонной смеси значительно не снижалась, а прочность на сжатие на ранних сроках при определенных концентрациях повышалась. Оптимальное содержание нанокарбоната кальция и нанокаолина составило 1 и 7 % соответственно. Была выявлена прямая зависимость между результатами микроанализа материалов и их испытаниями на прочность.
Evolution of Electronic Acoustic Targets: Research of Subsonic Mathematical Models
Authors: Egorov S F
Published: October 2018

Приведена история совершенствования за 25 лет на кафедре «Вычислительная техника» ИжГТУ имени М. Т. Калашникова и в Институте механики УдмФИЦ УрО РАН математических моделей дозвуковых акустических электронных мишеней, широко использующихся на производствах для испытания и диагностики стрелкового оружия с целью повышения их точности. Показаны модели мишеней с пространственным размещением акустических датчиков, модели с определением не только точки попадания, но и скорости объекта, в каждой модели проанализированы обоснованные упрощения физических процессов. Исследована физическая модель, учитывающая распространение возмущения от точки попадания не только по воздуху, но и по формирователю-резине. Показаны основные факторы, влияющие на точность определения точки попадания, приведены математические и конструкторские методы по снижению погрешностей работы акустической мишени, такие как несимметричное расположение акустических датчиков в пространстве мишени на разных расстояниях для невырождения системы уравнений и возможности использовать стандартный четырехканальный цифровой осциллограф для связи, использование взвешенных моментов времени при обработке сигналов с датчиков для инвариантности ориентации датчиков к точке попадания, использование демпфирующих прокладок для гашения вибрационных помех от формирователя, использование вторичной регрессионной математической модели для уменьшения неучтенных погрешностей. Сделан вывод о перспективности дальнейших исследований и усовершенствований математических моделей, конструкций и элементной базы дозвуковых электронных акустических мишеней с целью повышения их точности, снижения себестоимости и, значит, повышения конкурентоспособности.
Harland Bartholomew e o zoneamento racialmente informado: o caso de St. Louis | Harland Bartholomew and racially informed zoning: the case of St. Louis
Authors: Barone Ana Cláudia Castilho
Published: October 2018

Este artigo busca recuperar os fundamentos raciais que contribuíram para configurar as propostas de zoneamento compreensivo desenvolvidas por Harland Bartholomew para a cidade de St. Louis, Missouri, entre 1916 e 1947. Além de ter sido um dos urbanistas que mais produziu planos e propostas de zoneamento dos EUA, Bartholomew também tornou-se referência fundamental para o urbanismo em São Paulo. O caso de St. Louis é emblemático por ter se implantado em um contexto de grande disputa racial no território, em que parte da elite branca que dava sustentação política aos seus planos urbanísticos defendia a adoção de normas legais de regulação da segregação residencial na cidade. Assim, analisamos os planos feitos por Bartholomew para St. Louis entre 1918 e 1946, cotejando as decisões estabelecidas nesses processos com os embates raciais presentes em cada momento. Com este trabalho, buscamos trazer novos elementos para o debate público acerca da pertinência do zoneamento como instrumento de regulação de uso e ocupação do solo urbano.
SELECTING THE MANAGEMENT OF PATIENTS WITH CHRONIC HEPATITIS B AFTER THE COMPLETION OF THE LONG-TERM ANTIVIRAL THERAPY
Authors: Esaulenko E. V. , Zakharov K. A. , Alikian I. S. , Sukhoruk A. A. , Stasishkis T. A. , Kovelenov A. U.
Published: October 2018

Study aims: The study purpose was to analyze the results of the clinical and laboratory monitoring of HBeAg-negative chronic hepatitis B patients after discontinuation of longterm nucleosides analogues antiviral therapy in order to determine further management.

Materials and methods: A retrospective-prospective investigation was performed in 106 patients with diagnosis of HBeAg-negative chronic hepatitis B during the course of antiviral therapy using nucleosides analogues. Average treatment duration was 190,1±77,7 weeks. The therapy was discontinued for 29 patients in the period of time from two to five years of the treatment, they were followed up from 6 months to 6 years. The activity of aminotransferases, the levels of HBV DNA were evaluated, the liver elastometry was performed during the patients monitoring. The relapse of disease after the treatment discontinuation was considered when the viral load exceeded 2.0x103 IU / ml and/or alanine aminotransferase levels were above the reference values.

Results:The viral load varied from 4,0х102 IU/ml to 2,87 х 107 IU/ml at 86,2% cases after the 6 months of discontinuation of the treatment. However median levels of viral load were not higher than 2,5 х 103 IU/ml at different timepoints of observation. The VL was higher than 2,0 х 103 IU/ml in 62,1% patients and it matched to relapse criterion. Clinical relapse was not revealed in 13,8% cases at observational period from 6 months to 2 years. The second course of antiviral therapy was not required for 37,9% patients, at the same time it was necessary to consider it for the rest ones.

Conclusion: Regular medical checkups with periodical clinical, laboratory and instrumental examinations after antiviral treatment discontinuation are required for timely detection of relapse and decision regarding the next course of antiviral therapy.
ANALYSIS OF CONSUMPTION OF ANTIBACTERIAL DRUGS FOR SYSTEMIC USE IN HOSPITALS OF SAINT PETERSBURG IN 2014–2015
Authors: Gomon Yu. M. , Kurylev A. A. , Kolbin A. S. , Proskurin M. A. , Ivanov I. G. , Sidorenko S. V. , Arepieva M. A. , Sokolov A. V.
Published: October 2018

Introduction. The overuse of antimicrobial agents, and poor adherence to infection control measures are leading factors in the development of bacterial resistance. Despite the existence of numerous guidelines for the management of patients with different sites of infections up to 50% of assignments of antimicrobial agents does not follow them.

Aim. The aim of the study is to evaluate the structure and dynamics of the consumption of antimicrobial agents for systemic use in the multidisciplinary hospitals of St. Petersburg in 2014–2015.

Materials and methods. From the database of IMS Health were selected information regarding the supply of antimicrobial agents for systemic use (ATC code J01) in hospitals of St.Petersburg in 2014–2015. The Number of purchased antimicrobial drugs (g) is translated into a number of Defined Daily Dose (DDDh) for each international non-proprietary name.

Results. The level of consumption of AMP in 2014 was 83,3 DDDh/100 bed-days. In 2015, this figure amounted to 50,5 DDDh/100 bed-days. 70% of consumption of antimicrobial drug for systemic use in multidisciplinary hospitals amounted to 3 groups: fluoroquinolones, cephalosporins and semisynthetic penicillins. In 2015, in comparison with the previous year absolute value of fluoroquinolones decreased by 58% in favor of cephalosporins (+15%) while reducing the total number of DDDs used system antimicrobial agents (-40,5%), which is probably connected with the introduction into clinical practice of Russian clinical guidelines for the treatment of infections of various localizations and the perioperative antibiotic prophylaxis. There was growth in the number of purchased carbapenems and macrolides (+21 and +7% respectively) and significant decrease in the absolute number of purchased aminoglycosides (61%), with significant reduction in the consumption of expensive drugs: tigecycline, polymyxin, daptomycin, cefoperazone/sulbactam.

Conclusion. The level and structure of consumption of antimicrobial agents corresponds to global data. The implementation of monitoring of antimicrobial therapy is an important factor influencing the volume and structure of consumption of antibacterial drugs.
THE IMPORTANCE OF MORPHOLOGICAL INVESTIGATIONS IN DIAGNOSTICS AND STUDY OF INFECTIONS. TISSUE MICROBIOLOGY
Authors: Zinserling V. A.
Published: October 2018

The paper is based upon personal experience of the author compared with literary data includes information related to significance of life-time and postmortem morphological investigations in diagnostics and study of pathogenesis of viral, bacterial, fungal and mycoplasma infections including influenza, HIV, tuberculosis. Different clinical and pathological forms and some questions of terminology are discussed. Most difficult and unclear questions requiring further complex investigation including morphology are listed. Age given the bases to introduce new term “tissue microbiology”.
FRIEDRICH BRAUELL: LIFE AND RESEARCH
Authors: Trushin M. V.
Published: October 2018

The article, written on the basis of data from the Russian and European archives, is the most complete biography of the famous figure of the Russian medical and veterinary science of the middle of the XIX century Friedrich Brauell, one of the pioneers of anthrax research. The article describes in detail the period of formation of F. Brauell as a scientist – his education received in Germany, visit to the Russian Empire for service, confirmation of academic degree received at homeland. His first steps in the field of teaching and science at Kazan University are discussed in details, his efforts to create a collection of anatomical preparations are described. The main part of the article is devoted to his work in Derpat (Tartu) Veterinary School, where he fully revealed his talent as a major organizer of scientific and educational activities. Particular attention is paid to its study of the problem of anthrax and plague. In addition, the article deals with the issues of his personal life and family for the first time. Thus, the material contained in the article can be useful for scientists studying the history of medicine, infectious diseases and veterinary medicine.
CLINICAL CASE OF TYPHOID FEVER IN THE KALININGRAD REGION
Authors: Perminova L. A. , Ivanov I. B. , Gerasimov Yu. A. , Zakhar E. V.
Published: October 2018

Currently, on the territory of the Russian Federation, typhoid fever is registered in the form of sporadic cases, primarily due to imported cases when Russians visit epidemiologically unfavorable for typhoid fever in foreign countries. A clinical case of a woman from Kaliningrad, who returned from a tourist trip to India, is given. The erased picture of the disease requires the doctors’ alertness and knowledge of the main clinical variants of the disease course. The study of epidemics and the follow-up to normative documents made it possible to establish the correct diagnosis. The treatment was carried out with a positive result.
ESOPHAGEAL ACTINOMYCOSIS IN RECIPIENT AFTER HEART TRANSPLANTATION
Authors: Simonenko M. A. , Fedotov P. A. , Monosova K. I. , Sazonova Yu. V. , Mitrofanova L. B. , Karpenko M. A.
Published: October 2018

In this article, we reported a clinical case of late posttransplant complication – esophageal actinomycosis in 58-yr-old woman 8 months after heart transplantation. Recipient had presented with a complaint of dyspeptic phenomena. Patient’s examination did not show any features. Blood results were fine but tacrolimus concentration was increased (24 ng/ml). Esophagogastroduodenoscopy identified signs of esophageal candidiasis, biopsy was taken. Histological examination revealed esophageal actinomycosis. According to other investigations we did not find any signs of antinomycosis in other organs. Taking into account the results of obtained research, there was no evidence of deep tissue invasion and no indications for surgical treatment, conservative management was chosen. Three months of antibacterial treatment (Doxycycline) was effective. Considering long-term management of this complication in out-patient department it is important to accomplish strictly the protocol of posttransplant follow-up, the same as it allows to diagnose in time. Conservative management of esophageal actinomycosis diagnosed on early stage can be effective.
DIFFICULTIES OF TUBERCULOSIS DETECTION BY A LOCAL PHISICIAN IN THE PERIOD OF THE EPIDEMIC OF INFLUENZA (CLINICAL CASE)
Authors: Borodulina E. A. , Inkova A. T. , Borodulina E. V. , Zelter P. M. , Matkina T. N.
Published: October 2018

Purposeof issue is to show difficulties of detecting tuberculosis the general physician during epidemic of acute respiratory viral infection and flu, to show efficiency of modern methods of mycobacterial and HIV evaluation.

Materials and methods. Clinical case from general physician’s practice was discussed. All methods from primary healthcare were used.

Results. Possibilities of tuberculosis diagnostics by general physician during epidemic were shown. Tuberculosis was held under mask of flu. While carrying out diagnostic minimum negative results have been received. As a result of plane radiography dissemination was found. After analysis of social risk factors, analysis for HIV and «Diaskin-test» were made. Sputum also was sent for mycobacterium evaluation to antituberculosis center laboratory. Positive «Diaskintest» (8 mm), positive Gene-expert molecular-genetic test and BACTEC fluid growth were found. Diagnosis of tuberculosis was stated and patient was sent to specialized center.

Conclusion. During flu epidemic alertness of general practitioners about tuberculosis is needed especially in social risk groups. It is recommended to enlarge diagnostic minimum using molecular genetic methods. These actions can improve rate of tuberculosis proving.
MOLECULAR-GENETIC MECHANISMS OF PLASMODIUM FALCIPARUM VIRULENCE AND TROPICAL MALARIA PATHOGENESIS
Authors: Uskov A. N. , Soloviev A. I. , Kravtsov V. Yu. , Gudkov R. V. , Kolomoets E. V. , Levkovskiy A. E.
Published: October 2018

There is introduced the analysis of molecular-genetic mechanisms of tropical malaria pathogenesis and P. falciparum virulence. It is shown, that pathogenesis of tropical malaria is associated with the properties of red blood cells membrane surface (RBCs or erythrocytes) that are infected by P. falciparum. There are «knobs structures» on membrane surface infected RBCs. Knobs structures contains a complex of P. falciparum proteins – PfEMP1 (Plasmodium falciparum erythrocyte membrane protein 1). PfEMP1 is associated with virulence of P. falciparum. Complex PfEMP1 has difficult polymorphous structure. Domains of PfEMP1 are able to associate with different cell receptors. Virulence`s individual components of the main factor are selectively sensitive to different tissues and organs. The severity of the clinical malaria infection course depends on the complex structure PfEMP1 of malaria parasites. Composition of polypeptide PfEMP1 is determined by var-complex. Nowadays there are 60 variants of var-complex. Regulation of gene expression, forming part of the var-complex, is carried out on a molecular-genetic level, cellular level, tissue level. Modern research in this area are aimed to explore genes polymorphism of the virulence`s main factor, to identify mechanism of its differential expression. Search of molecular – genetic markers is relevant to develop methods of gene diagnostic and malaria vaccine.
MODERN POSSIBILITIES OF VIROLOGICAL DIAGNOSTICS OF POLIOMYELITIS
Authors: Murina E. A. , Goleva O. V. , Osipova Z. A. , Mukomolova A. L.
Published: October 2018

The review presents the data from the literature of our and foreign countries devoted to modern virologic diagnostics of poliomyelitis viruses of 1, 2, and 3 types that is especially topical in connection with WHO program on complete poliomyelitis elimination in the world. There is described the role of laboratory virologic investigations in making the diagnosis of poliomyelitis infection. The classical methods of poliomyelitis viruses detection are given in detail.
SCIENTIFIC PERSPECTIVES OF STUDY OF THE CAUSAL-INVESTIGATION CONNECTION OF MICROBIOTES OF THE INTESTINE AND THE STATE OF THE NERVOUS SYSTEM
Authors: Skripchenko N. V. , Ukraintsev S. E. , Makarova E. G. , Skripchenko E. Yu.
Published: October 2018

The review article presents the scientific substantiation of the prospective direction of research of the intestinal microbiota and its role in the formation of various neurological pathologies. Reflected information about the enteral nervous system, which has direct relevance in the interaction between the brain and intestines. The study of the intestinal microbiota is currently carried out using modern methods of metagenomics, sequencing and bioinformation analysis. Data are presented on the formation of functional digestive disorders in children with altered intestinal microbiota and the ways of correction are determined.
JUSTIFICATION OF RESEARCH ON SYSTEM OPTIMIZATION OF SURGICAL DENTAL CARE TO PATIENTS WITH HIV INFECTION. ANALYTICAL REVIEW OF LITERATURE
Authors: Bazikyan E. A. , Belyakova A. S. , Pchelin I. V.
Published: October 2018

The article presents an analysis of the Russian and foreign specialized literature on the problem of dental rehabilitation of patients with HIV infection. It has been revealed that the structure and prevalence of dental surgical pathology in HIV infection has not been studied to date, the indices of the need for treatment of diseases of the dental profile have not been determined. Unsatisfactory access to qualified dental care has been identified, including due to discrimination and stigmatization by health professionals regarding both the disease itself and patients with HIV infection. The urgency of improving the system of rendering surgical dental care to HIV-infected with the aim of ensuring the maximum achievable level of health is substantiated. The data of the presented analytical review represent an important theoretical basis for the development of new tactical approaches to the implementation of the strategic direction of dental implant treatment of people living with HIV to expand access to this medical service.
PERTUSSIS IN CHILDREN – CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS IN THE SAMARA REGION
Authors: Gasilina E. S. , Kitajchik S. M. , Gorelova I. A. , Kabanova N. P. , Fedoseeva O. A. , Bogoyavlenskaya I. Yu. , Revtovich O. M. , Bochkareva N. M. , Santalova G. V. , Frank A. A.
Published: October 2018

Objective:to study the features of the clinical and epidemiological characteristics of whooping cough in children in the Samara region.

Materials and methods: 389 cases of pertussis in the Samara region for 2015–2016 were analyzed.

Results: it is shown that in spite of 95–98% vaccination coverage, in recent years there has been an increase in the incidence of whooping cough. Seasonality of morbidity remains. Among the children observed, the youngest children were not vaccinated against pertussis. The clinical picture of the disease remains typical with the classic course of catarrhal and spasmodic periods. Moderately severe forms of the disease predominate. Complications were noted mainly in unvaccinated children of the first year of life. The most frequent complications were pneumonia and apnea. There is a hypodiagnosis of pertussis in outpatient conditions. Infection often occurs under the mask of ARVI, while the sensitivity of the bacteriological method of diagnosis is zero. Of the methods for confirming the diagnosis, the most reliable is ELISA and PCR.

Conclusion: these epidemiological and clinical features of pertussis current testify to the need to further improve methods of early diagnosis, especially express methods, etiopathagenetic treatment, specific prevention, antiepidemic measures in the foci of infection.
DIFFICULTIES OF DIFFERENTIAL DIAGNOSTICS OF MESADENITES IN HIV-INFECTION PATIENTS
Authors: Arutyunova D. D. , Umbetova K. T. , Parchomenko Yu. G. , Tishkevich O. A. , Volchkova E. V. , Pak S. G.
Published: October 2018

The development of mesenteric lymphadenitis is typical for patients with HIV infection at the stage of secondary diseases. The purpose of our study is to decipher the etiology of lymphadenitis in patients with HIV infection at the stage of secondary diseases. The analysis of disease histories of 113 HIV infection patients at the stage of secondary diseases with the use of statistical processing was carried out. The article presents examples that characterize the polymorphism of clinical variants of the development of mesadenitis in HIVinfected patients with stage 4B, which has developed as a result of the influence of various etiological factors.
CONTRIBUTION OF THE ACADEMICIAN VLADIMIR SERGIEV TO THE DEVELOPMENT OF THE RUSSIAN PARASITOLOGY (ON 75TH ANNIVERSARY)
Authors: Baranova A. M. , Kozlov S. S. , Morozov E. N.
Published: October 2018

Academician of the Russian Academy of Sciences, Professor, Doctor of Science (Med) Vladimir Petrovich Sergiev is a famous scientist who made a significant contribution to the Russian epidemiology and parasitology. After graduating from the Sechenov First Moscow medical institute in 1966, he worked at the Martsinovsky Institute of medical parasitology and tropical medicine (Moscow), where he defended his thesis on the created vaccines against zoonotic cutaneous leishmaniasis. In 1974 he was transferred to the Ministry of health of the USSR by the head of the main Department of quarantine infections. In 1988 he was appointed Director оf the Martsinovsky Institute of medical parasitology and tropical medicine, since 2002 he is head of the Chair of tropical medicine and parasitic diseases of Sechenov University. He combines educational work with research activities to study the problems of epidemiology of helminthiasis and tropical diseases, their prevention, as well as medical geography and molecular parasitology. Professor Sergiev is the author of 15 monographs and manuals, more than 400 scientific publications, Editor-in-Chief of the journal «Medical Parasitology and Parasitic Diseases», consultant of the World Health Organization on malaria and leishmaniasеs. Under his leadership, 5 doctoral and 7 master›s theses were defended.