bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of an Online Training Tool for the Automated Unit-Dose Dispensing System (ADS) Process
Authors: Hamon Marie , Capelle Flora , Passemard Raphaël , Gourieux Bénédicte
Published: April 2019

Background

Automated unit-dose dispensing system (ADS) of oral solid medication is a complex and sensitive production process in the drug distribution system. Hence, an appropriate training of hospital pharmacy technicians (HPT) is essential. A basic training (observational and practical) of 3 weeks is first organized to evaluate the HPT, followed by an interview with both the pharmacist and the HPT chief. The importance of the human factor (daily routine and repetitive tasks) showed by the risks analysis within this process has led us to search new learning methods to keep the team engaged. An e-learning training was selected in order to further complete the HPT initial training but also as a continuous training to the HPTs who are already working in the ADS process.

Process and Methods

The e-learning tool was developed using the Google® platform and includes four theoretical training modules (Google® Slides): Module 1 “General organization”, Module 2 “Automatic preparation machine”, Module 3 “Repackaging” and Module 4 “Non-automated drug dispensing”. Each module ends with a self-assessment (Google® Forms). Various teaching materials are included: links to institutional procedures, videos, photos, quizzes, simulations … A minimum of 75 % of correct answers is requested to validate each module. The e-learning, once final, was validated with a new HPT and with five HPTs already in place for more than a year. A satisfaction form is available at the end of the training.

Results

The 6 HPTs obtained an average of 17.75/20 correct answers. The most successful modules were 1 and 4 (average per module: M1 =  18.5/20; M2=16.8/20; M3=17/20; M4=18.7/20). For module 3, two HPTs scored below 75 % and therefore had to pass this module again. The average time to complete this training was 1.5 hours. HPTs are 100 % satisfied with the training and the teaching materials used.

Discussion/Conclusions

The e-learning tool fit well with the initial training and the continuous training of the HPTs. Its set up is simple. The duration length spent on the training is shortened for both the pharmacist and the learner. This tool is tailored to the learner needs and constraints. It allows the integration of playful and interactive teaching tool which were appreciated. An audit will be conducted to assess the impact of this training tool on the overall ADS process.
Project-Based Learning in Education for Sustainable Development: A Case Study of Graduate Planning Students
Authors: Teff-Seker Yael , Portman Michelle Eva , Kaplan-Mintz Keren
Published: April 2019

Urban planning can serve a vital role in meeting the goals of education for sustainable development (ESD); it could potentially provide future planners with the environmental considerations necessary to meet the needs of the present without compromising the ability of future generations to meet their own needs. This article presents findings from a quantitative study of planning students’ experiences with Project- and Problem-Based Learning (PPBL). Graduate planning students in an environmental planning class were divided into two groups according to their course assignment, PPBL or non-PPBL, and given pre- and post-questionnaires, with questions to grade statements on environmental attitudes and behaviors. PPBL students reported a statistically significant change in environmental behavior involving others, while neither behavior nor attitudes changed significantly for students in the control group. Then, semi-open interviews were conducted with 11 of the students 3 years later. The interviews indicate that PPBL students remembered more content related to their assignments and felt they received more types of planning experiences and tools than those in the control group.
Overlapping Roles in Chromosome Segregation for Heterochromatin Protein 1 (Swi6) and DDK in Schizosaccharomyces pombe
Authors: Shen Kuo-Fang , Forsburg Susan L
Published: April 2019

Fission yeast Swi6 is a human HP1 homolog that plays important roles in multiple cellular processes. In addition to its role in maintaining heterochromatin silencing, Swi6 is required for cohesin enrichment at the pericentromere. Loss of Swi6 leads to abnormal mitosis, including defects in the establishment of bioriented sister kinetochores and microtubule attachment. Swi6 interacts with Dfp1, a regulatory subunit of DBF4-dependent kinase (DDK), and failure to recruit Dfp1 to the pericentromere results in late DNA replication. Using the dfp1-3A mutant allele, which specifically disrupts Swi6-Dfp1 association, we investigated how interaction between Swi6 and Dfp1 affects chromosome dynamics. We find that disrupting the interaction between Swi6 and Dfp1 delays mitotic progression in a spindle assembly checkpoint-dependent manner. Artificially tethering Dfp1 back to the pericentromere is sufficient to restore normal spindle length and rescue segregation defects in swi6-deleted cells. However, Swi6 is necessary for centromeric localization of Rad21-GFP independent of DDK. Our data indicate that DDK contributes to mitotic chromosome segregation in pathways that partly overlap with, but can be separated from both, Swi6 and the other HP1 homolog, Chp2.
Bilateral Lower Limb Disabling Claudication in a Young Man: A Case of Mönckeberg’s Arteriosclerosis
Authors: Mowafy Khalid Abdelaziz , Soliman Mosaad , Hammoda Ahmed Magdy , Soliman Reem Mosaad
Published: April 2019

Mönckeberg’s arteriosclerosis, also called medial calcific sclerosis or Mönckeberg’s sclerosis, is a form of vessel hardening due to increased calcium deposits in the tunica media layer. There is disagreement over its clinical significance and aetiology and its relation to atherosclerosis and vascular calcification. Its clinical presentations and treatment are still debated. More effort should be directed on attempting to distinguish between atherosclerotic lesions and Mönckeberg’s lesions on the basis of age, location and the pattern of calcifications where there is considerable overlap between intimal or medial and involvement of the internal elastic lamina border between those planes. In-depth research is still needed to create consensus guidelines for the diagnosis and management of this condition. This article includes a review of the literature and a case report of a 22-year-old man with the condition.
Changes in Monetary Policy and Banks' Net Interest Margins: A Comparison across Four Tightening Episodes
Authors: Berry Jared , Ionescu Felicia , Kurtzman Robert , Zarutskie Rebecca
Published: April 2019

In this note, we examine how U.S. banks' NIMs have varied over the most recent monetary policy tightening episode compared with the three previous monetary policy tightening episodes.
Las sonatas woo 47 de beethoven. su importancia en el conjunto de las sonatas para piano
Authors: Del Real Barreto Cristian Job
Published: April 2019

El objeto de estudio de la presente investigación, en este caso, las sonatas tempranas para piano de Ludwig van Beethoven, como piezas esenciales en el repertorio pianístico de la historia de la música académica. El tema de investigación surge por la reciente publicación (2007) del conjunto completo de ellas, en una edición crítica, de las 35 sonatas para piano por el profesor Barry Cooper, reconocido especialista en Beethoven. Ésta es la única edición moderna que incluye, desde el principio, las tres sonatas WoO 47 y las siguientes 32 ya conocidas. Nuestra revisión está orientada a recopilar información de las tres Sonatas WoO 47 de Beethoven y la importancia de estas composiciones en el repertorio para piano del compositor. El presente artículo busca entonces mostrar como justificable la inclusión de estas obras en el catálogo de las sonatas completas para piano del compositor alemán, mediante la recopilación de fuentes a su respecto y la valoración de sus dificultades técnicas para el instrumento.
A rat model of contrast-induced acute kidney injury following intra-arterial contrast administration v1
Authors: Wang Zhiqing
Published: April 2019

Contrast-induced acute kidney injury (CI-AKI) is an iatrogenic complication frequently developed after cardiac catheterization procedures with the administration of iodinatedcontrast media. However, the precise pathological mechanisms remain obscure. Thus, the establishment of a reproducible rat model following intra-arterial contrast medium (CM) injection to simulate the process of arteriography is of great importance. Here, a detailed protocol for establishing a CI-AKI model was describe. Three-month-old male Sprague-Dawley rats, weighing approximately 300~400g at the start of the experiment, were used. The rats were pretreated with water dehydration for 48 hours, plus indomethacin and N-ω nitro-L-arginine methyl ester (L-NAME) injection, before intra-arterial contrast medium (CM) administration. Levels of serum creatinine (SCr) were measured and histopathological assessment of the kidney tissue by H&E staining were conducted. As expected, the administration of CM, following the pretreatment by indomethacin and L-NAME, induced remarkable renal dysfunction at 12hours post-procedure in comparing with controls. The pronounced histopathological alterations in the tubular epithelial cells of the inner medulla and outer medulla were also observed in the CI-AKI rats. Thus, this rat model was reliable as a valuable tool for exploring the pathogenesis of CI-AKI.
Vasculogenic mimicry in melanoma: molecular mechanisms and clinical significance
Authors: Rotin D. L. , Titov K. S. , Kazakov A. M.
Published: April 2019

The concept of vasculogenic mimicry (VM) was introduced to describe the unique ability of highly aggressive tumor cells to form capillary-like structures and matrix-rich patterned network in three-dimensional culture that mimic embryonic vasculogenic network. VM has been reported in several aggressive tumors including ovaries, breast, liver, lung cancer, sarcoma, glioblastoma. It is worth to note, that VM in melanocyte-originated tumors is the most studied. Although much attention has been focused on factors that stimulate or suppress vascular channel formation by tumor cells, the molecular mechanisms underlying this phenomenon remain enigmatic. This review will focus on molecular determinants and key signaling pathways involved in tumor VM. The exploration of drugs targeted at molecular signaling pathways in VM is a field of challenges and hopes. The research on VM will increase our knowledge of the molecular events causing aggressive tumor cells to gain plasticity resulting in their ability to mimic vasculature. To date, little functional data exist that show how tumor cell-lined channels contribute to the overall survival of the tumor. However, even among researches who have questioned the concept of VM as a crucial circulatory system, there is generally a consensus that the prognostic significance of PAS-positive patterns is valid.
Detection of human papillomavirus type 18 oncogen E7 in patients with prostate cancer
Authors: Volgareva G. M. , Ermilova V. D.
Published: April 2019

Introduction . High prostate cancer (PC) incidence rates testify to importance of research into genesis of the given disease and means of its prevention. The item of oncogenic human papillomaviruses (HPVs) participance in PC origination is still being the subject of debates. If association of PC with HPV is proven prophylaxis of the given disease becomes possible by means of inoculating boys with the vaccines made for cervical cancer (CC) prevention.Objective: to test whether prostate tissues surgically removed from PC patients harbor oncogen E7 of HPV18 – the second most common HPV type responsible for CC.Materials and methods . The study was carried out on prostate glands of 17 PC patients surgically treated in N.N. Blokhin National Medical Research Center of Oncology. Detection of HPV18 oncogen E7 was done by polymerase chain reaction. To elevate polymerase chain reaction sensitivity DNA was isolated from homogeneous cell populations collected by means of microdissections from cryopreserved PC specimens.Results . Amplification products corresponding to HPV18 oncogen E7 were registered in tests from 2 PC patients.Conclusion . HPV18 oncogen E7 was detected in surgically removed prostate tissues of 2 PC patients. In the aggregate with our previous result (7 HPV16-positive PC cases in the same group of 17 patients) the given result enables one to presume participance of oncogenic HPVs in PC genesis. The problem deserves further study.
Complex cytogenetic research of cryptic chromosomal aberrations in patients with multiple myeloma
Authors: Solodovnik A. A. , Mkrtchyan А. S. , Misyurin V. A. , Kesaeva L. A. , Kasatkina N. N. , Votyakova O. M. , Yakimovich O. Yu. , Medvedovskaya E. G. , Antipova A. S. , Zavodnova I. Z. , Kolomeytsev O. A. , Shirin A. D. , Osmanov E. A. , Misyurin A. V.
Published: April 2019

Background . Multiple myeloma (MM) is a malignant lymphoproliferative B-cell disease characterization by clonal proliferation of plasma cells in the bone marrow and beyond its borders. Currently, a wide range of cytogenetic anomalies and molecular-biological parameters are studied as prognostic factors.Objective: a comparative study of the frequency, features and clinical significance of chromosomal abnormalities in MM by conventional cytogenetic and fluorescent in situ hybridization (FISH) methods.Materials and methods . 77 patients with MM, which admitted in N.N. Blokhin National Medical Research Center of Oncology, were included in the study from 2016 to 2017.Results . Chromosomal alterations were detected only in one case (1/77) by conventional cytogenetic method G-banding. However cytogenetic aberrations were revealed in 26 % of cases (20/77) using FISH. Deletions of different regions of chromosomes, indicating the possible presence of a hypodiploid clone or loss of some regions, were found in one patient in the second FISH analysis after 6 months. In the cohort of patients with chromosomal abnormalities (n = 20) a partial trisomy 11q, a deletion of the region q32 of the chromosome 14, a translocation t(4;14)(p16;q32) and IGHV gene rearrangement were determined in 30 % (6/20) as sole anomalies. Two or more cytogenetic aberrations were identified in the remaining 14 patients. Our study confirms that chromosomal abnormalities are more likely detected at later stages of MM (IA и IIA – 0 %, IIIA и IIIВ – 27 and 47 % respectively).Conclusion . FISH allows to detect chromosomal changes in tumor plasma cells regardless of the mitosis phase. In MM, it becomes particularly important in connection with low proliferative activity of plasma cells. Additionally, in the fourth of MM patients in the study submicroscopic chromosomal aberrations were discovered using FISH. The improvement of the probe panel and the widespread use of locus specific FISH don’t replace G-banding that allows to see damages of all chromosomes at once.
BRCA1 participates in the expression of noncoding XIST RNA
Authors: Shestakova E. A. , Bogush T. A.
Published: April 2019

Introduction . Noncoding RNA of XIST gene (X inactivation-specific transcript) initiates inactivation of one of X chromosomes in cells of female organism. Further stages of this process include chromatin epigenetic modifications leading to the inhibition of the most genes on X chromosome. Recently the data were obtained that tumor suppressor BRCA1 is associated with inactive X chromosome (Xi) participating in XIST RNA localization on Xi and influencing XIST RNA expression.Objective: to reveal the role of BRCA1 in XIST RNA expression.Materials and methods . The objects of the study were mutant breast cancer cell lines (BRCA1–/–): HCC1395, HCC1937, SUM149PT, and, as controls – cell lines containing wild type of BRCA1 gene (BRCA1+/+): IMR90 и 293T. Method of reverse transcription coupled with polymerase chain reaction (RT-PCR) was used for the analysis of XIST RNA expression.Results . In the clone of doxycycline-inducible HCC1937 breast cancer cell line XIST RNA expression was observed upon BRCA1 induction. In HCC1395, HCC1937 and SUM149PT breast cancer cell lines containing mutant BRCA1 gene (BRCA1–/–) and nonfunctional BRCA1 protein the absence of XIST RNA expression was observed using RT-PCR. This observation indicates the indispensable role of functional BRCA1 protein in XIST RNA expression.Conclusion . Altogether, the data obtained in this study confirm the role of BRCA1 in the expression of noncoding inhibiting XIST RNA and suggest the involvement of BRCA1 in the inhibition of gene expression on Xi.
Equitoxicity of domestic hydroxycarbamide and reference drug hydrea in rats
Authors: Konyaeva O. I. , Kulbachevskaya N. Yu. , Chaley V. A. , Ermakova N. P. , Merkulova I. B. , Abramova T. V. , Kasatkina I. S.
Published: April 2019

Introduction . The appearance of high-quality and effective generics can significantly reduce the cost of health care for the drug supply of the population of Russia. According to expert estimates, the cost of treatment of cancer patients with generics of domestic can be 30– 40 % cheaper as compared to the original drugs. In Russia the pharmaceutical production company “Ozon” created by the domestic analogue of the original anticancer drug hydrea – hydroxycarbamide.Objective: comparative study of chronic toxicity of the drug hydroxycarbamide (“Ozon”, Russia) and registered reference drug hydrea (Corden Pharma Latina S. p. A., Italy) on rats.Materials and methods . A comparative study of the toxicity of drugs was carried out on 70 non-inbred white male rats weighing 220– 250 g obtained from the accredited laboratory animal nursery of LLC “Krolinfo”. Both drugs were administered in parallel daily orally 5-fold in 3 doses. As a solvent, 1 % starch paste was used. Doses were calculated according to the literature data on the basis of maximum tolerated dose. Standard methods of evaluation of chronic toxicity of drugs in rats were used.Results . The obtained data on chronic toxicity of the compared forms of the domestic drug hydroxycarbamide and the reference drug hydrea do not differ significantly in terms of quantitative and qualitative toxicity (lethality, biomarkers of toxicity, morphometry of organs). Conclusion . The compared generic and commercial preparations are practically equitoxic by 5 times oral administration to rats.
Thermal cycling stage in the optimization of the freezing processes in the technology of drug lyophilized
Authors: Blynskaya E. V. , Tishkov S. V. , Alekseev K. V. , Minaev S. V.
Published: April 2019

Introduction . In the lyophilization technology, the freezing stage plays a key role in determining the time of primary sublimation, secondary desorption, and often the appearance of the lyophilisate. The duration of lyophilization is related to the composition and freezing conditions through the parameter resistance to mass transfer, which depends on the size of ice crystals.Objective: to select temperature regimes of thermal cycling (“annealing”) to obtain the most vapor-permeable sublimation layer, calculate the value of resistance to mass transfer of water and select the most optimal lyophilization mode for preparing lyophilisate GK-2 for preparing solutions for injections.Materials and methods . Substance: GK-2 (hexamethyleneamide bis-(N-monosuccinyl-L-glutamyl-L-lysine)) (V.V. Zakusov Research Institute of Pharmacology, Russia); excipients intended for parenteral use: lyoprotector – sucrose (CompriSugar®) (CristalUnion, France), cryoprotector – polyethylene glycol 4000 (PEG, macrogol) (Polyglykol® 4000, Panreac, Spain). Edwards EF-6 Lyophilic Dryer (Italy); microscope Nikon Eclipse E200; digital camera Nikon DS-Ri2; confocal microscope LEXT OLS 4100. Various freezing, lyophilization, direct optical microscopy in a cold chamber, laser microscopy and mathematical formulas were used to determine the values of resistance to mass transfer of water vapor from model lyophilisates.Results . This article discusses the possibilities of optimizing the freezing stage and, accordingly, the entire lyophilization cycle by introducing an intermediate thermal cycling stage, provides calculations of the mass transfer coefficient of the composition under different freezing conditions and ice crystal sizes.Conclusion . A simplified equation for calculating the coefficient of resistance to mass transfer for model solutions of GK-2 based on the correlation dependence was determined. The selection of freezing and “annealing” modes was carried out on the basis of the most important indicators, such as productivity and time of lyophilization.
Hardiness and Coping-Strategies of Adolescents with Motor Impairments
Authors: Gorkovaya I.A. , Miklyaeva A.V.
Published: April 2019

The article presents results of the study on hardiness and coping strategies of adolescents with motor impairments. 67 adolescents with different motor impairments aged 13-16 years, 33 of them are adolescents with severe impairments and 34 of them are adolescents with mild impairments surveyed. The comparison group consisted of 112 healthy adolescents. The empirical data collecting made by the short version of the Hardiness Test, the Questionnaire of Coping Strategies, expert interviews of teachers, analysis of documents. The results show that in case of mild motor impairments there is no reduction of hardiness, in the case of severe impairments the hardiness is lower than in the comparison group. Adolescents with motor impairments have more adaptive coping strategies, in comparison with healthy peers, mainly in the aspect of emotionally-oriented coping. In the case of severe motor impairments, hardiness is correlated with the ability to maintain emotional well-being, in the case of severe motor impairments it also matters to abandon nonadaptive behavioral coping strategies.
Features of Formation of Compliance Behavior in Patients of Dental Clinic
Authors: Sitkina E.В. , Isaeva E.R. , Tachalov V.V. , Iskrenko K.K. , Tregubenko I.A.
Published: April 2019

The differences between men and women in compliance with the recommendations of the dentist in caring for the oral cavity are considered. The psychological characteristics of patients who fulfill and do not follow the recommendations are described. The study involved 98 people (63 women and 35 men). Dental indices: CPITN, PMA, Saxer & Muhlemann, Silness & Loe, Green-Vermillion. Psychodiagnostic methods: Multidimensional Questionnaire on Health, Test "Diagnosis of Interpersonal Relations", Characteristic Questionnaire Leonhard - Shmishek, Self-Assessment Questionnaire of the State of the Military Medical Academy, Personal Questionnaire Bekhterevsky Institute, Dental Questionnaire (Orekhova L.Yu., Kudryavtseva T.V., Tachalov V.V.). Indices of dental oral health during the I and II examinations, which reflect the quality of the patient's medical recommendations were obtained. Identified personality features of women and men associated with compliant behavior. Women with good oral hygiene had such personality characteristics as: extraversion, internal locus of control, authoritarian type of interpersonal relations, hyperthymic or demonstrative type of accentuation of character. For men with good hygiene, cooperative and altruistic types of interpersonal relationships are characteristic.
Ego-Perception and Thanatos-Centration as Sources of Suicide in Adolescence
Authors: Shneyder L.B. , Surgucheva N.V.
Published: April 2019

The article considers structural, processual and causal aspects of suicides. Problems of child philosophizing, specifics of adolescence in the context of suicide discussed. The concept of suicidal risk clarified and its diagnostic possibilities shown. Identified that according to parents opinion significant role belongs to conflicts and personality traits among causal factors of suicidal risk. According to adolescents, suicidal intentions are associated with the subjective impossibility to create satisfactory continuation of life. It has been found that suicidal risks and types of suicidal behavior in late adolescence differ depending on age, worldview, gender and personality traits.
About preparing clinical psychologists in medical higher education institutions
Authors: Orel Vasily I. , Averin Vyacheslav A.
Published: April 2019

On the background of the current difficult medical and social situation associated with an increase in the overall morbidity of the population, including socially significant pathology, the need for highly qualified psychological assistance is growing. The article presents an analysis of the problems associated with the training of clinical psychologists at the present stage. The article consists of two parts. The first part presents data on the dynamics of the number of non-medical and medical universities for the period from 2011 to 2017, as well as the number of budget places allocated to these universities for the same period. The main problems of training clinical psychologists in medical and non - medical universities: 1) the problem of shortage of highly qualified psychological personnel, especially in the specialty 19.00.04 – medical psychology, as well as the problem of the use of teachers of biomedical and medical departments in the preparation of clinical psychologists; 2) the problem of the qualitative composition of applicants and freshmen. The role of professional motivation of future clinical psychologists is emphasized: 3) the problem of quality of educational process in medical University. The second part of the article is devoted to the peculiarities of training clinical psychologists who will provide medical and psychological assistance to pregnant women, their families and children, starting with the perinatal period, and in institutions of maternal and child health,as well as how to solve the above problems at the faculty of clinical psychology of Saint Petersburg State Pediatric Medical University.
Early detection of insulin resistance in children with different types of intrauterine growth restriction
Authors: Islamova Kristina F. , Kaplina Alexandra V. , Shabalova Nina N. , Plotnikova Elena V. , Medinskaya Kseniya A.
Published: April 2019

Relevance of the research. Intrauterine growth restriction in children is associated with an increased risk of insulin resistance and non-insulin-dependent diabetes mellitus later in life. The influence of type of intrauterine growth restriction and the mechanisms of insulin resistance are still unknown; the role of catch-up growth in this process is controversial.

The aim of the study was to identify insulin resistance in children with different types of intrauterine growth restriction and to analyze the role of catch-up growth in this process.

Materials and methods. The research involved 95 newborns, which were divided into groups based on birth weight and length: 60 newborns with intrauterine growth restriction (group I – 31 with asymmetrical intrauterine growth restriction; group II – 29 with symmetrical intrauterine growth restriction) and control group (group III) – 35 newborns without intrauterine growth restriction. Children also were divided into groups according to the presence of catch-up growth to 3 months old. The levels of insulin, insulin-like growth factor-1, growth hormone were measured in cord blood at birth and in blood serum at 3 months old. Glucose levels were measured in serum and insulin resistance index “the homeostasis model assessment of insulin resistance” (HOMA-IR) was calculated in children at 3 months.

Results. The children with intrauterine growth restrictioncompared to control group had significantly lower levels of insulin-like growth factor-1 in cord blood. The differences between types of intrauterine growth restrictionhave been observed: children with symmetrical intrauterine growth restriction had higher levels of growth hormone, insulin and HOMA-IR then in asymmetrical one. Correlations between insulin and glucose in children with symmetrical intrauterine growth restriction were absent unlike to asymmetrical intrauterine growth restriction (+0.61). The negative role of catch-up growth in insulin resistance development has been defined: it was related to hyperinsulinemia and increased the frequency of insulin resistance in children either in asymmetrical or in symmetrical intrauterine growth restriction, but more in symmetrical one.

Conclusion. Children with symmetrical intrauterine growth restriction especially with catch-up growth are at the highest risk of metabolic syndrome development in later life and require increased monitoring by pediatricians and endocrinologists.
Morbidence of pregnant anemia and its impact on infant mortality
Authors: Ivanov Dmitry O. , Iurev Vadim K. , Shevtsova Kseniia G. , Moiseeva Karina E. , Kharbedia Shalva D. , Berezkina Elena N.
Published: April 2019

An important role in the normal development of the fetus and the successful outcome of pregnancy is played by the state of health of pregnant women. One of the significant factors of perinatal risk is anemia of pregnant women. In order to assess the level and dynamics of the incidence of anemia in pregnant women, official statistical reports and publications of the Federal State Statistics Service for 2005-2017 and Central Research Institute for Organization and Informatization of Health of the Ministry of Health of the Russian Federation for 2012-2018 were analyzed. Using a trend analysis using a trend method, a prognosis was made for the incidence of anemia in pregnant women up to 2021 in the Russian Federation as a whole and separately in the North-West Federal District. In order to assess the impact of the predictor “anemia of pregnant women” on the infant mortality rate, data from primary medical documentation was copied to 250 children who died before the age of 1 year in the North-West Federal District. It has been established that the incidence of anemia in pregnant women in the North-West Federal District significantly exceeds the average level in the Russian Federation. Provided that factors affecting the course of pregnancy remain unchanged, the incidence of anemia in pregnant women by 2021 on average in the Russian Federation will decrease to 32.2% of the number of women who have completed pregnancy, and in the North-West Federal District will increase to 37.5%. During pregnancy, the incidence of anemia in women whose child died before the age of 1 year in the North-West Federal District amounted to 44.16 ± 0.39% of the number of women who completed the pregnancy, which significantly exceeded the average figure in the district, which in 2017 was equal to 35.90 ± 0.35% (p < 0.05). A direct correlation has been established between the predictor “anemia in pregnant women” and the infant mortality rate.
The activity of transforming growth factor-β in young age with marfanoid habitus
Authors: Timofeev Eugene V. , Malev Eduard G. , Luneva Ekaterina B. , Zemtsovsky Eduard V.
Published: April 2019

According to contemporary views, hereditary connective tissue disorders divided classified Marfan syndrome, Loeys-Dietz’s, Ehlers-Danlos syndrome, the primary mitral valve prolapse. It is known that the fibrillinopaty, which include the Marfan syndrome and Loeys-Dietz’s is characterized by activation of TGF-β signaling pathway. With high le vels of TGF-β attributed most of these clinical manifestations these diseases – aneurysm of the aorta, arahnodaktylya, duralectasy. Assessment of the activity of TGF-β in persons with marfanoid habitus has not previously been studied.

Materials and methods. As part of this work, surveyed 70 people: 61 patients young age (median age of 20.1 ± 2.1 years), among which 36 boys and 25 girls and 9 men with verified diagnosis Marfan syndrome (median age 27.9 ± 9.3 years). All survey performed Echocardiography with a targeted search of small anomalies of heart.

Results. Correlation analysis showed a direct and reliable connection between arahnodaktylya and concentration of TGF-β1 in serum (r = 0.4, p = 0.05). For young people with signs of marfanoid habitus are characterized by reliably a higher concentration in the serum of both isoforms of TGF-β. Excess of threshold levels of TGF-β1 revealed at 20% of the core group and not found at all in the control (p < 0.05). Among persons with exceedances of threshold values for at least one faction of the TGF-β patients with signs of marfanoid habitus met almost three times more often than in the group with normal values of TGF-β (p = 0.01, χ2 = 5.58). In the group of persons with marfanoid habitus and increases TGF-β are detected more frequently such as atrial septal aneurysm, false chord left ventricle papillary muscles, incremental, deflection of shutters of the mitral valve in 1-2 mm, asymmetry tricuspid aortic valve.
Some results of the organization assessment of outpatient aid to children’s population in a municipal area
Authors: Sobolev Ilya B. , Moiseeva Karina E. , Kharbedia Shalva D. , Glushchenko Vladimir A. , Alekseeva Anna V.
Published: April 2019

Primary health care for children is the mainstay of the system of medical care for children and includes measures for the prevention, diagnosis, treatment of diseases, medical rehabilitation, the development of healthy lifestyles and sanitary and hygienic education for the children. Medical organizations located in rural areas have particularities in the system of providing medical care to the population. This concerns the type, capacity, disposition of medical organizations, their provision with qualified medical personnel, and the possibility of obtaining qualified medical care. In order to assess the state of outpatient care for children under the conditions of municipal health care, data was taken out of the federal statistical reporting “Information on medical organization” form 30 “Information about the number of diseases registered in patients living in the area of service of the medical organization” form 12 for 2015-2017. The research was based on the Toksovo District Hospital, a state budgetary health care institution in the Leningrad Region. In the course of the study, pediatric staff were evaluated for pediatric staff, indicators of outpatient care for the children, indicators of the burden of pediatricians and morbidity rates for the treatment of children. It was found that in the years under study there was a high level of provision of pediatricians with an attached pediatric population, an increase in the number of district pediatricians and a decrease in the part-time ratio. The increase in the workload of pediatricians conducting outpatient admissions, including district pediatricians, associated with an increase in visits for diseases in 2015-2017, indicates a deterioration in the health of the children’s population, as evidenced by an increase in the overall morbidity rate for outpatient using the child population.
State of health of St. Petersburg’s children which are engaged in sports schools
Authors: Zemlyanoy Dmytry A. , Antonov Andrey A. , Alexandrovich Irina V. , Krutova Elizaveta S.
Published: April 2019

Pupils have a high level of chronic disease, the indicators of their physical development are reduced with increasing educational load. In this regard, of particular interest is the state of health of schoolchildren, additionally engaged in active sports in special clubs.

Purpose of research. To study the state of health of schoolchildren of St. Petersburg attending the clubs of active sport, depending on age. Materials and methods. Data of medical examinations of 1122 schoolchildren 8-16 years old, engaged in sports schools in St. Petersburg. The Mann-Whitney U-test and the comparison of relative frequencies in two populations were used. Results of the research and discussion. Among children, the most popular sports are football (36.7%) and athletics (29.4%), the prevailing majority of children attend clubs from 1 year to 6.5 years. The proportion of pupils from the second health group was 84.9%, healthy children from the first health group – 13.1%, respectively. The most frequent deviations of musculoskeletal system were posture disorders (69.7% of children) and scoliosis (10.0%), at the same time, by the age of 16, the incidence of posture disorders significantly decreased (p < 0.05), and the proportion of scoliosis increased (p < 0.01). Myopia of weak and moderate degree was revealed in 13.3% of surveyed schoolchildren, the proportion of children with myopia by the age of 16 increased significantly (to 20.7%, p < 0.05). Among children attending sports clubs, fewer have myopia than among pupils enrolled in regular schools. The revealed dynamics of morbidity of the musculoskeletal system among children engaged in sports sections, indicates the need for continuous medical monitoring of the level of physical activity and the need to correct the training regimen in identifying children’s health abnormalities.
Testosterone replacement therapy in male urolithiasis patients with metabolic syndrome
Authors: Tagirov Nair S.
Published: April 2019

Urolithiasis is one of the most wide-spread kidney lesions in males and females all over the world. It is particularly important for males with hypogonadism and metabolic syndrome.

The goal of the study is to assess the effectiveness and safety of Testosterone replacement therapy in males with hypogonadism and metabolic syndrome. Patients and methods. 465 male urolithiasis patients were studied. Mean age was 46 (38-54 years). All patients involved in the study had excessive body mass and obesity of various extent. Mean body mass was 92 (85-97 kg) and body mass index 40.5. More than 50% of the patients had Ischaemic Heart Disease, Cholelithiasis and Goiter. Essential Hypertension was present in 76.3% of cases. In more than 50% of the cases there was a combination of two or three nosological forms present. Depending on the replacement therapy used all patients were distributed into two groups: the main (300 patients) and the control one (165 patients).

Results of the study. Testosterone replacement therapy proved to contribute to normalization of mineral and lipid metabolism as well as improvement of kidney function and restoration of normal bone tissue density. Analysis of 5-year relapse frequency demonstrated it to be considerably lower in the main group (10%) than in the control one (30%) which is astatistically valid difference (p < 0.05).

Conclusion. Testosterone replacement therapy is a highly effective and safe method for urolithiasis therapy in males with hypogonadism.
Dynamics of Coronary Calcification and Its Association with the Clinical Course of Ischemic Heart Disease and Osteopenic Syndrome
Authors: Zykov M. V. , Hryachkova O. N. , Kashtalap V. V. , Bykova I. S. , Kokov A. N. , Shibanova I. A. , Barbarash O. L.
Published: April 2019

Purpose: to study the relationship between degree of calcification of coronary arteries, osteopenic syndrome, and clinical course of ischemic heart disease (IHD) during 3–5 years of follow-up in men after coronary artery bypass grafting (CABG).Materials and methods. We included in this prospective study 111 men admitted for CABG under cardiopulmonary bypass. All patients underwent color duplex scanning (CDS) of brachiocephalic arteries (BCA), coronary angiography, multislice computed tomography (MSCT) of coronary arteries (CAs) to assess the degree of calcification, densitometry of femoral neck. Cardiac calcium score of the vessels was assessed by the Agatston method. After 3–5 (mean 4.2) years we assessed dead or alive status of 111 patients. Mortality during followup was 11.7 % (n=13). In 59 of 98 survived patients we repeated CDS of BCA and MSCT of CAs with calculation of CA calcification scores.Results. Significant CA calcification prior to CABG was detected in more than half of the patients (57.6 %). Among all clinical and anamnestic factors only one risk factor – smoking was associated with mortality (odds ratio [OR] 9.8, 95 % confidence interval [CI] 1.2–78.1, χ2=6.6, р=0.01). There were no association of mortality with index of CA calcification, Syntax score, osteopenic syndrome and BCA involvement. In the group of patients with baseline coronary calcification index >400 there were more smokers (р=0.026) and patients with lesions in >3 CAs (р=0.037) compared with the group with values ≤400. At the preoperative stage we revealed associations of CAs calcification index with T-test characterizing presence of the osteopenic syndrome (r= –0.24, р=0.06), Syntax score (r=0.26, р=0.041), and number of affected CAs (r=0.25, р=0.048). At repeated examination 3–5 years after CABG a medium positive correlation was detected between the severity of CA calcification and the severity of BCA stenoses (r=0.28, р=0.029). Linear regression analysis with stepwise selection identified baseline (prior to CABG) higher values of T-test evaluated at femoral bone as the only significant predictor of calcium score increase during 3–5 years of follow-up.Conclusion. Dynamics of calcification of CAs in men with IHD during 3–5 years of follow-up after CABG was multidirectional, but in most cases (66 %) it was progressive. There was correlation between coronary calcification and smoking status and decreased T-test assessed at femoral bone prior to CABG. In the long-term follow-up period the correlation between severity of BCA lesion and severity of coronary  calcification was found. Negative correlation was detected between progression of coronary calcification and baseline impairment of mineral density of femoral bone.
Type 2 Diabetes Mellitus and Heart Failure: Innovative Possibilities for Management of Prognosis
Authors: Kobalava Zh. D. , Yeshniyazov N. V. , Medovchshikov V. V. , Khasanova E. R.
Published: April 2019

Type 2 diabetes mellitus (T2DM) has gone beyond the professional interests of one specialty. T2DM, cardiovascular (CV) diseases and chronic kidney disease, considered from the standpoint of a single cardio-reno-metabolic continuum, place a heavy economic burden on society. At the same time, the improvement of diagnostic methods and medical technologies led to distinct decrease in the frequency and mortality from a number of complications of T2DM, including myocardial infarction and stroke, but other states took their place. Thus, heart failure (HF) has taken the position of one of the most frequent complications with average prevalence of 24–40 % and significant predominance of HF with preserved ejection fraction (HFpEF). According to this paradigm, HFpEF is not a disease of diastolic dysfunction, but a systemic disease, the central element of which is impaired renal function. All this together has a potential value for choosing the optimal therapy. In recent years the results of specially designed studies assessing the CV-safety of antidiabetic drugs from the groups of dipeptidyl peptidase-4 (DPP4) inhibitors, glucagon-like preptide-1 (GLP-1) receptor agonists and sodium – glucose co-transporter-2 (SGLT2) inhibitors have become known. These drugs, except for SGLT2 inhibitors, by their mechanism of action affecting insulin resistance and hyperglycemia, demonstrated neutral or negative result on the frequency of hospitalizations due to HF. The EMPA-REG OUTCOME study with SGLT2, which has a special insulin-independent mechanism of action, demonstrated not only the efficacy and CV-safety of the drug in the form of a decrease in CV mortality by 38 %, but also a decrease in hospitalizations for HF by 35 %. Further studies with SGLT2 inhibitors confirmed positive effect on HF, indicating a class effect of the drugs. The recently completed study DECLARE-TIMI 58 proved the advantages of using dapagliflozin for the primary and secondary prevention of HF. This review highlights the prevalence of HF in diabetes mellitus, a new concept of the pathophysiology of HF, the main groups of sugar-lowering drugs and their effect on CV outcomes, in particular on HF.
Macrophages and Their Role in Destabilization of an Atherosclerotic Plaque
Authors: Pigarevsky P. V. , Snegova V. A. , Nazarov P. G.
Published: April 2019

The modern data on structure and the functional activity of macrophages are presented in the review. It is shown that they are the nonhomogeneous cell population. Two of their main subpopulations are presented as M1 and M2 phenotypes which perform opposite functions at inflammation development. The main attention in the review is paid to a role of macrophages in pathogenesis of atherosclerosis and, first, in formation of unstable atherosclerotic plaques which are the cause of the most severe complications of the disease. It is shown that main subpopulations of macrophages play different roles in formation of unstable and stable atherosclerotic plaques. Macrophages of M1 phenotype in the vascular wall carry out pro-atherogenic role and influence destabilization of an atherosclerotic plaque, while M2 macrophages perform atheroprotective function.
Pressure and Volume Characteristics of the Left Ventriclе in Its Diastolic and Systolic Dysfunction
Authors: Abramov A. A. , Lakomkin V. L. , Prosvirnin A. V. , Kapelko V. I.
Published: April 2019

The Aimof the study was a detailed investigation of pressure volume-loop (PV-loop) curves in the rat heart during development of doxorubicin cardiomyopathy.Materials and methods. Cardiomyopathy in rats has been developed after 4 weeks doxorubicin administration (2 mg / kg weekly).Results. Echocardiographic study of rats in 8 weeks from onset of doxorubicin administration showed preponderance of systolic dysfunction (67 %) with decrease of left ventricular (LV) ejection fraction (EF) by 30 %. Simultaneous registration of LV pressure and volume showed that diastolic LV volume was preserved in doxorubicin-treated rats due to considerable lengthening of the diastole, the heart rate was reduced by 22 %. These hearts also showed slowing of relaxation, reduced maximal rate of pressure development and stroke work, as well as significant reduction in peripheral arterial resistance. Diastolic dysfunction differed from the systolic one by normal systolic EF and preserved LV contractility index as well as lower diastolic LV pressure throughout the diastole.Conclusions. Based on these data, four compensatory mechanisms associated with cardiomyopathy were distinguished - 1) slowing of myocardial relaxation, prolonging myofibrillar active state, 2) reduction of peripheral arterial resistance for easier LV ejection, 3) heart rate reduction, prolonging diastolic pause and thus facilitating better LV filling and 4) increased pressure in the small circle, also contributing to the LV rapid filling.
High prevalence of vitamin D deficiency in school children in Jammu: a whistle blower
Authors: Kaur Harleen , Bhatia Amarjeet Singh
Published: April 2019

Background: Vitamin D deficiency prevails in epidemic proportions among school going children in India, but there is scarcity of searchable data on vitamin D status in school children in Jammu and Kashmir; hence we have assessed the vitamin D status in school going children attending outpatient department in a tertiary care hospital Jammu.Methods: The study was conducted in the department of Biochemistry Government Medical College Jammu during June to December, 2018 and after obtaining informed consent, a total of 104 school going children between the age group of 6 years to 12 years, attending SMGS Hospital Jammu were screened for their vitamin D (25 OH-D) status by using Abbott architect chemiluminescent micro particle immunoassay.Results: Out of a total of 104 school going children screened in the study, 91 (87.5%) were found to be having insufficient vitamin D levels in their blood (<30ngm/dl) whereas 63 (60.5%) children showed severe deficiency with vitamin D levels below 20ngm/dl.Conclusions: Despite of abundant sunshine throughout the year and also with the consideration that people of this region are well off economically and can afford good nutrition, the results of our study revealing  high prevalence of Vitamin D deficiency in school going children can be taken as a whistle blower for the health policy makers of the region.