Work organization of the public health physicians of children and adolescents in schools and its role in medical aid improvement during education reform
A.V. Suvorova, I. Sh. Iakubova 5
2. Formation of health conditions in underground miners in the Polar regions of the Kola Peninsula S.A. Gorbanyov, S.A. Syurin 12
Еpidemic Еnterococcus faecium in Russia: clonal spread and genetic features of the mobilome.
V.V.Kolodzhieva, A.E. Goncharov, V. V. Gostev, L. P. Zueva 20
CLINICAL MEDICINE
Endovascular treatment of coronary bifurcation lesion of the left coronary artery using bifurcation stents
G.G. Khubulava, K.L. Kozlov, A.N. Shishkevich, V.N. Kravchuk, S.S. Mikhailov, A.I. Lubimov, V.A. Krivopalov 25
.2. Gut microbiota in children with asthma V.P. Novikova, A.P. Listopadova, T.V. Kosenkova, S.E. Pavlova, О.А. Demchenkova 30
3. Сhoosing approaches to respiratory support strategy in adult respiratory distress syndrome (scientific review) TP. Bulach, A.L. Ershov 35
The content of CD4+CD25+T cells in peripheral blood and cell adhesion molecules in psoriasis
S.L. Kashutin, A.K. Sherstennikova, V.I. Nikolaev, L.L. Shagrov, S.V. Klyuchareva, V.A. Piryatinskya 41
5. The comparison of oсeanol, polien and omacor by action on antioxidant blood system in patients with psoriasis in experiments in vitro. L.B. Gaykovaya, R.N. Pavlova, N.V. Tyunina, J.V. Antonova CH.R. Beyshebaeva, M.N. Smertina, L.A. Karyakina, K.S. Kukushkin 48
The role of intestinal dysbiosis in colorectal cancer etiology and prevention (scientific review).
The relationship between heliogeophysical factors and minute blood volume in hypertensive patients with different temperament.
G.A. Usenko, D.V. Vasendin, A.G. Usenko, N.A. Shakirova 61
8.Сlinical course of heart failure and indicators of structural-functional state of the myocardium against ubidecarenone treatment L B. Sichinava, G.A. Kukharchik, N.N. Nesterova, A.T. Burbello 68
Five-year experience of modern surgical treatment of liver echinococcosis.
Sapaev D.Sh., Ruzibaev R.Yu., Kuryazov B.N. 74
PREVENTIVE MEDICINE
WORK ORGANIZATION OF THE PUBLIC HEALTH PHYSICIANS OF CHILDREN AND ADOLESCENTS IN SCHOOLS AND ITS ROLE IN MEDICAL AID IMPROVEMENT DURING EDUCATION REFORM
A.V. Suvorova, I.Sh. Iakubova North-Western State Medical University named after I. I. Mechnikov, Russia, Saint-Petersburg, Abstract Introduction: Medical aid improvement to schoolchildren and adolescents in schools during education reform has become one of the principle directions in development of health care in the Russian Federation. Purpose: Substantiation of public health physicians’ work amount and algorithm in the department of health care services in schools. Material and methods: As a part of the study it was conducted the analysis of legislative and normative acts regulating pediatric care in educational institutions of the Russian Federation. Pediatric care in schools was assessed on the basis of schools in Central and Kalininsky districts of Saint-Petersburg. Data on the number of pupils, medical staff and the medical room equipment were analyzed. Results and conclusions. Public health physicians’ work amount and algorithm was proposed due to the number of pupils. Keywords: health status, schoolchildren, pediatric care, schools, public health physicians
FORMATION OF HEALTH CONDITIONS IN UNDERGROUND MINERS IN THE POLAR REGIONS OF THE KOLA PENINSULA
S.A. Gorbanyov, S.A. Syurin Northwest Public Health Research ; Russia, 191036, Saint-Petersburg, 2-Sovetskaya st., 4.
Abstract:
Introduction. Due to the exposure to a number of harmful production factors, the miners of the polar regions of the Kola Peninsula are the group associated with high risks of occupational and work-related diseases.
The purpose of the study was to investigate the effect of working conditions and duration on the formation of health conditions in 2832 underground miners in the polar region of the Kola Peninsula. Results. Workers, carrying out drifting, drilling and blasting operations, are at risk of health diseases development; mostly musculoskeletal system disorders (39, 6% of all cases).The greatest number of diseases was diagnosed in drifters and drill rig operators (3.94 cases). The downward trend in miners′ health was already observed in the first 2 years of work. The severity of the acquired diseases progressively increases up to 10-15 years of work record and to a lesser extent - up to 16-20 years of word record. The conclusion. It is necessary to pay special attention to the prevention of musculoskeletal system disorders from the very beginning of miners’ career. Keywords: working conditions, work experience, underground miners, and state of health polar region of the Kola Peninsula.
EPIDEMIC ENTEROCOCCUS FAECIUM IN RUSSIA: CLONAL SPREAD AND GENETIC FEATURES OF THE MOBILOME.
V. V Kolodzhieva1, A. E Goncharov1,2, V. V., Gostev3, L. P.Zueva1 1North-Western State Medical University named after I.I Mechnikov, Russia, Saint-Petersburg, 2 Institute of Experimental Medicine, Russia, Saint-Petersburg, 3 Children's Research of Infectious Diseases of the Federal Medical-Biological Agency, Russia, Saint-Petersburg
Abstract Introduction. The epidemic spread of vancomycin-resistant strains of Enterococcus faecium clonal complex CC17 determines the importance of studies aimed at uncovering of its pathogenic and epidemic potential. Purpose of the study is to identify the genomic structure features of Enterococcus faecium clonal complex CC17 circulating in hospitals of St. Petersburg by the whole-genome sequencing method. Material and methods. It was conducted genome sequencing of 13 epidemic strains of E. faecium with its furtherannotating. Results. The prevalence of epidemic CC17 (ST192, ST18, ST78) VRE strains with two types of Tn1546 transposon (A2 and F1) in Russian hospitals has been determined. Conclusion. The obtained results allow assuming the presence of a common epidemic area covering the Russian Federation and other European countries. Key words: vancomycin-resistant Enterococcus faecium, transposons, prophage, clonal complex CC17, whole-genome sequencing
CLINICAL MEDICINE
ENDOVASCULAR TREATMENT OF CORONARY BIFURCATION LESION OF THE LEFT CORONARY ARTERY USING BIFURCATION STENTS
G.G. Khubulava 1, K.L. Kozlov 2, A.N. Shishkevich 1, V.N. Kravchuk 1, S.S. Mikhailov 1, A.I. Lubimov 1, V.A. Krivopalov 1 1 Military Medical Academy named after S.M.Kirov, Russia, Saint- Petersburg 2 Saint- Petersburg Institute of Bioregulationand Gerontology of the North-Western Branch of the Russian Academy of Medical Sciences, Russia, Saint- Petersburg Abstract Introduction: Coronary artery stenting of unprotected left main coronary artery is one of the major unsolved problems in modern interventional cardiology, but in daily practice, bifurcation stenting is now being used and expands endovascular surgeries capabilities. Materials and methods: The comparison of left coronary artery bifurcation using bifurcation and conventional stents was performed on the base of treatment of 31 patients. Results: Intraoperative complications after conventional stenting were found in 27%, hospital mortality in 18%, lateral branch residual stenosis in 27% in comparison with bifurcation stenting with 5%, 5%, and 0% respectively. The average surgery cost for conventional stenting was 176 755 rubles vs. 134 735 rubles for bifurcation stenting. Conclusions: Bifurcation stents are more advantageous due to intraoperative complications, frequency of restenosis, but they are comparatively expensive and hence more expensive procedure. Key words: ischemic heart disease, stenosis of the left main coronary artery, stenting of the left main coronary artery, bifurcation stenting, bifurcation stents.
GUT MICROBIOTA IN CHILDREN WITH ASTHMA
V.P. Novikova 1, A.P.Listopadova 2, T.V.Kosenkova1, S.E.Pavlova 2, О.А.Demchenkova 2 1 Almazov National Medical Research Centre, Russia, Saint- Petersburg 28 th Children's Polyclinic «Diagnostic with day hospital, Russia, Saint -Petersburg,
Abstract Introduction. Currently, the investigation of microbiota influence on asthma development is a topical issue. Materials and methods. In the study were included 32 school-aged children with moderate persistent asthma, who were under drug-free remission (3-6 month) of underlying disease and received medium doses of inhaled corticosteroids (IGCs) as basic therapy (delivery method-spacer). Mass-spectrometry of microbial markers to assess gut microbiome was performed. Results. It was found the correlation between the number of bacteria of the gut microbiota and spectrum of sensitization: the number of Ruminococcus correlated with the sensitization to casein (r=0.53), weeds (r=0.79) and cereal (r=0.56); Eubacterium/Cl. Coccoides - weeds (r=0,59); Eggerthella lentа - cereals (r=0.52). Conclusions. School-aged children with moderate persistent asthma are characterized by reduced diversity of the gut microbiota; reduced number of the studied the gut microbiota with the only increased Ruminococcus and Streptococcus mutans (anaerobe); correlation between gut microbiota and the spectrum of sensitization. Key words: microbiota, microbiome, asthma, mass-spectrometry.
CHOOSING APPROACHES TO RESPIRATORY SUPPORT STRATEGY IN ADULT RESPIRATORY DISTRESS SYNDROME (SCIENTIFIC REVIEW)
T.P. Bulach, A.L Ershov North-Western State Medical University named after I. I. Mechnikov, Russia,Saint-Petersburg
Abstract Introduction. Severe hypoxemia in adult respiratory distress syndrome (ARDS) is associated with high mortality (45%) and the risk development of ventilator-induced lung injury (VILI). Purpose of the study is to determine the strategy of effective respiratory support in patients with acute ARDS. Materials and methods. Scientific data analysis to evaluate different methods of respiratory support in ARDS. Results and conclusions. All clinical observations and researches have demonstrated the necessity of system respiratory support and hemodynamics aimed at ensuring of adequate gas exchange and VILI risk minimization in patient with acute ARDS by safe mechanical ventilation and recruitment maneuver. In the most severe cases be considered the use of muscle relaxants, mechanical ventilation in the "prone" and extracorporeal membrane oxygenation (ECMO). Key words: Adult respiratory distress syndrome, respiratory support, extracorporeal membrane oxygenation
THE CONTENT OF CD4+CD25+T CELLS IN PERIPHERAL BLOOD AND CELL ADHESION MOLECULESIN PSORIASIS
S.L. Kashutin1, A.K. Sherstennikova1, V.I. Nikolaev2, L.L. Shagrov1, S.V. Klyuchareva 2, Piryatinskya V.A. 2 1Northern State Medical University, Russia, Arkhangelsk 2North-Western State Medical University named after I. I. Mechnikov, Russia, Saint-Petersburg Abstract Introduction. The pathogenesis of psoriasis is based on increased proliferation of keratinocytes, mediated by activated T lymphocytes, namely CD4+ and CD8+ subpopulations. There are several populations of CD4+ CD25+ regulatory T-lymphocytes: natural (Тreg), maturing in the thymus and activated effector T-lymphocytes. Thus, the issue of activation zone of CD3+ CD4+ cells and adhesion molecules role in in regulating their migration activity from microcirculation to tissue is topical. The aim of the study was to investigate the content of CD3 + CD4 +CD25-, CD3 +CD4 +CD25+, CD3+CD4-CD25- in the peripheral blood and to analyze their relation with adhesion molecules in patients with psoriasis. Material and methods: Clinical and immunological examination of 82 patients with vulgar and exudative psoriasis in the progressive and inpatient stage (39 female and 43 male) aged 20-60 years was carried out. The psoriasis duration ranges from 3 months to 10 years. The control group included 50 apparently healthy people (28 female and 22 male). In a flow cytometer FC-500- Beckman Coulter (USA) was analyzed the content of lymphocytes carrying the molecules of L-selectin, LFA-1, LFA-3, ICAM-1, PECAM-1 of lymphocytes from whole blood and the content of lymphocytes CD3+CD4+CD25-, CD3+CD4+CD25+, CD3+CD4-CD25-.Statistical data analysis was performed on SPSS 13.0 for Windows. Parameters distribution was abnormal thus the samples description was carried out by calculating the median (Md) and the interquartile interval Q25Q75.Probability of difference was estimated by Kolmogorov-Smirnov test. Correlation analysis was performed using the Spearman's rank correlation coefficient The results suggested the statistically significant reduction of lymphocytes CD3+CD4-CD25- within hyperproliferative keratinocytes and tendency to the reduction of CD3+CD4+CD25- under statistically significant reduction in total number of lymphocytes carrying the LFA-1 and PECAM-1 molecules. Differences in the content of CD3+CD4+CD25+ cells, as well as lymphocytes carrying L-selectin molecules, ICAM-1 and LFA-3 in patients with psoriasis and healthy individuals were not observed. The lower concentrations of CD3+CD4-CD25- lymphocytes in patients with psoriasis were correlated with the lymphocyte content carrying adhesion molecules, that involved in leukocyte extravasation: "rolling adhesion", "tight adhesion" and "transmigration". In the control group, statistically significant correlations were observed with the content of lymphocytes carrying the molecules of L-selectin, LFA-1 and LFA-3, but not with lymphocytes having PECAM-1 molecules. According to the obtained data, the lower concentration of lymphocytes CD3+CD4-CD25- in blood is likely related to their more intensive migration to the tissue .Due to the reduction tendency in the level of lymphocytes CD3+CD4+CD25- in psoriasis, it could be suggested that migration activity of these cells is less intensive than in lymphocytes CD3+CD4-CD25-. Conclusion. Probably, the hyperproliferation of keratinocytes observing in psoriasis is the impetus to changes in the level of CD4+ CD25+T cells in venous blood. Keywords: cells; adhesion molecules; psoriasis.
THE COMPARISON OF OСEANOL, POLIEN AND OMACOR BY ACTION ON ANTIOXIDANT BLOOD SYSTEM IN PATIENTS WITH PSORIASIS IN EXPERIMENTS IN VITRO
L.B. Gaykovaya, R.N. Pavlova, N.V. Tyunina, J.V. Antonova, CH.R.Beyshebaeva, M.N. Smertina, L.A. Karyakina, K.S. Kukushkina North-Western State Medical University named after I. I. Mechnikov, Russia, Saint-Petersburg
Abstract Introduction. Psoriasis treatment is a current issue of dermatology. The purpose of the study is the search of drugs to correct excessive proliferation in psoriasis. Material and methods. The main object of in vitro experiments within the present study was the blood of psoriasis patients. To estimate the level of free-radical oxidation was used the state of the antioxidant system indicators and intensity of lipid peroxidation. The antioxidant system (AOS) was estimated on the activity of glutathione peroxidase (GPx), catalase (CAS) , superoxid-dismutase (SOD), blood plasma hemolysate and CAS/SOD ratio; concentration of general SH-groups of blood plasma and plasma malondialdehyde (MDA). Blood plasma hemolysate (1:20) or blood plasms was incubated at 37 ° within 15 minutes using drug containing omega-3 at various concentration (depending on the content of polyunsaturated fatty acids) and further indices determination. Results. Patients with psoriasis in comparison with donors had moderate increase in MDA concentration of blood plasma (by 36%), increase of general SH-groups of blood plasma (by 34%). In the case of higher doses of oсeanol®, omacor® and polien® (7,5; 14,2; 21,5 mg/ml) the MDA concentration increased by 2-7 times. Lower doses of polien® and omacor® (total omega-3 concentration of unsaturated fatty acids-17,45*10-2 mg/ml), is similar to 100 mg/day of the drugs, resulted in decrease of intensity of lipids peroxidation by 9% and 10% correspondingly and increase of SH-groups of blood plasma. Higher polien® dose to 52,35*10-2 mg/ml (3000 mg/day) leads to the increase of lipid peroxidation intensity by 13%. Similar omacor® dose do not increase MDA. Polien® dose of 104,7*10-2mg/ml (6000 mg/day) increase the lipid peroxidation intensity by 83%, whereas omacor® by 38%. Conclusion. Drugs containing omega-3, being substratum for the formation of free radical oxidation products that are necessary for proliferation inhibition, could be used for the correction of excessive proliferation in patients with psoriasis. Polien® could be recommended in 3000 mg/day. The use of other drugs containing omega-3 to decrease proliferation requires preliminary test dosing, since lower doses of drugs containing omega-3 lead to the increase of lipid peroxidation. Keywords: psoriasis, excessive proliferation, apoptosis, omega-3 unsaturated fatty acids, antioxidant system.
THE ROLE OF INTESTINAL DYSBIOSIS IN COLORECTAL CANCER ETIOLOGY AND PREVENTION (SCIENTIFIC REVIEW)
S.V. Mulendeev 1,2, I.A. Soloviev1, K.G. Shostka1,2, K.V. Arutyunyan2, L.D. Roman 1,2 1 Military Medical Academy named after S.M. Kirov, Russia, Saint-Petersburg 2 Leningrad Regional Oncologic Dispensary, Russia, Saint- Petersburg Abstract
Colorectal cancer is the major oncological diseases: it is the third most common cancer in men and second most common in women.
From 70 up to 95 % of colorectal cancer cases are so-called sporadic. Meanwhile, the pathogenesis-based treatment and disease prevention couldn’t be provided without understanding causal relationships that could result in colorectal cancer. Recently, the researches to estimate the role of different intestinal microbiota organisms such as bacteria, viruses and fungi causing cancer have increased. Key words: colorectal cancer, intestinal microbiota, bacteria, viruses, fungi.
RELATIONSHIP BETWEEN HELIOGRAPHIC FACTORS AND MINUTE BLOOD VOLUME IN HYPERTENSIVE PATIENTS WITH DIFFERENT TEMPERAMENT
G.А. Usenko1, D.V. Vasendin1, A.G. Usenko2, N.А. Shakirova3, 1Novosibirsk State Medical University, Russia, Novosibirsk 2Military clinical hospital №2, Russia, Novosibirsk 3West-Siberian Department for Hydrometeorology and Environmental Monitoring, Russia, Novosibirsk
Abstract Introduction: During the periods of drastic heliometeotropic changes the number of hypertensive patients is increased. Thus, in the period of geomagnetic storms was observed an increase of gamma radiation dose rate, emotional tension and changes in the physiological processes in healthy controls and hypertensive patients. However, there are no studies on correlation between the gamma ray background from the external environment during geomagnetic storms and minute blood volume in patients with arterial hypertension. Purpose of the study is to establish a correlation between the annual average of minute blood volume in male hypertensive patients with different types of temperaments, high anxiety and solar activity during 1995 to 2015. Methods: The study included 848 patients with arterial hypertension and 422 healthy controls with the specification of the temperament type, anxiety level and minute blood volume. To compare the calculation method of minute blood volume with hardware method the researchers used tetrapolar rheography on the 6-NEG with computer console. Data on solar activity dynamics in Wolf numbers and radio emission at 10.5 cm was obtained from the West-Siberian Department for Hydrometeorology and Environmental Monitoring. Results: Variations of gamma ray background during the study period remained normal according to regional parameters (7,0-9,0 µr/h). Analysis of solar activity dynamics revealed its periodic increase and single increase in 2005-2006. During the periods of solar activity increases the environmental temperature and atmospheric pressure. It was found the significant increase of minute blood volume in healthy controls and patients at the same period, as well as the increase of solar activity and gamma ray background from the external environment. Discussion: In the period of solar activity increase the organism was affected by a number of factors, including socio-economic together with ionizing radiation, contribute to the reduction of oxygen utilization coefficient which is resulted in increase of minute blood volume, as a part of adaptive reaction development. Conclusion: It was established a significant correlation between solar activity indicators, meteorological factors and minute blood volume indicating the possibility of combined effects of the studied factors on the functional activity of the cardiovascular system. Key words: hypertension, minute blood volume, solar activity, gamma ray background, correlation.
CLINICAL COURSE OF HEART FAILURE AND INDICATORS OF STRUCTURAL-FUNCTIONAL STATE OF THE MYOCARDIUM AGAINST UBIDECARENONE TREATMENT
L.B. Sichinava, G.A. Kukharchik, N.N. Nesterova, A.T. Burbello North-Western State Medical University named after I. I. Mechnikov, Russia, Saint-Petersburg,
Abstract: Introduction: Chronic heart failure (CHF) often develops in patients after myocardial infarction (MI) [1,3,7]. Myocardium structural and functional changes of the left ventricle (LV) reflecting the course of postinfarction remodeling, are the major factors determining the development and course of CHF [3,7]. Over the decades, there is the necessity to find the ways and means for CHF treatment, in particular medication. The use of drugs containing coenzyme Q10 is considered as a promising trend [3,7]. Aim of the study is to evaluate the course of heart failure and myocardium structural-functional changes at baseline, after 3 and 12 months. Мaterials and methods: The study included 108 patients with II-III class CHF. The first group of patients received basic therapy of CHF and additionally 120 mg of ubidecarenone per day; the second group of patients received only basic therapy. Results: In both groups was observed an improvement of the clinical course of the disease. Within 3 months was observed the decrease of iEDV to 65.67 (56,54;77,94) ml/m2 in comparison baseline (p<0.05), iEDV– to 22.12 (16,74; 30,98) ml/m2 (p<0.05). The upper quartile value of iESV in the second group of patients after 3 months were more than 31.0 ml/m2, iESV in 12 patients exceeds 35 ml/m2. Ejection fraction mean value was similar in both groups. Within a year the first group of patients was characterized by decreased the number of points due to the scale of assessment of clinical condition (SACC). Additional ubidecarenone prescription to basic drug treatment for CHF managed structural and functional remodeling of myocardium and improved clinical course of heart failure. Key words: chronic heart failure, myocardial remodeling, ubidecarenone
FIVE-YEAR EXPERIENCE OF MODERN SURGICAL TREATMENT OF LIVER ECHINOCOCCOSIS
D.Sh.Sapaev, R.Yu.Ruzibaev, B.N.Kuryazov. Department of General surgery, traumatology and orthopedics, Uzbekistan , Khorezm region, Urgench
Abstract Introduction. The present article is a summary review of modern views on the pathogenesis, diagnosis and treatment of one of the topical problems of medical parasitology-echinococcosis. The aim of the research is to conduct the comparative evaluation of minamally invasive and traditional liver echinococcectomy; analyze the advantages of minimally invasive techniques in liver echinococcosis treatment. Materials and methods. The study is based on the diagnostic and surgical treatment of 110 patients with liver echinococcosis from the General Surgery Department,Urgench branch of Tashkent medical academy. It was found that minimally invasive techniquies in the treatment of liver echinococcosis allows to reduce a number of intra- and postoperative complications. Results. Modern treatment of echinococcosis should be complex and include surgery and further adjuvant chemotherapy (albendazole, mebendazole). Conclusion. Considering the complexity of early diagnosis, features of surgical intervention and further monitoring, treatment of echinococcosis should be multidisciplinary and conducted in specialized institutions. Key words: echinococcosis, echinococcectomy, pericystectomy, liver resection, chemotherapy.
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